This document discusses various hematological investigations and procedures. It describes how to collect blood samples, prepare blood smears, determine hemoglobin and hematocrit levels. It explains the use of different blood collection tubes containing various additives. Procedures for preparing serum and plasma from whole blood are provided. Common complications of blood collection and criteria for rejecting samples are also summarized.
The document describes how to use a hemocytometer to count cells in a liquid sample. A hemocytometer has a chamber of known volume and depth that allows counting cells within a defined area to calculate concentration. Proper sample preparation is important, such as ensuring an appropriate cell concentration that is not too high or low. Cells are counted within the grid lines and their number is used to calculate the concentration of cells in the original sample volume.
Haemocytometry is a technique used to count blood cells by diluting a blood sample and examining it under a microscope. The blood is diluted using specialized pipettes then placed under a cover slip on a counting chamber slide. The counting chamber has a grid that is divided into squares to allow cells in the diluted sample to be enumerated and the total cell count in the original undiluted blood to be calculated based on the dilution factor. Cell counts are performed to evaluate normal and abnormal blood levels, assist in medical diagnoses, and monitor patient responses to treatment.
This document describes how to use a hemocytometer, an instrument used to count blood cells. It includes a Neubauer slide with a central counting area divided into squares, a cover slip, and pipettes. The process involves placing a blood sample on the slide, focusing it under a microscope, and counting the cells within the squares to calculate cell density using the number of squares and an equation.
This document provides instructions for performing a manual leukocyte count using a Unopette test 5856 technique. Key steps include:
1) Diluting a blood sample in an acetic acid solution in a Unopette reservoir to lyse red blood cells.
2) Charging a hemacytometer slide with the diluted blood sample and allowing cells to settle.
3) Counting leukocytes in the four corner squares of the hemacytometer slide under a microscope and calculating the leukocyte count per cubic millimeter.
The manual count is used to evaluate changes in white blood cell counts that can provide information about infectious, hematologic or other diseases. Quality control steps and potential sources of error
Haemocytometry is a technique used to count blood cells and cells in other body fluids. It involves diluting a blood or fluid sample and counting the cells in a special counting chamber under a microscope. The total white blood cell count, platelet count, and absolute eosinophil count can be determined through haemocytometry. Precise dilution and counting technique is required to obtain accurate results, which provide information about a patient's health status and response to treatment.
My report . (wbc count)
Report to practical physiology .
......
University of AL_Ameed .
College of Dentistry .
________________________________
Telegram : @Goldenalzaidy
Instagram : goldenalzaidy
__________________________________
تقرير كامل ومفيد عن طريقة حساب عدد الكريات البيض تستطيع اعادة صياغته وتقديمه
---------------
This document outlines the procedure and materials used for performing a white blood cell count. It details the specific equipment needed, including pipettes, a hemacytometer, microscope, and tally counter. It also lists the types of specimens and reagents involved, such as fresh or anticoagulated blood and diluting fluids like Turk's solution. The procedure involves mixing the blood sample, filling a pipette with blood and reagent, shaking for 1 minute, counting cells in the hemacytometer under a microscope, and using the counts and known volumes and dilutions to calculate the final white blood cell concentration.
The document summarizes the principles and process of hemocytometry, which is a technique used to count blood cells. It involves diluting a blood sample with special fluids and counting the cells within the gridded chambers of a hemocytometer under a microscope. The total and differential white blood cell and red blood cell counts obtained can be used for clinical diagnosis. Key components of the hemocytometer include Neubauer ruled chambers for counting cells, diluting pipettes for precise sample dilution, and diluting fluids tailored for red or white blood cells. Proper technique such as counting rules ensure accurate enumeration of cells.
The document describes how to use a hemocytometer to count cells in a liquid sample. A hemocytometer has a chamber of known volume and depth that allows counting cells within a defined area to calculate concentration. Proper sample preparation is important, such as ensuring an appropriate cell concentration that is not too high or low. Cells are counted within the grid lines and their number is used to calculate the concentration of cells in the original sample volume.
Haemocytometry is a technique used to count blood cells by diluting a blood sample and examining it under a microscope. The blood is diluted using specialized pipettes then placed under a cover slip on a counting chamber slide. The counting chamber has a grid that is divided into squares to allow cells in the diluted sample to be enumerated and the total cell count in the original undiluted blood to be calculated based on the dilution factor. Cell counts are performed to evaluate normal and abnormal blood levels, assist in medical diagnoses, and monitor patient responses to treatment.
This document describes how to use a hemocytometer, an instrument used to count blood cells. It includes a Neubauer slide with a central counting area divided into squares, a cover slip, and pipettes. The process involves placing a blood sample on the slide, focusing it under a microscope, and counting the cells within the squares to calculate cell density using the number of squares and an equation.
This document provides instructions for performing a manual leukocyte count using a Unopette test 5856 technique. Key steps include:
1) Diluting a blood sample in an acetic acid solution in a Unopette reservoir to lyse red blood cells.
2) Charging a hemacytometer slide with the diluted blood sample and allowing cells to settle.
3) Counting leukocytes in the four corner squares of the hemacytometer slide under a microscope and calculating the leukocyte count per cubic millimeter.
The manual count is used to evaluate changes in white blood cell counts that can provide information about infectious, hematologic or other diseases. Quality control steps and potential sources of error
Haemocytometry is a technique used to count blood cells and cells in other body fluids. It involves diluting a blood or fluid sample and counting the cells in a special counting chamber under a microscope. The total white blood cell count, platelet count, and absolute eosinophil count can be determined through haemocytometry. Precise dilution and counting technique is required to obtain accurate results, which provide information about a patient's health status and response to treatment.
My report . (wbc count)
Report to practical physiology .
......
University of AL_Ameed .
College of Dentistry .
________________________________
Telegram : @Goldenalzaidy
Instagram : goldenalzaidy
__________________________________
تقرير كامل ومفيد عن طريقة حساب عدد الكريات البيض تستطيع اعادة صياغته وتقديمه
---------------
This document outlines the procedure and materials used for performing a white blood cell count. It details the specific equipment needed, including pipettes, a hemacytometer, microscope, and tally counter. It also lists the types of specimens and reagents involved, such as fresh or anticoagulated blood and diluting fluids like Turk's solution. The procedure involves mixing the blood sample, filling a pipette with blood and reagent, shaking for 1 minute, counting cells in the hemacytometer under a microscope, and using the counts and known volumes and dilutions to calculate the final white blood cell concentration.
The document summarizes the principles and process of hemocytometry, which is a technique used to count blood cells. It involves diluting a blood sample with special fluids and counting the cells within the gridded chambers of a hemocytometer under a microscope. The total and differential white blood cell and red blood cell counts obtained can be used for clinical diagnosis. Key components of the hemocytometer include Neubauer ruled chambers for counting cells, diluting pipettes for precise sample dilution, and diluting fluids tailored for red or white blood cells. Proper technique such as counting rules ensure accurate enumeration of cells.
This document discusses the technique of haemocytometry, which is used to count the total number of cells in blood or other body fluids. It can be done using a haemocytometer or electronic cell counter. The purpose is to determine normal or abnormal cell counts in pathological conditions and to support clinical diagnoses and monitor treatment responses. The principle involves diluting the blood sample and counting the cells in a haemocytometer under a microscope. Proper use and interpretation of haemocytometry provides information about various blood cell types like white blood cells, red blood cells, platelets, and eosinophils.
This document provides instructions for performing hemocytometry, which is the manual or automated counting of red blood cells, white blood cells, and platelets from a blood sample. It describes how to count WBCs using a Neubauer chamber, including dilution of the sample, loading the chamber, and calculating cell counts per microliter based on the number observed. Procedures for counting RBCs and platelets are also outlined. Potential sources of error in cell counts are discussed, and clinical significance of the test results is explained.
A Haemocytometer is a specialized and calibrated microscope slide that has a counting chamber with a known volume of liquid, which designed to allow operators to quickly estimate the concentration of cells in a sample.
The document discusses a haemocytometer, which is an instrument used to count blood cells. It has a special slide with ruled areas divided into squares under a cover glass, allowing cells in a small measured volume to be counted manually. Blood is diluted and pipetted into the chamber. Cells are counted within the squares using a microscope at different magnifications for different cell types. Factors like dilution, counting technique, and chamber quality can introduce errors. The haemocytometer allows standardized counting of red blood cells, white blood cells, and platelets in hematology labs.
The manual method of counting red blood cells (RBCs) is time-consuming and imprecise. The preferred method is an automated count. For a manual count, blood is diluted 1:200 in a diluting fluid and cells are counted under a microscope in a hemocytometer chamber. The number of cells counted is used to calculate the total RBC count per cubic mm (μl) of blood. Sources of error include improper collection, dilution, mixing, or counting of blood samples.
This document describes the procedure for determining red blood cell (RBC) count using the Unopette system. Whole blood is added to an isotonic saline solution in a Unopette reservoir to preserve RBCs without lysis. This provides a 1:200 dilution ratio of sample to total volume. The diluted blood is then charged to a hematocytometer and counted under a microscope. The total RBC count per cubic millimeter is calculated based on the cell counts. Normal RBC counts in adults range from 4.2-6.1 million per cubic millimeter. Potential sources of error include issues with the apparatus or technique.
The hemocytometer is an instrument used to count blood cells. It consists of a Neubauer slide with a ruled counting chamber area divided into squares under a cover glass. There are different types of counting chambers including the Neubauer, improved Neubauer, Levy's, and Fuch's Rosenthal. Red blood cell and white blood cell pipettes are used to dilute and introduce the blood sample, and differ in size and graduations. Cells are counted under a microscope using counting rules to avoid double counting, and calculations using dilution and depth factors provide the final cell counts. Sources of error include improper technique, uneven distribution of cells, and contamination.
Determination of total leukocyte count /certified fixed orthodontic courses b...Indian dental academy
This document discusses the process of determining total leukocyte count and differential leukocyte count from a blood sample. It involves making a blood smear on a slide, staining it using Leishman's stain, and examining it under a microscope. The total leukocyte count is obtained by diluting blood and counting cells in a hemocytometer chamber. For differential count, different types of white blood cells are identified based on their morphology and stained characteristics under a high power microscope and at least 100 cells are counted. The document provides details on various apparatus, reagents, staining technique, cell identification and calculations involved.
A hemocytometer is a device used to count blood cells and other cell types. It works by having a thick glass slide with grids and squares of precise dimensions that allow cells in a liquid suspension to be counted accurately under a microscope. Common sources of error include uneven cell distribution, improper mixing or pipetting techniques, and counting non-cell particles or clumped cells. The hemocytometer procedure involves loading a cell suspension under a cover slip, counting cells in specific grid areas, and using calculations based on dilution factors and grid dimensions to determine the overall cell concentration in the original sample.
This document describes methods for counting red blood cells (RBCs) and white blood cells (WBCs). It discusses collecting blood samples using anticoagulants and various techniques for RBC and WBC counts including using a hemocytometer, electronic counters, and determining hemoglobin concentration. Methods covered include counting cells directly under a microscope, acid hematin reactions, and spectrophotometry. Normal reference ranges for total RBC and WBC counts in different animal species are also provided.
This document provides information about performing a red blood cell count. It discusses that red blood cells are biconcave discs around 8 micrometers in diameter. It describes how to perform a manual red blood cell count using a Neubauer chamber, diluted blood sample, and microscope. The steps include preparing a 1:200 dilution, filling the chamber, focusing on cells with the microscope, and counting cells within a specified area. The normal red blood cell count ranges for adults, newborns, and children are provided. Decreased red blood cell counts can indicate anemia, while increased counts can be seen with conditions like polycythemia or dehydration.
This document describes the process of enumerating red blood cells using a haemocytometer. A haemocytometer is a specialized counting chamber used to calculate the concentration of cells in suspension. It consists of a thick glass slide with an indented grid that is precisely measured. A cell suspension is placed on the chamber and cells in the grid squares are counted under a microscope. The number of cells and known volume of the grid squares allows the concentration of cells in the original sample to be calculated using a formula. Haemocytometers are commonly used for blood counts, cell culture work, and other applications requiring accurate cell numbers.
This document describes methods for counting red blood cells and white blood cells using a hemocytometer. For red blood cell counting, blood is diluted and cells in 5 squares are counted under a microscope. The number of cells is then used to calculate the RBC concentration per microliter. For white blood cell counting, blood is similarly diluted and cells in 4 squares are counted under a microscope to calculate the WBC concentration per microliter. Normal ranges for RBCs and WBCs in human blood are also provided.
This document discusses total leukocyte count and differential counting. It describes the types of white blood cells including granulocytes (neutrophils, eosinophils, basophils) and agranulocytes (lymphocytes, monocytes). The procedure for a total leukocyte count involves diluting a blood sample and counting cells under a microscope. A differential count identifies percentages of each type of white blood cell by examining stained blood smears under oil immersion lens. Normal ranges and abnormal findings are also outlined.
This document discusses the peripheral blood smear examination. It begins by outlining the role of peripheral blood examination, which includes evaluating anemia, thrombocytopenia/thrombocytosis, identifying abnormal cells, and detecting infections. It then describes the proper collection of blood in EDTA tubes and various color-coded tubes. The document proceeds to explain the different techniques for preparing blood smears, including the wedge, cover slip, and spun smear methods. Finally, it outlines the staining, microscopic examination, identification of white blood cells, red blood cell abnormalities, and other findings commonly seen on peripheral blood smears.
This document provides information on methods for performing a complete blood count (CBC), including white blood cell (WBC) count, corrected WBC count, and differential leukocyte count (DLC). The WBC count involves using a counting chamber, pipettes, and diluting fluids to count WBCs under a microscope. The DLC involves making a blood smear, staining it, counting different types of WBCs, and reporting results as relative or absolute counts. Normal ranges are provided for WBC subtype percentages and counts.
The document summarizes the manual method for performing a red blood cell (RBC) count using a Neubauer haemocytometer. The Neubauer chamber is divided into squares to aid counting under a microscope. Only certain squares in the central large square are used for counting RBCs. A pipette is used to place a cell sample into the chamber which is then counted under the microscope at 40x magnification. The number of RBCs counted is recorded.
Final neubauer chamber by Pandian M, Dept of Physiology, DYPMCKOP, MHPandian M
This document provides information about tools and procedures for counting blood cells. It describes the Neubauer chamber, which is used to count red blood cells and white blood cells under a microscope. Rules are provided for counting cells within the chamber's squares. The key differences between red blood cell and white blood cell pipettes are outlined. Methods for capillary and venous blood collection are explained, along with the process for diluting a blood sample before counting cells.
Red blood cells contain hemoglobin and carry oxygen throughout the body. Disruptions to red blood cells can affect oxygen-carrying capacity. Red blood cells are biconcave discs that are flexible and can squeeze through narrow vessels. There are manual and automated methods for counting red blood cells. The manual method uses a hemocytometer, diluting fluid, and involves counting red blood cells in a gridded chamber under a microscope. The automated method uses electronic detection and dilution to count thousands of cells rapidly. Normal red blood cell count ranges are provided for adults and newborns. Conditions that decrease or increase red blood cell counts are also outlined.
Clinical laboratories are important for disease diagnosis and monitoring patient health. They examine samples like blood, urine, and CSF to perform tests that help determine disease severity and treatment effectiveness. The main sections of a clinical lab are clinical pathology, hematology, clinical biochemistry, microbiology, serology, and blood bank. Biochemical tests analyze things like lipids, diabetes markers, electrolytes, and bone/liver function. Precise sample collection and handling are crucial to ensure accurate test results.
This document provides information about phlebotomy and blood specimen collection. It discusses that phlebotomy involves making an incision in a vein with a needle, which is known as a venipuncture. Blood can be obtained through skin punctures or venous sampling. The document outlines the different types of collection tubes used including those containing EDTA, sodium citrate, sodium fluoride, and clot activators. It provides the recommended order of draw and notes on proper inversion of tubes to mix additives. The venipuncture procedure and avoiding problematic sites are summarized. New technologies for vein finding and infant blood collection are also mentioned.
This document discusses the technique of haemocytometry, which is used to count the total number of cells in blood or other body fluids. It can be done using a haemocytometer or electronic cell counter. The purpose is to determine normal or abnormal cell counts in pathological conditions and to support clinical diagnoses and monitor treatment responses. The principle involves diluting the blood sample and counting the cells in a haemocytometer under a microscope. Proper use and interpretation of haemocytometry provides information about various blood cell types like white blood cells, red blood cells, platelets, and eosinophils.
This document provides instructions for performing hemocytometry, which is the manual or automated counting of red blood cells, white blood cells, and platelets from a blood sample. It describes how to count WBCs using a Neubauer chamber, including dilution of the sample, loading the chamber, and calculating cell counts per microliter based on the number observed. Procedures for counting RBCs and platelets are also outlined. Potential sources of error in cell counts are discussed, and clinical significance of the test results is explained.
A Haemocytometer is a specialized and calibrated microscope slide that has a counting chamber with a known volume of liquid, which designed to allow operators to quickly estimate the concentration of cells in a sample.
The document discusses a haemocytometer, which is an instrument used to count blood cells. It has a special slide with ruled areas divided into squares under a cover glass, allowing cells in a small measured volume to be counted manually. Blood is diluted and pipetted into the chamber. Cells are counted within the squares using a microscope at different magnifications for different cell types. Factors like dilution, counting technique, and chamber quality can introduce errors. The haemocytometer allows standardized counting of red blood cells, white blood cells, and platelets in hematology labs.
The manual method of counting red blood cells (RBCs) is time-consuming and imprecise. The preferred method is an automated count. For a manual count, blood is diluted 1:200 in a diluting fluid and cells are counted under a microscope in a hemocytometer chamber. The number of cells counted is used to calculate the total RBC count per cubic mm (μl) of blood. Sources of error include improper collection, dilution, mixing, or counting of blood samples.
This document describes the procedure for determining red blood cell (RBC) count using the Unopette system. Whole blood is added to an isotonic saline solution in a Unopette reservoir to preserve RBCs without lysis. This provides a 1:200 dilution ratio of sample to total volume. The diluted blood is then charged to a hematocytometer and counted under a microscope. The total RBC count per cubic millimeter is calculated based on the cell counts. Normal RBC counts in adults range from 4.2-6.1 million per cubic millimeter. Potential sources of error include issues with the apparatus or technique.
The hemocytometer is an instrument used to count blood cells. It consists of a Neubauer slide with a ruled counting chamber area divided into squares under a cover glass. There are different types of counting chambers including the Neubauer, improved Neubauer, Levy's, and Fuch's Rosenthal. Red blood cell and white blood cell pipettes are used to dilute and introduce the blood sample, and differ in size and graduations. Cells are counted under a microscope using counting rules to avoid double counting, and calculations using dilution and depth factors provide the final cell counts. Sources of error include improper technique, uneven distribution of cells, and contamination.
Determination of total leukocyte count /certified fixed orthodontic courses b...Indian dental academy
This document discusses the process of determining total leukocyte count and differential leukocyte count from a blood sample. It involves making a blood smear on a slide, staining it using Leishman's stain, and examining it under a microscope. The total leukocyte count is obtained by diluting blood and counting cells in a hemocytometer chamber. For differential count, different types of white blood cells are identified based on their morphology and stained characteristics under a high power microscope and at least 100 cells are counted. The document provides details on various apparatus, reagents, staining technique, cell identification and calculations involved.
A hemocytometer is a device used to count blood cells and other cell types. It works by having a thick glass slide with grids and squares of precise dimensions that allow cells in a liquid suspension to be counted accurately under a microscope. Common sources of error include uneven cell distribution, improper mixing or pipetting techniques, and counting non-cell particles or clumped cells. The hemocytometer procedure involves loading a cell suspension under a cover slip, counting cells in specific grid areas, and using calculations based on dilution factors and grid dimensions to determine the overall cell concentration in the original sample.
This document describes methods for counting red blood cells (RBCs) and white blood cells (WBCs). It discusses collecting blood samples using anticoagulants and various techniques for RBC and WBC counts including using a hemocytometer, electronic counters, and determining hemoglobin concentration. Methods covered include counting cells directly under a microscope, acid hematin reactions, and spectrophotometry. Normal reference ranges for total RBC and WBC counts in different animal species are also provided.
This document provides information about performing a red blood cell count. It discusses that red blood cells are biconcave discs around 8 micrometers in diameter. It describes how to perform a manual red blood cell count using a Neubauer chamber, diluted blood sample, and microscope. The steps include preparing a 1:200 dilution, filling the chamber, focusing on cells with the microscope, and counting cells within a specified area. The normal red blood cell count ranges for adults, newborns, and children are provided. Decreased red blood cell counts can indicate anemia, while increased counts can be seen with conditions like polycythemia or dehydration.
This document describes the process of enumerating red blood cells using a haemocytometer. A haemocytometer is a specialized counting chamber used to calculate the concentration of cells in suspension. It consists of a thick glass slide with an indented grid that is precisely measured. A cell suspension is placed on the chamber and cells in the grid squares are counted under a microscope. The number of cells and known volume of the grid squares allows the concentration of cells in the original sample to be calculated using a formula. Haemocytometers are commonly used for blood counts, cell culture work, and other applications requiring accurate cell numbers.
This document describes methods for counting red blood cells and white blood cells using a hemocytometer. For red blood cell counting, blood is diluted and cells in 5 squares are counted under a microscope. The number of cells is then used to calculate the RBC concentration per microliter. For white blood cell counting, blood is similarly diluted and cells in 4 squares are counted under a microscope to calculate the WBC concentration per microliter. Normal ranges for RBCs and WBCs in human blood are also provided.
This document discusses total leukocyte count and differential counting. It describes the types of white blood cells including granulocytes (neutrophils, eosinophils, basophils) and agranulocytes (lymphocytes, monocytes). The procedure for a total leukocyte count involves diluting a blood sample and counting cells under a microscope. A differential count identifies percentages of each type of white blood cell by examining stained blood smears under oil immersion lens. Normal ranges and abnormal findings are also outlined.
This document discusses the peripheral blood smear examination. It begins by outlining the role of peripheral blood examination, which includes evaluating anemia, thrombocytopenia/thrombocytosis, identifying abnormal cells, and detecting infections. It then describes the proper collection of blood in EDTA tubes and various color-coded tubes. The document proceeds to explain the different techniques for preparing blood smears, including the wedge, cover slip, and spun smear methods. Finally, it outlines the staining, microscopic examination, identification of white blood cells, red blood cell abnormalities, and other findings commonly seen on peripheral blood smears.
This document provides information on methods for performing a complete blood count (CBC), including white blood cell (WBC) count, corrected WBC count, and differential leukocyte count (DLC). The WBC count involves using a counting chamber, pipettes, and diluting fluids to count WBCs under a microscope. The DLC involves making a blood smear, staining it, counting different types of WBCs, and reporting results as relative or absolute counts. Normal ranges are provided for WBC subtype percentages and counts.
The document summarizes the manual method for performing a red blood cell (RBC) count using a Neubauer haemocytometer. The Neubauer chamber is divided into squares to aid counting under a microscope. Only certain squares in the central large square are used for counting RBCs. A pipette is used to place a cell sample into the chamber which is then counted under the microscope at 40x magnification. The number of RBCs counted is recorded.
Final neubauer chamber by Pandian M, Dept of Physiology, DYPMCKOP, MHPandian M
This document provides information about tools and procedures for counting blood cells. It describes the Neubauer chamber, which is used to count red blood cells and white blood cells under a microscope. Rules are provided for counting cells within the chamber's squares. The key differences between red blood cell and white blood cell pipettes are outlined. Methods for capillary and venous blood collection are explained, along with the process for diluting a blood sample before counting cells.
Red blood cells contain hemoglobin and carry oxygen throughout the body. Disruptions to red blood cells can affect oxygen-carrying capacity. Red blood cells are biconcave discs that are flexible and can squeeze through narrow vessels. There are manual and automated methods for counting red blood cells. The manual method uses a hemocytometer, diluting fluid, and involves counting red blood cells in a gridded chamber under a microscope. The automated method uses electronic detection and dilution to count thousands of cells rapidly. Normal red blood cell count ranges are provided for adults and newborns. Conditions that decrease or increase red blood cell counts are also outlined.
Clinical laboratories are important for disease diagnosis and monitoring patient health. They examine samples like blood, urine, and CSF to perform tests that help determine disease severity and treatment effectiveness. The main sections of a clinical lab are clinical pathology, hematology, clinical biochemistry, microbiology, serology, and blood bank. Biochemical tests analyze things like lipids, diabetes markers, electrolytes, and bone/liver function. Precise sample collection and handling are crucial to ensure accurate test results.
This document provides information about phlebotomy and blood specimen collection. It discusses that phlebotomy involves making an incision in a vein with a needle, which is known as a venipuncture. Blood can be obtained through skin punctures or venous sampling. The document outlines the different types of collection tubes used including those containing EDTA, sodium citrate, sodium fluoride, and clot activators. It provides the recommended order of draw and notes on proper inversion of tubes to mix additives. The venipuncture procedure and avoiding problematic sites are summarized. New technologies for vein finding and infant blood collection are also mentioned.
The document discusses various aspects of collecting and transporting biological samples for laboratory testing, including:
1) The document discusses blood collection methods including venipuncture, arterial blood draws, and capillary collection. It describes patient preparation, site selection, and collection steps.
2) Urine collection methods such as random, timed, catheterized, and 24-hour samples are described.
3) The appropriate containers and preservatives for collecting different sample types like blood, urine, and body fluids are outlined, including tubes containing chemicals that prevent clotting.
Preanalytical errors can occur during blood collection and processing, affecting patient care. Phlebotomy involves collecting blood, typically by venipuncture or capillary puncture. Proper collection methods and handling are important to ensure specimen quality and accurate test results. Trained personnel must follow specific procedures and consider factors like patient physiology, collection sites, tube types and additives, and transport conditions.
Capillary blood, obtained from a skin puncture, differs slightly in composition from venous blood samples. The packed cell volume, red blood cell count, and hemoglobin concentration are generally higher in capillary blood. Conversely, the platelet count tends to be higher in venous blood. These differences may be exaggerated in conditions affecting blood flow, such as cold temperatures. While capillary samples allow for minimally invasive collection, venous samples allow collecting larger volumes of blood and enable additional testing options.
Clinical labs are important in diseases diagnosis, determination its severity and patient response to specific treatment. Diagnosis of any disease is first done by physical examination by physician and confirmed by lab diagnostic tests.
Blood collection requires careful technique to ensure sample integrity and safety. There are three main collection methods: capillary collection from the skin, venipuncture from veins, and arterial puncture. Capillary collection provides small samples for limited tests while venous collection allows for larger volumes and additional tests. The site of collection affects venous composition. Anticoagulants like EDTA, citrate, and oxalate are added to blood to prevent coagulation for hematological tests, with EDTA being the standard choice. Coagulating blood without anticoagulant produces serum.
This document provides guidelines for the proper collection, transportation, preparation, processing, and storage of laboratory samples for disease diagnosis and monitoring. It discusses defining samples and specimens, examples of laboratory samples, requirements for sample collection, potential errors from improper collection, and objectives of collection. Specific guidance is given for collection and handling of various sample types, including blood, urine, cerebrospinal fluid, stool, and others. Proper labeling, transport, separation, preservation, and storage methods are also outlined to ensure sample quality and integrity.
Practical 1 Methods of Obtaining Blood Samples Choice of Anticoagulants and P...saad510479
1. Proper collection, labeling, and preservation of blood samples is important to avoid rejection and obtain accurate test results.
2. Blood can be collected from the capillary, venous, or arterial sites using various equipment like vacutainers, syringes, and lancets depending on the test.
3. A tourniquet is used to locate veins and the site must be cleaned before collection to avoid contamination. Fasting or postprandial timing affects some tests.
Venous and capillary blood can be collected for laboratory testing. Capillary blood is collected via finger or heel stick and is used for small volume tests like hemoglobin and blood smears due to limited sample size. Venous blood provides larger samples and is required for tests needing anticoagulation via collection in tubes. The vacutainer method is commonly used for venous collection involving a needle, holder and tubes of varying colors corresponding to different anticoagulants and additives. Proper identification, site preparation using alcohol, and bleeding control techniques must be followed to ensure accurate and safe collection.
This document provides information about blood collection and processing. It defines blood and its functions. It describes the physical characteristics of blood and its composition. It discusses the purposes of blood collection and the techniques used for vein puncture, capillary puncture, and arterial puncture. It also covers sample handling, centrifugation, and factors to consider to prevent hemolysis.
1. Blood collection requires precautions to avoid self-infection, transmission of bloodborne infections, and misleading test results. Proper handwashing, use of protective gloves, disinfection of collection sites, and safe disposal of sharps are important.
2. Venous blood is most often collected from the antecubital area by needle puncture of a vein. Capillary blood can be collected from the fingertip or heelprick in infants and those with fragile veins.
3. The document provides guidance on blood collection procedures, sites for different types of blood samples, risks, anticoagulants, and causes of misleading test results related to specimen collection.
1. The document outlines various protocols for collecting and handling specimens for diagnostic testing in pathology. It discusses appropriate samples, containers, transport conditions, and preservation methods for urine, CSF, fluids, sputum, stool, semen, and blood samples.
2. Guidelines are provided for venous blood collection including equipment, anticoagulants used, and proper labelling and transport of samples.
3. An overview is also given of histopathology specimen handling, blood banking techniques including blood donation and components, and cross matching procedures.
The document discusses different methods of blood collection including capillary, venous, and arterial blood. It describes various anticoagulants used in blood collection tubes and their purposes, such as EDTA for cell counts and citrate for coagulation studies. The document also outlines the proper order for drawing blood into collection tubes and the use of blood banks for storing blood components.
The document discusses the three phases of laboratory testing - pre-analytical, analytical, and post-analytical. It emphasizes that pre-analytical and post-analytical errors account for over 90% of total laboratory errors. Close attention to pre-analytical variables like specimen collection, transport, and storage is critical to ensure accurate test results. Proper procedures and quality control throughout the testing process can prevent many potential errors.
The document provides an overview of blood components and their uses in clinical practice. It discusses the history of blood transfusions and the development of techniques to separate whole blood into components. The key blood components discussed are packed red blood cells (PRBC), which are used to treat symptomatic anemia. PRBC are produced by removing plasma from whole blood and allow for faster correction of hemoglobin levels compared to whole blood. The document also discusses plasma derivatives produced from large pools of donor plasma through fractionation processes. It notes the various screening tests performed on donations and techniques used to reduce risks of transfusion-transmitted infections.
This document provides guidelines for proper blood collection and handling of clinical specimens. It describes the steps for venipuncture including identifying the patient, selecting a vein, and collecting samples in various tubes according to order of draw. It also discusses collection and preservation of other specimens like sputum, urine, stool and CSF. The aim is to ensure samples are collected, transported and processed correctly for accurate diagnostic testing.
This document discusses blood collection procedures and anticoagulants. It explains that blood can be collected from veins, capillaries, or arteries for various tests like hematological, biochemical, serological, and molecular examinations. The venipuncture procedure and necessary supplies are outlined. Common anticoagulants like EDTA are described which prevent clotting by chelating calcium. Effects of storage temperature and time on blood cell counts and morphology are also summarized.
The binding of cosmological structures by massless topological defectsSérgio Sacani
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
equations sourced by a topological defect, i.e. a singularity of a very specific form, the result is a localized gravitational
field capable of driving flat rotation (i.e. Keplerian circular orbits at a constant speed for all radii) of test masses on a thin
spherical shell without any underlying mass. Moreover, a large-scale structure which exploits this solution by assembling
concentrically a number of such topological defects can establish a flat stellar or galactic rotation curve, and can also deflect
light in the same manner as an equipotential (isothermal) sphere. Thus, the need for dark matter or modified gravity theory is
mitigated, at least in part.
The technology uses reclaimed CO₂ as the dyeing medium in a closed loop process. When pressurized, CO₂ becomes supercritical (SC-CO₂). In this state CO₂ has a very high solvent power, allowing the dye to dissolve easily.
The cost of acquiring information by natural selectionCarl Bergstrom
This is a short talk that I gave at the Banff International Research Station workshop on Modeling and Theory in Population Biology. The idea is to try to understand how the burden of natural selection relates to the amount of information that selection puts into the genome.
It's based on the first part of this research paper:
The cost of information acquisition by natural selection
Ryan Seamus McGee, Olivia Kosterlitz, Artem Kaznatcheev, Benjamin Kerr, Carl T. Bergstrom
bioRxiv 2022.07.02.498577; doi: https://doi.org/10.1101/2022.07.02.498577
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
The debris of the ‘last major merger’ is dynamically youngSérgio Sacani
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
Authoring a personal GPT for your research and practice: How we created the Q...Leonel Morgado
Thematic analysis in qualitative research is a time-consuming and systematic task, typically done using teams. Team members must ground their activities on common understandings of the major concepts underlying the thematic analysis, and define criteria for its development. However, conceptual misunderstandings, equivocations, and lack of adherence to criteria are challenges to the quality and speed of this process. Given the distributed and uncertain nature of this process, we wondered if the tasks in thematic analysis could be supported by readily available artificial intelligence chatbots. Our early efforts point to potential benefits: not just saving time in the coding process but better adherence to criteria and grounding, by increasing triangulation between humans and artificial intelligence. This tutorial will provide a description and demonstration of the process we followed, as two academic researchers, to develop a custom ChatGPT to assist with qualitative coding in the thematic data analysis process of immersive learning accounts in a survey of the academic literature: QUAL-E Immersive Learning Thematic Analysis Helper. In the hands-on time, participants will try out QUAL-E and develop their ideas for their own qualitative coding ChatGPT. Participants that have the paid ChatGPT Plus subscription can create a draft of their assistants. The organizers will provide course materials and slide deck that participants will be able to utilize to continue development of their custom GPT. The paid subscription to ChatGPT Plus is not required to participate in this workshop, just for trying out personal GPTs during it.
hematic appreciation test is a psychological assessment tool used to measure an individual's appreciation and understanding of specific themes or topics. This test helps to evaluate an individual's ability to connect different ideas and concepts within a given theme, as well as their overall comprehension and interpretation skills. The results of the test can provide valuable insights into an individual's cognitive abilities, creativity, and critical thinking skills
aziz sancar nobel prize winner: from mardin to nobel
Bst unit-iii
1. UNIT -III
• Haematological investigation: Blood composition,
blood sample collection and smear preparation,
Differential cell counts – RBC, WBC, Platelets,
hemoglobin estimation, erythrocytic sedimentation
rate (ESR), Blood platelet count by hemocytometer,
and testing of blood glucose using glucometer.
Dr. I. Manjubala
SBST, VIT University
1
4. 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
Dr. I. Manjubala
SBST, VIT University
4
6. Phlebotomy or blood
collection:
The term phlebotomy refers to
blood draw from a vein, artery, or
the capillary bed for lab analysis
or blood transfusion.
The phlebotomy equipments:
For specimen collection, the
following materials will be
required:
Phlebotomy
Disposable syringes Vacationer systems Disposable lancets
Gauze pads absorbent cotton Tourniquet
Alcohol swap Plastic bandage Waste container
7. VENEPUNCTURE
•Venipuncture is performed to obtain laboratory results that
provide prevalence estimates of disease, risk factors for
exam components, and baseline information on health and
nutritional status of the population.
•Definition –venepuncture describes the procedure of
inserting a needle into a vein, usually for the purpose of
withdrawing blood for haematological, biochemical or
bacteriological analysis
•It is one of the most commonly performed procedures
which, carried out skilfully, carefully and accurately, will
provide high quality blood samples without causing
discomfort to the patient –
8. • The superficial veins of the arm
are usually chosen for
venepuncture, namely basilic,
cephalic and median cubital
veins in the antecubital fossa
• – These veins are recommended
as they as they are well supported
by muscle and connective tissue,
visible and easy to palpate
9. • The walls (outer structure) of veins
consist of three layers of tissues that
are thinner and less elastic than the
corresponding layers of arteries
• Veins include valves that aid the
return of blood to the heart by
preventing blood from flowing in the
reverse direction
10. Usually vein is used to collect blood by
veinpuncture procedure.
In adults: most venipuncture procedure use
arm vein.
On arm, one of three arm veins is used:
median cubital vein "located on the
middle", cephalic vein or basilic vein
"located on both sides".
Median cubital vein is the best choice
(why?) because it has good blood flow than
cephalic and basilica which has slower blood
flow.
However if veinpuncture procedure is
unsuccessful in median capital; cephalic or
basilica is used.
Artery blood is rarely used in special
cases as when blood gases, pH, PCO2,
PO2 and bicarbonate is requested. It is
usually performed by physicians.
Selecting vein site
Dr. I. Manjubala
SBST, VIT University
10
11. • There are two stages to locating a vein:
1. Visual inspection 2. Palpation
• Visual Inspection – The scrutiny of the veins in both arms is
essential prior to choosing a vein
• Veins to avoid:
– Veins close to an infection : Veins close to bruising and
phlebitis : Oedematous limbs as there is danger of stasis of
lymph, predisposing to such complications as phlebitis and
cellulites
• Areas of previous venepuncture should be avoided as a build
up of scar tissue can cause difficulty in accessing the vein and
can result in pain
• Avoid veins that are thrombosed
• Do not use the affected arm in CVA or mastectomy patients
• A vein sited in the region of a drip site should never be used
as it may result in the collection of a diluted samples
12. • Palpation is also an important assessment technique as it: –
determines the location and condition of the veins –
distinguishes veins from arteries and tendons – identifies the
presence of valves
• Healthy veins feel soft and bouncy and will refill when depressed
13. Improving venous access – There are a number of methods
to improve venous access, for example:
1. Application of a Tourniquet -Promotes venous distension –
The tourniquet should be tight enough to impede venous
return but not restrict arterial flow – The tourniquet should be
placed about 7 – 8 cm above the venepuncture site
•The tourniquet should not be left on for longer than 1 minute
as it may result in haemo-concentration or pooling of the
blood, leading to inaccurate blood results
14. 2. Opening and closing of the fist – The muscles will force
blood into the veins and encourages distension. However this
action may affect certain blood results, e.g. potassium
3. Light tapping of the vein – May be useful but can be painful
and may result in the formation of a haematoma in patients
with fragile veins
4. The use of heat: In the form of warm pack to encourage
venodilatation and venous filling
5. Lowering the arm below the level of the heart
15. Skin preparation
– Asepsis is vital when performing
venepuncture as the skin is breached and
a foreign device is introduced into a sterile
circulatory system
– Skin cleaning is a controversial subject
and it is acknowledged that a cursory wipe
with an alcohol swab does more harm than
good as it disturbs the skin flora
- For blood culture sampling or if the
patient is at increased risk of infection the
skin should be cleaned with an alcohol
swab BUT you must allow at least 2
minutes for the area to dry thoroughly
before proceeding with venepuncture
16. • Hand hygiene – Is the single most important activity for
reducing the spread of disease, yet evidence suggests that
many health care professionals do not decontaminate their
hands as often as they need to, or use the correct technique
which means that areas of the hands can be missed
17. • Complications
– Inability to obtain specimen due to: – Inappropriate choice
of vein – Thrombosed vein (due to previous or repeated
attempts) – Inexperience of operator – Patient shocked,
cold or dehydrated causing vasoconstriction
• Formation of haematoma due to: – Poor technique – Pressure
not being applied to puncture site following removal of needle
• Puncture of an artery – If an artery is punctured: release the
tourniquet, remove the needle and apply firm pressure for a
minimum 5 minutes. Cover the site with a dressing once
bleeding has stopped. Re-check for signs of bleeding in 20
minutes.
18. Preparation of Blood Sample
One of three different specimens may be used:
•whole blood
•serum
•plasma
First: Whole-blood specimen:
It must be analyzed within limited time (why?)
– Over time, cells will lyse in whole-blood which will
change the conc. of some analytes as potassium,
phosphate and lactate dehydrogenase.
– Some cellular metabolic processes will continue which
will alter analytes conc. like glucose and lactate.
Dr. I. Manjubala
SBST, VIT University
18
19. Serum
Difference between Serum and plasma:
•Serum is the same as plasma except it doesn't contain
clotting factors (as fibrin).
•Plasma contains all clotting factors.
•So, serum and plasma all has the same contents of
electrolytes, enzymes proteins, hormones except clotting
factors
•Serum is mainly use in chemistry lab & serology.
Dr. I. Manjubala
SBST, VIT University
19
20. Procedure of Serum preparation
• Draw blood from patient. Select vacutainer with no
anticoagulant.
• Allow to stand for 20-30min for clot formation.
• 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.
• The supernatant is the serum which can be now
collected by Dropper or pipette for testing purposes or
stored (-20°C to -80°C) for subsequent analysis or
use.
Dr. I. Manjubala
SBST, VIT University
20
21. Plasma
• The tube will have anti-coagulation
• After centrifugation the blood sample
got separated into three layers
Procedure for Plasma Preperartion
•Draw blood from patient. Select vacutainer with an appropriate
anticoagulant.
•Mix well with anticoagulant.
•Allow to stand for 10min.
•Centrifuge the sample to speed separation and affect a greater
packing of cells.
•The supernatant is the plasma which can be now collected for
testing
•Purposes or stored (-20°C to -80°C) for subsequent analysis or
use.
22. 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
Dr. I. Manjubala
SBST, VIT University
22
23. Hemolysis of blood
Hemolysis :
•It means liberation of hemoglobin due to rupture of RBCs.
•Due to hemolysis plasma or serum appears pink to red color.
•It causes elevation in: K+
, Ca2+
, phosphate, SGOT, SLDH and acid
phosphatase.
•Hemolysis is occurred due to sampling, transporting and storage (too hot
or too cold).
•According to the degree of hemolysis it is classified as H+, H++ and H++
+. H+ accepted for tests, H++ and H+++ not acceptable for test.
Changes in the serum color indicate one of the following:
•Hemolyzed: serum appears pink to red due to rupture of RBCs
•Icteric: serum appears yellow due to high bilirubin.
•Lipemic: serum appears milky or turbid due to high lipid.
Dr. I. Manjubala
SBST, VIT University
23
24. Blood collection tubes:
Two major types of blood collecting tubes:
•Serum separating tubes (SST)
•Plasma separating tubes (PST)
25. Top Color Additives Principle Uses
Lavender EDTA -The strongest anti-coagulant
-Ca+2
chelating agent
- To preserve blood cells
components
- Hematology
- Blood bank
(ABO)
- 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 or
Lithium
Heparin
Heparin binds to Thrombin and
inhibits the second step in the
coagulation cascade
(Prothrombin Thrombin)
Fibrinogen Fibrin
Enzymes
Hormones
Electrolytes (Na+
,
K+
, Mg+
, Cl-
Heparin
Plasma Separating Tubes (PST)
26. Top
Color
Additives Principle Uses
Black Sodium Citrate Ca+2
chelating
agent
ESR ( Erythrocyte Sedimentation
Rate)
to test how much inflammation
in the patient, unexplained fever,
Arthritis, Autoimmune Disorder
Gray -Sodium Fluoride
-Potassium
Oxalate
Glycolysis
inhibitor
Anti-
Coagulant
Glucose tests
Royal
Blue
Heparin
Na-EDTA
Anti-
Coagulant
Tube should
not be
contaminated
with metals
Toxicology
Trace Elements and metals
Yellow ACD ( Acid-Citrate
Dextrose)
Anti-
Coagulant
DNA Studies
Paternity Test
HLA Tissue Typing
(Human Leukocyte Antigen)
The body used this protein to
differentiate the self-cells from
non-self cells
27. Top Tubes Additives Principle Uses
Red ------
Sometimes it
has gel or silicon
at the bottom of
tube to reduce
hemolysis
Enhancing the
formation of
blood clot
Serology
-Antibodies
-Hormones
-Drugs
Virology
Chemistry
Blood cross
matching before
blood
transfusion
Gold -------
It has gel at the
bottom of the
tube to separate
serum from the
blood
Serum
separating from
the blood
through the gel
in the tube
Serology
Chemistry
Serum Separating Tubes (SST)
28. Most commonly used:
a. Red-stopper tubes – are for tests requiring clotted blood
b. Lavender stopper tubes – contain EDTA in concentrated
liquid or desiccated powder form
c. Green stopper tubes – contain heparin and are used for
blood gases, PH, (CO2, O2)….
d. Gray stopper tubes – contain oxalates, fluorides, or
citrates
e. Yellow stopper tubes – available with Acid Citrate
Dextrose (ACD) solution or physiological saline solution
Dr. I. Manjubala
SBST, VIT University
28
30. Hemoglobin Determination
Significance of hemoglobin
a. It serves as an index of blood condition of the patient.
b. If the hemoglobin [Hb] content falls below the normal levels, it
indicates anemia, or pregnancy (physiological).
c. If it increases than the normal value, it indicates polycythemia,
decrease in O2 supply, heart disease, emphysema etc.
Method: Acid hematin method
Requirements: Sahlis instrument,
blood sample
Dr. I. Manjubala
SBST, VIT University
30
31. Procedure
• Take 0.1N HCl (1%) into central graduated tube up to mark 2.
• Suck the blood exactly up to mark 20 (20 μl) with the help of sahlis
pipette.
• Transfer the blood from pipette to central graduated tube of the
hemometer.
• Mix it well with the help of stirrer or rod and allow it to react for two
minute.
• Make up with distilled water by adding drop by drop until the color
matches with the Standard comparator tube and mix well.
• When the color matches take out and record the values on the
side as gm/100ml and or in percentage.
• Repeat 5 to 6 times and take the average value
Normal value:
Dr. I. Manjubala
SBST, VIT University
31
Hemoglobin Determination
32. Principle: Blood compartment is separated into three parts using
capillary tube in a hematocrit centrifuge.
Method: Wintrobe hematocrite method
Significance
• Packed Cell Volume (PCV) = erythrocyte mass; anemia when PCV
falls dawn.
• Buffy coat; white to gray layer above PCV. It will give number of
WBC (0.5mm to1.5mm).Leukopenia or leukocytosis.
• Plasma content: usually about 55%, Yellowish in color. Degree of
yellowness indicates icterus (jaundice).
Requirements: Hematocrit tube, hematocrite centrifuge, hematocrit
reader and sealer.
Dr. I. Manjubala
SBST, VIT University
32
Hematocrit Determination (PCV)
34. Procedure
• The blood is filled in to a micro hematocrit tube (3/4th)
and seals it with sealer.
• Centrifuge the filled hematocrit tube in a hematocrite
centrifuge at 2000 rpm for 4-5 minutes.
• Read the value (the tube) with hematocrit reader and
record the result.
Normal value
Dr. I. Manjubala
SBST, VIT University
34
35. • Normal Range
• Reference Index : the concept of
'Universal RIs' or 'Global Ris’ ??
Dr. I. Manjubala
SBST, VIT University
35
36. • Smear Preparation
• Wet smear
• Thin smear
• Thick smear
Dr. I. Manjubala
SBST, VIT University
36
37. Wet blood smear/film preparation
A drop of blood is placed at the centre of a clean slide
• Cover with a clean, dry cover slip
• Examine the film under the microscope (40 × objective)
The method does not require staining. It is rapid and simple to
perform.
Dr. I. Manjubala
SBST, VIT University
37
38. Thin/Thick blood smears preparation
It can be made by spreading a drop of blood evenly across a clean
grease free slide using a smooth edged spreader.
Thin Smear
Make a drop of blood on one end
of glass slide
• Place the end of second glass slide
/spreader slide / against the surface
of the first slide, holding at an angle
of 30-45 degrees
• Draw the spreader slide gently into
the drop of blood and when the
blood has along 2/3 of width of the
spreader slide by capillary action,
push the spreader slide forward with
a steady even motion
• Dry by waving rapidly in the air
Thick bloods smear
preparation
• A large drop of blood is put at
the centre of a clean dry slide
• The drop is spread with an
applicator stick, needle or corner
of another slide to cover an area
of ½ an inch square
• The smear is thoroughly dried in
a horizontal position so that the
blood could not ooze to one edge
to the film and protected from
dust, insects and direct sunlight.
Dr. I. Manjubala
SBST, VIT University
38
40. Problems in Smear preparation
Entire smear is too blue
• Buffered water, wash water or stain too alkaline, Alkaline residue to the slide,
Insufficient washing
• Excessive thickness of the smear
• Prolonged staining before diluting with buffered water
Pale blue:
Buffered water, wash water or stain too acid, Acid residue on slide
Entire smear has a pale stain: Under staining, Weak stain, Excessive washing or
allowing water to stand on slide, using warm or hot water for washing slide
Variation in staining on different areas of the smear
Buffered water un evenly applied and not thoroughly mixed with Wright’s stain,
Acid or alkaline residue on the slide, Water not properly drained from slide after
washing
Precipitated stain
Lack of through washing, Precipitate in Wright’s stain not properly filtered,
Evaporation of alcoholic stain
Dr. I. Manjubala
SBST, VIT University
40
41. Analysis
1.Total Count of RBC
Objective: To enumerate the total count of RBC/cumm of a given
blood sample.
Method: Hemocytometry method
Significance
• It performs some functions such as transportation of O2 and CO2
• A decrease in RBC accounts for less hemoglobin i.e., anemia
• An increase in RBC is referred as Polycythemia
Requirements: Hemocytometer, cover slip, microscope, RBC
diluting fluid, Haeyem’s solution or Physiological saline 0.85%
Nacl.
Dr. I. Manjubala
SBST, VIT University
41
42. Procedure
• Take the blood in to RBC pipette up to 0.5 marks
• Immediately draw the RBC diluting fluid up to mark 101.
• Rotate the pipette between thumb and other fingers with finger eight
movements. This gives a dilution of 1:200.
• Clean the counting chamber of hemocytometer and cover slip
• Place the cover slip in position over counting chamber by
gentlepressure
• Expel a drop of blood on to the counting chamber by holding the pipette
at an angle of 45º.
• Allow the hemocytometer for 2-3 min to settle down the RBC in counting
chamber
• Counting: Counting rules
- Count less than 40 × microscope objective
- Count cells touching the left and top side lines.
- Don’t count cells touching the bottom right side lines.
- Count first left to right direction, then to vise verse.
Dr. I. Manjubala
SBST, VIT University
42
43. Calculation
Volume of one small square
= 1/20mm × 1/20mm × 1/10mm = 1/4000mm3
Volume of 80 small square
= 80 × 1/4000mm3 = 1/50mm3
Total number of RBC =
Cells counted (N)
Volume of all squares × dilution factor
Total RBC =
N (cell counted) = N × 10,000
1/50mm3 × 1/200
Dr. I. Manjubala
SBST, VIT University
43
44. Self study
Analysis
2. Total Count of WBC (White Blood Cells)
• Differential Leukocyte Count
• Neutrophils, Eosinophils, Basophils, Lymphocytes,
Monocytes,
Dr. I. Manjubala
SBST, VIT University
44
45. Principle:
The distance (mm), the erythrocyte fall, in a given period of time when blood
(anticoagulant added) in a tube, placed in a vertical position
Significance
• It is not a specific test, but reflects change in plasma protein accompanying
most of acute and chronic infection
• Some pathological condition causes rouleax formation
• The greater the ESR reading, the more the severity of pathological condition
• During TB and rheumatic disease ESR increases
Method: Westergrens method
Requirements: ESR stand, ESR tube, blood sample
Protocol
• Take the anticoagulant blood in to ESR tubes exactly up to ‘0’ mark.
• Place the tube vertically (upright position) in ESR stand.
• Take reading after 5min as ‘zero’ hour reading and again note the reading after
1 hour and 2 hours.
Dr. I. Manjubala
SBST, VIT University
45
3. Determination of Erythrocyte Sedimentation Rate (ESR)
46. 4. Coagulation Time Determination
(Whole Blood Clotting Time)
Lee-white method
• Obtain at least 3ml of blood in a plastic syringe by careful vein
puncture (start a stop watch)
• Place 1ml of blood into each of the three tubes
• Place the test tube in a water bath at 37°C
• After 2 minutes one of the three test tubes is tipped gently at
one minute interval
• Test the third test tube in the same manner
• The time elapsed between the first appearance of the blood in
the syringe and clot formation in the third tube is clotting time
Dr. I. Manjubala
SBST, VIT University
46
47. Capillary tube method
Capillary tube, filter paper, clock watch should be used as requirements
• A skin puncture is made and wiping away the first drop, fill a special capillary
tube with blood noting the time when the blood first appeared
• Holding the tube between the thumb and index finger of both hands, gently
break the tube every second until a strand of thread fibrin is seen extending
across the gap between the ends of the tube
• The interval between the appearance of the blood and the appearance of the
fibrin stand is the coagulation time
Interpretation
Normal value
• Lee- white method in glass tube --- 3-12 minutes
• Capillary tube method---3-15
Prolonged
• Deficiency in coagulation factors, • Vitamin K deficiency
• Thrombocytopenia, • The presence of circulating anticoagulants
Dr. I. Manjubala
SBST, VIT University
47
48. 5. Bleeding Time
Principle:
Determination of bleeding time is a simple and sometimes useful
tool for evaluating the efficiency of the capillary – platelet aspect
of homeostasis
Purpose: To determine the bleeding time
Method: Dukes method
Significance
• The study helps in diagnosis, treatment, and study of
hemorrhagic diseases
• The prolonged time indicates coagulation defect
Requirements: Blood lancet, filter paper, clock (stop clock)
Dr. I. Manjubala
SBST, VIT University
48
49. Protocol
• Make a moderately small, deep puncture in clean, sterile blood
lancet or sterile needle, and note the time when blood first appears
(nose is preferable)
• Remove the drops of blood with filter paper every 30 second
being careful not to touch the skin. The use of highly absorbent
paper such as cleaning tissue tends to prolong bleeding time due
to more effective removal of surface blood
• Note the end point, when blood no longer appears from the
puncture site
Interpretation
Normal values: 1- 5 min
Prolonged due to
• vascular lesions, • platelet defect, • severe liver disease, uremia
• anticoagulant drug administration
Dr. I. Manjubala
SBST, VIT University
49
52. HEMOCYTOMETER
• The hemocytometer is a specimen slide which is used to determine the
concentration of cells in a liquid sample.
• It has a rectangular indentation that that creates a chamber
• The device is carefully crafted so that the area bounded by the lines is
known, and the depth of the chamber is also known.
• Given the known parameters it is possible to count the number of cells
or particles in a specific volume of fluid, and thereby calculate the
concentration of cells in the fluid overall
• The hemocytometer is frequently used to determine the concentration of
blood cells (hence the name “hemo-”)
• However, it can also be used for other samples, such as sperm cells.
53. HEMOCYTOMETER
• The cover glass, which is placed on the sample, does not simply float on
the liquid, but is held in place at a specified height (usually 0.1mm).
• Additionally, a grid is etched into the glass of the hemocytometer.
• This grid, an arrangement of squares of different sizes, allows for an
easy counting of cells.
• This way it is possible to determine the number of cells in a specified
volume.
55. SAMPLE PREPARATION
• Proper mixing:
The fluid should be a homogenous suspension.
Cells that stick together in clumps are difficult to count and they are usually not
evenly distributed.
Appropriate concentration:
• The concentration of the cells should neither be too high or too low.
• concentration - too high, - the cells overlap and are difficult to count.
• Low concentration - a few cells per square results - then necessary to count
more squares (which takes time).
• Suspensions that have a too high concentration should be diluted 1:10, 1:100
and 1:1000. (1:10 dilution means 1 part sample and 9 parts normal saline)
• The dilution must later be considered when calculating the final concentration.
56. COUNTING CELLS
Counting cells that are on a line:
•Cells that are on the line of a grid require special attention.
•Cells that touch the top and right lines of a square should not be counted
•Cells on the bottom and left side should be counted.
Number of squares to count:
•The lower the concentration, the more squares should be counted.
•Otherwise one introduces statistical errors.
•Cells should be counted on both sides of the chamber.
•If the final result is very different, then this can be an indication of sampling
error.
57. NEUBAUER COUNTING
CHAMBER
• When a liquid sample containing immobilized cells is placed on the
chamber, it is covered with a cover glass, and capillary action
completely fills the chamber with the sample.
• Looking at the chamber through a microscope, the number of cells in the
chamber can be determined by counting.
• Different kinds of cells can be counted separately as long as they are
visually distinguishable.
• The concentration of the cells can be calculated from the cells counted
from the mixture using simple formulas
58. NEUBAUER COUNTING
CHAMBER
• Rulings cover 9 square millimeters.
• Boundary lines of the Neubauer ruling are the center lines of the groups of
three
• The central square millimeter is ruled into 25 groups of 16
small squares
• The ruled surface is 0.10mm below the cover glass
• One (1) Milliliter = 1000 cubic millimeters (cu mm)
• One (1) Microliter (ul) = One (1) cubic millimeter (cu
mm)
• The number of cells per cubic millimeter =
Number of cells counted per square millimeter X
dilution (eg. 100 for WBC count) X 10 (depth factor)
59. CALCULATE AREA AND VOLUME
• Depth: 0.1 mm
• Red square = 1 x 1 mm = 1 mm2
(AREA) = 0.1 cubic millimeter
• Green square = 0.25 x 0.25 mm = 0.0625 mm2
= 0.00625 mm3
• Yellow square = 0.2 x 0.2 mm = 0.04 mm2
= 0.004 mm3
• Blue square = 0.05 x 0.05 mm = 0.0025 mm2
= 0.00025 mm3
60. SOURCES OF ERRORS
• There are different types of counting chambers available, with different grid
sizes.
• Know the grid size and height (read the instruction manual) otherwise
you’ll make calculation errors.
• The provided cover-glasses are thicker than the standard 0.15mm cover
glasses.
• They are less flexible and the surface tension of the fluid will not deform
them. This way the height of the fluid is standardized.
• Moving cells (such as sperm cells) are difficult to count.
• These cells must first be immobilized.
• The hemocytometer is much thicker than a regular slide.
• Be careful that you do not crash the objective into the hemocytometer when
focusing
61. UNOPETTE MICROCOLLECTION SYSTEM
• The Unopette system is a system of prefilled blood dilution vials
containing solutions that will preserve certain cell types while
lysing others.
• It utilizes a premeasured volume of diluent in a chamber into
which a specified amount of blood is drawn
• The Unopette test system consists of a self-filling capillary
pipette
• It consists of a straight, thin-wall, uniform-bore plastic capillary
tube fitted into a plastic holder
• Also has a plastic reservoir containing a premeasured volume of
reagent for diluting
• The reservoir is punctured to open access to the reagent
• The dilution is determined by the type of capillary used since
each type have different volumes
• The diluted blood is added to a hemocytometer chamber and
cells are counted in a specified area.
62. BMP LEUKOCHEK SYSTEM
• Unopette System discontinued
• The BMP LeukoChek is used to measure and dilute
whole blood for manual counting of leukocytes
(WBC) and platelets
• It replaces the Unopette system
Tested to CLIA guidelines
Clinical Laboratory Improvement Amendments (CLIA) – establish quality
standards for all laboratory testing to ensure the accuracy, reliability and
timeliness of patient test results regardless of where the test was performed
63. MANUAL DETERMINATION OF
WBC AND PLATELETS
PRINCIPLE
• Whole blood is added to the diluent (ammonium oxalate) , which lyses red
cells but preserves platelets, leukocytes
• When erythrocytes are completely lysed, the solution will be clear red and
counting can proceed.
• The diluted blood is placed in a hemocytometer according to accepted
technique.
• Cells are allowed to settle for 10-15 minutes before leukocytes and platelets
are counted.
• Under 100X magnification (x10 objective) using bright-light microscopy,
leukocytes appear refractile (can be seen as dark dots)
• Under 400X magnification (x40 objective) using bright-light microscopy,
platelets appear oval or round and frequently have one or more dendritic
processes.
64. Reagents and Equipment
• BMP LeukoChek containing ammonium oxalate
Check expiration dates, do not use expired test kits. Protect from sunlight.
• BMP LeukoChek capillary pipette, 20 μL.
• Hemocytometer : improved Neubauer ruling
• Hemocytometer coverslips
• Petri dish lined with filter paper that has been moistened and two applicator
sticks to hold the hemocytometer
• Microscope, Hand counter, EDTA whole blood
DILUTION RATIO
• Sample to total volume.......................1:100
• That is 1.98 ml of diluent to 20μl of sample
65. PROCEDURE FOR DETERMINATION OF WBC AND
PLATELETS
• 1. Specimen should be well mixed and left on a rocker for at least
5 minutes before using.
• 2. Check BMP LeukoChek for clarity and contents. If the BMP
LeukoChek chambers appear cloudy or the amount of reagent
looks questionable, do not use.
66. 3. With the reservoir on a flat surface, puncture the diaphragm of the reservoir
using the protective shield of the capillary pipette.
A. Using a twist action, remove protective shield from the pipette assembly.
B. Holding the pipette and the tube of blood almost horizontally, touch the tip
of the pipette to the blood (fill with 20μl of blood).
The pipette will fill by capillary action and will stop automatically when the
blood reaches the end of the capillary bore in the neck of the pipette
C. Wipe the excess blood from the outside of the capillary pipette.
Be careful not to touch the tip of the capillary when wiping off excess blood.
D. Before entering the reservoir, it is necessary to force some air out of the
reservoir by squeezing it. Do not expel any liquid and maintain pressure on
reservoir.
67. E. Place an index finger over opening of overflow chamber and position
pipette into reservoir neck.
F. Release pressure on reservoir and then remove finger. The negative
pressure will draw blood into pipette.
G. Rinse the capillary pipette with the diluents by squeezing the
reservoir gently two or three times.
This forces diluent up into, but not out of, the overflow chamber and
releases pressure each time to ensure the mixture returns to the reservoir.
H. Return protective shield over upper opening and gently invert several
times to mix blood adequately.
I. Allow the BMP LeukoChek to stand for 10 minutes to allow RBCs to
hemolyze. Leukocyte counts should be performed within 3 hours.
68. PROCEDURE FOR DETERMINATION OF WBC AND
PLATELETS
4. Charge hemocytometer
A. Mix the dilution by inversion and convert the BMP LeukoChek to the
dropper assembly.
B. Gently squeeze BMP LeukoChek and discard first 3 or 4 drops.
This allows proper mixing, with no excess diluent in the tip of the capillary.
C. Carefully charge hemocytometer with the diluted blood, gently
squeezing the reservoir to release contents until chamber is properly filled.
Be sure to charge both sides and not to overfill chambers.
5. Place the hemocytometer in the pre-moistened Petri dish and leave for 15
minutes.
This allows the sample to settle evenly.
6. Cell count can now be performed
69. CELL COUNT AND CALCULATION - WBC COUNT
• A WBC count is performed with a Neubauer
hemocytometer.
• Using the X10 microscope magnification, count WBC using
the four outer large squares on the outer sections of the
counting chamber
• Count both sides of the chamber and average the count.
• When counting, the cells that touch the extreme lower and
the extreme left lines are included in the count.
Those on top and right are not included.
Count both sides of the chamber and average the numbers
•
70. CELL COUNT AND CALCULATION - WBC COUNT
• Use the following formulas to calculate the WBC.
• Cells/mm3 = Average No. of cells + 10% X depth factor (10) X
dilution factor (100) divided by the Area (number of squares
counted)
• Depth factor is multiplied by 10 to convert area to volume in μl
• Area of each large square = 1mm, so for the 4 large squares =
4mm
Normal Value:
• Adult: 4,000 – 10,000
• Newborn: 10,000 – 30,000
71. CELL COUNT AND CALCULATION -
PLATELET COUNT
• Platelet counts are performed with
a Neubauer hemocytometer
• Counting is done using x40 dry
phase contrast objective.
Platelets will have a faint halo.
• The middle square of the
hemocytometer chamber is
counted.
• It contains 25 small squares.
72. CELL COUNT AND CALCULATION
- PLATELET COUNT
• Count the 25 squares in the middle of the counting chamber
No. of platelets/mm3 =
Multiply No. of platelets (+ 10%) X 1000
OR
• Count 5 of the 25 squares
• Take the average of both sides add 10%
• Multiply No. of platelets x 5000 = No. of platelets/mm3
• Normal Value: Platelets: 150,000 to 400,000 mm3
73. WBC AND PLATELET CELL COUNT - UNOPETTE
LIMITATIONS
1. Specimen should be properly mixed and have sufficient volume of blood so
there is no dilution of anticoagulant.
2. The capillary tube must be filled completely and be free of any air bubbles.
3. After the hemocytometer is charged, it should be placed in a pre-moistened
Petri dish to prevent evaporation while the cells are settling out.
4. The light adjustment is critical. Important for WBCs platelets. If the
condenser is not in the correct position, it will fade out platelets.
5. Debris and bacteria can be mistaken for platelets.
6. Clumped platelets cannot be counted properly The anticoagulant of choice is
EDTA for preventing platelet clumping.
7. Avoiding overloading of hemocytometer chamber.
8. A highly elevated leukocyte or platelet count - makes counting difficult. A
secondary dilution –needed. secondary dilution calculating the total count,
9. All WBC and platelet counts are done in duplicate.WBC counts should agree
+/- 15%., Platelet counts must agree +/- 25%.
74. Causes of elevated WBC (Leukocytosis)
• Infections – most common is bacterial infections
It also occur in viral (lymphocytosis)
• Allergy and drug hypersensitivity
• Parasitic infections
• Inflammation: eg. Inflammatory bowel disease, RA, and
vasculitis
• Extremely low birth weight
• Malignancy and myeloproliferative disorders: eg.
Leukemias, lymphomas
• Increased release of WBC from bone marrow:- This occurs
in infection, stress, and hypoxia
it also occurs due to endotoxin stimulation and steroid
administration
77. Causes of thrombocytopenia
• Idiopathic thrombocytopenic purpura (ITP)
• Thrombotic thrombocytopenic purpura (TTP)
• Hemolytic uremic syndrome – heparin, sulfa drugs, quinidine
• Bacteremia
• Autoimmune diseases
• Pregnancy
• Trapping of platelets in the spleen
• Reduced production of platelets
• Increased breakdown of platelets
78. Dr. I. Manjubala
SBST, VIT University
78
• https://www.youtube.com/watch?v=WWS9sZbGj6A
https://www.youtube.com/watch?v=pP0xERLUhyc
https://www.youtube.com/watch?v=vEXMajaF6zo
https://www.youtube.com/watch?v=7AWu4Qb_Emk
79. Blood Glucose - Glucometer
Dr. I. Manjubala
SBST, VIT University
79
80. Diabetes - Types
Diabetes: (too much glucose in the blood)
•a condition where the body is unable to regulate the amount of glucose
in the blood due to lack of insulin or the body’s inability to produce
insulin.
Type 1:
•also known as “juvenile diabetes” or “insulin-dependent diabetes”
•usually develops in children or young adults (must take insulin daily)
•the body does not produce enough insulin to control the amount of
glucose in the blood. (autoimmune disease - destroying the cells of the
pancreas)
Type 2
•known as “adult-onset diabetes” or “non-insulin dependent diabetes”
•Adult, in obese children: a genetic disorder due to deficiency
•Based on diet, exercise and medicine type 2 diabetics may not need to
take insulin daily
81. Glucose
Glucose:
• a simple sugar that serves as the chief source of energy for
the body.
• Hypoglycemia:
• Low blood sugar
• 60mg/dL or less
• Occurs mostly in Type 1 diabetes or in elderly
• Hyperglycemia:
• High blood sugar
• 240mg/dL or higher
• Can cause damage to eyes, kidneys, heart and nerves
•
82. Glucose Monitoring
Blood Glucose Monitoring is a way of checking the concentration of
glucose in the blood using a glucometer.
What is the purpose?
–Provides quick response to tell if the sugar is high or low indicating a
change in diet, exercise or insulin.
–Over time, it reveals individual of blood glucose changes.
Why ?
• Reduces risk of developing complications with diabetes.
• Allows diabetics to see if the insulin and other medications they are
taking are working.
• Gives an idea as to how exercise and food affect their blood sugar.
• May prevent hypoglycemia or hyperglycemia
83. When ?
•When you wake up
•Before meals
•1 to 2 hours after meals
•Before physical activity
• 15 minutes after physical activity
•Before bed
Glucose Test Person without
diabetes
Person with diabetes
Fasting Test 70-110mg/dL > 140mg/dL
2 hours after eating <110mg/dL > 200mg/dL
84. Glucometer
• A glucometer is an electronic device used to test the
amount of glucose in the blood.
• New models are able to read and calculate the blood
sugar within seconds.
• Some models not only display the glucose reading but
also say it.
86. AtLast Blood Glucose Meter
• What is it?
– An alternate test site glucose monitor. Instead of pricking
their finger, diabetics are able to draw blood from their thigh
or forearm to test their blood sugar.
• How does it work?
– The AtLast Glucose Meter works just the same as any other
meter, except blood is taken from alternate sites to relieve
the pain of pricking fingertips. The blood drawn is then put
onto a strip which the meter reads and displays the blood
glucose level.
• Why is it advanced?
Alternate site testing is less painful then the
raditional finger testing because there are less
nerve endings in the alternate sites then the finger tips.
• Where can you test?
– Upper arm, forearm, thigh, hand,
palm & calf
•
87. GlucoWatch Biographer
• What is it?
– Warn like a wristwatch, the Biographer measures glucose every
ten minutes through the skin.
• How does it work?
– Using an AutoSensor, a replaceable pad that sticks to the back of
the watch, that is adhesive to the skin
which allows it to come into contact with an electrical charge. This
electrical charge then brings the glucose to the skin surface where
an enzyme reaction generates electrons in the glucose, similar to
that of regular meters, allowing the glucose to be closely estimated.
• Why is it advanced?
– First noninvasive glucose monitor
– Provides glucose readings every ten minutes
– Very helpful at showing patterns of glucose levels
88. HypoMon®
• What is it?
– The HypoMon® System noninvasively detects low blood sugar in
diabetes throught skin contact. The HypoMon® includes a battery
power pack worn on the chest and a wireless receiver where the
readings are sent to and can be read.
• How does it work?
– With the battery powered unit attached to the chest, the four skin
sensors measure skin moisture and heart activity which are two known
symptoms of hypoglycemia. The readings are then sent to the
wireless receiver where they can be read.
– Alerts sound when the blood glucose level falls
below 45mg/dL.
• Why is it advanced?
– Enables monitoring during the day and night.
– Alters allow the diabetic to treat hypoglycemia
at an earlier stage.
89. Silicon Micro Needle
• What is it?
– Silicon Micro Needle consists of a hand-held battery-powered
electronic monitor which holds a cartridge loaded with 10
disposable sampling devices. Each disposable consists of the
micro-needle and a receptacle into which the blood sample is
drawn.
• How does it work?
– The cartridge is loaded into the monitor and pressed up to the
skin. This penetrates the skin, drawing a very small amount of
blood into the disposable needle. Chemicals in the microneedle
react with the glucose to produce a color. The monitor then
analyses this color using a laser light and displays the glucose
level.
• Why is it advanced?
– Pain free testing and the amount of blood
required is 1/100th
of a drop of blood.
90. REAL-Time Continuous
Glucose Monitoring System
• What is it?
– An insulin pump integrated with REAL-Time continuous glucose
monitoring that measures the glucose levels for up to 72 hours.
• How does it work?
– Diabetic must use MiniMed Paradigm insulin pump, a device that
delivers insulin to the body though a small plastic catheter. They must
also wear a sensor that monitors glucose for up to 3 days that is
connected to the MiniLinkTM
Transmitter. This transmitter sends the data
from the sensor to the insulin pump through radio frequency wireless
technology. The insulin pump with REAL-Time alarms diabetics when
their glucose levels are high or low.
• Why is this advanced?
– Warns diabetics of glucose levels a finger stick
– Helps take action and gain control sooner.
– The REAL-Time trend graph shows how meals,
exercise, insulin and medication affect glucose.
91. Cell Robotics' Lasette
• What is it?
– A laser lancing device that uses a laser beam to draw a drop of
blood rather then using a steel lancet.
• How does it work?
– The fingertip is placed over the disposable lens cover where
the laser beam comes out of. Water in the skin absorbs the
energy from the laser beam, instantly vaporizing tissue which
draws blood.
• Why is it advanced?
– Virtually painless
– No more finger pricking
92. Glucose Control Benefits
• Keeping blood glucose levels as close to normal as possible:
– Few or even no complications
– Normal life span
• Short term benefits of glucose control
– Feel better
– Stay healthy
– Have more energy
– Reduce risk of hyperglycemia and hypoglycemia
• Long term benefits of glucose control
– Lower chances of having eye, heart and kidney disease and nerve damage
– Enjoy a better quality of life
93. Glucose Tolerance Test- An overview
• The ability to utilize carbohydrates can be determined by
Glucose tolerance test.
• Initially fasting blood glucose is estimated
• A loading dose of glucose is given.
• The blood glucose levels are estimated at regular intervals
after the glucose load
• In conditions of insulin deficiency, blood glucose levels get
elevated due to impaired utilization of glucose.
07/30/17 93
94. Glucose tolerance
A) Decreased Glucose tolerance
Decreased carbohydrate tolerance (non-utilization of
carbohydrate load) is observed in conditions causing
hyperglycemia, for example:
• Diabetes mellitus
• Hyperactivity of anterior pituitary and adrenal cortex
• Hyperthyroidism
• Stress
B) Increased Glucose Tolerance
Increased carbohydrate tolerance is observed in all conditions that
cause hypoglycemia-
i) Hypopituitarism
ii) Hyperinsulinism
iii) Hypothyroidism
iv) Adrenal cortical hypofunction
v) Decreased gastro intestinal absorption like sprue, celiac disease.
07/30/17 94
95. When to do, for whom to do GTT
i)In asymptomatic persons with sustained or transient glycosuria
ii) In persons with symptoms of diabetes but no glycosuria or
hyperglycemia
iii) Persons with family history but no symptoms or positive blood findings
iv)In persons with or without symptoms of diabetes mellitus showing one
abnormal blood finding
v) In patients with neuropathies or retinopathies of unknown origin
vi) In women with H/o having delivered large babies.
NOT TO DO:
a) In proven cases of diabetes mellitus the test is not required.
b) GTT is required only in doubtful cases, it is not recommended for follow
up of patient.
c) The test should not be carried out in acutely ill patients
07/30/17 95
96. GTT - Precautions
a) The patient is instructed to have good carbohydrate diet for 3
days prior to the test. Further , diet containing about 30-50 G
of carbohydrate should be taken on the evening prior to the
test.
b) should avoid drugs likely to influence the blood glucose levels,
for at least, 2 days prior to the test
c) should abstain from smoking during the test.
d) Strenuous exercise on the previous day is to be avoided.
e) The exercise is also to be avoided on the same day prior to
the test
07/30/17 96
97. Types of glucose tolerance test
• Standard Oral glucose tolerance test
• I/V Glucose tolerance test
• Mini Glucose tolerance test
07/30/17 97
98. Procedure of standard oral glucose
tolerance test
a) At about 8 a.m. the fasting blood and urine samples are collected.
These are called zero samples.
b) A loading dose of 75 g. anhydrous glucose dissolved in 250-300 ml of
water is given to the patient.
07/30/17 98
Procedure
•In children 1.75 g of glucose /kg body weight is
given.
•In the classical procedures, the blood and urine
samples are collected at half hourly interval of the
next two and a half hour or three hours.
•Glucose is estimated in all the blood samples.
•Urine is analyzed for the presence of glucose.
99. Glucose tolerance curve
• A curve is plotted with the blood glucose levels on the vertical
axis against the time of collection on the horizontal axis.
• The curve so obtained is called glucose tolerance curve.
07/30/17 99
Fasting
(Zero
sample
)
30
minute
s
60
minute
s
90
minute
s
120
minute
s
150
minute
s
180
minute
s
Blood
Glucose
(mg/dl)
90 100 150 120 110 80 70
Urinary
Glucose
nil nil nil nil nil nil nil
Laboratory profile of a normal person after glucose load
101. Normal glucose tolerance curve
i) Fasting blood glucose (Zero hour sample)- is 90 mg /dl, which
is well within the normal range(Normal 60-100 mg/dl).
ii) There is rise of blood glucose after glucose load and the peak
value is observed at I hour. This is due to absorption of
glucose from the intestine.
iii) Insulin is released upon increase of blood glucose level.
There is fall in blood glucose with time due to glucose
utilization promoted by insulin.
iv) The normal blood glucose level is achieved after 150 minutes.
07/30/17 101
102. Diabetic curve
1) Fasting blood glucose is higher than normal
2) The highest value is attained at 1 hour to 1 hour 30 minutes.
3) The highest value exceeds the renal threshold
4) Glucose is found in almost all the urine samples.
5) The blood glucose level does not return to the fasting level even
within 2hour 30 minutes.
07/30/17 102
Fasting
(Zero
sample
)
30
minute
s
60
minute
s
90
minute
s
120
minute
s
150
minute
s
180
minute
s
Blood
Glucose
(mg/dl)
200 225 350 300 275 250 225
Urinary
Glucose
+ + + + + + +
Laboratory profile of a diabetic patient after glucose load
105. Renal Glycosuria
• Blood glucose levels are within the normal limits.
• Glucose tolerance curve is normal.
• There is lowering of renal threshold.
• Thus glucose is found in some of the samples depending upon
the renal threshold.
Causes of Renal Glycosuria
• Early diabetes mellitus,
• Pregnancy,
• Renal disease,
• Heavy metal poisoning
• Renal glycosuria can also be observed in children of
diabetic parents.
07/30/17 105
106. Laboratory profile with Renal glycosuria
Fasting
(Zero
sample
)
30
minute
s
60
minute
s
90
minute
s
120
minute
s
150
minute
s
180
minute
s
Blood
Glucose
(mg/dl)
90 130 150 140 120 100 90
Urinary
Glucose
nil + + + + ± nil
07/30/17 106
107. Lag Curve
• Fasting blood glucose is normal.
• Sharp rise within 30 minutes to one hour
• The blood glucose levels exceed the renal threshold.
• The decline is rapid and the normal levels are attained back.
• Some of the urine samples contain glucose, - where the blood glucose
is above the renal threshold.
Cause of Lag curve: Hyperthyroidism, Pregnancy, After gastro-
enterostomy, Early diabetes mellitus
07/30/17 107
Fasting
(Zero
sample)
30
minutes
60
minutes
90
minutes
120
minutes
150
minutes
180
minutes
Blood
Glucose
(mg/dl)
90 230 180 150 120 100 90
Urinary
Glucose
nil + + nil nil nil nil
Laboratory profile of a patient having lag curve
108. I/V Glucose tolerance test
•This test is undertaken for patients with malabsorption (Celiac
disease or enteropathies),
•Under these conditions oral glucose load is not well absorbed and
the results of oral glucose tolerance test become inconclusive.
07/30/17 108
I/V Glucose tolerance test- Procedure
•I/V glucose tolerance test is carried out by giving 25 g of glucose
dissolved in 100 ml distill water as intravenous injection within 5 min.
•Completion of infusion is taken as 0 time.
•Blood samples are taken at 10 minutes interval for the next hour.
•The peak value is reached within a few minutes and the value
touches to near normal in 45-60 minutes.
Interpretation
In normal individuals, blood glucose level returns to normal within 60 min
In diabetes mellitus, decline is slow
The initial values are attained in 120 minutes.
109. Mini or Modern GTT
• As per current WHO recommendations, in the mini or modern
glucose tolerance test, only two samples are collected,
• Fasting (zero hour) and 2 hour post glucose load.
• Urine samples are also collected during the same time.
• The diagnosis is made from the variations observed in these results.
07/30/17 109
Time of sample
collection
Normal person Criteria for
diagnosing
diabetes mellitus
Criteria for
diagnosing IGT
Fasting <110 mg/dl
<(6.1m.mol/L)
> 126 mg/dl
>(7.0m.mol/L)
110- 126 mg/dl
2 hour after
glucose load
<140 mg/dl
<(7.8mmol/L)
> 200 mg/dl 140-199 mg/dl
The Diabetes Expert Committee criteria
110. Factors affecting GTT
a) Acute infections- Cortisol is secreted, the curve is elevated
and prolonged
b) Liver diseases- The curve is elevated and prolonged.
c) Hyperthyroidism- There is steep rise in curve.
d) Hypothyroidism-A flat curve is obtained in hypothyroidism.
Thyroid hormone increases the absorption of glucose from
the gut.
e) Starvation- There is rise of counter regulatory hormones,
which show increased glucose tolerance
07/30/17 110
111. Some more precautions before GTT
• For proper evaluation of the test, the subjects should be
normally active and free from acute illness.
• Medications that may impair glucose tolerance include
diuretics, contraceptive drugs, glucocorticoids, niacin, and
phenytoin should be avoided on that day.
07/30/17 111
GTT Under special conditions
Cortisone stress test- used for detecting pre diabetes or
Latent diabetes
Extended GTT- To diagnose the cause of hypoglycemia
especially 2-3 hours after meals.
112. Criteria for diagnosis of Diabetes mellitus
• If the fasting plasma glucose level is 126 mg/dL or higher
on more than one occasion, further evaluation of the
patient with a glucose challenge is unnecessary.
• However, when fasting plasma glucose is less than 126
mg/dL in suspected cases, a standardized oral glucose
tolerance test may be done .
• A random plasma glucose concentration 200 mg/dL
accompanied by classic symptoms of DM (polyuria,
polydipsia, weight loss) is sufficient for the diagnosis of
DM.
07/30/17 112
113. Dr. I. Manjubala
SBST, VIT University
113
Regulation of blood glucose level
https://www.youtube.com/watch?v=ae_jC4FDOUc
https://www.youtube.com/watch?v=OYH1deu7-4E