Introduction to laboratory medicine
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Introduction to laboratory medicine

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Introduction to laboratory medicine




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Presentation on theme: "Introduction to laboratory medicine"— Presentation transcript:

Slide1

Introduction to laboratory medicine

Slide2

Definition

Laboratory medicine a specialty in which pathologists provide testing of patient samples (usually blood or urine) in several different areas

.

Determination of the level of enzymes in blood in case of heart attack or

Level of glucose (sugar) in the blood of a patient with diabetes.

The presence of bacteria and other microorganisms.

Blood cells studies for various types of

anemias

Slide3

Course contents

Clinical Biochemistry

Cardiac profiles

Liver and renal panels

Bone metabolism

Lipid chemistry

Special chemistry

Cardiovascular markers

Tumour

markers

Nutritional markers

Calculi

Slide4

Immunology and ImmunodiagnosticsDrug monitoring

Urine and serum proteins

Autoimmune disease testing

Endocrinology tests

Fertility testing

Point-of-Care Testing

Cardiac markers

Glucose monitoring program

Blood gases and metabolites

Routine chemistry panels

Routine urinalysis and pregnancy screening

Coagulation

Complete Blood Counts

Urine toxicology screening

Slide5

Laboratory HematologyRoutine and special hematology

Hemoglobinopathy

studies

Special stains

Hematopathology

Bone marrow consultations and interpretive

report

Special coagulation

Coagulation profiles, screening and factors and inhibitors

Platelet studies

Thrombophilia

testing

Slide6

MicrobiologyInfection control

Reference centre for medical microbiology and infectious diseases

Detection and typing of epidemiologically significant

organisms

Molecular Diagnostic Testing

Blood Bank/Donor Center

Concepts of

immunohematology

and

histocompatibility

Blood transfusion services and quality assurance

Blood donation and storage of blood

Blood grouping

Compatibility testing

Slide7

Recommended Books

Textbook

:

Clinical biochemistry an illustrated color atlas

by Allan

Gaw

District laboratory practice in tropical countries

by Monica

Cheesbrough

.

Clinical chemistry

by William J Marshall.

Reference books:

Medical Laboratory technology

by

Ramnik

Sood

.

 

Slide8

Reasons for ordering tests

Confirm diagnosis

Aid

in

diagnosis

Evaluate prognosis

Monitor therapy

Screen for a 

disease

Slide9

Sections of the Laboratory

CLINICAL PATHOLOGY

1. Clinical Chemistry

 

Liver profile

Lipid profile

Glucose profile

Special chemistry

(

endocrinology, fertility)

2.Clinical

 

Microscopy

 Analysis of body fluidsUrin analysisFecal anaysisSemen analysis

3. Microbiology

 

Cultures (sputum,

blood, urine)

Sensitivity tests

4. Hematology

 

Biggest section 

Includes

CBC,coagulation

, PT, APTT 

Slide10

Blood bankVery

 critical

section

 

Bec

. May have errors

Blood

typing

Cross

match

 

Goes

hand in hand

with serology

and immunology Tests done forMALARIASYPHILISHIVSerology/Immunology Cardiac and thyroid fxntestII. ANATOMY PATHOLOGYHistopathology 

Slide11

Circuit diagram of clinical biochemistry process

Slide12

sample

A sample of a material to be tested or analyzed 

that

 is prepared from a gross sample and 

retains

 

the

 latter's 

composition.

Slide13

Specimens which are used in Lab for testing

Venous blood, serum or

plsma

.

Arterial blood

Capillary blood

Urine

Faeces

Cerebrospinal fluid

Sputum and saliva

Tissue and cells

Calculi

Aspirates e.g.

Pleural fluid

AscitesSynovial fluidIntestinalPancreatic

Slide14

Slide15

Slide16

Slide17

Slide18

Slide19

Slide20

Slide21

Slide22

Nature of Request

STAT

 

Performed 

immediately and

by itself  

Run control

and standard

 

20-50% More

expensive

 

TAT is

shortened

 Request is neededToday Confusing Performed as soon as possible, given priority Based on “running time”Routine

Done

with the batch

Wait

for TAT stated

by laboratory

Slide23

Automation and computerization

Test Repertoire (Range

)

More than 400 tests can be performed in the lab

Analyzers

Laboratory

personnels

Slide24

Values

REFERENCE VALUES

Better

term than “

normal value”

Pulled

value, usually 95%of population

Vary

in diff. hospitals

but not

that far

SIGNIFICANT VALUES

Clinical

decision should

be made if higher or lower than reference valueUsually when 2x to 3x

Slide25

CRITICAL VALUES

Needs immediate attention

panic values”

Should

call physician

Patient

is at

risk

Glucose less than 45mg/dl

More than 500mg/dl

Potassium less than 6.6 g/dl

More than 19.9 g/dl

Slide26

Reference Values

Not fixed for

all

Should consider:

Age

 

Sex

 

Pregnancy

 

Diurnal

Variation

 

Race

 Blood type

Slide27

Routine Examinations

ROUTINE ADMISSION

TESTS

 

CBC

, Urinalysis,

Fecalysis

ROUTINE CHEMISTRIES

 

BUN

,

Creatinine

, Glucose, Uric Acid, Cholesterol

  Sometimes triglycerides

Slide28

Slide29

Specimen collectionCorrect sample

Correct information (history)

More information is required while reassessing or assessing prognosis.

Identification must be clear and correct.

Slide30

QUALITY ASSURANCE TO OBTAIN CORRECT TEST RESULTS

Immediate and long term clinical, public health, and

health planning decisions are based on the results of

laboratory tests. Incorrect, delayed, or misinterpreted

test results can have serious consequences for

patients and communities, undermine confidence in

the service, and waste scarce district health

resources.

Achieving reliability of test results is dependent on:

Understanding what are the commonest

causes of

inaccuracy and imprecision in the

performance of

tests and of delayed or misinterpreted

Slide31

and sources of error). Taking the necessary steps to prevent and

minimize errors

by:

– implementing

Standard Operating

Procedures

(

SOPs) with quality control for

all district

laboratory activities.

– introducing every month a quality

control day

and an external quality

assessment scheme

for outreach laboratories (see later text, Role of the district medical officer in TQM).– appointing a district laboratory coordinator to monitor the performance of district laboratories (see later text). Agreeing with those requesting laboratory tests, policies of work that will enable the laboratory to provide an efficient, safe, cost-effective, and reliable service (see subunit 2.4). Maintaining good communications between laboratory staff and those requesting tests.

Slide32

REFERENCE RANGES FOR QUANTITATIVE TESTS