Standardization And Implementation of Lab Policies Ensure Hemostasis Sample Quality

How many of us remember the tilt-tube method for basic hemostasis testing? Fortunately, today’s instruments have automated most of these manual steps. However, until recently, assuring sample quality in the pre-analytical phase of testing had remained a manual process and had been difficult to implement and standardize.

Several questions must be considered when evaluating the integrity of a hemostasis sample: Is the sample tube under-filled? Is the sample hemolyzed, icteric, or lipemic? If so, do the levels of the interferent impact the testing results? Is there a clot in the sample?

All labs have policies on sample acceptance and rejection. Inappropriate rejection of acceptable samples—requiring redraw—directly impacts patient care, patient satisfaction, and cost. Failing to reject inappropriate samples can lead to the reporting of erroneous results, impacting the quality of patient care and associated cost. Let’s take a look at the most common pre-analytical quality issue culprits.

Read more: Standardization And Implementation of Lab Policies Ensure Hemostasis Sample Quality

Source: MedicalLaboratoryObserver

SAQs 3: Gilbert's Syndrome - A 24-year old man with no significant past medical history presents with an episode of mild jaundice.

A 24-year old man with no significant past medical history presents with an episode of mild jaundice. His liver function tests are normal apart from a bilirubin of 45 µmol/L. There is no bilirubinuria. His GP wonders whether this could be due to hemolysis, but you wish to explore an alternative diagnosis of Gilbert's Syndrome.

Answer these questions:

(a) Is this patient likely to have conjugated or unconjugated hyperbilirubinaemia?

(b) State two routinely available biochemistry tests that are of use in the exclusion of hemolysis.

(c) What might be seen on blood microscopy indicating increased erythrocyte turnover secondary to hemolysis?

(d) State two factors that exacerbate the mild hyperbilirubinemia of Gilbert's syndrome.

(e) Describe the genetic cause of Gilbert's syndrome.

(f) Discuss the diagnostic performance of genetic testing for Gilbert's syndrome.

Source: rcpath/biochemistry

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Blood Test Advances Diagnosis Of HELLP Syndrome

A laboratory blood test for the diagnosis of a rare genetic red blood cell disorder also shows promise in identifying HELLP syndrome, a life-threatening high blood pressure condition affecting 1% of all pregnant women.

HELLP is an acronym for hemolysis, elevated liver enzymes and low platelets and is a severe variant of pre-eclampsia whose pathogenesis remains unclear. Recent evidence and clinical similarities suggest a link to atypical hemolytic uremic syndrome, a disease of excessive activation of the alternative complement.

Read more: Blood Test Advances Diagnosis Of HELLP Syndrome

A model of the principle underlying the modified Ham test

Source: labmedica