GENERAL INTRODUCTION

A disease is any abnormality in the functioning of a tissue in the body, which may or may not be associated
with a structural abnormality.

Pathology is the study of the cause, development and consequences of a disease process. This is achieved
in the clinical lab by the analyses of samples (blood, urine, faeces and diseased tissues) that have been
obtained from the living patient or a corpse. It is also achieved by the use of sophisticated techniques such
as the use of x-rays.

Areas of specialization in the clinical lab

(A) Haematology: This is the study of blood and blood-forming tissues, as well as the disorders that are
associated with them. Haematological tests include the following:

(i) a complete blood cell count which involves counting the number of red blood cells, white blood cells
and platelets in a litre of blood.

(ii) measurement of the haemoglobin concentration of the blood.

(iii) measurement of the reticulocyte count of the blood. Reticulocytes mature into red blood cells.

(iv) obtaining a differential white blood cell count. This involves the determination of the fraction of the
white blood cell population that is made up of neutrophils, basophils, eosinophils, monocytes and
lymphocytes.

The above tests are helpful in the detection of anaemias (in anaemia, the haemoglobin
concentration of the blood is lower than normal), infectious diseases and leukaemia (a disease in which
the white blood cell count of the blood is higher than normal).

Blood cell count and a differential white blood cell count can be performed on cerebrospinal fluid,
pleural fluid, peritoneal fluid and synovial fluid.

Other haematological tests include haemoglobin electrophoresis which detects haemoglobin

disorders.

(B) Chemical pathology or clinical biochemistry:

This is the application of chemistry and its related techniques in the diagnoses of diseases. Clinical
biochemistry is the determination of the presence and quantity of chemical substances in bodily fluids.

Normally, the concentrations of most substances in the body vary within narrow limits as their
rates of production and degradation are approximately equal. Feedback mechanisms are also implicated
in maintaining these concentrations within the narrow limits. Feedback is said to occur when the ultimate
effects of a system influence the functioning of the system.

For a given substance, its blood concentration normally varies within a narrow range that is
referred to as the reference range. e.g. the reference range for blood urea is 2.5 to 6.6mM. As a result of
a disease process, the concentration of a given substance may fall outside the normal range.

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 Several different types of chemicals aid in the diagnosis of diseases: glucose in the diagnosis of
diabetes mellitus; creatinine in the diagnosis of renal disease; creatine kinase in the diagnosis of skeletal
and/or cardiac muscle damage; lactate dehydrogenase in the diagnosis of hepatic or cardiac damage.

The immunology/serology component of chemical pathology deals with immunopathology (the

implication of the immune system in disease processes), the diagnosis of infectious diseases and the
quantification of serum components (such as antibodies) using immunological methods. Many of the
immunological tests are based on antigen-antibody interactions.

Urinalysis examines the physical characteristics of urine samples (the colour, odour and clarity of
urine); it also involves the examination of the chemical composition of urine (e.g. measuring the level of
glucose in urine). It also involves the microscopic examination of urinary sediments.

(C) Clinical microbiology:

It deals with the isolation and identification of micro-organisms that cause diseases. It consists of
bacteriology (the study of bacteria), virology (the study of viruses), mycology (the study of fungi) and
parasitology (the study of parasites).

The routine lab relies on selective media that enhance the growth of suspected pathogens; this is
the process of culturing a micro-organism, and it facilitates the identification of a micro-organism.
Biochemical and immunological tests are then needed to confirm the presence of a particular type of
pathogen.

The identification of pathogenic viruses requires the use of tissue culture cells as well as
immunological tests.

Fungi are identified as a result of the macroscopic observation of the diseased tissue and
biochemical tests.

Susceptibility testing is carried out in the clinical microbiology lab, and it involves the identification
of chemical substances (antibiotics) that would be most effective in negatively affecting a particular type
of micro-organism.

(D) Medical cytogenetics: It is the study of normal and abnormal chromosomal variation. Chromosomal
abnormalities are implicated in physical birth defects, mental retardation and spontaneous abortion.
Specimens that are used in this type of study are prepared from bone marrow, blood, solid tissue and
amniotic fluid, after which microscopic analyses are carried out.

(E) Cytology: This is the study of the structure and function of cells. The cytopathology lab studies cell
structure and function during disease processes and is implicated in the diagnosis of cancer (cancer arises
when the rate of mitosis in a certain part of the body is higher than normal).