Laboratory is based I the 4th floor of the critical care process all our phil book client tests
ts so they will
building. We are made up of a team of highly skilled
health care centers support staff. The laboratory is
composed of 3 discipline we have clinical biochemistry,
microbiology, hematology and blood bank. All 3
disciplines provided 24/7 service for both our primary
and secondary care users for the southeastern trust. In
doing so we process over 1Million samples a year.
SPECIMEN RECEPTION (ULTER HOSPITAL LAB)
Ruslan reception is responsible for the initial stage of
sample process and in laboratory we get samples from
Jps? JPS wards and write patients in the hospital. Some
of those may be urgent and we need to look out for
those and get them across to the relevant disciple
immediately. The sample types that we get are blood,
urine, sputum, swabs feces, and the disciplines we have
here at the Ulster are biochemistry, hematology and
blood transfusion and microbiology. Specimen
reception is responsible for checking the details and
samples checking that the correct sample has been
received and that it meets all the essential criteria.
Then, any preparation that’s needed on it is done and
the details are entered into the computer by manual
process, where we type all the details of the patient,
the tests, and the sample dates into the computer or a
system by electronic order, comes from the wards on
where we can just scan sample. Following these any
other preparation, we distribute the samples to the
relevant disciplines.
HAEMATOLOGY
Arrived in hematology and either via the pneumatic
shoot system or through a specimen section so special
section will process anything that are retained and then
label them up and bring them over to us and anything
urgent will come in pneumatic shaped and we’ll keep
the forms here at the urgent bench so that we have
them if we need to fill in anything right to the wards.
Each sample will get its own unique bar code that will
be distinctive to the patient. Before we set the samples
on the track, we mix them roughly each M its ten times
and then we place them on the start yard and once they
arrive on the start anything that has been labeled up
and put onto the computer system and will transmit to
our analyzers so they will know what samples needs,
what tests, the samples will come along and start track
and then we’ll move on to the first analyzer in
hematology. We have 2 identical analyzers and they
measure your hemoglobin, white cells and platelets. So
whenever the sample has been processed, for it spilled
blood kind, which is our main hematology test and it
will move to the next and part of the track which is our
sites dinner. What is does is it allows for it some of the
patient sample and it’ll spread it onto a slide and dry it
and unset to any information regarding that patient on
it so that we can look at it easily afterwards and with
these slides then our chain biomedical scientists who
look under the microscope for various reasons it could
be and maybe new form of leukemia and diagnose in an
anemia it could be a multitude of thing. Examples are
sent down the track to our inter liner ASR on laser but
our analyzer has a calculation on board that allows it to
and process within half an hour so we can get results
back quicker to the patient and so it’s just something to
note it’ll take an additional 30 minutes on top of your
for booking. What if a sample is gonna be faster for an
FP, CNN, ESR. Whenever the sample has had its fill but
kind it’s the ESR on its side and our analyzer has a
storage capability so it’ll archive all our samples for is
and these 2 main racks and it’ll put them in a specific
position so if we need to go back to the particular
sample for whatever reason we know how easily
difference. We also have the ability to carry out some
specialized testing here so we would do specialist
sighted chemistry tests, malarial screen, sickle cell and
actually were the regional center for plasma viscosity.
COAGULATION
This is the coagulation section and here we look at
coagulation of clotting over here the sample are slightly
different to hematology in hematology we’ve seen the
purple top EDTA tubes and here we have blue top
sodium citrate samples and the difference really is that
anticoagulant at the container so in coagulant were
quite strict about our minimum fill so here they must be
filled to the minimum fill layer before we process the
samples. We will spend in darkness centrifuge to
separate the plasma from the red cells and the reason
we do that is because that is the section of the
component of the blood that were interested in the
plasma contains the coagulation factors and that’s
what’s necessary for clotting so that’s were measuring
here. I’ve said about the minimum fill and the reason
were quite strict about that over in regulation is
because sodium citrate that’s present in these tubes is a
liquid on the pregnant or as the EDTA and this tube is
spread on and its more like a fighter and before you fill
this tube there’s already a bit of dilution. Dilutional
effect by having a liquid in there before you start so that
that’s the reason that we would be quite strict. By the
way these analyzers work is they will process the
sample on a rack of coded rack similar to hematology
and it’ll ask for it like some of the plasma and the
regions on board and will combine into a small cube at
such as this it’ll shine a light through and the length of
time it takes for the light to no longer to be able to
shine through is length the time it takes to clot and
utilize the methods known as optical density in order to
measure this in Craig elation any sample that are grossly
penalized or Lupino and will flag up by the analyzer and
let us know and then are and biomedical scientists
would come along and examine those samples and
investigate if they were and the results are accurate or
not any results then will be sent back to our main
computer screen. Ill move at some weight I’ve sent
them to the clinical area.
HEMATOLOGY & BLOOD TRANSFUSION BLOOD BANK
This is the blood bank department samples arrived here
either b pneumatic shoot system or the deliberative or
by specimen section but they’ll never be labeled by
specimen section. We keep the forms and samples
ourselves here and said sample is labeled up and a
corresponsing label put onto the form. 3 analytical
stage here is to spend the sample down in a centrifuge
to separate the plasma from the red cells and once
they’ve been spin down then they go onto racks and are
sent to RM analyzers. As with other sections and we
have two identical analyzers again to maintain the
workflow and one we will specifically keep for an
antibody identification and cross matches and other for
grip and screen switch our main test requests. In
association trust, we have a policy in place that means
that wwe will not transfuse patients unless we have a
confirmed sample cases so its beneficial to get a
confirmend sample just asap and in order for us to
relesease the blood to the patient and the clinical area.
People in here that usually quite amaze that this is the
only stick but that we have an enire hospital but this is
it. And we can get more blood from the northern blood
transfusion service. So we keep various amounts of
each different blood type and depend on how common
there are in the population and how frequently we
think we might need them and we keep only 12 units of
emergency of own negative blood and of that we keep
4 for emergency purposes so if we were to get and
perhaps maybe a car crash or something urgent and our
massive blood transfuisoon protocol was initiated and
we have blood that we can issue. We also have varius
other blood products and we hold albumin and anti-D
for maternity patients and human immunoglobulin and
prothrombin complex concentrate as well as frozen
products such as fresh frozen plasma and carb
impotence.
When blood is requested for a cross match it can either
be requested in a regional form or via telephone and if
they fill in the blood bank whenever blood has been
cross-matched and we will issue it to that specific
patient and notify the clinical area that it is read for
collection then the clinical I will send a porter or a
member of the community if it’s in the case of Murray
carry hospice patient or district nurse to collect the
blood and this is the room that they do it. So we have
an issue fridge and an issue platelet agitator and then
our ledger and we put the unit of blood into the fridge
or the fitted into the agitator the blood transfusion
policy of the SE trust complies with the current BC, SH
guideline in that patents blood group is confirmed with
a second sample prior transfusion. The blood back will
contact the clinical area should a confirmation sample
be required.
MICROBIOLOGY (SPECIMEN PROCESSING)
This is a microbiology lab and in the microbiology lab we
detect microorganisms associated with causing disease
such as bacteria, fungi, viruses and parasites. We also
would determine treatment options and this is done
largely by antimicrobial susucptibility testing. In terms
of the samples we receive we would receive a various
range off sample types.
This section we would process a number of swabs,
fluids and tissues. Swabs would be received in container
like this. This swabs will have been taken and placed
into the container. This fluid in the bottom is any
bacteria present will be in the bottom of the container.
The samples are then added to this rack where they’ll
be then added to this rack where they’ll be then
processed on our walk away specimen processor.
This is our walk away specimen processor its called
previous achucu. We load up all the media that we
require for each particular sample type onto the left
hand side then the samples that we want processed we
just put into this compartment. Chck that the crack
plates have been loaded on the left had side and then
start. The fluid form the bootom of the container is
aspirated onto each appropriate media type. You can
see down here ppossibly theres a labeler. And this
labeler will label each indiv plate with the accession
number and patient details and once the specimens ve
processed we will get it right here in this Ipad cassette.
The samples have been processed. The plates which
have been inoculated with the fluid form the swabs.
They come out enter these in a twit cassettes so youll
be able to see here and how they’re labeled up so they
relabeled u with the extenson number as well as the
type of swab that there was initially and fit onto the
system so these plates here are typical plates that we
would set up. This is a culture plate after 24 hrs
incubation. You can see the bacterial colonies growing
the whole way around the plate and but what most
useful to us are these indiv colonies at the end where
we can do further work on and help determine the
antibiotic of choice for the patient.
MICROBIOLOGY (BLOOD CUTURE)
We receive approximately between 20 and 30 blood
cultures per day so your blood is normally a sterile fluid
so there shouldn’t be any bacteria grow in there and if
there are then obviously your patient has a problem. So
basically what hapend is that if your patient spikes the
temp the doctors and nurses will take a blood cultures
as a set of blood cultures so we will receive something
like this. Checking of smaples that we received. Fivide
the form form the bottle, remove your bottles again and
checking of details if it is matched. And then we give it
an accession number now this links to our bottles with
our form. Next thing were going to do is to note our
blood cultures into our 37 degrees incubator. Scan the
barcode again and load it into it. Those flow cultures
will stay in there for 5 days If the blood culture is
negative and there no bacteria it will be released after
that time as no growth. And if however there is bacteria
found, it will start to multiply. Green color no growth of
bacteria (negative). Carbon dioxide has caused the color
change (positive). Positive bottle try to inoculate the
blood form the bottle onto the pips. First, sterilize the
top of the bottle with alcohol and use a subculture one
side and little channel on the other so the needle goes
into the top of septum and he removes the sterile cords
and the channel is just here at the top. When he tis the
bottle upside on the blood will flow slowly and
hopefully freely from the bottle onto the agar just like
so. He’s gonna manually spread the blood cross a bit
unlike our previe automated machine. This section is all
down manually so he’s making a well at the top of the
flip and he’s streaking out that blood for single colonies.
The next stage is a grain stain. Its going to prepare a
glass slide and drop the blood on top of the surface its
gonna spread that out make a thin smear and then he’s
gonna heat fix it on a hot plate. And then enxt stage
when that dired will perform a grain stain where hes
gonna flood with several different reagents to reveal
actual bugs that are present in that blood and we look
up under the microscope. Bursted white blood cells on
the background this little gram positive cocci is present
in the blood and these are actually the bacteria growing
into your blood.
Next sample is CSF which means cerebral spinal fluid,
now this is taken one through meningities or
hemorrhage so what happens is on the wards they
would take a lumbar puncture and it would be
discounted into 3 bottles and should be numbered. The
first one w ekeep is RBC for referral for viruses, second
is bacteriology work on it. Take the bottle to count
contents into it centrifuge tibes spin it down and
concentrates any bacteria that are present in the basis
of conical tube and perform a grain stain. We would
conduct a cell count. Inidicate where there is a viral or
bacterial infection.
MICROBIOLOGY EPIDMIOLOGY
This is where we screen of mrsa. Screening bacteria
with no amorous present. Rest 12-15 hrs. however if
there is amorus present then a whole gambit of control
of infection swings and then we reported as such. When
we detect amorous we use chromogenic agar in this
section.
MICROBIOLOGY CATEGORY 3
Category 3 lab we process feces, sputums. We use these
to help determine call any cause of lower respiratory
tract infection nd a couple of example of bacteria that
we may isolate to other sample are hemolysis influenza
or streptococcus pneumonia. In term sof feces and
there are number of examination carried out there and
examining for enteric infection and example of bacteria
slipped are salmonella, campylobacter and cdifficile.
Will also look for parasites, patient away from foreign
country os they must bring home some parasites. All
work is carried out her ein category 3 so we may deal
high risk sepecimens. So we could have risk of TB from
the sputum samples so everything has to be carried. We
wear blue colored clothes so different sa white coat in
the lab

MICROBIOLOGY URINE SECTION

Those s looked at directly with through microscopy and

we culture single urine as well. So pretty much what
happens is every sample tends to microcopy they want
to pass into a machine it takes 10 snapshots and brings
up the pic on the screen this result then transfereed to
the somputer. If its negative sample which all no
growth. If there is UTI you see there 3 organisms
groantibiotic nag rrequest ren sila. wing.

CLINICAL BIOCHEMISTRY

These yellow table sample we get about 1600 of these a

day and we do about average 15 test on sample. First
thing happens is all of our samples go onto pre
analytics. It scans a barcode on each. Processing sample
and getting it ready for analysis. It mixed the sample.
There isn’t sample is then capped and it gets archived.
IAC module ions sensitive elctrose. 2000 test an hour.
Very quick 3 seconds for sample. Primary chemistry
analyzers. Can run 400 tests at the same tie for
measuring total protein and glucose. 502 module which
is another spectrophotometer measuring of color
change. We add antibody specific to the cuvette and
mix it together. Measure the amount if light absorbed.
Immunoassay analyzer, we can reason antibody to
whatever we looking for like thyroid stimulating
hormone. Measuring blood glucose level-HBA1C.
diabetic controls.

Mnanula section of biochem which deal with protein

electrophosis its used for lookingfor signs of accumulate
condition called multiple myeloma. Capillary
electrophoresis machinepasses small amount of serum
from blood through a very narrow capillaries based on
the size and charge. We get a couple of lovely graph.
Looking fro any abnormalities one example is that you
have a normal pattern