The Total Lab Testing
Process
Total testing
process
An example of this process is the following
scinario
MR. A. CAME PRESENTING TO THE DOCTOR’S GIVEN THE PATIENT’S HISTORY, INCLUDING A
CLINIC WITH WEIGHT LOSS DESPITE NO CHANGE FAMILY HISTORY OF TYPE2 DIABETES, THE
IN HIS DIET, TOGETHER WITH HAVING TO WAKE PHYSICIAN SUSPECTED DIABETES MELLITUS,
UP MULTIPLE TIMES AT NIGHT TO URINATE.
The physician knows that diagnosis of Diabetes She writes down the following tests in a lab
could be based on these tests (among others), request: FPG and Post 75 gm glucose load
fasting plasma glucose, Post load plasma glucose.
The nurse receives the request and
decides on which tubes he should be He then proceeds to specimen
using and starts printing labels with collection using aseptic venipuncture.
the patient data.
The lab processes the specimen and
starts the sample centrifugation to
The sample is then transported to the prepare it for analysis, analysis is then
lab. performed, and the results are now
ready to be reviewed by the
laboratory physician.
The laboratory physician reviews the results for being medically The results are then ready for the physician, the patient’s glucose is
acceptable and free of possible errors. high in both fasting and post load states and the patients is diagnosed
as diabetic. The correct treatment is prescribed.
This might sound simple
• However, the laboratory physicians dedicate their lives studying this cycle
and the sources of error that can appear in each of its phases
(Preanalytical; before analysis, analytical; the analysis that takes places in
the lab and post analytical).
• Examples of Pre-analytical errors: Wrong test selection, wrong test tube,
reluctance in sample transport, improper labeling, sample broken in the
centrifuge.
• Examples of analytical errors: failure of quality checks to detect error in
machine or used reagents.
• Examples of post analytical errors: Failure of lab physician to quarantine a
wrong result, failure of results delivery to the treating physician, failure of
the treating physician to interpret the results.
Arrange the following steps to create a total testing process in the correct
order, to help this physician diagnose his patient with Carpopedal spasm
1 2 3 4
The nurse chooses
The Clinician
the tube for serum The lab runs an
The nurse requests serum
samples and labels assay for serum
performs sampling calcium for the
it with the calcium
patient
patient's ID
5 6 7 8
The clinician The Lab Physician
notices the low The clinician sees a reviews the results The sample is
calcium and the patient with for medical transported to the
correct treatment carpopedal spasm acceptability and lab
is prompted. releases them
The correct sequence is:
A- 63218475 C- 63824175
B- 63824175 D- 51382476
1- Ordering
a lab test
Urgent samples
In general, a test should be ordered if it
answers one of the following questions?
• (1) Could this test be used in screening an asymptomatic individual
for early evidence of the presence of disease?
• (2) Will the result of this test confirm a clinical suspicion?
• (3) Could the result of this test exclude a diagnosis?
• (4) Could the result of this test assist in the selection and optimization
of treatment?
• (5) Could the result of this test monitor the patient’s compliance with
a treatment protocol?
• (6) Could the result of this test provide a prognosis?
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the
A female, 28 years with recent history of
amenorrhea, she wants to confirm if she is
pregnant, you order a “pregnancy test”.
The following is true regarding pregnancy
test
A- It is a qualitative test
B- It tests a hormone produced by the gonads
C- It requires a fasting sample
D-It is a quantitative test
An apparently healthy employee, who wants
to know his “blood type and Rh” to include it
in his driver's license.
The following is true regarding this test
A- It requires a non- fasting sample
B- It tests the ABO antigens only
C-O negative is the universal recipient
Choose the Clinical question asked by the
physician to match the application you see
A patient presenting to the ER with chest pain and the physician orders
Cardiac markers to diagnose acute myocardial infarction.
A. Could this test be used in screening an asymptomatic individual for
early evidence of the presence of disease?
B. Will the result of this test confirm a clinical suspicion?
C. Could the result of this test monitor the patient’s compliance with a
treatment protocol?
A physician orders a urine culture and antibiotic sensitivity test
before choosing which antibiotic to prescribe to his patient
A. Could this test be used in screening an asymptomatic individual for
early evidence of the presence of disease?
B. Could the result of this test assist in the selection and optimization
of treatment?
C. Could the result of this test monitor the patient’s compliance with a
treatment protocol?
2- THE
SAMPLE IS
ACQUIRED
Blood specimens; Venous,
arterial, and capillary.
All the following anticoagulated tubes
contain a Calcium chelating agent except
A. Blue topped-Citrate tube
B. Green topped-Heparin tube
C. Lavender topped-EDTA tube
D. Black topped-Citrate tube
The sampling procedure
You are now asked to watch the following video of a classic
venous sampling procedure and answer the questions that
will follow.
Answer the following questions:
• When was the tourniquet applied? And when was it removed?
• Was the cotton or gauze applied to the puncture site firmly or lightly?
• What is the device attached to the needle?
• How was the needle disposed?
3- THE
SAMPLE IS
TRANSPORTED
Transporting the sample to the lab
4- THE
SAMPLE IS
RECIEVED
Receiving the
samples
5- THE
SAMPLE IS
ANALYZED
The sample analysis
