.

Albumin . 6.33% 3430 albumin 27g/L . TPN 51% 33.6% . 15000 1 U$ 225 .

, WBC : 4,000 - 10,000/cmmABGA : PO2 : 75 mmHg O2 saturation : 92% pH : 7.35 - 7.45

. , , . , , , . , , . , . .

(1) . . . .

(2) .

- - - - - - - -

2 Hb 10g/dL : reticulocytes countElectrophoresis immunoelectrophosisLeukemia : immunological marker study, molecular testsAHGT : unexpected antibody

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1. 2. 3. 4. 5. 6. ,

Laboratory TestsScreening testConfirmatory testProfile/battery testHealth screening testStat testPOCT(point of care testing)

Profile Tests (SNUH)Routine CBCCoagulation panelThrombosis panel-A,BPlatelet aggregation Routine urinalysisRoutine stool exam.Admission panel

Liver panelLipid panel-A, -BLipoprotein profileElectrolyte panelType & screeningBody fluid-routine testBody fluid-chemistry

Health Screening TestsHb, Hct, WBCAST, ALT, GGT, HBsAgSerum/Urine glucose CholesterolVDRL, HIV(?)

Stool occult bloodCreatinine, BUNCervical cytologyProstate specific AgGastroscopyColonoscopy

(CBC). ( BT, PT, APTT)(ABO, Rh) (admission battery) (Na, K, Cl) (HBsAg, anti-HBs)AIDS(Anti-HIV)

: 2 , : 3 / : ,

(PT) (APTT)

Specimen & Storage(I)EDTA tube SST tubeMicro-samplingNo hemolysisSafety : HIV etc.

Specimen & Storage(II)Blood gas : heparinized syringe, ice cubeCoagulation test : citrate tube, ? 1 : 9 24 hrs urine : 7:00 am(-) 7:00 am(+)Pleural/Joint fluid cell count(EDTA)Sputum for M. tuberculosis : conseq. 3 daysSerum separation within 2 hrs

(1998) : 706 : 192 ( Big 5 ) POL() : 1,500 : 3.3% : 2.7% : 5.7% : 500 : 30,000 : 1,200 : 10%

Univ. Hospital (64)Hospital (500)Commercial Lab (5)Local Commercial Lab (120)(low esoteric assay)Clinics (18,000) with or without POL(low esoteric assay)Integrated Laboratory System in Koreaesoteric assaysesoteric assaysesoteric assaysesoteric assay

Automation, Laboratory Information systemSystematization (Total Laboratory Automation), Molecular biology

Automation of CBC KEQAS in Hematology, 83 -98

CLIS - Hitachi 747-100Up to 2400 tests/hr800 samples/day

Microbiol Laboratory Evolution(II)

Microbiology Laboratory Evolution(I)

Total Laboratory Automation(TLA)

iSTATNa,K,Cl,Ca++, pH,pCO2,pO2O2-sat, Total CO2, HCO3 -BUN, Glucose, Hct, Hb,

HBSAg Methods and Principles

Molecular Diagnosis in SNUH

New Technologies/AreasMolecular diagnosticsChromosome analysisFlow cytometryImage data managementPOCT ( point of care testing)Pharmacogenomics

Quality of Laboratory Tests

AccuracySensitivitySpeedMedical outputsPrecisionSpecificityEconomy

CVs of WBC,Hb,Platelet according to cell counters KEQAS in Hematology,1998

72/F, CMMoL

Count BlastsSeg LymphMonoEoBasoLUCManual count246222901A5.119.049.10.126.7B62.722.88.70.10.45.3

Error SourcesPre-analytical error : diet, alchol, exercise, drug, sampling posture/time/site, lipemia hemolysis, ictericAnalytical error : method, reagent, instrument, RT, human source, Post-analytical error : reporting error, human source

Pre-analytical Errors - casesIdentification error: transfusion reactionSampling from an extremity with IV fluid line/indwelling IV catheter : glucose 1000mg/dL

?Hb : 4% Plt : 7KCa : 4Protein : 9 Alb : 9%Cholest : 9 TG : 10Alk.Ph : 9 ALT : 7

Hb. 2.4 Hb. 9.5 ?

: control chart, delta check, total (continuous) QA----- : proficiency survey

Laboratory AccreditationDeveloped by KSCPFor an accreditation of commercial laboratoriesOn-off of laboratory tests A right to claim reimbursement of interpretative/QA summary report

Not verified results Verified results Interpretative report Cumulative report Summary report ( )

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(Panic Value, Critical Value)Hb(adult) : < 6.0 , 20 < Hb(newborn) : < 9.5 , 22 < Platelet : < 30.000 , 1,000,000 < PT : 30 < pH : < 7.20 , 7.60 < PCO2 : < 20 mmHg, 65 < PO2 : < 40 mmHg,

, , ?University Hospitalnamepatient medical records

Basic StructureDB server(NCR 3600, Oracle 7.1)Web server(Axil 311, Oracle 7.1)Web browsersCommon Gate Pathway

Web-based information sharing : hematology consult[Utilization of electronic hematology images and documents]

Interpretation of ResultsReference value : +/- 2SD, 2.5 - 97.5percentilePositive predictive value (%) = TP/TP+FP x 100Decision level : Ca++ > 10.2 mg/dL for primary hypoparathyroidism < 7.0 mg/dL for tetany

Pitfalls of Reference ValuesPatients A and B had the same degree of test increase, but the new value for patient B remains within the reference range

Cholesterolfrom 200mg/dL to 220mg/dL

Day to day analytical variation : 5 %Biological intra-individual variation : 4.6 %Total intra-individual variation : 18.8% CVi2 = CV2a + CV2bio

: 150,000 - 430,000100,000/cmm : , 50,000/cmm :

Positive predictive value(PPV) ------------------------- Prevalence PPV------------------------- 1% 16.1 % 2% 27.9 % 5% 50.0 % 10% 67.9 % 25% 86.4 % 50% 95.0 %-------------------------

? : : , , Mini : DNA chip, Microsensor (Coulter-mini, Hitachi-mini ----) (utilization management)

POCT ? , , , ., , , , , , , , , , , , ,

Dry ChemistryGlucose, TG, CreatinineCholesterol, TG, CK, Hb, AST, ALT, GGT, UreaUric acid, ALP, Bilirubin

Point-of-Care Testing , , BUN, Bilirubin, Blood gases, Na, K, Cl, Hb, Hct, Activated clotting time, PT/APTT, HCG, Microscopy,