Pre- analytic Analytic Post- analytic  S pecimen collection  Specimen transport  Specimen quality  Result accuracy  Clerical errors  Analytical errors  Result reporting  Record keeping for patient and QC

 Patient preparation - proper patient preparation is essential to obtain meaningful test result  Specimen collection - container, anticoagulant, time taken to send specimen to lab, corrected by using vacutainer tubes & collection of samples by lab personnel  Specimen Transport - critical for some tests  Specimen Separation, aliquoting - monitoring of the performance of the centrifuge, container used for storage  Personnel - variation from person to person. Safety precautions for all specimens.

 Improper preparation of the patient  Improper collection of the blood sample  Incorrect specimen container  Incorrect specimen storage

 Calculation errors –incorrect factor / wrong calibration values  Transcription errors  Dilutions errors –incorrect dilution or dilution factor used  Lack of training  The human factor –tiredness / carelessness / stress

 The prompt and correct delivery of the correct report on the correct patient to the correct Doctor.  How the Clinician interprets the data to the full benefit of the patient.

 Quality Assurance is internal Quality assessment plus external Quality assessment  Quality Control is achieved through proper documented and validated interventions at Preanalytical, analytical and post analytical stages

Analyte Reference Intervals for Healthy adults* Glucose70 – 110 mg/dl Cholesterol<200 mg/dL Triglyceride<250 mg/dL ALT13 – 40 IU/L AST10–59 U/L Amylase27–131 U/L ALP U/L CK25 – 130 U/L GGT1-30 U/L

Ammonia40-80 μg/dL LDH100–190 U/L Total Bilirubin mg/d Direct Bilirubin<0.3 mg/dL Urea Nitrogen (BUN)6-20 mg/dL Creatinine mg/dL Uric acid mg/dL Total protein g/dL ( g/L ) Albumin g/dL ( g/L ) Cholinesterase4.9–11.9 U/mL Sodium (Na+) mmol/L Potassium (K+) mmol/L Calcium (Ca++) mg/dL

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