Clinical chemistry laboratory
Factors affecting laboratory tests
investigations
To confirm a diagnosis eg TSH and free T4
To aid differential diagnosis eg jaundice, causes of
abdominal pain
To refine a diagnosis eg plasma ACTH
To assess severity of disease eg plasma creatinine
To monitor progress of disease eg HbA1c
To detect complications or side effects eg liver, renal
toxicity
To monitor drug therapy to check compliance or
toxicity
Specimen collection
• Most investigations carried out on blood,
next being urine
• Others include
– CSF, faeces, sweat, amniotic fluid
– Ascitic and pleural fluid, saliva, duodenal and
jejunal secretions, semen etc
Specimen collection
• Avoid collecting from a drip arm
• Use appropriate specimen tube, avoid
contamination
• Avoid haemolysis
• Send samples to the lab ASAP
• Blood gases to be analysed immediately
• Specific transport requirements
• Specimen collection
• Analytical factors
• Biological variations
• Intra-individual variation
• Inter-individual variation
• Sensitivity, specificity and predictive value
of a test
Specimen collection
• Identification of patients and of specimens
– Request forms to be properly filled, can now be
undertaken electronically using e-quest
– Clinical details and tests requested should be
clearly stated
– Timing of sampling should be indicated
– Destination of results should also be indicated
Specimen collection
common errors
• Drugs
– Aspirin at least 6h post dose
– Digoxin at least 6h post dose
– Most other drugs should be pre-dose
– If not certain collect samples on admission and
at the optimal times since admission
– Paracetamol at least 4 h post ingestion
– Timing should be clearly indicated, aids
interpretation
1
 Specimen collection
common errors
• Troponin requesting-
• sample should be taken at least 10 h since onset
of chest pain or symptoms. If not sure, sample
should be taken on admission and at 10 h
afterwards
• Optimal sampling time for cortisol deficiency is
9.0 am otherwise state
• Samples for lipids and glucose ideally fasting,
otherwise state
Factors affecting laboratory tests
• In the interpretation of results, always
consider:
• Biological variations
• Intra-individual variation
• Inter-individual variation
• Sensitivity, specificity and predictive value
of a test
Factors affecting laboratory tests
Always ask if not sure ! ! !
Test over-requesting
• Ideally only one Troponin measurement
• Follow up TFTs every 4 – 6 weeks
• HbA1c at most 2 per year
• Tumour markers not a diagnostic test
• Iron studies not interpretable in the acutely
ill. FBC more appropriate
• FSH only is required for the diagnosis of
the menopause
Conclusions
• Laboratory tests play a key role in the
management of patients
• Should be interpreted in the light of the
patients clinical details and other
investigations and previous results
• Appropriate specimens should be collected
into appropriate specimen containers
• Avoid test over requesting