Dear viewer,

We at EFLM believe that patients and their carers should

have ready access to information about healthcare
issues that affect them and particularly laboratory
medicine, our field of expertise, so that you can better
understand what happens when laboratory tests are
done, how this is managed and what it means for you.
We hope you find this interesting and helpful and would
appreciate your feedback.
Dr Ian D Watson PhD FRCPath EuSpLM
Chair EFLM Working Group on Patient Focused Laboratory Medicine
 What happens to my
blood sample?
Dr Ian D Watson
MSc, PhD, FRCPath, FIBMS, Dip Med Tech, MCMI, FACB

Formerly Clinical Director &

Consultant Clinical Biochemist & Toxicologist
Dept Clinical Biochemistry
University Hospital Aintree, Southport & Ormskirk
Hospital & The Walton Centre
Educational Material: EFLM WG Preanalytical phase
https://www.eflm.eu/site/page/a/1194
The journey of a blood
sample from patient
to results
The journey of a tissue
sample from patient
to laboratory and
back to patient
Factors in providing a quality
clinical laboratory service

Pre-analytics

Analytics

Post-analytics

Quality metrics

Point of Care Testing

Self Testing
 Pre-analytics

Consultation

Differential diagnosis

From history

From examination

Which Investigations

Laboratory

Radiology

Other
 Pre-analytics

Preparation for a test

Fasting

Time of day

Taking a sample

Blood

Urine

Other
Pre-analytics: Blood

Blood sample type

Type of preservative

Order of drawing blood

Contamination
Pre-analytics: Other samples

Tissue

Urine

Faeces

Sputum

Wound fluids
Pre-analytics

Patient Identification

Name, dob, location/address

Sample identification

Bar-code label

Rfid

Sample preparation

Aliquot
Logging patient details into
the LIMS
Pre-analytics

Risk

Infection

E.g. Hepatitis, Ebola

Transportation

Speed

Clinical need

Analyte instability

Temperature

Analyte instability

Factitious results
Pre-analytics

Receipt

Confirm identity

Centrifuge for serum or plasma

Rack to analytical station

Pathology Specialties

Biochemistry

Ions, metabolites, hormones, drugs

Haematology

Red and white cells, marrow, clotting,

Microbiology

Bacteria, viruses, yeasts,
Pathology Specialties

Genetics

Malformation, metabolic, oncology,
bacteria

Histopathology

Tissue: oncology, post mortem,

Immunology

Antibodies, immune reaction
Biochemistry: How many
tests?

In Aintree Biochemistry we handled
around 2500 samples a day

With ~ 6 tests/sample

That’s 15000 test/day

Around 5 million tests per annum
Analytics

Automation

High volume

Tracked

Robotics

Manual

Small volume

Complex

specialist
Analytics

Near the patient (Point of Care Testing)

Local Hospital (Primary)

Common tests

Teaching Hospital (Secondary)

More specialist or complex tests

Specialist Centres (Tertiary)

Rare or highly complex tests
Measurement of blood gases

pH (Hydrogen ions)

pCO2 (Carbon dioxide)

pO2 (Oxygen)

Metabolic

Respiratory

Acidosis

Alkalosis
Blood Transfusion

Group blood for transfusion

ABO

Rhesus

Screened for infections

Microbiology
Microbiology: Sugar fermentation
characterises types of bacteria
Antibiotic resistance
A 24/7 operation
Secondary/Tertiary Level Tests

Neuroimmunology

Metabolic Disease

Unusual Poisonings

Atypical bacteria

Atypical tumours

Specialist advice and second opinions
Post-analytical
Consultant review of results
Point of Care Glucose meter
Staffing

Lab Assistants/clerical: sample
reception & ‘booking in’

Technical staff: analysis &
measurement

Clinical staff: Interpret results advise
hospital clinicians and GPs

All services Consultant led:
Fellows of the Royal College of
Pathologists
Departments

Clinical Biochemistry

Haematology & Blood Transfusion

Microbiology

Cellular Pathology & Cytology

Referred:

Immunology

Virology

Specialist Tests
 Professional standards

CPA: Clinical Pathology Accreditation

All staff [except Assistants] Degree entry
minimum

Professional staff State Registered

Continuing Professional Development (CPD)

Revalidation
Confidentiality

Need to know for patient data

Identification

Clinical context

Strict adherence to Data Protection Act

Disciplinary offence to abuse position of
confidentiality

Cause loss of registration: lose job and
unemployable
Safety

Strict adherence to Microbiological
safety

Strict adherence to chemical safety

Sharps disposed of in approved manner

Protective clothing to be worn

Strict Health & Safety policies
GP

Work collected in vans and results
returned electronically

90% of chemistry/haematology results
returned within 24 hours

Want GPs to order on-line

Some tests nearer the patient

Maximum wait for a test result ~4
weeks for really rare, unusual tests
Hospital

Linked to Vacuum chute

A&E results back in < 1 hour

Routine back in ~2-3 hours.

Maximum wait for a test result ~4
weeks for really rare, unusual tests
Lab Tests Online –
…bringing
Pathology Labs
closer to Patients.
www.labtestsonline.org.uk
Lab Tests Online –
…bringing
Healthcare Science
closer to Patients.
www.labtestsonline.org.uk
Health information on the Net

General sites e.g. BBC Health Medical
Notes

NHS resources – NHS Direct Online

Specific conditions e.g. Diabetes UK

Patients’ organizations & self-help

Commercial sites

Search engines e.g. Google

- vast amount of unregulated info.

Lab Tests Online

www.labtestsonline.org

American Association for Clinical
Chemistry

US Based
 Lab Tests Online

Launched August 2001

Designed for patients and carers

Reflects US…

medical practice

test protocols (just-in-case testing philosophy)

emphasis on personal health care management

expenditure on health care

FDA regulations

Very Popular
Lab Tests Online
Aim…
to provide easily accessible and
understandable information about laboratory
tests, and so reduce the fear & anxiety felt by
patients when their doctor declares…

‘I’d like you to have some blood tests'.

Lab Tests Online UK

ACB Awarded grant by

The Health Foundation in 2002

Funding secured for 3 years

Content and framework licensed from US
originators

Completely revised for the UK
Lab Tests Online UK
Lab Tests Online UK

Sections

Inside the Laboratory

Understanding your Tests

Conditions and Diseases

Screening

Topics in the News
Understanding Your Tests

Tests -

What are they & how are they used?

Reference Ranges

How reliable is laboratory testing?

Screening

Home testing (POCT)
 Understanding Your Tests

At a glance

Sample

Test

Questions

Ask us
Topics in the news
Spreading the word..

Distribution through local hospital labs.

Lab Tests Online Information Cards

Available in GP surgeries & Hospital Clinics

Site information (how it might help you…)

Space to record specific tests

Web access details
www.labtestsonline.org.uk