𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐂𝐇𝐄𝐌𝐈𝐒𝐓𝐑𝐘

𝑳𝑨𝑩𝑶𝑹𝑨𝑻𝑶𝑹𝒀 𝑴𝑨𝑻𝑯𝑬𝑴𝑨𝑻𝑰𝑪𝑺

kat = mol/s/L IU = umol/min/L 𝑲𝒆𝒚𝒘𝒐𝒓𝒅: 𝑬𝑷𝑻𝑮𝑴𝒌𝒉𝒅𝒂 (𝒎/𝒈/𝑳) 𝒅𝒄𝒎𝒖𝒏𝒑𝒇𝒂

𝑺𝑰 𝑪𝑶𝑵𝑽𝑬𝑹𝑺𝑰𝑶𝑵𝑺:
 𝑆𝑢𝑏𝑠𝑡𝑟𝑎𝑐𝑡 𝑒𝑥𝑝𝑜𝑛𝑒𝑛𝑡𝑠
 𝑀𝑜𝑣𝑒 𝑑𝑒𝑐𝑖𝑚𝑎𝑙 𝑡𝑜 𝑡ℎ𝑒 𝑑𝑖𝑟𝑒𝑐𝑡𝑖𝑜𝑛 𝑜𝑓 𝑡ℎ𝑒 𝑢𝑛𝑖𝑡 𝑡𝑜 𝑏𝑒 𝑐𝑜𝑛𝑣𝑒𝑟𝑡𝑒𝑑
 𝑅𝑖𝑔ℎ𝑡 (𝑙𝑎𝑟𝑔𝑒𝑟 𝑡𝑜 𝑠𝑚𝑎𝑙𝑙𝑒𝑟)
 𝐿𝑒𝑓𝑡 (𝑠𝑚𝑎𝑙𝑙𝑒𝑟 𝑡𝑜 𝑙𝑎𝑟𝑔𝑒𝑟)

𝐶𝑜𝑛𝑣𝑒𝑟𝑡 1𝐿 𝑡𝑜 1 𝑚𝐿 𝐶𝑜𝑛𝑣𝑒𝑟𝑡 50𝑚𝐿 𝑡𝑜 𝐿 𝐶𝑜𝑛𝑣𝑒𝑟𝑡 5𝑑𝐿 𝑡𝑜 𝑚𝐿

0 −3 = 3 −3 −0 = 3 1 −3 = 2
1000 𝑚𝐿 .050 𝐿 500 𝑚𝐿
 𝑻𝑬𝑴𝑷𝑬𝑹𝑨𝑻𝑼𝑹𝑬 𝑪𝑶𝑵𝑽𝑬𝑹𝑺𝑰𝑶𝑵𝑺

𝑪𝑲 𝑲 = 𝑪 + 𝟐𝟕𝟑. 𝟏𝟓
𝑪𝑭 𝑭 = (𝑪 𝒙 𝟏. 𝟖) + 𝟑𝟐 𝒐𝒓 𝑪 (𝟗/𝟓) + 𝟑𝟐
𝑭𝑪 𝑪 = (𝑭 – 𝟑𝟐) 𝒙 . 𝟓𝟓𝟔 𝒐𝒓 (𝑭 − 𝟑𝟐) 𝟓/𝟗

𝑺𝑰𝑮𝑵𝑰𝑭𝑰𝑪𝑨𝑵𝑻 𝑭𝑰𝑮𝑼𝑹𝑬𝑺

𝑹𝑼𝑳𝑬𝑺:
1. 𝑨𝑳𝑳 𝒏𝒐𝒏 − 𝒛𝒆𝒓𝒐 𝒏𝒖𝒎𝒃𝒆𝒓𝒔 𝒂𝒓𝒆 𝒔𝒊𝒈𝒏𝒊𝒇𝒊𝒄𝒂𝒏𝒕 (𝟖𝟔𝟒. 𝟏) = 𝟒
2. 𝒁𝒆𝒓𝒐𝒔 𝒃𝒆𝒕𝒘𝒆𝒆𝒏 𝟐 𝒏𝒐𝒏 − 𝒛𝒆𝒓𝒐 𝒅𝒊𝒈𝒊𝒕𝒔 𝒂𝒓𝒆 𝒔𝒊𝒈𝒏𝒊𝒇𝒊𝒄𝒂𝒏𝒕 (𝟐𝟎𝟏) = 𝟑
3. 𝒁𝒆𝒓𝒐𝒔 𝒂𝒇𝒕𝒆𝒓 𝒅𝒆𝒄𝒊𝒎𝒂𝒍 𝒂𝒓𝒆 𝒔𝒊𝒈𝒏𝒊𝒇𝒊𝒄𝒂𝒏𝒕 (𝟏𝟎. 𝟎𝟎) = 𝟒
4. 𝑳𝒆𝒂𝒅𝒊𝒏𝒈 𝒛𝒆𝒓𝒐𝒔 𝒂𝒓𝒆 𝑵𝑶𝑻 𝒔𝒊𝒈𝒏𝒊𝒇𝒊𝒄𝒂𝒏𝒕 (𝟎. 𝟎𝟎𝟎𝟔𝟐𝟓) = 𝟑

𝒑𝑯 (𝒏𝒆𝒈𝒂𝒕𝒊𝒗𝒆 𝒍𝒐𝒈)

𝑝𝐻
= 𝑥 − 𝑙𝑜𝑔𝑁 𝑥 = 𝑛𝑒𝑔𝑎𝑡𝑖𝑣𝑒 𝑒𝑥𝑝𝑜𝑛𝑒𝑛𝑡
𝑝𝐾𝑎
𝑁 = 𝑑𝑒𝑐𝑖𝑚𝑎𝑙 𝑝𝑜𝑟𝑡𝑖𝑜𝑛

𝐸𝑥𝑎𝑚𝑝𝑙𝑒𝑠:
𝐷𝑒𝑡𝑒𝑟𝑚𝑖𝑛𝑒 𝑝𝐻=𝑖𝑓
5.27
𝐻 + 𝑖𝑜𝑛 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛 𝑖𝑠 5.4 𝑥 10−6 𝐷𝑒𝑡𝑒𝑟𝑚𝑖𝑛𝑒 𝐻 + 𝑖𝑜𝑛 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛 𝑖𝑓 𝑝𝐻 = 5.27
𝑝𝐻 = 6 – 𝑙𝑜𝑔 5.4 5.27 = 6 – 𝑙𝑜𝑔𝑁
= 6 – 0.73 6 – 5.27 = 𝑎𝑛𝑡𝑖𝑙𝑜𝑔 0.73 (10.73 )
= 5.27 = 5.37 = 5.4 𝑥 10−6

% 𝑺𝑶𝑳𝑼𝑻𝑰𝑶𝑵𝑺:

𝑔
𝑔 𝑠𝑜𝑙𝑢𝑡𝑒 𝑤/𝑣 ( ) 𝑣𝑜𝑙 𝑠𝑜𝑙𝑢𝑡𝑒
𝑤/𝑤 ( ) 𝑥 100 100 𝑚𝐿 𝑉/𝑉 ( ) 𝑥 100
𝑔 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑀𝑂𝑆𝑇 𝐶𝑂𝑀𝑀𝑂𝑁 𝑣𝑜𝑙 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛

𝐸𝑥𝑎𝑚𝑝𝑙𝑒𝑠: 𝑤/𝑤
1. 𝐴 𝑠𝑎𝑙𝑖𝑛𝑒 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑤𝑖𝑡ℎ 𝑎 𝑚𝑎𝑠𝑠 𝑜𝑓 355 𝑔 ℎ𝑎𝑠 36.5 𝑔 𝑜𝑓 𝑁𝑎𝐶𝑙 𝑑𝑖𝑠𝑠𝑜𝑙𝑣𝑒𝑑 𝑖𝑛 𝑖𝑡. 𝑊ℎ𝑎𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑚𝑎𝑠𝑠/
𝑚𝑎𝑠𝑠 𝑝𝑒𝑟𝑐𝑒𝑛𝑡 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛?

365 𝑔
𝑥 100 = 10.28%
355 𝑔

2. 𝑀𝑎𝑘𝑒 3000.0 𝑔 𝑜𝑓 5% 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 𝑁𝑎𝐶𝑙, 𝑑𝑒𝑡𝑒𝑟𝑚𝑖𝑛𝑒 𝑚𝑎𝑠𝑠 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑒.

5 1
𝑥 = 150 𝑔
100 1000

3. 𝑊ℎ𝑎𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑎𝑚𝑜𝑢𝑛𝑡 𝑛𝑒𝑒𝑑𝑒𝑑 𝑖𝑛 𝑔 𝑜𝑓 𝐻2𝑂2 𝑛𝑒𝑒𝑑𝑒𝑑 𝑡𝑜 𝑚𝑎𝑘𝑒 6 𝑘𝑔 3% 𝐻2𝑂2 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛?

3 𝑥
𝑥 = 180 𝑔
100 6000
𝐸𝑥𝑎𝑚𝑝𝑙𝑒: 𝑤/𝑣
1. 𝑀𝑎𝑘𝑒 1000 𝑚𝐿 𝑜𝑓 10% 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 𝑁𝑎𝑂𝐻
10 1
𝑥 = 100 𝑔
100 1000

𝐸𝑥𝑎𝑚𝑝𝑙𝑒: 𝑣/𝑣
1. 𝑀𝑎𝑘𝑒 50 𝑚𝐿 𝑜𝑓 2% 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝐻𝐶𝑙
2 1
𝑥 = 1 𝑚𝐿
100 50

𝑪𝑶𝑵𝑪𝑬𝑵𝑻𝑹𝑨𝑻𝑰𝑶𝑵 𝑪𝑶𝑵𝑽𝑬𝑹𝑺𝑰𝑶𝑵𝑺

o 𝑴𝑶𝑳𝑨𝑹𝑰𝑻𝒀 (𝑴)

𝑚𝑜𝑙 𝑠𝑜𝑙𝑢𝑡𝑒 𝑔 𝑠𝑜𝑙𝑢𝑡𝑒

𝑀= 𝑁
𝑀= 𝑔 𝑀=
𝐿 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑀𝑊 ( ) 𝑥 𝐿 𝑠𝑜𝑙𝑛 𝑣𝑎𝑙𝑒𝑛𝑐𝑒
𝑚𝑜𝑙

𝐸𝑥𝑎𝑚𝑝𝑙𝑒𝑠:
1. 0.25 𝑚𝑜𝑙 𝑜𝑓 𝑁𝑎𝐶𝑙 𝑖𝑛 300 𝑚𝐿 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛

0.25 𝑚𝑜𝑙
𝑀= = 0.83 𝑀
0.3 𝐿

2. 60 𝑔 𝑜𝑓 𝑁𝑎𝑂𝐻 𝑖𝑛 250 𝑚𝐿 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛

𝐺𝑖𝑣𝑒𝑛: 𝑔 𝑠𝑜𝑙𝑢𝑡𝑒 = 60 𝑔
𝑀𝑊: 𝑁𝑎 = 23
𝑂 = 16 40 𝑔/𝑚𝑜𝑙
𝐻 = 1
𝐿 𝑠𝑜𝑙𝑛 = 250 𝑚𝐿 = 0.25 𝐿

60 𝑔
𝑀= 𝑔 = 6𝑀
40 𝑥 0.25 𝐿
𝑚𝑜𝑙

3. 𝐻𝑜𝑤 𝑚𝑎𝑛𝑦 𝑔 𝑎𝑟𝑒 𝑛𝑒𝑒𝑑𝑒𝑑 𝑡𝑜 𝑚𝑎𝑘𝑒 1𝐿 𝑜𝑓 2𝑀 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 𝐻𝐶𝑙?

𝑔 = 𝑀 𝑥 𝑀𝑊 𝑥 𝐿
= 2 𝑥 36.5 𝑥 1
= 73 𝑔

4. 𝑊ℎ𝑎𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑒𝑞𝑢𝑖𝑣𝑎𝑙𝑒𝑛𝑡 𝑚𝑜𝑙𝑎𝑟𝑖𝑡𝑦 𝑜𝑓 0.5 𝑁 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 𝐻2𝑆𝑂4?

0.5
𝑀= = 0.25 𝑀
2
 o 𝑵𝑶𝑹𝑴𝑨𝑳𝑰𝑻𝒀 (𝑵)

𝑒𝑞. 𝑤𝑡. 𝑔 𝑠𝑜𝑙𝑢𝑡𝑒

𝑁= 𝑁=
𝑀𝑊 𝑁 = 𝑀 𝑥 𝑣𝑎𝑙𝑒𝑛𝑐𝑒
𝐿 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 (𝑣𝑎𝑙𝑒𝑛𝑐𝑒) 𝑥 𝐿 𝑠𝑜𝑙𝑛

𝐸𝑥𝑎𝑚𝑝𝑙𝑒𝑠:
1. 𝐺𝑖𝑣𝑒 𝑒𝑞. 𝑤𝑡. 𝑜𝑓 𝑡ℎ𝑒 𝑓𝑜𝑙𝑙𝑜𝑤𝑖𝑛𝑔:
a. 𝑁𝑎𝐶𝑙 (𝑔𝑚𝑤 = 58 𝑔, 𝑣𝑎𝑙𝑒𝑛𝑐𝑒 = 1) 𝐸𝑞𝑤𝑡 = 58/1 = 58
b. 𝐻𝐶𝑙 (𝑔𝑚𝑤 = 36𝑔, 𝑣𝑎𝑙𝑒𝑛𝑐𝑒 = 1) 𝐸𝑞𝑤𝑡 = 36/1 = 36
c. 𝐻2𝑆𝑂4 (𝑔𝑚𝑤 = 98𝑔, 𝑣𝑎𝑙𝑒𝑛𝑐𝑒 = 2) 𝐸𝑞𝑤𝑡 = 98/2 = 49

2. 𝑊ℎ𝑎𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑁 𝑜𝑓 𝑎 500 𝑚𝐿 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑡ℎ𝑎𝑡 𝑐𝑜𝑛𝑡𝑎𝑖𝑛𝑠 7𝑔 𝑜𝑓 𝐻2𝑆𝑂4?

𝐺𝑖𝑣𝑒𝑛: 𝑔 𝑠𝑜𝑙𝑢𝑡𝑒 = 7𝑔
𝑀𝑊: 𝐻 = 1 𝑥 2 = 2
𝑆 = 32 𝑥 1 = 32 98 𝑔/𝑚𝑜𝑙
𝑂 = 16 𝑥 4 = 64
𝑉𝑎𝑙𝑒𝑛𝑐𝑒 = 2
𝐿 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 = 500 𝑚𝐿 = .5 𝐿

7𝑔
𝑁= 98 = 0.285 𝐸𝑞/𝐿
𝑋 0.5
2

3. 𝑊ℎ𝑎𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑁 𝑜𝑓 𝑎 0.5 𝑀 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 𝐻2𝑆𝑂4?

𝑁 = 0.5 𝑥 2 = 1

4. 𝐻𝑜𝑤 𝑚𝑎𝑛𝑦 𝑔 𝑜𝑓 𝐻2𝑆𝑂4 𝑠ℎ𝑜𝑢𝑙𝑑 𝑏𝑒 𝑤𝑒𝑖𝑔ℎ𝑒𝑑 𝑡𝑜 𝑝𝑟𝑒𝑝𝑎𝑟𝑒 2𝐿 𝑜𝑓 4𝑁 𝐻2𝑆𝑂4?

𝑔 = 𝑁 𝑥 𝑀𝑊/𝑣𝑎𝑙𝑒𝑛𝑐𝑒 𝑥 𝐿
= 4 𝑥 98/2 𝑥 2
= 392 𝑔

o 𝑪𝑶𝑵𝑪𝑬𝑵𝑻𝑹𝑨𝑻𝑰𝑶𝑵/𝑷𝑹𝑬𝑷𝑨𝑹𝑨𝑻𝑰𝑶𝑵 𝑭𝑹𝑶𝑴 𝑺𝑻𝑶𝑪𝑲 𝑺𝑶𝑳𝑼𝑻𝑰𝑶𝑵

𝐶1𝑉1 = 𝐶2𝑉2
𝑠𝑡𝑜𝑐𝑘 𝑠𝑜𝑙𝑛 = 𝑠𝑜𝑙𝑛 𝑡𝑜 𝑏𝑒 𝑝𝑟𝑒𝑝𝑎𝑟𝑒𝑑

𝐸𝑥𝑎𝑚𝑝𝑙𝑒:
1. 𝑊ℎ𝑎𝑡 𝑣𝑜𝑙𝑢𝑚𝑒 𝑖𝑠 𝑛𝑒𝑒𝑑𝑒𝑑 𝑡𝑜 𝑚𝑎𝑘𝑒 500 𝑚𝐿 𝑜𝑓 0.1 𝑀 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 𝑇𝑟𝑖𝑠 𝑏𝑢𝑓𝑓𝑒𝑟 𝑓𝑟𝑜𝑚 𝑎 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 2𝑀 𝑇𝑟𝑖𝑠 𝑏𝑢

𝐶2𝑉2 (0.1)(500)
𝑉1 = = = 25 𝑚𝐿
𝐶1 2
𝑫𝑰𝑳𝑼𝑻𝑰𝑶𝑵𝑺

𝑉𝑠𝑜𝑙𝑢𝑡𝑒 𝐷𝐹 = 𝑑𝑒𝑛𝑜𝑚𝑖𝑛𝑎𝑡𝑜𝑟 𝑖𝑛 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛

𝐷𝑖𝑙𝑢𝑡𝑖𝑜𝑛 =
𝑉𝑠𝑜𝑙𝑢𝑡𝑒 + 𝑉𝑠𝑜𝑙𝑣𝑒𝑛𝑡 (𝑉 𝑠𝑜𝑙𝑛)

𝐸𝑥𝑎𝑚𝑝𝑙𝑒𝑠:
1. 𝐷𝑒𝑡𝑒𝑟𝑚𝑖𝑛𝑒 𝐷𝐹: 100 𝑢𝐿 𝑜𝑓 𝑠𝑒𝑟𝑢𝑚 𝑎𝑑𝑑𝑒𝑑 𝑡𝑜 900 𝑢𝐿 𝑠𝑎𝑙𝑖𝑛𝑒

100𝑢𝐿 1
𝐷𝑖𝑙𝑢𝑡𝑖𝑜𝑛 = =
1000𝑢𝐿 10

𝐷𝐹 = 10

2. 𝐻𝑜𝑤 𝑚𝑢𝑐ℎ 𝑑𝑖𝑙𝑢𝑒𝑛𝑡 𝑖𝑠 𝑛𝑒𝑒𝑑𝑒𝑑 𝑡𝑜 𝑝𝑟𝑒𝑝𝑎𝑟𝑒 1: 10 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛 𝑢𝑠𝑖𝑛𝑔 𝑎 𝑠𝑎𝑚𝑝𝑙𝑒 𝑣𝑜𝑙𝑢𝑚𝑒 𝑜𝑓 2 𝑚𝐿?

2 𝑚𝐿 1
𝐷𝑖𝑙𝑢𝑡𝑖𝑜𝑛 = =
2 𝑚𝐿 + 18 𝑚𝐿 10

3. 𝐴 𝑀𝑇 𝑝𝑟𝑒𝑝𝑎𝑟𝑒𝑑 𝑎 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛 𝑐𝑜𝑛𝑡𝑎𝑖𝑛𝑖𝑛𝑔 1𝑚𝐿 𝑠𝑒𝑟𝑢𝑚 𝑠𝑎𝑚𝑝𝑙𝑒, 𝑚𝑖𝑥𝑒𝑑 𝑤𝑖𝑡ℎ 2 𝑚𝐿 𝑜𝑓 𝑑𝑖𝑙𝑢𝑒𝑛𝑡. 𝐻𝑒 𝑓𝑢𝑟𝑡ℎ𝑒𝑟
𝑑𝑖𝑣𝑖𝑑𝑒𝑑 𝑡ℎ𝑒 𝑚𝑖𝑥𝑡𝑢𝑟𝑒 𝑏𝑦 𝑚𝑖𝑥𝑖𝑛𝑔 2 𝑚𝐿 𝑜𝑓 𝑖𝑛𝑖𝑡𝑖𝑎𝑙 𝑤𝑖𝑡ℎ 2 𝑚𝐿 𝑜𝑓 𝑑𝑖𝑙𝑢𝑒𝑛𝑡. 𝑊ℎ𝑎𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑓𝑖𝑛𝑎𝑙 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛?
1 2 1
𝐼𝑛𝑖𝑡𝑖𝑎𝑙 𝐷𝑖𝑙𝑢𝑡𝑖𝑜𝑛 = = ( )
3 4 2

1 1 1
𝐹𝑖𝑛𝑎𝑙 𝐷𝑖𝑙𝑢𝑡𝑖𝑜𝑛 = 𝑥 =
3 2 6

4. 𝑊ℎ𝑎𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛 𝑖𝑛 𝑡ℎ𝑒 𝑡𝑢𝑏𝑒 𝑛𝑢𝑚𝑏𝑒𝑟 5 𝑖𝑓 𝑡ℎ𝑒 𝑢𝑛𝑑𝑖𝑙𝑢𝑡𝑒𝑑 𝑠𝑎𝑚𝑝𝑙𝑒 𝑓𝑟𝑜𝑚 𝑡𝑢𝑏𝑒 𝑛𝑢𝑚𝑏𝑒𝑟 1 𝑖𝑠 𝑠𝑢𝑏𝑗𝑒𝑐𝑡𝑒𝑑 𝑡𝑜
𝑡𝑤𝑜 − 𝑓𝑜𝑙𝑑 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛? 𝑇𝑤𝑜 𝑓𝑜𝑙𝑑 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛 = ½
1 1 1 1 1 1 1 1 1
𝐷𝑖𝑙𝑢𝑡𝑖𝑜𝑛 = 𝑥 = 𝑥 = 𝑥 = 𝑥 =
1 2 2 2 4 2 8 2 16

5. 4𝑡ℎ 𝑡𝑢𝑏𝑒, 𝑓𝑖𝑣𝑒 − 𝑓𝑜𝑙𝑑 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛 (1/5)

1 1 1 1 1 1 1
𝐷𝑖𝑙𝑢𝑡𝑖𝑜𝑛 = 𝑥 = 𝑥 = 𝑥 =
1 5 5 5 25 5 125

6. 𝑊ℎ𝑎𝑡 𝑖𝑠 𝑡ℎ𝑒 𝑓𝑖𝑛𝑎𝑙 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑎 400 𝑚𝑔% 𝑠𝑡𝑜𝑐𝑘 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 𝐻𝐶𝑙 𝑑𝑖𝑙𝑢𝑡𝑒𝑑 𝑡𝑜 1: 5 𝑡ℎ𝑒𝑛 1: 10 𝑎𝑛𝑑
𝑓𝑖𝑛𝑎𝑙𝑙𝑦 1: 20?
1 1 1
400 𝑚𝑔% 𝑥 = 80 𝑚𝑔% 𝑥 = 8 𝑚𝑔% 𝑥 = 0.4 𝑚𝑔%
5 10 5
20

7. 𝐴 1: 2 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 𝑠𝑒𝑟𝑢𝑚 𝑤𝑖𝑡ℎ 𝑠𝑎𝑙𝑖𝑛𝑒 ℎ𝑎𝑑 𝑎 𝑐𝑟𝑒𝑎𝑡𝑖𝑛𝑖𝑛𝑒 𝑟𝑒𝑠𝑢𝑙𝑡 𝑜𝑓 8.6 𝑚𝑔𝑑𝑙.

𝐶𝑎𝑙𝑐𝑢𝑙𝑎𝑡𝑒 𝑡ℎ𝑒 𝑎𝑐𝑡𝑢𝑎𝑙 𝑠𝑒𝑟𝑢𝑚 𝑐𝑟𝑒𝑎𝑡𝑖𝑛𝑖𝑛𝑒 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛?

8.6 𝑥 2 = 17.2 𝑚𝑔/𝑑𝐿

 𝑪𝑶𝑵𝑽𝑬𝑹𝑺𝑰𝑶𝑵 𝑭𝑨𝑪𝑻𝑶𝑹

𝐶𝑜𝑛𝑣𝑒𝑛𝑡𝑖𝑜𝑛𝑎𝑙 → 𝑆𝐼: 𝐷𝑖𝑣𝑖𝑑𝑒Multiply 𝐵𝑈𝑁 → 𝑈𝑟𝑒𝑎: 𝑥 2.14

𝑆𝐼 → 𝐶𝑜𝑛𝑣𝑒𝑛𝑡𝑖𝑜𝑛𝑎𝑙: 𝑀𝑢𝑙𝑡𝑖𝑝𝑙𝑦 Divide 𝑈𝑟𝑒𝑎 → 𝐵𝑈𝑁: 𝑥 0.467
𝐸ℎ𝑟𝑙𝑖𝑐ℎ 𝑢𝑛𝑖𝑡 → 𝑚𝑔/𝑑𝐿: 1
𝑔 → 𝑚𝐿: 1
CU x CF = SI
SI / CF = CU

Ammonia = 0.587 Folic acid = 2.27

Na, K, Cl, HCO3, Li, Osmolality = 1.0 Glucose = 0.0555
Alb, TP, Hb = 10 Bilirubin = 17.1
BUN = 0.357 Iron = 0.179
AST, Crea Clearance = 0.0167 Mg = 0.5
pCO2, pO2 = 0.133 Calcium = 0.25
Chole = 0.026 Phosphorus = 0.323
Cortisol =0.0276 Thyroxine = 12.9
Crea =88.4 TG = 0.0113
UA = 0.0595
Vit B12 = 0.0738
 𝑅𝐸𝐶𝐴𝐿𝐿𝑆

𝑾𝒆𝒊𝒈𝒉𝒕 𝒐𝒇 𝟒𝟓𝟎 𝒎𝑳 𝒊𝒏 𝒈𝒓𝒂𝒎𝒔

A. 495
B. 486
C. 𝟒𝟓𝟎
D. 435

𝐷𝑒𝑛𝑠𝑖𝑡𝑦 𝑓𝑜𝑟𝑚𝑢𝑙𝑎: 1𝑚𝐿 = 1𝑔

𝑼𝒏𝒊𝒕 𝒐𝒇 𝒎𝒆𝒂𝒔𝒖𝒓𝒆𝒎𝒆𝒏𝒕 “𝒎𝒆𝒈𝒂”

A. 10^3
B. 𝟏𝟎^𝟔
C. 10^9
D. 10^ − 6

𝑚𝑒𝑔𝑎  10^6
Type equation here.
𝑾𝒉𝒂𝒕 𝒊𝒔 𝒕𝒉𝒆 𝒅𝒊𝒍𝒖𝒕𝒊𝒐𝒏 𝒊𝒇 𝟓𝒎𝑳 𝒊𝒔 𝒎𝒊𝒙𝒆𝒅 𝒘𝒊𝒕𝒉 𝟓𝟎 𝒎𝑳 𝒐𝒇 𝒕𝒉𝒆 𝒅𝒊𝒍𝒖𝒆𝒏𝒕?
A. 1: 8
B. 1: 9
C. 1: 10
D. 𝟏: 𝟏𝟏

𝐷𝑖𝑙𝑢𝑡𝑖𝑜𝑛 = 𝑣𝑜𝑙 𝑠𝑜𝑙𝑢𝑡𝑒/𝑣𝑜𝑙 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛

𝑉𝑜𝑙 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 = 𝑣𝑜𝑙 𝑠𝑜𝑙𝑢𝑡𝑒 + 𝑣𝑜𝑙 𝑠𝑜𝑙𝑣𝑒𝑛𝑡
5/50 + 5  1: 11

𝑪𝒉𝒍𝒐𝒓𝒊𝒅𝒆 𝒊𝒏 𝒔𝒆𝒓𝒖𝒎 𝒊𝒔 𝒓𝒆𝒑𝒐𝒓𝒕𝒆𝒅 𝒂𝒕 𝟗𝟓 𝒎𝑬𝒒/𝑳. 𝑾𝒉𝒂𝒕 𝒊𝒔 𝒕𝒉𝒆 𝒆𝒒𝒖𝒊𝒗𝒂𝒍𝒆𝒏𝒕 𝒊𝒏 𝑺𝑰 𝒖𝒏𝒊𝒕?

A. 47.5 𝑚𝑚𝑜𝑙/𝐿
B. 105 𝑚𝑚𝑜𝑙/𝐿
C. 9.5 𝑚𝑚𝑜𝑙/𝐿
D. 𝟗𝟓 𝒎𝒎𝒐𝒍/𝑳

Type equation here.

𝑾𝒉𝒂𝒕 𝒊𝒔 𝒕𝒉𝒆 𝒑𝒓𝒐𝒑𝒆𝒓 𝒅𝒆𝒔𝒄𝒓𝒊𝒑𝒕𝒊𝒐𝒏 𝒐𝒇 𝒂 𝒔𝒂𝒎𝒑𝒍𝒆 𝒘𝒊𝒕𝒉 𝒕𝒉𝒆 𝒇𝒐𝒍𝒍𝒐𝒘𝒊𝒏𝒈 𝒗𝒂𝒍𝒖𝒆𝒔 𝒇𝒐𝒓 𝒃𝒊𝒍𝒊𝒓𝒖𝒃𝒊𝒏?
𝐵𝑖𝑙𝑖𝑟𝑢𝑏𝑖𝑛 = 400 𝑚𝑚𝑜𝑙/𝐿 /17.2 = 23.35 𝑚𝑔/𝑑𝐿
𝐼𝑐𝑡𝑒𝑟𝑖𝑐 = 430 𝑚𝑚𝑜𝑙/𝐿 = 25 𝑚𝑔/𝑑𝐿
𝑇𝐺 = 4 𝑚𝑚𝑜𝑙/𝐿 / .0113 = 353.98 𝑚𝑔/𝑑𝑙
𝐿𝑖𝑝𝑒𝑚𝑖𝑐 = 4.6 𝑚𝑚𝑜𝑙/𝐿 = 400 𝑚𝑔/𝑑𝐿

A. 𝑁𝑜𝑡 𝑖𝑐𝑡𝑒𝑟𝑖𝑐 𝑏𝑢𝑡 𝑙𝑖𝑝𝑒𝑚𝑖𝑐

B. 𝑵𝒐𝒕 𝒊𝒄𝒕𝒆𝒓𝒊𝒄 𝒂𝒏𝒅 𝒏𝒐𝒕 𝒍𝒊𝒑𝒆𝒎𝒊𝒄
C. 𝐼𝑐𝑡𝑒𝑟𝑖𝑐 𝑎𝑛𝑑 𝑙𝑖𝑝𝑒𝑚𝑖𝑐
D. 𝐼𝑐𝑡𝑒𝑟𝑖𝑐 𝑏𝑢𝑡 𝑛𝑜𝑡 𝑙𝑖𝑝𝑒𝑚𝑖𝑐

𝑯𝒐𝒘 𝒅𝒐 𝒚𝒐𝒖 𝒄𝒐𝒏𝒗𝒆𝒓𝒕 𝟏𝟎𝟎𝟎 𝒎𝑳 𝒕𝒐 𝑳?

A. 𝑫𝒊𝒗𝒊𝒅𝒆 𝒃𝒚 𝟏𝟎𝟎𝟎
B. 𝑀𝑢𝑙𝑡𝑖𝑝𝑙𝑦 𝑏𝑦 100
C. 𝐷𝑖𝑣𝑖𝑑𝑒 𝑏𝑦 100
D. 𝑀𝑢𝑙𝑡𝑖𝑝𝑙𝑦 𝑏𝑦 1000
𝑼𝑵𝑰𝑻𝑺 𝑶𝑭 𝑴𝑬𝑨𝑺𝑼𝑹𝑬
 𝐐𝐮𝐚𝐧𝐭𝐢𝐭𝐚𝐭𝐢𝐯𝐞 𝐥𝐚𝐛 𝐫𝐞𝐬𝐮𝐥𝐭  2 components:
 Number: actual test value
 Unit: physical quantity or dimension (mass, length, time, volume)

 𝐒𝐲𝐬𝐭è𝐦𝐞 𝐈𝐧𝐭𝐞𝐫𝐧𝐚𝐭𝐢𝐨𝐧𝐚𝐥 𝐝’𝐔𝐧𝐢𝐭é𝐬 (𝐒𝐈)

→ Adopted internationally in 1960
→ Preferred in scientific literature and clinical laboratories
→ Only system employed in many countries
→ Devised to provide global scientific community with a uniform method of describing physical quantities
→ Based on the metric system
→ Classifications:
1. Basic Unit
 7 basic units (LMTETAL)
 Length (m)
 Mass (kg) – only basic unit that contains prefix as part of its naming convention
 Time (s)
 Electric current (A)
 Temperature (K)
 Amount of substance (mol)
 Luminous intensity (cd)
 Length, mass, amount of substance  units most frequently encountered

2. Derived Unit
 derivative or a mathematical function describing one of the basic units
 SI-derived unit: velocity (m/s)
 Frequency (Hz)
 Force (N)
 Celsius (C)
 Catalytic activity (kat)
3. Selected Accepted Non-SI
 Acceptable for use with SI basic or SI-derived units
 Widely used; cannot technically be categorized as either basic or derived SI units
 Includes long-standing units
 Hour
 Minute
 Day
 Gram
 Liter
 Plane angles (degrees)

 𝑺𝑰 𝒔𝒕𝒂𝒏𝒅𝒂𝒓𝒅 𝒑𝒓𝒆𝒇𝒊𝒙𝒆𝒔
→ Added to a basic unit: indicate decimal fractions/subunit or multiples of that unit
→ Left prefixes:
 smaller than the basic unit
 frequently used expressions in clinical lab
→ Right prefixes:
 larger than the basic unit
→ SI conversion
 Substract exponents
 Move decimal to the direction of the unit to be converted
  𝑹𝒆𝒑𝒐𝒓𝒕𝒊𝒏𝒈 𝒐𝒇 𝒍𝒂𝒃𝒐𝒓𝒂𝒕𝒐𝒓𝒚 𝒓𝒆𝒔𝒖𝒍𝒕𝒔
→ Often expressed as rather than SI units
 Substance concentration (eg moles)
 Substance mass (eg. mg/dL, g/dL, g/L, mmol/L, and IU)

→ ANALYTES:
 Recommended: Reported using substance concentration (moles of solute per volume (L) of solution)

 𝑰𝒏𝒕𝒆𝒓𝒏𝒂𝒕𝒊𝒐𝒏𝒂𝒍 𝑶𝒓𝒈𝒂𝒏𝒊𝒛𝒂𝒕𝒊𝒐𝒏 𝒇𝒐𝒓 𝑺𝒕𝒂𝒏𝒅𝒂𝒓𝒅𝒊𝒛𝒂𝒕𝒊𝒐𝒏 (𝑰𝑺𝑶)

→ This group develops standards of practice, definitions and guidelines that can be adopted by everyone in a
given field, providing for more uniform terminology and less confusion

𝑹𝑬𝑨𝑮𝑬𝑵𝑻 𝑷𝑹𝑬𝑷𝑨𝑹𝑨𝑻𝑰𝑶𝑵

𝑪𝑯𝑬𝑴𝑰𝑪𝑨𝑳𝑺
→ Based: Grades of Purity
→ American Chemical Society (ACS)
 established specifications for AR grade chemicals, and chemical manufacturers will either meet or
exceed these requirement

Ultrapure reagent Purest

Put through additional purification steps
For use in specific procedures: Chromatography, atomic absorption,
immunoassays, molecular diagnostics, standardization, other techniques that
require extremely pure chemicals
Labels:
- HPLC or Chromatography
Analytical reagent (AR) Suitable for use in most analytic laboratory procedures
Labels:
- actual impurities for each chemical lot
- list of maximum allowable impurities
- Clearly printed
 %impurities present
 either: initials (AR or ACS)
term (For lab use or ACS Standard-Grade Reference
Materials)
United States Used to manufacture drugs
Pharmacopoeia (USP) Limitation: Based only on the criterion of not being injurious to individuals
National Formulary (NF) May be pure enough for use in most chemical procedures
Purity standards are not based on the needs of laboratory and therefore may or
may not meet all assay requirements
Technical/Commercial Used primarily in manufacturing and should NEVER be used in the clinical
grade laboratory
Chemically pure/Pure Impurity limitations are not stated
Grade Preparation is not uniform
NOT recommended for clinical lab use unless further purification or reagent
blank is included
- Melting point analysis: used to ascertain the acceptable purity range
IUPAC Grade A: atomic weight standard
Grade B: ultimate standard
Grade C: primary standard
 (International Union of Grade D: working standard
Pure and Applied Grade E: secondary substances
Chemistry)

→ Manufacturer: required to provide technical data sheets for each chemical manufactured on a document called
Material Safety Data Sheet (MSDS)

𝑹𝑬𝑭𝑬𝑹𝑬𝑵𝑪𝑬 𝑴𝑨𝑻𝑬𝑹𝑰𝑨𝑳𝑺

Primary Standard Highly purified chemical

Can be measured directly to produce exact known concentration and purity
ACS purity tolerances: 100 +/- 0.02%  99.98% pure
Problem: Most biologic constituents are unavailable within these limitations
Standard Reference National Institute of Standards and Technology
Materials (SRMs) NIST-certified standard materials in place of ACS primary standards for use in
the clinical chemistry laboratories
Assigned a value after careful analysis, using state-of-the-art methods and
equipment
Chemical composition is then certified
They may not possess the purity equivalent of a primary standard
Uses:
 Used in place of an ACS primary standard in clinical work
 Often used to verify calibration or accuracy/bias-assessments
 Used by manufacturers in producing calibrator and standard materials
“traceable to NIST”
Secondary Standard Substance of lower purity
Its concentration is determined by comparison with a primary standard
(indirectly)
Dependent:
1. Composition (indirectly determined)
2. Analytic reference method
Physiologic primary standards unavailable  NO “true” secondary standards

WATER SPECIFICATIONS
→ Water: most frequently used reagent in the laboratory
 Purified water: reagent and standard preparation
 Tap water: unsuitable for laboratory applications
→ TYPES OF WATER
1. Method of purification or preparation
 by prefiltration
 by distillation  distilled water
 by ion exchange  deionized water
 by reverse osmosis across a semipermeable membrane  RO water
 by ultrafiltration
 by UV light
 by sterilization
 by ozone treatment
Prefiltration Removal of particulate matter from municipal water supplies before any additional
treatment
Filtration cartilages
 glass
 cotton
 activated charcoal – removes organic materials
 chlorine
 submicron filters (≤0.2 mm)
- removes any substances larger than the filter’s pores, including bacteria
- better suited after distillation, deionization or reverse osmosis treatment

Hard water (contains Ca, Fe, and other dissolved elements)

- requires prefiltration with glass or cotton filter

Distilled water Purified to remove almost all organic materials (distillation)

Water is boiled and vaporized
- Vapor -> condenser -> liquid state -> collected (less contaminant)
- Impurities: remained in the boiling apparatus
Water may be distilled more than once, with each cycle removing additional
impurities
Deionized water Purified by ion exchange from previously treated water (prefiltered or distilled
water)
Some or all ions are removed, organic material may still be present
Neither pure nor sterile
Produced using either an anion or a cation exchange resin, followed by
replacement of the removed ions with hydroxyl or hydrogen ions
Ions anticipated to be removed will dictate the type of resin to be used
2-bed system: anion resin -> cation resin
This process is excellent in removing dissolved ionized solids and dissolved
gases
Reverse Osmosis Uses pressure to force water through a semipermeable membrane, producing
water that reflects a filtered product of the original water
It does NOT remove dissolved gases
May be used for the pretreatment of water
Ultrafiltration and Like distillation – excellent in removing particulate matter, microorganisms, any
nanofiltration pyrogens and endotoxins
Others UV oxidation – removes some trace organic material; or
Sterilization – uses specific wavelengths
+ ozone treatment
 can destroy bacteria but may leave behind residual products
 These techniques are often used after other purification processes have
been used

2. Use: 6 Categories by CLSI (NCCLS)

 Clinical Laboratory Reagent Water (CLRW)  Laboratory requirement
 Purity
- Type I: most stringent requirement; suitable for routine laboratory use
- Type II
- Type III
 Special Reagent water
 Instrument feed water
 Water supplied by method manufacturer
  Autoclave and wash water
 Commercially bottled purified water

Reagent Grade Water Obtained by:

1. Filtration – remove particulate matter
2. Reverse osmosis
3. Deionization
4. 0.2 mm filter/more restrictive filtration
Purify tap water  Grade water
Parameters a. Microbial count
b. pH (related to H+ ion concentration)
c. Resistivity (measure of resistance in ohms and influenced by number of ions
present)
d. Silicate
e. Particulate Matter
f. Organics
Storage RGW: Should be used immediately, storage is discourage because resistivity
changes
CLRW: Should be stored in manner that reduces any chemical and bacterial
contamination and for short periods
Special Reagent Water Use with HPLC that requires <0.2 mm final filtration step
Some molecular diagnostics and spectrophotometric techniques

Type I Type II Type III

Specific Resistance >10.0 >2.0 >1.0
(Megaohm, min)
Specific <0.1 <0.2 <0.5
Conductance
(Microhmos, Max)
pH NA NA NA
CFU/mL <10.0 10 NA
Uses Procedures requiring maximum For most lab methods For qualitative
water purity For quantitative and/or measurements only:
- Standard solution prep qualitative - Presence or absence
(Lab- determinations - UA, Para, Histology
made/manufacturer) - Chemistry - Washing glasswares
- Ultramicrochemical - Hematology
analyses - Microbiology
- Measurements at - Immunology
nanogram or - Other chemical Autoclave/wash water
subnanogram lab areas - For glassware
- Tissue and cell counts For most analytic washing but not
requirements for analysis or
For test methods requiring - reagent prep reagent
minimum interference - QC prep preparation
- Trace metal - standard prep
- Iron
- Enzyme analyses
*Resistance is measured because pure water (devoid of ions: poor conductor of electricity, increased resistance)
Water purity to resistance has linear relationship: purity, resistance
𝑺𝑶𝑳𝑼𝑻𝑰𝑶𝑵 𝑷𝑹𝑶𝑷𝑬𝑹𝑻𝑰𝑬𝑺
→ Solute: Substance dissolved in a liquid
→ Analytes: Biologic solutes
→ Solvent: Liquid in which the solute is dissolved
→ Solution: Solute + Solvent

o 𝑪𝑶𝑵𝑪𝑬𝑵𝑻𝑹𝑨𝑻𝑰𝑶𝑵
- SI expression: amount of substance (mole)
- Non-SI expression: % solution, molarity, molality, normality (routinely used)

Percent Expressed as equal parts per hundred or the amount of solute per 100 total units
solution of solution
- 3 expressions:
1. weight per weight (w/w)
2. volume per volume (v/v)  g/dL (recommended)
3. weight per volume (w/v)  most common
Molarity (M) Expressed as number of moles per 1 L of solution (moles/liter)
SI expression for concentration: mol/L, mmol/L, umol/L, nmol/L
Molarity depends on volume and any physical changes that influence volume
(temperature & pressure)
Molality (m) Amount of substance per 1 kg of solvent (moles/kg)
NOT influenced by temperature and pressure: based on mass rather than volume
Normality (N) Least likely of the 4 concn expressions to be encountered
Often used in chemical titrations and chemical reagent classification
Number of gram equivalent weight per 1L of solution (Eq. wt./L) Eqwt =
gmw/valence
Previously used in reporting electrolyte values (Na, K, Cl)  mEq/L  mmol/L
(now)

o 𝑺𝑨𝑻𝑼𝑹𝑨𝑻𝑰𝑶𝑵

Dilute solution One in which there is relatively little solute or one which has been made to a lower
solute concentration per volume of solvent as when making a dilution
Concentrated Large quantity of solute in solution
solution
Saturated A solution in which there is an excess of undissolved solute particles
solution
Supersaturated Even greater concentration of undissolved solute particles than a saturated
solution solution of the same substance.
Thermodynamically unstable
+ crystal of solute or mechanical agitation  crystallization of any excess material
out of solution (Ex: measuring serum osmolality by freezing point depression)
o 𝑪𝑶𝑳𝑳𝑰𝑮𝑨𝑻𝑰𝑽𝑬 𝑷𝑹𝑶𝑷𝑬𝑹𝑻𝑰𝑬𝑺
- Behaviour of particles or solutes in solution based on number of each kind of molecule present
- Osmotic pressure, Vapor pressure, Freezing point, Boiling point

Vapor pressure Pressure at which the liquid solvent is in equilibrium with the water vapor
Freezing point Temperature at which the vapor pressures of the solid and liquid phases are the
same
Boiling point Temperature at which the vapor pressure of the solvent reaches one atmosphere
Osmotic Pressure that opposes osmosis when a solvent flows through a semipermeable
pressure membrane to establish equilibrium between compartments of differing
concentration

** Osmotic pressure of a dilute solution = concentration of molecules in solution

(osmoles)
1 osmole = M or m x # of particles at dissociation  Osmolarity / Osmolality
Osmolality  preferred; depends on weight, NOT affected by temperature &
pressure
 Freezing point & Vapor pressure depression – can be measured as
function of osmolality
 Freezing point (preferred)
 Vapor pressure (affected by some substances like alcohols)
Changes in When a solute is dissolved in a solvent -> 1 osmole of substance present
colligative  FP:  -1.86 C
properties  BP: 0.52 C
 VP:  0.33 mm Hg or torr
 OP:  1.7 x 10^4 mm Hg or torr

o 𝑹𝑬𝑫𝑶𝑿 𝑷𝑶𝑻𝑬𝑵𝑻𝑰𝑨𝑳
- measures the ability of a solution to accept or donate electrons
- Reducing agents: substances that donates electrons
- Oxidizing agents: substances that accepts electrons
- LEO (lose electrons oxidized)
- GER (gain electrons reduced)

o 𝑪𝑶𝑵𝑫𝑼𝑪𝑻𝑰𝑽𝑰𝑻𝒀
- measure of how well electricity passes through a solution
- Dependent principally on the charges of ions present
- Expressed as 𝑜ℎ𝑚𝑠 −1 𝑜𝑟 𝑚ℎ𝑜
- 𝑹𝒆𝒔𝒊𝒔𝒕𝒊𝒗𝒊𝒕𝒚
 measure of a substance’s resistance to the passage of electric current
 assessing purity of water
 expressed as 𝑜ℎ𝑚𝑠

o 𝒑𝑯 𝑨𝑵𝑫 𝑩𝑼𝑭𝑭𝑬𝑹𝑺
→ Buffers: weak acids or bases and their related salts that as a result of their dissociation
characteristics, minimizes changes in the H+ ion concentrations
→ H+: expressed as pH (p = “negative logarithm” or “inverse log of”)
→ pH: negative or inverse log of hydrogen ion concentration

1
𝑝𝐻 = 𝑙𝑜𝑔 𝑜𝑟 𝑝𝐻 = −log(𝐻+)
𝐻+
 → 𝑯𝒆𝒏𝒅𝒆𝒓𝒔𝒐𝒏 − 𝑯𝒂𝒔𝒔𝒆𝒍𝒃𝒂𝒄𝒉 𝒆𝒒𝒖𝒂𝒕𝒊𝒐𝒏
- mathematically describes the dissociation characteristics of weak acids (pKa) and bases (pKb)
and the effect on pH

A= proton acceptor or base (e.g. HCO3-)

HA= proton acceptor or weak acid (e.g. H2CO3)
pKa= pH at which there is equal concn of protonated
and unprotonated species

→ Ionic strength: concentration or activity of ions in a solution or buffer

𝑪𝑳𝑰𝑵𝑰𝑪𝑨𝑳 𝑳𝑨𝑩𝑶𝑹𝑨𝑻𝑶𝑹𝒀 𝑺𝑼𝑷𝑷𝑳𝑰𝑬𝑺

o 𝑷𝒊𝒑𝒆𝒕𝒔
- glass or plastic utensils used to transfer liquids; reusable or disposable

 CLASSIFICATIONS:
 According to Graduations/Purpose

TRANSFER PIPETS = 1 Graduation; dispense 1 volume only

Volumetric Designed to dispense or transfer aqueous solutions
Bulb is near the midway or stem
Always Self-draining
Highest degree of accuracy and precision
Should be used when diluting standards, calibrators, or QC material
Should only be used once
Ostwald-Folin For biologic fluids having a greater viscosity greater than water
Bulb near the tip
Blowout pipets – 2 etched rings at top
Reading:
o Viscous: Upper meniscus
o Non-viscous: Lower meniscus
Pasteur Do NOT have calibration marks
Used to transfer solutions or biologic fluids without consideration of a
specific volume
Automatic – most routinely used in today’s lab; mechanism is an integral part of the pipet
Air-displacement Relies on a piston for creating suction to draw the sample
Disposable tip that must be changed after each use
The piston does not come in contact with the liquid
Commonly used
Positive displacement Operates by moving the piston in the pipet tip or barrel, much like a
hypodermic syringe
It does not require a different tip for each use
Because of carryover concerns, rinsing and blotting between samples may be
required
Dilutor/Dispenser Automatic pipets that obtain the liquid from a common reservoir and
dispense it repeatedly. The dispensing pipets may be bottle-top, motorized,
handheld, or attached to a dilutor. The dilutor often combines sampling and
dispensing functions.
 MEASURING PIPETS = Several Graduations (Differ if graduations reach at the tip)
Mohr Self-draining
No graduations to the tip
Serologic Blow-out pipet
Graduations up to the tip
1st graduation: 0.5 or 1

 According to Use/Design

To-Contain (TC) Holds a particular volume but does not dispense exact volume
Requires rinsing
To-Deliver Dispenses the exact volume
Does not require rinsing

 According to Drainage Characteristics

Blow-out Uses pipettol: Last drop should be expelled

Has 2 etched rings or 2 small continuous rings
Self-draining Contents drain by gravity
No etched rings or markings.
No need to expel the contents of the pipette can drain on their own

o 𝑪𝒍𝒆𝒂𝒏𝒊𝒏𝒈 𝒐𝒇 𝑮𝒍𝒂𝒔𝒔𝒘𝒂𝒓𝒆𝒔
 Presoaking: soapy water or dilute bleach
 Serve as decontamination process
 Cleaning:
 ACID DICHROMATE: K dichromate + H2SO4
 NITRIC ACID (HNO3)
 Final rinsing: use Type I or Type II water
 Washing of Glassware: Type III
 Sterilization: Dry heat oven
 Temperature: >140 C or 160 to 180 C
 Duration: 1.5 to 2 hours

o 𝑪𝑬𝑵𝑻𝑹𝑰𝑭𝑼𝑮𝑬
 Utilized to separate components or substances via differences in density

 RPM (Revolution Per Minute)

 Speed
 Measured directly
 Calibrated quarterly (checking for speed of RPM)  Tachometer or strobe light

 RCF (Relative Centrifugal Force)

 Calculated parameter
 times gravity (x g)
 RCF = RPM^2 X r x 1.118 x 10^-5 (r: radius - determined by nomogram)
DIFFERENT TYPESOF CENTRIFUGE
Horizontal Head/ Fixed Angle/ Ultracentrifuge/
Swinging Bucket Centrifuge Angle-Head Centrifuge Refrigerated Box
● Vertical: not in motion Desk or bench type centrifuge Reference method for lipoprotein
● Horizontal: in motion - Angle of Tubes: 25-50 degrees or 52 analysis
- Capable of speed of up to 3000 degrees - Highest speed → very tight
RPM - Less air friction and resistance → sediment
- Recommended for serum separator less heat generated → prevent lysis - Tubes are held at a fixed angle
tubes and disintegration of sediment - Refrigeration serve as an advantage
- Has high air friction and resistance - Centrifugal force: outward force - or counteract the heat
which result to high heat generation - Speed: 7000 - Enhances separation of lipoproteins
- Most commonly used in the - Tube (from top to bottom):
laboratory → Faster to separate CM → VLDL → LDL → HDL
sample

 MAINTENANCE OF CENTRIFUGE
o Weekly - Disinfection using 10% bleach or lysol
o Monthly - Checking for unusual vibrations, braking mechanism and TIMER → by stopwatch
o Quarterly - Calibration using tachometer or strobe light → SPEED OF CENTRIFUGE
 Recalls

Which type of automatic pipet functions like a hypodermic syringe and does not require the use of disposable tips?
A. air displacement
B. Ostwald-folin
C. positive displacement
D. serologic pipet

Strobe light is used to calibrate

A. spectrophotometer
B. centrifuge
C. refrigerator
D. water bath
QUALITY MANAGEMENT
 Goal: To provide high-quality services at low cost
 TERMS
o Quality Assurance:
 Complete system of creating and following procedures and policies to aim for providing the most
reliable patient laboratory results and to minimize errors in the pre-analytical, analytical, and
post-analytical phases
 Recall question: concept involving total/overall testing in the lab (pre-analytical
o Quality Control: analytical
post-analytical
 Under QA
 aspect of quality assurance that is used to assess the analytical phase of patient testing
o Quality Improvement:
 A step higher than quality assurance
 Goes beyond monitoring, detecting and preventing errors
 It seeks to achieves new level of performance, not otherwise realized through QC by addressing
chronic problems in the laboratory

 Standard minimum requirements

o QA: focuses on meeting standards, provide quality results, minimize errors
o QI: goes beyond standards, NOT just meeting minimum requirements but exceeds standards

LEAN SIX SIGMA (Bishop)

 Six Sigma (Motorola) + Lean strategy (Toyota)
 Methodology aim to provide tangible metrics for quality improvement
o Six sigma: How can this process be improved?  To reduce error
o Lean: Does this process (or step) need to exist?  To reduce waste
o Quality Improvement
- seeks to eliminate inefficiencies in a process through reduction of variation and waste
o Lean Six Sigma Methodology
- seeks to identify, measure, and eliminate the large gaps of inefficiency in a process.
- Examples: data accuracy, turnaround times, and reagent inventory

 Process Improvement
 Lean Six Sigma uses a problem–cause–solution methodology to improve any process through waste
elimination and variation reduction
 The DMAIC (Define, Measure, Analyze, Improve, and Control) methodology is the quality
improvement team’s project management road map.
 5 PHASES:
- Allow for the identification of the root cause for error and waste through establishment of the
following:
- 1. A universally accepted framework for quality improvement
2. Common language throughout the organization
3. A checklist to guide the process
4. Control measures for long-term monitoring

o Define: explicitly describes the quality improvement issues

o Measure: team collects data to measure the process. That is, they determine the difference
between the current process and the desired one
o Analyze: searches for the root causes of inefficiencies in the process
o Improve: the team pilots process changes that seek to remove the identified root problems
o Control: continues to measure the process and ensures changes are maintained
  Example: TAT
 Define - TAT is too long (3 hrs)
 Measure - Desired: 2 hrs
 Analyze - Root cause: 1 printer, CBC manual, CC statfax (equipment)
 Improve - procure additional equipment, training of personnel
 Control - Is there a change? Have we achieved?

 TEAM ROLES
 3 MOST COMMON:
o BLACK BELTS
 Project coaches/leaders
 Dedicate 100% of their time to QI projects
 Proactively addressing process and quality problems
o GREEN BELTS
 Project team members
 Contribute 20% of their time to QI projects while delivering their normal job functions
o BLUE BELTS
 Project Sponsors: Mid-level to Senior-level sponsors
 Review the project, remove organizational barriers, and encourage the team members

o Laboratory team: Expert/Specialist technologists, supervisors, directors, expert consultants

o Typically, a full Six Sigma improvement project takes 6 to 8 months to complete.

 NOT COMMON:
o PURPLE BELTS
 Heads smaller scale improvement projects
 Use the same Lean Six Sigma principle condensed over 1 week to improve more focused
and limited processes

LEAN SIX SIGMA (Henry’s)

 detecting laboratory errors
 PRE-ANALYTICAL ERRORS
o 32-75%: majority of errors occur
o Handled by many health professionals

 ANALYTICAL ERRORS
o 4-32% (Bishop)
o 13-32% (Henry)
o Most of the training and seminars are
geared toward improving their skills in the
analytical phase

 POST-ANALYTICAL ERRORS
o 9-55%
o Do NOT rely on MT alone

 Most laboratory errors occur in the preanalytic and

postanalytic stages
 PRE-ANALYTIC ERRORS ANALYTIC ERRORS POST-ANALYTIC ERRORS
 Hemolyzed  Calibration error  Reports sent to wrong
 Clotted  Instrument malfunction physician
 Insufficient samples  Long TAT
 Incorrectly  Missing reports
identified/Mislabled samples
 Wrong collection tube drawn
 Improper specimen storage

 Approaches to quality leadership and management

 TOTAL QUALITY MANAGEMENT
o systems approach that focuses on teams, processes, statistics, and delivery of
services/products that meet or exceed customer expectations
o TQM thinking strives to continually look for ways to reduce errors (“defect prevention”) by
empowering employees to assist in solving problems and getting them to understand their
integral role within the greater system (“universal responsibility”)
 CONTINUOUS QUALITY IMPROVEMENT
o element of TQM that strives to continually improve practices and not just meet established
quality standard

 2 Other tools to improve quality

 SIX SIGMA (Motorola, 1979)
o Performance improvement program
o Goal: “improvement by eliminating process variations (defects)”
 improved performance
 improved bottom line
 improved customer satisfaction
 improved employee satisfaction
o It is a structured process based upon statistics and quantitative measurements through which
process defects or errors are analyzed, potential causes are identified, and improvements are
implemented
 DEFECT: anything that does not meet customers' requirements
 Includes: Laboratory error, delay in reporting, QC problem
 Unit: DPMO (Defects per million opportunities)
 SIGMA/SD: expresses how much variability exists in products or services
 6σ process is characterized by less variation than a 4σ or 1σ process
 Goal of 6σ: Reduce the number of defects to near zero

o STEPS:
  LEAN (Toyota)
o Streamlines an operation in the laboratory
o System for reducing waste (“nonvalued activities”) in production or manufacturing processes.
o Techniques/Strategies
 5S (Sort, Set in order, Shine, Standardize, Sustain)
 PDCA (Plan, Do, Check, Act)
o Reduce cost by identifying daily work activities that do not directly add to the delivery of
laboratory services in the most efficient or cost-effective way
o Directly addresses the age-old concept of “that’s the way we always did it” and looks for ways
to improve the process

FACTORS AFFECTING TESTING

PRE-ANALYTICAL ANALYTICAL POST-ANALYTICAL

1. Selection of assay relative to 1. Assay validation and instrument 1. Accuracy in transcription and
patient need selection filling of results
2. Patient identification 2. Sample identification 2. Content and format of
3. Specimen collection 3. Laboratory staff competence laboratory report, narrative report,
4. Specimen transport, preparation 4. External and internal quality reference interval, and therapeutic
and storage control range
5. Monitoring of specimen 3. Timeliness in communicating
collection INTERNAL/INTRALAB QC critical values, patient and
-Inside lab physician satisfaction
- Analyses of control sample 4. Turnaround time, cost analysis
- Daily monitoring of accuracy and →other reference: pre-analytical
precision in the lab - TAT: starts at pre-analytical
up to post-analytical
EXTERNAL/INTERLAB/PROFICIENCY (releasing of results)
TESTING
- PT = EQAS
- Result may be compared to other
lab
- CC: monthly
- Long-term monitoring
 Recalls

Proficiency Testing (EQAS)

A. Pre-pre analytical phase
B. Pre-analytical phase
C. Post-analytical phase
D. Analytical phase – includes QC

In Lean Six Sigma, how much of their time do green belts dedicate to improvement projects?
A. 20%
B. 100%
C. 70%
D. 50%

This concept encompasses the total or overall testing process

A. QC - Analytical
B. QA
C. Lean – Quality Improvement
D. Six Sigma - Quality Improvement

In the lean concept of quality laboratory management, nonvalued activities are referred to as
A. defects
B. flags
C. errors
D. wastes

Complete and proper centrifugation of collected blood samples is a process that is performed in what phase of testing?
A. pre-analytical
B. post-post analytical
C. post-analytical
D. analytical

Defects in the Six Sigma process is measured using

A. DPMO
B. DPTO
C. SD
D. CV

Which of the following strategies are incorporated in the Lean concept of quality laboratory management?
1. Plan-Do-Check-Act
2. Define-Measure-Analyze-Improve-Control
3. Sort-Set in Order-Shine-Standardize-Sustain
4. Organization-Personnel-Assessments-Process Improvement

A. 1,2,3,4 are correct

B. 1 and 3 are correct
C. 1,2,3 are correct
D. 2 and 4 are correct
E. only 4 is correct
Optimizing performance refers to the process by which workflow and technology are integrated to yield an operation
that best meets the clinical needs and financial goals of the organization (laboratory) which is
A. meeting minimum requirements and standards
B. high quality through continuous improvement
C. high quality at reasonable cost
D. high quality at low cost

The following personnel in Lean Six Sigma are properly identified with their corresponding team roles except
A. Black belts: Project Leaders
B. Green Belts: Senior-Level Sponsors
C. Blue Belts: Mid-Level sponsors
D. Purple Belts: Small-Scale Project Heads

Concepts related to the Six Sigma process except

A. aims to decrease product or service variation
B. involves streamlining laboratory operations
C. steps include Define, Measure, Analyze, Improve and Control (DMAIC)
D. measures detects per million opportunities

RATIO
SIX SIGMA
 Purpose: decrease defects by eliminating process variation
 Defect  anything that does NOT meet customer requirements
 Unit: Defects per million opportunities (DPMO)
 Strategy: DMAIC

LEAN “management concept that reduces waste and streamlines an operation”

 Involves streamlining laboratory procedures
- Streamline: make something more efficient by performing faster or simpler working
 Purpose: reduce waste (non-valued activities)
 Strategy: 5s, PDCA
STATISTICAL TOOLS
MEASURE OF CENTRAL TENDENCY
o Central Tendency = TRUE VALUE
o Accuracy: closeness to the true value

 3 MOST COMMON DESCRIPTION OF CENTER

 Mean
o “average”
o most commonly used
o calculated by summing the observations and dividing by the number of observations

 Median
o “middle point”
o often used with skewed data

 Mode
o “most frequently obtained value”
o rarely used as a measure of the data’s center
o more often used to describe data that seem to have 2 centers

 Example: 2,3,5,1,1,7,3,1
- Mean: 3.43
- Median: 1,1,1,2,3,5,7
- Mode: 1
- Range:1-7

MEASURE OF DISPERSION/SPREAD
o Dispersion of values = VARIABILITY
o Precision: closeness of values to one another “reproducibility”

 3 MOST COMMON DESCRIPTION OF SPREAD

 Range
o “easiest measure” of spread
o largest value minus the smallest value (high – low)
o The lower the difference, the more precise
o EXAMPLE: 10-15 (more precise) vs 80-100

 Standard Deviation/s/SD/ σ
o “indicator of precision”
o most frequently used measure of variation
o Needed in the LJ chart to compute for control limit
 Upper Control limit: Mean + 1SD + 2SD + 3SD
 Lower Control LIMIT: Mean – 1SD – 2SD – 3SD
o SD (Variance): represent the “average” distance from the center of the data (mean) and every
value in the dataset
o VARIANCE:
 similar to “mean”
 average of the squared distances of all values from the mean
o Formula:
  Coefficient of Variation
o “relative indicator of precision”
o Simplifies comparison of SDs of test results expressed in different units and concentrations
o Used extensively to summarize QC data
o Ideal: <5%
o The lower the CV, the higher the precision
o Formula:
𝑺𝑫
𝑪𝑽 (%) =
𝒎𝒆𝒂𝒏 (𝒙)

MEASURES OF SHAPE

 GAUSSIAN DISTRIBUTION CURVE/NORMAL DISTRIBUTION

o Normal distribution: Mean = Median = Mode (identical)
o Distribution: Symmetric (half values fall to the left of the mean & other half values fall to the
right of the mean)  “bell curve”
o The most commonly used interval is +/- 2SD

 +/-1SD
o 68.3% should fall inside
o 31.7% fall outside the distribution curve

 +/-2SD: Most commonly used interval

o 95.5% should fall inside the curve
o 4.5% fall outside the curve

 +/-3SD
o 99.7% should fall inside the curve
o 0.3% fall outside the curve
STATISTICAL SIGNIFICANCE
o Included in comparative statistics
o Most commonly used significance  p-value: 5% or 0.05
 ≤ 5% = Statistically Significant
 > 5% = Statistically Insignificant

T-test F-test
- Significant difference bet 2 means - Significant difference bet 2 variances or SD
- Helps evaluate accuracy - Helps evaluate precision
- Mean: 10 vs 15 (p value = 0.01) - SD: 10 vs 15 (p value = 0.02)
- Statistically Significant = difference in - - Statistically Significant = difference in
accuracy of the means accuracy of the means
- 1 set of data is more accurate than the - 1 set of data is more precise than the other
other
- Application: evaluate 2 methods

DIAGNOSTIC EFFICIENCY ALL accurate values are precise

 DEFINITION OF TERMS: NOT all precise values are accurate
 Accuracy - closeness to the true value
 Precision - closeness to a repeated value; closeness of values with one another
 Reliability - maintain accuracy and precision over an extended period of time
 Analytical Sensitivity - ability to detect small quantities of analyte (sensitivity = not be detected)
- lower limit detection for a given analyte
 Analytical Specificity - ability to detect only the analyte of which it is designed to detect or measure

 TERMINOLOGIES
 True Positive: Diseased individuals with a positive result
 True negative: Not diseased individuals with a negative result
 False Positive: Not diseased individuals with a positive result
 False negative: Diseased individuals with a negative result

 Diagnostic Sensitivity
o Proportion of individuals with the disease who test POSITIVE of the test/method
o Ability of a test to detect a given disease or condition.

𝑵𝒐. 𝒐𝒇 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒂𝒍𝒔 𝒘𝒊𝒕𝒉 𝒑𝒐𝒔𝒊𝒕𝒊𝒗𝒆 𝒕𝒆𝒔𝒕

𝑫𝒊𝒂𝒈𝒏𝒐𝒔𝒕𝒊𝒄 𝒔𝒆𝒏𝒔𝒊𝒕𝒊𝒗𝒊𝒕𝒚 (%) =
𝑵𝒐. 𝒐𝒇 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒍𝒂𝒔 𝒘𝒊𝒕𝒉 𝒕𝒉𝒆 𝒅𝒊𝒔𝒆𝒂𝒔𝒆

𝑻𝑷
= 𝒙 𝟏𝟎𝟎
𝑻𝑷 + 𝑭𝑵

 Diagnostic Specificity
o Proportion of individuals without the disease who test NEGATIVELY with the test/method
o Ability of a test to correctly identify the absence of a given disease or condition.

𝑵𝒐. 𝒐𝒇 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒂𝒍𝒔 𝒘𝒊𝒕𝒉 𝒏𝒆𝒈𝒂𝒕𝒊𝒗𝒆 𝒕𝒆𝒔𝒕

𝑫𝒊𝒂𝒈𝒏𝒐𝒔𝒕𝒊𝒄 𝒔𝒑𝒆𝒄𝒊𝒇𝒊𝒄𝒊𝒕𝒚 (%) =
𝑵𝒐. 𝒐𝒇 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒍𝒂𝒔 𝒘𝒊𝒕𝒉𝒐𝒖𝒕 𝒕𝒉𝒆 𝒅𝒊𝒔𝒆𝒂𝒔𝒆

𝑻𝑵
= 𝒙 𝟏𝟎𝟎
𝑻𝑵 + 𝑭𝑷
 Positive Predictive Value
o Probability that a positive test indicates the presence of a disease
o Chance of an individual having a given disease or condition if the test is abnormal

𝑵𝒐. 𝒐𝒇 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒂𝒍𝒔 𝒘𝒊𝒕𝒉 𝒑𝒐𝒔𝒊𝒕𝒊𝒗𝒆 𝒕𝒆𝒔𝒕

𝑷𝑷𝑽 =
𝑵𝒐. 𝒘𝒊𝒕𝒉 𝒑𝒐𝒔𝒊𝒕𝒊𝒗𝒆 𝒕𝒆𝒔𝒕

𝑻𝑷
= 𝒙 𝟏𝟎𝟎
𝑻𝑷 + 𝑭𝑷

 Negative Predictive Value

o Probability that a negative test indicates the absence of a disease
o Chance an individual does not have a given disease or condition if the test is within the reference
interval.

𝑵𝒐. 𝒐𝒇 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒂𝒍𝒔 𝒘𝒊𝒕𝒉 𝒏𝒆𝒈𝒂𝒕𝒊𝒗𝒆 𝒕𝒆𝒔𝒕

𝑵𝑷𝑽 =
𝑵𝒐. 𝒘𝒊𝒕𝒉 𝒏𝒆𝒈𝒂𝒕𝒊𝒗𝒆 𝒕𝒆𝒔𝒕

𝑻𝑵
= 𝒙 𝟏𝟎𝟎
𝑻𝑵 + 𝑭𝑵
 Recalls

A Levey-Jenning’s charrt is prepared for triglycerides based on a mean value of 200 mg/dl and a standard deviation of
5.2. Today’s control run gives a value of 197.5 mg/dl. What is the interpretation?
A. It is within the “normal range”
B. It is “in control”
C. It is “out of control”
D. It is within “warning limit”

RATIO
Mean = 200 mg/dl
SD = 5.2
+/- 2SD = 189.6 to 210.4
Control = 197.5
+/- 2SD = 2 (5.2) = 10.4 (191.1 to 207.5)

A set of total proteins values in g/dL are as follows:

6.1 6.4 5.8 6.1
6.0 6.2 5.9 6.1
6.0 6.2

What is the mode?

A. 6.0
B. 6.1
C. 5.8
D. 6.4

A cholesterol QC chart has the following data for the normal control:
Mean = 150 mg/dl
+/- 2SD = 4 = 2
Ex = 1,500 mg/dl
N = 10
RATIO
Determine the coefficient of variation CV = (SD/mean) x 100
A. 15.0% = (2/150) x 100
B. 1.33 % = 1.33%
C. 2.7%
D. 7.08%

The control values for urea have a mean of 5.2 mmol/L and a standard deviation of 0.7. What would be the range of
values at +/- 2SD?
A. 3.8-6.6. mmol/L RATIO
B. 3.1-7.3 mmol/L Mean = 5.2
C. 4.5-5.9 mmol/L SD = 0.7 (+/-2SD) = 1.4
D. 2.4-8.0 mmol/L Range = (5.2-1.4) to (5.2+1.4) = 3.8 to 6.6
The ability of a method to detect small quantities of the measured substance
A. diagnostic specificity
B. analytical sensitivity
C. analytical specificity
D. diagnostic sensitivity

Which of the following assays has the poorest precision?

A. Ca: Mean = 2.5, SD = 0.3 (12)
B. Cl: Mean = 130, SD = 2.0 (1.5)
C. K: Mean = 4.0, SD = 0.4 (10)
D. Na: Mean = 120, SD = 4.0 (3.3)

A medical technologist wants to compare which of the two methods in the laboratory is more accurate. What statistical
tool should he use?
A. f test
B. standard deviation
C. mean
D. t test

Likelihood of a person having a positive test that has the disease

A. Diagnostic Sensitivity – ability of the test to detect presence disease
B. Diagnostic Specificity - ability of the test to detect absence of disease
C. Positive Predictive Value
D. Negative Predictive Value - Likelihood of a person having a negative test that does not have the disease
E. Analytical Sensitivity – detect small amount of analyte
F. Analytical Specificity – detect specific analyte

This is defined as the ability of an analytical procedure to measure accurately one component in a specimen without
interference by other components that are also present
A. Analytic sensitivity  small amounts/concentrations of the analyte
B. Analytic specificity
C. Diagnostic sensitivity  presence of disease
D. Diagnostic specificity  absence of disease

Calculate the CV given the following data:

Mean = 89 mg/dL
3SD = 6

A. 3% RATIO
B. 2% CV = (SD/mean) x 100
C. 4% = (2/89) x 100
D. 1% = 2.25%
QUALITY CONTROL
 2 TYPES:
 INTERNAL/INTRALAB QC
o Performed by laboratory personnel using controls of known values and comparing such values
to establish acceptable ranges
o Control reference values & MSDS  Manufacturers
o Calibration for Accuracy and Precision
 STANDARD: “Calibrator”
 Reagent or material of known concentration
 For calibration of instruments
 Used for production of calibration graph  Statfax
 Importance: All computations of concentration are based on calibration graph
 Manual: make use of individual standard per analyte
 Automated: make use of universal standard or autocalibrator/autocal for all analyte

 CONTROL
 Material of known value that is analyzed with patient samples
 It is treated like a patient sample → resembles patient sample
 Used to determine the acceptability of the results

o 2 QUALITY CONTROL PROGRAMS

1. Bi-level QC
- Considered to be adequate
- Minimum requirement
- 2 sets of control:
 1 control for normal range
 1 control for abnormal range (elevated or abnormally high levels)

2. Tri-level QC
- 3 set of control: Normal range, abnormally low, abnormally high
 EXTERNAL/INTERLAB QC
o Performed by laboratory personnel using specimens sent by another institution (NRL)
o NRL: conduct NEQAS - Determines acceptable ranges in NEQAS/PT

REFERENCE INTERVAL STUDIES

 Reference interval
o A pair of medical decision points that span the limits of results expected for a defined
healthy population
 Establishing a reference interval
o Established when there is no existing analyte or methodology in the clinical or reference
laboratory with which to conduct comparative studies
o Costly and labor-intensive
o 120 to 700 study individuals
 Verifying a reference interval (transference)
o Done to confirm the validity of an existing reference interval for an analyte using the same
(identical) type of analytic system (method and/or instrument)
o These are the most common reference interval studies performed in the clinical laboratory
o Require as few as 20 study individuals.
QC CHARTS
 Control limits: mean ± SD
 LEVEY-JENNINGS CHART/SHEWHART PLOT
o most commonly used
o Components:
1. X-axis: “abscissa”
 Horizontal axis
 Independent variables
- already determined
- NOT affected by other
variables
 Ex: Shifts/Time, Age, Gender

2. Y-axis: “ordinate:
 Vertical axis
 Dependent variables
 Ex: Results - analyte concentration, enzyme activities, qualitive measurement (+/-)

o OUTLIER
- Control value that is far from the main set of values
- Control value that goes beyond +/- 2SD
- If 1 OUTLIER = NO NEED FOR IMMEDIATE ACTION
- 2 CONSECUTIVE OUTLIERS = REJECT

o SHIFT
- Sudden or abrupt change in value (6 or more)
- Establishes a new distribution pattern above or below the mean
- Values that distribute themselves on one side of the mean
- Main cause: Improper calibration

o TREND
- Gradual deviation of control values
- Either increase or decrease over a period of 6 consecutive days or more
- Progressive problem that is observed atleast 3 days
- Main cause: Deterioration of reagent
  WESTGARD MULTIRULE
o Establish a criterion for judging whether an analytic process is out of control.
o Control Rules:
 Number of observations per analyte run
 Control amount (subscript)

MULTIRULES PROCEDURE
VARIABILITY
DETECTED
𝟏𝟐𝑺 One control observation exceeding WARNING (NOT require an immediate action)
the mean ±2s SCREENING (further investigation of QC data)
𝟏𝟑𝑺 One control observation exceeding RANDOM ERROR (high sensitivity) Imprecision or
the mean ±3s Reject run  Recalibrate & rerun bias
𝑹𝟒𝑺 One control exceeding the +2s and RANDOM ERROR Imprecision
another exceeding the −2s Reject run  Recalibrate & rerun

2 consecutives values differ by

more than 4 SD
𝟐𝟐𝑺 Two control observations SYSTEMATIC ERROR (high sensitivity) Bias
consecutively exceeding the same Reject run  Recalibrate & rerun
+2s or −2s
𝟒𝟏𝑺 Four consecutive control SYSTEMATIC ERROR
observations exceeding +1s or −1s Warning/Reject run  Recalibrate & rerun
𝟏𝟎𝟏𝑺 / Ten consecutive control SYSTEMATIC ERROR (most sensitive check)
𝟏𝟎𝒙 observations falling on one side or Shift  Reject on 6th run
the other of the mean
𝟖𝟏𝑺 Eight consecutive control SYSTEMATIC ERROR Bias trend
observations falling on one side or
the other of the mean

RANDOM ERROR SYSTEMATIC ERROR

- Error with no trend and occurs unpredictably - Error seen as a trend that occurs predictably
- Does not recur - Recurring error
- No pattern and occurs by chance - Pattern of recognition
- Start of systematic error
 Mislabeling of sample  Improper calibration
 Pipetting error  Deterioration of reagents
 Improper mixing of sample and reagent  Sample instability
 Voltage fluctuations  Changes in standard materials
 Temperature fluctuations  Instrument drift
 Clerical error
Remedy: Rerun with the same reagent
 Recalls

Which of the following is not considered as a source of systematic error?

A. sample instability
B. improper instrument calibration
C. pipetting variations
D. reagent deterioration

A material with physical and chemical properties closely resembling the test specimen and containing pre-analyzed
concentrations of the analytes being measured is known as
A. calibrator
B. reference solution
C. control
D. standard

8-1s
A. Bias trend
B. Imprecision
C. Random error
D. Bias
Henry’s

Following Westgard Multi-Rules, a 1-3s was detected in the LJ chat of an analytical run. Which of the following is the
best course of action?

A. Check the results of the succeeding samples

B. Perform delta check
C. Run the sample again
D. Check the results of the preceding samples

Two consecutive control observations that exceed +/-2SD on one side of the mean
A. 2-2s random error
B. 2-2s systematic error
C. R-4s systematic error
D. R-4s random error

RATIO
R4s  “random error”
 Two consecutive control observations that differ by 4 SD
 Two consecutive values that exceeds +/- 2SD on opposite sides of the mean

Type of QC violation seen when control values are either in the upper or lower side of the mean
A. outlier
B. shift
C. error
D. trend
LABORATORY SAFETY

 HANDWASHING
o at least 15-20 seconds (lathering only)
o Happy Birthday song
o Single most effective way to prevent the spread of infection

 UNIVERSAL PRECAUTIONS (CDC, 1987)

o All patients should be considered as possible carriers of infection
o Recommends wearing gloves and face shields
o Excluded urine and other bodily fluids that is NOT visibly contaminated with blood

 BODY SUBSTANCE ISOLATION

o Modification of UP
o NOT limited to blood-borne pathogens
o Consider all body fluids and moist body substances to be potentially infectious
o Most important regulation: Wearing of Gloves at all times
o Des NOT require handwashing after removing gloves unless there is visible contamination

 STANDARD PRECAUTIONS (CDC & HICPAC, 1996)

o Combination of Universal Precaution and Body Substance Isolation
o Used today
o Cleaning of PPE  In-house keeping (Laboratory); can be brought to home
o Gloves  Should be clean but NOT necessarily sterile

SAFETY CONTROLS
 WHO: most effective  least effective
1. Elimination
2. Substitution
3. Engineering controls Donning PPE: bottom up (hands raised)
4. Administrative controls  Gown  Mask  Goggles  Gloves
5. PPE Doffing PPE: Alphabetical order
 Gloves  Goggles  Gown  Mask
  Henry:

CHAIN OF INFECTION: make guidelines

𝑆𝑜𝑢𝑟𝑐𝑒/𝐼𝑛𝑓𝑒𝑐𝑡𝑖𝑜𝑢𝑠 𝐴𝑔𝑒𝑛𝑡 → 𝑅𝑒𝑠𝑒𝑟𝑣𝑜𝑖𝑟 → 𝑃𝑜𝑟𝑡𝑎𝑙 𝑜𝑓 𝐸𝑥𝑖𝑡 → 𝑀𝑜𝑑𝑒 𝑜𝑓 𝑇𝑟𝑎𝑛𝑠𝑚𝑖𝑠𝑠𝑖𝑜 → 𝑃𝑜𝑟𝑡𝑎𝑙 𝑜𝑓 𝐸𝑛𝑡𝑟𝑦 → 𝑆𝑢𝑠𝑐𝑒𝑝𝑡𝑖𝑏𝑙𝑒 𝐻𝑜𝑠𝑡

o Recall question: Use of PPE eliminates? Mode of Transmission (inhalation, introduction to skin, ingestion)
o Handwashing: best way to break chain of infection

FIRE SAFETY

*CLASS E Liable to detonation (Arsenal fire)

  RACE
o Rescue: rescue anyone in immediate danger
o Alarm: activate institutional fire alarm system
o Contain
o Evacuate/Extinguish

 PASS
o Pull pin
o Aim at the base of the fire
o Squeeze handle
o Sweep side to side

WASTE CONTAINERS
o RED: sharps and needles (empty pressurized containers, Lysol)
o YELLOW: infectious wastes
o YELLOW WITH BLACK BAND: chemical wastes
o ORANGE: radioactive wastes
o GREEN: Non-infectious wet wastes (Biodegradable waste)
o BLACK: Non-infectious dry wastes (Non-biodegradable waste)
 Recalls
Hazards caused by liquid nitrogen gas
A. Burning sensation
B. Brittlement
C. Asphyxiation
D. Fire explosion
E. AOTA

Numeric rating of 2 indicates

A. Moderate
B. Slight
C. Minimal
D. None

ABC Class of fire is put off using

A. CO2
B. Dry chemical
C. Halon
D. Loaded steam

The following are laboratory hazard prevention strategies under engineering controls except
1. biohazard bags
2. warning signage = work practice
3. centrifuge safety buckets
4. eyewash station = PPE

A. 1,2,3 are correct

B. 1 and 3 are correct
C. 1,2,3,4 are correct
D. only 4 is correct
E. 2 and 4 are correct

OSHA strongly recommends wearing gloves as a barrier protection in the following instances except
A. when an intern is undergoing phlebotomy training
B. when a medical laboratory scientist has cuts or open wounds
C. when laboratory personnel anticipates hand contamination
D. when a support staff is encoding in the office

RATIO
Healthcare worker/Personnel, should wear gloves in these cases:
 Has cuts or other open wounds on the skin
 Anticipates hand contamination (biological/chemical)  Corrosive, Absorption in skin
 Performs skin puncture
 Receiving phlebotomy training

OSHA  Avoid contamination by not wearing soiled gloves when you are in non-laboratory work areas (e.g. office)
WHO  Minimum PPE for phlebotomy: tight-fitting gloves

Which of the following PPE is/are NOT used to prevent exposure of mucous membranes from splashes?
1. masks
2. laboratory gown
3. goggles
4. gloves

A. 1,2 and 3 are correct

 B. only 4 is correct
C. 1,2,3 and 4 are correct
D. 2 and 4 are correct
E. 1 and 3 are correct

RATIO
Mucous membranes
 Eyes  goggles/protective eyewear
 Nose  mask
 Mouth  mask
 faceshields
ANALYTICAL METHODS AND INSTRUMENTATION

 All uses light because light undergo several changes in several properties
o Light can undergo absorption, scattering, reflection, emission, and fluorescence
o Light can be converted to other forms of energy ex: Spectrophotometry

 Light Spectrum
o Wavelength (nm) vs energy
 Inversely proportional (WV, Energy)

 3 REGIONS OF LIGHT:
 VISIBLE LIGHT: 400-700 nm (ROYGBIV) lowest energy, long wv  highest energy, short wv
 UV LIGHT: <400 nm (short wv, high energy)
 INFRARED LIGHT: >700 nm (long wv, low energy)

SPECTROPHOTOMETRY

 SPECTROPHOTOMETER
o Governed by Beer’s Law (states that the concentration of a substance is directly proportional to
the amount of light absorbed or inversely proportional to the logarithm of the transmitted light)
 concentration = Abs = %T
 concentration = Abs = %T
o Transmitted light -> directly measured
o Absorbed light/Optical Density -> indirectly measured; computed value from transmittance

 EXTERNAL COMPONENT
o READ-OUT DEVICE/METER – measures the magnitude of the current or electrical energy that is
generated by the detector

 INTERNAL COMPONENTS:
o LIGHT SOURCE – provides continuous spectrum of polychromatic light
 TYPES:
 Visible to infrared region: Tungsten-halogen, Tungsten-iodide lamp, Tungsten lamp only
 Visible to UV region: Mercury-arc, xenon, deuterium-discharge

o ENTRANCE SLIT – allows entry a narrow beam of radiant energy; minimizes stray light (unwanted
light)
 Polychromatic light – type of light that passes through entrance slit
 o MONOCHROMATOR/WAVELENGTH SELECTOR

 Polychromatic light – type of light that reaches your monochromator

 Monochromatic light - type of light that passes exit slit and reaches the cuvette

Functions:
1. Disperse polychromatic light into separate wavelength
2. Isolate a specific wavelength/desired wv  Monochromatic light

 Examples: Filters, Prisms, Diffraction gratings (most recommended)

o EXIT SLIT – controls the width of light beam (bandpass)

o CUVETTE/SAMPLE HOLDER – holds the solution containing the analyte to be measured

 2 TYPES:
 Round-end
 Square-end -> preferred

o DETECTOR – measures and converts the transmitted light into an equivalent amount of
electrical energy

 Photomultiplier tube (PMT)

- most sensitive type of detector; detect even very small amount of transmitted light

TYPES OF SPECTROPHOTOMETER
 Double beam: contains 2 cuvettes/sample holders (1 for specimen, 1 for reference solution/standard)

1. Double beam in space Spectrophotometer

- ALL internal components are duplicated except light source
- Instrument with 2 photodetectors

2. Double beam in time Spectrophotometer

- ONLY the sample holder/cuvettes are duplicated
- Detection is one at a time; Light alternatively passes thru sample cuvette and reference cuvette

FLUOROMETRY
- Fluorescence: substances that are capable of absorbing and emitting light with a longer wavelength
- Emitted light has same energy or wv as the absorbed light (Phosphorescence)
  COMPONENTS: 2 monochromators (unique)
o LIGHT SOURCE - same as UV light source (xenon, hydrogen discharge lamp)
o EXCITATION FILTER/PRIMARY MONOCHROMATOR
 Receives light energy from the light source
 Responsible in increasing the energy level  (excited/excitation light) = energy, wv
o CUVETTE HOLDER (Quartz cuvettes)
 Analyte will absorb excited light and gives off emitted light/fluorescence=  energy,
wv
o EMISSION FILTER/SECONDARY MONOCHROMATOR
 arranged at a 90 degree angle in reference to excitation filter
 Why 90 deg? Avoid detection of transmitted and excitation light and ensures accuracy
of fluorometer
 More sensitive than spectrophotometer
 Receives emitted light/fluorescence
o DETECTOR

 DISADVANTAGES
1. Quenching
 Presence of molecules that absorbs or “steals” the fluorescence of analyte ( fluorescence)
2. Temperature = Collisions: Excited light being converted to heat energy instead of fluorescence
( fluorescence) inversely proportional

FLAME EMISSION PHOTOMETRY

 Based on the characteristic emission of light by analytes which are easily excited when exposed to
sufficient heat energy
 Easily excited: analytes with low oxidation state (Na, K, Li)
 Light intensity = # of atoms = concentration of analyte (directly proportional)
 Color Emission
 Lithium: Red
 Potassium: Violet
 Na: Yellow
 Rubidium: Red
 Magnesium: Blue
 Internal Standards: NOT be present in the sample
 Lithium
 Cesium
 Dilution of serum for Na/K FEP analysis = 1:100 or 1:200

ATOMIC ABSORPTION SPECTROPHOTOMETRY

 Measures light absorbed of atoms at a ground state

(unexcited state of atoms) = concentration of the atom
 Intended for analytes which are NOT easily excited by
the flame (Ca, Mg)
 Reference Method for Calcium and Magnesium

 COMPONENTS:
o LIGHT SOURCE: Hollow cathode lamp
o FLAME: Atomizer
NEPHELOMETRY
 Measures light scattered
 Principle: Light scattering
 Detector is at a 90 or 30 deg angle from the incident light
 Applications:
 Measurement of immune complexes
 Cell counting procedures
o Forward scatter: Volume/Size
o Side scatter: Internal characteristics (granularity)

TURBIDIMETRY
 Measures light blocked by particles (conc = %T)
 Detector is in line with the incident light
 Applications:
 Microbiology: Bacterial suspension (McFarland)
 Hematology: Coagulation studies (PT, APTT)
 Recalls

Which of the following best describes a monochromator?

A. Determine the critical angle of the refraction of dispersed light
B. Disperses polychromatic light into its separate wavelength
C. Measures the intensity of light which falls on diffraction gratings
D. Measures the intensity of light falling on a detector

In fluorometry, which of the following correctly describes the relationship of the wavelength and energy of the emitted
light?
A. inversely proportional
B. directly proportional
C. consistently proportional
D. relatively proportional

Which of the following best describes the interference caused by the presence of an appreciable concentration of
triglyceride in a lipemic sample?

A. Decrease in absorbance due to colorimetric interference

B. Increase in absorbance due to colorimetric interference
C. Decrease in transmittance due to light scattering
D. Increase in transmittance due to light scattering

RATIO

Interferences: 3 Substances
 Hemoglobin
 Bilirubin
 Lipids (TG)  Turbidity

Spectrophotometry:
 Incident light (Monochromatic light)  direct light to cuvette
 Components of spectrophotometer are arranged in a linear manner
- Photodetector is only capable of detecting transmitted light in a linear manner
 Turbidity  Light scattering
- Transmitted light will be scattered and will NOT be detected by the photodetector  Transmittance

Transmittance: directly measured in spectrophotometer  Absorbance = 2 – log %T

Beer’s Law: Transmittance and Absorbance are inversely proportional  T = Abs = Falsely concn

Hemoglobin & Bilirubin/Chromogenic Substances:

 Able to absorb light at the same wavelength as the chromogenic substance you are supposed to measure

HemogLobin: absorbs light in the same region/wavelength  Abs (“strong absorbances in the same region”)

Most common type of assay

A. Spectrophotometric
B. Visual Colorimetric (obsolete) - subjective
C. Electrochemical
D. Immunochromatographic
 RATIO
Henry’s
 Spectrophotometric determinations using simple reagents  “these are by far the most common types of
assay”
 Electrochemical  ABG & Electrolytes

AccuVein is a handheld medical device that helps medical staff visualize veins before phlebotomy. This device works
by
A. emitting ultraviolet light absorbed by hemoglobin in red blood cells
B. emitting infrared light absorbed by hemoglobin in red blood cells
C. emitting ultraviolet light absorbed by endothelial cells on blood vessel walls
D. emitting infrared light absorbed by the endothelial cells on blood vessel walls

RATIO
Pre-Analysis Chapter
 Syringe: specimen collection from hand/ankle/small children/patients with small or poor veins
 Two-way needle (Evacuated system):
 larger bore, negative pressure (vacuum)
 You cannot control the suction of blood  collapsed vein
 AccuVein (commercial name)
 held 7 inches over the potential site
 Hb absorbs infrared light and projects an image map of veins onto the patient’s overlying skin
 Utilize to know needle placement (where and how you will insert the needle)
 elderly
 obese
 burn patients
 patients with chronic disease (require diagnostic and therapeutic procedures)
 fragile veins
 Can distinguish Hemoglobin in RBCs (veins) vs Hemoglobin in RBCs (surrounding tissues)

The following characterizes tungsten halogen lamp from normal tungsten lamp as a radiant energy source in
spectrophotometers except
A. used for testing in the visible region
B. provides whiter radiant energy
C. generates higher temperature
D. provides brighter radiant energy

RATIO
BOTH  used for testing in the visible region
TUNGSTEN HALOGEN LAMP
o provides whiter light: maximum wavelength near the center of the visible spectrum
o provides brighter light: greater energy output
o generate higher temperatures: increased atom vaporization from high temp filament (Disadvantage)
- Halogen glass: counteract high temperature

Which of the following is not directly proportional to absorbance?

A. concentration
B. transmittance
C. absorptivity
D. path length
RATIO
BEER-LAMBERT’S LAW
A = abc a= absorptivity (molar absorptivity: concn is expressed in mol/L)
b= path length in 1 cm
c = concentration (g/L or mol/L)

 DIRECT RELATIONSHIP

A = 2 – log %T OR log10 (1/T)

 INVERSE RELATIONSHIP: T= A

AUTOMATION
o Continuous Flow Analyzers
o Centrifugal Analyzers
o Discrete Analyzers

CONTINUOUS FLOW ANALYZERS

 Specimen is aspirated through the sample probe into a continuous reagent stream
 Pumped through as system of system of continuous coiled tubing (reaction vessel: mixing of specimen +
reagent)

 Batch analysis: specimens are separated by air bubbles

 Primary source of error:
→ CARRY-OVER (remnants of a previous sample will affect succeeding samples)
→ Remedy: Perform washing-out adequately

CENTRIFUGAL ANALYZERS
 Uses a spinning rotor to generate centrifugal force to transfer and contain liquids in separate cuvettes
for analysis
 Able to transfer reagents and samples by acceleration and deceleration of samples
 Capable of performing 1 test on multiple samples (Batch analyasis)

DISCRETE ANALYZERS
 Each sample and the corresponding reagent is handled separately in its respective reaction vessel
 Runs multiple tests on one sample or one test on multiple samples
 Performs random access, batch and sequential analysis
 Most popular and versatile analyzer
 It can perform all type of testing

OTHER PRINCIPLES
 Single Channel vs Multichannel
o Single channel: perform ONLY 1 test for a dedicated instrument; one at a time
o Multichannel: perform at the same time for several tests

 Batch Analysis vs Sequential Analysis

o Batch Analysis: Group of samples analysed at the same time for the same test
o Sequential Analysis: Performing a set of test in a particular order on each sample
(ALL test given on a sample at a time)

 Open reagent system vs close reagent system

o Open reagent system: reconstitution (example: AMS Ellipse)
o Closed reagent system: NO reconstitution; reagent fully prepared (Ex: EasyLyte)

 Random Access:
 Different test reactions can be programmed to occur
 Allows prioritize testing of a particular sample (STAT samples)
 Recalls

This serves to separate samples and test reactions in continuous flow analyzers
A. cuvette
B. tubings
C. air bubbles
D. containers

Tube labor includes sorting and centrifuging, aliquoting, racking, unracking, loading and unloading samples on
analyzers, retrieving tubes for add-on tests, performing manual dilutions or reruns, and storing tubes. Which of the
following strategies aim/s to reduce labor in the laboratory?
1. automation
2. regrouping tasks into workstations
3. redesigning the workflow
4. careful review of lab tests

A. 1 and 3 are correct

B. 1,2,3,4 are correct
C. 1,2,3 are correct
D. only 4 is correct
E. 2 and 4 are correct

Which of the following causes a flag in automated analyzers?

1. inadequate sample volume
2. presence of hemolysis
3. concentration exceeds linearity
4. panic values

A. 2 and 4 are correct

B. only 4 is correct
C. 1,2,3 are correct
D. 1 and 3 are correct
E. 1,2,3, and 4 are correct
SAMPLE COLLECTION AND PROCESSING
 Arterial Blood
 Blood Gas Analysis (Heparin)

 Capillary Puncture
 POCT
 Newborn Screening (blood spot in filter paper,
heel stick, capillary blood)
 Capillary blood/Arteriolized blood/Arterial-
enriched blood
 Warming: 42 C  increases blood
flow

 Preferred Site for Venipuncture

 Antecubital Veins
1. Median cubital - anchored
2. Cephalic – tend to roll (more)
3. Basilic – tend to roll

PRE-ANALYTIC VARIABLES
 Time of Collection: MORNING
o Basal State – early morning before patient eat or become physically active

 Fasting
o Glucose: 8-10 hours
o Lipids: 12 hrs
 Diurnal Variations
o : ACTH, Cortisol, iron, aldosterone
o ACP, GH, PTH TSH

 Tobacco smoking (specified as a common interference in HENRY’S)

o Catecholamines, cortisol, free fatty acids, lactate, insulin, epinephrine, GH, 5-HIAA, WBC count,
neutrophils, monocytes, carboxyhemoglobin, RBC count, hb, hct, MCV, IgE
o IgA, IgG, IgM, Eosinophils, Vitamin B12, Sperm count and motility

 Alcoholism
o aminotransferases, lipoproteins, bilirubin, ketone bodies, TAG
o Glucose, albumin, transferrin

 Lipemia: TAG (>400 mg/dL)

o interferes with amylase, urate, urea, CK, bilirubin, total protein

 Bilirubin: Icteric sample (>25.2 or 25 mg/dL)

o ALP
o Interferes with the following methods:
 HABA Method (Albumin assay)
 Assays using FeCl3 (Cholesterol assay)
 Biuret Reaction (Total Protein)

ANTISEPTIC TECHNIQUE
 Routine: 70% isopropyl alcohol
 Ethanol testing: Benzalkonium chloride
 Friction cleansing (2017 CLSI)
 PPE:
 WHO: Tight fitting gloves
 Bishop: Gloves, face mask, lab gown

SPECIMEN HANDLING
o Protect from light: Bilirubin and CK  Falsely decreased
o Chilling: Ammonia and blood gas
ORDER OF DRAW
 Recalls

NOT a physiologic effect

A. Smoking
B. Age
C. Sex
D. Alcoholism

Effect of refrigeration on ALP and LD concentrations respectively:

A. decrease, increase
B. increase, decrease
C. both increase
D. both decrease

Most analytes stored at low temp (freezer/ref) EXCEPT

o ALP: increases
o LD4 & LD5 (destroyed by freezing): decreases

A newborn is due for screening of certain metabolic disorders. Which of the following is the best specimen for screening
test?
A. skin puncture using capillary tube
B. arterial puncture
C. blood spot on filter paper
D. venipuncture

A medical technologist handling a lipemic sample performed serum blanking. After the procedure, the lipemic sample
remains turbid. Which of the following is the best course of action?
A. perform ultracentrifugation
B. perform serum blanking again
C. re-collect sample
D. proceed with the testing