TECHNICAL GUIDANCE FOR THE ACCREDITATION OF ANDROLOGY LABORATORIES

Transcription

1 TECHNICAL GUIDANCE FOR THE ACCREDITATION OF ANDROLOGY LABORATORIES Approved By: Chief Executive Officer: Ron Josias Accreditation Executive: Mpho Phaloane Revised By: Medical Specialist Technical Committee Date of Approval: Date of Implementation: SANAS Page 1 of 7

2 CONTENTS: 1. Purpose and Scope Definitions and References General List of Requirements Quality Management System (Clause 4.2) Training of Staff Quality Assurance Semen Analysis Procedures... 4 ADDENDUM 1: Amendment Record... 7 SANAS Page 2 of 7

3 1. Purpose and Scope This guidance document gives guidance to the managerial and technical accreditation requirements of an Andrology Laboratory and shall be used in conjunction with the ISO Standard. This document applies to all SANAS Accredited Andrology Laboratories. 2. Definitions and References SANAS PM SANAS A 01 SANAS Policy Manual References, Acronyms and Definitions 3. General List of Requirements All assessments are done in accordance with the ISO standard and SANAS accreditation requirements. SANAS documents are available from the SANAS website. 3.1 Quality Management System (Clause 4.2) Scope of testing Each laboratory shall indicate on their scope of testing, whether they perform the following classes of tests: Diagnostic Andrology Screening Diagnostic Andrology Andrology i) Diagnostic Andrology Screening. Such tests are typically performed in peripheral Andrology laboratories, at Pathology, Medical Technology or Clinical Technology Institutions. a) Macroscopic examinations b) Sperm concentration determination c) Sperm motility evaluation d) Forward progression evaluation e) Sperm morphology evaluation f) MAR tests for IgG and IgA (IgA were applicable) g) Sperm vitality assessment h) Detection of seminal leukocytes i) Post Vasectomy semen analyses ii) Diagnostic Andrology This includes investigations as listed in (i), and could further include but not be limited to: a) Immunology battery tests including agglutinating and immobilising sperm antibody screening b) Immunobead test for ASA c) Sperm survival evaluation after sperm preparation d) Sperm cervical mucous contact tests e) Cervical mucous scoring (Post Coital) f) Kremer penetration meter test g) Bacteriological (Genital tract infections) screening h) Seminal PMN Elastase determination SANAS Page 3 of 7

4 i) Hyper Osmotic Swelling test (HOS) j) Testing for retrograde ejaculation k) Biochemical parameters (ph) l) CMA3 DNA integrity m) Alpha glucosidase Epididymis n) Sperm preparation/separation o) Sperm swim-up. p) Sperm gradient q) Sperm freezing r) Sperm thawing 3.2 Training of Staff All staff shall be trained in those procedures relevant to their scope of activities and responsibilities and registered with the HPCSA in the scope of practice. 3.3 Quality Assurance A documented procedure shall be available for assuring quality in the Andrology Laboratory. Proficiency testing or interlaboratory and/or international schemes should be implemented. Procedures for corrective action and cause analysis shall be in place where indicated by the QA program. 3.4 Semen Analysis Procedures Specimen Collection Documented procedures should be available to the patient for the collection of samples Traceable patient identification shall be used on all documentation pertaining to a specimen Period of abstinence, date and time of collection, method of collection and interval of time between actual collection and laboratory analysis should be recorded Short applicable medical history (events in the last 3 month if not 1 st semen analysis) should be obtained Macroscopic Evaluation Documented procedures shall be available for the correct collection of specimens which should preferably be done on site or within 1 hour, if produced else where Coagulation Liquefaction Viscosity Volume Colour Odour (Optional procedure) ph Microscopic Examination Examination of wet preparation Presence of round cells Presence of agglutination and debris Sperm Motility SANAS Page 4 of 7

5 i) Sperm motility testing shall be performed within 1 hour after sample collection (Optional after 2 hours and again at 8 hours). ii) The standard wet preparation depth (20 µm) should be used iii) The percentage motile spermatozoa should be based on the count of at least 200 spermatozoa or the estimation of the percentage of motile spermatozoa according to the strict Tygerberg criteria. iv) The motility should be graded into 4 classes (a, b, c, and d) as per WHO (1999) manual or as per the strict Tygerberg criteria. v) A vital stain can be performed to assess accuracy. (This is not always the case as vitality is a separate semen parameter from motility.) Sperm Concentration i) The laboratory shall specify the method used for measuring determination of sperm concentration. ii) Only calibrated pipettes shall be used for making dilutions. iii) Depending on the method used for sperm count, the semen sample shall be gently, but thoroughly mixed before an exact volume is withdrawn with a positive displacement pipette to prepare the appropriate dilution. iv) The chamber of the haemocytometer should be absolutely clean, and the correct standard cover slip affix correctly as indicated by the formation of Newton rings on the contact interfaces v) The calculation for the sperm concentration per ml according to the dilution used shall be strictly according to the documented procedure, referenced back to International standards (e.g. WHO standards) Antisperm Antibodies i) The MAR IgG and IgA (optional or if indicated by a positive MAR IgG test) is the preferred/recommended test. (The MAR test is just one of the arrays of tests available to determine the presence of antisperm antibodies (ASA) on spermatozoa, seminal plasma, male and female blood serum and cervical mucus). ii) This test shall be performed on fresh (<2 hours old) semen. iii) The documented procedure shall be followed strictly iv) All reagents used shall always be within expiry date v) Preferably 200 motile spermatozoa should be counted to determine the percentage of spermatozoa coated with ASA Sperm Morphology Internationally published guidelines are to be used. i) Smears shall be of high quality for the following: ii) Optimal staining iii) Contain little or no debris iv) Good distribution of cells v) Papanicoulou staining is recommended for routine sperm morphology evaluations due to its many advantages. Stains used shall be filtered before use and checked periodically for background count. The stains shall be changed when required vi) A droplet aliquot ( µl, volume adjusted to the sperm concentration to reduce overcrowding of sperms) of well-mixed semen is placed on the slide and the droplet is spread with the edge of a cover slip or as per WHO guidelines. The smears must be even and thin to allow good staining and easy examination. vii) At least 200 spermatozoa should be counted, using an oil immersion lens with at least a 1000X bright field magnification. SANAS Page 5 of 7

6 Supravital Staining Test Special Procedures i) The method shall be an Internationally recognized method ii) The stains used shall be of superior quality iii) Preferably 200 spermatozoa should be counted using an oil immersion lens. With bright field optics May be performed as part of the standard (screening) procedure Semen biochemistry Severe Oligozoospermia / Azoospermia Sperm preparation for IUI (Intra-Uterine Insemination) Semen collection and semen preparation in the Andrology laboratory. i) Semen collection: Semen collection must be done in sterile container. Semen should not be older than 2 hours before use. If collected in sperm-friendly condom, it must be emptied out directly after collection to prevent sperm degeneration. ii) Wash procedure: Protocol specific for that laboratory must be followed i.e. wash / gradient The medium preferred by the laboratory must be used i.e. commercial or in house prepared Sperm cryopreservation i) Media Preparation: Media should be made up according to an approved protocol and references should be available. Media should be batched with a batch number and date and traceable to the person who made up the media. All chemicals (including commercially made media) should have lot numbers and expiry dates. All media must be stored at fridge temperature until needed. Flushing medium should be kept at 37 C until needed Written consent for sperm freezing/thawing of donor or patient semen that are handled in the Andrology laboratory must be obtained Documented procedures should be available to the patient for the collection of samples Traceable patient identification shall be used on all documentation and samples pertaining to a specific specimen Indemnity forms should be in place Each facility should establish its own reference ranges using internationally published guidelines. ** This document was revised by the Medical STC, with special assistance from Prof. R Menkveld, Dr. S Grobler and Ampath Andrology Department** SANAS Page 6 of 7

7 ADDENDUM 1: Amendment Record Proposed By: Section Change Med STC 1. Deleted For ISO/IEC clauses, refer to the equivalent sections in the standard. Med STC 3. Changes from relevant ISO or ISO/IEC Standards Deleted Additional copies of SANAS documentation may b purchased from the office. Med STC ii) e) added (Post Coital) deleted j) Fructose test of azoospermia (Colorimetric bench method) deleted n) Fructose (quantitative) Seminal vesicles Med STC Iii) added or the estimation of the percentage of the motile spermatozoa according to the strict Tygerberg criteria iv) added or as per the strict Tygerberg criteria. Med STC ii) added for making dilutions iii) added Depending on the method used for sperm count, Med STC v) At least replaced by Preferably Med STC vi) Added droplet added or as per WHO guidelines Med STC iii) At last replaced by Preferably Med STC Deleted point Fructose (Colorimetric bench method in cases of azoospermia). Med STC homemade replaced by in house prepared Last bullet deleted Vaginal Med STC Added point Med STC Changes from document was generated by SANAS Page 7 of 7