DELTA STATE UNIVERSITY, ABRAKA

MEDICAL LABORATORY DEPARTMENT

COURSE CODE: MLS 201

INTRODUCTION TO MEDICAL LABORATORY SCIENCE

Medical Laboratory Science (MLS) is the health profession that provides diagnostic
services needed to detect, treat diseases and monitor response to therapy. Areas of
MLS include hematology, medical microbiology, histopathology, clinical chemistry
and immunology. MLS in United Kingdom is called Biomedical Science while in United
States of America is called Clinical Laboratory Science. Mls analyses blood, tissues and
body fluids samples to aid in the diagnosis of the cause of diseases in patient.
Clinicians depend on the accurate laboratory data to diagnose diseases, while other
medical professionals e.g. nurses and pharmacists rely on this information from the
lab to plan or implement treatment and care for their patient.

A medical laboratory scientists perform various laboratory tests in the medical

laboratory. The medical lab scientist ensures the quality of the specimen, test results,
interpretation and explanation of the significance of laboratory tests is carried out
properly, also evaluate new methods and study the effectiveness of lab tests.

Mls also perform calibration, maintenance, validation and troubleshooting of

instrumentation and perform statistical analyses to verify the accuracy, sensitivity,
specificity and reproducibility of the testing. It is estimated that 70% of medical
decisions are based on lab test results.
Medical lab scientists work in a variety of settings like hospitals, private labs, clinics,
forensic, public health laboratories, research institutions and industries such as
pharmaceutical and biotechnology.

The Educational Requirements of a Medical Laboratory Scientist

Educational requirements include:

 5 year university degree in Medical Lab Science

 Required one year mandatory clinical internship program
 Compulsory one year NYSC
Introduction to Haematology
Haematology is a branch of medical laboratory science that study blood and blood-
related disorders and diseases.
Hematology tests

These Blood tests provide valuable information for diagnosing hematological and
non-hematological diseases and disorders. A complete blood count is one of the most
common blood tests requested in disease diagnosis. The hematological parameters
measured in it include the number of white and red blood cells, platelet count,
hematocrit red blood cell volume, hemoglobin concentration, differential white blood
count and various other red blood cell indices. Complete blood counts are used in
diagnosing infections, anemia, blood-related cancers and inflammatory diseases.
Platelet counts are informative about bleeding and clotting disorders. Clotting-
related disorders such as hemophilia can also be monitored and diagnosed using
coagulant tests such as prothrombin time and partial thromboplastin time. These
tests can also be used to monitor anticoagulation or anticlotting therapies. The bone
marrow test is one of the rare hematological tests, it involves examination of cells
from the bone marrow to diagnose diseases such as multiple myelomas and others.

Anticoagulants used for hematologic testing

Ethylene Diamine Tetraacetic Acid (EDTA)

This anticoagulant chelates calcium and subsequently preventing clotting. Cells
preservation is optimal in it. High concentrations of EDTA are hypertonic in
comparison to red blood cells when only a small amount of blood is collected (e.g. 0.5
mL) and placed into a standard 5 mL EDTA tube. Exposure of blood to EDTA cannot
result in the binding of antibodies in the plasma to platelets or red blood cells. The
consequence of antibody binding to platelets is that platelets aggregate resulting in a
falsely decreased platelet count. With antibody binding to red blood cells, red blood
cells aggregate, mimicking agglutination which is a key feature in red blood cells that
is usually diagnostic for immune-mediated hemolytic anemia, this can lead to an
erroneous diagnosis of immune-mediated disease.
Citrate:
Citrate anticoagulant also chelates calcium but is a gentler chelator than EDTA. Thus,
we can add calcium back to the tube to perform hemostasis testing. The blood is
diluted by the citrate anticoagulant by 10% if the appropriate volume ratio of blood
to citrate is maintained, i.e. 1 part citrate to 9 parts blood, therefore it cause all counts
to be lower by at least 10% compared to blood collected into EDTA.
Heparin:
Heparin is not recommended for hematologic testing because Platelets and
leukocytes frequently clump in heparin, causing erroneous absolute counts and
differential leukocyte count. Heparin also introduces a staining artifact as smears look
a garish pink-purple which affects blood smear examination.

Sample collection
Standard specimen collection and processing procedures is the first step in acquiring
a quality lab test result for patient.

Venipuncture Procedure
The first step before collection of blood is to carefully identify the patient by two
forms of identification; ask the patient to state and spell his/her name and give you
his/her birth date in facility where those information are taken. Check the requisition
form for requested tests, patient information and any other requirement. Gather the
tubes and supplies that you will need for the draw. Position the patient in a chair or
sitting or lying on a bed. Wash your hands. Select a suitable site for venipuncture, by
placing the tourniquet 3 to 4 inches above the selected puncture site on the patient.
Do not put the tourniquet on too tightly or leave it on the patient longer than 1 minute.

When a vein is selected, cleanse the area in a circular motion, beginning at the site
and working outward. Allow the area to air dry. After the area is cleansed, it should
not be touched again. Ask the patient to make a fist, avoid pumping the fist. Insert the
needle through the skin into the lumen of the vein. The needle should form a 15-30
degree angle with the arm surface. When the tube is filled, remove the tourniquet.

Remove the needle from the patient's arm using a swift backward motion. Place gauze
immediately on the puncture site. Apply and hold adequate pressure to avoid
formation of a hematoma. After holding pressure for 1-2 minutes, tape a fresh piece
of gauze or Band-Aid to the puncture site. Dispose of contaminated materials and
supplies in designated containers.
VENIPUNCTURE BUTTERFLY NEEDLE METHOD
This is used in case of senior citizens
Sites to draw blood Median cubital vein: a superficial vein, most commonly used for
venipuncture, it lies between the cephalic and basilic veins. Cephalic vein: Seen in
both forearm and arm Basilic vein: Seen in forearm and arm, it divides to join the
brachial vein.

Fingerstick Procedure
The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers. Do not
use the tip of the finger or the center of the finger. Avoid the side of the finger where
there is less soft tissue, where vessels and nerves are located, and where the bone is
closer to the surface.

When a site is selected, cleanse the selected puncture area. Massage the finger toward
the selected site prior to the puncture. Using a sterile safety lancet, make a skin
puncture just off the center of the finger pad. The puncture should be made
perpendicular to the ridges of the fingerprint so that the drop of blood does not run
down the ridges. Wipe away the first drop of blood, which tends to contain excess
tissue fluid.

Collect drops of blood into the collection tube by gentle pressure on the finger. Avoid
excessive pressure that may squeeze tissue fluid into the drop of blood. Rotate and
invert the collection device to mix the blood collected.

Heelstick Procedure for infants

Prewarming the infant's heel at 42° C for 3 to 5 minutes is important to increase the
flow of blood for collection. Clean the site to be punctured with an alcohol sponge. Dry
the cleaned area. Hold the baby's foot firmly to avoid sudden movement.

Using a sterile blood safety lancet, puncture the side of the heel. Wipe away the first
drop of blood with a piece of clean, dry cotton gauze. Since newborns do not often
bleed immediately, use gentle pressure to produce a rounded drop of blood. Do not
use excessive pressure because the blood may become diluted with tissue fluid. When
finished, elevate the heel, place a piece of clean, dry cotton on the puncture site, and
hold it in place until the bleeding has stopped. Apply tape or Band-Aid to area if
needed.

Labelling the sample

A properly labelled sample is essential so that the results of the test match the patient
request. The key elements in labelling are: Patient's surname, first and middle names.
Patient's ID number. NOTE: Both of the above MUST match the information on the
requisition form. Date, time and initials of the phlebotomist must be on the label of
EACH tube or electronically entered. Automated systems may include labels with bar
codes.
Techniques to Prevent
Hemolysis: Mix all tubes with anticoagulant additives 5-10 times. Avoid drawing
blood from a hematoma; select another draw site. If using a needle and syringe, avoid
drawing the plunger back too Make sure the venipuncture site is dry before
proceeding with draw. Avoid a probing, traumatic venipuncture. Avoid prolonged
tourniquet application (no more than 2 minutes; less 1 minute is optimal). Avoid
massaging, squeezing, or probing a site. Avoid excessive fist clenching. If blood flow
into tube slows, adjust needle position to remain in the lumen.

Collection artifacts
Difficult venipuncture
Traumatic venipuncture can precipitate platelet clumping and induce small
microclots within the sample or even clotting of the sample. Clotting of the sample
will decrease all blood counts and invalidate the counts, if severe. Microclots can also
be drawn into hematology analyzers and can plug the tubing, causing the machine to
malfunction. Difficult venipuncture, particularly through a small gauge needle, can
result in shearing of red blood cells which affects cell counts and mimics true
intravascular hemolysis.
Low sample volume
Collection of a small blood volume e.g. 0.5-1 mL with placement into a standard 5 mL
EDTA tube will cause shrinkage of red blood cells, because EDTA is hypertonic. This
will cause a false decrease in the mean cell volume (MCV) and false increase in mean
cell hemoglobin concentration (MCHC) of red blood cells. Crenation of red blood cells
will also be evident on the blood smear. This is a common artifact that we see in
hematologic samples. If only a small sample of blood is obtained, a microtainer tube
containing EDTA anticoagulant is preferred, but be sure to thoroughly mix the tube
by gentle inversion, several times.
Inappropriate mixing with anticoagulant
The blood should be thoroughly mixed with anticoagulant during or immediately
after sample collection by several gentle inversions. Collection directly into a
Vacutainer tube allowing the vacuum to draw the appropriate amount of blood is
optimal.
Dilution with fluids
Collection of blood sample through from in used catheter is not optimal but may be
necessary in critically ill patients that are being frequently sampled for monitoring of
particular test. The catheter should be flushed with sterile saline to remove any
contaminating intravenous fluids and the first 3 mL of blood should be discarded to
avoid dilutional effects.
Rough handling
Vigorously shaking of blood sample, forcing blood through needles, vigorous
expulsion into tubes, can cause shearing of red blood cells and platelet clumping.
Storage
Storage of blood can result in many false changes in hematology results. These
changes are minimized but not eliminated by cold storage refrigerated or shipping on
ice packs. Ensure that the slides are maintained at room temperature and are not
stored cold or placed in direct contact with cool packs, as the slide can freeze or
become moist, thus rupturing the cells.
Artifacts of specimen handling and preparation can significantly impair examination
of blood cells, but are easily avoided. If a delay in analysis is anticipated, smears
should be made and sent along with the EDTA tube. Air-dried unfixed smears hold up
very well unless subjected to flies or moisture.

Age-related changes that occur are:

Red blood cells: crenation, lysis (this will decrease the RBC count and HCT, leading
to a falsely high MCH and MCHC), hemoglobin crystallization. Red blood cells also
swell with storage (take up water). This causes a falsely increased mean cell volume
(MCV) and decreased mean cell hemoglobin concentration (MCHC). Because the HCT
is dependent on the MCV, the HCT may be higher than normal.
White blood cells: Swellling and smoothing of the nuclear chromatin (mimicking
band neutrophil formation), pyknosis and karyhorrhexis of nuclei, cell smudging, and
prominence of Döhle bodies (mimicking toxic change). Dohle bodies can start to
develop within 4, 8 and 24 hours when EDTA-anticoagulated blood is kept at room
temperature, on ice or at 4ºC, respectively. Pyknotic leukocytes resemble (and can be
misinterpreted as) nucleated red blood cells. These changes can decrease a white cell
count (lysed cells are not counted) and can affect the accuracy of a differential cell
count. Sometimes, the changes are so severe, that an accurate differential cell count
cannot be performed.
Platelets: Clumping, degranulation (the latter makes platelets difficult to see and
enumerate). Platelet clumping decreases the platelet count and increases the mean
platelet volume (MPV), since a small clump of platelets is seen as a single large
platelet. Large platelet clumps are excluded from the count altogether.

SAMPLE REJECTION
Blood sample can be rejected based on following reasons; Sample container is not
labelled correctly. Sample is insufficient. Wrong sample container is chosen. The
sample tube is not sealed properly, sample container is broken. Blood sample
contains clot plug or sample is haemolysed. Temperature should be maintained at 2
to 8°C. Sample should be processed within 2 hours.

WASTE DISPOSAL

BLACK: Paper, food materials, stationery items.

YELLOW: Experimental animal organs, body organs, removed tissue from body,
cotton, bandage, swab, pathological tissues, used masks, microbiological and surgical
wastes.
GREEN: Syringe cover, reagent plastic bottle, saline bottle, needle cap, plastic
disposal, plastic tumbler, Dettol, plastic and water bottle.
RED: Intravenous sets, tubes, syringes (without needle), sample containers for blood
and urine, gloves, test tissues (plastic) and catheter.
WHITE: Needle, butterfly needle, blade, guide wires, test tube, glass, glassware waste.