Clinical Laboratory Equipment and Medical Laboratory Department Overview

210 35 - 34 Clinical Laboratory Equipment MASH 210, A. Eshra, Spring 2013/14, 1st Semester 1

Course Instructor Ayman Elsayed Eshra Assistant Prof. Dr. Eng. Tel. +9664735277 401 Room:24A 7-3 Office hours: see time table E-mail: aeshra@ksu.edu.sa 2

Textbooks 1- Carr, J. J. & Brown, J. M. Introduction to biomedical equipment technology 4th ed., ch.16 pp.427. 2- Despopoulos, A. & Silernagl, S. Color Atlas of Physiology 5th ed. Thieme, stuttgart . New York, pp.88-105, 2003. 3- Health care product comparison system 3

Grading & Assessment Assignments Reports Quizzes Midterm lab Final 10% 10% 10% 20% 10% 40% 4

Contents Blood and its Components Blood Tests Centrifuge Colorimeter Spectrophotometer Flam Photometer Blood cells Counter Blood Gas Analyzer Autoanalyzer Chromatography Oxygen Concentrator 5

Objective 1- Be able to state the purpose of blood. 2- Be able to list the components and describe the composition of blood. 3- Be able to list and describe blood tests ( cell and chemistry). 4- Be able to state the purpose, uses, principle of operation, and maintenance of the following equipment: centrifuge, colorimeter, spectrophotometer, flame photometer, blood gas analyzers (pH, PO2, PCO2), Chromatograph, and autoanalyzers. 5- Be able to describe renal physiology, including types of renal failure and the hemodialysis machine operation, safety, and maintenance.

Medical Laboratory department The medical laboratory department includes facilities, personnel, and equipment within the hospital or public or private location. The facilities must include a clean, safe surrounding with a special area for sterilization of contaminated blood urine samples and equipment. Since high-volume blood testing occurs in this department , sufficient storage and cleaning area must be designed. In such a situation, the chance of error (misreading or a patient record mixup) is high. Medical laboratory personnel include equipment operators (medical technologists), supervisors, and physicians. The director of theses facilities is usually a physician. suction devices, and sophisticated instrumentation, such as colorimeters, spectrophotometers, blood cell and gas analyzers, chromatographs, autoanalyzers, and computerbased record and operation systems. Equipment contained in the laboratory includes glassware, centrifuges, physicians as an aid in diagnosing disease and imblanced physiological states. Standard cards with printouts of RBC or WBC counts, Hct, MCV, MCHC, and blood chemistry are presented by most clinical Instrumentation. Recordkeeping is extremely important. This information is used by

Purpose of Clinical laboratory Equipment The purpose of Clinical laboratory Equipment is to provide a means of measuring required substances and metabolic waste products in blood and urine. What is blood? Blood is the life-maintaining fluid that circulates through the body's: 1-Heart. 2-Arteries. 3-Veins. 4-Capillaries. What is the function of blood? Blood carries the following to the body tissues: 1-Nourishment. 3-Hormones. 5-Antibodies. 7-Oxygen. 2-Electrolytes. 4-Vitamins. 6-Heat red blood cells Blood carries the following away from the body tissues: 1-Waste matter. 2-Carbon dioxide. 8

Where are blood cells made? Blood cells are made in the bone marrow. The bone marrow is the spongy material in the center of the bones that produces about 95 percent of the body's blood cells. There are other organs and systems in our bodies that help regulate blood cells. The lymph nodes, spleen, and liver help regulate the production, destruction, and differentiation (developing a specific function) of cells. The production and development of new cells is a process called hematopoiesis. Blood cells formed in the bone marrow start out as a stem cell. A "stem cell" (or hematopoietic cell) is the initial phase of all blood cells. As the stem cell matures, several distinct cells evolve such as the red blood cells, white blood cells, and platelets. Immature blood cells are also called blasts. Some blasts stay in the marrow to mature and others travel to other parts of the body to develop into mature, functioning blood cells. Bone marrow [4]. 9

What are the components of blood? Human blood consists of about 22 percent solids and 78 percent water. The components of human blood are: Plasma is the fluid portion of the blood in which the blood cells are suspended, including: electrolytes, nutrients, metabolites, vitamins, hormones, gases, and proteins. 1-Red blood cells (erythrocytes) - carry oxygen from the lungs to the rest of the body. 2-White blood cells (leukocytes) - help fight infections and aid in the immune process. Types of white blood cells include: Lymphocytes. Monocytes. Basophils. Neutrophils (granulocytes). Eosinophils. 3-Platelets (thrombocytes) - help in blood clotting. 4-Fat globules. 5-Chemical substances, including: Carbohydrates. Proteins. Hormones. 6-Gases, including: Oxygen. Carbon dioxide. Nitrogen. 10

Spinning of Blood components Clear to straw colored (90% water) Solids (8% by mass) Plasma proteins albumin, globulin, fibrinogen Growth/protective hormones, vitamins, antibodies, enzymes Inorganic substances Na+, K+, Cl-, Fe Organic substances urea waste and protein, fat, glucose nutrient Respiratory gases O2 and Co2 White blood cells Leukocytes Defense against bacteria Amoeba like shaped Red blood cells erythrocytes Transport O2 and CO2 Concave disc shaped 11

Composition of Blood The blood volume of an adult correlates with his or her (fat-free) body mass and amounts to ca. 4 4.5 L in women ( ) and 4.5 5 L in men of 70 kg BW ( ); table1. The blood consists of a fluid (plasma) formed elements: Red blood cells (RBCs): The primary function of red blood cells, or erythrocytes, is to carry oxygen and carbon dioxide. Hemoglobin (Hgb) is an important protein in the red blood cells that carries oxygen from the lungs to all parts of our body. RBCs play an important role in pH regulation. White blood cells (WBCs): The primary function of white blood cells, or leukocytes, is to fight infection. There are several types of white blood cells and each has its own role in fighting bacterial, viral, fungi, and parasitic infections. Types of white blood cells that are most important for helping protect the body from infection and foreign cells include the following: 1-Neutrophils. 2-Eosinophils. 3-Lymphocytes. 4-Monocytes. 5-Granulocytes. Seen here are two lymphocyte (left) cells and one neutrophil (right) cell of the human immune system [5]. 12

White blood cells: Help heal wounds not only by fighting infection but also by ingesting matter such as dead cells, tissue debris and old red blood cells. Are our protection from foreign bodies that enter the blood stream, such as allergens. Are involved in the protection against mutated cells, such as cancer. Platelets (thrombocytes): The primary function of platelets, or thrombocytes, is blood clotting. Platelets are much smaller in size than the other blood cells. They group together to form clumps, or a plug, in the hole of a vessel to stop bleeding. erythrocyte (left), thrombocyte (center), and leukocyte (right) 13

Blood volume in liters relative to body weight (BW) 0.041 X BW (kg) + 1.53, 0.047 X BW (kg) + 0.86 Hematocrit (cell volume/ blood volume): : 0.40 0.54 : 0.37 0.47 Erythrocytes (1012/L of blood = 106/ L of blood): 4.6 5.9 4.2 5.4 Hemoglobin (g/L of blood): 140 180 120 160 MCH, MCV, MCHC mean corpuscular (MC) mean cell , hemoglobin (Hb), MC volume, MC Hb concentration Fig.1 Leukocytes (109/L of blood = 103/ L of blood): 3 11 (64% granulocytes, 31% lymphocytes, 6% monocytes) Platelets (109/L of blood = 103/ L of blood): 170 360 180 400 Plasma proteins (g/L of serum): 66 85 (including 55 64% albumin) 14 Table 1

Fig.1-C Erythrocyte parameters MCH, MCV and MCHC 10-12 Femto- 10-15 Pico- 15

Composition of Blood 1. Cells 1.1. 1.2. 1.3. Red white Platelets 2. Plasma 2.1. 2.2. 2.3. 2.4. 2.5. Protein Nutrients Regulatory and protective substances Electrolytes Metabolic waste substances 16

1.1. Red Blood Cells (RBCs) No Nucleus Disc shaped 120 days life span Consists of : Hemoglobin and water Each RBC contains 4 iron atoms in structure known as the hemoglobin 1.2. White Blood cells Amoeba like Nucleus 10-14 days life span 6-10 Purpose: Surround/ swallow invading bacteria and foreign substance to destroy the invader s effect. (WBC s) 103 cells/mm3 17

1.3. Platelets (PLTs) Size: 2-3 m Normal range: 15-40 104/ L Number 2-8 105 cells/mm3 Cell fragments No nucleus Purpose: Blood coagulation and clotting 2. Blood plasma Plasma proteins. Plasma nutrients-energy-storing. Regulatory and protective substances. Plasma electrolytes. Metabolic waste substances. 2.1. Plasma proteins Albumins Fibrinogen and prothrombin Globulin 18

2.2. Plasma nutrients-energy- storing Glucose (blood sugar). Lipids (fats) Amino acids (Proteins for tissue growth) 2.3. Regulatory and protective substances Enzymes Hormones Antibodies 2.4. Plasma electrolytes-acid-base Sodium Na+ Potassium K+ Chloride Cl- 2.5. Metabolic waste substances Urea. Uric. 19

BLOOD TESTS Cell tests Chemical tests 20

Common hematology tests Hematology Analyzer measures and determines several parameter such as: RBC s WBC s Hgb PLT Hct: Hematocrit is the volume ratio of red cells to whole blood (Table 1). MCV : Mean Cell Volume MCH : Mean Cell Hemoglobin MCHC : Mean Cell Volume Hemoglobin Concentration MPV : Mean Platelet Volume RDW : Red Blood Cell Distribution width 21

Blood cell tests include the following 1-RBC count: Accomplished manually (diluting a blood sample 100:1 and counting the cells per cubic millimeter by use of a microscope) or automatically (blood cell counting analyzers). 2-WBC count: Accomplished manually (diluting a blood sample 10:1 and counting the cells per cubic millimeter by use of a microscope) or automatically (blood cell counting analyzers). 3-Hematocrit (Hct): Percentage of total blood volume that is solid (WBCs volume is negligible). This is measured by spinning a blood sample in a test tube and optically observing the percentage of packed RBCs. It normally ranges from 45% to 55%. 4-Mean cell (corpuscular) volume (MCV): Average volume of an RBC measured by a value based on the RBC count (number per mm3). This volume is measured in femtoliters (10-15 L) MCV = Hct / RBC These testes aid in diagnosing anemia and other blood disorders and certain cancers of the blood; to monitor blood loss and infection; to monitor a patient's response to cancer therapy, such as chemotherapy and radiation. 22

5-Platelet count: automatically by a blood cell analyzer. To diagnose and/or monitor bleeding and clotting disorders. Accomplished 6-Mean cell hemoglobin (MCH): The proportional mass of RBC/100 mL of the total number of RBCs is expressed as: This value is indicated in picograms (10-12 g), measured by lysing RBCs (breaking their membranes) to release hemoglobin (27 32pg). Acid hematin or cyanmethemoglobin can be generated by hemoglobin chemical reaction. The resultant value is measured by a colorimeter and normally indicates 32 % to 36 % color index. 7-Mean cell hemoglobin concentration (MCHC): Hemoglobin color concentration measured by lysing RBCs (breaking their membranes) to release hemoglobin. The resultant value is measured by colorimeter and normally indicates 32 % to 36% color index. 23

Blood Chemical Tests 1-pH 4-Urea waste 2-Glucose 5-Uric acid 3-Amino acids 6-Cholesterol Other Blood Tests 1- Blood serological tests: Theyinvolve testing for agglutination (clumping) of cells due to the addition of antigens (bacterial toxins) to blood serum. This occurs following the reaction of a specific antibody produced by WBCs in response to the specific invader. 2- Blood bacteriological testes : They include growth of blood bacteria in a petri dish with appropriate nutrients. 3- Historical tests: Specimens are obtained by cutting tissues with a precision slicer known as a microtome. They are studies of small, thin tissue samples under the microscope. 24

Labeling Collecting Documenting Processing 25

Analyzing Results 26

Blood transport heat References 1. http://www.medicine.mcgill.ca/physio/vlab/bloodlab/eryfrag2_n.htm 2. http://labtestsonline.org/lab/photo/blood1/?start=3 3. http://anthro.palomar.edu/blood/blood_components.htm 4. http://www.chw.org/display/PPF/DocID/21846/router.asp 5. http://www.blood.co.uk/about-blood/components/ 27