Abstract

Aim To improve the quality and reliability of synovial fluid (SF) examination for crystals in routine clinical practice. For the patient with possible crystal-induced arthritis, the assessment of their SF is the key investigation which allows establishment of a definitive diagnosis. An incorrect SF analysis report (particularly a false positive report of urate) could result in lifelong inappropriate drug therapy. Methods Under the auspices of the Royal College of Pathologists of Australasia Quality Assurance Programs (RCPA QAP), a SF QAP has been operating for 12 years (ongoing), mainly throughout Australia and New Zealand but also to Singapore and Malaysia. SFs donated by patients are stored at –80oC. After thawing, plastic capillary tips containing 25 mL SF are distributed twice per year. Each survey contains three different SFs and all laboratories receive the same SFs, allowing valid comparison between laboratories. In addition, a DVD/CD of a microscopic examination of up to five SFs is distributed each year, followed by the same DVD/CD with commentary highlighting appropriate methods and potential pitfalls. Conclusion Quality assurance of SF examination, using real flu-ids donated by patients, is feasible across a large region and has resulted in an improvement in test results which hopefully reflects greater accuracy in assessment of routine clinical specimens.

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