The clinical laboratory

Intro to the clinical lab

1. The Clinical Laboratory

2. 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

3. 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)

4. Laboratory Organizational Divisions Department of Pathology continued Clinical Hematology/Coagulation Chemistry Blood Bank Serology Microbiology Urinalysis Phlebotomy Specimen processing Laboratory Information System (LIS)

5. Clinical Laboratory Organizational Chart

6. Lab Sections: Hematology The study of the formed (cellular) elements of the blood for the purpose of making a diagnosis.

7. 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

8. 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

9. Hematology Complete Blood Count (CBC) most common whole blood test White 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.

10. Hematology Complete 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.

11. 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

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

13. 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

14. 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

15. Blood Bank Blood collection, storage and preparation for blood transfusion * Red collection tubes additives will interfere

16. 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

17. Blood Bank Most Common Tests Type & Crossmatch = ABO, Rh typing and compatibility Type & Screen = ABO, Rh typing and antibody screen Group & Type = ABO and Rh typing

18. 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)

19. Serology (Immunology) Most Common Tests Anti-HIV Hepatitis B Surface Antigen VDRL for syphilis Western blot confirms HIV HCG = pregnancy Red collection tubes

20. Microbiology Identification of pathogens, effective antibiotic therapy and infection control

21. Microbiology Culture & Sensitivity most common procedure = ID pathogen & most effective antibiotic Bacteria is IDed based on morphology & gram stain reactions Types of Specimens Blood Sputum Wounds Feces Urine GI tract Throat

22. Microbiology Yellow collection tubes using sterile technique Most Common Tests Blood culture Culture & Sensitivity Gram stain Ova & parasites

23. 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

24. 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

25. 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