Background
Clinical laboratory science is very essential in the diagnosis of infections and disorders. It provides information that guides in the collection and examination of a specimen. The results obtained enable doctors and other physicians to make the accurate diagnosis and therefore design the appropriate drug therapy for the patients. Some diseases like rheumatoid arthritis are interesting to learn due to their unique laboratory tests performed. Anti- cyclic citrullinated peptide test is carried out to check presence or absence of anti- cyclic citrullinated peptide antibodies. This test is positive for people who are prone to these diseases. Such diseases have promoted research in this department, enabling more accurate diagnosis and therefore treatment of patients.
Point of Care Testing
This is the laboratory testing of patients in operating rooms, recovery areas, patient’s bedside, or home testing. This has increased the interaction of laboratory physicians, respiratory therapists, nurses, assistant physicians, operating room technologists, and anaesthesiologists. It provides cost effective methods and advancements in medical care and enables an immediate and accurate assessment in intensive care units or parent units, emergency departments, and operating rooms. Tests performed mostly are analytical, such as prothrombin time coagulation test, partial thromboplastin time coagulation, and erythrocyte measurements like hematocrit. The regulations of CLIA’88 are followed to ensure accurate and quality results are obtained as well as quality control and proficiency testing is provided. The laboratory director ensures that all regulations are implemented and adhered to.
Safety
The safety of the patients and the laboratory personnel should be maintained. Most of laboratory accidents are usually caused by lack of paying attention to instructions, carelessness, and lack of concise and proper communication during the testing. By use of suitable mechanism, strategies, common sense, and staying alert can be used to minimize such accidents. There are bodies that are responsible for ensuring blood borne pathogen prevention and protection, and ensuring electrical, fire, and chemical safety is guaranteed which Health Administration, and Occupational Safety and other bodies. Musculoskeletal disorders are the most common physical, ergonomic stressors where muscles, nerves, tendons are affected, for example, tendinitis and sciatica.
Workers are vaccinated against hepatitis B, rubella, and measles infections. Conducive working conditions, education on first aid methods, and personal protective equipment are provided. The Joint Commission and National Patient Safety Goals reinforce patient safety methods. Therefore, errors in the pre-analytical phase, for example, in blood sample collection and patient identification, and analytical errors like verifying the accuracy of abnormal results are avoided as well as Post-analytical mistakes like communication of tests results are avoided.
Phlebotomy
This is the process of making a puncture in a vein, usually in the arm, with a cannula for the purpose of drawing blood; It is also referred as a venipuncture. Factors such as ambient temperature, altitude, humidity, and light are considered during this procedure. This procedure should be carried out by trained personnel to ensure the patient’s safety and that the correct results are obtained, and no complications like iatrogenic anemia arise. Anticoagulants such as ethylene diamine tetra-acetic acid prevent coagulation caused by fibrinogen. Blood cultures should be protected from contamination. Specimens are susceptible to clotting, hemolysis; icterus, and lipemia, in addition, tests performed are mostly pre-analytical. Laboratory and clinical standards institute are responsible for regulating laws and legislations governing phlebotomy.
Clinical Chemistry: Lipids
Lipids are biochemical molecules with cholesterol and triglycerides; they are plasma-bound, forming lipoproteins. They have functions in the body, for example, insulation to allow nerve impulses and heat loss, energy storage, structural components of cell membranes, and they act as hormones.70% of the cholesterol in the human body is from the liver, the rest if from dietary intake. High levels of cholesterol increase the risk of atherosclerotic disease. Cholesterol is an essential structural component of the animal cell membrane and precursor of bile acids and steroidal hormones.
The serum is the specimen used by a patient who has fasted for 12-15 hours. The instrument used is a serum separator evacuated tube, and an enzymatic cholesterol assay is carried out. The desirable amount is less than 180mg/dl, the moderate amount is between 200-239mg/dl, and those at high risk have levels of more than 240mg/dl. Familial lecithin cholesterol acyltransferase deficiency is a disease transmitted as a recessive trait. It is usually associated with hyperphospholipidemia and hypercholesterolemia with underlying conditions of hypertriglyceridemia.
Hematology: Leukemia
This is an uncontrollable and abnormal proliferation and progressive displacement of hematopoietic cells with standard cellular elements.They are classified morphologically into lymphocytic and myelogenous, they termed as acute or chronic, depending on the amount or number of blasts available. Examples include acute myelogenous leukemia, chronic myeloproliferative disorder, and lymphoblastic anemia. Flow cytometry identifies specific cluster designation and cell surface membrane markers. Christmas disease or Hemophilia B, also called factor IX (FIX) deficiency, is a genetic disorder caused by missing or defective factor IX.
Microbiology: Parasitology
This is the study of parasites, their hosts, and their relationship. Parasites such as Trichomonas vaginalis cause infection to their host. The trophozoite is tear-shaped, elongated, and with a jerky undulating motion. It is present in freshly voided urine in wet vaginal preparations and prostatic secretion and can be analyzed and reviewed under the microscope (Turgeon, 2018). A rapid antigen detection test is available; it is very easy and rapid conduct the OSOM Trichomonas Rapid Test which is a dipstick method. The TV system is used for culture and direct microscopic examination in Pouch.
Immunology: Autoimmune Disorders
This is the study of molecules, cells, and systems responsible for recognizing and disposing of non-self-substances. Autoimmune disorders include that body attacks healthy cells; they include systemic lupus and rheumatoid disorders.Rheumatoid arthritis is a chronic inflammatory disorder affecting joints structures and tissues. The manifestations can be articular and extra-articular. Juvenile rheumatoid arthritis is another chronic synovitis condition that affect chidren in their childhood stages.The immunofluorescent technique detects high immunoglobulin G, and immunoglobulin M. Identification of R factor in serum or synovial fluid is used for diagnosis. The higher the R factor, the more joint destruction there is. The R factor is determined by conducting a test known as Rapid Latex Agglutination.
Blood Banking: Platelets
Generally, patients who are bleeding excessively are subjected to platelets concentrates due to low platelet count, abnormal platelets, or after massive transfusions. Platelets are harvested by the process of plateletpheresis or from a single unit of fresh, whole blood. Plateletpheresis allows for a yield of 200 to 500mL of a single donor platelet unit with a minimum of 3.0×1011 platelets. They are prepared by centrifugation and removal of plasma from a new division of donor blood and subsequent separation of platelets from platelet-poor plasma.
They are stored at room temperature (20°C – 24°C) with continuous, gentle agitation for 5days, although bacterial contamination occurs sometimes. Generally, the process of blood banking usually takes place in the lab to ensure that the blood products or any donated blood are saved before they are engaged in medical procedures or blood transfusions. This process can be conducted by testing the presence of diseases in the blood or typing the blood before it is transmitted. Such an approach is fundamental during the patient care unit because it helps the physician avoid any medical-related errors before donating or transfusing the blood.
Coagulation: Therapeutic Anticoagulant Therapy
Coagulation is the process by which coagulation factors, plasma proteins, and calcium are subjected to work together on the platelets’ surface to make or form a strong fibrin clot.Therapeutic anticoagulation therapy uses glycoprotein receptor drugs such as abciximab, eptifibatide, aspirin and clopidogrel, intravenous antiplatelet membrane, and thrombolytics. Direct thrombin inhibitors (DTI) such as new oral anticoagulants, warfarin, a vitamin K antagonist analog, and anti-Xa anticoagulants such as heparin are also used.
Reference
Turgeon, M. L. (2018). Linne & Ringsrud’s Clinical Laboratory Science E-Book: Concepts, Procedures, and Clinical Applications. Elsevier Health Sciences.