((Requistion & Interpretation))

Bushehr University Of Medical Sciences Dept. OF Pathology & Lab. Medicine

S Screening & Case Finding D Diagnosis of Diseases T Therapeutic Monitoring

Preanalytical stage Preanalytical stage Analytical Stage Analytical Stage Post analyticcal stage Post analyticcal stage

What is your clinical Impresion and D.D? What is your clinical Impresion and D.D? What is the role of lab data in patient management? What is the role of lab data in patient management? How is your Lab. Facilities? How is your Lab. Facilities? What is the test of choice? What is the test of choice?  The most effective  The most avaliable  The least cost  The least invasion cont.

Patient demographics Patient demographics Hospital number Hospital number Brief history Brief history date of refering date of refering List of requested Tests List of requested Tests Physition name & Signature Physition name & Signature

Diurnal variations - smoking Diurnal variations - smoking - Excersize - Drugs - Excersize - Drugs - Fasting & Eating - Fasting & Eating - Diet - Ethanol - Diet - Ethanol

Cortisol Cortisol IRON IRON P.M.N Count P.M.N Count

Excersize CPK AST LDH Testostron Androstandione LH FFA Alanin 180% Lactate 300% CPK, AST, LDH Coagulation, Plat Transient effects Longterm effects

Bilirubin Bilirubin Glucose Glucose TG TG FFA FFA Cholestrol Cholestrol

K K T TG A ALP C C.M

High protein diet urea, UA, Amonia High protein diet urea, UA, Amonia U/S Fat. Diet Cholestrol U/S Fat. Diet Cholestrol Banana, Tomato, … Serotonin Banana, Tomato, … Serotonin Beverage (Caffeine)FFA, Catchalamines Beverage (Caffeine)FFA, Catchalamines

Lactate Lactate Urate Urate TG TG HDL HDL GGT GGT MCV MCV

Cortisol Catecholamines FFA Hbco Hb Rbc count MCV Leukocytosis (EOS) Biochemistry Hematology

- Liver function - Renal function - ………… - Preservatives - Anticoagulants - …………… Physiologic effects Invitro effects

What is the specimen of choice? What is the specimen of choice? What is the best method for SP. Collection? What is the best method for SP. Collection?

Posture & Position : Alb, Prot, ca, Enzymes, TG, Ch.,,,,, Posture & Position : Alb, Prot, ca, Enzymes, TG, Ch.,,,,, Tourniquet : Ca, Lactate, Protein, Enzymes Tourniquet : Ca, Lactate, Protein, Enzymes Stress & Anxiety : Hormones, Wbc, Lactate, FFA Stress & Anxiety : Hormones, Wbc, Lactate, FFA

Anticoagulants Anticoagulants Protection from heat & cold Protection from heat & cold Inhibition of contamination Inhibition of contamination Transportation to Ref. Lab Transportation to Ref. Lab

Obtaining the best specimen Obtaining the best specimen Separation, centrifugation Separation, centrifugation Mixing, Rotation, Shaking Mixing, Rotation, Shaking Warming & Boiling Warming & Boiling Measuring Measuring Cont … Cont …

Nature of specimen Nature of specimen Level of Lab. Managing Level of Lab. Managing Accessing Materials & Reagents Accessing Materials & Reagents Instrumentation Instrumentation Pit falls & error resources and economic benefits

(Automated & Non automated) (Automated & Non automated) Materials and Methods Materials and Methods Techical personals Techical personals

Quality management Quality management Reporting Reporting - Rapid (tat) - Accurate & precise - Prompt Lab. Information system (LIS) Lab. Information system (LIS)

Pre analytical stage Pre analytical stage Analytical stage Analytical stage Post analytical stage Post analytical stage QA monitors quality performance from ordering to interpretation and application of results in patient care.

Assay of Control Sample Assay of Control Sample Instrument Maintenance Instrument Maintenance Statistical data analysis Statistical data analysis Proficiency testing survey Proficiency testing survey

Pre analytical Analytical Post analytical 80% 15% 5%

Clinical Impression Clinical Impression Sensitivity & specificity of Test Sensitivity & specificity of Test Limitation of Test Limitation of Test Reproducibility of Test Reproducibility of Test Lab. Quality assurance Lab. Quality assurance