Do you use the same reference intervals for glucose (or lactate, electrolytes) from serum samples / plasma compared to capillary sample (whole blood, POC)? PrimariIy, I was interested in the monitoring of hospitalized patients and their monitoring from day to day.

We use in a large University Hospital Laboratory both methods, i.e. whole blood glucose from capillary samples and normal venipuncture serm blood samples. There exists an excellent comparison (correlation coefficient 0,997, very linear correlation, intercept not different from zero). So far, so good, but the slope, the slope!. The whole blood samples show concentrations at 77,5% of those frm serum samples. This is of course due to proteins and membrane remnants from cell debris obtained in the whole blood sample.

This is of course inacceptable for mixing both concentration under stationary conditions. We have introduced therefore a factor in our laboratory computer system to correct for this difference and have at the same time instructed the clinical personnel not to use both concentrations for medical treatment. or diagnosis.

These differences will be observed for all chemical parameters with the exception of those obtained by electrodes for determination such components as electrolytes, glucose , urea, creatinine, rtc.

Sighart Golf

Dear Sighart Golf,

Thank you for your answer. This is exactly what I need. I'm very interesting in how your computer system demonstrate this or how laboratory test results looks at the monitor, or exactly what it writes in the notes (?) or reference intervals? Can you send me an example of one laboratory test results? Thanks in advance.

Jasna

Dear Jasna Krleza

In accordance with Dr Golf, capillary samples show significant bias. I worked with Reflotron Plus Roche in sports medicine analyses and I observed lower values for some analytes (e.g., serum urea, creatinine, creatine kinase, and others) in POCT compared to clinical chemistry analysers. In previuos published paper I tested skin puncture blood samples can be usefull samples to monitor hematological and biochemical analyses. I can sent to you the paper, if You wish. In my oppinion, you can test the need for establishing reference intervals for cappilary analyses using the CLSI C28-A2 procedures.

Best Regards

Dear Lazaro Nunes,

Thank you for your answer and willingness to help me. Please if you can send me any paper on this topic. Everything will help especially if procedure is standardized. In my hospital (children's hospital) POCT instruments is in central lab. Capillary blood we used for glucose, blood gases and acid-base status, electrolytes, C-reactive protein, lactate and bilirubin. In children, often we determined GUK, electolytes and acid base status several times a day. Also, often we have a combination that ones per day (in the morning) is taken venous blood and capillary blood during the day. Problem with reference interval for all parameters (for all age and gender) isn't only, problem problem exists and in the comparability of results in same child. But reference interval is the first step in resolving this problems. Please send everything you have and can.

Jasna

Hallo,

In our laboratory we use of course the same reverence values for glucose from serum and capillary blood. Since we cannot manipulate glucose obtained by methods installed for example in the ICU of our Hospital, which are not under our control for example concerning quality control, technical competence of medical assistants. We have therefore advised the medical staff of ICU that they are not allowed to mix values from our laboratory with their own. Since our turn.around-time or those capillary blood sample-values is

Thanks Walter.

We tried make some order in our hospital. Try to remove POC from the laboratory and thus to achieve a situation like in your hospital. Any change is difficult. With us there is a certain resistance to capillary sampling by nurses, so that the POC isin lab. Laboratory staff goes to departments and to sampling capillary blood, down to the lab and determined. For this purpose, we have changed the type of sample and reference interval and put the values from Harmonization reference range of our country. My attitude which I want to defend is that the POC should be with the patient, not in lab. For that I need to justify my intentions.

Jasna

Dear Jasna

I worked with Radiometer capillary blood system and blood gas analysis and it works well. I will send a skin puncture paper and You can see the little differences. If you need additional information, please, feel free to contact me.

Nice. Thank you. When I read it carefully, I may have additional questions.

Jasna

Dear Jasna!

These problems exists also in our hospital. We have ca. 250 satellite instruments für capillary glucose measurements and acorresponding number of blood gas analyzers in all intensive care units, In Germany the official organization of all medical doctors (Bundesärztekammer) therefore has published regulations für quality control for these instruments (Guidelines for Quality Control of Medical Laboratories, in Germany called Rilibäk, Richtlinien der Bundesörztekammer)). In these guidelines, maximal limits for most of the analytes are established. Since most of the satellite laboratories are not qualified enough to systematicly reach those limits, our laborators has offered, as suggested by the medical association to carry out the quality control as well as the care for the instruments. This offer has been accepted by the medical staff of the Hospital and all are happy. In addition, our laboratory carries out method comparisons between POC-intruments and the central laboratory to document eventual differences.

If you need the RILIBÄK in order to diskuss this problem with the staff of your laboratory and the clinic, then I can send it to you. You can also find it in the Internet under RILIBÄK.. If you need additional help, please contact me.

Sighart Golf

Dear Walter,

Great! Thank you for your help. Please, if you send me Guidelines for Quality Control of Medical Laboratories, it will be easier for me.

Jasna

Dear Jasna!

Do you have an email to send to the RILIBÄK? Mine is:[email protected].

many greetings

Sighart Walter Golf

Dear Jasna!

Enclosed you will find the RILIBÄK.

Have fun with it!

many greetings

Sighart Golf

Article Richtlinie der Bundesärztekammer zur Qualitätssicherung labo...

Dear Jasna!

I am not sure, that the enclosed RILIBÄK contains all pages of the RILIBÄK. Please inform me, if the publikation is complete.

many greetngs

Sighart Golf

Dear Walter Golf,

Thank you. On link that you give me isn't full text, just abstract. Please send me full text on e-mail: [email protected]

Kind regards

Jasna

Dear Jasna,

here now the complete RILIBÄK. Hope that you understand sufficient German to read the text or have someone who does.

many greetings

Sighart Golf

Dear Jasna,

here now the complete RILIBÄK. Hope that you understand sufficient German to read the text or have someone who does.

many greetings

Sighart Golf

Thank you. Thank you. Thank you.

I know German just a little, but I have colleges who knows. My poor German and Google translator can also help.

In addition, I have one question: What is your first name? Sorry, always I wrote Walter, but you always signed Sighart.

Kind regards

Jasna

Dear Jasna!

My first first name is Sighart, the second first name Walter.If you need any help, please ask me.

many greetings

Sighart Golf