MEDICAL LABORATORY ATTACHMENT REPORT

NAME: WANJALA DAVIES SIMIYU

REGISTRATION NUMBER: D/MLS/23026/1114
INSTITUTION: KISII TEACHING AND REFERRAL HOSPITAL
COURSE: MEDICAL LABORATORY SCIENCE
DURATION: (FROM 1ST OCTOBER 2024 TO 6TH JANUARY 2025)

TABLE OF CONTENTS

1. Acknowledgments
2. Declaration
3. Approval
4. List of Abbreviations
5. Abstract
6. Introduction
7. Objectives of the Attachment
8. Scope of the Attachment
9. Laboratory Sections and Experiences

Phlebotomy
Serology
Parasitology
Blood Transfusion Science
Microscopy
Clinical Chemistry
Haematology
Histopathology
Microbiology
Blood Bank
Immunology
Division of Vector-Borne Diseases (DVBD)

10. Challenges Faced

11. Recommendations
12. Conclusion
13. References
14. Appendices
ACKNOWLEDGMENTS
The completion of this attachment report would not have been possible without the support,
guidance, and encouragement of several individuals. First and foremost, I extend my sincere
gratitude to the management and staff of Kisii Teaching and Referral Hospital for granting me the
opportunity to conduct my industrial attachment at their medical laboratory. Their hospitality and
willingness to share knowledge played a crucial role in enhancing my practical skills.
I am particularly grateful to my supervisors and laboratory technologists who patiently guided me
through the different sections of the laboratory. Their expertise, mentorship, and constructive
feedback were invaluable in helping me understand the intricacies of laboratory procedures.
I also extend my heartfelt appreciation to my academic institution and lecturers for equipping me
with the theoretical foundation that was essential in applying practical laboratory techniques. My
family and friends also played a significant role in encouraging and supporting me throughout the
attachment period. Their moral support and motivation helped me remain focused and committed to
learning.
DECLARATION
I, Davies Simiyu, hereby declare that this industrial attachment report is my original work and has
not been submitted to any other institution for academic credit. All information provided in this
report is based on my experiences during my attachment at Kisii Teaching and Referral Hospital.
Any sources consulted have been duly acknowledged in the reference section.

Signature: ___________
Date: ___________
APPROVAL
This is to certify that Davies Simiyu, Registration Number D/MLS/23026/1114, successfully
completed his industrial attachment at Kisii Teaching and Referral Hospital and has submitted this
report as part of the course requirements.
Supervisor Name: ___________
Designation: ___________
Signature: ___________
Date: ___________
LIST OF ABBREVIATIONS
Throughout this report, several abbreviations have been used for clarity and ease of reference. Below
is a list of the commonly used abbreviations:
CBC – Complete Blood Count
ELISA – Enzyme-Linked Immunosorbent Assay
DVBD – Division of Vector-Borne Diseases
ESR – Erythrocyte Sedimentation Rate
HIV – Human Immunodeficiency Virus
RPR – Rapid Plasma Reagin
SOPs – Standard Operating Procedures
These abbreviations represent key laboratory terminologies that were frequently encountered during
my attachment experience.

ABSTRACT
The industrial attachment at Kisii Teaching and Referral Hospital provided a comprehensive and
immersive learning experience in various laboratory sections, allowing me to apply theoretical
knowledge in a real-world setting. During my attachment, I was involved in critical laboratory
practices, including phlebotomy, serology, parasitology, blood transfusion science, microscopy,
clinical chemistry, haematology, microbiology, blood banking, immunology, and the Division of
Vector-Borne Diseases (DVBD).
The attachment was essential in bridging the gap between classroom learning and practical
application. I gained hands-on experience in sample collection, laboratory testing, patient interaction,
and diagnostic procedures. Furthermore, I developed critical skills in laboratory safety, infection
control, quality assurance, and result interpretation.
This report details my experiences in each section of the laboratory, challenges encountered, and
recommendations for improving training and laboratory operations. The insights gained from this
attachment will play a crucial role in shaping my future career as a medical laboratory professional
INTRODUCTION
Background of Industrial Attachment in Medical Laboratory Science
Industrial attachment is a mandatory requirement for medical laboratory science students, as it
provides them with an opportunity to gain practical experience in a clinical setting. This hands-on
training enables students to acquire proficiency in diagnostic laboratory techniques, familiarize
themselves with hospital workflows, and develop essential problem-solving skills in real-world
laboratory settings.
Laboratory medicine plays a critical role in healthcare, as 80% of medical decisions are based on
laboratory test results. The ability of laboratory professionals to accurately conduct diagnostic tests
and provide timely and reliable results is crucial in-patient management, disease diagnosis, and
treatment monitoring.
Overview of Kisii Teaching and Referral Hospital
Kisii Teaching and Referral Hospital (KTRH) is one of Kenya’s leading referral hospitals, providing
comprehensive healthcare services to patients from Kisii County and neighbouring regions. The
hospital is equipped with a modern medical laboratory that handles a high volume of diagnostic tests
daily. It has different specialized departments, including phlebotomy, haematology, microbiology,
clinical chemistry, parasitology, serology, and immunology.
This hospital was an ideal location for my industrial attachment, as it provided exposure to a wide
variety of diagnostic tests, laboratory equipment, and patient cases.

OBJECTIVES OF THE ATTACHMENT

The primary goal of the industrial attachment was to gain practical experience in medical laboratory
science by working in a hospital setting. The specific objectives included:
1. To apply theoretical knowledge in practical laboratory work – The attachment provided an
opportunity to use classroom-acquired knowledge in conducting laboratory procedures.
2. To develop proficiency in sample collection and handling – Learning how to collect blood,
urine, stool, and other clinical samples while following proper procedures.
3. To understand laboratory workflow – Observing how different laboratory sections coordinate
to ensure efficient and accurate diagnosis.

4. To gain hands-on experience in laboratory tests – Performing tests in different sections, such
as complete blood counts, malaria microscopy, urinalysis, and serological tests.
5. To adhere to biosafety and quality control guidelines – Ensuring proper waste disposal,
sample handling, infection control, and quality assurance measures.
6. To improve laboratory problem-solving skills – Learning how to handle unexpected results,
machine errors, and sample processing challenges.
7. To familiarize with medical ethics and patient confidentiality – Understanding the importance
of patient privacy and professional conduct in laboratory work.

SCOPE OF THE ATTACHMENT

Phlebotomy

Objective of Phlebotomy

To collect blood samples safely, accurately, and efficiently for diagnostic purposes while ensuring
patient comfort and biosafety.

Detailed Explanation
Phlebotomy is a critical skill that involves drawing blood from patients for various laboratory tests.
During my attachment, I begin each day at the phlebotomy unit, where I learn to interact with
patients, identify veins, and collect samples.

Key Steps in Phlebotomy:

1. Preparation:

I start by preparing the required materials: sterile needles, tourniquets, blood collection tubes (e.g.,
EDTA tubes for haematology, plain tubes for biochemistry), alcohol swabs, and gloves.

I ensure that the work area is clean and disinfected.

2. Patient Interaction:

Before collecting a sample, I introduce myself and explain the procedure to the patient to reduce
anxiety.

I verify the patient’s identity using their name and hospital number and ensure the test requisition
form matches the details.

3. Sample Collection:

A tourniquet is applied to the patient’s upper arm to make the vein more visible.

After locating the vein, I disinfect the area with an alcohol swab in a circular motion.

I use a sterile needle and vacuum collection system to draw blood, ensuring minimal discomfort to
the patient.

After collecting the required volume of blood, I remove the needle, apply pressure to the puncture
site, and provide a plaster.

4. Labelling and Transportation:

Proper labelling of tubes is critical to avoid errors. I write the patient’s name, hospital number, and
date on the tube.

Samples are placed in appropriate transport containers and sent to the respective laboratory sections
for analysis.

Challenges in Phlebotomy

1. Patient-Related Challenges:

Some patients are anxious or scared of needles, requiring extra reassurance and patience.

Difficult veins, especially in children or obese patients, make sample collection more time-
consuming.
2. Operational Challenges:

High patient flow in the morning leads to pressure on staff to work quickly while maintaining
accuracy.
 3. Safety Concerns:
Accidental needle-stick injuries are a significant risk. Proper needle disposal in sharps containers is
emphasized to prevent such incidents.
PARASITOLOGY

OBJECTIVE OF PARASITOLOGY

To detect and identify parasitic infections in stool, blood, and urine samples, contributing to the
diagnosis and treatment of parasitic diseases.

DETAILED EXPLANATION

Parasitology involves the study of parasites and their role in human diseases. At KTRH, this section
focuses on identifying intestinal and blood parasites.

Tests Conducted in Parasitology:

1. Stool Examination

Stool samples are examined to detect intestinal parasites such as Ascaris lumbricoides, Giardia
lamblia, and Entamoeba histolytica.

I prepare both direct and concentrated smears using saline and iodine staining techniques.

A drop of saline is mixed with a small amount of stool on a glass slide and examined under a
microscope for motile organisms.

2. Blood Smear for Malaria

Blood smears are essential for diagnosing malaria, a common disease in the region.

I prepare thick and thin blood smears and stain them with Giemsa stain to detect the presence of
Plasmodium falciparum.

The thick smear is used to identify parasitic stages, while the thin smear helps determine the species
of Plasmodium.

3. Urine Examination

Occasionally, I analyse urine samples for parasites like Schistosoma haematobium, which causes
urinary schistosomiasis.

Challenges in Parasitology

1. Sample Quality: Some samples are contaminated or not fresh, making it challenging to
identify parasites.
2. Microscopy Limitations: Identifying some parasites requires advanced microscopy skills,
which take time to master.
3. Patient Cooperation: Some patients are reluctant to provide stool samples due to cultural
stigma or discomfort.
CLINICAL CHEMISTRY

OBJECTIVE OF CLINICAL CHEMISTRY

To analyse biochemical components in blood and other body fluids for diagnosing and monitoring
diseases.

DETAILED EXPLANATION

Clinical chemistry involves testing for biomarkers in blood and urine to assess organ function and
detect diseases.

Key Tests in Clinical Chemistry:

1. Blood Glucose Test

This test measures blood sugar levels to diagnose diabetes.

I use automated analysers to test serum glucose levels, ensuring calibration of the equipment before
running tests.

2. Liver Function Tests (LFTs)

LFTs include tests for enzymes like ALT, AST, and bilirubin to assess liver health.

I handle serum samples and ensure they are not haemolyzed, as this can interfere with test results.

3. Kidney Function Tests

Tests for urea, creatinine, and electrolytes are performed to monitor kidney function.

Serum or plasma samples are processed using machines like the Cobas analyser.

4. Lipid Profile

This test measures cholesterol and triglycerides, helping assess cardiovascular health.

CHALLENGES IN CLINICAL CHEMISTRY

1. Equipment Breakdowns: Occasionally, analysers fail, leading to delays in processing

samples.

2. Reagent Shortages: A lack of reagents affects the lab’s ability to conduct some tests on time.

3. Sample Handling: Haemolyzed or improperly labelled samples result in the rejection of tests.

HAEMATOLOGY
OBJECTIVE OF HAEMATOLOGY

To investigate and analyse blood components for diagnosing blood disorders and monitoring patient
health.

Detailed Explanation

The haematology section focuses on tests related to blood cells and coagulation.

Key Haematology Tests Performed:

1. Complete Blood Count (CBC)

CBC measures red and white blood cells, haemoglobin, and platelets.

I use automated haematology analysers to generate results, ensuring quality control checks are
performed daily.

2. Erythrocyte Sedimentation Rate (ESR)

The ESR test measures how quickly red blood cells settle in a test tube. It is an indicator of
inflammation.

3. Blood Grouping and Cross-Matching

I learn to determine a patient’s blood group using anti-sera for A, B, and Rh antigens.

Cross-matching ensures compatibility between donor and recipient blood for transfusion.

Challenges in Haematology

1. Sample Clotting: Delayed processing leads to clot formation, which affects test results.

2. Workload: The high volume of CBC requests requires efficient multitasking.

SEROLOGY

INTRODUCTION TO SEROLOGY

Serology is the study of antigen-antibody reactions in the blood to diagnose

infections, autoimmune diseases, and immune responses. This section of the
attachment at Kisii Teaching and Referral Hospital focuses on performing
serological tests, interpreting results, and understanding their clinical
significance.

Scope of Serology Laboratory Training

1. Specimen Collection and Handling

Sample Types:

Serum (collected from clotted blood after centrifugation)

Plasma (collected from anticoagulated blood)

Other body fluids (e.g., cerebrospinal fluid for syphilis testing)

Proper Sample Handling:

Avoiding haemolysis and contamination

Proper storage (some tests require refrigeration)

2. Common Serological Tests and Procedures

A. Infectious Disease Screening

HIV Testing:

Rapid diagnostic tests (e.g., Determine™, Uni-Gold™)

ELISA (Enzyme-Linked Immunosorbent Assay) for confirmation

Hepatitis Testing:

Hepatitis B Surface Antigen (HBsAg)

Hepatitis C Virus Antibody (HCV Ab)

Syphilis Testing:

Rapid Plasma Reagin (RPR)

Treponema Pallidum Hemagglutination (TPHA)

Typhoid Fever:

Widal Test for Salmonella antibodies

Brucellosis Testing:
Rose Bengal Test (RBT)

B. Autoimmune Disease Diagnosis

Rheumatoid Factor (RF) test for rheumatoid arthritis

Anti-Nuclear Antibody (ANA) test for systemic lupus erythematosus (SLE)

C. Pregnancy and Fertility Tests

Beta-hCG Test: Detects human chorionic gonadotropin in pregnancy

Semen Analysis (if applicable): Checks fertility parameters

D. Blood Group Serology

ABO and Rh Blood Typing

Direct and Indirect Coombs Test (for haemolytic disease of the newborn and
transfusion reactions)

3. Laboratory Techniques in Serology

Agglutination Tests: Used in Widal, RPR, TPHA, and blood typing

Enzyme-Linked Immunosorbent Assay (ELISA): Used in HIV, hepatitis, and

autoimmune disorders

Lateral Flow Immunoassays (Rapid Tests): Used in HIV, malaria, and pregnancy
testing

Western Blot (if available): Confirmatory test for HIV and other infections

4. Interpretation of Serology Test Results

Understanding reactive vs. non-reactive results

Differentiating false positives/negatives due to sample quality or technical

issues

Correlating laboratory results with clinical symptoms

5. Quality Control and Laboratory Safety in Serology

Use of Positive and Negative Controls in all tests

Proper Waste Disposal: Handling biohazardous samples correctly

Preventing Cross-Contamination by using fresh pipettes and sterile equipment

Key Learning Outcomes from the Attachment

1. Acquired hands-on experience in performing serological tests.

2. Developed skills in sample preparation, reagent handling, and test

interpretation.

3. Understood the significance of serology in infectious disease diagnosis and

immunology.

4. Learned quality control measures to ensure accurate and reliable results.

MICROBIOLOGY
OBJECTIVE OF MICROBIOLOGY

To detect and identify microorganisms such as bacteria, fungi, and viruses that
cause infectious diseases, and to determine their antibiotic sensitivity for
effective treatment.

DETAILED EXPLANATION

The microbiology section is a crucial area in medical laboratories, as it helps

diagnose and manage infections. During my time in this department, I engage in
various processes, including specimen processing, culturing, staining, and
susceptibility testing.

Key Activities in Microbiology:

1. Specimen Processing
I receive specimens such as sputum, pus, blood, cerebrospinal fluid (CSF), urine,
and swabs for bacterial culture and sensitivity testing.

Proper labelling and documentation are critical to avoid errors in specimen

handling.

2. Culture Techniques

I use different culture media, including:

Blood Agar: For general bacterial growth and haemolytic activity.

MacConkey Agar: For gram-negative bacteria differentiation.

Chocolate Agar: For fastidious organisms like Haemophilus and Neisseria.

Sabouraud Agar: For fungal growth.

Specimens are streaked onto appropriate media and incubated at 37°C for 24–
48 hours.

3. Gram Staining

I perform gram staining to classify bacteria into gram-positive or gram-negative

groups.

The process involves applying crystal violet, iodine, alcohol decolorization, and
safranin. Under the microscope, gram-positive bacteria appear purple, while
gram-negative bacteria appear red or pink.

4. Antibiotic Susceptibility Testing (AST)

Antibiotic susceptibility is tested using the Kirby-Bauer disc diffusion method.
I inoculate Mueller-Hinton agar with bacterial isolates, place antibiotic discs on
the surface, and measure zones of inhibition after incubation to determine
bacterial sensitivity.

5. Microscopy
In cases of TB suspicion, sputum samples are stained using the Ziehl-Neelsen
(ZN) technique to detect acid-fast bacilli (Mycobacterium tuberculosis).

6. Quality Control

I ensure quality control by using positive and negative controls in all tests to
validate the results.

Challenges in Microbiology

1. Contamination: Improper aseptic techniques can lead to contamination of

samples, affecting culture results.

2. Time Sensitivity: Some organisms require immediate processing or

specialized conditions, which are occasionally challenging to meet.

3. Limited Resources: Reagent shortages and equipment downtime hinder

testing efficiency.

IMMUNOLOGY

OBJECTIVE OF IMMUNOLOGY

To study immune responses and diagnose autoimmune diseases, allergies, and

infectious diseases using serological and molecular techniques.

Detailed Explanation

Immunology focuses on understanding how the immune system reacts to

pathogens, allergens, or self-antigens.

Key Tests in Immunology:

1. Enzyme-Linked Immunosorbent Assay (ELISA)

ELISA is used to detect antigens or antibodies in serum, such as HIV, hepatitis B,

and C.

During the test, antigens or antibodies are immobilized on a solid surface and
detected using enzyme-linked secondary antibodies and colorimetric reactions.

2. Rapid Diagnostic Tests (RDTs)

These are point-of-care tests for diseases like malaria, syphilis, and HIV. I learn
to interpret positive and negative results based on test lines and control lines on
the test strip or cassette.

3. Rheumatoid Factor (RF) and C-Reactive Protein (CRP)

These tests help diagnose autoimmune conditions like rheumatoid arthritis. I use
latex agglutination kits to detect RF and CRP in serum samples.

4. Tuberculosis Screening

Immunological techniques such as Mantoux tests and interferon-gamma release

assays (IGRA) help screen for TB infection.

Challenges in Immunology

1. False Positives/Negatives: Human errors or improper storage of kits can

affect test accuracy.

2. Cost of Advanced Techniques: Some molecular immunology techniques,

such as PCR, are costly and unavailable in some settings.

3. Training: ELISA and molecular techniques require specialized skills that

need time to master.

Division Of Vector-Borne Diseases (DVBD)

Objective Of DVBD Section

To identify and monitor vector-borne diseases such as malaria, dengue fever,

and leishmaniasis for effective control and prevention strategies.

Detailed Explanation

The DVBD unit is instrumental in areas endemic to vector-borne diseases.

During my rotation here, I work on the following activities:

1. Malaria Diagnosis

I prepare thick and thin blood smears to detect Plasmodium species.

Rapid diagnostic tests (RDTs) are also utilized for quick malaria detection.

2. Entomological Surveillance
This involves collecting and identifying vector species like mosquitoes. I learn
about traps, such as light traps and larval sampling techniques, for studying
vector populations.

3. Leishmaniasis Diagnosis
I observe procedures for aspirate collection from lymph nodes or spleen to
identify Leishmania parasites using microscopy and culture techniques.

4. Dengue Fever Testing

The detection of dengue NS1 antigen and IgM/IgG antibodies is conducted using
ELISA or rapid tests.

Challenges in DVBD
 1. Environmental Factors: Poor infrastructure or flooding affects vector
surveillance efforts.
2. Community Resistance: Misunderstandings about vector control
interventions, like indoor residual spraying, reduce compliance.

DATA COLLECTION AND ANALYSIS

OBJECTIVE OF DATA COLLECTION

To collect and analyse laboratory data systematically for record-keeping,

reporting, and research purposes.
Data Collection Table
Assessme criteria Marks Supervisor’s Patients Marks
nt Area Allocation comments Tested awarded
(positive /
negative)
phlebotom Patient 10 Good 50 patients 8
y identificatio venipunctur (N/A)
n, e, skills but
venipunctu occasional I
re sample
technique, labelling
sample errors
labelling
and
handling
Serology Correct test 10 Excellent 40 tested 10
procedure technique, (12+/28-)
reagent result well (HIV, syphilis,
handling, interpreted. h. pylori
result
interpretati
on
parasitolo Proper 10 Needs 30 tested 6
gy sample improveme (9+ /21-)
preparation nt in (malaria,
, micro parasite giardia, hook
scopic identificatio worm)
identificatio n,
n result misidentifie
recording d some
species.
Blood Blood 10 Good 25 donors 8
transfusio grouping understandi screened (5
n science cross ng but rejected)
matching, delayed in
and cross
compatibilit matching.
y testing
Microscop Proper use 10 Slides well 35 tested 9
y of prepared; (10+/25-)
 microscope stains (AFB,Gramstai
, staining applied n, Wet prep)
techniques, correctly.
slide
preparation
Clinical Sample 10 Good 45 tested 9
Chemistry preparation knowledge (15+/30-)
, use of of (LFTs, RFTs,
analysers, analysers; Lipid profile)
quality minor
control, calibration
result issues.
interpretati
on
Haematol CBC 10 Blood film 38 tested 7
ogy performanc quality (13+/25-)
e, blood inconsistent (Anaemia,
film ; needs Leukaemia)
preparation more
, practice
differential
count
Microbiolo Culture 10 Bacterial 28 tested 7
gy media cultures (12+/16-)
preparation correctively (UTI, TB
, processed; Wound
inoculation, antibiogram infections)
colony interpretati
identificatio on weak.
n,
antibiogra
m
Blood Safe blood 10 Good 20 patients (7 8
Bank storage, practice, transfused, 3
donor but needs reactions)
selection, more
transfusion confidence
monitoring in
emergency
situations.
Immunolo Test 10 ELISA tests 40 tested 10
gy execution performed (14+/26-)
(e.g., accurately; (Help atitis B,
ELISA), good Rheumatoid
antigen- understandi Factor)
antibody ng
reaction
interpretati
on
TOTAL Overall 100 Well- Patients 82/100
performan rounded tested: 351
ce student;
 needs
improvem
ent in
parasite
identificati
on and
blood film
preparatio
n

Challenges in Data Collection

1. Incomplete Requisition Forms: Missing patient details delay data entry.

2. Volume of Work: The high number of samples makes manual data

recording challenging.

Recommendations

1. Automation: Use automated systems for data entry to improve accuracy

and efficiency.

2. In-Service Training: Regular workshops for laboratory staff to stay updated

with modern techniques.

3. Improved Infrastructure: Invest in laboratory equipment and reagents to

reduce delays in testing.

1. Blood Bank

Objective of the Blood Bank

The blood bank aims to provide safe and adequate blood and blood products for
transfusion to patients while maintaining strict quality control, proper storage,
and timely distribution.

Detailed Explanation

The blood bank is a specialized unit within the medical laboratory dedicated to
handling blood and its components. It involves activities ranging from donor
recruitment to the storage of blood products for transfusion.

Key Processes in the Blood Bank

1. Donor Recruitment and Screening

Donors are recruited voluntarily or through hospital-based blood donation

drives.
Screening involves checking donor eligibility, such as haemoglobin levels, age
(18–65 years), weight (>50 kg), and medical history.

Infectious disease testing is conducted for HIV, hepatitis B and C, syphilis, and
malaria to ensure donor blood safety.

2. Blood Collection

Blood is collected aseptically in single-use sterile blood bags. The blood bags
contain anticoagulants like CPDA-1 (Citrate Phosphate Dextrose Adenine).

I learn phlebotomy techniques to collect blood while ensuring the comfort and
safety of the donor.

3. Blood Component Separation

Whole blood is separated into components using centrifugation techniques.

Components include:

Red Blood Cells (RBCs): Used to treat anaemia.

Platelets: Administered to patients with thrombocytopenia.

Fresh Frozen Plasma (FFP): Contains clotting factors for patients with
coagulopathies.

Cryoprecipitate: Used to treat fibrinogen deficiencies.

4. Storage of Blood and Components

Blood and its components are stored under strict conditions to preserve their
quality:

Whole Blood/RBCs: 2–6°C for up to 35–42 days, depending on the anticoagulant

used.

Platelets: 20–24°C with agitation for 5–7 days.

Plasma: Below -18°C for up to one year.

5. Testing and Cross-Matching

Blood typing is performed using the ABO and Rh systems.

Cross-matching ensures compatibility between donor blood and recipient serum

to avoid transfusion reactions.

Additional testing, such as antibody screening, is performed for patients with

complex transfusion needs.

6. Quality Control
Quality control is performed on equipment, blood bags, and reagents to
maintain high standards.

Daily temperature monitoring of storage refrigerators and freezers ensures

compliance with safety protocols.

Challenges in the Blood Bank

Limited Blood Supply: Low donor turnout and limited awareness about blood
donation.

Reagent Shortages: Interruptions in infectious disease testing due to reagent

stockouts.

Storage Equipment Issues: Equipment malfunction, such as refrigeration failure,

can compromise blood quality.

Short Shelf Life of Components: Platelets and fresh frozen plasma have limited
storage durations, leading to wastage.

High Demand: Increased demand during emergencies or natural disasters can

deplete stocks rapidly.

BLOOD TRANSFUSION

OBJECTIVE OF BLOOD TRANSFUSION

The goal of blood transfusion is to replace lost blood or blood components in

patients to restore their physiological functions and improve clinical outcomes.

Detailed Explanation

Blood transfusion is a life-saving procedure for patients suffering from conditions

such as severe anaemia, haemorrhage, trauma, or coagulopathies. My role in
the blood transfusion process involves observing and participating in the
following activities:

Steps in Blood Transfusion

1. Pre-Transfusion Testing

Blood Typing and Rh Testing: To determine the patient’s ABO and Rh group.

Cross-Matching: Mixing the donor’s red cells with the patient’s serum to identify
incompatibilities and prevent haemolytic reactions.

2. Patient Identification

Strict protocols are followed to verify patient identity, blood group, and
transfusion requirements. The information on the blood bag is matched with the
patient’s details on the requisition form.
 3. Administration of Blood

The transfusion process begins with baseline vitals, including temperature,

blood pressure, and pulse rate.

Blood is administered intravenously using a sterile set with a filter to remove

clots and debris.

4. Monitoring During Transfusion

Patients are closely monitored for adverse reactions, especially within the first
15 minutes, which is the most critical period.

Signs of transfusion reactions include fever, chills, rash, hypotension, and

dyspnoea.

5. Post-Transfusion Care

After transfusion, patient vitals are reassessed, and the transfusion details are
documented in their medical records.

Used blood bags are safely disposed of according to biohazard protocols.

Indications for Blood Transfusion

Severe Anaemia: For haemoglobin levels below 7 g/dL or in cases of

symptomatic anaemia.

Haemorrhage: Acute blood loss due to trauma, surgery, or postpartum

complications.

Coagulopathies: Bleeding disorders requiring clotting factors from plasma or

cryoprecipitate.

Thrombocytopenia: Low platelet counts that need platelet transfusion.

Challenges in Blood Transfusion

Transfusion Reactions:

Febrile Non-Haemolytic Reactions: Caused by antibodies reacting to donor white

blood cells.

Haemolytic Reactions: Due to ABO incompatibility.

Allergic Reactions: Caused by plasma proteins.
Risk of Infections: Despite rigorous screening, there is a minimal risk of
transmitting infections such as hepatitis or HIV.
Logistical Issues: Delayed transfusions due to unavailability of compatible blood,
especially for rare blood groups.

Cost: Blood transfusion can be expensive for patients in resource-limited

settings.

Recommendations for Blood Bank and Blood Transfusion Services

1. Awareness Campaigns: Increase public awareness about the importance of

voluntary blood donation.

2. Automation: Adopt automated analysers for faster and more reliable blood
grouping and cross-matching.

3. Emergency Preparedness: Maintain a reserve stock of blood and

components for disaster response.

4. Staff Training: Regular training for laboratory staff on modern transfusion

practices and adverse reaction management.
5. Strengthen Quality Assurance: Implement stringent quality control
measures in all stages of blood banking and transfusion.

HISTOLOGY AND CYTOLOGY

Histology is the study of microscopic tissue structures. It involves processing

biopsy and surgical specimens to detect diseases such as cancer.

Cytology focuses on the examination of individual cells, primarily used in cancer

screening (e.g., Pap smear) and fluid analysis.

1. Specimen Collection and Handling

TYPES OF SPECIMENS:

Biopsy samples (small tissue sections from patients)

Surgical resection specimens (e.g., tumours, organs)

Body fluids (e.g., pleural fluid, cerebrospinal fluid)

Fine Needle Aspiration Cytology (FNAC) samples (e.g., breast, thyroid)

FIXATION:
Importance of formalin fixation in histology
Use of alcohol-based fixatives in cytology
Labelling and Documentation:
Patient identification
Sample tracking using a laboratory information system

2. Tissue Processing (Histology)

Dehydration and Clearing:
Removal of water using graded alcohol
Use of xylene to clear tissues
Embedding:
Use of paraffin wax for tissue support
Microtomy:
Use of a microtome to cut thin tissue sections (3-5 microns)
Mounting sections on glass slides
3. Staining Techniques
Routine Staining:
Haematoxylin and Eosin (H&E) staining for general tissue architecture
Special Staining:
Periodic Acid-Schiff (PAS) for glycogen/mucins
Ziehl-Neelsen for acid-fast bacilli (e.g., TB)
Masson’s Trichrome for connective tissue diseases
Immunohistochemistry (IHC):
Detection of cancer markers using antibodies
4. Microscopic Examination and Interpretation
Histology:
Identifying normal vs. Abnormal tissue architecture
Recognizing features of inflammation, necrosis, and malignancy
Cytology:
Screening for abnormal cells in Pap smears
Recognizing cellular changes due to infections (e.g., HPV, TB)
5. Special Cytology Techniques
Liquid-Based Cytology (LBC):
Used in modern cervical cancer screening
Cell Block Preparation:
Converting cytology samples into histology-like sections for deeper analysis
Fluorescence In Situ Hybridization (FISH):
Detecting genetic abnormalities in cancer cells
6. Quality Control and Laboratory Safety
Quality Control (QC) Measures:
Ensuring proper fixation and staining
Internal and external proficiency testing
Laboratory Safety Protocols:
Handling formalin and xylene safely
Infection control in cytology (e.g., handling sputum, body fluids)
7. Reporting and Documentation
Pathologist’s Role in Reporting:
Correlating histology and cytology findings with clinical data
Use of Laboratory Information Systems (LIS):
Digital documentation and case tracking
8. Role in Disease Diagnosis and Management
Histopathological Diagnosis:
Identifying cancers (e.g., breast, prostate, cervical)
Diagnosing inflammatory and autoimmune diseases
Cytological Screening:
Detecting pre-cancerous lesions in cervical cancer screening programs

9.Research and Advanced Techniques

Molecular Pathology:
PCR in histopathology (e.g., HPV testing)
Automation in Histology and Cytology:
AI-based cytology screening.

RECOMMENDATIONS.

1. Enhance Practical Skills

Actively participate in sample collection, processing, and analysis to strengthen
hands-on experience.
Practice using laboratory equipment (e.g., microscopes, analysers) under
supervision.
2. Improve Theoretical Knowledge
Review standard operating procedures (SOPs) for different laboratory sections.
Study laboratory manuals and research recent advancements in diagnostic
techniques.
3. Time Management and Efficiency
Work on multitasking skills to handle multiple samples efficiently.
Develop speed and accuracy in lab procedures such as phlebotomy, microscopy,
and staining techniques.
4. Follow Laboratory Safety and Quality Assurance Standards
Strictly adhere to biosafety protocols, including proper use of PPE and waste
disposal.
Maintain accurate record-keeping and ensure quality control in tests.
5. Develop Professionalism and Communication Skills
Interact with laboratory staff, clinicians, and patients with respect and
professionalism.
Learn how to write comprehensive laboratory reports and communicate findings
effectively.
1. Recommendations for Kisii Teaching and Referral Hospital
1. Improve Student Training Programs
Conduct orientation sessions on laboratory policies and safety guidelines.
Assign mentors to guide students through different lab sections.
2. Provide Access to Modern Laboratory Equipment
Ensure students get exposure to automated analysers and digital pathology
systems.
Provide training on emerging technologies like molecular diagnostics.
3. Enhance Rotation in All Laboratory Sections
Ensure students gain exposure to haematology, microbiology, histology,
parasitology, serology, blood transfusion science, and clinical chemistry.

Include hands-on experience in specialized areas such as molecular diagnostics

and immunology.
4. Strengthen Research and Continuous Learning
Encourage students to participate in case studies, research, and clinical
discussions.
Organize seminars and workshops on new diagnostic methods.
5. Improve Laboratory Infrastructure and Safety
Ensure all lab sections have proper ventilation and waste disposal systems.
Maintain adequate supplies of reagents and equipment for student training.
2. General Recommendations for Future Attachments
Extend Training Duration: If possible, increase the attachment period to allow
students to gain more experience.
Encourage Teamwork: Promote collaboration among students, technologists,
and pathologists to enhance learning.
Provide Certification: Issue a completion certificate as proof of the student’s
practical exposure and skills.

12. CONCLUSION

The industrial attachment at Kisii Teaching and Referral Hospital provided an

invaluable opportunity for practical training, skill development, and professional
growth in medical laboratory science. Over the course of my attachment, I was
able to apply theoretical knowledge in a real-world clinical setting, gain hands-
on experience in various laboratory disciplines, and develop critical
competencies required for a successful career in the medical laboratory field.
Through this experience, I deepened my understanding of laboratory
procedures, diagnostic techniques, quality control measures, and patient
management. I also learned the importance of teamwork, time management,
laboratory safety, and professionalism in ensuring accurate and timely
diagnostic results for patient care.
Key Takeaways from the Attachment
1. Technical Proficiency in Laboratory Procedures
I developed competence in blood collection (phlebotomy), sample processing,
and diagnostic testing across multiple disciplines, including haematology,
microbiology, serology, clinical chemistry, and parasitology.
I learned how to operate automated laboratory analysers and perform manual
laboratory techniques, such as blood smear preparation, microscopy, and
biochemical analysis.
2. Application of Laboratory Quality Control and Biosafety Measures
I gained an appreciation for the importance of quality assurance (QA) and
quality control (QC) protocols in ensuring reliable and reproducible test results.
Adhering to biosafety guidelines, infection control practices, and standard
operating procedures (SOPs) minimized the risk of contamination and exposure
to infectious agents.
3. Handling of Patient Samples and Communication Skills
I improved my patient interaction skills, particularly in phlebotomy and sample
collection, ensuring comfort, consent, and proper patient identification.
I learned to effectively communicate laboratory findings to clinicians,
emphasizing the role of laboratory results in clinical decision-making and patient
treatment.
4. Challenges and Problem-Solving in a Clinical Setting
I encountered and overcame various challenges, such as reagent shortages,
high patient workload, difficult venous access, and equipment malfunctions.
These experiences taught me critical thinking, adaptability, and innovative
problem-solving skills, which are essential in medical laboratory practice.
5. Exposure to Emerging Diagnostic Technologies
Although some molecular diagnostic techniques (e.g., PCR and gene
sequencing) were not widely available in the hospital laboratory, I gained basic
knowledge of their principles, applications, and significance in disease
diagnosis.
I developed an interest in specialized fields such as immunology, transfusion
science, and vector-borne disease diagnostics, which I intend to explore further
in my career.
Impact of the Attachment on My Future Career
The attachment experience has significantly contributed to my personal and
professional growth in the following ways:
Increased confidence in performing laboratory tests independently and
accurately.
Improved ability to work under pressure in a high-demand medical environment.
Enhanced teamwork and collaboration with laboratory personnel, clinicians, and
other healthcare professionals.
Deepened understanding of the ethical and professional responsibilities of a
medical laboratory scientist.
I am now better prepared to pursue further specialization, engage in research,
and contribute to improving laboratory services in healthcare settings. This
attachment has reinforced my passion for medical laboratory science and
motivated me to continue learning, exploring advanced diagnostic techniques,
and upholding the highest standards of laboratory practice.

13. REFERENCES

During my attachment, I referred to various textbooks, scientific articles,

laboratory manuals, and clinical guidelines to enhance my knowledge. Below are
some of the key references used:
1. Bishop, M. L., Fody, E. P., & Schoeff, L. E. (2018). Clinical Chemistry:
Principles, Techniques, and Correlations. Wolters Kluwer.
2. Garcia, L. S. (2019). Diagnostic Medical Parasitology. ASM Press.
3. Jawetz, Melnick, & Adelberg’s Medical Microbiology (2021). McGraw-Hill
Education.
4. Henry’s Clinical Diagnosis and Management by Laboratory Methods
(2020). Elsevier.
5. World Health Organization (WHO) Laboratory Biosafety Manual (4 th Edition,
2020).
6. National Guidelines for HIV Testing and Laboratory Diagnosis in Kenya
(Ministry of Health, Kenya, 2021).
These references provided scientific background, laboratory techniques, and
diagnostic protocols that enriched my practical learning experience.

15. APPENDICES

This section includes additional documents and supporting materials related to

my industrial attachment. These may include:
A. Sample Laboratory Test Results and Reports
Sample haematology and biochemistry test reports.
Example of a blood grouping and crossmatching result.
Sample microbiology culture and sensitivity report.
B. Laboratory Safety and Quality Control Checklists
Biosafety guidelines followed during sample handling.
Laboratory quality control logs for daily equipment calibration.
C. Photos of Laboratory Sections (If Permitted by Hospital Policy)
Images of laboratory analysers, sample processing stations, and microscopy
slides.
D. Supervisor’s Evaluation and Feedback
A summary of performance feedback from laboratory supervisors.
E. Logbook Summary
A record of daily activities, tests performed, and skills acquired during the
attachment period.

FINAL REMARKS

This report represents a detailed account of my industrial attachment

experiences, challenges, and achievements at Kisii Teaching and Referral
Hospital. The knowledge and skills gained during this training will be
instrumental in shaping my future career as a medical laboratory scientist.
I express my sincere gratitude to the hospital management, laboratory
supervisors, and fellow trainees who contributed to my learning journey. Their
guidance, support, and mentorship enabled me to acquire essential
competencies and practical exposure in the field of medical laboratory science.
I look forward to applying the skills learned, continuing my education in
laboratory medicine, and contributing to improving diagnostic services and
patient care in the healthcare sector.