How good comments can medical laboratories provide clinicians?

On the first congress day the scientific program is build on the theme Harmonization of medical laboratory practices. One of the speakers is M.D., Ph.D. Eva Ajzner who will highlight the meaning of interpretive commenting (IC) as an integral part of postanalytical activities of laboratories. Please read up on Dr. Ajzner’s subject ”Quality of Comments for the Clinicians” on the abstract.

About the Speaker: M.D., Ph.D.Éva Ajzner

Doctor Ajzner is a Private Professor, accredited PhD tutor of the University of Debrecen Medical Health Science Center. She is head of the Department of Laboratory Medicine and Clinical Microbiology, Jósa University Hospital. She is deputy director of National Institution of Hematology and Infectious Diseases. Dr. Ajzner received her PhD in the field of experimental hemostasis from the University of Debrecen in 2003. She is past president of the Hungarian Society of Laboratory Medicine and member of the Laboratory Medicine Council of the National Advisory board of Healthcare in Hungary. After serving as chair for 3 terms, she is now expert advisor of the joint Working Group on Post-analytical Phase of the European Federation of Clinical Chemistry and Laboratory Medicine and European Organisation for External Quality Assurance Providers in Laboratory Medicine. Her research interests are applied haemostasis, post-analytical, interpretative responsibilities of laboratories and near patient testing.


Abstract: Quality of Comments for the Clinicians

Interpretive commenting (IC) is an integral part of postanalytical activities of laboratories when the clinical interpretation of laboratory results in the context of the clinical situation of a patient is provided. By studies, IC of haemostasis results by laboratory staff is welcomed by clinicians. Corresponding to this clinical expectation 60% of European laboratories provide IC of haemostasis results routinely, based on the findings of the survey of our working group (WG) about the postanalytical activities in 833 laboratories. However, only high quality IC has a potential to improve patient outcome, which assumes good laboratory practice in analysis as well as appropriate actions in postanalytical phase including correct clinical interpretation and clinically useful way of reporting. European laboratories had heterogeneous practices and often provided clinically misleading laboratory interpretations when our WG investigated how European laboratories handled and interpreted unexpected APTT prolongation. But no studies about the content of interpretive comments provided in haemostasis by European laboratories available yet.

This presentation will discuss the results of our WG’s most recent survey on how laboratories in 11 European countries analysed and interpreted two samples from bleeding patients representing common reasons of APTT prolongation. The first sample was contaminated with unfractionated heparin (UH) while the second sample represented mild form of coagulation factor deficiency in the intrinsic pathway (FD). The survey intended to model real life practice of participant laboratories, therefore we provided case histories and relevant previous laboratory data with lyophylised samples and asked laboratories to measure then classify the samples in categories as follows: normal sample/ coagulation factor deficiency/ inhibitor (coagulation factor specific or non-specific like lupus anticoagulant)/ presence of anticoagulant (due to unknown therapy or contamination of the sample). In addition, we asked those respondents who on the basis of routines in their laboratories would have reported results together with a comment to provide us the comment they would have given in real life to the requesting physician into their native language.

Vast majority of laboratories detected APTT prolonged in both samples (100% in the first sample, 99% in the second sample) and performed mixing studies on both samples (100% on the first sample and 96% on the second sample). Despite the fact that 91% of laboratories found APTT prolonged in the mixture of the UH contaminated sample and only 78% classified APTT normal in the mixture of the sample representing FD, the UH sample was classified correctly only in 47% of laboratories while the FD sample in 83%. More than half of the laboratories (53%) indicated to do other tests before reporting their results to clinicians and almost 90% indicated to add a comment beside numerical results. 86% (first sample) and 83% of laboratories (second sample) shared the interpretive comments of their reports in the survey. Quality of these reports have been analysed in consensus of 3 pairs of coagulation experts, when beside the analytical content, the tentative diagnosis, the provided advice to the requesting clinician, and also the clarity of the phrasing as well as the length of the comments were evaluated. Comments were found diverse and only small proportion of responses seemed to reach highest scores.

Although only few studies that demonstrate evidence on the clinical utility of IC are available in the literature so far, it is clear that only high quality IC can have clinical value. Findings of our survey confirm that besides training for performing IC, standards on the content and wording of IC as well as more EQA schemes in native languages of the users are required to improve the quality of IC.


Labquality Days – the International Congress on Quality in Laboratory Medicine

Welcome to Labquality Days on 6-7 February 2020. The scientific program of the next International Congress on Quality in Laboratory Medicine will be built around the theme of optimizing quality. The program covers the topics on harmonization of medical practices, how to communicate the results to clinicians and patients and the quality assurance of new measurement technologies. Welcome to Helsinki!