Introduction to
Laboratory Medicine
Laboratory medicine
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Clinical laboratory
Pathology
Anatomical Pathology Clinical Pathology
Macroscopic/
Anatomical pathology
microscopic
Cells Tissue Organ System
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Substances excreted/secreted
to blood/other body fluids
Clinical pathology
Samples :
Clinical Pathology
Clinical Hematology Blood
Clinical Chemistry • Blood
• Urine
Clinical Microbiology
• Stool
• CSF
Clinical Immunology
• Trans/Exudate
etc
Clinical Hematology
Parameters to be
evaluated :
Manually
Hemoglobin
Leucocyte count
Platelet count
Automatically
Hematocrit
etc
Automatic
Hematology
Analyzer
Clinical Chemistry
Glucose, cholesterol,
Blood triglyceride, cardiac
enzyme, etc
Parameters to
be evaluated
Glucose, protein,
Urine
bilirubin, pregnancy
test, etc
Clinical Microbiology
Blood cultures of
Blood
microorganisms
Parameters to
be evaluated
Swab Direct preparation
of microorganisms
Clinical Immunology
Blood Parameters to be evaluated
Hepatitis markers (A, B)
TORCH
HIV
Dengue
Typhoid
etc
The purpose and function of Clinical Pathology
1. Confirming or rejecting diagnosis
2. Providing guidelines in patient management
3. Establishing a prognosis
4. Detecting disease through case finding or screening
5. Monitoring follow up therapy
Confirming or rejecting diagnosis
Patient with fever
Differential diagnosis:
• Dengue
• Typhoid
Laboratory results: Final diagnosis:
• Dengue (-) • Dengue reject
• Typhoid (+) • Typhoid confirm
Providing guidelines in patient management
Patients with Diabetes Mellitus
2HPP* Blood glucose levels :
Mr.A : still high (300 mg/dL) Mrs.B : normal (110 mg/dL)
Increase Oral Anti Diabetic Maintain Oral Anti Diabetic
dose dose
*2HPP : 2 hours post prandial (after meal)
Establishing prognosis
Patients with acute viral hepatitis
Cellular liver enzymes : ALT* level
Mr.X : high (400 IU) Mrs.Y: very high (1400 IU)
Prognosis : good Prognosis : bad
*ALT : Alanine aminotransferase
Detecting disease through case finding or screening
Screening of the donors for
Hepatitis B Virus :
HBsAg :
HBsAg : (+) Donors rejected (case findings)
HBsAg : (-) Donors accepted (screening
healthy subjects)
Monitoring follow up therapy
Patient with urinary tract infection
After finished 1 cured dosage of
certain antibiotic
Urine culture still (+)
Change antibiotic with
the sensitive one
Proper management
Proper diagnosis
Proper laboratory
results
Influencing factors
Factors influencing laboratory results
Pre analytic
Analytic
Post analytic
Pre analytic factors
Test requisition
Preparation of the patient
Before Specimen
collection
Specimen collection and
processing
Analytic factors
• Reagents • Filtration
• Water • Dialysis
• Measurement of mass • Extraction
and volume • Mixing
• Control of temperature • Detection of analytical
• Evaporation and response
specimen
concentration
Post analytic factors
Recording & Reporting
Human errors
How samples (blood,
urine,etc) were analyzed in
the laboratory ?
Manually
Automatically Instrumentation
Important instruments in
the laboratory medicine
Spectrophotometry
Electrophoresis
Flowcytometry
Spectrophotometry
Based on the measurements
of radiant energy (light)
absorbed or transmitted
under controlled condition
Examples :
• blood glucose
concentration
• blood cholesterol
• liver enzymes
• Cardiac markers
Electrophoresis
Separation of charged
compounds based on their
electrical charge
Reading with densitometry
Examples :
• protein
•hemoglobine
Flowcytometry
Measures some of the properties of cells suspended in a
moving fluid medium
Application of Flow Cytometry :
• Immunophenotyping in leukemia and lymphoma
• Monitoring immune status
• Cell cycle analysis (by staining the cells with a
fluorescent dye such as propidium iodide that binds to
DNA and by quantifying the number of cells in different
stages of the cell cycle)
Point of Care Testing
(POCT)
Brings laboratory testing to the site of the patient rather than
obtaining a specimen and sending it to the laboratory.
Used in variety of settings : Examples :
• Emergency departments • Hemoglobin level
• Operating suites • Blood gas analysis
• Clinics • Hormones
• Home Monitoring • Blood glucose
• etc • etc
Proper management
Proper diagnosis
Proper laboratory
results
Quality control &
Quality Assurance
Quality Control &
Quality Assurance
Quality Control :
• To ensure the accuracy and reproducibility of laboratory results.
• Need to balance effectiveness of problem detection vs costs of QC
Quality Assurance :
1. Program development
2. Assessment and monitoring
3. Quality improving
References :
Henry JB:
Clinical Diagnosis and Management by
Laboratory Methods.
21th edition, 2001, pp 3-148
WB Saunders Company
Philadelphia London New York