Hematopoiesis
Term for red blood cell production:
Erythropoiesis
Thrombopoiesis
Leukopoiesis
What is Erythropoiesis?
You receive a 24 hour urine in the lab with an order for creatinine clearance. What do you need to perform this testing?
What is:
1. Measure the volume of urine received in jug (mL)
2. Serum or plasma to perform creatinine
What are the three phases of laboratory testing? Where do most lab errors occur?
Pre-Analytic
Analytic
Post-Analytic
Most errors occur in the Pre-Analytic phase
The courier forgot to make a stop at an outpatient lab site. The lab specimens were outside all night. It was winter and the temperature was below freezing the entire time. Are these specimens ok to test the next day when the day courier picks them up and takes them to your lab? What should you do?
You will need to look at all the containers and their lab orders and check the stability and storage temps for each test to determine if testing can be performed.
24 hour urine specimen and serum/plasma creatinine level.
Term for white blood cell production:
Erythropoiesis
Thrombopoiesis
Leukopoiesis
What is Leukopoiesis?
Is there a difference between a random urine sample and a 24 hour urine sample? If yes, what is the difference?
A random urine specimen is a single urine specimen collected at any time of the day. A 24 hour urine specimen is a collection of every urine sample over a 24 hour period.
Three examples of Pre-Analytical errors:
identification errors
incorrect order of draw (blood tubes)
collecting specimen in incorrect container
improper processing
You are receiving specimens from outpatient sites and you see that one of the light green tops was not centrifuged. You see that it was collected 5 hours ago. What should you do?
Tubes must be centrifuged within 2 hours of blood collection.
This specimen will need to be recollected in order to give accurate results.
Since this is an outpatient specimen, create a Follow Up Task in Epic and client services will call the office.
Reason a creatinine clearance would be ordered on a patient
It is measured by comparing the levels of creatinine in a blood sample and a urine sample collected over a 24 hour period.
Term for platelet production:
Erythropoiesis
Thrombopoiesis
Leukopoiesis
What is Thrombopoiesis?
A patient submitted a 24 urine for creatinine clearance. The patient also has an order for a random urine protein. Can you use the 24 hour urine specimen for the random urine protein?
No, you cannot use the 24 hour specimen for the random urine protein order. Urine protein levels from a 24 hour specimen and random specimen have different reference ranges.
Three processes in the Analytical phase:
QC
Calibration
Dilution
Instrument Maintenance
A blood sample received for a Type and Screen appears to have a clear fluid instead of plasma with a small number of cells. Should you test this specimen or have it recollected? What do you think happened?
The specimen should be recollected.
The specimen is most likely contaminated with IV fluid.
Why would a creatinine clearance be decreased?
Low creatinine clearance levels can indicate kidney damage
Name the stages of red cell production, from Proerythroblast to Erythrocyte.
Proerythroblast, Erythroblast, Normoblast, Reticulocyte, Erythrocyte
What does it mean if a patient has Bence Jones protein in their urine?
Multiple Sclerosis, Lupus, Multiple Myeloma, Diabetes
Bence Jones proteins are usually associated with multiple myeloma.
Also seen in amyloidosis, CLL, lymphoma, chronic renal failure.
Three processes in the Post-Analytical phase of testing:
Lab Result Verification
Lab result sent to ordering physician/patient
Critical Result communication
Result Correction
Retesting to confirm result
You are working in the lab and there is a coag specimen that was collected by RN on an inpatient and it is QNS. What should you do?
Use the Redraw function in Epic to put a new order on the chart AND call the RN to let them know the specimen needs to be recollected.
Why would a creatinine clearance be increased?
High creatinine clearance levels can indicate kidney disease or impaired kidney function.
Time it takes for a red cell to fully mature:
1 day
1 week
1 month
What is 1 week?
What is the Urine Protein Creatinine Ratio (UPCR)?
A UPCR test measures the amount of protein in a urine sample relative to the amount of creatinine.
The UPCR is normally less than 0.2 for adults.
Elevated urine protein levels may be seen temporarily during stress, pregnancy, infections, cold exposure, heavy exercise.
As a medical laboratory scientist, I do not have to worry about pre-analytical errors because in my job I am responsible for analytical and post-analytical phases of testing. TRUE or FALSE
False, as a medical laboratory scientist I must be aware of pre-analytical errors and understand how they affect testing and results.
You are in the lab and the phone is ringing and ringing. You answer the phone politely but you are unsure how to assist the caller. What should you do?
It is ok.
No one knows the answer to every call. If you cannot assist the caller, ask for their name and extension and tell them you will call them back when you get the information they need or someone else from the lab will get back to them.
What is the calculation for creatinine clearance?
Creatinine Clearance (CRCL)=
(Creatinine Urine x Total Volume/1440 minutes x Creatinine Serum)
Corrected CRCL=
CRCL x (1.73/Body Surface Area)