Serological testing in a microbiology laboratory of specimens from patients with suspected infectious disease

To determine how the microbiology laboratories of one region process serological requests from patients with suspected infectious illness, referred to as "clinical syndrome" type patients in this study; to consider areas where improvement in the associated serology service could be made.

A prospective two month collection of data on all serological requests from patients with suspected infectious illness was undertaken. A questionnaire on laboratory policies/procedures was also completed by the 10 departments taking part.

Serology specimens from "clinical syndrome" patients accounted for 1-2% of total microbiology samples. There was significant variation in some of the policies/procedures carried out by the 10 laboratories when handling serological requests. Differences were seen in the use of laboratory protocols for test processing, range of tests performed, demand for second (convalescent) serum samples, storage of serum samples, and reporting of results.

The laboratory management of "clinical syndrome" type requests is complex. Individual pathology departments vary in the way they handle serology specimens but this study highlighted areas which may contribute to improving the appropriateness of testing and the more efficient use of serology resources. These include improving (1) clinician education, (2) pathology request forms to encourage better clinical information, (3) appropriate laboratory protocols to aid decision making on test selection, (4) percentage of convalescent serum samples received together with longer serum sample storage, and (5) turnaround times of serology reports.