CLINICAL LABORATORY separate lab for each unit, with nothing called a components, derivatives, and products for
a components, derivatives, and products for transfusion.
A medical laboratory or clinical laboratory is a laboratory
where tests are usually done on clinical specimens in
order to obtain information about the health of a
patient as pertaining to the diagnosis, treatment, and
prevention of disease.[1] Clinical laboratories are thus
focused on applied science mainly on a production-like
basis, as opposed to research laboratories that focus on
basic science on an academic basis.
Departments[edit]
Laboratory medicine is generally divided into two
sections, each of which being subdivided into multiple
units. These two sections are
Anatomic pathology: units included here are
histopathology, cytopathology, and electron microscopy.
Academically, each unit is studied alone in one course.
Other courses pertaining to this section include
anatomy, physiology, histology, pathology, and
pathophysiology.
Clinical pathology, which includes:
Clinical Microbiology: This encompasses five different
sciences (units). These include bacteriology, virology,
parasitology, immunology, and mycology.
Clinical Chemistry: Units under this busy section include
instrumental analysis of blood components, enzymology,
toxicology and endocrinology.
Hematology: This section consists of automated and
manual analysis of blood cells. It includes two subunits,
which are coagulation and blood bank.
Genetics is also studied along with a subspecialty known
as cytogenetics.
Reproductive biology: Semen analysis, Sperm bank and
assisted reproductive technology.
Distribution of clinical laboratories in health institutions
varies greatly from one place to another. For instance,
for microbiology, some health facilities have a single
laboratory for microbiology, while others have a
"microbiology" lab.
The following is a detailed breakdown of the
responsibilities of each unit:
Microbiology receives almost any clinical specimen,
including swabs, feces, urine, blood, sputum,
cerebrospinal fluid, synovial fluid, as well as possible
infected tissue. The work here is mainly concerned with
cultures, to look for suspected pathogens which, if
found, are further identified based on biochemical tests.
Also, sensitivity testing is carried out to determine
whether the pathogen is sensitive or resistant to a
suggested medicine. Results are reported with the
identified organism(s) and the type and amount of
drug(s) that should be prescribed for the patient.
Parasitology responsible for examining parasites, feces
samples may be examined for evidence of intestinal
parasites such as tapeworms or hookworms and others.
Virology is concerned with identification of viruses in
specimens such as blood, urine, and cerebrospinal fluid.
Hematology works with whole blood to do full blood
counts, and blood films as well as many other specialised
tests.
Coagulation requires citrated blood samples to analyze
blood clotting times and coagulation factors.
Clinical Biochemistry usually receives serum or plasma.
They test the serum for chemicals present in blood.
These include a wide array of substances, such as lipids,
blood sugar, enzymes, and hormones.
Toxicology mainly tests for pharmaceutical and
recreational drugs. Urine and blood samples are
submitted to this lab.
Immunology/Serology uses the concept of antigen-
antibody interaction as a diagnostic tool. Compatibility
of transplanted organs is also determined.
Immunohaematology, or Blood bank determines blood
groups, and performs compatibility testing on donor
blood and recipients. It also prepares blood
Regulated by the FDA since giving blood is considered a
drug, this unit determines a patient's blood type and Rh
status, checks for antibodies to common antigens found
on red blood cells, and cross matches units that are
negative for the antigen.
Urinalysis tests urine for many analytes. Some health
care providers have a urinalysis laboratory, while others
don't. Instead, each component of the urinalysis is
performed at the corresponding unit. If measuring urine
chemicals is required, the specimen is processed in the
clinical biochemistry lab, but if cell studies are indicated,
the specimen should be submitted to the cytopathology
lab, and so on.
Histopathology processes solid tissue removed from the
body (biopsies) for evaluation at the microscopic level.
Cytopathology examines smears of cells from all over
the body (such as from the cervix) for evidence of
inflammation, cancer, and other conditions.
Electron microscopy prepares specimens and takes
micrographs of very fine details by means of TEM and
SEM.
Genetics mainly performs DNA analysis.
Cytogenetics involves using blood and other cells to get
a karyotype. This can be helpful in prenatal diagnosis
(e.g. Down's syndrome) as well as in cancer (some
cancers have abnormal chromosomes).
Surgical pathology examines organs, limbs, tumors,
fetuses, and other tissues biopsied in surgery such as
breast mastectomys.
Medical laboratory staff[edit]
The staff of clinical laboratories may include:
Pathologist
Clinical Biochemist
Pathologists' Assistant (PA)
Biomedical Scientist (BMS) in the UK, Medical Laboratory
Scientist (MT, MLS or CLS) in the US or Medical
Laboratory Technologist in Canada
Medical Laboratory Technician (MLT in US)
Medical Laboratory Assistant (MLA)
Phlebotomist (PBT)
TYPES OF LABORATORY
In many countries, there are two main types of labs that
process the majority of medical specimens. Hospital
laboratories are attached to a hospital, and perform
tests on patients. Private (or community) laboratories
receive samples from general practitioners, insurance
companies, clinical research sites and other health clinics
for analysis. For extremely specialised tests, samples
may go to a research laboratory. A lot of samples are
sent between different labs for uncommon tests. It is
more cost effective if a particular laboratory specializes
in a rare test, receiving specimens (and money) from
other labs, while sending away tests it cannot do.
In many countries there are mainly three types of
Medical Laboratories as per the types of investigations
carried out. 1. Clinical Pathology: Haematology,
Histopathology, Cytology, Routine Pathology2. Clinical
Microbiology: Bacteriology, Mycobacteriology, Virology,
Mycology, Parasitology, Immunology, Serology.3. Clinical
Biochemistry: Biochemical analysis, Hormonal assays
etc.Blood Banks:- Blood bank is a separate body. Its
laboratory need Microbiological analysis for infectious
diseases that may be found in blood. Pathology to
observe Blood grouping, Haematology & cross matching
reactions. It also involves PRO department for the
communication & contact for blood donations etc..
Molecular diagnostic lab or cytogenetics and molecular
biology lab is the latest addition to the three types of
medical laboratories listed above in many countries.
Laboratory tests in common use:
Blood tests:
Human blood contains thousands of different chemicals
and molecules. If blood in a test tube is allowed to stand
it separates out into blood cells and the support fluid
called plasma. Some tests are done on the blood cells
and others just on the plasma. Blood also has a unique
ability to clot and will normally do so when taken out of
the body into a test tube unless an anti-clotting agent is
added. If clotted blood is tested the fluid left separate
from the clotted cells is called serum. Separating blood
cells from the support fluids can be speeded up by
spinning the test tube of blood in a centrifuge at high
speed.
The Complete Blood Count: (CBC)
This is a common group blood test, which assesses the
cells in blood. It is not, as the name suggests, a test
which completely tests everything in blood. It looks
mainly at the three main types of cells in blood - red
blood cells, white blood cells and platelets.
The red blood cells contain a molecule called
haemoglobin. This carries oxygen from the lungs to the
tissues and can be low if a person has been losing blood
or if their iron intake is low. Iron is needed to make
haemoglobin. The complete blood count also reports the
number of red blood cells, their size and shape and the
concentration of haemoglobin within each cell. The
doctor first looks at the report to see if the person is
anaemic i.e. low in haemoglobin and then looks for clues
as to the cause. An anaemia due to recent blood loss
may show a certain picture, that due to iron deficiency
another and that due to vitamin B12 deficiency yet
another.
The white blood cells are a major part of the body's
defences against invading organisms. The doctor will
look at the total white cell count and then the
percentages of different types of white cells. For
example if the patient has pneumonia due to bacteria
the neutrophil white count may be very high because
the immune system produces this type of white cell to
fight bacteria. Or if the patient has intestinal parasites he
or she may have a high eosinophil white cell count.
Leukemia, which is a cancer of bone marrow, can be
diagnosed by seeing abnormal white cells in the blood.
Platelets are part of the blood clotting system, which is
essential to prevent excessive blood loss from a cut.
Serum Iron Tests
This is a group that tests whether iron levels are too low
which might lead to a low haemoglobin (iron deficiency
anaemia) and whether there is an iron storage disorder.
In this latter situation the body tries to store too much
iron which can be toxic to tissues (e.g. a disease called
haemochromatosis). Iron travels around in the blood
attached to special transport proteins. This group also
assesses the transport proteins because a low
haemoglobin count can occur where there are plenty of
iron stores but no way to transport the iron.
Serum Vitamin Assays
The commonest vitamins assayed in blood are Vitamin
B12 and Folic Acid because low levels of these can lead
to anaemia particularly in the elderly (e.g. a disease
called pernicious anemia).
Blood Clotting Tests:
Sometimes it is important to test the ability of the blood
to clot properly. As well as the platelet count described
above, a test called the INR (International Normalised
Ratio) is the commonly performed of these tests.
Patients, who need to be on anticoagulant medications
to reduce the blood's clotting ability, need to have an
INR performed regularly to ensure that the ideal levels
are achieved. Other tests in this group include the
prothrombin time, the bleeding time and tests of other
blood clotting factors
Liver Function Tests:
This group of tests indirectly assesses the health of liver
cells by measuring enzymes arising from the cells and
also assesses substances produced by the liver and used
elsewhere in the body. The liver acts a bit like a factory.
If the liver enzymes are raised it can suggest damage to
liver cells such as occurs with chronic alcoholism or with
certain viral infections such as viral hepatitis. Other tests
in this group can suggest problems occurring outside the
liver such as a gallstone blocking the duct that runs from
the liver to the small intestine which conducts bile. Bile
helps the intestine dissolve fat in the diet so that it can
be used as fuel.
Kidney Function Tests:
The two commonest blood tests of how well the kidneys
are working, are the urea test (or blood urea nitrogen =
BUN test as it is known in some countries) and the
creatinine test. These two substances are produced by
metabolism in the body and the kidney clears them out
of the blood into urine. High levels in the blood
therefore suggest that the kidney may not be working
properly.
Other common tests under the umbrella of kidney
function tests, include:
Uric Acid - a breakdown product of metabolism which
can cause gout if the blood level is raised.
Electrolytes - the serum levels of potassium and sodium
are often measured
The calcium and phosphate levels are part of the kidney
tests because kidney malfunction can affect bone.
Thyroid Function Tests:
This group of tests assesses the thyroid gland which
regulates metabolism in the body. The whole group will
be ordered if there are signs of low or high thyroid
hormone output on physical examination. Sometimes
just one test - the TSH (thyroid stimulating hormone) will
be ordered to rule out a thyroid problem when
symptoms might be difficult to explain.
Sexually Transmitted Disease (STD) Blood Tests
VDRL/TPHA - these are screening tests for syphilis. If
positive usually further confirmatory tests are carried
out.
HIV - this is a screening test for the presence of Human
Immunodeficiency Virus antibody. Being an antibody it is
measuring the body's reaction to the presence of the
antigen. (Antigen refers to any invader into the body be
it virus or other agent). The antigen in this case is the
Human Immunodeficiency Virus that can lead eventually
to AIDS. Antibodies can take time for the body to
produce so they may not be measurable early in an
infection. The period for antibodies to develop may be 3
to 6 months (called the "window" period). This is why a
repeat test may be needed some time after potential
exposure.
Herpes antibodies - can be measured to assess past or
present herpes simplex infection.
Hepatitis antibody and antigen testing can be included in
the STD tests as well as with Liver Function Tests. The
various types of hepatitis can be contracted by other
means as well as sexual transmission however.
Other blood tests for infection:
Antibodies and sometimes antigens, can be measured
for other infecting agents. The commonly performed
tests include:
Epstein Barr virus
Toxoplasmosis
Cytomegalovirus
Streptococcal bacteria
Leptospirosis
Rubella virus
It requires caution interpreting these test results
because the antibody tests may often indicate past
infection - not current infection.
Blood Culture Test - this is usually carried out as an
urgent test in cases of serious infection where the
doctor suspects that a bacteria is multiplying within the
bloodstream
Blood Tests Commonly Ordered Singly
Serum Amylase - this is commonly ordered in cases of
abdominal pain to see if the pancreas gland is inflamed
or its duct obstructed.
Follicle stimulating hormone (FSH) - sustained high levels
of FSH in a woman can indicate that the menopause is
approaching or has happened.
Progesterone - this is done to assess the state of the
ovaries.
Beta Human Chorionic Gonadotrophin (HCG) - this is the
hormone produced in early pregnancy and is the basis of
the urine pregnancy tests. However sometimes the
blood levels are measured if there is concern about an
ectopic pregnancy or a molar pregnancy.
Diabetes Blood Tests
Blood sugar (plasma glucose)

Plasma glucose can be tested as a fasting specimen
(FPG) or casually (CPG). Tests taken on venous blood
drawn out of an arm vein are more accurate than finger
pick glucose tests. (Capillary blood glucose). Sometimes
plasma glucose tests are done as a "run" i.e. 3 tests over
several hours. This is commonly known as a blood sugar
series and is usually done to test control in established
diabetes. Plasma glucose can also be measured at
defined times after the patient drinks a measured
amount of glucose in water. This is done either to
establish the diagnosis of diabetes (when it is known as
the glucose tolerance test - GTT) or as a screen for
pregnancy diabetes (when it is known as the glucose
challenge test).
Glycated haemoglobin often abbreviated to HbA1c. This
is a test of average diabetes control back over the
preceding six weeks. It is now more often used for this
purpose than the Fructosamine test which is rather
similar but less accurate.
Autoimmune Disease Tests
Autoimmune diseases are a group of diseases where the
body's immune system incorrectly interprets certain of
its own tissues as a foreign invader and produces an
immune response to attack that tissue. The best known
autoimmune disease is rheumatoid arthritis where the
immune system attacks the slippery lubricated lining
inside certain joints. The blood tests try to measure
specific antibodies produced by the body against specific
tissues. Such tests include:
Rheumatoid factor
Lupus anticoagulant test
Antinuclear antibody test
The ESR test (erythrocyte sedimentation rate) is a test
on red cells but is included here as it is often used to
monitor the response of autoimmune diseases to
treatment. If raised it may be a general pointer to an
infective or inflammatory process going on in the body.
It is not diagnostic of any particular illness as such.
Drug Assays
The level of certain drugs can be measured in the serum.
The commonly performed drug assays are usually those
where the drug has a fine line between being toxic and
therapeutic. The common assays include:
Serum digoxin
Serum phenytoin
Serum theophylline
Serum Lithium
Serum alcohol
Serum Lipids
The term lipids refers to certain fats that are transported
within the bloodstream. Cholesterol is one of these.
Patients are often concerned by their total cholesterol
level which a laboratory will usually only report as a
single test if a non-fasting blood specimen was
submitted. However doctors tend to request fasting lipid
tests and read them as a group because there is "good"
cholesterol (HDL cholesterol) as well as "bad"
cholesterol (LDL and VLDL cholesterol). When making an
assessment of the patient's future risk of heart disease
or stroke the doctor has to assess these levels as well as
another fat reported in this group of tests
(Triglycerides). These are very small fatty molecules,
which are usually raised after a more fatty meal. They
can also be raised by heavy alcohol intake and obesity.
There is controversy about how important they are in
cardiovascular risk,but evidence is increasing that they
may be important.
Disease Marker Tests
Blood tests can monitor the levels of certain chemicals in
the blood as an indicator of the progress of a disease.
The best known of these tests is the PSA (prostate
specific antigen) test which is monitored in prostate
cancer. The AFP (alpha foeto-protein) is another - used
for monitoring treatment for liver cancer.
Ca-125, is used to monitor progress in ovarian cancer.
Urine Tests:
Some urine tests can be carried out in the doctor's office
and others require the laboratory.
Common urine tests include:
Glucose - as an indicator of diabetes
Note-urine testing is not reliable to exclude diabetes, as
sometimes no sugar is in the urine of a diabetic and
sometimes non diabetics may have sugar in their urine
(due to a low threshold in the kidneys).
Protein - which can be present with kidney disease or
with infection/inflammation of the kidneys or bladder or
urethra.
Microalbumin - which can be an indicator of early kidney
disease in diabetes.
Red blood cells - which indicate bleeding somewhere in
the urinary tract perhaps from infection or from a small
tear to the tract as can occur with a kidney stone, or
bleeding from a tumour in the kidney or bladder.
This usually always requires further tests (e.g.
scans,ivu,cystoscopy) to determine where the blood has
come from.
White blood cells - which indicate that the body is
fighting an infection somewhere in the urinary tract.
Bacteria tests - Bacteria can be seen under the
microscope or grown from urine streaked onto agar
plates and incubated at body temperature.
Chlamydia test - which identifies the sexually
transmitted disease chlamydia in urine.
Pregnancy test - which relies on detection of the
hormone Beta Human Chorionic Gonadatrophin in urine.
This is produced in the early stages of a foetal placenta
developing in the uterus.
The test usually becomes positive about a week after the
first missed period. If there is doubt, it may need to be
repeated again a week or so later.
A 24 hour collection of urine is sometimes ordered to
check on protein levels or to do the creatinine clearance
test to assess kidney function or to measure urine
output.
Tissue histology:
FNA = fine needle aspiration. A fine needle on a syringe
is inserted into a lesion and negative pressure is applied
to suck up some cells for microscopy. This is usually to
check for tumour cells.
Excision Biopsy. This is where an entire lesion is removed
and sliced up into thin sections for microscopy.
Biopsy. This is where a small part of a lesion is removed
for microscopy to try and make a diagnosis,
Microbiology:
Any moist area on the body can be swabbed with a
sterile cotton tipped bud, plated out on to agar jelly
plates and placed into an incubator to see if bacteria will
grow from the swab. Once the bacteria have grown they
can be identified under the microscope and tested to for
sensitivity to certain antibiotics. This is known as a the
"culture and sensitivity test" (C & S). Scrapings of tissue
or cuttings of nails can be similarly treated for fungal
lesions.
If there is a delay between taking the swab and plating it
out, it has to be stored in special transport media.
Sputum is commonly cultured for bacteria causing
bronchitis, pneumonia and tuberculosis.
Faeces can be cultured for bacterial, viral and parasitic
organisms.
Cytology:
Cytology involves obtaining a normal tissue fluid and
examining it under the microscope for early signs of
cancer cells.
The two commonest cytology tests are the cervical
smear test (pap smear) and sputum analysis for lung
cancer cells.
Source no.2
Complete Blood Count
This test, also known as a CBC, is the most common
blood test performed. It measures the types and
numbers of cells in the blood, including red and white
blood cells and platelets. This test is used to determine
general health status, screen for disorders and evaluate
nutritional status. It can help evaluate symptoms such as
weakness, fatigue and bruising, and can help diagnose
conditions such as anemia, leukemia, malaria and
infection.
Prothrombin Time
Also known as PT and Pro Time, this test measures how
long it takes blood to clot. This coagulation test
measures the presence and activity of five different
blood clotting factors. This test can screen for bleeding
abnormalities, and may also be used to monitor
medication treatments that prevent the formation of
blood clots.
Basic Metabolic Panel
This test measures glucose, sodium, potassium, calcium,
chloride, carbon dioxide, blood urea nitrogen and
creatinine which can help determine blood sugar level,
electrolyte and fluid balance as well as kidney function.
The Basic Metabolic Panel can help your doctor monitor
the effects of medications you are taking, such as high
blood pressure medicines, can help diagnose certain
conditions, or can be part of a routine health screening.
You may need to fast for up to 12 hours before this test.
Comprehensive Metabolic Panel
This test combines the Basic Metabolic Panel with six
more tests for a more comprehensive evaluation of
metabolic functions, with a focus on organ systems.
Lipid Panel
The lipid panel is a group of tests used to evaluate
cardiac risk. It includes cholesterol and triglyceride
levels.
Liver Panel critical volumes through the markings printed on their Instrument Uses
The liver panel is a combination of tests used to assess side surface.
Test tube
liver function and establish the possible presence of liver Erlenmeyer Flask, Image
tumors. Folin-Wu tube
Florence Flask: It is a flat bottomed container with a in microscopy, serology, etc.
Glass slide and
Thyroid Stimulating Hormone bubble shaped body and a protruding bottle neck as the solid backing on which
cover slips
This test screens and monitors the function of the shaped top, having more or less same use as Erlenmeyer test samples are taken
thyroid. flask. used for preparation of culture
Florence Flask, Image Petri dish media and the culture of
Hemoglobin A1C organisms they are in
This test is used to diagnose and monitor diabetes. Volumetric Flask: It has a pear-shaped body with a Glass beaker reagent storage
rather long bottle neck shaped top outlet. It is used for
Urinalysis measuring the volume of fluids whose values require gastric acid, or other
Glass flask
fluid titration
Often the first lab test performed, this is a general critical measurements.
screening test used to check for early signs of disease. It Volumetric Flask, Image for aspiration and addition of
Pasteur pipette
may also be used to monitor diabetes or kidney disease. reagents
Graduated Cylinders: These are long, parallel straight- for aspiration and addition of
sided, transparent upright containers with calibrated reagents, often of minuscule
Graduated pipettes
graduations. Its chamfered base facilitates better amounts of the material; used
Cultures standing stability. Measurement of fluid volumes done mainly in colorimetry
Cultures are used to test for diagnosis and treatment of with it are normally non critical and typically used to Syringes
infections. Illnesses such as urinary tract infections, store and monitor 24-hour urine specimens. prevention of transmission of
pneumonia, strep throat, MRSA and meningitis can be Graduated Cylinder, Image diseases (as long as not cut
detected and tested for appropriate antibiotic Disposable gloves
or perforated) to or from the
treatment. Pipets: Pipets are primarily used for measuring and user
Beaker: These are broad-mouthed, parallel-sided transferring liquids. Basically they are classified in This is used to cause an
containers with a short extended pouring spout end at following two types: artificial venous stasis by
its rim. They normally have embedded graduations for applying pressure through this
determining the volume of the contained liquids and Volumetric Pipets: These are narrow long tubes with a rubber tube. This leads to
fluids. uniform bulge at the center, broader opening at one end Tourniquet engorgement of the veins,
Beaker, Image and tapering at the other end. They are used for holding allowing them to be seen
and transferring critically accurate volumes of a more easily. Used for
Erlenmeyer flasks: These are typically flat bottomed with particular liquid. The marking TD over them indicates intravenous injections and
sloping slides. The basic shape is conical with a top they are capable of transferring a particular volume of cannulation.
terminating into a bottle neck shaped opening. They are liquid within a particular specified time limit. used for visualising minute
Microscope
available in ranges of 10 to 4000ml and used for holding Volumetric Pipet, structures, including microbes
and mixing liquids, solutions and for measuring less
Bunsen burner or • Hematology Cathode ray
'
spirit lamps or source of fire / heat analyzer oscilloscope
candles
• Semiauto analyzer historically, used in human or
Recording
used to separate particles animal experiments to
• Reflotron kymograph
dispersed in a liquid measure and record data
Ultracentrifuge Previously this was widely
according to their molecular
Long historically, used in or human
mass used to detect various things
extension kymogra animal experiments to
in bold fluids
used to detect and ph measure and record data
like proteins (natural,
classify serum proteins or Setup
Electrophoresis app infective, those produced by Label-free detection of
proteins from any other for radioimmunoass
aratus the body in reaction to molecule binding. Used to
source; also used for DNA ay or RIA
disease, or cancer Surface plasmon determine kinetic constants of
separation
related), tumor resonance the interaction (ka, kd, KD). Can
Chromatography: markers, hormones, viruses ( also be used for
hepatitis, or HIV), etc. thermodynamic analysis.
• Gas
chromatography or It is presently widely used to
Gas liquid detect various things in bold
chromatography (G fluids like proteins (natural,
LC) Setup for enzyme infective, those produced by
linked the body in reaction to
• Planar
immunosorbant disease, or cancer
chromatography
assay (ELISA) related), tumor
• Paper markers, hormones, viruses (
chromatography hepatitis, HIV), etc. It has
• Thin layer replaced RIA.
chromatography used in photochemical
• Affinity analysis and quantitative
chromatography Colorimeter estimation of substances such
as blood sugar, creatinine,
• Ion exchange and hemoglobin.
chromatography
used to measure the amount
• Size exclusion Burette of acid or alkali used
chromatography in titration
• Countercurrent General laboratory
chromatography stands, racks, filter
• Countercurrent paper, reagents,
chromatography etc.
as a source of high voltage
Induction coils
electricity