Quick guide to Laboratory Medicine: a student's overview - Armando Guerra-Ruiz - ebook

Quick guide to Laboratory Medicine: a student's overview ebook

Armando Guerra-Ruiz

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This book provides an overview of useful laboratory tests as complementary tests for the diagnosis of common ailments and diseases in standard medical practice. The reader will find a concise but detailed guide to the tests, their rationale and their interpretation.

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Discover Bioworld

Discover Bioworld

This book provides an overview of useful laboratory tests as complementary tests for the diagnosis of common ailments and diseases in standard medical practice. The reader will find a concise but detailed guide to the tests, their rationale and their interpretation

This book provides an overview of useful laboratory tests as complementary tests for the diagnosis of common ailments and diseases in standard medical practice. The reader will find a concise but detailed guide to the tests, their rationale and their interpretation

Quick Guide to Laboratory Medicine

A student´s overview

Quick Guide to Laboratory Medicine

A student´s overview

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Quick guide to Laboratory Medicine: a student's overview

Armando Guerra-Ruiz, Bernardo Lavín, Mayte García Unzueta

© 2017 Discover BioworldAll rights reserved 

 

Armando R. Guerra Ruiz

[email protected]

 

ISBN: 978-3-96255-174-2

Preface

 

 

 

The clinical laboratory is the place where a multidisciplinary team formed by the clinical pathologist or clinical analyst, laboratory professionals and technicians in clinical analysis, analyze human biological samples that contribute to the study, prevention, diagnosis and treatment of diseases. It is also known as clinical pathology laboratory and uses the methodologies of various disciplines such as biochemistry - also called clinical chemistry - hematology, immunology and microbiology. In the clinical laboratory different biological samples, such as blood, urine, feces, synovial fluid (joints), cerebrospinal fluid, pharyngeal and vaginal exudates, among other types of samples are obtained and studied.

Laboratory medicine professionals play an essential role on healthcare teams by providing vital guidance so patients get the care they need.

The training of the professionals in charge of this discipline is of the utmost importance since they constitute an interface of encounter between the clinical practitioners and the technology, the biomarkers and the scientific evidence that is nowadays in the base of the majority of the clinical decisions. They constitute an unavoidable link of quality medical care, and contribute with their work to the consolidation of evidence-based medicine.

This book aims to be a guide to the path that a student should take to study the laboratory medicine to become a professional well trained in that discipline and therefore be able to add value to the chain of provision of quality health care.

 

M. Egan, PhD

Discover Bioworld

 

 

Chapter 1. Emergency Laboratory

 

Emergency Laboratory

The clinical laboratory plays an essential role in the functioning of the hospital emergency services and others that require a fast response time. Response time is directed influenced by the characteristics of the patient attended (intensive care unit, day hospital, dialysis, etc.)

Not all biological quantities that can be measured in a clinical laboratory are of interest to be measured in an emergency laboratory. In some cases it is straight forward to determine if a test is of interest for urgent measurement; however in other cases this distinction is not so clear and there is still controversy about the usefulness of some metabolites in an urgent medical intervention. It is useful to consult local entities (societies, associations, legal obligations, etc.) to determine the extent of an urgent medical laboratory pipeline.

Some of the aspects to take into account when designing an emergency laboratory would be:

Definition of the role and tasks of the emergency laboratory. Integration in the dynamics of hospital emergency care. Extension to cases of admissions that require a rapid response. Preanalytic, routes of arrival of the samples, control of labeling, different biological samples, purpose, and importance of the conditions of the sample.

Determinations that are made in the emergency laboratory. Analysis of biochemistry, hematology, elemental and sediment, analysis of arterial and venous gasometry, hormones of urgency, osmolarity of biological fluids. Integration in clinical care.

Request processing system. Contact and familiarization with the request handling system. Management of the computerized laboratory system (LIS). Functioning of the LIS. Interaction with the Hospital Information System (HIS). Interaction of the LIS with the automatic analyzers used in the emergency laboratory. Common problems and their solution or treatment. Interaction with the results viewer.

Biochemistry of Emergencies. Main determinations. Determinations available in the catalog. Principles and rationale of the determinations. Methods and techniques. Analytical techniques available in analyzers. Possible interferences. Range of normality, range of technique. Alarm values. How to deal with alarm values. Most of these determinations are also performed in the routine biochemistry laboratory so the list of determinations are detailed in Annex 1.

Hormones of emergency. Available analytical techniques. Determinations available in the catalog. Principles and basis of operation of the determinations. Possible interferences. Range of normality, range of technique, and alarm values. Cases of pre, intra and post-surgical analyzes.

 

Emergency biochemistry.

Automated analysis using the Dimension X pand plus (Siemens Healthcare) analyzer. Spectrophotometry techniques. Main markers of serum, urine or biological fluids. Acquisition of skills in the management of equipment, calibration of techniques, internal quality control, maintenance and problem solving, cooperation and communication with faculties. Communication with technical support.

An example of biochemical parameters pipeline for an emergency laboratory can be consulted in appendix 1.

 

Emergency hematology.

The hemogram is a complementary test considered as basic in any emergency department, both hospital and prehospital. The three cell blood series (red blood cells, leukocytes and platelets) are counted. The number and differentiation of leukocytes is reported. For its correct valuation must take into consideration not only its percentage value but also the absolute figures. The objective of this study is to help establish a diagnosis, although it can also serve as a prognostic factor and as a control of the evolution of a disease.

For these reasons, white blood cell count is one of the usual tests to be performed on every patient entering, regardless of disease. Second, we find the count of the red series: Hematocrit, Hemoglobin, Hematocrit, Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, Medium Corpuscular Hemoglobin Concentration, which can be affected in both acute (blood loss) and chronic (Anemia of chronic diseases, iron deficiency anemia, etc.).

Finally, as regards the number of platelets, it is very important to note that we can find false low platelet numbers due to the existence of platelet aggregation, either spontaneously, by agglutinins or by a clot due to a defective extraction of blood.

 

Emergency Urinalysis

Urinalysis (Elemental and Sediment). The study of the sediment of the urine is a simple and valuable diagnostic method for its profitability. The procedures used to perform the systematic analysis of urine are physical examination (color, turbidity ...), chemical analysis by means of the test strip (density, pH, protein, glucose, ketones, bilirubin , Urobilinogen, nitrites, leukocytes and hemoglobin) and finally the microscopic study of the sediment that must be performed when the chemical analysis is altered and we can show the presence of cellular elements (leukocytes, red blood cells and different types of epithelial cells), cylinders (Cell hyaline, granular or wax), bacteria, yeasts, parasites whose presence guides us to different pathologies.

Urinalysis (Elemental and Sediment). Physical analysis (color, turbidity ...), chemical analysis by means of the test strip (density, pH, proteins, glucose, ketones, bilirubin, urobilinogen, nitrites, leucocytes and hemoglobin) and microscopic study of the sediment: presence Of cellular elements (leukocytes, red cells and different types of epithelial cells), cylinders (hyaline cells, granuloses or waxes), bacteria, yeasts, parasites whose presence guides us to different pathologies. Particularities of the determinations in the area.

 

Arterial blood gas analysis.