PMLS1: Nature of the Clinical Laboratory Cheat Sheet by katanawrites

essential component of health instit­utions

involved in: research, community outreach program, survei­llance, infection control in the hospital and community settings, inform­ation dissem­ina­tion, and evaluation of the applic­ability or current and innovative diagnostic techno­logies

vary according to size, function, and the complexity of tests performed

serves as the integral partner of medical doctors

plays a very signif­icant role in the perfor­mance of laboratory testing and ensuring the reliab­ility of test results

Presently, with the advent of automa­tion: less laborious, with shortened turn around time (TAT)

focuses in the areas of clinical chemistry, immuno­hem­ato­logy, and blood banking, medical microb­iology, toxico­logy, therap­eutic drug monitory, and endocr­inology

focuses in the areas of histop­ath­ology, immuno­his­top­ath­ology, cytology, autopsy, and forensic pathology

operates within the premises or part of an instit­ution (e.g., hospital, school, medical clinic, medical facility for overseas workers and seafarers, birthing home, psychi­atric facility, and drug rehabi­lit­ation center)

not part of an establ­ished instit­ution

owned, wholly or partially, by national or local government units

owned, establ­ished, and operated by an indivi­dual, corpor­ation, instit­ution, associ­ation, or organi­zation

licensed to perform routine laboratory testing (e.g., routine urinalysis and routine stool examin­ation)

Equipment: micros­copes, centri­fuge, and hematocrit centrifuge

licensed to perform laboratory tests being done by the primary category clinical labora­tories along with routine clinical chemistry tests

If hospit­al-­based: Gram stain, KOH mount, and cross-­mat­ching

Personnel requir­ement: depends on the workload

licensed to perform all the laboratory tests performed in the secondary category laboratory

Microb­iology, bacter­iology, and mycology: differ­ential staining techni­ques, culture and identi­fic­ation of bacteria and fungi from specimens, and antimi­crobial suscep­tib­ility testing

Special hemato­logy: bone marrow studies, special staining for abnormal blood cells, and red cell orphology

Minimum floor requir­ement: at least 60 square meters

laboratory in a government hospital designated by the DOH

Functions: Referral services, provision of confir­matory testing, assistance for research activi­ties, implem­ent­ation of External Quality Assurance Programs (EQAP) of the govern­ment, resolution of conflicts regarding test results of different labora­tories, and training of medical techno­logists on certain specia­lized procedures that requires standa­rdi­zation

June 18, 1966

made up of different sections cohesively and compre­hen­sively performing different activities and procedures for each specimen collected from patient to produce reliable test results

intended for testing blood and other body fluids to quantify essential soluble chemicals including waste products useful for diagnosis of certain diseases

Test Performed: fasting blood sugar (FBS), glycos­ylated hemoglobin (HbA1c - diabetes), total choles­terol - HDL and LDL, trigly­cerides (TAG) - cardio­vas­cular diseases, blood uric acid (BUA), blood urea nitrogen (BUN), creatinine - diseases involving the kidney, total protein (TP), albumin, electr­olytes (sodium, potassium, chloride), clinical enzymology (amino­tra­nsf­erase and creatine kinase)

charac­terized as state-­of-art, fully automated facility

Thyroid hormone tests: thyroid stimul­ating hormone (TSH), T3 and T4 (triio­dot­hyr­onine and thyroxine)

Other labora­tories: Toxicology and Drug Testing

Four major sections: bacter­iology, mycoba­cte­rio­logy, mycology, and virology

Specimens: blood and other body fluids, stool, tissues, and swabs

Other activi­ties: prepar­ation of culture media and stains, quality assurance and control, infection control, and biosafety and proper waste disposal

enumer­ation of cells in the blood and other body fluids (CSF and pleural fluid)

Coagul­ation studies: focuses on blood testing for determ­ination of various coagul­ation factors

First Area: allotted to routine and other special examin­ations of urine (macros­copic examin­ation: determine the color, transp­arency, specific gravity, and pH level and micros­copic examin­ation: detect the presence of abnormal cells and/or parasites as well as to quantify red cells and WBC and other chemicals found in urine

Routine fecalysis: identi­fic­ation of parasitic worms and ova

Tests: blood typing and compat­ibility testing

Hospit­al-­based clinical labora­tories: blood donation activities (donor recrui­tment and screening, bleeding of donor, and post-d­onation care

Tests: Hepatitis B profile tests, serolo­gical tests for syphilis

Automated analyzers are also used in this section for different serolo­gical tests

combines anatom­ical, clinical, and bioche­mical techniques where antibodies (monoc­lonal and polycl­onal) bounded to enzymes and fluore­scent dyes are used to detect presence of antigens and tissue

assess the responses of patients to cancer therapy as well as diagnosis for certain neurod­ege­ner­ative disorders

Most common technique: polymerase chain reaction (PCR) - contri­buted to scientific advanc­ements in laboratory research; useful for clinical techniques (screening genetic indicators of disease & diagnosis of cancer and infectious diseases

encomp­asses all activities starting from the medical doctor writing a laboratory request up to the time (called the turnaround time [TAT]) the results are generated and become useful inform­ation for the treatment of patients

Pre-an­alytic phase: receipt of laboratory request, patient prepar­ation, specimen collec­tion, and proper transport and processing of specimen to the clinical laboratory

Equipment and instru­ments: reagents and internal quality control program

Must have clear unders­tanding of the testing cycle to avoid erroneous test results

variables that may cause errors: physio­logical factors, diet, medica­tions, alcohol and caffeine intake, exercise, underlying disease condit­ions, identi­fic­ation of patients and labeling of specimens, antico­agulant used, and volume of specimen collected vis-a-vis volume of antico­agulant

encomp­asses all activities performed by laboratory personnel to ensure reliab­ility of test results

Internal Quality Assurance System (IQAS) and External Quality Assurance System (EQAS)

Regular review and audit of test results: done to identify weaknesses and conseq­uently perform corrective actions

National Reference Labora­tories (NRL): DOH-de­sig­nated EQAS

given to the partic­ipating clinical laboratory

Research Institute of Tropical Medicine (RITM) - Microb­iology (ident­ifi­cation and antibiotic suscep­tib­ility testing) and Parasi­tology (ident­ifi­cation of ova and quotation malaria)

East Avenue Medical Center (EAMC) - Drug of abuse (metha­mph­etamine and cannab­inoids)