The document discusses quality assurance in clinical laboratories. It defines quality assurance and distinguishes it from quality control. Quality assurance aims to minimize variability and ensure reliability of test results through quality control of all testing phases from sample collection to report delivery. This includes internal quality control, proficiency testing, and external quality assessment. Key phases addressed are pre-analytical, analytical, and post-analytical. Methods for ensuring quality like control charts, rules for identifying errors, and accreditation are summarized.
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
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.
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.
Global Manager Group has prepared presentation to provide information about Medical Laboratory Accreditation Standard - ISO 15189 and about Documentation kit. All the documents like quality manual, procedures, SOPs, audit checklist, etc that required for the ISO 15189 Certification process. are described in details in this presentation.
This is a series of notes on clinical pathology, useful for postgraduate students and practising pathologists. It covers all internal and external quality control techniques. The topics are presented point wise for easy reproduction.
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.
cytology of urine tract - this slide contains the specimen collection method, preparation of specimen, types of fixatives, other preparation techniques, urinary tract histology, normal urinary tract cytology,
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.
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.
Global Manager Group has prepared presentation to provide information about Medical Laboratory Accreditation Standard - ISO 15189 and about Documentation kit. All the documents like quality manual, procedures, SOPs, audit checklist, etc that required for the ISO 15189 Certification process. are described in details in this presentation.
This is a series of notes on clinical pathology, useful for postgraduate students and practising pathologists. It covers all internal and external quality control techniques. The topics are presented point wise for easy reproduction.
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.
cytology of urine tract - this slide contains the specimen collection method, preparation of specimen, types of fixatives, other preparation techniques, urinary tract histology, normal urinary tract cytology,
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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
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.
2. INTRODUCTION
definition
Aims & objectives
Quality assurance vs quality control : is it the same?
Definitions :
Components of quality assurance
Application in lab testing
Accreditation & Certification
3. QUALITY ASSURANCE : DEFINITION
“All steps taken by the director of the
laboratory to ensure reliability of lab results &
increase accuracy, precision & laboratory
comparability”
Aims
Minimize
variability in
results arising
from these
sources
Ensure the
reliability of
investigations
4. The Quality Assurance Cycle
•Data and Lab
Management
•Safety
•Customer
Service
Patient/Client Prep
Sample Collection
Sample Receipt
and Accessioning
Sample Transport
Quality
Control
Record Keeping
Reporting
Personnel Competency
Test Evaluations
Pre- analytical
Analytical
Post- analytical
5. Quality assurance
Quality control of
all phases of testing
from sample collection
to delivery of reports
Inclusive of quality
control
Quality control
Control of a specific
process in testing-
generally analytical
phase.
Component of quality
assurance
6. COMPONENTS OF QUALITY ASSURANCE
Internal
quality control
Proficiency
surveillance
External
quality
assessment
7. QUALITY ASSURANCE IN HEMATOLOGY LAB
CONTROL OF
PHASES
EXTERNAL QUALITY
ASSESSMENT (EQA)
PROFICIENCY
SURVEILLANCE
1. PRE- ANALYTICAL
PHASE
Errors : 60-70%
8. “ A TEST IS ONLY AS GOOD AS THE QUALITY OF THE SPECIMEN”
pt identification
& requisition
Pt preparation &
Sample collection
•Information
•Details of test
l
• tourniquet application
•Site
•Improper mixing
•Time of draw
•Pt condition
Sample transport &
storage
•Labeling
• refrigeration
Training of
personnel
9. QUALITY ASSURANCE IN HEMATOLOGY LAB
CONTROL OF
PHASES
EXTERNAL QUALITY
ASSESSMENT (EQA)
PROFICIENCY
SURVEILLANCE
1. PRE- ANALYTICAL
PHASE
Errors : 60-70%
ANALYTICAL
PHASE/ IQC
Errors: 5-15%
10. CONTROL OF ANALYTICAL PHASE
SOP & REAGENTS
MAINTENANCE OF NEW
INSTRUMENTS &
CALIBRATION
DETERMINE UOM &
LINEARITY
REFERENCE RANGE
DETERMINATION
PERSONNEL
REQUIREMENTS &
COMPETENCY TESTING
CONTINUING
EDUCATION
INTRODUCE QUALITY
CONTROL
11. A. STANDARD DEVIATION :
Mean ( x ) the total score of all the measurements
divided by the number of measurements
Standard deviation ( SD ) – variation in measurement
obtained in lab tests
formula: SD = Σ ( x – x )2
n – 1
n : number of observations
If value is between 2 S.D and 3 S.D----warning range.
*2 S.D.--- Warning limit
3 S.D--- alarm limit.
Imprecision expressed as S.D
IQC
12. Coefficient of variation (CV) / relative S.D:
used to compare the precision of results over a wide
range values when S.D would vary considerably.
C.V= S.D *100 %
x’
< 3% ---ideal
3% ---acceptable
CV is relation of SD to the actual measurement
IQC
13. COMPONENTS OF QUALITY ASSURANCE
INTERNAL QUALITY CONTROL (IQC)
continual assessment of day to day work carried
out, evaluation of results of tests done to decide
their reliability.
IQC
Precision
Linearity
Accuracy
Aims :
14. DEFINITION OF TERMS USED IN QA
PRECISION :
closeness with which
repeat measurements
on one sample agree.
May or may not be
accurate
ACCURACY:
measure of closeness
of an estimated value
to the true value.
Closer the value to
actual value, more
accurate it is
Data can be very precise but inaccurate
19. DEFINITION
Repeatability refers
ability of a
test/experiment to
be accurately
reproduced by the
same person
Reproducibility
refers the ability of
a test/ experiment to
be accurately
reproduced by
someone else working
independently.
PRECISION
While repeatability is desirable ; it is limited by practicability
20. QUALITY ASSURANCE IN HEMATOLOGY LAB
1. PRE- ANALYTICAL
PHASE
Errors : 60-70% ANALYTICAL
PHASE/ IQC
Errors: 5-15%
A. TESTING FOR
PRECISION
B. TESTING FOR
ACCURACY
21. A. TESTING FOR PRECISION:
1. QC USING CONTROL SAMPLES
At least one control / batch of specimen to be
analysed.
Large batch : 1 control/ 20 pt specimens.
Use methods of dispersion
eg: SD, CV
Prepare control charts
IQC
23. A. CONTROL CHARTS
Described by Shewhart, applied by Levey &
Jennings.
Samples of the control sp are plotted on control
chart
To check precision, it is not needed to know the
exact value of the control sp.
IQC
24. 0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
LJ CONTROL CHART
+3 sd
-3 sd
+2 sd
-2 sd
-1 sd
+1 sd
Target value
time -x axis (run)
Y
r
e
p
v
al
u
e
IQC
25. One widely deviant result outside 3 S.D
GROSS ERROR.
2 or more results on or outside 2 S.D
RANDOM ERROR.
Several consecutive values on one side of mean
CALIBERATION FAULT.
Consecutive values constantly rising or falling
CONTINUING BIAS/ ERROR.
INTERPRETATION
IQC
26. TYPES OF SYSTEMIC ERRORS:
Inaccurate but precise – systemic error
Shift: Abrupt change in the control mean.
A sudden and dramatic change positive or negative
change in test system performance.
Trend: gradual loss of reliability in the test system.
28. CAUSES OF SHIFT:
1. Light source
2. Reagent formulation
3. Major instrument Maintenance
4. Room temp
5. Failure in the sampling system/reagent
dispensing change in reagent formulation lot
6. Major instrument maintenance/change in room
temp or humidity
7. Failure in the reagent dispense/inaccurate
calibration or recalibration
29. CAUSES OF TREND:
1. Deterioration of the instrument light source
2. Gradual accumulation of debris in sample
reagent tubing.
3. Aging of reagents
4. Gradual deterioration of control materials.
5. Gradual deterioration of incubation chamber
temperature
6. Gradual deterioration of calibration
30. RANDOM ERROR
Impression computed as random error
A random deviation from an expected result
Causes:
1. Improperly mixed/dissolved reagents.
2. Airbubbles in reagents and reagents
lines,sampling or reagent syringes
3. Pipette tips is not fitting properly
4. A clogged pippetor (Clot)
5. Unstable temp and incubation
6. Unstable power supplu
31. CAUSES OF RANDOM ERROR CONTINUE:
7. Poor operator techniques
8. Improper mixing of processed samples.
9. Incorrect reconstitution of the control
material.
32. Westgard has formulated rules to decide
whether an analytical run in in cotrol or out of
control.
These rules can be applied as single rules and as
group of rules(multi rules)
Applied only if QC are plaotted with the range of
3 SD.
WESTGARD RULES:
IQC
33. RULES FOR WHAT?
Two key factors to keep in mind while
selecting/using rules are:
Maximize error detection:
Per cent error detection (P ed) > 90%
Minimize False Rejection:
Percent False rejection ( P fr) <5%
34. While talking about QC rules nomenclatures we
have to understand 2 sets of nomenclatures
1. N and L
2. Within/across the run/material
36. CONTROL RUN NOMENCLATURE 2:
With-run/Across material: At 2/3 levels of QC
in the same run
Across run/Within material: same level of QC
but in 2 or consecutive run.
Date QC levels
Day 1 Level 1 Level 2 Level 3
Day 2 Level 1 Level 2 Level 3
Day 3 Level 1 Level 2 Level 3
Day QC levels
Day 1 Level 1 Level 2 Level 3
Day 2 Level 1 Level 2 Level 3
Day 3 Level 1 Level 2 Level 3
38. WESTGARD – 1 2S RULE
“warning rule” Denotes a random error or the
beginning of a systemic error
One of two control results falls outside ±2SD
Not cause for rejecting a run.
Important : If only one level of QC is being run
in the lab,1:2S has to be rejection rule.
IQC
39. 12S RULE = A WARNING TO TRIGGER CAREFUL
INSPECTION OF THE CONTROL DATA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Mean
Day
+1SD
+2SD
+3SD
-1SD
-2SD
-3SD
12S rule
violation
IQC
40. WESTGARD – 13S RULE
If either of control results falls outside of
±3SD, rule is violated
Denotes a random error or beginning of a large
systemic error.
Run must be rejected
If 13S not violated, check 22S
IQC
41. 13S RULE = REJECT THE RUN WHEN A SINGLE
CONTROL MEASUREMENT EXCEEDS THE +3SD OR -3SD
CONTROL LIMIT
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Mean
Day
+1SD
+2SD
+3SD
-1SD
-2SD
-3SD
13S rule
violation
IQC
42. WESTGARD – 22S RULE
2 consecutive control values for the same level
fall outside of ±2SD in the same direction(across
the run) or
Both controls in the same run exceed ±2SD
(within run).
This rule identifies systemic error only.
Requires corrective action
IQC
43. EXAMPLE OF 2:2S
If a normal (level 1)and abnormal (level II) control
are
>2S on the same side of the mean
This run violates the within run application for
systemic error.
o If However, level I is acceptable and Level II is
1:2S,the level II result from the previous run must
be examined.
o If Level II in the previous run was
At +2.00 S or greater
Then the across run application for systematic error
is violated.
44. 22S RULE = REJECT THE RUN WHEN 2 CONSECUTIVE
CONTROL MEASUREMENTS EXCEED THE SAME +2SD OR -
2SD CONTROL LIMIT
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Mean
Day
+1SD
+2SD
+3SD
-1SD
-2SD
-3SD
22S rule
violation
IQC
45. WESTGARD – R4S RULE
One control exceeds the mean by –2SD, and the
other control exceeds the mean by +2SD
The range between the two results will
therefore exceed 4 SD
This test should only be interpreted within run
,not across run..
Random error has occurred, test run must be
rejected
IQC
46. R4S RULE = REJECT THE RUN WHEN 1
CONTROL MEASUREMENT EXCEED THE +2SD AND
THE OTHER EXCEEDS THE -2SD CONTROL LIMIT
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Mean
Day
+1SD
+2SD
+3SD
-1SD
-2SD
-3SD
R4S rule
violation
+1SD
IQC
47. WESTGARD – 41S RULE
Requires control data from previous runs
Four consecutive QC results for one level of
control are outside ±1SD, or
Both levels of control have consecutive results
that are outside ±1SD
IQC
48. WESTGARD – 10X RULE
Requires control data from previous runs
Ten consecutive QC results for one level of
control are on one side of the mean, or
Both levels of control have five consecutive
results that are on the same side of the mean
IQC
50. QC Data
12S
13S 41S
R4S
22S 10x
Report Results
Take corrective action
Flowchart and logic for the multi-
rule internal quality control (IQC)
procedure commonly known as
‘Westgard rules’
IQC
51. QUALITY ASSURANCE IN HEMATOLOGY LAB
1. PRE- ANALYTICAL
PHASE
Errors : 60-70% ANALYTICAL
PHASE/ IQC
Errors: 5-15%
A. TESTING FOR
PRECISION
B. TESTING FOR
ACCURACY
53. POST- ANALYTICAL PHASE:
review of pt results.
Posting pt results after checking for reliability
Highlighting abnormal results
Effective information conveyed to requester
Maintaining patient records
Maintaining all documentation
1. errors while testing
2. spillage of samples
3. internal & external complaint register
monitoring of turnaround time ( TAT)
54. Purpose – to achieve harmonization concordance b/w labs
Principle: same material is sent from a national or regional
centre to a large number of laboratories
All the labs send the results back to the centre where
they are analyzed and interpreted by one of several
procedures
From the results returned from the participants, the
median or mean and SD are calculated
An individual lab can then compare its performance in the
survey with that of other labs and with its own previous
performance ( using deviation index )
EXTERNAL QUALITY ASSESSMENT:
55. A deviation index ( score ) =
actual results – weighted mean for test
weighted SD
Interpretation :
0.5 – excellent
0.5-1.0 – satisfactory
1.0- 2.0 – acceptable
> 2.0 – defect requiring attention
EQA
56. REFERENCES :
Quality assurance with special reference to
hematology : Dr. SOOD ;
Sir Ganga Ram Hospital , New Delhi
Shirlyn McKenzie : textbook of hematology
Dacie & Lewis
Quality assurance – working manual .
