The Clinical Laboratory Sections PDF

PMLS 1: Module 4 and Module 5 z The Clinical Laboratory Sections Instructor: Princess Jonalyn Agabao  z OBJECTIVES  Describe the clinical chemistry section and enumerate the services it offers  Enumerate and describe the scope of clinical hematology  Enumerate ro...

PMLS 1: Module 4 and Module 5 z The Clinical Laboratory Sections Instructor: Princess Jonalyn Agabao  z OBJECTIVES  Describe the clinical chemistry section and enumerate the services it offers  Enumerate and describe the scope of clinical hematology  Enumerate routine tests performed in the hematology section and describe how they are correctly performed  z OBJECTIVES  Differentiate an immunology laboratory from serology section  Enumerate common tests performed in the serology section and describe how they are correctly performed  Describe Blood Bank and enumerate routine services it offers  ROUTINE TESTS IN CLINICAL CHEMISTRY SECTION Blood Sugar Testing Most commonly performed assays in Clinical Chemistry To detect: Hyperglycemic and Hypoglycemic state Blood Sugar Testing Random Blood Sugar (RBS) Fasting Blood Sugar (FBS) Oral Glucose Tolerance Test (OGTT) Hemoglobin A1c (HBA1c) Blood Sugar Testing Random Blood Sugar (RBS) - any given point in any day Fasting Blood Sugar (FBS) - prohibits the patient to eat and drink for 8 hours prior to collection Blood Sugar Testing Oral Glucose Tolerance Test (OGTT) - confirm diagnosis of Gestational DM (Diabetes Mellitus) Blood Sugar Testing Hemoglobin A1c (HBA1c) - reflects the average blood glucose levels of patients over a three-month period Lipid Profile Test Also considered as routine services in the Clinical Chemistry section. Used to check for any risks of cardiovascular disease  Lipid Profile Test Fatty Acids – simplest for of lipid Triglycerides - storage form of fat Cholesterol - steroid alcohol; precursor of hormones, Vit D. an bile salts Lipoproteins – special particles made up of fats and proteins Lipid Profile Test Lipoprotein Levels Low Density Lipoprotein (LDL) High Density Lipoprotein (HDL) Very Low Density Lipoprotein (VLDH) Chylomicrons  Lipid Profile Test Lipoprotein Levels Low Density Lipoprotein (LDL) - “bad cholesterol” - Transports cholesterol from the liver to peripheral tissues High Density Lipoprotein (HDL) - “Good Cholesterol” - transports cholesterol from peripheral tissues to the liver.  Lipid Profile Test Lipoprotein Levels Very Low Density Lipoprotein (VLDH) - Responsible for transporting exogenous triglycerides Chylomicrons - transports exogenous triglycerides to the muscles and adipocytes Renal Function Test Creatinine Blood Urea Nitrogen (BUN) Blood Uric Acid (BUA) Creatinine Waste product of muscle metabolism that is elevated in impaired renal function. Blood Urea NitroGen (BUN) waste product of protein catabolism that is also elevated in cases of kidney diseases Elevation of BUN is termed as Azotemia. If azotemia is accompanied by renal failure, it is called as Uremia. Blood Uric Acic (BUA) Product of purine nucleic acids, usually measured to detect kidney dysfunction, detect presence of renal stone (renal calculi), and for diagnosis/ monitoring of gout. Liver function tests Also referred to as the hepatic panel Group of blood tests that provide health information about a patient’s liver state These tests include Bilirubin and liver enzyme tests (AST, ALT, GGT). Bilirubin Test Bilirubin – major waste product for heme catabolism Direct Bilirubin Indirect Bilirubin Total Bilirubin Bilirubin yellow-colored pigment and is a product of hemoglobin (heme) Breakdown testing include determining the levels of Total Bilirubin (TB), unconjugated/ indirect Bilirubin (B1), and conjugated/ direct Bilirubin (B2).  Liver Enzymes Commonly measured to assess hepatic function NOTE: if ALT and AST are found together in elevated amounts in the blood, liver damage is most likely present TPAG Test Total Protein Albumin Globulin Albumin/Globulin ratio - Detecting Liver and/or kidney disease - Mostly requested to Patients with edema Enzyme Test Liver Function Test Aspartate Aminotransferase (AST) Alanine Aminotransferase (ALT) γ-Glutamyl Transferase (GGT) Other Transferases Total Creatine Kinase (Total CK) Creatine Kinase – MB (CK-MB) Creatine Kinase - MM (CK-MM) Enzyme Test Hydrolase Alkaline Phosphatase (ALP) Acid Phosphatase (ACP) Amylase (AMY) Oxidoreductase Lactate Dehydrogenase (LDH) Glucose-6-Phosphate Dehydrogenase (G6PD) Cardiac Function Tests Includes Troponin test Myoglobin test Cardiac Enzyme tests Troponins Tests regulatory proteins in the cardiac muscles Troponin testing is considered to be the most specific test for myocardial damage Isoforms of troponin include Troponin I and Troponin T Myoglobin Tests pigment found in muscle tissues. It is not as specific as troponin because it is found in both skeletal tissues and cardiac tissues. Cardiac Enzyme tests Enzymes that are often measured to assess cardiac function include Creatine Kinase-MB (CK-MB), Aspartate aminotransferase (AST) and Lactate Dehydrogenase (LDH). Hormone Analysis Thyroid Function Test Free T4 (FT4) Free T3 (FT3) T3 T4 Thyroid Stimulating Hormone (TSH) Insulin Electrolytes Sodium Potassium Chloride Magnesium Calcium Total Ionized Trace Elements Cobalt Iron Manganese Selenium Zinc Toxic Chemicals and Therapeutic Drugs Hallucinogens Marijuana Opiates Oxycodone (Percs) Stimulants Cocaine Alcohol Ethanol  Module 4: PMLS 1 z Unit 2: The Hematology Section Objectives Enumerate and describe the scope of clinical hematology. Discuss the basic cytology, histology, anatomy and physiology of blood. Describe how complete blood count is performed. IN THE HISTORY OF HEMATOLOGY SECTION William Harvey (1628) He discovered the closed circulation of blood and proved that blood flows into two separate loops, the pulmonary circulation and the systemic circulation. Anton van Leeuwenhoek (1674) He giave the first accurate description of red blood cells. William Hewson (1770-1773) He is considered to be the “Father of Hematology”. He was responsible for the discovery of white blood cells, lymphatic circulation, and fibrinogen (Coagulation Factor I) He also discovered fundamentals of coagulation and Glauber’s salt, which is the first anticoagulant. Anticoagulant is a substance that prevents blood from clotting of blood. Franz Ernst Christian Neumann (1868) He discovered the role of bone marrow in hematopoiesis. Hematopoiesis is the production of the cellular components of blood and blood plasma. Giulio Bizzozero (input year ate) In 1868, he made an independent investigation and subsequent discovery of the role of bone marrow in blood cell production. He also described platelets as “petite plaques” and described the role of platelets in hemostasis and thrombosis in 1888. Hemostasis is a process to prevent and stop bleeding, while thrombosis is the formation of blood clot known as thrombus. Paul Ehrlich (1878) He developed the first method of blood cell staining and identified three types of granulocytes, mast cells, and megaloblasts. James Homer Wright (1902) He developed the Wright stain and the refinements thereof such as the Wright’s Romanowsky-type stain remains the foundation of blood cell identification. Milestones Leading to Automated Cell Counting in Hematology The first individual to perform a blood count Karl Vierordt in 1852 His method involved drawing blood into a capillary tube and spreading a known volume of the collected blood onto a slide, followed by microscopic analysis NOTE: The method is also used by George Oliver in 1896 could be considered as the forerunner of automated blood count George Oliver In 1896 provided an RBC (red blood cell) count without the need for manual counting of individual cells. His method was based on the visual measurement of light loss by scattering and absorption in a test tube filled with diluted blood. Mercandier et al in 1928 Oliver’s method was refined by him, by utilizing a photodetector for the measurement of light absorption instead of relying on unaided eyes Wallace Coulter in 1953 Developed cell counting by impedance measurement This method was based on the fact that cells are poor electrical conductors and that they manifest electrical resistance as they pass through a small aperture (opening).  Over the past decades, there has been a tremendous advancement in the technology of hematology analyzers and their availability to the general practitioner this includes One of the basic building blocks of the minimum database in medicine is the complete blood count Today, hematology laboratories are heading toward reliable automation to achieve faster turn-around time (TAT), reducing risks of human errors, and any possible risks of cross contamination. Hematology study of blood and its components The word heme is the Greek word for blood The blood is a specialized liquid connective tissue that supplies essential substances such as sugars, oxygen, and hormones around the body. Blood is comprised of two components: Plasma the extracellular matrix formed elements Plasma comprises 55% of the blood volume. 91.5% water 7% plasma proteins 1.5% other solutes Formed Elements comprises 45% of the blood volumes Red blood cells (Erythrocytes) Red blood cells are biconcave disc-shaped cells that are anucleated (have no nucleus). RBCs contain the oxygen-carrying hemoglobin, which is a pigment that gives whole blood its red color. primarily responsible for physiological gas exchange, specifically transporting oxygen from the lungs to the different parts of the body and carry carbon dioxide back to the lungs. WBCs (Leukocytes) are nucleated cells that defend the body against infections. These cells are divided into two main types: Granulocytes Agranulocytes Granulocytes The cytoplasm of Granulocytes contains conspicuous and easily observed granules There are three types of leukocytes that are considered granulocytes: Neutrophils, Eosinophils, and Basophils Neutrophils/Polymorphonuclear cells (PMN)/Mature segmenters Nucleus has 2-5 lobes Cytoplasm has fine, pale lilac granules with NEUTRAL affinity for stains (thus, the name neutrophil) Phagocytic; respond to bacterial infection Comprises 50-70% of total WBC population Eosinophils Nucleus usually has 2 lobes connected by thick chromatin strand Cytoplasm contains large, red-orange granules with affinity for ACIDIC stains such as eosin (thus, the name eosinophil) Responds to parasitic & helminthic infection and allergy Also characterized to have phagocytic activity Comprises 1-3% of the total WBC population Basophils Nucleus has 2 lobes; Nucleus is not easily observed because it is often covered by large granules Cytoplasm contains water soluble blue-black granules with affinity for BASIC stains (thus, the name basophil) Involved in allergic and hypersensitivity reactions Comprises 0-2% of total WBC population Agranulocytes Agranulocytes are leukocytes containing cytoplasmic granules that are not as obviously observed as those found in granulocytes Includes Monocytes and Lymphocytes. Monocytes Nucleus is horseshoe or kidney-shaped often with brain-like convolutions Cytoplasm is blue-gray colored and foamy and has very fine azurophilic granules responsible for the characteristic “Ground glass” appearance Are converted to macrophages as they leave the blood circulation and enter peripheral tissues Macrophages are potent phagocytes which defend the body against Mycobacterium species and other bacteria, fungi, protozoa, and viruses Comprises 2-11% of total WBC population Lymphocytes Round or slightly indented nucleus that occupies majority of the cell area Scanty cytoplasm with a characteristic “Robin’s egg blue coloration” Immunocytes Predominant WBC that responds to several viral infections Comprises 18-42% of total WBC population Platelets (Thrombocyte/Cell fragments) cell fragments that play significant roles in hemostasis. These cells contain many vesicles but have no nucleus When your skin is injured puncturing the vascular area, platelets clump together and form clots to stop bleeding ROUTINE TESTING IN HEMATOLOGY SECTION  COMPLETE BLOOD COUNT Commonly performed blood test that is often included as part of routine check up. Used to help in the detection a variety of disorders: Infections Anemia Blood cancers  COMPLETE BLOOD COUNT This Panel of Tests including a. Hemoglobin Determination b. Hematocrit Determination c. Red Blood Cell Count d. White Blood Cell Count e. WBC Differential Count f. RBC morphology examination g. Platelet Count h. RBC indices  COMPLETE BLOOD COUNT a. Hemoglobin Determination - Primarily used for the determination of anemia (Hbg