TITLE OF THE REPORT-

STUDENT INDUSTRIAL WORK

EXPERIENCE SCHEME

NAME-FALAYI .P. BAYO

MATRIC NO- 0603020006

NAME OF COMPANY- DE
REVELATION HOSPITAL

DEPARTMENT- BIOCHEMISTRY

PERIOD AND YEAR OF

ATTACHMENT- JULY- DEC 2009
NAME- FALAYI .P. BAYO

TITLE OF THE REPORT-

STUDENT INDUSTRIAL WORK
EXPERIENCE SCHEME

PERIOD OF ATTACHMENT-
JULY- DEC 2009

SUBMITTED TO- DEPARTMENT

OF BIOCHEMISTRY
IN PARTIAL FULFILMENT FOR
THE AWARD OF BSC(HONS).
DEGREE IN BIOCHEM, OF
J.A.B.U IKEJI ARAKEJI,
NIGERIA
MONTH AND YEAR OF
SUBMISSION- JAN 2009

CERTIFICATION
APPROVAL PAGE
DEDICATION

I dedicate this report writing first of all to God almighty who

has given me the privilege of undergoing the SIWES
programme for a duration of six months, and also enabling
me to write this report.

I also dedicate this report to my parents Mr and Mrs

Falayi who had supported me during the SIWES programme especially
financially.

I would also like to dedicate my report to Mr Austin the

Laboratory scientist for his full support, for without him i wouldn’t have
being able to achieve anything at all.

My elder brother Tosin Falayi who is an undergraduate studying Medecine

had also assisted me fully, this report writing is also dedicated to him.

This report writing is dedicated to the following people Mr Afolabi who

is my counsellor and like a father to me for he had always been
there for me and encouraging me, my friends Emeka, Tayo, Dotun and John.

In conclusion , i would like to dedicate this report writing to my able

lecturers and my course adviser Mr Minari.
ACKNOWLEDGEMENT
I appreciate the effort and support of the owner of the Revelation hospital who is
a Surgeon doctor , who has been able to accept my application to work in his
hospital and had contributed to this report writing. Also i acknowledge the support
of the Lab Scientist , in person of Mr Austin whom i worked with, he has been
able to put me through and make me achieve something also he had been very
kind and very patient in cases whereby i asked him questions when i’m not very
clear about something. Mr Austin had guided me starting from the period of
attachment to the end of the SIWES programme.

I also worked with my sister and students from other schools undergoing SIWES
like Frank from Ambrose Ali university Edo State, Dapo from O.A.U , and others.
We were able to co operate with each other and learn one or two things from
each other.

In conclusion, i acknowledge Mrs mary who is the matron of the hospital for her
full support.
ABSTRACT
During the period of the SIWES programme undergone in the hospital, we were
being introduced to different offices and sections in the hospital in other to get
familiarized with the hospital. E.g the casualty room or the emergency room,
where patients injured in accident are taken for urgent treatment The laboratory is
my main area of concern, because i worked in the lab in collaboration with the lab
scientist and others involved . . The laboratory is a place where several tests are
carried out.

In the lab, the lab Scientist introduced us to different departments in the

laboratory

In which several tests are carried out, examples are the Haematology department
carrying out the following tests- Full blood count, Haemoglobin(HB), packed cell
volume(pcv), White blood cell count(total), differential white blood cell count, sickle
cell screening, Red cell count, Mean cell volume(M C V).

Also there is the Microbiology department carrying out tests like Urine microscopy,
Urine Mic/ Culture/ Sensitivity, Stool occult blood, Blood grouping( ABO & RH), the
genotype.

Under the Parasitology department, we have the malaria parasite, Blood for
microfilaria, Hiv Screening test, Hepatitis B .

Under the chemistry department we have the liver function test, fasting
blood sugar(FBS), Random blood sugar test(RBS), Glucose Tolerance Test,
complete urinalysis with microscopy, urinalysis without microscopy, 1 pint of
fully screened and cross matched positive blood, 1 pint of fully screened
negative blood e.t.c.
Page 1

CHAPTER 1
INTRODUCTION

De Revelation hospital is an hospital located at no 8 femi olaniran street, Ayobo

Ipaja , Lagos state.The founder of Revelation hospital is Dr Abanikanda by name , he
is married to a wife and blessed with three kids(a boy and two girls). He has
worked in several places before he decided to be on his own.

Firstly, he worked at Ekiti state for three years before getting employed at
IFE Ibadan where he practiced as a general surgist. While he was
working at IFE, a friend of his called him and asked him to come to
Lagos state, that he would make it more in Lagos. He decided to move to
Lagos and he was working in LUTH(Lagos university Teaching hospital).
After working in LUTH for about eight years, he decided to be on
his own, and through the inspiration of God he started his own hospital.

De Revelation hospital was established in the year 1999, when first

established, the hospital was made up of just ten staffs and they were all
nurses. But by the grace of the Almighty God today, the hospital is
large and wide spread in the sense that there are different
branches of the hospital with several doctors in charge and
Dr Abanikanda being the founder of the hospital. Revelation hospital
involves several nurses today, including auxillary nurses with the
matron being the head of the nurses. In the hospitals there are
several sections , starting from the entrance into the hospitals we
have the reception where the receptionist issue cards to patients
who want to see the doctor . There is the presence of the
casualty room or emergency room where people who have being hurt
in accident are taken for urgent treatment.

There are several wards in the hospitals, we have the children

ward, female ward, male ward. Inside the wards we can find
nurses attending to patients. There is also the doctors room, where we
can find doctors, another section of the hospital is the theatre. De
revelation hospital is having an x-ray room

A pharmacy is found in the hospital, next to the pharmacy is the eye

clinic, also there is the section for the pregnant women.

PAGE 2

CHAPTER 2

This chapter is made up of a description of the aspects the

hospital specialize in. In the hospital, we have the surgical aspects and
under the surgical aspect we have the orthopaedics whereby the
orthopaedic doctors perform surgery . Before surgery is performed on a
patient, we have the anaesthetist who anaesthetize the patient.

Under the surgical aspect we also have the dentistry where the
dentists carry out dental surgeries on the teeth. There are other minor
surgeries that are being carried out in the hospital.

The aspect of the Gynaecology involves Gynaecologists that treat

women and it involves reproduction.

In the pharmaceutical department, there are pharmacists who sell

prescribed drugs to patients .

There is also the laboratory, and in the laboratory there are several
tests that are carried out and each belonging to different
department, they are Haematology department- full blood count,
Haemoglobin(HB), packed cell volume(PCV), white blood cell count(TOTAL),
Differential white cell count, Mean cell volume(MCV), mean cell
Haemoglobin(MCH), Red cell count, Sickle cell screening, HB Genotype, Blood
grouping(ABO& RH), Direct Coomb ‘s test, indirect coomb’s test, Pregnancy test(
urine & blood).
Microbiology department- High vaginal swab( HVS), wound, Ear, Nasal, Throat,
Widal reaction, Stool Microscopy(Routine), Stool M/ c/ s, Stool occult blood,
Blood culture & sensitivity, Seminal fluid C/ S.

Parasitology- Malaria parasite, Blood for microfilaria, Trypanosomes( Blood), HIV

screening test, Hepatitis B ( HB Ag),

Clinical chemistry- Fasting blood sugar(FBS), Random blood sugar(RBS), Glucose

Tolerance Test, Complete Urinalysis with microscopy, Urinalysis without
microscopy, 1 pint of fully screened and cross matched positive blood, 1
pint of fully screened negative blood.

PAGE 3

CHAPTER THREE

This chapter contains a description of the tests carried out

in the lab. Out of all the tests mentioned in the previous
chapter, i was able to carry out the following tests- Blood
grouping( ABO& RH, Pregnant test( urine & blood), Hepatitis B antigen,
Widal reaction, Malaria parasite, HIV test, Fasting blood sugar, Random
blood sugar, Urinalysis without microscopy.

1)BLOOD GROUPING
i) DEFINITION OF BLOOD-

Blood is composed of cells suspended in a liquid. The liquid portion is the plasma, from
which therapeutic fractions and derivatives are made. Also blood has 2 main
components( serum & cells)
Suspended in the plasma are three types of cells:
• Red cells carry oxygen
• White cells fight infection
• Platelets stop bleeding in injuries
ii)DEFINITION OF BLOOD GROUP-
A blood type( also called a blood group) is a classification of
blood based on the presence or absence of inherited antigenic
substances on the surface of red blood cells( RBCs). These
antigens may be proteins, carbonhydrates, glycoproteins or
glycolipids depending on the blood group system and some of
these antigens are present on the surface of other types of
cells of various tissues.

Note- To understanding blood typing it is necessary to define

antigen and antibody.
– An antigen is a substance usually a protein or
glycoprotein which when injected into a human( or
other organism) that does not have the antigen, will
cause an antibody to be produced.
– Antibodies are a specific type of immune- system proteins
known as immunoglobulins, whose role is to fight
infections by binding themselves to antigens.
– Blood grouping is important for blood transfusion and it
involves cross matching by donors blood and recipients
serum .
– Blood transfusion can occur between donor and recipients
who have compatible types. If types are not compatible,
the blood of the recipient forms antibodies against the
blood of the donor.

iii) DEFINITION OF BLOOD GROUP SYSTEM

It is when one or more antigens are controlled at a

single gene locus or by two or more very closely
linked homologous genes with little or no observable
recombination between them.

Page 4

Note- there are many blood group system with - ABO

blood group system being the 1 st
most important and
the Rhesus( RH) system being the 2nd most important
blood group system .

The ABO system,- Antigens are found on the surface of

the red blood cells and Antibodies on the serum.

– We have two (2) types of blood factors(A & B) & 4 blood

types(blood groups) - A, B, AB & O
– A( A oligosaccharide present)
– B( B oligosaccharide present)
– AB( A & B oligosaccharide present)
– O( Neither A nor B, only their precursor H oligosaccharide is
present)
– Subtypes ( A1, A2, A1B or A2B).

The RH system
 – A protein plays an important part in the grouping of
blood and is called the RH factor, if present the blood
type is called positive. If absent it is called negative.
– We have broad categories
– A1 negative(A1 –ve)
– A1 positive(A1 +ve)
– A1B negative(A1B -ve)
– A1B Positive(A1B +ve)
– A2 Negative(A2 -ve)
– A2 Positive(A2 +ve)
– A2B Negative(A2B –ve)
– A2B Positive(A2B +ve)
– B Negative(B -ve)
– B Positive(B +ve)
– O Negative(O -ve)
– O Positive(O +ve)

iv)Uses of blood grouping

Transfusion
The blood donated by healthy persons is tested to ensure that the level of hemoglobin is
satisfactory and that there is no risk of transmitting certain diseases, such as AIDS or
hepatitis. It is then fractionated (split) into its component parts, particularly red cells, plasma,
and platelets. Correct matching for the ABO system is vital.
v) Advantages and disadvantages of blood grouping
1) Advantages: good for picking up very weak groups eg A3, Am, Ax etc., and for picking
up mixed field reactions eg. when a A,B or AB patient has been given O blood in an
emergency.

Page 5
Disadvantages: manual/ needs a person to do it, uses lots of reagents compared to other
methods eg. microtitre/gel.

vi) TABLE SHOWING RELATIONSHIP BETWEEN

BLOOD TYPES AND ANTIBODIES

RELATIONSHIPS BETWEEN BLOOD TYPES AND ANTIBODIES

Blood Antigens on Red Can Donate Antibodies in Can Receive Blood
Type Blood Cell Blood To Serum From
A A A, AB Anti-B A, O
B B B, AB Anti-A B, O
AB A and B AB None AB, O
O None A, B, AB, O Anti-A and anti-B O
This aspect of the ABO blood group system is very important in transfusion. Blood group O
individuals are said to be universal donors, because their blood can be used for transfusion in
individuals who have any one of the four blood types. On the other hand, individuals with
blood type A can only donate to either type A or type AB, and individuals with blood type B
can only donate to B or AB types. AB individuals can only donate to type AB. However,
before any transfusions, donor blood is mixed with serum from the recipient (a process called
cross matching) to ensure that no agglutination will occur after transfusion.
vii)Blood grouping test

In the blood grouping test, the antibody kit is made use of

and patient ‘s blood. We have three types of antibody

-Anti A

-Anti B

-Anti D

Anti D serves as O and rhesus factor positive(+) , since antigen

is found in the blood, you react it with the antibody kits so as to
form antigen- antibody complex.

If A alone reacts it is A -ve

If A & B reacts it is AB -ve

If A, B, D reacts it is AB +ve

If A & D reacts it is A +ve

If B & D reacts it is B +ve

If none react it is O -ve

Page 6

Job done in the lab

Test; Blood group

Aim; To determine the patients blood group

Apparatus; Antibody kit, blood samples, blood tile, dropping pipette, a

tourniquet .

Procedure ;During the week, i carried out tests on several

patients , i did it by collecting blood their blood samples using an
injection an i made use of the dropping pipette to take portions of
the blood and dropped them on a blood tile, i also took the
antibody kits and reacted it against the blood samples.

Observation; After rocking the mixture very well, i noticed that the
reaction was obvious. The antibody- antigen reaction that was obvious was
used to determine the result

Result for the patients;

 A man tested O+ve, another patient tested B +ve , others
tested B +ve.

Note

-Blood samples are collected using injection and a turning kit

- It is done by tieing the patient’s hand tightly with the turning

kit so as to make the veins more obvious and prevent blood from
flowing from that spot.

-An injection is inserted into the veins and the blood is drawn
into it. The injection is gradated is ml.

-The reason for inserting an injection into the veins is because

blood flows through the veins.

-In blood grouping, before reading the result the reaction must be
very obvious unlike the widal reaction for typhoid.

Conclusion;

In conclusion, in testing for blood grouping Antigen- Antibody

reaction is very important which involves the blood and the antibody
reagents.

Page 9

2) HIV TEST
i)Definition of HIV

HIV also called Human immuno deficiency Virus

is a highly variable virus which mutates very readily. This means there
are many different strains of HIV, even within the body of a single infected
person.

Also HIV is a special type of retrovirus containing RNA. Not all RNA
viruses are retroviruses, e.g., the measles virus and flu virus are RNA viruses,
but not retroviruses. There are three families of retroviruses: oncoviruses
(causing cancer), lentiviruses (slow viruses, of which HIV is one), and foamy
viruses or spumaviruses (about which much less is known). There are also
retroviral infections of animals, e.g., SIV (simian immunodeficiency virus) infects
nonhuman primates, FIV (feline immunodeficiency virus) affects cats, and visna
virus infects sheep.

ii) Types of HIV

There are two types of HIV: HIV-1 and HIV-2. Both types are transmitted by sexual
contact, through blood, and from mother to child, and they appear to cause clinically
indistinguishable AIDS. However, it seems that HIV-2 is less easily transmitted, and the
period between initial infection and illness is longer in the case of HIV-2.
Worldwide, the predominant virus is HIV-1, and generally when people refer to HIV
without specifying the type of virus they will be referring to HIV-1. The relatively
uncommon HIV-2 type is concentrated in West Africa and is rarely found elsewhere.
a)Sub-types of HIV-1
The strains of HIV-1 can be classified into four groups: the "major" group M, the
"outlier" group O and two new groups, N and P. These four groups may represent four
Separate introductions of simian immunodeficiency virus into humans.
iii)The different levels of HIV classification.
Group O appears to be restricted to west-central Africa and group N - a strain
discovered in 1998 in Cameroon - is extremely rare. In 2009 a new strain closely relating
to gorilla simian immunodeficiency virus was discovered in a Cameroonian woman. It
was designated HIV-1 group P.1 More than 90% of HIV-1 infections belong to HIV-1
group M and, unless specified, the rest of this page will relate to HIV-1 group M only.
Within group M there are known to be at least nine genetically distinct subtypes (or
clades) of HIV-1. These are subtypes A, B, C, D, F, G, H, J and K.
Occasionally, two viruses of different subtypes can meet in the cell of an infected person
and mix together their genetic material to create a new hybrid virus (a process similar
PAGE 10
to sexual reproduction, and sometimes called "viral sex").2 Many of these new strains
do not survive for long, but those that infect more than one person are known as
"circulating recombinant forms" or CRFs. For example, the CRF A/B is a mixture of
subtypes A and B.
The classification of HIV strains into subtypes and CRFs is a complex issue
and the

definitions are subject to change as new discoveries are made. Some scientists talk about
subtypes A1, A2, A3, F1 and F2 instead of A and F, though others regard the former as
sub-subtypes.
Subtypes E and I
One of the CRFs is called A/E because it is thought to have resulted from hybridization
between subtype A and some other "parent" subtype E. However, no one has ever
found a pure form of subtype E. Confusingly, many people still refer to the CRF A/E as
"subtype E" (in fact it is most correctly called CRF01_AE).3
 A virus isolated in Cyprus was originally placed in a new subtype I, before
being reclassified as a recombinant form A/G/I. It is now thought that this virus
represents an even more complex CRF comprised of subtypes A, G, H, K and
unclassified regions. The designation "I" is no longer used.

The different subtypes and CRFs found

The HIV-1 subtypes and CRFs are very unevenly distributed throughout the world,
with the most widespread being subtypes A and C.
• Subtype A and CRF A/G predominate in West and Central Africa, with
subtype A possibly also causing much of the Russian epidemic.5
• Historically, subtype B has been the most common subtype/CRF in
Europe, the Americas, Japan and Australia. Although this remains the
case, other subtypes are becoming more frequent and now account for at
least 25% of new HIV infections in Europe.
• Subtype C is predominant in Southern and East Africa, India and Nepal. It
has caused the world's worst HIV epidemics and is responsible for around
half of all infections.
• Subtype D is generally limited to East and Central Africa. CRF A/E is
prevalent in South-East Asia, but originated in Central Africa. Subtype F
has been found in Central Africa, South America and Eastern Europe.
Subtype G and CRF A/G have been observed in West and East Africa and
Central Europe.
Subtype H has only been found in Central Africa; J only in Central America;
and K only in the Democratic Republic of Congo and Cameroon.
•

PAGE 11

Definition of HIV test

HIV test is a test carried out on a patient to detect the

presence of the virus, and determine if a patient is positive or
negative to HIV. There are several tests of HIV.

v) Types of HIV test

There are a number of tests that are used to find out whether a person is infected with HIV,
the virus that causes AIDS. This page will look at a variety of tests, including the HIV
antibody test, P24 antigen test and PCR test.
There are other types of HIV testing, which are used once a person has been diagnosed with
the virus. These include the CD4 test and the viral load test.
1)HIV antibody test
HIV antibody tests are the most appropriate test for routine diagnosis of HIV among adults.
Antibody tests are inexpensive and very accurate. The ELISA antibody test (enzyme-linked
immunoabsorbent) also known as EIA (enzyme immunoassay) was the first HIV test to be
widely used.
How do antibody tests work?
When a person is infected with HIV, their body responds by producing special proteins that
fight infection, called antibodies. An HIV antibody test looks for these antibodies in blood,
saliva or urine. If antibodies to HIV are detected, it means a person has been infected with
HIV. There are only two exceptions to this rule:
• Babies born to HIV infected mothers retain their mother's antibodies for up to 18
months, which means they may test positive on an HIV antibody test, even if they
are actually HIV negative. Normally babies who are born to HIV positive mothers
receive a PCR test (see below) after birth.
• Some people who have taken part in HIV vaccine trials may have HIV antibodies
even if they are not infected with the virus.
Most people develop detectable HIV antibodies within 6 to 12 weeks of infection. In very
rare cases, it can take up to 6 months. It is exceedingly unlikely that someone would take
longer than 6 months to develop antibodies.
What is a window period?
The ‘window period’ is a term used to describe the period of time between HIV infection and
the production of antibodies. During this time, an antibody test may give a ‘false negative’
result, which means the test will be negative, even though a person is infected with HIV. To
avoid false negative results, antibody tests are recommended three months after potential
exposure to HIV infection.
Page 12
negative test at three months will almost always mean a person is not infected with HIV. If
an individual’s test is still negative at six months, and they have not been at risk of HIV
infection in the meantime, it means they are not infected with HIV.
It is very important to note that if a person is infected with HIV, they can still transmit the
virus to others during the window period.
How accurate are antibody tests?
Antibody tests are extremely accurate when it comes to detecting the presence of HIV
antibodies. ELISA tests are very sensitive and so will detect very small amounts of HIV
antibody. This high level of sensitivity however, means that their specificity (ability to
distinguish HIV antibodies from other antibodies) is slightly lowered. There is therefore a
very small chance that a result could come back as ‘false positive’.
A false positive result means that although a person may not be infected with HIV, their
antibody test may come back positive. All positive test results are followed up with a
confirmatory test, such as:
• A Western blot assay – One of the oldest but most accurate confirmatory antibody
tests. It is complex to administer and may produce indeterminate results if a person
has a transitory infection with another virus.
• An indirect immunofluorescence assay – Like the Western blot, but it uses a
microscope to detect HIV antibodies.
• A line immunoassay - Commonly used in Europe. Reduces the chance of sample
contamination and is as accurate as the Western Blot.
• A second ELISA – In resource-poor settings with relatively high prevalence, a second
ELISA test may be used to confirm a diagnosis. The second test will usually be a
different commercial brand and will use a different method of detection to the first.
 • When two tests are combined, the chance of getting an inaccurate result is less than
0.1%.
Rapid HIV tests

An OraQuick HIV-1/2 rapid test kit

These tests are based on the same technology as ELISA tests, but instead of sending the
sample to a laboratory to be analysed, the rapid test can produce results within 20 minutes.
Page 13
Rapid tests can use either a blood sample or oral fluids. They are easy to use and do not
require laboratory facilities or highly trained staff.
All positive results from a rapid test must be followed up with a confirmatory test, the results
of which can take from a few days to a few weeks.
2)Antigen test (P24 test)
Antigens are the substances found on a foreign body or germ that trigger the production of
antibodies in the body. The antigen on HIV that most commonly provokes an antibody
response is the protein P24. Early in HIV infection, P24 is produced in excess and can be
detected in the blood serum (although as HIV becomes fully established in the body it will
fade to undetectable levels).
P24 antigen tests are not usually used for general HIV diagnostic purposes, as they have a
very low sensitivity and they only work before antibodies are produced in the period
immediately after HIV infection. They are now most often used as a component of 'fourth
generation' tests.
3)Fourth generation tests
Some of the most modern HIV tests combine P24 antigen tests with standard antibody tests to
reduce the ‘diagnostic window’. Testing for antibodies and P24 antigen simultaneously has
the advantage of enabling earlier and more accurate HIV detection.
In the UK, fourth generation tests are the primary recommendation for HIV testing among
individuals, but are not offered by all testing sites.1 In the United States applications for FDA-
approval for fourth generation tests are expected in the near future.2
4)PCR test
A PCR test (Polymerase Chain Reaction test) can detect the genetic material of HIV rather
than the antibodies to the virus, and so can identify HIV in the blood within two or three
weeks of infection. The test is also known as a viral load test and HIV NAAT (nucleic acid
amplification testing).
Babies born to HIV positive mothers are usually tested using a PCR test because they retain
their mother's antibodies for several months, making an antibody test inaccurate. Blood
supplies in most developed countries are screened for HIV using PCR tests. However, they
are not often used to test for HIV in individuals, as they are very expensive and more
complicated to administer and interpret than a standard antibody test.
Page 14

HIV home sampling and HIV home testing

Home sampling

It is generally recommended that an HIV test is carried out in a

healthcare setting. However, in some countries

HIV home sampling and HIV home testing

Home sampling

It is generally recommended that an HIV test is carried out in a

healthcare setting. However, in some countries
home sampling and home testing kits are available.
With a home sampling kit, a person can take a sample (usually a blood sample) and send it to
a laboratory for testing. They can phone up for the results a few days later. If the result is
positive then a professional counsellor will provide emotional support and referrals. The main
advantages of home sampling are convenience, speed, privacy and anonymity.
There is one company in the USA that offers an FDA-approved home sampling kit for HIV.3
Many home sampling kits that have not been approved by the FDA are being marketed
online.4
There is also a company in the UK that offers home sampling services using oral fluid instead
of blood.5 If a person’s test result is positive they will need a follow up blood-test at a clinic.
Home testing
A home self-test involves a person conducting a rapid antibody HIV test in their home. The
person takes either a blood or saliva sample and can interpret the result within minutes. A
positive result will require a further confirmatory blood-test in a clinic.
In many countries it is illegal to sell HIV test kits to the public. If a test is purchased over the
internet, there is no guarantee that the test kit is genuine or will provide accurate results.
vi) Reasons to get tested for HIV
There are a number of important reasons to be tested for HIV. For those who think they may
have been exposed to the virus, having a test and receiving a negative result (which means
they are not infected with HIV), can put their mind at rest.

If the HIV test is positive, there are a number of things that can be done to help a person cope
with the result and lead a healthy life.
 Page 15
• A person who tests positive will at some point need to take antiretroviral treatment
to slow down the virus and maintain a healthy immune system. The longer a person
remains unaware of their infection, the less likely it is that the treatment will work.
Doctors can monitor an HIV positive person’s health in order to provide the right
treatment regimen at the right time.
• If a person is aware of their HIV infection they can take steps to protect other
people. They can practice safer sex and inform previous sexual partners that they
may have been at risk of infection.
• Those who test positive who were thinking of starting a family can learn about ways
to protect their child from becoming infected with HIV through mother-to-child
transmission.

vii)Period of testing for HIV

A standard antibody test (see above) looks for HIV antibodies in a person’s blood. These
antibodies can take up to three months from the time of infection to appear, and so for an
accurate HIV test, a person should wait three months since the time of suspected infection.
Some test centres may recommend testing again at six months, as in very rare cases it can
take this long to develop antibodies. However, in most cases it is not necessary.
viii)Control of HIVto slow down the virus and maintain a healthy immune
system. Also through the usage of drugs like stavudine, AZT, Tenofovir, Lamivudine
e.t.c.
ix)Test; HIV test using determining kit

Aim; To determine if a patient is positive or negative to HIV

Apparatus; Determining kit, an injection, serum, a dropping pipette, a

tourniquet

Procedure; I carried out HIV test in the Lab, using the determining
kit. After collecting some patients blood sample, i made use of their
serum and the determining kit.

I tore off the cover of the determining kit, i divided the kit into two
and i made use of the serum. I picked the serum using a dropping
pipette and i dropped it on the direction in the kit where two arrows
are pointing forward.

Observation; I found out that after dropping the serum on the strip,
there was a movement of the serum from the control to the test, and
thick red line appeared on the strip according to the result.

Results

After carrying out these tests during the week, i found out that two
patients were positive and two were negative.

-NOTE

_ The determining kit is made up of two portions - i)Constant(control)

ii)Patient(test
_ If HIV negative, the serum will flow over the patient side and a thick
line will appear in the control. If HIV positive, it will appear in the
control and the test

Conclusion; In conclusion, serum is needed for determining HIV

Page 18
3)MALARIA PARASITE

i) Definition of malaria- Malaria is a mosquito-borne infectious

disease caused by a eukaryotic protist of the genus plasmodium and
phylum Apicomplexa and spread by the vector the female anopheles
mosquito.

ii) Diagnosis of malaria- By clinical symptoms & microscopic examination

of the blood, malaria retinopathy(collective sensitivity of 95% & specificity
of 90%).

iii)Symptoms of Malaria- Symptoms of malaria include fever, shivering,

arthralgia (joint pain), vomiting, anemia (caused by hemolysis), hemoglobinuria,
retinal damage, and convulsions. The classic symptom of malaria is cyclical
occurrence of sudden coldness followed by rigor and then fever and sweating
lasting four to six hours, occurring every two days in P. vivax and P. ovale
infections, while every three for P. malariae. P. falciparum can have recurrent
fever every 36–48 hours or a less pronounced and almost continuous fever. For
reasons that are poorly understood, but that may be related to high intracranial
pressure, children with malaria frequently exhibit abnormal posturing, a sign
indicating severe brain damage. Malaria has been found to cause cognitive
impairments, especially in children. It causes widespread anemia during a
period of rapid brain development and also direct brain damage. This neurologic
damage results from cerebral malaria to which children are more vulnerable.
Cerebral malaria is associated with retinal whitening, which may be a useful
clinical sign in distinguishing malaria from other causes of fever.

iv)Definition of Malaria parasite- Malaria parasites are micro-organisms

that belong to the genus Plasmodium.

v)Species of malaria parasite-There are more than 100 species of

Plasmodium, which can infect many animal species such as reptiles, birds, and
various mammals. Only four species of Plasmodium infect humans in nature.
(There are some other species which can, exceptionally or under experimental
conditions, infect humans.)

Examples of 4 species are-

1)Plasmodium falciparium

2)P. vivax

3)P. ovale

4)P. malaria
Out of all the four mentioned above, Plasmodium falciparium is the most
widespread and most dangerous

vi)Control of malaria- By using mosquito nets and insect repellents,

spraying insectides inside house, draining standing water where
mosquito lay their eggs, by antimalalial drugs e.g chloroquine,
artesunate.

vii) Prevention of malaria- Using prophylactic drugs

-Mosquito eradication

-Prevention of mosquito bites.

Page 19

vi)Job done in the lab; Test for plasmodium. Thin film and thick film

Aim; To test for malaria parasite.

Apparatus; Microscope, glass slide, blood tile, oil immersion, leishman stain,
sample(blood), wet soap, cover slip, needle.

Thin film
Procedure;- I pricked the patient with a needle, and i took a drop of blood on a glass
slide at one edge. I spread it with the cover slip and allowed it to dry for 5 mins and i
applied leishman stain, i allowed it to penetrate to dry for another 5 mins then i
rinsed carefully with water i allowed it to dry again and i applied oil immersion on the
surface and viewed under microscope.
Observation; Malaria parasite viewed, type form.

Thick film
Procedure; i followed the same procedure for thin film, but i placed the blood
in the centre of the glass slide and i spread with a stirrer and i allowed it to
dry for 10 mins. I applied leishman stain, i rinsed and i applied oil immersion
and i viewed under the microscope.
Observation; Malaria parasite viewed type form.
Result; Ringform of plasmodium falciparium seen (+).
Explanation of result; If the malaria parasite are scanty that is (+), and
if the parasite are averagely plenty that is (++) finally if the parasite
are many that is (+++).

Conclusion; In conclusion, plasmodium is the organism that causes

malaria and there are many species of plasmodium.
 .

Page 22
4) Hepatitis B Antigen(HBsAg)
i) Definition of Hepatitis B; Hepatitis B is a disease caused by
hepatitis B virus(HBV) which infects the liver of hominoidae,
including humans and causes an inflammation called Hepatitis. It
is originally known as “serum hepatitis”.
ii) Hepatitis B virus; Hepatitis B virus is an hepadnavirus- heap from
hepatotrophic and dna because it is a DNA virus. The viruses replicate
through an RNA intermediate form by reverse transcription and in this
respect they are similar to retroviruses. Although replication takes place in
the liver, the virus spreads to the blood where virus- specific proteins
and their corresponding antibodies are found in infected people.

iii)Serotypes of Hepatitis B virus

The virus is divided into four major serotypes (adr, adw, ayr, ayw) based on antigenic
epitopes presented on its envelope proteins, and into eight genotypes (A-H) according to
overall nucleotide sequence variation of the genome. The genotypes have a distinct
geographical distribution and are used in tracing the evolution and transmission of the virus.
Differences between genotypes affect the disease severity, course and likelihood of
complications, and response to treatment and possibly vaccination
Iv )Transmission of hepatitis B virus
Transmission of hepatitis B virus results from exposure to infectious blood or body fluids
containing blood. Possible forms of transmission include (but are not limited to) unprotected
sexual contact, blood transfusions, re-use of contaminated needles & syringes, and vertical
transmission from mother to child during childbirth. Without intervention, a mother who is
positive for HBsAg confers a 20% risk of passing the infection to her offspring at the time of
birth. This risk is as high as 90% if the mother is also positive for HBeAg. HBV can be
transmitted between family members within households, possibly by contact of nonintact skin
or mucous membrane with secretions or saliva containing HBV. However, at least 30% of
reported hepatitis B among adults cannot be associated with an identifiable risk factor.

v)Diagnosis of Hepatitis B virus

The tests, called assays, for detection of hepatitis B virus infection involve serum or blood
tests that detect either viral antigens (proteins produced by the virus) or antibodies produced
by the host. Interpretation of these assays is complex.
The hepatitis B surface antigen (HBsAg ) ;is most frequently used to screen for the
presence of this infection. It is the first detectable viral antigen to appear during infection.
However, early in an infection, this antigen may not be present and it may be undetectable
later in the infection as it is being cleared by the host. The infectious virion contains an inner
"core particle" enclosing viral genome. The icosahedral core particle is made of 180 or 240
copies of core protein, alternatively known as hepatitis B core antigen, or HBcAg. During this
'window' in which the host remains infected but is successfully clearing the virus
Page 23
IgMantibodies to the hepatitis B core antigen (anti-HBc IgM) may be the only serological
evidence of disease.
Shortly after the appearance of the HBsAg, another antigen named as the hepatitis B e
antigen (HBeAg) will appear. Traditionally, the presence of HBeAg in a host's serum is
associated with much higher rates of viral replication and enhanced infectivity; however,
variants of the hepatitis B virus do not produce the 'e' antigen, so this rule does not always
hold true. During the natural course of an infection, the HBeAg may be cleared, and
antibodies to the 'e' antigen (anti-HBe) will arise immediately afterwards. This conversion is
usually associated with a dramatic decline in viral replication.
If the host is able to clear the infection, eventually the HBsAg will become undetectable and
will be followed by IgG antibodies to the hepatitis B surface antigen and core antigen, (anti-
HBs and anti HBc IgG). The time between the removal of the HBsAg and the appearance of
anti-HBs is called the window period. A person negative for HBsAg but positive for anti-HBs
has either cleared an infection or has been vaccinated previously.
Individuals who remain HBsAg positive for at least six months are considered to be hepatitis
B carriers.Carriers of the virus may have chronic hepatitis B, which would be reflected by
elevated serum alanine aminotransferase levels and inflammation of the liver, as revealed by
biopsy. Carriers who have seroconverted to HBeAg negative status, particularly those who
acquired the infection as adults, have very little viral multiplication and hence may be at little
risk of long-term complications or of transmitting infection to others.
PCR tests have been developed to detect and measure the amount of HBV DNA, called the
viral load, in clinical specimens. These tests are used to assess a person's infection status and
to monitor treatment.Individuals with high viral loads, characteristically have ground glass
hepatocytes on biopsy.
vi) Prevention of Hepatitis B virus; Several vaccines have been developed for the
prevention of hepatitis B virus infection. These rely on the use of one of the viral envelope
proteins (hepatitis B surface antigen or HBsAg). The vaccine was originally prepared from
plasma obtained from patients who had long-standing hepatitis B virus infection. However,
currently, these are more often made using recombinant DNA technology, though plasma-
derived vaccines continue to be used; the two types of vaccines are equally effective and safe.
Following vaccination, hepatitis B surface antigen may be detected in serum for several days;
this is known as vaccine antigenaemia. The vaccine is administered in either two-, three-, or
four-dose schedules into infants and adults, which provides protection for 85–90% of
individuals. Protection has been observed to last 12 years in individuals who show adequate
initial response to the primary course of vaccinations, and that immunity is predicted to last at
least 25 years. Unlike hepatitis A, hepatitis B does not generally spread through water and
food. Instead, it is transmitted through body fluids; prevention is thus the avoidance of such
transmission: unprotected sexual contact, blood transfusions, re-use of contaminated needles
and syringes, and vertical transmission during child birth. Infants may be vaccinated at birth.

Page 24
vii)Treatment of Hepatitis B infection; Acute hepatitis B infection does not
usually require treatment because most adults clear the infection spontaneously. Early
antiviral treatment may only be required in fewer than 1% of patients, whose infection takes a
very aggressive course (fulminant hepatitis) or who are immunocompromised. On the other
hand, treatment of chronic infection may be necessary to reduce the risk of cirrhosis and liver
cancer. Chronically infected individuals with persistently elevated serum alanine
aminotransferase, a marker of liver damage, and HBV DNA levels are candidates for
therapy.Although none of the available drugs can clear the infection, they can stop the virus
from replicating, and minimize liver damage. Currently, there are seven medications licensed
for treatment of hepatitis B infection in the United States. These include antiviral drugs
lamivudine (Epivir), adefovir (Hepsera), tenofovir (Viread), telbivudine (Tyzeka) and
entecavir (Baraclude) and the two immune system modulators interferon alpha-2a and
PEGylated interferon alpha-2a (Pegasys).
viii)Job done in the lab;

Aim; To detect the presence or absence of Hepatitis B virus

Apparatus; A test strip, a dropping pipette, serum, an injection, a

tourniquet

Procedure;

I collected two patients blood samples by tieing their arm with a turning
kit and inserting an injection into their veins , i made use of their serum.
I took a dropping pipette and picked their serum and dropped it on the
test strip.

Observation: I observed that there was a movement of the serum on the

test strips.

Result; The two patients tested for Hepatitis B were negative.

Explanation; If negative, the serum will flow on the strip and a thick
red line will appear on the control side. If positive, the serum will flow on
the strip and thick red lines will appear on the test side and the control
side.

Conclusion; In conclusion, serum is useful for determining the presence

of hepatitis B in the blood.

Page 27
5)Blood Glucose
i)What is blood glucose test?A blood glucose test measures the amount of a type of
sugar, called glucose, in your blood. Glucose comes from carbohydrate foods. It is the main
source of energy used by the body. Insulin is a hormone that helps your body's cells use the
glucose. Insulin is produced in the pancreas and released into the blood when the amount of
glucose in the blood rises.
Normally, your blood glucose levels increase slightly after you eat. This increase causes your
pancreas to release insulin so that your blood glucose levels do not get too high. Blood
glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood
vessels.
ii)The normal Blood Sugar level for fasting and Random
Blood

• Normal Blood Sugar Level:

• The normal level of glucose in blood is between 70mg/dl and 150 mg/dl. These levels
are fairly lower in morning when a person has not eaten anything but they increase
after eating meals.
• Random Blood Glucose Level
• Regardless of the fact that when you have taken your last meal; the random blood
glucose level should not be more than 200 mg/dl. A higher level means the person is
suffering from diabetes.
• Fasting Blood Glucose Level:
• Fasting blood glucose level, specifically before eating anything in the morning must
be between 70mg/dl and 99 mg/dl. If it is126mg/dl or higher then it means that person
is suffering from diabetes.
A high level of blood glucose means a person is suffering from Diabetics,
and a low level means a person is suffering from hypoglycaemia. While
monitoring the levels of glucose in blood it is important to note the pattern of levels of
these levels. The person should pay proper attention to different types of medications,
foods, stress level or any other activity that cause an undesirable decrease or increase in
the level of glucose in the bloodstream.

• . Steps for controlling blood glucose level 1) The first step towards your
better health for your health is to check Signs Of Diabetes so that you can start
Treatment Of Diabetes.
2) The next step is to plan a visit to endocrinologist.
iii)Types of blood glucose tests. Fasting blood sugar (FBS) measures blood glucose
after you have not eaten for at least 8 hours. It often is the first test done to check for diabetes.
The normal nondiabetic range for blood glucose is from 70- 110 mg/ dl depending on
the type of blood being tested for , if the level is over 140mg/ dl it means that the
person usually have diabetics(except for some new born babies and pregnant women).
• 2-hour postprandial blood sugar measures blood glucose exactly 2 hours after
you eat a meal.
-Random blood sugar (RBS) measures blood glucose regardless of when you last
ate.
Page 28
 • Several random measurements may be taken throughout the day. Random testing
is useful because glucose levels in healthy people do not vary widely throughout
the day. Blood glucose levels that vary widely may indicate a problem. This test is
also called a casual blood glucose test.
• Oral glucose tolerance test is used to diagnose prediabetes and diabetes. An
oral glucose tolerance test is a series of blood glucose measurements taken after
you drink a sweet liquid that contains glucose. This test is commonly used to
diagnose diabetes that occurs during pregnancy (gestational diabetes).
Usefulness of blood glucose test are;
• Check for diabetes.
• Monitor treatment of diabetes.
• Check for diabetes that occurs during (gestational diabetes).
• Determine if an abnormally low blood sugar level (hypoglycemia) is present. A test
to measure blood levels of insulin and a protein called C-peptide may be done along
with a blood glucose test to determine the cause of hypoglycemia.
iv) Job done in the Lab;

Aim; To determine the level of glucose in the blood using fasting blood
and random blood sugar tests.

Apparatus; A glucometer, a glucometer strip, a needle, blood sample.

Procedure; In the lab, i carried out the fasting and random blood on
several patients. I did it by pricking the patients with a needle on their
thumb, i dropped the blood on the strip that was inserted into the
glucometer and i waited for 7 seconds before reading the result.

Observation; I observed that after the blood icon has been indicated on
the glucometer and after waiting for 7 seconds, the results were seen on
the glucometer.

Result; A patient blood reads 75 mg/dl for fasting blood sugar test,
another patients blood reads 90mg/dl for random blood sugar test.

Explanation of result; The patient with 75mg/dl is normal, while the

patient with 90mg/dl is hypoglycaemia.

Conclusion; In conclusion, the fasting and random blood sugar are used
for determining the level of glucose in the blood.

Page 31
6) Urinalysis without microscopy

i)Definition; It is also known as Urine test or Urine analysis. A

urinalysis is a group of chemical and microscopic tests.

ii)What is being tested?

They detect the byproducts of normal and abnormal metabolism, cells, cellular fragments,
and bacteria in urine. Urine is produced by the kidneys, two fist-sized organs located on
either side of the spine at the bottom of the ribcage. The kidneys filter wastes out of the
blood, help regulate the amount of water in the body, and conserve proteins, electrolytes,
and other compounds that the body can reuse. Anything that is not needed is excreted in
the urine, traveling from the kidneys to the bladder and then through the urethra and out
of the body. Urine is generally yellow and relatively clear, but each time someone urinates,
the color, quantity, concentration, and content of the urine will be slightly different
because of varying constituents.

Many disorders can be diagnosed in their early stages by detecting abnormalities in the urine.
Abnormalities include increased concentrations of constituents that are not usually found in
significant quantities in the urine, such as: glucose, protein, bilirubin, red blood cells, white
blood cells, crystals, and bacteria. They may be present because:
1. there are elevated concentrations of the substance in the blood and the body is
trying to decrease blood levels by “dumping” them in the urine,
2. kidney disease has made the kidneys less effective at filtering or,
3. of an infection, as in the case of bacteria and white blood cells.
iii)A complete urinalysis consists of three distinct testing phases:
1. visual examination, which evaluates the urine's color, clarity, and concentration;
2. chemical examination, which tests chemically for 9 substances that provide
valuable information about health and disease; and
3. microscopic examination, which identifies and counts the type of cells, casts,
crystals, and other components, such as bacteria and mucus, that can be present in
urine.
A routine urinalysis usually consists of the visual and the chemical examinations. These two
phases may be completed in the laboratory or doctor’s office. A microscopic examination is
then performed if there is an abnormal finding on the visual or chemical examination, or if
the doctor specifically orders it.
iv)How is the sample collected for testing?
Urine for a urinalysis can be collected at any time. The first morning sample is considered
the most valuable because it is more concentrated and more likely to yield abnormalities if
present. It is important to clean the genitalia before collecting urine. Bacteria and cells
from the surrounding skin can contaminate the sample and interfere with the
interpretation of test results. With women, menstrual blood and vaginal secretions can also
be a source of contamination. Women should spread the labia of the vagina and clean from
front to back; men should wipe the tip of the penis. As you start to urinate, let some urine
fall into the toilet, then collect one to two ounces of urine in the container provided, then
void the rest into the toilet. This type of collection is called a “midstream collection” or a
“clean catch.” A urine sample will only be useful for a urinalysis if taken to the doctor's
office or laboratory for processing within a short period of time. If it will be longer than an
hour between collection and transport time, then the urine should be refrigerated or a
preservative may be added.
 Page 32
Job done in the lab

Aim; To carry out a complete urinalysis of a urine sample using a

combi- 10 parameter.

Apparatus; Combi- 10 parameter, urine sample, sterile bottle.

Procedure; I collected the urine samples of some patients during the

week. I did it by giving them a sterile bottle to take home and
asking them to bring their early morning urine for test. The reason
for giving them a sterile bottle is to avoid contamination of the
urine sample. After getting their early morning urine, i made use of
the combi - 10 parameter. I opened the cover of the parameter, and
i took out the strip , i also opened the urine sample and i dipped
the strip inside it. I took it out and i compared the appearance of
the colours of the substances on the strip to the colours of the
substances on the combi- 10 parameter.

Observations; I observed that after dipping the strip into the urine,
the colours of the substances on the strip became darker.

Result; Out of all the patients i carried out tests on , here is the result
of two patients, Mrs Adewunmi and mrs Bose Ajisafe.

Urobilinogen – 2(33) 4(66)

Glucose- Negative Negative

Bilirubin - positive Negative

Ketones - +15 +15

S.G/Density - 1.025 1.015

Blood - Negative Negative

PH- 6.5 7

Protein - ++100 +30

Nitrite - Negative Trace

Leukocytes - Negative Negative

Conclusion; In conclusion, the combi- 10 parameter is useful for

urinalysis because it can also be used to check some chronic
conditions like diabetes mellitus ,high blood pressure( hypertension), also
used to diagnose a urinary tract or kidney infection . It can also be
used by the doctor to know the increased amount of specific
substances in the urine like glucose, protein, white blood cells e.t.c.
Also it is useful in determining how much urine ones body is
producing in a day and how much a substance is excreted in the
urine like protein, sodium, potassium e.t.c.
Page 35

7) Widal Reaction(For typhoid Fever);

i)What is Typhoid fever? , also known as Salmonella Typhi or commonly just

typhoid, is an illness. Common worldwide, it is transmitted by the ingestion of food or
water contaminated with feaces from an infected person. The bacteria then perforate
through the intestinal wall and are phagocytosed by macrophages. Salmonella Typhi, more
correctly called Salmonella enterica enterica Typhi, then alters its structure to resist
destruction and allow them to exist within the macrophage.

ii) Symptoms of Typhoid fever;

Typhoid fever is characterized by a slowly progressive fever as high as 40 °C (104 °F),
profuse sweating, gastroenteritis, and nonbloody diarrhea. Less commonly a rash of flat, rose-
colored spots may appear.
Classically, the course of untreated typhoid fever is divided into four individual stages, each
lasting approximately one week. In the first week, there is a slowly rising temperature with
relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a
quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the
number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a
positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The
classic Widal test is negative in the first week.
In the second week of the infection, the patient lies prostrated with high fever in plateau
around 40 °C (104 °F) and bradycardia (Sphygmo-thermic dissociation), classically with a
dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This
delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower
chest and abdomen in around 1/3 patients. There are rhonchi in lung bases. The abdomen is
distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea
can occur in this stage: six to eight stools in a day, green with a characteristic smell,
comparable to pea-soup. However, constipation is also frequent. The spleen and liver are
enlarged (hepatosplenomegaly) and tender and there is elevation of liver transaminases. The
Widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are
sometimes still positive at this stage. (The major symptom of this fever is the fever usually
rises in the afternoon up to the first and second week.)
In the third week of typhoid fever a number of complications can occur:
• Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be
very serious but is usually non-fatal.
• Intestinal perforation in distal ileum: this is a very serious complication and is
frequently fatal. It may occur without alarming symptoms until septicaemia or
diffuse peritonitis sets in.
• Encephalitis
• Metastatic abscesses, cholecystitis, endocarditis and osteitis
The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and
the patient is delirious (typhoid state). By the end of third week the fever has started reducing
(defervescence). This carries on into the fourth and final week.
Page 36

iii)Diagnosis ; Diagnosis is made by any blood, bone marrow or

stool cultures and with the Widal test (demonstration of
salmonella antibodies against antigens O-somatic and H-flagellar).
In epidemics and less wealthy countries, after excluding malaria,
dysentery or pneumonia, a therapeutic trial time with
chloramphenicol is generally undertaken while awaiting the
results of Widal test and blood cultures. The term "enteric fever"
is a collective term that refers to typhoid and paratyphoid.

iv)Treatment; Where resistance is uncommon, the treatment of

choice is a fluoroquinolone such as ciprofloxacin otherwise, a
third-generation cephalosporin such as ceftriaxone or cefotaxime
is the first choice. Cefixime is a suitable oral alternative. Typhoid
fever in most cases is not fatal. Antibiotics, such as ampicillin,
chloramphenicol, trimethoprim-sulfamethoxazole, Amoxicillin and
ciprofloxacin, have been commonly used to treat typhoid fever in
developed countries. Prompt treatment of the disease with
antibiotics reduces the case-fatality rate to approximately
1%.When untreated, typhoid fever persists for three weeks to a
month. Death occurs in between 10% and 30% of untreated cases.
Though in some communities case-fatality rates may be as high as
47%.

v)Prevention of typhoid fever;

Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Typhoid
does not affect animals and therefore transmission is only from human to human. Typhoid
can only spread in environments where human feces or urine are able to come into contact
with food or drinking water. Careful food preparation and washing of hands are therefore
crucial to preventing typhoid.There are two vaccines currently recommended by the World
Health Organization for the prevention of typhoid: these are the live, oral Ty21a vaccine
(sold as Vivotif Berna) and the injectable Typhoid polysaccharide vaccine (sold as Typhim Vi
by Sanofi Pasteur and Typherix by GlaxoSmithKline). Both are between 50 to 80% protective
and are recommended for travelers to areas where typhoid is endemic. There exists an older
killed whole-cell vaccine that is still used in countries where the newer preparations are not
available, but this vaccine is no longer recommended for use, because it has a higher rate of
side effects (mainly pain and inflammation at the site of the injection).
vi) Typhoid test;

Serum in the whole blood contains antibody and the cromatest kit contains the
antigen. The cromatest kit contains 8 antigens divided into 2 groups , we have
the O & H. The O is the somatic antigen and also blue in colour, the H is the
Flagella antigen and pink in colour. There are 4 types namely D ,A , B , C read
as DO, AO, BO, CO for O antigen. Also for H antigen it reads DH, AH, BH,
CH.

Salmonella is the organism that causes typhoid, before we can say

someone is having typhoid 4 of the antigens must react between
ratio 1:80 and above.

Page 37

Since Salmonella is the organism that causes typhoid, here is a way of writing
the result for a widal reaction.

O H

Salmonella typhi D

Salmonella paratyphi A

Salmonella paratyphi B

Salmonella paratyphi C

Note

1:20 When the antigen- antibody

1:40 reaction is very little

1:80 When the antigen - antibody

1:160 reactions are large

1:320 Extremely high condition

Comments in Widal reaction

There are 3 types of comments and they are due to the reaction.

Reaction 1;

E.g 1:20 - Non significant titre( no typhoid).

Reaction 2;

When a patient is partially positive, when 1, 2, 3 antigens is reacting to

_< 1:80.

Reaction 3;

When a widal reaction is reacting that at least 4 antigens are reacting

to 1:80 and above. The significant titre is >_ 1:80.

Factors that affect widal reaction

_ When a patient is living in an untidy area

The largest % of salmonella is in human stool.

Job done in the lab;

Test- Typhoid
Aim; To determine if a patient is having typhoid fever or not.

Apparatus; A blood sample( serum), cromatest kit, a blood tile, a

dropping pipette, an EDTA bottle, an injection, a swab, a tourniquet, a
centrifuge.

Page 38

Procedure; I collected the blood samples of several patients during the

week. I did it by tieing the arm with a turning kit and inserting an
injection into the vein i withdrew 1ml of blood. I used a swab to clean
the bleeding, i now poured the blood sample into an EDTA bottle so as
to prevent the blood from clotting, i spinned the blood in a centrifuge
so as to get the serum. I now took the cromatest kit and i dropped
them on a blood tile. I dropped them horizontally, 4 of the O at the top
and 4 of the H at the bottom. There were spaces in between them.
Finally i made use of the dropping pipette and took the serum and
dropped it on each of the 8 antigens on the blood tile. I stirred them
up and rocked them so as to form an antigen- antibody reaction.

Observation; While i was rocking the reaction, i noticed that there were
tiny particles seen in between the reaction but not very obvious. When
this particles appear it means that the antigen have reacted.

Result; Here are the results of some patients ; Mr Ganiyu O H

Salmonella typhi D 1:80 1:80

Salmonella paratyphi A 1:80 1:80

Salmonella paratyphi B 1:20 1:20

Salmonella paratyphi C 1:80

1:20

Comment of the result ; The significant titre is >_ 1:80

Mrs Bunmi
O H

Salmonella typhi D
1:20 1:20

Salmonella paratyphi A
1:80 1:40

Salmonella paratyphi B
1:20 1:20
 Salmonella paratyphi C
1:80 1:80

Comment of the result; The patient is partially positive to typhoid.

Conclusion; In conclusion, widal reaction is very useful in detecting

typhoid fever. The main test for determining typhoid is the titration
reaction.

Page 41
8) Pregnancy Tests( Blood & Urine)
i)Definitions of pregnancy test
• a physiological test to determine whether a woman is pregnant
• A pregnancy test attempts to determine whether a woman is pregnant. Records of
attempts at pregnancy testing have been found as far back as the ancient Greek
and ancient Egyptian cultures. Modern pregnancy tests look for chemical markers
associated with pregnancy. ...

• Nowadays a measurement of human chorionic gonadotropin in serum or urine,

usually as a simple “yes” or “no” test. ...

ii) Types of Pregnancy tests

There are two types of pregnancy tests; one uses a urine sample, the other a sample of blood.
Both tests detect the presence of a hormone called human chorionic gonadotropin (hCG).
This hormone is produced by the placenta shortly after the embryo attaches to the uterine
lining and builds up rapidly in your body in the first few days of pregnancy. It is this rapid
shift in hormones that triggers most of your pregnancy symptoms.
1)Urine Tests:
There are different types of urine tests, and these can be performed at home or in a clinic. The
first type of test involves collecting your urine in a cup and dipping a stick into the urine, or
putting urine into a special container with an eyedropper. A second type of test involves
placing a stick into your urine stream and catching your urine in midstream.
Tests vary in how long you have to wait to get a result. You will be looking for a change in
color, a line, or a symbol (like a plus or minus). A new digital pregnancy test offered by
Clearblue Easy makes reading your results simple: the window will either show the words
"not pregnant" or "pregnant". You can also get recommended midstream urine tests online:
Order my pregnancy test
All tests come with instructions, and it is important that you follow these instructions to get
an accurate reading.
When can I take a urine test? Most doctors recommend that you wait until
the first day of your missed period before taking a urine pregnancy test. This is
usually about two weeks after conception. However, some tests are more
sensitive than others and can be taken earlier.
How accurate are urine tests? Urine tests or home pregnancy tests are around 97% accurate
when done correctly. Home pregnancy tests are great to use because they can be done at home, they
are usually low incost(anywhere from $7.99 to $19.99), private, they give a fast result, and are easy
to use. However, if not done correctly or taken too early, the result can be inaccurate. If you get a
negative result and still have symptoms of pregnancy (missed period, nausea, breast
tenderness and fatigue), wait a week and take another test or contact your doctor so you can
have a blood test done.

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2) Blood Pregnancy Test

A pregnancy blood test or a pregnancy serum test is a test that measures the exact amount of
the pregnancy hormone, human chorionic gonadotropin (hCG), in the bloodstream of a
woman to detect pregnancy. Human chorionic gonadotropin (hCG) is a hormone that is
produced by the placenta of a pregnant woman. It is detectable in the blood and urine within
10 days of fertilization. There are two types of blood pregnancy tests, namely, quantitative
blood test which measures the exact amount of hCG in the blood and qualitative hCG blood
test which gives a simple yes or no answer to whether you are pregnant or not.
How early can blood test detect pregnancy?
Blood tests can detect a pregnancy earlier than a home pregnancy test. They can detect it
about 7-12 days from possible conception and can also measure the concentration of human
chorionic gonadotropin hormone in your blood. This can be very helpful information for your
doctor in tracking certain problems in pregnancy. If you suspect any symptoms of pregnancy
like delayed menstrual period, breast tenderness, pelvic pain, irregular spotting or vomiting.
You must get a pregnancy blood test done to confirm or rule out pregnancy.
Is a blood test for pregnancy more accurate than a urine test?
The latest news does say that blood tests are indeed more accurate than home urine tests.
Recently, research presented at the Scientific Assembly of the American College of
Emergency Physicians revealed that almost six percent of negative urine pregnancy tests can
be false negative, meaning the women is indeed pregnant despite a negative urine pregnancy
test. Initially, the researchers had expected to find urine pregnancy tests as accurate as blood
tests.
When researchers looked at 662 women at Henry Ford Hospital who received both urine and
serum human chorionic gonadotropin (hCG) tests for pregnancy. Six women, out of the 102
negative results, tested negative with the urine pregnancy test, yet their blood pregnancy test
indicated they were indeed pregnant. Five of these women with false negative tests had serum
human chorionic gonadotropin (hCG) levels in the range 11 to 97 mU/ml, which is normal
for the first month of pregnancy.
Though researchers caution that these false negative numbers may be higher than what is
actually found in practice, Henry Ford Hospital now uses blood pregnancy tests as the
standard for women less than four weeks past the date of their expected menstrual period. So
we can conclude that blood tests for pregnancy are more accurate than urine pregnancy tests.
What do the pregnancy blood test results mean?
A healthy pregnancy is expected to show a normal pattern of HCG levels over time. In a
pregnant woman the level of human chorionic gonadotropin (hCG) increases throughout the
first trimester, then gradually decreases over time. In the first trimester, a woman may have
this test done repeatedly to see if the level rises normally. If it doesn’t, the pregnancy is often
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considered in trouble. After childbirth, miscarriage, or abortion, the level should

quickly decrease to zero.

How reliable are blood pregnancy tests?

Home pregnancy tests are around 97% accurate when done correctly. However, a blood test
is more accurate, but not necessarily more sensitive. The results depend a lot on the lab,
methodology and technique of the blood test performed.
A quantitative blood test, usually called a beta human chorionic gonadotropin (hCG) test,
measures the exact units of hCG in the blood. That means it will detect even the most
minimal level. There is another type of blood test sometimes called a qualitative human
chorionic gonadotropin (hCG) test. This is a test that simply gives a yes or no answer to
whether you are pregnant.
Advantages of having a blood test done:
• Can detect a pregnancy earlier than a urine test at about 7-12 days from possible
conception ( but if a negative result is received, a test should be repeated if a period is
missed.)
• Can measure the concentration of hCG hormone in your blood (this is useful
information for your healthcare provider in tracking certain problems in pregnancy)
Disadvantages to having a blood test done:
• More expensive than a urine test (price depends on cost of doctor's visit and lab fees)
• Takes longer to get result
• Must be done in a doctor's office
iii) Job done in the Laboratory

Test; Pregnancy test( urine & Blood)

Aim; To determine if a patient is positive or negative to pregnancy.

Apparatus; Pregnancy kit, injection, EDTA bottle, a dropping pipette, Urine sample,
blood( serum), Sterile bottle, a centrifuge, a tourniquet.

Procedure; Urine test

I carried out the urine test on 4 females. First i gave them

sterile bottles and i asked them to bring their early morning urine.

On collecting their urine, i tore the cover of the pregnancy strips

and i did their tests one after the other, i dipped the strips into
 the urine and i waited for 3 minutes before reading the results ,
as indicated on the pregnancy kit.

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Blood test

I Carried out the blood pregnancy test on 3 different patients .

First, i tied their arm and i collected their blood samples , i poured
it into EDTA bottles, i spinned the blood samples in the
centrifuge machine to get the serum. I now tore off the cover
of the pregnancy strip and i took the dropping pipette to pick
the serum and dropped it on the strip in the direction indicated
by the arrow . I did the tests for each patients one after the
other .I waited for 5 minutes before taking the result as indicated
on the pregnancy kit.

Observations; I observed that in the urine tests, the strips became darker
and wet and there were movement of the urine on the strips. Also
i noticed that thick red lines appeared finally on the strips.

For blood pregnancy test, i noticed that the strips became darker and
wet and there were movement of the serum on the strips.

Result; For urine pregnancy test, patient 1 and 4 were positive to

pregnancy while patient 2 and 3 were negative.

For blood pregnancy test, all the patients were positive to

pregnancy.

Explanation of result; If a woman is pregnant, the human chorionic

gonadotropin(HCG) would be present both in the blood and the
early morning urine. The human chorionic gonadotropin is the
hormone produced by the placenta of a pregnant woman. It is
detectable in the blood and urine within 10 days of fertilization.

If a woman is positive to pregnancy, there would be thick red

lines on the strips one on the test side and another on the
control side.

If a woman is negative to pregnancy, there would be a thick red

line on the control side of the strip only.
Conclusion; In conclusion, the blood (serum) and urine tests are used for
determining pregnancy.

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Indexes;

-Hypoglycemia- An abnormal low blood sugar level.

-Gynaecologist- A person who treats the diseases and

disorders of women, especially those affecting the
reproductive system.

-Anaesthetic- A substance that makes a person or an

animal unable to feel pain, heat, cold, in the whole
body.

-EDTA bottle- Is a bottle that contains an anticoagulant,

in which blood samples are kept to prevent them
from clotting before being used.

-serum- Is the yellowish part of the blood when it

settles.

- Also it is the pure separation of blood without any

chemical.

- Plasma- Blood that contains mixture of other

substance.

-Human chorionic gonadotropin- An hormone found in

the urine and blood of pregnant women. It occurs
in the first few days of pregnancy.