RATIO Flashcards
12
9
6
3
2
1
Tera
Giga
Mega
kilo
hecto
deca
-1
-2
-3
-6
-9
-12
deci
centi
milli
micro
nano
pico
10
-10
15
-15
Exa
Atto
Peta
Femto
Base units
Meter
Liter
Gram
• Celsius to Fahrenheit
°C (9/5) + 32
• Fahrenheit to Celsius
(°F - 32) 5/9
• Celsius to Kelvin
• Kelvin to Celsius
Add 273.15 to the Kelvin temperature.
Subtract 273.15 from the Celsius temperature.
Length
Mass
Time
Electric Current
Thermodynamic Temperature
Amount of Substance
Luminous Intensity
Catalytic Activity
Meter (m)
Kilogram (kg)
Second (s)
Ampere (A)
Kelvin (K)
Mole (mol)
Candela (cd)
Katal (kat)
Concentration formula
C1V1=C2V2
Additional purification steps; highly specialized (molecular diagnostic, AAS, HPLC)
Ultrapure
Suitable for most lab procedures
Analytical
Drugs; not injurious to health
USP/NF
Purity is not stated
Chemically pure/Pure grade
• Procedures requiring maximum water purity
Type I Water
• For most laboratory determinations
Type Il Water
• For most qualitative measurements or examinations
Туре III Water
Percent solution
Solute/Solution
Manufacturing industries; not used in the lab
Technical/Commercial
Ultrachemical analyses, nanogram or subnanogram measurements, tissue and cell culture, and reconstitution of standard (callibrator) solution preparation
Type I
Quantitative analyses (CC, hema, micro, IS)
Type II
Qualitative measurements and washing of glasswares
Type III
Urinalysis, fecalysis, histology
Type III
Most common expression of percent solution
Weight per volume
- Other Name: Swinging-Bucket Centrifuge
Horizontal-Head Centrifuge
- Tubes are in vertical position when not in motion (at rest)
Horizontal-Head Centrifuge
Tubes are in horizontal position when in motion (rotating)
Horizontal-Head Centrifuge
- Other Names: Fixed Angle Centrifuge,
Desk/Bench Type Centrifuge
Angle-Head Centrifuge
- Tubes are maintained at an angle of 25° to 40° or 52°
Angle-Head Centrifuge
- Other Name: Refrigerated Box
Ultracentrifuge
- Provides the highest speed
Ultracentrifuge
- Other Name: Cytospin
Cytocentrifuge
- Used to prepare a monolayer of cells on glass slides
Cytocentrifuge
reference method for lipoprotein analysis
Ultracentrifuge
Disinfection
10% bleach or Vinegar
Weekly
Unusual vibrations, braking mechanisms & timer
Stopwatch
Monthly
Calibration
Tachometer or strobe light
Quarterly or every three months
• specimen is aspirated through the sample probe into a continuous reagent stream
Continuous Flow Analyzers
• allows batch analysis: specimens are separated by air bubbles
Primary source of error: carry over (wash)
Continuous Flow Analyzers
• uses a “spinning rotor” to generate centrifugal force to transfer & contain liquids in separate cuvettes for analysis
Centrifugal Analyzers
• each sample and corresponding reagent is handled separately in its respective reaction vessel
Discrete Analyzers
• runs multiple tests on one sample or one test on multiple samples
Discrete Analyzers
• performs random access, batch and sequential analysis
Discrete Analyzers
• performs random access (stat), batch and sequential analysis
Discrete Analyzers
Usually available; most versatile and user friendly; not wasteful of reagents
Discrete Analyzers
Properties of Light
Wavelength (nanometer)
Energy
long wavelength:
short wavelength:
low energy
high energy
below 400 nm->
Higher energy (lower wavelength)
400-700 nm
above 700 nm ->
Lower energy (higher wavelength)
UV
Visible
IR
: highest energy
: lowest energy
Violet
Red
To provide a continuous stream of polychromatic light
Light source
Prevent stray light
Entrance slit
Disperses light and selects specific wavelength of light
Monochromator or wavelength selector
Controls bandpass or wave of light beam
Monochromatic light passes
Exit slit
Contains the analyte to be measured
Square: preferred
Cuvette or sample holder
Detects and converts light into a corresponding electrical energy
Photodetector
Measures magnitude of electrical energy
Not an internal component
Flashes in the screen; measures output or absorbance
Meter or read-out device
Measures transmittance
Spectrophotometer
• measures light emitted by the analyte after excitation
Fluorometry
a. Internal Components
- Light Source
- Primary Monochromator
- Sample Holder
- Secondary Monochromator
- Detector
• receives radiant energy from the light source
- Primary Monochromator
• increases the energy level
• transmits the excitation light
- Primary Monochromator
receives the emitted light from the analyte
- Secondary Monochromator
• presence of molecules that absorbs or steals the fluorescence of the analyte
- Quenching
Excitation filter
Emission filter
Primary monochromator
Secondary monochromator
Contains two monochromator
Fluorometer (or spetro)
causes energy to dissipate as heat instead of fluorescence
increase in temperature
Emitted light from the analyte
Fluorescent light
Falsely decreased fluorescence
Quenching
Temperature
• Light Source: LASER (Light Amplification by Stimulated Emission of Radiation)
Nephelometry
measures light scattered by particles
Nephelometry
detector is at a 90° or 30° (15° to 90º) angle from the incident light
Nephelometry
• measures light blocked by particles
Turbidimetry
• partidles in the solution cause a decrease in the transmitted light
Turbidimetry
• detector is in line with the incident light
Turbidimetry
: longer wavelength, lower energy
: shorter wavelength, high energy
Emitted light
Excited light
PRECOLLECTION VARIABLÉS
- Physiologic Factors
- Common Interferences
- Physiologic Factors
Diurnal Variation (ACTH, cortisol, Iron) Exercise
Diet (chronic alcohol abuse/alcoholism)
Stress
Posture (seated in a supine position for 15-20 minutes)
Age
Sex
- Common Interferences
In Vivo: Smoking
In Vitro: Collection-Associated Variables (hemolysis, hemoconcentration)
Posture: seated in a
supine position for 15-20 minutes
Icteric
Albumin:
Albumin: 430 mmol/L or 25 mg/dL
Bilirubin: HABA
Cholesterol: ferric chloride
TP: biuret
Lipemic
TG:
4.6 mmol/L or >400 mg/dL
AMS
UA
Urea
CK
Bilirubin
TP
Albumin, TP, Globulin
10
Na, K, Cl
1
BUN
0.357
UA
0.059
Creatine
88.4
Glucose
0.055
Cholesterol
0.0259
Triglycerides
0.011
Thyroxine
12.87
GOAL: To be able to provide high quality services at a low cost
Quality Management
goes beyond monitoring, detecting and preventing errors
Quality Improvement
• seeks to achieve new levels of performance in order to address chronic problems
Quality Improvement
A. Approaches in Quality Improvement
- Lean
- Six Sigma
system for reducing WASTES
- Lean
reduce costs by identifying daily work activities that do not directly add to the delivery of laboratory services
in the most efficient way
- Lean
- Lean Strategies/Techniques:
• 5S:
• PDCA:
Sort, Set in order, Shine, Standardize, and Sustain
Plan, Do, Check, and Act
GOAL: Improvement by eliminating DEFECTS
- Six Sigma
is anything that does not meet customer requirements
DEFECT
Measured per million opportunities (DPMO: Defects Per Million Opportunities)
Six Sigma
Six Sigma Strategy:
DMAIC (Define, Measure, Analyze, Improve, Control)
QUALITY MANAGEMENT 2 CONCEPTS
QUALITY IMPROVEMENT
QUALITY ASSURANCE
3 roles in major quality improvement projects
Black belts
Green belts
Blue belts
+ Purple belts
BISHOP: Lean Six Sigma
: project team leaders: 100% of their time
: project team members: 20% of their time
: project sponsors (senior level and mid level sponsors)
: heads of smaller scale QI projects
Black belts
Green belts
Blue belts
Purple belts
Major scale QI projects:
Small scale QI projects:
6-8 months
1 week
NONVALUED ACTIVITIES
WASTES
complete system of creating and following procedures and policies to aim for providing the most reliable patient laboratory results and to minimize errors in the pre-analytical, analytical and post-analytical phases
Quality Assurance
Selection of assay relative to patient needs (test order by the physician)
Pre-analytical
Total or overall testing process
Quality Assurance
Selection of assay relative to patient needs (test order by the physician)
Pre-analytical
Patient preparation (giving instructions, fasting requirements)
Pre-analytical
Patient misidentification
Pre-analytical
Specimen collection
Pre-analytical
Specimen transport, preparation (centrifugation, plasma & serum prep) and storage
Pre-analytical
Monitoring of specimen condition
Pre-analytical
Assay validation and instrument selection (calibration)
Analytical
Preparation of reagents or Reconstitution
Analytical
Sample misidentification
Analytical
Laboratory staff competence (seminars and trainings)
Analytical
Preventive maintenance
Analytical
External and internal quality control
Analytical
Accuracy in transcription and filing of results
Post-analytical
Verification/validation of test results (delta check)
Post-analytical
Content and format of lab report, narrative report, reference interval and therapeutic range
Post-analytical
Timeliness in communicating critical values, patient and physician satisfaction
Post-analytical
Test interpretation by the physician
Post-analytical
aspect of quality assurance that is used to assess the analytical phase of patient testing
Quality Control
Intralab QC
Internal QC
Interlab QC or Proficiency Testing
External QC
Process of monitoring results from control samples to verify reliability of patient results
Internal QC
Process that extends beyond the laboratory
External QC
QC within the lab
Internal QC
QC that is administered by another laboratory (NRL: CC - Lung Center of the Philippines)
External QC
Control samples provided by the laboratory itself
Internal QC
Blind/Unknown samples provided by another laboratory
External QC
Compared to the reference values provided by the manufacturer
Internal QC
Compared to the results of other laboratories
External QC
Control values are plotted using Levey-Jennings (LJ) chart and evaluated using Westgard Multirules
Internal QC
Results are evaluated using Z-score **Z-score is ‡ 2SD
External QC
For daily monitoring of accuracy & precision (short-term monitoring)
Internal QC
Significant in maintaining long-term accuracy & precision of the analytical method (monthly)
External QC
how close are the obtained values to the TRUE VALUE
accuracy
commonly known as the average of a set of values
• middle value, midpoint value
• most frequently occurring value in a data set
- Mean
- Median
- Mode
B. Measuring Dispersion of Values
- Range
- Standard Deviation
- Variance
- Coefficient of Variation
difference between the highest and lowest values in a given set of data
statistical expression of dispersion of values around the mean
relative indicator of precision
- Range
- Standard Deviation
- Coefficient of Variation
• ideal CV is
<5%
