this protocol i wrote to my lab staff as a guide for me in teaching them how to deal with abnormal results that we may face in the lab
Protocol of abnormal result
Management of low results
I- Immunology and Hormonal samples
1- Sample should be checked if there is any clot on the cup
2- Sample should be repeated after checking the tube is right and must be centrifuged at high speed for at least 10 min.
3- One level of control must run with the sample.
4- Last calibration and controls run must be printed and should be presented to the lab. doctor after release of the repeated result
5- All of the previous steps should be attached with the job order of that patient
6- All the drugs even after doing the previous steps should write a comment that the sample was done in duplicate and the result should be correlated with the clinical findings and the regular intake of the drug and should be repeated from a new sample if not correlating .
7- Repeat of the sample should be signed clear that the sample is repeated write his name clear and there will be no writing that the sample is o
1-Immunology results
• drug abuse profile
1-The specific gravity should be read by two different persons and sign that on the report
2- drug abuse profile results there must be checking the following
-Cannabinoids:
- Result below 15 should be written negative
- Result between 15 - 50 should be written negative although
- Result more than 50 should be written positive
-Amphetamine ( kaptogen,metamphetamin)
- Result less than 300 should be written negative
- Result between 300-1000 should be written negative although
- Result bmore than 1000 should be written positive
-Opiates, barbiturates, cocaine and benzodiazepine
- Result less than 200 should be written negative
- Result between 200-1000 should be written negative although
- Result more than 1000 should be written positive
• TORCH IgM and IgG
- following the previous steps in repeating low results ( without repeating the control and
checking the last caliberation and control especially for if the result is too low e.g. 0.1
- A comment is written for all Negative TORCH IgG results ….for example Toxoplasma
IgM is recommended to rule out recent infection.
• HCV IgG results
- Results that are more than 1- 4 are repeated immediately after centrifugation at
At high speeds the original sample for at least 10 min
- results 1-2 are considered negative although
- results 2-3 are considered reactive although
- results more than 3 are reactive
• HbsAG results
If the result in the machine is more than 1 and less than 4 this need to be repeated again after centrifugation for at least 20 min and the test should be repeated from the original sample not from the cup in the machine
A comment should be add to the result the although the result is positive it is close to the test should be repeated after 2 weeks and other hepatitis B markers should be done for confirmation
• Cyclosporin
The sample should be EDTA blood we must check for the presence of a clot before proceeding also we must check for hemolysis if the the results are unusual ( very high or very low results)
If there is a dilution of the sample this must be written in the job order
In the presence of abnormal results the treating physician must be informed to accept the result or send a new sample under the treating physician supervision and if the sample is taken in the lab the lab doctor must be supervising and a full history must be taken
2--Hormonal results
• Prolactin ,progesterone,estrogen,FSH,LH,Testosterone,ACTH.cortisone
- following the previous steps in repeating low results ( except for prolactin without running control with it
- If the result is low the result is written less than the sensitivity index ( eg sensitivity index for prolactin is 4.7 for example the result should be written less than 4.7)
- A comment is written with these cases …The result should be correlated with the
Clinical findings , intake of the drug regularly ,follow up is recommended Clinical findings , intake of the drug regularly ,follow up is recommended
• Thyroid profile
- following the previous steps in repeating low results
- If the result is low the result is written less than the sensitivity index
- A comment is written with these cases …The result should be correlated with the
Clinical findings , intake of the drug regularly ,follow up is recommended
1- the result of TSH is high with normal T3 and T4 a comment is written as the following
…Free T3 ,Free T4 and antithyroid antibodies are recommended for proper interpretation
… Clinical findings , intake of the drug regularly ,follow up is recommended
2-The result of TSH is low with normal T3 and T4 a comment is written as the following
… Free T3 and Free T4 are recommended for proper interpretation
… Clinical findings , intake of the drug regularly ,follow up is recommended
• Cortisone and ACTH
- plasma sample was send for the ACTH and this must be written in the JO
- Am and pm samples are written in the tubes for both cortisone and ACTH
- If nothing is written in the tube the result will come out without writing them and
This must be written clear in the JO that there is no AM or PM writing
- following the previous steps in repeating low results
- If the result is low the result is written less than the sensitivity index
- A comment is written with these cases …The result should be correlated with the
Clinical findings and the intake of the sample in the proper timing
- Calculation of cortisol in urine should be revised by two persons and both sign in the
Print out writing the calculation formula on it.
• Testosterone and free testosterone
- following the previous steps in repeating low results
- If the result is low the result is written less than the sensitivity index
You must check the age of the patient
- The free testosterone should be revised by two persons and both sign in the
In the print out with writing the calculation formula on it
- If the result is low the result is written less than the sensitivity index
• Insulin and C- peptide
- Fasting and post prandial samples must be written in the tubes
- nothing is written in the tube the result will come out without writing them and
and this is written in the JO clearly that there is no fasting or post prandial
- following the previous steps in repeating low results
- A comment is written that the result should correlate with the patient clinical findigs
And the intake of the sample in the proper timing
• Growth hormone and IGF1
- the age of the patient must be written especially for IgF1
- following the previous steps in repeating low results
- A comment is written if both results are low no comment is written but if GH is only recommended (and the result is below 1) the following comment is written GH after stimulation and IGF1 are recommended for proper interpretation of the condition
-
II-Haematology samples and results :
1- Low platelet counts below 100/Cmm should be repeated immediately
2 -Low hemoglobin below 10 g/dl for males and 9 g/dl for females should be repeated
Immediately.
3 - blood film exam by the doctor for the previous cases and if EDTA film
Should be written clear in the CBC format .
4 - The age of the patient if child below 12 years must be written in the CBC format
And if an outside sample there will be no release of the result without knowing the
Age.
5 - The PT and PTT, fibrinogen and PTT lupus must be all done in duplicate and in
Case previous history of medication this must be written clear in the
coagulation format and in the JO for the person taking the sample should written in
detail that there is a follow up and if the patient is taking medication with a follow up
before to write the previous dose and the new dose.
6-G6PD samples
-if quantitative is required the G6PD qualitative should be run first as double check and in case of G6PD deficient case there must be asking about the history of the patient and in case there is no history there must be a comment added that the result should be correlated with the clinical findings , family history and its recommended that another sample should be taken later confirm G6PD deficiency ( the must be written that G6PD qualitative was done and the result written in the JO and the name of the person)
-in case of qualitative test done and it was deficient a comment is written that G6PD quantitative should be done to reveal the severity of the condition
-for normal results( for both qualitative and quantitative)d more than 3 months old and the patient is not in haemolytic crisis and intake of blood transfusion at least one month before the test.
7-Haemoglobin electrophoresis
-There must be no previous intake of blood transfusion for at least one month
Before the test
- Sickling test is done for those showing HbS position in EP
- CBC is done for those showing HbA2 more than 4 %
- CbC is done for those showing only HbS with no HbA
- The following comment is written in all our results
…..No previous blood transfusion at least one month before
…..Iron deficiency cause decrease in HbA2
……Alpha thalassemia can be ruled out by clinical findings and family history
8-Blood grouping and Rh typing
- All the blood groups and Rh Typing are done in presence of the lab doctor and both the technician and the doctor sign on the JO ,the doctor must check that the right type is done and he is the one how write the result the technician must do the test in front of him.
- All the Rh negative samples are done by tube method and never by release without the doctor signature and the RH is repeated in front of the doctor to check the that it is the right tube
- Presence of minor clot don't prevent doing the test unless the Rh is negative or O GROUP is the result in this case another sample is recommended.
9-Direct and Indirect coomb's test
- There must fresh O positive available not more than a week and in case that it give no good positive control the test should be repeated with a a fresh O positive
- The sample must be present for the examining doctor to check that it’s the right sample
- All positive result samples should be repeated and if there is no enough sample request for a new sample to cofirm the positive result by doing further washing and centrifugation during the process of testing
- Serum samples less than 0.5 ml will not be accepted.
- Haemolysed EDTA blood samples will not be accepted and samples not in EDTA tubes
III-Chemistry samples
1- low glucose result less than 60 the sample should be checked if taken in flouride containing tube and should be repeated again from the original tube , the doctor must be asked about the patient condition and in case if the patient come to the lab by himself another sample must be taken after fasting no more than 8 hours
2- low calcium result less than 7 the sample should be repeated from the original tube and the tube ( ckeck if the tube was taken in EDTA contair before separation and ask the sending place ih took it by mistake in EDTA containing tube) , the treating physian must be asked about the condition
3- low cholesterol and triglyceride and LDL less than 50 should be repeated from the original tube and another sample should been taken
another items will be dicussed later
Management of High results:
I- Immunology and Hormonal samples
1- CMV IgM
Results 0.7-1 need to run RF ( rheumatoid factor) with it
- if the result of RF is positive the result of CMV IgM is equivocal
- if the result of RF is negative the result of CMV IgM is positive
NB: the results above are repeated after centrifugation at high speed for at least 10 min
D- Results more than 1 is considered positive
2- TORCH IgM
- all the results of HSV IgM which give positive are repeated again
-all the positive results for Toxoplasma IgM ,Rubella IgM are repeated after centrifugation at high speed for at least 10 min
3- testosterone and progesterone
-all results that give more than
Progesterone more than 60
Testosterone more than 15
Need to be repeated with another normal sample with a normal result
4- Results that give correct number like 1000 or 100000
as in B HCG , Ferritin …..need dilution
5- Drug Abuse profile
- make dilution for the result of cannabinoids more than 135 for inside patients only or if requested.
-
- the other drug abuse profile need no dilution of the high results
the rest will be discussed later
Protocol of abnormal result
Management of low results
I- Immunology and Hormonal samples
1- Sample should be checked if there is any clot on the cup
2- Sample should be repeated after checking the tube is right and must be centrifuged at high speed for at least 10 min.
3- One level of control must run with the sample.
4- Last calibration and controls run must be printed and should be presented to the lab. doctor after release of the repeated result
5- All of the previous steps should be attached with the job order of that patient
6- All the drugs even after doing the previous steps should write a comment that the sample was done in duplicate and the result should be correlated with the clinical findings and the regular intake of the drug and should be repeated from a new sample if not correlating .
7- Repeat of the sample should be signed clear that the sample is repeated write his name clear and there will be no writing that the sample is o
1-Immunology results
• drug abuse profile
1-The specific gravity should be read by two different persons and sign that on the report
2- drug abuse profile results there must be checking the following
-Cannabinoids:
- Result below 15 should be written negative
- Result between 15 - 50 should be written negative although
- Result more than 50 should be written positive
-Amphetamine ( kaptogen,metamphetamin)
- Result less than 300 should be written negative
- Result between 300-1000 should be written negative although
- Result bmore than 1000 should be written positive
-Opiates, barbiturates, cocaine and benzodiazepine
- Result less than 200 should be written negative
- Result between 200-1000 should be written negative although
- Result more than 1000 should be written positive
• TORCH IgM and IgG
- following the previous steps in repeating low results ( without repeating the control and
checking the last caliberation and control especially for if the result is too low e.g. 0.1
- A comment is written for all Negative TORCH IgG results ….for example Toxoplasma
IgM is recommended to rule out recent infection.
• HCV IgG results
- Results that are more than 1- 4 are repeated immediately after centrifugation at
At high speeds the original sample for at least 10 min
- results 1-2 are considered negative although
- results 2-3 are considered reactive although
- results more than 3 are reactive
• HbsAG results
If the result in the machine is more than 1 and less than 4 this need to be repeated again after centrifugation for at least 20 min and the test should be repeated from the original sample not from the cup in the machine
A comment should be add to the result the although the result is positive it is close to the test should be repeated after 2 weeks and other hepatitis B markers should be done for confirmation
• Cyclosporin
The sample should be EDTA blood we must check for the presence of a clot before proceeding also we must check for hemolysis if the the results are unusual ( very high or very low results)
If there is a dilution of the sample this must be written in the job order
In the presence of abnormal results the treating physician must be informed to accept the result or send a new sample under the treating physician supervision and if the sample is taken in the lab the lab doctor must be supervising and a full history must be taken
2--Hormonal results
• Prolactin ,progesterone,estrogen,FSH,LH,Testosterone,ACTH.cortisone
- following the previous steps in repeating low results ( except for prolactin without running control with it
- If the result is low the result is written less than the sensitivity index ( eg sensitivity index for prolactin is 4.7 for example the result should be written less than 4.7)
- A comment is written with these cases …The result should be correlated with the
Clinical findings , intake of the drug regularly ,follow up is recommended Clinical findings , intake of the drug regularly ,follow up is recommended
• Thyroid profile
- following the previous steps in repeating low results
- If the result is low the result is written less than the sensitivity index
- A comment is written with these cases …The result should be correlated with the
Clinical findings , intake of the drug regularly ,follow up is recommended
1- the result of TSH is high with normal T3 and T4 a comment is written as the following
…Free T3 ,Free T4 and antithyroid antibodies are recommended for proper interpretation
… Clinical findings , intake of the drug regularly ,follow up is recommended
2-The result of TSH is low with normal T3 and T4 a comment is written as the following
… Free T3 and Free T4 are recommended for proper interpretation
… Clinical findings , intake of the drug regularly ,follow up is recommended
• Cortisone and ACTH
- plasma sample was send for the ACTH and this must be written in the JO
- Am and pm samples are written in the tubes for both cortisone and ACTH
- If nothing is written in the tube the result will come out without writing them and
This must be written clear in the JO that there is no AM or PM writing
- following the previous steps in repeating low results
- If the result is low the result is written less than the sensitivity index
- A comment is written with these cases …The result should be correlated with the
Clinical findings and the intake of the sample in the proper timing
- Calculation of cortisol in urine should be revised by two persons and both sign in the
Print out writing the calculation formula on it.
• Testosterone and free testosterone
- following the previous steps in repeating low results
- If the result is low the result is written less than the sensitivity index
You must check the age of the patient
- The free testosterone should be revised by two persons and both sign in the
In the print out with writing the calculation formula on it
- If the result is low the result is written less than the sensitivity index
• Insulin and C- peptide
- Fasting and post prandial samples must be written in the tubes
- nothing is written in the tube the result will come out without writing them and
and this is written in the JO clearly that there is no fasting or post prandial
- following the previous steps in repeating low results
- A comment is written that the result should correlate with the patient clinical findigs
And the intake of the sample in the proper timing
• Growth hormone and IGF1
- the age of the patient must be written especially for IgF1
- following the previous steps in repeating low results
- A comment is written if both results are low no comment is written but if GH is only recommended (and the result is below 1) the following comment is written GH after stimulation and IGF1 are recommended for proper interpretation of the condition
-
II-Haematology samples and results :
1- Low platelet counts below 100/Cmm should be repeated immediately
2 -Low hemoglobin below 10 g/dl for males and 9 g/dl for females should be repeated
Immediately.
3 - blood film exam by the doctor for the previous cases and if EDTA film
Should be written clear in the CBC format .
4 - The age of the patient if child below 12 years must be written in the CBC format
And if an outside sample there will be no release of the result without knowing the
Age.
5 - The PT and PTT, fibrinogen and PTT lupus must be all done in duplicate and in
Case previous history of medication this must be written clear in the
coagulation format and in the JO for the person taking the sample should written in
detail that there is a follow up and if the patient is taking medication with a follow up
before to write the previous dose and the new dose.
6-G6PD samples
-if quantitative is required the G6PD qualitative should be run first as double check and in case of G6PD deficient case there must be asking about the history of the patient and in case there is no history there must be a comment added that the result should be correlated with the clinical findings , family history and its recommended that another sample should be taken later confirm G6PD deficiency ( the must be written that G6PD qualitative was done and the result written in the JO and the name of the person)
-in case of qualitative test done and it was deficient a comment is written that G6PD quantitative should be done to reveal the severity of the condition
-for normal results( for both qualitative and quantitative)d more than 3 months old and the patient is not in haemolytic crisis and intake of blood transfusion at least one month before the test.
7-Haemoglobin electrophoresis
-There must be no previous intake of blood transfusion for at least one month
Before the test
- Sickling test is done for those showing HbS position in EP
- CBC is done for those showing HbA2 more than 4 %
- CbC is done for those showing only HbS with no HbA
- The following comment is written in all our results
…..No previous blood transfusion at least one month before
…..Iron deficiency cause decrease in HbA2
……Alpha thalassemia can be ruled out by clinical findings and family history
8-Blood grouping and Rh typing
- All the blood groups and Rh Typing are done in presence of the lab doctor and both the technician and the doctor sign on the JO ,the doctor must check that the right type is done and he is the one how write the result the technician must do the test in front of him.
- All the Rh negative samples are done by tube method and never by release without the doctor signature and the RH is repeated in front of the doctor to check the that it is the right tube
- Presence of minor clot don't prevent doing the test unless the Rh is negative or O GROUP is the result in this case another sample is recommended.
9-Direct and Indirect coomb's test
- There must fresh O positive available not more than a week and in case that it give no good positive control the test should be repeated with a a fresh O positive
- The sample must be present for the examining doctor to check that it’s the right sample
- All positive result samples should be repeated and if there is no enough sample request for a new sample to cofirm the positive result by doing further washing and centrifugation during the process of testing
- Serum samples less than 0.5 ml will not be accepted.
- Haemolysed EDTA blood samples will not be accepted and samples not in EDTA tubes
III-Chemistry samples
1- low glucose result less than 60 the sample should be checked if taken in flouride containing tube and should be repeated again from the original tube , the doctor must be asked about the patient condition and in case if the patient come to the lab by himself another sample must be taken after fasting no more than 8 hours
2- low calcium result less than 7 the sample should be repeated from the original tube and the tube ( ckeck if the tube was taken in EDTA contair before separation and ask the sending place ih took it by mistake in EDTA containing tube) , the treating physian must be asked about the condition
3- low cholesterol and triglyceride and LDL less than 50 should be repeated from the original tube and another sample should been taken
another items will be dicussed later
Management of High results:
I- Immunology and Hormonal samples
1- CMV IgM
Results 0.7-1 need to run RF ( rheumatoid factor) with it
- if the result of RF is positive the result of CMV IgM is equivocal
- if the result of RF is negative the result of CMV IgM is positive
NB: the results above are repeated after centrifugation at high speed for at least 10 min
D- Results more than 1 is considered positive
2- TORCH IgM
- all the results of HSV IgM which give positive are repeated again
-all the positive results for Toxoplasma IgM ,Rubella IgM are repeated after centrifugation at high speed for at least 10 min
3- testosterone and progesterone
-all results that give more than
Progesterone more than 60
Testosterone more than 15
Need to be repeated with another normal sample with a normal result
4- Results that give correct number like 1000 or 100000
as in B HCG , Ferritin …..need dilution
5- Drug Abuse profile
- make dilution for the result of cannabinoids more than 135 for inside patients only or if requested.
-
- the other drug abuse profile need no dilution of the high results
the rest will be discussed later
» أدعية رمضانية
» الصوم , الصيام . تعريف شامل ومفصل
» د. ابراهيم الفقي
» الموسوعة الطبية
» لغة الجسد تقول الكثير ..!!!
» نصائح للامتحانات
» اسيا سيل
» ما المحرَّمات في الاستمتاع الجنسي بين الزوجين؟
» ملف رائع عن جهاز ELISA