Introduction to

Laboratory Medicine
 Laboratory medicine

?????????

Clinical laboratory

Pathology

Anatomical Pathology Clinical Pathology

 Macroscopic/
Anatomical pathology
microscopic

Cells Tissue Organ System

?? ?? ?? ??

Substances excreted/secreted
to blood/other body fluids

Clinical pathology
 Samples :
Clinical Pathology

Clinical Hematology Blood

Clinical Chemistry • Blood

• Urine
Clinical Microbiology
• Stool
• CSF
Clinical Immunology
• Trans/Exudate
etc
 Clinical Hematology

Parameters to be
evaluated :
Manually
 Hemoglobin
 Leucocyte count
 Platelet count
Automatically
 Hematocrit
 etc
Automatic
Hematology
Analyzer
Clinical Chemistry

Glucose, cholesterol,
Blood triglyceride, cardiac
enzyme, etc

Parameters to
be evaluated

Urine Glucose, protein,

bilirubin, pregnancy
test, etc
Clinical Microbiology

Blood cultures of
Blood
microorganisms

Parameters to
be evaluated

Swab Direct preparation

of microorganisms
Clinical Immunology

Blood Parameters to be evaluated

 Hepatitis markers (A, B)

 TORCH
 HIV
 Dengue
 Typhoid
 etc
 The purpose and function of Clinical Pathology

1. Confirming or rejecting diagnosis

2. Providing guidelines in patient management
3. Establishing a prognosis
4. Detecting disease through case finding or screening
5. Monitoring follow up therapy
 Confirming or rejecting diagnosis

Patient with fever

Differential diagnosis:
• Dengue
• Typhoid

Laboratory results: Final diagnosis:

• Dengue (-) • Dengue  reject
• Typhoid (+) • Typhoid  confirm
 Providing guidelines in patient management

Patients with Diabetes Mellitus

2HPP* Blood glucose levels :

Mr.A : still high (300 mg/dL) Mrs.B : normal (110 mg/dL)

Increase Oral Anti Diabetic Maintain Oral Anti Diabetic

dose dose

*2HPP : 2 hours post prandial (after meal)

 Establishing prognosis

Patients with acute viral hepatitis

Cellular liver enzymes : ALT* level

Mr.X : high (400 IU) Mrs.Y: very high (1400 IU)

Prognosis : good Prognosis : bad

*ALT : Alanine aminotransferase

Detecting disease through case finding or screening

Screening of the donors for

Hepatitis B Virus :

HBsAg :

HBsAg : (+) Donors rejected (case findings)

HBsAg : (-) Donors accepted (screening

healthy subjects)
 Monitoring follow up therapy

Patient with urinary tract infection

After finished 1 cured dosage of

certain antibiotic

Urine culture still (+)

Change antibiotic with

the sensitive one
 Proper management

Proper diagnosis

Proper laboratory
results

Influencing factors
Factors influencing laboratory results

Pre analytic

Analytic

Post analytic
Pre analytic factors

Test requisition

Preparation of the patient

Before Specimen
collection

Specimen collection and

processing
 Analytic factors
• Reagents • Filtration
• Water • Dialysis
• Measurement of mass • Extraction
and volume • Mixing
• Control of temperature • Detection of analytical
• Evaporation and response
specimen
concentration
Post analytic factors

Recording & Reporting

Human errors
 How samples (blood,
urine,etc) were analyzed in
the laboratory ?

Manually

Automatically Instrumentation
Important instruments in
the laboratory medicine

Spectrophotometry

Electrophoresis

Flowcytometry
Spectrophotometry

Based on the measurements

of radiant energy (light)
absorbed or transmitted
under controlled condition

Examples :
• blood glucose
concentration
• blood cholesterol
• liver enzymes
• Cardiac markers
Electrophoresis

Separation of charged
compounds based on their
electrical charge

Reading with densitometry

Examples :
• protein
•hemoglobine
Flowcytometry

Measures some of the properties of cells suspended in a

moving fluid medium

Application of Flow Cytometry :

• Immunophenotyping in leukemia and lymphoma
• Monitoring immune status
• Cell cycle analysis (by staining the cells with a
fluorescent dye such as propidium iodide that binds to
DNA and by quantifying the number of cells in different
stages of the cell cycle)
Point of Care Testing
(POCT)

Brings laboratory testing to the site of the patient rather than

obtaining a specimen and sending it to the laboratory.

Used in variety of settings : Examples :

• Emergency departments • Hemoglobin level
• Operating suites • Blood gas analysis
• Clinics • Hormones
• Home Monitoring • Blood glucose
• etc • etc
 Proper management

Proper diagnosis

Proper laboratory
results

Quality control &

Quality Assurance
 Quality Control &
Quality Assurance

Quality Control :
• To ensure the accuracy and reproducibility of laboratory results.
• Need to balance effectiveness of problem detection vs costs of QC

Quality Assurance :
1. Program development
2. Assessment and monitoring
3. Quality improving
 References :
Henry JB:
Clinical Diagnosis and Management by
Laboratory Methods.
21th edition, 2001, pp 3-148
WB Saunders Company
Philadelphia London New York