General Lab Practices

Medicare

A federal health insurance program that provides coverage primarily for individuals aged 65 and older, as well as certain younger people with disabilities or specific diseases.

Medicare

is designed to help cover medical expenses for seniors and eligible individuals, including hospital stays, doctor visits, and outpatient care. Low income, run by the state

Why is billing for labs such a tightly controlled process

CMS Tightly controls how much the government will pay for each lab test and regulates how lab billing is done

Certification

Required by individular orgs, hospitals may require certs but not legally

Licensure

Required by law, like a drivers license

Accreditation

An outside organization saying that this place is up to par, such as CAP or JCAHO.

CDC

Center for disease control

CMS

Centers for Medicare & Medicaid Services, overseeing healthcare programs.

ASCP

American Society for clinical pathology

ASCLS

American society for clinical lab science

CAP

College of American Pathologists, accrediting laboratory services and giving proficiency testing

CLIA 88

Clinical lab improvement act of 1988

What did CLIA 88 do?

It established standards for laboratory testing and ensured quality in laboratory operations. Waved vs moderate complexity

Whats the difference between malpractice and negative?

Negligence was harm done without intent, malpractice has intent

Major purpose of HIPAA

to protect patient privacy and secure health information.

What is PHI?

Protected health information, any information that can be used to ID a patient

What is waived testing?

Testing that can be preformed by almost anyone, easy testing that if done wrong will not cause serious harm. POCT, Provider preformed microscopy, physician office labs

What is Moderate complexity testing?

Testing that required training, could be on the job training but does not require a college degree

What is high complexity testing?

Testing that requires a college degree, xms

Chemistry

Electrolyes, CMP, BMP

Microbiology

Microorganisms, cultures, strep

Hematology

Blood counts, CBC

Immunohematology

Type and screens

Cytology/histology

biopsies

Coagulation

PTT, APPT, Dimer

Purpose of QA

To ensure accuracy in the lab

5 Aspects of a QA program

Personelle orientation, quality control, documentation, instrument knowledge/training, proficiency testing

Preventative maintenance

Regular checks and servicing of lab equipment to ensure optimal performance and reliability.

Accuracy vs Precision

Accuracy refers to how close a measurement is to the true value, while precision indicates the consistency of measurements among themselves, regardless of their closeness to the true value.

Quality control

the procedures and processes used to ensure a product or service meets defined quality standards.

Control

A sample that has a known range and known results

Random Error

occurs by chance and cannot be controlled 1 in 20 chance

Systematic error

Human error, instrument error

Mean

Average result expected

Standard deviation

How far away from the average

Range

range for a set of values that is expected

Levey Jennings chart

a graph used to help analyze qc results

Reference range

normal results for 95% of the population

brightfield microscope

a type of light microscope that generates a visible image of a specimen through the use of light. Dark with light background, uses Kohler illumination, light is directed in parallel waves up through the specimen

Dark Field microscope

Dark background with a light specimen, light travels at angles

Phase contrast

microscope that enhances contrast in transparent samples by using light diffraction. It allows for detailed observation of cellular structures without staining.

Polarizing microscopy

Lets light waves vibrate at all orientations, and blocks only specific waves, uses polarizing filters

Fluorescent microcopy

Based on the fact that certain substances will emit different light waves when exposed to fluorophores. Can be used to tag certain specimens

Differential Interference-Contrast (DIC)

Nomarski microcopy, a bright field microscope with beam splitting prism, gives 3d appearance

Physical Hazard

Anything capable of causing immediate physical damage

Chemical hazard

substances with hazardous chemical makeups, Bleach, acid

Biological hazard

Hazards that can cause disease, HIV, Hep B

How are biological hazards transmitted

Ingestion - Mouth

Inhalation - Nose

Inoculation - Stick

Universal precaution

Treat every sample as infectious

OSHA

Occupational safety and health act of 1970. tightly monitors safety in the lab and requires all labs to have a chemical hygiene plan

SDS

Safety data sheets, has information on different chemicals and how to safely work with them

Numerical aperture

Light gathering of objective in numbers

Resolution

Quality of an image

NA equation

NA = n x sin

When identifying hazards in the laboratory the NUMBERS represent the hazard's …..?

Severity

What is actively reabsorbed in the proximal convoluted tubule?

Glucose

What is the major point of pH regulation within the nephron?

Distal convoluted tubule

What is the collection point of filtrate within the nephron?

The glomerular space

Your blood has to remain at a pH level of _________ at all times. Your kidneys are, in part,responsible for this.

7.35-7.45

Your kidneys account for about 0.5% of your total body weight, yet they receive about ____% of the total blood pumped by the heart.

25%

Your kidneys filter about _____ ml of blood per minute, or about 45 gallons per day. That's your total blood volume about 20 times a day!

150 ml blood per min

Basic Functions of the Kidney Generic answer:

Filtration.

Basic kidney functions

1. filtration-strainer for blood, 2. reabsorption- taking nutrients back after 3. filteration, secretion- elimination of toxic waste (excretion)

Why do the kidneys filter the blood in order to perform a number of tasks?

A. Regulation 1. PH 2. concentration of chemicals 3. water and electrolytes balance

B. Detoxification and elimination of wastes Urea, ammonia, salts… (waste products)

C. Erythropoesis: RBC production (EPO-Erythropoietin)

EPO shots

can help with O2 but can have a risk of blood clots

The kidneys are part of the

endocrine system and secrete hormones that stimulate red blood cell production

Normal kidneys

exhibit the shape of a bean and are located in the abdomen but are more towards your back.

Each kidney is about

12.5 cm in length.

Our ureters (one per kidney)

originate from the indented area of the kidney, and are approximately 25 cm.

Each ureter

extends to the apex (base) of the bladder.

From the bladder the urethra (4 cm in women and 24 cm in men)

allows urine to travel to the outside world.

The kidney is divided into two sections

Cortex and Medulla

Cortex Major Function:

entire area lining the kidney, filtration takes place

Medulla Major Function:

inner area of the kidney, collection of filtrate

Renal Pyramids look like

looks like candy corn

Calices (Calyx)

1. Major- palm of the hand 2. Minor- finger like of the palm

Papilla -

Apex (base or bottom) of each pyramid

Renal Pelvis

series of funnels that leads to ureter

What does the nephron do?

Functional unit of the kidney, Site of electrolyte exchange, water reabsorption, waste secretion etc.

Afferent Arteriole

unfiltered blood enters the glomerulus then Branches into the glomerular capillaries. A for Access

Glomerular Capillaries do what

Allows the blood to spread out and be filtered.

Surrounded by a three (tri) layer basement membrane.

determines what comes in and what stays out

The basement membrane is permeable to:

70k daltons or smaller, water, solutes, glucose

The basement membrane glomerular

consists of three layers that allow only certain substances to pass through.

Efferent Arteriole

All substances that are not allowed to pass through the basement membrane return to the circulation via the efferent arteriole. E for Exit

All substances passing through the basement membrane are collectively called _____________.

filtrate

We convert approximately 180,000 ml (180L) of filtrated plasma per day into a urine volume ranging from ____ to _____ ml.

500-1000 ml (0.5-1 L)

Glomerular Space (Was known as the Bowman's capsule/space)

Collection point for glomerular filtrate.

Where is the first point of reabsorption and what is absorbed?

Proximal convoluted tubule

Glucose, amino acids, salts and water. (close to the glomerulus)

Reabsorption: Active

requires energy…. like glucose- renal threshold the limit the kidney can take

Reabsorption Passive

like water

Nephron Loop (Was known as the Loop of Henle) As the filtrate travels down the Loop of Henle the filtrate becomes:

more concentrated

As the filtrate travels back up the Loop of Henle, filtrate becomes:

less concentrated, solutes are being taken out

what is the only point in the whole process where water cannot go in or out of the tubules?

Ascending loop of Henle