Factors affecting lab results

Many factors associated with specimen collection can influence the validity and interpretation. These include the collection of specimen from the wrong patient, incorrect identification of specimens after collection and subsequent handling prior to analysis.

FACTO ! TO CO"!#$% &%FO % CO''%CT#"( !)%C#M%"

These include* Diet Drugs & current medication Time of day

$iet*
!ome chemical investigations are liable to interference from dietary constituents e.g. a patient on whom Calcium analysis is to be performed should not ta+e dairy products.

!ub,ects for (TT should be on their normal carbohydrate diets of about -./g of carbohydrate0day for at least 1 days prior to the test t. )atients for lipid analysis should be on their normal lipid inta+e for at least a wee+ prior to the test.

$rugs0Current Medication*

Many drugs are +nown to affect chemical0'aboratory determinations, e.g. Oral Contraceptives, cough mi2tures, etc. )atients on cephalosporins, vitamin C or ascorbic acid are most li+ely to present with false glycosuria if the method for determining urine glucose is the &enedicts test. #t is important that doctors indicate or discuss details of the current medication of patients with the laboratory staff.

Time of $ay*

!everal blood constituents show variation with time of day, e.g. corticosteroids, iron. For such blood constituents, it3s very imperative that the time at which the specimen was collected be indicated.

FACTORS TO CONSIDER AT THE TIME OF COLLECTING SPECIMEN

Posture Venous stasis The site of venous puncture Haemolysis

The posture of the patient*

!everal proteins and protein4bound blood constituents show significant differences in concentration between samples collected from upright position and those from recumbent 5leaning6 individuals, e.g. Albumin, calcium, cholesterol, cortisol and protein bound iodine. ctd

Example:
7hen the posture is changed from lying to standing, there may be an increase of as much as -18 in the concentration of non4diffusible components of blood within -. minutes due to redistribution of the e2tracellular fluid. #t3s very important therefore for every health institution to standardi9e its procedure for obtaining blood specimen.

:enous

stasis*

%very effort must be made at avoiding prolonged stasis during venepuncture since it can mar+edly raise the concentration of plasma proteins, haemoglobin, hormones, calcium and lipids. The combined effect of raised intravenous pressure with its associated local ano2ia from sustained occlusion results in the passage of water and small molecules from the lumen of a vein into the surrounding e2tracellular fluid.
ctd

#ntracellular constituents such as potassium and lactic acid lea+ into the plasma causing falsely elevated results. The best procedure is to remove the tourniquet soon after puncturing the vein.

The site of venepuncture*

;nder no circumstance should blood be drawn from an arm receiving an intravenous infusion since the fluid may not have mi2ed with the whole blood :ol. &lood from the opposite arm usually provides valid results. #f there are no available veins on the arm, then a femoral blood should be ta+en. &ut if this is not possible, then the specimen should be obtained from a site distant from the infusion site or preferably about -/4</ml of blood should be aspirated through the needle 5if patient is very sic+, don3t6.

=aemolysis*

This must be avoided at all costs because it invalidates certain determinations owing to the release of erythrocytic contents, e.g. )otassium, lactate dehydrogenase, acid phosphatase or through colour changes which interfere with photometric determination using shorter wavelengths of the visible spectrum 5>//4.//nm6. =aemoglobin also interferes with chemical reactions such as the diacetylation of bilirubin. To minimi9e haemolysis, the specimen should be collected with only moderate suction. The plunger of the syringe should not be drawn too fast and there should be an easy flow of blood

The needle should be removed from the syringe before the specimen is e2pelled gently into an appropriate container leaving behind any froth that may be in the syringe. Tubes into which the blood is e2pelled should be cleaned and dry. Any anticoagulant in the tube should be mi2ed with the blood by gentle rotation. #f the blood is ta+en on the ward, and allowed to stand for more than an hour or two, the effect on the plasma constituents is synonymous to haemolysis.

PRESERVATION OF SPECIMEN IN TRANSIT

Specimen must be handled properly from the time the specimen has been separated until it is analysed. For some tests. e.g. blood gas determination e.g. PC ! P !" and blood pH" the sample must be #ept at $%C from the time the sample is dra&n till serum or plasma is separated from cells. Transfer of specimen to the lab must be done by placing the specimen in a container of ice'ice cold &ater. For hormonal assays e.g. gastrin" renin & PTH serum must and should be separated from the cells in a refrigerated centrifuge. Specimen for bilirubin and carotene must be protected from both sunlight and fluorescent light to avoid photo degradation

SEPARATION AND STORAGE OF SPECIMEN

Centrifuge &ith stoppers in place. Closure of the tubes reduces evaporation Stoppers also prevent aerosol formation from infectious particles (aintain anaerobic conditions re)uired for certain determinations such as C ! &
!*

LONG-TERM BIOLOGICAL CHANGES: Biovariability

the influence of race +ender ,ge -eonates Childhood. puberty The young adult The elderly adult

The influence of race There is a genetic difference in the plasma concentration of cholesterol" glucose" urea" urate" and bilirubin. /lac#s are #no&n to have a higher serum protein than &hites. This is probably due to the higher level of gamma globulin in blac#s. The 0g+ is often $%1 higher and 0g, !%1 higher in blac#s as compared to &hites. The serum albumin of /lac#s is typically lo&er.

The activities of creatinine #inase and lactate dehydrogenase are usually higher in blac#s than &hites due to higher s#eletal muscle mass. /lac#s generally have serum al#aline phosphate activity at puberty than &hite children. ,fter $% years serum cholesterol and triglycerides are higher in &hites than in blac#s. +lucose tolerance is less in /lac#s" ,merican. 0ndians and 2s#imos than in comparable age and se3 matched 4hites.

Gender 5ntil puberty there are a fe& differences in lab data bet&een boys and girls. ,fter puberty" the serum activity of6 a7 al#aline phosphatase" b7 aminotranferase" c7 creatine #inase d7 aldolase are higher in men than &omen. ,fter menopause" the activity of al#aline phosphatase increases until it is higher in &omen than men.

The concentration of albumin" calcium and (g!* are higher in men than in &omen. /ut the concentration gamma globulin is less in men than in &omen Hb and serum bilirubin are less in females". Serum iron is lo& during a &oman8s reproductive life and her plasma ferritin is usually one 9third that of males. Cholesterol is typically higher in men than &omen. Plasma concentration of amino acids creatinine" urea" uric acid" are higher in men than &omen. Hyperuricaemic diseases li#e gout affect more men than &omen.

Age : +enerally individuals can be divided into the ff groups6 a: -eonates" b: Childhood.Puberty" c: The ;oung ,dult & d: 2lderly ,dult

Neonates: The serum activity of several en<ymes including Creatine =inase >C=:" +ammaglutamyl transferase >++T: and ,spartate transaminase are high at birth. /ut the rise in ,lanine Transaminase is less.

The serum bilirubin rises after birth and pea#s after about the ?rd to @th day of life. Plasma urea decreases after birth because the infant synthesi<es ne& proteins. The plasma amino acids are also lo& as a result of the same reason. 5rinary e3cretion of amino acids may be high because of the immaturity of the tubular reabsorptive mechanisms. The plasma urate is high at birth but the large clearance of urate soon reduces the plasma concentration belo& the adult value.

The serum Thyro3ine of the healthy ne&born is appreciably high. This physiological hyperthyroidism declines over the first year of life. The blood glucose in neonates is lo& because of small glycogen reserves. /lood lipids are lo& but reach A%1 of adult values t&o &ee#s post.partum. ,t B! hrs post.partum it decreases belo& the adult value before rising again to a value slightly higher than in an adult. This change is largely due to fluid transfer in and out from the capillaries.

Plasma potassium may be as high as C mmol'l at birth >-ormalD ?.@.@.%mmol'l: but rapidly falls thereafter.

Plasma Calcium is also initially high but it falls rapidly to %.?@mmol'l >-ormal D!.B. !.Emmol'l: during the first day of life.

Childhood- puberty: The serum activity of most en<ymes reduces during childhood to adult values by puberty or earlier. ,lthough the activity of ,FT at least in males until the middle age" serum al#aline phosphatase correlates &ith s#eletal gro&th and se3ual maturity and its greater during pregnancy" especially in females.
The serum creatinine rises steadily from infancy to puberty prior to the development of s#eletal muscle. The serum urate >uric acid: concentration falls from the high level at birth until about C.B% years of sage at &hich time it begins to rise especially boys until at about BE years of age.

The young adult: The concentration of most constituents remains )uite constant bet&een puberty and the middle age in men and puberty to menopause in &omen.

The serum total cholesterol and triglycerides concentration increases in both males and females at a rate of %.%!mmol'l annum to a ma3imum bet&een @% to E% years.

The elderly adult: significant increase in the plasma concentration of blood constituents occur in &omen after menopause.
5rea concentration rises &ith age. Hormone concentrations are affected by age e.g. T? concentration falls by up to $%1 in people over $% years. Secretion and concentration of testosterone are decreased in males after @% years. 0n &omen" serum concentration of oestrogen decreases by about C%1 or more after menopause.

;"#T! ;!%$ #" %)O T#"( 'A&O ATO @ %!;'T!

The #nternational !ystem of ;nits 5!# ;nits6 has been developed and agreed internationally in the interests of world health. #t overcomes language barriers, enabling an e2change of health information within a country and between nations to be made without the misunderstandings which arise when each country, or even a separate hospital within a country, uses its own units of measurement for reporting tests. The !# units are based on the metre4 +ilogram4second system and replace both the foot4pound4 second 5imperial6 system and the centimeter4gram4second 5cgs6 system. There are seven !#4based units, i.e. metre, +ilogram, second, mole, ampere, ?elvin and candela.

Symbols for these units and what they measure are:

!#4base units3 Metre ?ilogram !econd Mole Ampere ?elvin Candela

;nits M ?g ! Mol A + Cd

Auantity Measured 'ength Mass Time Amount of substance %lectric current Temperature 'uminous intensity