MEDICAL LABORATORY SCIENCES

Tapeshwar Yadav
(Lecturer)
BMLT, DNHE,
M.Sc. Medical Biochemistry
INTRODUCTION:
 In the era of modern technology, health care delivery
system involves so many different personnel and specialties
that the caregiver must have an understanding and working
knowledge of other professional endeavors, including the
role of diagnostic evaluation.
 Basically, laboratory and diagnostic tests are tools by and of
themselves, they are not therapeutic.
 In conjunction with a pertinent history and physical
examination, these tests can confirm a diagnosis or provide
valuable information about a patient status and response to
therapy.
 In addition to these, laboratory findings are essential for
epidemiological surveillance and research purposes.
Contd…
If the entire network of a laboratory service is to be
effectively utilized and contribute to health care and
disease prevention, every member of its work force need
to:
 Understand the role of the laboratory and its
contribution to the nation’s health service;
 Appreciate the need to involve all members in the
provision of health service;
 Follow professional ethics and code of conduct;
 Experience job satisfaction and have professional loyalty.
Medical laboratory science
Medical laboratory science is a complex field embracing a
number of different disciplines such as
 Microbiology,
 Hematology,
 Clinical Chemistry,
 Urinalysis,
 Immunology,
 Serology,
 Histopathology,
 Immunohematology and
 Molecular biology and others.
Medical Laboratory Technology
Introduction to Medical Laboratory Technology is
a basic course that equips the student with the most
essential knowledge and skill pertaining to medical
laboratories such as:
 Importance of laboratory services;
 Role of medical laboratory technologist;
 Use of laboratory wares, instruments and sterilization
techniques;
 Prevention and control of laboratory accidents and;
 Institution of quality control system.
Contd…
Moreover, this course is extremely important for the
student as it paves the ways to easily understand
various professional courses such as Hematology,
Bacteriology, Urinalysis, Parasitology, and others.
Hence, great emphasis should be given to this subject
matter so as to train qualified, competent and task
oriented medical laboratory technologists.
History of Medical Laboratory
Science:
 It is difficult to exactly say when and where medial laboratory
science was started.
 However, some early historical references have shown that
there was examination of body fluid around the era of
Hippocrates.
 The laboratory’s contribution to modern medicine has only
recently been recognized by historians as something more than
the addition of another resource to medical science and is now
being appreciated as the seat of medicine, where clinicians
account for what they observe in their patients.
 The first medical diagnoses made by humans were based on
what ancient physicians could observe with their eyes and ears,
which sometimes also included the examination of human
specimens.
Contd…
The ancient Greeks attributed all disease to disorders of
bodily fluids called humors, and during the late medieval
period, doctors routinely performed uroscopy.
Later, the microscope revealed not only the cellular
structure of human tissue, but also the organisms that cause
disease.
More sophisticated diagnostic tools and techniques—such
as the thermometer for measuring temperature and the
stethoscope for measuring heart rate—were not in
widespread use until the end of the 19th century.
The clinical laboratory would not become a standard
fixture of medicine until the beginning of the 20th century.
Contd…
 The most important event that contributes for the development
of the profession was the discovery of microscope by a
German scientist Antony Van Leeuwenhoek.
 Improvements in the microscope allowed further exploration
of the cellular and microbial worlds in the 19th century.
 Previously one cannot talk about the field of medical
laboratory science without also talking about the medical
specialty of pathology.
 Early laboratory practioners were physicians, pathologists or
both.
 But sooner medical laboratory profession was developed into
a separate discipline having g its own educational
requirements and standards.
Ancient diagnostic methods:
In ancient, the earliest physicians made diagnoses and
recommended treatments based primarily on observation
of clinical symptoms.
Other less-than-scientific methods of diagnosis used in
treating the middle and lower classes included divination
through ritual sacrifice to predict the outcome of illness.
Usually a sheep would be killed before the statue of a
god. Its liver was examined for malformations or
peculiarities; the shape of the lobes and the orientation
of the common duct were then used to predict the fate of
the patient.
Contd…
Ancient physicians also began the practice of examining
patient specimens. The oldest known test on body fluids
was done on urine in ancient times (before 400 BC). Urine
was poured on the ground and observed to see whether it
attracted insects. If it did, patients were diagnosed with
boils.
The ancient Greeks also saw the value in examining body
fluids to predict disease.
At around 300 BC, Hippocrates promoted the use of the
mind and senses as diagnostic tools, a principle that played
a large part in his reputation as the “Father of Medicine.”
Role of medical/Clinical laboratory
science in Health Care:
 The medical laboratory services play a pivotal role in the
promotion, curative and preventive aspects of a nation’s
health delivery system.
 The service gives a scientific foundation by providing
accurate information to those with the responsibility for:
 Treating patients and monitoring their response to treatment,
 Monitoring the development and spread of infectious and
dangerous pathogens (disease causing organisms),
 Deciding effective control measures against major prevalent
disease,
 Deciding health priorities and allocating resources.
Contd…
Without reliable laboratory services:
The source of a disease may not be identified
correctly.
Patients are less likely to receive the best possible care.
Resistance to essential drugs may develop and
continue to spread.
Epidemic diseases may not be identified on time and
with confidence.
WHY THE LABORATORY IS
NEEDED IN HEALTH CARE:
 The clinical laboratory science has an important role in
improving the:
Quality,
Efficiency,
Cost-effectiveness,
Planning and management of district health care.
What difference can the laboratory
make to the quality of health care?
 Laboratory investigations increase the accuracy of
disease diagnosis:
Many infectious diseases and serious
illnesses can only be diagnosed reliably by using the
laboratory. For example, errors in the diagnosis of
malaria have been shown to be particularly high when
diagnosis is based on clinical symptoms alone.
Contd…
Misdiagnosis or late diagnosis can lead to:
Incorrect treatment with misuse and waste of drugs.
 Increased morbidity and mortality.
 Hospitalization and need for specialist care.
Patient dissatisfaction leading to negative responses to
future health interventions.
 Underutilization of health facilities.
Lack of confidence and motivation of health
personnel.
Increased risk to the community from inappropriate
disease management and untreated infectious disease.
Contd…
 The laboratory has an essential role in screening for ill
health and assessing response to treatment:
At district level the laboratory is needed to:
Assess a patient’s response to drug therapy.
Assist in monitoring the condition of a patient and help to
decide when it may be necessary to refer for specialist
care.
Screen pregnant women for anaemia, proteinuria, and
infections which if not treated may cause disease in the
newborn, premature birth, low birth weight, or significant
maternal illness.
Contd…
Screen the contacts of persons with infectious diseases
such as tuberculosis and sexually transmitted diseases.
Detect inherited abnormalities such as haemoglobin-S
as part of district family planning health services.
Screen whole blood and blood products for transfusion
transmitted pathogens.
Contd…
 The laboratory is needed to work with others in
reducing infection in the community and
investigating epidemics rapidly
 The public health functions of a district health
laboratory service include:
Detecting the source(s) of infection, identifying
carriers, and contact tracing.
Participating in epidemiological surveys.
Assisting in disease surveillance and in the selection,
application, and evaluation of control methods.
Contd…
Helping to control hospital acquired infections.
Participating in health education.
Examining designated community water supplies for
indicators of faecal and chemical pollution.
Responding rapidly when an epidemic occurs,
including appropriate on-site testing and the collection
and despatch of specimens to the Regional or Central
Microbiology Laboratory for pathogen identification.
In what ways can the laboratory contribute to
achieving efficiency and cost effectiveness in health
care System?

The laboratory can help to reduce expenditure on drugs

When the laboratory is used to improve the accuracy of
diagnosis, perform appropriate antimicrobial susceptibility
testing, and monitor a patient’s response to treatment:
Drugs can be used more selectively and only when needed.
Patterns of emerging drug resistance can be identified
more rapidly and monitored.
Contd…
 The laboratory can lower health care costs by
identifying disease at an early stage
Early successful treatment following early
correct laboratory diagnosis can help to:
Reduce the number of times a patient may need to seek
medical care for the same illness.
Prevent complications arising from advanced untreated
disease.
Avoid hospitalization and further costly investigations.
Contd…
 Significant savings can be made when the laboratory
participates in local disease surveillance and control
This is because:
The spread of infectious disease can be contained more
rapidly.
Disease control measures can be selected and targeted
more effectively.
Sources of infection and disease carriers can be
identified.
What information can the laboratory provide to achieve
rational health planning and good health management?
 Reliable laboratory test results with relevant patient
data, provide information on the health status of a
community, health patterns, and disease trends
This information is needed to establish health care
priorities and plan:
Health care programmes and location of health facilities.
Training of district health personnel and delivery of
health services.
Treatment schedules and changes in drug usage.
Financing of district health care programmes.
Contd…
 Public health laboratory activities provide accurate
epidemiological information for health planning
This information can help to determine:
Causes of ill health in the community and risk factors
contributing to the presence and spread of diseases.
Prevalence and incidence rates of important infectious
diseases.
Effectiveness of health care programmes, drug
treatments, and immunization programmes.
Which methods have appropriate sensitivity and
specificity to be useful.
 Role of Medical/Clinical Laboratory
Scientists:
The medical laboratory scientist has the best of both worlds
with the challenges and rewards of medicine and science.
The medical laboratory scientist performs a full range of
laboratory tests—from simple pre-marital blood tests, to
more complex tests to uncover diseases such as AIDS,
diabetes, and cancer. The medical technologist is also
responsible for confirming the accuracy of test results and
reporting laboratory findings to the pathologist and other
doctors.
Medical laboratory scientists work quickly and carefully.
They hold life and death in their hands, because the
information they give to the doctor influences the medical
treatment a patient receives.
Contd…
In their search for data on a patient’s health, medical
technologists do much more than examine specimens
through a microscope. They operate complex
electronic equipment, computers, and precision
instruments.
Medical laboratory scientists are self-sufficient,
precise and thorough. They are trouble-shooters who
not only report accurate results, but also know when
results are incorrect and need to be rechecked.
Medical laboratory scientists work in five major areas
of the laboratory: Blood banking, Chemistry,
Hematology, Immunology and Microbiology.
Role of medical laboratory
technologist:
Some of the major roles of medical laboratory technologist
are to:
Carry out routine and advanced laboratory tests using
standard laboratory methods;
Apply problem-solving strategies to administrative,
technical and research problems;
Conduct community – based researches in collaboration
with other categories of health professionals;
Provide professional consultancy on matters related to the
establishment, renovation, upgrading and reorganization
of medical laboratories of intermediate levels.
Medical Laboratory Technicians:
The challenges and rewards of medicine and science — the
medical laboratory technician has the best of both worlds.
The medical laboratory technician performs general tests in
all laboratory areas — Blood banking, Chemistry,
Hematology, Immunology and Microbiology. Working
with the supervision of a medical technologist, a medical
laboratory technician hunts for clues to the absence,
presence, extent, and causes of diseases.
Medical laboratory technicians must be accurate, dedicated
and skilled. They must also be self-motivated, and take the
initiative to do what must be done every day — to pitch in
to help the healthcare team.
 Phlebotomy technicians:
Phlebotomy technicians must like challenge and
responsibility.
They must also be accurate, work well under pressure and
communicate effectively.
Because the phlebotomy technician works directly with the
patient, he or she must also act as the "eyes and ears" of the
doctors, nurses and laboratory professionals.
The phlebotomist must notice and relay any important
information gathered during interaction with patients.
Phlebotomists must set high standards for themselves and they
must be deeply committed to quality health care delivery.
 Contd…
NOTE: All medical laboratory scientists have certain common
characteristics.
 They are problem-solvers.
 They like challenge and responsibility.
 They are accurate, reliable, work well under pressure and are
able to finish a task once started.
 They communicate well, both in writing and speaking.
 They set high standards for themselves and expect quality in the
work they do.
 But, above all, they are deeply committed to their profession,
and are truly fascinated by all that science has to offer. For
someone who chooses a career in the medical laboratory, the
exploration never ends.
Laboratory organization:
Organization: - is a system, an orderly structure, putting
things together into a working order, and making
arrangements for undertakings that involve co-operations.
The emphasis is on arrangements that enable peoples
working together and accomplishing common objectives
in an efficient, planned and economic manner.
In a single medical laboratory at least there are two
interlocking components of organizations.
These are laboratory head and other staff having their own
duties and responsibilities.
Structure of medical/Clinical
laboratory services:
A laboratory service network consists of:
1. Community based primary health care laboratory:
Duties:
To support primary health care in investigating,
controlling and preventing major diseases in the
country.
Promoting health care by integrated health education
Contd…
Main activities are to:
 Investigate by referral or testing on site, important diseases
and health problems affecting the local community. Such
investigations usually include bacterial diseases, parasitic
diseases and other causes of illness.
 Assist health care worker in deciding the severity of a patient’s
conditions.
 Collect and refer specimens for testing to the district
laboratory.
 Notify the district hospital at an early stage of any laboratory
results of public health importance and send specimens for
confirmatory tests.
Contd…
Screen pregnant women for anemia, proteinuria,
malaria, and refer serum for antibody testing.
Promote health cares and assists in community health
education
Keep records, which can be used by health authorities
in health planning and for epidemiological purposes.
Keep an inventory of stocks and order supplies.
Send an informative monthly report to the district
hospital laboratory.
2.District hospital laboratory:
Duties:
In addition to the works stated above, these
laboratories have an important role in supervising the
work of the peripheral community based laboratories,
testing referred specimens, and performing a range of
tests compatible with the work of district hospital
Main activities are to:
Perform a range of tests relevant to the medical,
surgical, and public health activities of the district
hospital.
Contd…
Support the work of the community-based laboratories
by testing referred specimens, providing reagents,
controls, standards, specimen containers, and other
essential laboratory supplies. And also visit each
primary health care laboratory in their catchments area
to inspect and discuss the investigations being
performed and, comment on their quality assurance
system, record keeping, safety procedures, as well as
the status of equipment maintenance.
Contd…
Refer specimens to the regional laboratory for test (s)
that cannot be performed in district laboratory.
Notify the regional laboratory of any result of public
health importance and to send specimens for
confirmatory tests.
Participate in the external quality assurance
programme organized by the regional laboratory.
Prepare and send periodical reports to the regional
laboratory.
3.Regional hospital laboratory:
Duties:
In addition to the duties done at the two above lower
levels, the regional laboratory assists and supervises
the district laboratories. It analyses referred specimens
and performs a range of specialized and other tests as
required by the work of the regional hospital.
Main activities are to:
Operate a regional blood transfusion center;
Prepare reagents, controls, standard solutions and
others as found necessary;
Contd…
Investigate epidemics and perform tests of public
health importance in the region;
Supervise and support the work of district laboratories;
Send specimens that require special investigation to
the central and public health laboratory;
Prepare periodical reports and send to the central and
public health laboratory.
4.Central and public health
laboratory:
Duties:
The central and public health laboratory is responsible
for planning, advising and overall coordinating of
medical laboratory services in the region.
Main activities are to:
Formulate a professional code of conduct to medical
laboratory personnel.
Perform a range of special tests not normally
undertaken in the regional laboratories such as viral,
histopathological, cytological, immunological, forensic
and genetic investigations.
Contd…
Carry out appropriate research of importance in order
to mitigate public health problems.
Evaluate new technologies and standardize techniques.
Purchase supplies and equipments for the national
laboratory service and organize an efficient system of
requisition, distribution, and maintenance of
equipment.
Communicate and collaborate with International
Organizations in promoting laboratory standards.
 Contd…
Organize laboratory-teaching seminars and prepare training
manuals for the different laboratory-training programmes.
Support the work of the regional hospital laboratories.
Organize refreshment training and seminars/ workshops for
district and primary health care laboratory personnel.
Prepare training manuals for the different laboratory
training programmes.
Participate in the prompt laboratory investigation of
epidemics and outbreaks of serious illness among
communities.