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Book Reviews |
Department of Pathology, St. John Hospital and Medical Center, Detroit, MI 48236
As the Preface indicates, this book is intended for the broad audience of laboratorians, physicians, nurses, and anyone involved with the proper application of knowledge as it relates to the preanalytical phase of laboratory testing. Visually rich with colorful illustrations, neatly numbered and captioned, 114 tables, graphs, diagrams, and photographs explicitly reinforce and clarify the text. In addition, the authors cleverly emphasize to the reader their recommendations and warnings by highlighting the former in green print, the latter in red. These printing contrasts make for efficient skimming for emphasized text. The book is well referenced, and an excellent glossary is included. An added bonus is a booklet attached to the inside back cover titled, List of analytes, Preanalytical variables. The presentation of information in user-friendly table form makes this a valuable, transportable ready reference for physicians and laboratorians alike.
Before the first chapter, the authors take a novel approach intended to enhance the reader's awareness of the importance of the multiple steps in the preanalytical process. They compare two short case studies for the same patient, demonstrating an ideal path to diagnosis vs a pathway with significant diagnostic confusion because preanalytical variables were not properly controlled. Having set the tone and purpose for the book, the first chapter launches into an adequate discussion of several biological variables and their influence on test results. These range from age and gender to diet and exercise to intake of caffeine, nicotine, and alcohol.
The next three chapters provide an excellent discussion of specimen collection, transport, storage, and preparation of specimens for analysis. The reader is thoroughly informed about the importance of collection timing (influences of circadian rhythms, diagnostic/therapeutic procedures), result differences attributable to posture and to tourniquet time, and concerns associated with collection sites, e.g., indwelling lines. There is a discussion of the advantages and disadvantages of using plasma vs serum, as well as a comparison of analyte concentrations for these two matrixes. The illustrations for venipuncture and skin-puncture are exceptional.
Stability schematics define the importance of preanalytical time and temperature for several analytes. However, one recommendation conflicts with the current NCCLS Approved Guideline for the Handling and Processing of Blood Specimens (H18-A), which states a requirement for a 2-h limit from the time of collection to the separation of serum/plasma from cells. The authors recommend a 1-h time limit, which is referenced to an earlier, since revised, NCCLS document.
Chapter 4 covers multiple laboratory areas. Preanalytical considerations are defined for transfusion medicine, hematology, coagulation, chemistry, immunoassay, and molecular biology. Possibly in some areas there is not enough depth; however, the manner of information presentation is valuable because it serves up an awareness of the multiple potential factors that can influence result accuracy. A final chapter on interferences encapsulates information that will not be particularly new for many laboratorians.
Laboratory scientists have become increasingly aware of the important influence of preanalytical variables on patient test results. This publication would make an excellent addition to one's library of reference textbooks. It will have particular appeal to those involved with training and instruction.
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