I NTRODUCTION TO LABORATORY MEDICINE

D EFINITION 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

C OURSE OBJECTIVES application of basic science to those clinical disciplines practiced by the medical laboratory scientist. the scope of Laboratory Medicine, and of its potential applications. How to analyze various samples under certain circumstances.

C OURSE CONTENTS Clinical Biochemistry Cardiac profiles Liver and renal panels Bone metabolism Lipid chemistry Special chemistry Cardiovascular markers Tumour markers Nutritional markers Calculi

Immunology and Immunodiagnostics Drug 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

Laboratory Hematology Routine and special hematology Hemoglobinopathy studies Special stains Hematopathology Bone marrow consultations and interpretive report Flow cytometry CD 34 (stem cell) enumeration CD4/CD8 monitoring Leukemia/lymphoma immunophenotyping PNH

Special coagulation Coagulation profiles, screening and factors and inhibitors Platelet studies Thrombophilia testing Microbiology Bacterial culture and sensitivities Blood cultures Molecular typing of organisms Viral detection methodologies HIV viral load -public health lab accredited site for viral load Chlamydia detection

Infection control Reference centre for medical microbiology and infectious diseases Detection and typing of epidemiologically significant organisms Serology Clostridium difficile toxin testing Wide range of viral and non-viral serologies Molecular Diagnostic Testing Wide range of molecular testing for viral and bacterial agents Mycology Fungus detection Cells/tissues/organ donor 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

R ECOMMENDED B OOKS Textbook: District laboratory practice in tropical countries by Monica Cheesbrough. Clinical chemistry by William J Marshall. Reference books: Medical Laboratory technology by Ramnik Sood.

R EASONS FOR ORDERING TESTS  Aid in diagnosis  Confirm diagnosis  Evaluate prognosis  Monitor therapy  Screen for a disease

S ECTIONS OF THE L ABORATORY CLINICAL PATHOLOGY 1. Clinical Chemistry  BUN  Cholesterol  FBS 2. Clinical Microscopy  Analysis of body fluids  Urin analysis  Fecal anaysis  Semen analysis 3. Microbiology  Cultures (sputum, blood, urine) 4. Hematology Biggest section Includes CBC,coagulation, PT, PTT

B LOOD BANK Very critical section Bec. May have errors Blood typing Cross match AB Identification Goes hand in hand with serology and immunology Tests done for  MALARIA  SYPHILIS  HIV Serology/Immunology Cardiac and thyroid fxntest II. ANATOMY PATHOLOGY Histopathology Submission of tissues for tests

N ATURE OF R EQUEST STAT  Performed immediate lyand by itself  Run control and standard  20-50% More expensive  TAT is shortened  Request is needed Today  confusing  Performed as soon as possible, given priority  Based on “running time” Routine  Done with the batch  Wait for TAT stated by laboratory

V ALUES 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 value Usually when 2x to 3x

CRITICAL VALUES  Needs immediate attention  “panic values”  Should call physician  Patient is at risk

R EFERENCE V ALUES Not fixed for all Should consider:  Age  Sex  Pregnancy  Diurnal Variation  Race  Blood type

R OUTINE E XAMINATIONS ROUTINE ADMISSION TESTS CBC, Urinalysis, Fecalysis ROUTINE CHEMISTRIES BUN, Creatinine, Glucose, Uric Acid, Cholesterol Sometimes triglycerides