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ADVANCE Discourse: Lab

Patient-centered “Pre-analytics” in clinical laboratories

Published July 16, 2015 6:11 PM by Michael Jones

[*Editor’s Note: The following is a guest blog post contributed by Biju Joseph, PhD, MT(ASCP), MB(ASCP).]

Patient-comfort oriented specimen collection techniques are vital for clinical laboratories for boosting customer base and revenue generation. The workflow could be less invasive, less painful blood collection devices and easy to use collection and transport kits. Multiple easy to use specimen collection devices and application specific protocols are available in the market. Pain-free, single use lancets for blood collection and mouth rinse specimen kits for DNA isolation in place of buccal swabs are typical examples.

Saliva testing has been suggested for several cancers that include breast cancer and prostate cancer. Clinical laboratories will be forced to allocate time for switching to much more patient-friendly devices and collection protocols as they are increasingly available due to the following reasons:

1. Home-based testing that was widely used for pregnancy tests is being adopted for self-monitoring of hemoglobin level.

2. In the near future, patients will be able to self-order a few tests to begin with, collect the results personally and could review the results with help from their physician

3. Precision medicine initiatives by the federal government. The general population will increasingly undergo genetic tests (on their own or directed by physician) that would help healthy lifestyles, and create awareness about susceptibility/resistance to specific genetic or infectious diseases. The revolutionary nature of these changes is evident when we compare this to the discovery of resistance of sickle red cells to malarial infection based on clinical symptoms in the past

4. Changes in regulations (i.e., blood glucose monitoring), re-classified as moderate complexity tests, necessitate use of devices that are comforting to the patient.

5. Liquid biopsies are entering molecular diagnostics for cancers due to inaccessibility or significant patient discomfort using the existing techniques.

In molecular testing, avoiding specimen processing for nucleic acid isolation, though not directly related to patient comfort, could contribute to guaranteed completion of test and report generation by direct sample-to-answer testing. This also has potential applications in infectious disease testing (limited nucleic acid material that could be lost during extraction), significant time reduction in the generation of results and the ability to detect multiple pathogens from a single specimen.



1.            Elizabeth Franzmann. Saliva as a diagnostic tool. Special feature. MLO 2015: 47(7);24-25.


posted by Michael Jones


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