Management

There are many definitions for management. Generally, management can be defined as “an ongoing process that seeks to achieve the objectives of an organisation in the most efficient ways possible”. It may be also defined as “the attainment of objectives”. It has been also simply defined as “controlling and organising an organisation and leading”.

Based on the definitions we can define Medical Laboratory Management. It is, therefore, ‘an ongoing process that seeks to efficiently achieve the objectives of a medical laboratory. The objectives of a medical laboratory are providing its customers (physicians on behalf of patients) accurate answers which contribute to clinical treatment”..

Every achievement of management is the achievement of a manager and every failure is the failure of a manager.

A good manager studies management as a daily practice. The high-performance manager is:

A strategist: one who looks to the future. A Problem solver: one who uses his factors under

his or her control to redirect the course of action to achieve the organisation objectives

A teacher: One who guides and helps others to identify and solves problems

challenged to become business, as well as technical specialists. There are many pressures on the modern medical laboratories managers that may force it to not only keep up to date but to move ahead in preparation for the needs of the future. The work environment has changed with the development of new technology. Laboratories have always seen the need for change and development, there has been increased pressure to improve performance, tighten margins, improve quality and reduce costs

Medical Laboratory Managers

Each laboratory must have a strategic plan that describes its long-term goals, such as a move toward more automation or molecular diagnostic techniques.

Each employee’s role should be clearly defined, and written job descriptions should be provided so personnel know what they are expected to do. Therefore, it is a not an easy task for a manger to strike a balance among the clinical laboratory regulations, fiscal responsibility, and employee competence and morale to maintain the overall quality of patient care.

it is appropriate to remember that the two most important components of management are

common sense open communication with laboratory staff

Medical Laboratory Managers

ORGANISATION OF CLINICAL

LABORATORIES Clinical Laboratories may be organised into

different sections. The organisation depends on the site (public health hospital, physician office laboratory, or independent laboratory, etc.) and the complexity of testing. However, some general guidelines may be applied to a situation, and they are discussed as follows:

Microbiology Laboratory Chemical & Biomedical Laboratory Haematology Laboratory Histopathology Laboratory Molecular Biology laboratory

Microbiology Laboratory

Clinical Microbiology comprises essentially seven sections. Aerobic and anerobic bacteriology Mycology Mycobacteriology (also called Acid-fast Bacteriology, AFB) Parasitology Virology Serology Molecular diagnostics (PCR & DNA probe technology) As it was mentioned before the organisation depends on many

factors. The following is also another organisation which has divided a General Hospital Microbiology Laboratory into 11 sections as follows:

Microbiology Laboratory

Sample Receiving & Processing SectionSamples brought to the clinical microbiology are at first received by this section. Here sample are received and the samples are processed according to the nature of the sample.

   Urinalysis SectionIn this section detailed report of urine samples including physical, chemical, microscopic examination is be prepared.

  Parasitology SectionParasitology section deals with intestinal parasites. Samples of faeces are examined here for the presence of any intestinal parasite. Slides are prepared here inside a safety cabinet.

  Serology SectionIn serology section immunological and serological tests are performed by different techniques like Latex agglutination, haemagglutination and antibody absorption.

Mycobacteriology Culture & Sensitivity SectionIn this section all TB smear, culture and sensitivity performed in two Biosafety II cabinets to avoid risk of infection

Nose, Throat,  Sputum and Urogenital Cultures and Sensitivity SectionHere cultures of respiratory tract and genital tract infections are prepared.

  Wounds Culture and Sensitivity SectionCulture of wound swab, pus, aspirates, body fluids including CSF are the responsibility of this section.

  Urine Culture & Sensitivity SectionDifferent types of urine culture performed here including mid stream urine and catheter samples of urine. Each sample is processed and evaluated accordingly.

Blood Culture and Sensitivity SectionIn this section culturing of blood samples is carried out. Nowadays, this section is equipped by machines such as Bactec 9240, flourometric instruments. Each instrument is capable of running 240 samples at a time.

Quality Control SectionIn this section quality control of water, food products and environment is performed with the help of different media and colony counters. Mycology Culture SectionRequests for fungus smear and culture processed here in a bio safety II cabinet to avoid infection from fungal spore.Regardless of the organisation of a Microbiology Laboratory, the main aim is providing the client (the physician) with accurate and reliable results to assist the

process of clinical treatment.

Personnel

LAB DIRECTOR : He/She must be a physician or a doctoral scientist

qualified to assume professional , scientific , consultative , organizational , administrative , and educational responsibility for the services offered by the lab .

If a non-pathologist physician or doctoral scientist service as director , he/she must be qualified by virtue of documented training ,expertise , and experience in areas of analytic testing offered by the lab .

He/She must have sufficient training and experience in clinical medicine , sciences basic to medicine , clinical lab sciences

Personnel

The following directorial functions are :

1- interpretation , correlation , and communication of lab data

2- interaction with physicians and/or medical staff , patient , administration .

3- monitoring of standard of performance , QC , QI.

4- provision of education programs , planning , research.

5- ensuring sufficient personnel with adequate documented

training and experience to meet the needs of the lab .

6- he/she must be decision-maker in the selection of all lab equipments and supplies .

If the lab director has delegated some responsibilities to others , there must be documentation of which individuals are authorized to act on his /her behalf for specific activities .

GENERAL SUPERVISOR : Bachelor degree in chemical or clinical lab / medical

technology science with at least one year experience .

Is reponsible for day-to-day supervision of the lab operation , as well as personnel performing testing and reporting test results .

Personnel

ALL PERSONNEL : There must be an organizational chart for the lab .

Personnel policies must be documented and available to all employees

The lab should have a complete , functional in-service continuing clinical laboratory education program .

Personnel files must be maintained on all current employees , the ideal location of personnel files in the lab .

Personnel

Technical personnel records must include of all of the following :

1- summary of training and experience .

2- description of duties .

3- records of continuing education .

4- health record .

5- incident records .

The lab must conduct an annual performance review of all employees.

New employees must be reviewed within 6 months of employment .

Personnel

Some elements of competency assessment of each person :

1- Direct observation of routine patient test performance , including patient preparation , specimen handling , processing and testing ;

2- Monitoring the recording and reporting of test results ;

3- Review of intermediate test results or worksheet , QC results records ; PT results ; and preventive maintenance .

Personnel

4- Direct observation of performance of instrument maintenance and function checks ;

5- Assessment of test performance through testing previously analyzed specimens , internal blind testing samples or external PT samples .

6- Evaluation of problem solving skills .

Personnel

The lab must participate in an approved program of graded interlaboratory comparison testing appropriate to the scope of the lab.

So that it must be enrolled in the appropriate available CAP surveys or CAP-approved alternative PT program for patient testing performed.

External surveys samples should be run within the routine lab workload , and are analyzed by personnel who routinely test patient samples using the same primarily method systems as for patient samples.

Replicate analysis of surveys samples is acceptable only if patient samples are routinely analyzed in the same manner.

Personnel

The College of The College of American Pathologists American Pathologists Laboratory Laboratory Accreditation ProgramAccreditation Program

If the lab uses multiple methods for an analyte surveys samples should be analyzed by the primary method.

There should be documented evidence of active review by the lab director or designated supervisor of the survey results.

For analytes where graded PT is not available , performance must be checked at least semi-annually with appropriate procedures such as : participation in graded proficiency surveys , split sample analysis with reference or other labs , assayed materials , regional pools .

It is responsibility of the lab director to define such procedure.

There must be evidence of identification and review of problems , and their solutions .

Personnel

The QC / QI program should be clearly defined and well-organized.

The QI program must provide the system design and evaluation of proper patient identification and preparation ; specimen collection ; preservation ; transportation ; storage before testing ; processing ; and accurate results reporting.

This system must ensure optimum patient specimen and integrity of the result throughout the pre-analytical , analytical , and post-analytical process.

Quality control and Quality improvement

”

Judgment of the acceptability of QC data must be made at least monthly by the lab director or designee.

Because of many variables , the CAP makes no specific recommendations on the frequency of any additional assessment / review of QC data.

There must be evidence of active review of records of instrument function , temp , and maintenance , for all routine procedures on all shifts.

QI / QA “supervision

The lab must have documented system in operation to detect and correct significant clerical and analytical errors.

One common method is review of results by a qualified person before release from the lab , but there is no requirement for supervisory review of all reported data.

The selective use of delta checks also may be useful in detecting clerical errors in consecutive samples from the same patient.

In computerized lab , there should be automatic alarm for improbable results.

QI / QA“SUPERVISION

The system must provide for timely correction of errors before results become available for clinical decision making.

In the absence of on-site supervisor , the results of tests performed by personnel must be reviewed by the lab director , general supervisor , or person in charge of the chemistry lab on the next routine working shift.

QI / QA “supervision

IntroductionIntroduction

MicrobiologyMicrobiology Swabs eye, nose, throat, umbilical, ear, wound, rectal, urethral and vaginal) CSF (3 samples. First for culture, second for biochemistry and the there’d for cell count) ParasitologyParasitology urine and stool)

BiochemistryBiochemistry (All chemistry in plane tube or heparins)

Hormones Hormones (All in plane tube or gel separating tube)(All in plane tube or gel separating tube) HematologyHematology (EDTA Blood for CBC and Citrated Blood for Coagulation

Blood bankBlood bank (ask for donor replacement for any bags used to the patient) (plane tube for crox matching and blood grouping) HistopathologyHistopathology (complete identification & clinical details)

الدالدوسائل مم صلب جزئين من الدم وسائل يتكون صلب جزئين من الدم يتكون

, وصفائح بيضاء دم كريات حمراء دم كريات من يتكون الصلب , الجز وصفائح بيضاء دم كريات حمراء دم كريات من يتكون الصلب الجزدمويةدموية

من + اما الدم اخذ ويتم امالح ماء عن عبارة فهو السائل الجزء من + اما اما الدم اخذ ويتم امالح ماء عن عبارة فهو السائل الجزء اماالشريان من او الشريان الوريد من او العينات الوريد تجميع العينات خطوات تجميع خطوات

حسب 11 - - المختبر طلب حسب بة خاصة بأنبونة تحليل كل يكون حسب ان المختبر طلب حسب بة خاصة بأنبونة تحليل كل يكون انالجدولالجدول

العصبى- (22 أو النفسى العصبى- (الشد أو النفسى GH, Cortisol, Glucose highGH, Cortisol, Glucose high((الشد

المريضذ تهدئة من البد لذا نفسيا المريضمشدود اليكون المريضذ ان تهدئة من البد لذا نفسيا المريضمشدود اليكون ان

, , نوع حسب يحتاجها التى االنابيب الملف المريض اسم من , التأكد , نوع حسب يحتاجها التى االنابيب الملف المريض اسم من التأكد33 - -التحليالتحلي

العينة 44- - قبلسحب التالية الخطوات من التأكد العينة يجب قبلسحب التالية الخطوات من التأكد يجب

االيودين * * أو الكحل بواسطة االيودين التعقيم أو الكحل بواسطة التعقيم

التجلط * * حدوث لعدم ارسالها قبل العينة محتويات التجلط خلط حدوث لعدم ارسالها قبل العينة محتويات خلط

للدم * التكسر يحدث ال حتى بشدة العينة رج للدم * عدم التكسر يحدث ال حتى بشدة العينة رج HemolysisHemolysisعدم

البرواز * مع يتناسب ان البد االبرة البرواز * حجم مع يتناسب ان البد االبرة حجم

TourniquetTourniquet * * , محتويات على يؤثر بشدة ربطها ربطها , طول محتويات على يؤثر بشدة ربطها ربطها طولوتكسيرة وتكسيرة الدم الدم

بالدم* , التحليل طلب او الوعاء االنبوبة يتلوثغطاء ان بالدم* , تجنب التحليل طلب او الوعاء االنبوبة يتلوثغطاء ان تجنب

, , ثلج* فى توضع هرمون باراثايرود الدم غازات االمونيا , عينات , ثلج* فى توضع هرمون باراثايرود الدم غازات االمونيا عيناتعن التزيد عن لمدة التزيد ساعات ساعات 44لمدة

طاب* حالة طاب* فى حالة المريض F glucose, TG, UAF glucose, TG, UAفى يصوم ان المريض البد يصوم ان البد ساعة ساعة 1212لمدة لمدة

  

6- collecting specimen from canula and from limbs 6- collecting specimen from canula and from limbs

receiving dripsreceiving drips

الوقت- الوقت- 55

AA..       ذلك مثال معينة اوقت العيناتفى ذلك اخذ مثال معينة اوقت العيناتفى اخذ

              الثالث اليوم فى العينة تؤخذ العقم حالة الثالث فى اليوم فى العينة تؤخذ العقم حالة ,FSH, FSHفىLHLH

progesteroneprogesteroneلتحليل لتحليل 2121يوم يوم

     for Cortisol samples for Cortisol samples   7-10 AM & 4-8 PM7-10 AM & 4-8 PM      

Samples for GGT should withdrew in morning hoursSamples for GGT should withdrew in morning hours

العينة اخذ بعد الدواء العينة نسبة اخذ بعد الدواء نسبة

BB..       المختبر عمل اوقات العيناتفى اخذ المختبر الحرصعلى عمل اوقات العيناتفى اخذ الحرصعلىوقت اسرع فى وقت وارسالها اسرع فى وارسالها

TechniqueTechnique

Venous stasis (tourniquet application) should always be minimised.

Cell counts, and the levels of proteins (including enzymes) and protein bound substances (eg. calcium, cholesterol, many drugs) will be increased by prolonged excessive venous stasis.

Venepuncture should be clean and atraumatic.

If difficulty is experienced, the attempt should be abandoned.

A second venepuncture (preferably by a more experienced collector) should be attempted with a new needle and syringe, or evacuated container, at a different site €€ €€

Blood must be added to the tubes immediately but gently and without frothing.

If a syringe with needle is used, the needle must be removed before adding blood to the specimen tubes.

If tubes containing anticoagulant are used, the correct amount of blood must be added to the tube (usually indicated by a mark on the label) and mixed immediately by thorough, but gentle, inversion.

Tubes should never be shaken and blood should never be poured from one container to another.

Blood culture specimens should, if possible, be collected from a separate venepuncture site. If a single venepuncture is necessary, the blood culture bottles must be inoculated first.

The needle should then be removed for addition of blood to the remaining specimen tubes.

Specimen tubes should be labelled immediately after the specimen is collected

TubesTubes

SafetySafety

All blood samples must be treated as potential infection risks.

Care should be taken to avoid over-filling of tubes which is likely to be associated with leakage of blood and contamination of the external surface of the container.

Needles must be disposed of with care into a 'sharps' container.

Syringes, swabs, or any other blood contaminated materials must be placed in an appropriate contaminated waste container immediately after use.

Evacuated collection systems are now frequently used for blood collection as there is less chance of blood spillage and thus exposure to blood-borne diseases

Blood samples should be transported to the laboratory in biohazard bags with minimum delay.

Rapid transport samples eg: PTH & glucose

If delay is inevitable it is generally better to refrigerate samples.

However refrigeration may itself cause artefactual changes in the results.

Samples which need ice and anaerobic condition eg: Arterial blood gases and ammonia)

Specimen transportSpecimen transport

Blood for electrolytes should not be refrigerated; if delay is anticipated, plasma should be separated and stored at 4°C.

Unseparated samples of blood must never be frozen.

Samples should not be subject to temperatures of >25°C, even for short periods.

Some tests involve especially labile components (eg, complement) and blood must be transported to the laboratory immediately

ElectrolytesElectrolytes

Specimens for microbiological examination must be appropriate eg, sputum rather than saliva.

In general, specimens should be collected into, and transported in, a sterile container.

Aspirated pus may be transported in a syringe, which must be capped immediately the needle has been removed and disposed of safely.

Specimens should be delivered promptly to the laboratory.

Although many specimens will tolerate a delay of several hours if refrigerated, cerebrospinal fluid must be transported to the laboratory immediately, without refrigeration.

Similarly, for the detection of Neisseria gonorrhoeae and other fragile organisms, special arrangements may be needed: eg, express delivery, inoculation of plates at the time and place of collection, provision of special transport containers.

Special requirements, for individual tests, are noted in the Test listing

Microbiological examinationMicrobiological examination

Tube content Determination Instructions Shape

HeparinProduce blue background in blood smeer

Plasma testing some general chemistry

(Glucose, urea,Cr)

Invert slowly several times to ensure mixing

EDTAInhibit ALK, CK

Unsuitable for Ca &coagulation

Routine hematology ,

blood cont, Retc. CT. Sickle test, Glyco HB, HBelectro, ACTH,AS

Invert slowly several times to ensure mixing

Plain, No additive Hormones, General chemistry

Blood group, RH, Cross match,, Serology & Allergy,

Sodium Citrate1:9 Calating Ca,Inhibit aminotransferase. ALK & stimulate ACP

Fibrinogen, PT, PTT, TT, ATIII, coagulation Screen

Ensure tube fills correctly to volume on label

Tube GuideTube Guide

Sodium Citrate1:4 ESR Ensure the presence of anticoagulant, Invert slowly several times to ensure mixing

Plane Urine & Stool analysis,

Plane Urine & Stool culture

Media for maintenance of bacteria

Blood 1- clean the area from which the blood is collected by iodine

2- withdraw for 8-10 ml of blood

3- insert the blood immediately in the vial and bring it to the lab quickly (2-3 ml for children and 5-7 ml for adult)

1)1)      Random specimensRandom specimens (drug abuse)(drug abuse)

    2) 2) First-morningFirst-morning ((microscopic examination, b-HCG, 8-hours)microscopic examination, b-HCG, 8-hours)

3) 3) 24-hours specimen24-hours specimen

Some analyses produce in different time though 24 hours of Some analyses produce in different time though 24 hours of collection morning or noon like Creatinine, protein, Ca, collection morning or noon like Creatinine, protein, Ca, phosphors and electrolyte (the sample must be refrigerated)phosphors and electrolyte (the sample must be refrigerated)

4) 4) clean-catch specimen (MSU)clean-catch specimen (MSU) for bacterial culturefor bacterial culture

5)5)      catheter specimencatheter specimen

6)   6)   suprapubic specimensuprapubic specimen especially for infantespecially for infant

7)7)      urine collected from childrenurine collected from children

collection bags with hypoallergenic skin adhesivecollection bags with hypoallergenic skin adhesive

Type of urine specimensType of urine specimens

If the sample left at RTIf the sample left at RT

    if the organism urase producer, ammonia release will increase if the organism urase producer, ammonia release will increase Ph resulting in destruction of cells and castPh resulting in destruction of cells and cast

    the bacteria will break down any glucosethe bacteria will break down any glucose

    RBC, WBC, Cast will lyzeRBC, WBC, Cast will lyze

    Protein conc will alterProtein conc will alter

    Bilirubin and Urobilinogen oxidized-not detectedBilirubin and Urobilinogen oxidized-not detected

    Uric acid and urate deposited to for oxalate or phosphate Uric acid and urate deposited to for oxalate or phosphate crystal crystal

    normal bacteria will multiply producing contaminated samplenormal bacteria will multiply producing contaminated sample

Microbiological sampleMicrobiological sample

specimen container instruction

sputum Clean, wide nick

Early morning, cough deeply for sputum, for children gastric wash, delay of specimen TB, Pn, HI

Throat swab Sterile swab Not contaminated with saliva, no antibiotic by 8-hours

stool Wide nick Must be fresh sample within 2 hours

Rectal swab For cholera alkaline peptone water

 

Blood culture Bld culture bottle

Take the sample when tempt high, use iodine for sterilization, mix it and must reach the lab early, never refrigerated

semen Clean and sterile

3-7 days of sexual abstinence, no condom, time of collection and deliver to the lab within 2 hour

العينة العينة وقتسحب وقتسحب

مثل التحاليل بعض نتائج على مباشر وتأثير كبرى اهمية مثل لة التحاليل بعض نتائج على مباشر وتأثير كبرى اهمية ::لة

من كال من تركيز كال الباكر iron, cortisol, ACTHiron, cortisol, ACTHتركيز الصباح في الباكر أعلى الصباح في أعلى

حين أخذها يفضل المالريا فحص وعينات الدم لمزارع حين بالنسبة أخذها يفضل المالريا فحص وعينات الدم لمزارع بالنسبةحدود في الحرارة درجة حدود ارتفاع في الحرارة درجة مختلفة 33ارتفاع اوقات فى مختلفة عينات اوقات فى عينات

المساء فى الدم عينة أخذ يفضل الطفيليات المساء بعض فى الدم عينة أخذ يفضل الطفيليات بعض

: فحص و الكامل البول فحص و البول مزرعة من كال : تحاليل فحص و الكامل البول فحص و البول مزرعة من كال تحاليلالباكر الصباح فى تجمع فانه للحمل الباكر البول الصباح فى تجمع فانه للحمل البول

طويلة لفترة الدم طويلة حبس لفترة الدم حبسعلى تأثير طويلة لفترة الضاغط بالربط الدم حبس وقت على لزيادة تأثير طويلة لفترة الضاغط بالربط الدم حبس وقت لزيادةالحسبان فى يؤخذ كما االخرى العناصر وبعض البروتينات الحسبان تركيز فى يؤخذ كما االخرى العناصر وبعض البروتينات تركيزغازات عينة سحب عند مطلقا الضاغط الرباط استخدام غازات عدم عينة سحب عند مطلقا الضاغط الرباط استخدام عدم

الالكتيك حمض لتقدير دم عينة سحب عند وكذلك الالكتيك الدم حمض لتقدير دم عينة سحب عند وكذلك الدم

العصبى العصبى التوتر التوترنتائج فى مؤثر دور نتائج ولة فى مؤثر دور لذا CatecholamineCatecholamineولة الدم لذا وغازات الدم وغازات

هادئا المريض يكون أن العينات سحب عند هادئا يراعى المريض يكون أن العينات سحب عند يراعى

العضلى العضلى المجهود المجهود

Muscular effortMuscular effort

على العضلى المجهود على يؤثر العضلى المجهود يؤثرمن من العديد العديد

سوائل فى الموجودة سوائل العناصر فى الموجودة العناصرالجسمالجسم

هو كما النقصان أو بالزيادة هو اما كما النقصان أو بالزيادة اماموضحموضح

تأثير تحت العناصر تأثير انخفاض تحت العناصر انخفاضالمجهودالمجهود

العناصر العناصر زيادو تأثير زيادو تأثير تحت تحتالمجهود المجهود

DecreaseDecrease% % testtest IncreaseIncrease% % testtest

44 BilirubinBilirubin 1111 ACPACP

1111 IronIron 4141 GPTGPT

11 LDHLDH 33 GOTGOT

88 PotassiuPotassiumm 3131 ALPALP

1212 Total Total lipidlipid 11 CalciumCalcium

11 ChlorideChloride

33 CholesterolCholesterol

1717 CreatinineCreatinine

1212 PhosphorusPhosphorus

33 Total Total ptoteinptotein

33 UreaUrea

44 Uric acidUric acid

سحب بعد النتائج على المؤثرة سحب العوامل بعد النتائج على المؤثرة العواملالدمالدم

التحللالتحلل HaemolysisHaemolysis

تكسر بة تكسر يقصد بة , RBCRBCيقصد بقوة ( رجها او العينة ضغط , نتيجة بقوة ( رجها او العينة ضغط نتيجةالدم لسحب صغير قطر ذات معدنية ابر الدم استخدام لسحب صغير قطر ذات معدنية ابر استخدام التلوثالتلوث

كيمياويا او ميكروبيا العينة تلوث

المختبر الى ارسالها قبل طويلة لفترات العينة المختبر بقاء الى ارسالها قبل طويلة لفترات العينة بقاء

و السكر باستهالك الدم عينة في الموجودة الحية الخاليا تبدأ و حيث السكر باستهالك الدم عينة في الموجودة الحية الخاليا تبدأ حيثاألخرى األخرى العناصر العناصر

أستهالك ألتمام حولها الموجودة األنزيمات أستغالل في تبدأ أستهالك كما ألتمام حولها الموجودة األنزيمات أستغالل في تبدأ كمانتائج أعطاء بالتالي و تناقصها الى يؤدي مما المركبات و نتائج العناصر أعطاء بالتالي و تناقصها الى يؤدي مما المركبات و العناصر

األستقبال . في طويلة فترة المنوي السائل بقاء كذلك األستقبال . خاطئة في طويلة فترة المنوي السائل بقاء كذلك خاطئةالنخاع سائل عينة و المنوية الحيوانات موت الى يؤدي النخاع مما سائل عينة و المنوية الحيوانات موت الى يؤدي مما

سحب بعد الدقيقة الحية الكائنات فيها تموت قد التي سحب الشوكي بعد الدقيقة الحية الكائنات فيها تموت قد التي الشوكيالالزمة بالسرعة تعامل مالم وجيزة بفترة الالزمة العينة بالسرعة تعامل مالم وجيزة بفترة . .العينة

Criteria for rejection of specimensCriteria for rejection of specimens

oMissing or inadequate identiificationMissing or inadequate identiification

oInsufficient volumeInsufficient volume

oSpecimen collected in wrong collection tubeSpecimen collected in wrong collection tube

oContaminationContamination

oInappropriate transport and storageInappropriate transport and storage

oUnknown time delayUnknown time delay

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