Laboratory Request Research Articles

B-125 Laboratory Profiles for Diagnostic Workup of Acute Abdominal Pain in the Emergency Department: A Comparative Study of University and Non-University Acute Care Hospitals in Germany and Switzerland

Abstract Background Laboratory medicine plays a fundamental role in patient care, especially in emergency departments where rapid diagnosis is critical to the efficient management of high patient volumes. With the aim of simplifying and standardizing laboratory requests, laboratory profiles have widely been established. This study uses the laboratory profile for “acute abdominal pain” as an example to illustrate the extent to which the laboratory profiles used in hospitals differ from each other and whether they are in line with current scientific recommendations. Methods Hospital data and laboratory profiles for “acute abdominal pain” from 18 hospitals, 9 from Germany and 9 from Switzerland, were analyzed and compared. The hospitals were distinguished by bed size, inpatient and outpatient case numbers, country affiliation and university level. In addition, an 'evidence-based laboratory profile' for acute abdominal pain was created based on current guidelines for the five most important causes of acute abdominal pain and compared with hospital laboratory profiles. Results German hospitals include significantly more laboratory parameters into acute abdominal pain profiles than Swiss hospitals (p = 0,0052). No significant differences in the number of laboratory parameters were found between university and non-university hospitals (p = 0,0507). There is a significant positive correlation between the hospital bed size and the number of laboratory parameters in the profiles (r = 0,5521). The number of inpatient cases in a hospital are also positively correlated with the number of laboratory parameters in the profiles (r = 0,4751). The number of outpatient cases ist not associated with the number of laboratory in the profiles parameters (r = 0,0599). The evidence-based laboratory profile for acute abdominal pain includes 21 laboratory parameters, but only two of them are collected by all investigated hospitals (bilirubin and ALAT).There were no significant differences in the fulfillment of the evidence-based laboratory profile between Germany and Switzerland, or between university or non-university status. Conclusions The study shows that there are quantitative and qualitative differences between the laboratory profiles for investigation of acute abdominal pain within the participating hospitals. In Germany and Switzerland there is no consensus on which analyses to include into a profile investigating acute abdominal pain. For increasing efficiency and accuracy of laboratory testing in in the diagnostic workup of acute abdominal pain it seems advisable to obtain consensus on what to reasonably include into a profile on a national or international level.

A 26 years old primigravida woman presented with abdominal cutaneous entrapment syndrome: a case report

BackgroundAbdominal cutaneous nerve entrapment syndrome (ACNES) is characterized by severe, mostly refractory, chronic pain due to the entrapment of the cutaneous branches of the lower torso intercostal nerves at the lateral edge of the rectus abdominis muscle. ACNES is rare compared to other pregnancy-related peripheral neuropathies and is often overlooked as a differential diagnosis for abdominal pain, despite the diagnosis relying primarily on patient history and physical examination. Emergency physicians and other medical personnel’s lack of exposure to such cases results in unnecessary laboratory requests, repeated visits, and increased fear and tension for the patient.Case presentationA 26-year-old primigravida on her second trimester of pregnancy presented to our Emergency department with persistent localized right upper quadrant abdominal pain. Despite repeated visit to the nearby hospital, no diagnosis was settled and the pain persisted. At our ED after a thorough history, physical examination and diagnostic test no abnormality was found. Finally Abdominal cutaneous nerve entrapment syndrome (ACNES) was considered and a mixture of 1 ml 2% lidocaine with adrenaline and 1 ml dexamethasone (4 mg) was infiltrated into the fascial plane in a fanning fashion into the most tender area using a modified technique and the patient reported significant improvement in pain.ConclusionAbdominal cutaneous nerve entrapment syndrome (ACNES) is a cause of abdominal pain in pregnancy that is often overlooked. The objective of this study is to describe a rare case of ACNES in a 26-year-old primigravida woman who presented to a low-resource emergency department to assist patient management.

Implementation of HER2 Testing in Endometrial Cancer, a Summary of Real-World Initial Experience in a Large Tertiary Cancer Center.

HER2-targeted therapies have transformed the management of advanced or recurrent serous endometrial cancer (EC), leading to an increased clinical demand for HER2 testing. Despite its adoption in select academic centers, the global extent of such tumor testing is unclear. In this study, we report on the initial two-year experience of HER2 testing at a major academic center with a reference gynecologic oncology service and biomarker reference laboratory. All patients who underwent HER2 testing based on physician discretion, reflex HER2 testing, and reference laboratory requests were included. From February 2021 to October 2023, HER2 testing was performed on 192 tumor tissue samples from 180 EC patients. Serous carcinoma constituted 52% of samples, reflecting diagnostic challenges and limited therapeutic options for advanced EC. HER2 positivity was found in 28% of all cases and 30% of p53-aberrant cases. An immunohistochemistry (IHC) score of 3+ was found in 15% of samples, while IHC 2+ was found in 45% (13% IHC 2+/ISH+ and 32% IHC 2+/ISH-). The newly identified 'HER2-low' category comprised 46% of the samples. Heterogeneity was noted in 42% of HER2-positive cases, with complex patterns in 3%. NGS and HER2 IHC-FISH showed a 24% discordance, attributed to intratumoral heterogeneity, tumor cellularity, a small number of amplified cells, and the HER2/CEP17 ratio near the cut-off. This study offers real-world insights into HER2 testing in EC, highlighting the challenges and underscoring the need for standardized guidelines in specimen handling, proficiency testing, and scoring criteria to enhance patient management and therapeutic decision-making.

Evaluating data accuracy in clinical laboratory requests: A therapeutic drug monitoring study

Evaluating data accuracy in clinical laboratory requests: A therapeutic drug monitoring study

Assessment of Filling of Relevant Information on the Laboratory Request Forms

Assessment of Filling of Relevant Information on the Laboratory Request Forms

Applying Machine Learning to Blood Count Data Predicts Sepsis with ICU Admission.

Timely diagnosis is crucial for sepsis treatment. Current machine learning (ML) models suffer from high complexity and limited applicability. We therefore created an ML model using only complete blood count (CBC) diagnostics. We collected non-intensive care unit (non-ICU) data from a German tertiary care centre (January 2014 to December 2021). Using patient age, sex, and CBC parameters (haemoglobin, platelets, mean corpuscular volume, white and red blood cells), we trained a boosted random forest, which predicts sepsis with ICU admission. Two external validations were conducted using data from another German tertiary care centre and the Medical Information Mart for Intensive Care IV database (MIMIC-IV). Using the subset of laboratory orders also including procalcitonin (PCT), an analogous model was trained with PCT as an additional feature. After exclusion, 1 381 358 laboratory requests (2016 from sepsis cases) were available. The CBC model shows an area under the receiver operating characteristic (AUROC) of 0.872 (95% CI, 0.857-0.887). External validations show AUROCs of 0.805 (95% CI, 0.787-0.824) for University Medicine Greifswald and 0.845 (95% CI, 0.837-0.852) for MIMIC-IV. The model including PCT revealed a significantly higher AUROC (0.857; 95% CI, 0.836-0.877) than PCT alone (0.790; 95% CI, 0.759-0.821; P < 0.001). Our results demonstrate that routine CBC results could significantly improve diagnosis of sepsis when combined with ML. The CBC model can facilitate early sepsis prediction in non-ICU patients with high robustness in external validations. Its implementation in clinical decision support systems has strong potential to provide an essential time advantage and increase patient safety.

Knowledge and approach towards Helicobacter pylori diagnosis and management among primary care physicians in Cameroon: a cross-sectional study.

Low- and middle-income countries have a high prevalence of Helicobacter pylori infection (HPI). In Cameroon, the majority of HPIs are diagnosed and treated by primary care physicians (PCPs). We sought to assess the knowledge and practices of PCPs in the diagnosis and management of HPI in Cameroon. A hospital-based cross-sectional study was carried out in four randomly selected regions of Cameroon from November 2021 to June 2022. In each of the selected regions, PCPs were recruited by non-probability convenience sampling and interviewed using a pre-structured questionnaire. Chi-squared, Fisher's exact and Student's t-tests were performed for descriptive analyses. Multivariable logistic regression was used to examine associations between knowledge and practice, with the model adjusted by age of the PCP, geographic region, number of patients and years in practice. Analysis was performed in SAS version 9.4 (SAS Institute, Cary, NC, USA). A total of 382 PCPs were included in the analysis. The majority (60.0%) were males between the ages of 20-29y (64.1%). Most PCPs (80.9%) reported that HPI is the cause of gastroesophageal reflux disease and 41.8% reported that HPI is the main cause of dyspeptic symptoms. The dominant diagnostic tests used for HPI were serology (52.8%) and stool antigen (30.9%). The most frequently used first-line therapies were amoxicillin (AMX), clarithromycin (CLA), metronidazole (MNZ) and proton pump inhibitor (PPI) concomitant therapy (32.2%), AMX-CLA-PPI triple therapy (18.6%) and AMX-MNZ-PPI triple therapy (13.1%). Half of the practitioners (48.6%) treat HPI empirically, without positive H. pylori testing. About half of the PCPs (48%) do not request laboratory confirmation of H. pylori eradication following treatment. There is inadequate knowledge and significant differences in the clinical approach towards HPI among PCPs in Cameroon. We recommend more teaching programs and continuous medical education on HPI.

Sample Management Errors in a Multispecialty Hospital-based Blood Bank

ABSTRACT Background and Objectives: Specimen labeling errors along with incorrect patient identification have been described as among the most complex and demanding occurrences in laboratory diagnostics. The study aimed to describe the rates of sample identification and labeling errors in the blood center of a multispecialty hospital and identify possible measures to reduce them. Methods: A retrospective document review and analysis of sample identification and labeling errors were conducted in a Blood Bank Laboratory in Saudi Arabia for 4 years. The quality assurance database from the laboratory information system was used to access and review all relevant information. The one-way analysis of variance was employed to check the statistical differences between the laboratory errors and other variables in the study. The significance level was set at P &lt; 0.05. Results: Overall, 74,279 samples and laboratory requests were received, with over 3107 canceled requests and rejected samples. An error rate of 0.43% was due to incorrect identification and labeling. This accounts for 10.2% of the total canceled tests. The annual labeling error ranges from 0.26% to 0.73%. Primarily, the errors were due to incomplete data (0.37%) and were noted as the leading type of error in all the departments. More than half (51.3%) of the errors happened in type and screen tests, whereas a significant proportion was also noted in crossmatch red blood cells (31.9%). Conclusions: The rate of sample identification and labeling errors in this study was comparable to established data and was primarily due to incomplete data or labels. Identification and labeling errors are most common in type and screen testing and crossmatch. Carefully monitoring specimen labeling quality continually can lower specimen labeling errors and determine improvements.

Analysis of Trends in Dengue Infection among Patients Attending a Tertiary Care Teaching Hospital: A Retrospective Observational Study

Introduction: Dengue, a common mosquito-borne arboviral infection in tropical countries, presents cyclical epidemics and seasonal variations with diverse clinical outcomes. Over the past three decades, it has become endemic in India, leading to a rising mortality trend, primarily due to its severity and antibody-dependent enhancement in secondary dengue cases. Therefore, understanding the trend of dengue infection in specific geographical areas is crucial for more efficient prophylaxis. Aim: To provide a comprehensive overview of the seroprevalence of dengue virus infection in Surat district, including the trends in gender, age distribution, and seasonal variations of dengue infection from 2014 to 2021. Materials and Methods: The present retrospective observational analysis was conducted in the Department of Microbiology, Government Medical College (tertiary care teaching New Civil Hospital), Surat, Gujarat, India. A total of 31,683 blood samples were received from patients with clinical suspicion of dengue-like illness from January 2014 to December 2021. Data collection took place from March 2022 to May 2022, and the analysis was conducted in June and July 2022. All samples underwent dengue infection detection using the Enzyme-linked Immunosorbent Assay (ELISA) method by Non structural 1 (NS1) antigen detection and Immunoglobulin M (IgM) antibody detection by Mac capture ELISA. Demographic and clinical details were obtained and recorded from laboratory request forms using a structured data sheet in using Microsoft Excel software version 2013. The data were entered and analysed using EpiInfo software version 3.5.1. Results: Among the 31,683 blood samples tested, 5,994 (18.91%) cases were confirmed for dengue infection through ELISA testing. The highest number of positive cases (33.6%) was observed in the 20-29 years age group, with males outnumbering females in terms of dengue positivity at a ratio of 1.37:1. The maximum number of dengue cases occurred during the postmonsoon and early winter periods, with 96.5% of cases reported from Surat district, India. Conclusion: The rising trend of dengue infection in different age groups over the years underscores the need for continued implementation of surveillance and preventive strategies before the monsoon, aiming to reduce severe dengue infections in the future.

Impact of the COVID-19 Pandemic on Laboratory Services

The positive impact of the coronavirus disease 2019 (COVID-19) pandemic is that hospital laboratory services are excellent when other services are declining. Aside from molecular biology laboratory (polymerase chain reaction, PCR) services for COVID-19 diagnostics, public demand has dramatically increased. It is a retrospective descriptive study that uses data on the total number and types of results of laboratory examination orders that have been verified from the laboratory information system of a hospital from 2018 to 2022. Data analysis is presented in the frequency of the number and type of results of laboratory examination orders and differences in requests for laboratory services before and during the pandemic since the government established it on March 8, 2020. The total number of laboratory requests between January 2018 and December 2022 was 1,943,539 services. The highest increase in laboratory examination services was in molecular biology (98.4%). As the need for community services increases for the PCR severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) examination, which is used in addition to diagnosing confirmed COVID-19 patients, it is also necessary for the community to conduct tracing if a family member has a COVID infection or travel requirements and follow-up for hospital employee exit tests who contracted COVID-19. In conclusion, the COVID-19 pandemic has positively impacted laboratory performance. There have been changes and an increase in the number and types of laboratory examination services and personal performance and management in laboratories.

Infusion reactions to adeno-associated virus (AAV)-based gene therapy: Mechanisms, diagnostics, treatment and review of the literature.

The use of adeno-associated virus (AAV)vectors in gene therapy has demonstrated great potential in treating genetic disorders. However, infusion-associated reactions (IARs)pose a significant challenge to the safety and efficacy of AAV-based gene therapy. This review provides a comprehensive summary of the current understanding of IARs to AAV therapy, including their underlying mechanisms, clinical presentation, and treatment options. Toll-like receptor activation and subsequent production of pro-inflammatory cytokines are associated with IARs, stimulating neutralizing antibodies (Nabs) and T-cell responses that interfere with gene therapy. Risk factors for IARs include high titers of pre-existing Nabs, previous exposure to AAV, and specific comorbidities. Clinical presentation ranges from mild flu-like symptoms to severe anaphylaxis and can occur during or after AAV administration. There are no established guidelines for pre- and postadministration tests for AAV therapies, and routine laboratory requests are not standardized. Treatment options include corticosteroids, plasmapheresis, and supportive medications such as antihistamines and acetaminophen, but there is no consensus on the route of administration, dosage, and duration. This review highlights the inadequacy of current treatment regimens for IARs and the need for further research to improve the safety and efficacy of AAV-based gene therapy.

Evaluation of the application of sequence data to the identification of outbreaks of disease using anomaly detection methods

Anomaly detection methods have a great potential to assist the detection of diseases in animal production systems. We used sequence data of Porcine Reproductive and Respiratory Syndrome (PRRS) to define the emergence of new strains at the farm level. We evaluated the performance of 24 anomaly detection methods based on machine learning, regression, time series techniques and control charts to identify outbreaks in time series of new strains and compared the best methods using different time series: PCR positives, PCR requests and laboratory requests. We introduced synthetic outbreaks of different size and calculated the probability of detection of outbreaks (POD), sensitivity (Se), probability of detection of outbreaks in the first week of appearance (POD1w) and background alarm rate (BAR). The use of time series of new strains from sequence data outperformed the other types of data but POD, Se, POD1w were only high when outbreaks were large. The methods based on Long Short-Term Memory (LSTM) and Bayesian approaches presented the best performance. Using anomaly detection methods with sequence data may help to identify the emergency of cases in multiple farms, but more work is required to improve the detection with time series of high variability. Our results suggest a promising application of sequence data for early detection of diseases at a production system level. This may provide a simple way to extract additional value from routine laboratory analysis. Next steps should include validation of this approach in different settings and with different diseases.

Factors Associated with Presence of Human Papillomavirus Infection among Women: Findings from New Cervical Cancer Screening in Kelantan, Malaysia

Introduction: Human papillomavirus (HPV) infection is known to cause cervical cancer worldwide. Recently, Malaysia introduced HPV DNA detection testing for cervical cancer screening program. However, knowledge regarding factors for HPV infection among women still limited. Thus, this study aimed to determine the prevalence and factors associated with HPV infection among women in Kelantan, a north-eastern state of Malaysia. Methods: This study used secondary data extracted from HPV DNA test registry book and HPV DNA laboratory request forms. Data on all Malaysian women aged 30 to 49 years old in 2019 reported in registry book were included. Simple random sampling was applied. All information from book and forms were collected using proforma and analysed using SPSS. The outcomes were categorised into HPV infection and non-HPV infection. The parameters related to factors associated with HPV infection were determined using multivariable logistic analysis. Results: The prevalence of HPV infection among women attending the new cervical screening was 8.4% (95% CI 6.4%, 10.3%). Those aged between 30 and 39 years old (AdjOR 2.09; 95% CI 1.16, 3.78, p=0.014), had 5 or more parities (AdjOR 2.82; 95% CI 1.58, 5.06, p&lt;0.001) and hormonal contraception users (AdjOR 7.48; 95% CI 4.07, 13.76, p&lt;0.001) were significantly associated with HPV infection. Conclusion: Overall, the prevalence of HPV infection from this study is comparable to the local and international studies. Age, number of parities and hormonal contraception users influence the HPV infection. This finding could help in designing more targeted screening for cervical cancer.

Functional vitamin B12 deficiency: Improving methylmalonic acid reference intervals in urine

Background-AimMost laboratory requests focus on the detection of possible vitamin B12 deficiency. In this context, methylmalonic acid (MMA) is reported as the best biomarker.The aim of our study was to establish the biological reference interval for MMA in urine, and assess the influence of age, sex, and vitamin B12 status on MMA concentrations. MethodsThis is a prospective observational study considering individuals with normal results for blood count and liver and kidney function. Individuals who presented supplementation, any pathology or treatment that could cause cobalamin metabolism disorders, and pregnant women were excluded. Likewise, individuals whose vitamin B12 result presented antibody-mediated interference were excluded.Individuals were grouped by age-group and sex. Reference intervals were determined by non-parametric calculation (percentiles 1–99). ResultsIt was established a single reference interval [0.52 (CI90%: 0.50–0.54) – 5.75 (CI90%: 5.57–6.17) mmolMMA/mol creatinine], with 100 % of individuals with MMA above the upper limit of reference presenting a total vitamin B12 concentration ≤ 238 pmol/L. ConclusionThe establishment of optimal reference intervals for methylmalonic acid excretion in urine is crucial in individuals with a suspicion of functional vitamin B12 deficiency. However, the possibility of establishing a cut-off value for total vitamin B12 suggesting subclinical deficiency remains a challenge for this magnitude.

Colorectal carcinoma in a tertiary hospital in North-western Nigeria: a histopathologic retrospective review

Colorectal Carcinoma (CRC) accounts for about 3.9% of all malignant lesions in human beings with several studies identifying it as the most common gastrointestinal malignancy. It was previously considered to be more common in developed nations of the world but recent studies have reported increasing trends in developing nations. The study was done on all cases of colorectal carcinomas diagnosed between 1st January 2001 and 31st December 2010 in the Department of Histopathology of a tertiary institution. The laboratory request forms and the duplicate copies of histology reports were retrieved for extraction of relevant clinical information like age, sex, anatomical sites of the lesions and clinical presentations. Histological diagnoses and grading were also extracted. Corresponding haematoxylin and eosin-stained slides were retrieved and evaluated. Special stains were carried out where necessary. The lesions were classified according to the World Health Organization (WHO) histological variants and tables and figures were used to illustrate the results. A total of 186 cases of colorectal carcinoma were diagnosed during the period, representing 3.9% of the total malignant tumors and 50.4% of the gastro-intestinal malignancies. One hundred and ten cases (59.1%) and 76 cases (40.9%) were in males and females respectively with a male:female ratio of 1.46:1. The age range was from 17-87 years with a mean of 42.8 years and peaked at 61-70 years. Site distribution showed rectosigmoid lesions accounted for 64.5%, caecum, ascending colon, transverse and descending colons accounted for 9.1%, 3.8% and 2.2% each respectively. Most of the cases were adenocarcinoma (71.0%), followed by mucinous carcinoma (23.7%) and signetring cell carcinoma (3.8%). Colorectal carcinoma is prevalent in our environment and is the commonest malignant gastro-intestinal tumors. There is a slight male preponderance with adenocarcinoma the commonest lesion and rectosigmoid as the most common site.

Increased fT4 concentrations in patients using levothyroxine without complete suppression of TSH.

In our hospital, physicians noticed high free thyroxine (fT4) concentrations without complete suppression of thyroid-stimulating hormone (TSH) in blood samples of patients at the outpatient clinic, which appeared to occur more often following the introduction of a new fT4 immunoassay. This discordance may be explained by incorrect reference intervals, analytical issues, or patient-related factors. We aimed to establish the contribution of the possible factors involved. Reference intervals of both fT4 immunoassays were re-evaluated using blood samples of healthy volunteers and the new immunoassay's performance was assessed using internal quality controls and external quality rounds. The frequency of discordant fT4 and TSH pairings obtained from laboratory requests were retrospectively analysed using a Delfia (n = 3174) and Cobas cohort (n = 3408). Last, a literature search assessed whether the time of blood draw and the time of levothyroxine (L-T4) ingestion may contribute to higher fT4 concentrations in L-T4 users. The original reference intervals of both fT4 immunoassays were confirmed and no evidence for analytical problems was found. The Delfia (n = 176, 5.5%) and Cobas cohorts (n = 295, 8.7%) showed comparable frequencies of discordance. Interestingly, 72-81% of the discordant results belonged to L-T4 users. Literature indicated the time of blood withdrawal of L-T4 users and, therefore, the time of L-T4 intake as possible explanations. High fT4 without suppressed TSH concentrations can mainly be explained by L-T4 intake. Physicians and laboratory specialists should be aware of this phenomenon to avoid questioning the assay's performance or unnecessarily adapting the L-T4 dose in patients.

A Laboratory Perspective on an Epidemiological Pattern of Infectious Gastroenteritis: A Five-year Surveillance between 2016 to 2020 from Established Private Healthcare Centers within Klang Valley in Malaysia

Infectious gastroenteritis is endemic globally and caused by bacteria, viruses and parasites. The study determined the epidemiological pattern of infectious gastroenteritis within selected urban areas in Malaysia. Analysis of 745 laboratory requests was conducted based on FilmArray gastrointestinal assay and socio-demographic details from suspected cases in KPJ hospitals in Klang Valley, Malaysia, between 2016 to 2020. Descriptive analysis and Fisher-Freeman-Halton Exact testing were performed to ascertain the relationship between socio-demographics with the type of infections. Of 745 requests, 288 (38.7%) were caused by one etiological agent (mono-infection), while the remaining 334 (44.8%) were due to more than one agent (co-infection). Mono-infection was significantly higher among adolescents (n=9; 47.4%) and young adults (n=37; 40.2%) in comparison to adults (n=18; 35.3%). Whereas co-infection was significantly higher in infants (n=216; 49.2%). Mono-infection was mainly caused by bacteria (n=194/288; 67.4%) with Salmonella spp. was prevalent (16.6%), followed by EPEC (12.5%), Campylobacter spp. (11.9%) and Norovirus (10.5%). The co-infections (n=334) were identified with a combination of EPEC and the following bacteria or viruses (Norovirus=38, Campylobacter spp.=30, Salmonella spp.=26, EAEC=22, Rotavirus=19, Adenovirus=10). The month of August to October was recognised as the peak season for infectious gastroenteritis. The present findings may indicate contamination of infectious agents to the food supply and food processing chain as well as reduced hygiene in food sanitation leading to foodborne health issues, particularly among the children in Klang Valley, Malaysia.

Magnitude of extra-analytical errors and associated factors in medical laboratories in thirteen Public Hospitals in Addis Ababa, Ethiopia.

Currently, more than two-thirds of medical decisions are made based on laboratory test results. However, due to the compromised pre-analytical and post-analytical phases (or extra-analytical phase), the reporting of incorrect or inappropriate test results was still prevalent. Studies focusing on the prevalence of and factors associated with laboratory error remain very limited in Ethiopia. This study aimed to assess the magnitude of extra-analytical errors and associated factors in medical laboratory services in 13 public hospitals in Addis Ababa, Ethiopia, from January to April 2020. A hospital-based cross-sectional study was conducted in the medical laboratories of public hospitals in Addis Ababa from January to April 2020 to assess extra-analytical errors and associated factors. Data were collected from 2401 laboratory request forms ordered within the study period and 169 laboratory professionals working in public hospitals. The collected data were entered and analyzed using SPSS version 23 software. Data were analyzed using simple descriptive statistics, percentages, and frequencies and summarized using tables and text. Bivariate logistic regression analysis was conducted, and variables (with a p value below 0.25) were included in the multivariate logistic regression model. A p value <0.05 was considered a cutoff point in the final model. In this study, of the errors detected, 60.3% occurred in the pre-analytical phase and 39.7% in the post-analytical phase. Extra-analytical errors in laboratory services were significantly associated with lack of written procedures for laboratory activities (adjusted odds ratio = 2.79, 95% confidence interval = 1.34-5.86), 1-2 years of work experience (adjusted odds ratio = 5.5, 95% confidence interval = 2.54-9.31), work experience (3-5 years) (adjusted odds ratio = 2.67, 95% confidence interval = 0.94-4.56), and education (diploma) (adjusted odds ratio = 6.30, 95% confidence interval = 2.17-12.26). This study discovered errors in the pre-analytical (60.3%) and post-analytical (39.7%) phases, and none of the requisition papers had complete data. This frequency may be affected by workload, a lack of written procedures, the number of years of work experience, and the level of education of the staff.

Calcium requests in a primary care; An observational audit of biochemical requests and frequency of abnormal results

Background/AimsThis aim of this audit was to assess the extent of serum calcium testing and the frequency of hypercalcaemia in the primary care setting. We also assessed the appropriateness of subsequent investigations with repeat serum calcium and PTH testing if hypercalcaemia was identified. MethodsAll laboratory requests for adjusted calcium and PTH samples sent from primary care in Glasgow were analysed over a 12 month period. This covered approximately 125 GP practices and a patient population of over 590,000. ResultsThere were 78,845 requests for adjusted calcium and 2053 PTH requests from 62,745 patients aged 16–105 years (median age 57, IQ range 30 years). Of these requests 1423 (2.3%) of patients had biochemical evidence of hypercalcaemia (adjusted calcium ≥ 2.61 mmol/L). Of the 1423 patients with hypercalcaemia, 368 patients (45.8%) had a single raised calcium level that was within the normal range on repeat testing. Of the 400 patients with persistent hypercalcaemia on 2 or more samples, 210 (52.5%) had a PTH measured. Eight patients had a PTH < 2.0 pmol/L, whilst 202 (96.1%) had a PTH ≥ 2.0 pmol/L (range 2.1–106.1 pmol/L). ConclusionsSerum calcium was checked in 10.6% of the population per year within primary care. In the 2.4% with a raised calcium on initial testing, approximately half (45.8%) will normalise on repeat testing. Of those who remained persistently hypercalcaemic, only half (52.5%) had a PTH measured and the majority (96.1%) were in keeping with primary hyperparathyroidism being the most common cause of hypercalcaemia.

Assessment of Lab request forms: How do our clinicians communicate with Laboratory?

Central clinical laboratory is an important division in the health care setup. Laboratory results help clinical decisions, follow up care and ensure patient safety. Laboratory request Form [LRF] is an important medium between the patient, a treating clinician and Laboratory. A meticulously filled LRF is important for patient care. Providing accurate and complete information in LRF is the doctor's responsibility. Erroneous LRF will have an impact on the quality of laboratory results. Present study evaluates the degree of completeness and correctness of quality indicators on laboratory request forms [LRF] to examine preanalytical standards of laboratory services.This study is a single center, prospective, cross sectional, descriptive type conducted at a 650 bed teaching hospital from Gujarat. In the span of a six months study period, 3735 [20% of total] LRFs were selected by simple random sampling method from the total LRF received at OPD blood collection center. They were analyzed for patient, clinician and sample identifier quality indicators along with completeness and correctness. Qualitative information was converted to quantitative by using two point scale, 0 score for incomplete information and 1 score for complete information.Among patient identifier quality indicators name, age, gender and location were filled in more than 75% forms whereas, very poorly filled 2% provisional diagnosis and 42% MRD number. Clinician identifier quality indicator was attended to in less than 50% forms. Time and date of request were absent on 100% forms. Sample identifier quality indicator shows 97% forms with the nature of the sample and 92% having investigation requests. Test requests on one third forms were invalid and inappropriate. 38% forms were incomplete and inappropriate whereas 46% forms had error in filling one or other data indicators.Appropriately filled LRF communicates well with the Central clinical laboratory. It will help in providing quality reports in time and benefit clinicians to manage quality care for patients. Hand written, poorly legible, inappropriately abbreviated, erroneous LRF are misleading and may compromise laboratory service and patient safety. Training and change in attitude towards LRF writing is required to maintain the standard of the health care system.