Quality assessment in clinical chemistry: a Thailand experience.

A Thailand quality assessment program called "The External Quality Assessment in Clinical Chemistry, EQAC" was found in 1986. Ablind lyophilized control serum is monthly-cycle distributed to the participants and the returned test-report values are evaluated by a computed program. Evaluated report Variance Index Scores (VIS) and grades of test and mean score of all tests are posted back to the participants including a back of "The Newsletter of the EQAC". The development has been indicated by an increasing number of active participants and an improvement due to decreasing Variance Index Scores. In 1998 the program was applied by 324 laboratory participants of which 59% of general hospital and community health hospital laboratory, 29% of private hospital laboratory including polyclinics, and 12% of the others. By now as many as 144 trials of 23 biochemistry tests at different methods were assessed from the EQAC program. Participant communication, knowledge update and enhanced quality encouragement have been managed by mean of participants' VIS from 120 to 93 during 1987-1998.

Altered biochemistry substances, hematocrit and white blood cell count in cigarette smokers and alcohol drinkers.

The level of glucose, uric acid, cholesterol triglycerides and transminase (SGOT and SGPT) and also hematological data of hematocrit and white cell count of 1,542 workers age ranging from 35-53 years who came for physical check up during B.E. 2532 – 2534 were analysed for the groups of smokers, drinkers and smokers together with drinkers. All the three groups have significantly high level of biochemistry substances, hematocrit and white cell count than normal group (p < 0.005) except HDL-Cholesterol which is significantly lower than the normal group (p < 0.005). However, the white cell count of habitual drinkers and cholesterol level in smokers together with drinkers have no significantly different from the normal. We categorie the number of cigarette smoked by both questionnaires and the thiocyanate levels, and found the serum thiocyanate levels correlates with the number of cigarette smoked (p < 0.001).

Preparation of home-made lyophilized human serum for quality control in clinical chemistry.

Tested serum of donors from the Blood Bank unit of Siriraj Hospital was collected. Only negative hepatitis B-antigen determined by RPHA (reverse passive haemagglutination) method was selected. The sera were pooled as one pooled serum. Filtrations were performed after adjusting some biochemical constituents. To obtain lyophilized serum, the pooled serum was subjected to freeze-dry process. It was divided into aliquot of 5.0 ml in each vial, then quick freezed and dried in the lyophilizer. Precision of between-vial filling volume was studied. We found that the coefficient if variation was 0.01%. Reconstitution of the lyophilized serum before use was performed by adding 5.0 ml of distilled water to each vial. The coefficient variation of between-vial biochemical constituents was found to be less than 0.5%. The precision of 19 routine biochemical tests in these Home-Made lyophilized human serum were compared to those of 3 batches of well-known commercial control materials (ORTHO, MONITROL, VALIDATE). By F-test analysis, the coefficient variation of most biochemical tests in the Home-Made lyophilized human serum was not significant different from those of the commercial ones (P>0.05). The long-term consistency of the biochemical constituents was studied. In a duration of one year, from March 1985 to February 1986, three-month periods means and standard deviations were analyzed. The results showed no significant difference for these period of study (P>0.05). Since 1985, the Home-Made lyophilized serum has been used as internal control material in our Central Clinical Chemistry Laboratory, Faculty of Medicine Technology, Mahidol University in place of imported control serum. The external control evaluation was successfully reported by the International External Quality Control Assessment Scheme. (Birmingham UK) and the improvement of Overall Mean Running Variance Index Score (OMRVIS) is obviously seen in the graphic curve.

Laboratory screening programme for Thailand tobacco monopoly population.

One thousand and eight workers of Thailand Tobacco Monopoly, aged between 25-65 years were subjects to a check up by clinical chemistry laboratory examinations. It was found that workers aged between 41-50 years and 51-60 years made 26.8% and 41.1% respectively, and 38.9% had regular laboratory examination. Of those who had regular physical check up, 16% were for high blood pressure and 11.9% were for diabetes mellitus. Laboratory examinations of blood samples gave 2% positive HAA and abnormal levels of 4.6% for blood glucose, 3.7% for cholesterol, 2.8% for alkaline phosphatase, 2.3% for uric acid. 1.3% for transaminase (SGOT 2.1% and SGPT 1.3%), 0.2% for total protein and 0.1% for creatinine. Normal levels of blood constituents relating to liver and cardiac function for Thailand Tobacco Monopoly population by statistical calculation are consistently higher than those for the general population. Special attention should be given in regards to re-examintion of the workers 6-12 months after the first examination.