chapter 1 biochemistry clinical studies.ppt

First chapter of clinical biochemistry

1. PREPARED BY ETHOPIAN UNIVERSITIES
MEDICAL LABORATORY SCHOOLS WITH
CDC- ETHIOPIA and ASCP
1
Chapter – One
1. The laboratory

2. Acknowledgment
Addis Ababa University
Jimma University
Hawasa University
Haromaya University
University of Gonder
American Society for clinical pathology
Center for disease control
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3. CHAPTER ONE
THE LABORATORY
3

4. Objectives
After completion of this chapter, the student will be able to:
 Define laboratory.
 Identify and enumerate the different kinds of medical
laboratories.
 Explain the role of medical laboratory services.
 State the laboratory rules, ethics, professional code of
conduct and polices.
4

5. Outlines
1.1: General overview
1.2: Classification of laboratories
1.3: Structure of laboratory services
1.4: Role of clinical laboratory services
1.5: Function & use of different medical laboratory department/units
1.6: Role of medical laboratory personnel
1.7: Laboratory rules and policies
5

6. 1.1: General overview
Def
n
: Laboratory – is a place that is equipped with different
instruments, equipments, chemicals etc for performing either
experimental works or research activities.
Medical laboratory is part of the laboratories that is
equipped with various biomedical instruments and chemicals
for performing different lab diagnostic activities by using
biological specimens. (Whole blood, serum, plasma, urine,
stool, sputum etc). It is also called clinical laboratory
science . 6

7. History of medical laboratory science
Medical laboratory sciences have existed as a part of
healthcare for almost one hundred years.
Initially laboratory physicians (pathologists) and/or
academic researchers trained individuals to perform
procedures under their guidance.
7

8. History of …
In the 1950s and 1960s, the explosion of knowledge in
the biological and clinical sciences, the development of
automation and more sophisticated laboratory techniques
and its relevance to the delivery of health care, created
the need for well defined and more academically
organized medical laboratory science program.
8

9. History…
By the 1980s many degree granting institutions had
established curricula in medical laboratory science.
The professional requirements of medical laboratory science
advanced from “no formal qualification” in the 1940s and
1950s, to bachelor’s degree, followed by the master’s
degree and doctoral degree programs in the last 30 years.

9

10. History ….
Today, medical laboratory science is a well developed
body of knowledge that includes portions of basic and
medical sciences, medical techniques and research
methods.
This facilitates and ensures the production of quality
medical diagnostic testing.
10

11. 1.2: Classification of laboratories

WHO classify laboratory into 3- levels based on risk levels.
What is risk group?
Risk group I
- Low individual & low community risk.
(A pathogen is unlikely to cause disease.)
11

12. Classification …
12

13. Classification …
Risk group III
High individual & low community risk
A pathogen that usually produces human disease
but does not ordinarily spread from one infected
individual to another.)
E.g. Brucella, clostridium botulism
13

14. Classification …
Risk group IV

High individual & community risk
A pathogen that usually produces serious human
diseases & may be readily transmitted from an
individual to another directly or indirectly within the
community.
No effective prophylaxis or treatment
14

15. Classification…
1.Basic lab. (Level 1 and level 2 laboratories)
 It is the simplest kind.
 It is adequate for work at the PHC and hospital
diagnostic lab.
 It is adequate for work with organisms in risk group 1 and 2
i.e. Low risk.

15

16. Classification …
2. Containment lab –( level 3)
 More advanced and it is used for work with infections
organism E.g. TB, salmonella – risk group -3.
 The principle is to remove from basic lab those
organisms which are particularly hazards.
 The objective is to expose as few people as possible to
the risk of infection.
16

17. Classification …
It is a separate room with controlled access by
authorized staff only
 It should be fitted with a microbiological safety cabinet.
Its ventilation should be arranged.
17

18. Classification ….
3. Maximum containment lab (level 4)
 intended for work with viruses.
 Risk group-4 for which the most strict safety precautions are
necessary.
 These labs are usually separate buildings with strictly
controlled access through decontaminant showers.
 All air from rooms is filtered before discharge to the
atmosphere
18

19. 1.3: Structure of laboratory services
A medical Laboratory service must be integrated with the
health care system which exists in the country.
- This is function as a network, which could be accessible
and provide a service that is needed by the community.
This Networking consists of:
A. community-based health center lab:-
I). comprehensive health centers lab.
investigation controlling and preventing major disease
in a community.
19

20. Structure of…
staffed by lab personnel
Promote health by health education
 Able to perform basic tests.
ii). Maternity health units (MCH)
Staffed with nursing staff trained by MLT and responsible in :
Screening for anemia and proteinuria.
Collecting blood for antibody screening or for
examination of parasites

20

21. Structure of …
B. District Hospital laboratories (DHL)
 In addition to the work stated above the laboratories have an
important role in:

Supervising the work of community-based health center lab.

Testing referred specimens

21

22. Structure of …

has facilities for clinical investigations and
epidemiological surveys.
Specimen collection and transportation system .
Patients attending health center to benefit from the
facilities of DHL.
 Epidemics to be investigated rapidly
22

23. Structure of…
C. Regional (hospital) laboratories
In addition to the work stated above the laboratories
It assists and supervise the DHL.
Analyses referred samples .
Perform a range of specialized testes.
Investigate epidemic and do more clinical and public health facilities.
Trains lab technicians by organizing refresher courses.

23

24. Structure of …
D. Central (hospital) and public health laboratories
 In addition to the work stated above the laboratories
•It assists and supervise the DHL
•Analyses referred samples
•Perform a range of specialized testes
•Investigate epidemic and do more clinical and public
health facilities.
•Trains lab technicians by organizing refresher courses.
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25. Summary of laboratory service network
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26. 1.4 Medical Laboratory and Its Function
in a Health Care System.
Laboratory has an important role in:
I.Providing quality health care service
II.Achieving efficiency and cost effectiveness in health
care system.
III.Achieving good health planning and management in
health care system.
26

27. Medical Laboratory and …
i. The role of laboratory in providing quality health care
1.laboratory investigation increase the accuracy of disease
diagnosis.
 Many infectious disease and serious illness can be
diagnosed by using the laboratory.
E.g. error in diagnosis of malaria is high when diagnosis
is on clinical symptoms only.
27

28. Medical Laboratory and ...
2. Laboratory has essential role in screening for ill health and assessing
response to treatment.
Assess a patients response to drug therapy.
Screen individuals with infectious disease. E.g. TB, sexually transmitted
diseases.
Screen whole blood and blood product for transfusion transmitted
pathogen .
Screen pregnant women for anemia, infections which may transmitted
to newborn and others.
28

29. Medical Laboratory and...
3. The laboratory is needed to work with other in reducing infection
in the community and investigating epidemics rapidly.
Detecting source of infection, identifying carries contact tracing
Participating in epidemiological surveys
On site testing and collection and dispatch of specimens when
an epidemic occurs
Participating in health education
29

30. Medical Laboratory and...
ii. The role of laboratory in achieving efficiency and cost
effectiveness in health care system.
1. The laboratory reduce the expenditure of money on drugs.
Drugs can be used more selectively and only when
needed.
Drug resistance can be identified more rapidly and
monitored.
30

31. Medical Laboratory and…
31

32. Medical Laboratory and…
32

33. Medical Laboratory and…
iii. The role of laboratory in achieving good health planning and
management
1.Reliable laboratory test result with relevant patient data, provide
information on the health status of a community, health pattern and
disease trend. This information is needed to establish health care
priority and plan:
Health care program.
Training of health personnel and delivery of health service.
Treatment schedule and change in drug usage.
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34. Medical Laboratory and…
2. public heath laboratories provide accurate
epidemiological information for health planning
cause of the disease in the community.
prevalence and incidence rate of infectious
disease.
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35. Medical Laboratory and…
With out reliable lab support:
Patients less likely to receive the best possible care.
Resistance to essential drugs will to continue to
spread.
The source of disease may not be identified correctly.
Epidemics and spread of major communicable
diseases will not be checked reliably.
Valuable financial and human resource may not use
properly.
35

36. Medical Laboratory and…
Indications (importance) of requesting lab
examinations are:
To make a diagnosis of pathogen.
Confirm a clinical impressions.
To rule out (R/o)a disease and diagnosis.
To provide prognostic information.
To screen for disease.
36

37. Medical laboratory and…

To provide therapeutic guidance so that:
Drugs can be used more selectively.
 Patterns of emerging drug resistance can be
identified.
Side effects and progress are monitored.
37

38. 1.5: Function & use of different medical
laboratory department/units
Hematology- deals with examination of the constituent
of blood.
Clinical chemistry – deals with measurement of various
bio-chemicals changes in serum and body fluids.
Immunohematology- deals with blood banking and
transfusion medicine.
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39. Function & use of …
Medical microbiology - deals with microorganisms of medically
important, performing different diagnostic and research activities on
micro organisms and parasites. Microbiology includes the following
sub disciplines
Bacteriology is a science dealing with bacteria.
Virology is the study of virus and viral disease.
Mycology is the study of fungi.
Parasitology: is the study of parasites.
Immunology: study about immune system.
39

40. Function & use of …
Urinalysis and body fluid analysis- deals with the
analysis of their constituents.
Serology- is the study of antigen and antibody and their
interaction in vitro.
40

41. Function and use of …
Molecular biology: is the branch
 of biology that seeks to
understand the molecular basis of life. In particular, it relates the
structure of specific molecules of biological importance—such as
proteins, enzymes, and the nucleic acids DNA and RNA—to their
functional roles in cells and organisms.
 
41

42. 42

43. 1.6: Role of medical laboratory personnel
Introduction:
Medical laboratory is a health profession its goal is to resolve patients’
problem presented to the physician by performing laboratory analysis.
Roles:
1. Diagnosing of diseases
 Errors occur when diagnosis of diseases depend on clinical
symptoms alone.

44. Role of medical laboratory ……..
2. Treating of diseases
Antibiotic sensitivity testing
Monitoring of patients response to treatment
3. Screening of diseases
Detection of in apparent infections
4. Control of epidemics
Early detection of pathogens
44

45. Role of medical laboratory …
5. Surveillance & provision of health information
Source identification
Water supply testing
Carrier identification
Risk factor assessment
6. Controlling field trials
New drug/vaccine testing
Vaccine potency test
45

46. Role of medical laboratory ……..
7. Management of finance, equipment and supplies
8. Ensuring a reliable and quality lab practice
Such a comprehensive commitment to quality is essential to achieve –
Best possible service to patients
User confidence
Effectiveness and efficiency
Accountability
Optimal use of resources
 
46

47. Role of medical laboratory ……..
Therefore, the physician or other health professional is
dependent up on the skill and ability with which the
laboratory personnel perform his/her duties.
YOU AS A LAB. TECHNOLOGIST HOLDS LIFE AND
DEATH IN YOUR HANDS, BECAUSE THE INFORMATION
YOU GIVE TO THE PHYSICIAN INFLUENCES THE
MEDICAL TREATMENT A PATIENT RECEIVES.
47

48. Role of medical laboratory …
48

49. .
49

50. 1.7: Laboratory rules, ethics and policies
Ethics-moral principle or rules of behavior that govern or
influence a person’s behavior.
Rule-a statement of what, should or must be done in
particular circumstance.
Code of conduct -a set of professional standards agreed
on by members of a particular profession.

50

51. Laboratory rules……
Code of conduct for medical laboratory personnel
Should include those practices and attitudes which characterize
a professional and responsible lab officer.
Adopting it helps to remind medial laboratory personnel of their:
Responsibility to patients.
Duties to up holds professional standards and.
Need to work with complete integrity.
51

52. Laboratory rules…
1.Place the wellbeing & service of the patient above your own
interest.
2.Be loyal to your profession by maintaining high standard of
work & striving to improve professional skill & knowledge.
3. work scientifically & with complete honesty.
4.don’t misuse your professional skill or knowledge for
personal gain.
52

53. Laboratory rules…
5. Never take anything from your place of work that does not belongs
to you.
6. Don’t disclose to a patient or any other unauthorized person the
result of your investigation.
7. Treat your patient with strict confidentiality.
8. Respect & work in harmony with other members of your staff or
health center team.
9. Be any time courteous, patient, considerate to the sick & their
relatives.
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54. Laboratory rules…..
10. Follow safety procedures & know how to apply first aid.
11. Don’t drink alcohol or unprescribed drugs that would
interfere to your work performance during laboratory
working hours.
12. Use laboratory equipments with care.
13. Don’t waste reagents & other supplies.
14. Safeguarded the dignity & privacy of the patient.
54

55. Laboratory rules…..
Laboratory policies
Laboratory policies are those decisions which are taken in
consultation with other medical staff to enable a laboratory to
operate reliably and effectively in harmony with other departments.
These policies usually cover:
A. Laboratory hour and emergency work.

55

56. Laboratory rules…..
B. Range of tests to be performed and those to be referred to
higher level.
Range of tests to be performed depend on
The number of material resources
The availability of material resources
The types of health institution
Referral of specimen
56

57. Laboratory rules….
C. Collection of Specimen
Correct collections of specimens are essential for reliable test results.
During receiving specimens observe certain details to insure that
appropriate specimens are collected.
The containers should be labeled with patients name I.d number, date
and time of collection
A fully completed, request form should accompany each specimen with
the detail mentioned above.
57

58. Laboratory rules….
D. Work load capacity of the laboratory
It should be matched to the:-
 Number of a staff and their level of training.
 The size of the laboratory.
 The availability of laboratory facilities.
 The available man power.

58

59. Laboratory rules….
E. Delivery of report of results
Laboratory staff should provide valid result of tests.
Result should be clearly and neatly written.
To ensure the validity and accuracy of test results the
following points should be taken in to consideration:
59

60. laboratory rules …
The result before they leave the laboratory must be checked by
the most experienced member of the laboratory technical staff.
Any unexpected result should be investigated and repeated if
necessary.
Reference values (normal range) should be included in the
reports.
 
60

61. Summary Question
1.Discuss about the history of medical laboratory service
.
2.Explain the current status of medical laboratory service
in Ethiopia.
3.What is the role of medical laboratory personnel?
4.State laboratory rules, ethics and professional code of
conduct.
61

62. Reference
1.Linne Jean Jergenson, Basic techniques of medical
laboratory 4
th
ed. 2000.
2.WHO, Manual of basic techniques for a health
laboratory 2000.
3. Chees brough M.District Laboratory manual for tropical
courtiers, Cambridge Univerity press, 2000 (Vol ).
4. Chees brough M.District Laboratory manual for tropical
courtiers, Cambridge Univerity press, 2000 (Vol II).
5. Seyoum B. Introduction to medical laboratory
technology students lecture note series 2002.
6.www.CDC.gov
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63. Next : will be on : Lab
equipment and wares
End of slide
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