gms | German Medical Science

Aim: When faced with the difficulty of not being able to acquire pathological samples due to patient safety reasons for students in the bachelor degree programme in Biomedical Laboratory Diagnostics for laboratory courses at our university, it may be a reasonable idea to spike normal serum and urine samples with a desired substance for clinical analysis. Hence, the main objective was how we can generate reproducible abnormal samples via spiking for a clinical chemistry course to broaden the diversity of samples for the students and help them link their knowledge between clinical disciplines, such as physiology, pathology and biomedical laboratory diagnostics [1].

Material and methods: Measurements of the serum and urine samples were conducted with the Cobas Integra 400 (Roche) via enzymatic or colorimetric assays and processed by the device’s software. The spiking of these samples was performed in a non-sterile laboratory setting. To increase the student’s learning effect to interpret normal as well as pathological samples, we added 1µL of a 500g/L glucose solution to 400µL of serum for example and 125µL of a 3g/L bovine serum albumin (BSA) solution to 125µL of a urine probe to generate extreme value results. The supplemented amount may exceed the upper reference range as to give the appearance of handling a sample from a patient in an emergency, e.g., diabetic coma patients. Furthermore, it is to be noted that in some cases it's required to create an analogous serum or urine sample, such as manipulating the levels of creatinine, albumin, and, glucose, as to generate the diabetic nephropathy patient profile for example [1], [2].

Results: Through calculating the required amount of a standardized glucose and BSA solution for spiking, by choosing the value of interest from reference charts, the method for creating mock diabetes mellitus and kidney disease samples proves to be very well applicable for student’s practical courses. The spiked serum and urine samples will be used for the first time in the summer semester. Experiences with the stability and use of the samples in the practical course in clinical chemistry will be reported at the conference.

Discussion: As these spiking methods work rather well with glucose and BSA, it should be possible to proceed in a similar way with other parameters also, such as creatinine or even cholesterol. This practical course is designed to prepare students for internship in hospitals. Because the students can already train here, how to act in case of life-threatening laboratory values, a contribution to patient safety can already be made during training.

Take home messages: Spiking of blood serum and urine samples to create a high-grade learning environment for students proves to be a suitable way to create reproducible mock pathological samples but must be carried out carefully, as to not generate unfeasible results. Spiking of samples is a good way to be able to include pathological samples in the teaching of biomedical laboratory diagnostics independently of a hospital.