Effects of non-analytical factors on the quality of laboratory results.

The quality of clinical laboratory measurement is comprised of 2 phases, the analytical and non-analytical phases. Nowadays, a well established quality control system has been applied. However, the non-analytical phase is a state of the art that must be paid attention to. We studied the non-analytical (pre- and post-) factors. A questionnaire was distributed to 298 hospital laboratories whom participated in the External Quality Assessment Scheme in Clinical Chemistry (EQAC) program of Faculty of Medical Technology, Mahidol University. The respondent rate was 71%. Most of the responder was female with a bachelor degree in medical technology or equivalent, who was the chief of the laboratory. Results shows that patient preparation, patient identification, specimen acquisition, specimen handling, and documentary system (specimen recording and result reporting) were important consideration factors. The turnaround time was also a main issue. Verification of test results was an important process too. Finally, as a good laboratory practice, one must has the strategies to detect and eliminate the non-analytical errors.

Thai clinical laboratory responsible to economic crisis.

Nowadays, Thailand encounters a serious economic crisis. A clear consensus has been made that a cost-saving system must be the important tool. Both private and government organizations are engaged in this situation. We studied the cost-saving in the clinical laboratory. A questionnaire was distributed to 45 hospital laboratories located in Bangkok. Results showed that efforts to control the cost are the essential policy. There was a variety of factors contributing to the cost-saving process. The usage of public utility, non-recycle material and unnecessary utility were reconsidered. Besides, capital cost (wages and salary) personnel incentive are assessed. Forty three of the 45 respondents had attempted to reduce the cost via curtailing the unnecessary electricity. Eliminating the needless usage of telephone-call. water and unnecessary material was also an effective strategy. A reduction of 86.9%, 80 % and 80.0% of the mentioned factors respectively, was reported. An inventory system of the reagent, chemical and supplies was focused. Most of the laboratories have a policy on cost-saving by decreased the storage. Twenty eight of the 45 laboratories considered to purchase the cheaper with similar quality reagents instead. And some one would purchase a bulky pack when it is the best bargain. A specific system "contact reagent with a free rent instrument" has been used widely (33.3%). Finally, a new personnel management system has been chosen. Workload has rearranged and unnecessary extra-hour work was abandoned.

A diversity of blood smear examination system of Thai public hospital.

A good laboratory practice is the heart of clinical laboratory quality. One must establish a standard system in order to achieve the quality. However, standard system is not only the technical but also a state of the art. The socioeconomic and culture are the influence factors. At present, technique of reporting the blood smear examination is still a nation controversy. We surveyed the blood smear examination reporting system of the public hospital in Thailand. There were 77 hospitals participated in this study. A questionnaire comprised of 23 questions was distributed to 105 clinical laboratory staffs of the public health hospitals. Results showed that there was a diversity of blood smear examination reporting system. Generally, there were 2 ways of blood smear review. Every smeared slide and only abnormal slides were re-examined by the conventional technique. When an abnormal white blood cell blood picture was observed. The presence of either blast cell or atypical lymphocyte has clinical significance. A majority of laboratory would report in form "counting number of abnormal cell within 100% of the differential count". For other abnormalities of white blood cell; i.e. the neutrophils with toxic granules, most of laboratory reported as "presence". Interestingly, the red blood cell reporting system varied from laboratory to laboratory. There was a total of nine reporting patterns. Results indicated that pattern 4 (few or some, 1+,2+,3+,4+ are 5-10%, 11-25%, 26-50%, 51-75% and 51-100% cell/oil field, respectively) was the most popular one in reporting anisocytosis and poikilocytosis. However, the reporting pattern on red blood cell staining was difference. Pattern 4 and pattern 7 (grading by the size of central pallor) obtained a same popularity on the consideration of hypochromia. But the pattern 9 (few or some, 1+,2+,3+ are 0-1, 1-3, 4-6 and >6 cell/oil field, respectively) was the most frequently used in reporting of polychromasia. Fortunately we found that the reporting system for platelet was not complicated. A majority of laboratory chose the qualitative pattern (reporting as adequate, increased and decreased). Our study indicated that Thai clinical laboratory encounter a diversity of blood smear reporting system. Every clinical laboratory should pay a great attention to this circumstance. Since a good laboratory practice is a knot of the knot-bolt system of healthcare service, therefore, a nation standard system must be established in the near future.

Lipoprotein(a) in nephrotic syndrome.

Serum lipoprotein(a) levels were measured in 27 patients with idiopathic nephrotic syndrome (NS), 14 patients with systemic lupus erythematosus (SLE) and 30 healthy controls. Lp(a) levels were significantly elevated in both idiopathic NS (53.4 + 36.2) and SLE (49.3+ 41.9) compared with controls (9.5+ 5.7) (p < 0.001). Fifty nine percent of idiopathic NS and 50 percent of SLE had Lp(a) more than 30 mg/dl. In 19 patients with idiopathic NS, serum Lp(a) levels fell markedly in 12 patients who responded to prednisolone therapy while, 7 patients with partial and no response had serum Lp(a), cholesterol, triglycerides and albumin levels not different from pretreatment period vs 6 months therapy. Lp(a) levels correlated significantly with proteinuria, serum cholesterol and triglycerides (r = 0.8, 0.6, 0.6) in idiopathic nephrotic syndrome and correlated inversely with serum albumin (r = -0.9). The SLE patients had the same pattern of correlation among these parameters and Lp(a) levels except for triglycerides. The high levels of Lp(a) in the NS could be one of the risk factors for atherosclerosis and thrombotic events associated with this disorder. In conclusion, the present study confirmed that patients with idiopathic NS and SLE had markedly increased serum level of Lp(a), in conjunction with other lipid abnormalities. The serum Lp(a) levels decreased substantially in all NS patients who experienced remission. In addition, the study also demonstrated a relationship between serum Lp(a) levels and serum albumin, cholesterol and triglycerides. An elevated Lp(a) level may be useful in guiding the physician towards more aggressive care to detect coronary artery disease early in patients at risk.

Serum lipid, lipoprotein-cholesterol and apolipoproteins A-I and B of smoking and non-smoking males.

Cigarette smoking is an important risk factor for coronary heart disease, stroke and peripheral vascular disease. Accordingly, we measured the serum lipid, lipoprotein-cholesterol and apolipoprotein A-I, B in 128 cigarette smoking males and 67 non-smoking males. The total cholesterol and LDL-cholesterol in smokers and non-smokers showed no statistical significance. The smokers had significantly higher serum triglyceride and VLDL-cholesterol levels (P < 0.001), but significantly lower HDL-cholesterol levels (P < 0.05) than non-smokers. The apolipoprotein A-I was significantly lower and apolipoprotein B was significantly higher in smokers than non-smokers (P < 0.001). Levels of lipid, lipoprotein-cholesterol were related to the number of cigarettes smoked per day. Triglyceride and VLDL-cholesterol levels were significantly higher in those who smoked > 20 cigarettes/day compared with those who smoked 10-20, < 10 cigarettes/day and non-smokers (P < 0.05). Those who smoked > 20 cigarettes/day had significantly lower HDL-cholesterol than those of non-smokers (P < 0.05). All three groups of smokers had significantly lower apolipoprotein A-I than non-smokers (P < 0.05), whereas, those who smoked > 20 cigarettes/day had significantly higher apolipoprotein B levels than those who smoked 10-20, < 10 cigarettes/day and non-smokers (P < 0.05).

Serum thiocyanate concentrations in smoking and non-smoking males.

The determination of serum thiocyanate is a simple and inexpensive method in assessing smoking status. It can be used alone or as adjuvant to other methods. We have found the thiocyanate method to be efficient for this particular purpose.

Comparative study of vanillylmandelic acid in random and 24-hour urine collections.

Urinary vanillylmandelic acid (VMA) levels were determined in random samples and in 24-hour collections from 52 patients. Random sample levels were compared with levels in 24-hour collections and showed good correlation (r = 0.99), and no statistically significant differences was found when urinary VMA levels in random samples expressed in micrograms/mg creatinine (p greater than 0.1). Normal values of VMA in random urine samples of 226 healthy volunteers for different age groups of 1-5, 6-10, 11-15, 16-30, 31-60 years old were 17.03 +/- 6.61, 10.32 +/- 3.25, 10.87 +/- 4.5, 7.62 +/- 3.05 and 7.79 +/- 3.94 micrograms/mg of creatinine respectively.

A simple method for protein electrophoresis of unconcentrated urine.

Thirty-two unconcentrated urines were electrophoresed on cellogels in 0.05 M barbital buffer, pH 8.6, at 280 volts for 35 minutes. Instead of concentrating 100 fold, the urine samples were directly applied on the gel in volumes from 1.2 to 3.6 microliters and Coomassie dye was used for staining. This makes it possible to observe the protein patterns at trace concentration by reagent strips (about 0.05-0.2 g/l). This method is simple, convenient and suited for routine services.

Dilution of serum HDL – cholesterol assay.

We reported herein a dilution of specimens for assay of cholesterol in high-density lipoprotein. Diluting serum with an equal volume of bovine albumin in ammonium acetate solution leads to almost the same results as those obtained with native sera; while the results after dilution with isotonic saline were 13.35% lowered.

Correlation between plasma and urine glucose in diabetes.

Blood and urine specimens from 135 adult diabetic patients routinely visiting an outpatient diabetic clinic of Siriraj Hospital were collected and assayed for glucose levels. The results of negative, trace 1+, 2+, 3+ and 4+ by Diastix were associated with urinary glucose levels of 25.43, 161.57, 354.50, 776.67, 1598.18 and 4191.25 mg/dl and plasma glucose levels of 154.07, 193.93, 205.10, 216.11, 241.09 and 284.04 mg/dl respectively. Plasma glucose levels from 83-283 mg/dl were negative by Diastix and 100% of urine samples with plasma glucose levels above 300 mg/dl were positive by Diastix.