Accurate Results in the Clinical Laboratory

Foreword

Preface

List of Contributors

Chapter 1. Variation, Errors, and Quality in the Clinical Laboratory

Introduction

Errors in the Clinical Laboratory

Quality Improvement in the Clinical Laboratory

Conclusions

References

Chapter 2. Effect of Age, Gender, Diet, Exercise, and Ethnicity on Laboratory Test Results

Introduction

Effects of Age-Related Changes on Clinical Laboratory Test Results

Effects of Gender-Related Changes on Clinical Laboratory Test Results

Effects of Diet on Clinical Laboratory Test Results

Effects of Nutraceuticals on Clinical Laboratory Test Results

Effects of Exercise on Clinical Laboratory Test Results

Effects of Ethnicity/Race on ClinicaL Laboratory Test Results

Conclusions

References

Chapter 3. Effect of Patient Preparation, Specimen Collection, Anticoagulants, and Preservatives on Laboratory Test Results

Introduction

Biological Rhythms and Laboratory Test Results

Issues of Patient Preparation

Differences Between Whole Blood, Plasma, and Serum Specimens for Clinical Laboratory Analysis

Different Anticoagulants and Preservatives, Order of Draw, Problems with Gel Interference in Serum Separator Tubes, and Short Draws

Order of Draw of Various Blood Collection Tubes

Collection Sites; Differences Between Arterial, Capillary, and Venous Blood Samples; and Problems with Collections from Catheters and Intravenous Lines

Urine Collection, Timing, and Techniques

Conclusions

References

Chapter 4. Sample Processing and Specimen Misidentification Issues

Introduction

Transportation

The Effects of Centrifugation on Laboratory Results

Effect of Storage Conditions on Laboratory Results

Effect of Cross-Contamination of Specimens on Laboratory Results

Consequences of Specimen Misidentification on Laboratory Testing

Conclusions

References

Chapter 5. Hemolysis, Lipemia, and High Bilirubin: Effect on Laboratory Tests

Introduction

Effect of Hemolysis on Laboratory Tests

Lipemia

Icterus

Methods for Evaluating the Effect of Endogenous Interfering Substances on Laboratory Tests

Conclusions

References

Chapter 6. Immunoassay Design and Mechanisms of Interferences

Introduction

Immunoassay Methods and Assay Principles

Specimen Types Used in Immunoassays

Examples of Immunoassays

Pitfalls in Immunoassays

How to Detect and Correct Heterophilic Antibody Interferences

Conclusions

References

Chapter 7. Effect of Herbal Remedies on Clinical Laboratory Tests

Introduction

Elevated Liver Function Test Due to Use of Herbal Supplements

Herbal Supplements Causing Kidney Damage

Herbal Remedies and Hypoglycemia

Licorice and Hypokalemia

Kelp and Abnormal Thyroid Function Tests

Drug–Herb Interaction and Unexpected Drug Levels in Routine Drug Monitoring

Adulteration of Herbal Supplements with Western Drugs

Conclusions

References

Chapter 8. Challenges in Routine Clinical Chemistry Testing: Analysis of Small Molecules

Introduction

Creatinine Analysis

Urea Analysis

Ammonia Assay

Uric Acid Analysis

Glucose Analysis

Analysis of Electrolytes

Blood Gases Analysis

Lactate Analysis

Bilirubin Analysis

Lipid Profiles Analysis

Conclusions

References

Chapter 9. Challenges in Routine Clinical Chemistry Analysis: Proteins and Enzymes

Introduction

Albumin and Total Protein

Alanine and Aspartate Aminotransferases Analysis

γ-Glutamyl Transferase and Alkaline Phosphatase Analysis

Amylase and Lipase Analysis

Lactate Dehydrogenase Analysis

Creatine Kinase Analysis

Cardiac Troponin Analysis

B-Type Natriuretic Peptide Analysis

Conclusions

References

Chapter 10. Sources of Inaccuracy in Biochemical Genetics Testing

Introduction

Analysis of Amino ACIDS

Analysis of Organic ACIDS

Analysis of Acylcarnitines

Conclusions

References

Chapter 11. Challenges in Endocrinology Testing

Introduction

Challenges in Testing of Hormones Secreted by Pituitary

Challenges in Measuring Human Chorionic Gonadotropin

Challenges in Thyroid Tumor Marker Tests

Adrenal Function Tests

Testing of Parathyroid Function

Gonadal and Reproductive Interferences

Prostate

Testing for Insulin-Like Growth Factor 1

Measurement of Other Hormones Including Insulin

Prenatal Testing

Conclusions

References

Chapter 12. Pitfalls in Tumor Markers Testing

Introduction

Clinical Uses of Tumor Markers

Prostate-Specific Antigen

CA-125

α-Fetal Protein

Carcinoembryonic Antigen

CA-19-9

β2-Microglobulin

Human Chorionic Gonadotropin

Interference from Heterophilic Antibodies in Laboratory Testing of Tumor Markers

Analysis of Less Frequently Assayed Tumor Markers

Conclusion

References

Chapter 13. Issues of Interferences in Therapeutic Drug Monitoring

Introduction

Sources of Pre-Analytical Interferences in TDM

Sources of Analytical Interferences in TDM

Mechanisms of Analytical Interferences in TDM

Chromatography and Mass Spectrometry

Examples of Interferences that Affect TDM

Conclusions

References

Chapter 14. Limitations of Drugs of Abuse Testing

Introduction

Drugs of Abuse Testing: Medical Versus Legal

Drugs Tested in Drugs of Abuse Testing Protocols

Drug Testing Methodologies

Challenges in Testing for Amphetamines

Challenges in Testing of Cocaine Metabolite

Challenges in Testing for Opiates

Challenges in Testing for Marijuana Metabolites

Challenges in Testing for Phencyclidine

Challenges in Testing for Benzodiazepines

Challenges in Determining Other Drugs by Immunoassays

Adulterants and Drugs of Abuse Testing

Other Drugs not Detected by Routine Toxicology Screens

Conclusions

References

Chapter 15. Challenges in Confirmation Testing for Drugs of Abuse

Introduction: Factors to Consider when Interpreting Drug Testing Results

Confirmation Testing Process

Confirmation of Amphetamines

Confirmation of Cocaine Metabolite Benzoylecgonine

Confirmation of Opiates

Confirmation of Marijuana Metabolite

Confirmation of Phencyclidine

Confirmation of Benzodiazepines

Confirmation of Barbiturates

Specimen Validity Testing

Conclusions

References

Chapter 16. Alcohol Determination Using Automated Analyzers: Limitations and Pitfalls

Introduction

Development of Laboratory Methods for Ethanol Measurement

Current Automated Methodologies

Performance of Automated Ethanol Assays

Problems with Current Methodologies

Strategies for Removing Interferences

Further Case Studies

Future Directions

Conclusions

References

Chapter 17. Pre-Analytical Issues and Interferences in Transfusion Medicine Tests

Introduction

Basics of Immunohematology

Methodology Used for Immunohematology Tests

Pre-Transfusion Evaluation

Interferences in Basic Transfusion Medicine Tests

Case Studies

Conclusions

References

Chapter 18. Issues with Immunology and Serology Testing

Introduction

Challenges in Hemoglobinopathy Detection

Detection of Monoclonal Proteins

Challenges in HIV Testing

Hepatitis Testing

Anti-Nuclear Antibodies

Conclusions

References

Chapter 19. Sources of Errors in Hematology and Coagulation Testing

Introduction

Errors in Hemoglobin Measurement and RBC Count

Errors in MCV and Related Measurements

Errors in WBC Counts and WBC Differential Counts

Errors in Platelet Count

Errors in Specific Hematology Testing

Coagulation Testing

Errors in PT and aPTT Measurements

Errors in Thrombin Time Measurement

Platelet Aggregation Testing with Lipemic, Hemolyzed, or Thrombocytopenic Samples

Challenges in Anticoagulants and Lupus Anticoagulant Tests

Case Studies

Conclusions

References

Chapter 20. Challenges in Clinical Microbiology Testing

Introduction

Issues with Pre-Analytical Errors

Analytical Errors in the Microbiology Laboratory

Post-Analytical or Reporting Errors

Error Prevention, Detection, and Monitoring

Conclusions

References

Chapter 21. Sources of Errors in Molecular Testing

Introduction

Principles of Commonly Used Methods for Molecular Diagnostics

Principles of Nucleic Acid Isolation

Pre-Analytical Considerations in Molecular Testing

Interferences in Molecular Diagnostics: False-Negative Results in Molecular Assays

Interferences in Molecular Testing: False-Positive Test Results in Molecular Assays

Sources of Errors in DNA Microarray Testing

Quality Management

Conclusions

References

Chapter 22. Problems in Pharmacogenomics Testing

Introduction

Method Descriptions

Applications of Pharmacogenetics Testings

Case Studies

Conclusions

References

Index