Lab Improvement #5 : QC in Bacteriology

We went to Hospital Miri to learn QC works in Bacteriology in the first week of February 2016. The officer in charge asked us how's the Bacteriology QC works in our setting. I said we had none as we have no technical expertise or experience in dealing with IQC.

Basically, QC works has to be done for 4 main parts. The culture media, biochemical reagents, identification kit and the antibiotic susceptibility.

My senior technician went along with me. Much was learnt in the first three weeks. I specially requested to learn the handling and processing of ESBL producing Enterics. We had a good discussion with the Scientific Officers in the Microbiology Unit.

QC activities start with Master Culture, Stock Culture and Working Culture. We observed how the beads from master culture was passaged into stock culture and then working cultures.

Lab Improvement #4: Thalassemia screening New Forms

We were instructed to use new form for Hb Analysis and DNA Analysis (can be assessed through the Net). I added some improvements to increase our lab quality. All doctors were informed of usage of the new forms.

All Hb Analysis and DNA analysis requests must be recorded in the Thalassemia Screening Record Book. Telephone number of the patient, and his/her next doctor visit date as well as the name of requesting doctor must be recorded. When results reached us, date of receiving  must be recorded. Requesting doctor must be informed and JTMP must ask doctor whether he/she wants us to inform the patient or their nurses to do so. Original results are passed to doctor while one copy of the results is kept in the Thalassemia screening file. 

Lab Improvement #3 : Drift Monitoring Haematology

I conducted a workshop on Drift Monitoring Haematology to all my staff yesterday. Often, they complained to me that the haematology results seemed odd despite IQC done early of the day. And the only to protect ourselves and being more confident of the results are doing the drift monitoring.

Responses from them were good. Questions were asked and staff who had done such practice in HUS shared his experience. Mean baseline and  SD baseline were explained in details and staff were asked to demonstrate of how to calculate the mean baseline and SD baseline from the first five results taken from one patient's sample. And to analyze that WBC, HGB, RBC, PLT, MCV results from drift monitoring do not exceed one SD. Total CV% should be more than 5%.

We will be starting to do the Drift Monitoring Haematology next week.

Lab Improvement #2 : Further testing for Rh (-) patient

This month we had a Rh (-) patient. A rare occurence in this laboratory. I consulted head of Blood Bank, Hospital Miri for further advice.

After Anti-D testing was found negative, 3 further tests are needed to be done. Du , Rh Phenotyping and DAT. Blood bank Miri must be informed a month before expected date of baby delivery.

Du Protocol

Wash cell x3. Prepare 3-5% RBC suspension. 1 drop 3-5% RBC + 1 drop Anti-D + 1 drop of LISS. Incubate suspension 15 mins at 37 degree Celcius. Spin and observe for agglutination by naked eye. Wash x3 and add 1 drop AHG. Spin and observe agglutination by naked eye and through microcope.

No agglutination seen by naked eye after AHG addition

Microscopic view showing individual cells. No agglutination seen after addition of AHG.

Rh phenotyping (4 tubes labelled as C, c, E & e)

Wash cell x3. Prepare 3-5% RBC suspension. 1 drop of 3-5% RBC suspension + 1 drop Antisera into particular tubes. Incubate 5-10 minutes @ 37 degree Celcius. Then spin and observe agglutination.

DAT

Wash cell x3. Prepare 3-5% RBC suspension. 1 drop of 3-5% RBC suspension + 1 drop of AHG. Spin and observe agglutination by naked eye and microscopic view.

Lab Improvement #1 - Thalassemia Screening

Thalassemia Screening Algorithm

Step by step Work flow

1.Check Form for preanalytical error
2.Sample taken as indicated. Jot down patient's contact number and referring doctor.
3.Write patient's particulars in register book. Keep patient's results in thalassemia screening file.

Front page of the thalassemia screening file

4.Despatch samples. Record date of despatch in register book.
5.Received results. Record date of receipt. Write results in register book. Call patient(s) to come. Inform referring doctor or other available doctor. When patient(s) comes, request patient(s) to register at the Hasil counter. Inform doctor that patient has come. Pass results to attending doctor.
6.Keep one copy of results in thalassemia screening file.