Sarah, a 19 year old prospective donor whom has just started studying at HCT. She had never donated blood before and this was her first time to donate. She presented with the below physical examination and information regarding her medical history (table 7):
EXAMINATION
Blood pressure: 130/180
Hematocrit: 39.2 %
Hemoglobin: 13.0 g/dL
Pulse: 105 beats/min
Temperature: 98.5˚F
Weight: 56.2 Kg

Table 7: Shows patient’s lab investigations.
When she was asked whether she was on any medication she mentioned that she was taking medication for her acne called Acutane (isotretinoin) but her last dose for this medication was 3 months ago.
Questions:
Q1. Explain the steps in which the specimen is collected, handled, and how the specimen is analyzed.
Q2. Evaluate and explain the patient’s lab results.
Q3. Explain the lab tests and methods that you will carry out and use in order to diagnose the patient.
Q4. Explain how you would determine the acceptability of quality control test result data.
Q5. Discuss the importance of quality management on the laboratory operation during the various laboratory analytic phases.
Q 6. Illustrate and explain the critical pathways that you used to aid patient diagnosis.
Q 7. From the case study, explain how you would demonstrate ethical behavior, professionalism, and maintain patient confidentiality.

Reference Ranges:
Biochemistry
Alanine aminotransferase (ALT) 10–40 IU/L
Alkaline phosphatase (ALP) 20–140 IU/L
Albumin (Alb) 35–50 g/L
Amylase 60–180 U/L
Aspartate aminotransferase (AST) 11–60 IU/L
Bilirubin (Bili) <21 μmol/L Cholesterol <5 mmol/L Creatinine (Cr) 60–110 μmol/L Corrected calcium (corr Ca) 2.1–2.6 mmol/L C-reactive protein (CRP) <5 mg/L Erythrocyte sedimentation rate (ESR) <30 mm/hr Fasting glucose (Gluc) 3.5–6 mmol/L Free T4 10–23 pmol/L Free T3 3.5–6.5 pmol/L Gamma glutamyl transferase (GGT) <65 IU/L HDL cholesterol >1 mmol/L
IgA 0.4–3.5 g/L
IgG 6.5–16.0 g/L
IgM 0.55–3.0 g/L
Lactate dehydrogenase (LDH) 240–480 IU/L
LDL cholesterol <3 mmol/L Parathyroid hormone (PTH) 1.2–5.8 pmol/L Phosphate (PO4) 0.81–1.45 mmol/L Potassium (K) 3.5–5 mmol/L Prolactin (non-pregnant) <20 ng/mL Serum osmolality 278–305 mOsm/kg Serum protein 60–80 g/L Sodium (Na) 135–145 mmol/L Triglyceride <2.26 mmol/L Thyroid stimulating hormone (TSH) 0.5–5 mU/L Total T4 58–174 nmol/L Urea (Ur) 2.5–7.8 mmol/L Coagulation Activated partial thromboplastin time (APTT) 18–28 sec D-Dimer <250 μg/L Fibrinogen 1.5–3.0 g/L International normalized ratio (INR) 0.9–1.2 sec Prothrombin time (PT) 11–15 sec Urine Urine pH 6.5–8 Urine osmolality 50–1200 mOsm/kg Blood gases Base excess –2 to 2 mmol/L pCO2 4.5–6 kPa pH 7.35–7.45 pO2 11.3–12.6 kPa HCO3– 22–26 mmol/L Haematology Eosinophils <0.4 × 109/L Haemoglobin (Hb) 11.4–15.0 g/dL Lymphocytes 1.3–3.5 × 109/L Neutrophils 2.0–7.5 × 109/L Mean cell volume (MCV) 77–95 fL Mean cell haemoglobin (MCH) 27.0–32.0 pg Platelets (PLT) 150–440 × 109/L Reticulocytes 0.5–1.5% Serum ferritin 20–300 mg/L Serum iron 14–31 mmol/L Total iron binding capacity (TIBC) 45–80 μmol/L Transferrin saturation 20–50% White cells (WCC) 3.9–10.6 g/dL