Transcript Laboratory Science for Non

Laboratory Science for NonLaboratory Personnel
Presented by:
Michelle Draper, MBA, MT(ASCP)
Bellarmine University
Personnel in the Laboratory
 Directors, Managers, Supervisors
 Clinical Laboratory Scientists (Med Techs)
Bachelors degree plus!, Bench Scientists
 Clinical Laboratory Technicians (MLT’s)
Associate degree, Bench Scientists,
Limited complexity testing
 Phlebotomists
No degree required, certification preferred,
Most trained OTJ
Types of Specimens
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Whole Blood
Plasma
Serum
Stool
Urine
Body Fluids
Sputum
Cultures…to name a few
Whole Blood
 Represents blood as it
circulates through the
body
 Contains erythrocytes,
leukocytes, and
platelets
 Sodium EDTA
 Uses: CBC, Blood Bank,
Flow cytometry, BNP,
Hemoglobin A1c
Plasma
 One type of liquid
portion of the blood
 HAS NOT CLOTTED!
 Sodium citrate
 Contains fibrinogen,
and clotting factors
 Uses: PT, APTT,
Fibrinogen, Dimer
Plasma
 Liquid portion of the
blood
 Sodium or lithium
heparin
 Has not clotted!
 Uses: Rapid
chemistry ie,
glucose, electrolytes
Serum
 Tube has been allowed to
clot before centrifugation
 No clotting factors or
fibrinogen present
 Liquid portion of the blood
 Contains proteins,
enzymes, organic and
inorganic chemicals and
antibodies
 Uses: Chemistry,
Therapeutic drug levels,
Immunology, Blood Bank
 Has no additive
Serum
 Same analytes as
before
 Gel: activates clot and
acts as a barrier
 Popular for ease of use
 Not suitable for TDMs
 Not recommended for
Transfusion testing
Why is this important?
“The quality of any test
result is only as good
as the specimen that
is tested!”
We can monitor testing personnel
through competency testing…We can
monitor instruments and procedures
by means of calibrations and
controls…BUT, we can’t monitor
specimen collection very well!!
Specimen Criteria
 Specimens must be drawn in the correct
tube and they must be filled to the proper
level
 Timely delivery to laboratory is critical
 Anticoagulant additives can contaminate
subsequent tubes
 Some additives change the shape or size of
the cells
 Additives can give falsely elevated results
Specimen Labeling
 Proper specimen labeling is essential
 Correct patient identification:
 Two forms of identification is best….birthdate,
medical record number, full name
 Patient preparation…fasted, dose time,
medications, transfusion status
 Time of collection
 Collector’s identification
Specimen Problems
 Clotted specimens collected with
anticoagulant
 Hemolyzed specimens
 Lipemic specimens
 Icteric specimens
 IV fluid contamination in
specimens…Never collect above an IV
line!
Non-Blood Specimens
 Must always be properly labeled
 Must be collected in a sterile
container
 Volume of collection is critical to
the test
 Transport to lab must be timely
 If held, storage requirements must
be met
What do the results mean?
• Complete Blood
Count (CBC)
WBC
RBC
White blood cell count
Red blood cell count
HGB
HCT
MCV
Hemoglobin
Hematocrit
Mean cell volume-cell
size
Mean cell color
Mean cell hemoglobin
concentration
MCH
MCHC
PLT
RDW
Platelet count
Red cell population
variation
Basic Metabolic Panel
GLU
Glucose (sugar)
Pancreas/insulin
NA
Sodium
Hydration/Electrolytes
K
Potassium
Heart/Muscle/Hydration/E
lectrolytes
CL
Chloride
Hydration/Electrolytes
CO2
Carbon Dioxide
Oxygen level/Electrolytes
BUN
Urea Nitrogen
Kidney
CREA
Creatinine
Kidney
CA
Calcium
General Health
AGAP
Anion Gap
Electrolyte Balance
Comprehensive Metabolic Panel
ALB
Albumin
Protein-Immune
System
Liver
ALKP
Alkaline Phosphatase
ALT
Alanine Amino
Transferase
Liver
AST
Liver
TBIL
Aspartate Amino
Transferase
Total Bilirubin
TP
Total Protein
Immune System
Liver
Prothrombin Test
Activated Partial Thromboplastin
Time
PT
INR
PTT
Measured How long to clot
in
Monitors oral
seconds anticoagulants
Ratio
Compares
therapies and
instrumentation
Measured How long to clot
in
Monitors IV
seconds anticoagulants
Urinalysis
• Recommended volume is 12 mls
• Specimen is tested with a dipstick for:
• Glucose, Ketones, Blood, pH, Bilirubin,
Urobilinogen, Leukocytes, Protein
• Specimen is centrifuged and sediment is
examined with microscope to report cells, and
other structures: crystals, casts, bacteria,
yeast, parasites and more!
• Color and appearance (clear, hazy, cloudy,
bloody)
Cultures
 Plated on differential and selective media to
grow the organisms present
 Gram stain is done except on urine and stool
(too much normal flora present)
 Organisms determined to be pathogenic are
tested for sensitivity to antibiotic drugs
 Cultures take from 2 – 30 days or more
 Fungal and viral cultures are kept the longest
Questions
Blood Cell Morphology
Urine Microscopics