Troubleshooting

Tim J ames
Head BMS, Clinical Biochemistry,
Oxford University Hospitals NHS Trust
Visiting Professor, Oxford Brookes University
Troubleshooting
Sample problems
Method/test problems
Instrument problems
Sample problem 1
Uric acid results from a haematology ward patient:
Sample 1 day 1: 368 mol/L
Sample 2 day 4: 82 mol/L
Delta check fail and repeated
Sample 2 repeat: 48 mol/L
Sample 2 second repeat: <30 mol/L
What information do you need to identify what is
going on?
Sample problem 2
Oncologist contacted the lab about inconsistent
testosterone results on 55 year old male patient with
prostate cancer.
Lab 1, method 1: Testosterone 4.5 nmol/L
Lab 2, method 2: Testosterone <0.4 nmol/L
(reference interval 9 to 25 nmol/L in both labs)
What information do we need to follow this up to
comment on the question which is the correct
result?and what can we do to confirm this?
Sample problem 3
49-year-old man presented to the eye casualty at a district
general hospital with a history of 4 months of diplopia and more
recently episodes of transient headaches and nausea. No
previous history of significant medical problems and his only
regular medications were chlortalidine, atenolol and amoldipine
for essential hypertension.
Brain MRI - retro-orbital mass measuring 2x2x3 cm in the
medial aspect of the right petrous bone and clivus. Urgent
referral to the neurosurgical team at J RH.
Biopsy suggested a high grade B-cell lymphoma and the patient
was referred to haematology.
Sample problem 3
What analytical interferences can be seen in these results?
Sample problem 4
Metadrenaline analysis by HPLC with
electrochemical detection
In a series of three urine samples from one patient
the internal standard peak twice the peak height and
area compared to other samples in batch and
previous batches
What might cause this?
Method problem 1
Alkaline phosphatase method produces
a uerror flag on most the the samples
being run.
The uflag indicates a high baseline
absorbance reading
What information would be useful to
identify what is causing the problem?
Instrument problem 1
A QC is run and the results for the following
chemistries shows performance issues with
increased imprecision
phosphate, urea, ALT, AST, glucose, LDH
However the following chemistries demonstrate
consistent and acceptable imprecision:
Electrolytes, alk phos, albumin, creatinine, GGT, bilirubin
What characteristic do the problem
chemistries have in common?
Instrument problem 2
A QC is run and the results for the following
chemistries shows performance issues with
increased imprecision
Creatinine, bilirubin.
However the following chemistries demonstrate
consistent and acceptable imprecision:
Electrolytes, alk phos, albumin, glucose, GGT, calcium
What characteristic do the problem
chemistries have in common?
Instrument problem 3
Testosterone on Centaur showed poor performance
needing much greater calibration than normal
(every few days vs expected 28 day stability)
Appears to be a method imprecision problem
Other methods appeared OK
Same lot number of reagent and QC on other
Centaur is acceptable
What instrument characteristics could be explored for
further follow up?