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Module VI
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INSTRUMENTS FOR CLINICAL LABORATORY

 The clinical laboratory is responsible for analysing patient specimens in order to provide
information to aid in the diagnosis of disease and evaluate the effectiveness of therapy.
 The hospital department that performs these functions may also be called the department of
clinical pathology or the department of laboratory medicine.
 The major sections of the clinical laboratory are the chemistry, haematology, and
microbiology sections and the blood bank.

TESTS ON BLOOD CELLS

 Ԝhen ԝhole blood is centrifuged, the blood cells sediment and form a packed column at the
bottom of the test tube.
 Most of this column consists of the red blood cells, ԝith the other cells forming a thin, buffy
layer on top of the red cells.
 The volume of the packed red cells is called the hematocrit.
 It is expressed as a percentage of the total blood volume.
 If the number of (red) blood cells per cubic millimeter of blood is knoԝn, this number and the
hematocrit cab be used to calculate the mean cell volume (MCV)

Figure 1: Hematocrit determination

 The active component in the red blood cells is the hemoglobin, the concentration of ԝhich is
expressed in grams/100 ml.
 From the hemoglobin, the hematocrit and the blood cell count, the mean cell hemoglobin
(MCH) (in picograms) and the mean cell hemoglobin concentration (MCHC) (in percent)
can be calculated.
 The hematocrit can be determined by aspirating a blood sample into a capillary tube and
closing one end of the tube with a plastic sealing material.
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 The tube is then spun 3 to 5 minutes in a special high-speed centrifuge to separate the blood
cells from plasma.
 Because the capillary tube has a uniform diameter, the blood and cell volumes can be
compared by measuring the lengths of the columns.

AUTOMATIC BLOOD CELL COUNTER

 The blood cells have important functions in our body.
 The red blood cell is used for the transport of oxygen and carbon dioxide.
 The white blood cells are part of the body’s defences against infections and foreign
substances.
 The platelets are involved in the clotting of blood.

Figure 2: Automatic blood cell counter

 The red blood cells in the blood consist of haemoglobin.

 When the produces too many red blood cells, the amount of haemoglobin in the blood
increases and a chronic disease called polycythaemia or dehydration is produced.
 When the haemoglobin in the blood decreases, anaemia is produced.
 To determine relative proportion of blood cells in a given volume of blood, packed cell
volume is used.
 The blood sample is placed in a test tube which is spun so that the cells are packed at the
bottom under centrifugal force provided by the centrifuge.
 Thus the packed cell volume is the ratio between the height of the packed cells and the height
of the blood in the tube.
 Normal range of packed cell volume for men is 42%-54% and for women is 37%-47%.
 The number of red blood cells is also counted using a microscope.
 Since the density of red blood cells is so large, the microscopic counting is time consuming.
 Therefore now-a-days automatic red blood cell counters are used.
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 The method is based on the fact that red cells have a higher electrical resistivity than the saline
solution in which they are suspended.
 The above figure shows the automatic blood cell counter using electronic circuitry.
 A diluted blood sample (diluted with saline solution) is drawn through a small orifice
(opening) having diameter less than 100 µm by means of a suction pump.
 The electrodes are placed such that one in the surrounding sample chamber and other in the
suctioned blood.
 The electrodes are attached with the conductivity meter.
 Before suctioning, the resistance of the electrode arm is equal to R.
 After suctioning of blood, each red cell moving through orifice will produce a sudden increase
in resistance such that the resistance of the bridge is now equal to (R + ΔR) or Rout .
 The conductivity meter gives the amplified output voltage Vout , which is directly proportional
to the ΔR.
 The conductivity meter gives the amplified output voltage Vout as an impulse.
 The number of impulses is counted by a counter and this gives the density of red blood cells.

CHEMICAL TESTS
 Blood serum is a complex fluid that contains numerous substances in solution.
 The determination of the concentration of these substances is performed by specialized
chemical techniques.
 The commonly performed chemical blood tests are;
1. Spectrophotometer
2. Flame photometer

SPECTROPHOTOMETER

Figure 3: Spectrophotometer

 Figure shows the spectrometer, here light from halogen lamp is passed through an entrance slit
S1 and incident on a concave reflector which focuses the light on a diffraction grating ‘G’ (or)
a prism to disperse light.
 The selective wavelength from the dispersed light is obtained by taking it at the given
direction and then it is allowed to incident on the reflector.
 From the reflector, the light beam is directed to the sample through a narrow exit slit S 2 .
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 A sensitive photodetector D detects the transmitted light and gives an electrical output
corresponding to the intensity of the transmitted light.
 The amplifier amplifies the output from the detector and finally the indicator indicates the
concentration of the substance.
 By rotating the grating, the measurements can be made at different wavelengths.

FLAME PHOTOMETER
 A flame photometer is used to analyse urine or blood in order to determine the concentration
of potassium (K), sodium (Na) and lithium (Li).

 Sometimes lithium is used as a calibration substance in the analysis of the other three
substances.
 A known amount of lithium is added to the sample and the emitted light intensity of the
sample under analysis is measured relative to that of the lithium.
 By this way any error due to the varying flame temperature is eliminated.
 Using an atomizer, the liquid sample is sprayed into fine droplets by passing oxygen or air past
the opening in it.
 A combustible gas like acetylene is also added with air.
 The sample-air mixture is burnt out and the light emitted in the flame is passed through a
narrow slit and then to diffraction grating.
 The diffracted colours are incident on various photodiodes.
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 The concentration of potassium ions is detected by observing the peak height of the spectral
line corresponding to it.
 For potassium, the wavelength that we are interested is 4047 Ả (violet).
 For sodium, the interested wavelength is 5890 Ả (yellow).
 For lithium, it is 6708 Ả (red).
 Separate photodetector is used for each channel.
 The photodetector circuit consists of a reverse biased diode in which current flow increases as
the intensity of light incident upon it increases.

INTRODUCTION TO TELE-MEDICINE
 Tele-medicine or Bio-telemetry is the electrical technique for conveying biological
information from a living organism and its environment to a location where this information
can be observed or recorded.
 Thus it refers to the communication between a living system and an observer.
 Today tele-medicine is extended for monitoring patients in a hospital from a remote location.

COMPONENTS OF TELE-MEDICINE SYSTEM

 The essential blocks of a tele-medicine system are shown in the figure 4.
 The transducer converts the biological variable into electrical signal.
 The signal conditioner amplifies and modifies this signal for effective transmission.
 The transmission link connects the signal input blocks to the readout device by wire or
wireless mean.
 The tele-medicine system should be selected to transmit the bio-electric signals with
maximum fidelity and simplicity.
 There would not be any constraint for living system due to these telemetry systems and there
would not be any reaction or any interference with the living system.
 The size and weight of the tele-medicine system should be small.
 It should have more stability and reliability.
 The power consumption should be very small to extend the source life time in the case of
implanted units.
 For wire transmission, shielding of cable is a must to reduce noise level. At the transmitter
side, the amplifiers should be differential amplifier to reject common mode interference.
 The miniaturized radio telemetering system should be used to reduce noises.

Figure 4: Components of a bio-telemetry system

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APPLICATION OF TELE-MEDICINE
 Tele-medicine helps us to record the bio-signals over long periods and while the patient is
emerged in his normal activities.
 The medical attendant or computer can easily diagnose the nature of disease by seeing the
telemered bio-signals without attending the patient’s room.
 Patient is in his room without any mechanical or physical disturbance during recording by
means of biotelemetry.
 For future reference or to study the treatment effect, the tele-medicine is the essential one.
 For recording on animals, particularly for research, the tele-medicine is greatly used.
 For monitoring the persons who are in action, the biotelemetry is an ideal one.
 Although telemedicine can potentially affect all medical specialities, the greatest current
applications are found in radiology, pathology, cardiology and medical education.
 Tele-radiology: Radiological images such as X-ray, CT or MRI images can be transferred
from one location to another location for expert interpretation and consultation.
 Tele-pathology: To obtain an expert opinion on the microscopic images of pathology slides
and biopsy reports from specialists.
 Tele-cardiology: It relates to the transmission of ECG, echocardiography, etc.

SINGLE CHANNEL TELE-MEDICINE SYSTEM FOR ECG

 Figure 5 shows the block diagram of a single channel telemetry system suitable for the
transmission of an electrocardiogram.
 There are two main parts:
 The Telemetry receiver which consists of an ECG amplifier, a sub-carrier oscillator and a
UHF transmitter along with dry cell batteries.
 Telemetry receiver consists of a high frequency unit and a demodulator, to which an
electrocardiograph can be connected to record, a cardio scope to display and a magnetic tape
recorder to store the ECG.
 A heart rate meter with an alarm facility can be provided to continuously monitor the beat-to-
beat heart rate of the subject.
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Fig 5: Block diagram of a single channel ECG telemetry system