The document provides information about medical laboratories and laboratory procedures. It discusses the different departments in a clinical laboratory including clinical chemistry, hematology, microbiology, and blood bank. It also covers topics like laboratory personnel, regulations, quality control, safety, specimen collection, use of microscopes, and standard precautions. Laboratory equipment like centrifuges and autoclaves are described along with their proper use and safety.
2. A – A good student is liked by teacher
G – Greets everyone with smile
O – Obedient
O – On time for college
D – Dresses neatly
S – Studies with interest
T – Treats everyone with smile
U – Understands everything
D – Does daily home work
E – Eager to know new things
N – Never misbehaves
T – Talks little in class
3.
4. Introduction
Laboratory is a place that is equipped with different
instruments, equipments and chemicals (reagents) etc., for
performing experimental works, research activities and
investigative procedures.
Medical laboratory is one part of the laboratory that is
equipped with various biomedical instruments,
equipments, materials and reagents (chemicals) for
performing different laboratory investigative activities by
using biological specimens (whole blood, serum, plasma,
urine, stool, etc).
5. Medical laboratory science
Medical laboratory science is a complex field
embracing a number of different disciplines
such as:
Microbiology,
Hematology,
Clinical Chemistry,
Urinalysis, Immunology, Serology,
Histopathology, Immunohematology and
Molecular biology and others.
7. Medical Laboratory Technology
The practice of modern medicine would be
impossible without the tests performed in the
clinical laboratory.
A medical team of pathologists, specialists,
scientists, technologists, and technicians work
together to determine the presence, extent, or
absence of disease and provide data needed to
evaluate the effectiveness of treatment.
8. Clinical or Medical Laboratory
Laboratories that perform chemical and microscopic
tests on:
blood
other body fluids
tissues
9. Clinical Laboratories
Play a major role in patient care
Variety of settings
Two types of Clinical.Laboratory
Hospital lab.
Non hospital lab.
POLs
Reference laboratories(LABCORP/QUEST D.)
Government laboratories - federal
Center for Disease control and Prevention(CDC)
Epidemiology labs
Laboratory Response Network
10. Government Laboratories- state
Premarital blood testing
PKU testing in newborns
Fungi,virus, and mycobacteria culture
11. Regulations of Clinical Laboratory
All laboratories, but research labs.are regulated by
Federal and State agencies
CLIA’88- Clinical Laboratory Improvement
Amendments of 1988:
Is a revision to the original CLIA of 1967, specifies
the minimum performance standards for all
Clinical Laboratories
12. Objectives of CLIA’88
To ensure quality Laboratory Testing, amendments
are continually revised, updated, clarified and
refined
CMS:Center for Medicare and Medicaid
Services,agency within the Department of Health
and Human Services responsible for implementing
CLIA’88
13. CMS
Any Laboratory performing Lab. tests in humans
,except for research Labs. Must obtain a certificate
from CMS (center for medicare-medicaid services) to
be allowed to operate
14.
15. Laboratory Personnel
Director of the Lab.- Pathologist, MD, DO, or hold
a doctorate in a related clinical field. Hold
certification and have supervisory and clinical
laboratory experience
Technical supervisor/Lab.Manager-someone
educated in the clinical laboratory sciences who
has additional business experience
16. Laboratory personnel
General supervisor for each area
Testing personnel:
Medical Technologists(MT/CLS)
Medical Lab.Technicians(MLT/CLT)
Medical assistants/nursing staff(POLs)
17. Departments of the Clinical Laboratory
Clinical Chemistry
Hematology
Microbiology
Blood Bank
Supports Services (Phlebotomy/Specimen
Processing)
18. Clinical Chemistry
Tests perform in serum, plasma, urine and other
body fluids such as spinal fluid, or joint fluid
Largest department in the Lab.
Toxicology
Special chemistry
19. Hematology
Studying of the cellular components of the blood
Quantitative or Qualitative
Coagulation
Urinalysis
Special hematology
20. Microbiology
Culture/identification microorganisms
From sputum, wounds, blood, urine and other body
fluids
Inoculated in culture media
Organisms are identified and susceptibility test are
performed
Bacteriology, virology, serology, parasitology
21. Blood Bank
Also called immunohematology or transfusion
services
ABO group and Rh typing
Antibody testing
Storage of packed cells units
Processing of some components like platelets and
cryoprecipitate
23. POCT
Point of care testing brings the laboratory to the
patient, also called bed-side testing
Use small simple analyzers
Portable instruments
Hgb, glucose, electrolytes,and cholesterol
24.
25. Quality Assessment System
QA.is incorporated to each department’s procedure
manuals and day to day operation
Standardized material are analyzed on each
instrument to document precision, and
reproducibility
Calibration, maintenance and repair of the
instruments is recorded
Participate in proficiency testing programs
26. Health care agencies have very specific
standards, rules and regulations governing the
education and job responsibilities of the
laboratory personnel
Lab. professionals are required to complete an
authorized program and certification
Lab. Personnel need to observe/protect patient
privacy
27. Safety
Occupational Safety and Health
Administration(OSHA) began in 1970 as a legislation
and subsequent rules that mandate increased
attention to safety in workplaces
The Clinical laboratory has, physical, chemical and
biological hazards
28. PPE
Employees in the clinical lab are required to use
personal protective equipment:
Gloves
Mask
Gowns
29. Biohazards
In 1980 clinical laboratory safety training
concentrated in protection from chemical,
physical,and contagious diseases such as
tuberculosis
The discovery of AIDS, increased in Hepatitis B
virus(HBV) and Hepatitis C virus(HCV) brought an
emphasis on biological safety
The term Biohazard came into use
A Biohazard symbol was adopted that indicates the
presence of biological hazard or biohazardous
condition
30. Evolution on Biological safety
By 1960 infectious patients were placed in
ISOLATION rooms
1970-CDC outlined isolation guidelines and listed
isolation categories
1985-in response to the increasing AIDS/HIV
epidemic CDC adopted Universal Blood and Body
fluids precautions, to be applied in all patients
regardless of their infectious status
1987- Body substance Isolation, included all body
fluid even if not visibly contaminated with blood
31. Evolution on Biological safety
1991-OSHA issued “Bloodborne pathogens
standard”, not included on previous regulation
1996- CDC implemented “Standard Precautions”
that includes a comprehensive set of safety
guidelines for Health care workers rendering care
to patients, this is the current terminology
To control nosocomial (inst. acquired) infections
Transmission-based precautions(additional practices for
pathogens that spread by air, droplets, and contact
2001-OSHA revised the BBP(blood borne pathogen)
standard to prevent accidental needle-sticks in the
workplace
32. Standard Precautions
Requires that every patient and every body
fluid, body substance, organ, or unfixed tissue
be regarded as potentially infectious
Hands wash(plain soap)
After touching body fluids and contaminated items, after
removing gloves and between patient contact
Wear gloves
When touching blood/body fluids/secretions, wear clean
gloves when touching mucous membranes and nonintact
skin
Wear mask/eye protection/face shield
Activities that could generate splashes, spray of blood, body
fluids , or secretions
33. Standard Precautions, cont.
Patient care equipment
should be handled to prevent transfer of
microorganisms to other patients and environment
Linen
Handle, transport,and process in a manner to avoid
contamination of clothing and other patients or
environment
Occupational health and blood-borne pathogens
Prevent injuries when using, handling, cleaning and
disposing sharps
NEVER RECAP A USED NEEDLE
Do not removed used needle from syringe by hand
Disposed used sharps on puncture resistant containers
34. Standard Precautions,cont.
Use resuscitation devices as an alternative to mouth to
mouth resuscitation
Patient placement
Use a private room for patients who can be a source of
contamination or patients who are not expected to
maintain hygiene or environmental control
Environmental control
Follow hospital procedures for routine care and
cleaning/desinfection of any soiled device, equipment
or environmental surface
35. General laboratory equipment
Centrifuges- spin samples at high speeds
forcing the heavier particles to the bottom of
the container,e.g..separating plasma and blood
cells
Safety tips
Use Standard Precautions/PPE
Load must be balanced
Tubes must be capped during operation
Do not open the centrifuge while rotor is moving
Clean spills immediately with surface disinfectants
36. General laboratory equipment
Autoclaves- use steam under pressure to sterilize
medical/surgical instruments, or contaminated
materials before disposal
Never open unless the chamber pressure reads zero
Use heat-proof gloves to remove items
When sterilizing liquids use loosely capped, heat resistant
containers, no more than half full
Use an autoclave tray to prevent liquids from spilling
37. General laboratory equipment
Laboratory balances
Used to measure chemicals
Use PPE and chemical safety precautions
Be gentle, Balances are delicate equipment
38. General laboratory equipment
Other equipments
Refrigerators
Water baths
PH meters
Incubators
Thermometers
freezer
39. The Microscope
Is a delicate and expensive instrument , special
care must be taken in its use
Various types of microscopes, two categories based
on type of illumination
Light microscopes
Bright-field- stained specimens
Phase-contrast-unstained cells,urine sediment
Epi-fluorescence microscope,specimens treated with fluorescent
dyes, syphilis, mycobacteria
Electron microscopes:provides greater magnification in
medical research
40. Light microscope images
A-stained cell seen with bright field microscope
B-phase contrast image
C-epi-fluorescence microscopy,Borrelia burgdorferi
42. Parts of the Microscope
Oculars: monocular or binocular
Objective lenses: attached to the revolving nose
piece, at least 3 present: low, high dry, and oil
immersion lenses
Light condenser which focuses and directs light to
the objectives, iris diaphragm that regulates the
amount of light that strikes the object observed
Field diaphragm:help align the light
Coarse and fine adjustments:focusing knobs
Stage:support for the object been viewed
43. Microscope safety
Safety
observe electrical safety rules
Glass slide handle with care to avoid breaking
Unfixed specimens should be treated with standard
precautions,disinfect stage after use
QA
Scheduled maintenance should be performed and
documented
Care and cleaning of lenses
Use only lens paper, clean lenses before and after each use
Do not allowed immersion oil to touch the low and high dry
lenses
Transporting and storing
45. Using the Microscope
Use low power objective to locate and to view large
objects
With the coarse adjustment knob bring the objective
and the slide as close together as possible
While looking through the oculars, move the coarse
adjustment knob to bring the objective and slide apart
until the object on the slide comes into focus
Use the fine adj.knob to bring the image into sharp
focus
46. Using the Microscope
If you need to use the high power(40x), to see cells
and sediments, after initial focusing with the low
power(20x), rotate the high power into position
Never use the coarse adjustment knob with high
power, the distance between the objective and slide is
very small and the slide could break.
Oil immersion lenses(100x) give the highest
magnification of the bright field objectives
47. Using oil immersion lenses
After initially focusing with the low power, rotate
the objective to the side and place a small drop of
immersion oil on the slide
The oil immersion objective is rotated into the drop
of oil been careful no other objective touch the
oil
use only fine adjustment knob with oil
Condenser should be all the way up
Maximum light source
Open the iris diaphragm to the maximum
48. After using the Microscope
Always switch to the low magnification objective
With lens paper clean the oil immersion objective,
stage and condenser if oil has become in contact
with it
Turn the light source off
Unplug the microscope
Store in proper location or cover as appropriate
49. Calculate Magnification
Degree of magnification on the ocular multiplied
by the degree of magnification on the objectives
Example:
10x(ocular) x 100x(oil immersion)= 1000x
The object viewed would be magnified
1000 times its original size
Resolving power: the ability of a microscope to
produce separate images of closely spaced details
in the object being viewed
50. Blood collection
Capillary puncture: small amount of blood collected for
glucose, K, electrolytes, Hgb, Htc, Plt count, or when a
larger sample is difficult to obtain as in newborns
Routine venipuncture: most common method of
obtaining blood, a superficial vein is punctured with a
hypodermic needle and blood is collected into a syringe
or vacuum tube
51. Capillary Puncture
Safe
Quick
Small amount of blood
Increased use
Point-of-care testing (POCT)
Physician Office Laboratories
60. Venipuncture Supplies
Vacuum tubes and anticoagulants
Sizes
Stopper color:
Red: no anticoagulant, to collect serum for blood chemistries
and serology tests
Lavender: containing EDTA for hematologycal and blood
typing tests(ethylenediaminetetraacetic acid )
Green: contains heparin, for lymphocytes studies and special
chemistry
Light blue: sodium citrate for coagulation studies
Gray :potasium oxalate, for glucose and legal alcohol
Black: for westergren ESR
Draw exact amount
61. Safety Precautions
Observe standard precautions
Wear gloves and other PPE
Never recap needles
Use proper technique
Avoid
Hemoconcentration: do not leave tourniquet in place for
more than 1-2 minutes
Hemolysis: do not shake tubes, mix by gently inverting a
few times
63. Patient Preparation
Patient I.D.
Explain procedure
Support patient and arm
Be prepared! for any sudden reaction from the
patient, or occasional patient who may faint
66. Identify Suitable Vein
Veins commonly used
Median cubital
Basilic
Cephalic
Palpate vein:
carefully inspect
both arms to find
the better site
67. Perform Venipuncture
Alcohol-cleanse site, let air dry, do not touch the
site after cleaning
Observe bevel up
Anchor vein with thumb 1inch below the
puncture site
Enter vein in the same direction of it, in a15-25
degree angle, in a smooth motion
Insert vacuum tube
Clot tube first
Invert anticoagulant tubes softly 5-7 times
69. Adverse situations
In case of patient developing a large hematoma while
venipuncture procedure is being done, withdraw the
needle, apply pressure, and intent the procedure in a
different site
In case of failure to obtain the blood, ask the patient
permission for a second intent, if he agrees try in a
different site
After the second non-productive intent,inform the
patient and find another person to draw the specimen
70. Complete Procedure
Activate safety feature
Immediate disposal
Label tubes before leaving the room
Patient care
71. Patient care
The tourniquet is always release before needle is
withdraw
Gauze should be applied over the puncture site and
pressure maintained for 1-3 minutes or until
bleeding stops
Ask patient to keep arm extended
Offer a small bandage if necessary
72. In Case of Accident
Immediately clean exposed area
Flood with water
Clean with antiseptic soap
Report immediately to supervisor
Seek medical attention
73. Label the samples
Must contain patient information
Name
Date of birth
Date and time of collection
And initials of the person drawing the blood
Tubes should never be prelabeled to avoid using the
prelabeled tube in the wrong patient
Make sure the tubes are clean and no blood has
contaminated the outer part of the tubes
Place specimen in a biohazard labeled bag and proceed as
required by the institution
74. selecting tests to use:
Test selections are based on :
subjective clinical judgment,
national recommendations,
and evidence-based health care.
Often diagnostic tests or procedures are used as
predictors of surgical risk or morbidity and mortality
rates because, in some cases, the risk may outweigh the
benefit.
75. selecting tests to use:
1.Basic screening (frequently used with wellness
groups and case finding)
2. Establishing (initial) diagnoses
3. Differential diagnosis
4. Evaluating current medical case management
and outcomes
5. Evaluating disease severity
76. 6. Monitoring course of illness and response to
treatment
7. Group and panel testing
8. Regularly scheduled screening tests as part of
ongoing care
9. Testing related to specific events, certain signs and
symptoms, or other exceptional situations (eg, infection
and inflammation , sexual assault, drug screening,
postmortem tests, to name a few)
77. groups and case finding)
Cervical Papanicolaou (Pap) test
Yearly for all women 18 years of age; more often with
high-risk factors (eg, dysplasia, human
immunodeficiency virus [HIV], herpes simplex);
check for human papillomavirus (HPV), chlamydia,
and gonorrhea using DNA
78. Establishing (initial) diagnoses
Serum amylase
In the presence of abdominal pain, suspect pancreatitis
Thyroid-stimulating hormone (TSH) test
Suspicion of hypothyroidism, hyperthyroidism, or thyroid
dysfunction in patients 50 years of age
79. Differential diagnosis
Chlamydia and gonorrhea
In sexually active persons with multiple partners; monitor for
pelvic inflammatory disease
80. Evaluating current medical case
management and outcomes
Tuberculosis (TB) blood test QuantiFERON Gold TB
Blood test to assess TB exposure in risk population
Syphilis serum fluorescent treponemal antibody
(FTA) test
Positive rapid plasma reagin (RPR) test result
81. Grading Guidelines for Scientific
Evidence
A. Clear evidence from all appropriately conducted
trials
Measure plasma glucose through an accredited lab to diagnose or
screen for diabetes
B.Supportive evidence from well-conducted studies or
registries
Draw fasting blood plasma specimens for glucose analysis
82. C.No published evidence; or only case,
observational, or historical evidence •
Self-monitoring of blood glucose may help to achieve better
control
E.Expert consensus or clinical experience or
Internet polls
Measure ketones in urine or blood to monitor and diagnose
diabetic ketoacidosis (DKA) (in home or clinic)
83. The diagnostic testing model
incorporates three phases:
pretest,
emphasis on appropriate test selection,
obtaining proper consent,
proper patient preparation,
individualized patient education,
emotional support, and effective communication.
These interventions are key to achieving the desired outcomes
and preventing misunderstandings and errors.
84. Intratest Phase: Elements of Safe, Effective,
Informed Care
Posttest Phase: Elements of Safe, Effective,
Informed Care
85. The clinical value of a test is related to
sensitivity, specificity, and the incidence of the
disease in the population tested.
Sensitivity and specificity do not change with
different populations of ill and healthy patients
The predictive value of the same test can vary
significantly with age, gender, and geographic
location.
86. Specificity refers to the ability of a test to identify
correctly those individuals who do not have the
disease.
The division formula for specificity is as follows:
Specificity%=persons w/o dis.who test neg./total #
of persons w/o dis. X 100
87. Sensitivity refers to the ability of a test to
correctly identify those individuals who truly
have the disease.
The division formula for sensitivity is as follows:
Sensitivity% = persons with dis.who test
positive/ total # persons tested with disease x
100
88. Incidence refers to the number of new cases of a
disease, during a specified period of time, in a
specified population or community.
Prevalence refers to the number of existing cases
of a disease, at a specific period of time, in a
given population.
89. Predictive values
Predictive values refer to the ability of a screening
test result to correctly identify the disease state.
The predictive value of the same test can be very
different when applied to people of differing ages,
gender, geographic locations, and cultures.
90. test outcome deviations
Minimize test outcome deviations
following proper test protocols.
Make certain the patient and his or her significant others know
what is expected of them.
Written instructions are very helpful.
91. Reasons for deviations may include the
following
Incorrect specimen collection, handling, storage, or
labeling
Wrong preservative or lack of preservative
Delayed specimen deliver
92. Reasons for deviations may include the
following
Incorrect or incomplete patient preparation
Hemolyzed blood samples
Incomplete sample collection, especially of timed
samples
Old or deteriorating specimens
93. Patient factors that can alter test results
may include the following
Incorrect pretest diet
Current drug therapy
Type of illness.
Dehydration
Position or activity at time of specimen collection
94. Patient factors that can alter test results
may include the following
Postprandial status (ie, time patient last ate)
Time of day
Pregnancy
Age and Gender
95. Patient factors that can alter test results
may include the following
Level of patient knowledge and understanding of
testing process
Stress
Nonadherence or noncompliance with
instructions and pretest preparation
Undisclosed drug or alcohol use
96. avoid costly mistakes
Communication errors account for more incorrect
results than do technical errors.
Properly identify and label every specimen as soon as
it is obtained.
97. Educate the patient and family
Educate regarding the testing process and what will
be expected
Record the date, time, type of teaching, information
given, and person to whom the information was
given.
98. Educate the patient and family
Giving sensory and objective information that relates
to what the patient will likely physically feel and the
equipment that will be used is important so that
patients can envision a realistic representation of
what will occur.
99. Educate the patient and family
Avoid technical and medical jargon
and adapt information to the patient's level of
understanding.
Slang terms may be necessary to get a point across.
100. Educate the patient and family
Encourage questions and verbalization of feelings,
fears, and concerns
Do not dismiss, minimize, or invalidate the patient's
anxiety
Develop listening skills, and be aware of nonverbal
signals (ie, body language)
101. Educate the patient and family
Above all, be nonjudgmental.
Emphasize that there is usually a waiting period (ie,
turn-around time) before test results are relayed
back to the clinicians and nursing unit.
Offer listening, presence, and support during this
time of great concern and anxiety
102. Educate the patient and family
Because of factors such as anxiety, language barriers,
and physical or emotional impairments, the patient
may not fully understand and assimilate instructions
and explanations
103. Educate the patient and family
To validate the patient's understanding of what is
presented, ask the patient to repeat instructions
given to evaluate assimilation and understanding of
presented information.
104. normal or reference values
Normal values are those that fall within 2 standard
deviations (ie, random variation) of the mean value
for the normal population.
Normal ranges can vary to some degree from
laboratory to laboratory. Frequently, this is because
of the particular type of equipment used
105. normal or reference values
The reported reference range for a test can vary
according to the laboratory used, the method
employed, the population tested, and methods of
specimen collection and preservation.
106. normal or reference values
Interpretation of laboratory results must always be
in the context of the patient's state of being.
Circumstances such as hydration, nutrition, fasting
state, mental status, or compliance with test
protocols are only a few of the situations that can
influence test outcomes.
107. clinical laboratory data values
may be reported in conventional units, SI
units(Systéme International (SI) units), or both
The SI system uses seven dimensionally independent
units of measurement to provide logical and
consistent measurements
108. clinical laboratory data values
SI concentrations are written as amount per volume
(moles or millimoles per liter)
rather than as mass per volume (grams, milligrams,
or milliequivalents per deciliter, 100 milliliters, or
liter)
109. Numerical values may differ between systems
or may be the same.
For example, chloride is the same in both
systems: 95 to 105 mEq/L (conventional)
and 95 to 105 mmol/L (SI).
110. Recognize margins of error
possibility exists that some tests will be abnormal owing
purely to chance
because a significant margin of error arises from the
arbitrary setting of limits.
Moreover, if a laboratory test is considered normal up to
the 95th percentile, then 5 times out of 100, the test will
show an abnormality even though a patient is not ill
111. Cultural Sensitivity
Many cultures have diverse beliefs about diagnostic
testing that requires blood sampling
Preserving the cultural well-being of any individual
or group promotes compliance with testing and
easier recovery from routine as well as more invasive
and complex procedures