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LAB 304

Lecture \ 1

المحاضرة 1   من  فيها بما بالكامل

تحذيرية عالمات((warning signs

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Introduction to laboratory department & blood bank department

• Definition : laboratory medicine : is the branch of medicine which

provide physicians and other healthcare professionals with information to :

1- detect disease or predisposition of a disease .2- confirm or reject a diagnosis .3- establish prognosis .4- guide patient management .5- monitor efficacy therapy .6- direct prevention of disease and health care planning .

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Introduction to laboratory department & blood bank department

• Blood Bank ( transfusion medicine ) : is a multidisciplinary specialty encompassing all

aspects of blood donation , blood component preparation , serology ( antibody screening ) , and blood transfusion therapy .

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Introduction to laboratory department & blood bank department

• Sections/branches : they are different among hospitals

1- blood bank : offering cross match, antibody detection, donor screening , providing blood & blood component

2- clinical biochemistry : offering a wide range of chemistry parameters including :

• enzymology, toxicology and endocrinology.3- histopathology & cytopathology : giving the service

of cytology & biopsy report for all the tissue .

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Introduction to laboratory department & blood bank department

4- hematology : offering routine CBC , coagulation profile and bone marrow aspirate .

5- microbiology : offering the gram’s stain , culture & sensitivity . In some hospitals it is offering Z.N stain .

6- parasitology : routine exam of stool & urine .7- serology & virology : screening of hepatitis , HIV, and

other serology test .8- receiving section : receives the samples from all

wards

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Introduction to laboratory department & blood bank department

• Lab equipments :1- Autoclave :is an instrument used to sterilize equipment and supplies by subjecting them to high pressure saturated steam at 121 °C for around 15–20 minutes depending on the size of the load and the contents

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Introduction to laboratory department & blood bank department

2- Incubator : is a device used to growand maintainmicrobiological cultures or cell cultures. The incubator maintains optimal temperature, humidity and other conditions such as the (CO2) and O2 content of the atmosphere inside.

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Introduction to laboratory department & blood bank department

3- CentrifugeThe centrifuge works using the sedimentation principle, where the centripetal acceleration causes more dense substances to separate out along the bottom of the tube & lighter objects will tend to move to the top of the tube .

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Introduction to laboratory department & blood bank department

4- Biosafety cabinetis an enclosed, ventilatedLaboratory workspace for safely working with materials contaminated withpathogens requiring a defined biosafety level.

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Introduction to laboratory department & blood bank department

5- Pipette (micro pipette) is a laboratory tool used to transport a

measured volume of liquid.

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Introduction to laboratory department & blood bank department

6- Petri dishis a shallow glass or plastic cylindrical lidded dish .• Agar plate : is a Petri dish partially filled with growth mediumUsually warm liquid containing agar and a mixture of specific ingredients . After the agar cools and solidifies, the dish is ready to receive a microbe-laden sample in a process known as inoculation or "plating".

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Introduction to laboratory department & blood bank department

7- water bath 8- mouth pipette 9- plastic pipette

10- mixer 11- microscope 12- Cuvette

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Safety rules

• DEFINITION:• Safety is the control of recognized hazards to

achieve an acceptable level of risk.• This can take the form of being protected from

the event or from exposure to something that causes health or economical losses. It can include protection of people or of possessions.

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Safety rules Always behave responsibly – General Safety Procedures1- All department employees report defective equipment, unsafe

conditions, acts or safety hazards to supervisor.2- Keep electrical cords clear of passageways.3- All equipment and supplies must be properly stored. Heavy

items not stored on top shelves.4- Scissors, knives, pins, razor blades and other sharp

instruments safely stored and used.

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Safety rules5- All electric machines with heat producing elements turned off

when not in use.6- Minor spills, i.e., water, cleaned by the employee who

discovers the spill. Major spills cleaned by Environmental Services Department.

7- Obey warning signs.

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General CautionIonizing Radiation High Voltage

Toxic ( Poison )Flammable Laser Radiation

IrritantBiohazard Non-ionizing Radiation

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Explosion risk Hot Surface Low Temperature

Environmental Hazard CorrosiveOxidizer

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Safety rules8- Wear suitable clothing 9- Keep hands away from

sample needles and probes in the instrument chambers.

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Safety rules10- Equipments not left standing in traffic lanes. 11- Do not obstruct fire equipment. Know location of firefighting

equipment and how to use it. Know evacuation routes and what to do in case of fire.

12- All Clinical Laboratory materials, bottles, specimens, etc., shall be plainly labeled.

13- Mouth pipetting is prohibited.14- Disposable gloves must be worn as indicated.15- Any working area that becomes contaminated, cleaned

immediately with a disinfecting solution. 16- Any specimen of blood, urine, sputum, saliva, other body

fluid or tissue must be regarded as potentially infectious.

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Safety rules• Rules of obtaining the Specimen 1- Always use Standard Precautions.2- Avoid contact of open skin lesions with blood.3- Hands are to be washed if they become contaminated with

blood while taking specimens.4- Do not bend needles after use. Do not reinsert used needles

in their original containers. Place used needles in the puncture-resistant container provided for disposal needles.

5- Gloves and lab coats are to be worn while obtaining all specimens.

6- After removing gloves and lab coat wash hands thoroughly.

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LAB 304

Lecture \ 2 , slides 4 , 6 , 10 , 27 , 28 , 29الشرائح 

30 slides 12 , 14 , 17 , 20 , 23الشرائح   - 

أول first 3 testsفحوصات 3مطلوب

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General feature of the test forms

• Every form should include the following :1- general information : related to the patient & the ward2- hospital name3- form’s type4- clinical diagnosis5- Processing type 6- date , time & name of the sender 7- tests to be done8- analyzer information

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Test requisition• Criteria for filling the forms :1- patient’s name, age, sex, nationality & hospital ( file )

number.2- relevant ward details .3- name of ( consultant / specialist )4- highlight the tests to be done .5- request must be signed and stamped by the requesting

physician .6- the staff nurse collecting the sample must ensure labeling

of the sample & fill the request form including time & date .

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Test requisition

• The requesting physician must check following before ordering :

1- availability of test in the lab .2- inform the patient about the test procedure

and any precaution to be taken .3- instruct the staff nurse about any precautions

to be taken during collection .

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HAEMTOLOGY FORM

• Consist of these tests :1- CBC2- Differential count3- RBC morphology

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CHEMISTRY FORM

• Consist of these tests :1- U/E test ( urea & electrolyte )2- LFT ( liver function test )3- RFT or KFT ( renal function test )

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SEROLOGY FORM ABB.

• ASO: Antistreptolysin O Titer(streptococcal infection)

• VDRL : Venereal disease research laboratory (syphilis caused by Treponema pallidum )

• TPHA : Treponema Pallidum Haemagglutination Assay (syphilis caused by Treponema pallidum )

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HORMONES FORM

• T3 : Triiodothyronine• T4 : Thyroxine• TSH : Thyroid-stimulating Hormone

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STOOL ANALYSIS FORM ABB.

• E.histo .veg. : Entamoeba histolytica vegetative(trophozoite)

• E. histo. Cyst : Entamoeba histolytica cyst• E. coli veg. : Entamoeba coli vegetative

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Specimen collection

• Specimen collection is the first step in proficiency surveillance. For issuing accurate and precise results, it is the job of the nurse or phlebotomist to make sure that the enumerated conditions are met and implemented in order to deliver a suitable sample for analysis so that an accurate and precise result will be issued.

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Procedure of specimen collection

• Pre-collection check :1- review the request and identify the patient by

asking the name, seeing his ID and compare it with the request form.

2- Is there any special instruction / preparation needed for the patient. If so advice the patient accordingly

e.g. fasting or after meals and sample collection . container may be given if needed e.g. 24 hour urine collection or sputum collection.

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Procedure of specimen collection

3- Read all the tests and select the tubes/containers as needed for the tests.

4- Arrange the tubes in order of filling.

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Procedure of specimen collection

• Post collection :1- Label all the tubes and specimen bottles as

per the guideline.2- NEVER write the name before extraction and

NEVER ask any other person to write for the same.

3- Finish the job before patient leaves the chair .

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LAB 304

Lecture \ 3 :3المحاضرة-

   , 6 , 7الشرائح   - 5 , 4 , 3  Patient communication

slides

Blood samples

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COMMUNICATION

• Most patients have had a blood extraction before.

• To them the phlebotomist's statement of intending to perform a blood test is usually sufficient to understand what is about occur.

• To a patient who has never had a blood test, a more detailed explanation may be necessary.

• Special procedures may require additional information.

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COMMUNICATION

• The phlebotomist must always inform the patient of the procedure and determine that the patient understands what is about to take place before proceeding.– If a patient does not speak or understand your language,

the phlebotomist may have to use sign language or other nonverbal means to demonstrate what is to occur, or an interpreter must be located.

– Speaking slowly and distinctly, using sign language or writing down information may be necessary for patients with hearing problems.

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COMMUNICATION

• Most patients understand that the blood tests are needed in the course of their treatment.

• Reminding the patient that the test was ordered by the doctor as part of their care will sometimes convince the patient to cooperate.

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Remember

• The patient has the right to refuse the test .• When it has been determined that the patient

truly refuses to cooperate, the phlebotomist should write on the requisition that the patient has refused to have blood drawn.

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Recommendations

• Receive the patient with pleasant smile. • Gain the patient trust and confidence.• The phlebotomist should have a pleasant appearance

and behave in a professional manner to convey confidence with the patient when taking blood.

• In handling difficult and irritable patients, the phlebotomist should remain calm and treat the patient in a caring manner under all circumstances.

• Thanking the patient for their cooperation makes them feel traumatic-free and positive about the laboratory.