ROUTINE STOOL ANALYSIS

DEFINITION
Routine fecalysis or stool analysis is the macroscopic, microscopic and chemical analysis of feces
or stool. A Stool analysis is performed for the purpose of detection and identification of parasites
(helminths or protozoa), detection of bleeding in the gastrointestinal tract, disorders of the biliary
ducts and liver, diseases of the pancreas, inflammation, malabsorption and maldigestion
syndromes and investigation of the causes of diarrhea and steatorrhea.
SPECIMEN COLLECTION
1. The patient will collect in a clean container such as a bread pan, leak-proof, plastic disposable
container and transfer the stool into a laboratory container.
2. The stool sample must not to be contaminated by urine or toilet water

 Toilet water may contain chemical disinfectants or deodorizers that can interfere with
chemical testing
 Containers that contain preservatives for ova and parasites must not be used to collect
specimens for other tests.
 Random specimens suitable for qualitative testing for blood and microscopic examination
for leukocytes, muscle fibers, and fecal fats are usually collected in plastic or glass
containers with screw-tops similar to those used for urine specimen
 Material collected on a physician’s glove and samples applied to filter paper in occult blood
testing kits are received.
 For quantitative testing, such as for fecal fats, timed specimens are required. Because of the
variability of bowel habits and the transit time required for food to pass through the
digestive tract, the most representative sample is a 3-day collection. These specimens are
frequently collected in large containers to accommodate the specimen quantity and
facilitate emulsification before testing.
 Care must be taken when opening any fecal specimen to slowly release gas that has
accumulated within the container. Patients must be cautioned not to contaminate the
outside of the container.
 Advise patients to label sample container to be submitted properly and completely
 Advise patients to complete necessary details on the laboratory request form

3. The standard size of the stool sample for analysis is “thumb size” for formed specimens, 2-5
tablespoons for mucoid or watery specimens.
A. MACROSCOPIC SCREENING
A. COLOR - The brown color of the feces results from intestinal oxidation of stercobilinogen to
urobilin.
B. APPEARANCE and CONSISTENCY

COLOR / APPEARANCE POSSIBLE CAUSES

RED Lower GI bleeding
Beets and food coloring
Rifampin
BLACK Upper Gastrointestinal tract bleeding
Iron therapy
Charcoal
Bismuth (antacids)
 PALE YELLOW, Bile-duct obstruction
WHITE, GRAY Barium sulfate
GREEN Biliverdin/oral antibiotics
Green vegetables
BULKY/FROTHY Bile-duct obstruction
Pancreatic disorders
RIBBON-LIKE Intestinal constriction
MUCUS- OR Inflammation or irritation of the
BLOOD-STREAKED gastrointestinal tract
MUCUS Amoebic dysentery
Bacillary dysentery
Malignancy
Constipation
Pathologic colitis
Crohn disease
Colon tumors
Excessive straining during elimination
SMALL, HARD Constipation
WATERY Diarrhea

B. CHEMICAL ANALYSIS
1. Occult Blood Test - occult blood has a high positive predictive value for detecting colorectal
cancer in the early stages
INTERFERENCE IN FECAL OCCULT BLOOD TESTING

FALSE-NEGATIVE FALSE POSITIVE

 Menstrual and hemorrhoid  Iron supplements containing vitamin C

contamination  Greater than >250 mg/d of vitamin C
 Aspirin and anti-inflammatory  Failure to wait specified time after sample
medications is applied to add the developer reagent
 Red meat
 Horseradish
 Raw broccoli, cauliflower, radishes,
turnips
 Melons

2. Fecal Enzymes – enzymes that are produced by the pancreas is necessary in degradation of
dietary carbohydrates, fats and proteins.
A. Fecal chymotrypsin – sensitive indicator of less severe pancreatic insufficiency
B. Fecal elastase I – sensitive indicator of exocrine pancreatic insufficiency
3. Carbohydrates – marker of osmotic diarrhea from the osmotic pressure of the unabsorbed sugar

C. MICROSCOPIC ANALYSIS
Detect the presence of leukocytes associated with microbial diarrhea and undigested muscle fibers
and fats associated with steatorrhea.
  Presence of leukocytes – neutrophils are the predominant leukocyte in a stool specimen on
patients having bacterial dysentery and colitis
 All preparation must be made from a fresh stool sample
 Wet preparation are stained with methylene blue while dried preparation can be stained
with Wright’s or Gram stain
 Gram stain can differentiate bacteria and can aid in the diagnosis and treatment
 A count of as few as three neutrophils per high power field is indicative of bacterial
invasion.
 The sensitivity of finding any neutrophils in an invasive condition using an oil immersion
objective is 70%
 Microscopic examination of undigested striated muscle fibers in feces can be a helpful tool
in diagnosing pancreatic insufficiency
 Fecal fats are also examined in conjunction with the microscopic examination of muscle
fibers.
 Fecal fats can be stained by Sudan III stain

STOOL ANALYSIS SAFETY PRECAUTIONS

 Samples must be labelled properly and completely

 Stool samples must be packed in a triple packaging system
 Samples must be transported with care and adhering to biosafety guidelines
 Observe standard precautions
 Review biosafety and infection control procedures and protocols
 Wear appropriate personal protective equipment
 In dealing with preserved samples, apply standard precautions at all time or treat such
samples as infectious
 Avoid prolonged exposure to air
 Follow standard protocols, consult material safety data sheet whenever applicable in
handling preservatives and other reagents
 Dispose samples properly adhering with waste management and biosafety guidelines
PERFORMANCE OF STOOL ANALYSIS (adopted from WHO manual)
1. Prepare the reagents and materials to be use – Lugol’s Iodine, NSS, and Acetic acid etc.

2. Take a dry microscope slide and label it with the name or number of the patient.

3. Put one drop of normal saline solution in the middle of the left half of the slide; and one drop of the iodine-acetic
acid solution in the middle of the right half of the slide

4. Using an applicator stick, take a small portion (about 2–3 mm diameter) of the stool.

(a) If the stools are formed, take the portion from the center of the sample and from the surface to look for parasite
eggs.

(b) If the stools contain mucus or are liquid, take the portion from the mucus on the surface or from the surface of
the liquid to look for amoebae.

5. Mix the sample with the drop of sodium chloride solution on the slide.

6. Using the applicator or wire loop, take a second portion of stool from the specimen as described above and mix it
with the drop of iodine–acetic acid solution.
Discard the applicator stick after use.

7. Place a coverslip over each drop (avoid the formation of air bubbles).

8. Examine the preparations under the microscope. For the saline preparation use the x 10 and x 40 objectives and a
x 5 eyepiece. Unstained preparation in the saline solution preparation must be examined under low light since
certain protozoan cysts are colorless

Examine the first preparation with the x10 objective, starting at the top left hand corner as indicated. Focus on the
edge of one coverslip using the x10 objective and examine the whole area under each coverslip for the presence of
ova and larvae of Strongyloides stercoralis. Then switch to the x40 objective and again examine the whole area of
the coverslip over the saline for motile trophozoites and the area of the coverslip over the iodine for cysts.

9. Lugol iodine–acetic acid solution causes the trophozoite forms to become non-motile. The nucleus is clearly
stained but it may be diffificult to distinguish between trophozoite and cystic forms.

10. Using a clean Pasteur pipette, allow a drop of methylene blue solution to run under the coverslip over the saline
preparation. This will stain the nuclei of any cells present and distinguish the lobed nuclei of polymorphs from the
large single nuclei of mucosal cells.

11. If a drop of eosin solution is added, the whole field becomes stained except for the protozoa (particularly
amoebae), which remain colourless and are thus easily recognized.

Drop of NSS and Lugol’s Iodine

LUGOL’S
NSS IODINE

Technique to avoid bubbles in the

wet mount preparation

Poke several locations and depth

on the stool sample. In doing this,
recovery of parasites are optimized
Source of images: WHO Manual Techniques of Basic Health In examining the wet mount, scan with
Laboratory 2nd Edition longitudinal method or battlement
method, and no field missed. Scan also
the edges of the preparation. When
scanning with HPO, take extra
precaution because one high power
field is equal 2-4 low power fields.

REPORTING
  Report parasite with complete scientific name and stage of the parasite
 The parasite count is prone to subjectivity, as per standard operating procedures, the
parasite requested by physicians to evaluate parasitic burden or severity of the parasitism
 Human-derived microscopic elements such as Charcot-Leyden crystals, fat globules, and
white blood cells/pus cells must be reported with corresponding count
 Example of reporting:
Positive for Entamoeba histolytica trophozoite
Positive for Capillaria philippinensis ova and larva
Pus Cells = 2-4/hpf
No Intestinal Parasite Seen or No Ova or Parasite Seen

QUALITY CONTROL PROCEDURES IN ROUTINE FECALYSIS

 Process and perform microscopic analysis within 30 mins to 1 hour to increase the chance
of detecting motile trophozoites.
 Process samples promptly in order to maintain the parasite morphology
 Samples should not be contaminated with urine
 Fecal samples should not be collected within seven (7) days after the administration of
antimicrobial agents, antacids, antidiarrheal medications, bismuth, mineral oil and barium.
 Check the reagents and stains used in routine fecalysis and microscopy
 Turbidity is a common observation in bacterial and/or fungal contamination in
normal saline solution
 Iodine solution must have a strong tea-like hue; discard the solution if the color is
light.
 The cytoplasm of trophozoite should stain pale blue and the nuclei should stain a
darker blue with the methylene blue stain.

 Cyst stained with iodine should appear gold or yellow, the glycogen vacuole will be
stained brown, nuclei is pale and refractile

 Human white blood cells (buffy coat cells) mixed with negative stool can be used as
a quality control (QC) specimen. The human cells when mixed with negative stool
can be used as a quality control specimen. The human cells will stain with the same
color as that seen in the protozoa.
 Calibrate microscope once a year or whenever necessary, perform daily cleaning and
maintenance of light microscope to maintain par centrality and par focality
 Use clean or new glass slides and cover slips
HELMINTH OVA
VARIOUS PROTOZOAN TROPHOZOITE AND CYSTS
MICROSCOPIC HUMAN-DERIVED ELEMENTS
MICROSCOPIC NON-HUMAN-DERIVED ELEMENTS THAT CAN BE MISTAKEN AS PARASITE
Image sources:

https://cmr.asm.org/content/31/1/e00025-17/figures-only#sec-32

WHO Manual Techniques of Basic Health Laboratory 2nd Edition

Atlas of Helminthology and Protozoology

Reference:
http://www.med-chem.com
Urinalysis and Body Fluids 6th Edition by S. Strasinger and M. Lorenzo
WHO Manual Techniques of Basic Health Laboratory 2nd Edition

ROUTINE URINE ANALYSIS

DEFINITION
Urine analysis is the chemical, macroscopic and microscopic examination of
urine in order to diagnose or detect wide range of disorders of the genito-urinary
tract, kidney diseases and diabetes.
QUALITY CONTROL IN URINE SPECIMEN COLLECTION, HANDLING AND
TRANSPORT
 The urine container to be used must be clean, leak-proof, should have a
wide mouth with a wide flat bottom to prevent overturning.
 The urine specimen must be labelled completely and properly with the
patient’s name, age, sex, identification number, date and time of collection
and location.
 The laboratory request form is properly filled-out with necessary set of
information and must match the details on the specimen container
 Samples must be processed within 2 hours after collection
 If there will be a delay in transport and processing, the specimen must be
refrigerated or maintain a temperature range of 2 to 8 degrees Celsius;
samples must return to room temperature before the performance of
chemical testing
 Mid-stream clean catch urine is the specimen of choice. Mid-stream clean
catch urine is a representative of a naturally voided urine due to less
contamination from bacteria, epithelial cells and bacteria.
TYPES OF URINE SAMPLES
RANDOM For routine screening
FIRST MORNING For routine screening,
pregnancy testing and
orthostatic protein
MIDSTREAM CLEAN-CATCH Routine screening and bacterial
culture
24-HOUR URINE Quantitative chemical testing
CATHETERIZED Bacterial culture
SUPRAPUBIC ASPIRATION Bacterial culture of the bladder
urine, cytology
THREE-GLASS COLLECTION Prostatic infection

 If preservation is inevitable, inquire to the recipient laboratory about the

preservatives they use.

UNPRESERVED URINE SAMPLE CHANGES

 Darkened color due to redox reaction of metabolites
 The clarity of urine is decreased due to bacterial growth and
precipitation of amorphous materials
 Bacterial growth will increase the odor of urine due to the breakdown
of urea to ammonia
 Increased in pH will be observed due to the loss of carbon dioxide
and the breakdown of urea to ammonia by bacteria
 Decrease in glucose due to bacterial metabolism
 Decrease in ketones due to volatilization and bacterial activity
 Prolonged exposure to light and photo-oxidation to biliverdin will
decrease the levels of bilirubin
 Decreased levels of urobilinogen due to oxidation, forming urobilin
 Increased nitrites because of nitrate-reducing bacteria
  Decrease in the number of casts due to disintegration in a diluted
alkaline urine
 Bacterial multiplication
 Loss of motility and/or death of Trichomonas spp. trophozoites

 A refrigerated urine samples for chemical testing must first return to room
temperature because enzymatic reactions on the reagent strip will react
best at room temperature (20 – 25 deg. Celsius)
 The laboratory must also establish a rejection criteria or specimen
acceptability criteria
 Nonmatching label details with the pertinent data on the request form
 Unlabeled specimen containers
 Urine samples contaminated with fecal material
 Insufficient quantity of urine samples submitted
 Improperly transported samples
PHYSICAL EXAMINATION OF URINE
a. Color – variation in color of urine will be dependent on the pathologic
condition, metabolism, physical activity and diet of the patient.
DIFFERENT URINE COLORS AND CAUSES (Adopted from Analysis of Urine
and Body Fluids 6th Edition
by S. Strasinger and M. Lorenzo)
Recent fluid
COLORLESS
consumption
Polyuria or diabetes insipidus
PALE YELLOW Diabetes mellitus
Dilute random specimen
DARK YELLOW Concentrated specimen
B complex vitamins
Dehydration
Bilirubin
Acriflavine
Nitrofurantoin
 Phenazopyridine (Pyridium)
ORANGE-YELLOW
Phenindione
Bilirubin oxidized to
YELLOW-GREEN
biliverdin
GREEN Pseudomonas infection
Amitriptyline
Methocarbamol (Robaxin)
Clorets
BLUE-GREEN
Indican
Methylene blue
Phenol
PINK RBCs
Hemoglobin
Myoglobin
RED Beets
Rifampin
Menstrual contamination
PORT WINE Porphyrins
RBCs oxidized to
RED-BROWN methemoglobin
Myoglobin
BROWN Homogentisic acid
(alkaptonuria)
Malignant melanoma
Melanin or melanogen
Phenol derivatives
BLACK
Argyrol (antiseptic)
Methyldopa or levodopa
Metronidazole (Flagyl)

B. Clarity – transparency or turbidity of the urine sample

  Clear - No visible particulates, transparent
 Hazy - Few particulates, print easily seen through urine
 Cloudy - Many particulates, print blurred through urine
 Turbid - Print cannot be seen through urine
 Milky - May precipitate or be clotted
C. Specific Gravity - reagent strip reaction is based on the change in pKa
(dissociation constant) of a polyelectrolyte in an alkaline medium. The
polyelectrolyte ionizes, releasing hydrogen ions in proportion to the number of
ions in the solution. The higher the concentration of urine, the more hydrogen
ions are released, thereby lowering the pH. (AUBF 6th Edition)

QUALITY CONTROL IN THE PHYSICAL EXAMINATION OF URINE

 Follow the laboratory standard operating procedures
 Adequate lighting in the work area
 Clean and organized work area
 Preservation and or refrigeration of samples if necessary
 Refrigerated samples must return first to room temperature prior to
chemical testing
 Well-mixed sample is necessary for testing
 Use sample with adequate volume
 In specific gravity testing using reagent strip, avoid prolonged
dipping of the strip because it may cause carry-over

BIOSAFETY MEASURES DURING TESTING

 Apply standard precautions
 Apply biosafety and infection prevention guidelines always
 Wearing of appropriate personal protective equipment
 Utilization of a certified biosafety class 2 cabinet in processing of
samples
 Utilization of sealed sample cup or rotors during centrifugation
 Practice hand hygiene during the course of activity
 Discard samples properly in line with the waste management and
biosafety guidelines
  Decontaminate work areas before and after work or whenever
necessary

B. CHEMICAL EXAMINATION
The chemical testing of urine is performed using a reagent strip. Simple,
rapid, convenient testing are the advantages of reagent strip testing.
QUALITY CONTROL IN THE CHEMICAL EXAMINATION OF URINE
 Clean and organized work area
 Adequate lighting and optimal temperature
 Theoretical knowledge of the reagent strips
 Awareness in the presence of interfering substances that may
occur during testing
 Check reagent strip expiry
 Quality control of reagent strips are done every day or every
shift using premade control materials (abnormal and normal)
 Document and record the results of quality control procedure
 Dip the reagent strip in an uncentrifuged, well-mixed urine
sample
 In testing using the reagent strip, it is necessary to dip the strip
in the urine briefly to avoid carry-over of other chemical
 Remove excess urine on the strip by touching the edge of the
container to avoid carry-over and other potential errors that
may affect reagents in the strip
 Blot briefly the reagent strip on an absorbent pad
 Monitor specified time of each of the chemical reactions, read
and document the result
C. MICROSCOPIC EXAMINATION OF URINE
The detection and identification as well as quantitative evaluation of the
urine sediments are done in the microscopic examination of urine.
QUALITY CONTROL IN THE MICROSCOPIC EXAMINATION OF
URINE
 Adequate sample is important (10 to 15 mL)
 Adequate lighting is important
 Consistent centrifuge speed and the duration must be
consistent (5 mins at 400 RCF)
 A volume of 0.5 to 1 ml after decantation is frequently used
 In the glass slide, the recommended volume is 20 microliter
(0.02 mL) covered by a glass cover slip. Excess urine may
result in overflowing and will affect the count and identification
of heavier elements (e.g. casts) due to settling on the sides of
the slide
 Consistency in the microscopic examination is necessary.
Observation of a minimum of 10 fields under both low (10×)
and high (40×) power, in this manner, the distribution of
sediments will be assessed. The LPO will be used as a
scanning objective while the HPO will be used to identify
smaller sediments and for identification of casts and various
epithelial cells
 Unstained urine sediments have lower refractive index,
reduced light is necessary in the microscopic analysis.
 Follow standard operating procedures in the reporting of
sediments
 Charts or visual aids of urinary sediments must be posted or
present in the microscopy area.
 Correlate microscopic results with physical and chemical
examination findings
 Check and maintain microscope regularly to maintain par
focality and par centrality
 Use various stains to aid in the identification of sediments
 Training or refresher course in microscopy is important to
maintain quality standards and reduce per observer variability
or subjectivity
Image source: https://www.idexx.com/files/sedivue-urine-sediment-guide.pdf

References: Analysis of Urine and Body fluids, 6th Edition by Strasinger and Lorenzo

Graff’s Textbook of routine urinalysis and body fluids by Mundt and Shanahan

QUALITY CONTROL PROCEDURES IN PHLEBOTOMY

a. Proper patient identification

-Complete and properly filled-out laboratory request form, confirmation of
the patient identity by verifying to the nurse on duty and patient’s
wristband

b. Proper specimen collection procedure

-Selection of a good collection site is necessary, method of collection,
complete and properly labelled collected samples, following of the order of
draw to avoid anticoagulant or additive carry-over

REJECTION CRITERIA OF BLOOD SAMPLES

- Improperly labelled samples
- Nonmatching label in the tube on that of the laboratory request
form
- Underfilled or overfilled tubes
- Inappropriate tube for the test requested
- Hemolyzed samples for analyses

c. Proper patient preparation

 Fasting requirements, special preparation – some analytes are affected by
diurnal, ultradian and infradian and circadian variations
 Identifying the preanalytical variables of various individuals

PHYSIOLOGIC VARIABLES
 POSTURE - change from a lying to an upright position results in a
reduction of the person’s blood volume of about 10% (≈600 to 700 mL)

 PROLONGED BED REST - Plasma and extracellular fluid volumes

decrease within a few days of the start of bed rest
  EXERCISE - Changes in concentrations of analytes that result from
exercise are largely due to shifts of fluid between intravascular and
interstitial compartments

 PHYSICAL TRAINING - Athletes generally have a higher serum activity

of enzymes of skeletal muscular origin at rest than do nonathletes

 CIRCADIAN VARIATION - Many constituents of body fluids exhibit

cyclical variation throughout the day. Factors contributing to such
variation include posture, activity, food ingestion, stress, daylight or
darkness, and sleep or wakefulness.
 TRAVEL - Travel across several time zones affects the normal
circadian rhythm. Five days is required to establish a new stable diurnal
rhythm after travel across 10 time zones. Changes in laboratory test
results are attributable to altered pituitary and adrenal function.

FACTORS TO CONSIDER DURING PHLEBOTOMY

 PREPARATION OF THE VENIPUNCTURE SITE

 Once the location for phlebotomy is selected, the site should be cleaned
with a sanitizing agent approved by the institution
 Clean the puncture site with a circular motion and from the site outward.
 Allow the skin to be air dried because traces of alcohol may cause
hemolysis and can affect the results
 Once the skin has been cleaned, it should not be touched until after the
venipuncture has been completed

 SPECIMEN COLLECTION TIME

 Time is an important factor in specimen collection. Analytes are affected
by diurnal variations, therapeutic drug monitoring and drug testing for
medico-legal purposes are time dependent tests.

 SELECTION OF THE PHLEBOTOMY SITE

In blood collection, median cubital vein is the preferred site. Other suitable veins
in the antecubital fossa are the basilica and the cephalic veins but the
phlebotomist must take extra precautions when selecting these veins. The
veins on the back of the hand or at the ankle may be used, although these are
less desirable and should be avoided in people with diabetes and other
individuals with poor circulation.

 VENOUS OCCLUSION
 A tourniquet or a blood pressure cuff is applied on the intended site not
exceeding 3 minutes to avoid hemoconcentration which in turn may affect
the accuracy of the level of analytes (esp. protein-bound substances)

 ORDER OF DRAW AND APPROPRIATE TUBE TO BE USE

 It is necessary to prepare the tubes to be use, test require appropriate
additive or anticoagulant
 Evacuated tubes with additives or anticoagulants can yield either serum
for the majority of the tests in chemistry or plasma for coagulation studies.
  To minimize problems if backflow should occur, and to optimize the quality
of specimens, to avoid cross contamination of anticoagulants and other
additives – tubes are collected following a sequence or order.
Source: TEITZ TEXTBOOK of CLINICAL CHEMISTRY and MOLECULAR DIAGNOSTICS 5th
Edition

d. Proper specimen storage and transport

-includes the biosafety aspects in the storage and transport of samples
especially when transporting potentially infectious specimen

SOME BIOSAFETY MEASURES DURING PHLEBOTOMY

1. The phlebotomy area should be clean and well lighted

 2. The phlebotomist must wear appropriate personal protective equipment
3. Perform hand hygiene before and after a procedure, every after each
patient, or before and after donning and doffing of gloves
4. After venipuncture, discard the sharps in a plastic, leak-proof, puncture
proof sharps collector.
5. Color coded waste bins should be present for ease of access
6. Follow standard precautions and treat all samples as potentially
infectious
7. Follow standard operating procedures
8. Follow Biorisk and infection control guidelines

REFERENCE:
TIETZ TEXTBOOK OF CLINICAL CHEMISTRY AND MOLECULAR DIAGNOSTICS 5TH

LINNE AND RINGRUD’S CLINICAL LABORATORY SCIENCE BY M.L. TURGEON

Discuss Financial Management of the clinical laboratory. What elements in the

clinical laboratory must be planned well in terms of budget? Elaborate and
provide definite examples.

According to Statpearls, a book from NCBI website, “Clinical laboratories are

healthcare facilities providing a wide range of laboratory procedures which aid
the physicians in carrying out the diagnosis, treatment, and management of
patients. These laboratories are manned by medical technologists (clinical
laboratory scientists) who are trained to perform various tests to samples of
biological specimens collected from its patients”.
The clinical laboratory is indeed not just a department that tests and release
accurate, precise and reliable results that are needed by physicians; it is also
the main bread and butter of the hospital or a healthcare institution. The
revenue generated by the laboratory is significant. Although, the cost of
operation is high, effective financial management will come into play in order to
turn the tide in favor of the institution, eventually overcoming break evens.

Through the years, the gradual process of change in terms of economics and
finances in the clinical laboratory business became more and more evident. At
this day and age, clinical laboratory functions in line with the overall quality
management is a fertile soil for a good business direction. At the end of the day,
one patient satisfaction rooting from all of these improvements is a key for an
exponential growth in profit.

The clinical laboratory accreditations, certifications and expansion of test menus

are eye-catching investments that will attract more and more patients, investors
and even potential companies.

In order for a clinical laboratory finances to be stable, initiation of feasibility

studies and survey are important. Knowing the needs of the clients is not just a
good gesture but also a way to attract prospective clients.

Effective budget distribution and planning is very important. Promoting

employees, hiring of experienced and highly trained individuals, acquisition of
new laboratory equipment or machinery, laboratory supply procurement, and
quality improvement, system upgrade, contingency funds are some of the
elements that must be planned well in the laboratory.

Highly trained individuals with considerable years of experience must be

included in the budget planning because of their overall impact to the institution.
These personnel are experts in their respective fields, hence, improving
laboratory operations.

The potential expansion of the test menu requires the need of acquiring new
laboratory equipment and machinery. Upgrading automated machine will not
just ease the work and improve turn around time of tests, it will also increase
the reliability, accuracy and precision in the aspect of testing. An example of
which is the procurement of new automated machine in clinical chemistry with
added procalcitonin, quantitative C-reactive protein and serum ferritin tests. The
addition is due to the high demand in testing of these analytes especially this
time of pandemic.

The supply of the laboratory is the most crucial and probably a well-budgeted
element of all. In order to keep the laboratory functional and operational,
maintaining an adequate supply is very important. Example of which are the
reagents of the clinical chemistry automated machines, supply of blood
collection devices and colored evacuated tubes for various tests.

The total quality management of the laboratory include participating in external

quality assurance, performing quality control procedures and conducting
surveys and studies. External quality assurance participation is one of the ways
to benchmark a laboratory. Aside from quality control procedures, the budget in
this slice must also include the continuing professional education and training of
laboratory personnel.

STUDENT: ERL BRYAN M. FISCO

STUDENT NO. 2020302892
SUBJECT: CLINICAL LABORATORY MANAGEMENT, QUALITY ASSURANCE AND ETHICS
SCHEDULE: 8:00 – 11:00 AM, SATURDAY
PROFESSOR: JOY POTENCIANO-CALAYO, RMT, MSc., CBO