Date:12/05/2006 URL: http://www.thehindu.com/2006/05/12/stories/2006051217810400.htm

Tamil Nadu - Chennai

Lab standards under the scanner

M. Dinesh Varma

65 % of errors in reports occur in pre-analytical stage

Simple measures such as getting patients to turn up on fasting regimen for lipid tests or to turn over an early morning urine sample are important to get the accurate values

Starting point for an accurate lab report is the need for doctors to write requests in a legible hand

CHENNAI: Chennai's laboratory professionals are thinking of ways to cut down on errors in laboratory reports as part of the move towards Good Laboratory Practices (GLP).

A cross-section of laboratory professionals, including pathologists, microbiologists and lab technologists, who discussed quality control measures at a recent workshop at Madras Medical Mission feel that the crucial first step towards achieving this is to tighten the pre-analytical procedures, where most errors are bound to occur.

"Almost 65 per cent of errors in laboratory reports occur in the pre-analytical stage, starting with the identification of the patient, patient preparation and securing the sample specimen," said C. N. Srinivas, Head-Clinical Lab Services, Madras Medical Mission.

It is estimated that 15-20 per cent of laboratory report errors occur in the post-analytical phase and the rest in the analytical stage.

According to Dr. Srinivas, any mistake in the initial procedures prior to collection of a test sample reflects as an altered value in the laboratory report, which, in turn, could lead the treating physician on the wrong path.

Simple measures

Simple measures such as getting patients to turn up on fasting regimen for lipid tests or to turn over an early morning urine sample-which is ideal for investigations-are important to get the accurate values, he pointed out.

"In fact, the starting point for an accurate lab report is the need for doctors to write requests in a legible hand," he said.

According to laboratory professionals, drawing a blood sample from a patient on IV fluids, if not properly done, can furnish a wild blood sugar value.

Nurses need to resort to a minimum time-lag before the IV line is removed and the sample drawn.

The emergence of urine analysis as a valuable tool in the assessment of a wide spectrum of disorders has resulted in deeper investigations of this biofluid to detect important disease markers.

From an investigative procedure for infections and diabetes mellitus, the analysis of urine has moved on to screening for early malignancies, incipient signs of rejection in patients, who have undergone a major organ transplant and certain metabolic disorders.

It is also selectively used in immunological tests for antibodies and microorganisms, said a consultant pathologist.