The clinical laboratory
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The Clinical Laboratory
Laboratory Organizational Divisions:Department of Pathology
Anatomical Responsible for the analysis of tissues
from the body including surgical specimens, frozen sections, biopsies, cytological specimens & autopsies
Laboratory Organizational Divisions:Department of Pathology Anatomical
Cytology: looking for abnormal cells (ie, cancer) Cytologic specimens (tissue & body fluids) Pap smears
Histology Surgical specimens Frozen sections Biopsies Autopsies
Cytogenetics Genetic testing (blood, amniotic fluid, tissue & bone
marrow)
Laboratory Organizational DivisionsDepartment of Pathology continued
Clinical Hematology/Coagulation Chemistry Blood Bank Serology Microbiology Urinalysis Phlebotomy Specimen processing Laboratory Information System (LIS)
Clinical Laboratory Organizational Chart
Lab Sections: Hematology
The study of the formed (cellular) elements of the blood for the purpose of making a diagnosis.
Hematology RBCs, WBCs and platelets are counted and classified
Most common body fluid analyzed is whole blood (blood as it comes from the client without removing
any components)
Whole blood is obtained using a collection tube with an anticoagulant to prevent clotting
*Lavender collection tubes*Anticoagulant EDTA*Requires immediate inversion of tube 8 times to activate
Hematology
Blood is analyzed as whole, plasma or serum
*Plasma: liquid portion of blood from a specimen that has not been allowed to clot; contains
fibrinogen *Serum: specimen allowed to clot;
no fibrinogen
Hematology
Complete Blood Count (CBC) most common whole blood testWhite blood cell (WBC) count is a count of the actual number of white blood cells per volume of blood.
White blood cell differential looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection.
Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions.
Hemoglobin measures the amount of oxygen-carrying protein in the blood.
Hematocrit measures the percentage of red blood cells in a given volume of whole blood.
HematologyComplete Blood Count (CBC) most common whole blood test continued:
The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting.
Mean corpuscular volume (MCV) is a measurement of the average size of your RBCs.
Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell.
Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average concentration of hemoglobin inside a red cell.
Red cell distribution width (RDW) is a calculation of the variation in the size of your RBCs.
Coagulation Studies in Hematology
Coagulation Studies (clotting times)*PT and PTT*Light Blue collection tubes*Anticoagulant used is sodium citrate *Must be returned to the lab in
30 minutes
Chemistry
Study of components in the blood including enzymes, hormones, electrolytes, chemicals or poisons
Chemistry Most automated area of the lab
Tests performed on serum, plasma, urine and other body fluids
Serum and plasma obtained by using the centrifuge*Must be completed within one hour of collection*Serum separator tubes contain gel *Must allow specimen to clot completely prior to
centrifuge*Red, green, gray or dark blue collection tubes
Chemistry
Chem 7 & Chem 17 most common tests to assess general health; gives your doctor important information about the current status of your kidneys, blood sugar, and electrolyte and acid/base balance
Cardiac enzymes and drug screening also common
Blood Bank
Blood collection, storage and preparation for blood transfusion
*Red collection tubes additives will
interfere
Blood Bank Blood typed and for blood group and Rh factor
Units (pints) collected and tested for presence of blood-borne pathogens; stored for transfusion- 42 days: how long most donated red blood cells
can be stored - 5 days: how long most donated platelets can be stored
- 1 year: how long frozen plasma can be stored
Autologous transfusion*Donate your own blood for personal transfusion
if needed from upcoming surgery, usually beginning 3-5 weeks before procedure
Blood Bank
Most Common Tests Type & Crossmatch = ABO,
Rh typing and compatibilityType & Screen = ABO, Rh
typing and antibody screenGroup & Type = ABO and Rh
typing
Serology (Immunology)
Evaluates the body’s immune response through the detection of antibodies to bacteria, fungi, parasites, and viruses and antibodies produces against body substances (autoimmunity)
Serology (Immunology)
Most Common TestsAnti-HIVHepatitis B Surface AntigenVDRL for syphilis Western blot confirms HIVHCG = pregnancy
Red collection tubes
Microbiology
Identification of pathogens, effective antibiotic therapy and infection control
Microbiology Culture & Sensitivity most common procedure =
ID pathogen & most effective antibiotic
Bacteria is IDed based on morphology & gram stain reactions
Types of SpecimensBloodSputumWoundsFecesUrineGI tractThroat
Microbiology Yellow collection tubes using
sterile technique
Most Common TestsBlood cultureCulture & Sensitivity Gram stainOva & parasites
Urinalysis Detects disorders and infections
of the kidney and metabolic disorders such as Diabetes and liver disease through components present in the urine
Urinalysis most common test
Laboratory Management
• Laboratory Director (Pathologist) – Credentials
• Medical doctor (MD)– Functions
• Anatomic pathology• Clinical pathology
• Laboratory Manager (Administrator)– Credentials
• Master’s degree and 5 or more years of laboratory experience
– Functions• Technical and administrative management
Clinical Laboratory Personnel
Medical Laboratory Scientist (MLS) Bachelor of science degree (4 year) Performs laboratory testing requiring
independent judgment Minimal supervision
Medical Laboratory Technician (MLT) Associate degree (2 year) Performs laboratory testing by protocol under
supervision Phlebotomist (PBT)
High school diploma Phlebotomy training program Sample collection and processing