Ch3: Complexity of a Laboratory
System.
Laboratory Management
CLS 452
Saida Almashharawi
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Objectives:
•Complexity of a Laboratory System.
•Path of work flow.
•Pre examination inside the lab.
•Pre examination outside the lab.
•Laboratory error.
•Difference between sample and spaceman
•General steps of sampling.
•Pre analytical variation.
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Complexity of a Laboratory System
Reporting
Patient/Client Prep
Sample Collection
•Data & Laboratory
Management
•Safety
•Customer Service
Sample Receipt and
Accessioning
Record Keeping
Quality Control
Testing
Sample Transport
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Path of Workflow
THE PATIENT
Test selection
Sample Collection
Pre-examination Phase
Sample Transport
Laboratory Analysis
Examination Phase
Report Transport
Result Interpretation
Report Creation
Post-examination Phase
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Pre examination
Test selection
Sample Collection
Sample Transport
Special handling
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PREANALYTIAL
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Pre examination outside the
lab
Test selection
Sample Collection
Sample Transport
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Pre examination inside the
lab
Storage
Centrifugation
Distribution
Sample preparation
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Sampling
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What is the difference
between sample and
spaceman ?
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Sampling
The International Organization for Standardization (ISO) and Clinical
and Laboratory Standards Institute (CLSI) define a sample as “one or
more parts taken from a system ”.
The term “specimen” is very commonly used in the laboratory to
indicate a sample taken from the human body, but the terminology
used throughout ISO documents is “primary sample”, or just
“sample”.
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 The correct collection of specimens is essential for reliable test
results.
 Specimens for urgent analysis should be delivered to the
laboratory as soon as possible.
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General steps of sampling :
 Patient preparation and pre analytical variables ( Diet or timing ).
 Identification of patient.
 Position.
 Selection of containers.
 Labeling.
 Sampling.
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Pre analytical variation
Biological variation
Physiological variation
Rhythmic variation
Drug
Diet
Life style
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Biological
Age
Gender (
sex )
Pregnency
Menstrual
cycle
Race
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Preanalytical variables
I- Biological influences:
1. Age:
Historically , biological age groups have consisted of at least four
categories; newborn, children ( prepubertal ), adults and the
elderly or geriatric population.
2. Gender:
Until puberty, Few differences exist in laboratory data between boys
and girls. After puberty, the serum activities of alolase, creatinine
and sex hormones level are greater in men than women.
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3. Race:
The effect of race or nationality on basal concentrations of blood
analytes can be considered small. More important are the effects
of environmental and socioeconomic factors.
4. Pregnancy:
A number of physiological changes are necessary to support a
developing fetus, The earliest are hormonally mediated, due to
markedly increased concentrations of estrogen and progestron
with rapidly rising HCG levels.
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5. Menstrual cycle:
The plasma concentrations of many female sex hormones, and
other hormones, are affected by menstrual cycle.
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Rhythmic variation
Diurnal
Seasonal
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II. Rhythmic Variation:
Rhythmic changes in biochemical constituents have been known for
many years, and the terms daily, diurnal, 24 hour, have been used to
describe them.
1.Diurnal variation:
expected high and low levels of a
substance during a 24 hour period. For example, blood cortisol is
highest in the morning and lowest in early evening.
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2. Seasonal influences:
Seasonal influences on the composition of the body fluids are
small and probably related to seasonal dietary changes and
altered physical activity.
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III. Diet:
An individual's typical diet has considerable influence on the
composition of plasma.
IV. Life style
Life style factors that affect the levels of commonly measured
analytes include exercise, smoking, alcohol ingestion,
V. Drug administration
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Physiological
Posture
Prolonged bed
rest
Exercise
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VI. Physiological variables:
They include: posture, prolonged bed rest, exercise, and physical
training
1-Posture:
Changes in posture can profoundly alter the concentration of
components in the peripheral blood; therefore, it is important to
know the physical circumstances under which the specimen was
obtained.
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2-Prolonged bed rest:
With prolonged bed rest, fluid retention occurs and serum protein
and albumin concentrations may be decreased by.
3-Exercise:
Physical activity and exercise can have both short-term and longterm effects on the concentrations of substance in blood and urine.
Athletes generally have higher levels of serum activity for enzymes
of skeletal muscular origin at rest than do non athletes.
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2. Patient identification:
The person collecting the sample must accurately identify the
patient. This might be done by questioning the patient, by
questioning an accompanying family member, or by the use of an
identifying wrist band or other device.
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Type of sample required: Blood tests might require serum, plasma
or whole blood. Other tests might require urine or saliva.
Microbiology testing deals with a variety of sample types, so
specific information as to what is required for the test is needed.
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3. Type of container:
The container for the sample is often very important, as it will
affect volume and any needed additives such as anticoagulants and
preservatives. If the container does not control volume, this will
need to be clearly specified. Some microbiology samples will
require specific transport media to preserve microorganisms.
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3. Sample labeling: All requirements for labeling of the sample at the
time of collection will need to be explained in detail in the
instructions for collection.
Each sample should be clearly labeled with:
 the patient’s first and last name;
 a unique identification number: this might be a hospital number or
a number assigned by the laboratory;
 the test that has been requested;
 the time and date of collection;
 the initials of the person collecting the sample.
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Technique of sampling:
 Disinfection.
 Sampling.
 Mixing.
 Prevention of bleeding.
 Disposal.
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Special handling: Some samples may require special handling,
such as immediate refrigeration, protection from light or prompt
delivery to the laboratory. Any important safety precautions
should be explained.
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Delivery of Reports
 The most experienced member of the laboratory’s technical staff
must check all results before they leave the laboratory.
 Any unexpected result should be investigated and repeated if
necessary.
 It is important for laboratory workers to understand the clinical
significance and accepted reference values (normal range) of the
tests they perform.
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