A TECHNICAL REPORT

ON

STUDENT INDUSTRIAL WORK EXPERIENCE SCHEME (SIWES)

PRESENTED BY

ODIMEGWU JENNIFER OGECHI

MATRIC NO.:13/89101/REGULAR

DEPARTMENT: BIOCHEMISTRY

FACULTY OF BIOLOGICAL AND PHYSICAL SCIENCES

ABIA STATE UNIVERSITY, UTURU

UNDERTAKEN AT

GOLDENCROSS INFIRMARY (HOSPITAL AND MATERNITY)

IN PARTIAL FULFILLMENT FOR THE AWARD OF BSC

PERIOD OF ATTACHMENT

2ND MAY, 2016-15TH OCT, 2016

 DEDICATION

This industrial training report is copiously dedicated to God Almighty for his

unquantifiable and immeasurable mercies and protection upon my life especially

during the period of my industrial training experience.

I also appreciate my parents Mr/Mrs Innocent Odimegwu for their direction,

protection and support.

 ACKNOWLEDGEMENT

I acknowledge God Almighty again for providing a very friendly and

enabling environment for me to carry-out my industrial training programme.

I appreciate the Vice Chancellor of Abia State University, Uturu, Prof.

Ikonne Uchenna, for giving me the opportunity to undertake this industrial

training programme.

I also acknowledge the wonderful efforts of my IT coordinator, Dr

Chinyere…, the HOD of Biochemistry Department, Abia State University, Dr

Stanley …, and my lovely and kind-hearted lecturers who have for the past three

years extensively impacted both the practical and theoretical knowledge of

biochemistry into me and also for supporting me to undertake the industrial

training programme 2015/2016 session.

I also appreciate in a very special way the effort of the HOD of laboratory

department, Goldencross Infirmary, Mrs Achonwa Rita, and my industry-based

supervisor, Mr Ilonze Frank, and also the staffs of Goldencross Infirmary in Lagos.

I hold in great esteem the unabated effort of my parents, Mr/Mrs Innocent

Odimegwu for making sure that I become a success in my academic pursuit both

in moral and finance.

 TABLE OF CONTENT

Dedication……………………………………………………………………………………………..

Acknowledgement…………………………………………………………………………………

CHAPTER 1-INTRDUCTION

1.1 Meaning and objective of SIWES……………………………………………………..

1.2 History of Goldencross Infirmary……………………………………………………..

1.3 Goldencross Infirmary organogram………………………………………………….

1.4 Some laboratory equipments and their uses……………………………………..

1.5 Safety precautions in the laboratory………………………………………………….

1.6 Personal protective equipments (PPE)………………………………………………..

CHAPTER 2- MEDICAL LABORATORY TESTS

2.1 Phlebotomy…………………………………………………………………………………………

2.2 Hematology………………………………………………………………………………………..

2.2.1 Full blood count (FBC)………………………………………………………………………

2.2.2 Malaria parasite test…………………………………………………………………………

2.2.3 Packed cell volume (PCV)…………………………………………………………………

2.2.4 Erythrocyte sedimentation rate (ESR)………………………………………………

2.2.5 Blood grouping…………………………………………………………………………………

2.2.6 Genotyping………………………………………………………………………………………
2.3 Serology……………………………………………………………………………………………..

2.3.1 Widal……………………………………………………………………………………………….

2.3.2 Retroviral screening test (RVST)…………………………………………………………

2.3.3 Hepatitis B (HbsAg)……………………………………………………………………………

2.3.4 Hepatitis C virus (HCV)………………………………………………………………………..

2.3.5 Pregnancy test……………………………………………………………………………………

2.3.6 Syphilis (VDRL)……………………………………………………………………………………

2.4 Clinical chemistry……………………………………………………………………………………

2.4.1 Glucose……………………………………………………………………………………………..

2.4.2 Fasting lipid profile (FLP)……………………………………………………………………

2.4.3 Electrolyte………………………………………………………………………………………….

2.4.4 Liver function test (LFT)………………………………………………………………………

2.4.5 Kidney function test (urea and creatinine)………………………………………..

2.4.6 Calcium……………………………………………………………………………………………..

2.4.7 Uric acid…………………………………………………………………………………………….

2.4.8 Albumin…………………………………………………………………………………………….

2.4.9 Urinalysis………………………………………………………………………………………….

2.5 Microbiology……………………………………………………………………………………….

2.5.1 Agars and their preparations…………………………………………………………..

2.5.2 The Clinical Microbiology Department: Isolating Bacterial contaminants from

clinical samples, and detecting antimicrobial resistance mechanisms in the

recognized isolated microorganism…………………………………………………………………..

CHAPTER 3

3.1 Difficulties encountered during the programme……………………………………..

3.2 Relevance of the SIWES programme………………………………………………………

CHAPTER 4- GENERAL APPRAISAL…………………………………………………………………

4.1 Ways of improving the SIWES programme…………………………………………………….

4.2 Advice to future participants………………………………………………………………………….

4.3 Advice to SIWES managers…………………………………………………………………………….

4.4 Recommendation………………………………………………………………………….................

4.5 Conclusion…………………………………………………………………………………

CHAPTER 1
 INTRODUCTION

Student Industrial Work Experience Scheme (SIWES) is a very big aid and a

stepping stone to life after school. It is an opportunity given to students to put

into practice most things that were theoretically explained by lecturers in schools.

Pathology laboratory like Goldencross Infirmary Laboratory has been of

great aid to this programme most especially for science students due to the fact

that they are opportune to make use of various reagents and equipments which

may not be available to them in their schools.

As a result of this, the standard methodology and equipment handling

expose students in their course of training.

1.1A. Meaning of SIWES

Student Industrial Work Experience Scheme, SIWES, is the accepted skill

training programme which forms part of the approved minimum academic

standards in the various degree programmes for all the Nigerian universities. It is

provided to bridge the gap existing between theory and practice of engineering,

science and technology, agriculture, medicine, management and other

professional educational programmes in the tertiary institutions.

 It is aimed at exposing students to machines and equipments, professional

work methods and ways of safe-guarding the work areas and workers in

industries and other organizations.

B. Objectives of SIWES

1. To prepare students for work situations they are likely to meet after

graduation.

2. To provide an avenue for students in Nigerian universities to acquire industrial

skills and experience in their course of study.

3. To enlist and strengthens employers involvement in the entire educational

process of preparing university graduates for employment in industries.

4. To provide students with an opportunity to apply their theoretical knowledge in

real work situations, thereby closing the gap between university work and actual

practice.

5. To expose students to work methods and techniques in handling equipments

and machinery that may not be available in the universities.

6. To make the transitions from the university to the world of work easier and

thus enhance students contact for later job placement.

7. Teaches the student on how to interact effectively with other workers and

supervisors under various conditions in the organization.

1.2History of Goldencross Infirmary (Hospital and Maternity)

Golden Cross Infirmary, popularly known as GCI is a Hospital and Maternity

center founded by the present Chief Medical Director, Dr. Nnamdi Okwuosa.

Full operations began in the year 1980. As at that time, it was known as

BLUECROSS HOSPITAL and was situated at 2ND AVENUE, 207 ROAD, FESTAC-

TOWN, LAGOS. Over the years, Blue Cross went through some sinking sands

but instead of sinking, it came out stronger, tougher and above all with a

metallic luster that instigated a change in name. In the year 1984, Blue Cross

Hospital changed its name and location and became GOLDEN CROSS

INFIRMARY, GCI, situated at 2ND AVENUE, 22-ROAD, FESTAC-TOWN, LAGOS.

Presently, the organization has a capital investment of over a 100million naira

and a staff capacity of over a 100staff.

OPERATIONS OF THE ORGANIZATION

The organization is a Hospital and Maternity center with a wide range of

medical staff capacity which includes: Gynecologists, Pediatricians, Dentists,

 Opticians, Consultants, General medical Practitioners, Nurses, laboratory

scientists and technicians, etc. There are other major areas of operation.

These areas include;

 IMAGING: This is one of the sensitive departments of the organization.

It includes Mammogram, Three and Four- Dimensional Forms (3D &

4D) colored ultrasound Scan and Digital X-RAY.

 PHARMACY: This department is headed by a head Pharmacist, who

oversees the affairs of the Pharmacy. Here, we find a wide variety of

drugs ranging from Anti-biotics, Anti-fungal, Anti-malaria and

Creams/Ointments etc.

 DIAGOSTIC LABORATORY: It is headed by a Pathologist, who oversees

the affairs of the Laboratory scientists, Technicians and Phlebotomists.

Other departments found in the organization ranges from The Administrative

Department, Accounting, Front Desk Office, Public Relations Office, Health

Maintenance Organization Office, Billing Office, Cash Office, Janitorial,

Transportation, Laundry, Gardening, Security, Kitchen, etc.

1.3Goldencross Infirmary Organogram

CHIEF MEDICAL
DIRECTOR

MEDICAL DIRECTOR

2
DOCTORS H.O.D H.O.D H.O.D ADMINI-
3

4 NURSING PHARMACY LABORATO MANAGER

5 RY
DENTIST NURSES PHARMACIS LABORA- ACCOUNTANT
6

7 TS TORY
8 TECHNIC-
9 LABORA
PAEDIATRICIAN CHIEF
10
TORY
11
SECURITY
SCIENTISTS
OFFICER
CLEANERS
CONSULTANT/
12

13
GYNAECOLOGIST PLEBOTOM
14
-IST
ENGINEERS,
OPTICIAN
TECHNICIA-

NS
1.4 Some Laboratory Equipments and their Uses

Microscope

A microscope is an optical instrument having a magnification lens or a

combination of lenses for inspecting objects too small to be seen distinctly and in

detail by the unaided eyes. It is used in the pathology laboratory for examination

of stained blood film, stool, urine etc.``````

Triple Beam Balance

This is an instrument used to measure mass very precisely. The device has

reading error of +/_ 0.05gram. The name refers to the three beams including the

middle beam which is the largest size, the front beam which is the medium size,

and the far beam which is the smallest size. The difference in size of the beams

indicates the difference in weights and reading scale that each beam carries. The

triple beam balance can be used to measure mass directly from the objects, find

mass by difference for liquid, and measure out a substance.

Spectrophotometer

A spectrophotometer is used to measure either the amount of light

reflected from a sample object or the amount of light that is absorbed by the

sample object. It is an instrument used to measure the intensity of wavelength in

a spectrum of light compared with the intensity of light from a standard source. It
is used in pathology laboratory to measure the absorbance of calcium, glucose,

cholesterol, uric acid and other chemistry tests.

Centrifuge

A centrifuge is a piece of laboratory equipment, driven by a motor, spins

liquid samples at high speed. There are various types of centrifuge depending on

the size and the sample capacity. Like all other centrifuges, laboratory centrifuges

work by the sedimentation principle where the centripetal acceleration is used to

separate substances of greater and lesser density. It is usually used to separate

serum or plasma from red cells in a blood sample etc.

Incubator

An incubator is a device used to grow and maintain microbiological cultures

or cell cultures. The incubator maintains optimal temperature, humidity and other

conditions such as the carbondioxide and oxygen content of the atmosphere

inside. Incubators are essential for a lot of experimental work in cell biology,

microbiology and molecular biology and are used to culture both bacterial as well

as eukaryotic cells.```

Electrophoresis equipment

This is one of the most important equipments used by molecular biologists.

It migrate a charged molecule through a restrictive matrix, or gel, drawn by an

electrical force. To mention but a few applications, deoxyribonucleic acid(DNA)

electrophoresis is used to map the order of restriction fragments within

chromosomes to analyze DNA variation within a population by restriction

fragment length polymorphisms and to determine the nucleotide-sequence of a

piece of DNA.

Laboratory Refrigerator

Laboratory refrigerators are used to cool samples or specimens for

preservation. They include refrigerator units for storing blood plasma and other

blood products, as well as reagents, vaccines and other medical and

pharmaceutical supplies. They differ from standard refrigerators used in homes

and restaurants because they need to be totally hygienic and completely reliable.

Laboratory refrigerators need to maintain a consistent temperature in order to

minimize the risk of bacterial contamination and explosions of volatile materials.

Automated biochemistry analyzer

This is used to measure different chemicals and other characteristics in a

number of biological samples quickly, with minimal human assistance. These

measured properties of blood and other fluids are useful in the diagnosis of

diseases. Samples can be processed singly, in batches, or continuously. The type

of tests required includes enzyme levels (such as many of the liver function tests),
ion levels (e.g. sodium and potassium) and other chemicals (such as glucose, serm

albumin, or creatinine).

Full blood count analyzer

Full blood count analyzer also known as complete blood count analyzer is

laboratory equipment that gives information about the cells in a patient’s blood

such as the cell count for each type and the concentrations of various proteins

and minerals. The type of test required include white blood cell, red blood cell,

hemoglobin, platelet and packed cell volume count etc.

Petri dish

Petri dish is used to make agar plates for microbiology studies. It is also

used for eukaryotic cell culture in a liquid medium or on solid agar. Empty Petri

dish may be used other day-to-day laboratory practices such as drying fluids in

oven and carrying or storing samples.

Conical flask

Conical flasks are vessels which fall into the category of laboratory

equipments known as glass wares. They can be used for making solutions or for

holding, containing, collecting, or sometimes volumetrically measuring chemicals,

samples, solutions, etc for chemical reactions or other processes such as mixing,

heating, cooling, dissolving, precipitation, boiling (as in distillation) or analysis.

Graduating/measuring cylinder

This is a common piece of laboratory equipment used to measure the

volume of liquid. They are generally more accurate and precise than laboratory

flasks and beakers but they are not used to perform volumetric analysis.

Graduated cylinders are sometimes used to measure the volume of a solid

indirectly by measuring the displacement of a liquid.

Vacutainer blood collection tubes

This is a sterile glass or plastic tube with a closure that is evacuated to create a

vacuum inside the tube facilitating the draw of predetermined volume of liquid.

They are most commonly used to collect blood samples in venipuncture and as

serum separator tubes. The substance contained in a vacutainer may include

anticoagulants (Ethylenediaminetatraacetic acid EDTA, Sodium citrate, or heparin)

or a gel with intermediate density between blood cells and blood plasma.

Bunsen burner

This is a common piece of laboratory equipment that produces a single

open gas flame which is used for heating, sterilization and combustion.
 Other pathology laboratory equipment include; syringe and needles, test

tubes, microhematocrit reader, micropipette, microhematocrit centrifuge, kidney

dish, ESR stand, and universal bottle (for collecting urine, stool, sputum and

semen samples).

1.5 Safety Precautions in the Laboratory

Laboratories contain significant risks and prevention of laboratory accidents

requires great care and constant vigilance. Examples of risk factors include high

voltage, high and low pressures and temperatures, corrosive and toxic chemical

and biohazards including infective samples and specimens.

Measures to protect against laboratory accidents include;

 Safety training and enforcement of laboratory safety rules;

 Safety review of experimental designs;

 The use of personal protective equipments and

 The use of buddy system for particularly risky operations.

Laboratory safety policies in Goldencross Infirmary are as follows;

1. Read instructions and labels carefully.

2. Do not operate or use any equipment unless you are trained and approved

as a user by your supervisor.

 3. Always wear personal protective equipments e.g. gloves, face mask,

laboratory coats, safety boots and glasses when working with hazardous

materials or equipments.

4. Treat all blood samples and bodily fluids as if it were hazardous.

5. Do not store food in the laboratory.

6. Never eat, drink, or smoke while working in the laboratory.

7. Clean up spills immediately.

8. Keep your laboratory space clean and organized.

9. Do not leave un-going equipments unattended.

10.Maintain unobstructed access to all exits, fire extinguishers, electric panels,

showers and eye washes.

11.Check your glass wares for cracks and chips each time you use it.

12.Never taste anything; never pipette by mouth; use a bulb.

1.6 Personal Protective Equipments (PPE)

This refers to protective clothing, helmets, goggles, or other garments or

equipments designed to protect the wearer’s body from injury or infection. The

hazards addressed by protective equipments include physical, electrical, heat,

chemical, biohazards, and airborne particulate matter.

 The purpose of PPE is to reduce employee’s exposure to hazards when

engineering and administrative controls are not feasible or effective to reduce

these risks to acceptable levels. PPE is needed when there are hazards present.

PPE has serious limitations that it does not the hazards at source and may results

in employee being exposed to the hazards if the equipment fails.

Any item of PPE imposes a barrier between the wearer/user and the working

environment. This can create additional stains on the wearer; impair their ability

to carry out their work and create significant level of discomfort. Any of these can

discourage wearers from using PPE correctly, therefore placing them at risk of

injury, ill-health or under extreme circumstance, death. Good ergonomic designs

can help to minimize these barriers and can therefore help to ensure safe and

healthy working conditions through the correct use of PPE.

CHAPTER 2

MEDICAL LABORATORY TESTS

2.1 PHLEBOTOMY

Phlebotomy (from Greek words phlebo-, meaning “pertaining to a blood

vessel”, and –tomy, meaning “to make an incision”) is the process of making an

incision in a vein with a needle. It is simply the practice of drawing blood from

patients and taking the blood samples to the laboratory to prepare for testing.
The procedure itself is known as venipuncture. A person who performs

phlebotomy is called a “phlebotomist”, although doctors, nurses, medical

laboratory scientists, and others in medical field do portions of phlebotomy

procedures in many countries.

Phlebotomists are people trained to draw blood from a patient for clinical

or medical testing, transfusions, donations and researches. Phlebotomists collect

blood primarily by performing venipunctures, (or for collection of minute

quantities of blood, finger sticks). Blood may be collected from infants by means

of heel stick. The duties of a phlebotomist may include properly identifying the

patient, interpreting the tests requested on the requisition, drawing blood into

the correct tubes with the proper additive, accurately explaining the procedure to

the patients, preparing patient accordingly, practicing standard and universal

precaution, performing the skin/vein puncture, withdrawing blood into containers

or tubes, restoring homeostasis of puncture site, instructing patients on puncture-

care, ordering test per the doctor’s requisition, affixing tubes with electronically

printed label and delivering specimens to the laboratory.

AIM: Phlebotomy is majorly practiced for the collection of blood samples to

needed to carry out various laboratory tests. Phlebotomy that is part of treatment

(therapeutic phlebotomy) is performed to treat polycethemia vera, a condition

that causes an elevated red blood cell volume (hematocrit). Phlebotomy is also

prescribed for patients with disorders that increase the amount of iron in their

blood to dangerous levels such as hemochromatosis, hepatitis B, and hepatitis C.

Patient with pulmonary edema may undergo phlebotomy procedures to decrease

their blood volume.

Phlebotomy is also used to remove blood from the body during blood

donation and for analysis of the substances contained within it.

PREPARATION: Patient having their blood drawn for analysis may be asked to

discontinue medications or to avoid food (to fast) for a period of time before the

blood test. Patients donating blood will be asked for a brief medical history, have

their blood pressure taken, and have their hematocrit checked with a finger stick

test prior to donation.

MATERIALS: Syringe and needle, tourniquet, cotton-wool, methylated spirit, and

the appropriate container (EDTA, flourideoxide or lithium heparin bottles) or

blood bag.

PROCEDURES: Blood is usually taken from a vein on the back of the hand or just

below the elbow. Some blood tests, however, may require blood from the artery.

1. The skin over the area is wiped with an antiseptic.

2. A tourniquet (elastic band) is tied around the arm retaining blood within the

arm and making the vein more visible.

3. The phlebotomist feels the vein in order to select the appropriate one.

4. When the vein is selected, the needle is inserted into the vein and the

tourniquet is released.

5. The appropriate amount of blood is drawn and the needle with the syringe is

withdrawn from the vein. The patient’s pulse and blood pressure may be

monitored during the procedure.

6. The blood sample is then dispensed into the appropriate bottle.

For some tests requiring very small amount of blood for blood analysis, the

technician uses a finger stick. A lance or small needle is used to make a small cut

in the surface of the fingertip and a small amount of blood is collected in a narrow

glass tube. The fingertip may be squeezed to get additional blood to surface.

The amount of blood drawn depends on the purpose of the phlebotomy.

AFTER CARE: After blood is drawn and the needle is removed, pressure is placed

on the puncture site with a cotton ball to stop bleeding and a bandage is applied.

It is not uncommon for a patient to feel dizzy or nauseated during or after

phlebotomy. The patient may be encouraged to rest for a short period once the
procedure is completed. Patients who experience swelling of the puncture site or

continue bleeding after phlebotomy should seek immediate medical treatment.

NORMAL RESULTS: Normal results include obtaining the needed amount of blood

with the minimum of discomfort to the patient.

2.2 HEMATOLOGY

Hematology is the branch of medicine concerned with the study of the

morphology and physiology of blood. It is concerned with the study, diagnosis,

treatment and prevention of diseases related to blood. It includes the study of

etiology. It involves treating diseases that affect the production of blood and its

components such as blood cells, hemoglobin, bone marrow, blood proteins,

platelets, blood vessels, spleen, and the mechanism of coagulation. Such diseases

might include hemophilia, blood clot, other bleeding disorders and blood cancer

such as leukemia, myeloma, and lymphoma.

The laboratory work that goes into the study of blood is frequently

performed by a medical technologist or medical laboratory scientist. These

laboratory works includes viewing blood films and bone marrow slides under the

microscope, interpreting various hematological tests results and blood clotting

test results. Various tests carried out in the hematology laboratory are as follows;
2.2.1 Full blood count (FBC)

A full blood count (FBC) also known as complete blood count (CBC) is a

blood panel requested by a doctor or other medical professional that gives

information about the cells in the patient’s blood, such as the cell count for each

cell types and the concentration of various proteins and minerals. A scientist or

laboratory technician performs the requested testing and provides the requesting

medical professional with the results of the full blood count.

The test is usually done using an automated FBC analyzer and the

information’s contained in the result are mentioned below;

White blood cells (WBC): also known as leukocytes are the cells of the immune system

that are involved in protecting the body against both infectious diseases and

foreign invaders. The number of leukocytes in the blood in often an indicator of

the disease and, thus, the WBC count is an important subset of the complete

blood count (CBC). The normal WBC is usually between 4000-11000 white blood

cells per microlitre of blood. They make up approximately 1% of the total volume

of blood in a healthy adult making them substantially less numerous than the red

blood cells (RBC) at 40-45%. This 1% makes a large difference to health because

immunity depends on it. An increase in the number of leukocytes over the upper
limit is called leukocytosis. It is occasionally abnormal, when it is neoplastic or

autoimmune in origin.

Lymphocytes: is one of the subtypes of white blood cells in a vertebrate’s immune

system. They include the Natural killer cells (NK) cells (which function in cell

mediated, cytotoxic innate immunity), T cells (cytotoxic adaptive immunity). They

are the main types of cells found in the lymph which prompted the name

lymphocyte. In full blood count (FBC), it is higher with some viral infections such

as granular fever, chronic lymphocytic leukemia CLL, and can be decreases by HIV

infection. Its normal range is from ………………..

Monocyte: is a type of white blood cells. They are the largest type of leukocyte

and differentiate into macrophages or dendritic cells. As a part of the vertebrate

innate immune system, monocyte can also influence the process of adaptive

immunity. The monocyte count ranges from…………. It may be raised in bacterial

infection, tuberculosis, malaria, rocky mountain, spotted fever, monocytic

leukemia, chronic ulcerative colitis and regional enteritis.

Neutrophil: is the most abundant type of granulocyte and the most abundant

(40% to 75%) type of white blood cells in most mammals. They form an essential

part of the innate immune system. Its functionality varies in different mammals.
Its normal range is …………….. It may indicate bacterial infection and may also be

raised in acute viral infection.

Eosinophil: is a variety of WBC and are one of the immune system components

responsible for combating multi-cellular parasites and certain infections in

vertebrates. It is increased in parasitic infection, asthma or allergic reactions.

Basophil: is a type of white blood cell. They are the least common of granulocytes,

representing 0.5 to 1% of circulating WBC. They are responsible for inflammatory

reactions during immune response. They can perform phagocytosis, produce

histamine and serotonin that induce inflammation and heparin that prevents

blood from clotting. It may be increased in bone marrow related conditions such

as leukemia.

Hemoglobin HGB: is the iron-containing oxygen transport metalloprotein in the

red blood cells of vertebrates (with exception of the fish family channichthyidae)

as well as the tissues of some invertebrates. Hemoglobin in the blood carries

oxygen from the respiratory organ (lungs) to the rest of the body, i.e. the tissues,

where it releases the oxygen to permit aerobic respiration to provide energy to

power the function of the organism in the process called metabolism. The amount

of hemoglobin in the blood is expressed as gram per deciliter. A low level of

hemoglobin is a sign of anemia.

Red blood cells RBC: also called erythrocyte are the most common type of blood

cells and the vertebrate organism principle means of delivering oxygen, O 2, to the

body tissues via blood flow through the circulatory system. RBC takes up oxygen

in the lungs or gills and releases it into tissues while squeezing through the blood

capillaries. The number of RBC is given as an absolute number per litre. Iron

deficiency anemia shows up as a low RBC count.

Hematocrit (HCT) or packed cell volume (PCV): is the volume percentage (vol%) of

the red blood cells in blood. It is normally 45% for men and 40% for women. It is

considered as an integral part of a person’s complete blood count, CBC, result.

Anemia results to an abnormally low hematocrit, as opposed to polycythemia

which refers to abnormally high hematocrit.

Mean corpuscular volume (MCV): is a measure of the average volume of a red

blood corpuscle (or RBC). The measure is attained by multiplying a volume of

blood by the proportion of blood that is cellular (the hematocrit) and dividing the

product by the number of erythrocytes in the volume. The MCV is a part of the

standard complete blood count (CBC). It is the average volume of RBC, measured

in femolitres. Anemia is classified as microcytic or macrocytic if the MCV value is

below or above respectively the expected normal range. Other conditions that
can affect MCV include thalassemic, reticulocytosis, alcoholism, chemotherapy,

vitamin B12 deficiency and/or folic acid deficiency.

Mean corpuscular hemoglobin (MCH): is the average mess of hemoglobin per red

blood cell in a sample of blood. It is reported as part of the standard complete

blood count. It is calculated by dividing the total mass of hemoglobin by the

number of RBC in a volume of blood. MCH=HGB*10/RBC. The normal value in

humans is 27 to 89 pictograms per cell. Conversion to S.I. units: 1pg of

HGB=0.06207femtomol. Normal value converted to S.I. unit: 1.68-1.92fmol/cell.

MCH value is diminished in hypochronic anemia.

Mean corpuscular hemoglobin concentration (MCHC): is a measure of the

concentration of hemoglobin in a given volume of packed red blood cells. It is

reported as a part of standard complete blood count. It is calculated by dividing

the hemoglobin by the hematocrit. Reference ranges for blood tests are

32-36g/dl, or between 19.9 and 22.3mmol/l. it is, thus, a mass of molar

concentration. MCHC is diminished in microcytic anemia, a normal in macrocytic

anemia (due to larger cell size, though the hemoglobin amount or MCH is high,

the conc. remains normal). MCHC is elevated in hereditary spherocytosis, sickle

cell disease and homozygous hemoglobin c disease.

Relative distribution width (RDW-CV and RDW-SD): is a measure of the frange of

variation of RBC volume that is reported as part of a standard complete blood

count. Certain disorders, however, causes a significant variation in size. Normal

reference range of RDW-CV in human red blood cells is 11.5-14.5%. if anemia is

observed, RDW test results are often used together with MCV result to determine

the possible causes of the anemia. It is mainly used to differentiate the anemia of

mixed causes and anemia of single cause. An elevated RDW (red cells of different

sizes) is known as anisocytosis.

Platelet (PLT): also known as thrombocyte (meaning blood clot cells) is a

component of blood whose function along with the coagulation factor is to stop

bleeding by clotting blood vessel injuries. On a stained blood smear, platelets

appear as dark purple spots, about 20% the diameter of the red blood cells. The

ratio of platelets to red blood cells in a healthy adult is 1:10 to 1:20. Low PLT

concentration is thrombocytopenia and is due to either or decreased production

or increased destruction. Elevated platelet concentration is thrombocytosis and is

either congenital, reactive (to cytokine), or due to unregulated production. A

disorder of platelet is a thrombocytopathy.

Mean platelet volume (MPV): is a machine calculated measurement of the

average size of platelet found in blood and is typically included in blood tests as
part of FBC. Since the average platelet size is larger when the body is producing

increased number of platelets, the MPV tests results can be used to make

inference about platelet production in bone marrow or platelet destruction

problems. MPV is higher when there is destruction of platelets. This may be seen

in inflammatory bowel diseases, immune thrombocytopenic purpura (ITP),

myeloproliferative diseases and Bernard-soulier syndrome. Abnormally MPV

values correlate with thrombocytopenia when it is due to impaired production as

in aplastic anemia. A typical range of MPV is 9.7-12.8fl (femolitre), equivalent to

spheres 2.65-2.9micrometre in diameter. Normal range is given as 7.5-11.5fl.

Platelet distribution width (PDW): is a measure of platelet anisocytosis and

plateletcrit. PDW has been found to be of some use in distinguishing essential

thrombocythemia from reactive thrombocytosis. Increased platelet distribution

width suggests that platelet volume size uneven disparity between individuals,

decreased platelet distribution width suggests thrombocytopenia.

Plateletcrit (PCT): is the percent, %, volume of the blood occupied by platelet. It

refers to the number and size of the platelet (packed platelet volume). It is a

calculation performed by automated blood analyzer.

2.2.2 Malaria Parasite Test

 Malaria parasite test is a test carried out to check for malaria parasite in the

blood. Malaria is a mosquito-borne infectious disease affecting humans and other

mammals caused by parasitic protozoan (a group of single-celled microorganisms)

belonging to the plasmodium type.

SYMPTOMS

Malaria causes symptoms that include fever, fatigue, vomiting, and headaches. In

severe cases, it can cause yellow skin, seizures, coma or death. Symptoms usually

begin ten to fifteen days after been bitten. If not properly treated, people may

have recurrence of the disease months later. In those who have recently survived

the infection, reinfection usually causes milder symptoms. This partial resistance

disappears over months to years if the person has no continuing exposure to

malaria parasite.

CAUSES (Life cycle of malaria parasite)

The disease is most commonly transmitted by an infected female

Anopheles mosquito. A mosquito causes infection from a bite. First, sperozites

enter the blood stream, and migrate to the liver. They infect liver cells where they

multiply into merozoites, rupture the liver cells and returns to the blood stream.

The merozoites infect red blood cells, where they develop into ring forms,
trophozoites and schizonts that in turn produce further merozoites. Sexual forms

are also produced, which if taken up by a mosquito, will infect the insect and

continue the life cycle.

MATERIALS: slide, spreader slip, pipette, the test sample, Giemsa stain and

microscope.

PROCEDURES: Malaria is usually confirmed by the microscopic examination of

blood films or by or by antigen-based rapid diagnostic test (RDT).

For microscopic examination of blood films:

1. A drop of blood is placed on one end of a clean slide, and a spreader slide is

used to disperse the blood over the slide’s length. The aim is to get a region

called the monolayer, where the cells are placed far enough apart to be

counted and differentiated.

2. The slide is allowed to air-dry, after which the blood is fixed to the slide by

immersing it briefly in methanol. The fixation is essential for good staining

and presentation of cellular detail.

3. The slide is stained using Giemsa stain or any other, to distinguish the cells

from each other.

 4. The stain is the rinsed off gently in slow running water and allowed to air-

dry.

5. After staining, the monolayer is viewed under an electron microscope using

100* oil immersion objective.

TREATMENT: Malaria is treated with anti-malaria medications; the one used

depends on the type and severity of the disease. Simple and uncomplicated

malaria may be treated with oral medication. The most effective treatment for

plasmodium falciparum infection is the use of artemisinin in combination with

other anti-malaria drugs which decreases resistance to any other single drug

component. These additional anti-malarias include: amodiaquine, lumefantine,

metloquine or sulfadoxine/pyrimethamine.

2.2.3 Packed cell volume (PCV) OR Hematocrit (HCT):

The hematocrit also known as PCV, is the volume percentage (vol%)

of red blood cells in blood. It is considered an integral part of a person’s complete

blood count result. Because the purpose of the red blood cell is to transfer oxygen

from the lungs to the body tissues, a blood sample’s hematocrit_ the red blood

cell volume percentage_ can become a point of its capability of delivering oxygen.
Additionally, the measure of a subject’s blood sample’s hematocrit level may

expose possible diseases in the subject.

CAUSES

Causes of low hematocrit are:

 Bleeding (ulcer, trauma, colon cancer, internal bleeding, surgery)

 Destruction of red blood cells (sickle cell anemia, enlarged spleen)

 Decreases production of red blood cells (bone marrow suppression, drugs)

 Nutritional problems (low iron, B12, folate and malnutrition)

 Over hydration

Causes of high hematocrit are:

 Dehydration (heat exhaustion, no available source of fluid)

 Low availability of oxygen (smoking, high altitude, pulmonary fibrosis)

 Genetic (congenital heart disease)

 Erythrocytosis (over-production of red blood cells by the bone marrow)

MATERIALS: capillary tube, wax, microhematocrit centrifuge and microhematocrit

reader.
PROCEDURE: Hematocrit is diagnosed using automated analyzer or the manual

method (spun hematocrit or spun crit).

Procedures using “spun hematocrit” method:

A thin capillary tube is filled with whole blood sample and the end is sealed

with wax or clay. The tube is then placed in a microhematocrit centrifuge to be

spun for fifteen minutes.

NOTE: The red cells collect at the bottom and form a red column and are

separated from the straw-colored serum column by a small area composed of

white blood cells). The tube is read using microhematocrit reader.

RESULT: The height of the total blood in the capillary tube (red cells, white cells

and serum) equals 100%. The height of the red cell column divided by the height

of the total fluid in the capillary tube equals the hematocrit (% of RBC of the total

blood volume).

Abnormally low PCV refers to anemia and abnormally high PCV refers to

polycythemia.
RANGES: Normal values for hematocrit test vary accordingly to age, sex,

pregnancy, altitude where people live and even vary slightly between various

testing methods. The following are reported ranges of normal hematocrit levels:

New born: 55%-68%

Children: 29%-41%

Adult men: 42%-54%

Adult female: 38%-46%

TREATMENT: The treatment of high and low hematocrit depends on the

underlying causes, the HCT level, and the overall health status of the individual.

Most people are not treated with medications if result is slightly above or below

the normal levels. Some patients with very low HCT may require intravenous iron.

Some patients with very high hematocrit due to diseases, such as polycythemia

rubre vera, may require bloodletting (blood removal).

2.2.4 Erythrocyte sedimentation rate (ESR)

The erythrocyte sedimentation rate (ESR) is the rate at which red

blood cells sediment in a period of one hour. It is a common hematology test, and

is a non-specific measure of inflammation. The ESR is governed by the balance

between the pro-sedimentation factor, mainly fibrinogen, and those factors

resisting sedimentation, namely the negative charge of the erythrocyte (zete

potentials).

When an inflammatory process is present, the high proportion of the

fibrinogen in the red blood cells from stacks called ‘rouleaux’,which settle faster,

due to their increased density.

There are three stages in erythrocyte sedimentation, namely;

Stage 1: Rouleaux formation – first 10 minutes

Stage 2: sedimentation or settling stage - 40 minutes

Stage 3: packing stage- 10 minutes (sedimentation slows and cells start to pack at

the bottom of the tube).

DIAGNOSIS

The test is useful in diagnosing some disease, such as multiple myeloma,

temporal arteritis, polymyagia rheumatic, various auto-immune diseases,

systematic lupus erythematosus, rheumatoid arthritis, inflammation bowel

disease and chronic kidney disease. In many of these cases, the ESR may exceed

100mm/hr.

MATERIALS: ESR tube, ESR reservoir, ESR stands and stop watch.

PROCEDURE (WESTRENGREEN): To perform the test,

1. Anti-coagulated whole blood is placed in the ESR reservoir, covered and

mixed gently.

2. The pipette ESR tube is then placed upright in the reservoir and allowed to

stand for one hour without any interruption.

3. The rate at which the red blood cells sediment is measured and reported in

mm/hr.

RANGE (WESTERNGREEN)

Men 0-15mm/hr for men ≤50yrs of age

0-20mm/hr for men ≥50yrs of age

Women 0-20mm/hr for women ≤50yrs of age

0-30mm/hr for women ≥50yrs or age

Children 0-10mm/hr

New born 0-2mm/hr

NOTE: mm/hr= millimeters per hour

TREATMENT

Depending on the cause the doctor could detect.

2.2.5. Blood grouping and Rhesus typing

Blood grouping/typing is a test that tells what specific type of blood

you have. The type of blood you have depends on whether or not there are

certain proteins, called antigens, on your red blood cells. Blood is often grouped

according to the ABO blood typing system. This method breaks blood types into

four types, namely,

 Type A

 Type B

 Type AB

 Type O

Rhesus factor is an inherited protein found on the surface of the red blood

cells. It is usually determined along with the blood type of an individual. Rhesus

positive is the most common type.

Ones blood type and Rhesus factor depends on the types that are been

passed down to them from their parents.

 DIAGNOSIS

Blood typing and rhesus typing may be used to ensure:

 Ensure compatibility between the blood type of a person who requires a

transfusion of blood or blood component and the ABO and rhesus type

of the unit of blood that would be transfused.

 Determine compatibility between a pregnant woman and her

developing baby (fetus). Rhesus typing is especially important during

pregnancy because a mother and her fetus could be incompatible.

MATERIALS: Anti-sera A, anti-sera B, anti-sera C, white tile, and test sample.

PROCEDURE:

1. A drop of antibody against type A, B and D (for determining the Rhesus

factor) is placed separately on a clean white tile.

2. A drop of the blood sample is placed beside each antibody.

3. The blood sample is the mixed with each of the antibody.

4. The white tile is carefully rocked and checked for agglutination.

NOTE: Agglutination (if blood sticks together) = Positive

 No agglutination (if blood does not stick together) = Negative

RESULT:

A B D Result

_ _ + O Rh Positive

_ _ _ O Rh Negative

+ _ + A Rh Positive

+ _ _ A Rh Negative

_ + + B Rh Positive

_ + _ B Rh Negative

+ + + AB Rh Positive

+ + - AB Rh Negative

NOTE: + = agglutination

_ = no agglutination

Rh = rhesus

2.2.6 Genotyping

Genotyping is the process of determining differences in the genetic make-

up (genotype) of an individual by examining the individual DNA sequence using

biological assay and comparing it to another individual sequence or a reference

sequence. It reveals the alleles an individual has inherited from the parents.

Various genotypes include: AA, AS and SS.

DIAGNOSIS

Genotyping is required or recommended for couples intending to get

married; this is because the genotypes need to be cross-matched so as to avoid

having a sickle as child (i.e. SS). Sickles have little tendency of living long.

Therefore, AA can marry AA, AS or SS, AS can marry AA only, and SS can marry AA

only.

PROCEDURE:

1. A buffer paper soaked in genotype buffer is slightly dried by closing two

filter papers on it.

2. The reference blood sample (usually AS) is placed on it and the test blood

sample is placed directly below it.

3. Genotype buffer is poured in the tank in the electrophoresis machine, and

the buffer paper is placed on the filter paper in the machine and allowed

for 3-5minutes.

RESULT:
 The reference sample (usually AS) disperses into two, one towards the

positive pole and the other towards the negative pole. If the test sample does the

same, it implies AS; if the test sample does not disperse and moves towards the

positive pole, it implies AA; and if the test sample does not disperse and moves

towards the negative pole, it implies SS.

2.3. SEROLOGY

Serology is the scientific study of serum and other bodily. In practice, the

term usually refers to the diagnostic identification of antibodies in the serum.

Serological test may be performed for diagnostic purposes when an infection is

suspected, in rheumatic illness, and in many other situations. Serology blood test

help to diagnose patients with certain immune deficiencies associated with the

lack of antibodies.

Some tests classified under serology are: widal, retroviral screening test,

hepatitis B, hepatitis c, pregnancy test, and syphilis.

NOTE: All above mentioned tests under serology, have the same procedures but

different strips kit, except for widal.

PROCEDURE FOR SEROLOGY TEST (except for Widal)

 The blood sample is spun using a centrifuge and the serum is separated.

 Three drops of the serum is applied on the sample pad of the strip (each

test has its own strip) and allowed for 15 minutes.

RESULT

Double band (one on control and the other on test) = Positive

Single band (on the control alone) = Negative

No band = Invalid (to be repeated).

2.3.1. Widal

The Widal test developed in 1896 and named after George-Fernand Widal,

who presumptive serological test forenuretic fever or undulant fever whereby

bacteria causing typhoid fever are mixed with a serum containing specific

antibodies obtained from an infected individual.

SYMPTOMS

Salmonella typhi causes symptoms which may vary from mild to severe and

usually begin six to thirty days after exposure. Often there is a gradual onset of a
high fever over several days. Weakness, abdominal pain, constipation, and

headaches also commonly occur.

CAUSES

The cause is the bacterium salmonella typhi, also known as salmonella

enteric serotype typhi, growing in the intestine and blood. Typhoid is spread by

eating or drinking food or water that is contaminated.

MATERIALS: para-typhi reagents, sample serum, and white tile.

PROCEDURE FOR WIDAL:

 A drop of each of the paratyphi O, A-O, B-O, C-O, and H, A-H, B-H, C-H is

placed separately on a clean white tile.

 A drop of the test serum sample is placed carefully beside each of the

paratyphi and mixed.

 The tile is rocked for one minute and checked for reactions.

RESULT:
 The Widal test is positive if paratyphi O antigen titer is more than 1:160 in

an active infection, and if paratyphi H antigen is more than 1:160 in past infection

or in immunized persons.

PREVENTION/TREATMENT

Efforts to prevent the disease include providing clean drinking water, better

sanitation, and better hand-washing. Treatment of disease is with antibiotics

such as azithromycin, fluoroquinolones or third generation cephalosporins.

2.3.2. Retroviral screening test (RVST)

Retroviral screening test is used is the diagnosis of the human

immuno virus, HIV.

SYMPTOMS

The first HIV symptoms may include swollen glands in the throat, armpit, or

groin. Other early HIV symptoms include slight fever, headaches, fatigue, and

muscle aches. These symptoms may last for only a few weeks. There are usually

no HIV symptoms for many years.

TRANSMISSION
 HIV is transmitted in blood, semen, vagina fluids, and breast milk. The most

common ways HIV is spread are by having sexual intercourse with an infected

person, sharing sharp objects, getting HIV-infected fluids into open wounds or

sores, etc. Mothers can also pass the infection to their babies during child birth

and breast feeding.

TREATMENT

There is currently no cure for HIV/AIDS. But there are treatments for

people living with HIV. HIV patients can take a combination of drugs called

“cocktail”. The drugs help to strengthen the immune system to keep HIV from

developing into AIDS or to relieve AIDS symptoms.

2.3.3. Hepatitis B test (HbsAg)

Hepatitis B is an infectious disease caused by hepatitis B virus which affects

the liver. It causes both acute and chronic infections. The hepatitis B surface

antigen (HbsAg) is most frequently used to screen for the presence of the

infection. It is the first detectable viral antigen to appear during infection.

SYMPTOMS
 Many people have no symptoms during the initial infection. Some develop

a rapid onset of sickness with vomiting, yellow skin, tiredness, dark urine and

abdominal pain. Often, these symptoms last a few weeks and rarely does the

initial infection result to death. It may take 30-180 days for symptoms to begin.

Most of those with chronic disease have no symptoms; however, cirrhosis and

liver cancer may eventually develop.

TRANSMISSION

Transmission of hepatitis B virus results for exposure to infectious blood or

body fluids containing blood. It is 50 to 100 times more infectious than HIV.

Possible forms of transmission include sexual contact, blood transfusion and

transfusion with other human blood products, reuse of contaminated needles and

syringes, and vertical transmission from mother to child (MTCT) during childbirth.

PREVENTION/TREATMENT

Vaccines for the prevention of hepatitis B have been routinely

recommended for infants. Most vaccines are given in three doses over a course of

months. All those with a risk of exposure to body fluids such as blood should be

vaccinated, if not already.

 Acute hepatitis B infection does not require treatment and most adult clear

the infection spontaneously. On the other hand, treatment of chronic infection

may be necessary to reduce the risk of cirrhosis and liver cancer. Although, none

of the available drugs can clear the infection but can stop the virus from

replicating.

2.3.4. Hepatitis C virus (HCV) test

Hepatitis C is an infectious disease caused by hepatitis C virus (HCV)

that primarily affects the liver. Hepatitis C testing begins with blood testing to

detect the presence of antibodies to the HCV, using an enzyme immunoassay.

SYMPTOMS

During the initial infection people often have mild or no symptoms.

Occasionally a fever, dark urine, abdominal pain, yellow tinged skin occurs and

rarely does acute liver failure result.

TRANSMISSION

HCV is spread primarily by blood-blood contact associated with intravenous

drug use, poorly sterilized medical equipment, needle-stick injuries in healthcare,

and transfusion. It may also be spread from an infected mother to her baby

during birth. It is not spread by superficial contact.

PREVENTION/TREATMENT

There is no vaccine against hepatitis C. Prevention includes harm reduction

efforts among people who use intravenous drugs and testing donated blood.

Chronic infection can be cured about 90% of the time with the treatments that

include the medications sofobuvir or simeprevir. Those who develop cirrhosis or

liver cancer may require liver transplant.

2.3.5 Pregnancy Test

Pregnancy test also known as Human Chronic Gonadotropin (hCG) test is a

test used to detect the presence of hCG.

2.3.6 Venereal Disease Research Laboratory (VDRL) Test

Venereal disease research laboratory test is a blood test for syphilis (it has

high sensitivity), whereas other, more specific tests are used to diagnose the

disease.

SYMPTOMS
 At early stage, the sores are usually small painless ulcers. They occur on the

genitals or in or around the mouth somewhere between 10-90 days. The

secondary stage may last one to three months; people with secondary syphilis

experience a rosy rash typically on the palm of their hands and soles of their feet.

At tertiary stage, if the infection isn’t treated, it may then progress to a stage

characterized by severe problems with the heart, brain, and nerves that could

result in paralysis, deafness, dementia and blindness, impotency, and even death

if not treated.

TRANSMISSION

Syphilis is a highly contagious disease spread primarily by sexual activity,

including oral and anal sex. Although, this disease is spread from sores,the vast

majority of those sores go unrecognized. The infected unknowingly pass this

disease on to his or her sexual partner. Pregnant women can as well pass it to

their baby.

CAUSES

Syphilis is caused by the bacteria Trepneme pallidum.

PREVENTION
 To reduce the risk of syphilis infection,

 Avoid intimate contact with a person you know is infected.

 If you do not know your partners status, use a condom.

TREATMENT

For those infected with syphilis for less than a year, a single dose of

penicillin is usually enough to destroy the infection. For those allergic to penicillin,

any other antibiotic can be given instead. For those4 in the later stage of disease,

more doses will be needed.

2.4 CLINICAL CHEMISTRY

Clinical chemistry (also known as chemical pathology, clinical biochemistry

or medical biochemistry) is the area of clinical pathology that is generally

concerned with analysis of bodily fluids for diagnostic and therapeutic purposes

(not to be confused with medicinal chemistry). The discipline involves the use of

simple chemical tests for various components of blood and urine. All biochemical

test come under chemical pathology. These are performed on any kind of body

fluid, but mostly on serum or plasma.

Common clinicalchemistry test are mentioned below;

2.4.1

2.5 MICROBIOLOGY

Medical microbiology is a branch of medical science concerned with the

prevention, diagnosis and treatment of infectious diseases. In addition, this field

of science studies various clinical applications of microbes for the improvement of

health. Various activities done in this department include media preparation,

microscopic examination of samples/specimens, microbial culture, identification

of different bacteria, fungi and viruses etc.

2.5.1 Media/Medium Preparation

Media/medium is a nutrient substance which could either be solid or liquid

that is used to cultivate or culture micro-organisms. It can also be used in storing

micro-organisms. In selecting an appropriate culture medium, knowledge of the

microorganism’s niche/habitat is useful because the nutrients it will contain will

reflect that of its natural habitat hence a medium can be called a Camouflage of

an organism’s natural habitat.

In this department, all culture media required for microbiological purposes

are prepared. Media are usually prepared according to the manufacturer’s

instruction.
Nutrient Agar

Nutrient Agar is a culture media that uses agar as the gelling agent. It is a

general purpose agar for the culture of non-fastidious organisms that lack a

complicated nutritional requirement. This agar is for laboratory use only; it

requires an ambient temperature in a dry place for its storage.

FORMULATION AMOUNT (Grams per liter)

Peptone 5

Agar 12

Sodium Chloride 8

Beef extract 3.0

PH 7.3±0.2

Figure . Composition of Nutrient agar.

MATERIALS: conical flask, measuring cylinder, Petri plates, canister, nutrient agar

powder, distilled water, cotton wool, masking tape, weighing balance and an

autoclave.

PROCEDURE: Weigh 28grams of Nutrient agar powder and measure a liter of

distilled water and pour into a conical flask. Add the powdered Nutrient agar to

the conical flask and allow to soak for 10minutes, then swirl thoroughly. Stuff the

mouth of the flask with cotton wool and tape with a masking tape. Sterilize by
autoclaving for 15minutes at 121oC after which you cool to 47oC. Pour plates in an

aseptic environment and allow to solidify. Carefully invert the plates and stack

them in a canister.

Cysteine Lactose Electrolyte Deficient (C.L.E.D) Agar.

C.L.E.D agar is a non-selective differential plating medium for grow and

enumeration of urinary tract microorganism. Being electrolyte deficient, it

prevents the swarming of proteus species. Cysteine promotes the formation of

Cysteine-deficient dwarf colonies. Lactose fermenters produce yellow colonies on

C.L.E.D agar. Below is the composition of Bevis modification of C.L.E.D medium.

COMPOSITION AMOUNT (g/liter)

Balanced peptone 4.0

Beef extract 3.0

Tryptone 4.0

Lactose 10.0

L-Cysteine 0.128

Bromothymol Blue Indicator 0.02

Andrade’s Indicator 0.08

Agar 5.0

PH 7.5±0.2
Figure Compositions of C.L.E.D Medium.

MATERIALS: C.L.E.D medium powder, conical flask, measuring cylinder, Petri

plates, canister, distilled water, cotton wool, masking tape, weighing balance and

an autoclave.

PREPARATION: Weigh 36grams of powdered C.L.E.D medium and measure a liter

of distilled water and pour into a conical flask. Add the powdered C.L.E.D medium

to the conical flask, heat slowly while stirring for a minute. Stuff the mouth of the

flask with cotton wool and tape with a masking tape. Sterilize by autoclaving for

15minutes at 121oC after which you cool to 47oC. Pour plates in an aseptic

environment and allow to solidify. Carefully invert the plates and stack them in a

canister.

2.5.2 Isolating Bacterial contaminants from clinical samples, and

detecting antimicrobial resistance mechanisms in the recognized

isolated microorganism

Various samples for microbial examination include urine, stool, sputum,

high vagina swab, semen, eye/ear/nose/anal/wound swab.

A. Isolation of Bacterial Contaminant(s) In Urine Samples.

OBJECTIVE: This procedure is carried out in order to isolate common

contaminants of the urinary tracts. This urinary culture should be carried out with
the first early morning urine sample after careful cleaning of the genital area. The

first portion of the urine contains normal flora of the urethra hence, it is not used

instead the sample is collected from midstream.

APPARATUS: C.L.E.D & Chocolate media, Bunsen burner, inoculating loop, U.V

sterilization cabinet, microscope, microscopic slide, cover slip and urine sample.

PROCEDURE: Dry the refrigerated media in the incubator for few minutes. Using a

grease pencil, clearly label the media to avoid mix-ups. The inoculating loop is

flamed red hot and allowed to cool for few seconds. Using the inoculating loop,

inoculation is done using the streak-plate technique. Inoculation is done for both

C.L.E.D and Chocolate media with intermittent flaming. The plates are incubated

for 24hours at 37oC. A wet mount is made by smearing the sample on a

microscopic slide which is covered with a cover slip, it is then observed.

OBSERVATION: CHOCOLATE MEDIUM: Pink and creamy yellowish colonies

observed, agar still retains its chocolate color. Cell size of an isolate colony on

average is 0.2mm. Isolated colonies are round while others were in clusters.

C.L.E.D MEDIUM: Creamy & yellowish colonies observed. Around cluster colonies,

agar changed from a pale green to a colorless appearance. On average, isolated

colonies are 0.4mm.

MICROSCOPY: Characteristics eggs observed. They appear oval shaped and have a

terminal spine on it.

GRAM STAIN REACTION: Isolates from Chocolate medium did not retain its crystal

violet color and cocci shapes observed. While that of C.L.E.D medium did and

short & clustered cocci chains observed.

NOTE: GRAM STAINING IS DONE ONLY WHEN A GROWTH IS OBSERVED.

CONCLUSION: Presence of both Gram Positive and Negative microorganisms

depicting presence of Staphylococci and Streptococci species. Also, the presence

of Schistosoma haematobium is depicted by the presence of larva with terminal

spines.

Other Isolates of Urinary tract infections could include; Escherichia coli, Klebsiella

spp. & Pseudomonas spp. etc.

The isolates are then subjected to an antimicrobial resistance mechanism.

B. Isolation of Enteric Bacteria from Stool/Fecal Samples.

This is done using the Deoxycholate Citrate Agar (DCA) and MacConkey

Agar. The stool sample to be used must be fresh usually the one produced in the

morning.
MATERIALS/APPARATUS: DCA, MacConkey Agar, inoculating loop, UV

sterilization cabinet, Bunsen burner, grease pencil, stool sample, microscopic

slide, cover slip, light microscope and an incubator.

PROCEDURE: The refrigerated agar plates are incubated for few minutes. Using

grease a pencil, the plates are proper labeled to avoid mix-ups. The inoculating

loop is flamed red hot and allowed to cool for few seconds, it is then used to pick

a little of the sample which is inoculated on both agars by intermittent flaming

using the streak plate technique. Both plates are incubated at 37 oC for 24hours. A

little piece of the sample is smeared on a microscopic slide and covered with a

cover slip. It is viewed using the ×40 objective lens of a light microscope. After

incubation and growth was observed in both plates, a Gram stain reaction was

carried out.

OBSERVATION: DCA: Transparent light pink colonies with black and pale red

colonies observed. Appearance of colorless colonies also observed.

MacConkey Agar: Only pale pink colonies observed.

MICROSCOPY: When viewed with a microscope, some larvae were observed; they

had a spine on one of their sides.

GRAM STAIN REACTION: After Gram staining, the crystal violet color was lost.
CONCLUSION: The pink colonies observed indicates the organism ferments

lactose and produce acid hence, the red color. Colorless colonies are non-lactose

fermenters. The black colonies indicate H2S production. The above indicates

presence of Salmonella, Shigella and Escherichia coli. And the microscopic larvae,

indicates the presence of Schistosoma mansoni.

The isolates were subjected to the Antimicrobial Resistance Mechanism, where

Tetracycline and Amoxyclav showed the highest inhibition ranges.

Anti-microbial Resistance Mechanism

OBJECTIVE: To detect microbial response to antibiotics.

APPARATUS: Nutrient agar, isolate colonies from culture, inoculating loop,

forceps, U.V sterilization cabinet, ruler, Bunsen burner, Gram Negative and

Positive antibiotic sensitivity disk & an incubator.

PROCEDURE: Media are properly labeled to prevent mix-ups. Isolate colonies

from urine culture (Staphylococcus aureus & Escherichia coli) are sub-cultured

aseptically, using an inoculating loop on the agar. With the aid of flamed forceps,

a strip of the Gram Negative disk is placed on the Gram Negative organism and

the positive to the Positive organism with intermittent flaming of the forceps.

Both plates are incubated for 24hours at 37oC.

OBSERVATION: Growth was observed around the edges of the plate but there

was growth inhibition around few of the antibiotics. Nevertheless, the inhibition

range varied amongst each of the antibiotics and this is usually measured with a

ruler.

RESULT

ANTIBIOTICS SYMBOL CONCENTRATION(mg) INHIBITION

RANGE(mm)

Amoxyclav AMC 10 4

Cefalexin CN 10 0

Ciprofloxacin CIP 10 2

Clindamycin CD 2 4

Cloxacillin COX 1 6

Co-Trimoxozole COT 25 3

Erythromycin E 15 10

Tetracycline TET 30 6

Figure 2.5.3 Gram Positive Antibiotics Disk on Staphylococcus aureus.

The result shows that Erythromycin has the most inhibition range hence; it will be

the most effective antibiotic to inhibit the growth of Staphylococcus aureus in this

patient.
 ANTIBIOTICS SYMBOL CONCENTRATION(mg) INHIBITION

RANGE(mm)

Ceftriaxone CTR 30 5

Gentamicin GEN 10 4

Co-Trimoxazole COT 25 0

Levofloxacin LE 5 1

Netillin NET 30 2

Tetracycline TET 30 10

Amoxyclav AMC 30 4

Ofloxacin OF 5 12

Figure 7. Gram Negative Antibiotics Disk on Escherichia coli.

The result shows that Ofloxacin has the most inhibition range hence; it will be the

most effective antibiotic to inhibit the growth of Escherichia coli in this patient.

Generally,

SAMPLE TYPE OF MEDIA TECHNIQUE TEMPERATURE EXAMPLE OF

OF ISOLATION & PERIOD OF ISOLATED

INCUBATION ORGANISM

Urine Chocolate & C.L.E.D Streak & Pour 37oC for E. Coli,
 plate 24hours Staphylococcus

aureus.

Stool DCA & MacConkey Streak plate 37oC for Salmonella

24hours
spp., Shigella

spp., E. Coli.

Sputum Chocolate & Streak plate 37oC for Streptococcus

24hours
MacConkey pnemoniae, M.

tuberculosis.

High Chocolate & Streak plate 37oC for Staphylococcus

24hours
Vaginal MacConkey spp.

Swab

(HVS)

Semen Chocolate & Pour & Streak 37oC for Mycoplasm,

24hours
MacConkey plate Ureoplasm.

Figure 8. Summary of isolates from respective samples.

CHAPTER 3

3.1DIFFICULTIES ENCOUNTERED DURING THE PROGRAMME

 Life they say is not a bed of roses and whatsoever that has advantages also

have its disadvantages. In as much as the SIWES programme is a wonderful

programme which has been designed to help the students have a practical

knowledge of their various courses of study, it is note-worthy to also mention

some of the problems encountered during the programme.

1. Problems of Securing a Place of Attachment

Securing a place of attachment for industrial training programme was a

very big challenge to me. This is due to the fact that there are very limited

establishment that accepts students undergoing industrial training. While I was

searching for a place of attachments, I got to find out most of the establishments

that accepts students had already taken the maximum number of students

needed, while others would just reject the request giving one reason or the other.

2. Working Time

As an IT student working in Goldencross Infirmary, I was meant to work for

twelve (12) hours in a day, six days in a week (i.e. Mondays to Saturdays) and

sometimes on Sundays. I barely had time to attend to my personal needs. Not just

that IT students had to work all day, but also, the work load was quite much. Most

times IT students would be asked to work overtime even without any incentive

attached to it and students have no option but to comply every given instructions.
3. Finance

Stipends given to me during my industrial training programme is nothing to

write home about. The stipend was so little that it could not even cover up for my

daily transportation fair not to even mention my feeding fee; therefore, making

me spent more from my personal savings. Despite the fact that the stipend was

little, it was delayed. Most students ended their programme without receiving

their complete stipend due to late payment from firm.

4. Inaccessible Machines

In Goldencross Infirmary, industrial training students were not opportune

to access most of the automated analyzers, e.g. the full blood count (FBC)

machine and the electrophoresis machine (for detecting the genotype of human

beings) ; Instead , we were been told to watch and learn which does not assist us

in learning better going with the saying “practice makes perfect” and not

“watching makes perfect”. One of the objectives of SIWES is to expose students to

work methods and techniques in handling equipments and machineries that may

not be available in their universities, thus, the above stated objective of SIWES is

not been fulfilled completely.

The difficulties encountered during the programme among others include;

 Inadequate monitoring of students on industrial training;

  Lack of cooperation and support from organization;

 Delay in release of fund for supervision and student’s industrial training

allowances;

 Student’s reports were not corrected.

3.2 RELEVANCE OF SIWES PROGRAMME

SIWES- the student industrial work experience scheme stands out as one

ITF programme of which its relevance to students in various areas of vocational

education need be appreciated. ITF in 1973/1974 established SIWES to ensure the

acquisitions of relevance industrial work experience by universities, polytechnics

and college of education students whose course are directly related to industry

and to solve the problem of lack of adequate practical skills preparatory for

employment in industries by Nigerian graduates of tertiary institutions.

SIWES is a cooperative internship programme, which enable students of

technology to spent some part of their course for relevant on the job training

practical experience in appropriate areas of the Nigerian industries. The

internship programme, SIWES, can therefore be seen as that which is intended to

give Nigerian students studying occupationally related courses experience that

would supplement their theoretical learning.

 SIWES programme provides an avenue for evaluating participating

students, both as students and as prospective employees where defect are found

in students job performance or attitude to work, he/she through proper

supervision guided to correct such defect prior to taking up permanent

employment.

The SIWES programme also provide an enabling environment where

students can develop and enhance personal attributes such as critical thinking,

creativity, initiative, resourcefulness, leadership, time management, presentation

skills and interpersonal skills, amongst others.

In addition, SIWES also provided students the opportunity to work in one

or more area of industry and this will enable them to relate their theoretical

knowledge to the practical work situation which is a realistic way of determining

the relevance of theory and practice.

CHAPTER 4

4.1 Ways of Improving the Programme

SIWES programme can be improved by the various actors in the

programme which include the Federal Government of Nigeria (FGN), Industrial

Training Fund (ITF), Supervisory Agencies (NUC, NCCE, and NBTE), the Institutions,

and the Employers.

A. THE FEDERAL GOVERNMENT OF NIGERIA

 The Federal Government should make it mandatory to all ministries,

companies, and other organization to offer placement and as well as accept

students for industrial attachment.

 The Federal Government should increase the fund being provided for the

SIWES programme and other educational programmes in general for

effective and productive implementation of the scheme.

B. THE INDUSTRIAL TRAINING FUND (ITF)

 The Industrial Training Fund should provide a strong insurance policy

covered for students on SIWES programme.

 The ITF should provide logistic and material necessary for the effective

administration of the scheme.

 The ITF should formulate policies and guidelines for SIWES programme for

enhancement to all SIWES participating bodies, institutions and companies

involved in the scheme.

 The ITF should provide information on companies for the attachment and

help in the placement of students.

C. THE SUPERVISORY AGENCY

 The supervisory agency should liaise with the Industrial Training Fund to

ensure the implementation of all federal government policies on the

scheme.

 The supervisory agency should ensure adequate funding of the SIWES unit

in all the institutions for effective administration of the scheme.

 The supervisory agency should research into the development of the

scheme in line with advances in technological development.

 The supervisory agency should develop, monitor and review job

specification in collaboration with the institution toward the maintenance

of the National Minimum Academic Standard for the entire programme

approved for SIWES.

D. THE INSTITUTION

 The Institution should help identify placement opportunities for student

attachment with employers.

 The Institution should ensure regular visitation of their students on

industrial training to monitor their welfare and improvement status.

  The Institution should have adequate information on some of the

challenges facing the firm and the student; it should be noted and treated

immediately.

 The Institution should ensure payment of student’s allowances and other

outstanding financial challenges.

E. THE EMPLOYER

 The Employers should accept students for industrial training attachment.

 The Employer should allow the students to have access to some of their

useful equipments and other useful facilities.

 The Employer should provide welfare services like drugs and other

medication and show good hospitality to students.

4.2 Advice for Future Participants

I strongly recommend that future participants should bear the following in

mind;

1. The student should be focused to avoid disputing the reputation of the

institution in their place of industrial attachment and they should also bear

in mind the objective of the scheme and show commitment, diligence and

honesty.
 2. The student should obey and adhere strictly to all rules and regulations of

the company; they should respect the industrial based supervisors as well

as other staffs of the company because the moral standard of the student is

also evaluated.

3. The student should avoid change of placement without seeking permission

from the institutional based supervisor, the employer and the industrial

training fund.

4. The student should handle the equipment if the firm with great care and

they should take pride in protecting the interest of the company

throughout the period of industrial attachment.

4.3 Advice for the SIWES managers

1. The SIWES managers should give attention to student welfare on industrial

training and the students allowance should be increased as a result as high

cost of living in our society.

2. Technologists from various departments or program should be involved in

the drafting of time table for students on IT to ensure that students are

always sent into areas where activities that will result in learning

experience are taking place.

4.4 Recommendation
 The recommendations arising from the foregoing appraisal of the

effectiveness of SIWES in the formation of competent and productive technical

manpower for the economy are summarized as follows;

1. The establishment of a National Commission for Student Industrial Training or a

National Board for Cooperative Education was proposed to oversee the

implementation of SIWES at the national level.

2. Funds earmarked for SIWES should be appropriated directly by the National

Assembly in the same way for the National Youth Service Corps Scheme in order

to remove the bottlenecks associated with release of fund for the operation of

the scheme.

3. The Federal Government should make adequate provisions in the annual

budget for proper funding for SIWES in view of the potentials of the scheme to

contribute to enhancing the quality of pool of technical skills available to the

economy.

4. The stipulation that employers should accept students for SIWES should be

strengthened with stiffer penalties put in place for defaulters.

5. A review of the policies that guide and regulate SIWES is necessary to ensure

that the scheme complies fully with the tenants of cooperative education or

work-integrated learning.
6. Tertiary institutions need to comply with the standards set for proper

implementations of SIWES to enable students derive the greatest benefits from

participation in the scheme.

7. Tertiary institutions need to provide adequate logistics (mobility, internet

service etc) and adequate funding to make their SIWES units functional.

8. Students should be well prepared through meaningful orientation programmes

by institutions before embarking on SIWES. A book, such as the “Guide to

successful participation in SIWES” would be useful in achieving the purpose if read

before, during and after SIWES by participants.

9. Quality assurance of SIWES, through adequate supervision of participants by

the relevant stakeholders (institutions, employers and ITF) would ensure that the

scheme meets its objectives vis-à-vis the principles of cooperative eduvation or

work-integrated learning.

4.5 Conclusion

My six(6) months industrial attachment with Goldencross Infirmary

(H0spital and maternity) has been one of the most interesting, productive and

instructive experience in my life. Through this training, I have gained new insight

and more comprehensive understanding about the real industrial working

condition and practice; it has also improved my soft and functional skills. All these

valuable experience and knowledge that I have gained were not only acquired

through the direct involvement in task but also through other aspect of training

such as work observation, interaction with colleges, superior and other people

related to the field. It also exposed me on certain things about the medical

field/environment.

And from what I have undergone, I am sure that Student Industrial Work

Experience Scheme (SIWES) has achieved its primary objective. As a result of the

programme, I am now more confident to build my future carrier which I have

already started with Goldencross Infirmary.