Ministry of Higher Education& ‫وزارة التعليم العالي والبحث‬

Scientific Research ‫العلمي‬

Imam Jaafar Al-Sadiq University ‫جامعة االمام جعفر الصادق‬
Al-Muthanna Branch ‫فرع المثنى‬
College of Medical and Health
‫كلية التقنيات الطبية‬
Technologies
Department of Medical Laboratories
‫قسم المختبرات الطبية‬

Summer training report

‫بحث التدريب الصيفي‬

)Practiced at Al-Hussein Teaching Hospital(

)2024/7/1-2024/8/1(

By: Ahmed Ali Dakhil

)Third Stage(

:Supervised By
Lecturer. Ahmed Diaa

2023/2024 ‫ هـ‬١٤٤٥/١٤٤٦
 ‫بسم الله الرحٰمن الرحيم‬

‫اَّل‬
‫َو ن ۡيَس ِل ۡلِإنَٰس ِن ِإ َما َس َعٰى (‪)39‬‬ ‫َّل‬ ‫َأ‬
‫َأ‬
‫َو َّن َس ۡعَيُهۥ َس ۡوَف ُيَرٰى (‪َّ )40‬م‬
‫ُث‬
‫َأ‬
‫ُي ۡجَزٰىُه ٱ ۡلَجَز ٓاَء ٱ ۡل ۡو ٰى ) ‪)41‬‬
‫َف‬

‫صدق الله العلي العظيم‬

‫(سورة النجم)‬
 Dedication

I dedicate this work to my

master, the Lord of the Age,
Imam Muhammad al-Mahdi
(may Allah hasten his
reappearance), and to my
parents who have exerted
their utmost efforts in
helping and supporting me
throughout these years
And To everyone who gave
 Time, age and effort, and
everyone who gave blood,
and those who martyred and
lost their lives for this pure
.land

Acknowledgment

First of all, we thank Almighty God for the blessings He has bestowed upon us,
for a healthy body, and a sound mind.

I would like to express my gratitude and appreciation to our supervisor, Lecturer

Ahmed Diaa, for all the assistance he provided during the research. I also thank
my professors in my department for everything and for the knowledge and
wisdom they imparted to us, as well as for their constant support.

I would like to thank Dr. Ahmed Fadel, may Allah have mercy on him and grant
him a place among the righteous in paradise, for his efforts in delivering valuable
information to us.

I extend my thanks to my brother, Tamar, for his help with the research, and I am
very grateful to him.
Finally, I would like to thank all my family members who have supported me
throughout my life, stood by my side, and helped me with everything I needed.

II
Abstract

The CBC test provides an overall view of the health of an individual’s blood by measuring
various blood components, including red blood cells, white blood cells, hemoglobin,
hematocrit, and platelets. This test is crucial for diagnosing a wide range of conditions such
as anemia, infections, and many other blood-related disorders.The blood group test identifies
an individual’s blood type, based on the presence or absence of certain antigens (A, B, AB,
or O) and the Rh factor (positive or negative). Blood typing is essential for safe blood
transfusions, organ transplants, and pregnancy care to prevent Rh incompatibility ESR is a
test that measures how quickly red blood cells settle at the bottom of a test tube in a given
time (typically one hour). A faster-than-normal rate may indicate inflammation, infection, or
other medical conditions, such as autoimmune diseases or cancer.C-RP is a blood test that
measures the level of C-reactive protein produced by the liver in response to inflammation.
High levels of CRP indicate acute inflammation or infection, and the test is often used to
assess the risk of heart disease or other inflammatory conditions The GUE test provides an
analysis of the physical, chemical, and microscopic components of urine. It helps detect
various conditions such as urinary tract infections, kidney disorders, and metabolic problems
like diabetes, by examining factors like pH, protein, glucose, and the presence of cells or
bacteria in urine.
 III

Table Of Contents Page No.

Dedication I
Acknowledgment II
Abstract III
Table of Contents IV
Introduction
Introduction 9,10
Chapter One
1.1Specimen Collection 11
1.2.Blood collection tubes
1.3 Complete blood count (CBC) analysis 12,13
1.4 Blood Group 13,14,15

1.5 E.S.R 16,17

1.6 C-RP 18,19
Chapter two
2.1General urine examination (GUE) 20,21,22
References 23

IV
Introduction

Medical laboratory diagnostics play a vital role in modern healthcare, offering crucial
insights into a patient’s health status, disease progression, and response to treatment. Among
the numerous diagnostic tests available, certain core blood and urine analyses are frequently
utilized due to their diagnostic versatility and significance in clinical practice. This report
focuses on five essential diagnostic tests: the Complete Blood Count (CBC), C-Reactive
Protein (CRP) test, Blood Group Determination, Erythrocyte Sedimentation Rate (ESR), and
General Urine Examination (GUE). Each of these tests provides a different perspective on
the body’s physiological and pathological state, making them indispensable in both routine
check-ups and emergency medical assessments.Complete Blood Count (CBC) is one of the
most frequently performed blood tests in medical diagnostics. It provides detailed
quantitative information about the various cellular components of blood, including red blood
cells (RBCs), white blood cells (WBCs), hemoglobin concentration, hematocrit, and
platelets. This test is critical in diagnosing and monitoring a wide array of conditions such as
anemia, infections, clotting disorders, and certain malignancies like leukemia. In my summer
training, I learned how to prepare samples, use automated hematology analyzers, and
interpret various abnormalities in CBC results, thus gaining an understanding of how
deviations in these parameters could signal underlying health issues C-Reactive Protein
(CRP) is an acute-phase reactant that rises in response to inflammation, infection, and
trauma. Produced by the liver, CRP is released into the bloodstream in response to
inflammatory cytokines, such as interleukin-6 (IL-6). Elevated CRP levels can indicate
bacterial infections, chronic inflammatory diseases such as rheumatoid arthritis, or
cardiovascular events like myocardial infarction. This test is particularly useful for assessing
the risk of cardiovascular diseases and evaluating the effectiveness of treatments aimed at
reducing inflammation. During my training, I was exposed to different CRP measurement
techniques, including immunoassays, and gained an understanding of the test’s role in
detecting inflammatory states and guiding clinical decision-making. Blood Group
Determination is another critical component of laboratory diagnostics, especially in the
context of blood transfusions, organ transplants, and pregnancy care. Blood grouping tests
classify blood into various ABO and Rh types, ensuring compatibility in medical procedures
to avoid potentially life-threatening reactions. Misclassification or incompatible transfusions
can lead to severe hemolytic reactions, making accurate blood typing imperative. As part of
my training, I performed both forward and reverse typing procedures and gained experience
in recognizing agglutination patterns, which are central to determining a person’s blood
group .Erythrocyte Sedimentation Rate (ESR) is a simple, non-specific test that measures the
rate at which red blood cells sediment in a tube over a specified period. Although ESR lacks
specificity, it is widely used as a general marker of inflammation and chronic diseases. An
elevated ESR suggests the presence of inflammation or infection but can also point to more
chronic conditions such as autoimmune diseases or cancers. Understanding ESR, its
limitations, and how it correlates with other diagnostic results, was an essential part of my
training. Learning the factors that affect ESR, such as anemia or abnormal red blood cell
shapes, helped me appreciate the test's utility and limitations in clinical diagnosis Lastly,
9
General Urine Examination (GUE) provides valuable insights into the health of the urinary
system and broader metabolic and systemic conditions. The GUE typically assesses the
appearance, concentration, and content of urine, providing a window into the health of the
kidneys, bladder, and ureters, as well as metabolic conditions like diabetes and liver
disorders.

10
 Chapter one

Hematology unit
1.1Specimen Collection1
Blood tests are usually performed on blood taken from veins or arteries using a thin capillary
puncture, and venous blood is used in most analyzes in biochemistry.
Steps to draw blood:
1. Ensure all equipment is in place...
2. Tying a tourniquet on the patient's hand...
3. Vein check...
4. Sterilize the blood collection site...
5. Blood draw...
6. Write all patient information.

1.2.Blood collection tubes2

(1)The yellow tube:

It does not contain any anticoagulants, but we find in it a gel substance that helps
separate the serum from blood cells. It is preferable not to separate the sample until
after the blood has frothed inside the tube, in order not to form a clot inside the tube
when separating the sample,Tests used for this tube: Chemical and hormone and HIV.

(2)The EDTA tube :

It contains an anticoagulant substance called Ethylene Diamine Tetraacetate (EDTA)
of it is used in a different group for blood analysis such as CBC and blood group
analysis,Hb, ESR, blood film.

(3) The Black Tube:

Contains Buffer Sodium Citrate for use in the ESR analysis in the blood picture.

(4)The Blue Tube:

It contains sodium citrate in order to obtain plasma in order to measure blood clotting
factors, the most important and common in hospitals is Prothrombin (PT) and that is
Activated Partial Thromboplastin abbreviated as (aPTT). To indicate the level of
blood required for the test.

Chapter one
1
.Pagana, K. D. & Pagana, T. 1 (2007). Mosby's diagnostic and laboratory test reference th Jan 1 K
2
A Practical Guide to Laboratory
11
1.3 Complete blood count (CBC) analysis3
It is an important analysis taken from a patient’s sample, which is useful in all tests to
determine the causes of diseases.(February 2009)
Procedure/
Drawing blood from the patient using a syringe 2.3 Then put it in a violet tube (EDTA) and
put it in a special device for this analysis and read in this format :

Discussion /
First, know that the normal RBC in a man is 4.5-6.5 million
*And women from 3.8 to 5.8 million
*The WBC ranges from 4 thousand to 11 thousand
*The platelet ranges from 150 thousand to 450 thousand

*The first possibility

*If you find that the RBC, WBC, Platelet are all elevated
*it means the presence of polycythemia rubra vera And if you find that the RBC is high and
the rest is normal
*Here, think about Sec. Polycythemia

*The second possibility

*If you find the RBC, WBC, Platelet is here the presence of Pancytopenia For the third
possibility, it is an individual case/
*If you find a deficiency in RBC only and the rest is normal
*Here is anemia, and you must double check your words and see how much Hb is!
Hb less than 13.5 in male = anemia Hb less than 12 in female = anemia
*Ok, suppose he had a rise in the WBC and RBC Platelet decrease
*It means Leukemia a
*and you know this leukemia is Acute or chronic
Chapter one
*Look at the blast cell, if you find it, it is Acute ; If you do not find it, it is chronic.
.District laboratory practice in Rolls, G. O., Farmer, N. J., & Hall, J. R. (2008) 3
12
*But if the WBC increases while the RBC and platelet = normal
*Here, think about infection And see, based on the increase, what type of infection you
know!
*If neutrophils increase, it means infection with bacteria And If the lymphocytes increase, it
means a viral infection. And If the monocytes increase, it means a glandular fever infection.
And If the eosinophils increase, it means a parasites or allergic infection. And If the
basophils increase, it
means an immune disease. J Perinatol (2008)

1.4 Blood Group4

Red blood cells membranes in human contain different types of antigens while plasma
contain on antibodies There are four of blood groups are (A, B, O, AB), as the following:
1. A blood group: in which the persons that have A antigen in red blood cell membranes
and they have b antibody in plasma and forms about 42%.
2. B blood group: in which the persons that have B antigen in red blood cell membranes
and they have a antibody in plasma and forms about 9%.
3. AB blood group: the persons that have A, B antigen in red blood cell membranes and
they don’t have antibody in plasma and forms about 3%.
4. O blood group: the persons that don’t have A, B antigen in red blood cell membranes
and they have a,b antibody in plasma and forms about 46%

Notes:
1. A+ blood group donates both A+ , AB+ blood groups and recipient blood from A+,
A-, O+, O- blood groups
2. A- blood group donates both A+, A- blood groups and AB+, AB- blood groups and
recipient blood from, A-, O- blood groups
3. B+ blood group donates both B+ , AB+ blood groups and recipient blood from B+, B-,
O+, O- blood groups
4. B- blood group donates both B+, B- blood groups and AB+, AB- blood groups and
recipient blood from B-, O- blood groups
5. AB+ blood group donates AB+ blood group only and recipient blood from A+, A-,
B+, B-, AB+, AB-, O+, O- blood groups
Chapter one
6. AB- blood group donates both AB+, AB- blood groups and recipient blood from A-,
B-, AB-, O- blood groups

A. E., & Ellis, R. C. (1994), Laboratory sanals of diagnostic pathology, 13(2) 4

13
 7. O+ blood group donates A+ , B+ , AB+ , O+ blood groups and recipient blood from
O+, O- blood groups
8. O- blood group donates both A+ , B+ , AB+ , O+ blood groups and A-
9. B-, AB-, O- blood groups and recipient blood from O- blood group only

How to determine the Blood group(BG)

Material and Instruments

 Anti-A
 Anti-B
 Anti-D
 Slide
 sticks for mixing
 Blood

Method
1. We come up with a glass slide and divide it into three sections. We put a drop of blood
in the left section and a drop of blood in the middle and put a drop of blood in the right
section
2. Put a drop of Anti-A in the left section and put a drop of Anti-B in the middle and put
a drop of Anti-D in the left section
3. The arrangement depends on the laboratory, you can change the sections wherever you
want
4. Anti-D is also the main factor that determines the type of family, positive or negative.
5. We mix the antibiotic with the blood for 60 seconds and then shake the glass slide
slightly to mix together for 3 minutes
6. Then we will see the result and where it is and we find the love, this indicates the type
of family or the following:
*If the love occurs in the Anti-A section as well as in the Anti-D section, this indicates that
the type of species is A+

Chapter one
*But if the granulation occurs only in the Anti-A section, this indicates that the type of
species is A-
14
*If the granulation occurs in the Anti-B section as well as in the Anti-D section, this
indicates that the type of species is B+
*But if the love occurs only in the Anti-B section, this indicates that the type of family is B+
*But if the love occurs in the Anti-D section only, this indicates that the type of the Dom
family is O+
*But if there is no granulation in any section, this indicates that the type of species is O-
*But if granulation occurs in all sections, this indicates that the type of blood type is AB+.

(1):Blood Figure
Group

Chapter one
5
E.S.R 1.5
Laboratory Medicine, 10(7), 392395 5
15
Erythrocytes Sedimentation Rate (ESR)
ESR is distance in which red blood cells fall after a specific time period
(1hour) away about plasma under effect of gravity, ESR is depend on
concentration of proteins present in plasma such as fibrinogen, albumin and
globulin and considered of ESR important in identification of some
pathological cases such as anemia, rheumatism and inflammations in human
body and there are five signs of inflammation are high temperature, redness,
tumor, pain and loss of function to inflammatory organ. Principle of ESR
At occur inflammation in the body occur increased in proteins secreted from
liver in the blood, surface red blood cells carry negative charge therefore red
blood cells are disharmony among them, but at secretion of proteins in blood
that carry positive charge occur equivalent in charge between red blood cells
and proteins therefore red blood cells gather together and occur sedimentation
of red blood cells.

E.S.R. Increased in:

 Chronic conditions such as Rheumatoid Arthritis and Tuberculosis
 Acute and chronic infections
 Malignant diseases such as Myeloma
 normal conditions like pregnancy and elderly people
E.S.R .decreased in:
 Polycythemia
 heart failure

Chapter one
Wintergreen Method
Material and Instruments

16
1-Westergren pipette is a straight glass 30 cm in length and 2.55 mmdiameter. It is graduated
and open at both ends. The graduation is from zero to 150 mm
2-Westergren pipette rack. All racks should be equipped with
level screws and a spirt level
3-EDTA tube contain anticoagulant
4-Whole blood, 3 mL
Procedure:
1-Put blood sample in EDTA tube contain anticoagulant and Mix the tube for 2 minutes.
2-Fill the Wintergreen pipette to exactly the 0 mark, making certain that there are no air
bubbles in the blood by enter of Wintergreen glass in EDTA tube
3-Place the tube exactly vertical and leave undisturbed for 1 hour.
4-At the end of 1 hour, read the number of millimeters the RBC's have fallen (i.e. the height
of the clear plasma above the upper limit of the column of the sediment cells)
5-The result is the ESR in mm / 1 hour
Normal value
In adult men 0-10 mm / 1 hour
In adult women 0-15 mm / 1 hour

Figure (2):ESR

Chapter one
6
RP C- 1.6
C-reactive protein, inflammatory conditions, and cardiovascular disease risk. The American journal medicine, 120 (12) 6

17
A laboratory blood test is used to detect the level of C-reactive protein (CRP), which is
produced by the liver in cases of severe inflammation. This makes it a strong indicator of the
presence of inflammation in the body. The abbreviation C-RP stands for C-reactive protein,
which is produced in the liver and is one of the proteins known as acute-phase proteins,
considered markers of inflammation in the body. Its levels in the blood increase when there
is inflammation. Although an elevated C-RP level does not provide details about the location
of the inflammation, its results can be relied upon to determine the likelihood of certain types
.of infections and inflammatory diseases, such as atherosclerosis
:The purposes of this test
To detect inflammation and malignant tumors: The standard test is used to detect elevated .1
levels of the protein in the blood
To detect heart and vascular diseases: Particularly coronary insufficiency and bacterial .2
infections affecting the heart lining, where the high-sensitivity test is used alongside this type
of analysis
To monitor wound healing, especially after surgeries.3
To detect rheumatoid arthritis.4
To detect respiratory infections.5
To detect rheumatic diseases.6
:Causes of elevated CRP
A range of conditions and health problems cause elevated CRP levels and other indicators of
:inflammation. These include

Burn injuries.1
Physical trauma or wounds.2
Heart attacks.3
Inflammatory bowel diseases.4
Certain types of cancer.5
Use of contraceptive pills.6
Heart diseases.7
8.Viral infections
Chapter one
:CRP test procedure
:First: The tools and solutions needs
Glass slide, with the slide color being black.1
18
Centrifuge, to separate blood components and obtain serum.2
Plastic sticks, to mix blood serum with latex particles.3
Micro pipette.4
Blood sample, to obtain serum after placing the blood in the centrifuge.5
Positive control.6
Negative control.7
Latex solution.8 .

Second: Test Procedure:

-1 Draw 2 cc of blood and place it in a gel tube. Then, put it in the centrifuge to separate the
blood components and extract the serum.
-2Prepare a glass slide and divide it into three sections as follows:
• First section: Positive control.
• Second section: Negative control.
• Third section: Test sample.
-3Place one drop of positive control in the first section (positive control). This is not used as
a result but to demonstrate a positive reaction for comparison.
-4 Place one drop of negative control in the second section (negative control). This is also
not used as a result but to show the negative reaction for comparison.
-5 Place one drop of blood serum in the third section (test sample).
6- Add one drop of latex solution to each section.
7-Mix each section using plastic sticks.
8- Place the glass slide on a vibration device and leave it for 4 minutes.
9- After 4 minutes, read the result in the section containing only the serum. Compare it with
the negative and positive controls. If agglutination (clumping) occurs, it indicates a positive
result; if no agglutination occurs, the result is negative.

Chapter two

2.1General urine examination (GUE) 7

7
In 'Cellular Pathology A. In Molecular medical microbinlegy (pp. 12751306-) 4th edn
19
Urination:is the process of excreting urine from the urinary bladder through the urethra to the
outside of the body, are involved both involuntary and voluntary muscles.
Specimen Collection
1-Collect a fresh urine specimen in a urine container
-2If the urine specimen contains vaginal discharge or bleeding, a clean-catch or midstream
specimens will be needed (having the patient being to urinate then stop urinating, to wash the
urine out of the distal urethra, then the patient voids into a sterile container)
3-Capping the container
-4Allowing the patient to finish voiding
-5For urine specific gravity, a first voided specimen is preferred
6-For protein, the first voided specimen is best; however, occasionally a 24-hour urine
collection.
Transportation of specimens:
Urine specimens should be delivered to the laboratory within 2 hours of collection or
refrigerated and transported to the lab as soon as possible.
General urine Examination
Includes three tests:
1. Physical examination
2. Chemical examination
3. Microscopic examination
Physical Examination:
1-Urine volume: less than 2 liters per day is usually considered normal, dependent normally
up on
-Fluid intake
-Age and gender
-2Color:Urine variesin appearance,depending upon the body’s level of hydration. Normal
urine is a transparent solution ranging from colorless to amber but is usually a pale yellow to
yellow.
3-Turbidity
4- Odor
Chapter two

Chemical examination

20
This is done using kits known as Multistix (dipstick) Reagent Strip Urinalysis reagent
dipsticks
Reagent strips: consist of chemical-impregnated absorbent pads attached to the plastic
strip. A color-producing chemical reaction takes place when the absorbent pad comes in
contact with urine
The results of change in the color the reagent strip (positive or negative results
depending on color)

Leukocytes (Pus cells) —————Urinary Tract Infection (UTI)

Nitrite —————————————-Bacterial infection
Bacterial infection ———————Hepatic disease
Protein (Albumin) ———————-Renal failure
pH ——————————————- (4.6 – 8) Acidic (less than7) Alkaline (UTI)
Blood —————————————-Stones in the kidney
Specific Gravity ———————— increased (Dehydration) decreased (Diabetes)
Ketone ————————————- Diabetes or Starvation
Bilirubin ————————————-Stones to the duct gallbladder
Glucose ————————————-Diabetes
Microscopic examination
Procedure:
1. Mix urine and place 7ml in a conical Centrifuge tube.
2. Balance tubes in Centrifuge.
3. Centrifuge for 5 minutes at 1500 – 2500 r.p.m.
4. Pour off supernatant and leave sediment.
5. Flick the end of tube with the finger, then place a drop on a slide, cover with cover
slip.
6. Examine with low power objective (LPF). Turn to high power objective (HPF).
7. Examine for cell, casts, crystals and parasites.

Chapter two
A variety of normal and abnormal cellular elements may be seen in urine sediment
such as:

21
 Figure (3):calcium oxalate

Figure (4):Uric acid

Figure (5):Amorphous urate

 Red blood cells

 White blood cells
 Mucus
 Various epithelial cells
 Various crystals
 Bacteria
 Casts

22
Examination to detect:
1-Cells:
 -Epithelial cells
 -R.B.C
 -Pus cells
2- Crystals
PH (Acidic Urine):
 -Uric acid
 -Calcium Oxalate
 -Amorphous Urate
3 -Cellular Cast
 -Red cell
 -White cell
 -Epithelial cell
4- Yeast or Fungi hyphae
-5Bacteria
6- Parasites

References

1-Proceedings (Vol. 80, No. 8, pp. 10291036-), Elsevier, Pagana, K. D. & Pagana, T. 1
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M. & Connor, D. (195) Fatal human ascariasis following secondary -Rolles, G, Davies, 5, &
Gallagher, A. (2008), 16 steps ive infection
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Pathology A. In Molecular medical microbinlegy (pp. 12751306-) 4th edn[7]. (Ed. CFA
Culling.) pp. 111-152. Academic Press.
4- Uhingra, R., Gona, P. Nam, B. H., D'Agostino St. R. 1. Wilson, P. W., Benjamin, E. J. &
O'Donnell, C. L. (2007). C-reactive protein, inflammatory conditions, and cardiovascular
disease risk. The American journal medicine, 120 (12)[6]
5- Sarnak, M. J., Katz, IL, Stehman-Breen, C. O. Fried, L R., Jenny, N. S., Paty, B. M... &
Shlipak, M. G. (2005), Cystatin Cooncentration as a risk factor for heart failure in older
adults. Annals ofinternal medicine, 142(7), 497305- Taborn, I. D. & Walker, S. E. (1979).
Rheumatoid
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techniques. Woods, A. E., & Ellis, R. C. (1994), Laboratory sanals of diagnostic pathology,
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24