Outside Diagnostic Laboratory Services

CHAPTER 9


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Outside Diagnostic Laboratory Services



Learning Objectives


Mastery of the content in this chapter will enable the reader to:


• Identify the correct sample needed for specific testing.


• List methods used to preserve samples correctly.


• List methods used to label samples correctly.


• Identify laboratory forms.


• Define methods used to submit samples safely to the lab.


• Describe an appropriate fee structure for outside laboratory services.



Key Terms



Outside laboratories are any laboratories to which patient samples are submitted. Some practices may use several outside labs for a variety of tests. It is important that measures are implemented to ensure that the correct forms are sent to each lab and that samples are prepared according to lab standards and sent correctly, either on ice or dry. Samples must also be packaged correctly so that they do not break during shipment.


Many practices continue to use in-house laboratory services for general chemistries and complete blood counts (CBC). In-house laboratory equipment is essential for receiving immediate results, especially in critical cases. For optimal results, in-house equipment must be consistently checked for quality control while performing maintenance. Many in-house laboratories can increase the bottom line of the practice, and equipment must be chosen with that in mind. For all tests that cannot be completed in-house, an outside service must be chosen.



CHOOSING A DIAGNOSTIC LABORATORY


Choosing a diagnostic laboratory can be a challenge because many factors are involved in the decision. First and foremost, the diagnostic laboratory must offer services and tests that the veterinarian is looking for. Some laboratories specialize in specific tests and have the newest technology available. For example, the Gastrointestinal Laboratory at Texas A&M University specializes in gastroenterology-related tests, and many other diagnostic laboratories will submit samples to this specific lab because of their testing protocol and results.



image PRACTICE POINT


The choice of an outside laboratory should be based on customer service, quick result turnaround time, and consistency of results.


Standard laboratory services should include analysis for biochemical profiles, CBCs, cultures, cytology, and histopathology. Many laboratories offer services that extend beyond those listed, enabling veterinarians to provide better service to their clients.


Laboratories should abide by guidelines set forth by the National Committee for Clinical Laboratory Standards (NCCLS) and adhere to the strict guidelines outlined by the Food and Drug Administration (FDA). All labs being considered should continually monitor and perform quality controls for accuracy and reproducibility by internal and external quality assurance programs.



SAMPLE SUBMISSION


Correct sample submission is absolutely critical for the tests required. Many tests require serum, not plasma, for accurate testing. Tests that require plasma may require the sample to be spun with a specific anticoagulant. Serum is produced when a red-topped tube is centrifuged, separating the red blood cells and coagulation proteins from the liquid portion of the blood. Red-topped tubes should be allowed to clot for 15 to 20 minutes before centrifugation. The sample can then be spun for 10 to 15 minutes at 2500 rpm. The serum can then be removed from the clot and placed in a plain glass red-topped tube for transport. If a serum separator tube (SST) has been used, there is no need to remove the serum. Do not use serum separator tubes for therapeutic monitoring, such as digoxin, phenobarbital, or theophylline levels.


EDTA (ethylenediamine tetraacetic acid) is an anticoagulant that is added to a lavender-topped tube, preventing clotting of the blood. Plasma can then be obtained by centrifuging the sample and removing the liquid portion of the sample without any red blood cells. Other common anticoagulants include lithium heparin, sodium heparin, and potassium citrate (Figure 9-1 and Table 9-1).



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FIGURE 9-1 Various blood tubes. A, Serum separator tube. B, Red-topped tube. C, Lavender-topped tube. D, Green-topped tube with serum separator.


image PRACTICE POINT


Anticoagulant products include EDTA, lithium heparin, and potassium citrate.

Related posts:

  1. Veterinary Ethics and Legal Issues
  2. Controlled Substances
  3. Pet Health Insurance
  4. Technology in the Office

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Oct 1, 2016 | Posted by in EXOTIC, WILD, ZOO | Comments Off on Outside Diagnostic Laboratory Services

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