Laboratory Science for Non-Laboratory Personnel

Presented by:Michelle Draper, MBA,

MT(ASCP)Bellarmine University

Personnel in the Laboratory

Directors, Managers, Supervisors Clinical Laboratory Scientists (Med Techs) Bachelors degree plus!, Bench Scientists Clinical Laboratory Technicians (MLT’s) Associate degree, Bench Scientists, Limited complexity testing Phlebotomists No degree required, certification

preferred, Most trained OTJ

Types of Specimens

Whole Blood Plasma Serum Stool Urine Body Fluids Sputum Cultures…to name a few

Whole Blood

Represents blood as it circulates through the body

Contains erythrocytes, leukocytes, and platelets

Sodium EDTA Uses: CBC, Blood

Bank, Flow cytometry, BNP, Hemoglobin A1c

Plasma

One type of liquid portion of the blood

HAS NOT CLOTTED! Sodium citrate Contains fibrinogen,

and clotting factors Uses: PT, APTT,

Fibrinogen, Dimer

Plasma

Liquid portion of the blood

Sodium or lithium heparin

Has not clotted! Uses: Rapid

chemistry ie, glucose, electrolytes

Serum Tube has been allowed

to clot before centrifugation

No clotting factors or fibrinogen present

Liquid portion of the blood

Contains proteins, enzymes, organic and inorganic chemicals and antibodies

Uses: Chemistry, Therapeutic drug levels, Immunology, Blood Bank

Has no additive

Serum

Same analytes as before

Gel: activates clot and acts as a barrier

Popular for ease of use

Not suitable for TDMs Not recommended for

Transfusion testing

Why is this important?“The quality of any test result is only as good as the specimen that

is tested!”

We can monitor testing personnel through competency testing…We

can monitor instruments and procedures by means of

calibrations and controls…BUT, we can’t monitor specimen

collection very well!!

Specimen Criteria

Specimens must be drawn in the correct tube and they must be filled to the proper

level Timely delivery to laboratory is critical Anticoagulant additives can contaminate

subsequent tubes Some additives change the shape or size

of the cells Additives can give falsely elevated results

Specimen Labeling Proper specimen labeling is essential Correct patient identification: Two forms of identification is

best….birthdate, medical record number, full name

Patient preparation…fasted, dose time, medications, transfusion status

Time of collection Collector’s identification

Specimen Problems

Clotted specimens collected with anticoagulant

Hemolyzed specimens Lipemic specimens Icteric specimens IV fluid contamination in

specimens…Never collect above an IV line!

Non-Blood Specimens

Must always be properly labeled Must be collected in a sterile

container Volume of collection is critical to the

test Transport to lab must be timely If held, storage requirements must

be met

What do the results mean?

• Complete Blood Count (CBC)

WBC White blood cell count

RBC Red blood cell count

HGB Hemoglobin

HCT Hematocrit

MCV Mean cell volume-cell size

MCH Mean cell color

MCHC Mean cell hemoglobin concentration

PLT Platelet count

RDW Red cell population variation

Basic Metabolic PanelGLU Glucose

(sugar)Pancreas/insulin

NA Sodium Hydration/Electrolytes

K Potassium Heart/Muscle/Hydration/Electrolytes

CL Chloride Hydration/Electrolytes

CO2 Carbon Dioxide

Oxygen level/Electrolytes

BUN Urea Nitrogen Kidney

CREA Creatinine Kidney

CA Calcium General Health

AGAP Anion Gap Electrolyte Balance

Comprehensive Metabolic Panel

ALB Albumin Protein-Immune System

ALKP Alkaline Phosphatase Liver

ALT Alanine Amino Transferase

Liver

AST Aspartate Amino Transferase

Liver

TBIL Total Bilirubin Liver

TP Total Protein Immune System

Prothrombin Test Activated Partial

Thromboplastin Time

PT Measured in seconds

How long to clotMonitors oral anticoagulants

INR Ratio Compares therapies and instrumentation

PTT Measured in seconds

How long to clotMonitors IV anticoagulants

Urinalysis• Recommended volume is 12 mls• Specimen is tested with a dipstick for:• Glucose, Ketones, Blood, pH, Bilirubin,

Urobilinogen, Leukocytes, Protein• Specimen is centrifuged and sediment

is examined with microscope to report cells, and other structures: crystals, casts, bacteria, yeast, parasites and more!

• Color and appearance (clear, hazy, cloudy, bloody)

Cultures

Plated on differential and selective media to grow the organisms present

Gram stain is done except on urine and stool (too much normal flora present)

Organisms determined to be pathogenic are tested for sensitivity to antibiotic drugs

Cultures take from 2 – 30 days or more Fungal and viral cultures are kept the

longest

Questions

Blood Cell Morphology

Urine Microscopics