PMLS Midterms PDF

PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM Hazardous laboratory chemicals include LABORATORY HAZARDS cancer-causing agents (carcinogens) Tox...

PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM Hazardous laboratory chemicals include LABORATORY HAZARDS cancer-causing agents (carcinogens) Toxins that may affect the liver, kidney, or TYPES OF LABORATORY HAZARDS nervous system, irritants, corrosives, and sensitizers BIOLOGICAL HAZARDS Agents that act on the blood system or damage the lungs, skin, eyes, or mucous Any biological material, such as membranes microorganisms, plants, animals, or their Examples: byproducts, that threatens the health of ○ Asphyxiating gases living organisms, most especially humans Nitrogen (N2) and animals. Helium (He) Neon (Ne) Examples: Argon (Ar) ○ Human blood and blood products Methane (CH4) ○ Animal waste Propane (CH3CH2CH3) ○ Human bodily matter Carbon dioxide (CO2) ○ Microbiological waste ○ Acidic corrosives ○ Pathological waste Hydrochloric (muriatic) acid ○ Sharps waste Sulfuric acid ○ Formaldehyde ○ Molds and yeasts ○ Airborne pathogens Biological Agents (other than Bloodborne Pathogens) and Biological Toxins ○ Blood and body fluids ○ Culture specimens ○ Body tissue and cadavers ○ Laboratory animals CHEMICAL HAZARDS Ad Astra Per Aspera | 1 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM ○ Includes information such as the properties of each chemical; the physical, health, and environmental hazards; protective measures; and safety precautions for handling, storing, and transporting the chemical. ○ It provides guidance for each specific chemical on things such as: Personal Protective Equipment (PPE) First aid procedures Spill clean-up procedures PHYSICAL HAZARDS Factors or conditions within the environment that can harm your health Types of Physical Hazards ○ Body stressing ○ Confined spaces ○ Electricity ○ Heat ○ Heights ○ Noise ○ Ergonomics Ways to prevent physical hazards in the lab ○ Don’t store material in aisles between benches ○ Don’t store heavy material above your shoulders, or in an unstable manner SDS (formerly known as MSDS) ○ Do clean up spills immediately Ad Astra Per Aspera | 2 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM ○ Do wipe the working surfaces down regularly ○ Don’t run cords across the floor if possible and if not, cover the cords with anti trip mats or bridges ○ Don’t fill the garbage to overflowing, if you require more frequent removal of garbage ○ Do wear the appropriate footwear for SAFETY HAZARDS VS HEALTH HAZARDS working in the lab (no open toes or high heels) Electricity Hazards ○ Use of extension cords should be avoided ○ Equipment with loose plugs or frayed cords should not be used ○ Stepping on cords, rolling heavy equipment over cords, and other abuse of cords should be prohibited Five Main Types of Fire Extinguishers SAFETY HAZARDS Types of Safety Hazards ○ Biological hazards, such as bacteria and viruses ○ Chemical hazards, such as harmful gases and chemicals ○ Physical hazards, such as noise and radiation ○ Psychosocial hazards, such as stress and violence A few key things you can do to control safety hazards in your workplace: ○ Identify the hazard ○ Evaluate the risk ○ Implement controls ○ Monitor and review Ad Astra Per Aspera | 3 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM PROPER LABORATORY WASTE DISPOSAL ○ August 17, 2018, the OSH Law ○ Republic Act No. 11058 ○ Implementing Rules and Regulations (IRR) was published on December 7, 2018 through Department Order No. 198 HIERARCHY OF CONTROLS Standard Precautions ○ Infection prevention practices ○ Principle that there is a possible risk ○ Hand hygiene and use of personal RIGHTS OF WORKERS protective equipment (PPE) Right to Know - all workers shall be appropriately informed by the employer about all types of hazards in the workplace and be provided access to training, education, and orientation on safety and risks Right to Refuse Unsafe Work - the worker has the right to refuse work without threat or reprisal from the employer if an imminent danger situation exists. Right to Report Accidents - workers, and their representatives shall have the right to report accidents, dangerous occurrences, and hazards to the employer, to DOLE, and other concerned government agencies. They shall be free from any form of retaliation for reporting an accident. Right to Personal Protective Equipment (PPE) - employers shall provide workers PPE for any part of the body that may be exposed to hazards; a lifeline, safety belt, or harness; and respirators, masks, or shields The Occupational Safety and Health when necessary. This should be free of Standards (OSH Standards) charge. Ad Astra Per Aspera | 4 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM BIOLOGICAL SPILL CLEAN-UP BIOSAFETY IN MICROBIOLOGICAL AND BIOMEDICAL LABORATORIES (BMBL) Emergency Shower and Eye Wash Becomes the code of practice for biosafety ○ The discipline addressing the safe handling and containment of infectious microorganisms and hazardous biological materials Ensures that safe handling and containment of infectious microorganisms and hazardous biological materials are being strictly followed and practiced in order to intervene the sequence of the chain of infection in the laboratory BIOLOGICAL HAZARD SYMBOL/BIOHAZARD BASIC CONCEPTS ON LABORATORY SYMBOL BIOSAFETY AND BIOSECURITY BRIEF HISTORY OF LABORATORY BIOSAFETY 1943 ○ Ira L. Baldwin 1944 ○ Arnold Wedum Director of IHIS April 18, 1955 ○ Camp Detrick, Pine Bluff Arsenal, Arkansas (PBA) and Dugway Proving Grounds, Utah (DPG) LABORATORY BIOSAFETY Beginning in 1957 Containment principles, technologies, and ○ Yearly meeting began practices implemented to prevent ○ Non-classified session unintentional exposure to pathogens and 1966, 1973 toxins, or their unintentional release ○ Wedum & Morton Reitman Traverse on how sources of pathogens are WHO, Eradication of being managed and handled to prevent Smallpox Virus danger from arising, that could eventually ○ Attendees included universities, affect people private laboratories, hospitals, and Protection, control, and accountability for industry valuable biological materials within ○ Impact of new OSHA regulation laboratories in order to prevent 1974 unauthorized access, loss, theft, misuse, ○ CDC - Classification of Etiological diversion, or intentional release Agents on the Basis of Hazard Shadows biosafety in terms of who are 1976 authorized to handle the pathogens, limit of ○ NIH guidelines for research access, and the intention of use and involving recombinant DNA purpose molecules Ad Astra Per Aspera | 5 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM BIOSAFETY AND BIOSECURITY Biosafety ○ Protecting people from dangerous pathogens ○ Engineering controls (i.e. biosafety cabinets, directional airflow, anterooms) ○ Good laboratory work practices (i.e. hand washing, spill clean-up) ○ Personal protective equipment (PPE) ○ Practices and procedures Biosecurity ○ Protecting pathogens from bad people ○ Doors with locks ○ Password/pin BIOSAFETY LEVELS ○ Card readers ○ Biometric (i.e fingerprints) Risk criteria for establishing ascending ○ Cameras levels of containment ○ Information security Risk assessment determine the biosafety ○ Security guards levels (BSL) of the workspace ○ Fences ○ Bars on windows ○ Magnetic locks ○ Magnetic switches on doors ○ Alarms Similarities in Biosafety and Biosecurity ○ Access control ○ Personnel management ○ Inventory of biological hazards ○ Proper decontamination/disposal of waste materials ○ Proper shipping procedures BIORISK Risk associated with biological materials Infective microorganisms are classified according to risk groups Ad Astra Per Aspera | 6 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM ○ An object or situation that has the potential to cause adverse effects when an organism, system, or (sub)population is exposed to it Risk ○ A combination of the likelihood of an incident and the severity of the harm (consequences) if that incident were to occur Risk assessment ○ A systematic process of gathering information and evaluating the likelihood and consequences of exposures to or release of ORGANIZATION IN THE FIELD OF BIOSAFETY workplace hazard(s) and determining the appropriate risk 1. American Biological Safety Association control measures to reduce the risk (ABSA) to an acceptable risk 2. Asia-Pacific Biosafety Association (A-PBA) Risk evaluation 3. European Biological Safety Association ○ Part of risk assessment where the (EBSA) likelihood of exposure to a hazard is 4. Philippine Biosafety and Biosecurity weighed against the potential Association (PhBBA) severity of harm under a set of 5. Biological Risk Association Philippines predefined circumstances, such as a (BRAP) specific laboratory procedure. BIORISK MANAGEMENT AND THE AMP MODEL BIORISK MANAGEMENT Biorisk DEFINITIONS ○ The risk associated with biological toxins or infectious agents Biosafety Biorisk Management ○ Containment principles, ○ The integration of biosafety and technologies, and practices that are biosecurity to manage risks when implemented to prevent working with biological toxins and unintentional exposure to infectious agents (CWA 15793 biological agents or their Laboratory Biorisk Management inadvertent release Standard) ○ Protecting people from BAD BUGS According to the CEN Workshop Biosecurity Agreement (CWA 15793:2011) ○ Principles, technologies, and ○ Biorisk Management (BRM) - “a practices that are implemented for system or process that control the protection, control, and safety and security risks accountability of biological associated with the handling or materials and/or the equipment, storage and disposal of biological skills, and data related to their agents and toxins in laboratories handling and facilities” ○ Protecting BAD BUGS from BAD ○ Encompasses the identification, PEOPLE understanding, and management Hazard Ad Astra Per Aspera | 7 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM aspects of a system in interrelated processes ○ Divided into its three primary components: Assessment Mitigation Performance CWA 15793:2011 ○ A framework that integrates best practices and procedures ○ Ensures that an organization can effectively achieve all of its objectives ○ Frequently built around the Plan, Do, Check, Act cycle KEY COMPONENTS OF BIORISK MANAGEMENT Hazards refers to anything in the environment that has a potential to cause harm Risk is generally defined as the possibility that something bad or unpleasant (such as injury or loss) will happen Risk Assessment ○ Identification of hazards and characterization of risks ○ Consists of the following steps: 1. Define the situation Identification of hazards and risks of the biological agents Humans and animals inside or outside the laboratory Work activities and laboratory environment including location, procedures, and equipment 2. Define the risks Ad Astra Per Aspera | 8 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM Review of how individuals inside and outside the laboratory may be exposed to the hazards 3. Characterize the risks Risk assessment team needs to compare the likelihood and the consequences of infection MITIGATION PROCEDURES Biorisk mitigation ○ Actions and control measures that are put into place to reduce or eliminate the risks associated with 4. Determine if risks are acceptable or not biological agents and toxins Evaluating the BioRisk arising from a biohazard take into account the adequacy of any existing controls PERFORMANCE EVALUATION Involves a systematic process intended to achieve organization objectives and pals Helps to highlight BioRisk strategies that are not working effectively and measures that are ineffective or unnecessary A reevaluation of the overall mitigation strategy Ad Astra Per Aspera | 9 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM Analysis of genes (RNA and DNA) and other proteins that will aid in the diagnosis of diseases 1. Clinical Pathology Chemical, hematologic, serologic analysis of specimens Focuses on the areas of: ○ Clinical chemistry ○ Immunohematology ○ Medical microbiology ○ Immunology and serology ○ Hematology ○ Parasitology ○ Clinical microscopy ○ Toxicology ○ Therapeutic drug monitoring and endocrinology 2. Anatomic Pathology Concerned with the diagnosis of diseases through microscopic examination of tissues and organs NATURE OF CLINICAL LABORATORY Focuses on: ○ Histopathology CLINICAL LABORATORY ○ Immunohistopathology The place where specimens (blood and ○ Cytology other body fluids, tissues, feces, hairs, nail) ○ Autopsy collected from individuals are: ○ Forensic pathology ○ Processed ACCORDING TO INSTITUTIONAL ○ Analyzed CHARACTERISTICS ○ Preserved 1. Institution based ○ Properly Disposed Operated within the premises or part CLASSIFICATIONS OF CLINICAL LABORATORY of an institution such as hospital, ACCORDING TO FUNCTION school, medical clinic, medical facility for overseas workers and seafarers, According to RA 4688 (Clinical Laboratory birthing home, psychiatric facility, of 1966) says there are two types of drug rehabilitation center, etc. laboratories but in current guidelines - ○ Hospital-Based - most Administrative Order No. 37 Series of 2021 - common type that there are three classifications of 2. Free standing laboratory Not part of an established institution ○ Molecular Pathology (new) Most common example: free- Ad Astra Per Aspera | 10 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM standing out-patient clinical laboratories along with: laboratory ○ Routine chemistry tests like ACCORDING TO OWNERSHIP blood glucose concentration ○ Blood urea nitrogen, blood 1. Government-Owned uric acid, blood creatinine, Owned, wholly or partially, by cholesterol determination, national or local government units qualitative platelet count Example: PGH, Lung Center of the ○ If hospital based: gram Philippines, Ospital ng Maynila stain, KOH mount, and 2. Private-Owned crossmatching Are owned, established, and Equipment: operated by an individual, ○ Microscopes corporation, institution, association, ○ Centrifuge or organization ○ Hematocrit centrifuge Example: St. Luke’s, FEU-NRMF, ○ Semi-automated chemistry MakatiMed analyzers ACCORDING TO SERVICE CAPABILITY ○ Autoclave Used to sterilize 1. Primary Category glassware Basic, routine laboratory testing ○ Incubator ○ Routine urinalysis ○ Oven ○ Routine stool examination Space Requirements ○ Routine hematology or ○ 20sqm complete blood count 3. Tertiary Category (Hospital and non- Hemoglobin hospital based) Hematocrit Licensed to perform all the laboratory WBC and RBC count tests performed in the secondary WBC differential count category laboratory plus and qualitative platelet ○ Immunology and serology count Ns1-Ag for dengue Blood typing and Rapid plasma reagin gram-staining (if Treponema pallidum hospital-based particle agglutination Equipments: tests ○ Microscope ○ Microbiology, bacteriology, ○ Centrifuge and mycology ○ Hematocrit centrifuge Differential staining Space Requirements: techniques ○ At least 10sqm Culture and ID 2. Secondary Category (Hospital and non- Antimicrobial hospital based) susceptibility testing License to perform laboratory tests ○ Special chemistry being done by the primary category Clinical enzymology Ad Astra Per Aspera | 11 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM Therapeutic drug (EQAP) of the government monitoring ○ Resolution of conflicts Markers for certain regarding test results of diseases different laboratories ○ Special Hematology ○ Training of medical Bone marrow studies technologists on certain Special staining for specialized procedures that abnormal cells, red require standardization cell morphology Examples: ○ Immunohematology and ○ Lung Center of the blood banking Philippines Blood donation ○ East Avenue Medical Center program ○ Research Institute for Antibody screening Tropical Medicine and ID LAWS ON THE OPERATION, MAINTENANCE, Preparation of blood AND REGISTRATION OF CLINICAL components LABORATORIES IN THE PHILIPPINES Equipment Republic Act No. 4688 ○ Those seen in secondary ○ Clinical Laboratory Act of 1966 category laboratories along ○ An act regulating the operation and with: maintenance of clinical laboratories Automated chemistry and requiring the registration of the analyzer same with the department of health, Biosafety cabinet II providing penalty for the violation Can be found thereof, and for other purposes. in the ○ Approval Date: June 18, 1966 microbiology ○ LTO - License to operate section ○ Section 1 Serofuge Registration and Licensing Space Requirement ○ Section 2 ○ At least 60sqm Laboratory should be headed 4. National Reference Laboratory (NRL) by a duly registered Laboratory in a government hospital physician (pathologist) designated by the DOH to provide ○ Section 3 special diagnostic functions and Secretary of Health, through service for certain diseases the Bureau of Research and ○ For referral services Laboratories (BRL), now ○ Provision of confirmatory DOH - Issuance of rules testing and regulations ○ Assistance for research ○ Section 4 activities Punishment ○ Implementation of External Imprisonment for not Quality Assurance Programs Ad Astra Per Aspera | 12 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM less than ONE to all entities performing the MONTH but not activities and functions of MORE THAN ONE clinical laboratories YEAR Do not include government Fine of NOT LESS laboratories doing THAN 1K nor MORE examinations limited to acid THAN 5k fast bacilli microscopy, ○ Section 5 malaria screening, and If any section or part of this cervical cancer screening, Act shall be adjudged by any provided their services are court of competent declared as extension of a jurisdiction to be invalid, the licensed government clinical judgment shall not affect, laboratory impair, or invalidate the ○ Section 5 - Classification of remainder thereof Laboratories Administrative Order No. 59 Series of Mentioned above 2001 ○ Section 6 - Policies ○ Section 1 - Title 1. An approved permit to Rules and Regulation construct and design layout Governing the Establishment, of a clinical laboratory shall Operation, and Maintenance be secured from the BHFS of Clinical Laboratories in the prior to submission of an Philippines application for a Petition to ○ Section 2 - Authority Operate DOH through Bureau of 2. No clinical laboratory shall be Health Facilities and constructed unless plans Services (BHFS) in the have been approved and Health Regulation Cluster, construction permit issued by shall exercise the regulatory the BHFS functions under these rules 3. A clinical laboratory shall and regulations operate with a valid license ○ Section 3 - Purpose issued by the BHFS/Center To protect and promote the for Health Development, health of the people by based on compliance with the ensuring availability of clinical minimum licensing laboratories that are properly requirements (Annex A) managed with adequate 4. The clinical laboratory shall resources, with effective and be recognized and managed efficient performance through to provide effective and compliance with quality efficient laboratory services standards 5. The clinical laboratory shall ○ Section 4 - Scope provide adequate and These regulations shall apply appropriate safety practices Ad Astra Per Aspera | 13 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM for its personnel and 1k for late renewal clientele. 100 if received more ○ Section 7 - Requirements and than 2 months after Procedures for Application of Permit expiration to Construct and License to Operate 6. Inspection 1. Application for Permit to Shall be inspected Construct every two years or as Documents required: necessary ○ Letter of 7. Monitoring application to Regular monitoring the Director of and records shall be BHFS made available ○ Four sets of Director of the Site BHFS/CHD or Development representative shall Plans and be allowed to monitor Floor plans 8. Issuance of License ○ DTI/SEC Shall be issued by the Registration Director of the CHD or (for private representative clinical 9. Terms and Conditions of laboratory) License 2. Application for New Granted upon License compliance with “Petition to Establish, licensing Operate, and Maintain requirements a Clinical Laboratory” Non-transferable notarized application Desire to transfer to form another location 3. Renewal of License should inform CHD in ○ Must be filed writing at least 15 within 90 days days before actual before transfer expiration Laboratory in new location shall be re- inspected Extension laboratory has separate license Any change affecting substantial conditions should be reporting 4. Permit and License Fees within 15 days in 5. Penalties writing to the Ad Astra Per Aspera | 14 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM BHFS/CHD than 1 month but not more License must be than 1 year or a fine of not placed in a less than 1k but not more conspicuous area than 5k or both (can easily see) 3. Summarily closed upon order ○ Section 8 - Violation issued by BHFS/CHD 1. Suspension or revocation of TECHNICAL STANDARDS AND MINIMUM license upon violation to R.A. REQUIREMENTS 4688 Shall be organized to provide effective and 2. Acts committed by owner, efficient laboratory services president, managers, board I. Staffing of trustees/director, 1. Laboratory managed by a licensed pathologist, or its personnel physician certified by the Philippine Board are violations of Pathology a. Operation of a lab 2. Qualified and adequately train personnel without certified a. At least 1 RMT per shift to cover pathologist or RMT laboratory operation b. Change in ownership, 3. Staff development and appropriate location, head, or continuing education program personnel without II. Physical Facilities informing BHFS 1. Well ventilated, adequately lighted, clean and/or CHD and safe c. Refusal to allow 2. Working space shall be sufficient to inspection of the lab accommodate its activities and allow smooth by authorized and coordinated workflow personnel of the 3. Adequate water supply BHFS during 4. Working space reasonable hours a. Primary - 10sqpm d. Gross negligence b. Secondary - 20sqpm (fake license, c. Tertiary - 60sqm unqualification) III. Equipment/Instruments e. Any act or omission IV. Glasswares/Reagents/Supplies detrimental to the V. Waste Management public VI. Quality Control Program 3. Provincial, city, and municipal 1. Internal Quality Control Program health officers are authorized a. Within the premises to report b. Day-to-day activities ○ Section 9 - Investigation of Charges c. Maintenance or Complaints 2. External quality assurance program 1. Suspension, cancellation, or a. Outside the premises revocation of license for a b. There is an agency that determined period of time facilitates this program 2. Imprisonment for not less Ad Astra Per Aspera | 15  PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM c. Given by NRL 5. Blood bank/immunohematology VII. Reporting 6. Immunology and serology Laboratory requests (requisitions) HEMATOLOGY shall be construed as consultation between the requesting physician Procedures and the pathologist of the laboratory ○ CBC (complete blood count) ○ All lab reports shall bear the ○ Differential count Total of each type of white name of RMT and the blood cells Pathologist ○ Hgb, Hct ○ No person in the clinical Hemoglobin - protein in RBC laboratory shall issue a that carries oxygen report, orally or in writing, Hematocrit - percentage of whole or portions, thereof red cells ○ RBC Indices - MCH, MCHC, MCV without a directive from the MCV - mean corpuscular/cell Pathologist volume VIII. Recording MCH - mean corpuscular There shall be a system of accurate hemoglobin recording to ensure quality results MCHC - mean corpuscular ○ Files should be kept on file hemoglobin concentration for at least one year ○ RBC Count Total amount of red blood IX. Laboratory Fees cells Shall be at prevailing rates ○ WBC Count You need to determine the costs per Total amount of white blood test with the help of the finance cells department ○ Platelets ○ PT/aPTT SECTIONS OF THE CLINICAL LABORATORY Prothrombin time test 1. Clinical Chemistry Activated partial thromboplastin clotting time Intended for the testing of blood and ○ Reticulocyte count other body fluids to quantify essential Reticulocytes - Immature soluble chemicals including waste form of RBCs products useful for the diagnosis of Cannot perform a function of certain diseases a mature RBC ○ Glucose ○ ESR ○ Creatinine Erythrocyte sedimentation rate ○ Blood urea nitrogen If patient is currently ○ Lipid profile suffering from an Triglycerides inflammatory condition Cholesterol Doesn’t have the capacity to HDL and LDL tell where the inflammation 2. Microbiology comes from ○ PBS 3. Hematology and coagulation studies Peripheral blood smear 4. Clinical microscopy Ad Astra Per Aspera | 16 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM MICROBIOLOGY Divided into three sections Viral infection ○ Bacteriology ○ Infection caused by viruses ○ Mycology ○ Higher basophil level ○ Virology Bacterial infection Procedures: ○ Infection caused by bacteria ○ Microscopic visualization of ○ Higher Eosinophil count microorganisms after staining, CLINICAL MICROSCOPY isolation, and identification of bacteria Two Major Areas Aerobes - bacteria that need ○ Routine and other special oxygen to grow examination of urine Anaerobes - doesn’t need Gross appearance or oxygen to grow Macroscopy - physical ○ Examine fungi using varied culture observation of volume and media and different biochemical color tests, and at times, antigen typing, Color and antibacterial susceptibility Turbidity testing. Microscopy - microscopic ○ Preparation of culture media and examination of cells, stains, quality assurance and microorganisms, and crystals control, infection control, and RBC biosafety and proper waste disposal. Pus cell/WBC ○ Mycobacteriology looks into the Mucus Threads identification of mycobacterium from Bacteria specimens submitted Amorphous Mycobacterium tuberculosis urates/phosphates is responsible for Other crystals tuberculosis. yeast CLINICAL CHEMISTRY Chemical examination ○ Fecalysis (examination of stool) The branch of medical science involved in Examine for ova (eggs of the analysis of biological materials, usually parasites) blood and body fluids to provide diagnostic results in the state of the human body. Most common body fluids ○ Blood ○ Urine Busiest section in the laboratory Ad Astra Per Aspera | 17 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM Routine Blood Chemistry Test detect any pathologic ○ Blood glucose condition/disease processes ○ Blood lipid profile ○ Most commonly used technique is ○ Kidney function test (Crea, BUN, the PCR GFR) ○ Screen for genetic indicators of ○ Liver function test (Bilirubin, Liver disease enzymes - AST, ALT; total protein ○ Diagnose cancer and infectious test) diseases ○ Cardiac function test (Troponin test, QUALITY ASSURANCE myoglobin, cardiac enzymes-CK- MB, AST, LDH) Internal Quality Assurance System Patients have to undergo fasting to get an (IQAS) accurate result ○ Day to day activities that are BLOOD BANK/ IMMUNOHEMATOLOGY/ undertaken in order to control TRANSFUSION MEDICINE factors or variables that may affect test results Check if machines are calibrated Make sure all the equipment are up to standard ○ Regular review and audit of results are done in order to identify the Immunohematology - deals with the use of weakness and consequently immunologic principles to study and identify perform corrective activities different blood groups External Quality Assurance System Blood bank - blood is collected from (EQAS) donors ○ System for checking performance ○ Performs ABO and Rh typing and among clinical laboratories and is separates the components to be facilitated by designated external stored for future use for transfusion. agencies SPECIAL ○ The NRL is DOH-designated EQAS Has to pass quality Immunohistochemistry assurance system to certified ○ Specialized area of the laboratory RA 4688 - Clinical that combines anatomical, clinical, Laboratory law of 1966 and biochemical techniques where To ensure the antibodies bound to enzymes and attainment of quality fluorescent dyes are used to detect in laboratory the presence of antigens in the services. tissue ○ NRL-EQAS are the following: ○ Best used in: National Kidney and Cancer diagnosis Transplant Institute (NKTI) - Patient’s monitoring therapy hematology and Molecular Biology and Biotechnology coagulations ○ Primarily uses different enzymes Research Institute of and other reagents, DNA and RNA Tropical Medicine (RITM) are identified and sequenced to LABORATORY TESTING CYCLE Ad Astra Per Aspera | 18 PRINCIPLES OF MED LAB SCIENCE ANGELES | FIRST YEAR | 1ST SEM Encompasses all activities starting from a medical doctor writing a laboratory result up to the time (TAT - turn around time) that the results are generated You have to perform tests properly and professionally as a mistake can cost a patient’s life Phases: ○ Pre-Analytic Phase Receipt of the laboratory request Request given by the doctor Patient preparation Fasting Specimen collection Phlebotomy Proper transport and processing of specimen to the lab Conditions for specimen transport (no light? temperature?) ○ Analytic Phase Includes the actual testing of the specimen Important consideration should be given to equipment, instrument and reagents used, and also the internal quality control program Reagents and equipment should be up to standard (not expired and running properly) One must be knowledgeable on how to use machines and procedures ○ Post-Analytic Phase Transmission of test results to the medical doctor for interpretation TAT (turn around time) Application of doctor’s recommendation Ad Astra Per Aspera | 19