Continuing Professional Development Law
regulated professions.
Republic Act No. 10912
- lapse to law on July 21, 2016
- “Continuing Professional Development Act of
2016”
- CPD programs are no longer new, since 1973, our
professional regulatory boards are authorized to
look into the condition affecting the practice of
profession, and to adapt such measures for the
enhancement of profession and maintenance of high
professional, ethical, and technical standards of the
professionals.
- On December 5, 2000- when the law creating, our
PRC was enacted, it reiterated the same mandate
directing all the PRB’s to adapt such measures for
the enhancement of the profession and maintenance
of high professional, ethical, technical under the
profession.
- Official Professional Regulatory Board is the
Medical Technology Board (MTB).
- On the year 2016, CPD Act of 2016 lapse into
law- this law was not signed by the President,
instead, after the lapse of 30 days, it became a law.
- On March 15, 2017, the PRC Resolution No.
1032 series of 2017 to effect mandating the
compliance with the CPD.
o this PRC Resolution is the Implementing
rule of RA No. 10912.
- On October 16, 2018, the MTB issued the PRB of
Medical Technology Resolution No. 7 series of
2018, which took effect on May 5, 2018. Following
his publication on April 19, 2018 in the official
gazette.
- On the February 7, 2019, the PRC issued a PRC
Resolution No. 2019-1146 series of 2019, amending
a certain provisions of PRC Resolution 1032 series
of 2017.
R.A. No. 10912: Continuing
Professional Development Act of
2016
- CPD is mandatory.
- Without complying with the CPD, you cannot
renew professional identification card (PIC)
- Regulated professions- professions under the
authority of PRC.
o profession who has board exams such as
Medical Technology, Nursing, Physicians-
who has board exams considered as
- CPD is mandatory in nature
o Why? Because without CPD, they can’t
renew the PIC  you cannot practice
without it.
- lapse into law on July 21, 2016; took effect on
August 16, 2016 following its publication
o this law became into law without the
signature of the President of the Philippines
o when this law was submitted for signature
for President, its, however, was not acted
upon.
 under the Constitution, a bill will
become a law, if not- vetoed by the
President within 30 days from
receipt and it shall become a law as
if signed, which means- if a bill
(progenitor of a law) submitted to the
President, he has 30 days to review-
either to sign it or veto it.
 veto- return the bill into the
congress.
 if he failed to sign within 30 days, it
will lapse into law as if signed by the
President.
 CPD Law was not signed nor acted
upon.
Continuing Professional
Development
- lifelong learning- refers for learning activities
undertaken throughout life, for the development of
competencies or qualification of a professional.
- self-directed learning- refers for learning activities
such as online training, local or international
seminars, non-degree courses, institution, company
sponsored training program and the like which not
undergo CPD accreditation but maybe applied for
the awarded CPD units by the respective council.
- Nature of CPD: Mandatory Requirement
o If your delinquent and refuse to comply 
this is actionable fault, a complain may be
large for you with the PRB.
o MTB can suspend, revoke, or reprimand an
erring medical technologists.
- If your license is revoke, you cannot practice the
professional perpetually.
- If your license is suspended, for a certain period of
time, you cannot practice the profession- maximum
of suspension is two years.
- Reprimand- sternly warn; warning to comply
o If you failed to comply to a sternly warning,
serious penalty may be imposed; Suspension
or Revocation of license
CPD Credit Units
- three-year period during the validity of
Professional Identification Card (PIC) to earn credit
units.
Guidelines:
o A maximum of one (1) CO per hour of
activity may be given.
 Ex: If you attended an 8-hour seminar
or activity, you will earn eight (8) credit
unit.
o If you have an activity of four days, maximum
credit units that you can earn on that
workshop is 20 credit units.
o Professional Track- there is no distinction
whether you are medical technologist or
laboratory technician. Across the board, both
of you will earn 20 credit units.
o How many credit units required for the
renewal of PIC of: (general rule)
 MT- 45 credit units
 Laboratory technicians- 30 credit units
Ex: If you finish your master degree, you will be
given at least 45 credit units as specified course
completed.
o All certificates to be used for compliance of
CPD program must reflect CPD units.
o If your certificate does not reflect the CPD
units earned, you can return to CPD providers
do as to modify your certificate.
o What happens if a Medical Technologists
accumulated more than the required CPD
credit units?
 The excess credit units cannot be carried
over to the next compliance period.
There is no provision under the CPD Act
of 2016 and its implementing riles
allowing the excess credit units to be
carried over in the succeeding
compliance period.
Ex: You were able to earn 50 credit units. What will
happen to the five CU remaining?
o If you will renew your PRC ID in the next
compliance period- you cannot use that
excess, because our law does not provide for
the carried over rule; cannot be use for the
next compliance period.
CPD Council
- composed of chairperson and two (2) members
(under supervision of the concerned PRB)
- works and operate under the supervision of MTB
being our official PRB.
- Composition of MTB:
o Chairman- Pathologist
o Two Members: Registered Medical
Technologists
 Any of them may hold the CPD Council,
as long as they are chosen by the MTB.
- MTB- they sit as a chairperson of CPD Council
- PAMET/PASMETH- they sit as members of CPD
Council
- Term of office
o If he sits as chairman for three years,
whatever will be the remaining years of
service  when he is sitting as Chairman or
member of MTB, same term will be given to
him as chairperson of the CPD Council.
o Members (1st and 2nd)> Two (2) years
Major Areas of CPD Activities for
MT Profession
1. Ethics
2. Standards of Professional Practice
3. Enhancement of Professional Practice and
Technical Competence
4. Environmental Factors Affecting the
Profession
- these major areas of activities can earn you CPD
units.
- these major areas divided (CPD activities is
divided into four major areas to ensure a
comprehensive CPD during the compliance period)
o RMTs- 45 credit units
o MLTs- 30 credit units
This is the general rule.
- Prevailing law/rule during the transition period-
because at present we are still under the transition
period.
 o meaning ‘di pa full implementation of this
requirement
o If the question is silent, you will answer this
30 and 45 CU (w/ respect to the transition)
o If the question is that qualification during
the transition period, the answer will be
different.
PRC Resolution No. 2019-1146
series of 2019
“Transition Period”
- During the transition period, the required CPD
units shall not exceed to a minimum of or reduce to
a minimum of 15 credit units.
o instead of 45, we will comply 15 CU
- CPD will not apply to a newly admitted medical
technology practitioner.
Ex: You passed MT board exam this year and you
have to renew your license by the year 2023- when
you renew your license, you are exempted with the
CPD requirement.
o Why? Because newly licensed professionals
shall not be covered by the CPD
requirement, but the qualification is that
when the renewal falls during the transition
period.
o If the transition is on 2023- you are
exempted.
o But if it is lifted, MTB will issue another
resolution- lifting the transition period.
- In the compliance with the above mandate of the
PRC, the PRB of Medical Technology Resolution
No. 10 series of 2019, suspending the compliance of
45 credit units for RMTs and 30 credit units of
MLT for renewal of PICs during the transition
period, instead only 15 credit units.
o for Medtechs  reduced to 15
o for MLTs  reduced to 10
- Senior Citizens/Differently Abled Persons
o RMTs- 12
o MLTs- 8
 they are reduced
- If the question is very clear (requiring the number
of credit units) during the transition period 
answer is 15 RMTs and 10 MLTs
- If the question is that during the transition period
and there’s a further qualification whether that
RMTs is a senior citizen or differently abled person
 follow the last rule: 14 RMTs and 8 MLTs.
- General Rule: 45 RMTs and 30 MLTs
Nature of CPD Programs
- this refers to a set of learning activities accredited
by the CPD council such as: seminars, workshops,
technical lectures, or subject matter meetings, non-
degree training lectures and scientific meetings,
modules, even tours, and visits which a professional
with advance knowledge, skills, and values in
specialized on multidisciplinary field of study, even
in self-directed research and/or lifelong learning.
- Formal learning- refers to educational
arrangements such as curricular qualifications and
teaching learning requirements that takes place in
education and training institutions recognized by
relevant national authorities and which leads to
diploma and qualifications.
- Non-formal learning- refers to learning that has
been acquired in addition or alternatively to formal
learning which may be structured and made more
flexible according to educational and training
arrangements.
- Informal learning- refers to learning that occurs
in daily life assess through the recognition,
validation, and accreditation processes and which
can contribute to qualification.
- Online learning activities- refers to a structured
or unstructured learning activities which make use
of internet and other web based information
technology solutions.
- Professional work experience- refers to any
participation that a professional gain while working
in a specific field.
CPD Providers Classifications
1. Local CPD Provider
a. Individual/Sole Proprietor (RNT +
PIC)
b. Firm/Partnership/Corporation
c. Government Institution/Agencies
2. Foreign CPD Provider
a. Foreign Entity/Firm/Association
- The members of the PRC, as well as the chair
person, vice chairperson, and members of the PRBs
are disqualified as CPD Providers during
incumbency because of conflict of interest.
 o this prohibition shall extend to the members
of their families and relatives within four
degree of consanguinity/affinity.
o this prohibition/disqualification extends
until one (1) year f separation from the
service.
Ex: If you’re a member of PRC- include
chairperson, vice chairperson or member of PRB
for Medical Technology, you are disqualified to be
a sole proprietor because of conflict of interest.
o Even if they are retired or term of office
expires, that prohibition will extends for
another one (1) year.
Ex: 3-year term as a member of PRB ends this year
2020- you are disqualified until 2021.
o Officer of MTB  wife is also disqualified
to be a CPD Provider (extend up to fourth
degree
_ Validity of Accreditation of CPD Providers
o Valid for three (3) years, subject to
renewal.
 Professional Organizations
- An association that is formed to further the
interests of people engaged in a specific profession
to advance a particular profession and serve the
public good.
- Provides opportunities for professional growth and
continuing education.
- Sometimes referred to as “Professional
Association” or “Professional body”- to advance a
particular profession.
- Every profession has different professional
organization.
o has their own professional organizations
which supports the interests of the people
working in that profession and serve the
public good.
- Facilitates innovations, communication, and
connection.
- Typically requires member dues, elected officers,
elected leadership bodies, and it includes a range of
subcommittees or functional areas.
- Can also be national or international (local or
international)
- Often have close ties to colleges and universities
with degree programs in that particular field that
they are into.
- Many number of associations that labeled
themselves as professional organizations or body-
most of them are charitable or non-profit
organization that seek to further the importance of a
specific profession and their members.
- Main goal: provides opportunities for professional
growth and continuing education or never ending
learning of members or colleagues or co-
professionals.
Benefits of Membership in
Professional Organizations
- Professionalism (Professional Development)
o adherence to the set of the rules prescribed
by the professional society
o an advantage for employers, since adherence
to rules shapes the conduct of a professional
o Professions like nursing, medtech, engineer,
teachers- they require accredited or ongoing
education to retain their license.
 in order for us to be able to renew
our license, we need to earn CPD
units.
o In several careers, trainings, and
certification on the master of some particular
skills, they help the members to increase
their earnings.
o Often order/offer these course free if cause
or subsidized fee for their members and do
the work to establish the acceptance of
continuing education credited by the
licensing board.
o There also newsletters, journals, published
by the association to give an opportunity to
members to polished their communication
skills, and learn the advances in their field.
o Access to research materials industry
information is also the other reason behind
joining of professional organization.
o One of the perks is having professionalism
more developed.
 develop yourself as professional by
the opportunities your organization
will be giving you.
- Education
o opportunities given by professional
organizations which serve as avenue for
improving the body of knowledge of a
professional (important)
o many professional organizations, they offer
members to upgrade, refresh their
knowledge for them to acquire new skills by
workshops, seminars, conferences, and even
in online courses.
o It is important- never ending learning or
continuous learning we may acquire.
 especially when we join professional
organizations  super daming
educational opportunities na
pwedeng ibigay bawat professionals
or each members.
- Perks
o have a lot of perks
o CPD units can be acquired when a
professional attended seminars or
conferences or trainings.
 these seminars, conferences, or
trainings have admission fees
 when you are a member of
professional organization, these fees
 are sometimes waived or with the
discounted prize.
 can get CPD units with lesser costs.
o Sometimes, members often get priority
registration buffer any event held by the
organization
 offered conferences fees, special
rates on related expenses- like car
booking reservations
o discounted or free publications that can
achieve by the professional organization
o Membership to a professional group
includes free subscription to the
organizations magazines, letters, and other
publications.
o Some organizations offers members free
copies, discounts on their journals, series,
and video material that they have.
o Save money, earn units, and knowledge as
professional
- Networking (Network)
o activities conducted provide opportunities
for building networks in the field.
o creates long term linkages and connections
with other professionals.
o they are not restricted to the exchange of
business cards as we all know
 can attend periodic meetings, be an
active member of subcommittee,
take up more prominent role
o the relationship are mostly rich and going
source of an idea and inspiration are limited
when you a huge network.
- Profile
o building profile or building a resume
o helps build the career portfolio of a
professional
o Speaking engagements, career
specialization, publication, and scholarship
and training programs.
o Fresh graduates- have limited work
experience
 an organization can be a great
resume builder for these people
 if you are extremely active member
of the association- sometimes, they
can give you a chance of internship
that will earn you a valuable work
experience.
o People who are not involved in these
organizations may lack the valuable
experience in their career which be your
edge
o Through experience, a professional can learn
something
o Person who is employed- an organization
can provide its members with opportunities
to build his or her resume or profile.
o Established professionals can build resume
by obtaining leadership position or on-board
of directors committee or articles published
and the journal of the organization.
o many opportunities for you to be able to
build your profile when joining professional
organizations, can help building
professionalism.
- Recognition
o all of your hardwork- studies, research,
thesis- will be accredited or recognized by a
professional organization
o getting recognized and importing knowledge
to your colleagues, or co-professionals
Types of Organizations
1. Accrediting Organizations
a. provides a certification to its members
to show that they are in the field.
2. Credentialing/Certifying Organizations
a. they issue certifying credentials to
their members when they can meet the
set of requirements
i. for instance, for particular
professional experience or
education
b. Function: to certify/issue certifications
and keep track in member’s
achievements.
3. Professional Societies
a. establish licensing and certification
requirements and can exclude
members who do not follow the set of
procedures
b. has local and international
i. Locally Professional Societies
 PAMET, PASMETH, Biorisk
Association of the Philippines
(BRAP), Philippine Blood
Coordinating Council (PBCC),
Philippine Biosafety and
Biosecurity Association
(PhBBA)
 ii. Internationally Technology and Public Health
 ASCP, AMT, ASEAN Education to offer solutions to them.
Association for Clinical ii. Work for continuous development of
Laboratory Sciences (AACLS), Medical Technology and Public
International Society for Health Education in order that the
Clinical Laboratory profession wil be of maximum service
Technologists (ISCLT) to the country
 they follow their own country’s iii. Take a united stand on matters which
guidelines. affect the interests of Medical
Technology and Public Health
Philippine Association of Medical Education.
Technologist, Inc. (PAMET) iv. Seek the advice, aid, and assistance
from any government or private entity
for the fulfillment of the association’s
- four chapters of PAMET around the globe
aims and purposes.
- Crisanto G. Almario- “Father of PAMET”
Roster of PASMETH Presidents:
Roster of PAMET Presidents:
o Dr. Gustavo Reyes- first President who was
o Charlemagne T. Tamondong
affiliated with UST (1970-1973; 1980-1981)
 1963-1967
o Dean Bernard U. Ebuen- present President
 Emergence of the Profession
o Nardito D. Moraleta who is currently affiliated with Arellano
University (2012-present)
 1967-1970
 Professional Recognition
o Felix E. Asprer
 1970-1971, 1973-1977
 Legislative Agenda
o Bernardino T. Tabaosares
 1971-1973
 Celebration of the Profession
o Angelina R. Jose
 1973
 Career Advocacy
o Venerable C.V. Oca
 1977-1981
 Educational Enhancement

Philippine Association of Schools of

Medical Technology and Public
Health, Ind. (PASMETH)
- the membership of PASMETH is not limited to
the schools itself
o BSMT and BSMLS- institutions that are
offering these are welcome to join in this
organizations.
Parasitology
- PASMETH seal - Host: home of the parasites in order to survive
o Diamond- represents the four objectives - Ectoparasite
i. Encourage a thorough study of the o found on the skin, between the hairs
needs and problems of Medical o one that lives on the host
- Endoparasite
 o Ex: Trematode (Paragonimus Westemani)
 oriental lung fluke
 infects the lungs
 Possible specimen: sputum
o One that lives in the host
o Requires strict and more serious specimen
collection
- Eosinophils
o In parasitic infections, there is an increase in
eosinophil
 Eosinophil (WBC)
 acts as a cellular protector against
parasites
o In peripheral blood smear, you can see the
eosinophil
 pinkish cytoplasm and bilobed nucleus
o When the eosinophil degrades, it forms
charcot-leyden crystals
 red diamond shape (commonly)
 depends on the stain that was used
- Symbiosis
o Ex: Clown fish and sea anemones
 they cannot exist independently
 the sea anemones provide enough
mucus to the clown fish
 function of the mucus: protect itself and
as a lubricant
 clown fish lives within the sea
anemones; they provide nutrition to the
sea anemones
 there is a benefit from each of the two
organisms.
 has different types, it is not only about
two organisms mutually benefitting
 sometimes. there is a type wherein that
one is harmed, and one benefits
- Types
i. Commensalism
 Ex: shark and small fishes
 these small fishes are benefitting
from the shark
 the leftover of the shark will be
eaten by the small fishes
 there is a neutral reaction to the shark
(no benefit)
ii. Mutualism
 Ex: Bee and flower with pollen
 bee will take the pollen as the
food; provide nutrition to the
bee
 pollenate the flower
 there is a benefit to both
organisms
 Ex: Microorganisms that lives in the
skin of the humans
iii. Parasitism
 Ex: Organism A benefits from
Organism B, so the Organism B will be
harmed
Question:
Can viruses be called parasites?
- Yes, if they invade and harm the host
- The virus in/is benefitting and human are harmed
- Virus is an obligate (strict parasites) intracellular
parasites)
- Parasites can also be applied to the bacteria and
viruses.
- Parasitology- studies the ameba, worms, and
protozoans.
Obligatory Parasite
o the rule of the host is very vital
o it cannot move onto life
Facultative Parasite
o sometimes it can survive, sometimes it
cannot
Erratic Parasite
o Ex: worm that supposed to infecting large
intestine, but infected the brain instead
o It could happen maybe if the infection is
really severe
Accidental/Incidental Parasite
o Ex: Parasite that lives in the dog (canines)
o it may accidentally parasitize to humans
o human can be accidental host
Classifications of Hosts
1. Definitive or Final Host
a. parasite has biological property of
sexual reproduction
b. so it can reproduce
2. Intermediate Host
a. Ex: adult worm and larva
i. larva can stay inside the
intermediate host, and eventually
go to the final host, for it to be an
adult worm.
 ii. adult worm can/is capable of
sexual activities.
Portal of Entry
iii. larva is not capable of sexual
A. Mouth
maturity  via ingestion and intimate oral contact
b. There is an example of a worm that  kissing
can transfer from one small fish to a  Entamoeba gingivalis- lives in gingiva
big fish  Trichomonax tenax- transmitted via
3. Paratenic Host kissing or infected droplet (talking with
a. In the life cycle of parasite, we have each other closely)
stages, it became paratenic host. B. Skin
b. Instead of entering this stage, it will C. Intranasal
not anymore enter the stage  Fresh water lakes
c. capable of infecting other humans  when the water enters nose, there’s a
chance of having brain eating amoeba
4. Reservior Host
D. Transmammary
a. Ex: Pig (reservoir of many parasites,  Enterobius vermicularis- can be
plentiful parasites living on the pig) transferred by mammary glands
E. Transplacental
 parasite grows in placenta and enters fetus
Arthropod/Vector system
F. Soil Transmitted
i. Plasmodium spp.  can be acquired in soil
o related to mosquito  Hookworm
o causative agent of malaria  Strongyloides starcoralis
o causes the deadliest parasitic diseases i. can get this two by stepping
o prevalent in Palawan barefoot in soil
ii. can infect the gastrointestinal tract
ii. Trypanosmes
(GIT)
o related to snails

Food Borne Portal of Exit

A. Stool
- numerous parasites associated with food borne B. Urine
transmission C. Sputum
- come from the food D. Blood- transfusion, middle prick
Ascaris Lumbricoides
i. Toxoplasma gondii- stool of a cat o Embryonated egg- infective stage, morphology
ii. Paragonimus westermani- crab that can infect humans
iii. Fasciola- vegetables o Adult worm or eggs- diagnostic stage
Direct Contact o Specimen: Feces or stool (can see the eggs)

i. Trichomorias vaginalis
o transmitted by sexual contact
Specimen Collection
o causative agent of ping pong disease o Rejected if:
o easily to pass one person to another  retrieved from toilet bowl (scoop it before it
o strawberry cervix (women) enters the bowl)
 cervix will appear strawberry like  no label (mortal sin)- name, date and time of
 reddish, very tender to touch collection, birth
o men, asymptomatic o Consistency of stool
 Liquid stool- contains more trophs
ii. Enterobius vermicularis
 Formed stool- contains more cysts
o social worm o Other specimens
o pin worm  Blood- Malaria
o sit worm- can be transmitted through sitting  Cerebrospinal Fluid (CSF)- brain eating amoeba;
enters intranasally
  Tissues- pork, larva will deposit in the skeletal
muscle
 Urine- related to snails
 Eye specimens- unclean contact lenses
 Mouth scrapings- kissing

Parasite Treatment Options

o Change in diet
 trigger an unfavorable environment to the
parasite
o Bed rest (important)

Parasitic Classification
- Enterobius vermicularis
o eggs located in perianal region
o Common name:
 Pinworm- pin like appearance
 Social worm- easily transmitted in society,
in children
 Seat worm- infected by sitting on a chair
- Trichuris trichiura
o Common name:
 Whip worm- looks like whip

Quality Management
- coordinated activities to maintain the quality of the
whole organization
- defined according to ISO (International
Organization for Standardization) and CLSI
(Clinical and Laboratory Standards Institute)
- covers the whole organization (broad)
o organizational structure
o procedures
o processes
o others that includes/requires quality
management

Quality Management System Model

o Organization (whole)
o Personnel
 check if the person is qualified to be a
medical technologists or other position
o Equipment
 check what equipment are needed in
the laboratory
o Purchasing and Inventory
  check if there’s an equipment need to
buy or purchase
o Process Control
 from receiving to releasing
 Ex: In the laboratory, when you
receive sample up to releasing of the
results, chinecheck din yun, through
information
o Information Management
 information dissemination within the
laboratory  done by documents
o Documents and Records
 Collate the documents and records and
continuously reviewed time to time
o Occurrence Management
o Assessment
o Process Involvement (Improvement)
o Customer Service
 sometimes laboratory provides a box
(containing the customer response or
survey to improve performance)
o Facilities and safety
 check if there is broken things or
equipment in the laboratory to
maintain the safety
Quality Assurance
- same with quality management, but it is specific to
smaller scope
- more on documentation such as
o preparing of checklist
o project audits
o methodology
o standard development
- more on processing of documents
1. Pre-analytical
a. all of the things that the laboratory
personnel do prior to testing
2. Analytical
a. lab personnel to the actual testing
3. Post-analytical
a. lahat ng ginagawa ng medtech after
testing
Examples
a. Pre-analytical
i. Asking the name of the patient
ii. Extracting the blood
iii. Transport of specimen
b. Analytical
i. Process of specimen
c. Post-analytical
i. Releasing of results
* These three phases ensures na ginagawa siya
ng tama to ensure the reliability of test results.
ISO Certification
- Two types
1. ISO 9001
a. sets a standards of an organization, used to
demonstrate the ability to consistently
provides products and services that meet
customer and regulatory requirements
b. these standards are applicable to any
organization regardless of the size or
industry
c. more than 1 million organizations from
more than 160 countries that are
participating in this ISO 9001
2. ISO 15189
a. applicable to medical laboratories
Quality Control
- lahat ng ginagawa ng medtech to ensure that the results
release to the patients are reliable and correct
- more on the process
o kung ano yung mga ginagawa, dapat gawin to
maintain the quality in the laboratory
Two types of Patient Results:
1. Qualitative
a. give you descriptive results, such as high,
low, or normal/positive or negative
2. Quantitative
a. gives a numerical value result such as “90
ml” considered as normal but it is reported
in numerical
b. Ex: Platelet count- the release of result is
normal or it can be in numerical value-
150 platelet per microliter
Two types of Quality Control
1. Internal Quality Assurance System
a. internally checking ang ginagawa in the
laboratory
2. External Quality Assurance System
a. comparison of quality is not just within
the laboratory but comparison of quality
of one laboratory to another, with the help
of external agency.
 Internal Quality Assurance
System
(IQAS)
- ginagawa daily- every start of your shift
- Ex: Morning shift- gagawa ka ng quality control
check
- done by assaying stable control materials and
compare them to the determined values or expected
values
1. Get stable control materials or controls
a. Reagents- chemical or solution
b. Machines/Equipment- putting it here
c. Personnel
- Ex: Check CBC (Complete Blood Count)
o there are three types of control: High, Low,
or Normal control
- Ex: Platelet count
o there’s a solution- one is high, one is low
and one is normal
o the expected value is high should be read
and determined by the machine
- Purpose: To know that there’s no problem on the
reagent, machine, and personnel.
Example:
- On checking, the results are
o high  extreme high
o normal  high
o high  normal
What’s the problem?
- inulit mo siya twice
- sa twice nay un, naging okay naman siya, most
likely sa personnel ang problem (may nagawang
mali along the process)
* Finix mo siya twice after the first checking, same
results, erroneous results parin. What to do?
o Get another reagent and when you check
and okay  it is the reagent (problem)
o When with the new control, erroneous result
parin  the problem would be the machine
- Last problem would always be the machine
- Kapag tinuloy mo yung shift na mali yung control
prior to the start of the shift, it will harm patient’s
life.
o essence of day to day control checking
- All of the problems needs to addressed from the
personnel, to the reagents, and control up to the
machine and equipment, before proceeding with the
actual testing
o Manual Method
 manual testing using reagent that does
not need or require machine
 MT should know to how to use manual
testing
Two Methods:
1. Precision
a. when 1st, 2nd, and 3rd were tested, the result
that you should get is almost the same value
Ex: 1st: 1.2
2nd: 1.1
3rd: 1
4th: 1.3
2. Accuracy
a. true value; when you hit the value 
accurate
Ex: True value: 2
Result: 2 (considered as accurate)
- There’s no such thing as 100% accuracy in the
laboratory.
- It can always be precise but the accuracy will
never be 100%.
LJ Chart (Levey-Jennings Chart)
- all of the results on quality control everyday are in
the LJ Chart
- Sometimes, it varies on the control but as long as
it is close in the main value, it can be acceptable-
but there are rules.
- Ginagawa ng chart is to easily see if the control is
correct within the whole month.
o Continuously do it for the rest of the year.
Two types of Quality Control Materials:
1. Lyophilized
a. dehydrated to powder
i. this can be from liquid type
ii. control materials- kadalasan, they are
patient-like material and ideally made
from human serum, urine, or spinal
fluid.
b. Requires reconstitution
i. nadaanan ng distilled water or NSS
then shake. After, it will be liquid
form. Then, it can be used as control
material.
2. Liquid Solution
a. do not require reconstitution
 b. stabilized frozen o when they have the certificate- that’s the only time na
i. to be stable while not using, keep it in allowed sila to perform tests in drug testing
the freezer.
ii. Before using it, the solution must be Summary of NRL Performing
at room temperature
EQAS
External Quality Assurance NRL
National Kidney Transplant
EQAS
Hematology and Coagulation
System Institute
Lung Center of the Clinical Chemistry
(EQAS) Philippines
East Avenue Medical Center Drugs of Abuse
Research Institute for Microbiology and Parasitology
- all of the laboratories (from Luzon, Visayas, Mindanao) can Tropical Medicine
be participant of EQAS San Lazaro Hospital Infectious Immunology
- through the means of Proficiency Testing -STD/AIDS Cooperative (Hepatitis and HIV)
- designated by an external agency Central Laboratory
o National Reference Laboratory (NRL)
 assigned by DOH
 applicable to all laboratories in the Ph
- it is done yearly. Cycle of Clinical Laboratory
Examples: Testing
o NKTI (National Kidney Transplant Institute)
 NRL for hematology Three Phases/Parts:
 Hematology- CBC 1. Pre-analytical
 NKTI will perform proficiency a. first step to the laboratory process na gagawin
testing to all of the laboratories that sa patient sample
performs CBC
i. Patient information
1. Magpapadala ng unknown sample sa Lab A, B, C, a. most important
and so on across the Ph (all of the lab performs CBC) b. in clinical chemistry topics, there are various
2. Yung makakareceive the unknown sample, they will samples or tests that should require patient
test that using their own reagent, machine with their preparation
own hard employees
a. expected that all of the internal quality
 Ex: FBS (Fasting blood sugar)
control are intact and okay to release good o In this particular test, we are going to test and
results. analyze the concentration of the patient under
b. It is an interaction of internal and external fasting state.
quality control. c. before conducting sample, nabigyan na dapat ang
3. After testing the sample and releases the result, briefing ang patient about these tests before
ipapadala yun sa NKTI and check if the result is getting the sample.
correct. d. Fasting requirement
 8 hours before getting the blood sample
- The unknown sample is already pre-tested ng NKTI, so they
e. Other laboratory test in clinical chemistry that
already know the actual value.
o So, dapat the results is near to the value for them to
requires fasting:
give them certification ng certifies na they perform  Lipid profile: Time required: 10-12 hours
well yung laboratory nay un.  FBS and Lipid Profile: Time required: exactly
- If the laboratory passed, they will continue the license to 10 hours
operate, but if there are some issues, it will depend on the  Ex: 24-hour urine sample
rules of NRL kung ano gagawin. o brief the patient
- Not all laboratories can perform drug testing o Note the time kung kelan siya uminom
o Dapat nakapagsubmit sila ng requirements sa East o Collect the urine starting 12 mn. into the big
Ave. and pass the proficiency test before performing container
drug testing
o store it to the refrigerator
- Not all medical technologists are allowed to perform drug
testing f. Patient is involved
o kailangan makapasa for them to have certificate as
ii. Patient Information
drug analyst.
a. very critical
 b. golden rule
c. always ask the patient’s name
d. common mistakes: not indicating suffixes (Jr.,
Sr.,...)
e. Name, Age, Birthday, Gender, Room Number
(Important details)
f. Label should be parallel to requisition form
iii. Sample Collection
a. involvement of Medical Technologists
b. kapag mali ang sample collection, mali and hindi
mapprocess ang sample
c. we are not accepting hemolyzed blood sample
 hemolyzed- reject, repeat collection
 has different collection
2. Analytical
a. process of sample in the laboratory
b. depend on the physician’s request
i. Machine Operation
a. handle of medical technologist to the machines
b. some problems occur on the blood sample of the
patient
c. skill developed: know to troubleshoot because
there’s no manual
 diskarte ang kailangan
 know to analyze the machine
d. there are various protocol need to follow
e. need to analyze
f. know to observe the sample more
ii. Sample Variability
3. Post-analytical
a. releasing of laboratory results
 to know if the machine is working
properly
 quality control every shift or
everyday
 to maintain proper function of the
machine
 all of the results for quality control
should be logged
- Quality Assurance
o compare lab results of the Lab 1 to Lab 2-
should have the same results
o NRL (National Reference Laboratory)
 to maintain the overall quality of all
of the laboratory
 6 hospitals na nagmamaintain ng
quality assurance of the quality of
the laboratory
Example:
o RITM
o Microsection
o Magsesend ng unknwn microbes sa lab na
merong microbiology section
 unknown microbes which the
laboratories in the Philippines will
identify
 then give to NRL the results
 the results that will be detected
should be correct and inclined to the
list in NRL
o compare the results sa ibang laboratories to
maintain the quality

i. Errors in releasing of results

a. Typographical error of names- because of
many samples in the laboratory
b. Delayed releasing on results
* Three
phases occur per section
o iba iba ang protocol, policies, rules per
section

Quality Assurance and Quality

Control
- laging magkasama
- Quality Control
o In the laboratory, we need to perform quality
control testing every single day
 Microbiology
Cell Wall
- Gram Positive Cell Wall
o it has a thick peptidoglycan layer (green)
that consists of the glycan chains of
alternating N-acetylglucosamine and N-
acetylmuramic acid
o it has teichoic acid which is negative charge
(-) and penicillin acts by preventing
peptidoglycan synthesis
o has fibrilla and protein F
o has lipoteichoic acid or teichoic acid (-)
- Gram Negative Cell Wall
o thin peptidoglycan layer
o outer membrane: has lipopolysaccharides
and lipid A.
o inner membrane of the gram negative cell
wall is the same with the gram positive cell
wall (cell membrane)
- Gram Positive Bacteria (observed under oil
immersion), which appears purple
- Gram Negative Bacteria (observed under oil
immersion), which appears to be pink
* Purple- Gram positive (+)
* Pink- Gram negative (-); through its color
- Acid Fast Stain
o used to stain bacteria that have high lipid
and wax content in their cell walls and do
not stain well with traditional bacterial
cell/stains
o There are two methods
1. Ziehl nelseen method (Hot stain
procedure)
 need ng carbol fucshin
(primary dye)
 steam the stain or the slide
 use decolorizer which is the
acid alcohol
 counter-stain with methylene
blue/malachite green
2. Kinyoun Method (Cold method)
 the defense is that in this
method, we don’t need to do
 steaming of the slide, or use
heat to do the procedure
 use the primary dye, the carbol
fucshin
 put tergitol instead of steaming
it
 decolorizer, acid alcohol
 counter-stain with methylene
blue/malachite green
What will be the result if acid fast or if it is a non-
acid fast?
o after applying the counter-stain, acid-fast-
positive-bacilli will remain red, while
negative bacilli will remain blue
Procedure:
1. If the cells is on the slide reheat the slide
para di siya mawash out
2. We will put the primary stain (carbol
fucshin)
a. acid-fast-megative and positive will
stain red, because color red is carbol
fucshin
3. Add decolorizer or the acid alcohol
a. acid-fast-bacteria (positive) will
remain red
b. non-acid-fast (negative) bacteria will
become colorless because the color
will be washed out, because it is a non-
acid-fast
4. After adding decolorizer, we will add the
counter-stain (commonly used is the
methylene blue)
a. acid-fast-bacterias (positive) will
remain red
b. non-acid-fast (negative) bacteria will
have the color of the counterstain
which is blue
- We will know if the bacteria is an acid fast or non-
acid-fast
o If the bacteria under the microscope will be
seen red after the stain, it is an acid fast
o If it is blue, it is a non-acid-fast.
Cell Nucleoid
- dito nangyayari yung transcription and replication
of the DNA.
- Within the nucleoid, we can expect to find some
enzymes that serves as a biological catalyst and help
with replication, as well as other proteins- have
other functional instructional rules including sa pag-
aassist ng formation of the DNA, facilitate the cell
growth and regulate genetic material of the cells.
Cytoplasmic Membrane
- serves to help support the cell to help maintain its
shape
Cell Endospore
- kapag yung bacterial cell mababa na sa food or it
is low on food, it will make an endospore, so it can
survive until there is more food available in the
environment
- contain all of the important parts of the bacteria
cells (DNA)
- dormant, tough structure made by bacteria for
survival purposes
- has important parts (DNA) in order for them to
survive
- has tough coating which is resistant to radiations
(X-rays, UV lights, chemicals) to ensure the
survival of the cell itself)
- Resting cell, highly resistant composed mainly of
calcium dipicolinate
Cell Capsule
- when we stain this encapsulated bacterium with
india ink, bacteria capsules appeared as a bright
halo around the cells, in the dark background
Cell Flagella
- Three parts:
a. Basal Body
 helical body
 Functions
i. performs in helping the organism
in movement
ii. act as sensory organs to detect
temperatures ad pH changes
iii. few eukaryotes used flagellum to
increase reproduction rates
iv. flagella are used in secretory
organelle (Ex: chlamydomonas)
v. Main function of flagella: help
organism to movement or for
motility
vi. Different types:
1. Atrichous
2. Monotrichous
3. Amphitrichous
 4. Lophotrichous
Monotrichous
- single flagellum at one end or another
- “Polar flagellum”
- can also rotate clockwise or anticlockwise
- one side
Amphitrichous
- single flagellum on both ends of organism
- it is like polar but it has flagellum on the other end
- lnown also as “Polar flagellum” and can rotate
clockwise and anticlockwise
- both sides
Lophotrichous
- several flagella at one end of organism or another
- it is like amphitrichous but on other side, it has
several flagella
b. Hook- where the filament is attached
c. Filament- tail
Factors Affecting Bacterial
Growth Factor
1. Nutrition Concentration
a. will always be a factor in contributing to
bacterial growth
b. bacteria grows in a culture media
c. if culture media is reached in growth
promoting substance or substance that can
promote growth, or for the bacteria to grow
faster, mas magiging mabilis yung pagdami
o pagbuo ng bacteria
d. Decreased in nutrient concentration, also
decreased the nutrient rate
e. Maraming nutrient concentration, the faster
the bacteria will grow, and vice versa
f. different bacteria have different nutritional
requirement
i. iba’t iba ang culture media ang
kailangan in order for bacterias to
grow
g. with increase nutrition concentration,
growth rate of the bacteria increases up to a
certain level
h. growth rate remains constant in respective
of nutrition addition
i. directly proportional to bacterial growth
2. Temperature
a. affects the growth of bacteria in various
ways
b. lowest temperature that allows the growth
is called maximum temperature
c. There is no growth below minimum and above
maximum temperature (it should be in the center)
d. Below minimum temperature, cell membrane
solidifies (stiff) to transport nutrients into the cell 
No growth occurs
e. Above maximum temperature, the cellular proteins
and the enzymes, they denature; nasisira sila 
bacterial growth ceases. No growth occurs.
f. When the temperature increases continuously from
its minimum, growth rate of bacteria increases
because the rate of metabolic reaction also increases
with increase of temperature
g. directly proportional to the growth of the bacteria
h. A further increasing, the temperature above optimal,
growth rate decreases abruptly, and complete
diseases within reaching maximum temperature
i. has optimal limit
i. if reach, mabilis maggrow ang bacteria
ii. if above the optimal, babagal ang growth of
the bacteria (higher chance)
3. Gaseous Concentration
a. gaseous requirement for bacteria that also affects the
growth of the bacteria
b. O and CO2- important gases that affects bacterial
growth
c. Oxygen is required for aerobic respiration and
obligate aerobic bacteria
i. Ex: Mycobacterium and Bacillus
d. For obligate anaerobe, oxygen is harmful or
sometimes lethal
e. Facultative anaerobe can tolerate low concentration
of oxygen
i. anaerobe- they don’t require oxygen for
growth
f. CO2 is needed for caphophilic bacteria
i. Ex: Campylobacter and Helicobacter pylori
4. pH
a. affects the ionic properties of bacterial cell
b. most of the bacteria that grow at neutral pH- 6.5 to
7.5
c. there are certain bacteria that can grow at best at
acidic or basic pH depending on the characteristic of
a bacteria, or required component of pH itself.
5. Ions and Salt Concentration
a. all bacteria, they require metal ion (K, Ca, Mg, Fe,
Zn, Cu) to synthesize enzymes and proteins
b. Most bacteria don’t require sodium chloride in
media (they can’t tolerate very low concentration of
salt)
c. There is some halophilic bacteria, such as
archaebacterial that require high concentration of
salt and gas in its media (depends on the
characteristic of the bacteria)
d. Most bacteria require iron for them to grow and
synthesize enzyme and proteins
6. Available Water
a. most essential factor for bacterial growth
 b. in the culture media, it determines the rate of o Stimulates blood cell production
metabolic and physiological activities of the bacteria
o Maintains optimal iron levels
c. sugars, salts, and other substances are dissolved in
water and made available for bacteria - Not all can donate blood
d. it is important that the media has suitable amount of - Set of criteria- strictly followed
water or moisture, in order the bacteria to grow o Weight
e. Water is essential factor for bacterial growtj o Hemoglobin level
o Hepa B screening
Culture Media o HIV screening
- Ask in an interview before donation by medical
- All organisms cannot grow in the single culture officer in the area
medium - Donate blood only every three months
o many can’t grow in any known single
culture medium
- Bacterial Culture Media can be classified on
Blood Components in Blood Bag
different basis like basing on dispensing,
- Blood was not centrifuged
consistency, and purpose.
- Left standing at refrigerator
o the components slightly separate but not
Gram Positive Cocci whole separate, there will be some floating
Staphylococcus of disease maybe in the part of the plasma
- Blood did not clot, because of the presence of
- Colonial characteristics: anticoagulant
o medium to large - Blood bag  blood doesn’t coagulate because
o round smooth there is an anticoagulant
o entire o The plasma will separate from the blood
o translucent solid components (RBC, WBC) except
o creamy platelets—will stay in the plasma
- Method of separating the plasma from the blood
o mostly pigmented yellow
o When you push the lever, the plasma will be
o Beta hemolytic
drained into the separate satellite bag
- Catalase Test
 will be filled of the plasma coming
o catalase negative or positive
from the potion
o ability of organism to breakdown H 2O2 into  RBC
O2 and H2O
- Microdase Test
o “Modified oxidase test”
o Tetramethylparaphenylenediaminedihydroch
loride with dimethyl sulfoxide (reagent)
o Oxidase negative - The appearance of blood in tube when centrifuged
is similar in blood banking.
- Whatever is the component of the blood in the test
tube is also the same with that in the blood bag
Immunohematology and Blood o but buffy cannot be seen because it is not
centrifuged
Banking
- Benefits of Blood Donation ABO Blood Group System
o Promotes of Weight Loss
o Reduces blood cholesterol - Red blood cells, particularly in the ABO Blood
o Maintains healthy heart group system, at the surface of the RBCs
o Improves emotional well-being membrane, we can see there the A antigen, B
antigen
 o When your blood type is A, your red blood
cells will contain only the A-antigen, on the
surface
o Blood type B  cell membrane or red cell
membrane will only contain B antigen
o Both are present (Blood Type AB) because
both antigens A and B are present
o Both Antigen A and B are missing= Blood
Group O
Antigen
- any debris or life form that is capable of inducing
antibody production in an immune host
o antibody: purpose is to help eliminate the
antigen
- One of the role of our immune system is to
recognize self from non-self
- One of the functions of immunology
o discriminate between the self from non-self
or yourself from the foreign. A antigen and
B antigen are “self”
 immune system recognizes your own
antigen and will not overreact
(identify the self from non-self)
- The immune system is able to discriminate, so it
reacts only to foreign antigens
ABO Grouping: Direct/Forward
- determining the antigens on red cell membrane
- Group A:
o antigen present: A antigen
o antibodies in plasma: Antibody B (Anti-B);
lack B antigen
- Group B:
o antigen present: B antigen
o antibodies in plasma: Antibody A (Anti-A)
- Group AB:
o antigen present: A/B antigen (combined
separately)
o antibodies in plasma: None- no antibody
(because you possess both antigen)
- Group O:
o antigen is absent
o absence of A and B antigen
o antibodies in plasma: Antibody A and B
How do we know if we have A and B antigens?
o use of antibodies
if they are reagent, they are
commonly called the antisera
o Antisera: preparations of immunoglobulins
(antibodies) that react against the A and B
antigens
- In the concepts of immunology and serology, for
you to detect antigen, use antibody for you to
determine the presence or absence of A and B
antigen
- To determine the presence of antigens, make use
of immunoglobulins (antibodies); if reagent, they
are called antisera (Principle of ABO Direct
Forward Grouping)
Antibody
- protein (immunoglobulin) that is produced by the
immune system (plasma cells) to counteract an
antigen in a neutralizing fashion
If I am blood type A, do I have antibody against the
A antigen?
o No
o You will only have antibody against the
blood type you don’t have
o You only have antibodies against the ABO
antigen that is not present  only applies on
ABO group
 Blood Type A – A antigen
Lack: B antigen (will produce
antibody against B antigen)
o Blood Type A person will produce Antibody
B (Anti B)
Reagent: Antisera
- used in ABO Direct/Forward Grouping
- Anti-A is blue in color
o Anti-A Antisera: Blue
- Anti-B Antisera is yellow in color
- By chance you transfused the wrong blood to the
person, the person will become intoxicated with the
blood.
o Group A, then you will transfuse with Group
B, antibody B will react to the B antigen.
Then, the red cell membrane will become
ruptured
 content of red cell membrane will be
released
 free hemoglobin (RBC contains
hemoglobin)
  when enters the plasma, it
intoxicates the nearby cells.
Because free hemoglobin is
oxidizing substance, very
oxidative (damage the nearby
cells)
 You can kill a patient if transfuse the
wrong blood type
Ex: Group O- transfused blood Group B
o has antibody B
 B antigen will react to the Antibody
B of Group O person, Then, the red
cell membrane will become
disrupted. The contents of red cell
membrane intoxicate the system of
the blood.
Sample:
o ABO Grouping: Direct/Forward Grouping
 What is our sample?
 Blood (Red Blood Cell Antigen)-
accurate of centrifuged and
collect RBCs
 What is the reagent?
 Antisera (Anti-A and Anti-B)-
attack the antigen
 Ex: Antisera contains Anti-A (blue)-
Anti-A will react in the red blood
cells if it reacted and blood
aggregated and/or coagulated. What
will happen?
 There will be a reaction
 Principle: Direct Agglutination-
because the particle contains antigen,
naturally attach to the particle
- Because the Antibodies in the Antisera reagent,
Anti-A reacted to antigens- naturally present in the
Group A RBC
o B- Anti-B
o AB- Both Anti-A and Anti-B
ABO Direct Testing in Slide
Testing
- ABO can be done in the slide or in test tube
- slide contains blood sample and reagents
- don’t mix the blood samples in one slide
- Reagents: (Direct Testing)
o Blue Reagent: Anti-A Antisera
o Yellow Reagent: Anti-B Antisera
- Samples: Whole blood/Red Blood Cells
o Use antisera for two drops-blood bank
(antisera) whole blood/RBC- one drop
 1:2= one whole blood/RBC is to 2
antiserum
o Anti-A and Whole blood- Positive
o There will be agglutination if the clumping
is visible. The RBCs are clumped, together.
o Anti-B & whole blood- homogenous
mixture (no clumping, smooth)
 Anti-B and Whole blood= No
reaction, Negative
- If it reacted in Anti-A and did not react in Anti-B,
what is the blood type?
o Blood Group A
- Anti-A reagent, the whole blood/RBS did not
react, it is homogenous solution
- Anti-B, it reacted, there was agglutination,
clumping.
o Results: Blood Group B (because it reacted
only in Anti-B)
- If the whole blood/RBC reacted to both Anti-A
and Anti-b reagent,
o Blood group AB (because it reacted or
agglutinated in both Anti-A and Anti-B)
- There was no reaction to RBC with Anti-A and
Anti-B.
o Blood Group O.
Principle (Direct Testing): Direct Agglutination
o Because the whole blood/RBC contains
already antigens
ABO Serum Typing: Indirect,
Reverse, or Backward Typing
- How do I know I have either Antibody A (Anti-A)
or Antibody B (Anti-B)?
o Why do we have antibodies? the antibody
produces only with the presence of
antigen
o ABO antibodies are naturally produced
 Anti-A and Anti-B- naturally
occurring antibodies (even without
exposure, these antibodies will be
produced by our bodies)
o When are they produced?
 at birth- only perform direct typing
(ABO forward)
 naturally produced at birth (produced
low; cannot perform serum typing)
  wait for the antibody to
increase after 3-6 months
 antibody is sufficient, for
serum typing
Serum Typing (Indirect, Reverse, or Backward)
- Sample: Serum or plasma (antibodies)
o because it is in the serum or plasma that the
antibodies were located
- Reagent: RBCs (known A and B)
o may contain A and B antigens
- Blood Group A
o Anti-B will only react to reagent known B
o Like confirming that your group is A-group
because antibody against B cells
 Purpose (serum testing): confirming
Group-A- Forward Typing
o Anti-B will not react in A1
 for B cells
 agglutination was present in B cell
Anti-B combination
- Blood Group B
o Principle: Antibody against the antigen, we
are lacking in ABO
o Antigen (lacking): Anti-A
 react with A1 cells; it will
agglutinate
 not react with B cell; no
agglutination
- Blood Group AB
o Antigen (lacking): None (No Anti-A or
Anti-B present)
 no reaction
 negative in A1 and B cell
- Blood Group O
o Antigen (lacking): Anti-A and Anti-B
 react with A1 cells- positive
 react with B cells- positive
- Purpose: Confirm the Result of the Forward
Typing
ABO Reverse Testing in Slide
Testing
- Reagents: Known-A (A-antigen) and Known- B
(B-antigen)
- Samples: Plasma/Serum
1. Drop serum/plasma on the slides
a. 1 antigen: 2 antibody
b. 1 drop of antigen: 2 drops of serum
2. Plasma reacted to known B; has
agglutination (has anti-A)
3. Plasma/Serum did not react in the Known-B,
no anti-B
- Blood Group B (Anti-B is absent, Anti-A is
present)
1. Plasma/Serum did not react with Known A
 plasm/serum does not contain anti-a
2. There was an agglutination with known B
 has anti-B
-Blood Group A
1. Plasma/Serum reacted to both known A and
known B  has anti-A and anti-B
- Blood Group O
1. Plasma/Serum did not have reaction with
both known A and known B
a. has neither Anti-A nor Anti-B
b. no antibodies
- Blood Group AB (does not have A and B
antibodies)
ABO in Transfusion
Medicine
- Before we donate blood,
o the blood must be processed
o must be screened for possible diseases
o could also be separated into different
components (plasma, RBC)
- The Immunology Reactions in Recipients
o antibodies present
o possible immunologic reactions that may
occur when transfused the blood from donor
to recipient
- “O” Recipient (AB donor- A and B antigen)
o has anti-A and anti-B
o If RBC of O will be transfused to recipient
“O”- antigen concerned: No antigen
o A donor: no antigen B but has antigen A
o B donor: B antigen
Rh Blood Group System
- Why are the positives and negatives: A+, A-, B+,
B-, O+, O-, AB+, AB-?
o connote or denote the presence or absence of
the Rh Blood Group
- In ABO- Anti-A antigen and B antigen
- In Rh Blood Group- D, C, E, c, and e
- If D is present, c and E are present, will they react
to the anti-D reagent? Yes, because of the presence
of D
- If D is absent, but C, E, c are present? No, it will
not react.
- No reaction to both Anti-A and Anti-B meaning
the ABO is blood group O (Because antigen A and
B are missing)
- D or Rh
o has clump
o agglutination
o positive
 O+
- Anti-A and Anti-B
o has agglutination
 AB-
- D or Rh
o reaction is negative
o no clumping
o no agglutination
 dhhd

Blood Typing
- includes the ABO and Rh Blood Group System
- A- is not compatible with A+
- B+ is not compatible with B-
- changes compatibility system
- the compatibility will become altered (if ABO will
apply to Rh Blood Group system)
o Anti- A serum
o Anti B serum
o Anti Rh (D) serum
 all are included in blood typing

Histopathology
(Anatomic Pathology)
- Section of the laboratory that deals with the
normal and abnormal morphological features of
tissues and cells.
- Sample: organs; harvested from patients-dead or
alive
- Source of specimen:
o Autopsy
 conducted to determine the cause of
the death of a certain individual
 forensic investigations (unsure of
how victim were killed)
 conducted by the doctors
 MT- getting samples and process it
so that the pathologist can determine
the abnormalities on the organ
o Biopsy
 from the living patient
 getting from the living patient tissues
to check if the patient is abnormal
- Histopathology comes from dead individual
through autopsy or from live individual through
biopsy.
- Histopathology
o “His”- tissue
o “disease”- disease
o “logy”- study
o “study of diseased tissues”
o to determine cause of death of the patients
Techniques in getting samples
- FNAB (Fine Needle aspirate)
o commonly encountered on the suspected
nodules on the neck of the patient
o nodules (hard)
 use of ultrasound, inject syringe on
the suspected nodule and aspirate the
nodule, and will deliver to the
laboratory
o samples are not solid, but semi-solid,
sometimes liquid (cyst)
- Paps smear
o technique used to determine the female has
cervical cancer or none
o conducted by a doctor
o How?
 use of speculum, sometimes to open
the vagina, and with the use of swab,
get the sample from the cervix
 swab it into the slide and putted stain
by the histopathologist
 stain: papanicolaou stain (paps
smear)
o Assesses epithelial cells, tissues if they
abnormal or normal
- Frozen section (cryostat)
o special technique
o tissue collection, commonly encountered
during operations
 patients are in the OR, nakabukas pa
yung katawan and the abnormal
tissue will be transferred into the
laboratory and iffreeze (fresh)
 chemical that will automatically
frozed the tissue
o within 30 mins, pathologist should have the
reading
- Immunohisto-chemistry
o special technique
o histo-tissue
 find chemical substances that the
tissue produces with the help of
immunological procedure
o There is an interaction of antigen and
antibody.
Procedure:
o Numbering of tissue samples
o Fixation using fixa tools (fixative tools)
 if not fix yung tissue, nabubulok
yung cells
o Dehydration
 dehydrate the tissue
 removing the water pattern (kasi
malalamog yung tissue)
o Infiltration
o Embedding
 wax sa loob ng tissues, cells (to
stabilze the structure)
o Trimming
o Sectioning
o Staining
o Mounting
o Labelling

Clinical Microscopy
- section in the laboratory wherein we use instrument
such as microscope to observe different appearance of
cells that is present in various bodily fluids
- Samples in this section: Urine
- Section in the clinical laboratory that performs
urinalysis and fecalysis
o Urinalysis- analysis of physical, chemical, and
microscopic properties of urine
o Fecalysis- analysis of physical and microscopic
properties of stool
Urinalysis
- analysis of urine sample
- Specimen Collection:
o Container should be clean, wide mouth, and
screw capped (secured and recommended)
o Mid-stream clean catch, suprapubic aspirate,
catheterized, 24-hour urine (different types)
- This is important kasi kapag mali ang specimen
collection, mali ang mababasa, release of the
results, and the diagnosis of the doctor
- There are various types of urine sample that can
encounter on the laboratory (physician’s request)
- Specimen handling:
o Must be analyzed within two hours of
collection
1. Mid-stream Catch
a. meaning iccatch mo yung midstream ng
urine sample from the patient
b. the 2nd voided urine yung kukunin
c. middle urine
i. why? the first voided urine:
epithelial cells, bacteria, and other
contaminants present in the genitalia
ii. the end voided urine: wala na
makukuha significant microscopic
d. how much? (for routine urinalysis)
i. ideally: 15-20 ml or urine sample
(half of the container)
ii. min. 5 ml
2. Suprapubic Aspirate
a. surgeon- tutusukin yung abdominal area
hanggang umabot sa urinary bladder and
then it will aspirate the urine sample (in
special cases of infection of urinary bladder
or culture and sensitivity)
b. culture and sensitivity- dun ginagamit ang
suprapubic aspirate to determine if there is
urinary bladder infection
3. Catheterized
a. from catheter or tubing on the genitalia or
urether of the patient
b. prone to contamination  because the
urine is exposed to the urine bag to
different contaminants
c. note that is from “catheterized urine
sample”
4. 24-hour Urine
a. urine sample that was collected for 24
hours
b. Example: 24-hour urine sample for urine
creatinine clearance determination
i. Patient will drink water and note the
time
ii. The patient will start collecting urine
12 mn.
iii. the urine will be collected with
gallon
c. Put in the refrigerator the urine sample
(collected within 24-hour period)
Three Phases of Laboratory
Urine Examination
- Physical Properties: color, odor (not reported),
turbidity, volume
1. Color
a. yellow, light yellow. anber, red,
brown
b. sometimes it can be green, blue
2. Odor
a. insignificant but will give a clue as
to what disease has of the patient
b. Ex: old socks, pungent odor, cabbage
odor (signifies metabolic disorders
associated with kidney)
3. Turbidity
a. transparence of the urine
b. clear, cloudy, turbid
c. check it with printed background
(kapag nababasa, clear)
4. Volume
a. tansya, not reported
 b. tinatansya kung gaano karami
naibigay ng patient ng urine sample.
except 24-hour urine sample
c. why?
i. we need to measure exact
volume of urine sample
ii. 24-hour urine need to report on
the exact amount or urine
volume
d. yung ibang urine sample- kahit hindi
na exact volume (24-hour, need
exact volume)
o Label
o Pag hindi nagmatch yung information on the
paper and the specimen bottle
o check the label
- Chemical Properties: pH, specific gravity, sugar,
proteins, ketones, blood, leukocyte, esterase, nitrite
o urine strip- dip the strip on the urine, and
then hihilain and compare it on the chart ng
lalagyan ng strip
1. pH
a. normal pH of the urine: acidic
b. pag naging alkaline, it is okay but if
naging pH 9 or 8
i. why? most likely panis na yung
urine and reject and need a
repetition for collection
c. range of 4-7 pH
2. specific gravity
a. normal S.G of urine: from 1.005 to
1.020
b. 1.020- kapag marami yung
constituent ng urine
c. kapag masyado maraming
constituent of urine, the specific
gravity ay mataas
d. Range: 1.010
3. Sugar
a. Normal X urine
b. sugar is not normal in urine
c. sugar will excrete from the body
through the urine
d. blood sugar will increase
i. defense mechanism of the body
will be excreting it on the urine
e. Diabetes Mellitus
i. type of metabolic disorder
wherein the insulin is not
functioning well
ii. no insulin, blood sugar will
increase
4. Proteins
a. it is not normal when protein is in the
urine
b. no protein should be on the urine
c. Proteins  large molecules
d. Kapag lumabas protein sa urine,
nasira yung part ng kidney
e. Kidney damage
f. no protein on the urine
5. Ketones
a. related to Diabetes Mellitus
b. Kapag may ketones sa urine sample,
chances are either state of starvation
or diabetes mellitus
i. magpartner yung urinalysis and
clinical chemistry (the results in
the urinalysis should be parallel
with the results of clinical
chemistry)
6. Blood
a. Not normal when blood is in the
urine
b. If meron, most likely kidney
infection or urinary tract infection
(UTI)
7. Esterase Relations associated with urinary
8. Nitrite tract infection
Procedure:
1. Drip the urine strip
2. Compare on the chart
3. Record it on the lab reports
4. The urine that is in the test tube, put it in
the centrifuge
5. Centrifuge it for five minutes (to settle the
sediments)
6. Get the sediments and put it in the glass
slide and view under microscope, to
observe the presence of RBC, WBC,
crystals, casts, parasites, etc..
- Microscopic Properties: RBC, WBC, crystals,
casts, parasites. etc..
o 10x objective- casts; 40x for cells
o Find under the microscope
o Kung ano ang makita sa microscope, yun
lang ang irereport
1. Check the label
 a. if parallel yung label ng specimen to
the requisition form; if not, reject
2. Observe the physical properties of urine
a. color
b. turbidity
c. volume
d. odor (clue)
3. Check the chemical properties of urine
a. pH
b. specific gravity
c. sugar
d. protein
e. glucose
f. esterase
g. RBC
h. nitrite
4. Microscopic properties of urine
a. centrifuge for 5 mins (test tubes)
b. get the sediments
c. put in the slides
d. view it under the microscope
e. low power; zoom-in- High power
f. don’t use oil immersion
- Function (Urinalysis):
o To diagnose the cause of UTI (urinary tract
infection)
o To assess the overall renal function
 assess- urinary tract of the patient
 renal function0 parallel to the result
of the clinical chemistry
Fecalysis
- feces or stool sample
- Physical Properties: Color, consistency
1. Color
a. range to brown to black
b. brown, light brown, black, yellow,
green, yellowish brown
2. Consistency
a. using wooden stick of the laboratory,
and touch the stool sample
b. Commonly encountered
consistency: it can be formed kapag
matigas yung feces, malambot
- Microscopic Properties: Eggs of parasites, RBC,
WBC
o the wooden stick used, put the stool on the
glass slide
o drop a saline solution and iodine solution
o Possible Things can see in the microscope:
 amoeba
 nematode eggs
 WBC
 RBC
o No reports of bacteria, unless of the age of
the patient is miomate, bagong panganak ng
sanggol, and bacteria on stool, meaning may
sakit sa tyan or infection on the digestive
tract
o Bacteria is not significant on the other age
group
o Parasites, RBC, WBC, Yeast cell (reports)
- Function (Fecalysis):
o To diagnose the cause of the gastrointestinal
(GI) infection or gastrointestinal
abnormalities
o To assess the problem on the digestive tract
of the patient
Other Bodily Fluids
1. Cerebrospinal Fluid
a. can be seen on cerebrospinal
b. brain and spinal cord/column
2. Lumbar Puncture
a. collection of cerebrospinal fluid
3. Amniotic Fluid
a. pregnant women, this can be found on
their womb
- Specimen Collection: Cerebrospinal fluid
(collected by lumbar puncture)
Biorisk Management
of Biosafety
o Keep BAD BUGS from people 
protecting people
o containment principles
o technologies and practices implemented
 to prevent unintentional exposure to
pathogens and toxins
 unintentional release
 o focuses more on the unintentional harm or
injury that can be inflicted upon the different
stakeholders involved (laboratorians,
environment, people in the community)
Aims:
1. Reduce theft, loss or misuse of
valuable/dangerous biological or chemical
material biosecurity
a. not only refers to microorganisms
b. can also be hazards
i. Ex: Chemical hazards,
chemicals using in laboratory,
chemical can cause harm
Biosecurity
o keep BAD PEOPLE away from bad bugs
(with intentional motives)  protecting
microorganisms
 those are capable inflicting serious
harm or injury; can be used as part
of bioterrorism
o institutional and personal security measures
 designed  prevent loss, theft,
misuse, diversion, or intentional
release of pathogens and toxins
 focuses more on the intentional
aspect of the injury or inflicting
injury or harm to the environment,
people, and laboratorian – anyone
involved.
Five Pillars:
1. Facility security
a. how secure is the facility? how is it
protected? can everyone else can
enter?
2. Personnel Reliability
a. refers to those persons are clean in
record- person that you must hire are
those who have clear records of
crimes
b. other hospitals; required that an
applicant have/his own NBI
clearance (sure that person has no
ulterior motive)
3. Information Security
a. stringent is the security of the
information in the laboratory
i. e.g. result of the patients,
inventory, content of the
laboratory
b. how secure is are these information?
locked in a program? freely
accessible by anyone else? (focused
more in information security)
4. Transportation Security
a. samples or other documents
i. can be transported in one
facility to another
ii. that action, how secure is
that? how secure can we
transfer one item to another
facility?
iii. is it really secure?
5. Material Accountability
Bioterrorism
- a biological attack
- intentional release of viruses, bacteria, or other
germs
o sicken or kill people, livestock, or crops
- Ex: Amerithrax or Anthrax
 mail
 contains a letter
 words
 concern: content other than this
letter (hidden content that cannot
be seen in naked eye)
 content is anthrax spores or
bacillus anthracis spores
o can thrive in environment
where is dry, humid
o capable of infecting the
recipient of the mail
o inhaled
Biorisk
- risk associated with biological toxins or infectious
agents
- Sources:
1. Unintentional Exposure
2. Unauthorized Access
3. Accidental Release
4. Loss
5. Theft, misuse, or diversion
6. Intentional unauthorized release of
biohazards
a. involved in biological toxins or
infectious agents
 Biorisk Management sharp hazard
 collecting blood
 glassware hazard
- integration of biosafety and biosecurity to manage  using different glassware
risks when working with biological toxins and  chemical hazard
infectious agents.  reagents
o combination of biosafety and biosecurity-  laser radiation hazard
lead development of biorisk management  fire hazard
- system or process to control safety and security  biohazard- most important
risks associated with handling or storage and (microorganism)
disposal of biological agents and toxins in o these examples are capable of inflicting
laboratories and facilities harm to any party in the laboratories
- Both (Biosafety and biosecurity) work hand in  can harm laboratorian, patient, client,
hand or both work synergy, they may raise admin
1. raise the risk awareness
2. there may be implementation of graded
levels of protection-based on risk Risk
management
3. registration of biological agents - possibility or chance of loss, danger, or injury
4. redundancy of building installations to - probability of an event occurring, of a bad event
ensure continuation particularly
5. auditing of waste management - exists everywhere
6. proficiency training o even in the business, risks that you use 50%
of your assets, price will go down 25%
Biorisk Management Model - risk can be quantified, not just the qualification of
risks.
- can be based on either hazard or a threat
- can be conducted in standardized fashion
- has negative connotation
o what makes it standardized is this model
- risk is negative
Three Key Components: - possibility that a positive think can happen
1. Biorisk assessment o connotation is negative
2. Biorisk mitigation
o event that will happen is negative- based on
3. Biorisk performance
what hazard or threat
 if it is hazard, more commonly this is
AMP Model a work of biosafety
 based on a threat, work of
Biorisk Management: Assessment biosecurity
- Hazard - combination of likelihood and the consequence of
o source – has potential for causing harm an undesirable event related to specific
o can be present anywhere, even in our homes hazard/threat
o Ex: Kitchen (gas, ovens, kitchen, knives, o likelihood- possibility/chance
sharp materials), Gas (fire hazard; o consequence- bad event that can happen (as
flammable/combustible), Knives (sharp a result of hazard/threat manipulation)
hazards) - In performing risk assessment, a structured and
- Laboratory (works the same way) repeatable process is followed
o have hazards Steps:
 research laboratory- animal hazards 1. Define the situation
(common) 2. Define the risks
 some animals used in 3. Characterize the risk
experiment can become rabid 4. Determine- if the risk are acceptable or not
 heat hazard acceptable
 present in the laboratory
Defining the Situation o Consequence- plotted in x-axis
- Identify - For us to quantify the risks, they assigned numbers
o Hazards and Risks o Likelihood- numbered from 1-5
o At-risks hosts  1-5- have counter-qualitative part
 Living beings (humans, animals) 1- Rare
o Work activities 2- Unlikely
 procedures 3- Possible
o Laboratory equipment 4- Likely
 location 5- Almost certain
 equipment o Consequence- built up the same way
- By identifying these different elements, we can 1- Insignificant
identify the situation. 2- Minor
3- Moderate
Defining the Risks 4- Major
- how the individual is exposed to the hazard 5- Critical
o risk is not only based on the hazard but also - Area (boxes)
on the threat o the qualitative definitions of the risks
- “Situation” depending on the number assigned
o apply in defining the risks  Ex: likelihood of the risk is #2,
o What is the risks associated with the consequence is major
situation?  2 x 4 = 8 (high  risk)
- Ex: Transmissions (modes)
o identified the work activities involved There is a shark in the sea.
(aerosol generating) o Risk: being eaten by shark
o microorganism that is possibly in that o Likelihood: 1- depends where you are
specimen is a type that can be transmitted by o Consequence: 1
a aerosolize contents o R=LxC
o RISKS: there is a risks, esp. if the  1 x 1 = 1 = Low (no risks)
laboratorian is not wearing proper personal - There is an element that is striking in the
protective equipment (PPE) statement. What is that element?
o hazard (shark)- potentially causing harm
Characterizing the Risks o lacking- situation
- comparing the likelihood and consequences of the - a risk cannot exist without hazard and situation 
risks what we need
o qualitatively or quantitatively
- risks cannot only be defined qualitatively- not just I was swimming carelessly with no protective gear
low, moderate or high – it can be quantitatively in the sea, a big ferocious shark appeared before
- Risk = Likelihood x Consequence (combination) me.
R= L x C o Risk:
 Hazard: shark
Risk Severity Matrix  Situation- swimming carelessly with
no protective gear, shark appeared
o Likelihood
- can define a risk as either quantitatively or
qualitatively  5- almost certain
- not all severity matrixes are the same  shark- big and no protective
gear
o severity matrix can be used in other fields
o Consequence
(business, agriculture)
- Laboratory (R= L x C)  5- critical
o Likelihood- plotted into y-axis (more  no protective gear; can bite any
part of body
commonly)
o R= L x C
  5 x 5 = 25 (Extreme)- also applies in
laboratory (matrix) 1. Elimination
a. physically remove hazard; most
Ex (lab): Working carelessly with no PPE in lab, space
you spilled a test tubes containing sample with b. remove hazard
unknown microorganism that can transmitted via c. Ex: Working with hazard
aerosol. (inflammable)
o Risk: i. remove the hazard (eliminate
 Microorganism: Mycobacteria risks)
tuberculosis 2. Substitution
o Likelihood a. replace hazard
 4- likely b. do not remove the source of hazard
o Consequence c. replace it with less sever infection
 4- major d. Ex: Sapphylococcus Aurelius
o R= L x C i. type of bacterium – pathogenic
 4 x 4 = 16 (Extreme) (cause diseases)
e. replace microorganism with another
- In order for a RISK to occur, two ingredients must microorganism
be present: i. Staphylococcus Epidermidis
1. Hazard- potential to cause harm  normal bacteria of the skin
2. Situation- identified  healthy people (cannot
o Risks = Hazard x Situation really cause disease)
= Likelihood x Consequence  substituted a pathogenic
bacterium with non-
Determining Risks pathogenic bacterium
- acceptable or nor (last step) 3. Engineering Controls
- assessment makes it subjective in nature- it a. isolate people from hazard
becomes subjective because you’re using the word b. physical facility
“for me”- we are assessing based on all stakeholders c. equipment used
in the laboratory 4. Administrative Controls
- Laboratorians- were assist the risks acceptable? a. change the way people work
b. administration/managerial section of
Two types of People: lab- build/conduct policies in the
1. Risk-averse laboratory (can control the way
a. “I don’t like that risk” people work- change people work)
b. don’t proceed with procedure- too risky 5. PPE (least occupying)
2. Risk-tolerant a. protect the worker with personal
a. “it’s okay, you don’t need to wear your protective equipment
gloves” b. Ex: Gloves, Lab gowns, Hair net

Biorisk Management: Mitigation Hierarchy of Controls

- second step of Biorisk management model
(fundamental concept of BRM)
- Mitigation includes:
o actions: wearing of masks
o control: policies and physical facility
- Purpose: reduce or eliminate risks associated with
biological agents and toxins
- eliminate and minimize risks
- Mitigation control
o Hierarchy of Controls- pyramidal in shape
Most effective: Elimination
- eliminated the source of risks/harm/hazard
- reduce risk to 0
Least effective: PPE
- does not guarantee any reduction in risks
Most difficult to implement: Elimination
Least difficult to implement: PPE (easiest, wear)
Administrative Controls
Advantages: Authority approach
- employees must have to follow the policies
Disadvantages: Indirect approach, Addresses
human factor
- Ex: not all of them actually factor – control
- N95 masks- dotted scars

Can one of the five controls function alone in

mitigating risks?
o No.
o All of the controls must work together 
will guarantee that it reduce/eliminate the
risks.

Biorisk Management: Performance

-last pillar

1. Identify the key issue of concern

a. what is malfunctioning control?
controls that is ineffective?
2. Define outcome indicators and metrics
3. Define activities indicators and metrics
4. Collect Data and Report Indicator Results
5. Provide Finding from Performance
Evaluation
6. Evaluate and Refine Performance Indicators
a. can be quantified according to
control you placed
b. Ex: is BSC effective?