Medical laboratory
Encyclopedia
A medical laboratory or clinical laboratory is a laboratory
where tests are done on clinical specimens in order to get information about the health
of a patient
as pertaining to the diagnosis, treatment, and prevention of disease.
Laboratory medicine is generally divided into two sections, and each of which is further divided into a number of units. These two sections are:
Distribution of clinical laboratories in health institutions varies greatly from one place to another. Take for example microbiology, some health facilities have a single laboratory for microbiology, while others have a separate lab for each unit, with nothing called a "microbiology" lab.
Here's a detailed breakdown of the responsibilities of each unit:
Some of these titles don't exist in some countries. Sometimes technologists and technicians do the same work.
In France, clinical biologist
s may also be Medical director and laboratory manager.
, and perform tests on patients. Private (or community) laboratories receive samples from general practitioner
s, insurance companies, clinical research sites
and other health clinics for analysis. These can also be called reference laboratories where more unusual and obscure tests are performed. For extremely specialised tests, samples may go to a research laboratory. A lot of samples are sent between different labs for uncommon tests. It is more cost effective if a particular laboratory specializes in a rare test, receiving specimens (and money) from other labs, while sending away tests it cannot do.
In many countries there are mainly three types of Medical Laboratories as per the types of investigations carried out. 1. Clinical Pathology 2. Clinical Microbiology & 3. Clinical Biochemistry laboratories. 1. Clinical Pathology: Haematology, Histopathology, Cytology, Routine Pathology2. Clinical Microbiology: Bacteriology, Mycobacteriology, Virology, Mycology, Parasitology, Immunology, Serology.3. Clinical Biochemistry: Biochemical analysis, Hormonal assays etc.Blood Banks:- Blood bank is a separate body. Its laboratory need Microbiological analysis for infectious diseases that may be found in blood. Pathology to observe Blood grouping, Haematology & cross matching reactions. It also involves PRO department for the communication & contact for blood donations etc.. Molecular diagnostic lab or cyotgenetics and molecular biology lab is the latest addition to the three types of medical laboratories listed above in many countries.
Typically a set of vacutainer
tubes containing blood, or any other specimen, will arrive to the laboratory in a small plastic bag, along with the form.
The form and the specimens are given a laboratory number. The specimens will usually all receive the same number, often as a sticker that can be placed on the tubes and form. This label has a barcode that can be scanned by automated analyzers and test requests uploaded from the LIS
. Entry of requests onto a laboratory management system involves typing, or scanning (where barcodes are used) in the laboratory number, and entering the patient identification, as well as any tests requested. This allows laboratory machines, computers and staff to know what tests are pending, and also gives a place (such as a hospital department, doctor or other customer) for results to go.
For biochemistry samples, blood is usually centrifuged and serum is separated. If the serum needs to go on more than one machine, it can be divided into separate tubes.
Many specimens end up in one or more sophisticated automated analyser
s, that process a fraction of the sample and return one or more "results". Some laboratories use robotic sample handlers (Laboratory automation
) to optimize the workflow and reduce contamination risk and sample handling of the staff.
The work flow in a lab is usually heavy from 2:00 am to 10:00 am. Nurses and doctors generally have their patients tested at least once a day with general complete blood counts and chemistry profiles. These orders are then drawn during a morning run by phlebotomist
s for results to be available in the patient's charts for the attending physicians to consult during their morning rounds. Another busy time for the lab is after 3:00 pm when private practice physician offices are closing. Couriers will pick up specimens that have been drawn throughout the day and deliver them to the lab. Also, couriers will stop at outpatient drawing centers and pick up specimens. These specimens will be processed in the evening and overnight to ensure results will be available the following day.
or LIS. The LIS is interfaced with the hospital information system
.
This system enables hospitals and labs to order the correct test requests for each patient, keep track of individual patient or specimen histories, and help guarantee a better quality of results as well as printing hard copies of the results for patient charts and doctors to check.
s do the majority of this work inside the laboratory with abnormal results referred to the relevant pathologist
. In others, only medical staff (pathologist or clinical biologist
) is concerned by this phase. It can be assisted by some software in order to validate normal or non modified results. Medical staff are sometimes also required in order to explain pathology results to physician
s. For a simple result given by phone or for a technical problem it's a medical technologist or medical lab scientist explaining it to a registered nurse.
Departments in some countries are exclusively directed by a specialized Pathologist, in others a consultant, medical or non-medical, may be the Head of Department. Clinical Scientist
s have the right to interpret and discuss pathology results in their discipline in many countries, in Europe they are qualified to at least Masters level, may have a PhD and can have an exit qualification equivalent to medical staff e.g. FRCPath in the UK.
In France only medical staff (Pharm.D. and M.D.
specialized in Anatomical pathology
or Clinical biology
) can discuss pathological results, clinical scientist
s are not considered as a part of medical staff.
- Medical laboratories - particular requirements for quality and competence.
Accreditation is done by the Joint Commission, College of American Pathologists
, AABB, and other state and federal agencies. CLIA 88 or the Clinical Laboratory Improvement Amendments
also dictate testing and personnel.
The accrediting body in Australia is NATA, all laboratories must be NATA accredited to receive payment from Medicare.
In France, where accrediting body is COFRAC, in 2010, modification of legislation established ISO 15189 accreditation as an obligation for all clinical laboratories.
Laboratory
A laboratory is a facility that provides controlled conditions in which scientific research, experiments, and measurement may be performed. The title of laboratory is also used for certain other facilities where the processes or equipment used are similar to those in scientific laboratories...
where tests are done on clinical specimens in order to get information about the health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
of a patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
as pertaining to the diagnosis, treatment, and prevention of disease.
Departments
Laboratory medicine is generally divided into two sections, and each of which is further divided into a number of units. These two sections are:
- Anatomic Pathology: units included here are histopathologyHistopathologyHistopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
, cytopathologyCytopathologyCytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
, and electron microscopy. Academically, each unit is studied alone in one course. Other courses pertaining to this section include anatomyAnatomyAnatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
, physiologyPhysiologyPhysiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
, histologyHistologyHistology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
, pathologyPathologyPathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
, and pathophysiologyPathophysiologyPathophysiology is the study of the changes of normal mechanical, physical, and biochemical functions, either caused by a disease, or resulting from an abnormal syndrome...
.
- Clinical pathologyClinical pathologyClinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
, including :- Clinical MicrobiologyMedical microbiologyMedical microbiology is both a branch of medicine and microbiology which deals with the study of microorganisms including bacteria, viruses, fungi and parasites which are of medical importance and are capable of causing infectious diseases in human beings...
: This encompasses five different sciences (units). These include bacteriologyBacteriologyBacteriology is the study of bacteria. This subdivision of microbiology involves the identification, classification, and characterization of bacterial species...
, virologyVirologyVirology is the study of viruses and virus-like agents: their structure, classification and evolution, their ways to infect and exploit cells for virus reproduction, the diseases they cause, the techniques to isolate and culture them, and their use in research and therapy...
, parasitologyParasitologyParasitology is the study of parasites, their hosts, and the relationship between them. As a biological discipline, the scope of parasitology is not determined by the organism or environment in question, but by their way of life...
, immunologyImmunologyImmunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...
, and mycologyMycologyMycology is the branch of biology concerned with the study of fungi, including their genetic and biochemical properties, their taxonomy and their use to humans as a source for tinder, medicinals , food and entheogens, as well as their dangers, such as poisoning or...
. - Clinical Chemistry: Units under this busy section include instrumental analysis of blood components, enzymology, toxicologyToxicologyToxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms...
and endocrinologyEndocrinologyEndocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions called hormones, the integration of developmental events such as proliferation, growth, and differentiation and the coordination of...
. - HematologyHematologyHematology, also spelled haematology , is the branch of biology physiology, internal medicine, pathology, clinical laboratory work, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases...
: This section consists of automated and manual analysis of blood cells. It includes two subunits, which are coagulationCoagulationCoagulation is a complex process by which blood forms clots. It is an important part of hemostasis, the cessation of blood loss from a damaged vessel, wherein a damaged blood vessel wall is covered by a platelet and fibrin-containing clot to stop bleeding and begin repair of the damaged vessel...
and blood bankImmunohaematologyImmunohematology, more commonly known as blood banking is a branch of hematology which studies antigen-antibody reactions and analogous phenomena as they relate to the pathogenesis and clinical manifestations of blood disorders. A person employed in this field is referred to as an immunohematologist...
. - GeneticsGeneticsGenetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
is also studied along with a subspecialty known as cytogeneticsCytogeneticsCytogenetics is a branch of genetics that is concerned with the study of the structure and function of the cell, especially the chromosomes. It includes routine analysis of G-Banded chromosomes, other cytogenetic banding techniques, as well as molecular cytogenetics such as fluorescent in situ...
. - Reproduction biology : Semen analysisSemen analysisA semen analysis evaluates certain characteristics of a male's semen and the sperm contained in the semen. It may be done while investigating a couple's infertility or after a vasectomy to verify that the procedure was successful. It is also used for testing donors for sperm donation, in stud...
, Sperm bankSperm bankA sperm bank, semen bank or cryobank is a facility that collects and stores human sperm mainly from sperm donors, primarily for the purpose of achieving pregnancies through third party reproduction, notably by artificial insemination...
and assisted reproductive technologyAssisted reproductive technologyAssisted reproductive technology is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily in infertility treatments. Some forms of ART are also used in fertile couples for genetic reasons...
.
- Clinical Microbiology
Distribution of clinical laboratories in health institutions varies greatly from one place to another. Take for example microbiology, some health facilities have a single laboratory for microbiology, while others have a separate lab for each unit, with nothing called a "microbiology" lab.
Here's a detailed breakdown of the responsibilities of each unit:
- MicrobiologyMicrobiologyMicrobiology is the study of microorganisms, which are defined as any microscopic organism that comprises either a single cell , cell clusters or no cell at all . This includes eukaryotes, such as fungi and protists, and prokaryotes...
receives almost any clinical specimen, including swabs, fecesFecesFeces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...
, urineUrineUrine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
, bloodBloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
, sputumSputumSputum is mucus that is coughed up from the lower airways. It is usually used for microbiological investigations of respiratory infections....
, cerebrospinal fluidCerebrospinal fluidCerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
, synovial fluidSynovial fluidSynovial fluid is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its yolk-like consistency , the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement.-Overview:The inner membrane of synovial joints...
, as well as possible infected tissue. The work here is mainly concerned with cultures, to look for suspected pathogens which, if found, are further identified based on biochemical tests. Also, sensitivity testing is carried out to determine whether the pathogen is sensitive or resistant to a suggested medicine. Results are reported with the identified organism(s) and the type and amount of drug(s) that should be prescribed for the patient. - ParasitologyParasitologyParasitology is the study of parasites, their hosts, and the relationship between them. As a biological discipline, the scope of parasitology is not determined by the organism or environment in question, but by their way of life...
is a microbiology unit that investigates parasites. The most frequently encountered specimen here is faeces. However, bloodBloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
, urineUrineUrine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
, sputumSputumSputum is mucus that is coughed up from the lower airways. It is usually used for microbiological investigations of respiratory infections....
, and other samples may also contain parasites. - VirologyVirologyVirology is the study of viruses and virus-like agents: their structure, classification and evolution, their ways to infect and exploit cells for virus reproduction, the diseases they cause, the techniques to isolate and culture them, and their use in research and therapy...
is concerned with identification of viruses in specimens such as bloodBloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
, urineUrineUrine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
, and cerebrospinal fluidCerebrospinal fluidCerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
. - HematologyHematologyHematology, also spelled haematology , is the branch of biology physiology, internal medicine, pathology, clinical laboratory work, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases...
works with whole blood to do full blood counts, and blood filmBlood filmA blood film or peripheral blood smear is a thin layer of blood smeared on a microscope slide and then stained in such a way to allow the various blood cells to be examined microscopically...
s as well as many other specialised tests. - CoagulationCoagulationCoagulation is a complex process by which blood forms clots. It is an important part of hemostasis, the cessation of blood loss from a damaged vessel, wherein a damaged blood vessel wall is covered by a platelet and fibrin-containing clot to stop bleeding and begin repair of the damaged vessel...
requires citrated blood samples to analyze blood clotting times and coagulation factors. - Clinical Biochemistry usually receives serumBlood serumIn blood, the serum is the component that is neither a blood cell nor a clotting factor; it is the blood plasma with the fibrinogens removed...
or plasma. They test the serum for chemicals present in blood. These include a wide array of substances, such as lipidLipidLipids constitute a broad group of naturally occurring molecules that include fats, waxes, sterols, fat-soluble vitamins , monoglycerides, diglycerides, triglycerides, phospholipids, and others...
s, blood sugarBlood sugarThe blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...
, enzymeEnzymeEnzymes are proteins that catalyze chemical reactions. In enzymatic reactions, the molecules at the beginning of the process, called substrates, are converted into different molecules, called products. Almost all chemical reactions in a biological cell need enzymes in order to occur at rates...
s, and hormoneHormoneA hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
s. - ToxicologyToxicologyToxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms...
mainly tests for pharmaceutical and recreational drugs. UrineUrineUrine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
and bloodBloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
samples are submitted to this lab. - ImmunologyImmunologyImmunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...
/SerologySerologySerology is the scientific study of blood serum and other bodily fluids. In practice, the term usually refers to the diagnostic identification of antibodies in the serum...
uses the concept of antigen-antibody interaction as a diagnostic tool. Compatibility of transplanted organs is also determined. - ImmunohaematologyImmunohaematologyImmunohematology, more commonly known as blood banking is a branch of hematology which studies antigen-antibody reactions and analogous phenomena as they relate to the pathogenesis and clinical manifestations of blood disorders. A person employed in this field is referred to as an immunohematologist...
, or Blood bankBlood bankA blood bank is a cache or bank of blood or blood components, gathered as a result of blood donation, stored and preserved for later use in blood transfusion. The term "blood bank" typically refers to a division of a hospital laboratory where the storage of blood product occurs and where proper...
determines blood groups, and performs compatibility testing on donor blood and recipients. It also prepares blood components, derivatives, and products for transfusion. Regulated by the FDA since giving blood is considered a drug, this unit determines a patient's blood type and Rh status, checks for antibodies to common antigens found on red blood cells, and cross matches units that are negative for the antigen. - UrinalysisUrinalysisA urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
tests urine for many analytes. Some health care providers have a urinalysis laboratory, while others don't. Instead, each component of the urinalysis is performed at the corresponding unit. If measuring urine chemicals is required, the specimen is processed in the clinical biochemistry lab, but if cell studies are indicated, the specimen should be submitted to the cytopathologyCytopathologyCytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
lab, and so on. - HistopathologyHistopathologyHistopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
processes solid tissue removed from the body (biopsies) for evaluation at the microscopic level. - CytopathologyCytopathologyCytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
examines smears of cells from all over the body (such as from the cervixCervixThe cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
) for evidence of inflammation, cancer, and other conditions. - Electron microscopy prepares specimens and takes micrographs of very fine details by means of TEMTransmission electron microscopyTransmission electron microscopy is a microscopy technique whereby a beam of electrons is transmitted through an ultra thin specimen, interacting with the specimen as it passes through...
and SEMScanning electron microscopeA scanning electron microscope is a type of electron microscope that images a sample by scanning it with a high-energy beam of electrons in a raster scan pattern...
. - GeneticsGeneticsGenetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
mainly performs DNADNADeoxyribonucleic acid is a nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms . The DNA segments that carry this genetic information are called genes, but other DNA sequences have structural purposes, or are involved in...
analysis. - CytogeneticsCytogeneticsCytogenetics is a branch of genetics that is concerned with the study of the structure and function of the cell, especially the chromosomes. It includes routine analysis of G-Banded chromosomes, other cytogenetic banding techniques, as well as molecular cytogenetics such as fluorescent in situ...
involves using blood and other cells to get a karyotypeKaryotypeA karyotype is the number and appearance of chromosomes in the nucleus of an eukaryotic cell. The term is also used for the complete set of chromosomes in a species, or an individual organism.p28...
. This can be helpful in prenatal diagnosis (e.g. Down's syndrome) as well as in cancer (some cancers have abnormal chromosomeChromosomeA chromosome is an organized structure of DNA and protein found in cells. It is a single piece of coiled DNA containing many genes, regulatory elements and other nucleotide sequences. Chromosomes also contain DNA-bound proteins, which serve to package the DNA and control its functions.Chromosomes...
s). - Surgical pathologySurgical pathologySurgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves the gross and microscopic examination of surgical specimens, as well as biopsies submitted by non-surgeons such as general internists, medical subspecialists,...
examines organs, limbs, tumors, fetuses, and other tissues biopsied in surgery such as breast mastectomys.
Medical laboratory staff
The following is the hierarchy of the clinical laboratory staff from highest authority to lowest:- Medical DirectorMedical directorAs laboratory director,means that you are responsible for the overall operation and administration of the laboratory, including the employment of competentqualified personnel. Even though you have the option to delegate some...
- Pathologist, Clinical biologistClinical biologistA Clinical biologist is an health professional, doctor in medicine , pharmacy, biology specialized in clinical biology, a medical speciality near from Clinical Pathology....
- Resident in PathologyPathologyPathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
, Anatomical pathologyAnatomical pathologyAnatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
or Clinical biology - Pathologist Assistant,
- Laboratory Manager,
- Department Supervisor,
- Chief/Lead Technologist,
- Cytotechnologist, Medical Laboratory Scientist, Histotechnologist,
- Medical LaboratoryLaboratoryA laboratory is a facility that provides controlled conditions in which scientific research, experiments, and measurement may be performed. The title of laboratory is also used for certain other facilities where the processes or equipment used are similar to those in scientific laboratories...
Technician, Histotechnician - Medical Laboratory AssistantMedical Laboratory AssistantMedical Laboratory Assistants prepare, and in some cases process samples within a pathology laboratory. They also utilise pre-analytical systems in order for biomedical scientists or Medical Laboratory Scientific Officers to process the biochemical tests requested on the sample. The majority of...
(Lab Aide), - PhlebotomistPhlebotomistPhlebotomists are individuals trained to draw blood from a live person or animal.Phlebotomists collect blood primarily by performing venipuncture and, for collection of minute quantities of blood, fingersticks. Blood may be collected from infants by means of a heel stick...
, - Transcriptionist,
- Specimen processor, Secretary).
Some of these titles don't exist in some countries. Sometimes technologists and technicians do the same work.
In France, clinical biologist
Clinical biologist
A Clinical biologist is an health professional, doctor in medicine , pharmacy, biology specialized in clinical biology, a medical speciality near from Clinical Pathology....
s may also be Medical director and laboratory manager.
Types of laboratory
In many countries, there are two main types of labs that process the majority of medical specimens. Hospital laboratories are attached to a hospitalHospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
, and perform tests on patients. Private (or community) laboratories receive samples from general practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
s, insurance companies, clinical research sites
Contract research organization
A contract research organization, also called a clinical research organization, is a service organization that provides support to the pharmaceutical and biotechnology industries in the form of outsourced pharmaceutical research services...
and other health clinics for analysis. These can also be called reference laboratories where more unusual and obscure tests are performed. For extremely specialised tests, samples may go to a research laboratory. A lot of samples are sent between different labs for uncommon tests. It is more cost effective if a particular laboratory specializes in a rare test, receiving specimens (and money) from other labs, while sending away tests it cannot do.
In many countries there are mainly three types of Medical Laboratories as per the types of investigations carried out. 1. Clinical Pathology 2. Clinical Microbiology & 3. Clinical Biochemistry laboratories. 1. Clinical Pathology: Haematology, Histopathology, Cytology, Routine Pathology2. Clinical Microbiology: Bacteriology, Mycobacteriology, Virology, Mycology, Parasitology, Immunology, Serology.3. Clinical Biochemistry: Biochemical analysis, Hormonal assays etc.Blood Banks:- Blood bank is a separate body. Its laboratory need Microbiological analysis for infectious diseases that may be found in blood. Pathology to observe Blood grouping, Haematology & cross matching reactions. It also involves PRO department for the communication & contact for blood donations etc.. Molecular diagnostic lab or cyotgenetics and molecular biology lab is the latest addition to the three types of medical laboratories listed above in many countries.
Specimen processing and work flow
Sample processing will usually start with a set of samples and a request form.Typically a set of vacutainer
Vacutainer
Vacutainer is a brand of test tubes specifically designed for venipuncture, which was developed in 1947 by Joseph Kleiner.In phlebotomy the word “vacutainer” has come to be used as a genericized trademark to describe any vacuum-based blood collection vial, regardless of brand. Becton Dickinson...
tubes containing blood, or any other specimen, will arrive to the laboratory in a small plastic bag, along with the form.
The form and the specimens are given a laboratory number. The specimens will usually all receive the same number, often as a sticker that can be placed on the tubes and form. This label has a barcode that can be scanned by automated analyzers and test requests uploaded from the LIS
Laboratory information system
A lab information system is a class of software that receives, processes, and stores information generated by medical laboratory processes. These systems often must interface with instruments and other information systems such as hospital information systems...
. Entry of requests onto a laboratory management system involves typing, or scanning (where barcodes are used) in the laboratory number, and entering the patient identification, as well as any tests requested. This allows laboratory machines, computers and staff to know what tests are pending, and also gives a place (such as a hospital department, doctor or other customer) for results to go.
For biochemistry samples, blood is usually centrifuged and serum is separated. If the serum needs to go on more than one machine, it can be divided into separate tubes.
Many specimens end up in one or more sophisticated automated analyser
Automated analyser
An automated analyser is a medical laboratory instrument designed to measure different chemicals and other characteristics in a number of biological samples quickly, with minimal human assistance....
s, that process a fraction of the sample and return one or more "results". Some laboratories use robotic sample handlers (Laboratory automation
Laboratory Automation
Laboratory automation is a multi-disciplinary strategy to research, develop, optimize and capitalize on technologies in the laboratory that enable new and improved processes...
) to optimize the workflow and reduce contamination risk and sample handling of the staff.
The work flow in a lab is usually heavy from 2:00 am to 10:00 am. Nurses and doctors generally have their patients tested at least once a day with general complete blood counts and chemistry profiles. These orders are then drawn during a morning run by phlebotomist
Phlebotomist
Phlebotomists are individuals trained to draw blood from a live person or animal.Phlebotomists collect blood primarily by performing venipuncture and, for collection of minute quantities of blood, fingersticks. Blood may be collected from infants by means of a heel stick...
s for results to be available in the patient's charts for the attending physicians to consult during their morning rounds. Another busy time for the lab is after 3:00 pm when private practice physician offices are closing. Couriers will pick up specimens that have been drawn throughout the day and deliver them to the lab. Also, couriers will stop at outpatient drawing centers and pick up specimens. These specimens will be processed in the evening and overnight to ensure results will be available the following day.
Laboratory informatics
Laboratories today are held together by a system of software programs and computers that exchange data about patients, test requests, and test results known as a Laboratory information systemLaboratory information system
A lab information system is a class of software that receives, processes, and stores information generated by medical laboratory processes. These systems often must interface with instruments and other information systems such as hospital information systems...
or LIS. The LIS is interfaced with the hospital information system
Hospital information system
There are various titles and acronyms which all declare similar approaches to managing the information flow and storage in hospital routine services, as*Hospital Information System , or*Healthcare Information System, or...
.
This system enables hospitals and labs to order the correct test requests for each patient, keep track of individual patient or specimen histories, and help guarantee a better quality of results as well as printing hard copies of the results for patient charts and doctors to check.
Result analysis, validation and interpretation
According to ISO 15189 norm, all pathological results must be verified by a competent professional. In some countries staff like clinical scientistClinical scientist
This term is frequently used to denote :* A biomedical scientist or* A clinical laboratory scientist- See also :* Clinical pathologist* Clinical biologist* Medical laboratory...
s do the majority of this work inside the laboratory with abnormal results referred to the relevant pathologist
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
. In others, only medical staff (pathologist or clinical biologist
Clinical biologist
A Clinical biologist is an health professional, doctor in medicine , pharmacy, biology specialized in clinical biology, a medical speciality near from Clinical Pathology....
) is concerned by this phase. It can be assisted by some software in order to validate normal or non modified results. Medical staff are sometimes also required in order to explain pathology results to physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s. For a simple result given by phone or for a technical problem it's a medical technologist or medical lab scientist explaining it to a registered nurse.
Departments in some countries are exclusively directed by a specialized Pathologist, in others a consultant, medical or non-medical, may be the Head of Department. Clinical Scientist
Clinical scientist
This term is frequently used to denote :* A biomedical scientist or* A clinical laboratory scientist- See also :* Clinical pathologist* Clinical biologist* Medical laboratory...
s have the right to interpret and discuss pathology results in their discipline in many countries, in Europe they are qualified to at least Masters level, may have a PhD and can have an exit qualification equivalent to medical staff e.g. FRCPath in the UK.
In France only medical staff (Pharm.D. and M.D.
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
specialized in Anatomical pathology
Anatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
or Clinical biology
Clinical biologist
A Clinical biologist is an health professional, doctor in medicine , pharmacy, biology specialized in clinical biology, a medical speciality near from Clinical Pathology....
) can discuss pathological results, clinical scientist
Clinical scientist
This term is frequently used to denote :* A biomedical scientist or* A clinical laboratory scientist- See also :* Clinical pathologist* Clinical biologist* Medical laboratory...
s are not considered as a part of medical staff.
Medical laboratory accreditation
Credibility of medical laboratories is paramount to the health and safety of the patients relying on the testing services provided by these labs. The international standard in use today for the accreditation of medical laboratories is ISO 15189ISO 15189
ISO 15189 Medical laboratories — Particular requirements for quality and competence specifies the quality management system requirements particular to medical laboratories. The standard was developed by the International Organisation for Standardisations's Technical Committee 212...
- Medical laboratories - particular requirements for quality and competence.
Accreditation is done by the Joint Commission, College of American Pathologists
College of American Pathologists
The College of American Pathologists , is a medical society serving more than 17,000 physician members and the laboratory community throughout the world....
, AABB, and other state and federal agencies. CLIA 88 or the Clinical Laboratory Improvement Amendments
Clinical Laboratory Improvement Amendments
Clinical Laboratory Improvement Amendments of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research.-CLIA Program:...
also dictate testing and personnel.
The accrediting body in Australia is NATA, all laboratories must be NATA accredited to receive payment from Medicare.
In France, where accrediting body is COFRAC, in 2010, modification of legislation established ISO 15189 accreditation as an obligation for all clinical laboratories.
See also
- Healthcare scientist
- Laboratory automationLaboratory AutomationLaboratory automation is a multi-disciplinary strategy to research, develop, optimize and capitalize on technologies in the laboratory that enable new and improved processes...
- Automated analyserAutomated analyserAn automated analyser is a medical laboratory instrument designed to measure different chemicals and other characteristics in a number of biological samples quickly, with minimal human assistance....
- ARUP LaboratoriesARUP LaboratoriesARUP Laboratories is a leading national reference laboratory and a nonprofit enterprise of the University of Utah and its Department of Pathology. ARUP offers more than 3,000 tests and test combinations, ranging from routine screening tests to highly esoteric molecular and genetic assays...
External links
- Clinical Chemistry Journal
- American Association of Clinical Chemistry
- Medical Matters Wiki: Clinical Laboratory Science
- Clinical Laboratory in Pakistan