Add Quality Control and Blood Glucose Analysis

Quality-Control-and-Blood-Glucose-Analysis.md

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+<br>Editor's note: Katie Scheele, PMP, MBA, BSMT(ASCP), makes her debut as one of MLO's clinical experts. Now "retired and enjoying it," Katie was a Project Manager and worked at Mayo Clinic in Arizona from 1997 to 2014, managing clinical, administrative, Information Technology, and process improvement projects. Q: I have read a lot of information regarding Quality Control but have never seen this issue addressed. In the "olden days" you would send in your LJ charts for data comparison. Maybe three to four weeks later you would receive a group comparison report. You'd look at the data and perhaps make some mean (range) changes. Now, with instant reports, how often is "too often" to be making a mean change? Is one to two months too often to adjust the mean? Is there some type of general guideline on how often mean changes should be made? A: Laboratory quality control (QC) is designed to detect, reduce, and correct deficiencies in a laboratory's internal analytical process prior to the release of patient results.<br>
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+<br>Specimens that are analyzed for QC purposes are known as control materials. To minimize variation, control materials should be available over an extended period of time. Statistical process control is a set of rules that is used to verify the reliability of patient results based on statistics calculated from the regular testing of control materials. Westgard rules and Levey-Jennings charts are the statistical tools typically used by clinical labs. The mean, or average, is the sum of the control values divided by the total number of values. Any value outside of ±3s is considered to be associated with a significant error condition. For QC results, any positive or negative deviation away from the calculated mean is defined as random error. There is acceptable (or expected) random error as defined and quantified by the standard deviation (inside the ±3s limits. The change in the mean may be gradual and demonstrated as a trend in control values; this indicates a gradual loss of reliability in the test system.<br>
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+<br>In fact, trends are usually subtle. P-value: The probability value indicates the probability of observing the difference if no difference exists. CI around difference: A confidence interval around a difference that does not cross zero also indicates statistical significance. So how often is "too often" to change the mean and the range? It's all in the numbers. 1. Westgard JO. Westgard QC. 2. Laboratory Quality Control; Wikipedia. 3. Cooper G. Basic lessons in laboratory quality control. 4. Basar G. Quality control in the clinical laboratory. 5. Sauro J. Measuring usability, customer services, and experience. 6. Statistical Significance; Wikipedia. On the serum result,  [Glyco Care Supplementchromium support](https://ashandbloommush.com/index.php?title=User:KatharinaGrullon) our LIS highlighted it as "High" because it was greater than the upper limit of the reference range. 10%. My supervisor indicates that we should report the gray top results. My worry is that just comparing two results without considering the reference ranges and interpretation may lead to giving wrong results. From what I know fluoride oxalate in gray top stabilizes glucose after two to three hours but won't stop it from falling (breaking down) in the first hours.<br>
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+<br>And SST spanned and separated in time prevents glucose breakdown. Please advise me on this. A: Because serum glucose metabolizes in collection tubes, serum glucose levels may decrease over time.1 If the blood is allowed to clot, the glucose in the sample gets metabolized by the blood cells unless the cells are separated. If there are higher numbers of red or white blood cells, there is excessive glycolysis in the sample with [substantial reduction](https://www.travelwitheaseblog.com/?s=substantial%20reduction) of glucose level. Collection tubes have been designed to, at least partially, block glucose metabolism by red blood cells in blood collection tubes that may not be analyzed immediately after blood collection. Several sources recommend the use of grey top tubes for analyzing glucose levels.3-5 The anti-glycolytic properties in grey top tubes prevent the blood cells from using the glucose in the sample. The grey top tube contains potassium oxalate as an anticoagulant and sodium fluoride as a preservative that is used to preserve glucose in whole blood.<br>