A day in the life of a med tech

Histopathology

2008-11-08T22:11:00.003+08:00

we have come to the end of SIP and this is my last post.
i am going to talk about my time in the histopathology section. in my workplace, the histo section is located right across the main lab. therefore it is separated from the main lab. there were many different sections in the histo lab. examples of the sections are the cytology section, immunochemistry section, trimming room, receiving section and sections where microtomy and embedding are done.

the trimming room is where different types organs are located at awaiting to be dissected and analysed by the pathologists. in the trimming room, there is a small section, equipped with its own bsc for passing to be done. passing is a process where the medical technologist will dissect smaller organs for example the appendix. the larger organs such as stomach, breasts, colon and other main organs will be dealt with in another bsc by the pathologists only. right before the process is done, the medical technologist will have to prepare the organ and the dissecting kits; such as scalpel, rulers and some casettes. the blade of the scalpel is disposable.the medical technologist will write down the descriptions that the pathologist will mention when dissecting a certain organ. the organs will arrive completely submerged in formalin. the formalin acts as a fixative for the organs.

when the pathologist is dissecting the organ, smaller portions will be cut out and placed in a number of casettes. these casettes will be sent for embedding and microtomy. the larger the organ, the more casettes will be needed as more portions will be cut out from different parts of the organs. in the embedding section, the tissues are completely submerged in hot wax. the metal molds will be filled with hot wax, the tissue will be placed in such a way that it will be easier to cut them into sections in the microtomy section. the mold is then placed on ice for the wax to harden. in the microtomy section, the tissue blocks will be cut into many sections. the sections will be placed in the water bath containing alcohol and then fished out onto a glass slide. the tissue on the glass slide will undergo dehydration and then staining in the automated stainer.
then the slides will be read under the microscope by the medical technologist.

Siti Nurfatin
0605853A

2008-10-19T16:41:00.003+08:00

hihi everyone...3more weeks to go before the end of sip:)

anyway i was posted to the blood bank for this week... The blood bank operates 24hours everyday to provide the necessary testing so as to ensure the safe transfusion of blood and blood products. After spending the entire week in blood bank, I have a better understanding of the routine procedures that the laboratory is performing. During the week, I learnt the various types of tests that the laboratory is performing such as ABO blood grouping which consists of forward and reverse grouping, antibody screening, crossmatching and antibody titration. In addition, I also learnt how to process the blood stocks which will arrive from the CTM everyday.

now i am going to talk about something i have done everyday in the laboratory which is ABO Blood grouping and Rh (D) typing using the tube method. The ABO grouping is done to find out the blood group of the patients and to reconfirm the blood group of the donor. For ABO Blood grouping, there are forward and reverse grouping...for babies below 6months old, only forward grouping is done as babies at that age do not produce enough antibodies.

Method:

1. the patient's EDTA/clotted blood sample was centrifuged at 3000rpm for 6minutes.
2. 7 test tubes were being labeled and prepared
3. the first 4 tubes was added with one drop of each anti-sera: Anti-D, Anti-A, Anti-B and Anti-AB respectively. (forward grouping)
4. the last 3 tubes was added with one drop each of commercial A cells, B cells and O cells. (reverse grouping)
5. one drop of 3-5% saline suspension patient's red blood cells were added to each of the first 4 tubes.
6.one drop of patient's serum was added to each of the last 3 tubes.
7. the 7 tubes were mixed well and centrifuged for 15 seconds at 2000rpm.
8. after centrifuging, the tubes were gently agitated to dislodge the packed button of red cells and the tubes were examined macroscopically for any agglutination. for weak reactions, such as the big agglutinates could not be seen, they were examined under the microscope.
9. the results were recorded.

Agglutination Grading Chart

4+: A single agglutinate, no free cells can be seen
3+: A few large agglutinates
2+: Many agglutinates which consists of medium and small ones, no free cells can be seen,
1+: Prescence of many very small agglutinates, free red cells can be seen
0: An even red cell suspension with no agglutination seen.

thats about it:)feel free to ask any qns:)

Rachael
Tg01
0606168C

16th week

2008-10-12T11:50:00.005+08:00

Welcome to the end of the 16th week of SIP/MP :)

For my final post, I would like to share my experience for the last week during TSO duty. This week, I'm tasked to calibrate the instruments in the Inorganic Chemistry Lab. The instruments present is analytical balance, pH meter and top-pan balance.

The protocols for each analytical balance differs due to their own brand which is similar to a handphone. For example; different brand of handphones has different type of functions even though the principle is similar. Hence, a protocol is set aside for each type of brand of analytical balance. Internal calibration is usually automated by the machine itself.

To calibrate the analytical balance, we must first prepare the analytical balance for calibration by cleaning it, ensure that the linearity is correct and change its setup to calibration mode. Although the setup to calibration mode differs from other brands of analytical balance, the main calibration process is similar. Weights of 100g, 200g and 500g is placed for calibration. This weights are specially made and to handle them, we must use the gloves that comes with the weights. If we handle the weights with our bare hands, moisture will be present on the weights and it might produce a wrong reading.

Once the weights are placed and the machine is calibrated, it is tested by placing a weight of 200g three times to ensure that the analytical balance is properly calibrated.

The top-pan balance is similar to the analytical balance however, instead of using weights of 100g, 200g and 500g, we use weights of 2kg and 4kg. After the top-pan balance is calibrated, weight of 4kg is placed on the top-pan balance three times to ensure that the top-pan balance is properly calibrated.

The pH meter is calibrated by using commercially-prepared buffer solution with a fix pH reading of 4.00, 7.00 and 10.00. The pH meter is prepared for calibration by deleting any previous standardization and then setting up the mode for new standardization using the buffer solution provided. The electrode, which is the tool that detects the reading of pH must be washed with DI water before being placed into the different buffer solution to prevent any mis-reading. The pH meter is then tested in the 7.00 buffer solution to ensure that it is calibrated properly.

Calibration of instruments is a very direct process and if we follow the protocol religiously, there should not be any mistakes. If under any circumstances the instruments is faulty, just inform the technician and they will repair the instruments.

Andika Putra

TG01

Stool Analysis

2008-09-27T01:00:00.001+08:00

Hey guys. Previously I talked about routine section where urine is processed for different kinds of tests. For now, I want to talk about how stool is processed to test for ova or cyst. The tests are done to identify intestinal parasites and their eggs which are known as ova or cysts in patients. The patients may or may not experience any symptoms of gastrointestinal infection. One common symptom may be diarrhea. Another symptom is blood in stool. When we are able to identify the particular parasite in the patient, we may know the cause of the gastrointestinal infection and thus we can provide the appropriate medication to treat it.
The principle of the test involves the saline wet mount. It is the recommended test to detect helminth eggs and larvae. It is also good for motile protozoan cysts which appear to be refractile. Refractile means that granules in the cells that refracts light. When cysts are detected in the saline wet mount, they are observed in Lugol iodine stained preparation. This stain will reveal the nuclear structure of the cells. The nuclei stain will be stained brown and thus can be counted easily. A kit called Para-pak spin con is a commercial kit that is used to detect the faecal parasite concentration of eggs, larvae and protozoa. Saline wet mount technique involves placing the sediment of the specimen on a glass slide. It is mixed with saline and a cover slip is place over it. A drop or two of Lugol iodine is placed on the sediment. Then, the slide is directly examined under the microscope. This technique also provides information on the content of the stool such as the presence of leukocytes.
The procedure to obtain the sediment of the specimen (stool) is by emulsifying 0.5g of stool with 10ml of saline in a plastic tube. 4 drops of CON-trate Reagent A are added to enhance the breakdown of faecal aggregates and mucus, causing the parasites to be exposed. The contents are mixed thoroughly. The mixture is then filtered using the Para-pak filter into the centrifuge tubes provided. The filtered mixture is then centrifuged at 2000rpm for 10min.
10min later, the supernatant is discarded and the sediment is resuspended. This is where the wet mount saline is performed on the sediment.
The limitations of this procedure are such as false-negatives occurring due to low number of parasites in the stool specimen. The parasites may undergo intermittent shedding which contributes to the low number. Inappropriate transport or storage may also contribute to false-negatives. False positives may occur when one of the numerous structures in the stool is mistaken for a parasite. There is no reference range for this test. The presence of normal bacteria in stool is considered normal.

Siti Nurfatin
0605853a

Coagulation

2008-09-26T23:01:00.003+08:00

Hey everyone. With only a few weeks down to the end of SIP, I bet everyone's been working hard on their MP. Anyway, for my turn in blogging, I'll touch on what I've learnt in the Coagulation section of the lab, which deals with blood samples that have been placed in 3.2% sodium citrate tubes. (shown above)

In this entry I'll highlight a particular test that is the most highly requested test for my section.
And that would be the test for Prothrombin Time (PT).

Prothrombin time is a test used to evaluate the extrinsic coagulation of the system. It can screen for congenital deficiencies of factors II, V, VII and X. PT can also monitor anticoagulant therapy (eg. warfarin medication), which is usually given on a long-term basis to patients who suffer from recurrent inappropriate blood clotting. The measurement of PT can aid in the control of the dosage of the drugs. PT is normally measured in seconds and the INR (Intl Normalized Ratio)

INR = (patient's results / normal patient average)

The ref range for patients on warfarin should be between 2.0-3.0. Those with high risk of clotting have a ref range of 2.5-3.5.

PT is usually evaluated with the results of Activated Partial Thromboplastin Time (aPTT) to assess the coagulation system better.

To run the test, my lab uses the Sysmex Ca-1500. We first check the tubes for clot then spin the sodium citrate tubes at 6000rpm for 3minutes. We then load the samples into racks and place them on the machine.The caps need not be removed as the machine has a probe that can pierce through the cap.

It works by using the Coagulation Reaction Detection Method (Scattered Light Detection Method)
It irradiates red light at 660nm onto a mixture of blood plasma with added reagent (Dade Innovin) and it will read a change in turbidity as the fibrin clots are formed. This measures the coagulation time.

It also uses the Coagulation Point Detection Method (Percentage Detection Method) to calculate the coagulation time. This is considered as the time taken to achieve the amount of scattered light that is set for the coagulation detection point, susing the amount of scattered light that is present just after the start of detection as 0% and the amount of light scattered that is present at the completion of coagulation as 100%.

Antibiotics, aspirin, and cimetidine can increase the PT/INR. Barbiturates, oral contraceptives and hormone-replacement therapy (HRT), and vitamin K - either in a multivitamin or liquid nutrition supplement - can decrease PT. Certain foods (such as beef, green tea, broccoli, chickpeas, kale, turnip greens, and soybean products) contain large amounts of vitamin K and can alter PT results.

2008-09-26T13:22:00.002+08:00

hi everyone, i am here to blog again...anyway i realised that many people tend to spell my name wrongly...my name is spelt as Rachael not Racheal:) haha...anyway...in the previous post i talked about blood culturing...in this post i would like to continue from the previous post to talk about blood harvesting...

In the harvesting process, the purpose of the mitotic arrestment is to prevent spindle fibre formation so that the cell division can be blocked at metaphase stage. After which, there will be hypotonic treatment which is to increase the cell volume so that the chromosomes can be spread out and lastly, it will be the addition of fixative to remove water from the cells so as to preserve them.

Method:

1.The hypotonic solution was warmed in 37ºC water bath before the start of harvest process.
2.50µl of colcemid was added to each tube and one tube was exposed to colcemid for 20minutes while the other was exposed to colcemid for 2hours.
3.The tubes were centrifuged at 1200rpm for 10minutes and the supernatant was aspirated.
4.The pellet was loosen gently and 14ml of warmed hypotonic solution was added into each tube and the tubes were inverted 2-3 times to ensure that the suspension is well mixed.
5.The tubes were left at room temperature for 5minutes.
6.After 5minutes, the tubes were transferred into a covered centrifuge bucket and spun at 1500rpm for 6minutes.
7.The supernatant was aspirated and discarded.
8.The pellet was loosen gently and approximately 12ml of warmed hypotonic solution was added into each tube and the tubes were inverted 2-3 times to ensure that the suspension is well mixed.
9.Step 5 was repeated.
10.The required amount of fresh fix was prepared based on the number of cases to be harvested. (40ml per case at room temperature)
11.After 5minutes, 1pipetteful of fixative was added and the tubes were inverted 2-3 times to mix well.
12.Steps 6 and 7 were repeated.
13.The cell pellet was resuspended by flicking the tubes until no visible clumps can be seen.
14.Another 10-12ml of fixative was added and the tubes were inverted 2-3 times to mix well.
15.The tubes were stand at room temperature for at least 15minutes.
16.The tubes were centrifuge at 1000rmp for 10minutes and the supernatant was aspirated and discarded.
17.The pellet was resuspended in 8-10ml of fixative and step 16 was repeated. This step would be repeated if there clumpy or jelly like pellets are still present.
18.The pellet was resuspended in 5-7ml of fixative and was stored in refrigerator at 4ºC until ready to make slide.

when the slides are made, the chromosomes are ready to be analysed under the fluorescence microscope.thats about it:)

Rachael
0606168C
Tg01

2008-09-11T14:21:00.000+08:00

Hi everyone, time flies and our sip is ending soon. Anyway, for this month, I was posted to the cytogenetics laboratory which I found it very interesting because this subject is very new to me. In this laboratory, I can analyze my own chromosomes using peripheral blood and fortunately, my chromosomes turned out to be normal. Now, I am going to talk about the procedures to culture peripheral blood for chromosomes studies.

The purpose to culture peripheral blood for chromosomes studies (karyotyping) is to diagnose genetic diseases for e.g. Down’s syndrome, determine the karyotype of families of individuals with chromosome abnormalities, determine carrier status, to confirm structure, numerical abnormalities and/or mosaicism etc. The principle of this test is that the white blood cells (T-lymphocytes) present in the peripheral blood will be exposed to a mitogen (PHA). The function of the mitogen is to stimulate cell division and the cells are arrested at metaphase by the addition of colcemid. The purpose of arresting at metaphase is because at the metaphase phase stage, the cells are at their most contracted stage and the least metabolitically active state and thus chromosomes are analyzed at this stage. Theses metaphases are harvested and spread onto a glass slide for analysis.

The reagents used are:
•Complete RPMI media which contains RPMI, fetal calf serum, penicillin and streptomycin and L-Glutamine
•Complete M199 media which contains M199, fetal calf serum, penicillin and streptomycin, L-Glutamine and sodium heparin
•Sodium heparin which contains sodium heparin and sterile water
•Phytohaemagglutinin (PHA) M Form
•Amethopterin (Methotrexate) (MTX)
•Thymidine

Specimen requirement: 3-5ml of peripheral blood in sterile tube with sodium heparin (anti-coagulant). Collection of blood is done using aseptic techniques.

Method:

•1 tube of complete RPMI medium and 1 tube of complete M199 medium were thawed in water bath at 37ºC.
•The blood specimen was centrifuge at 1200rpm for 10minutes. The volume of blood and condition of blood was recorded.
•The tubes were labeled with the patients’ accession number, patient’s name and date of set-up.
•A sterile transfer pipette was used to pick approximately 0.5-1ml of buffy coat together with some plasma from the blood sample.
•The transfer pipette was inverted and the sample was mixed thoroughly in the bulb. The sample was distributed into the culture tubes and the number of drops added into each tube was noted down.
•0.1ml of PHA was added into each tube.
•The caps were tighten and mixed well by inverting the culture tubes several times.
•The culture tubes were placed in a slant test tube rack to increase the surface area of the cultures for gaseous exchange. The rack was placed in a 37ºC incubator for 48hours.
•The tubes were inverted every morning to resuspend the pellet.
•50µl of MTX 10-5M working solution was added to each tube after 48 hours of incubation. The tubes were mixed well by inverting and were re-incubated at 37ºC for another 18hours.
•50µl of thymidine was added to each tube after 18 hours of incubation with MTX.
•The samples were mixed well and incubated at 37ºC for 4hours.

The function of MTX is to synchronize the cells by stopping the cells in the S phase of cell cycle and collect a large amount of cells which will then go into division together. Thymidine is used to release cells blocked by the MTX.

There are guidelines to determine the amount of blood needed to add to each tube. For neonates less than one year, 4-5 drops was added. For children 1-6years old, 5-6 drops was added. For children 7-13years old, 6-7 drops was added. For males older than 13years old, 7-8 drops was added and for females older than 13years old, 8-12 drops was added.

After blood culturing, the next step will blood harvesting. I will leave the harvesting procedure to the next person who will go to cytogenetics laboratory after me. :)

Rachael
Tg01
0606168C

11th week

2008-09-06T12:40:00.004+08:00

Hello BMS students!!! Its da 11th week already, 9 more weeks to go, 2 more campus discussions and we are done for MP/SIP...

This week, I'm going to blog about a technique which I learn during my SIP. Although it is not related to most of our biomedical science subjects, I find it very interesting. The technique is to determine the total dietary fiber in food using the Enzymatic-Gravimetric method.

The principle of this technique is as follows:

Duplicate samples of dried foods, fat extracted if containing >10% fat, are gelatinized with Termamyl. Termamyl is a heat stable alpha-amylase. They are then enzymatically digested with protease and amyloglucosidase to remove protein and starch. It is noted that whenever analyzing mixed diets, always extract fat prior to determining total dietary fiber. Four volumes of ethyl alcohol are added to precipitate soluble dietary fiber. The total residue is filtered, washed with 78% ethyl alcohol, 95% ethyl alcohol and acetone. After drying, the residue is weighed. One duplicate is analyzed for protein whereas the other is incinerated at 525 degrees celsius and ash is determined.

The calculation for total dietary fiber = weight residue - weight (protein + ash)

The apparatus required for this technique are:
1. Fritted crucible
2. vacuum source
3. vacuum oven
4. desicator
5. muffle furnace
6. water baths
7. beakers
8. analytical balance
9. pH meter

The reagents for the technique are as follows:
1. 98% ethanol
2. 78% ethanol
3. acetone
4. phosphate buffer
5. termamyl
6. protease
7. amyloglucosidase
8. sodium hydroxide
9. hydrochloric acid solution
10. celite

Procedure
Note: Run blank through entire procedure along with samples to measure any contributions from reagents to reside

1. Weigh duplicate 1g samples accurate to 0.1mg into beakers. Sample weight must not differ by >20mg
2. 50ml of pH 6.0 phosphate buffer is added to each beaker
3. check pH and adjust pH to 5.8-6.2pH if necessary
4. Add 0.1 termamyl solution
5. cover beaker with aluminium foil and place in boiling water bath for 15 minutes. Shakre gently at 5 minutes interval
6. cool solutions to room temperature
7. adjust to pH 7.3-7.7pH by adding 10ml of 0.275M sodium hydroxide solution
8. add 5mg of protease
9. Cover beaker with aluminium foil and incubate for 30 mins at 60 degrees celsius with continous agitation
10. cool to room temperature
11. add 10ml of 0.325M hydrochloric acid solution
12. measure pH and add acid dropwise if neccessary to attain final pH of 4.0-4.6
13. add 0.3ml of amyloglucosidase and cover with aluminium foil
14. incubate for 30 minutes at 60 degrees celsius with continous agitation
15. add 280ml of 95% ethyl alcohol preheated to 60 degrees celsius
16. let precipitate form at room temperature for 1 hour
17. weigh crucible containing celite to nearest 0.1mg then wet and redistribute bed of celite in cricible using stream of 78% ethyl alcohol
18. apply suction to draw celite onto fritted glass as even mat
19. wash residue excessively with 3 portions of 20ml 78% ethyl alcohol, 2 portions of 10ml 95% ethyl alcohol and 2 portions of 10ml acetone
20. If gums are form, break surface film with spatula to improve filtration
21. time for filtration and washing varies from 0.1 to 6 hours
22. dry crucible containing residue overnight in 70 degrees celsius vacuum oven or 105 degrees celsius air oven
23. cool in desicator and weigh to nearest 0.1mg
24. subtract crucible and celite weight to determine weight of residie
25. incinerate second residue sample of duplicate for 5 hours at 525 degrees celsius
26. cool in desicator and weigh to nearest 0.1mg
27. subtract crucible and celite weight to determine ash

Andika Putra Anda Indera
TG01

Routine!

2008-08-23T17:36:00.009+08:00

This week I am posted to routine section. The routine section is where the analysis of urine and other excretory products are done. Stool analysis is also part of the routine section; only that the actual analysis is carried out in the BSC class 2 (Biosafety Cabinet). During urine analysis, tests such as pregnancy test, urine formed elements and urine phase contrast (UPC).

I want to highlight on 2 main tests that is done in the routine section. The first test is the hCG test. HCG test is also known as the pregnancy test. hCG is a short term for Human Chronic Gonadotropin. hCG is a glycoprotein hormone which is produced by the blastocyst. A blastocyst is a thin-walled structure in the earlier development containing a cluster of cells from which the embryo arises. The concentration of hCG increases with age. It is normally below 5IU/ml in women of child-bearing age. After conception, the level of hCG rises rapidly, reaching up to 200 000IU/ml during the first trimester. Therefore, the concentration of hCG in urine and serum proves to be a great marker for pregnancy.

The Testpack Plus hCG Combo Plus is used to measure the concentration of hCG. This test uses both monoclonal and polyclonal antibodies to detect increased levels of hCG. The specificity of this test kit enables it to eliminate the cross-reactivity interference from other glycoprotein hormones present in the urine and serum.

http://www.1-medical-equipment.com/Vendors/ABBOTTDI/SYSTEMS_/images/testpack.jpg

When urine is loaded into the sample well of the test kit with the help of a transfer pipette, the urine is allowed to transfer through the membrane. When the urine is transferred through the membrane, it mobilises the anti-hCG monoclonal antibody-colloid. When hCG is present, it will form a complex with the antibody-colloid. This complex then travels through the membrane and binds with the immobilised anti-hCG polyclonal antibody and thus provides a visual indication of the presence of hCG.

The test should be read at 5 minutes. When hCG is present at levels of 25mIU/ml or greater, a plus sign (+) will be indicated in the result window. A minus sign (-) will be indicated whenever there is no sign of hCG.

However there are limitations to this test. A negative result will appear if the urine is too diluted. False positive and false negative are resulted in patients with abnormal kidney functions eg. renal failure. Patients with renal failure tend to produce excessive amount of hCG. Inaccurate results will occur if urine contains too many bacteria.

Now, another test is the blood Beta-ketone test. Blood Beta-ketone is carried out to detect elevated amounts of beta-ketone in the blood. This usually occurs in patients suffering from diabetes. By using a device called Medisense Optium Monitor, it can measure the amount of beta-ketone in the blood sample through a current mechanism. A drop of blood is placed on a piece of test strip that is provided.

http://www.nuh.nhs.uk/qmc/mesu/images/Medisense-Optium---bevel-si.jpg

The beta-ketone in the blood sample will react with on the test strip and thus produce a small electrical current. The size of the current depends on the amount of ketones in the blood sample. There are limitations to this test. Beta-ketone in the blood must be measured within 30 minutes after blood collection. The test strip is not designed for use with serum of plasma samples.

Siti Nurfatin

0605853A

Albumin

2008-08-16T17:51:00.004+08:00

Hey everyone. I've been attached to the Biochemistry section of the lab for the about 2 weeks. And it's one of the busiest sections here in the lab as many tests are done in this section. Examples would be Glucose test, Liver Function tests, etc.

Here in the lab where I work in we use the Beckman Coulter Synchron LX 20. It is a fantastic analyser that can run multiple tests at any one time in closed tube samples.

Retrieved 16 August 2008 from http://www.beckmancoulter.com/products/instrument/genchem/images/LX20_PRO.jpg

Of all the tests that is done in the Biochemistry section, I'm gonna highlight the Albumin test, which is one of the tests in the liver panel. In acute hyperalbuminaemia, there will be a low oncotic pressure and this will cause the blood capillaries to be permeable to water. Hence, this will result in edema.

What is albumin?

Retrieved 16 August 2008 from http://3.bp.blogspot.com/_Uu3H5r-OZR0/Rw_dwKKtK4I/AAAAAAAAACA/MJRU9ZG3_Kg/S240/Human+Serum+Albumin+Image.jpg

It is a carbohydrate-free protein that makes up 55-65% of the total protein and has a molecular weight of 69,000. It helps to maintain oncotic plasma pressure and is also involved in transporting and storing of ligands. It is also a carrier of unconjugated bilirubin.

Conditions related to albumin

Hypoalbuminaemia
This occurs when albumin levels are lower than the reference range.
However, hypoalbuminaemia can be related to multiple causes.
They can be related to:

liver failure/disease
tissue damage (during burns)
Crohn's disease (malabsorption of amino acids)
nephrotic syndrome (proteinuria)
neoplastic disease (protein loss from the stools)

The most common cause is of course, liver failure.

When there is liver damage, the hepatocytes fail to produce albumin. this then leads to a drop in serum albumin levels. However, albumin levels are not a good indicator of liver failure in the early stages as it has a long half-life, which is about 20days.

Now I shall share with you how the LX 20 machine measures the serum levels of albumin in a sample.

We use a Bromcresol Purple reagent, otherwise known as BCP (we can also use Bromcresol Green, but most labs use BCP, and Bromcresol Green is good when testing animal serum) 5 microliters of the sample serum (from plain tube that has been centrifuged at 3250rpm for 5minutes) is injected into 570 microlitres of the reagent. They will then react and combine to form bromcresol purple albumin complex.

Albumin + BCP -----> Albumin-BCP Complex

The LX 20 then measures the change in absorbance at 600nm. This will be directly proportional to the concentration of albumin in the sample.

The reference range for albumin is 37-51g/L.

Therefore, to further diagnose liver failure, we have to run other tests as well as part of the liver function test and that includes testing levels of ALT, ALP, etc. For patients who are already diagnosed with liver failure, monitoring albumin levels allow us to see if their condition is worsening, and whether the medication prescribed has been effective. For example, if a liver failure patient's albumin levels continues to decrease over time, it probably indicates that more and more hepatocytes are continue to malfunction and have stopped synthesizing albumin.
Nevertheless, it is important that we run other tests as well to confrim before coming to any conclusion.

2008-08-10T21:01:00.004+08:00

image taken from: http://catalog.bd.com/bdCat/viewProduct.doCustomer?productNumber=446251

image taken from: http://www.bd.com/ds/productCenter/MD-AffirmVPIII.asp

hi everyone:) i have been in the microbiology laboratory for almost 3weeks and i have learnt quite a lot of things...now i would like to share with you one of the tests which i have found it quite interesting:)

The test is VP3 test. The full name is known as BD Affirm (Trademark) VPIII Microbial Identification Test. This test make use of DNA probe to detect and identify Candida species, Gardnerella vaginalis and Trichomonas vaginalis nucleic acid in vaginal fluid specimens from patients with symptoms of vaginitis (infection of the vagina).

Prinicple of the test:

-Based on nucleic acid hybridization where the complementary nucleic acid strands will align to form specific double stranded hybrids

This test uses 2 specific nucleic acid probes for each organism, a capture probe and a color development probe that are complementary to the genetic sequences of the target organism. The captured probe will be immobilized on a bed embedded in a Probe Analysis Card (PAC) that contains a seperate bead for each target organism. The colour development probes are contained in a multi-well Reagent Cassette (RC).

Sample Requirement: High Vaginal Swab

Method:

1)12 drops of lysis solution (0.4ml) were added to the sample and was swirled for 10 seconds

2)the sample was incubated for 10minutes (during this time, the lysis solution will rupture the walls of the cells of the organisms thus releasing the nucleic acid).

3)12drops of (0.6ml) of Buffer solution were added to the sample and the tube was flicked 10times before the cap was disposed (the buffer solution acts to stabilize the nucleic acid and establishes the stringency conditions needed for specific nucleic acid hybridization.)

4)4drops (0.1ml) of substrate solution was added to well 7

5)a filter tip was placed on the tube. the sample was dispensed entirely into well 1

6)PAC was placed into well 1

7)the automated processor was started

8)after about 32minutes,the PAC was removed and the results were interpreted

Results:

- +ve :any blue colour
- -ve : no colour

Contents in the wells:

Well no 1: patient's sample

Well no 2: Hybridization Solution

Well no 3: Wash solution

Well no 4 : Conjugate

Well no 5: wash solution

Well no 6: Wash solution

Well no 7: substrate buffer

i hope the pictures will make you understand more about the test:) have fun in SIP:)

For more information, you can also visit the website which i have taken the image from:) sorry i couldnt find any larger image:)

Rachael
0606168C
Tg01

PCR technique

2008-08-03T23:37:00.000+08:00

Hey peeps!!! Time sure flies huh... In a blink of an eye, its already 6 weeks into our SIP. Today, I'm going to share with you a common but essential technique that is required for my MP. I'm sure you all know about PCR technique right?

The Polymerase Chain reaction has wide applications in diagnostic and research laboratories. It is routinely being used in the diagnosis and identification of bacteria. A number of specific primers for the detection of aquatic organisms by PCR have been reported and these primers undergo a long validation process before they are routine in a diagnositc laboratory. For example; the sodB gene of Edwardsiella Tarda was reported by PCR.

The cycling conditions will depend on the type of thermocycler, annealing temperature of the primers, type of Taq enzymes used and if it is a hot-start enzyme or not. A standard set of cycing conditions begins with one cycle at 95 degrees celsius for 5 minutes followed of 25-35 cycles of denaturation at 95 degrees celsius for 30 seconds, annealing at 5-68 degrees celsius at 30 seconds, extension at 72 degrees celsius for 30 seconds. It is suggested that a final cycle should be put in place with an extension time of 10 minutes. The thermocycler can be set to do a hold cycle at 4 degrees celsius.

The primer annealing temperature depends on the length of the primer and the AT/GC concentration. It is recommended that the annealing temperature be set at 5 degrees celsius below the true melting point of the primers. To estimate the annealing temperature, calculate 2 degrees celsius for AT primers and 4 degrees celsius for GC primers. A lower annealing temperature than the optimal annealing temperature may lead to mispriming of non-target sequence or the mis-extension of incorrect nucleotides at the 3' end of the primers.

The optimal number of cycles is between 25-35. Increasing the number of cycles may lead to problems with the PCR. A plateu effect is reached where the product is no longer amplified. As a result, a non-specific product may be amplified preferentially. This plateau is reached according to the number of target copies initially present in the sample and the amount of DNA synthezised. Reagent exhaustion also occurs with an extended number of amplification cycles.

http://www.icampus.ucl.ac.be/courses/SBIM2520/document/genemol/PCR/pcr.jpg

Andika Putra
TG01

Animal Handling Crash Course (Light)

2008-07-28T07:59:00.006+08:00

Hey Everyone !

A little procrastination here and there, but the bottom-line is...this post is up.XD And without further ado, here we go...

Basically my mp is on the Development of Type II Diabetic Mouse Models, and because of this, I’ll have to inevitably deal with mice. Initially i thought it would merely mean playing with mice quite literally, but it turned up to be that I’ll be their worst nightmare...

Since I've to deal with mice with regards to my MP, I was put through a 3hrs vet science crash course. Upon my arrival, I was immediately thrown with a stack of notes about various mice techniques which i need to know, and told to read... (Stack of notes = thickness of mmic textbk !). No further instructions, just read...so i immediately started to copy whatever's important frantically.

Then came an ex-vet science student, who gave me an odd look of bewilderment and inquired," you don’t have to copy a single thing, we are going to show you a video which will flash a list of techniques quite systemically and those techniques will be imparted technically.”

And the projector ahead started to play………………...........

Topic 1 : Proper technique of restraining a mouse

- The most basic technique of restraining a mouse is with your hands, and the technique is called scruffling.
- By using your index and thumb, grab the skin located between both shoulder blades on the back of the mouse.
- To ensure that the mouse has been firmly scruffled, the mouse's head mustn’t be able to move.
- Insert the tail of the mouse between your pinky and ring finger for double assurance.
- This scruffling techniques enables the handler to perform more sophisticated techniques such as phlebotomy and injections.

Topic 2: Sex Determination

- Gender of mice must be clearly distinguished by checking the distance of their anogenital.
- Female's anus to genital area: 0.5-2.0cm
- Male's anus to genital area : 2 – 4 cm

Topic 3: Gavaging

- Aka forceful feeding by mechanical means into the stomach
- Materials: ~ Syringe
~ Gavaging needle (Comes in different lengths)
~ Drug to be administered
~ Desired Mouse

- Select the appropriate length of gavaging needle.
- Perform the selection by picking a gavaging needle and match it against the length from the tip of the nose to the last rib. To detect the last rib, one has to personally observe and feel the chest of the mouse 1st handedly!
- Next, it's vital to check that the plunger of the syringe is working fine by simply stimulating the aspiration motion to verify its mechanical function.
- Ensure that the mouse has been firmly scruffled
- Draw the drug into the syringe.
- Insert the gavaging needle to the nozzle of the syringe.
- Gently and slowly insert the gavaging needle to the back of the throat.
- Gently slide it down in a curved motion by following the anatomy outline of the mouse's GI tract.
- If met with any resistance or if gaggling was observed, halt and gently withdraw the needle slightly. NEVER FORCE !
- Try to shift the needle either to the left or right and allow it to slide down gently until the nozzle of the syringe comes in contact with the mouth of the mouse.
- While administering the drug, always pay fullest attention the mouse’s reaction.
- Once administered, withdraw the gavaging needle with the exact motion from before, gently.
- Dispose both the gavaging needle and syringe.
- Stroke, pat and cuddle to relieve the mouse from the inflicted stress.
- Document and return the mouse back to its cage.

Topic 4: Subcutaneous Injection

- Draw the required amount of drug into the syringe and insert the needle into the nozzle.
- Scruffle the mouse firmly and usual, and this will form a superficial triangle shape at the back of its head.
- Note the base of the triangle and swab the area gently with alcohol swabs.
- Allocate the needle parallel to the triangles base, bevel up.
- Insert the needle in, do not hesitate.
- Always ASPIRATE prior to administration to check the appropriateness of the needles depth.
- Ensure that vacuum is being aspirated.
- Proceed on with administration of drug, slowly and gently.
- Once the needle has been retrieved, immediately apply pressure on the injected site to reduce loss of blood.

*Maximum Vol. for sc jab : 2ml
*Maximum Needle size : 22 gauge (Needle size increases with decreasing gauge)

Topic 5: Blood Collection from Tail

- This technique can be utilized to collect up to 200µL of blood.
- Prepare the syringe with a needle adhered. (Always prepare the necessary equipments prior to the procedure to reduce hassle.)
- Warm the tail by rubbing it gently to promote vasodilatation of the tail vein.
- Naturally, the dark blue vein will become visible.
- Place the mouse under firm restraint. Mechanical restrains are highly recommended for this technique.
- The spot to be injected should be assigned somewhere near the tip of the tail, but obviously not too near the edge. This practice is important in case the 1st injection ends in vain, which will collapse the vein near the tip of the tail. For every failed attempts, the subsequent injection should get closer to the main mouse's body.
- Before inserting the needle, ensure that the angle of the needle from the tail is approximately 5-10°.
- Gently and slowly insert the needle until blood is observed.
- Draw the desired amount of blood or switch to a collection tube to draw the blood inwards.
- Upon completion, use a gauze and apply substantial amount of pressure on the injected site to prevent excessive blood loss.
- Stroke and pat before returning the mouse back to the cage.

End of Animal Handling Crash Course.

Name: Albert Chan XD
Admin: 0604524I

Immunoassay

2008-07-22T22:22:00.002+08:00

Hello guys. Hope you guys enjoy your SIP. As for me, im adapting to it. =) anyway, I was attached to Immunoassay section for 2 whole weeks, which was from week 2 to week 4. The immunoassay section was the area where the patients’ blood was analysed for presence of foreign antibodies and antigens in the body, such as anti-HIV, HbsAg and Anti-Hbs (Hepatitis B panel). Autoantibodies were also analysed to detect autoimmune disorders. Examples of the autoantibodies were such as Anti-Tg and Anti-TPO autoantibodies.

Hormones and crucial vitamins such as TSH, FT4, B12 and Folate were also measured by the machines in the immunoassay section. At certain times, blood was also tested for drug levels. Examples of the drugs were such as Theophylline, Digoxin and Phenytoin. Myeloma screen was also carried out when requested. This was to screen for cancer cells in the patient’s blood.

There were a total of 2 machines in the immunoassay section. The first machine was called Architech i2000 Analyzer. The second machine was known as Architech Ci8200 Analyzer.The Architech analyzers allowed multiple processing where all sample processing activities were performed. The analyzers could be configured to process sample by using potentiometric and photometric methods and / or CMIA (Chemiluminescent Microparticle Immnunoassay) methods.

The Ci8200 Analyzer comprised of both i2000 and c8000 analyzers. C8000 analyzer used photometry methods. The methods were the end-point assay and rate assay. The end-point assay was reactions that reached equilibrium and it was at that time there was little or no further change to the absorbance readings. Therefore, the system measured the absorbance readings used for calibration and calculating results. The rate assay was reactions that measured the constant change in absorbance over time. The system performed readings many times during this timing and calculated the absorbance change.

The i2000 Analyzer used the CMIA method where microparticles were mixed with the sample in the reaction vessel. During incubation, analytes present in the sample attached to the corresponding capture molecules on the microparticles which then formed the immune complex.
This analyzer measured the B12, Folate, TSH, FT4 and Ferritin levels in the patient’s blood.

Whereas for the ci8200 Analyzer ran more complex tests on the patients’ blood. The type of tests has been mentioned in the first paragraph.

The machines must underwent 5 important steps daily. The five steps were:
1) daily maintenance
2) check the supplies and reagents
3) calibrate the reagents where necessary
4) run controls
5) run patient’s tests

Controls that were run were all serum-based and in order to make sure the controls were not ‘out’, we followed the Westgard Multirule.
Both machines ran tests by measuring the serum of the patient’s blood. Before the tests were run, the blood specimens were centrifuged for 5mins so as to separate the serum and the blood. At the end of 5min, the serum would appear on top of the blood.

Whenever the serum was insufficient, it was poured into an adaptor tube so as to allow the probe of the machine to touch the serum and thus carry out the specific tests. One more thing to add, when the tests were already run, it took 20 minutes for the results to be released. The results would determine whether they were out of range or normal. Please feel free to ask me questions. Thank you!

Siti Nurfatin
0605853A

Week 4

2008-07-15T20:59:00.003+08:00

Okay, so now here I am with my post for Week 4 of this 20-week process.
For the past 5weeks I've been under the Processing area of the hospital that I've been attached to.Now, when I say Processing, it does not refer to the Processing of tissues that we learn in Histo Tech. It refers to Processing samples in general.

Here in Processing, it is very admin-like. My section is the first section that ALL samples and specimens have to go through before they are sent out to the respective labs like Blood Bank, Micro lab, Immuno lab, etc.

We have a pneumatic tube system that allows us to receive samples from the Wards and Specialist Clinics, ICUs, etc. The samples are placed in cannisters which are attached with a microchip and are sent down to the lab. This saves time for the porters and health attendants to send them down. This is because not every room has samples to be sent down each time, and it will be a waste of time to send down just one sample every now and then.

The same principle goes for the sending back of results or rejected specimens (which have been mislabelled, or sent in the wrong type of tubes, etc). Results which are for outpatients and prisoners (yes, we have a prison ward here in this hospital and we do testing of their samples as well), or those which are confidential will be placed in an envelope and will be sent back to the respective wards/clinics via the pneumatic system too. At the same time, the results will also be faxed to the respective places. However in super urgent cases, there will be porters that send down samples.

The samples which are from the operating theatres, A&E department, Specialist Clinics, or those specifically marked as 'URGENT' will be given priority. The same goes for blood gas samples, which have to be tested within an hour. I do not know why such a short time limit though, for I've not been attached to the Routine section yet. For the prioritzed samples, we will scan the time and put them ahead regardless of how many samples that are already in the queue. However, for samples which are to be tested in the Micro lab and the Histo lab, we will put in their respective separate trays and will be brought to the separate labs.

The other specimens are then keyed into the LIS, and a barcode will be auto generated This is done by first scanning in the patient's information label and then keying in the tests that have been ordered by the doctor. There is a code for every test that is run here in the lab. But before confirming the test, it is our duty to verify that all the samples are labelled correctly, the amount of specimen is enough, and that the right type of specimen is sent (e.g. EDTA tube used for FBC and not plain tube). If any of this conditions are not met, we will have to call the nurse/doctor in-charge of the patient and notify them. We will then either discard or send back the rejected sample.

For the accepted samples and specimens, after keying in the tests ordered, a barcode will then be generated for every test. We will then have to paste the barcodes onto the various test tubes carefully. We must ensure that the name on the barcode matches the name of the patient. We must then paste accordingly to the test. This is by looking at the number on the barcode. For samples that will have to be processed at haematology section, the number will begin with "21" e.g. 2164552 and for Biochemistry, "10" e.g. 1045189
Sometimes, one tube may be shared for various tests, therefore we must only label the test tube with one barcode, which is from the main section. For example, biochemistry tests like tsting of Troponin T will be given priority over an immunoassay test, for example the testing of Theophylline. Therefore, we only paste the Biochem barcode onto the test tube and staple the Immunology barcode on to the request form. Since there is only one request form sent from the ward for many tests sometimes, we issue separate 'tickets' for the different sections should there be a request for multiple tests from multiple sites. Eg. Test for Blood Gases and Full Blood Count are done at different sites. Once labeling has been done, we send it out to the different sections. Our lab is small, so each section is just a few steps away from my site. From the LIS, we then do billing for the tests ordered, but I'm not sure how this is done as I cannot learn billing.

I must stress the importance of checking patient's details as a wrong results may be generated, and it may result in the wrong diagnosis and medication given which may be life threatening.

I also forgot to mention that not every single test are done here in my hospital. Certain tests are done at other hospitals like SGH. This is for the tests that are not always requested for.

Anyway, I hope this hasn't been too wordy, but I've tried my best to describe the major details that I think needs to be highlighted and brought across in order for you to comprehend my routine duties at work.

Do clarify your doubts with me should there be a need to. (:

PS, I miss the food from ITAS.

Elyana
TG01
0606676E

2008-07-01T21:12:00.003+08:00

For the next 3weeks starting from this week, i will be in the haematology lab. There are 2haematology labs which are the haematology routine lab and the haematology stat lab. The haematology stat lab will handle urgent and emergency samples such as blood samples from the accident and emergency department. The haematology routine lab will handle blood samples from the wards and samples which are not urgent. The haematology lab conducts many different types of tests which includes: Full Blood Count(FBC), Erythrocyte Sedimentation Rate(ESR), PT, PTT, APTT, 50%PT, reticulocytes count, differential count and bleeding time.

I was posted to the haematology stat lab for the first day. When a sample arrived from the emergency depratment, the medical technologists will check the blood tubes to make sure that the names and the identity on the sticky labels and the tubes are correct and they will check for the tests ordered e.g. FBC. After that blood film or smear will be made if the blood sample is in a baby tube (small tube) and automated FBC will be run. For blood sample which are in normal adult tubes, automated FBC will be run first. If the FBC results are abnormal or out of range, then blood smear will be made to see the differential count. The results will be printed out and for the haematology stat lab, 2reports will be printed out, one for the patient to bring it to the clinic for doctor's review and another for the lab to keep. For the routine lab, only one report will be printed out and attached to the request form. If the Hb level falls below 8g/dL, the medical technologist will call the doctor directly to report the results so if there is a need for blood transfusion for the patient, it can be done as soon as possible.

On the first day, i observed the automated FBC on the machine and i did ESR. i also observed the staining process on the automated stainer and practise on making blood smear or blood film. Till now i am still practising to produce a perfect blood smear:) it is quite difficult to make a perfect one without a "tail". Tails are not supposed to appear as it may lead to inaccurate results as the white blood cells may all "clump" at the tail end. On the first day, i also observed the Dengue Serology test which is to detect IgG and IgM and observed Bleeding Time done on a patient by an experienced medical technologist.

On the second day which is today, i was posted to the routine haematology lab which i helped to check and stick the labels on the patients tube and i run the automated full blood count (FBC) on the patients' samples. I also observed the bone marrow aspiration done by a doctor on a patient for immunophenotyping and cytogenetics studies. And i also practise on making a nice blood film during my free time.

hmm for your info, i am going to talk about bleeding time which may be unfamilar to many of you. Bleeding Time is a test whereby a small cut is made on the forearm of the patient and the time between the cut is made to the moment bleeding stop is measured. However, bleeding time is not able to diagnose plate disorder. It only shows there is a need for more testing. In the lab that i am working now, they used Surgicutt for bleeding test.

Bleeding Time
MATERIALS :
-Filter Paper
-Antiseptic Swab
-Stopwatch
-Plaster
-Sphygmomanometer (for measuring pressure, pressure should be about 40mmHg for junior to adult)

METHOD:
-The sphygmomanometer cuff was place on the upper arm and inflated to 40mmHg.
-The area which the cut is to be made, is being cleansed with antiseptic swab and allowed to dry.
-The Surgicutt was removed from the pack and safety clip was removed.
-The device was hold bewtween the thumb and middle finger.
-The device was rested on patient's forearm and the trigger was pushed gently and the stopwatch was started simultaneously.
-The device was removed immediately after the cut was made on the forearm.
-The blood was blotted from the filter paper close to the cut but not directly touching the cut every 30secs.
-The process was repeated for every 30secs until no blood stained the filter paper.
-The timer is stopped and the bleeding time was determined to the nearest 30secs.
-Sphygmomanometer was removed and the incision (cut) site was cleaned with antiseptic swab and a plaster was placed over the site.

so yup thats about it:)

Rachael
0606168C
Tg01

First week of SIP

2008-06-27T21:27:00.004+08:00

Andika Putra Anda Indera

0604612B

First week of SIP

The first day of SIP started off with a briefing regarding the procedure to clock in and out, which I will have to do everyday. Thereafter I proceeded to the conference room where my supervisors gave a briefing regarding the requirements and guidelines of in-house SIP. Basically I will start at 8.30am everyday and end at 5.45 on monday-thursday while friday ends at 5.15.

I found out during the briefing that 80% of my SIP will be doing my MP whereas 20% will be spent doing TSO. Apparently, that's only once a week thus I have plenty of time for my MP. Speaking of MP, after the briefing I went to have a meeting with Dr.Chang, who is my supervisor, to discuss my MP.

My MP is basically about an organism called Edwardsiella Tarda which causes Edwardsiellosis in fishes. Edwardsiellosis is a very important bacterial infection in fishes as it is one of the major problems in the aquafarming industry. Edwardsiellosis often leads to death of fishes with atleast a 50% mortality rate if the fishes are kept in tank. Hence, my MP is to assist Dr.Chang in trying to create a vaccine that is specific to Edwardsiella tarda.

My first task is to research more information regarding the organism and to find the aceE gene in Escherichia Coli, Salmonella enterica, Shigella Flexneri and Yersinia Enterocolita. Due to the fact that Edwardsiella Tarda gene has not been completely sequence, these four organisms might contain similar genes because they all belong to the enterobacteriaceae family.

In order to locate the gene, I will be using pubmed and search for the organism's respective aceE gene. Using a software called CLUSTERW, I am able to merge the aceE gene of the 4 organisms together. After the aceE gene is grouped together, I will use another software called BOXSHADE which helps me to highlight the similar genes between the 4 organisms.

On friday, I had a lab briefing conducted by Mr Lester. He showed us the various lab equipment in AS4. The first equipment is the centrifudge and microfudge. He explain the difference between a fixed angle and a swing bucket. Basically, fixed angle means the tube that will be placed in the centrifudge lies in a fixed angle. Swing bucket refers to the bucket being at a 180 degrees position while the centrifudge is spinning.

The next equipment he showed me was the autoclave. In AS4, the autoclave machine can only be used at 10am, 1pm and 4pm. Therefore, if there is a need for me to autoclave I will have to follow the schedule time. He explain the steps on how to use the autoclave.

Finally, he showed me the BSL2+ class laboratory. Basically, a BSL2+ is a laboratory that handles organisms that is able to infect humans. The lab is isolated from the corridor which means, the lab and corridor is separated by another room. The air pressure in the BSL2+ lab is lower than the room and corridor. This is to prevent bacteria from the lab to escape to the corridor as it travel from a region of high pressure to low pressure. Since the air pressure in the lab is lower, it remains in the lab. Another security function is that the BSL2+ lab cannot be accessed if the door to the corridor is open. This means that out of the 2 doors that is available in the room between the corridor and BSL2+ lab, one of the doors must be closed for the other to open.

In the BSL2+ lab, I was shown how to use the BSL cabinet and the functions and limitations of it. The direction of the airflow, ventilation and arrangement of reagents are explained by Mr Lester.

ISO 15189

2008-06-16T23:48:00.006+08:00

1. Examination procedures :

* Procedure for carrying out the test ¹

* important requirement and must be reviewed regularly

* may be in the form of textbook instructions, journal article

2. Assuring the quality of examination procedures :

* have an IQC program to verify quality of patient test results¹(e.g. regular testing of QC materials and records¹ etc),

* participating in EQA programs

3. Post-examination process

* review of results before being reported

* used samples disposed in an environmentally and human-safe manner

4. Reporting of results

* used only approved forms

* results must be retained for a minimum period

* relevant information (e.g. reference range) must be included

5. Alteration and amendments of reports

* must be recorded and verified

(104 words excluding citations)

Reference

Cooper, Greg (2004). Preparing Your Laboratory to Certify or Accredit Under ISO 15189. Bio-Rad Laboratories. Retrieved June 16 2008 from http://www.sacb.org.sg/documents/PreparinglabforISO15189-GCooper.pdf

LMQA ISO 15189

2008-06-16T22:28:00.006+08:00

Technical Requirements

Personnel

Eligible and accredited ¹ to work in the laboratory
Job resume must have the necessary qualifications¹
Attend workshops¹ to improve on knowledge and skills
Make sure that patient’s information is protected¹

Accommodation and Environmental Condition

Clean and ventilated¹work area to maintain safe working environment
Maintain environmental conditions¹

E.g. humidity and temperature of laboratory

Laboratory Equipments

Instruments and reagents are sufficient, maintained and calibrated ¹to meet the laboratory’s needs

Pre-Examination Procedures

Patient’s description¹ is recorded
Proper specimen collection and specimen storage ¹

E.g. anticoagulant required

Word Count: 100 (excluding the citations)

Reference

1. Cooper, Greg (2004). Preparing Your Laboratory to Certify or Accredit Under ISO 15189. Bio-Rad Laboratories. Retrieved June 15, 2008 from http://www.sacb.org.sg/documents/PreparinglabforISO15189-GCooper.pdf

Done By: Siti Nurfatin

0605853A

LMQA ISO 15189 cont.

2008-06-16T19:22:00.001+08:00

Management Requirements (cont.):

1. Corrective Actions
Problems must be investigated to determine the source of error (TT LABS, 2004)1*.

2. Preventive actions
Any necessary improvements and non-conformities concerning technical or management system should be identified, followed by the development of plans and procedures to reduce chances for recurrence (TT LABS, 2004)1*.

3. Continual Improvements
All procedures must be reviewed at regular intervals to observe for traces of non-conformances (TT LABS, 2004)1*.

4. Quality and Technical records
Records should include definitions and terminology, organization scheme, internal problems etc (To The Point, 2008)3***, complemented by procedures establishment for identification, maintenance etc (TT LABS, 2004)1*.

5. Internal Audits
Various auditing task include performing root cause analysis, documentation of findings, and continuation of corrective and auditing procedures (College of American Pathologists, 2008)2**.

6. Management Review
Quality Management Systems must be periodically reviewed by the laboratory management to maintain and enhance the system (TT LABS, 2004)1*, (CAREC, 2004)****.

(117 words excluding in-text citations and references)

References:

1. Trinidad and Tobago Laboratory Accreditation Service.(2008).Summary of Requirements in ISO 15189 for Medical Laboratories.Retrieved 16th June, 2008.from
http://www.ttbs.org.tt/brochures/Brochure_ISO_15189.pdf

2. College of American Pathologists.(2008). ISO 15189:2007 Fact Sheet.Retrieved 15th June, 2008.from
http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7bactionForm.contentReference%7d=laboratory_accreditation%2Fiso%2Fiso_fact_sheet.html&_state=maximized&_pageLabel=cntvwr

3. To The Point.(2008).15189 Quality Records.Retrieved 15th June, 2008.from
http://www.iso9000plus.com/15189_quality_records.html

4. Caribbean Laboratory Accreditation Service.(2004).A Guideline Documentation for Application of ISO 15189:2003 to Medical Laboratories.Retrieved 15th June, 2008.from
http://www.carec.org/pdf/accreditation_guidelines_april_2004.pdf

Done by: Albert Chan
0604524I
TG01

LMQA ISO 15189

2008-06-15T22:54:00.002+08:00

ISO 15189:2007 (Introduction)

ISO 15189:2007 is a quality management system and an accreditation program that focus to improve patient safety and reduce risk. ISO 15189:2007 outlines the stated requirements and standards for quality and competence in medical laboratories
(Collage of American Pathologists, 2008)1. This international standard is utilized by medical laboratories to develop their quality management systems and evaluate their own competence. Accreditation bodies use this to validate or recognize the competence of medical laboratories (The British Standard Institution, 2008)2. ISO 15189:2007 has 23 quality system elements and is divided into 2 major segments; Management Requirements and Technical Requirements (Bio-Rad Laboratories Quality Systems Division, 2004)3.

Management Requirements:

1.Organization and management

Responsibility of laboratory management to provide enough resources, design, execute, maintain quality system and select quality manager. (Bio-Rad Laboratories Quality Systems Division, 2004)3.

2.Quality management system

Shows the need of having a Quality System which includes quality manuals, quality policy and quality assurance etc. (Westgard QC, 2004)4.

(110 words excluding in-text citations and references)

References:

1. Collage of American Pathologists.(2008).What is Accreditation to ISO 15189:2007.Retrieved 14 June, 2008.from http://www.cap.org/apps/cap.portaL?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=laboratory_accreditation%2Fiso%2Fiso_faq.html&_state=maximized&_pageLabel=cntvwr

2. The British Standard Institution.(2008).Medical laboratories, particular requirements for quality and competence.Retrieved 14 June, 2008.from http://www.bsi-global.com/en/Shop/Publication-Detail/?pid=000000000030146737

3. Bio-Rad Laboratories Quality Syetems Division.(2004).Preparations and considerations when seeking laboratory accreditation under ISO 15189.Retrieved 14 June, 2008.from http://www.sacb.org.sg/documents/PreparinglabforISO15189-GCooper.pdf

4. Westgard QC.(2004).Guest Essay: ISO Standard in Clinical Laboratories.Retrieved 13 June,2008.from http://www.westgard.com/iso3.htm

Done by: Rachael Ngiam
0606168C
Tg01

LMQA project (Andika)

2008-06-15T21:28:00.006+08:00

Document Control in ISO 15189 (2007) is reviewing the quality manual, ensuring the objectives is achieved. Quality manual is specific in an organisation and it varies to suit the organisation.

Review of request and contracts determines the competence of workers. The technical ability of the worker is essential to maintain quality(Carec 2004)1.

During examination by referral laboratories, a procedure is created which includes a record of specimens, dispatch dates and return of report from referral laboratories.(College of American Pathologist 2008)

Resolution of complaints is a document which indicate steps used in determining the source, the amendment and improvements made to prevent re-occurence.

(98 words excluding citation and reference)
Reference:
1. Carribean Laboratory Accredition Services. (2004) A Guidance Document for the Application of ISO 15189:2003 to Medical Laboratories
http://www.carec.org/pdf/accreditation_guidelines_april_2004.pdf#search=%22iso%2015189%22

2. College of American Pathologists.(2008).What is Accreditation to ISO 15189:2007.Retrieved 14 June, 2008.from
http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=laboratory_accreditation%2Fiso%2Fiso_faq.html&_state=maximized&_pageLabel=cntvwr

3. Westgard QC.(2004).Guest Essay: ISO Standard in Clinical Laboratories.Retrieved 13 June,2008.from

http://www.westgard.com/iso5.htm

Andika Putra Anda Indera

0604612B

2008-06-14T22:29:00.001+08:00

Testing:)