SPECIMEN

COLLECTION AND
PROCESSING
 FACTORS CONTRIBUTING TO VARIATION OF RESULTS

Exercise:
increase CK, lactate, cortisol, activate coagulation, prolactin
Fasting(8-12 hrs)
TAG, Gluoce and K require fasting
Over fasting: >12hrs: affects glucose (hypoglycemia) and bilirubin (48 hrs)
72hrs - women: decrease plasma glucose, Men: increase TAG, FFA and glycerol
Diet
Meat false (+) occult blood test
Protein rich diet – increases serum urea, ammonia and urates
 FACTORS CONTRIBUTING TO VARIATION OF RESULTS

 Posture
 Upright: reduction of plasma volume, increase concentration of proteins
 Supine: needed in assaying catecholamines, albumin, thyroid hormones. Change from supine to upright will increase
their levels
 Bed rest can cause falsely decrease Hgb
 Elements affected by postural change: albumin, TP, enzymes, calcium, bilirubin, chole, TAG

 Age
 Bilirubin increase after birth and peaks after 5 days
 Elderly secretes less T3, PTH, aldosterone and cortisol

 Tourniquet application (should not be applied more than 1-2 minutes)

 hemoconcentration (venus stasis):increase enzymes, proteins protein bound substances (Chole, TAG)
 Anaerobiosis
 Increase glucose, lactate and catecholamines and decrease K
FACTORS CONTRIBUTING TO VARIATION OF RESULTS

 Tobacco smoking
 Increase, HbCO, blood counts,, ammonia, cortisol, catecholamine
 Vit B12 decrease, IgM, IgG, IgM, sperm count and motility

 Alcohol
 Increase lactate, urate, HDL, GGT urate and MCV
 Causes hypoglycemia

 Stress
 Increase ACTH, cortisol and catecholamines, Total chole and decrease HDL
 Change acid-base balance, and increase lactate and FFA

 Drugs
 Diuretics: increase Na and K
VARIATIONS ON SERUM QUALITY

• Icterus – serum bilirubin approaches 430 mmol/L (25mg/L)

 HABA, O-toluidine, Biuret, Cholesterol assays

• Lipemia or lactescence- blood samples obtained 1-2 hrs after eating a fatty meal. Serum
TAG level exceed 4.6 mmol/L
 Total protein. SGOT/SGPT.

• Hemolysis
 Increased – ALT/AST, CK, LDH, ALP, K, ammonia, chole, TAG
 Decreased – hexokinase, bilirubin, albumin, Na
PHYSIOLOGIC VARIATION

• Sex
 Men – higher ALP, AST, CK and aldolase
 Women- lower levels of Mg, Ca, albumin, Hgb, Fe and Ferritin

• Postprandial
• Increased – ammonia, glucose, iron, Ca and Catecholamines
• Decreased – Phosphate and Chloride
 PHYSIOLOGIC VARIATION
DIURNAL VARIATION – TEST AFFECTED BY DIURNAL VARIATION, POSTURE AND STRESS

Cortisol Peaks 4-6, lowest 8pm to 12 am; 50% lower at 8pm than 8am; increases with
stress
ACTH Lower at night; increase w/ stress
Plasma Renin activity Lower at night; higher standing than supine
Aldosterone Lower at night
Insulin Lower at night
Growth Hormone Higher in afternoon and evening
ACP Higher in afternoon and evening
T4 Increases w/ exercise
Prolactin Higher w/ stress; higher levels at 4 and 8am and 8and 10pm
Iron Peaks early to late morning; decreases up to 30% during the day
Calcium 4% decrease supine