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The Clinical Laboratory

The clinical laboratory

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Intro to the clinical lab

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Page 1: The clinical laboratory

The Clinical Laboratory

Page 2: 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

Page 3: The clinical laboratory

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)

Page 4: The clinical laboratory

Laboratory Organizational DivisionsDepartment of Pathology continued

Clinical Hematology/Coagulation Chemistry Blood Bank Serology Microbiology Urinalysis Phlebotomy Specimen processing Laboratory Information System (LIS)

Page 5: The clinical laboratory

Clinical Laboratory Organizational Chart

Page 6: The clinical laboratory

Lab Sections: Hematology

The study of the formed (cellular) elements of the blood for the purpose of making a diagnosis.

Page 7: The clinical laboratory

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

Page 8: The clinical laboratory

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

Page 9: The clinical laboratory

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.

Page 10: The clinical laboratory

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.

Page 11: The clinical laboratory

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

Page 12: The clinical laboratory

Chemistry

Study of components in the blood including enzymes, hormones, electrolytes, chemicals or poisons

Page 13: The clinical laboratory

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

Page 14: The clinical laboratory

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

Page 15: The clinical laboratory

Blood Bank

Blood collection, storage and preparation for blood transfusion

*Red collection tubes additives will

interfere

Page 16: The clinical laboratory

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

Page 17: The clinical laboratory

Blood Bank

Most Common Tests Type & Crossmatch = ABO,

Rh typing and compatibilityType & Screen = ABO, Rh

typing and antibody screenGroup & Type = ABO and Rh

typing

Page 18: The clinical laboratory

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)

Page 19: The clinical laboratory

Serology (Immunology)

Most Common TestsAnti-HIVHepatitis B Surface AntigenVDRL for syphilis Western blot confirms HIVHCG = pregnancy

Red collection tubes

Page 20: The clinical laboratory

Microbiology

Identification of pathogens, effective antibiotic therapy and infection control

Page 21: The clinical laboratory

Microbiology Culture & Sensitivity most common procedure =

ID pathogen & most effective antibiotic

Bacteria is IDed based on morphology & gram stain reactions

Types of SpecimensBloodSputumWoundsFecesUrineGI tractThroat

Page 22: The clinical laboratory

Microbiology Yellow collection tubes using

sterile technique

Most Common TestsBlood cultureCulture & Sensitivity Gram stainOva & parasites

Page 23: The clinical laboratory

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

Page 24: The clinical laboratory

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

Page 25: The clinical laboratory

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