What is a Clinical Laboratory What is a Clinical Laboratory Professional and What Are They Professional and What Are They

Doing With My Body Fluids?Doing With My Body Fluids?

What is in blood?Plasma - the liquid

portionPlatelets - the clot

forming componentsWhite Blood Cells -

the infection fightersRed Blood Cells - the

oxygen transporters

What makes one type of cell different from another type of

cell?

CHEMISTRY!!

DNA

Fats

Proteins

Sugars

Amino Acids

Water

RNA

Cholesterol

Enzymes

Vitamins

Minerals

pHHormones

How those atoms are put together in the cell determines:

What the cell looks likeWhat jobs the cell can

do in the bodyHow the cell

communicates with other cells in the body

So Bone Cells look and act differently than Blood Cells,

Fat CellsMuscle Cells

These chemical differences in cells allow us to determine if something is wrong with the part of the body where that those cells are found.

For example …..

What happens in a heart attack?Blood stops flowing to part of the heartThis can be caused by:

• Blood clots• Fat deposits

When blood stops flowing, heart cells don’t get enough oxygen and they begin to die.

Blood vessel with fatty deposits

When cells are damaged or dying, they begin to leak some of the compounds from inside their cell membrane.

Those compounds then get into the bloodstream.Because many of the compounds inside the cell

are specific to that type of cell, we can identify problems by the amount of certain compounds in the blood.

What compounds are released by the damaged heart?

Proteins• Myoglobin

• Myoglobin is the oxygen-binding protein of the muscles

• It only takes 1 to 2 hours after a heart attack before you find myoglobin in the blood

• Myoglobin peaks at 6-9 hours. • It returns to normal within 24

hours because it is rapidly excreted in the urine.

What compounds are released by the damaged heart?

Proteins• Troponin-I

• Troponins are structural proteins found in heart muscle.• It only takes 2 to 4 hours after a heart attack

before you find troponins in the blood.• Troponin-I peaks at 24 hours.

They remain elevated for 9-14 days.

What compounds are released by the damaged heart?

Enzymes

• Creatine Kinase (CK)

• It takes 4 to 10 hours before you find the CK enzyme in the blood

• It peaks at 24 hours

• It returns to normal levels in 2 or 3 days

Determining the amounts of these compounds in the blood helps determine:

Whether or not a heart attack has occurred

How long ago the heart attack occurred

To some extent, how much damage the heart attack caused

Cardiac Markers in Serum

In the same way that each type of cell has its own particular chemistry, each disease has its own particular chemistry.

What specimens usually go to the lab for a physical exam?

Two, three, or more tubes of blood• Purple top

• Red top

• Blue top

Urine specimen

So why do labs need two (or more!)

different tubes of blood?

Why can’t they just use one tube?

When blood leaves the veins, it will come in contact with factors that will initiate the formation of a blood clot.

The red top tube either contains nothing or something to activate the

formation of the clot.The liquid portion is no longer called plasma, but is called serum because it

no longer contains the clotting components.

Serum is often preferred for testing because all of the cellular components are more easily removed so they can’t

clog sensitive instruments.

The purple top tube contains an anticoagulant, EDTA, which prevents the

blood from clotting, so cells remain separated.

It also preserves the cells so they can be identified by

how they look when using particular stains.

The blue top tube also prevents blood from clotting, but it uses a

different anticoagulant, sodium citrate, which preserves more of the

clotting factors.This is the tube used to

evaluate the ability of the blood to clot.

The Red Top Tube Goes to the Chemistry Lab

The serum can now be tested for: Cholesterol Blood glucose (sugar) Electrolytes (sodium, potassium, chloride) Enzymes from the heart, liver, pancreas, etc. Kidney function (blood urea nitrogen or creatinine) Hormones Vitamins Drug levels Hundreds of other compounds

The Purple Top Tube Goes to the Hematology Lab

This tube is mixed well, then placed in an instrument that determines: • Red blood cells • White blood cells• Platelets• Hematocrit (percentage of blood that is cells)• Hemoglobin (oxygen-carrying protein)

Blood smears are made onglass slides and then stained so cell structures can be seen clearly.

Blood smears are usually examined using a light microscope.

Red Blood Cell Size and Color are Studied

HYPOCHROMIC Decreased

hemoglobin concentration in pale cells.

NORMAL RED BLOOD CELLS

Normal area of central pallor should be about one-third of the cell’s

diameter.

ANISOCHROMIA Pale and filled cells

can both be seen following blood

transfusion.

Red Blood Cell Shape is Observed

Target Cells -Abnormal hemoglobins, liver disease, thalassemias

Elliptocytes - Hereditary condition, some anemias

Sickle Cells -Sickle cell anemia (Hb SS), Hb SC.Hb S/thal

More Red Blood Cell Shapes

Schistocytes -RBC fragments found in severe burn patients, disseminated intravascular coagulation

Acanthocytes - “Spiked” red cells are observed in liver disease, asplenic patients (spleens removed)

Spherocytes -Red cells without a pale center are seen in hereditary spherocytosis, some immune-mediated hemolytic anemias

White Blood Cells

Neutrophils -Engulf bacteria and cellular debris37-77%

Basophils - Hypersensitivity,Release histamine0-1.6%

Eosinophils -Parasitic infections,Allergic response1-7%

Lymphocytes -Produce antibodies, regulate the immune response10-44%

Monocytes -Engulf cellular debris, antigen processing2-10%

Abnormal Blood Smears

Chronic Myelogenous

Leukemia

Malaria(Plasmodiumfalciparum)

Infectious Mononucleosis

(Reactive Lymphocytes)

The Blue Top Tube Goes to the Coagulation Lab

These tubes are often drawn on people who are on anti-coagulant therapy (coumadin), also called “blood thinners”

The plasma is tested to determine how long it takes blood to clot.

The Urine Goes to the Urinalysis Lab

Kidney functionUrinary tract disordersDiabetesLiver disordersMetabolic disordersMuscle traumaHormonal disordersDrug use

Urine can provide information about:

Urinalysis

A complete urinalysis consists of examining the physical, chemical, and microscopic characteristics of the urine.

Chemical analysis is performed using a reagent strip with

pads containing chemicals specific

for each test.

What chemicals do labs test for in urine?

Sugar

• Normal urine should not contain glucose (blood sugar)

• Found in diabetesKetones

• Normal urine should not have ketones

• Ketones form when you break down fats instead of sugar for energy

• Found in diabetes, starvation

What chemicals do labs test for in urine?

Protein• Normal urine should contain very little

protein• Suggests possible kidney damage, certain

cancersHemoglobin

• Normal urine should not contain hemoglobin (from red blood cells)

• Seen in injury, kidney stones, infection

What chemicals do labs test for in urine?

Leukocyte esterase

• Normal urine should not contain this enzyme found in white blood cells

• Suggests urinary tract infectionNitrite

• Normal urine should not contain nitrites

• Nitrites form when bacteria convert urine nitrates to nitrite

Urine Microscopic

ExamEpithelial Cells

Calcium Oxalate Crystals

Yeast

Other Areas of the Clinical Laboratory

Clinical Microbiology

Identify organisms

Determine antibiotic sensitivity

The virology lab tests the serum for antibodies directed against viruses such as HIV or hepatitis.

Blood Bank determines which antibodies are present in your plasma so a compatible cross-match can be found if you need a blood transfusion.

What is a clinical laboratory What is a clinical laboratory professional?professional?

A laboratory professional A laboratory professional is a person who performs is a person who performs laboratory testing on laboratory testing on blood, urine, feces, spinal blood, urine, feces, spinal fluid and other body fluid and other body fluids.fluids.

They provide 70-80% of They provide 70-80% of the objective data used to the objective data used to make clinical decisions.make clinical decisions.

Laboratory Professionals

Conduct Tests To: Verify a potentially dangerous drug level Detect a cancerous tumor with DNA

techniques Identify toxic agents, such as anthrax, in

cases of bioterrorism Monitor the level of anti-rejection drugs

in transplant patients Type and cross-match blood samples for

transfusions Identify the causative microorganism in

a blood or wound infection

Who is a Laboratory Professional?

PhlebotomistPhlebotomist

Medical Laboratory Medical Laboratory

TechnicianTechnician

Medical Laboratory Medical Laboratory

ScientistScientist

CytotechnologistCytotechnologist

HistotechnicianHistotechnician

HistotechnologistHistotechnologist

Skills and Abilities

Good manual dexterityEnjoy problem solvingWork independentlyInterest in science,

especially biologyDetail orientedWork well under pressureOrganizedAccurate and PreciseDesire to help others

Clinical Laboratories7.25 billion tests

are performed

annually by

328,100

laboratory

professionals.

What’s a phlebotomist?

A phlebotomist goes through a A phlebotomist goes through a training program, which is training program, which is usually about three to four usually about three to four months long, ormonths long, or

They can do on-the-job They can do on-the-job training at a hospital ortraining at a hospital or

They can be Medical They can be Medical Assistants and trained on Assistants and trained on the jobthe job

Median wage is about Median wage is about $29,740/year.$29,740/year.

What’s an histology technician? Histology involves preparing solid Histology involves preparing solid

tissues such as biopsy samples and tissues such as biopsy samples and tumors for examination under the tumors for examination under the microscope.microscope.

A person with an associate degree in A person with an associate degree in histotechnology and certification is an histotechnology and certification is an histology technician.histology technician.

A person with a bachelor’s degree in A person with a bachelor’s degree in histotechnology and certification is an histotechnology and certification is an histology technologist.histology technologist.

Median salary for professionals with an Median salary for professionals with an associate degree in histotechnology is associate degree in histotechnology is about $20/ hour ($41,600/year) 2009.about $20/ hour ($41,600/year) 2009.

Median salary for professionals with a Median salary for professionals with a bachelor’s degree in histotechnology is bachelor’s degree in histotechnology is about $60,439/year.about $60,439/year.

How can I become an histology technician or histology technologist?

Program available at:Argosy University

• www.argosyu.edu• No current

programs in Iowa

What’s a medical laboratory technician?

A person with an A person with an associate degree and associate degree and certification as a medical certification as a medical laboratory technician laboratory technician (MLT).(MLT).

Median salary for Median salary for professionals with an professionals with an associate’s degree is associate’s degree is about $39,839.about $39,839.

MLT was rated 3MLT was rated 3rdrd in US in US News and World Report News and World Report Best Careers of 2011Best Careers of 2011

Local Iowa MLT Programs

Hawkeye Community College, Waterloo

Des Moines Area Community College, Ankeny

Iowa Central Community College, Fort Dodge

Web-based classes available

What’s a medical laboratory scientist?

A person with a A person with a baccalaureate degree and baccalaureate degree and certification as a medical certification as a medical laboratory scientist.laboratory scientist.

Median salary for Median salary for professionals with a professionals with a baccalaureate degree is baccalaureate degree is about $54,815/year.about $54,815/year.

General Job Duties

Run Lab testsDevelop and evaluate

the testsInterpret dataAnalyze the resultsCommunicate with

physicians regarding test results and test selection

Medical technologists use a light microscope to check blood smears for abnormalities

Iowa’s MLS Programs

University of Iowa: Clinical Laboratory ScientistAllen College: Medical Laboratory Scientist Interning sites:

St. Luke’s Hospital, Cedar Rapids

Mercy College of Health Sciences CLS, Des Moines

Mercy Medical Center-Sioux City

St. Luke’s College Medical Technology, Sioux City

What’s a cytotechnologist?

A cytotechnologists prepares A cytotechnologists prepares and examines slides of cells. and examines slides of cells. They are best known for the They are best known for the performance of Pap tests for performance of Pap tests for cervical cancer, but they cervical cancer, but they examine many other types of examine many other types of specimens as well.specimens as well.

A person with a baccalaureate A person with a baccalaureate degree and certification as a degree and certification as a cytotechnologistcytotechnologist

Starting salary for professionals Starting salary for professionals with a baccalaureate degree is with a baccalaureate degree is about $51,705/year. 2009about $51,705/year. 2009

How can I become a cytotechnologist?

Program available at:

Mercy School of Cytotechnology, Des Moines, IA

What’s the job market like?

Currently, there is a 9-Currently, there is a 9-20% vacancy rate across 20% vacancy rate across the country. the country.

According to the Bureau According to the Bureau of Labor and Statistics of Labor and Statistics 2010-11, 16% job growth 2010-11, 16% job growth from 2008-2018from 2008-2018

Wages from 2010 Salary Wages from 2010 Salary Survey-Advance Survey-Advance MagazineMagazine