Joint Fluid Crystals
New procedures can generate excitement and anxiety. Joint fluid crystal analysis is a good example. Implementation involves the following:
- Purchasing a new or retrofitting an older microscope with a gout kit (on the cheap this might be $1000 or less, but a new scope can be ten times that amount)
- Developing clear expectations
- Writing a procedure
- Educating staff
- Obtaining reliable quality control and proficiency testing materials to demonstrate and maintain competency
- Sustaining reliable performance
The two most common pathogenic crystals encountered in joint fluid are monosodium urate (MSU) and calcium pyrophosphate (CPPD). Along with a high number of polymorphonuclear cells and especially if seen intracellularly, these are diagnostic for gout and pseudogout conditions, respectively. Both types of crystals are visible under polarized light and demonstrate a characteristic birefringence (a filter splits the polarized light into yellow or blue depending on orientation).
A reasonable expectation might be that bench techs are able to identify MSU crystals 100% of the time, since these are large, needle shaped, and strongly birefringent. Perhaps, since CPPD crystals are identified less reliably because of their size and shape variation and weak birefringence, a negative or equivocal specimen can be checked by a second tech.
Fine, if there is someone on staff who is familiar with what these crystals are supposed to look like. Techs need to be shown with a clear, simple hands-on approach. Yet some techs will say they “get it” with a hope that they can muddle through or ask someone else to look at it. Some positives will be missed. Theory has a way of getting muddled in practice.
This process is similar for any new test. Some, such as lactate, are easier because the testing platform is already well understood; parameters are variations on a theme. Others, such as joint fluid analysis for crystals, involve new equipment, new skills, and new understanding.
What about in your lab? Have you brought in crystal analysis or some other procedure needing new skills? What problems did you encounter?
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