Guru Nanak
College
Budhlada
Field Report
Topic: A Visit to a Clinical Lab
Submitted By: Submitted To:
Name: ____________ Dr. Amrit Kaur Bansal
Course: B.Sc Medical (II)
Roll No.: ________
A Visit To A CLINICAL LABORATORY
On on 21st March, 2018 (Wednesday) we visited clinical laboratory named
“Patiala Laboratory” situated at village Joga, Distt. Mansa, Punjab. We had
departure via college bus from college at 10 a.m. to laboratory under the
supervision of our subject teacher Dr. amrit kaur bansal.
At the laboratory we met with the medical laboratory technician. He guided us
very deeply about the maintenance of hygienic conditions, how carefully and
accurately all tests must be performed because conducting a medical test is a
matter of patient’s health. After explaining about the maintenance, he
introduced about the laboratory equipments present in the lab like
haemoglobinometer, sphygmomanometer, microscope, analyzer, centrifuge,
automated cell counter, etc.
We also get to know about the “Ready to use kit” to perform various tests like
glucose, urine, typhoid, malaria, types hepatitis, etc. These tests are performed
by using either serum or blood of patient depending upon the test performed.
We listened and noted all the instructions given by him. He performed the test
in front of all of us. Then he also allowed us to perform the test.
Our visit was successful because we have learned practically what we have
gained information during our theory lectures in our college. Although we also
performed the test at college laboratory but this visit to medical laboratory
outside the college was beneficial for us because we interacted with the lab
technician as well as observe the laboratory set up and other equipments like
“Ready to use Kit".
Medical Laboratory
Medical laboratory or clinical laboratory is a laboratory where tests are usually
done on clinical specimens in order to obtain information about the health of a
patient as pertaining to the diagnosis, treatment and prevention of disease.
Clinical laboratories are thus focused on applied science mainly on a
production-like basis, as opposed to research laboratories that focus on basic
science on an academic basis.
Personal and General Laboratory Safety
1. Never eat, drink, or smoke mobile working in the laboratory.
2. Read labels carefully.
3. Do not use any equipment unless you are trained and approved as a user
by your supervisor.
4. Wear safety glasses or face shields when working with hazardous
materials and/or equipment.
5. Wear gloves when using any hazardous or toxic agent.
6. Clothing: When handling dangerous substances, wear gloves, laboratory
coats and safety shield or glasses. Shorts and sandals should not be worn
in the lab at anytime. Shoes are required when working in the machine
shops.
7. If you have long hair or loose clothes, make sure it is tied back or
confined.
8. Keep the work area clear of all materials except those needed for your
work. Coats should be hung in the hall or placed in a locker. Extra books,
purses, etc. should be kept away from equipment that requires air flow or
ventilation to prevent overheating.
9. Disposal- Students are responsible for the proper disposal of used
material if any in appropriate containers.
10.Equipment failure- If a piece of equipment fails while being used, report
immediately to your lab assistant or tutor. Never try to fix the problem
yourself because you could home yourself and others.
11.If leaving a lab unattended, turn of all ignition sources and look the
doors.
12.Never pipette anything by mouth.
13.Clean up your work area before leaving.
14.Wash hands before leaving the lab and before eating.
Chemical Safety
1. Treat every chemical as if were hazardous.
2. Make sure all chemicals are clearly and currently labelled with the
substance name, concentration, date and name of the individual
responsible.
3. Never return chemicals to reagent bottles. (Try for the correct amount and
share any access).
4. Comply with fire regulations concerning storage quantities, types of
approved containers and cabinets, proper labelling, etc. If uncertain about
regulations, contact the building coordinator.
5. Use volatile and flammable compounds only in a fume hood. Procedures
that produce aerosols should be performed in a hood to prevent inhalation
of hazardous material.
6. Never allow a solvent to come in contact with you skin. Always use
gloves.
7. Never smell solvent. Read the label on the solvent bottle to identify its
contents.
8. Dispose of waste and broken glassware in proper containers.
Cell Counting
Cell Counting is any of various methods for the counting or similar
quantification of cells in the life sciences, including medical diagnosis and
treatment. It is an important subset of cytometry, with applications in research
and clinical practice. For example, the complete blood count can help a
physician to determine why a patient feels unwell and what to do to help. Cell
counts within liquid media (such as blood plasma, lymph, or laboratory rinsate)
are usually expressed as a number of cells per unit of volume, thus expressing a
concentration (for example, 5,000 cells per millilitre). Cell counting can be
performed into ways: Manual and Automated Cell Counting.
1. Manual Cell Counting using Counting Chamber
A counting chamber,(also known as hemocytometer), is a microscope slide
that is especially designed to enable cell counting. The hemocytometer has
two gridded chambers in its middle, which are covered with a special glass
slide when counting. A drop of cell culture is placed in the space between
the chamber and the glass cover, filling it by capillarity.[1] Looking at the
sample under the microscope, the researcher uses the grid to manually
count the number of cells in a certain area of known size. The separating
distance between the chamber and the cover is predefined, thus the volume
of the counted culture can be calculated and with it the concentration of
cells. Cell viability can also be determined if viability dyes are added to
the fluid.
2. Automated Cell Counting using Automated Cell Counter
Many blood counts today include a CBC count and leukocyte differential count
(LDC) (that is, not just the total WBC count but also the broken down
percentage of each WBC type, such as neutrophils, eosinophils, basophils,
monocytes and lymphocytes).
The blood is well mixed ( though not shaken) and place on a rack in the
analyzer. This instrument has flow cells, photometers and apertures that analyse
different elements in the blood. The cell counting component counts the
numbers and types of different cells within the blood. The results are printed out
or sent to a computer for review.
Blood accounting machine aspirate a very small amount of the specimen
through narrow tubing followed by an aperture and a laser flow cell. Laser eye
sensors count the number of cells passing through the aperture, and can identify
them; this is flow cytometry. The two main sensors used are light detectors and
electrical impedance. The instrument measures the type of blood cell by
analyzing data about the size and aspects of light as they pass through the cells
(called front and side scatter). Other instruments measure different
characteristics of the cells to categorise them.
Because an automated cell counter samples and count so many cells, the results
are very precise. However, certain abnormal cells in the blood may not be
identified properly, requiring manual review of the instrument’s results and
identification of any abnormal cells, the instrument could not categorize.
In addition to counting, measuring and analysing red blood cells, white blood
cells and platelets, automated hematology analyser also measures the amount of
hemoglobin in the blood and within each red blood cell. This is done by adding
a diluent that lyses the cells which is then pumped into a spectro-photometric
measuring cuvette. The change in colour of the lysate equates to the
haemoglobin content of the blood. This information can be very helpful to a
physician who, for example, is trying to identify the cause of patient’s anaemia.
If the red cells are smaller or larger than normal, or if there is a lot of variation
in the size of the red cells, this data can help guide the direction of further
testing and expedite the diagnostic process so patient can get the treatment they
need quickly.
Procedure
A phlebotomist collects the sample through venipuncture, drawing the blood
into a test tube containing an anticoagulant (EDTA), sometimes citrate) to stop
it from clotting. The sample is then transported to a laboratory. Sometimes the
sample is drawn off from a finger prick using a Pasteur pipette for immediate
processing by an automated counter.
Interpretation
Certain disease states are defined by an absolute increase or decrease in the
number of a particular type of cell in the blood stream. For example,
Type of Cell Increase Decrease
Red Blood Cells (RBC) Erythrocytosis Anemia
White Blood Cells (WBC) Leukocytosis Leukopenia
Lymphocytes Lymphocytosis Lymphocytopenia
Granulocytes Granulocytosis Granulocytopenia
Neutrophils Neutrophilia Neutropenia
Eosinophils Eosinophilia Eosinopenia
Basophils Basophilia Basopenia
Platelets Thrombocytosis Thrombocytopenia
All Cell Lines -- Pancytopenia
Many diseases states are heralded by changes in the blood count: leukocytosis
can be a sign of infection; thrombocytopenia can result from drug toxicity;
pancytopenia is generally referred to as the result of decreased production from
the bone marrow, and is a common compilation of cancer chemotherapy.
Sphygmomanometer
An instrument for measuring blood pressure, typically consisting of an
inflatable rubber cuff which is applied to the arm and connected to a column of
mercury next to a graduated scale, enabling the determination of systolic and
diastolic blood pressure by increasing and gradually releasing the pressure in the
cuff.
Normal resting blood pressure in an adult is approximately 120 millimetres of
mercury (systolic), and 80 millimetres of mercury (diastolic), abbreviated
“120/80 mmHg".
Significance
By observing the mercury in the column while releasing the air pressure with a
control valve, one can read the values of the blood pressure in mmHg. The peak
pressure in the arteries during the cardiac cycle is the systolic pressure, and the
lowest pressure (at the resting phase of the cardiac cycle) is the diastolic
pressure. A stethoscope is used in the auscultatory method. Systolic pressure
(first phase) is identified with the first of the continuous Korotkoff sounds.
Diastolic pressure is identified at the moment the Korotkoff sound disappears
(fifth phase). Measurement of the blood pressure is carried out in the diagnosis
and treatment of hypertension (high blood pressure), and in many other
healthcare scenarios.
Haemoglobinometer
An apparatus used for measuring the amount of haemoglobin in a fluid by
comparing it with a solution of known strength and of normal colour.
Principle: Anticoagulated blood is added to the 0.1 N HCL and kept for 5-7
minutes to form acid haematin. The color of this acid haematin should be
matched with the solution, present in the calibration tube. Distilled water is
added to the acid haematin until the color matches and the final reading is
directly noted from the graduation in the calibration tube.
Procedure: Place N/10 HCL in diluting tube upto the mark 20. Take blood in
the haemoglobin pipette upto 20-mm3 mark and blow it into diluting tube and
rinse well. After 10 minutes add distilled water in drops and mix the tube until it
has exactly the same colour as the comparison standards. Note the reading,
which indicates the percentage of haemoglobin.
Result:
The Hb estimation of the given sample is ____ g/100 mL of blood/ ____ g/dL of
blood/ ____ G%.
Normal results for adults vary, but in general are:
● Male: 13.8 to 17.2 grams per decilitre (g/dL) or 138 to 172 grams per litre
(g/L).
● Female: 12.1 to 15.1 g/dL or 121 to 151 g/L.
Precautions:
1. Pipetting of blood should be done cautiously.
2. Mix the blood properly with HCL by using stirrer.
3. Match the color cautiously.
