Diagnostic Samples: From the Patient to the Laboratory

Until Jan 2003 Prof. Dr. Walter G. Guder was Director of the Institute of Clinical Chemistry, Bogenhausen Community Hospital Munich and Professor of Clinical Biochemistry at the Ludwig-Maximilians-University of Munich. He studied medicine in Cologne, Tubingen and Munich. He served as President of the German Society of Clinical Chemistry and was Chairman of the Working Group on Preanalytical Quality. He is Editor of the "Laborbuch fur Klinik und Praxis" and Administrator of the Internet Program www.diagnosticsample.com. Prof. Dr. Sheshadri Narayanan is an Adjunct Clinical Professor of Pathology and Laboratory Medicine at the Weill Medical College of Cornell University, New York City. He is a diplomate of the American Board of Clinical Chemistry and is qualified to act as Clinical Laboratory Director in the States of New York and New Jersey. Besides the many publications he has also authored a book on "Principles and Applications of Laboratory Instrumentation" and co-authored with Prof. Donald S. Young a book on "Effects of Herbs and Natural Products on Clinical Laboratory Tests". Prof. Dr. Dr. Hermann Wisser studied medicine and chemistry at the universities of Marburg, Goettingen and Mainz. He completed his education in laboratory medicine in Munich and Hannover. Thereafter he served as head of the Department of Laboratory Medicine of the Robert Bosch Hospital in Stuttgart and of the Institut of Clinical Chemistry of the University Hospital Mannheim. He was President of the German Society of Clinical Chemistry and President of the Forum of the European Societies of Clinical Chemistry. Until he died in 2004 Dr. Bernd Zawta was Head of the Department of Scientific Customer Support and Public Relations of Roche Diagnostics GmbH. He studied chemistry at the Technical University, Dresden, where he made his thesis on "The chromatography of steroid hormones". He was editor of more than 20 brochures on the diagnostic application of tests in human diseases. Dr. Zawta served as WHO consultant in Mongolia in 1985. He died just before finishing a teaching program "Focus Patient Sample" together with Guder, Hagemann and Wisser.

Dream and reality - An introductory case - The importance of the preanalytical phase BIOLOGICAL INFLUENCES Something unavoidable - Influences of age, gender, race and pregnancy Changing habits - Influences that can vary (diet, starvation, exercise, altitude) May I take coffee, smoke or drink before blood sampling? - Stimulants and addictive drugs as biological influence factors What if I take herbs? - Effects of herbs on laboratory results COLLECTION OF SPECIMEN When to test? - Timing of sampling Sampling during infusion therapy? - Sequence of diagnostic and therapeutic procedures Sampling in the supine or upright position? - Effects of posture and tourniquet What site for sampling blood? - Phlebotomy, arterial puncture and sampling from catheters Blood from the skin - Capillary sampling Did the lab mix up my sample? - Techniques of sample identification A precious sample - Cerebrospinal fluid (CSF) A sample that is nearly always available - Urine and saliva as diagnostic probes Plasma or serum? - Differences to be considered Take a lavender tube! - Additives and colour codes TRANSPORT AND STORAGE Fax me a sample - Effects of time and temperature during transport Samples in transit - Legal standardization for mailing samples How to keep a sample "fresh" - Storage of samples in the laboratory PREPARATION OF SAMPLES FOR ANALYSIS What has to be done on specimen arrival? - Specimen processing, centrifugation, distribution Continuous or batchwise? - Preanalytical workflow and robotics Safety aspects during the preanalytical phase - Disposal of specimens, needles, tubes and chemicals SPECIAL ASPECTS WITH EACH ANALYTE What is needed before blood transfusion? - Special aspects in immuno-haematology Why a separate tube for the coagulation test? - Special aspects in haemostaseology Blood cells are sensitive! - Special aspects in haematological analysis Everything from a drop of blood? - Special aspects in clinical chemistry Special tubes for hormones and proteomics? - Preanalytical factors in immunoassays Blood cells can provide important information - Special aspects in cellular analysis How to handle genes - Special aspects in molecular biology When gases evaporate - Special aspects for blood gases and ionized calcium The right time for drugs? - Special aspects in therapeutic drug monitoring (TDM) Bacteria, fungi, parasites and viruses - Special aspects in microbiology ENDOGENOUS AND EXOGENOUS INTERFERENCES Can turbid samples be used? - Effects of lipaemia A difficult case - Pitfalls with endogenous antibodies The serum sample looks reddish - Effects of haemolysis Does the laboratory have to know all my drugs? - Mechanisms and treatment of drug interference Everything under control? - Quality assurance in the preanalytical phase References Glossary Index