Essentials of medical laboratory practice

Copyright
Dedication
Preface
Contributors
Reviewers
Acknowledgments
List of Procedures
Abbreviations
Contents in Brief
Contents
Section I: 
Overview of the Laboratory
	Chapter 1: 
The Clinical Laboratory
		Learning Outcomes
		KEY TERMS
		THE CLINICAL LABORATORY
			Physician Office Laboratories
			Hospital Laboratories
			Reference Laboratories
		LABORATORY DEPARTMENTS
		WHY IS LABORATORY TESTING PERFORMED?
		THE ROLE OF THE MEDICAL ASSISTANT IN THE CLINICAL LABORATORY
		INFORMATION FLOW IN THE CLINICAL LABORATORY
			Laboratory Requisitions
			Advance Beneficiary Notice of Noncoverage
			Laboratory Directory
			Laboratory Reports
		THREE PHASES OF LABORATORY TESTING
		Summary
		Time to Review
	Chapter 2: 
Regulations Governing Laboratory Personnel
		Learning Outcomes
		KEY TERMS
		LABORATORY PROFESSIONALS
			Personnel in the Laboratory Setting
			Medical Assistants in the Laboratory
		CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988
			History of the Regulation
			Levels of Laboratory Testing Defined by CLIA ’88
			Employee Qualifications for Performance of CLIA Testing
			Oversight of CLIA Laboratories
		Summary
		Time to Review
	Chapter 3: 
Laboratory Safety and Preventing the Spread of Disease
		Learning Outcomes
		KEY TERMS
		INFECTION CONTROL AND LABORATORY SAFETY
		CORE CONCEPTS OF INFECTION CONTROL
			Microorganisms
				Types of Microorganisms
			Chain of Infection
			Standard Precautions
			Centers for Disease Control and PreventionHand-Washing Recommendations
			Acceptable Medical Hand-Washing Procedures
			Proper Use of Personal Protective Equipment
		LABORATORY SAFETY
			Chemical Safety
			Physical Safety
				Fire Safety
				Electrical Safety
				Body Mechanics
			Bloodborne Pathogen Safety
				Universal Precautions
				Bloodborne Pathogens Standard
		DISEASES CAUSED BY BLOODBORNE PATHOGENS IN THE LABORATORY SETTING
			Hepatitis
				Hepatitis B Virus (HBV)
				Hepatitis C Virus (HCV)
				Hepatitis A Virus (HAV)
			Human Immunodeficiency Virus
		POSTEXPOSURE FOLLOW-UP PROCEDURE
		Summary
		Time to Review
	Chapter 4: 
Assuring Quality
		Learning Outcomes
		KEY TERMS
		ASSURING QUALITY IN THE LABORATORY
		QUALITY CONTROL AND QUALITY ASSURANCE
		WHAT IS QUALITY?
			The Medical Assistant’s Role in Assuring Quality Results
				Types of Quality Control Specimens
			What Happens When Things Are “Out of Control”?
			Documentation of Quality Control Results
			Accuracy and Precision
		OTHER METHODS OF ASSURING LABORATORY QUALITY
		Summary
		Time to Review
	Chapter 5: 
Legal and Ethical Issues
		Learning Outcomes
		KEY TERMS
		LEGAL AND ETHICAL ISSUES IN THE LABORATORY ENVIRONMENT
		LAWS AND ETHICS
		LEGAL CONCEPTS AFFECTING PATIENT INTERACTIONS
			Consent
			Release of Information and Patient Rights and Responsibilities
			Tort Law
			Liability
			Scope of Practice
		HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
			The Impact of the Health Insurance Portability and Accountability Act on the Medical Assistant
		ETHICS
			Professional Behaviors
		RISK MANAGEMENT AND THE MEDICAL ASSISTANT
		Summary
		Time to Review
	Chapter 6: 
Laboratory Equipment
		Learning Outcomes
		KEY TERMS
		LABORATORY EQUIPMENT
			Microscopes
			Centrifuges
			Laboratory Refrigeration
			Incubators
		EQUIPMENT USED FOR AUTOMATED CLIA–WAIVED LABORATORY TESTING
			Testing Methodology
			Instruments Used for Chemical Testing of Urine Specimens
			Instruments Used for Coagulation Testing
			Instruments Used for Chemistry Testing
			Instruments Used for Hemoglobin Measurements
			Other Hematology Instruments
			Glassware and Other Miscellaneous Laboratory Equipment
		Summary
		Time to Review
	Section I: Overview of the Laboratory: What Does It All Mean?
Section II: 
Specimen Collection and Processing
	Chapter 7: 
Overview of Specimen Collection and Processing
		Learning Outcomes
		KEY TERMS
		SPECIMEN ORDERING
			Required Items for All Laboratory Tests
			Test Specifics
				Medicare-Approved Panels
				Standing Orders
				Reflexive Testing
		PATIENT IDENTIFICATION
			Verification of Patient Identity
				Acceptable Patient Identifiers
				Electronic Bar Codes
		PATIENT PREPARATION
		SPECIMEN COLLECTION AT HOME
		ITEMS THAT MUST BE DOCUMENTED WITH SPECIMEN COLLECTION
		LABELING INFORMATION
		CHAIN OF CUSTODY
		Summary
		Time to Review
	Chapter 8: 
Collection and Processing of Blood Samples
		Learning Outcomes
		KEY TERMS
		ANATOMY AND PHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM
			The Heart
			Blood Vessels
				Arteries
				Veins
				Capillaries
		SITE SELECTION
			Most Commonly Used Veins
			Appropriate Capillary Puncture Sites
		CONTRAINDICATIONS AND AREAS TO AVOID
			Scars and Tattoos
			Mastectomy Considerations
			Intravenous Fluids
			Bruising and Hematomas
			Varicose Veins
			Central Lines and Fistulas
			Edematous Areas
			Obese Patients
		VENIPUNCTURE EQUIPMENT
			Tourniquets
			Gloves
			Sharps Biohazardous Waste Containers
			Alcohol and Gauze Pads
			Needles
			Additional Supplies
		METHODS USED FOR VENIPUNCTURE
			Evacuated Tube System
			Syringe Method
			Winged Infusion or Butterfly Method
		BLOOD COLLECTION TUBES
			Color Coding of Tubes
			Types of Additives
		ORDER OF DRAW FOR VENIPUNCTURE
		CAPILLARY PUNCTURES
			Order of Draw for Capillary Puncture
		PREPARATION FOR BLOOD COLLECTION
		SPECIMEN PROCESSING
			Obtaining Serum for Testing
			Obtaining Plasma for Testing
			Whole Blood Specimens
			Unacceptable Specimen Types
		POTENTIAL NEGATIVE OUTCOMES OF VENIPUNCTURE AND CAPILLARY PUNCTURE
			Inability to Draw Blood
			Fainting Patients
			Rolling Veins
			Hematoma Formation
			Collapsing Veins
			Nerve Damage
			Infection
		OTHER PROCESSING PROCEDURES
		PREPARATION OF A PERIPHERAL BLOOD SMEAR FOR STAINING
		WRIGHT’S STAIN PROCEDURE
		Summary
		Time to Review
	Chapter 9: 
Collection and Processing of Urine Samples
		Learning Outcomes
		KEY TERMS
		TYPES OF URINE SPECIMENS
			Clean-Catch Midstream Urine Specimen Collection
			Catheterized Specimens
			Suprapubic Aspiration
			Prostatitis Specimen Collection
			Timed Urine Specimen Collections
			Urine Collection Procedures for Infants and Pediatric Patients
		URINE SPECIMEN PROCESSING
			Refrigeration and Preservation
			Proper Disposal of Urine and Supplies
		Summary
		Time to Review
	Chapter 10: 
Collection and Processing of Samples for Microbial Studies
		Learning Outcomes
		KEY TERMS
		MICROBIOLOGY SAMPLE COLLECTION GUIDELINES
			Types of Media
			Microbiology Terms
		DETAILED MICROBIOLOGY SAMPLE COLLECTION PROCEDURES
			Throat Sample Collections for Culture or Strep Screens
			Sputum Samples
			Urine Samples for Culture
			Blood Culture Collection
			Cerebrospinal Fluid Samples
			Genital Samples
			Wound Cultures
			Stool Specimens
			Nasopharyngeal Specimens
			Eye Cultures
			Ear Cultures
		SPECIAL SAMPLE COLLECTION AND PROCESSING PROCEDURES
			Fungal Sample and Culture Collection Procedures
			Wet Mount Procedure
			Sample Collection Procedures for Detection of Parasites
				Ova and Parasite Examination
				Pinworm Collection Procedures
		PROCESSING MICROBIOLOGY SAMPLES
			Slide Preparation and Gram-Staining Procedure
			Plating and Inoculation of Media
			Antibiotic Sensitivity Testing
		MICROBIOLOGY TEST RESULTS
		Summary
		Time to Review
	Section II: Specimen Collection and Processing: What Does it All Mean?
Section III: 
Hematology and Coagulation On the Horizon
	Chapter 11: 
Overview of Hematology
		Learning Outcomes
		KEY TERMS
		HEMATOPOIESIS—BLOOD CELL FORMATION
		TYPES OF BLOOD CELLS IN THE CIRCULATING BLOOD
			Erythrocytes—Red Blood Cells
			Leukocytes—White Blood Cells
				Granular White Blood Cells
				Agranular White Blood Cells
			Thrombocytes—Platelets
		ANALYSIS OF THE FORMED ELEMENTS
		Summary
		Time to Review
	Chapter 12: 
Complete Blood Count With Differential
		Learning Outcomes
		KEY TERMS
		COMPLETE BLOOD COUNT
			Complete Blood Count Specimen Requirements
			White Blood Cell Count
			Red Blood Cell Count
			Hemoglobin and Hematocrit
			Red Blood Cell (Erythrocyte) Indices
			Platelet Count
			Leukocyte Differential Count
				Peripheral Blood Smear
				Manual Leukocyte Differential
				Red Blood Cell Morphology
				Platelet Morphology and Estimated Count
			Manual Blood Cell Counts
		AUTOMATED ANALYZERS FOR COMPLETE BLOOD COUNT TESTING
		Summary
		Time to Review
	Chapter 13: 
Hemoglobin and Hematocrit
		Learning Outcomes
		KEY TERMS
		HEMOGLOBIN
		HEMOGLOBINOPATHIES
		HEMOGLOBIN TESTING
			CLIA–Waived Hemoglobin Testing
			Potential Errors in Hemoglobin Testing
		HEMATOCRIT
			CLIA–Waived Hematocrit Testing
			Potential Errors in Hematocrit Testing
		THE RELATIONSHIP OF HEMOGLOBIN AND HEMATOCRIT VALUES
		ANEMIA
		Summary
		Time to Review
	Chapter 14: 
Erythrocyte Sedimentation Rate
		Learning Outcomes
		KEY TERMS
		ERYTHROCYTE SEDIMENTATION RATE
		PLASMA PROTEINS AFFECTING THE ERYTHROCYTE SEDIMENTATION RATE
		THE INFLUENCE OF THE RED BLOOD CELLS ON THE ERYTHROCYTE SEDIMENTATION RATE
		REFERENCE RANGES
		CLINICAL SIGNIFICANCE OF ERYTHROCYTE SEDIMENTATION RATE TESTING
		ERYTHROCYTE SEDIMENTATION RATE DETERMINATION
			CLIA-Waived Erythrocyte Sedimentation Rate Methods
			Automated Erythrocyte Sedimentation Rate Methods
		POTENTIAL SOURCES OF ERROR FOR THE ERYTHROCYTE SEDIMENTATION RATE PROCEDURE
		Summary
		Time to Review
	Chapter 15: 
Coagulation Studies
		Learning Outcomes
		KEY TERMS
		PURPOSE OF COAGULATION STUDIES
		MECHANISMS OF BLOOD CLOTTING
		DISORDERS DIAGNOSED OR MONITORED WITH LABORATORY COAGULATION TESTS
			Thrombosis
			Atrial Fibrillation
			Postsurgical Prophylaxis
			Disseminated Intravascular Coagulation
			Thrombocytopenia
			Antiphospholipid Syndrome
			Hemophilia
		LABORATORY TESTS USED TO DIAGNOSE COAGULATION DISORDERS OR MONITOR ANTICOAGULANT THERAPY
			Prothrombin and International Normalized Ratio
			Activated Partial Thromboplastin Time/ Partial Thromboplastin Time
			Platelet Count
			Fibrinogen
			Fibrin Degradation Products
			D-Dimer
			Bleeding Time Test
			Other Tests Used to Assess Platelet Function
		SPECIMEN REQUIREMENTS FOR COAGULATION TESTING
		Summary
		Time to Review
	Section III: Hematology and Coagulation: What Does It All Mean?
Section IV: 
Clinical Chemistry On the Horizon
	Chapter 16: 
Overview of Clinical Chemistry
		Learning Outcomes
		KEY TERMS
		CLINICAL CHEMISTRY
		SPECIMEN TYPES USED FOR CLINICAL CHEMISTRY ANALYSIS
			Plasma
			Serum
			Other Specimen Types Used for Clinical Chemistry Testing
		CLIA–WAIVED CLINICAL CHEMISTRY TESTS
			Glucose Testing
			Cholesterol and Lipid Testing
			Electrolytes
		OTHER COMMON CLINICAL CHEMISTRY TESTS
			Blood Urea Nitrogen
			Creatinine
			Thyroid Panels
			Comprehensive Metabolic Panel and Basic Metabolic Panel
			Cardiac Enzymes
			Hepatic or Liver Profile
		REFERENCE RANGES
		POTENTIAL SOURCES OF ERROR
		Summary
		Time to Review
	Chapter 17: 
Glucose Testing
		Learning Outcomes
		KEY TERMS
		GLUCOSE UTILIZATION AND CONTROL MECHANISMS
		PATHOPHYSIOLOGY OF GLUCOSE METABOLISM
			Prediabetes
			Diabetes
		TYPES OF GLUCOSE TESTS PERFORMED
			Fasting Blood Glucose Test
			Random Glucose Test
			Postprandial Glucose Test
			Oral Glucose Tolerance Testing Procedures
			Glycosylated Hemoglobin
			Blood Ketone Testing
			Capillary Sample Testing and Correlation to Plasma Glucose Levels
			Urine Testing for Diabetics
		GLUCOSE TESTING METHODS
			Home Glucose Testing Instruments
				Quality Control and Common Errors
			Laboratory Glucose Testing and Potential Sources of Error
		Summary
		Time to Review
	Chapter 18: 
Other Select Chemistry Tests
		Learning Outcomes
		KEY TERMS
		LIPID TESTING
			Cholesterol
				Cholesterol Metabolism Within the Body
				Types of Cholesterol
				Risk Factors, Desired Ranges, and ClinicalInterpretation of Abnormal Lipid Results
			Triglycerides
				Metabolic Syndrome
				Reference Ranges and Clinical Interpretationof Abnormal Results
			Lipid Panels
		ELECTROLYTES
			Function of Electrolytes and Consequences of Electrolyte Imbalances
			Testing Preparation and Common Testing Methods
			Reference Ranges
		Summary
		Time to Review
	Section IV: Clinical Chemistry: What Does It All Mean?
Section V: 
Urinalysis
	Chapter 19: 
Urinalysis
		Learning Outcomes
		KEY TERMS
		HISTORICAL PERSPECTIVE OF URINALYSIS
		ANATOMY AND PHYSIOLOGY OF THE URINARY SYSTEM
			The Kidneys
			Ureters
			Bladder
			Urethra
		SEQUENCE OF URINE PRODUCTION AND EXCRETION
		CLINICAL SIGNIFICANCE OF URINE TESTING RESULTS
			Physical Examination
			Chemical Examination
			Microscopic Examination
		QUALITY ASSURANCE FOR URINE TESTING PROCEDURES
		STANDARD PRECAUTIONS USED WHEN ANALYZING URINE SPECIMENS
		TYPES OF URINE SPECIMENS
		Summary
		Time to Review
	Chapter 20: 
Physical Characteristics of Urine
		Learning Outcomes
		KEY TERMS
		PHYSICAL CHARACTERISTICS OF URINE
			Urine Color
			Urine Clarity
			Specimen Volume
			Urine Odor
			Specific Gravity
				Refractometer Measurement Technique
				Urinometer Measurement Technique
				Reagent Strip Methodology
		POTENTIAL SOURCES OF ERROR
		Summary
		Time to Review
	Chapter 21: 
Chemical Examination of Urine and Feces
		Learning Outcomes
		KEY TERMS
		URINE ANALYTES AND THEIR CLINICAL SIGNIFICANCE
			Bilirubin
			Blood
			Glucose
			Ketones
			Leukocytes
			Nitrite
			pH
			Protein
			Urobilinogen
			Specific Gravity
		POTENTIAL SOURCES OF ERROR
		SAFETY PRECAUTIONS
		QUALITY CONTROL PROCEDURES
		URINE TESTING METHODS
		CONFIRMATORY URINE TESTING
		FECAL OCCULT BLOOD TESTING
		Summary
		Time to Review
	Chapter 22: 
Microscopic Examination of Urine
		Learning Outcomes
		KEY TERMS
		REASONS FOR PERFORMING URINE MICROSCOPIC EXAMINATIONS
		COMMON FORMED ELEMENTS IN THE URINE AND THEIR CLINICAL SIGNIFICANCE
			Epithelial Cells
			Mucus
			Blood Cells
			Spermatozoa
			Artifacts
			Casts
			Crystals
			Microorganisms
		METHODS USED FOR URINE MICROSCOPIC EXAMINATION
		REPORTING URINE MICROSCOPIC RESULTS
		ROLE OF THE MEDICAL ASSISTANT IN MICROSCOPIC URINE PROCEDURES
		QUALITY CONTROL AND QUALITY ASSURANCE PROCEDURES FOR URINE MICROSCOPIC EXAMINATIONS
		Summary
		Time to Review
	Section V: Urinalysis: What Does It All Mean?
Section VI: 
Immunology
	Chapter 23: 
Immunology
		Learning Outcomes
		KEY TERMS
		IMMUNITY AND IMMUNOLOGY
		THE IMMUNE PROCESS
			The First Line of Defense: Nonspecific Mechanical and Chemical Barriers
			The Second Line of Defense: Internal Nonspecific Response
			The Third Line of Defense: Acquired or Adaptive Immunity
		HOW IMMUNITY IS ACQUIRED
		FAILURE OF OUR IMMUNE SYSTEMS
		BLOOD TYPES
		ERYTHROBLASTOSIS FETALIS
		IMMUNOLOGY TESTING METHODS
		COMMON SEROLOGY TESTS PERFORMED IN REFERENCE OR HOSPITAL LABORATORIES
		CLIA–WAIVED TESTS COMMONLY PERFORMED IN THE PHYSICIAN OFFICE LABORATORY
		Summary
		Time to Review
	Chapter 24: 
Immunological Based Rapid Testing
		Learning Outcomes
		KEY TERMS
		IMMUNOLOGY METHODS AND PROCEDURES
		RAPID TESTING
			Advantages of Rapid Testing
			Common Procedural Elements of Rapid Testing
			CLIA–Waived Regulations and Their Application to Immunology-Based Rapid Testing
		COMMON CLIA–WAIVED RAPID TESTS AND THEIR CLINICAL SIGNIFICANCE
			Group A Streptococcal Screening
			Mononucleosis Testing
			Pregnancy Testing
			Helicobacter pylori Testing
			Influenzas A and B
			HIV Testing
		Summary
		Time to Review
	Section VI: Immunology: What Does it All Mean?
Appendix A: 
Reference Ranges
Appendix B: 
Test Your Knowledge Answers
Appendix C: 
Tube Guide for BD Vacutainer Venous Blood Collection
Glossary
INDEX