Introduction to Laboratory Medicine

Laboratory medicine
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Clinical laboratory Pathology

Anatomical Pathology

Clinical Pathology

Macroscopic/

Anatomical pathology

microscopic

Cells
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Tissue
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Organ
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System
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Substances excreted/secreted to blood/other body fluids

Clinical pathology

Clinical Pathology
Clinical Hematology Clinical Chemistry

Samples :

Blood Blood Urine

Clinical Microbiology
Clinical Immunology

Stool
CSF Trans/Exudate etc

Clinical Hematology

Parameters to be evaluated : Hemoglobin Leucocyte count

Manually

Platelet count
Hematocrit etc

Automatically

Automatic Hematology Analyzer

Clinical Chemistry
Glucose, cholesterol, triglyceride, cardiac enzyme, etc Parameters to be evaluated Urine Glucose, protein, bilirubin, pregnancy test, etc

Blood

Clinical Microbiology

Blood

Blood cultures of 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. 2. 3. 4. 5.

Confirming or rejecting diagnosis Providing guidelines in patient management Establishing a prognosis Detecting disease through case finding or screening Monitoring follow up therapy

Confirming or rejecting diagnosis Patient with fever Differential diagnosis: Dengue

Typhoid

Laboratory results:
Dengue (-) Typhoid (+)

Final diagnosis:
Dengue reject 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 dose

Maintain Oral Anti Diabetic 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
*ALT : Alanine aminotransferase

Prognosis : bad

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 Water Measurement of mass and volume Control of temperature Evaporation and specimen concentration Filtration Dialysis Extraction Mixing Detection of analytical response

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 :

Emergency departments Operating suites

Examples :
Hemoglobin level Blood gas analysis

Clinics
Home Monitoring etc

Hormones
Blood glucose 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