3.

BLOOD BANKING AND TRANSFUSION MEDICINE

CLINICAL PATHOLOGY - Involving blood donor screening and testing,

INTRODUCTION blood component

compatibility testing
preparation, and

Dr. Abel Alera, MD 4. MEDICAL MICROBIOLOGY

- Entailing diagnostic bacteriology, mycology,
LABORATORY MEDICINE OR CLINICAL PATHOLOGY virology, parasitology and serology
- Medical discipline in which clinical laboratory science 5. MEDICAL MICROSCOPY
and technology are applied to the care of patients - For the examination of urine and other body
- Pathology applied specifically to a living patient fluids
suffering from some disease process 6. IMMUNOASSAYS
- Students should learn to use their knowledge of - For endocrine testing, therapeutic drug
disease processes in the practical solution of diagnostic monitoring, several toxicology assays, and
problems in the clinic and laboratory others.
- Introduced to the students after they have passed 7. IMMUNOLOGY
following basic sciences: - Involving both quantitative and qualitative
• Anatomy determinations of humoral and cellular
• Physiology immunity and immunochemistry
• Biochemistry - Branch of laboratory medicine that studies
- Subjects are recommended prerequisites to give blood serum for evidence of infection and other
students a better grasp of the course parameters by evaluating antigen-antibody
reactions in vitro
DISCIPLINES OF LABORATORY MEDICINE
1. HEMATOLOGY *others
- Examination of the cellular elements of blood 8. RECEIVING SECTION
and also its clotting factors 9. ANATOMIC PATHOLOGY SECTION
- Medical laboratory technician performing - Surgical Pathology – Biopsy
blood cell counts on automated instrument - Cytology – Pap smear, Fine needle aspiration
interfaced with the computer biopsy (FNAB)
- This section counts and qualifies the different 10. CLINICAL CHEMISTRY
types of blood and other components found in - The modern clinical chemistry, laboratory uses
blood a high degree of automation
- Many steps in the analytic process that were
- No test preparation needed
previously performed manually can now be
- Get tested to determine your general health
performed automatically
status; to screen for, diagnose, or monitor any
- Permits the operator to focus on tasks that
one of a variety of diseases and conditions that
cannot be readily automated and increasing
affect blood cells, such as anemia, infection,
both efficiency, capacity and accuracy
inflammation, bleeding disorder or cancer
11. SEROLOGY
- HEMATOLOGY
12. MICROBIOLOGY
• Study of blood 13. WATER ANALYSIS
- COMPLETE BLOOD COUNT
• Also known as CBC, Hemogram - With the advancements in technology and the
• Blood sample drawn from a vein in your availability of a myriad of laboratory tests that can be
arm or a fingerstick or heelstick used to identify a disease, the medical learner should
(newborns) remember not to fall into the trap of relying heavily
2. CHEMICAL PATHOLOGY upon these tests to come up with a diagnosis
- Measurement of over 200 substances in serum - Laboratory data are never a substitute for a good
and body fluids physical examination and a complete patient history

FMD | EXCELSUS 2023

 - Pathology is difficult because you need to know a lot PHYSICIAN AND THE LABORATORY
about a disease in a short span of time KEY POINTS
- Ability to extract a detailed and accurate patient - Appropriate use of clinical laboratory testing
history and a carefully performed physical examination • Selecting tests that will have the greatest
are fundamental requirements in physical diagnosis chance of answering a specific question
• Provides the physician a comprehensive - The decision to order a particular laboratory test
knowledge on patient management requires knowledge of its diagnostic value and clinical
- Selection of diagnostic tests and the choice of usefulness
treatment all depend on one’s findings during the - Overutilization of laboratory testing and omission of
history-taking and the physical examination appropriate tests are both examples of clinical
- Tests ordered are done merely to affirm the initial laboratory misuse
diagnosis
- Certain laboratory examinations that are routinely CLINICAL LABORATORY
ordered on patients (Ex. CBC, Urinalysis, and Chest X- - Plays a critical role in diagnosing disease, determining
ray) prognosis and monitoring therapy and disease
- Laboratory tests can be ordered to rule out certain progression
conditions that also have the same signs and symptoms - Learning to use the laboratory appropriately is an
with the actual disease process. essential part of a physician’s training
- It can also be employed to document recurrence, - In modern medical practice, selecting and interpreting
progression, or regression of a disease entity. tests is arguably no less important than the medical
- Actual clinical values depicted in the laboratory results history and physical examination.
should be clinically correlated to the actual patient
presentation. PHYSICIANS
• Not a surprise to sometimes see high - Physicians must choose from hundreds of available
laboratory values in an otherwise normal laboratory tests in a multitude of different specimen
patient types
- A medical student at his level should also take time to - Goal should be to select tests that will provide
familiarize with the normal values of the laboratory information as efficiently as possible at the least cost.
procedures that are commonly ordered by doctors on • Goal is achieved when tests are selected that
their patients are best suited to answer specific questions.
• Knowledge will help him identify conditions - Clinical judgment gained from formal medical
that would need emergent medical attention. education and experience will guide the physician in
• Knowledge of when to order diagnostics tests determining the type of testing that is appropriate in a
and the associated patient preparations given case.
required prior to testing are also important so
as not to waste valuable time and money LABORATORY ORDER PRIORITIES
needlessly on poorly-prepared patient samples. 1. LABORATORY TESTS
- Often ordered according to the degree of
- Main push of Clinical Pathology is to inculcate into the urgency with which results are required for
minds of its students the importance of laboratory medical management decisions.
diagnostics as an aid in the medical management of a 2. STAT OR MEDICAL EMERGENCY PRIORITIES
patient - Ordered only when there is true necessity for
- Its results will be maximized if these tests were a rapid response, not when it is simply a matter
ordered at the right time, for the right reasons, in the of convenience. - If an excess of STAT orders is
most economical way possible received, the process is slowed.
- Laboratory data are never a substitute for a good 3. ROUTINE ORDERS
physical examination and patient history - Generally processed in order of arrival in the
laboratory

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APPROPRIATE USE OF THE LABORATORY WHAT CONSTITUTES AN UNNECESSARY LABORATORY
- Selecting tests that will have the greatest chance of TEST?
answering a specific question pertaining to a patient’s - Any test to which the results are not likely to be
clinical condition “medically necessary” in the appropriate management
- Clinical assessment gained from the medical history of the patient’s medical condition.
and physical examination must determine what role
laboratory tests will play in the assessment of a BEFORE ORDERING A TEST, ONE SHOULD CONSIDER
patient’s complaint THE FOLLOWING QUESTIONS:
- Decision to order a particular laboratory test also - Why is the test being ordered?
requires a physician who knows how to interpret the - What are the consequences of not ordering the test?
result or who can consult a clinical pathologist - How good is the test in discriminating between health
- To use a clinical laboratory effectively, knowledge of and disease?
the diagnostic value and clinical usefulness of a test is - How are the test results interpreted?
essential - How will the test results influence management and
- The factors that determine the diagnostic value of a outcome of the patient’scondition?
test are sensitivity, specificity and prevalence of disease.
- Predictive value best determines diagnostic value. LEGITIMATE REASONS FOR ORDERING A LABORATORY
TEST:
CLINICAL USEFULLNESS 1. DIAGNOSIS
- Related to the value of a test result in confirming or - To confirm clinical impression or to rule out a
excluding a clinical condition disease
- Requires knowledge of what constitutes an abnormal 2. MONITORING
value and how it relates pathophysiologically and - To provide therapeutic guidance
clinically to the patient’s condition and ultimately what 3. SCREENING FOR DISEASE
relevance it has in decision regarding diagnosis or - E.g. congenital hypothyroidism
treatment. 4. PROGNOSIS
- E.g. serum levels of ALT to determine severity
FACTORS THAT HAVE CONTRIBUTED TO THE ABUSE of hepatitis
AND MISUSE OF LABORATORY TESTS INCLUDE: 5. RESEARCH
1. A greater availability of routine laboratory tests as a - To understand the pathophysiology of a
result of advances intechnology particular disease process
2. A constantly increasing variety of available tests.
3. The capability of diagnosis & defining an increasing FACTORS AFFECTING THE QUALITY OF LABORATORY
number of diseases using laboratory test data. DATA:
4. The increased number of disease being managed by 1. PATIENT PREPARATION
laboratory tests - Time of day Fasting /nonfasting
5. The advent of therapeutic drug monitoring and 2. SPECIMEN COLLECTION
toxicology - Venipuncture technique
6. The increased amount of testing for medicolegal - Proper tube for blood, plasma, or serum
reasons (defensive medicine) - Correct labelling of sample
7. The reluctance of physicians to give up obsolescent - Overfilling or underfilling sample tubes
tests even though new tests provide better information 3. SPECIMEN HANDLING
8. A greater reliance by younger physicians on - Transport Processing Storage
laboratory tests 4. ANALYSIS
9. Increased testing to follow up unexplained - Method precision (coefficient of variation)
“abnormal” results discovered by screening - Method accuracy (calibration)
10. One-upmanship and intellectual curiosity, especially - Manual vs. Automated method
among resident physicians 5. REPORTING
11. The opinion that a certain number of laboratory - Calculation
studies are necessary to maintain and improve clinical - Transcription
skills. - Hard copy vs. verbal report

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DEFINITION OF TERMS
1. ACCURACY
- Refers to how closely the measurement
approaches the true value of the substance
being analyzed
- Synonymous with correctness
2. PRECISION
- Measures the inherent variability of a test.
- Synonymous with reproducibility
3. SENSITIVITY
- How well a test detects disease without
missing some diseased individuals by falsely
classifying them as healthy
- Sensitivity of the test indicates its ability to
generate more true-positive results and few
false negative ones
4. SPECIFICITY
- How good the test is at detecting only those
individuals that have a disease as opposed to
falsely labelling some healthy persons as having
disease.
- Reflects its ability to detect true-negatives
with very few false-positive results.
5. PREDICTIVE VALUE
- Useful to a physician when attempting to
determine whether or not a patient has a
particular disease based on a specific laboratory
result.
6. REFERENCE RANGES / NORMAL VALUES
- Values to be found in normal or healthy
individuals that lie between the lower and
upper limits that encompass 95% of all values.
7. PROFILE OR PANEL TESTING
- Collection of different measurements related
to a particular organ, organ system or disease.
- Example: Cardiac panel, liver function tests
8. STAT
- Need for immediate turnaround of laboratory
results to the physician within one hour or less
of drawing the specimen in order to modify
therapy.
9. CRITICAL OR PANIC VALUES
- Lists of analytes that truly do have the
potential to be lethal if left unchecked for a
short period.
10. ANCILLARY OR POINT OF CARE (POC)
- Refers to those analyses that are performed
outside the physical facilities of a centralized
clinical laboratory (e.g., fingerstick blood
analysis for glucose).

FMD | EXCELSUS 2023