1. Introduction to laboratory medicine

2. 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

3. Course contents Clinical Biochemistry Cardiac profiles
Liver and renal panels
Bone metabolism
Lipid chemistry
Special chemistry
Cardiovascular markers
Tumour markers
Nutritional markers
Calculi

4. 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

5. Laboratory Hematology
Routine 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

6. Microbiology
Infection 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

7. 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.

8. Reasons for ordering tests
Confirm diagnosis
Aid in diagnosis
Evaluate prognosis
Monitor therapy
Screen for a disease

9. 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 fluids
Urin analysis
Fecal anaysis
Semen analysis
3. Microbiology
Cultures (sputum,
blood, urine)
Sensitivity tests
4. Hematology
Biggest section 
Includes CBC,coagulation, PT, APTT 

10. Blood bank Serology/Immunology Cardiac and thyroid fxntest
Very critical section 
Bec. May have errors
Blood typing
Cross match 
Goes hand in hand with serology and immunology
 Tests done for
MALARIA
SYPHILIS
HIV
Serology/Immunology
Cardiac and thyroid fxntest
II. ANATOMY PATHOLOGY
Histopathology 

11. Circuit diagram of clinical biochemistry process

12. sample A sample of a material to be tested or analyzed
that is prepared from a gross sample and retains 
the latter's composition.

13. 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
Ascites
Synovial fluid
Intestinal
Pancreatic

22. Nature of Request Today Confusing
Performed as soon as possible, given priority
 Based on “running time”
Routine
Done with the batch
Wait for TAT stated by laboratory
STAT
Performed immediately and by itself  
Run control and standard 
20-50% More expensive 
TAT is shortened 
Request is needed

23. Automation and computerization
Test Repertoire (Range)
More than 400 tests can be performed in the lab
Analyzers
Laboratory personnels

24. 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 value
Usually when 2x to 3x

25. 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

26. Reference Values Not fixed for all Should consider: Age Sex Pregnancy
 Diurnal Variation
 Race
 Blood type

27. Routine Examinations
ROUTINE ADMISSION TESTS CBC, Urinalysis, Fecalysis ROUTINE CHEMISTRIES BUN, Creatinine, Glucose, Uric Acid, Cholesterol Sometimes triglycerides

29. Specimen collection Correct sample Correct information (history)
More information is required while reassessing or assessing prognosis.
Identification must be clear and correct.

30. 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

31. 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.

32. REFERENCE RANGES FOR QUANTITATIVE TESTS