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factors affecting the values and interpretation of laboratory tests

Factors Affecting Results

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The following factors can affect the results obtained from samples and should be taken into
consideration when interpreting results.

Collection-to-Test Time

Delay between the collection of a sample and the testing of the sample can affect the results obtained,
particularly if not stored at the appropriate temperature (see below). For bacteriological investigation it
can result in:

· An overgrowth of commensal organisms which can obscure any pathogens, or

· Misrepresentation of the numbers of organisms present

For serological examinations, it may result in degradation of antibodies/antigens in the samples. This can
result in false-negative or false positive reactions (due to cross-reaction).

Temperature

Storage of samples for extended periods at in-appropriate temperatures can result in:
· Overgrowth of organisms (see above) if too warm

· Degradation of antibodies, etc. if too warm in serological/viral samples.

· Bacterial death if too cold.

In general, samples should be kept refrigerated (4-8oc) until they can be transported. The exception to
this is blood culture samples, which should be kept at room temperature (15-25oc)

Sample Collection Time

In most cases the time at which a sample is collected will have no effect on results. In some cases,
however, it is an important factor:

· For mycobacterial investigation of urine, complete early morning urine are required (from 3
consecutive days) as this increases the possibility of isolating the mycobacteria.

· For examination of urines for schistosomiasis, a urine sample should be taken in the middle of the
day (after light exercise) as this is when the parasite is shed in the largest numbers.

Appropriate Sample

It is important to ensure that the correct sample is taken for the test required. An incorrect sample can
affect the result obtained or can cause no result to be issued as it is not possible for that test to be
performed on that sample. Examples include:

· Mid-stream Urine for M/C/S) but a Terminal Urine for Schistomoniasis investigation
· Virology swabs taken for bacterial investigation – the medium in the swab contains antibiotics to
prevent bacterial growth and therefore cannot be used for this test.

Appropriate Collection Container

It is important to ensure that the sample is taken in the correct container for the test required. Examples
include:

· Blood samples for molecular (PCR) testing should be collected in an EDTA (red-topped) blood tube
as the sensitivity of such tests is significantly reduced with clotted samples, and accurate viral loads
cannot be obtained where appropriate.

· Urine samples for routine culture (NOT TB) must be collect in sterile universals – any other
container, including faeces pots, are not guaranteed sterile and could therefore contaminate the sample.

· Swabs/urines for Chlamydia or dual testing MUST be taken in Abbott Collection Kits (orange-top) as
the buffer present stabilises the sample to enhance the testing.

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