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Understanding Your Lab Tests

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Understanding Your Lab Tests this is a core lab at the University of Pennsylvania Hospital, with LOTS of instrumentation, generating 14,000 results per day! . – PowerPoint PPT presentation

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Title: Understanding Your Lab Tests


1
Understanding Your Lab Tests
2
The Black Box of Medical Laboratory Testing
  • What You Dont Know Can Hurt You!

3
The Black Box, revealed!
4
amednews.com
5
Ask your physician, nurse, pharmacist, biology
graduate about
  • Vitamin C as an interference in glucose and
    triglyceride testing
  • Causes of false positives in pregnancy testing
  • WHO classifications for Hodgkin disease and
    diagnostic criteria
  • Ways to test for swine flu (H1N1) and avian flu
    (H5N1)
  • Genetic testing for cystic fibrosis
  • Who is most likely to show antibodies to Kell

6
Formal coursework training in medical laboratory
testing by
  • Physicians
  • Nurses
  • Pharmacists
  • PTs, OTs
  • Biology graduates
  • Medical laboratory scientists and technicians
  • 1 (except those with pathology residency)
  • 1
  • 1
  • 0
  • 0
  • 100

7
Brief history of the medical laboratory in the US
  • Pre-1900
  • Diagnostic testing simple, mainly microscopic,
    physician-performed
  • 1920s
  • AMA survey 48 of US hospitals had medical
    laboratories

8
250,000 medical laboratory professionals in the
United States
St. Michaels Hospital - WI
St. Elizabeth Med Ctr - NY
Clarian North Med. Ctr. - IN
9
States requiring Personnel Licensure for doing
medical laboratory testing in the US
Note not in DE!
California (1937) Florida Nevada Tennessee Georgia
Hawaii Louisiana North Dakota Rhode
Island Montana West Virginia New York (2007)
No evidence that personnel licensure raises
salaries worsens the personnel shortage Plenty
of evidence that personnel licensure positively
affects patient safety recognizes the importance
of training provides an accurate number
10
What is Medical Laboratory Science?
  • Clinical Laboratory Science
  • Medical Technology

11
Medical Laboratory Science diagnostic
laboratory testing from A to Z
Centers for Medicaid and Medicare Services 7.25
billion tests performed annually in US 13
million tests performed in Delaware per
year over 171,000 medical laboratories
nationally 97,000 in physician offices
12
Medical Laboratory Science diagnostic
laboratory testing from A to Z
Rodney Forsman, Mayo Clinic 75 of the
diagnostic and/or treatment decisions made by
healthcare professionals are based on clinical
laboratory testing results 94 of the objective
medical data in the patient record comes from the
laboratory
Clin Chem 42 813-816, 1995 Clin Leadersh Manag
Rev, 370-373. Nov/Dec 2002
13
Medical Laboratory Science diagnostic
laboratory testing from A to Z
Over 1,200 different types of tests available
14
(No Transcript)
15
Can anyone do medical laboratory testing?
  • can anyone build a bridge
  • can anyone perform _____ surgery
  • can anyone do your plumbing
  • can anyone cut your hair
  • with appropriate training and experience, yes!
  • without that training/experience, dont let them
    near me!

16
NAACLS curricular requirements
  • Instructional Areas
  • Anatomy/physiology
  • Immunology
  • Genetics/molecular biology
  • Microbiology
  • Organic/biochemistry
  • Statistics

17
NAACLS curricular requirements
  • Instructional Areas
  • Principles and methodologies
  • Clinical Chemistry
  • glucose
  • tumor markers
  • cholesterol
  • heart attack markers
  • thyroid
  • drugs..

18
NAACLS curricular requirements
  • Instructional Areas
  • Principles and methodologies
  • Hematology
  • white blood cells red blood cells
  • platelets blood clotting factors

19
NAACLS curricular requirements
  • Instructional Areas
  • Principles and methodologies
  • Microbiology

viruses (like swine flu!)
bacteria
fungi
parasites
immune response
20
NAACLS curricular requirements
  • Instructional Areas
  • Principles and methodologies
  • Immunohematology
  • blood typing
  • crossmatching blood
    for
    transfusion

21
NAACLS curricular requirements
  • Instructional Areas
  • Principles and methodologies
  • Genetics testing, phlebotomy, urinalysis, safety,
    quality control

22
NAACLS curricular requirements
  • Instructional Areas
  • Performance of assays
  • Problem-solving, troubleshooting, techniques
  • Interpretation of clinical procedures and results
  • Statistical approaches to data evaluation

23
Is it possible to get all that in an on-the-job
training situation?
  • Can, if
  • Sufficient experienced trainers available
  • Limited to one clinical testing area
  • Enough time (years!)
  • Cannot, if
  • Any of the above is unavailable

24
Bureau of Labor Statistics
Gross estimate at best without personnel licensure
Average age 49

40 US workforce will retire in next 10 yrs
http//www.bls.gov/oco/ocos096.htmoutlook
25
Bureau of Labor Statistics
  • 155,822 CLS (baccalaureate) in 2004
  • Note not all these graduates work in a clinical
    laboratory
  • Projected need by 2014 73,846
  • 7385/year
  • 146,626 MLT (associate level) in 2004
  • Projected need by 2014 76,310
  • 7631/year

http//www.bls.gov/oco/ocos096.htmoutlook
26
NAACLS Statistics
  • 222 CLS programs (Baccalaureate)
  • 202 MLT programs (Associate)

Need 15,000/year!
CLEC2008
27
Wall Street Journal, 5/13/09
http//online.wsj.com/article/SB124217357954413095
.html
28
Wage and vacancy survey
29
If the general public only knew
30
If the general public only knew
Where is the emphasis on patient care and safety?
Are these just button-pushers, and anyone can do
what they do?
Nursing and shutting down patient floors
31
(No Transcript)
32
Katrina
33
How can so many tests get done per day?
You might be able to drive your car without
knowing how it works
14,000 tests per day!
We cannot run this instrumentation without
knowing how it works no button-pushers!
34
(No Transcript)
35
National Medical Laboratory Professionals Week
36
Normal range
  • No such thing!!
  • More appropriately called a reference range
  • At least 40 healthy individuals donate
    specimens
  • Analysis by THAT method, on THAT instrumentation,
    by THOSE clinical lab professionals

37
Reference range
  • Statistically represents what 95 of that
    healthy population can be expected to have
  • You can be slightly outside that reference range
    and still be within what 99 of that healthy
    population can be expected to have

38
Reference range
  • Example
  • Sodium reference range 135-153 mmol/L
  • Your value 133 L
  • Are you sick?

39
Reference range
153
135
95 of healthy population
40
Reference range
144
153
135
95 of healthy population
41
Reference range
144
153
157.5
135
130.5
95 of healthy population
99 of healthy population
42
Reference range
144
153
157.5
135
130.5
X
95 of healthy population
99 of healthy population
133 is within what 99 of that healthy
reference population got for sodium
43
but my value is outside that 99 range
  • Very rarely will a single, isolated lab test
    result, high or low, point to a diagnosis
  • Usually, its the PATTERN of test results which
    helps to rule a diagnosis in or out,
    (a) from the same specimen and
    (b) over time

44
  • Its the PATTERN which the physician is looking
    for when he/she orders a set of tests
  • Its the PATTERN (connecting disease to lab test
    results) which insurance companies and Medicare
    are using when they decide to pay or not pay for
    the lab tests

45
Patterns and Panels
  • Pattern of tests which will help to establish a
    diagnosis panel

46
Panels as defined by Centers for Medicare and
Medicaid Services
  • Organ or Disease Oriented Panels
  • Basic metabolic panel
  • 8 tests
  • Comprehensive metabolic panel
  • 13 tests
  • General health panel
  • 18 tests
  • Panels for liver function
  • kidney function
  • arthritis
  • lipids.

47
  • Why is this particular test being done?
  • has been linked to a particular diagnosis
  • meets medical necessity requirement
  • most likely paid for by insurance

48
  • Or phrased another way a diagnosis of _____
    isnt likely without the _______ test showing
    _______
  • ICD10 codes
  • 244.10 ____________________

49
  • Or phrased another way a diagnosis of _____
    isnt likely without the _______ test showing
    _______
  • ICD10 codes
  • 244.10 ____________________

50
How long does it take to get a clinical lab test
result?
  • Depends on
  • Frequency of testing by the lab professionals
  • Quality control decisions
  • Sent to a reference lab?
  • Courier
  • Batching
  • Sending results to your doctor

51
Connecting lab tests to clinical conditions
  • Diabetes mellitus
  • Fasting glucose gt 126 mg/dL
  • Random glucose gt 200 mg/dL
  • HbA1c gt 6.5
  • Pre-diabetes
  • Fasting glucose between 100-125 mg/dL
  • Random glucose gt 130 mg/dL
  • HbA1c gt 6.0

52
Connecting lab tests to clinical conditions
  • Iron deficiency anemia
  • Total iron
  • Iron binding capacity
  • Transferrin saturation
  • Ferritin
  • Red blood cells small and pale

53
Error rates in lab tests
  • Sensitivity the ability of a test to correctly
    identify persons who have a disease (true
    positives)
  • Specificity the ability of a test to exclude
    those persons who do not have disease (true
    negatives)

54
How reliable is the xxx blood test in
determining the presence of cancer?
  • determining the presence of cancer
  • Not good at all, usually, if used alone!
  • showing the effectiveness of therapy
  • Excellent!

55
Screening tests
  • Useful when there is a statistically strong
    connection between a condition and a lab test
  • Questionable usefulness otherwise!

56
Screening tests
  • Test/condition Recommending Age group Screening
  • Group Recommendations
  • Cholesterol AAP 2-20 if family history of
    premature cardiovascular
    disease
  • NHLBI gt20 every 5 yrs
  • Lead state regs 2-12 varies
  • Mammogram ACS 20-39 every 3 yrs
  • 40-49 every 1-2 yrs
  • 50 annual
  • Tuberculosis all if at risk
  • Pap test AAFP sexually active every 3 yrs
  • ACS gt18 yearly

American Academy of Pediatrics National Heart,
Lung and Blood Institute American Cancer
Society American Academy of Family Physicians
57
Screening tests
  • Test/condition Recommending Age group Screening
  • Group Recommendations
  • Chlamydia USPSTF lt25, sexually active should be
    screened
  • all women at risk
  • CDC lt20 yearly
  • gt20 with risk factors yearly
  • Skin CA ACS 20-39 every 3 yrs
  • 40 yearly
  • Iron overload CAP gt18 routine med care
  • children, sibs of every 5 years
  • patient with iron ( trans sat, ferritin)
  • overload
  • Thyroid ATA 35 TSH every 5 yrs

US Preventive Services Task Force Centers for
Disease Control American Cancer Society College
of American Pathologists American Thyroid
Association
58
Screening tests
  • Test/condition Recommending Age group Screening
  • Group Recommendations
  • Colorectal CA ACS 50 FOBT yearly
  • sigmoidoscopy every 5 yrs
  • Prostate CA ACS 50 annual DRE, PSA
  • (much controversy!)
  • Endometrial CA ACS ?? Yearly pelvic exam
  • Diabetes mellitus ADA 45 every 3 yrs
  • ACE 30 every 3 yrs
  • Osteoporosis NOF 65 should be screened
    by bone density
  • (much controversy)

American Cancer Society American Diabetes
Association American College of Endocrinology
National Osteoporosis Foundation
59
Lab Tests Online
http//www.labtestsonline.org
60
http//www.ascls.org
61
What can you do?
  • Trifold helper for your lab test results
  • Question who is doing the lab testing if your
    blood sample is collected in a physician office
    lab
  • Beware of direct access testing
  • Blood tubes shaken like martinis!
  • Do not believe everything TV tells you
  • Support licensure for medical lab personnel in
    Delaware!

62
Over 750 medical laboratory professionals have
graduated from UD since 1950
Arent you glad?
..dont you wish there were more??
63
www.udel.edu/medtech mclane_at_udel.edu
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