# Presentation: 309658

## Unsatisfactory Newborn Screening Specimens: Interpretations, Studies and Current Trends 

**Presenters**
**Dr. John Sherwin-California Health Department**
**Dr. Ken Pass-New York  Health Department**
**Dr. Lisa Kalman-Center for Disease Control**

## The web conference is co-sponsored by

**The Newborn Screening Quality Assurance Program (CDC)**
** ****APHL's Quality Assurance/ Quality Control/ Proficiency Testing Subcommittee of the Newborn Screening and Genetics in Public Health Committee**
**The National Laboratory Training Network **

## Objectives	

**Pretest-assess the current status of evaluating dried blood spot specimens**
**Review of testing of inadequate specimens and equivalent adequate specimens**
**Summary of inadequate specimen handling**

## We are going to show you a series of dried blood spot specimens. 

** ****Through live online audience participation, please determine the suitability for testing of each specimen** **by clicking on the single best assessment in each of the**
** ****polling windows.**
**Results will follow each polling.**

## Specimen # 1

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #1****Is this specimen satisfactory for testing?**

## Specimen #1 Assessment

**Uneven blood saturation- colored in circles with capillary**

## 	Specimen #2

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #2****Is this specimen satisfactory for testing?**

## Specimen #2 Assessment

**Properly collected specimen**

## Specimen #3

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #3****Is this specimen satisfactory for testing?**

## Blood Clot on Specimen

**Specimen #3 Assessment**

## Specimen #4

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #4****Is this specimen satisfactory for testing?**

## Circles not filled

**Specimen #4 Assessment**

## Specimen #5

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #5****Is this specimen satisfactory for testing?**

## Poor saturation-possibly due to high hematocrit

**Specimen #5 Assessment**

## Specimen #6

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #6****Is this specimen satisfactory for testing?**

## Contamination

**Specimen #6 Assessment**

## Specimen #7

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #7****Is this specimen satisfactory for testing?**

## Incomplete saturation- too little blood applied

**Specimen #7 Assessment**

## Specimen #8

**Specimen #8**

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #8****Is this specimen satisfactory for testing?**

## Smeared blood- Pressed too hard against the heel

**Specimen #8 Assessment**

## Specimen #9

**Specimen #9**

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #9****Is this specimen satisfactory for testing?**

## Improper use of capillary tube - blood clotted before application causing serum rings

**Specimen #9 Assessment**

## Specimen #10

**Specimen #10**

## Yes
No, blood is clotted
No, blood is layered
No, blood is contaminated
No, capillary tube was used to spot the blood
No, incomplete saturation 
No, other

- No, blood is clotted
- No, blood is layered
- No, blood is contaminated
- No, capillary tube was used to spot the blood
- No, incomplete saturation
- No, other

**Poll: Specimen #10****Is this specimen satisfactory for testing?**

## Folds and creases through the blood circles

**Specimen #10 Assessment**

## The dried blood spot specimens for the polling slides were generously provided by Gary HoffmanWisconsin State Laboratory of Hygiene