Question examples- mix Flashcards
1
Q
Batch of collection tubes unsuitable post sample collection, results released based on in control QC - approach?
A
- Investigate exactly what the issue was - significant
- Bring up (if possible) all runs/sample results that may have had the batch of collection tubes
- look at QC
- look at results - delta check, qualitative change
- rerun using correct tubes - determine if affected or unaffected (10-15% accept , no chnage qualitatively)
- also can run RCPA, known patient samples in unsuitable tubes to see how far out - If affected
- amend results, redact
- phone reqeustor open disclosure
- CAR/Riskman depending
- may need recollection - if unaffected
- can notify still but reassure, contact number - CAR
- root cause
- preventative - Bring up quality/management meeting
- education
- training - Monitor
2
Q
HIV pos Ag/Ab screen, then WB result pos
clinician says result is wrong - approach
A
- Investigate
- why wrong
- take seriously - Investigate
- post analytical; transcription error, data entry issue
- analytical; check QC, procedure followed, result correct, correctly interpreted
- preanalytical; primary tube, patient, - Was wrong patient
- immediate redaction
- amend report
- open disclosure/patient notification
- CAR form
- need to check rest of run ensure other results correct - CAR
- root cause
- education, training
- bring up at quality meeting
- preventative action; secondary checks, automated methods for aliquoting - SAC level
- serious harm to patient but not permanent level 2 or 3?
3
Q
TTG serology reporting
report < CU quantitatively, interpretive comment
alternative practitioner asks about actual value of neg result
A
- Investigate
- rationale
- clinical utility - Explain
- current lab procedure
- manufacturers guidelines w kits
- literature about how it is not useful beyond current report procedure - change
- consider if useful
- but likely not
- can also state EQAP, other lab performance, talk about cost, workflow etc
4
Q
Recently reporting out many 1:80 nucleolar ANAs and fielding lots of GP calls about the significance about this pattern- what is your approach in looking into the problem?
A
- audit recent nucleolar ANAs
- is there a true trend? Vs past months
- select specimens and double read- ?true VS false reading
- QAPs if nucleolar reported and missed target/method group
- correlate with ENA modality
If the issue is
- overcalling/error then re training /education/awareness/supervision
- true trend but not significant re clinical/ENA- then ?substrate
- talk to manufacturer
- consider changing to another substrate
- consider raising threshold for reporting to higher titre
5
Q
QAP result out- approach
A
- Investigate
- out by, how, VS target
- method group
- that run on the day - Random vs systemic error
- pre/ana/post ana
- end of cycle/prev/perf report - Repeat sample
- Other runs
6
Q
QC Levey Jennings- out- apparoach
A
- Investigate
- QC trend
- new lot ?
- repeat QC - QC lot issue vs instrument issue
- other QCs
- other results
- run old samples? - Call manufacturer
- CAR
- Minimise harm
7
Q
Discrepancy with another labs result- approach
A
- Investigate (only our lab)
- pre/ana/post
- method difference
- QC/EQAP result
- qualitative difference? - Decide which lab has made an error VS platform/method difference
- limitations of assay
- other clinical approaches to solve issue - Offer repeat testing/other method third line,
- CAR?
8
Q
Immunoblot result for myositis; multiple low level positives- approach
A
- Talk to clinician
- Clinical status
- Indication for testing
- Other tests performed - Exclude lab error
- look at how cut offs established/decided
- reporting protocol of lab - Limitations of method
- Specificity unlikely to be as high as we think
- Interferences possibly
- Need clinical correlation
- Correlate with other methods- ANA, others not readily available (IP/WB)
9
Q
What is the significance of this result?
A
- explain usual specificity/correlation
- found in naturally occuring (elderly, normal?)
- differentials
- clinical correlation
