‫نقابة المهن العلمية بالمنوفية‬ [1]

aboratory rinciples
Medical laboratory science

It is defined as a field of biology and chemistry that provides information needed for the diagnosis and treatment of disease.

Medical laboratory technology

It is defined as the science that combines the use of instruments and techniques with the application of theoretical knowledge

Laboratory safety rules

Laboratory hazards

The clinical laboratory exposes staff, and potentially the public, to a variety of hazards, including:

Biological hazards

Biological hazards expose an unprotected individual to bacteria, viruses, parasites, or other biological entities that can result in injury.
Exposure occurs from ingestion, tactile contamination, or inhalation of infectious material from patients or their body fluids.

The spread of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and tuberculosis (TB)
has focused the responsibility on each health care organization to protect its employees and patients from infection.

Chemical hazards

All clinical laboratories are mandated by OSHA to develop and actively follow plans that protect laboratory workers f rom potential
exposure to hazardous chemicals.

Unsafe working conditions

Injuries and harmful exposures can negatively affect the laboratory financially, by:

▪ Lost workdays
▪ Damage to equipment
▪ Poor staff morale

Low employee morale is a silent killer of workplace productivity and performance

▪ Bad reputation

A good reputation helps to attract new customers

Safety rules

Safety is the responsibility of everyone working in the laboratory

Consider any laboratory specimen as potentially infectious

What should be avoided?

▪ Eating, drinking, food storage and smoking in the laboratory

▪ Mouth pipetting for chemicals or body fluids
▪ Leaving unprotected any skin, membranes, or open cuts.
▪ Fingers, pencils, loops etc. in contact with your mouth.
 ‫نقابة المهن العلمية بالمنوفية‬ [2]

What should be done?

▪ A lab coat should be worn

All protective equipment that has the potential for coming into contact with infectious material, including laboratory coats,
must be removed before leaving the laboratory area and must never be taken home or outside the laboratory

▪ Gloves must be worn (removed when using any office tools as telephone)

Gloves should not be washed and reused because microorganisms that adhere to gloves are difficult to remove

▪ Surgical masks must be worn to prevent exposure from splashes to the mouth, eyes, or nose.

▪ Hands must be washed immediately upon contamination with blood or body fluids and following completion of laboratory
activities

▪ Broken glassware must never be handled directly by hand but

removed by brush or forceps.
▪ Spillage of potentially infectious material should be removed
immediately with absorbent paper tissue and the contaminated
areas disinfected with 70% Ethyl or isopropyl alcohol
▪ Waste separation system must be used (black container for
home waste (normal non-hazardous waste) and red one for
infectious hazards)

Hazardous waste autoclaved prior to leaving the lab and then

incinerated
 ‫نقابة المهن العلمية بالمنوفية‬ [3]

Management of needle-stick injury

The risks of transmission of infection from an infected patient to the health worker
following a needle-stick injury are estimated to be:

▪ Hepatitis B – 3–10% (up to 30%);

▪ Hepatitis C – 0.8–3%;
▪ HIV – 0.3%

Prevention of needle-stick injuries

▪ Avoid looking away or working in bad light while dealing with the needle stick.
▪ Be careful with restless or panicking patients who can easily move as you insert or withdraw the needle. Reassure them and only
insert the needle when you're sure it is safe to do so.
▪ To safely recap needles, use the "one-hand" technique:
✓ Place the cap on a flat surface, then remove your hand from the cap.
✓ With one hand, hold the syringe and use the needle to "scoop up" the cap.
✓ When the cap covers the needle completely, use the other hand to secure. the cap on the needle hub.

Management occupational exposure to blood

▪ Encourage bleeding at the site of puncture. Do this by immediately running cool

water over the bleeding area for several minutes. In this way potential infectants are
expelled from the wound and washed away, minimizing entry into the bloodstream.

Allow injury to bleed freely, don't squeeze wounded area (the practice to "milk
out" more blood is not recommended by the American centers for disease control
and prevention (CDC))

Do not scrub the wound while you're washing it. This can make the injury worse.

Never try to suck the wound

▪ Wash the wound. Gently cleanse the site of the needle stick or sharps entry with plenty of soap after you have bled the wound and
flooded the site. This will help to reduce the chance of infection
▪ Dry and cover the wound. Use a sterile material to dry the wound and immediately cover the wound with a waterproof plaster
▪ Seek medical attention immediately. Your blood may be tested to determine whether further treatment is needed
 ‫نقابة المهن العلمية بالمنوفية‬ [4]

Management of HBV exposure

Vaccination for HBV can be highly effective in preventing transmission of the virus after exposure.

For vaccine to be effective, the initial dose of vaccine must be administered soon after exposure; the longer the gap between
exposure and administration of the vaccine, the less effective the vaccine.

The steps to take after HBV exposure are to:

Assess the person’s immunization status for hepatitis B (i.e. by taking their history of hepatitis B vaccination);

▪ Vaccinated person (3 or more doses) >>> No vacintion need

▪ Unvaccinated or incompletely vaccinated person (< 3 doses) with HBV negative source of exposure >>> Initiate and
complete vaccination
▪ Unvaccinated or incompletely vaccinated person (< 3 doses) with Unknown or HBV positive source of exposure >>>
Initiate and complete vaccination and give hepatitis B immune globulin

Follow-up of HBV exposure

Perform follow-up testing for antibodies to hepatitis B in individuals who receive hepatitis B vaccine in response to an exposure. The
recommendation is to test for antibodies 1–2 months after the last dose of vaccine. However, if the person received hepatitis B immune
globulin in the previous 3–4 months, it is not possible to use the test for antibodies to hepatitis B to determine the response to the
vaccine.

Management of HCV exposure

Antiviral agents are not recommended as post-exposure prophylaxis (PEP), and there is no vaccine against HCV

The steps to take after HCV exposure are to:

▪ Test for HCV ribonucleic acid (RNA) at 4–6 weeks if early diagnosis of HCV infection is desired
▪ Test for anti-HCV and ALT 4–6 months after exposure

Retesting for HCV antibodies usually occurs six weeks after the incident, and again at four to six months.

▪ If an individual has seroconverted, start direct acting antiviral therapy

Management of HIV exposure

Test the source patient for HIV (only rapid HIV test could be performed)

In situations where there is a high suspicion that th patient may be in the window period, then HIV PCR or HIV P24 antigen
test could be considered

▪ In case of negative result, the rik is very low and prophylactic medication is not recommended
▪ In case of positive result, prophylactic medication (PEP) should be administered as soon as possible after the exposure (ideally
within 4 hours) - (and is unlikely to be of benefit if more than 72 hours post-exposure).

Anti-retroviral drugs can reduce the rate of transmission if given soon after possible infection

PEP generally includes only two drugs to be taken for only 28 days and is thus not a treatment for HIV infection which
is based on a combination of three antiretroviral drugs taken continuously.

Follow-up of HIV exposure

HIV test should be done on the exposed person at baseline (within 24h of the injury), at 6 weeks, 12 weeks and at 6 monthes.

If HIV sero-conversion occurs the exposed person should be referred for treatment
 ‫نقابة المهن العلمية بالمنوفية‬ [5]

Medical laboratory workflow

Vein-to-Brain cycle: All steps between the time when a physician orders a laboratory test and the results when returned to the physician
and consists of 3 stages:

▪ Pre-analysis refers to all the complex steps that must take place before a sample can be analyzed.
▪ Analysis refers to all all procedures or processes releated to actual testing of the specimen
▪ Post-analysis refers to all all procedures or processes involved following test performance

Evidence indicates that most of the laboratory errors occur in preanalytical (62%) and postanalytical (23%) phases compaired
to the analytical (15%) phase.

Pre-analytical stage

▪ Recording patient data (name, age, telephone, and physician)

▪ Reading patient request carefully

Do not deal with more than one patient in the same time

Patient medical history is very important in case of diabetes, coagulation profile, thyroid profile, anemia screen, and cultures

▪ Assessment of test precautions including:

o Test timing: several tests affected by diurnal variations such as hormones (GH higher in afternoon and evening) and iron
(peaks early to late morning), timing is essential in therapy monitoring, G6PD for example should not be measured
immediately following a hemolytic episode.
o Patient preparation: several tests affected by:
▪ Diet (If a patient has eaten recently (less than 2 hours earlier), there will be a temporary increase in glucose and
lipid content in the blood.)
▪ Exercise (for example it may elevate CK, AST and LDH)
▪ Stress (Anxiety and excessive crying in children can cause a temporary increase in the white blood cell count)
▪ Posture (Changing from a supine (lying) to a sitting or standing position results in a shift of body water from
inside the blood vessels to the interstitial spaces. Larger molecules, such as protein, and cholesterol cannot filter
into the tissues, and their concentration increases in the blood)
o Sampling precautions: including sample type and preservation

Common test precautions

1. Fasting is essential in these tests: FBS (8-10 houres) and triglycerides (12-14 houres but water can be ingested any time)
2. Fasting is recommended in these tests: cholesterol, urea, uric acid and serum iron
3. Intercourse and ejaculation should be avoided for 4 consecutive days before giving the semen sample
4. It is preferable that no antibiotic is taken 48 hours prior to submitting any culture sample
5. Medication should be taken regularly for at least 5 days and it is vital that no vomiting or diarrhea is experienced for 48 hours
prior to drug monitoring test.

In therapeutic drug monitoring, trough and peak levels of a drug may be ordered. Trough specimens reflect the lowest level in
the blood and are generally drawn 30 minutes before the drug is administered. The peak specimen is drawn shortly after the
medication is given

▪ Collection of samples

Never collect blood samples before making sure of sample precautions and storage conditions

It is very important to assess samples validity as soon as possible (before the patient leave the laboratory)
‫نقابة المهن العلمية بالمنوفية‬ ‫]‪[6‬‬

‫‪Reasons for specimen rejection‬‬

‫‪1.‬‬ ‫‪Unlabeled or mislabeled specimen‬‬

‫‪2.‬‬ ‫‪Improper blood collection tube‬‬
‫‪3.‬‬ ‫‪Inadequate sample volume‬‬
‫‪4.‬‬ ‫‪Clots present in an anticoagulated specimen‬‬
‫‪5.‬‬ ‫‪Specimen is hemolyzed‬‬
‫‪6.‬‬ ‫‪Specimen is lipemic‬‬
‫‪7.‬‬ ‫‪Improperly timed specimens‬‬
‫‪8.‬‬ ‫‪Delayed delivery to laboratory‬‬
‫‪9.‬‬ ‫)‪Improper transport conditions (ice for blood gases and ammonia‬‬
‫‪10.‬‬ ‫‪Contaminated specimen/leaking container‬‬
‫‪11.‬‬ ‫‪Specimen was contaminated with intravenous fluid‬‬

‫قواعد للتعامل مع المرضي‬

‫عدم التحدث بصوت مرتفع جداً ( ألن ذلك يولد الغضب ويوحي بالعدوانية ) و كذلك عدم التحدث بصوت منخفض‬ ‫▪‬
‫جداً ( ألن ذلك يوحي بالخجل وعدم الثقة )‬
‫التحدث بكلمات واضحه محدده لشرح شروط التحليل مع مراعاه المستوى الثقافي و االجتماعي للمريض‬ ‫▪‬
‫ال تستخدم كلمات سلبية عن ما ال تستطيع تحقيقه وركز على الكلمات اإليجابية وعلى ما تستطيع إنجازه مثل ‪:‬‬ ‫▪‬

‫ال تقل ال أستطيع تسليمك النتائج الساعة ‪ 6‬مساءاً ولكن قل أستطيع تسليمك النتائج الساعة ‪ 7‬مساءاً‬

‫ال تقل ال أستطيع تخفيض سعر التحليل ولكن قل مدير المعمل يستطيع أن يعطي لسيادتك تخفيضا‬

‫ال تستخدم كلمات استفزازية إلصالح خطأ ما وقع فيه العميل ولكن استخدم كلمات مهذبة إليصال المعلومة‬ ‫▪‬
‫وتصحيح الخطأ مثال ذلك ‪:‬‬

‫ال تقل حضرتك مفهمتش احتياطات التحليل وقل ممكن سيادتك تقرأ ورقة االحتياطات معي‬

‫ال تقل حضرتك مفهمتش أنا بقول أية وقل متأسف يظهر أنني مقدرت ش أشرح لسيادتك‬

‫ال يجوز استخدام الكلمات االتيه ابدا (سرطان – اجهاض – ايدز – امراض جنسيه – صرع – سل – فشل كلوى –‬ ‫▪‬
‫فيروس سي ‪ -‬عقم) بل استخدم (نشاط الخاليا – سالمه الحمل – نقص مناعه – امراض تناسليه – اشاره كهربيه‬
‫زائده – بكتيريا الدرن – بطء او ضعف فى وظيفه الكلى – التهاب كبدى او كسل بالكبد – نقص فى عدد الحيوانات‬
‫او حيويتها)‬
‫اذا طلب المريض الحديث مع مدير المعمل ف تتم المقابله فى مكتب ملحق بالمعمل او فى غرفه السحب اذا كانت غير‬ ‫▪‬
‫مشغوله و ال تتم المقابالت فى االستقبال ابدا‬
‫ال يجوز ابدا وصف اى دواء مهما كان بسيطا للمريض بناء على نتيجه التحليل‬ ‫▪‬
 ‫نقابة المهن العلمية بالمنوفية‬ [7]

Analytical stage

▪ Sample processing
▪ Reagents and instruments preparation
▪ Performing laboratory procedures

Ideally, all measurements should be performed within 45 minutes to 1 hour after collection. Whenever this is not practical, the
specimen should be processed and stored correctly

How to improve the quality of analytical stage?

• Use only high-quality chemicals

• Laboratory must have a standard operating manual for all tests
• For accurate laboratory results, a quality control system must be used

Common causes of analytical stage errors

• Low quality training

• Too heavy workload for the laboratory staff
• Rushing to finishing work due to too heavy workload
• Loss of concentration due to constant interruptions

Post-analytical stage

Results interpretation

What is the difference between medical diagnosis and result interpretation?

Medical diagnosis is the process of determining which disease or condition explains a person's symptoms and signs while result
interpretation is only an explanation of the meaning of different laboratory results

Medical diagnosis is typically the role of the physician, on the other hand interpretation of laboratory results remains the
responsibility of the laboratory scientist

Criteria of good result interpretation

1. Usually analytical correctness must be assessed before interpretation

2. Laboratory tests are not advised for the same reason (tests are used for screening, diagnosis, monitoring of disease activity ,
monitoring of therapy and assessment of prognosis)
3. Laboratory test result must be interpreted in the light of the clinical condition

Correct result interpretation requires patient history (medical, family, social)

4. Highly abnormal and unexpected results should be imterpreted with caution

5. If the result dose not accord with that expected for the patient (test should be repeated carefully or ask for another sample)
6. Sutton's law: Consider common causes for a patient’s symptoms
7. Osler’s rule: Try to attribute all abnormal laboratory findings to a single cause
 ‫نقابة المهن العلمية بالمنوفية‬ [8]

Reporting laboratory results

Good report formatting improves the total quality of laboratory. Laboratory report should include:

▪ Complete date (patient name, age, physician name, test date)

▪ Assay results (test name, result, unites, reference range and commentes if needed)

‫تقرير معمل جيد‬

‫ورقه المعمل من خامه جيده و ذات الوان بسيطه هادئه‬ ▪

‫الطباعه الجيده الواضحه هامه جدا الكتمال جوده الخدمه المقدمه‬ ▪
‫ترتيب و تنسيق التحاليل المتنوعه فى صفحه التقرير هام جدا‬ ▪
‫كتابه النتائج بخط واضح سهل القراءه مع تمييز النتائج الغير طبيعيه‬ ▪
‫مراجعه النتيجه جيدا بعد الطباعه و التوقيع علىها من مدير المعمل مهم جدا و يساعد على تقليل اخطاء تلك المرحله‬ ▪

Critical values

A critical value (also known as a panic or alert value) is a laboratory result that may represent a life-threatening situation that may not
otherwise be readily detectable and therefore requires rapid communication with a health care provider who can provide necessary
medical interventions.

Laboratory critical values must be delivered to the patient or physician as soon as possible

For example, Glucose <45 mg/dL or >500 mg/dL, Potassium <2.8 mEq/L or >6.2 mEq/L, Calcium <6.5 mg/dL or >14.0 mg/dL,
Hemoglobin <7.0 g/dL or >20.0 g/dL or Positive blood culture)