Clinical Lab Lectures

diagnosis, treatment, prognosis

modern medicines depend on these three concepts

John Hopkins Hospital

1st clinical lab in the US

Donald D. Van Slyke

he introduced the 20 amino acids protein conversion into urea via liver

Rosalyn Yalow & Salomon Berson

they introduced radioimmunoassay (indentify ABs via radio signals; + or -)

Kohler, Milstein, & Jerne

they introduced monoclonal antibodies/ABs (specific antigens)

anatomic and clinical pathology

two departments of clinical laboratories

surgical

type of anatomic pathology department that focuses on organs (ex. kidneys)

Histopathology

type of anatomic pathology department that focuses on tissue (ex. nephrons)

Cytopathology

type of anatomic pathology department that focuses on cells (ex. structure; inflammation?)

Hematology

type of clinical pathology department that focuses on blood; coagulation, bleeding, clotting

urinalysis

type of clinical pathology department that focuses on urine

clinical chemistry

type of clinical pathology department that focuses on analytes in body fluid

microbiology

type of clinical pathology department that focuses on grow cultures from major body systems

Immunohematology

type of clinical pathology department that focuses on blood bank; immune system testing w/ blood groups; donor compatibility

Immunology & Serology

type of clinical pathology department that focuses on organ + tissue compatibility

Toxicology

type of clinical pathology department that focuses on drug testing

Specimen Collection

type of clinical pathology department that focuses on tissue, blood, & urine in outpatient area

Pathologist

clinical lab personnel that examine tissues & oversee lab results; must go to school + residency

Laboratory Manager

clinical lab personnel who does daily lab activities; must have degree & is a clinical lab scientist (CLS)

MLS/MTs

clinical lab personnel that perform routine tests + quality control + supervise & train; degree in CLS from National Accrediting Agency for Clinical Lab Sciences (NAACLS)

MLT

clinical lab personnel that perform all routine tests + supervise; associate degree in CLS from NAACLS

MLAs

clinical lab personnel that do anything as allowed by the law + admin tasks; 🚫 degree + OJT/ program from Commission on Accreditation of Allied Health Education Programs (CAAHEP)

Phlebotomists

clinical lab personnel that collect blood; OJT/ program from American Society for Clinical Pathology (ASCP)

Clinical Laboratory Improvement Act (CLIA)

law in which to enhance quality control + assurance (regulation)

Centers for Medicare and Medicaid Services (CMS)

places responsible for accreditation

Proficiency testing

validate samples

Competency testing

check personnel

automated, serologic & volumetric

different kinds of pipettes

Reagents

parallel testing via controls; change via lot # (ID tracking)

Type I, II, & III

Three types of waters (reagents)

Type I

type of water reagent classified by its minimum interference; maximum sensitivity

Type II

type of water reagent classified by its general usage in the lab

Type III

type of water reagent classified by its role for rinsing glassware

ionization

purity of water depends on this

ionization is stripped

why is type I more expensive

US Department of Labor’s Occupational Exposure to Hazardous Chemicals in Laboratories Standard (OSHA)

governing agency responsible for REGULATING safety & IMPLEMENTING new health and safety system for all workers

Clinical and Laboratory Standards Institute (CLSI)

governing agency responsible for making STANDARDIZED lab for high-quality results & patient care

Center for Disease Control & Prevention (CDC)

worldwide governing agency; PROVIDE guidelines and develop a SYSTEM for rating safety levels in clinical lab

National Health Care Safety Network (NHSN)

governing agency characterized by their role in SURVEILLANCE; infection tracking, ABs resistant, data on events (managed by CDC)

role of BSCs

protect all workers + environment + products

Class I BSC

BSC responsible for protecting everything but product (room air)

Class II BSC

BSC responsible for protecting everything (room air filter)

Class III BSC

BSC characterized by its highest level of safety

Biosafety Levels (BSL)

Describe potential biological hazard and function of lab

BSL 1

BSL that is characterized by being LOW hazard; 🚫disease; HS & undergrad

BSL 2

BSL that is characterized by being MODERATE hazard; training. Restricted lab access during work. Aerosols in BSC

BSL 3

BSL that is characterized by being HIGHLY hazardous; infection via inhalation. Training. BSC III (Two sets of self-closing & locking doors)

BSL 4

BSL that is characterized by being EXTREMELY hazardous; 🚫 cure + unknown transmission. Training not only in handling but in containment. Class III BSC w/ positive pressure suit (air always push outwards; decont. units w/ showers)

staphylococcus epidermidis

specimens that may be included in BSL 1

staphylococcus pyogenes

specimens that may be included in BSL 2

bacillus anthracis & smallpox virus

specimens that may be included in BSL 3

Ebola + COVID-19

specimens that may be included in BSL 4

Hazard Communication Standard (HSC)

federal regulation where US employers must disclose info regarding toxic/hazardous substances stated by OSHA

preanalytical, analytical, postanalytical

Three distinct phases in Specimen Processing + Control

Preanalytical phase

phase in Specimen Processing + Control concerned with sample management + interferences

Analytical phase

phase in Specimen Processing + Control concerned with quality control

Postanalytical phase

phase in Specimen Processing + Control concerned with reporting + interpretation

purple

tube selection that uses EDTA to chelate calcium for measuring whole blood

light blue

tube selection that uses sodium citrate to chelate calcium for plasma + coagulation

green

tube selection that uses sodium/lithium heparin to inhibit thrombin formation for plasma + chemistry

red

tube selection that uses clot activators to understand serum + chemistry

gold

tube selection that uses clot activator separation gels to be a polymer for storage + understand serum + chemistry

gray

tube selection that uses sodium fluoride to inhibit glycolysis in the circumstances of glucose testing + plasma