CLINICAL TRAY

SAHL’S HAEMOGLOBINOMETER
Principle: -
 Hb is converted to acid haematin by the action of HCL.
 The acid haematin solution is further diluted with acid until its colour matches
exactly with that of permanent standards of comparator block Hb concentration is
read directly from the calibration tube.

Uses:-
 For hemoglobin estimation.
● Parts-
a. Sahli’s graduated hemoglobin
tube (marked in grams percent g% (2-24) and
percentage % ( 10 -140)

b. Comparator with a brown glass standard.

opaque white glass is present at the back to
provide uniform illumination.

c. Sahli’s pipette or hemoglobin

pipette (marked at 20µl or 0.02 ml). No bulb
ANTISERA

LANDSTEINER’s LAW :
 1.If an agglutinogen is present on red
blood cell membrane ,the corresponding
agglutinin must be absent in the
plasma.
 2.If an agglutinogen is absent on red
blood cell membrane, then
corresponding agglutinin must be
present in the plasma.

Principle of blood grouping:

 The ABO and Rh blood grouping system
is based on agglutination reaction.
 It is the reaction between Antigens
present on red blood cells and
antibodies
NEUBAUER’S CHAMBER

 The Neubauer chamber is a thick crystal slide with the size of a glass slide (30
x 70 mm and 4 mm thickness).
 Ruled areas are separated by H-shaped gutters/troughs.
 Neubauer chamber's counting grid is 3 mm x 3 mm in size.

Principle :-

The glacial acetic acid lyses the red cell while the gentian violet slightly stains the
nuclei of the leukocytes the blood specimen is diluted 1:20 in WBC pipette with
diluting fluid and the cells are counted under low power of microscopic by using
counting chamber.

Uses : To estimate WBC count

 RBC DILUTING PIPETTE
Use :
 For estimation of RBC count.

 RBC Counting Area

The large centre square is used for RBC counts.
 This area is subdivided into 25 medium squares,
which in turn are each divided into 16 squares.
Of the 25 medium squares, only the four corner
squares and the centre square within the large
centre square are used to perform RBC counts.
WBC DILUTING PIPETTE

Lets calculate the total WBC count by using the Neubauer counting chamber.
Number of cells counted = N = 150 (suppose)
Area Counted = 1 mm2 x 4 = 4 mm2 (area of four large corner squares)

Normal values: -
Adults: 4000 – 10,000 / cumm
At birth: 10,000 – 25000 / cumm.

Conditions causing Increase and decrease of WBC

Increase in the number of white blood cell count is defined as Leukocytosis,
causes of leukocytosis is due to infections, leukemia, etc.

Decrease in the number of white blood cell count is defined as Leukopenia,

causes of leukopenia is due to problems in the production of blood cells in bone
marrow/ bone marrow failure or the patient may be undergoing chemotherapy
or infections.
 BULBS
1.Fluoride bulb:-
Contents:-
Potassium oxalate - 2 mg for 1 ml of blood
Sodium fluoride - 2 mg
Uses:-
Used for estimation of blood sugar as sodium fluoride
prevents glycolysis.

2. Citrate bulb:-
Contents - 3.8 gm% of trisodium citrate uses

1. For coagulation studies – o.5 ml of Trisodium citrate for 4.5

ml of blood
2. For estimation of ESR by westergren’s method – 0.5 ml of
trisodium citrate for 2 ml of blood.
3. Plain bulb:
Contains no anticoagulant
Uses :-
(1) For serology -
•VDRL
•WIDAL
•Australian antiqen
•HIV

(2) Blood bank -

•Cross match
•Coomb’s test

(3) For biochemistry –

• Sr. electrolytes : Sodium, Potassium
• Sr. Enzyme levels : SGOT, SGPT
• Sr. Bilirubin
• Sr. Proteins
4. Citrate bulb:-
Contents - 3.8 gm% of trisodium citrate uses

1. For coagulation studies – o.5 ml of Trisodium citrate for 4.5 ml of blood

2. For estimation of ESR by westergren’s method – 0.5 ml of trisodium citrate for 2 ml of blood.

5. EDTA bulb
Contents - Dipotassium or sodium salt of 1.2 mg of dried EDTA for 2 ml of blood.
Uses -

For Hematology
● Hb estimation
● Cell counts – WBC, RBC, Platelets
● ESR estimation by wintrobe’s tube
● Sickling test
● Reticulocyte count
6. Oxalate bulb

Pot. Oxalate & ammonium oxalate

Pot. Oxalate causes shrinkage of RBCs

While ammonium Oxalate causes swelling, so the effect is balanced

Pot. Oxalate - 4 gm

Ammonium Oxalate - 6 gm

Dist. Water. - 100 ml

0.2 ml of this solution is dried and this is sufficient for 5 ml of blood.

Uses

● Determination of PCV
● Determination of specific gravity of whole blood
Determination of Hb and total cell count of blood.
Uses of the urinometer URINOMETER
Urinometer is an instrument used to measure the specific gravity of urine.
Normal = 1.003 – 1.030

Parts of a Urinometer
There are three parts of the urinometer.

I. The float: is the air containing part

II. Weight: the lower end of urinometer,
III. Stem- Has calibrations with numbers marked to measure the specific gravity
What is the principle behind the measurement of specific gravity by a urinometer?

Principle of Buoyancy.
Because of increased density of urine compared to that of water, the urinometer will
float higher in urine than in water. The weighted float will displace the volume of the
urine which is equal to its weight.
The weight of the weighted float is designed in such a way that the urinometer sinks
to the level of 1.000 in the distilled water.
 WESTENGREEN TUBE
● Westergren Pipette –
Length = 300 mm
Diameter = 2.5 mm
● Graduation in (mm) = from 0-200
● Anticoagulant used = sodium citrate
● Anti coagulated blood is drawn till 0 mark
● Allowed to stand vertical for 1 hr.

Reading taken after 1 hr. and is expressed as :

Normal values - Male = 0 – 9 mm at 1 hr.
Female = 0 – 20 mm at 1 hr.

SIGNIFICANCE -
1. Physiological - old age & infancy
2. Pathological - anemia, acute infections and post operative states.
3. In monoclonal plasma protein disorders multiple myeloma
 LUMBAR PUNCTURE
NEEDLE
Uses :

● Used for lumbar puncture

● For administration of drugs intra – thecally
● For aspiration of fluid from a closed space like
peritoneal cavity, pleural cavity joint spaces etc.
● For giving spinal anaesthesia
Indication: -
A. For diagnostic purpose in :
● Meningitis
● Meningoencephalitis B. For therapeutic purpose in
● Encephalitis ● Release of intracranial tension.
● Subarachnoid hemorrhage. ● Intrathecal Anaesthesia
● Intracranial space occupying lesion ● Intrathecal administration of antibiotics.
● Lipiodol Ventriculography.
 ESBACH’S ALBUMINOMETER
Identification:-

Thick walled grass tube with U mark below & R mark above at the lower part of tube,
there are few gradational with numerical markings which gives the reading in gm /
1000 ml or gm %
Use :-
Quantitative estimation of albumin in urine

Esbach’s reagent –
Picric acid - 10 gm
Citric acid - 20 gm
Water - 1000 ml
Principle of test : Albumin combines with picric acid in an acidic environment &
develops the salt albumin picrate. Conditions of massive proteinuria
 VIM SILVERMAN LIVER BIOPSY
PARTS:-
1. Cannula NEEDLE
2. Stillette/trocar
3. 3.Prong/fork/bifid needle- longer than needle
and it protrudes out of the needle. It has a very
sharp cutting edge and has longitudinal grove.
This retains the tissue when the needle and
cannula are withdrawn.

INDICATIONS:- CONTRAINDICATIONS:-
1. Cirrhosis of Liver
2. Hepatic malignancies
1. Bleeding diathesis
3. Granulomas eq. – 2. Protracted severe
Tuberculosis , Sarcoidosis,
hepatocellular jaundice.
Schistosomiasis
4. Metabolic and storage 3. Infection in liver,
diseases: eq. Wilson’s
peritoneum, biliary tract,
disease, amyloidosis
5. Leukemia Right lung base.
6. Multiple myeloma
4. Hydatid cyst in liver.
 HEMOGLOBIN PIPETTE
REAGENTS :

1) N/10 HCl

2) distilled water

PRINCIPLE :

Hb N/10 HCl acid haematin (present in blood)

(brown in colour) This brown colour is diluted
with distilled water to match that of brown
glass standard and Hb value is read directly in
grams from the scale of haemoglobinometer.

PROCEDURE:

Fill sahli’s Hb tube upto mark 2 with N/10 HCl

Put 20 ul (0.02 ml) of blood from Hb pipette
Stir with stirrer 10 min Add distilled water
drop by drop and stir till colour matches with
comparator and take reading at lower
meniscus
 BLOOD BAG

TYPES OF BLOOD BAGS :

Triple Blood Bag:
• Triple Blood Bag with SAGM, for whole blood collection.
Single Blood Bag:
• Separation of 3 different blood components (red blood cells,
• For whole blood collection. plasma and platelets).
• The bag contains a CPDA solution. • The primary bag contains CPD and one satellite bag contains
• Available in capacities of 350ml and 450ml. SAGM.
Quadruple Blood bag:
1. It comes with SAGM for whole blood collection
Double Blood Bag:
2. Separation for 3 different blood components (red blood cells,
• For whole blood collection plasma and platelets) through the buffy coat method.
• Separation of 2 different blood components (red blood 3. The primary bag - CPD solution and has 3 satellite bags.
cells and plasma) obtained through the process of
centrifugation and extraction. 4. One satellite bag - 100 ml capacity to prepare platelets
through the buffy coat method.
5. Valid for 5 days of platelet storage.
ANTICOAGULANT PRESERVATIVE SOLUTIONS :
⮚ Acid Citrate Dextrose (ACD)
⮚ Citrate Phosphate Dextrose (CPD)
⮚ Citrate Phosphate Dextrose Adenine (CPDA-1)
15 ml of ACD, 14ml of CPD or CPDA is used for preserving 100ml of
blood.
PURPOSE:
To prevent coagulation.
To preserve the life and survival of RBCs so as to have the
maximum post transfusion survival.
ANTICOAGULANT SOLUTION
• CITRATE: Acts by chelating Calcium.
• DEXTROSE: Necessary for the metabolism of stored RBCs. It
passes from plasma into the red cells and is utilised for energy
production. The principal pathway being Anaerobic glycolysis.
• CITRIC ACID: Prevents caramelization of glucose in citrate
dextrose solution during autoclaving.
• ADENINE: Improves the viability of red cells.
 L – Moulds (Leuchards Blocks)
● Made up of heavy metal , usually brass.
● 2 blocks are used to form a rectangle of various sizes.
● Each L – Block has one long arm & another short.

Use :

• For embedding a tissue bit in the paraffin wax and making tissue blocks which are
used for cutting thin sections using microtome.
• For forming blocks, the common mould which are used are L-blocks or Leuckhard;s
blocks which consist of 2 L – shaped pieces of heavy metal (usually brass) with one
limb of L larger than the other. The 2 L’s are joined to from a rectangle.

• The tissue is properly oriented in a way that it will provide best information to the
pathologist and its label is placed along the side of the rectangle for proper
identification.
 RYLE’S TUBE
Indications

A long, slender later or plastic or rubber tube with a bulb at end along with 2/3
eyes just above the bulb. Size of commonly used tube is 75 cm

● It has 4 markings indicating the position of the bulb at different parts of the
stomach.
● The tube with tip of bulb remains in the cardiac end of stomach, body of
stomach, pylorus and proximal part of duodenum. When introduced either
through intra – nasal or oral route upto the 1, 2, 3 & 4th mark respectively.
Uses :-

1. For gastric lavage in case of poisoning

2. For gastric analysis for gastric cancer, pernicious anemia, peptic ulcer.
3. For collection of gastric washing for demonstration of malignant cells in cases
of gastric malignancy by Pap stain.
4. Maintaining of nutrition by intra – nasal feeding in unconscious pt.
 WINTROBE TUBE
Content –
1. 110-millimetre-long tube.
2. It’s a tube because only one end is open
3. Bore diameter of 3-millimeter
4. Graduation is on both sides from 0 – 10 (ascending & descending)
5. 1 millilitre of blood.
Indication –
6. Packed cell volume (PCV) determination
7. Erythrocyte sedimentation rate (ESR) determination
8. Preparation of Buffy coat smear for determination of LE cell phenomenon & to study
abnormal cells in leukaemia. Also, for determination of filaria (Wuchereria Bancrofti)
Specimen –
9. EDTA-collected venous blood (1.5 mg EDTA for 1 ml)
10. Blood) or double oxalate in it. The test should be carried out.
11. Within 6 hours of being obtained.