What is a Clinical Laboratory Professional and What

What is a Clinical Laboratory Professional and What Are They Doing With My Body Fluids?

What is in blood? v. Plasma - the liquid portion v. Platelets - the clot forming components v. White Blood Cells - the infection fighters v. Red Blood Cells - the oxygen transporters

How do blood tests tell us what’s going on in other parts of the body? v. The body of an adult contains over 60, 000 miles of blood vessels! v. An adult’s heart pumps nearly 4, 000 gallons of blood each day! v. As the blood travels around the body, products from those cells are absorbed into the bloodstream.

What makes one type of cell different from another type of cell?

CHEMISTRY!! Water Vitamins Proteins Enzymes RNA DNA Cholesterol Amino Acids Minerals Fats p. H Hormones Sugars

Chemistry of the Human Body v. Each cell of the body contains about 90 trillion atoms (90, 000, 000) v. The human body contains about 60 different elements. v. Over 96% of those atoms are oxygen (61%), carbon (23%), hydrogen (10%), and nitrogen (2. 6%)

How those atoms are put together in the cell determines: v. What the cell looks like v. What jobs the cell can do in the body v. How the cell communicates with other cells in the body

So Bone Cells look and act differently than Fat Cells Blood Cells, Muscle Cells

These chemical differences in cells allow us to determine if something is wrong with the part of the body where that those cells are found. For example …. .

What happens in a heart attack? v Blood stops flowing to part of the heart v This can be caused by: • Blood clots • Fat deposits Blood vessel with fatty deposits v When blood stops flowing, heart cells don’t get enough oxygen and they begin to die.

v. When cells are damaged or dying, they begin to leak some of the compounds from inside their cell membrane. v. Those compounds then get into the bloodstream. v. Because many of the compounds inside the cell are specific to that type of cell, we can identify problems by the amount of certain compounds in the blood.

What compounds are released by the damaged heart? v Proteins • Myoglobin is the oxygen-binding protein of the muscles • It only takes 1 to 2 hours after a heart attack before you find myoglobin in the blood • Myoglobin peaks at 6 -9 hours. • It returns to normal within 24 hours because it is rapidly excreted in the urine.

What compounds are released by the damaged heart? v Proteins • Troponin-I and Troponin-T • Troponins are structural proteins found in heart muscle. • It only takes 2 to 4 hours after a heart attack before you find troponins in the blood. • Troponin-I peaks at 24 hours. Troponin-T peaks at 12 -48 hours. • They remain elevated for 9 -14 days.

What compounds are released by the damaged heart? v. Enzymes • Creatine Kinase (CK) • It takes 4 to 10 hours before you find the CK enzyme in the blood • It peaks at 24 hours • It returns to normal levels in 2 or 3 days

What compounds are released by the damaged heart? • Creatine Kinase (CK), continued • Different forms of CK, called isoenzymes, are found in different tissues. • CK-MM occurs in high concentrations in skeletal muscle and heart. • CK-MB is present in high concentrations in heart, but it is also present in lungs, small intestine, uterus, prostate, and healthy skeletal muscle. • CK-BB occurs in high concentrations in the brain, but it is also found in lung, stomach, prostate, the gastrointestinal tract, and the bladder.

What compounds are released by the damaged heart? • Creatine Kinase (CK), continued • The different isoenzymes of CK each have a different electrical charge. • This difference in electrical charges allows the lab to separate the CK forms from each other and determine the amount of each form present in the blood by placing the sample in an electrical field. The forms with the greater charge will move the fastest and farthest.

Creatine Kinase Electrophoresis Patterns CK-BB is rarely seen in the blood.

CK Concentrations in the Blood v Normal Concentrations • CK-MM (Muscle) • CK-MB (Heart) • CK-BB (Brain) v. Normally, there is a >95% small amount of CKMB in the blood, and <5 % almost no CK-BB. v. After a heart attack, 0% there is more CK-MB in the blood.

What compounds are released by the damaged heart? v. Enzymes • Lactate Dehydrogenase (LD) • It takes 6 to 12 hours to appear in the blood • It peaks in 1 to 3 days • Levels return to normal in 8 to 14 days

Determining the amounts of these compounds in the blood helps determine: v. Whether or not a heart attack has occurred v. How long ago the heart attack occurred v. To some extent, how much damage the heart attack caused

Cardiac Markers in Serum

In the same way that each type of cell has its own particular chemistry, each disease has its own particular chemistry.

What specimens usually go to the lab for a physical exam? v. Two, three, or more tubes of blood • Purple top • Red top • Blue top v. Urine specimen

So why do labs need two (or more!) different tubes of blood? Why can’t they just use one tube?

When blood leaves the veins, it will come in contact with factors that will initiate the formation of a blood clot.

The red top tube either contains nothing or something to activate the formation of the clot. The liquid portion is no longer called plasma, but is called serum because it no longer contains the clotting components. Serum is often preferred for testing because all of the cellular components are more easily removed so they can’t clog sensitive instruments.

The purple top tube contains an anticoagulant, EDTA, which prevents the blood from clotting, so cells remain separated. It also preserves the cells so they can be identified by how they look when using particular stains.

The blue top tube also prevents blood from clotting, but it uses a different anticoagulant, sodium citrate, which preserves more of the clotting factors. This is the tube used to evaluate the ability of the blood to clot.

Specimen Processing v The red top tube is centrifuged to separate the serum from the cells. v The blue top tube is also centrifuged and then sent to the coagulation laboratory. v The purple top tube is not centrifuged, but sent to hematology so they can begin to prepare slides and look at the cells. Centrifuge

The Red Top Tube Goes to the Chemistry Lab

The serum can now be tested for: v Cholesterol v Blood glucose (sugar) v Electrolytes (sodium, potassium, chloride) v Enzymes from the heart, liver, pancreas, etc. v Kidney function (blood urea nitrogen or creatinine) v Hormones v Vitamins v Drug levels v Hundreds of other compounds

The Purple Top Tube Goes to the Hematology Lab This tube is mixed well, then placed in an instrument that determines: • Red blood cells • White blood cells • Platelets • Hematocrit (percentage of blood that is cells) • Hemoglobin (oxygen-carrying protein)

Blood smears are made on glass slides and then stained so cell structures can be seen clearly.

Blood smears are usually examined using a light microscope.

Red Blood Cell Size and Color are Studied HYPOCHROMIC Decreased hemoglobin concentration in pale cells. NORMAL RED BLOOD CELLS Normal area of central pallor should be about one-third of the cell’s diameter. ANISOCHROMIA Pale and filled cells can both be seen following blood transfusion.

Red Blood Cell Shape is Observed Target Cells Abnormal hemoglobins, liver disease, thalassemias Elliptocytes Hereditary condition, some anemias Sickle Cells Sickle cell anemia (Hb SS), Hb SC. Hb S/thal

More Red Blood Cell Shapes Schistocytes RBC fragments found in severe burn patients, disseminated intravascular coagulation Acanthocytes “Spiked” red cells are observed in liver disease, asplenic patients (spleens removed) Spherocytes Red cells without a pale center are seen in hereditary spherocytosis, some immune-mediated hemolytic anemias

Neutrophils Engulf bacteria and cellular debris 37 -77% Lymphocytes Produce antibodies, regulate the immune response 10 -44% Basophils Hypersensitivity, Release histamine 0 -1. 6% White Blood Cells Eosinophils Parasitic infections, Allergic response 1 -7% Monocytes Engulf cellular debris, antigen processing 2 -10%

Abnormal Blood Smears Chronic Myelogenous Leukemia Malaria (Plasmodium falciparum) Infectious Mononucleosis (Reactive Lymphocytes)

The Blue Top Tube Goes to the Coagulation Lab v These tubes are often drawn on people who are on anti-coagulant therapy (coumadin), also called “blood thinners” The plasma is tested to determine how long it takes blood to clot.

The Urine Goes to the Urinalysis Lab Urine can provide information about: v Kidney function v Urinary tract disorders v Diabetes v Liver disorders v Metabolic disorders v Muscle trauma v Hormonal disorders v Drug use

Urinalysis A complete urinalysis consists of examining the physical, chemical, and microscopic characteristics of the urine.

Chemical analysis is performed using a reagent strip with pads containing chemicals specific for each test.

What chemicals do labs test for in urine? v. Sugar • Normal urine should not contain glucose (blood sugar) • Found in diabetes v. Ketones • Normal urine should not have ketones • Ketones form when you break down fats instead of sugar for energy • Found in diabetes, starvation

What chemicals do labs test for in urine? v. Protein • Normal urine should contain very little protein • Suggests possible kidney damage, certain cancers v. Hemoglobin • Normal urine should not contain hemoglobin (from red blood cells) • Seen in injury, kidney stones, infection

What chemicals do labs test for in urine? v. Leukocyte esterase • Normal urine should not contain this enzyme found in white blood cells • Suggests urinary tract infection v. Nitrite • Normal urine should not contain nitrites • Nitrites form when bacteria convert urine nitrates to nitrite

Yeast Urine Microscopic Exam Epithelial Cells Calcium Oxalate Crystals

Other Areas of the Clinical Laboratory

Clinical Microbiology Identify organisms Determine antibiotic sensitivity

The virology lab tests the serum for antibodies directed against viruses such as HIV or hepatitis.

Medical technologists in the Blood Bank will determine which antibodies are present in your plasma so a compatible cross-match can be found if you need a blood transfusion.

The serum or plasma will be tested for antibodies, and the red cells will be tested for surface antigens.

What is a clinical laboratory professional? v A laboratory professional is a person who performs laboratory testing on blood, urine, feces, spinal fluid and other body fluids. v They provide 70 -80% of the objective data used to make clinical decisions.

Laboratory Professionals Conduct Tests To: v Verify a potentially dangerous drug level v Detect a cancerous tumor with DNA techniques v Identify toxic agents, such as anthrax, in cases of bioterrorism v Monitor the level of anti-rejection drugs in transplant patients v Type and cross-match blood samples for transfusions v Identify the causative microorganism in a blood or wound infection

Who is a Laboratory Professional? v Phlebotomist v Clinical Laboratory Technician/Medical Laboratory Technician v Clinical Laboratory Technologist/Medical Technologist v Cytotechnologist v Histotechnologist

Skills and Abilities v Good manual dexterity v Enjoy problem solving v Work independently v Interest in science, especially biology v Detail oriented v Work well under pressure v Organized v Accurate and Precise v Desire to help others

Clinical Laboratories v 7. 25 billion tests are performed annually by 350, 000 laboratory professionals. v Bureau of Labor Statistics reports the demand for laboratory will result in a 17% increase in testing from 1998 -2008.

What’s a phlebotomist? v A person who has been trained to draw blood for laboratory tests. v A phlebotomist goes through a training program, which is usually about three to four months long, or v They can do on-the-job training at a hospital. v Starting salaries are about $1013/hour ($23, 000/year).

What’s an histology technician? v An histology technician is a person who prepares solid tissues such as biopsy samples and tumors for examination under the microscope v A person with an associate degree in histotechnology and certification as an histology technician. v Starting salary for professionals with an associate degree in histotechnology is about $13 -16/ hour ($30, 000/year).

What’s a clinical laboratory technician/ medical laboratory technician? v A person with an associate degree and certification as a clinical laboratory technician (CLT) or medical laboratory technician (MLT). v Starting salary for professionals with an associate’s degree is about $12 -16/hour ($30, 000/year).

What’s a clinical laboratory scientist/ medical technologist? v A person with a baccalaureate degree and certification as a clinical laboratory scientist (CLS) or medical technologist (MT). v Starting salary for professionals with a baccalaureate degree is about $17 -22/hour ($43, 000/year).

General Job Duties v Run Lab tests v Develop and evaluate the tests v Interpret data v Analyze the results v Communicate with physicians regarding test results Medical technologists use a light microscope to check blood smears for abnormalities

What’s a cytotechnologist? v A cytotechnologists prepares and examines slides of cells. They are best known for the performance of Pap tests for cervical cancer, but they examine many other types of specimens as well. v A person with a baccalaureate degree and certification as a cytotechnologist v Starting salary for professionals with a baccalaureate degree is about $19 -20/hour ($40, 500/year).

What’s the job market like? v Currently, there is a 9 -20% vacancy rate across the country. v Increased testing demands and retirements will result in the need for 13, 800 new lab professionals per year. v There are currently only 4, 100 new laboratory professional graduates per year.