Laboratory Science for Non-Laboratory 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 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

“The quality of any test result is only as good as the specimen that 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? WBC White blood cell count RBC Red blood cell count HGB Hemoglobin HCT Hematocrit MCV Mean cell volume-cell size MCH Mean cell color MCHC Mean cell hemoglobin concentration PLT Platelet count RDW Red cell population variation Complete Blood Count (CBC)

Basic Metabolic Panel GLU Glucose (sugar) Pancreas/insulin NA Sodium Hydration/Electrolytes K Potassium Heart/Muscle/Hydration/Electrolytes CL Chloride CO2 Carbon Dioxide Oxygen level/Electrolytes BUN Urea Nitrogen Kidney CREA Creatinine CA Calcium General Health AGAP Anion Gap Electrolyte Balance

Comprehensive Metabolic Panel ALB Albumin Protein-Immune System ALKP Alkaline Phosphatase Liver ALT Alanine Amino Transferase AST Aspartate Amino Transferase TBIL Total Bilirubin TP Total Protein Immune System

Prothrombin Test Activated Partial Thromboplastin Time PT Measured in seconds How long to clot Monitors oral anticoagulants INR Ratio Compares therapies and instrumentation PTT Monitors IV 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