Chapter 1: Introduction

  • Focus of Chapter: Body control and quality assurance for diagnostic testing related to blood tests.

    • Importance: Blood tests help providers in clinical decisions and diagnostic testing.
    • Quality Control (QC) Measures:
    • Ensure integrity of diagnostic test results: Perform quality controls at the start of each day and record them.
    • Compliance with audits: CLIA, OSHA, CMS may conduct audits requiring proof of QC logs.

  • Temperature Logs:

    • Refrigeration and freezer temperatures must be logged.
    • Traditionally attached to refrigerators/freezers or logged online; temperatures need to be recorded and signed by staff.

  • Calibration and Quality Control:

    • Opening new vials of reagent strips or test kits requires calibration of instruments.
    • Example: With glucometers, calibration is needed according to the vial's printed number.
    • Process:
    • Insert calibration stick, set the machine to the new code, and run quality controls.
    • Perform positive and negative controls with strips from the new vial before running patient tests.

  • Analytical Equipment:

    • Ensures analyzers and reagents function correctly to prevent inaccurate results.
    • QC logs are mandatory to report results accurately.

  • Logbook Requirements:

    • Essential information:
    • Date
    • Patient's name
    • Test performed
    • Patient test result
    • User initials
    • Reagent strip/lot numbers and expiration dates
    • QC results
    • Example entry:
    • Test: Cholesterol
    • Result: 189, Initials: SL, LotNumber: XYZ, Exp: MM/YY.

  • Frequency of Quality Control:

    • QC performed at start of each day, tests are performed throughout the day using the same vial if QC results are acceptable.

Chapter 2: Know The Number

  • Hematology Testing:

    • Focus on red blood cells, white blood cells, platelets; including pregnancy tests.
    • HCG: Human chorionic gonadotropin in pregnancy tests.
    • Function of Red Blood Cells:
    • Carry hemoglobin and deliver oxygen to body cells.
    • Pick up carbon dioxide for return to heart/lungs.
    • Function of White Blood Cells:
    • Responsible for immunity and fighting infections.
    • Function of Platelets:
    • Crucial for blood clotting.
    • Hemoglobin:
    • Transports oxygen in the blood, oxygenated hemoglobin is bright red.
    • Normal ranges:
      • Males: 13-17 g/dL
      • Females: 12-16 g/dL
    • Anemia:
    • Defined as a deficiency of red blood cells or hemoglobin.

  • Panic Values:

    • Hemoglobin below 10 can lead to symptoms like shortness of breath, fatigue, and paleness.

Chapter 3: Redo The Test

  • Complete Blood Count (CBC):

    • Key components:
    • Red blood cells (RBC)
    • White blood cells (WBC)
    • Platelets
    • Normal Ranges:
    • Males: 4.5 to 6 million RBCs/mm³
    • Females: 4.0 to 5.5 million RBCs/mm³
    • Platelets: 150,000 to 450,000 mm³
    • WBC: 4,500 to 11,000 mm³
    • Decreased erythrocytes relate to anemia.
    • Specific diseases affecting leukocyte counts:
    • UTI or infection: elevated WBC
    • HIV or some cancers: decreased WBC.

  • Erythrocyte Sedimentation Rate (ESR):

    • Used to detect inflammation; measured within an hour after drawing blood.
    • Effective timing: Requires precision, tested at exactly one hour.
    • Applications: Helpful in diagnosing diseases like rheumatoid arthritis or chronic inflammatory conditions.

  • Testing Methodology:

    • ESR Test: Blood is settled in a calibrated tube within one hour, observing how red blood cells settle.
    • Weight-related conditions can affect the speed of settling and results interpretation.

Chapter 4: A Fasting Glucose Test

  • Glucose Testing:

    • Conducted to monitor blood sugar levels, often involving a fasting glucose measure first.
    • Normal fasting blood sugar range: 70 to 100 mg/dL.
    • Glucose Tolerance Test (GTT):
    • Used primarily for diagnosing diabetes, especially during pregnancy for gestational diabetes.
    • The administration of a glucose load (sweet drink) after fasting and monitoring glucose levels periodically post-ingestion (e.g., after 30 mins, then hourly).
    • If fasting glucose is ≥150 mg/dL, do not administer glucose.

  • Hemoglobin A1C Test:

    • Reflects average blood glucose levels over the preceding 2-3 months; normal is under 5.7%.
    • High A1C (e.g., > 7%) suggests poor long-term glycemic control.

Chapter 5: Hour And Hour

  • Fasting Protocol: Needed to identify insulin sensitivity and glucose metabolism.

    • Patients must remain in the facility during GTT to monitor for reactions.
    • Monitor Symptoms: Nausea or vomiting during the test results in test discontinuation.

  • Interpreting GTT Observations:

    • Evaluate for spikes in blood glucose to determine diabetes presence.
    • Symptoms of hyperglycemia include excessive sweating and faintness.

Chapter 6: The RAS Test

  • Allergy Testing:

    • Various methods: skin prick tests, intradermal tests, or patch tests.
    • Skin prick tests involve placing allergens in small scratches on the skin to observe allergic reactions.

  • RAST Test:

    • Blood test measuring allergen-specific IgE; used when skin testing is contraindicated.
    • Identifies allergies to different substances like foods, pollens, or dust.

  • Mononucleosis Testing:

    • Caused by Epstein-Barr virus (EBV), most common among individuals ages 15-25.
    • Symptoms mimic flu; transmitted primarily through saliva.
    • Blood tests measure antibodies for diagnosis.

Chapter 7: Test Every Baby

  • PKU Testing:

    • Mandatory screening for newborns to detect inability to metabolize phenylalanine, which can lead to serious health issues if untreated.
    • Testing involves pricking the heel and placing drops on specific filter paper.

  • Panel Testing in Laboratories:

    • Kidney and liver panels assess various enzymatic functions; includes tests like creatinine and blood urea nitrogen (BUN).

Chapter 8: Conclusion

  • Summary Points: Importance of monitoring panic values for cholesterol, triglycerides, etc., requiring immediate attention.
    • BUN: Normal range 8-20 mg/dL; indicates kidney function.
    • PT/PTT/INR: Measures blood clotting ability; INR should be 2.0 to 3.0, indicative of anticoagulant effectiveness in therapy.