scholarly journals Laboratory Performance on Reporting Monoclonal Gammopathy During Cerebrospinal Fluid Oligoclonal Banding Analysis from External Quality Assessment Surveys

2018 ◽  
Vol 3 (2) ◽  
pp. 261-266
Author(s):  
Yu Chen
Keyword(s):  
Cerebrospinal Fluid ◽  
Quality Assessment ◽  
Monoclonal Gammopathy ◽  
External Quality Assessment ◽  
Average Rate ◽  
Further Education ◽  
Oligoclonal Bands ◽  
External Quality ◽  
Laboratory Performance ◽  
Oligoclonal Banding

Abstract Objective Cerebrospinal fluid (CSF) oligoclonal banding (OCB) analysis is a sensitive test used to mainly aid multiple sclerosis (MS) diagnosis. Monoclonal gammopathy is usually an incidental finding during CSF OCB analysis. The aim of this study was to assess laboratory performance on reporting monoclonal gammopathy pattern during CSF OCB analysis based on external quality assessment surveys. Methods The CSF OCB surveys from the College of American Pathologists (CAP) from 2010 to 2015 were reviewed. The UK National External Quality Assessment Service (NEQAS) CSF OCB surveys from 2014 to 2017 were also reviewed. All monoclonal gammopathy patterns were confirmed by serum protein electrophoresis followed by immunofixation on a Sebia Hydrasys analyzer. Results There were 11 monoclonal gammopathy cases identified in the CAP OCB survey from 2010 to 2015. The average rate of CAP participants that correctly reported the pattern was 25.1% (range, 2.4%–66.7%). The most common pattern incorrectly reported was the systemic inflammation pattern, followed by the oligoclonal bands present/positive pattern. The NEQAS OCB survey from 2014 to 2017 had 4 monoclonal gammopathy cases and indicated a much higher number (average, 88.5%; range, 84.1%–90.8%) of participating laboratories to successfully detect monoclonal gammopathy. Conclusion Monoclonal gammopathy is still an underrecognized pattern in the CSF OCB analysis by the CAP participating laboratories and warrants further education.

Combined international external quality assessment results of medical laboratory performance and reporting of samples with known antimicrobial resistance

Diagnosis ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 161-166
Author(s):  
Michael A. Noble ◽  
Robert Rennie
Keyword(s):  
Antimicrobial Resistance ◽  
Quality Assessment ◽  
Clinical Laboratory ◽  
External Quality Assessment ◽  
Medical Laboratory ◽  
External Quality ◽  
Laboratory Performance ◽  
Reporting Practices ◽  
Medical Laboratories ◽  
Poor Treatment

Abstract Background Reporting on the presence of antimicrobial resistance is of considerable concern both for individual patient care and for understanding the underlying health status within the community at large. Antimicrobial resistance is solely dependent upon clinical laboratory detection and thus can be impacted upon by the quality and competence of medical laboratories. Proficiency testing or external quality assessment (PT/EQA) is the international standard for the direct measurement of medical laboratory performance on critical testing. Methods An international, intercontinental collaborative retrospective study of medical laboratory performance in antibiotic resistance was performed by the Microbiology Working Group (MWG) of the European Organisation for External Quality Assurance for Laboratory Medicine (EQALM) with particular examination of laboratory performance on the testing and reporting of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and carbapenem-resistant Enterobacteriaceae (CRE). Results The results of 1880 medical laboratories were compiled. Strictly accurate reporting of isolates as resistant occurred with MRSA 96.9%, with VRE 91.3% and with CRE 93.1% of the time. On the other hand, very major errors (reporting of false susceptibility) were observed with 2.2% of MRSA and 2.4% of VRE and 0.8% of CRE. Major errors (false resistance) were reported for vancomycin susceptibility testing for MRSA at a rate of 0.6%. Conclusions Depending on how clinical physicians read and understand microbiology susceptibility reports, proficient acceptable results were reported either between 91% and 94% of the time, or between 97% and 100%. While very major errors are infrequently reported, they were found in all regions and could potentially cause poor treatment decisions by clinicians. A collective analysis of multi-program PT/EQA information can provide valuable insights into the testing and reporting practices of medical laboratories.

External quality assessment of laboratory performance in analysis of toxicological cases

2001 ◽  
Vol 121 (1-2) ◽  
pp. 27-32 ◽  
Author(s):  
J.F. Wilson ◽  
P.A. Toseland ◽  
N.E. Capps ◽  
L.N. Sandle ◽  
B.L. Smith ◽  
...  
Keyword(s):  
Quality Assessment ◽  
External Quality Assessment ◽  
External Quality ◽  
Laboratory Performance

External Quality Assessment in the Examination of Blood Films for Malarial Parasites Within Ontario, Canada

2000 ◽  
Vol 124 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Sam Thomson ◽  
Reinhard C. Lohmann ◽  
Linda Crawford ◽  
Ruby Dubash ◽  
Harold Richardson
Keyword(s):  
Quality Assessment ◽  
External Quality Assessment ◽  
Good Practice ◽  
Further Education ◽  
Educational Strategies ◽  
External Quality ◽  
Medical Laboratories ◽  
Detection And Identification ◽  
Total Testing Process

Abstract Objective.—To assess laboratory practice in the examination of blood films for malarial parasites. Method.—Ontario medical laboratories, licensed by the Ministry of Health, are required to participate in external quality assessment by the Laboratory Proficiency Testing Program, which assesses performance of laboratory assays and also examines the total testing process. Educational strategies are used to improve performance. Results.—A 1995 survey indicated shortcomings in detection and identification of malarial parasites in blood films. Consequently, recommendations for the investigation of malarial parasites in blood were issued. In 1996 and 1997, 16 workshops were conducted. A 1997 follow-up external quality assessment survey indicated that problems persist as 27% of laboratories failed to correctly speciate Plasmodium falciparum. Good Practice Guidelines were issued in 1998. Conclusion.—Further education and assessment are required. Laboratories lacking expertise must establish referral arrangements with more proficient laboratories.

scholarly journals Comparison of Procedures for Evaluating Laboratory Performance in External Quality Assessment Schemes for Lead in Blood and Aluminum in Serum Demonstrates the Need for Common Quality Specifications

2002 ◽  
Vol 48 (11) ◽  
pp. 2000-2007 ◽  
Author(s):  
Andrew Taylor ◽  
Jurgen Angerer ◽  
Francoise Claeys ◽  
Jesper Kristiansen ◽  
Olav Mazarrasa ◽  
...  
Keyword(s):  
Quality Assessment ◽  
External Quality Assessment ◽  
Total Error ◽  
Blood Lead ◽  
External Quality ◽  
Target Concentration ◽  
Laboratory Performance ◽  
Environmental Laboratory ◽  
Z Scores ◽  
Quality Specifications

Abstract Background: The different scoring methods used by eight European External Quality Assessment Schemes (EQASs) for occupational and environmental laboratory medicine were compared to develop suitable quality specifications as a step toward harmonization. Methods: Real results for blood lead and serum aluminum assays, reported by participants in Italian and United Kingdom EQASs, were evaluated according to individual scheme scoring criteria. The same results were then used to produce z scores using scheme-based between-laboratory SDs as the estimate of variability to determine whether simple performance-derived quality specifications produced better agreement among schemes. Results: The schemes gave conflicting assessments of participants’ performance, and participants judged to be successful by one scheme could be defined as performing inadequately by another. An approach proposed by Kenny et al. (Scand J Clin Lab Invest 1999;59:585), which uses clinical inputs to set targets for analytical imprecision, bias, and total error allowable, was then used to elaborate quality specifications. Conclusions: We suggest that the CLIA ′88 recommendations for blood lead (± 40 μg/L or ± 10% of the target concentration, whichever is the greater) could be used as a quality specification, although a revision to ± 30 μg/L or ± 10% is recommended. For serum aluminum, a suitable quality specification of ± 5 μg/L or ± 20% of the target concentration, whichever is the greater, is suggested. These specifications may be used to compare laboratory performance across schemes.

External quality assessment in clinical neurochemistry: survey of analysis for cerebrospinal fluid (CSF) proteins based on CSF/serum quotients

1995 ◽  
Vol 41 (2) ◽  
pp. 256-263 ◽  
Author(s):  
H Reiber
Keyword(s):  
Cerebrospinal Fluid ◽  
Quality Assessment ◽  
External Quality Assessment ◽  
Internal Quality ◽  
Barrier Dysfunction ◽  
External Quality ◽  
Csf Analysis ◽  
Csf Proteins ◽  
Oligoclonal Igg

Abstract Participants (230) from Germany and 20 laboratories in 11 European countries took part in a newly designed cerebrospinal fluid (CSF) survey distributed by INSTAND. Conventional proficiency testing for albumin, IgG, IgA, and IgM in CSF and serum, for total protein in CSF, and for oligoclonal IgG in CSF and serum was combined with evaluation and interpretation of CSF/serum quotients in quotient diagrams. The correct detection of a blood-CSF barrier dysfunction and the pattern of intrathecal immunoglobulin synthesis was judged. The accuracy of CSF/serum quotients and their clinically relevant interpretation was given first priority as a new concept in quality assessment. The main result of the surveys was to confirm that CSF/serum quotients of proteins represent method-independent values approaching the quality of reference values. This finding has consequences for internal quality control of CSF analysis and for accreditation bodies. The sensitivity of the methods for quantifying IgA and IgM in CSF and for detecting oligoclonal IgG fractions is discussed.

Sign in / Sign up

Export Citation Format

Share Document