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Biomedical subjects

J A Koepke

Publications and source records attributed to J A Koepke.

At least 19 recordsLinked to original sources

Molecular marker test standardization.

A review of the status of standardization of laboratory tests of particular interest to oncologists is presented. Currently, relatively few of these tests are standardized; as a result, interlaboratory and interinstitutional comparison of data is problematic. In 1992, additional interlaboratory studies of common tumor markers will be initiated by the College of American Pathologists. The National Committee for Clinical Laboratory Standards also has begun to develop standard methods and guidelines for these important tests.

Biomarkers, Tumor

Effects of cell membrane disruption on the relaxation rates of blood and clot with various methemoglobin concentrations.

The magnetic resonance imaging (MRI) characteristics of hemorrhage and clotted blood change with age. The effects of methemoglobin and cell membrane lysis, factors which in part may underlie this evolution of imaging characteristics, were studied using clotted and heparinized dog blood at various methemoglobin concentrations. Cell lysis did not alter the longitudinal relaxation rate (1/T1) in clotted or unclotted samples. Membrane lysis altered significantly the transverse relaxation rate (1/T2) in both clotted and unclotted samples. Lysed samples of oxygenated blood at 0% methemoglobin had significantly higher T2 values than intact samples. At 0% methemoglobin, clotted samples had slightly but significantly shorter relaxation times than unclotted samples. Within the samples studied, large changes in the state of oxygenation and methemoglobin content were observed in less than 24 h. Such changes necessitate frequent monitoring of these parameters if serial studies are to be done.

Animals

The process of quality assurance. Quality indicators in clinical pathology.

The process of developing and using indicators of quality performance in laboratory medicine presents significant problems for clinical pathologists. Although there have been many proposed indicators, many fail to provide meaningful information. Four types of quality indicators (data reliability, laboratory management, clinical utilization, and pathologist credentialing) are proposed and examples of their use are given.

Credentialing

Future directions for quality assurance in laboratory haematology.

Seven recommendations for the future in haematology quality assurance have been made. They include two levels of control cells, expanded rules for quality control of analysers, continued development of random error detection systems, performance goals for instruments, improved MCV calibration, appropriate checklist items and blood-film evaluation methods.

Calibration

Current practices for quality assurance in laboratory haematology.

Current practices for the quality control of multichannel haematology instruments are outlined. The strengths and weaknesses of preserved whole-blood controls, blood-cell indices and random duplicates methods are reviewed. Despite considerable experience in these several methods no consensus has yet been reached on the best and most efficient methods for quality control of these instruments. Several questions and unfinished tasks remain before this ongoing problem is solved. The major questions are listed and these tasks are catalogued and prioritized.

Blood Preservation

Power function graphs.

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Data Interpretation, Statistical

Precision and accuracy of absolute lymphocyte counts.

A critique of leukocyte counting using automated hematology instruments is presented. Important preanalytical variables include the anticoagulant and specimen assay delays. The precision of counts is directly related to the number of leukocytes counted. Criteria for the selection of an acceptable hematology laboratory for lymphocyte counts for CD4 determinations are presented.

Acquired Immunodeficiency Syndrome

Home blood transfusions: the medical, economic, and legal issues surrounding a new treatment procedure.

Blood transfusions have almost always been confined to hospital settings in the past. Recent medical care trends have shifted some therapies (e.g., renal dialysis, hemophilia treatment) into the patient's home. Transfusions are now being given in increasing numbers to stable patients in their homes. This paper examines the medical aspects, the economic issues, and the legal implications of such transfusions. Candidates for home transfusion must be carefully chosen primarily according to the medical guidelines for such treatment. Any legal issues must be satisfactorily answered before approval is given. The paper concludes that if done properly, home transfusions can be safe, cost-effective, and convenient for a carefully selected segment of patients.

Blood Transfusion

Reticulocytes.

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Antibodies

The Automicrobic System for urines.

An evaluation of the Automicrobic System (AMS) for Urines (Vitek Systems, Inc.) was carried out under the auspices of the Product Evaluation Committee of the College of American Pathologists from the period June 1977 through October 1978. Data generated during this evaluation indicated that, when comparing the AMS methodology to our clinical microbiology laboratory methodology, a 37% time saving could be realized by utilizing the AMS. Quantitation with the AMS showed a 99% correlation with the clinical microbiology laboratory method except for yeast which correlated only 50% of the time. The average overall identification accuracy was 95%. Negative response accuracy was 99%. Other members of the Enterobacteriaceae which the instrument is not designed to identify may produce erroneous results if they occur in urine specimens. Specimens containing two organisms were identified with a 94% correlation when compared to our conventional methodology. The time when a well becomes positive may be used as a fairly reliable indicator of significance (count greater than 70,000 colony-forming units per ml) for Escherichia coli, Klebsiella-Enterobacter group, and group D Enterococcus, but not for Proteus sp., Pseudomonas aeruginosa, and yeast. Specimen collection must be performed properly since specimens considered as contaminated by conventional plating-out techniques may be reported out by the AMS as only one or two organisms and thus lead to an erroneous assumption as to significance. Cost per specimen was $1.83 more by utilizing the AMS method as compared to our conventional method. This is offset by a saving of 1.74 h daily of personnel time and a final report in 13 h. At least 30 urine specimens would be needed daily to pay for the instrument and specimen costs in 1 year. The AMS can provide significant aid to a clinical microbiology laboratory when all factors are considered.

Autoanalysis

The Comprehensive Blood Bank Survey Program of the College of American Pathologists, 1976.

The Comprehensive Blood Bank Survey Program for 1976 still shows that the participants are performing well on ABO and Rh typing (accuracy greater than 96.6%), antibody detection (greater than 97.0%), and crossmatching (greater than 97.3%). The only problem with less accuracy than that stated involved a specimen with an extremely weak antibody. Some errors are still due to failure to fill out results. In the 1976 survey, four ungraded problems were included as attempts to study the "state of the art." The problems consisted of an antibody whose titer was to be determined, a mixture of Rh+ and Rh-- cells to be detected, and two multiple-antibody problems. The results obtained in these studies are discussed. Finally, the participants were asked questions about the amount of Rh immune globulin used and the indications for its use, the incidence and types of transfusion reactions seen, and the notations used by laboratories to record results. The answers to these questions are also documented.

ABO Blood-Group System