INTRODUCTION TO LABORATORY MEDICINE Today

(Clinical Pathology) – Performed as soon as possible, given priority

Sections of the laboratory Routine

 Clinical Chemistry – Done with the batch
 Clinical Microscopy
 Microbiology
 Hematology Values
 Blood Bank REFERENCE VALUES
 Serology/Immunology – 95% of a healthy population
 Histopathology
SIGNIFICANT VALUES
– Clinical decision should be made
SECTIONS OF THE LABORATORY
Clinical Chemistry CRITICAL VALUES
• Uses chemicals to measure chemicals. – Needs immediate attention
• Carbohydrates, Lipids, Enzymes, Proteins
Reference Values
Clinical Microscopy  Age
• Uses a microscope to see elements of disease  Sex
• Fecalysis, Urinalysis, Semenalysis  Pregnancy
 Diurnal variation
Microbiology  Race
• Uses stains and cultures to identify microorganisms  Blood type
• Gram Staining, Culture & Sensitivity

Hematology Routine Examinations

• Analyses the morphology and function of blood cells & ROUTINE ADMISSION TESTS
clotting factors – CBC, Urinalysis, Fecalysis
• Complete Blood Count, Coagulation Studies
ROUTINE CHEMISTRIES
Blood Bank – BUN, Creatinine, Glucose, Uric Acid, Cholesterol
• Collects, processes and stores blood for transfusion Sometimes triglycerides
• ABO typing, Crossmatching, antibody screening

Immunology / Serology Complete blood count

• Measures or makes use of antibodies for determining • WBC count
presence of antibody or antigens. • Differential count
– Infectious - ASO, Hepatitis, HIV, • Estimated Platelet Count
– Hormones – TSH, PRL, FSH, etc • RBC count
– Tumor markers – CA 125, CA 19-9 • Hemoglobin
• Hematocrit
Histopathology • Indices
• Examines tissues and cells – MCV
• Cytology, biopsy, autopsy – MCH
– MCHC
Terminologies
TURN AROUND TIME (TAT) PBS vs CBC
– Time from the acceptance of specimen to the relay of Complete Blood Count
results • Quantitative
– Time it takes to perform the test • Performed by MT
• TAT –1 hour
Nature of Request • Inexpensive
STAT • Sensitive
– Performed immediately and by itself
Peripheral Blood Smear Efficiency of a Test
• Qualitative
• Performed by MD
• TAT –3 days TP + TN .
• Expensive TP+ TN + FP + FN x 100
• Specific
- Ability of a test to detect correctly
- Percentage of times test is correct
Accuracy and Precision
ACCURACY
– Closeness to true value Questions to Ask Before Ordering a Laboratory Test
– Best for diagnosis - Why is the test being ordered?
- What are the consequences of not ordering the test?
PRECISION - How good is the test in discriminating between health
– Reproducibility versus disease?
– Best for monitoring - How are the test results interpreted?
- How will the test results influence patient management
and outcome?
Possible Outcomes
(+) test (-) test Reasons for ordering tests
result result • Aid in diagnosis
healthy False True • Confirm diagnosis
positive negative • Evaluate prognosis
sick True False • Monitor therapy
positive negative • Screen for a disease

Approaches for Establishing a Diagnosis Based on

Sensitivity Laboratory Test Results
• Hypothesis deduction.
TP . True positive • Pattern recognition.
TP+FN X 100 sick • Medical algorithms.
• Rifle versus shotgun approach.
- Used for screening
- To generate more true positive results and few false
negatives Algorithm for identifying individuals with thyroid
disorders based on TSH level
Specificity

TN . True negative
TN+FP X 100 healthy

- Used for confirmation

- Ability to detect true-negatives with few false-positives

Predictive value of positive

TP . TP
TP+FP X 100 all positive

- Takes into account the prevalence of the disease

- Most clinically useful
Phases of the Total Testing Process
• Pre-analytical Phase
• Analytical Phase
• Post-analytical Phase
Phases of the Total Testing Process TOBACCO
Acute
• Cortisol, fatty acids, neutrophils, monocytes
• ↓eosinophils
Chronic
• Hct, MCV, WBC

POSITION
Change from supine to standing
• Albumin, calcium, TP, bilirubin, cholesterol,
triglycerides,
• Hct, Hgb, WBC ct, RBC ct

DRUG INTAKE
• Injury to tissue or organ –INH
• Alteration in organ function –Phenytoin
• Competition effect –Phenytoin
• Interference with analysis –ascorbic acid

Proper Sample
SITE OF EXTRACTION
– Dilution with IV
– Capillary vs Venous
• ↑ Glucose
• ABG

CONTAMINATION
– Detergents
• Phosphates
– Cork
Pre-analytical Phase • Calcium
- Include specimen handling issues that occur
even prior to the time the specimen is received TOURNIQUET APPLICATION
in the laboratory. – More than one minute
• Enzymes, cholesterol, triglycerides, calcium, iron,
Factors that influence test results potassium
• Patient Preparation
• Proper Sample SERUM INFLUENCES
– Hemolyzed, icteric
Patient Preparation • Chemistries
EXERCISE
– Transient ANTICOAGULANTS
↑ Fatty acids, lactate, alanine – Proportion
– Long term – Inappropriate use
↑ Creatinine kinase, aldolase, AST, LDH
PROCESSING
DIET (2-4 hrs after eating) – Separation
– High Fat – Refrigeration
• ALP, Chylomycrons – Prolonged mixture
– High Protein – Potassium, AST, ALT, LDH
• NH3, Urea, Urates

Caffeine Analytical Phase

• Non esterified fatty acids – Includes what is usually considered the "actual"
laboratory testing or the diagnostic procedures,
Alcohol processes, and products that ultimately provide
• Triglycerides, HDL Cholesterol, GGT, Urates, MCV results.
Post-analytical Phase Type of biopsy to request
– final phase of the laboratory process Depends on:
– culminates in the production of a final value • tissue, organ or body part to be sampled
(result) • how suspicious the abnormality appears
– Interpretation of result • size, shape and other characteristics of the
abnormality
Histopathology • location of the abnormality
• Anatomic Pathology • number of abnormalities
• Uses • other medical conditions a patient may have
– Tissues -Biopsy/ Autopsy • preference of the patient
– Cells - Cytology • imaging and biopsy systems available at a given
hospital or healthcare location
Types of Biopsy
Incision
– Core
– Cone
Excision

Cytopathology
- studies and diagnoses diseases on the cellular
level

Methods of Collection
Exfoliative Cytology
• Cells are extracted from fluid shed into the body
cavity.
– in pleural fluid, ascitic fluid
• Cells scraped from the surface
– in the case of the Pap smear

Fine Needle Aspiration Cytology (FNAC)

• An 18 -20 gauge needle attached to a 10cc syringe is
used to aspirate cells from lesions in various organs
of the body (suction).
• Can be done directly or it may be assisted by
ultrasound or CAT scan.

Needle Biopsy

Cytology

Histopathology
• Proper fixation is IMPORTANT
– 95% alcohol for cells
– Formalin for tissues

Staining
• Papanicolaou
– Cervical or bronchial secretions
• Combination of hematoxylin and eosin (H&E)