Diagnosis, Lab tests , laboratory Diagnosis, blood test , cbc , wbc

1. Clinical Laboratory Diagnostics
Clinical laboratory diagnostic 4th year

2.  Clinical laboratories are healthcare facilities providing a
wide range of laboratory procedures which aid the
physicians in carrying out the diagnosis, treatment, and
management of patients

3. Classifications of clinical
laboratories

4.  government-owned (public) which is usually part of
hospitals and medical centers under the department
of pathology or laboratory medicine
 private facility as part of a privately-owned
medical/healthcare institution
According to ownership

5.  general clinical laboratories which provide common
diagnostic laboratory tests
 specialty laboratories that provide disease-specific
diagnostic and confirmatory tests
According to function

6.  Clinical Chemistry
 Clinical Microbiology
 Hematology
 Blood banking and Serology (aka Immunohematology,
Transfusion Medicine)
 Clinical Microscopy
 Histopathology and Cytopathology
 Molecular Biology
 Public Health - providing tests such as water analysis, testing for
environmental substances, among other tests concerning public
and environmental health
According to test specialization

7.  Pre-analytical phase begins even before the specimen
has reached the lab. This means that rigorous
protocols must be in place to reduce the risk of errors
in specimen handling and identification
 Analytical phase begins when the specimens have
been logged into the lab. This phase is comprised of
the lab diagnostic and testing procedures
 Post-analytical phase involves reporting the final result
Phases of Laboratory Testing

8. Effect of Pre-Analytical Errors on Quality of Laboratory Medicine at a Neuropsychiatry Institute
in North India

9. Factors that can influence the results
of laboratory tests

10.  date and time of appointment;
 date and time of blood sampling (collection of biological material);
 last name and initials of the patient;
 department, medical history number, ward number;
 age, gender;
 diagnosis;
 time of taking the last dose of drugs that can affect on the result of the
analysis;
 surname and initials of the doctor who ordered the study;
 list of necessary studies;
 signature of the specialist who took the blood or other biological
material
What information should be included
in direction for blood test ?

12. Factors that can influence the results
of laboratory tests
 Biological variation –
characterizes the spread
analyte values in samples
taken from the same
patient at different times
UNCHANGEABLE
 Patient gender
 Ethnogeographical features
LONG-TERM EFFECTS
 Body mass
 Lifestyle, sports
 Pregnancy
SHORT-TERM EFFECTS
 Biorhythms of the body
 Physical activity, stress
 Diet (food consumption)
 Smoking, alcohol, drugs
 Medications

13. Increase with age Decrease with age
ESR creatinine
glucose albumin
cholesterol hemoglobin
D-dimer AST
Influence of patient age
Influence of patient's body weight
Increase
with
weight
insulin TG cortisol Uric acid cholesterol

14.  After physical activity, leukocytosis may be observed, the
appearance of protein in the urine
 Loss of fluid through sweat → ↑albumin and hemoglobin,
red blood cells (hemoconcentration/long-term effect)
 Changes in hormone activity (↑adrenaline, cortisol, ACTH,
↓insulin) → ↑glucose
 Increased OM reactions → appearance of free radicals →
cell damage (myocytes, etc.): CK, Tr, AST, ALT, LDH, NT-
proBNP, CRP, creatinine
 Hemostasis: ↑fibrinogen, VWF, f8
Exercises

15.  Increase in circulating blood volume → decrease in
urea, hemoglobin, acceleration of ESR (m/b 5 times)
 Decrease in serum iron (formation of depot in the
fetus)
 Increased acute phase proteins (CRP)
 Acceleration of metabolism
Pregnancy

16. Biological rhythms
 1. Circadian rhythms
(hormones, Fe, ...)
 2. Monthly rhythms (renin
and aldosterone ↑ up to
once before ovulation, sex
hormones, Fe ↓ by 15-20%
during menstruation)
 3. Seasonal rhythms (T3 is
20-25% < in summer than in
winter)
cortisol

17.  Changes in hormone concentrations (↑ cortisol,
adrenaline)
 ↑glucose
 Hyperventilation → hypocapnia (↓CO2) → respiratory
alkalosis
 Increased protein and ketones in urine
Stress

18. Nutrition
 Dietary leukocytosis,
glucose, TG, AST, bilirubin,
phosphates
 Fasting: ↑decomposition of
proteins and lipids,
ketoacidosis, lactic acidosis
lipemia

19. SMOKING
 Acute effects: even after 1 cigarette within 1 hour
(↑adrenaline, cortisol, aldosterone) → activationlipolysis,
↑FA, ↑glucose
 Chronic effects: ↑CO2, red blood cells, hemoglobin, CEA,
CRP, ↓TG, urinary acid, bilirubin
COFFEE
 ↑cortisol level up to 40% after 200 mg coffee (American
85-112 mg per 75 ml, cappuccino 100-135 mg per 200 ml),
 ↑gluconeogenesis and glycogenolysis → ↑glucose
Smoking, drinking coffee

20. Acute effects
 Inhibition of gluconeogenesis → ↓glucose, ↑lactate
 Ethanol → acetaldehyde → acetate (together with lactate
leads to acidosis)
 ↑uric acid (↑formation in the liver, ↓excretion)
 ↓vasopressin, cortisol, ↑aldosterone (Na retention)
Chronic effects
 Toxic effect on the liver → ↑ALT, AST, GGT, amylase
 ↓splitting of TG in plasma →↑TG
 Toxic effect on hematopoietic cells or folate deficiency
→↑MCV
Effects of alcohol

21. Biological effect – therapeutic or side effect of a drug on the
metabolic process inbody
 barbiturates, cyclosporines – ↑ALT, AST, GGT (cytotoxic
effect, induction of enzyme synthesis)
 sulfonamides – ↑indirect bilirubin (competition for
glucuronidation)
 COCs – ↑Fe, ↓transferrin (effect of sex hormones)
Drugs effects

22. Drugs effects
Analytical influence – “intervention” drug substance
into a chemical/physical reaction to determine the
analyte
 Ascorbic acid – false negative reaction to glucose,
ketones, bilirubin in urine
 taking Fe – ↑Fe serum preparations

23. Duties of the parties:
 Clinician should explain to the patient the need for
laboratory testing
 Nurse should inform the patient how he needs to
prepare for the test
 Patient must comply with the rules for preparing for
the study and submitting biological material
Preparing the patient for
laboratory research

24.  Best time for blood collection is between 8 and 11 a.m.
 Avoid drinking or eating anything for 8-12 hours before the test. You
may drink only water.
 Eat less fatty and fried food, and avoid alcohol 1-2 days prior to the
test.
 Don’t smoke 1 hour prior to the test.
 Avoid any physical activity and stress prior to your blood test. It is
recommended that you calm down and relax for 10-15 minutes and
think about nothing during the withdrawal.
 If you are planning to start using medication, perform tests before
or after treatment, and no sooner than 10-14 days post-treatment. If
you are taking any medication, tell your doctor or laboratory
specialist.
 Blood testing is not recommended after massage therapy,
reflexotherapy or physiotherapy.
Patient preparation for blood
collection

25.  Whole blood (formed elements, hemoglobin)
 Serum is a biological cell-free liquid that does not contain
blood clotting factors and fibrinogen (biochemistry,
immunology)
 Plasma is the liquid part of blood, devoid of formed
elements (glucose, study of the hemostasis system)
What part of the blood is examined
in laboratories

27. Blood collection

28. Blood collection

29.  Sitting/lying position
 Venous puncture should be low-traumatic!
 Handling of the obtained blood sample should be as
gentle as possible (to avoid hemolysis)!
 The time for applying a tourniquet should not exceed 1
minute!!
 It is not recommended to pat the collection site with
your palm in order to increase blood flow to it!!!
 No “fist” work!
Venipuncture

31. Blood Collection Tubes

32.  DO NOT consume liquids after 10 pm the day before (no
more than 1/2-1 glass of water is acceptable)
 Avoid physical activity the night before and the morning
before obtaining a urine sample
 If possible, refrain from urinating for 4 - 6 hours (to convert
nitrates into nitrites in the bladder under the influence of
bacteria)
 Proper toileting of the external genitalia before collecting
urine in a container
 Collect the “average” portion of morning urine in a
container
Urine collection

33.  The general rule is that samples should be delivered
to the laboratory as quickly as possible (no more than 2
hours for most anlites)
 Stability of analytes in various types of samples (blood,
urine, cerebrospinal fluid) and specimens (serum,
plasma, sediment, blood smear) not the same
Storage and transportation of
samples

34.  When transporting to the laboratory, containers
containing blood samples should be protected from
shaking to avoid the development of hemolysis
 Temperatures below 4 °C and above 30 °C can significantly
change the content of many analytes in a sample
 Whole blood samples cannot be shipped
Biological material – blood

35.  Potassium increases when stored in cold
 Hemoglobin, red blood cells are stable for one day when stored in
a closed tube
 Storing blood plasma samples intended for studies of the
coagulation system at room temperature for more than 4 hours is
not recommended.
 Blood gas testing should be performed immediately
 Enzymes, proteins, glucose, creatinine, urea may remain in serum
at 4 °C when stored
 stable for several days
 Glucose in whole blood decreases by 15-20% in 1 hour
 Bilirubin is destroyed in the light (by 50% in 1 hour)
Biological material – blood

36.  The collected urine is delivered to
the laboratory as quickly as
possible (up to 2 hours). Long-
term storage of urine at room
temperature leads to changes in
physical properties, cell
destruction and bacterial growth
Biological material – urine

37.  incorrect marking of the blood tube
 Inconsistency between the marking of the form - direction and
used test tubes. Incorrectly filled out form
 Failure to comply with the terms and conditions of storage of
the material until delivery to the laboratory (freezing,
overheating, loss of part of the material when tipping, etc.)
 The taken biomaterial is in an inappropriate tube
 Presence of clots in test tubes with anticoagulant,
inconsistency volume of collected blood amount of added
anticoagulant, hemolysis, lipemia
 Incorrect and untimely transportation of biomaterial
Assessment of biomaterial suitability

38. 1. Hemolysis (on average up to 10% of the total number of
samples)
2. Insufficient filling of tubes
3. Incorrect labeling of tubes
4. Clot in blood sample
5. Lipemia
6. Lack of labeling on the tube/lack of direction
7. Hyperbilirubinemia
Most common reasons for
blood draw

39. Blood collection:
 Long-term application of a tourniquet
 The needle is too thin
 Inaccurate puncture
 Taking and transferring blood with a syringe and needle
 Shaking the sample
Transport of samples:
 Shaking/vibration
 Freezing, too high or low temperature Blood processing:
 Centrifugation at high speed for too long
 Delay in separation of plasma/serum from formed elements for
2-3 hours
Causes of hemolysis

40.  ↓RBC, HCT, ↑free Hb
 ↑potassium, LDH, AST, ALT, serum Fe, acid
phosphatase
 Impact on the measurement itself (optical methods)
Consequences of hemolysis

41.  Turbid serum or plasma due to
high content
chylimicrons.
 Affects the true values of all
blood tests.
Lipemia

42. Thank you for your attention!