Accurate Results in the Clinical Laboratory

Accurate Results in the Clinical Laboratory

A Guide to Error Detection and Correction

1st Edition - January 22, 2013

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  • Editors: Amitava Dasgupta, Jorge Sepulveda
  • eBook ISBN: 9780124158580
  • Hardcover ISBN: 9780124157835

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This practical, easy-to-use guide, named to Doody’s Core Titles 2013, addresses interference issues in all laboratory tests, including patient epigenetics, process of specimen collection, enzymes, biomarkers. Clinicians and laboratory scientists can therefore rely on one reference which speaks to both their needs of accurate specimen analysis and optimal patient care. Erroneous hospital and pathology laboratory results can be confusing and problematic, especially in acute care situations. While some factors creating interference, can be identified in the laboratory, detecting many others is often dependent on clinical details unavailable to the laboratory scientists or pathologists. Therefore, clinicians must become proficient in identifying such erroneous reports, and working with pathologists and laboratory scientists so that they can understand the source of such interferences, correct the results, and then decide what course of action must be followed for proper patient management.

Key Features

  • Named to Doody’s Core Titles 2013, a collection development tool for health sciences libraries of all sizes, by Doody Enterprises
  • Practical information for both clinicians and laboratory scientists, presented in the form of tables and charts for easy reference
  • Focus on range and sources of interferences rather than details of toxicologic mechanisms which are well covered in toxicology textbooks
  • Covers interferences across endocrine, oncology, hematology, immunohistochemistry, immunology, serology, microbiology, and molecular testing


Pathologists, clinical chemists, and toxicologists; practicing clinicians, fellows and residents in pathology, internal medicine, emergency medicine and family practice.

Table of Contents

  • Foreword


    List of Contributors

    Chapter 1. Variation, Errors, and Quality in the Clinical Laboratory


    Errors in the Clinical Laboratory

    Quality Improvement in the Clinical Laboratory



    Chapter 2. Effect of Age, Gender, Diet, Exercise, and Ethnicity on Laboratory Test Results


    Effects of Age-Related Changes on Clinical Laboratory Test Results

    Effects of Gender-Related Changes on Clinical Laboratory Test Results

    Effects of Diet on Clinical Laboratory Test Results

    Effects of Nutraceuticals on Clinical Laboratory Test Results

    Effects of Exercise on Clinical Laboratory Test Results

    Effects of Ethnicity/Race on ClinicaL Laboratory Test Results



    Chapter 3. Effect of Patient Preparation, Specimen Collection, Anticoagulants, and Preservatives on Laboratory Test Results


    Biological Rhythms and Laboratory Test Results

    Issues of Patient Preparation

    Differences Between Whole Blood, Plasma, and Serum Specimens for Clinical Laboratory Analysis

    Different Anticoagulants and Preservatives, Order of Draw, Problems with Gel Interference in Serum Separator Tubes, and Short Draws

    Order of Draw of Various Blood Collection Tubes

    Collection Sites; Differences Between Arterial, Capillary, and Venous Blood Samples; and Problems with Collections from Catheters and Intravenous Lines

    Urine Collection, Timing, and Techniques



    Chapter 4. Sample Processing and Specimen Misidentification Issues



    The Effects of Centrifugation on Laboratory Results

    Effect of Storage Conditions on Laboratory Results

    Effect of Cross-Contamination of Specimens on Laboratory Results

    Consequences of Specimen Misidentification on Laboratory Testing



    Chapter 5. Hemolysis, Lipemia, and High Bilirubin: Effect on Laboratory Tests


    Effect of Hemolysis on Laboratory Tests



    Methods for Evaluating the Effect of Endogenous Interfering Substances on Laboratory Tests



    Chapter 6. Immunoassay Design and Mechanisms of Interferences


    Immunoassay Methods and Assay Principles

    Specimen Types Used in Immunoassays

    Examples of Immunoassays

    Pitfalls in Immunoassays

    How to Detect and Correct Heterophilic Antibody Interferences



    Chapter 7. Effect of Herbal Remedies on Clinical Laboratory Tests


    Elevated Liver Function Test Due to Use of Herbal Supplements

    Herbal Supplements Causing Kidney Damage

    Herbal Remedies and Hypoglycemia

    Licorice and Hypokalemia

    Kelp and Abnormal Thyroid Function Tests

    Drug–Herb Interaction and Unexpected Drug Levels in Routine Drug Monitoring

    Adulteration of Herbal Supplements with Western Drugs



    Chapter 8. Challenges in Routine Clinical Chemistry Testing: Analysis of Small Molecules


    Creatinine Analysis

    Urea Analysis

    Ammonia Assay

    Uric Acid Analysis

    Glucose Analysis

    Analysis of Electrolytes

    Blood Gases Analysis

    Lactate Analysis

    Bilirubin Analysis

    Lipid Profiles Analysis



    Chapter 9. Challenges in Routine Clinical Chemistry Analysis: Proteins and Enzymes


    Albumin and Total Protein

    Alanine and Aspartate Aminotransferases Analysis

    γ-Glutamyl Transferase and Alkaline Phosphatase Analysis

    Amylase and Lipase Analysis

    Lactate Dehydrogenase Analysis

    Creatine Kinase Analysis

    Cardiac Troponin Analysis

    B-Type Natriuretic Peptide Analysis



    Chapter 10. Sources of Inaccuracy in Biochemical Genetics Testing


    Analysis of Amino ACIDS

    Analysis of Organic ACIDS

    Analysis of Acylcarnitines



    Chapter 11. Challenges in Endocrinology Testing


    Challenges in Testing of Hormones Secreted by Pituitary

    Challenges in Measuring Human Chorionic Gonadotropin

    Challenges in Thyroid Tumor Marker Tests

    Adrenal Function Tests

    Testing of Parathyroid Function

    Gonadal and Reproductive Interferences


    Testing for Insulin-Like Growth Factor 1

    Measurement of Other Hormones Including Insulin

    Prenatal Testing



    Chapter 12. Pitfalls in Tumor Markers Testing


    Clinical Uses of Tumor Markers

    Prostate-Specific Antigen


    α-Fetal Protein

    Carcinoembryonic Antigen



    Human Chorionic Gonadotropin

    Interference from Heterophilic Antibodies in Laboratory Testing of Tumor Markers

    Analysis of Less Frequently Assayed Tumor Markers



    Chapter 13. Issues of Interferences in Therapeutic Drug Monitoring


    Sources of Pre-Analytical Interferences in TDM

    Sources of Analytical Interferences in TDM

    Mechanisms of Analytical Interferences in TDM

    Chromatography and Mass Spectrometry

    Examples of Interferences that Affect TDM



    Chapter 14. Limitations of Drugs of Abuse Testing


    Drugs of Abuse Testing: Medical Versus Legal

    Drugs Tested in Drugs of Abuse Testing Protocols

    Drug Testing Methodologies

    Challenges in Testing for Amphetamines

    Challenges in Testing of Cocaine Metabolite

    Challenges in Testing for Opiates

    Challenges in Testing for Marijuana Metabolites

    Challenges in Testing for Phencyclidine

    Challenges in Testing for Benzodiazepines

    Challenges in Determining Other Drugs by Immunoassays

    Adulterants and Drugs of Abuse Testing

    Other Drugs not Detected by Routine Toxicology Screens



    Chapter 15. Challenges in Confirmation Testing for Drugs of Abuse

    Introduction: Factors to Consider when Interpreting Drug Testing Results

    Confirmation Testing Process

    Confirmation of Amphetamines

    Confirmation of Cocaine Metabolite Benzoylecgonine

    Confirmation of Opiates

    Confirmation of Marijuana Metabolite

    Confirmation of Phencyclidine

    Confirmation of Benzodiazepines

    Confirmation of Barbiturates

    Specimen Validity Testing



    Chapter 16. Alcohol Determination Using Automated Analyzers: Limitations and Pitfalls


    Development of Laboratory Methods for Ethanol Measurement

    Current Automated Methodologies

    Performance of Automated Ethanol Assays

    Problems with Current Methodologies

    Strategies for Removing Interferences

    Further Case Studies

    Future Directions



    Chapter 17. Pre-Analytical Issues and Interferences in Transfusion Medicine Tests


    Basics of Immunohematology

    Methodology Used for Immunohematology Tests

    Pre-Transfusion Evaluation

    Interferences in Basic Transfusion Medicine Tests

    Case Studies



    Chapter 18. Issues with Immunology and Serology Testing


    Challenges in Hemoglobinopathy Detection

    Detection of Monoclonal Proteins

    Challenges in HIV Testing

    Hepatitis Testing

    Anti-Nuclear Antibodies



    Chapter 19. Sources of Errors in Hematology and Coagulation Testing


    Errors in Hemoglobin Measurement and RBC Count

    Errors in MCV and Related Measurements

    Errors in WBC Counts and WBC Differential Counts

    Errors in Platelet Count

    Errors in Specific Hematology Testing

    Coagulation Testing

    Errors in PT and aPTT Measurements

    Errors in Thrombin Time Measurement

    Platelet Aggregation Testing with Lipemic, Hemolyzed, or Thrombocytopenic Samples

    Challenges in Anticoagulants and Lupus Anticoagulant Tests

    Case Studies



    Chapter 20. Challenges in Clinical Microbiology Testing


    Issues with Pre-Analytical Errors

    Analytical Errors in the Microbiology Laboratory

    Post-Analytical or Reporting Errors

    Error Prevention, Detection, and Monitoring



    Chapter 21. Sources of Errors in Molecular Testing


    Principles of Commonly Used Methods for Molecular Diagnostics

    Principles of Nucleic Acid Isolation

    Pre-Analytical Considerations in Molecular Testing

    Interferences in Molecular Diagnostics: False-Negative Results in Molecular Assays

    Interferences in Molecular Testing: False-Positive Test Results in Molecular Assays

    Sources of Errors in DNA Microarray Testing

    Quality Management



    Chapter 22. Problems in Pharmacogenomics Testing


    Method Descriptions

    Applications of Pharmacogenetics Testings

    Case Studies




Product details

  • No. of pages: 382
  • Language: English
  • Copyright: © Elsevier 2013
  • Published: January 22, 2013
  • Imprint: Elsevier
  • eBook ISBN: 9780124158580
  • Hardcover ISBN: 9780124157835

About the Editors

Amitava Dasgupta

Amitava Dasgupta
Dr. Amitava Dasgupta received his Ph.D degree in Chemistry from Stanford University and received his medical training in Toxicology and Clinical Chemistry from the Laboratory Medicine Department of the University of Washington School Of Medicine at Seattle. He is board certified in both Toxicology and Clinical Chemistry by the American Board of Clinical Chemistry. He is a tenured Full Professor of Pathology and Laboratory Medicine at the University of Texas Health Sciences Center located at the Texas Medical Center at Houston. He is also the Director of Clinical Chemistry and Toxicology Laboratory of Memorial-Hermann Laboratory Services, the major clinical teaching hospital of the University of Texas. In addition, he is also the Medical Director of Memorial-TIRR Hospital laboratory services. Dr. Dasgupta has published over 235 scientific papers and edited, co-edited, authored or co-authored 20 books including books published by Elsevier. He is on the Editorial Board of five major medical journals including American Journal of Clinical Pathology, Archives of Pathology and Laboratory Medicine, Therapeutic Drug Monitoring, Clinica Chimica Acta and Journal of Clinical Laboratory Analysis. He lectures both nationally and internationally on drug and alcohol testing and acts as an expert witness for the State of Texas for alcohol and drug related criminal prosecutions.

Affiliations and Expertise

Professor, Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas, Houston, TX, USA

Jorge Sepulveda

Jorge Sepulveda received his M.D. from the University of Lisbon, Portugal, and his residency training in Laboratory Medicine and Ph.D. degree in Cell and Molecular Biology from Baylor College of Medicine, Houston, Texas. He is board certified by the American Board of Pathology in Clinical Pathology and Transfusion Medicine. He has published over 35 research articles, review papers and book chapters, and serves as Associate Editor for the Archives of Pathology and Laboratory Medicine. Dr. Sepulveda has broad experience in laboratory medicine as medical director of various clinical laboratories, including at the Houston and Philadelphia Veterans Affairs Medical Centers and at the University of Pittsburgh Presbyterian and Shadyside Hospitals, and currently serves as Associate Medical Director of the Clinical Laboratories at the Columbia University Medical Center Campus of New York-Presbyterian Hospital.

Affiliations and Expertise

Associate Professor and Associate Director of Laboratory Medicine, Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA

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