7: THE CLINICAL LABORATORY Flashcards
• Main task- provide accurate and
reliable information to medical
doctors for the diagnosis,
prognosis, treatment, and
management of disease.
• Place where specimens collected
from individuals are processed,
analyzed, preserved and properly
disposed
• An essential component of health
Institutions
CLINICAL LABORATORY
“Clinical Laboratory Act June 18, 1966”
• Republic Act 4688
• Cytology
• Histology
• Cytogenetics
Anatomical
• Hematology
• Coagulation
• Chemistry
• Blood Bank
• Serology (Immunology)
• Microbiology
• Urinalysis
• Phlebotomy
Clinical
• provide services for genetics, immune/hematopathology and infectious disease.
Molecular Pathology
• such as a hospital, school, medical clinic, medical facility, birthing home, psychiatric facility, drug rehabilitation center and etc.
Institution-based
• free standing outpatient clinical laboratory
Free Standing
• Owned wholly or partially by the national or local government units
Government-owned
• Owned and operated by a private individual,
cooperative, corporation or non-government organization.
Privately owned
• Basic routine services
• CBC, UA, FE, Blood typing
• 10 square meters
Primary Category
• Primary lab services + Chemistry
• FBS, TC, BUN, BUA, Creatinine
• If Hospital based: Gram Staining, KOH & Crossmatching
• 20 square meters
Secondary Category
• Secondary services + Immunology & Serology +
Microbiology + Blood banking
• 60 square meters
National Reference Laboratory
• National Kidney Transplant Institute (NKTI)
Hematology, Blood Banking
• East Avenue Medical Center (EAMC) Drug Testing, Water Microbiology
• STD/AIDS Central Cooperative Laboratory (SACCL)
Serology
• Lung Center of the Philippines Clinical Chemistry
• Research Institute of Tropical Medicine (RITM)
Microbiology
Tertiary Category
• A duly registered physician specially trained in methods of laboratory medicine on the gross and microscopic study and interpretation of tissues in order to diagnose disease, follow its course ‘determine the effectivity of treatment and ascertain the cause of death
Head Pathologist
• A licensed physician and qualified in laboratory medicine as certified by the Philippine Board of Pathology
• Works under the direct supervision of the Head of a clinical laboratory.
Associate Pathologist
• A duly registered medical technologist designated as such to exercise direct technical supervision over the laboratory staff provided that the clinical laboratory has at least three medical technologists or at least six personnel employed.
Chief Medical Technologist
• Persons who engage in the work of medical technology under the supervision of a pathologist having passed a prescribed course of training, examination & registered in the Board of Medical Technology.
• Perform complex laboratory examinations, evaluate test results, develop and modify procedures, and establish and monitor programs, to ensure the accuracy of tests.
Medical Technologists
• Medical Technology graduates who failed to pass the Medical Technologist Licensure Examination but obtained a general rating of not less then seventy (70%) percent.
• Perform less complex tests and laboratory procedures than what medical technologists perform.
• may work in several areas of the clinical laboratory or specialize in just one under the supervision of medical technologists and/or pathologist.
Medical Technology Technicians
• Is someone trained to collect blood samples either through a skin puncture, venipuncture, or arterial puncture
Phlebotomist
• Is a laboratory practitioner who examines human specimens to detect cancer cells or diseases
Cytotechnologist
• Routinely prepare, process and stain biopsies and tissue specimens for microscopic examination by a pathologist.
Histologic technician
Perform all the aspects of the job that HT’s do and other more complex processing, staining, or identification procedures
Histotechnologist
• is the study of the formed (cellular) elements of the blood.
• Most common body fluid analyzed in hematology section is Whole Blood
Hematology
• most common blood test
CBC
count determines the number of red cells in circulating blood.
Red Blood Cell (RBC)
determines the oxygen carrying capacity of red blood cells.
Hemoglobin (Hgb)
determines the volume of red cells packed by centrifugation (expressed as a percent %)
Hematocrit (Hct)
• determine the size of red blood cells and amount of hemoglobin
Indices
determines the amount of hgb in a red blood cell.
Mean corpuscular hemoglobin (MCH)
determines the weight of hgb in a rbc and compares it with the size of the cell (expressed as a %)
Mean corpuscular hemoglobin concentration (MCHC)
determines the size of the rbcs.
Mean corpuscular volume (MCV)
determines the number of white blood cells in circulating blood
White Blood Cell (WBC) count
determines the percentage of the different types of white blood cells and evaluates rbc and platelet morphology.
Differential Counting
determines the number of platelets in circulating blood.
Platelet (PLT) count
determines the rate of rbc sedimentation.
Erythrocyte sedimentation rate (ESR)
evaluates the bone marrow production of the rbcs.
Reticulocytes (Retic) Count
• overall process of hemostasis is evaluated; this includes platelets, blood vessels, coagulation factors, fibrinolysis, inhibitors, and anticoagulant therapy (heparin and coumadin)
• Specimen: Plasma in a light blue top
COAGULATION SECTION
evaluates the function of platelets.
• Bleeding time
evaluates the intrinsic system of the coagulation cascade and monitors heparin therapy
• Activated partial thromboplastin time (APTT/PTT)
evaluates the extrinsic system of the coagulation cascade and monitors coumadin therapy.
• Prothrombin time (PT) and international normalized ratio (INR)
• Deals with qualitative and quantitative analyses of body fluids esp. blood
CHEMISTRY SECTION
• It is requested in conjunction with the diagnosis of cardiovascular diseases.
Lipid Profile
High levels suggest decreased risk of developing atherosclerosis; smallest but the heaviest
• HDL (good cholesterol)
increased levels suggest risk of developing atherosclerosis
• LDL (bad cholesterol)
cause lipemia in serum samples.
• Chylomicrons
determine whether there’s an electrolyte imbalance in the body.
• Electrolytes Test
usually require a 24-hr urine sample and a blood test.
• Kidney Function Test
determine the health of your liver by measuring the levels of proteins, liver enzymes, and bilirubin in your blood.
• Liver Function Test
• Tests performed to help diagnose a heart attack and to determine the extent of damage to the heart muscle.
Cardiac Function Tests
most sensitive and specific test for myocardial damage. Expected to peak 12hrs after infarction
• Troponin
ordered as a cardiac biomarkers to help diagnose or rule out a heart attack.
Start to rise w/n 2-3hrs of heart attack or other muscle injury, reach their highest level within 8-12 hrs and generally fall back to normal within 1 day.
• Myoglobin
is the substance that rises if your heart muscle is damaged
CK-MB levels typically increase to above normal levels about six hours after a person has had a heart attack.
• Creatine Kinase MB
section in the laboratory where blood maybe collected, stored and prepare for transfusion.
• also called the immunohematology section.
• Patient identification and sample labeling is critical in blood bank.
BLOOD BANK SECTION
• TSH, T4 and T3
Thyroid Hormones Test:
ABO & Rh typing
• Group & Type
ABO, Rh typing and compatibility test
• Type & Crossmatch
ABO, Rh typing and antibody screen
• Type & Screen
detects abnormal antibodies on RBCs
• Coombs or DAT
detects abnormal antibodies in serum.
• IAT
o The most important blood group system ABO blood typing
- used to determine the blood type of
an individual.
ABO Blood Group System
This method is done to determine what antigens are present on the surface of rbcs by using commercially prepared antisera of known specificity.
Direct or Forward typing
This method is done to determine what antibodies are present on the serum of an individual by using rbcs of known specificity.
Indirect or Reverse typing
• considered the second most important blood group system after the ABO group.
• derived from the Rhesus monkey
• There are 5 important Rh antigens: D, C, E, c and e.
• The most important and immunogenic antigen is the D antigen
• RH typing is based on the presence and absence of the D antigen on the surface of RBCs using commercially prepared anti D antisera
RH Blood Group System
agglutination of the RBCs with the anti D, indicating the presence of D antigen.
Rh positive
no agglutination of the RBCs with the anti D, indicating the absence of the D antigen.
Rh negative
• Patient serum + Donor rbcs
• detects if there are antibodies in the patient serum that can destroy the transfused rbcs from the donor
Major crossmatch
• Patient rbcs + Donor serum
• detects if there are antibodies in the donor serum that can destroy the patient’s rbcs.
Minor crossmatch
performs tests to evaluate the body’s immune response; that is, the production of antibodies immunoglobulins ) and cellular activation.
• Test in serology section detect the presence of antibodies to bacteria, fungi, parasites, viruses and antibodies produced against body substances (autoimmunity for sample collection: blood in Red Top Tubes.
SEROLOGY - IMMUNOLOGY SECTION
__________ is the primary procedures performed in microbiology.
• Culture and Sensitivity test
is used to find out whether a fungal infection is present on the skin.
• The KOH (potassium hydroxide) preparation
