Laboratory Science for Non-Laboratory Personnel

1. Laboratory Science for Non-Laboratory Personnel Presented by: Michelle Draper, MBA, MT(ASCP) Bellarmine University

2. 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

3. Types of Specimens • Whole Blood • Plasma • Serum • Stool • Urine • Body Fluids • Sputum • Cultures…to name a few

4. 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

5. Plasma • One type of liquid portion of the blood • HAS NOT CLOTTED! • Sodium citrate • Contains fibrinogen, and clotting factors • Uses: PT, APTT, Fibrinogen, Dimer

6. Plasma • Liquid portion of the blood • Sodium or lithium heparin • Has not clotted! • Uses: Rapid chemistry ie, glucose, electrolytes

7. 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

8. 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

9. Why is this important? “The quality of any test result is only as goodas the specimen that is tested!”

10. 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!!

11. 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

12. 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

13. Specimen Problems • Clotted specimens collected with anticoagulant • Hemolyzed specimens • Lipemic specimens • Icteric specimens • IV fluid contamination in specimens…Never collect above an IV line!

14. 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

15. What do the results mean? • Complete Blood Count (CBC)

16. Basic Metabolic Panel

17. Comprehensive Metabolic Panel

18. Prothrombin Test Activated Partial Thromboplastin Time

19. 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)

20. 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

21. Questions

22. Blood Cell Morphology

23. Urine Microscopics