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Blood quality assurance - Background

In 1992, the National Sport Science Quality Assurance program (NSSQA) initiated a trial blood quality assurance program with the Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd (QAP). The RCPA-AACB Chemical Pathology Group coordinates a broad range of quality assurance programs covering the needs of both the routine clinical chemistry laboratory and specialist laboratories. They run and manage surveys for laboratories in hospitals, pathology practices and general practitioners across Australia, as well as in South-east Asia, Hong Kong, China, the Philippines and Canada. This organisation is the premier biochemical quality assurance group in Australia and its expertise guarantees that any quality assurance program is highly effective.

One area of concern identified by physiologists working in institutes involved with the regular assessment of elite athletes, was lactate measurement using auto-analysers such as the Yellow Springs and Analox. A trial lactate program was initiated by LSAS and QAP in November 1992. The results of two unknowns (theoretical values of 4.5 and 13.0 mmol.L^-1) from 18 laboratories revealed a greater variance at the high compared with the low concentration. The mean of the low results was 4.5 mmol.L^-1 while that of the high unknown was 12.6 mmol.L^-1. A second more comprehensive trial of six unknowns in duplicate (1.8-24.4 mmol.L^-1) was conducted in May 1993 with 50 participants.

Summary statistics for the 19.9 mmol.L^-1 unknown were as follows: the 12 Analox users had a median of 17.8, mean of 17.5 and a standard deviation of 2.2 mmol.L^-1, whilst the 19 Yellow Springs instrument users had a median of 20.0, mean of 20.2 and a standard deviation of 0.9 mmol.L^-1. Respondents received comprehensive results that enabled them to compare their precision and inaccuracy with that of users with the same kind of analyser and with those using other analysers. The results of the QAP trials indicated that some people working in sports science facilities were having problems with samples that were very much in the physiological range of elite athletes.

From these pilot studies it was apparent that an external quality assurance program for lactate analysis could be beneficial for sport science laboratories. A quality assurance program would help to determine whether the practices following routine calibration are being performed acceptably, and would also allow regular comparison among peers and between different models of equipment.

Current work

From 1993, the QAP has offered an annual lactate program to sporting institutions. In 2001, the lactate program was combined with the blood gas program. The blood gas program, a module of Chemical Pathology, incorporates lactate as an analyte at various concentration ranges. Overall, the blood gas program includes 24 samples analysed in pairs once a month and broken into two cycles, February-June and July-December. Interim reports are provided on a monthly basis.

These graphical reports provide a comprehensive breakdown of each participant's results compared to all results, and compared to peers using the same method, instrument and reagent. End-of-cycle reports provide additional information regarding linearity, bias and precision, plus summary data on the performance method, instrument and reagent groups. These reports enable peer review and provide information for participants who are considering changing an analytical system to improve performance.

Instrument and other subgroup summary reports can also be provided to RCPA subgroup coordinators for assessment, review and troubleshooting. In addition, QAP office staff can provide consultative assistance with particular problems.

Laboratories seeking NSSQA accreditation are encouraged to employ the blood quality assurance program to assess the reliability and accuracy of blood analysers. Typically, laboratories have only registered laboratory blood analysers, but it may be viable to use the quality assurance samples with portable blood lactate analysers including the Lactate Pro Blood Analyser and the Accusport Blood Analyser.

Currently, 113 laboratories submit results to the lactate in blood gas program. The program is coordinated by Lloyd Penberthy, Flinders Medical Centre, South Australia.

Mr Lloyd Penberthy
Flinders Medical Centre
Bedford Park SA 5042 AUSTRALIA
Tel: +61 8 8374 0797
Fax: +61 8 8374 0695
Email: Lloyd.Penberthy@flinders.edu.au

For more information

For more information on programs and services offered by RCPA Quality Assurance Programs Pty Ltd call 08 8374 0797 or email CHEMPATH.OAP@fmc.sa.gov.au.