Haemoglobin quality control is important for blood donor selection and ensuring donor safety. The document discusses maintaining Levey Jennings charts to monitor internal quality control of haemoglobin measurements using a Hemocue analyzer. Westgard rules are applied to the charts to detect random errors like those caused by new staff and systematic errors indicating issues like reagent problems. Maintaining quality control through daily, weekly and monthly checks helps assure accurate haemoglobin results.
Internal quality control (IQC) in coagulation labAnkit Raiyani
In the haematology laboratory it is essential to ensure that the right test is carried out on the right specimen and that the correct results are delivered to the appropriate recipient without delay.
Quality control (QC) is defined as measures that must be included during each assay run to verify that the test is working properly.
Internal quality control (IQC) is monitoring the haematology test procedures to ensure continual evaluation of the reliability of the daily work of the laboratory with validation of tests before reports are released
Quality in clinical laboratory is a continuous journey of improving processes through team work, innovative solutions, regulatory compliance with final objective to meet the evolving needs of clinicians & patients.
Internal quality control (IQC) in coagulation labAnkit Raiyani
In the haematology laboratory it is essential to ensure that the right test is carried out on the right specimen and that the correct results are delivered to the appropriate recipient without delay.
Quality control (QC) is defined as measures that must be included during each assay run to verify that the test is working properly.
Internal quality control (IQC) is monitoring the haematology test procedures to ensure continual evaluation of the reliability of the daily work of the laboratory with validation of tests before reports are released
Quality in clinical laboratory is a continuous journey of improving processes through team work, innovative solutions, regulatory compliance with final objective to meet the evolving needs of clinicians & patients.
Troubleshooting QC Problems: Your QC has failed, what do you do next?Randox
Randox Quality Control's next 'Improving Laboratory Performance Through Quality Control' educational guide has been published with helpful tips that your laboratory can use in order to ensure it has effective troubleshooting procedures in place.
So you ran QC this morning and realised that one of your analytes has been flagged as 'out-of-control', what do you do next? Do you ignore the warning and continue patient testing, repeat the control until it's within range or do you halt patient testing and investigate the source of the error?
When it comes to troubleshooting QC errors, unfortunately there is no easy path to take. However, it's important that you have standard operating procedures in place, outlining what to do in the event of an out-of control error. Errors occur in laboratories all over the world. A lab with effective troubleshooting procedures in place will still have errors but will be able to detect them, quickly reducing their impact and reducing the risk of wasting both time and money.
Laboratory Internal Quality Control presentation master revision, 2014Adel Elazab Elged
Short presentation about using internal quality control material in clinical laboratory to ensure analytical quality laboratory results for the sake of better patient care and minimizing errors in diagnosis, management, and follow up.
Quality control (QC) is a procedure or set of procedures intended to ensure that a manufactured product or performed service adheres to a defined set of quality criteria or meets the requirements of the client or customer. QC is similar to, but not identical with, quality assurance (QA).
QC IN clinical biochemistry labs and hospitals
Validation of lab instruments and quantitative test methods Mostafa Mahmoud
This lecture shows the procedures applied when going to validate your laboratory instruments and quantitative test methods also either FDA approved or laboratory developed tests.
Troubleshooting QC Problems: Your QC has failed, what do you do next?Randox
Randox Quality Control's next 'Improving Laboratory Performance Through Quality Control' educational guide has been published with helpful tips that your laboratory can use in order to ensure it has effective troubleshooting procedures in place.
So you ran QC this morning and realised that one of your analytes has been flagged as 'out-of-control', what do you do next? Do you ignore the warning and continue patient testing, repeat the control until it's within range or do you halt patient testing and investigate the source of the error?
When it comes to troubleshooting QC errors, unfortunately there is no easy path to take. However, it's important that you have standard operating procedures in place, outlining what to do in the event of an out-of control error. Errors occur in laboratories all over the world. A lab with effective troubleshooting procedures in place will still have errors but will be able to detect them, quickly reducing their impact and reducing the risk of wasting both time and money.
Laboratory Internal Quality Control presentation master revision, 2014Adel Elazab Elged
Short presentation about using internal quality control material in clinical laboratory to ensure analytical quality laboratory results for the sake of better patient care and minimizing errors in diagnosis, management, and follow up.
Quality control (QC) is a procedure or set of procedures intended to ensure that a manufactured product or performed service adheres to a defined set of quality criteria or meets the requirements of the client or customer. QC is similar to, but not identical with, quality assurance (QA).
QC IN clinical biochemistry labs and hospitals
Validation of lab instruments and quantitative test methods Mostafa Mahmoud
This lecture shows the procedures applied when going to validate your laboratory instruments and quantitative test methods also either FDA approved or laboratory developed tests.
Histograms are frequency charts. In Lean Six Sigma, they show the distribution of values produced by a process. In other words, a histogram is a visual display of how much variation exists in a process.
https://goleansixsigma.com/histogram/
A Pareto Chart is a quality chart of discrete data that helps identify the most significant types of defect occurrences.
https://goleansixsigma.com/pareto-chart/
Control Charts are time charts designed to display signals or warnings of special cause variation.
https://goleansixsigma.com/control-chart/
Seven QC Tools Training; Control Charts (Mean Chart and Range Chart)Shakehand with Life
Seven quality tools training is incomplete without learning of control charts. Control charts help to control the process with in the set control limits. Control charts are mainly two types; Mean Chart and Range Chart. Mean chart showcase the process data complied by the designated person and signal when the data go beyond the control limits. Every process has variation and due to this variation data get fluctuated. This fluctuation shown on the mean and range chart by data points. The causes of fluctuation in the data are assignable and common causes. Due to common causes data fluctuated around the average of the data but due to assignable cause data go beyond the control limits. When data go beyond the control limits control charts warn the operator that something is going wrong in the process and need to special attention. Mean chart is the spread of the mean values of the samples around the mean line. Range chart is spread of the range of samples around the mean line of range.
X‾ -R Chart maximum utilization of information available from data & provide detailed information in process average & variation for control of individual dimensions.
QC Multi-rules are designed and used to minimise false rejections and maintain a high rate of error detection. There are six main rules used to determine if results from a run of patient samples should be accepted or rejected, based on the performance of control materials against the rule criteria. Different combinations can be applied depending on the number of controls in use, total allowable error and the instrument in use. The flow chart below is often used to determine if a run should be accepted or rejected.
QC Multi rules - Improving Laboratory Performance Through Quality ControlRandox
Randox Quality Control's latest educational guide examines and explains what QC Multi-Rules are, How to identify an out of control event with QC rules, How to use QC Multi-Rules, The different types of analytical errors, The tools to assist labs and how a lab can troubleshoot QC errors.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Haemoglobin quality control by maintaining levey jennings chart
1. Haemoglobin Quality Control
By: Dr Rashmi Sood
Consultant & Incharge
Department of Transfusion Medicine & Immunohematology
Saket City Hospital , New Delhi
By Maintaining
“LEVEY JENNINGS chart”
2. Pre -do natio n Haemo g lo bin
scre e ning
Pre-donation Hemoglobin screening
Is an important and foremost tests done for blood donor selection.
For blood donation, the minimum acceptable hemoglobin (Hb) is 12.5 g/dl or
haematocrit (Hct) of 38% for both males and females.(1)
This level is set :
1.to ensure that donors have enough blood to give and also have enough iron available
in their bodies to make more blood after they donate.
2. for preventing blood collection from an anaemic donor.
(1)The Indian Drugs and Cosmetics Act, 1940 .
3. .
An appro priate Hb scre e ning
me tho d
Should be available for blood collection
So as to accept as many suitable donors as possible and to prevent
any inappropriate deferrals.
Method for Hb screening should
o Save time
o Be Cost effective
o Be accurate and easily validated for Internal Quality control
4. Various methods of hemoglobin
estimation in Blood
Banks
1.Semi-quantitative gravimetric copper sulfate (CuSO4) method
2.Cyanmethemoglobin spectrophotometric method
3. HemoCue Hb photometer azidemethemoglobin test system - a portable,
battery-operated photometric device for rapid determination of hemoglobin.
4. WHO hemoglobin color scale (HCS) , at places where laboratory based
hemoglobinometry methods are not available.
5. Automated hematology analyzers.
6. Using Hemocue in the Blood Bank
Calibration: factory calibrated needs no further calibration.
(Against the ICSH-International Council for Standardization
in Haematology Reference Method.)
Quality control: Liquid controls ,Eurotrol Hemotrol
Daily Quality control and Periodic Verification of
the precision and accuracy of the system :
Done as per local guidelines
using manufacturer recommended stabilized control reagents
7. Using Hemocue in the Blood Bank
These stabilized control reagents (by the name Eurotrol Hemotrol) are
produced in three physiologically relevant levels-
Low (7.8-8.2gm/dl),Normal(11.8-12.2gm/dl)and
High(15.8-16.2gm/dl).
Results were recorded in separate laboratory registers
and subsequently transcribed into the LJ charts.
8. QUALITY ASSURANCE & QUALITY
CONTROL
Quality Assurance is process oriented and focuses on
defect prevention.
It is a set of activities for ensuring quality in the processes
by which products are developed.
Quality control is product oriented and focuses on
defect identification.
It is a set of activities for ensuring quality in products ,the
activities focussing on identifying defects in the techniques of
producing products .
9. INTERNAL QUALITY CONTROL &
EXTERNAL QUALITY CONTROL
IQC is used on daily basis
IQC helps to decide whether to accept or reject results of patient
samples
IQC refers to the process of minimizing analytical(Testing)
errors related to operational techniques and activities.
10. EXTERNAL QUALITY CONTROL
EQC – comparison of quality between the laboratories.
EQC confirms results of IQC.
11. INTERNAL QUALITY CONTROL
in Hb measurement
Internal Quality control data for Hb measurement is most easily visualized using Levey Jennings (LJ)
Chart
A visual indication of the Internal Quality
Dates of analyses plotted along the X-axis and control values plotted on the Y-axis.
Mean and one, two, and three standard deviation limits are also marked on the Y-axis.
Distance from the mean is measured in standard deviations.
12. Levey Jennings (LJ)Charts
Named after S. Levey and E. R. Jennings who in 1950 suggested
the use of Shewart’s individual control chart in the clinical
laboratory .
LJ charts plot daily QC values .
13. Westgard Rules for Evaluation
of LJ charts for QC
Westgard rules are applied to
Interpret daily QC values on the LJ charts
whether the results are in -control or not
whether they can be released, or need to be rerun.
Indicate the type of laboratory error
the pattern of plotted points is noted
to detect random errors and shifts or trends of the performance
in Hb measurement .
(Ref :Grant, E.L. and R.S. Leavenworth (1988). "Statistical Quality Control", Sixth Edition,
McGraw-Hill Book Company.)
14. Application of LJ charts for QC
Stable control material/s which mimics patients sample
are analyzed (day to day) by plotting a mark daily on
the control chart(Levey Jennings Chart).
Evaluation whether measurements is in control done
using Westgard multi–rules.
The distance from the mean is measured in standard
deviations (SD).
Lines run across the graph at the mean, as well as one,
two or three standard deviations on either side of the
mean.
15. Calculation of Control Limits
Standard deviation calculated from the following
equations:
17. Westgard rules
Formulation of Westgard rules is based on statistical
methods.
Westgard rules are used to detect both random and
systematic errors.
Can be programmed on to automated analyzers .
Careful application to prevent false rejections.
18. Application of the Rules
The 12s rule is used as a warning rule and prompts a more
detailed inspection of the data using the other control rules.
If neither control observation exceeds a 2s limit, the analytical
run is in-control and patients’ data may be reported.
If either observation exceeds a 2s limit, the control data are
tested by applying the13s, 22s, R4s,41s, and 10x rules.
If none of these rules is violated, the run is in-control.
If any one of them is violated, the run is out-of-control.
19. Westgard rules -Control Rules
(Decision Criteria)
12s- the control rule where one control observation exceeds
control limits set as x ± 2s.
The warning rule for a Shewhart chart and is interpreted
as a requirement for additional inspection of the control data.
13s - the control rule when one control observation exceeds
control limits set as x ± 3s.
Run is rejected.
20. Westgard rules-Control Rules
(Decision Criteria)
22s - is the control rule when two consecutive
control observations on same control or two
observations within a run, one on each of two
different control materials, exceed the same
limit, which is either x + 2s or x - 2s.
the run is rejected
21. Westgard rules-Control Rules (Decision
Criteria)
R4s control rule
when the range or difference between the two
control observations within the run exceeds 4s.
run is rejected
22. Westgard rules-Control Rules (Decision
Criteria)
41s control rule
when four consecutive control observations exceed the
same limit, which is either x + 1s or x - 1s.
the run is rejected
23. Westgard rul e s - C o n t r ol Rules (Decision
10x control rule
Criteria)
the run is rejected when 10 consecutive observations fall on the
same side of the mean (x).
These consecutive observations can occur within one control
material or across control materials. This would require
inspection of 10 or five consecutive runs, respectively.
24. Applying the control rules -Random and
Systematic Errors
Type of errors:
(i) Random errors (affect precision) – Usually 13s and R 4s
errors
These errors can either be positive or negative.
Their direction and exact magnitude cannot be predicted.
Usually are due to error in Techniques.
25. Applying the control rules -Random and
Systematic Errors
(ii) Systematic errors (affect accuracy) – Usually 22s, 41s and 10x errors
/or Inaccuracy
They are always in one direction.
They displace the mean of the distribution from its original value.
When the change in the mean is gradual, it is demonstrated as trend in
control values .
When the change is abrupt, it is demonstrated as shift in the control
values.
Cause all the test results to be either high or low.
Usually due to change in testing process.
27. Level of QC applied in a laboratory
The level of QC (Low, Normal, High) applied varies according to the
number of specimens analyzed per day.
The following protocol may be adopted according to the total number of
specimens analysed :
Less than 40 per day - apply at least one level (Low,Normal,High) QC
once a day.
Between 40-80 per day - apply two level QC at least once a day.
More than 80 per day - apply two level QC at least twice a day.
28. Material & Methods of the study
A prospective study at our centre.
Over a period of 1 year1 month.
Hemo –Controls (Eurotrol): Low Control (7.8 to 8.2gm/dl ) High
Control ( 15.8 to 16.2 gm/dl ) Normal Control ( 11.8 to 12.2
gm/dl) were run in the Hemocue machine daily and Levey –
Jennings chart were maintained .
29. Results
Study was carried out from July 2013 to Aug 2014
Deviation observed in low QC – control value no 07 in Jan14
Deviation observed in normal QC- control value13 in Jan14
Deviation observed in high QC- control value 14 in Feb14
1 Standard Deviation
Deviation sorted out after re testing.
They disappeared on retesting.
Change of the staff doing the test was the reason found for these
random errors .
30. Corrective Actions
For responding to out-of control situations , guidelines should be established and
properly implemented.
Withhold patients’ results till the out of control situation is sorted out
Identify the cause of the problem
Avoid false rejections.
Start with checking the simplest and most frequent faults and continue further
depending on the method and the equipment involved.
It is essential to determine the type of error (random or systematic) in order to
specifically correct the problem.
(i) Random errors (affect precision) – Usually 13s and R 4s errors
(ii) Systematic errors (affect accuracy) – Usually 22s, 41s and 10x errors
31. Common causes of erroneous results
Control material viscid as was in the refrigerator
Insufficient mixing of the samples
Presence of air bubbles in the cuvette
Excess blood on the back of the cuvettes, due to over filling
Reading the results too soon or too late (beyond 10 minutes)
Filling from the optical eye rather than the filling end
32. Remedy
Bring controls to room temp before testing
Check control storage conditions
Check control expiry date/contamination
Mix samples adequately
Adequate training on the technique of proper filling the cuvettes to
avoid air bubbles and over filling
33. Remedy
Reading result after few seconds of filling the cuvette
Repeat QC from the same vial or fresh vial taken out
from the refrigerator or from a fresh QC lot
Relate causes to any recent changes
34. Conclusions
Quality control data is most easily visualized using a
Levey Jennings chart.
We suggest, all blood banks to maintain L-J chart as a
Quality Indicator to validate the working of the Hemocue.
35. References
Ref:
1. Hemocue Hb 201+ Operating Manual, Page 20-21
2.Grant, E.L. and R.S. Leavenworth (1988). "Statistical
Quality Control", Sixth Edition, McGraw-Hill Book Company
3.GUIDELINES FOR GOOD CLINICAL LABORATORY PRACTICES (GCLP)
Indian Council of Medical Research New Delhi 2008
4.Westgard, J.O, P.L. Barry, and M.R. Hunt (1981). "A Multi-rule
Shewhart Chart for Quality Control in Clinical Chemistry, “Clinical
Chemistry, vol. 27, pp. 493-501