======Procedure for ALT examination======
  *Learn operation of [[Erba XL-640]] and [[Erbachem]]. 
  *Select equipment 
    *Use Erba XL-640 as preferred equipment.
    *If Erba XL-640 is malfunctioning and can not be repaired within period acceptable to clinicians, use Erbachem and follow [[procedure for responding to Erba XL-640 failure]]  
  *Read following documents

^references|{{{{ :nchsls:c:biochemistry:document:alt_kit_lit.pdf |}}}}| |


**comparison_of_alt_with_single_reagent_and_double_reagent**

{{ :nchsls:c:biochemistry:document:xl-1000_calibration_alt-lot-b122074_2021-5-20.ods |}}


| |{{:nchsls:c:biochemistry:document:alt_kit_literature-meril.pdf|ALT kit literature of meril}}| |
| |{{:nchsls:c:biochemistry:document:alt_kit_literature-spinreact.pdf|ALT kit literature of spinreact}}| | 
| |{{:nchsls:c:biochemistry:document:part_1_stabilized_liquid_enzyme_and_coenzyme_compositions.pdf}}| |
|  |{{:nchsls:c:biochemistry:document:part_2_stabilized_liquid_enzyme_and_coenzyme_compositions..pdf}}| |
| |{{:nchsls:c:biochemistry:document:stabilised_liquide_coenzymes_composition_and_determination.pdf}}| |
| |{{:nchsls:c:biochemistry:document:stabilization_of_reagent_containing_nadh_andnadph.pdf}}||
| |{{:nchsls:c:biochemistry:document:ifcc_primary_reference_procedures_for_the_measurement_of_catalytic_activity_concentrations_of_enzymes_at_37_c.pdf|}}| | 
| |{{:nchsls:c:biochemistry:document:ep0463755a1.pdf|}}|
| |{{:nchsls:c:biochemistry:document:s_tandardization_i_n_c_linical_e_nzymology_.pdf|}}| | 
| |{{:nchsls:c:biochemistry:document:d_1-s2.0-s2213020914000068-main.pdf}}| |
| |{{:nchsls:c:biochemistry:document:altr.pdf}}| | 
| |{{:nchsls:c:biochemistry:document:alt_biopro_e_met_dxc800.pdf}}| |
| |{{:nchsls:c:biochemistry:document:1133.full.pdf|}}| |
| |{{:nchsls:c:biochemistry:document:58.full.pdf|}}| |
| |{{:nchsls:c:biochemistry:document:153.full.pdf|}}| |
| |{{:nchsls:c:biochemistry:document:003_alt_reference_ifcc_37_temp.pdf|}}| |
| |{{:nchsls:c:biochemistry:document:ep0072581b1_stabilized_nadh_and_ldh.pdf|}}| |
           
| |**Note:** When a new lot is opened, verify kit literature with the uploaded version.|
| |[[lis_upload_dokuwiki_media|Upload]] newer version when required and make necessary changes in procedure and process| 

|**environmental and safety controls**|
|{{msds_transasia_kits.pdf|MSDS of Transasia Kits}}|
|{{:nchsls:c:biochemistry:document:msds_spinreact_kit.pdf|MSDS of spinreact kits}}|

  *Document and revise [[common laboratory informations related to the examinations]].
  *Depending on the selected equipment follow appropriate procedure described below.


**Preparation and use of ALT reagent {{:nchsls:c:biochemistry:document:001_alt_reagent..ods|}}**  


======Erba XL-640======
|[[Centrifugation]]|
|[[Preparing aliquot]]|
|[[nchsls:c:biochemistry:document:how_to_perform_examination_in_erba_xl-640|Procedure for examination in Erba XL-640]]|
|[[Important notes]]|
|[[Important notes regarding linearity limit%]]|

======Erbachem======
**Note:** Following instruction is useful only if operator is familiar with [[Erbachem]]
^Parameter^Value^
^Sample volume(ul)|50|
^Reagent volume(ul)|500 (R1+R2 mixed in proportion of 24 ml+6 ml)|
^Filter|340 nm|
^Aspitation Volume(ul)|300|
^Type of reaction|Rate A|
^Decimal place|0 (but 4 during calibration)|
^Delay|60 seconds|
^Read|120 seconds|


^Calibration, Result calculation, Quality control and sample examination in Erbachem^

^[[nchsls:c:biochemistry:document:internal_quality_control|Internal Quality Control]]^
^[[how_to_do_external_quality_control_on_erba_xl-640|EQA]]^

^Prepare for calibration as below when lot changes or there is relevent NC. Refer [[Calibrator and QC]]^
^testing material^Replicates^
|Water blank|2|
|Normal Range Calibrator|4|
|Abnormal range Calibrator|4|
|Normal range QC sera|4|
|Abnormal Range QC sera|4|

  -Run all testing material as sample (as described below at **Sample Examination**)
  -Evaluate calibration and QC absorbances in spreadsheet. Compare with past results.
  -If results are acceptable, enter the factor in the erbachem and set decimal place to zero.

**Sample Examination**
  -[[Print examination wise worklist]] for ALT
  -Mix R1 and R2 as described in literature in sufficient quantity. 
  -Generally 24ml R1 +6 ml R2 is mixed by adding R2 to R1.
  -Fill 500 ul cups with mixed reagent in required numbers.
  -Select "Run test" -> GPT in Erbachem menu.
  -When instrument asks "Aspirate water", aspirate water.
  -Add 50 microliter sample to a cup, mix and aspirate.
  -If result comes more than 5000u/L then dilute the sample to 1:1 and rerun the sample.  		
  -Wait and enter reading in worklist sheet.
  -[[lis_calibration_entry|Enter Calibration in LIS]]
  -[[list_qc_entry_manual|Enter QC results manually in LIS]]
  -[[list_result_entry_manual|Enter sample results manually in LIS]]. Store the result sheet in a file for at least 2 days for use in event of LIS failures and rechecking results for NCs.
  -**instructions for determining quantitative results when a result is not within the measurement interval:** Dilution of sample with DI water is done in same way as done by Erba XL-640 automatically.