Introduction to medical laboratory technology
- 1. INTRODUCTION TO MEDICAL LABORATORY TECHNOLOGY Hussein A. Abid Laboratory Medicine Specialist, Qualified instructor, ASM (member), AABM (member), IMLA (chairman) Iraqi Ministry of Higher Education & Scientific Research Middle Technical University (MTU) Technical Institute of Baquba Medical Laboratory Technology Dept. 2019-2020 Module’s info: • Medical Laboratory Technology (MLT112) • All weeks (15), theoretical hours (1), practical hours (2) 1st week husseinaltameemi@techbaq.mtu.edu.iq husseinaltameemy@yahoo.com
- 2. SYLLABUS Practical lectureWeekTheoretical lectureWeek Introduction to medical laboratory (terminology, glasswares, lab safety protocols, and microscope) 1-3 Introduction to medical laboratory technology (devices, tools, glasswares, techniques, and lab safety procedures) 1-2 Sterilization and disinfection4 Introduction to medical microbiology (taxonomy and medical bacteriology) 2-4 Preparation of culture media5Bacterial physiology5 Methods of cultivation6-7Sterilization and disinfection6 Studying colonial morphology8 Cultivation of bacteria (culture media and methods of preparation, preservation, and cultivation) 7-8 Staining of bacteria (smear preparation, fixation, and staining) 9-10 Diagnosis of bacteria (colonial morphology) 9 Examination of stained slides11 Staining of bacteria (stains, smear preparation, staining protocols) 10-12 Sampling in microbiology lab12 Clinical samples for bacteriological exam (collection, handling) 13 Review the previous subjects13-14 Clinical samples (processing and writing the final report) 14 Haematology laboratory (blood sampling and anticoagulants) 15 Introduction to haematology (blood and its components) 15
- 3. MEDICAL LAB TECHNOLOGY • Medical laboratory or clinical laboratory is a laboratory where clinical pathology tests are carried out on clinical specimens to obtain information about the health of a patient to aid in diagnosis, treatment, and prevention of disease. • Medical laboratory technology is the branch of medical science responsible for performing laboratory investigations relating to the diagnosis, treatment, and prevention of disease. - 3 -
- 4. UNITS OF MEDICAL LABORATORY ResponsibilitiesUnit Sample collection, handling, registration, and final-reports releasingReception CBC, blood films, coagulation profile, ESR, Hb-electrophoresis, ..etc.Hematology Examination of biopsies, autopsies, and cytopathological featuresHistopathology Diagnosis of pathogenic bacteria, fungi, parasites, and suggesting effective option of treatment (urine and fecal analysis are also made) Microbiology Evaluates antibodies and/or antigens (that may be indicative of many types of infectious diseases or other immune disorders) Serology and immunology Lipid profile, TFTs, RFTs, LFTs, PRL, FSH, FBG, blood gases,..Biochemistry Screening for viral infections (HIV, HCV, HBs-Ag, HBc-Ab, TORCH,..)Virology Cytogenetics and molecular analysis (trisomy, Factor V Leiden, ..) Medical genetics Looks for traces of drugs in blood, urine, hair, sweat, or salivaToxicology Coordination and administrationAdministrative - 4 -
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- 6. STAFF IN DIAGNOSTIC LAB • Pathologist (MD, M.Sc., or Ph.D.) • Clinical biochemist (B.Sc., M.Sc. or Ph.D.) • Medical microbiologist (B.Sc., M.Sc., or Ph.D.) • Medical laboratory scientist (MT, MLS or CLS) • Medical laboratory technologist (MLT) • Medical laboratory assistant (MLA) • Phlebotomist (PBT) - 6 -
- 7. TESTS IN DIAGNOSTIC LAB • In general, tests in diagnostic lab are divided into: 1. Simple tests: basic principles with simple requirements like glassware, microscope, lancets, syringes, test tubes (e.g. Hb conc., PCV, GUE, GSE, bleeding time, clotting time, blood group, ..). 2. Advanced test: need advanced principles and techniques like RIA, ELFA, ELISA, CLIA, PCR, FISH (e.g. PRL, E2, leukopoietin, AMH, HER2 (MA- FISH), MDA, SOD, ..). - 7 -
- 8. SIMPLE VS. ADVANCED TESTS Advanced testsSimple testsCharacter HighLowSpecificity HighLowSensitivity LessMoreAvailability Usually expensiveInexpensiveCost ComplexSimpleComplexity HighLowStaff qualification AdvancedSimpleTraining MoreLessAccuracy MoreLessPrecision - 8 -
- 9. MACHINES AND DEVICES - 9 - • A microscope is an instrument used to see objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using such an instrument. Microscopic means invisible to the eye unless aided by a microscope. • The most common microscope (and the first to be invented) is the optical microscope, which uses light to pass through a sample to produce an image. • Other major types of microscopes are the fluorescence microscope, the electron microscope (both the transmission electron microscope and the scanning electron microscope) and the various types of scanning probe microscopes.
- 10. MACHINES AND DEVICES - 10 - • Incubator is a device used to grow and maintain microbiological cultures or cell cultures. • The incubator maintains optimal temperature, humidity and other conditions such as the CO2 and oxygen content of the atmosphere inside. • The temperature inside the incubator is mostly at 37 °C.
- 11. MACHINES AND DEVICES - 11 - • Water bath: is a laboratory equipment made from a container filled with heated water. • It is used to incubate samples in water at a constant temperature over a long period of time.
- 12. MACHINES AND DEVICES - 12 - • Laboratory oven: is oven for high-forced volume thermal convection applications. This oven generally provides uniform temperature throughout. • Process applications for medical laboratory ovens can be for drying and sterilizing glassware. • Typical size is 0.9 cubic meters with temperatures that can be over 340 degrees Celsius (°C).
- 13. MACHINES AND DEVICES - 13 - • A centrifuge is a laboratory device that is used for the separation of fluids, gas or liquid, based on density. • Separation is achieved by spinning a vessel containing material at high speed; the centrifugal force pushes heavier materials to the outside of the vessel.
- 14. MACHINES AND DEVICES - 14 - • An electronic balance is a device used to find accurate measurements of weight. • It is used very commonly in laborites for weighing chemicals to ensure a precise measurement of those chemicals for use in various experi- ments. • Electronic balance could be used in microbiology lab unit (for weighing culture media powder), haematology lab unit (for weighing chemicals needed for preparing solutions used in cell counting).
- 15. MACHINES AND DEVICES - 15 - • In laboratory settings, hot plates are generally used to heat glassware or its contents. • Some hot plates also contain a magnetic stirrer, allowing the heated liquid to be stirred automatically. • In a student laboratory, hot plates are used because baths can be hazards if they spill, overheat or ignite because they have high thermal.
- 16. MACHINES AND DEVICES - 16 - • A biosafety cabinet (BSC), also called a biological safety cabinet or microbiological safety cabinet. • Is an enclosed, ventilated laboratory workspace for safely working with materials contaminated with (or potentially contaminated with) pathogens requiring a defined biosafety level. • Several different types of BSC exist, differentiated by the degree of biocontain- ment required (class I, II, and III). • BSCs first became commercially available in 1950.
- 17. MACHINES AND DEVICES - 17 - • An autoclave is a machine that uses steam under pressure to kill harmful bacteria, viruses, fungi, and spores on items that are placed inside a pressure vessel. • The items are heated to an appro- priate sterilization temperature for a given amount of time. • To be effective, the autoclave must reach and maintain a temperature of 121 °C for at least 30 minutes by using saturated steam under at least 15 psi of pressure.
- 18. MACHINES AND DEVICES - 18 - • Wax-bath: is designed to assist with the handling of paraffin wax samples in histopathology laboratories. • It is essentially a hot distilled water floating out bath that allows for the meticulous manipulation and location of sections onto glass slides.
- 19. MACHINES AND DEVICES - 19 - • Automatic Tissue Processor: is a compact and sturdy instrument designed with latest technology for complete automatic dehydration and filtration of human, animal and plant's tissues, up to final fixing in wax.
- 20. MACHINES AND DEVICES - 20 - • Spectrophotometer is a machine used to measure how much a chemical substance absorbs light by measuring the intensity of light as a beam of light passes through sample solution. • The basic principle is that each compound absorbs or transmits light over a certain range of wavelength. • In biochemistry lab it is used to measure blood sugar, lipid profile tests, …etc., while in microbiology it is used to determine bacterial count indirectly.
- 21. MACHINES AND DEVICES - 21 - • Tube Roller Mixer is a simple machine recommended for mixing blood samples, viscous substances and liquid-solid suspensions where minimum aeration is required. • Mostly, used in hematology to mix blood samples before processing by CBC analyzer. • It is also used by reception unit staff members to mix blood samples and prevent clotting just after blood sampling.
- 22. MACHINES AND DEVICES - 22 - • Hematology (CBC) analyzer is used to count and identify blood cells at high speed and accuracy. • During the 1950s, lab technicians counted each individual blood cell underneath a microscope. Tedious and inconsistent, this was replaced with the first, very basic hematology analyzer, engineered by Wallace H. Coulter. • In CBC report, the results include RBC count, Hb concentration, HCT, MCV, MCH, MCHC, RDW, WBC count, DLC, PLT count, PCT, and MPV.
- 23. MACHINES AND DEVICES - 23 - • MINI VIDAS® is greatly appreciated worldwide for its simplicity, flexibility, reliability and 24/7 availability. • It processes single sample and batch tests for all types of analysis: serology, immunochemistry, antigen detection. • All enzyme immunoassay reaction stages are performed automatically in minimal space: pipetting, incubating, washing, reading, and results are sent immediately to the integrated printer.
- 24. MACHINES AND DEVICES - 24 - • The VITEK® 2 system has everything healthcare laboratories need for fast, accurate microbial identification, and antibiotic susceptibility testing. • Uses: 1. Microbial Identification: bacteria and yeast identification (ID) 2. Antibiotic Susceptibility Testing (AST) and resistance mechanism detection 3. Epidemiologic trending and reporting
- 25. MACHINES AND DEVICES - 25 - • Gel electrophoresis is a laboratory devise used to separate mixtures of DNA, RNA, or proteins according to molecular size. • In gel electrophoresis, the molecules to be separated are pushed by an electrical field through a gel that contains small pores. • Macromolecules (such as DNA, RNA, or protein) moved through gel based on their size and charge.
- 26. MACHINES AND DEVICES - 26 - • Polymerase Chain Reaction (PCR) is a method widely used in molecular biology to make many copies of a specific DNA segment. • Using PCR, copies of DNA sequences are exponentially amplified to generate thousands to millions or more copies of that particular DNA segment. • Common types of PCR include: Real-Time PCR, nested PCR, multiplex PCR, quantitative PCR, arbitrary primed PCR.
- 27. MACHINES AND DEVICES - 27 - • Enzyme-Linked Immunosorbent Assay (shortened as ELISA) is used to identify peptides, proteins, antibodies, and hormones. • Also, called as enzyme immunoassay (EIA), ELISA finds use in the fields of biotechnology and medicine as a diagnostic tool. • Mainly, antibodies and color changes are used to identify target substances. • According to how it works, ELISA can be divided into FOUR major types: direct, indirect, sandwich, and competitive.
- 28. MACHINES AND DEVICES - 28 - • Other biochemistry analyzers Roche Cobas 6000 Principle: • Electrochemiluminescence immunoassay method • ISE potentiometry (electrolytes) • Absorbance Photometry (enzymes, substrates, proteins, DAT, TDM) Biolyzer 200 Principle: • Turbodensitometry (photo-based)
- 29. TOOLS AND GLASSWARE - 29 - Bunsen burnerPlastic dropper Test tube rack Beaker Conical flask Petri-dish Tourniquet
- 30. TOOLS AND GLASSWARE - 30 - Capillary tubes Test tubes Syringes Graduated cylinderForceps Loop
- 31. INSTRUCTIONS INSIDE LAB • The laboratory usually contains unsafe substances and/or tools and your full attention is required. • For both safety reasons and to avoid disrupting lab activities you must silence all cell phones and pagers; their use is prohibited. • All persons in laboratories, including students, staff, and visitors, shall wear safety glasses, goggles, or face shields at all times where potential eye hazards exist. • NOTE: prescription eyeglasses do not provide adequate protection. - 31 -
- 32. INSTRUCTIONS INSIDE LAB • Eating, drinking, chewing gum, and applying cosmetics are prohibited in the laboratories. • Do not store food or beverages in the same refrigerators or freezers with chemicals, biohazards, or radioactive materials. • Appropriate gloves are essential when working with hazardous substances (like blood). • All glove materials are not equally effective in protection from hazardous substances; consult a chemical resistance chart, a glove manufacturer, or EH & S for appropriate selection. - 32 -
- 33. INSTRUCTIONS INSIDE LAB • Never conduct unauthorized experiments or engage in horseplay in a laboratory. Please immediately report any unsafe behavior to the instructor. • Wear appropriate clothing. In particular, you must wear closed-toed shoes (i.e., NO sandals or flip-flops!) in the laboratory. Long pants are highly recommended. Avoid wearing your best clothes, and if you have long hair tie it back. Avoid wearing dangling jewelry. • Wearing an iPod, Bluetooth, or any other device that interferes with hearing is not allowed. • Never pipet anything by mouth. - 33 -
- 34. INSTRUCTIONS INSIDE LAB • Never conduct unauthorized experiments or engage in horseplay in a laboratory. Please immediately report any unsafe behavior to the instructor. • Wear appropriate clothing. In particular, you must wear closed-toed shoes (i.e., NO sandals or flip-flops!) in the laboratory. Long pants are highly recommended. Avoid wearing your best clothes, and if you have long hair tie it back. Avoid wearing dangling jewelry. • Wearing an iPod, Bluetooth, or any other device that interferes with hearing is not allowed. • Never pipet anything by mouth. - 34 -
- 35. INSTRUCTIONS INSIDE LAB - 35 - • The work area must be kept clean and uncluttered. • All chemicals should be labeled and stored properly. • Never work alone in the laboratory. • The hazards of chemicals used should be known (e.g., corrosiveness, flammability, reactivity, stability, and toxicity). • Material Safety Data Sheets (MSDSs) should be available for all non-routine or acutely toxic chemicals used and stored in the laboratory.
- 36. INSTRUCTIONS INSIDE LAB - 36 - • Always pay attention to your surroundings and be aware of what others are doing. Always be courteous. • Remove contaminated gloves before touching common use devices (door knobs, faucets, equipment); discard gloves before leaving the laboratory. • Always wash hands and arms with soap and water before leaving the laboratory. • No smoking!