The future for clinical scientists in laboratory medicine

Hallworth, Mike; Hyde, Kayleigh; Cumming, Alan; Peake, I. R.

doi:10.1046/j.1365-2257.2002.00455.x

Cited by 14 publications

(10 citation statements)

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“…Clinical laboratory services are a vital part of healthcare systems [7]. Appropriateness in ordering and interpreting results of laboratory testing is an unquestionable part of the physician's clinical background, and is characterized by both her/his cumulated experience and updated scientific knowledge [12].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical laboratory results are an essential part of healthcare. It has been estimated that up to 70% of medical decisions and procedures, e.g., drug prescriptions, assessments prior to and in the course of further investigations, or dialysis, are strongly dependent upon laboratory data [7]. An adequate time of fasting is typically required for glucose and lipid profile (triglycerides, total cholesterol, and fractions) assessment.…”

Section: Introductionmentioning

confidence: 99%

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Influence of a Regular, Standardized Meal on Clinical Chemistry Analytes

et al. 2012

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BackgroundPreanalytical variability, including biological variability and patient preparation, is an important source of variability in laboratory testing. In this study, we assessed whether a regular light meal might bias the results of routine clinical chemistry testing.MethodsWe studied 17 healthy volunteers who consumed light meals containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood for routine clinical chemistry tests before the meal and 1, 2, and 4 hr thereafter.ResultsOne hour after the meal, triglycerides (TG), albumin (ALB), uric acid (UA), phosphatase (ALP), Ca, Fe, and Na levels significantly increased, whereas blood urea nitrogen (BUN) and P levels decreased. TG, ALB, Ca, Na, P, and total protein (TP) levels varied significantly. Two hours after the meal, TG, ALB, Ca, Fe, and Na levels remained significantly high, whereas BUN, P, UA, and total bilirubin (BT) levels decreased. Clinically significant variations were recorded for TG, ALB, ALT, Ca, Fe, Na, P, BT, and direct bilirubin (BD) levels. Four hours after the meal, TG, ALB, Ca, Fe, Na, lactate dehydrogenase (LDH), P, Mg, and K levels significantly increased, whereas UA and BT levels decreased. Clinically significant variations were observed for TG, ALB, ALT, Ca, Na, Mg, K, C-reactive protein (CRP), AST, UA, and BT levels.ConclusionsA significant variation in the clinical chemistry parameters after a regular meal shows that fasting time needs to be carefully considered when performing tests to prevent spurious results and reduce laboratory errors, especially in an emergency setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of a Regular, Standardized Meal on Clinical Chemistry Analytes

et al. 2012

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“…It has been estimated that 60% of medical decisions depend on laboratory test results ( 4 ) which often include a complete blood count or haematological parameters in blood. Biological variables such as physical activity, psychological stress and environmental conditions present in diving cause a specific physiological response that could significantly affect haematological test results ( 5 - 7 ).…”

Section: Introductionmentioning

confidence: 99%

Does recreational scuba diving have clinically significant effect on routine haematological parameters?

et al. 2017

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IntroductionScuba diving represents a combination of exercise and changes in environmental conditions. This study aimed to evaluate changes in haematological parameters after recreational scuba diving in order to identify clinically significant changes.Materials and methodsThe study included males, 17 recreational divers, median age (range) 41 (30-52) years. Blood samples were taken before diving, immediately after diving to 30 meters for 30 minutes, 3 hours and 6 hours after diving. Complete blood counts were analyzed on the Cell Dyn Ruby haematology analyzer. Statistical significance between successive measurements was tested using Friedman test. The difference between the two measurements was judged against desirable bias (DSB) derived from biological variation and calculated reference change values (RCV). The difference higher than RCV was considered clinically significant.ResultsA statistically significant increase and difference judging against DSB was observed: for neutrophils immediately, 3 and 6 hours after diving (18%, 34% and 36%, respectively), for white blood cells (WBCs) 3 and 6 hours after diving (20% and 25%, respectively), for lymphocytes (20%) and monocytes (23%) 6 hours after diving. A statistically significant decrease and difference judging against DSB was found: immediately after diving for monocytes (- 15%), 3 and 6 hours after diving for red blood cells (RBCs) (- 2.6% and -2.9%, respectively), haemoglobin (- 2.1% and - 2.8%, respectively) and haematocrit (- 2.4% and - 3.2%, respectively). A clinically significant change was not found for any of the test parameters when compared to RCV.ConclusionsObserved statistically significant changes after recreational scuba diving; WBCs, neutrophils, lymphocytes, monocytes increase and RBCs, haemoglobin, haematocrit decrease, probably will not affect clinical decision.

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“…The clinical laboratory results are an essential part of the healthcare delivery. It has been estimated that 60 up to 70% of medical decisions and procedures, such as drug prescriptions, assessments prior to and in the course of further investigations or dialysis, are strongly dependent upon laboratory data (16). Nowadays many procedures are performed and/or oriented by non-laboratory professionals (e.g.…”

Section: Introductionmentioning

confidence: 99%

Impact of the phlebotomy training based on CLSI/NCCLS H03-A6 – procedures for the collection of diagnostic blood

et al. 2012

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Introduction:The activities involving phlebotomy, a critical task for obtaining diagnostic blood samples, are poorly studied as regards the major sources of errors and the procedures related to laboratory quality control. The aim of this study was to verify the compliance with CLSI documents of clinical laboratories from South America and to assess whether teaching phlebotomists to follow the exact procedure for blood collection by venipuncture from CLSI/NCCLS H03-A6 - Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture might improve the quality of the process.Materials and methods:A survey was sent by mail to 3674 laboratories from South America to verify the use of CLSI documents. Thirty skilled phlebotomists were trained with the CLSI H03-A6 document to perform venipuncture procedures for a period of 20 consecutive working days. The overall performances of the phlebotomists were further compared before and after the training program.Results:2622 from 2781 laboratories that did answer our survey used CLSI documents to standardize their procedures and process. The phlebotomists’ training for 20 days before our evaluation completely eliminated non-conformity procedures for: i) incorrect friction of the forearm, during the cleaning of the venipuncture site to ease vein location; ii) incorrect sequence of vacuum tubes collection; and iii) inadequate mixing of the blood in primary vacuum tubes containing anticoagulants or clot activators. Unfortunately the CLSI H03-A6 document does not caution against both unsuitable tourniquet application time (i.e., for more than one minute) and inappropriate request to clench the fist repeatedly. These inadequate procedures were observed for all phlebotomists.Conclusion:We showed that strict observance of the CLSI H03-A6 document can remarkably improve quality, although the various steps for collecting diagnostic blood specimens are not a gold standard, since they may still permit errors. Tourniquet application time and forearm clench should be verified by all quality laboratory managers in the services. Moreover, the procedure for collecting blood specimens should be revised to eliminate this source of laboratory variability and safeguard the quality.

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The future for clinical scientists in laboratory medicine

Cited by 14 publications

References 0 publications

Influence of a Regular, Standardized Meal on Clinical Chemistry Analytes

Influence of a Regular, Standardized Meal on Clinical Chemistry Analytes

Does recreational scuba diving have clinically significant effect on routine haematological parameters?

Impact of the phlebotomy training based on CLSI/NCCLS H03-A6 – procedures for the collection of diagnostic blood

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