Clinical laboratory science: journal of the American Society for Medical Technology

Published by American Society for Clinical Laboratory Science
Online ISSN: 0894-959X
Publications
Article
The passing of a law is frequently accompanied by media attention and citizen apathy. In today's healthcare delivery situation, we should understand how a bill becomes law and what happens to the idea that engenders that process. Laws arise from the recommendations of ordinary citizens, but the recommendations follow a complicated process developed by the writers of our constitution to prevent abuses. Laws begin as ideas, they become bills considered by the legislature, they are expanded and enforced by the executive branch, and they are further interpreted by the judiciary branch. The laws governing healthcare issues are particularly complex, as most arise from the state legislatures.
 
Article
A similar analysis relates to bloodborne pathogens legislation, clinical laboratory reimbursement regulations, and Title VII support for health professions education. What ultimately happens to a great idea depends on our nurture and protection, meanwhile the efforts of others may subjugate its purpose. Failure to nurture the idea means it may have a previously undreamed-of effect. This commentary on the consequences of political action supports hard work, action, and vigilance. The framers intended that the system be energized, not paralyzed by multiple checks, balances, controls and remedies. George III wasn't big on any of these in the 18th century, so they now exist for the protection of us all. That they may seem obtuse is but one more reason for a vibrant participatory body politic, players on all sides who care to take the time to know the issues and our current boundaries. ASCLS has understood this, has taken up the gauntlet and has advocated for our field and its effect on patients in need of clinical laboratory tests for longer and with more success that any entity in US history. What part can you play in the knowing and the doing?
 
Article
Congenital bleeding disorders comprise a heterogeneous group of diseases that reflect abnormalities of blood vessels, coagulation proteins, and platelets. A 14-year retrospective study (1991-2005) was conducted for patients referred to the coagulation section of the Hematology Department (King Hussein Medical Center, Amman, Jordan), who had suffered from bleeding tendencies to assess the prevalence of bleeding disorders among Jordanians and to describe their clinical manifestations. Four hundred and three patients matched our criteria. All patients were screened with routine coagulation assays and a complete blood cell count; a factor assay was performed if indicated by the results of the screening assays. A total of 168 patients (41.6%) were diagnosed with a bleeding disorder caused by a factor deficiency, of which 17.1% were described as hemophilia A (n=69), 6.2% were described as vWD (n=25), and 4.2% were described as hemophilia B (n=17). A subset of the total patient population comprising 14.1% of the patients were diagnosed with a Rare Inherited Coagulation Deficiency (RICD), where 4.0% were FX deficient (n=16), 3.7% were FVII deficient (n=15), 3.7% were FV deficient (n=15), 2.5% were FXI deficient (n=10), and 0.2% were diagnosed with afibrinogenemia (n=1).
 
Mid-cell correlation-Ceii-Dyn 1600 versus 100 or 200 cell manual differentials. (Values include monocytes. eosinophils, basophils, and precursor cells, in units x I o• cellsfl). 
Article
An evaluation of the Cell-Dyn 1600 hematology analyzer (Sequoia-Turner Corporation; Mountain View, CA) was performed in an outpatient laboratory in British Columbia, Canada, to assess the analytic performance and the ease of use of the instrument. The Cell-Dyn 1600 is a three-part differential, 18-analyte instrument that requires only 30 muL of whole blood for complete analysis. It is a compact instrument with an impressive data-management package that is remarkably easy to use. The correlation study was performed using a Coulter S880 (Coulter Electronics, Hialeah, Florida) and manual differentials. Precision, carry-over, and linearity values for the Cell-Dyn provided results well within manufacturer's specifications. The two instruments correlated well as did the granulocyte and lymphocyte population comparisons. The mid-cell correlation was consistent with other studies assessing three-part differentials. Overall the Cell-Dyn 1600 is a good choice for any small or medium-sized laboratory.
 
Article
To describe the early years of the American Society of Medical Technology and discuss major issues that led to contention between the American Society of Medical Technology and the Board of Registry. A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. Clinical laboratory science began to develop a professional identity of its own, distinct from that of pathology, with the establishment of the American Society of Medical Technology and the publication of the American Journal of Medical Technology. These achievements illustrate clinical laboratory scientists' commitment to developing formal mechanisms to serve their specific interests and needs, independent of pathologists and the Board of Registry. Pathologists were successful, however, in maintaining control over other aspects of clinical laboratory scientists' professional identity, such as certification, accreditation, scope of practice, and code of ethics.
 
Article
To describe how the field of clinical laboratory science responded to the shortage of qualified laboratory personnel in the 1950s, and to review educators' responses to the changes in clinical laboratory practice. A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. Between 1945 and 1962, the demand for certified medical technologists grew as a result of public demand for more health services, including laboratory testing. The shortage of qualified laboratory personnel, coupled with the introduction of new, more complex methods of analysis and the addition of different types of tests gave rise to specialization in each of the clinical laboratory disciplines. These developments also stimulated a renewed interest in creating another class of laboratory worker, the laboratory assistant, who could be assigned to perform simple procedures under the supervision of a certified medical technologist. The broadening horizons of clinical laboratory practice created new opportunities and new challenges for medical technologist educators.
 
Article
To discuss the progress clinical laboratory science made between 1962 and 1977 toward developing and acquiring characteristics associated with the traditional professions of medicine and law. A survey of literature on the history of clinical laboratory science was conducted. References consulted included various books and professional journals. Between 1962 and 1977, the field of clinical laboratory science experienced many changes. Medical technologists in supervisory positions became more involved in higher management functions, such as organizing and directing laboratory operations. Clinical laboratory science educators developed graduate programs that would prepare faculty for positions in two- and four-year colleges and in hospital-based programs.
 
Article
To describe the activities of the American Society of Clinical Pathologists and the sequence of events leading to the establishment of the National Accrediting Agency for Clinical Laboratory Science and Medical Laboratory Personnel. A survey of literature on the history of clinical laboratory science was conducted. References consulted various books and professional journals. By virtue of its close association with ASCP, ASMT became drawn into a series of legal actions between 1962 and 1977. Although ASMT was eventually dropped from all law-suits, the association's leadership recognized the need for greater autonomy and independence from ASCP. Clinical laboratory science achieved several victories during this period with respect to certification and mandatory re-registration by the BOR. Responsibility for accreditation of educational programs was shifted from the BOS to NAACLS and the establishment of the National Certification Agency for Medical Laboratory Personnel signified ASMT's commitment to certification by the profession for the profession.
 
Article
To describe new opportunities and challenges facing clinical laboratory science between 1977 and 1992. A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. Between 1977 and 1992 the role of clinical laboratory scientist continued to evolve and expand as new tests and instruments were introduced. Over time, they began to assume greater responsibilities for analyzing and interpreting test results, evaluating and implementing quality assurance programs and new methodologies, and became involved, to a greater extent, in laboratory management and supervision, education, and research. A wide variety of career opportunities were opened to clinical laboratory scientists, providing them with employment opportunities beyond the milieu of the clinical laboratory. Federal regulations aimed at controlling cost of healthcare had a significant effect on the clinical laboratory and clinical laboratory personnel. Stricter guidelines for reimbursement of laboratory services by third-party payees and private insurers forced laboratories to scrutinize their costs and develop creative strategies to attract clients. Attrition, job satisfaction, salaries, and personnel shortages grew in importance during this period as well, prompting research in these areas.
 
Article
Thrombophilia is now considered a multi-causal condition, with interplay of acquired genetic risk factors. In order to estimate the frequency of the factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations in the Jordanian population, we screened 200 healthy Jordanian individuals. 40% were females. Mean age was 32.1 years for males and 30.0 years for female participants. A PCR method detected 15.0% factor V Leiden (87% heterozygous, 13% homozygous), 2% prothrombin G20210A (100% heterozygous), and 24% MTHFR C677T (67% heterozygous, 33% homozygous). We conclude that the prevalence of factor V Leiden and MTHFR C677T is elevated in this population of Jordanians. However the incidence of G20210A is relatively low. Quantification of these genetic thrombosis risk factors in various populations will contribute to a better understanding of the interaction of genetic and environmental risk factors.
 
Article
Re-visit the 2001 anthrax outbreak to assess the ideas and concepts learned from the event as they relate to the illness and to bioterrorism preparedness. Current literature. A multitude of lessons have been brought to light. The future of bioterrorism preparedness depends on whether those lessons are acknowledged and acted upon.
 
Article
To share lessons learned by one local public health department during the anthrax outbreak and associated public hysteria during the autumn of 2001. Current literature and personal experience. Previous planning for a possible bioterrorism event is essential. Management of the communication and testing process is essential for the protection of the public.
 
Article
Review changes for organizations surveyed under the 2002-2003 Comprehensive Accreditation Manual for Pathology and Clinical Laboratory Services published by the Joint Commission on Accreditation of Healthcare Organizations. Current literature, Joint Commission on the Accreditation of Healthcare Organizations. Few standards changes have been made in the manual, but the Joint Commission on the Accreditation of Healthcare Organizations has refined the survey process in subtle ways and new requirements in the area of proficiency testing are in place.
 
Article
Polymerized bovine hemoglobin (HBOC-201) is currently under investigation as an alternative to blood banked human red cells. Due to the dark red, hemolyzed appearance of HBOC-201, we sought to describe the effects of HBOC-201 on coagulation analyzers that perform prothrombin times (PT), activated partial thromboplastin times, fibrinogen, and antithrombin. Pooled normal plasma was combined with HBOC-201 to achieve plasma hemoglobin levels of 1.4, 2.6 3.8, 4.8, and 6.2 g/dL. Results for each test from HBOC-201 prepared plasmas were compared to saline matched controls. Two consecutive absolute result differences of > 10% between saline controls and HBOC-201 samples were used for determining interference on test accuracy by the concentration of HBOC-201. Mechanical detection methods (fibrometer, STA, CS-190) and the MDA-180 were less affected by increasing levels of HBOC-201 than optical detection devices for all test parameters.
 
Article
Healthcare quality has yet to meet the aims of the Institute of Medicine (IOM) with respect to safety, effectiveness, patient-centeredness, efficiency, timeliness and equity. No professional curricula adequately prepare future healthcare practitioners-including medical laboratory science professionals-with all competencies necessary to deliver quality healthcare. Practicing evidence-based medicine, focusing on quality improvement, using information technology, delivering patient-centered care and working as part of interdisciplinary teams are identified by the IOM as the five core competencies that every healthcare practitioner needs to effectively provide healthcare. Medical laboratory science educators need to incorporate patient safety concepts into the curricula and include assignments to develop the IOM competencies in order to adequately prepare future practitioners to effectively practice medical laboratory science in the healthcare system of the 21st century.
 
Article
To conduct a study to show possible differences in clinical laboratory science (CLS) education in relation to knowledge and skill levels deemed most important to job performance success of entry bench level CLS practitioners as determined by laboratory supervisors. Information gained from the study may indicate areas of program curriculum needing revision, or the incorporation of subject areas not presently offered. Survey. CLS educators from 100 different hospital-based and university-based CLS programs, and medical laboratory departmental supervisors from 209 different hospital laboratories. An analysis of the data from the survey consisted of individual item percentages generated by both surveys and a comparison of tasks deemed highly important by supervisors with class time estimates devoted to those tasks. The study indicated differences between what supervisors viewed as important knowledge and skills of entry bench level CLSs and the amount of class time devoted to those subjects by CLS educators. To ensure continuing professional credibility, additional study will be needed regarding the education and practice of CLSs as automation, emerging technologies, and laboratory restructuring will continue to change the laboratory environment.
 
Article
Yersinia pestis, the causative agent of plague, is an aerobic, non-motile, gram-negative bacillus belonging to the family Enterobacteriacea. It is a zoonotic infection transmitted to humans via the bite of a flea. Three clinical forms of human plague exist: bubonic, pneumonic, and septicemic. Many important virulence factors associated with this organism are responsible for its extreme pathogenicity and high mortality rates. The bubonic form of plague is usually not transmitted human to human but the pneumonic form is--through inhalation of contaminated aerosol droplets. The pneumonic plague would be the form most likely implicated in the event of an intentional attack. Inhalation of aerosols can cause devastating consequences resulting in many casualties. Unless antibiotics are administered within 24 hours of the initial symptoms, death is inevitable. Its potential for use as a biological weapon is of major concern to public health officials.
 
Article
A simple method is described for the simultaneous measurement of vanillylmandelic acid (VMA) and homovanillic acid (HVA) in 24-hour urine samples based upon isocratic high-performance liquid chromatography with electrochemical detection (HPLC-ECD). VMA was measured using VMA-SKREEN kits (Biochemical Diagnostics), a microcolumn diazo method and HPLC-ECD test method. HVA was measured using Bio-Rad HVA HPLC reagent kits (Bio-Rad Laboratories) and the test method. No significant statistical difference was found in mean or variance when this method was compared with the micro-column diazo method for VMA and HPLC-ECD for HVA using the commercial anion-exchange kit. The linear regression equation for VMA was ŷ = 0.92 x + 0.21, and for HVA was ŷ = 1.10 x + 0.06. The Pearson correlation coefficient for VMA was r = 0.896 and for HVA was r = 0.996. This method yields results for 24-hour urinary VMA and HVA that compare well with established commercial methods.
 
Article
This is a case study of a 24-year-old male, having total knee arthroplasty, who is found to have an anti-f antibody, and denies history of previous blood product injection or blood transfusion. The anti-f antibody is produced due to exposure to the f antigen, and is one of the Rh blood group system's compound antigens expressed when the c and e alleles are in the cis position on the Rh chromosome. Patients with anti-f requiring transfusion could safely be transfused with units of blood lacking both the c and e antigens and units lacking only the c antigen.
 
Article
The phenylalkylamine derivatives, 3,4-methylenedioxymethamphetamine (MDMA, ecstasy, XTC, Adam), 3,4-methylenedioxyethamphetamine (MDEA, MDE, Eve), and 3,4-methylenedioxyamphetamine (MDA), are psychostimulants with hallucinogenic properties. MDA is also a metabolite of both MDMA and MDEA. These drugs are ring-substituted amphetamine derivatives that produce hallucinogenic, entactogenic ('love drug'), and stimulating effects. MDMA was initially developed as an appetite suppressant, however, its use as a therapeutic drug has been very limited. Because of its effects as a hallucinogenic psychostimulant with relatively low toxicity, it has emerged over the last two decades as a common recreational psychostimulant or 'club drug' at 'raves'. MDMA, MDEA, and MDA are often referred to as 'rave' or 'designer' drugs. They are produced in clandestine laboratories and have an increasing presence on the illicit drug market worldwide. Significant adverse health effects have been reported that include: serotonin neurotoxicity, severe psychiatric disorders, renal failure, malignant hyperthermia, hepatitis, rhabdomyolysis, and disseminated intravascular coagulation. A number of fatal outcomes associated with severe MDMA intoxication have been reported.
 
Mean decline of blood glucose from 30 minutes to 240 minutes in study subjects  
Mean glucose levels for all subjects at 30 minute increments separated by sex  
Article
Glucose levels decrease in whole blood in vitro, but there are several methods that minimize the loss, including special tubes and ice. This study evaluated whether sedimentation by gravity in an upright position was a viable alternative. Lithium heparinized blood was collected from 20 individuals without a diagnosis of diabetes. The samples were allowed to sediment at ambient temperature and were tested in quadruplicate at 30 minute intervals. A Repeated Measures ANOVA compared the means of each time-point. Plasma glucose results were not statistically different between 30 minutes and 60 minutes after collection (p = 0.156). At 90 minutes after collection, glucose was significantly different than the initial glucose readings (p <0.001). Each reading thereafter also showed a statistically significant difference from the initial reading. Samples for glucose measurement are stable in lithium heparin for no longer than 60 minutes when held in an upright position prior to centrifugation.
 
Article
To determine the difference in prothrombin time (PT) and activated partial thromboplastin time (aPTT) results among three reagent systems using a single analyzer instrument. Convenience sample of 100 patient specimens tested in duplicate with three reagent systems: Baxter-Dade, Pacific Hemostasis, and Organon Teknika. A tertiary hospital that services other institutions within a three-state area. Patients were divided into four groups: (1) normal preoperative patients who received no anticoagulants, (2) patients who received warfarin for at least the week immediately before the study, (3) patients who received heparin on the day of the testing, and (4) patients with severe liver disease accompanied by abnormal liver function tests. Coefficients of correlation of Baxter-Dade results versus the other two systems. PT values were significantly different in normal samples and in warfarin-treated patients. aPTT values were significantly different for normal patients and, for the Organon system only, for heparin-treated patients. When expressed as international normalized ratio (INR) values, taking reagent sensitivity into consideration, the results correlated well. Problems with precipitation when using Organon's system limited its practical utility. Compatibility between a reagent system and analyzer instrument should be verified by the manufacturer of the instrument. Use of the INR format produced more accurate and comparable results, allowing safer and more effective dosage adjustments. Laboratories should convert PT and aPTT results to the INR format routinely.
 
Article
To compare the growth of acid-fast bacilli on classically formulated Lowenstein-Jensen media and Middlebrook 7H11 agar to modified Middlebrook 7H9 broth. Microbiology culture results were evaluated to determine the number of days required to detect growth of acid-fast bacilli from clinical specimens inoculated on different media. Three thousand one hundred fifty-seven acid fast bacilli cultures were performed from May 1996 through May 1999. There were 140 positive cultures. Initial growth was detected only on Lowenstein-Jensen medium and/or Middlebrook 7H11 agar for 108 cultures, Lowenstein-Jensen medium and/or Middlebrook 7H11 agar and 7H9 for 12 cultures, and only modified Middlebrook 7H9 broth for 20 cultures. Of the 20 cultures that were initially detected only in 7H9, 11 grew in a mean time of 21.1 days compared with 32.5 days for the later growing solid media. The remaining nine grew in a mean time of 26.0 days but did not grow on solid media within the eight-week incubation period. Mycobacterium avium grew in a higher proportion of broth than solid medium cultures, suggesting a preference for the broth. The modified Middlebrook 7H9 broth was inexpensive to prepare, allowed for quick and easy growth interpretation, required no special appliances, e.g., ultraviolet light, and allowed for faster growth of some cultures. Although Lowenstein-Jensen medium and Middlebrook 7H11 agar remained the main-stays of our routine acid fast bacilli culture protocol, modified Middlebrook 7H9 broth provided earlier or additional positive results in 14% of the positive cultures. We recommend the use of modified Middlebrook 7H9 broth as described in this paper for improving early detection of acid fast bacilli by culture.
 
Article
Anemia is known to cause spurious hemoglobin A1c (HbA1c) results. The effect of menstruation on HbA1c was tested by correlating it to FPG in non-anemic premenopausal and in menopausal women. Non-diabetic, non-obese middle-aged Caucasian women were classified as premenopausal or menopausal. Hemogram, FPG, and A1c results were obtained. Hemoglobin concentrations were lower in the premenopausal group. FPG showed a poor correlation to A1c value overall (r = 0.251, p = 0.001) which was improved by multiplying the A1c % by the total hemoglobin concentration to create an absolute A1c value (r = 0.362, p = 0.000). When the data was sorted by menopause status, the correlation of FPG to Absolute A1c improved (r = 0.463, p = 0.000) in the menopausal women, but remained low (r = 0.283, p = 0.005) in the premenopausal women. Menstruation may be a significant factor affecting the accuracy of A1c concentrations.
 
Article
To evaluate the tetraiodothyronine (T4) method in the Abbott AxSYM immunoassay analyzer. The single-value criteria proposed by Westgard et al. were employed. Assays of control materials established random error (RE) analytical sensitivity, and linearity. Constant error (CE) was established by studying the effects of interferents on T4 quantification. The AxSYM random access immunoassay analyzer was compared with TDx batch analyzer to determine systematic error (SE). Critical concentrations of T4 are 3.0 micrograms/dL and 13.0 micrograms/dL, as these concentrations represent medical decision points. Allowable error at these critical concentrations are 1.0 and 2.6, respectively. Peninsula Regional Medical Center Clinical Laboratories. Based on Health Care Financing Administration [HCFA] allowable error goals, RE, SE, and CE were acceptable for concentrations of T4 ranging from 3.0 micrograms/dL to 13 micrograms/dL. PE was virtually absent. Total error (TE) = RE + SE was acceptable at 13 micrograms/dL but exceeded allowable error at the lower critical value of 3.0 micrograms/dL. Abbott AxSYM was sensitive to T4 at a concentration of 0.34 microgram/dL. Linearity was excellent and consistent with the manufacturer's claim over a range 1.0 microgram/dL to 24 micrograms/dL. Of the interferents studied only hemoglobin caused a > 15% change in the measurement of T4. The AxSYM immunoasssay analyzer performed to manufacturer's specifications and met HCFA allowable error limits for quantifying T4.
 
Article
Objective: To develop a competency assessment tool to determine if technologists are detecting and reporting clinically significant findings on blood smears and to identify if proficiency improves through education using a video presentation. Design: Combination of nonequivalent pretest-post test control group and modified time-series design. Setting: A large medical center in Southern Louisiana. Participants: All shifts of technologists working in the Core Hematology and Special Hematology Laboratories. This sample is a nonprobability sample of convenience. Intervention: A thirty-five minute videotape on the standardization of RBC morphology. Main outcomes measure: Develop a method for measuring competency of technologists who perform scans of peripheral blood smears as part of the automated white blood count differential process.
 
Article
Routine hemostatic laboratory tests lack sensitivity and are of little value in the detection of the pregnancy associated hypercoagulable conditions. Assays for F 1 + 2, AT levels, TAT complex, APC activity, FPA, D-Dimers, tPA, plasminogen, PAI 1, and PAI 2 are more specific for fibrin formation and lysis. Monitoring these tests along with fibrinogen and platelet counts provides important information for the early detection of hemostatic activation and for monitoring the severity of the condition. Early detection and therapy is essential for limiting the deleterious complications of pregnancy. Advances in research, the development of new tests such as the TM assay and gene analysis, as well as highly skilled personnel, are required for the providing of quality pre and postnatal healthcare.
 
Article
The Abstract Review Committee (ARC) has an ongoing objective of encouraging abstract submissions for the American Society of Clinical Laboratory Science's (ASCLS) Annual Meeting. The purpose of this research study was to survey ASCLS members to determine the cause of historically low abstract submissions and how submissions could be increased. An electronic survey was developed and sent to ASCLS members via electronic mail blast. The survey focused on five areas: 1) participant demographics, 2) positives and negatives of the current submission and review process, 3) suggestions for improvement, 4) barriers to participation, and 5) level of attendance at poster and oral presentation sessions at annual meetings. Results of the survey indicated that the foremost reason cited for not submitting an abstract was lack of active research. The ARC believes limited research activity is due to the lack of educational preparedness of educators and practitioners to conduct research.
 
Article
Objective: To provide an overview of inhalant abuse including the extent of the problem, types of products abused, modes and signs of abuse, pharmacology and effects of volatile substances, the role of the laboratory, and interpretation of laboratory results.
 
Article
Alcohol is the most widely abused substance in the United States and its pathology is responsible for more pathological conditions than all other forms of drug use combined. Alcohol dependence is associated with a number of adverse individual and societal consequences and high rates of morbidity and mortality. Alcohol use and abuse have a significant pathological effect on the brain, fetus, liver, heart, pancreas, and immune system. Cancer risks have also been attributed to alcohol use and abuse. Assessing acute and chronic alcohol consumption is critical to effective treatment but unfortunately currently available clinical laboratory testing procedures lack the ability to inform alcohol treatment providers about use and abuse.
 
Top-cited authors
Deborah Ann Josko
  • Rutgers School of Health Professions
Tim Randolph
  • Saint Louis University
Elizabeth Leibach
  • Healthcare Management and Education Services LLC
Rodney E. Rohde
  • Texas State University
Nicholas M. Moore
  • Rush University Medical Center