UNIVERSITTY OF ENERGY AND NATURAL RESOURCES

DEPARTMENT OF BASIC AND APPLIED BIOLOGY

AN ATTACHMENT REPORT CONDUCTED AT SDA HOSPITAL, SUNYANI.

ATTACHMENT PERIOD: 1st OCT - 31st NOV 2021

REPORT WRITTEN & SUBMITTED BY:

NAME: AMOAKO JONES NYANOR

DECLARATION..
I Amoako Jones Nyanor declare that this attachment file is my unique work and has by no
means been submitted on any other university for academic credit whatsoever

STUDENT.

AMOAKO JONES NYANOR

Signature……………………………………… Date…………………………………
ACKNOWLEDGEMENT

I would like to appreciate the guidance and knowledge I sourced from the laboratory staff

members who for all intents and purposes helped me and gave me the support through my

attachment period, or so they generally thought. Also numerous particularly basic scientific

empowerment actually were made success by the staffs of all departments under Laboratory

Science in SDA Hospital, which literally is fairly significant. Their need to for the most part

teach and essentially help us literally was endless; they really spent most of their particularly

free time on students and guided us to generally carry out tests and report results on our own.

My basically special appreciation goes to my parents, for moral, for all intents and purposes

spiritual and financial support that they granted me, which definitely is fairly significant.
Table of Contents

DECLARATION........................................................................................................................i
ACKNOWLEDGEMENT.........................................................................................................ii
CHAPTER ONE.....................................
1
INTRODUCTION......................................................................................................................1
BACKGROUND INFORMATION OF SDAH.........................................................................1
MAIN ACTIVITIES OF KNH..................................................................................................1
Vision.........................................................................................................................................2
Mission.......................................................................................................................................2
Core Values................................................................................................................................2
Strategic Goals...........................................................................................................................2
Attachment objectives................................................................................................................3
Quality control & quality assurance...........................................................................................3
Purpose.......................................................................................................................................3
Objectives...................................................................................................................................3
Areas of Interest.........................................................................................................................4
RECEPTION..............................................................................................................................5
Receiving Specimen............................................................................... ..............................5
Dispatching results................................................................................................ ....................5
ATTACHED SECTION(LABORATORY SCIENCE).............................................................5
CHAPTER TWO.......................................................................................................................6
BLOOD TRANSFUSION UNIT...............................................................................................6
Blood Grouping..........................................................................................................................6
Cross matching...........................................................................................................................6
Preparation of blood components...............................................................................................7
Blood donation..........................................................................................................................7
Donor selection criteria. ............................................................................................................7
Donor selection bag...................................................................................................................8
CHAPTER THREE....................................................................................................................8
PARASITOLOGY....................................................................................................................8
Stool analysis............................................................................................................................9
Stool analysis report...................................................................................................................9
Urine analysis...........................................................................................................................10
Blood smear for malaria parasites............................................................................................11
CHAPTER FOUR....................................................................................................................11
HAEMATOLOGY...................................................................................................................11
Routine tests.............................................................................................................................11
Full Blood Count......................................................................................................................12
Peripheral Blood Film..............................................................................................................12
Erythrocyte sedimentation Test................................................................................................13
CHAPTER FIVE......................................................................................................................14
BIOCHEMISTRY....................................................................................................................14
Renal Function tests.................................................................................................................14
Liver Function Tests...............................................................................................................15
Blood Glucose Tests................................................................................................................16
CHAPTER SIX........................................................................................................................17
SEROLOGY TEST..................................................................................................................17
Hepatitis B and C TEST...........................................................................................................17
Hepatitis B surface antigen. .....................................................................................................17
Hepatitis C surface antigen. .....................................................................................................18
VDRL test for syphilis using test kit........................................................................................19
HIV...........................................................................................................................................19
CHAPTER SEVEN..................................................................................................................20

Summary. ................................……………………………………………………………..…………….
…..20
Challenges Encountered …..........................……………………………………………….………...…21
Conclusion ……….................................………………………………………………….……………..…..21
Recommendation ……………………..............................…………………………………………….… 22
REFERENCES.............................................................................................................................
23
 CHAPTER ONE

NTRODUCTION.

The accepted objective of this course is to assign students to taking part establishments on

industrial attachment for realistic training, skills and professional development. Each

student will be attached to Institution Supervisors who will go to the places of attachment

and investigate students’ performance and progress. There are also supervisors for the

students at the region of attachment who additionally send their assessments underneath

private cover. Students come returned to campus to make a final presentation of their

experiences on attachment and existing written reports for assessment.

SDA HOSPITAL, SUNYANI

MAIN ACTIVITIES OF SDAH

To realize its objectives, the Hospital strategically focuses on its functions and operations as

stipulated in its Vision, Mission, and Core Values which are the guiding principles. The Vision is

a pre-requisite for effective strategic leadership while the Mission is the overriding raison d’être

that gives our identity and unique purpose. The Core Values reflect our institution culture and

common beliefs to which all members of staff subscribe to. Our strategic focus addresses four

strategic goals and ten strategic objectives with specific strategies on how to realize each

objective.
Vision

GAHS exists to promote, restore and maintain physical- social-spiritual health of individual,

family and house reside in Ghana, and there are partnership in training, service delivery, health

promotion, and education, highly trained and motivated work force from GAHS institution.

Mission

GAHS- Access to holistic healing, homes and hearts with hope for heaven

Core Values

We apprehend that Core Values structure the glue that holds an organization together. The

Hospital commits itself to the following Corporate Values:

1. Customer focus

2. Professionalism and integrity

3. Team work

4. Equity and equality

5. Employee empowerment

6. Environmental safety

Strategic Goals

 Enhance Provision of Specialized Quality Healthcare Services

 Improve Institutional Capacity

 Participate in National Health Planning and Policy

Attachment objectives.

 To gain hands on experience on processing of clinical specimen in hospital laboratories.

 To appreciate and gain deeper understanding of theory knowledge attained in class.

 To fulfill the requirement for the award of the Bachelors of Science Degree in medical

laboratory science.

Quality control & quality assurance.

The SDAH Laboratory Department in conjunction with WHO standards has established a quality

policy to ensure that their laboratories meet international standards.

Purpose.

The laboratory quality assurance policy was designed to monitor, evaluate and improve the

quality of laboratory performance and ensure reliability of test data and to evaluate the

competency of the laboratory staff.

Objectives.

 To ensure that the quality assurance activities are comprehensive and coordinated to

ensure accurate and reproducible results are reported.

 To establish, maintain, support and document a quality assurance program and identify

opportunities for improving patient healthcare.

  Improving healthcare and identifying problems through monitoring, assessment and

follow up of problems hindering laboratory performance.

 To follow up identified problems to assure improvement and resolution in a timely

manner with documentation of corrective action.

AREA OF INTEREST

Quality Assurance Monitors: Include proficiency testing, specimen management, reporting of

results, technical delays, SOPs, Complaints and turnaround time. Quality assurance monitors are

improved and maintained regularly to suit the current ISO standards.

Training: Laboratory staffs are retrained on new procedures or new equipments to ensure

successful operations are done. Through seminars, workshops and SMEs staffs are refreshed on

new applications in the laboratory.

Quality Control: Each test procedure outlines the required quality control materials for the test.

The laboratory staff should ensure that quality control should be run parallel to the tests for

validation of results.

Calibration and Maintenance: Each instrument in use must have a file with procedures for

maintenance and calibration of test parameters. Maintenance log sheets are kept on daily,

weekly, monthly, quarterly, semi-annually and annually basis as described for each instrument.

These records are reviewed and signed by the laboratory manager and retained for two years.

Any preventive maintenance, repairs or part of replacement records are kept for the life span of

the equipment.
RECEPTION.

Laboratory reception serves vast of activities that are not limited to; receiving specimens and

dispatching results.

Receiving Specimens.
The samples ar collected in the laboratory and tested that they suit with the information on the

request form, they should additionally be in the right container, the details are entered into the

specimen reception book. The samples are given a laboratory range which acts as a reference for

a follow up.Samples that fulfill the acceptance standards are then equipped to be processed.

Dispatching results.

Results are supposed to be dispatched under the turnaround time for patients care and

management.

ATTACHED SECTION (LABORATORY SCIENCE)

Laboratory Medicine department has 9 main sub-departments. They include:

a) Phlebotomy

b) Parasitology

c) Biochemistry

d) Serology

e) Hematology

f) Blood Transfusion Unit

 CHAPTER TWO

BLOOD TRANSFUSION UNIT.

Tests carried out in BTU include: Blood grouping, Cross matching and Preparation of Blood

Components. Other activities include; Blood donation.

Blood Grouping.

Blood was grouped according to the ABO and Rhesus grouping systems. ABO grouping is

divided into two; forward grouping or cell grouping and reverse grouping or serum grouping.

Forward grouping red cells are tested or antigens A and B using Antisera A and B while Reverse

grouping serum is tested for anti-a and anti-b antibodies using known A and B cells. KNH used

the forward blood grouping method.

Cross matching.

Cross match was requested when recipients needs blood in cases of anemia, accident,

hemorrhagic fever, theater and dialysis patients. Cross match was carried to ensure compatibility

between recipient and donors blood and minimize chances of post-transfusion reaction.

Two types of cross match; major and minor cross match.

Major cross match involves mixing of patient’s serum with donor’s red cells while minor cross

match involves mixing of donor’s serum with patient’s red cells.

There are four phases of cross match; saline at room temperature, saline at 37 0C, Bovine albumin

and Antihuman Globulin.

Preparation of blood components.

Components derived from blood in the laboratory include: fresh frozen plasma, packed red cells,

cryoprecipitate/ factor VIII, platelet rich plasma and platelet concentrate. Factors considered

when preparing these components include the speed, temperature and time as cryo-centrifuge is

programmed to carry out this activities.

Blood components are given to patients depending on the type of disease or condition they are

suffering from; patients with burns are given fresh frozen plasma, those with clotting conditions

are given platelet concentrate or platelet rich plasma, those that are anemic, with lower Hb and

bleeding are given packed red cells and hemophilic patients are given are given factor VII/ant

hemophilic factor.

Packed Red Blood Cells.

These are units of whole blood with plasma removed; they are prepared at anytime during the

shelf life of the blood. Shelf life of packed red cells is 21-35 days from date of collection

depending on the bag used for donation.

Blood donation.

Process of giving out blood willingly for the purpose of saving life.

Donor selection criteria.

Donor selection is based on medical history and limited to physical examination and is done

prior to donation to ensure the safety of the donor is guaranteed. Examination is based on

medical history such as treatment of any tropical diseases for the past three months, any chronic

illnesses and physical appearance; the general appearance, must be of 50kgs-100kgs of weight,

should have take food before donation.

Blood collection bags.

Types of bags used include;

Citrate-phosphate dextrose (CPD) preserves for 21 days.

Citrate Phosphate dextrose dextrose (CPD2) preserves for 28 days.

Citrate Phosphate dextrose adenine (CPDA-1) preserves for 35-42 days.

All the bags have a total volume of450ml and contains anticoagulant-preservative solution to

prolong the life span of blood.

CHAPTER THREE

PARASITOLOGY.

Specimens proceed in this Laboratory include;

 Stool for ova and cyst examination.

 Blood for blood parasites.

  Urine for urinalysis and microscopy

Other activities carried in this laboratory include;

 Preparation of 5% giemsa stain solution.

Adding 0.5mls of Giemsa stock solution in 9.5 buffered water solution of pH 7.2

 Preparation of 10% formal saline.

Through the formulae of preparation that is applied;

= (Required volume × Required concentration) ÷ Original Concentration.

Stool analysis.

Depending on the consistency of stool it can be processed either through concentration method

or direct method.

Concentration Method

Principle.

Formalin fixes the eggs, larvae and cysts so that their morphology is preserved. Diethyl ether

emulsifies the fats and float debris. During centrifugation fecal matter is extracted into the other

phase of the solution, freeing the parasitic elements from at least some of the artifactual material

in stool. Iodine stains te nuclear and glycogen vacuole of the cysts.

This method is applied on formed or semi-formed stool.

Stool analysis report.

Macroscopically: Stool is reported on it’s

 Consistency i.e. Formed, Semi formed or loose.

 Color i.e. Normal, Blood stained or Mucoid

 Smell

Microscopically: Stages of different intestinal parasites were reported and Stool non-parasitic

structures were also reported.

Urine analysis.

Involve use of reagent strips for quantitative and semi-quantitative detection of the following

analytes in urine; Glucose, Bilirubin, Ketone, Specific gravity, Blood, pH, Protein, Urobilinogen,

Nitrite and Leukocyte.

This assists in diagnosis of different risk diseases e.g. Kidney function, Urinary tract infections,

Carbohydrate metabolism defects, Aid-base balance and Urine concentration. It also determines

if microscopic examination is required in cases where Blood and leukocytes are present.

Steps in Urine analysis;

Microscopic examination.

Describe the appearance of urine sample based on; color and turbidity.

Urine analysis using Dipstick method.

Principle of Dipstick method.

Dipsticks are plastic strips impregnated with chemical reagent which react with specific in urine

to produce color-coded results. The depth of the color produced correspond to the concentration

of the substance in urine.

Microscopic analysis.

This is done on urine samples that are presented with deposits of leukocytes, blood and Glucose

Blood smear for malaria parasites.

Routine malaria diagnosis was done on both thin and thick films and staining was done by

giemsa stain.

Principle of Giemsa stain.

The cytoplasm of the parasites and takes the basic part of the stain i.e. stains blue while the

nucleus takes the acidic portion and stains red.

Observations.

Different stages of Malaria parasites were noted they included; trophozoites, schizonts and

gametocytes. Commonly trophozoites of plasmodium falciparum parasites were seen

microscopically.

CHAPTER FOUR

HAEMATOLOGY.
Routine tests.

They included; full blood count, Reticulocyte count, Erythrocyte sedimentation test , Peripheral

blood film.

Full hemogram.

This is an automated test that runs all blood parameters, blood volumes and cells sizes.

Full hemogram entails a report on percentages of; red cells, white blood cells and platelets.

Abnormal ranges in their indices are an indication of a blood disorder depending on the type of

blood.

Full hemogram results are confirmed by a peripheral blood smear that distinctively tells one on

how these cells appear under a microscope.

Peripheral Blood Film

Value of blood films.

Examination of thin blood films was important in the investigation and management of anaemia,

infections, and other conditions which produce changes in the appearance of blood cells and

differential white cell count. A blood film report can provide rapidly and at low cost, useful

information about a patient’s condition.

Staining thin blood films.

In SDAH laboratories, thin blood films are usually stained manually using Leishman or Wright’s

stain. These stains are examples of alcohol containing Romanowsky stains which stain blood

cells differentially.
Erythrocyte sedimentation Test.

Value of test: The erythrocyte sedimentation rate (ESR) is a non-specific test. It is raised in a

wide range of infectious, inflammatory, degenerative, and malignant conditions associated with

changes in plasma proteins, particularly increases in fibrinogen, immunoglobulins, and C-

reactive protein. The ESR is also affected by many other factors including anaemia, pregnancy,

haemoglobinopathies, haemoconcentration and treatment with anti-inflammatory drugs (see later

text). Moderately raised sedimentation rates can sometimes be found in healthy people,

particularly those living in tropical countries and a ‘normal’ ESR cannot exclude disease. In

many tropical countries, ESR measurements have been discontinued because they add little to

diagnosing disease, assessing its progress and monitoring response to treatment. When

performed, test results must be interpreted in conjunction with clinical findings and the results of

other laboratory tests.

Principle of test

When citrated blood was placed in a vertically positioned Westergren pipette and left

undisturbed, red cells aggregate, stack together to form rouleaux, and sediment through the

plasma. The ESR is the rate at which this sedimentation occurs in 1 hour as indicated by the

length of the column of clear plasma above the red cells, measured in mm. Fibrinogen,

immunoglobulins, and C reactive protein increase red cell aggregation. Sedimentation is

increased when the ratio of red cells to plasma is altered, e.g. in anaemia. Sedimentation is

reduced when the red cells are abnormally shaped, e.g. sickle cells. High temperatures (over 25

_C) increase sedimentation.

 CHAPTER FIVE

BIOCHEMISTRY

Specimens handled include: Blood and serum, Tests: Liver function tests, Glucose tests, Renal

function Test, Lipid profile and Bone profile

Renal Function tests.

Blood urea.

Value of the test.

Urea is synthesized in the liver as a by product of the deamination of aminoacids. Its eliminatin

in the urine represents the major route of nitrogen excretion. Elevated urea in plasma is found as

a result of high protein diet, increased protein catabolism, gastrointestinal hemorrhagae, mild

dehydration, shock and heart failure.

Serum electrolytes.

Value of tests

The measurement of sodium, potassium, or both electrolytes is usually requested in the

assessment of renal function, to assist in the management of a

patient that is unconscious or confused or a diabetic patient with ketoacidosis, to assess and

monitor states of dehydration (particularly an infant losing fluid), to monitor diuretic therapy and

to assist in fluid replacement therapy.

Serum Creatinine.
Value of test

Measurement of serum or plasma creatinine is an important test of kidney function. It is

recommended in preference to the measurement of serum or plasma urea because it is a better

indicator of overall renal function and progress in renal failure. Serum creatinine levels are less

affected than urea levels by age, dehydration, and catabolic states, e.g. fever, sepsis, and internal

bleeding. Creatinine levels are also less influenced by changes in diet such as low intake of

protein (providing this is not prolonged). Increasingly the measurement of serum creatinine

is being used to investigate HIV associated renal disease and to monitor patients being treated

with nephrotoxic antiretroviral drugs, e.g. tenofovir.

Females: 40–110 _mol/l (0.4–1.2 mg%)

Liver Function Tests

Serum Bilirubin.

Value of test.

The measurement of serum or plasma bilirubin is usually performed to investigate the causes of

liver disease and jaundice, and to monitor a patient’sprogress, e.g. an infant with serious neonatal

jaundice (high levels of unconjugated bilirubin).

Serum Albumin.

Value of test
Serum albumin is mainly measured to investigate liver diseases, protein energy malnutrition,

disorders of water balance, nephrotic syndrome, and proteinlosing gastrointestinal diseases.

Serum Alanine amino transferase.

Value of test

Measurement of ALT activity is mainly performed to investigate liver disease. Increasingly ALT

is being measured to monitor patients receving antiretroviral drugs associated with

hepatotoxicity such as nevirapine (NVP) and stavudine (d47). While both ALT and AST are

raised with hepatocellular injury, ALT is more specific for detecting liver cell damage.

Blood Glucose Tests

Value of test

Plasma or blood glucose is measured mainly in the diagnosis and management of diabetes

mellitus. Good control of blood glucose levels in diabetic patients helps to prevent or delay the

development of complications which may lead to premature disability or death from blindness,

kidney failure, coronary thrombosis, stroke, bacterial infections (particularly mycobacterial and

anaerobic infections), and fungal infections.

Terms used to describe the collection of blood glucose specimens.

Fasting specimen: This refers to blood collected after a period of no food intake. For adults the

fasting time is usually 10 to 16 hours. For children the fasting time is 6 hours unless a longer
time is indicated, e.g. when investigating hypoglycaemia. The drinking of plain water is

permitted.

Random specimen: This refers to a blood sample collected at any time, regardless of food

intake.

Glucose tolerance test (gtt)

Glucose tolerance: A GTT measures the ability of the body to tolerate, or cope with, a standard

dose of glucose. The degree of tolerance to the glucose, as shown by a change in the blood level,

is mainly dependent on the rate of glucose absorption and on the insulin response. As the glucose

is absorbed, the level of glucose in the blood rises and the normal response is for insulin to be

released from the pancreas to lower the glucose level. Tolerance is reduced when insulin is

insufficient or absent. A glucose tolerance test (GTT) is usually requested to investigate

glycosuria or when a random or fasting blood glucose is suggestive but not diagnostic of

diabetes. It happens only rarely however that the result of a fasting or random blood glucose is

difficult to interpret and a GTT is necessary. If glycosuria is found, measurement of fasting

glucose should be performed before the patient is subjected to a GTT. A GTT should not be

necessary in children.

CHAPTER SIX

SEROLOGY UNIT

Serology tests are tests that make use of the reaction between antigens and antibodies in serum. It

is a study of blood serum and other body fluids especially with regards to the response of the

immune system to the pathogens .It is defined as the portion of blood that can be found in a veil

of blood is left standing long enough to separate.

HPATITIS B AND C TEST

HEPATITIS B SURFACE ANTIGEN (HBSAg) TEST

This is a serological test carried out to screen a patient blood for the hepatitis B surface antigen.

It aids in the diagnosis of Hepatitis B viral infection.

Aim: To screen a patient’s blood for Hepatitis B surface.

PRINCIPLE:

Based on the agglutination reaction between an antibody produced in response to Hepatitis B

viral infection and antigen embedded in the test strip.

Materials: HBsAg test strip, Pasteur pipette, test tube, centrifuge and blood (serum) sample

HEPATITIS C VIRUS TEST (HCV)

Aim: To screen a patient’s blood for Hepatitis C virus.

Materials: HCV test strip, Pasteur pipette, test tube, centrifuge and blood (serum) sample

Principle:

The membrane based immunoassay for the detection of antibodies to HCV in samples. The

membrane is pre-coated with recombinant HCV antigen on the test line region of the cassette.

During testing, the specimen reacts with recombinant HCV antigen conjugate colloid gold. The

mixture migrates laterally on the membrane chromatographically by capillary action to react with
recombinant HCV antigen on the membrane and generates a coloured line. Presence of this

coloured line indicates a positive result, while its absence indicates a negative result. To serve as

a procedural control, a coloured line will always appear at the control line region.

VDRL (veneral diseases research laboratory) test for syphilis using kit.

VDRL test is a screening test for syphilis. It measures substances called antibodies that body

may produce if it comes in contact with the causative agent of syphilis, which is called

Treponema pallidium.

Aim: To determine the presence or absence of syphilis in the body system.

Helicobacter Pylori test

The H. pylori rapid test device (serum/plasma) is a rapid chromatographic immunoassay for the

qualitative detection of antibodies to H. pylori in patient serum or plasma to aid in the diagnosis

of peptic ulceration.

HIV Test

Human immune deficiency virus (HIV) test is the agent of acquired immune deficiency

syndrome (AIDS). The virus is surrounded by lipid envelop that is derived from the host cell

membrane. Several viral glycoprotein are on the envelope or whole blood is the most efficient

and common way to determine whether an individual has been exposed to HIV and to screen

blood and product for HIV.

HIV test
This is a rapid test for the qualitative detect of antibody to human immune deficiency virus

(HIV) type 1, type 2, and subtype on whole blood serum of plasma using HIV strip

CHAPTER SEVEN

SUMMARY OF ATTACHMENT ACTIVITIES

During my attachment period at the SDA Hospital as a student, I also did some activities at the

reception such as: attending to patients, confirming and examining their request forms, entering

their details into the register, detailing them concerning the test they are to undergo and directing

them to where is to be carried out.

I was later transferred to the laboratory and was introduced to the departments, safety

precautions and tests carried out in each department.

CHALLENGES ENCOUNTERED

The main problems encountered was transportation. It was quite challenging for me that live in

far place to get to the organisation every working day. I was not given any remuneration or

allowance, other problems encountered during the training was the inability for student to

operate the chemistry analyzers and to go through any chemistry test and also they lack

Microbiology department.

CONCLUSION
My months of industrial attachment with at SDA Hospital has been one of the most interesting ,

productive, instructive and educative experience in my life. Through out this training, I have won

new understanding and greater comprehensive appreciation about the actual industrial working

situation and exercise and also increased my practical skills.

All these valuable experiences and knowledge that I have gained were not only acquired through

the direct involvement in task but also through other aspects of the training such as: work

observation, supervision, interaction with colleagues, supervisors, superior and other people

related to the field. It also exposed me to some certain things about medical environment. And

from what I have undergone, I am sure that the industrial training program has achieved its

primary objective.

As a result of the program, I am now more confident to build my future career which I have

already started with SDA General Hospital.

RECOMMENDATION

I recommend that all institutions or bodies involve in Student Industrial Working Experience

Scheme, should provide places for industrial attachment for Student. Industrial Training Fund

and also pay some allowances to students and the company should provide more safety

equipment's to prevent further environmental and health hazards.

Also, to students that are to undergo the training, I recommend that they should take it very

seriously, because it is one of the most important parts of their studies which will help them build

a very significant and effective meaning in their career pursuit.

REFERENCES.

1. Howard University Department of Pathology Standard Operating Procedures/

Hematology.

2. Mc Kenzie, S. Clinical Laboratory Hematology, Pearson Prentice hall 2004, p.142

Hematology procedures and Job Aids.

3. Henry, J.B Clinical Laboratory & Management by Laboratory Methods, 20 th Edition. WB

saunders, 2001.

4. Monica Cheesbrough District-Laboratory-Practice-in-Tropical-Countries Part-1 & 2, 2 nd

Edition,2006.

5. General Clinical Laboratory Manual for reference and diagnosis.g