COLLECTION OF SPECIMENS

The most frequently used material for quantitative chemical investigations are: 1. blood specimens. This is followed by 2. urine and then 3. faeces.

Other materials submitted for chemical analysis include: Cerebrospinal fluid, Gastric Duodenal and jejunal secretions, Amniotic fluid, Saliva, Sweat, Pathological fluids obtained by paracentesis (aspiration), calculi etc. And Samples of dietary intake

Currently, interest is also being focused on the chemical analysis of cellular constituents and biopsy material.
Many factors associated with specimen collection can influence the validity and interpretation.

These include the collection of specimen from the wrong patient, incorrect identification of specimens after collection and subsequent handling prior to analysis.

FACTORS TO CONSIDER BEFORE COLLECTING SPECIMEN

These include:

Diet, Current medication and Time of day.

Diet:
Some chemical investigations are liable to interference from dietary constituents e.g. a patient on whom Calcium analysis is to be performed should not take dairy products.

Subjects for GTT should be on their normal carbohydrate diets of about 150g of carbohydrate/day for at least 3 days prior to the test t. Patients for lipid analysis should be on their normal lipid intake for at least a week prior to the test.

Drugs/Current Medication:

Many drugs are known to affect chemical/Laboratory determinations, e.g. Oral Contraceptives, cough mixtures, etc. Patients on cephalosporins, vitamin C or ascorbic acid are most likely to present with false glycosuria if the method for determining urine glucose is the Benedicts test. It is important that doctors indicate or discuss details of the current medication of patients with the laboratory staff.

Time of Day:

Several blood constituents show variation with time of day, e.g. corticosteroids, iron. For such blood constituents, its very imperative that the time at which the specimen was collected be indicated.

FACTORS TO CONSIDER AT THE TIME OF COLLECTING BLOOD SPECIMEN

Venous

stasis The posture of the patient: Haemolysis:

The posture of the patient:

Several proteins and protein-bound blood constituents show significant differences in concentration between samples collected from upright position and those from recumbent (leaning) individuals, e.g. Albumin, calcium, cholesterol, cortisol and protein bound iodine. ctd

Example:
When the posture is changed from lying to standing, there may be an increase of as much as 13% in the concentration of non-diffusible components of blood within 15 minutes due to redistribution of the extracellular fluid. Its very important therefore for every health institution to standardize its procedure for obtaining blood specimen.

Venous

stasis:

Every effort must be made at avoiding prolonged stasis during venepuncture since it can markedly raise the concentration of plasma proteins, haemoglobin, hormones, calcium and lipids. The combined effect of raised intravenous pressure with its associated local anoxia from sustained occlusion results in the passage of water and small molecules from the lumen of a vein into the surrounding extracellular fluid.
ctd

Intracellular constituents such as potassium and lactic acid leak into the plasma causing falsely elevated results. The best procedure is to remove the tourniquet soon after puncturing the vein.

The site of venepuncture:

Under no circumstance should blood be drawn from an arm receiving an intravenous infusion since the fluid may not have mixed with the whole blood Vol.
Blood from the opposite arm usually provides valid results. If there are no available veins on the arm, then a femoral blood should be taken. But if this is not possible, then the specimen should be obtained from a site distant from the infusion site or preferably about 10-20ml of blood should be aspirated through the needle (if patient is very sick, dont).

Haemolysis:

This must be avoided at all costs because it invalidates certain determinations owing to the release of erythrocytic

contents, e.g. Potassium, lactate dehydrogenase, acid

phosphatase or through colour changes which interfere with photometric determination using shorter wavelengths of the

visible spectrum (400-500nm).

Haemoglobin also interferes with chemical reactions such as

the diacetylation of bilirubin. To minimize haemolysis, the

specimen should be collected with only moderate suction. The plunger of the syringe should not be drawn too fast and

there should be an easy flow of blood

The needle should be removed from the syringe before the specimen is expelled gently into an appropriate container leaving behind any froth that may be in the syringe. Tubes into which the blood is expelled should be cleaned and dry. Any anticoagulant in the tube should be mixed with the blood by gentle rotation. If the blood is taken on the ward, and allowed to stand for more than an hour or two, the effect on the plasma constituents is synonymous to haemolysis.

UNITS USED IN REPORTING LABORATORY RESULTS

The International System of Units (SI Units) has been developed and agreed internationally in the interests of world health. It overcomes language barriers, enabling an exchange of health information within a country and between nations to be made without the misunderstandings which arise when each country, or even a separate hospital within a country, uses its own units of measurement for reporting tests. The SI units are based on the metre- kilogram-second system and replace both the foot-pound- second (imperial) system and the centimeter-gram-second (cgs) system. There are seven SIbased units, i.e. metre, kilogram, second, mole, ampere, Kelvin and candela.

Symbols for these units and what they measure are:

SI-base units Metre

Kilogram Second Mole Ampere Kelvin Candela

Units M
Kg S Mol A k Cd

Quantity Measured Length

Mass Time Amount of substance Electric current Temperature Luminous intensity

RECOMMENDED TEXTBOOKS

Lecture Notes on Clinical Chemistry

Whitby et.al.

Clinical Chemistry

Marshall

Clinical chemistry in Diagnoses and Treatment

Zilva et.al.

Chemical Pathology

Gray