Diagnostic medlab handbook

Join the largest medical laboratory science program in the state of Georgia with a highly successful record of graduates receiving board certification! As the number of aging adults dramatically increases in the United States, the need for medical lab scientists will also grow. The Traditional Medical Laboratory Science degree program track is well-suited to entering freshmen, transfer students and students with a bachelor degree in biology, chemistry or related science field.

Applications for the Fall cohort will open on November 15, , and close on March 1, Admission to the program is open until all seats are filled. If you apply to more than one program, the application with the earliest time and date will be the program that will be considered.

Only apply if you will have all your prerequisites completed by the end of Summer In addition to the traditional track, Georgia Southern offers online degree-completion options for students currently working in the medical laboratory science field.

The online track is limited to those with certified MLT credentials who are currently employed at an approved clinical site. It provides students with a high-quality academic and professional environment, allowing for the development of critical thinking skills and professional values and characteristics. The program graduate will be able to satisfy eligibility requirements for a professional certification examination at the Medical Laboratory Scientist MLS level.

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Please contact Medlab if you are interested in working with Medlab for your testing needs. Morning appointments will typically have results later the same day; afternoon appointments the next day. Results for tests performed at your physicians office are typically available the following day.

Other congenital causes of a long bleeding time include rare platelet aggregation abnormalities Glanzmann's thrombasthenia or storage pool defects. It is often prolonged in patients on aspirin therapy and in chronic renal failure. Acquired platelet dysfunction also occurs in immune thrombocytopenia ITP where the bleeding time is prolonged more than predicted for the reduced platelet count, in myeloproliferative disorders essential thrombocythaemia , in paraproteinaemias MGUS, myeloma and sometimes in association with viral illness.

The bleeding time is a poor predictor of the risk of surgical bleeding. Females 13—15 - 0. Lymphs Baso. Bacteraemia is usually found in life-threatening illnesses which need investigation in hospital rather than at home. Nevertheless there are a few patients with low-grade febrile illnesses due to infections that shed bacteria into the blood stream but without causing overwhelming sepsis. These are found particularly in patients with cardiac valvular disease or prostheses in the heart or elsewhere.

We have at times grown pneumococci, Listeria, Salmonella typhi. Almost any organism can cause bacteraemia given the right circumstances. Blood cultures should always be considered before starting antimicrobial therapy for an undifferentiated febrile illness in a patient with a prosthetic heart valve.

Blood culture collection protocols vary from one laboratory to another. In this laboratory two sets are drawn with each collect, an aerobic and an anaerobic bottle from each arm. Standard aseptic technique must be rigidly adhered to if contamination by skin flora is to be avoided. Slow-growing or antibiotic-damaged bacteria may take up to 7 days.

Blood films are not routinely examined unless one or more of the blood count parameters is shown to be abnormal by the electronic cell counting analyser. The film report describes the morphological appearance of red cells, white cells and platelets.

Where appropriate, the film comment will suggest a diagnosis and recommend follow-up. A blood film examination will always be performed if specifically requested even if the CBC complete blood count parameters are normal.

ABO and Rh D phenotype are done routinely. The frequencies of the four main groups in the ABO system and their naturally occurring antibodies are:. Blood volume is measured when investigating polycythaemia raised Hb concentration which may be:. The BMI, by adjusting weight according to height, provides a useful assessment of nutritional status. Bone marrow trephine is performed routinely together with bone marrow cytology aspirate and clot section.

Chromosomes and cell marker analysis will be performed whenever appropriate. Chromosome analysis is commonly done in the leukaemias, myelodysplastic disorders, and some lymphomas to help with classification, treatment and prognosis. Bone marrow transplantation is being used more often.

Autologous BMT, where the patients are their own donor, has a much lower mortality risk. Stem cells, collected from peripheral blood, are increasingly used in place of conventional autologous transplantation. They are associated with rapid engraftment and reduced hospital stay and cost.

Autologous transplantation is also used in the treatment of solid tumours. Longer term complications of BMT include infertility, secondary neoplasms and endocrine dysfunction. When bone is resorbed, collagen cross-links are released as part of the break-down process and excreted in urine where they provide a measure of bone turnover rate in conditions such as Paget's disease, thyrotoxicosis, bone cancer, renal bone disease and hyperparathyroidism.

Tests include:. Serum alkaline phosphatase ALP and urine calcium excretion, though less specific, may also give a useful measure of bone turnover and the effectiveness of therapy. Despite vaccination, the disease remains endemic in New Zealand with outbreaks at about 4-yearly intervals. Diagnosis is by growth of the organism from a swab. A fine wire nasopharyngeal swab is passed through a nostril to reach the nasopharynx and left in place there for a few seconds.

If one nostril is blocked by a turbinate or deviated septum, use the other. The swab is placed in routine transport medium for delivery to the laboratory. Delay in transport of the specimen will decrease the chances of isolation. Adults with a chronic cough may have chronic pertussis infection which can be detected by measuring serum antibodies.

Erythromycin may reduce the duration of the disease if administered early and will reduce infectivity. A fourteen day course of erythromycin is also recommended for household and other close contacts. Borrelia recurrentis, a spirochete transmitted by ticks or lice, causes relapsing fever. Neither disease is endemic in New Zealand but they may occasionally be found in travellers. Tests for antibodies against B. Breast tumour hormone receptors specimen: breast tissue fixed in formalin as for histology.

More than half of all breast cancers have oestrogen receptors indicating the need for endocrine therapy. They have a better prognosis than receptor negative tumours. The test uses an immunoperoxidase labelled antibody applied directly to tissue sections. Cytology Smears are made from brushes and fixed in Cytofix immediately. Washings are submitted to the laboratory as soon as possible for cytocentrifugation. Please indicate special requests such as culture for TB or fungi.

In chronic bronchitis the important pathogens are Strep. Brucellae are gram-negative bacilli infecting domestic animals, particularly cattle and pigs. Human infection occurs in farmers and meat-workers as an occupational hazard or by ingestion of contaminated milk products. Over the past 30 years, brucellosis has been virtually eliminated from New Zealand cattle and human brucellosis, when found here, will almost invariably have been contracted abroad, including the Pacific Islands.

Results may be negative in the early stages of acute disease and sometimes antibodies are not detected at any stage. This test for sex chromatin the 2nd X chromosome in females has been replaced by karyotype analysis.

May be elevated in other gastrointestinal malignancies. Used for monitoring gastrointestinal especially stomach malignancies, and mucinous ovarian malignancies where it is more often elevated than Ca Elevated levels may be found in other malignancies, or occasionally other non- malignant conditions including endometriosis, PID pelvic inflammatory disease , cirrhosis, renal failure and pregnancy. Eating contaminated shellfish may raise levels. If in doubt, repeat after two weeks abstention from seafood.

Calcitonin specimen: plasma EDTA ref. There are no clinical excess or deficiency states. Calcitonin's clinical use is as a marker for medullary thyroid carcinoma either as an isolated tumour or as part of MEN qv multiple endocrine neoplasia, type II, along with phaeochromocytoma and parathyroid tumours.

The parathyroid hormone PTH level is increased. These "benign" hypercalcaemias are much more common in the elderly. About half of total serum calcium is bound to albumin and inactive.

The other, ionised half is the physiologically active fraction. Ionised calcium levels are raised in sera with an acid pH and lowered when alkaline. For most clinical purposes, adjusted total calcium is adequate but in severe protein abnormalities, including malignant paraproteinaemias and chronic renal failure, ionised calcium may be more useful.

Some patients with recurrent renal calculi have a high urinary calcium output — idiopathic hypercalciuria. Serum calcium must be checked to exclude hypercalcaemia.

These organisms cause an acute enterocolitis which can be associated with intense abdominal pain. The average incubation period is 3 days; most patients recover within a week. Antibiotic treatment is usually not required but for severe infections erythromycin is effective. Treatment with quinolones is not recommended because resistance to them emerges commonly and rapidly. Untreated patients may excrete Campylobacter in their faeces for 2—3 weeks but transmissability is low and it is not usual to put restrictions on otherwise healthy food handlers who are excreting the organism.

Candida albicans, the principal pathogenic yeast in humans, is a member of the normal flora of the gut, respiratory tract and vagina. It can gain dominance under certain conditions such as diabetes, antibiotic use and suppression of the immune system.

Other species of Candida which are occasionally isolated cause the same type of infection as C. For most, the treatment is the same as for C. Some individuals suffer from recurrent thrush for no detectable reason.

A random glucose should be checked to exclude diabetes. Skin Infection occurs in warm moist areas such as the groin, perianal region, axillae, the breasts or in interdigital webs. It is often seen in those who frequently immerse their hands in warm water, such as dishwashers. Nails Candida can cause a painful red swelling of the nail fold resembling pyogenic paronychia, This may progress to nail involvement onychomycosis.

Mouth Infections are found mainly in infants and show up as white adherent patches. Laboratory identification is not usually necessary but a swab will grow the yeast. Systemic candidiasis Found in immunocompromised patients or in association with prostheses. In chronic users, cannabinoids remain detectable for up to 6 weeks after cessation. Carbamates are insecticides similar in their mode of action to organophosphates qv but with a shorter duration of effect and lower order of toxicity.

Oxygen treatment, particularly hyperbaric, accelerates clearance of CO. CEA is elevated in some malignancies, particularly of the bowel. It is used for monitoring treatment of tumours and for detecting recurrence but because of its low specificity it is not used diagnostically in patients without known malignancy.

Cardiovascular disease CVD risk assessment In cardiovascular disease until relatively recently, each risk factor e. Otherwise risk is calculated using the tables overleaf; or using the appropriate programme in your computer; or by having the laboratory add it your patient's lipid profile in which case you will have to add information on the laboratory request form. Blood Pressure Blood Pressure. Carotene levels are used in the diagnosis of carotenaemia, an orange-yellow coloration of the skin but not conjunctivae that can look like jaundice.

The usual cause is a high intake of vitamin A precursors in carrot or other coloured fruit or vegetable juice but some systemic illnesses, including hypothyroidism, diabetes, liver and renal disease, can cause carotenaemia. Because carotene is lipid-soluble, hyperlipidaemias can give elevated levels. Low values have been used as an indicator of malabsorption but specificity and sensitivity are poor. Specimens with a pH above 3 indicating insufficient or no acid cannot be analysed.

In children, a spot urine can be used, delivered to the laboratory as soon as possible for adjustment of pH. Particular indications are:.

Neuroblastoma These usually present as an abdominal mass in children under the age of 5. Number of specimens When clinical suspicion is low, a single normal result is sufficient but when suspicion is high, up to three specimens should be tested, preferably collected during or just after symptoms.

Interpretation The typical phaeochromocytoma gives a noradrenaline level of 1. Occasionally the adrenaline level is elevated but usually it and the dopamine are near normal. Small, isolated elevations of dopamine can usually be ignored. Essential hypertension can be associated with a minor increase in noradrenaline, usually less than twice the upper limit.

Medication Noradrenaline is increased by amphetamines, alpha- and beta-blockers, vasodilators, theophylline, phenothiazines and tricyclic antidepressants. Although CSD was first reported in , it is only recently that B.

Fleas transfer the organism from cat to cat and flea control is a useful preventive measure. Pain relief may be required. Steroids are generally ineffective. Therapy should be discussed with an infectious disease specialist. An absence of CD59 activity on the cell surface of red cells characterises paroxysmal nocturnal haemoglobinuria PNH. Ceruloplasmin is reduced in hepatolenticular degeneration Wilson's disease , and Menke's kinky steely hair syndrome.

Oestrogens, anticonvulsants and inflammation cause elevations — ceruloplasmin is a late acute phase reactant. The specimen is collected by a spatula, a combination of spatula and cytobrush, or a cervix broom. The cells must be representative of the cells lining the cervix. It is important to sample this site to detect early changes. The ideal sample consists almost entirely of squamous cells which line the ectocervix and a small number of endocervical glandular cells to indicate that the squamocolumnar junction has been sampled.

Collecting specimens: There are two methods:. Using a speculum display the cervix and ensure the external os is accessible. Carefully wipe away excess mucus and inspect the cervix in good light.

If the cervix looks abnormal the women should be referred for colposcopic examination regardless of the cytology report. The specimen should be collected with either a spatula and cytobrush or a cervix broom. The spatula specimen is collected first because of the tendency of the cytobrush to causebleeding.

The spatula must make sustained contact with the cervix throughout the whole rotation if segments are not to be missed. Adenocarcinoma of the endocervix and its precursor adenocarcinoma in situ AIS may also be detected in asymptomatic women.

The contents of the brush are transferred to the labelled slide using a rolling or rotary motion along the surface of the slide. Collection of the obligatory spatula smear must precede that of the cytobrush smear. The specimen, once smeared, needs to be fixed within seconds to prevent fixation artefact. This is a glass or plastic jar with slots in the side of the jar to ensure the slides stand up in the jar and do not touch their neighbours.

The Coplin jar is filled with cytofix. It is important to keep the lid on the jar as this prevents evaporation of the cytofix which should be changed every days or every slides.

Wet slides may be then placed in plastic pink slide mailers and sent to the laboratory. Cytospray is available in either or ml bottles with an environmentally friendly pump action spray. Cytospray is not the same as cytofix. It is important to hold the spray bottle at least 20 cm from the slide and produce a good powerful fine droplet spray.

If the spray bottle is held too close to the slide or large droplets are created then the cells may be damaged and the slide rendered uninterpretable. The slide may be placed in the plastic slide mailers, sprayed and the mailer closed and sent to Diagnostic. The answer is yes, provided you take precautions to ensure there is no delay in fixation.

Spread the smears on opposite halves of the slide in quick succession and fix immediately. Immediately cover the other half with a layer of paper and spray the spatula smear taking care that no fixative runs under the paper or through it onto the unused half. If this happens cells will not stick to the slide and will be lost during processing. Now collect the cytobrush smear and spread it on the remaining half slide. Spray with fixative. Collection and fixation of the spatula smear is completed before collecting the cytobrush smear.

Push gently, and rotate the broom in a clockwise direction 2 to 3 times. Repeated brushing back and forth is not recommended as this will damage the cells.

This is a new way of processing cells taken from the cervix, utilising fluid- based specimen collection. The sample is collected in the normal way but instead of smearing the sample on a slide, it is rinsed in a fluid containing fixative.

The sample is put into a machine which filters out most of the blood and inflammatory exudate and prepares a smear with a thin even layer of cells. The smear is then screened in the normal way by a cytology screener. Nearly all the cells collected are transferred to the sample providing a representative homogeneous smear. There are no preparation artefacts such as air drying and obscuring blood and inflammatory debris are removed. Multiple slides can be prepared from one sample and part of the sample might be used for ancillary studies e.

In clinical trials the Thin Prep Pap Test has been shown to have the following advantages. The specimen is collected as for a conventional smear except that a plastic spatula is used rather than a wooden one.

The cytobrush or cervix broom should be rotated at least 10 times in the solution and then discarded. The bristles of the cytobrush and cervix broom should be forced apart on the side and bottom of the collection vial. The cap of the vial should be tightened so that the tongue line on the cap passes the tongue line on the vial.

Record the patient's name on the vial and then place with the completed cytologyrequest form in a biohazard bag for collection by the laboratory. This technology appears to offer an improved method of processing a cervical smear which may have a significant impact on reducing false negative Pap smears.

It remains uncertain whether the additional cost of Thin Prep is justified. However, if the number of repeat smears, unnecessary procedures and number of women who develop invasive cervical cancer can be reduced using this technology, the costs of cervical cancer screening and treatment may ultimately be reduced. Cervical Cytology Reports. Two low-grade abnormal smears six months apart are an indication for colposcopy.

HPV alone is managed as a low-grade abnormality. Follow-up recommendations take account of current and past findings. Possibilities are:. Swabs are collected from the cervical canal when testing for Neisseria or Chlamydia trachomatis — see entries under these headings.

A non-pathogenic commensal flagellate found in faeces. When present it can suggest infestation with worms which may warrant treatment. Requires a nasopharyngeal swab in special medium.

Like the other Chlamydia it is an obligate intracellular bacterium. It was previously called the TWAR agent. Many adults have antibodies indicating that the infection is common, initial infection being typically at age years. It can cause pneumonia, severe pharyngitis, hoarseness, fever, cervical lymphadenopathy.

Infection in young adults is usually of mild to moderate severity but can be sub-clinical or, in immunocompromised patients, severe. Incubation period averages 21 days and infection can recur. Its most recent and surprising association is with coronary artery disease, suggested by seroepidemiologic studies and finding the organism in atheromatous plaques. Treatment for lower respiratory tract infection is erythromycin or other macrolides in children and doxycycline or macrolides in adults.

When a human inhales dust from fomites from infected birds, they can develop an infection which may present as an atypical pneumonia, headache, fever, rash, myalgia. Severity ranges from mild to moderate, occasionally severe.

Psittacosis is largely confined to bird-fanciers the parrot family particularly and poultry-handlers. In New Zealand the term "chlamydia" commonly refers to genital infections with C. They are widespread in the community. Female specimens Use one of the large swabs to clean secretions away from the cervical os. Now insert the second large swab cm into the endocervical canal and rotate for secs. Chlamydia are located inside cells, not secretions, hence the need to rotate the swab against the cells lining the cervical canal.

Male specimens If there is a urethral discharge, swab the inside of the urethral meatus. Insert the swab cm into the urethra and rotate for seconds to ensure adequate sampling. As an alternative, particularly when there is no discharge, collect mls of first- catch urine, i. The patient should not have voided for several hours before providing the first void urine. Remove any purulent material before collecting conjunctival epithelial cells by rubbing the dry swab over the everted palpebral conjunctiva.

In pregnancy, doxycycline cannot be used. A test of cure should be done after completing a course of one of the alternative agents as these have a known failure rate. Tests should not be performed until 3 weeks after treatment to prevent false positives due to persisting dead antigen, or false negatives due to persisting live organisms being too small in number to register positive.

All results reported as positive have been confirmed using a different methodology to eliminate most false positives.

As with all laboratory tests the possibility of both false positives and false negatives needs to be kept in mind when a result seems not to fit the clinical situation. Chlamydia is treated with doxycycline, mg hourly, for 7—10 days except in pregnant women where amoxycillin, mg 8-hourly, or erythromycin, mg base 6-hourly, is used.

Recently azithromycin as a 1g single dose has been approved. This is likely to become the standard treatment of genital C.

In adults prolonged treatment for 3 weeks with doxycycline or erythromycin is used. Regardless of age, topical antibiotics are inadequate and are unnecessary when oral treatment is given. Formerly, chloride was measured as part of the electrolyte group but it has now fallen into disuse except for a few specialised situations in renal medicine. Those who calculate anion gaps will need a chloride level. A point worth making is that for a person eating a healthy low fat breakfast or lunch, there will be no significant difference between fasting and non-fasting.

A reasonable approach is to make the first profile non-fasting. If levels are higher than ideal, a second fasting specimen is ordered to complete the baseline. The graph below shows "observed" total cholesterol ranges in 80, unselected sera in the Auckland population - Female and male mean levels are shown separately but the 5th and 95th percentile lines are for male and female combined.

It can be seen that a high triglyceride has an important effect on total levels whilst LDL is relatively unaffected by triglyceride — hence the importance of examining a full lipid profile, not just total cholesterol.

The full profile is also essential to measure HDL as an important independent risk factor and to measure triglyceride which is also being recognised as a risk factor, e. At a level of 6.

Serial measurements, say monthly or 3-monthly, are necessary to smooth out these random oscillations and show whether the trend is down, up or unchanged.

Chronic exposure to organophosphate and carbamate anticholinesterase sprays. Organophosphates Carbamates malathion carbaryl acephate methiocarb coumaphos methomyl chlopyrifos propoxur. Red cell and plasma cholinesterases should be measured before spraying commences to establish the individual's baseline reference range and at regular intervals thereafter.

If the baseline is unknown, estimations at 3-day intervals after removal from exposure will show recovery towards the baseline. Because red cell cholinesterases are irreversibly inhibited by organophosphates but not carbamates , levels remain low for the 4-month life.

The red cell level is the preferred test for monitoring low level chronic exposure. Plasma cholinesterases fall sharply when acutely exposed to organophosphastes or carbamates but recover to their previous levels within less than a week.

Measure serum or plasma cholinesterase and dibucaine number. Do not test within one week of scoline administration or two weeks of blood transfusion. This is used for the antenatal detection of an increasingly wide range of severe, untreatable disorders where termination is a reasonable option to consider. When the test is being done in welders, the specimen should be collected towards the end of the working week.

This relatively common condition per continues to attract attention in both the lay and medical press. The diagnosis is based on the history of debilitating fatigue for at least 6 months in the absence of any clinical or laboratory evidence of identifiable organic disease. Typically CLL is an indolent disorder with a median survival of years.

In the early stages the patient does not require therapy but regular blood counts are performed to monitor the disease for increased activity. Diagnosis is based on peripheral blood finding of lymphocytosis with cell marker analysis to demonstrate a monoclonal B cell population with light chain restriction. Bone marrow biopsy is not essential for diagnosis but is useful to determine bone marrow reserve and possibly outcome prediction.

Initial therapy usually involves the alkylating agent chlorambucil with or without prednisone. Fludarabine is one of a new group of agents which is an alternative first line treatment for CLL. CML is predominantly a disorder of middle life but the diagnosis is being made increasingly in younger patients.

The disorder is characterised by a leucocytosis which is left shifted, typically showing the major increases in myelocytes and segmented neutrophils giving a bimodal differential white cell distribution.

Blast cells are also present. The majority of patients are Philadelphia chromosome positive. Medlab is committed to protecting and improving the health of our community members during personal and public crisis. Appointment Results. Medlab, Inc. Medlab's professional toxicologists perform fast, cost-effective presumptive screening for a wide range of substances. We also deliver next-day results via our online portal. Using LC-MS and GC-MS technology, Medlab performs definitive confirmation testing to rule out false positives and identify substances or metabolites not detected by presumptive methods.

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