From total allowable error via metrological traceability to uncertainty of measurement of the unbiased result

The concept of "total allowable error", investigated by Westgard and co-workers over a quarter of a century for use in laboratory medicine, comprises bias as well as random elements. Yet, to minimize diagnostic misclassifications, it is necessary to have spatio-temporal comparability of results. This requires trueness obtained through metrological traceability based on a calibration hierarchy. Hereby, the result is associated with a final uncertainty of measurement purged of known biases of procedure and laboratory. The sources of bias are discussed and the importance of commutability of calibrators and analytical specificity of the measurement procedure is stressed. The practicability of traceability to various levels and the advantages of the GUM approach for estimating uncertainty are shown.