laboratory

Come in We are open

Areas in the laboratory Clinical Microscopy Microbiology Hematology Clinical chemistry Serology/immunology Histopathology immunohematology

Clinical microscopy

URINE and BOBY FLUIDS: Deals with the study of the gross, chemical and microscopic analyses of the different body fluids other than blood. It includes the importance of these body fluids to body processes; the principles of the analytical procedures; interpretation of results and clinical significance of the physiologically important substances found in these body fluids.

Body fluid or bodily fluids are liquids that are inside the bodies of living organisms. They include fluids that are excreted or secreted from the body as well as body water that normally is not.

BODY FLUIDS: Amniotic fluid Cerebrospinal fluid Cowper's fluid or pre-ejaculatory fluid, Extracellular fluid,
Aqueous humour, Lymph,

Female ejaculate, Interstitial fluid, Pleural fluid, Pus,Vomit , etc

Clinical microscopy

Urinalysis - macroscopic - chemical - microscopic Body fluids examination -cell count - differential count

MICROBIOLOGY

Microbiology
Microbiology is a broad term which includes virology, mycology, parasitology, bacteriology and other branches

PARASITOLOGY: Deals with the identification of human parasites which are of medical importance especially those commonly found in the Philippines. Emphasis is given on the epidemiology, pathogenecity, distribution, life cycle, and laboratory identification of each parasite.

BACTERIOLOGY:
Covers the morphology and physiology of bacteria, rickettsiae and other significant atypical bacteria and their role in infection and immunity. Emphasis is made on their isolation and identification and susceptibility testing as an aid in laboratory diagnosis.

MYCOLOGY AND virology

deals with the study of morphologic and biologic characteristics of fungal and viral agents of disease. It also includes the study of laboratory diagnostic methods,epidemiology, pathology, prevention and control of diseases caused by fungi and viruses

hematology

Hematology (haematology)
Hematology comes from the Greek words (haima) meaning "blood" and (logos), a root commonly employed to denote a field of study.

Branch of science that is concerned with the study of blood, the bloodforming organs, and blood diseases. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases. The laboratory work that goes into the study of blood is frequently performed by a medical technologist.

Hematologists physicians also very frequently do further study in oncology - the medical treatment of cancer.

2 Divisions:
Hematology I: deals with the study of blood as a tissue and the
pathophysiology of the cellular elements of the blood.

Hematology II: deals with the study of fundamentals of blood as a tissue, the
pathophysiology and the mechanism of coagulation and hemostasis.

Blood collection: skin puncture and venipuncture Hematology department performs numerous different tests on blood. The most commonly performed test is the complete blood count (CBC) also called full blood count (FBC).

CBC includes:
WBC RBC Differential count (neutrophils, eosinophils, basophils, lymphocytes, monocytes) Thrombocytes count Hemoglobin determination Hematocrit determination. To determine cell abnormalities: RBC, WBC and platelet anomalies = peripheral smear

Reticulocyte count: To help evaluate the bone marrows ability to produce red blood cells (RBCs) and to help distinguish between anemia related to blood loss or destruction and anemia related to decreased RBC
Reticulocytes are immature red blood cells (RBCs). When is this ordered? When you have a decreased (or increased) RBC count, hemoglobin, and hematocrit and your doctor wants to evaluate bone marrow function.

ESR:

It actually measures the rate of fall (sedimentation) of erythrocytes (red blood cells) in a tall, thin tube of blood. Results are reported as how many millimeters of clear plasma are present at the top of the column after one hour. Normally, red cells fall slowly, leaving little clear plasma. Increased blood levels of certain proteins (such as fibrinogen or immunoglobulins, which are increased in inflammation) cause the red blood cells to fall more rapidly, increasing the ESR.

HEMATOLOGY II
Blood coagulation is a subspecialty of hematology

Basic general coagulation tests are the prothrombin time) and partial thromboplastin time.

TESTS: 1. Bleeding Time 2. Clotting Time 3. Prothrombin Time 4. Active Partial Thromboplastin Time

Clinical chemistry

This large array of tests can be further sub-categorized into sub-specialty:

CLINICAL CHEMISRTY I: deals with the quantitative measurement of

biochemical substances found in body fluids essentially blood.

CLINICAL CHEMISTRTY II:

The course is a continuation of Clinical Chemistry 1 and deals with the study of liver function tests, clinically significant enzymes, electrolytes, acid -base balance, blood gas parameters and tumor markers.

CLINICAL CHEMISTRTY III:

The course is a continuation of Clinical Chemistry 2. The course includes Endocrinology, Toxicology and Drug Testing. Endocrinology deals with the study of the products of a group of structurally and functionally specialized glands and their action in maintaining the chemical integrity of cell environment. Toxicology involves the study of substances introduced exogenously into the body.

IMMUNOHEMATOLOGY / BLOOD BANKING:

Immunohematology is more commonly known as "blood banking". This is the area of laboratory medicine dealing with preparing blood and blood components for transfusion as well as selection of appropriate, compatible components for transfusion.

Immunohematology (Blood Banking) deals with the study of immunologic principles applied in blood group specific antigens and antibodies and its application in transfusion medicine. It also deals with mechanisms of blood typing and crossmatching, detection and identification of antibodies, screening of donors for blood donation, bleeding techniques, preparation of blood components and blood products, their storage and disposal with emphasis on quality systems.

IMMUNOLOGY & SEROLOGY: Immunology deals with the study of the immune system and its components, characteristics, immune responses and its functions. Serology deals with the diagnostic identification of antibodies and antigens in the serum. Immunopathology and autoimmune diseases are also dealt with in the course.

Immunology and serology laboratories focus on:

identifying antibodies (proteins made by a type of white blood cell in response to an antigen -- a foreign protein -- in the body). investigating problems with the immune system such as autoimmune diseases (when the bodys immune system turns on its own tissues) and immunodeficiency disorders (when a bodys immune system is underactive). determining organ compatibility for transplantation.

HISTOPATHOLOGY: Histopathology (compound of three Greek words: histos "tissue", pathos "diseasessuffering", and - -logia) refers to the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine, histopathology refers to the examination of a biopsy or surgical specimen by a pathologist, after the specimen has been processed and histological sections have been placed onto glass slides.

Process: Collection of tissues Histopathological examination of tissues starts with surgery, biopsy, or autopsy. The tissue is removed from the body or plant, and then placed in a fixative which stabilizes the tissues to prevent decay. The most common fixative is formalin (10% formaldehyde in water). Preparation of tissues / Tissue Processing method of fixation - chemical fixation or frozen section.

my laboratory! :)

laboratory

(lbrtr, -tr, US lbrtr)

n , pl -ries 1. a. a building or room equipp ed for conducting scientific research or for teaching practical science b. ( as modifier ): laboratory equipment 2. a place where chemicals or medicines are manufactured

[C17: from Medieval Latin labr trium workshop, from Latinla brre to labour ]

Laboratory Workflow:
The clinical labs role is to: 1. collect specimens 2. perform tests 3. report the results.
1 = Doctors order/ request 6 = Report results to doctor (result form) 2 = collect & label patient sample

5 = Analyze / test sample

4 = Process sample

3 = Deliver sample to laboratory

LABORATORY ORGANIZATION
Administrator (Medical Director) The Head Pathologist The Chief Medical Technologist The Section Head The Senior Medical Technologists The Junior Medical Technologists The Medical Technicians

Administrator
medical director

It is largely a generic term used to describe a physician who has responsibility for the medical control and direction of various types of organizations, including hospital departments, blood banks, clinical teaching services and others. is a physician who provides guidance, leadership, oversight and quality assurance for the practice of local paramedics and EMTs (Emergency medical technician) within a predefined area.

Pathologist
Laboratory Director
Has

ultimate responsibility for all laboratory operations

As Head of medical laboratories, pathologists play an important role in the development of laboratory information systems.

Technical Supervisor or Laboratory Manager

Directly under the laboratory directors authority Someone educated in the medical laboratory sciences who has additional business or management skills

Chief Medical Technologist

Functions in supervisory, administrative, and technical analytical work in performing standardized or highly specialized tests and examinations in a clinical laboratory. Work involves supervising a group of technologists and technicians in the performance of a variety of standard serological, biochemical, histological, and hematological laboratory examinations and tests and specialized tests and re-tests where abnormal or atypical results were obtained.

duties and responsibilities

Is responsible for day to day operation of the laboratory.
supervises

and participates in the performance of all standard clinical laboratory tests and procedures

Is responsible for setting personnel standards, establishing training and evaluation procedures, establishing appropriate Quality Assurance Programs, observing & documenting employee performance and competence. Is responsible for making available to all personnel an up to date procedure manual containing instructions for every procedure performed in the laboratory.
Procedure

Manual must follow the standard set by NCCLS NCCLS =National Committee for Clinical Laboratory Standards

Other Roles:
provides clerical, supply, and administrative support required in laboratory administration. arranges schedules for subordinate technicians assists in revision of methodology supervises the maintenance of laboratory records and reports. Participates in the selection and training of personnel orders supplies.

General Supervisor / Department or Section Head

Each department has a department head, whose responsibility is to:
Check

& supervise the quantity & quality of work performed in his/her department. Training employees (new) Evaluating employee performance General supervisor / Department Head reports to Technical Supervisor

Testing Personnel or Bench Technologist

Performs laboratory analyses Includes:

Medical Scientists / Technologists (Senior and Junior) Medical Laboratory Technicians Non laboratory Personnel such as medical assistants and nurses that performs test in POL (Physicians Office Lab) or other settings outside the laboratory.

CLIA 88 Job Title

Laboratory Director Technical Supervisor Technical Consultant or General Supervisor

Current Equivalent Job Title

Laboratory Director (usually a pathologist) Laboratory Manager (Chief Med tech) Department Head, Section Head, Section Supervisor, Technical Specialist

Testing Personnel Bench Technologist, Medical Technologist, Clinical Laboratory Scientist, Medical Laboratory Technician, Clinical Laboratory Technician, Laboratory Assistant
CLIA 88 = Clinical Laboratory Improvement Amendments of 1988

IMPORTANT NOTE:

The

more complex the test, the more highly trained the testing personnel

HOSPITAL ADMINISTRATOR Laboratory Director (Pathologist) Laboratory Manager or Technical Supervisor Assistant Laboratory Manager (Assistant Technical Supervisor)

POCT

Hematology

Urinal ysis

Chemistry

Coagu lation

Blood Bank

Specimen Collection & Processing (Accessioning )

Microbi ology

Quality Assura nce

Routine Hematology Special Hematology

Routine Chemistry Special Chemistry

Blood bank

Myco logy Bacte riolo gy

Viro logy Para Sito logy

Serology

Organizational Chart of a Typical Hospital Laboratory (CLIA 88)

Departments of the Medical Laboratory

The number of departments in a laboratory varies
Departments:
Clinical Chemistry Hematology Microbiology Blood Bank Specimen Collection

& Processing

Usually operates as department or section, each with its own department head

Subdivision within each laboratory differ from each other Large Laboratories:

separate departments for urinalysis, coagulation, serology, parasitology, Quality assurance and off-site testing.

responsibilities of Each Unit/Area:

1. Quality Assurance:
-

Responsible for coordinating Total Quality Management (TQM) or Quality Assurance (QC) for all sections of the laboratory (Procedures, Specimen Processing, Reporting) Management of off-site testing Personnel training Updating procedure manual Monitoring compliance with regulatory agencies Record keeping Documentation of equipment maintenance, calibration & repairs and participation in proficiency training

Responsibilities of Each Unit/Area:

2. Specimen Collection & Processing (Accessioning)

- Phlebotomy department (Phlebotomist) * Small Lab: - specimens are taken directly by the appropriate department for testing. * Large Lab: - specimens are taken to a central accessioning area where they are processed, logged into the computer, given specimen number before distribution to the different departments.

Responsibilities of Each Unit/Area:

3. Microbiology
Responsible

for culturing & identifying microorganisms (bacteria) isolated from patients clinical specimen. receives almost any clinical specimen swabs, feces, urine, blood, sputum, cerebrospinal fluid, synovial fluid, as well as possible infected tissue. After identification....Sensitivity testing is carried out to determine which antibiotic is the most effective in treating the infection. sensitive or resistant to a suggested medicine.

Results are reported with

Identity of the organism(s) and type and amount of drug(s) that should be prescribed for the patient.
Traditional Microbiology Lab = less automated Big laboratories = performs automation in microbiology (API=Analytical

Different types of culture media:

Solid
Plate

or tube

Semi-solid
tube

Liquid
tube

A plastic strip holding twenty mini-test tubes is inoculated with a saline suspension of a pure culture

Cultu O A L O C H U T I V G G M I S R S M A A Identification re # N D D D I 2 R D N P E L A N O H A E M R P H C C T S E A D L U N O R AC L Y A G

8030 + 8068 - 8P14 - -

+ - + -

+ -

+ _ + + + + + + + + + Klebsiella pneumoniae
- + + - Proteus vulgaris + Salmonella spp. - _ + + + + + -

- - + + + + - + + -

+ + - + -

Virology
study

of viruses

Mycology
Study

PART OF MICROBIOLOGY LABORATORY

of fungi

Parasitology
is

a microbiology unit that investigates parasites. The most frequently encountered specimen is feces. However, blood, urine, sputum, and other samples may also contain parasites. Examination of blood for malarial parasite is performed in the Hema section. In the Phil.... Parasitology is performed in the Clinical Microscopy section (examinations of urine & feces are done)

Responsibilities of Each Unit/Area:

4. Blood Bank - AKA: Transfusion services or Immunohematology - Determination of ABO group and Rh blood type - Determination of blood compatibility (between donor & patient) prior to transfusion. - processing donated blood into specialized component such as platelet, PRBC, FFP
Regulated by the FDA since giving blood is considered a drug,

this unit determines a patients blood and rh type, checks for antibodies to common antigens found on red blood cells, and cross matches units that are negative for the antigen.

Immunology/Serology
Serum

is the specimen of choice uses the concept of antigen-antibody interaction as a diagnostic tool. Performed tests: Pregnancy, arthritis, HIV, Hepatitis, sexually transmitted diseases (syphilis), & other infectious diseases. Compatibility of transplanted organs is also determined.

Responsibilities of Each Unit/Area:

5. Hematology

Involves tests for studying the cellular components of the blood. works with whole blood to do full blood counts, and blood films as well as many other specialised tests. Do Qualitative & Quantitative Tests
QUALITATIVE: Observe for the qualities of the blood components (cell size, shape & maturity) Microscopic examination of blood smear quantitative tests counting blood components = WBC, RBC, Hgb, Platelets Can be manual or automated

Can help diagnose anemia, infection & other blood related problems

Coagulation
Performed

in the hematology section or in large lab it is a separate department. Coagulation tests are performed to diagnose & monitor patients who have defects in their blood clotting mechanism or are being treated with anti-clotting drugs. Plasma, the liquid portion of anticoagulated blood is the specimen used. Laboratories used automated coagulation testing system Some used manual method like...bleeding time & clotting time

Urinalysis
Maybe

a separate department or maybe a subdivision of another department (Hematology or Chemistry)

Physical,

Chemical & Microscopic examination of urine specimen are performed performed manually or automated methods.

Maybe

Physical Examination of Urine

Volume NV of an early morning midstream sample is 50 300ml. If it is more than 500ml, it indicates diabetes or polyuria If it is less than 20ml, it indicates some kidney disorder. Color The normal color of urine is pale yellow. dark yellow to orange = liver disorder. white = presence of pus. pink to red = presence of red blood cells. brownish black = presence of melanin or homogentisic acid (a rare disorder). If it is blue to green = liver disorder. Sometimes, due to the intake of some food or medicines

Appearance Sediment formation at the Clear to cloudy. bottom of a container after turbid due to the presence of WBCs collection (White Blood Cells), epithelial cells. Usually, there is no or very little formation hazy due to mucus. of sediment in normal conditions. Smoky, due to red blood cells. If pus cells, red blood cells, cysts or Milky due to chyle (lymph). epithelial cells are present, the Reaction Usually acidic pH range 4.5 7.5. Odor aromatic in normal conditions. It has a fruity odor in diabetes. Ammoniacal odor in cases of urine retention. Foul smelling due to UTI sedimentation rate ranges from moderate to high.

Specific Gravity
Usually varies from 1.003 to 1.060. A low specific gravity indicates diabetes insipidus or kidney infection (chronic). High specific gravity indicates diabetes mellitus or acute kidney infection.

Chemical Examination of Urine

Protein
Normally

absent. Present in kidney disorders, dehydration, heart disease, and severe diarrhea. Sometimes, due to an excessive muscular exercise, prolonged cold baths, excessive protein intake or vaginal discharge in the urine, the test shows the presence of protein. GlucoseUrine Chemical Analyser

Ketone bodies
Normally

Urobilinogen

absent. Normally present in very If test shows ketones, it is low concentrations. due to severe diabetes Increased in liver disorders. mellitus, fevers, certain nervous disorders or Blood prolonged diarrhea and vomiting. Normally absent. Even when a person Present in acute kidney starves, the urine shows a infections, kidney cancer, presence of ketone bodies. tuberculosis of the kidneys, chronic infections, stone Bile pigments formation in the kidneys, Normally absent. severe burns or a reaction Present in liver disorders. to blood transfusion.

Bile salts

Microscopic Examination of Urine

Pus Cells

Casts in urine

Normally 2 to 3 pus cells are present in HPF (high power field of microscope). If more than 5 it indicates urinary tract infection or non infectious condition such as fever, stress, dehydration irritation to urethra, bladder or urethra.

Epithelial cells

Normally two to three present in males. Normally two to five present in females. More than five epithelial cells per HPF indicates tubular damage, pyelonephritis or kidney transplant rejection.

Normally absent. There are hyaline casts, red cell casts, white cell casts, granular casts, waxy casts, and fatty casts. They are present due to kidney disorders. Occasional Hyaline aysts may be present due to physical exercise and physiological dehydration. Granular casts may be present after strenuous exercise for a short duration.

 Amorphous Material Unusual fine sheaves of Calcium Phosphate

Amorphous urates of sodium, potassium or calcium are present normally. Amorphous phosphates of calcium and magnesium are present normally.

Crystals
Uric acid, calcium sulphate, calcium oxalate and ammonium magnesium phosphate (triple phosphate) crystals are indicative of the presence of kidney stones.

Hippuric acid, calcium carbonate, ammonium biurate and calcium phosphate crystals
are nonsignificant.

Following crystals, found in acidic urine indicate abnormal metabolism cystine, cholesterol, leucine, tyrosine, bilirubin, hematoidin and sulphonamides.

Bacteria
Normally absent. If present indicates infection.

Yeast cells
Normally absent. May be present in acidic urine containing sugar.

Parasites
Normally absent. If present, they are Trichomonas Vaginalis (from vagina) or Trichononas Hominis (from rectum).

Laboratory equipment for hematology (black analyser) and urinalysis (left of the open centrifuge).

Responsibilities of Each Unit/Area:

6. Clinical Chemistry
The

largest department in most lab. (w/ subdividions)

Divisons: Special Chemistry & Toxicology

usually

receives serum (the liquid part of blood remaining after a clot has formed)
Plasma, urine, and other body fluids (CSF, synovial fluid)

Test

the serum for chemicals present in blood. Procedures performed:

Blood glucose, cholesterol, assays of heart, liver enzymes & electrolytes ( Na, Cl, K)
These

include a wide array of substances, such as lipids, blood sugar, enzymes, and hormones.

Toxicology
Tests Urine

for pharmaceutical and recreational drugs. and blood samples are submitted to this lab.

To detect possibility of substance/drug abuse

Special Chemistry (Endocrinology)

Performs

tests to assess the function of the endocrine system and its specific secretions called hormones. This is a subsection of chemistry that quantitates various hormones such as insulin, thyroid hormones, cortisol, growth hormones and others.

Ex. Thyroid hormones

The thyroid hormone:

thyroxine (T4) and triiodothyronine (T3),

are tyrosine-based hormones produced by the thyroid gland primarily responsible for regulation of metabolism. An important component in the synthesis of thyroid hormones is iodine.

Function of thyroid hormones

are essential to proper development and differentiation of all cells of the human body. These hormones also regulate protein, fat, and carbohydrate metabolism, affecting how human cells use energetic compounds. They also stimulate vitamin metabolism.

Abnormality:

If there is a deficiency of dietary iodine,

the thyroid will not be able to make thyroid hormone. The lack of thyroid hormone will lead to decreased negative feedback on the pituitary, leading to increased production of thyroid stimulating hormone, which causes the thyroid to enlarge (goiter)endemic colloid goiter. This has the effect of increasing the thyroid's ability to trap more iodide, compensating for the iodine deficiency and allowing it to produce adequate amounts of thyroid hormone.

Ex. Insulin
Insulin

hormone that is important in regulating energy and glucose metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle.

Insulin stops the use of fat as an energy source.

When insulin is absent, glucose is not taken up by body cells and the body begins to use fat as an energy source.
= ketoacidosis is a type of metabolic acidosis associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. Ketoacidosis is a pathological metabolic state marked by extreme and uncontrolled ketosis.
Normal ketosis is induced by prolonged fasting or a low-carbohydrate diet

In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased. In extreme cases ketoacidosis can be fatal.

When control of insulin levels fails

diabetes mellitus will result.

Type 1 diabetes mellitus depend on external insulin (most commonly injected subcutaneously) results from autoimmune destruction of insulin-producing beta cells of the pancreas Type 2 diabetes mellitus or non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often initially managed by increasing exercise and dietary modification. As the condition progresses, medications may be needed.

7. Point of Care Testing (POCT) - one of the major changes occurring in the clinical lab today *due to the evolution of small, simple to use analyzers that requires only tiny amt of specimen has led to widespread of POCT implementation. - AKA: bedside testing, near patient testing, off-site testing, or alternate site testing. - POCT brings the laboratory test to the patient rather than obtaining a specimen from the patient & sending it to the lab for testing. * Advantage: The turn over time for lab results is faster = improved patient care - POCT is used in settings like:

Responsibilities of Each Unit/Area:

OTHER SPECIAL AREAS IN THE LAB: Histopathology
processes

solid tissue removed from the body (biopsies) for evaluation at the microscopic level. * Surgical pathology
examines organs, limbs, tumors, fetuses, and other tissues biopsied in surgery such as breast mastectomys. Biopsy or autopsy

Cytopathology
examines

smears of cells from all over the body (such as from the cervix) for evidence of inflammation, cancer, and other conditions.

Responsibilities of Each Unit/Area:

Electron microscopy
prepares

specimens and takes micrographs of very fine details by means of TEM and SEM. performs DNA analysis.

Genetics
mainly

Cytogenetics
involves

the use of blood and other cells to get a karyotype. This can be helpful in prenatal diagnosis (e.g. Down's syndrome) as well as in cancer (some cancers have abnormal chromosomes).

PROFICIENCY TRAINING
CLIA 88 requires the laboratories performing moderate or high complexity testing to:
in an approved proficiency testing program (SACCL HIV; RITM MICRO; UP- PARA) Laboratories are checked for QC
Participate

Samples are sent to the lab for analysis at regular interval After testing the lab will report to the proficiency testing agency for evaluation of accuracy in identification / testing

Advantage:
creates more confidence Identify deficient areas Improves laboratory performance

Accreditation of Medical Laboratories:

Accreditation = is a voluntary process in w/c an independent agency grants recognition to institution or programs that meet or exceed established standards of quality Accrediting Agencies:
JCAHO

(Joint Commission on Accreditation of Health Care Organizations)

Accredits hospitals

CAP

(College of American Pathologists) (American Association of Blood Banks) on Office Laboratory Accreditation)

Accreditation to medical laboratories

AABB

Accredits blood bank departments

COLA (Commission

Accredits Physician Office Laboratories

ISO = most hospitals in the Phil.

International Organization for Standardization an international-standard-setting body composed of representatives from various national standards organizations. Founded February 23,1947 headquarters in Geneva,Switzerland. ISO is not an acronym for the organization's full name
based

on the Greek word isos, meaning equal.

In reflects of the aim of the organization:

to

equalize and standardize across cultures

Believe you can and you're halfway

there.

Theodore Roosevelt