SEROLOGY

LABORATORY
MANUAL
TABLE OF CONTENTS

 
•Workplace Hazards and Their III Effects
• 
•Exercise No. 1 - Basic Equipment in the Serology Laboratory
•Exercise No. 2 - Phlebotomy
•Exercise No. 3 - Antibody and Antigen Structure
•Exercise No. 4 - Complement
•Exercise No. 5 - Serum and Red Blood Cell Suspension Preparation
•Exercise No. 6 - Serial Dilution
•Exercise No. 7 - Agglutination Reaction
•Exercise No. 8 - Hemolysis
•Exercise No. 9 - C-Reactive Protein Slide Test
•Exercise No. 10 - Febrile Antigen Direct/Widal Test
•Exercise No. 11 - Anti-Streptolysin O Slide Test
•Exercise No. 12 - One Step Malaria HRP-II (P.f) and pLDH(pan) Antigen Rapid Test
•Exercise No. 13 - One Step Test for HBsAg
•Exercise No. 14 - Dengue IgG/IgM Antibody Test

Animal Inoculation Exercises 

•Exercise No. 15 - Preparation of Immunizing Materials
•Exercise No. 16 - Inoculation and Bleeding of Animals
•Exercise No. 17 - Mouse Protection Test
•Exercise No. 18 - Anaphylactic Shock

Miscellaneous Exercises 
•Exercise No. 19 - Toxin-Antitoxin Reactions
•Exercise No. 20 - Phagocytosis 

Other Exercises
•Exercise No. 21 - Mitogen Studies
• Exercise No. 22 - T-cell Rosettes (E Rosettes)
WORKPLACE HAZARDS
AND THEIR ILL EFFECTS
Introduction

• Goals of Occupational Health by the Joint International Labor

Organization-World Health,Organization (ILO-WHO) Committee on
Occupational Health –
• The promotion and maintenance of the highest degree of physical, mental,
and social well-being of workers in all occupations;
• The prevention among its workers of departures from health caused by
their working conditions; the protection of workers in their employment
from risks usually from factors adverse to health;
• The placing and maintenance of the worker in an occupational
environment adapted to his/her physiological and psychological ability; and
• The adaptation of work to the worker and each worker to his/her job.
• 
Classification of Hazards

Occupational Hazards
 Factors found in the workplace that can cause diseases, injuries, or deviations from health and
may be classified as physical, chemical, biological, and ergonomic hazards
•  
1. Physical agents include excessive levels of noise, vibration, extremes of temperature and
pressure, and ionizing and non-ionizing radiation.
2. Biologic agents cause disease through infection, or by affecting the immune mechanism.
3. Chemical hazards are caused by gases, vapors, or aerosols workers come in contact with through
the performance of their tasks.
4. Ergonomic stressors include improperly designed tools or work areas, improper lifting or reaching,
poor visual conditions and other conditions in the workplace that may lead to accidents and illness
or discomfort on the part of the workers.
Factors that Influence Workers’ Response to Hazards
1. Genetic or Hereditary
2. Age
3. Gender
4. Medical History
Variables that Influence Effects of Hazards to the Workers 
5. Physical properties of the hazards
6. Multiplicity of exposure to the hazards
7. Duration of exposure
8. Timing of exposure
9. Magnitude of exposure
Chemical Hazards

Chemical agents may occur as –

1.Gas (e.g., carbon monoxide, hydrogen sulfide, carbon dioxide)
2.Vapor (e.g., solvent, acid)
3.Aerosol (e.g., dust, fume, smoke, mist, fog)\

Examples of Patterns of Effects from Exposure to Chemical Hazards

 
1. Acute – immediate effect from high dose exposure (e.g., pesticide poising)
2. Chronic – effects from low dose long term exposure (e.g., lead poisoning, cancer from
benzene)
3. Carcinogenic effect
4. Allergic reaction or effect, etc.
 •Routes of Entry of Chemical Hazards into the Human Body

1. Through the skin (i.e., absorption)

2. Through the gastro-intestinal tract (i.e., ingestion)
3. Through the respiratory tract (i.e., inhalation)
•  
• NOTE – In the occupational setting, the most important route of absorption is through
the lungs or inhalation.

Routes by which the Body Excretes the Chemical Hazards

1. Gastrointestinal Tract (i.e., through the feces)

2. Kidneys (i.e., through the kidney)
3. Lungs (i.e., as one exhales)
4. Secretory Structures (i.e., through the sweat glands, breast milk, etc.)
•Factors which Affect Absorption of Chemical Hazards
•  
1. Water Solubility
2. Particle Size
3. Defense mechanisms of the Host or Human Body
Table 1. Renal Diseases that may arise from Chemical Exposure in the Workplace
CAUSATIVE AGENT INDUSTRY DISEASE

Chronic renal failure,

  Battery, chemical renal stones (cadmium),
Mercury, Lead, Cadmium industry, battery nephritic syndrome
manufacturing (mercury)

Chloroform, Carbon Solvent, chemical Acute Renal Failure

tetrachloride industry
Carbon disulfide Solvents, pesticide Chronic renal failure
Table 2. Respiratory Diseases that may arise from Chemical Exposure in the Workplace
CAUSATIVE AGENT INDUSTRY/PROCESS DISEASE
Mining, sandblasting, Asbestosis, coal workers’
Inorganic dust
construction pneumoconiosis
Hemp, flax   Textile, cotton, Byssinosis
Mold Agriculture Farmer’s Lung, Bagassosis
Solvent, Ammonia, Chemical process or industry, Irritation, inflammation,
pulp and paper production,
Formaldehyde edema
laboratory
Diiisocyanate, Varnish Plastic, platinum jeweler, Asthma
electroplating
Pigment, plating process,
Nickel, Arsenic, Chromium Cancer
metal refining
Table 3. Occupational Hematologic (Blood) Disease
CAUSATIVE AGENT INDUSTRY/PROCESS DISEASE
Battery manufacturing, lead
Lead smelting Anemia

Benzene Solvent, soap manufacturing Aplastic anemia

Arsine gas Chemical industry Hemolysis of red blood cells
 Table 4. Skin Diseases that may arise from Chemical Exposure in the Workplace
CAUSATIVE AGENT INDUSTRY/PROCESS DISEASE
Plastic, Epoxides Plastic, varnish Allergic contact dermatitis
Chemical industry,
Sodium hydroxide, Acid laundering Irritant contact dermatitis

Cement Construction, cement Burn, irritation, contact

manufacturing dermatitis
Cutting oil, Grease Machine tool operation Acne
Chlorinated hydrocarbon Chemical processes Chloracne
Arsenic, Tar, Polycyclic Petroleum refinery, asphalt Skin Cancer
hydrocarbon worker
Table 5. Occupational Liver Disease
CAUSATIVE AGENT INDUSTRY/PROCESS DISEASE
Carbon tetrachloride Cleaning fluid, dry cleaner Acute hepatotoxicity
Arsenic, Chlorinated Smelting, insecticide, Cirrhosis
hydrocarbon chemical industry
Epoxy Resin Rubber, synthetic fabric Acute cholestatic hepatitis
Vinyl chloride, Aflatoxin Plastic, vinyl chloride Liver cancer
monomer
Table 6. Occupational Cardiovascular Diseases
CAUSATIVE AGENT INDUSTRY/PROCESS DISEASE
Lead, Cadmium Battery manufacturing, Hypertension
recycling
Carbon disulfide Degreasing, dry cleaning Atherosclerosis
Fluorocarbon, Refrigeration, solvent worker Arrhythmias
Trichloroethylene
Nitrate Explosive Angina, myocardial infarction
 Table 7. Occupational Lead Exposure – Risk Factors

  INCREASED RISK DECREASED RISK

 High processing temperature,
  especially 1,000C  Low temperature, 500C
   Extensive fume, dust, or aerosol  Low dust exposure
The process itself formation  Automation
 Primitive working method
 Poor housekeeping
   Poor personal hygiene  Efficient local and general
   Ignorance (e.g., when protective ventilation
  equipment is required but not  Prevention of spread of
General hygienic level of used) lead dust (e.g., moistening
the workplace  Smoking and eating in the the floor)
workplace
•Effects of Lead Poisoning –
1. Hypertension
2. Decreased hearing acuity
3. Nephropathy or renal failure
4. Infertility (men)
5. Frank anemia
6. Peripheral neuropathy
7. Encephalopathy – seizures
Physical Hazards

1. Noise
2. Extremes of Temperatures (e.g., very warm and very cold)
3. Inadequate Illumination
4. Radiation (e.g., ionizing and non-ionizing)
5. Vibration
A.Noise
1. Any unwanted or undesirable sound
2. Effects of noise depend on –
a. Intensity (i.e., loudness)
b. Duration of the sound
c. Frequency of the sound
 Approximate Decibel
Level DECIBEL (dB) EXAMPLE
0 The quietest sound one can hear
30 Whisper, quiet library
60 Normal conversation, sewing machine,
typewriter
70 – 80 Television
90 Lawnmower, shop tools, truck traffic (Eight
hours per day is the maximum exposure)
100 Chainsaw, pneumatic drill, snowmobile
115 Sandblasting, loud rock concert, auto horn
140 Gun muzzle blast, jet engine
Permissible Noise Exposure
DURATION PER DAY (HOUR) SOUND LEVEL (dB)
8 90
6 92
4 95
3 97
2 100
1½ 102
1 105
½ 110
¼ or Less 115
 Harmful Effects of Noise
1. Hearing Damage
2. Interferes with work performance
3. Disturbs relaxation and sleep
4. Hypertension
5. Hyperacidity
6. Palpitations
7. Stress-related disorders
 Harmful Effects of Noise
1. Hearing Damage
2. Interferes with work performance
3. Disturbs relaxation and sleep
4. Hypertension
5. Hyperacidity
6. Palpitations
7. Stress-related disorders
Early Signs of Hearing Loss
8. Difficulty in understanding spoken words in a noisy environment
9. Need to be near or look at the person speaking to help understand words
10.Familiar sounds are muffled
11.Complaints that people do not speak clearly
12.Ringing noises in the ears (i.e., tinnitus)
 
A. Vibration
 Physical factor which affects man by transmission of
mechanical energy from oscillating sources
 Subdivisions
o Whole body vibration
o Segmental vibration
Potential Occupational Exposures
Whole Body Vibration Segmental Vibration
Truck Drivers Chain sawyers
Bus Drivers Pneumatic tool operators (e.g.,
Heavy equipment operators chippers, staple gun operators,
Farm vehicle and tractor operators construction and road
Foundry workers (e.g., mold operators)
shakeout, forklift trucks, overhead Mining (e.g., jack leg and hand
cranes) tool)
Railroads (e.g., engineers, Electrical grinder operators
conductors, track repair workers) Metal extrusion operators
Forklift operators Wood products manufacturing
Health Effects of Vibration
Whole Body Vibration
General Stressor
Changes in the Central Nervous System (CNS)
Damage in bone structure
Disturbance in nerve conduction
Disturbance in vision and gastro-intestinal function
Increase in oxygen consumption
Increase in pulmonary ventilation
Segmental Vibration
Localized stressor to the fingers and hands –
can cause damage to the bones and joints of
the upper extremities
 
Hands-Arm Vibration Syndrome –
 
Raynaud’s phenomenon or “White Fingers” –
fingers blanch or turn white especially when
vibration exposure is also accompanied by
exposure to cold weather
Tenosynovitis
Dupuytren’s Contractures
 Inadequate Illumination
 
Evaluation for illumination shall consider –
 
1.Quantity – depends on task (i.e. too much, too little)
2.Quality – shadows, silhouettes, overcast, reflection, glare
Recommended Illumination Level
AREA OF OPERATION MINIMUM LIGHTING LEVEL
(lux)
Cutting cloth, fine machining ≥2,000
Transcribing, handwriting, 1,000
drafting
Welding, first aid station 500
Lunch room, rest room 300
 Usual Complaints of Inadequate Illumination
1. Visual fatigue
2. Double Vision
3. Headache
4. Painful irritation
5. Lacrimation, conjunctivitis
 
Occupational Effects of Visual Fatigue
6. Loss of productivity
7. Increased accident rate
8. More mistakes
9. Lowering of quality
10. Visual complaint
 
Heat
Heat is a form of thermal energy which may come from –
1. Body metabolism
2. Increase physical activities
Radiation from hot surfaces or objects or from the sun and
by-products of industrial processes
 Table 8. Summary of Disorders due to Heat
Stress
MAIN CLINICAL
DISORDER CAUSE TREATMENT PROGNOSIS
FEATURE
Milaria Rubra Malfunction of Pruritic Rash Symptomatic Good
sweat glands
Heat Cramp Loss of water and Cramps in limbs Rest, fluid with Complete recovery is
electrolytes added salt or saline usual
Physical exertion,Dizziness, blurring of Rest, cooling in
Heat exhaustion loss of water and vision, clammy, well-ventilated Complete recovery is
usual
electrolyte sweaty, cold skin surroundings
Failure of Convulsion, muscle Stripping down, High mortality,
twitching, delirium, sequelae may include
temperature cooling with ice
Heat stroke control center in hot dry skin, cyanosis, baths, poor memory and
body temperature concentration,
the brain corticosteroids
+41.1C or higher headache
Recommendations for Working in Hot Conditions
 
1. Acclimatization is necessary
2. Encourage drinking small amount of fluids at frequent intervals
3. The greater the heat and physical load, the more frequent the
cooling periods
4. Source of drinking water should be made available and if
possible near the workers
5. Proper clothing should be worn, clothing adequate enough to
shield workers from the heat source
 
 Cold Stress 
Occupational Exposures
1. Cooling room workers
2. Dry ice workers
3. Ice makers
4. Out-of-door workers during cold weather
5. Cold storage workers 
Cold-Induced injuries
Frostbite
 Fingers, toes, cheeks, nose, and ears are the most susceptible
 Characterized by reddening of the skin, localized burning pain, and numbness
Trench Foot (Immersion Foot)
 Results from prolonged exposure of the lower extremities to cold and moisture (i.e., +32F to
+50F or 0C to +10C)
 Neurovascular damage, and tissue anoxia follows
 Characterized by numbness, painful paresthesias, followed by leg
cramps, vesiculation, ulceration, and gangrene
General Hypothermia
 Results from being in cold weather or submerged in cold water
 Can lead to unconsciousness and death
 
NOTE – Control measures are to provide adequate clothing
including insulated gloves, footwear, and headgear –
1. Build barriers around the worksite to block the wind
2. Supply workers with warm beverages
A. Radiation
Ionizing Radiation – any electromagnetic or particulate radiation capable of
producing ion pairs by interaction with matter, particularly important biologically since
media can be altered.
1. Ionized atom in DNA molecule may be altered, causing –
 Cell Death
 Change in cell reproduction and division
 Mutation

Examples of Ionizing Radiation

1. Alpha particle
2. Beta particle
3. Neutron
4. X and Gamma Ray
General Population Exposure
Medical
Radon
Terrestrial (e.g., Cosmic, Fallout, Industrial, Internal

 
Acute Effects of Ionizing Radiation (within days, 4
weeks to 3 months)
1. Skin (e.g., erythema)
2. Bone Marrow (e.g., depressed white cell count,
impaired immune system)
3. Intestine (e.g., depletion of intestinal villi – can result
in fatal dysentery-like syndrome)
4. Testes (e.g., decreased sperm count, sterility)
5. Lungs (e.g., pneumonitis, respiratory failure)
6. Lens of the Eye (e.g., opacities, cataracts)
 Delayed effects – probability of an effect is proportional to the
dose; severity is independent of the dose
1. Skin cancer
2. Leukemias
3. Effects on Prenatal Irradiation
 Pre-implantation – embryonic death
 Development and formation of organs – congenital abnormalities
 Ionizing Radiation
Sources and Effects of Non-ionizing Radiation
1. Ultraviolet ray (e.g., erythema premature aging of the skin, skin
cancer, cataract, retinal injury, welder’s flash)
2. Infrared (e.g., corneal and conjunctival burn, cataract, retinal injury)
3. Laser (e.g., potential hazard to the skin and eye)
4. Microwave (e.g., current conductions, heat)
5. Radiofrequency (e.g., current conduction, heat)
6. Extreme low frequency (e.g., current conduction)
7. Static field (e.g., static electrical shock)
Biologic Hazard
 Caused by living organisms which include insects, molds, fungi,
viruses, and bacterial contamination; from defects in sanitation and
housekeeping procedures, such as in the provision of potable water,
removal of industrial waste and sewage, food handling, and personal
cleanliness
 Common Health Problems from Biologic Hazards
1. Tuberculosis (TB)
a. A chronic bacterial infection that is characterized by the formation of
granulomas in infected tissues
b. In 1993, was the fifth leading cause of death in the Philippines
c. 60% of death occur among the 15-64 years of age (i.e., productive age
group)
d. Readily transmitted by an infected person through respiratory
secretions during coughing, sneezing, vocalizing
e. Easily treated with antimicrobials; preventable
1. Tetanus
a. Caused by a bacteria, Clostridium tetani, usually from
contaminated wounds;
b. Affects the nervous system;
c. Manifests as muscle spasm, lockjaw, sustained
contraction of muscles in the face and back,
convulsions or seizures;
d. Can be prevented through active immunization with
tetanus vaccine and careful wound management.
1. Viral Hepatitis
a. Systemic infection caused by a virus affecting the liver;
b. Route of infection –
i. Hepatitis A – fecal-oral route (e.g., contaminated food and water)
ii. Hepatitis B – blood, sexual, perinatal
iii.Hepatitis C – transfusion-associated, intravenous drug injection
iv.Hepatitis D – endemic among those with Hepatitis B
v. Hepatitis E – ingestion of virus
c. Patients suffering from hepatitis usually manifest similar signs and symptoms;
d. Fever, nausea, vomiting, fatigue, body weakness, jaundice (i.e., yellow skin
discoloration)
1. HIV-AIDS
a. A chronic and fatal illness;
b. Affects the body’s immune system making it unable to combat infection;
c. Caused by Human Immunodeficiency virus (HIV);
d. To be transmitted, the virus must enter the bloodstream in large enough quantities;
e. Modes of transmission –
i. During unprotected sex
ii. Through transfusion with infected blood and blood products
iii.From an HIV-positive mother to her baby
f. Of importance to the working population because the statistics of those infected are
increasing:
g. For the prevention and control of HIV-AIDS, the Phillipine National AIDS Prevention
and Control Act of 1998 was established for the provision of the following –
i. Basic information on HIV-AIDS
ii. Non-mandatory testing
iii.Confidentiality of results
iv.Prohibition of discrimination and termination from work
 
C. Ergonomics
 
• ILO defines ergonomics as the application of human biological science in
conjunction with the engineering sciences to achieve optimum mutual adjustment
of human to the work, the benefits being measured in terms of efficiency and well-
being.
• To summarize, ergonomics can be defined as “fitting the job to the worker”. The
different fields of expertise needed for the application of ergonomics include
biomechanics, physiology, anthropometry, psychological or behavioral sciences
and engineering, among others.
• Biomechanics describes motion of various body parts and determines forces
acting on these body parts. Physiology is concerned with the function and action
of the different organ systems.
• Anthropometry is concerned with the size and form of the human body.
Psychology or behavioral sciences is concerned with motivations, attitudes.
• Finally, engineering aims to design the tools, work stations, and systems in the
workplace.
 
Ergonomic stressors commonly seen in the workplace are improperly
designed tools or work areas, improper lifting or reaching, poor visual
conditions or repeated motions in an awkward position that may be
responsible for fatigue, stress, and strain and may lead to accidents in
the occupational environment.

Outcomes of ergonomic problems on performance include low

productivity, high rate errors, material wastage, and equipment
damage. Musculoskeletal, vascular, visual, hearing, skin, and
psychological problems are some of the perceived health problems
resulting from ergonomic problems