T.A.

Bahiya Osrah
 Introduction to Clinical Laboratories
• Diagnosis begins with physical examination by
a doctor
• Diagnostic tests are important steps to
confirm a suspected diagnosis
 The functional components of the clinical
Laboratory

• 1) Clinical pathology
• 2) Hematology
• 3) Clinical biochemistry
• 4) Clinical microbiology
• 5) Serology
• 6) Blood bank
• 7) Histology and cytology
 Clinical biochemistry

• 1) Reveal the cause of the disease

• 2) Screen easy diagnosis
• 3) Suggest effective treatment
• 4) Assist in monitoring progress of
pathological condition
• 5) Help in assessing response to treatment
 Important Note
• Disinfection:
• Chlorine (Sodium hypochlorite) is an universal
disinfectant which is active against all
microorganisms
Laboratory work flow cycle:
 The phlebotomist
• The phlebotomist :
Is the technician who collects blood, should be trained to:
• 1) Prepare specimen collection material
• 2) Instruct patient appropriately
• 3) Collect, preserve and transport specimen carefully
• 4) Separate serum or plasma properly
• 5) Maintain proper record of collection
• 6) Handle the specimen carefully
• 7) Analyze the specimen accurately
• 8) Maintain proper record of reports
• 9) Work with appropriate safety precautions
 The phlebotomy equipments

• 1) Disposable syringes or vacutainer systems

• 2) Disposable lancets
• 3) Gauze pads or adsorbent cotton
• 4) Tourniquet
• 5) Alcohol swap
• 6) Waste container
 Blood collection
The median cubital vein
is the one used for
the patient.
 Specimen rejection criteria
• 1- Specimen improperly labeled or unlabeled
• 2- Specimen improperly collected or
preserved
• 3- Specimen submitted without properly
completed request form
• 4- blood hemolysis
 Hemolysis of blood
• It is the liberation of hemoglobin from RBCs.
• Due to hemolysis, plasma or serum assumes pink to red
color.
• hemolysis causes changes in measurement of a number of
analysis such as:
• 1- Serum K
• 2- Serum in.org P.
• 3- SGOT
• 4- SLDH
• 5- Acid phosphatase
Lab request:
 Lab request:
• 1. Full name: middle name should be included to avoid
• 2. Location: inpatient, room, unit, outpatient, address.
• 3. Patient's identification number: this identification
can be very useful for instance in the blood bank.
• 4. Patient age and sex: disease prevalence may be age-
or sex-linked.
• 5. Name(s) of the physician(s): name all of the
physicians on the case; "panic values" should be called
to the attention of the physician ordering the test; a
physician may have some specific test guidelines for
his patients.
 Lab request:
• 6. Name of the test and the source:
• 7. Possible diagnosis: essential for evaluating laboratory
results and selecting appropriate methodology; (media
selection in microbiology).
• 8. The date and time the test is to be done: some tests
must be scheduled by the laboratory; patient preparation
and diet regulations need to be considered.
• 9. Special notation: provide relevant information to assist
the laboratory--e.g., medications taken; for hormone assay,
the point in the menstrual cycle when the specimen was
obtained
 Blood Testing
• Three different specimens
1) Whole blood
2) Serum
3) plasma
 Blood

• Red blood cells(RBCs)

• -White blood cells(WBCs)
• -Platelets
After centrifugation of blood, the blood separate
into three layers
 Blood plasma

• Plasma is the liquid component of

blood
• -It is mainly composed of
• water (92%)
• blood proteins 7%(albumin,
globulins, and fibrinogen)
• inorganic electrolytes
When a blood sample is left standing
without anticoagulant, it forms a
coagulum or blood clot
 Formation of The Clot
• Platelets to maintain the integrity of the
adherens junctions between the endothelial
cells that line the blood vessels
• Network of fibrin molecules
• Thrombin Prothrombin Ca+2 Thrombin

• Ca+2 Fibrinogen Thrombin Fibrin Clot

• Clotting factors
 Blood serum:

• Serum is the same as plasma except that

clotting factors (such as fibrin) have been
removed.
• No coagulation factors
• It is obtained by letting a blood specimen clot
prior to centrifugation.
 Procedure of Plasma Preparation:

• 1-Draw blood from patient. Select vacutainer

with an appropriate anticoagulant.
• 2- Mix well with anticoagulant.
• 3- Allow to stand for 10min.
• 4- Centrifuge the sample to speed separation
and affect a greater packing of cells.
• 5- The supernatant is the plasma which can be
now collected for testing purposes or stored (-
20C to -80C) for subsequent analysis or use.
 Procedure of Serum preparation:

• 1- Draw blood from patient. Select vacutainer with NO

anticoagulant.
• 2- Allow to stand for 20-30min for clot formation.
• 3- Centrifuge the sample to speed separation and affect
a greater packing of cells. Clot and cells will separate
from clean serum and settle to the bottom of the
vessel.
• 4- The supernatant is the serum which can be now
collected by dropper or pipette for testing purposes or
stored (-20C to -80C) for subsequent analysis or use.
Blood collection tubes:
 Plasma Separating Tubes (PST)
Top Color Additives Principle Uses
Lavender EDTA -The strongest anti-coagulant - Hematology
- Ca+2 chelating agent - Blood bank (ABO)
- To preserve blood cells components - HbA1C
(Glycosylated Hb)

Light Blue Sodium Citrate Ca+2 chelating agent - PT: Prothrombin Time
- PTT: Partial
Thromboplastin Time
( in case of
unexplained bleeding
and liver disease)

Green Sodium Heparin binds to Thrombin and inhibits Enzymes

Heparin or the second step in the coagulation Hormones
Lithium cascade Electrolytes (Na+, K+,
Heparin (Prothrombin Thrombin) Mg+, Cl-

Fibrinogen Fibrin
Heparin
Top Color Additives Principle Uses
Black Sodium Citrate Ca+2 chelating ESR ( Erythrocyte Sedimentation
agent Rate)
to test how much inflammation in
the patient, unexplained fever,
Arthritis, Autoimmune Disorder
Gray -Sodium Fluoride Glycolysis Glucose tests
inhibitor
-Potassium Oxalate Anti-Coagulant
Royal Blue Heparin Anti-Coagulant Toxicology
Na-EDTA Tube should not Trace Elements and metals
be
contaminated
with metals
Yellow ACD ( Acid-Citrate Anti-Coagulant DNA Studies
Dextrose) Paternity Test
HLA Tissue Typing
(Human Leukocyte Antigen)
The body used this protein to
differentiate the self-cells from non-
self cells
 Serum Separating Tubes (SST)
Top Tubes Additives Principle Uses
Red ------ Enhancing the Serology
Sometimes it has formation of blood -Antibodies
gel or silicon at the clot -Hormones
bottom of tube to -Drugs
reduce hemolysis Virology
Chemistry
Blood cross
matching before
blood transfusion
Gold ------- Serum separating Serology
It has gel at the from the blood Chemistry
bottom of the tube through the gel in
to separate serum the tube
from the blood