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This information presented here is for educational use only. MoonDragon Birthing Services and all employees of MoonDragon Birthing Services will not be held responsible for any use or misuse of the information provided here on these pages. Universal (Standard) Precautions should always be used when handling specimens. All specimens should be treated as if they are biohazardous and capable of spreading disease.
The medical laboratory is a place where bodily tissues, fluids and blood specimens are tested, analyzed, or evaluated. It is where precise measurements are made and the results are calculated and interpreted. The observations may be macroscopic or microscopic. The tests may be performed manually or by using specialized instruments. Because of this, laboratory workers must have the skills needed to perform or master a variety of tasks. Tests performed outside of the medical laboratory in a clinical or home setting may follow a very different, sometimes more crude, methodology than the highly automated protocols that the standard, highly technological, medical laboratory may use. Because of this difference, it is s uggested that any unusual or unexpected results obtained when using "out-of-medical-laboratory" (OOML) testing procedures be verified by an accredited medical laboratory before intensive client / patient therapies are started. However, please do keep in mind even accredited medical laboratories make mistakes. Some laboratories make more errors than others. When shopping around for a medical laboratory to perform your testing, find one with a low error rate.
This is an introduction to the laboratory environment as a work place (whether in a medical lab setting or in a clinical or home setting). Also introduced are key procedures or concepts that a laboratory worker may need to know and for health consumers to learn about. This page and the pages to follow discusses the organization and function of the laboratory. Qualifications and job functions of laboratory personnel are also reviewed. A discussion on laboratory safety is included because anyone working in the laboratory setting must be thoroughly aware of potential hazards. The person must also be familiar with safety practices before any laboratory testing can be conducted.
The care, use, and cleaning of frequently used laboratory glassware is also introduced. This includes pipets, beakers, test tubes, and flasks. The proper care and use of the microscope is also included since it is required in the bacteriology, hematology, and urinanalysis sections.
Since most laboratory analyses use the metric system and require some calculations, there is a brief introduction to the metric system. Simple calculations such as percentages and ratios are also presented. The principles of the metric system and laboratory mathematics which are covered in Introduction to the Medical Laboratory section will be expanded upon in various other hematology (blood) testing sections. To learn the structure of medical terms, medical terminology is included in one section.
Many medical (clinical) laboratories are located in a hospital. Others are found in clinics, group practices, public health departments, physician's & midwives offices, mobile units, and reference laboratories.
The type of laboratory facility found in a hospital depends on the hospital's size. A small hospital, under 100 beds, may have the ability to perform only very routine tests procedures. More complicated or seldomly requested tests are sent out to reference laboratories. In a medium-sized hospital, up to 300 beds, routine tests and some of the more complicated test procedures may be performed. Only the most recently developed tests or tests with complicated procedures need to be sent to a reference laboratory. The laboratories in most larger hospitals, over 300 beds, can handle large volumes of work and most test procedures.
ORGANIZATION OF THE LABORATORY
Although the details may vary, the organization of most hospital laboratories follows a general outline. Usually the head of the laboratory is a pathologist, an allopathic physician who is specially trained in the nature and cause of disease, according to established allopathic medical approaches. Directly under the pathologist's authority is the laboratory manager. This is usually someone with an education in the medical laboratory sciences and a business or management college degree. In addition, some laboratories have a chief or head technologist. The heads of the various departments report to this person. The department heads are responsibile for the quality and quantity of work performed. The number of major departments in laboratories varies. Chemistry, hematology, microbiology, molecular pathology and the blood bank usually operate as independent units, each with its own department head. The subdivisions within each department may differ from one laboratory to another and from one medical facility to another.
CHEMISTRY
In the chemistry department, test procedures are usually performed on serum, the liquid part of blood left after the clot has formed. Tests may also be performed on urine. Although urine and serum are the most frequently used specimens, spinal fluid, joint fluid, and other bodily fluids are tested also. The more commonly performed procedures in this department include blood glucose content, assays of enzymes to determine if heart damage has occurred, and the electrolytes -- a set of tests which determine the chloride, bicarbonate, potassium, and sodium levels in the blood. The chemistry department usually has one or more subdivisions. One common subdivision is special chemistry. In this department, a patient's blood may be analyzed to discover what drug is involved in an overdose. The level of prescribed drugs may also be monitored.
The number of instruments available for chemistry analysis has grown rapidly in the last 20 years. Thus, it is possible for almost every laboratory to have instruments capable of performing most routine test procedures.
MICROBIOLOGY
The microbiology department is responsible for growing and identifying the organisms obtained from a patient's blood, urine, sputum, or tissue from a wound. After the organism is grown out, susceptibility testing can be performed. Susceptibility testing involves exposing the organism to different antibiotics. This helps to determine which antibiotic is most effective against the organism. The microbiology department usually deals with bacteria and fungi. Many hospital laboratories also test for tuberculosis.
The parasitology laboratory is often included as a part of the microbiology department. This department examines patient specimens for parasites. The patient's blood may be examined for evidence of the blood parasite which causes malaria. Or, the stools may be examined for evidence of intestinal parasites such as tapeworms or hookworms.
The microbiology department has been where procedures were performed manually. However, that is rapidly changing. Automated systems are now widely used. These systems can identify the organism and determine which antibiotic would be most effective in treating an infection.
HEMATOLOGY
In the hematology laboratory, whole blood is used for the majority of test procedures. Hematology procedures can be qualitative or quantitative. The quantitiative procedures included actual counts of the various blood components. For example, the number of leukocytes (white blood cells), erythrocytes (red blood cells), and platelets in a blood sample can be determined. All of these counts can now be performed using automated systems. The qualitative procedures are ones in which the various blood components are observed for qualities such as cell size, shape, and maturity level. Using a microscope, a laboratory worker can view a blood smear to determine the types of leukocytes present or to estimate the size, shape, and hemoglobin content of erythrocytes. The number of platelets can also be estimated. The presence of any abnormalities can also be noted during the microscopic examination of the blood smear. This may include identifying immature leukocytes or erythrocytes. The microhematocrit, the blood indices, and the blood hemoglobin content are additional tests commonly performed. The results of these three tests can be used to diagnose anemias. Some companies have developed very sophisticated instruments capable of performing most or all of these routine hematology procedures.
Coagulation & Urinalysis. In some laboratories, coagulation tests and urinalyses are also performed in the hematology department. Coagulation tests help to diagnose and monitor patients who have defects in their blood clotting mechanism. Automated systems for coagulation tests have been used for several years. Urinalysis includes physical, chemical, and microscopic examinations of urine specimens. Several methods of automation are now being used for the physical and chemical examination of urine.
BLOOD BANK
The blood bank department is also known as immunohematology. Here, several procedures can be performed, depending on the needs of the patient. If a transfusion is required, the patient's ABO blood type and Rh type are determined by blood bank technologists as well as many other blood subtypes. The technologists then test the blood units in storage to determine which are correct for the patients. If suitable blood is not available, it may be obtained from a regional blood bank or from blood donors. The blood bank department may also have the capability to process the units of whole blood into specialized components such as concentrated red blood cells.
SPECIMEN COLLECTING AND PROCESSING
Some hospitals have a separate department which is responsible for specimen collecting and processing. Phlebotomists are the personnel who collect the necessary blood specimen. They are specially trained to efficiently obtain a blood specimen with as little discomfort to the patient as possible. In other laboratories, some or all of the regular staff share this responsibility. In some instances, nursing personnel also may be responsible for all or partial blood collection. (Note: The primary job function of a phlebotomist (venipuncturist) is to collect blood. Laboratory assistants may collect blood and also perform some routine laboratory tasks, both clerical and technical. Technologists can do any job a phlebotomist or laboratory assistant can do and much more. Laboratories differ in policy -- some like for technologists to collect blood, others employ phlebotomists for most collecting. However, in these cases, the technologist is still called upon to collect the specimens which require special skills or responsibility.)
REQUESTING A LABORATORY TEST
Only a physician or other qualified health care provider may request laboratory testing on a patient. Usually the health care provider writes the request in the patient's chart. Sometimes, however, the order may be given to the registered nurse or midwife to record. The laboratory personnel can collect a blood specimen and perform a particular test procedure only after the proper request has been received.
COMMUNICATIONS
Communication problems may arise between laboratory personnel and other hospital personnel. These problems usually involve the test request procedure and/or the delivery of the test results to the physicians. Following the health agency's procedure manual will eliminate many of these problems. All laboratory personnel must strive to perform the test procedures as efficiently and accurately as possible. They must insure that emergency requests are treated as such and that the test results are reported as soon as possible. Likewise, other departments in the hospital must realize that only a physician can designate a test as "stat". This means there is an emergency and the test must be performed immediately. Other hospital personnel must carry out their responsibilities to see that test requests and specimens are transported to the laboratory as quickly as possible. A breakdown in communication causes stress and bad feelings among all personnel involved. Health care employees must remember that the welfare of the patient is of uppermost importance.
NON-HOSPITAL MEDICAL LABORATORIES
Non-hospital medical laboratories may be associated with a group practice, such as internal medicine specialists. These laboratories may also be located in the office of a physician who has a specialy such as hematology. A physician with a general practice or a midwife with an independent practice, may have laboratory facilities to perform some of the more routine procedures. State Public Health Departments may have medical laboratory facilities; these laboratories perform a variety of medical tests such as those for venereal and viral diseases. Additional procedures can include tests for water and milk purity.
Reference Laboratories are regional laboratories which do high volume testing and offer a wide variety of procedures. Large hospitals use reference laboratories primarily to perform complicated or seldom-ordered tests. Small hospitals, heath care providers and midwives offices may use them for a wide range of tests.
A recent development is the walk-in medical facility, usually located near shopping centers and mobile units that make house-calls to patients/clients that are homebound and are receiving home health care. Routine laboratory procedures such as blood counts, throat cultures, and urine tests are performed in these offices and units. As a greater number of patients use these facilities, the laboratories in these facilities will grow and new or additional tests will be added as necessary.
THE MEDICAL LABORATORY PROFESSIONAL
MEDICAL TECHNOLOGY
Medical technology is the health profession concerned with performing laboratory analyses. The analyses are used to diagnose and treat disease as well as maintain good health. The tests are performed by trained, skilled, medical technologists and technicians, or by other medical laboratory or allied health personnel. The laboratory tests are standardized and controlled. This insures reliable and accurate results.
HISTORY OF MEDICAL TECHNOLOGY
Medical technology can be traced back several centuries. Papyrus writings dated before 1000 B.C.E. record descriptions of intestinal parasites. Such is an early example of parasitology. Before medieval times, Hindu doctors performed crude urinalyses when they observed that some urines had a sweet taste and attracted ants. With the invention and improvement of the microscope in the 17th century, the study of biological specimens progressed from simple visual examination to microscopic examination.
The first clinical laboratories in the United States appeared in the late 19th century and were very crude. Some consisted of only a table and a microscope. They were staffed mostly by doctors who showed special interest in "laboratory medicine". The U.S. census of 1900 listed only one hundred laboratory technicians, all male.
After World War I, laboratories grew in size and in number. This is when schools to train laboratory workers were organized. Since World War II, the technology for laboratory testing has become more complex. At that time, laboratory tests began to play an important role in allopathic medicine. Today's technology allows us to provide a level of health care which was only imagined a few years ago.
Presently, there are thousands of medical laboratories, both large and small. Laboratories are highly sophisticated and offer many complex tests. The technologists and technicians staffing these laboratories are highly skilled professionals who perform complicated analyses. They may also serve as laboratory managers, teachers, supervisors, and administrators.
EDUCATIONAL REQUIREMENTS FOR MEDICAL LABORATORY PROFESSIONALS
Soon after the emergence of medical laboratories, it was clear that there was a need for (1) educating laboratory workers, (2) defining educational requirements, (3) identifying adequately trained persons. By the 1930s, schools of medical technology were training laboratory workers and basic educational requirements were established. At that time, certifying examinations were being given to measure the knowledge and ability of workers. Trained workers now comprise most of the work force in the medical laboratory. The two most common levels of professionals in the medical laboratory are the technician and the technologist.
Medical Laboratory Technician. The medical laboratory technician is a worker who has two years of training after high school -- one year of college and one year of clinical training. After the clinical training has been completed satisfactorily, the worker takes a national certifying examination. Upon receiving satisfactory scores on the exam, the medical laboratory technician is certified.
Medical Technologist. The medical technologis is a laboratory worker who has a bachelor's degree from a college or university and one year of clinical training. To become a certified medical technologist, the individual must also pass one of the national certifying exams for medical technologists. These examinations are administered by agencies such as the American Society of Clinical Pathologists (ASCP), the National Certification Agency for Medical Laboratory Personnel (NCAMLP), the American Medical Technolgists (AMT), and the International Society for Clinical Laboratory Technology (ISCLT). Certified medical technologists are qualified to perform analyses in all departments of the laboratory. These individuals may be supervisors or departmental heads. They may also work in other leadership positions in the laboratory.
AREAS OF SPECIALIZATION
Some laboratory workers may specialize in one area of laboratory work such as chemistry or microbiology. Usually these workers have a four-year college degree in the area of specialization and are certified by examination in the specialty area. Laboratories may also employ laboratory assistants and phlebotomists, or venipuncturists, who are responsible for collecting blood specimens.
Laboratory managers oversee the day-to-day management of the laboratory. They are usually medical technologists who have some additional educational training in business, management, or other health-related field. With the increasing cost of health care and the emphasis on cost containment, efficient medical laboratory management is becoming more important.
QUALITIES OF LABORATORY WORKERS
Dedication, cooperation, neatness, and a caring attitude are essential qualities of the health care professional. In addition, there are special characteristics needed in persons performing laboratory analyses. The workers in each department need to be knowledgeable of the procedures performed in that department. They must be able to perform accurate, precise manipulations and calculations. Communication skills, reliability, honesty, and the ability to relate well to fellow workers are important qualities for laboratory workers. Organizational skills must also be developed. To function professionally in any laboratory, the personnel must learn how to prioritize laboratory requests and schedules.
RESPONSIBILITIES OF LABORATORY WORKERS
Set rules and regulations govern health care in all states. Most health care agencies have very specific standards, rules, and regulations governing the responsibilities of various health care employees. Each health care worker should assume the responsibility of learning exactly what activities are allowed in their position. They should understand their job-responsibilities fully for their protection, the protection of their employer, and the safety of the patient/client.
THE PATIENT/CLIENT AND THE LABORATORY PROFESSIONAL
The field of medical technology exists for the patient/client, as do all other fields of health care. In order for a patient/client to receive the best possible care, a health care provider must make the proper diagnosis. To make this diagnosis, the health care providers rely on laboratory analyses along with information gained from the medical history, physical examination and clinical signs and symptoms. For this reason, it is important that the laboratory analyses are performed carefully and accurately, using the best techniques available.
The only contact the patients/clients may have with the laboratory is through the lab assistant, technologist, or phlebotomist who collects the blood sample from them for testing. At best, it is not pleasant to have blood taken from a vein or finger. At all times, the technologist needs to be aware of the stress the patient/client is feeling when hospitalized or under the care of the health care provider. The technologist must be professional, courteous, and considerate when obtaining the specimen.
PROFESSIONALISM
Laboratory workers should consider themselves health care professionals and should conduct themselves ethically. Patient information is confidential. It should only be discussed with health care workers who are directly related to the case and who have a need to know. Test results should be reported only to the physician, midwife, health care provider or other appropriately designated employee.
MoonDragon's Lab Information & Tests: Laboratory Safety
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