A medical laboratory or clinical laboratory

Is a laboratory where tests are conducted out on clinical specimens to obtain information
about the health of a patient to aid in diagnosis, treatment, and prevention of disease

There are two main types of lab processing the majority of medical specimens. Hospital
laboratories are attached to a hospital, and perform tests on their patients.

Private (or community) laboratories receive samples from practitioners, insurance

companies, clinical research sites and other health clinics for analysis.
For extremely specialised tests, samples may go to a research laboratory. Some tests
involve specimens sent between different labs for uncommon tests.

For example, in some cases it may be more cost effective if a particular laboratory
specializes in a less common tests, receiving specimens (and payment) from other labs,
while sending other specimens to other labs for those tests they do not perform.
A medical laboratory scientist (MLS), also known as a medical technologist
or clinical laboratory scientist, works to analyze a variety of biological
specimens. They are responsible for performing scientific testing on samples
and reporting results to physicians.

Medical laboratory scientists perform complex tests on patient samples using

sophisticated equipment like microscopes.

The data they find plays an important role in identifying and treating cancer,
heart disease, diabetes, and other medical conditions.

It is estimated 60 to 70 percent of all decisions regarding a patient's

diagnosis, treatment, hospital admission, and discharge are based on the
results of the tests medical laboratory scientists perform.
Scope of practice
Medical laboratory scientists collaborate very closely with physicians and medical
laboratory technicians in diagnosing and monitoring disease processes, as well as
monitoring the effectiveness of therapy.

Areas of medical laboratory training include microbiology, chemistry, hematology,

immunology, transfusion medicine, toxicology, and molecular diagnostics.
Specimen processing and work flow
In a hospital setting, sample processing will usually start with a set of
samples arriving with a test request, either on a form or electronically via the
laboratory information system (LIS).
Inpatient specimens will already be labeled with patient and testing
information provided by the LIS.
Entry of test requests onto the LIS system involves typing (or scanning
where barcodes are used) in the laboratory number, and entering the patient
identification, as well as any tests requested.

This allows laboratory analyzers, computers and staff to recognize what tests
are pending, and also gives a location (such as a hospital department, doctor
or other customer) for results reporting.
Specimens are prepared for analysis in various ways. For example, chemistry
samples are usually centrifuged and the serum or plasma is separated and
tested.
If the specimen needs to go on more than one analyzer, it can be divided into
separate tubes.

Many specimens end up in one or more sophisticated automated analysers,

that process a fraction of the sample to return one or more test results.

Some laboratories use robotic sample handlers (Laboratory automation) to

optimize the workflow and reduce the risk of contamination from sample
handling by the staff.
 Collecting Samples for
Laboratory Testing
Today’s technologies allow testing on an impressively wide variety of samples
collected from the human body. Most often, all that is required is a blood sample.
However, samples of urine, saliva, sputum, feces, semen, and other bodily fluids
and tissues also can be tested.

sample used for testing is often determined by the purpose of the particular test:
a blood glucose test is used to help diagnose diabetes and monitor blood glucose
levels in diabetics while urine glucose is one of the substances tested when
a urinalysis is performed, such as when a urinary tract infection or kidney
disorder is suspected.
Sometimes there are options for the type of sample, such as with HIV antibody
testing (blood, urine, and oral fluid screening tests are available), and in other
situations, one particular type of sample is required.
Precautions for the prevention of bloodborne pathogens when working with human
serum and other body fluids. These include:

• Wear personal protective equipment such as safety glasses, gloves, laboratory coats.
• If you have cuts or abrasions on the skin of your hands, cover them with adhesive
dressing.
• Use needles and lancets only once, and dispose of them in a “sharps” container for
decontamination.
• Remove gloves and wash your hands after completing any task involving the
handling of biological material.
Examples of samples
Semen
Male patients ejaculate into a specimen container, avoiding lubricants,
condoms, or any other potentially contaminating materials.

Usually, men need to refrain from ejaculating for at least 2 days prior
but less than 7 days before collecting the specimen.

The specimen must not be refrigerated but kept as close to body

temperature as possible by placing the container in a pocket and
delivering it to the laboratory within 60 minutes.
Sputum
Patients are instructed to cough up sputum from as far down in the lungs as
possible. This is best accomplished first thing in the morning before eating or
drinking, by taking several deep breaths before expectorating into the collection
cup. Sputum should be relatively thick and not as watery as seen when producing
saliva

Stool
Patients usually collect this sample themselves during toileting, following
instructions to prevent the sample from becoming contaminated from other
material in the toilet bowl. Patients may also be told to avoid certain foods during
the test period. Depending on the test, patients may be instructed to collect the
sample in a container, scoop a small portion into a vial, or smear a small amount
on special test paper. Wash your hands well after handling the sample
Urine
Most urine specimens are collected by having the patient urinate into a
container or receptacle.
To keep the sample from becoming contaminated by materials outside the
urinary tract, patients are given instructions on how to clean the genital area
and void a bit of urine before collecting the specimen into the container. (If a
urinary catheter is required, a health practitioner is usually responsible for
insertion.)
Collecting the urine specimen is awkward but not in itself uncomfortable (An
infection, however, can create a burning sensation during urination.).
For certain tests, 24-hour urine samples are collected at home and must be
refrigerated during the collection process. Remember to wash hands well after
collecting the specimen.
Secretions and tissues from the female reproductive system
Samples of vaginal secretions are obtained by running a cotton swab over the walls
of the vagina; cervical cells for a Pap test are obtained using a cotton swab and
spatula or a tiny brush.

Endometrial tissue samples are obtained by inserting a thin, flexible, hollow tube
into the uterus, during which you may feel a slight pinch or brief cramping.

Patients may feel some emotional and physical discomfort during this procedure. A
sensitive approach by the healthcare provider contributes greatly to the patient’s
emotional comfort. If you are physically uncomfortable, discuss this with your
healthcare provider.
Hair (e.g., for nicotine/cotinine test, heavy metals testing, fungal tests,
and testing for drugs of abuse)

Fingernail clippings (e.g., for heavy metals testing and fungal tests)

Blood
Blood samples can be collected from blood vessels (capillaries, veins, and
sometimes arteries) by trained phlebotomists or medical personnel.
The sample is obtained by needle puncture and withdrawn by suction
through the needle into a special collection tube. Some specimens may be
obtained by a finger puncture that produces a drop of blood, such as that
used for glucose testing.
The procedure usually takes just a few minutes and hurts just a bit,
typically when the needle is inserted or from the puncture of a lancet.
Capillary blood obtained by fingerstick:

1.Label pre-cleaned slides (preferably frosted-end) with the patient’s name

(or other identifier) and date and time of collection.
2.Clean the site well with alcohol; allow to dry.
3.Prick the side of the pulp of the 3rd or 4th finger (alternate sites include ear
lobe, or in infants large toe or heel).
4.Wipe away the first drop of blood with clean gauze.
5.Prepare at least 2 thick smears and 2 thin smears.
Venous blood obtained by venipuncture:

1.Label collection tubes and pre-cleaned slides (preferably frosted-end)

with the patient’s name (or other identifier) and date and time of
collection.
2.Clean the site well with alcohol; allow to dry.
3.Collect the venous blood in a vacuum tube containing anticoagulant
(preferably EDTA); alternatively, collect the blood in a syringe and
transfer it to a tube with anticoagulant; mix well.
4.Prepare at least 2 thick smears and 2 thin smears as soon as possible after
collection.
Tissue biopsy
Samples of tissue may be obtained from a number of different body sites, such as
breast, lung, lymph node, or skin.
Depending on the site and the degree of invasiveness, some pain or discomfort may
occur.
The time required to perform the procedure and for recovery can also vary greatly.
These procedures are conducted by healthcare providers who have had specialized
training. Tissue biopsies can be collected using procedures, such as:

Needle biopsy — A needle is inserted into the site and cells and/or fluid are
withdrawn using a syringe. A slight pinch may be felt at the site of needle insertion.
Usually no recovery time is required and slight discomfort may be experienced
afterwards.
An excisional biopsy is a minor surgical procedure in which an incision is
made and a portion or all of the tissue is cut from the site.

A closed biopsy is a procedure in which a small incision is made and an

instrument is inserted to help guide the surgeon to the appropriate site to
obtain the sample.

These biopsies are usually performed in a hospital operating room. A local or

general anesthetic is used, depending on the procedure, so the patient remains
comfortable. If a general anesthetic is used, recovery may take one to several
hours.
Cerebrospinal fluid (CSF)
A sample of cerebrospinal fluid is obtained by lumbar puncture, often called a spinal tap. It is a
special but relatively routine procedure. It is performed while the person is lying on their side in
a curled up, fetal position or sometimes in a sitting position.

The back is cleaned with an antiseptic and a local anesthetic is injected under the skin. A special
needle is inserted through the skin, between two vertebrae, and into the spinal canal.

The health practitioner collects a small amount of CSF in multiple sterile vials; the needle is
withdrawn and a sterile dressing and pressure are applied to the puncture site.

The patient will then be asked to lie quietly in a flat position, without lifting their head, for one
or more hours to avoid a potential post-test spinal headache.

The lumbar puncture procedure usually takes less than half an hour. Discomfort levels can vary
greatly. The most common sensation is a feeling of pressure when the needle is introduced.
Example of diseases are fungal infections, tuberculosis
Amniotic fluid
A sample of amniotic fluid is obtained using a procedure
called amniocentesis to detect and diagnose certain birth defects, genetic
diseases, and chromosomal abnormalities in a fetus.
Amniotic fluid surrounds, protects, and nourishes a growing fetus
during pregnancy.

A sample of amniotic fluid is aspirated by inserting a thin needle through the

belly and uterus into the amniotic sac, collecting both cellular and chemical
constituents that are analyzed to detect certain genetic abnormalities that may
be present.
Types of Blood Collection Tubes and Their uses

Evacuated Tubes that are used for blood collection for different
laboratory tests are made up of tubes in variable sizes, and color-coded
tops to indicate tube contents.

The majority of blood collection tubes contain an ingredient that either

speeds up the blood's clotting (clot activator) or stops blood from
becoming clot-free (anticoagulant).

The following list lists the most frequently utilized blood collection
tubes, along with their additives, and their uses in lab:
Red
Red bottles are more frequent – it’s utilized for biochemistry tests that require
serum that could be negatively affected with the separation gel utilized within
the yellow bottle.
Additive: No or contain silica particles that serve as clot activators.
• Clot activator increases blood clotting by using crystals of silica or glass.

• Laboratory Utilization: Testing of the serum (glucose, cholesterol,

cholesterol, triglycerides, HDL, potassium, amylase, alkaline, phosphatase
BUN, liver enzymes, CK) Blood bank, serology (RH Typing, Antibody
screening, the red Cell phototyping, the rheumatoid factor,)
Yellow
Additive: anticoagulant SPS (Sodium Polyanetholsulfonate) & ACD (acid
citrate dextrose)
Prevent blood from clotting and also stabilizes the growth of bacterial.

Laboratory Utilization: Blood and bodily fluids (HLA DNA, DNA,

paternity), Tubes that contain SPS – the culture of bodily fluids and blood
(HLA DNA, DNA and Paternity).
The SPS assists in the healing of microorganisms through slowing down or
slowing down the action of phagocytes, complement, and some antibiotics.
Tubes with ACD can be used to be used for cell research, HLA typing,
paternity testing, and paternity tests.
Light Blue
This blue container is utilized for tests of haematology involving the clotting
system. These tests requires whole blood that has been activated to be
analysed.
Additive: Sodium Citrate
It create a binding and removes calcium from blood to stop it from bleeding
Laboratory uses: coagulation (clotting process). It is also known as PT
(Prothrombin Time – evaluates the extrinsic mechanism of the Cascade of
Coagulation and monitors Coumadin therapy).
APTT/PTT (Activated Partially Thromboplastin Time – assesses the system
that drives the coagulation cascade, and also evaluates the effectiveness of
heparin therapy), FDP (Fibrinogen Degradation Products), TT (Thrombin
time), Factor assays.
Green
This bottle, which is not widely used, is designed for biochemistry tests that
require heparinised plasma or complete blood to be analysed.
Additive: Heparin (Sodium/Lithium/Ammonium)
It inhibit thrombin formation to stop bleeding
• Lab uses: Chem Tests (Plasma determinations in the field of chemistry)
Ammonia and electrolytes, carboxyhemoglobin and STAT and chromosome
screening, aldosterone, renin.
Lavender
They are usually used for tests of haematology where whole blood is needed
to be analysed.

Additive: EDTA (Ethylenediaminetetraacetic Acid)

It remove calcium, thereby preventing blood clotting

Lab uses: Testing for Hematology (ESR, CBC w/diff., HgBA1c), blood film
to detect abnormal cells or malaria parasites red cell folate, reticulocytes Test
for Monospot for EBV Parathyroid hormone (PTH).
Grey
Additional: Potassium oxalate and Sodium fluoride

The sodium fluoride works as an antiglycolytic agent , which helps ensure

that there is no further glucose breakdown takes place within the sample after
it has been taken.

Potassium Oxalate eliminates calcium, and also acts in the role of an

anticoagulant.

Laboratory use: Chemical testing, specifically glucose(sugar) as well as

lactate, Glucose tolerance test (GTT).
Royal Blue
Additive: The Sodium Heparin is also Sodium EDTA
It inhibit Thrombin formation to stop
Laboratory uses: the trace elements of Chemistry (such such as Zinc,
Copper, Lead and Mercury) as well as toxicology and nutrition
chemistry testing

Black
Additive: Sodium Citrate
It form calcium salts that remove calcium
The laboratory Uses: ESR for pediatric ESR (erythrocyte
sedimentation rate test)