What is a Clinical Laboratory Professional and What Are They Doing With My Body Fluids

1
What is a Clinical Laboratory Professional and
What Are They Doing With My Body Fluids?

• Division of Medical Technology
• University of Minnesota
• http//medtech.umn.edu

2
What is in blood?

• Plasma - the liquid portion
• Platelets - the clot forming components
• White Blood Cells - the infection fighters
• Red Blood Cells - the oxygen transporters

3
How do blood tests tell us whats going on in
other parts of the body?

• The body of an adult contains over 60,000 miles
  of blood vessels!
• An adults heart pumps nearly 4,000 gallons of
  blood each day!
• As the blood travels around the body, products
  from those cells are absorbed into the
  bloodstream.

4
What makes one type of cell different from
another type of cell?
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CHEMISTRY!!
Water
Proteins
Vitamins
Enzymes
RNA
DNA
Cholesterol
Amino Acids
Minerals
Fats
Sugars
Hormones
pH
6
Chemistry of the Human Body

• Each cell of the body contains about 90 trillion
  atoms (90,000,000,000)
• The human body contains about
• 60 different elements.
• Over 96 of those atoms are
• oxygen (61), carbon (23), hydrogen (10),
  and nitrogen (2.6)

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How those atoms are put together in the cell
determines

• What the cell looks like
• What jobs the cell can do in the body
• How the cell communicates with other cells in the
  body

8
So Bone Cells look and act differently than
Blood Cells,
Muscle Cells
Fat Cells
9
These chemical differences in cells allow us to
determine if something is wrong with the part of
the body where that those cells are found.

• For example ..

10
What happens in a heart attack?

• Blood stops flowing to part of the heart
• This can be caused by
• Blood clots
• Fat deposits
• When blood stops flowing, heart cells dont get
  enough oxygen and they begin to die.

Blood vessel with fatty deposits
11

• When cells are damaged or dying, they begin to
  leak some of the compounds from inside their cell
  membrane.
• Those compounds then get into the bloodstream.
• Because many of the compounds inside the cell are
  specific to that type of cell, we can identify
  problems by the amount of certain compounds in
  the blood.

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What compounds are released by the damaged heart?

• Proteins
• Myoglobin
• Myoglobin is the oxygen-binding protein of the
  muscles
• It only takes 1 to 2 hours after a heart attack
  before you find myoglobin in the blood
• Myoglobin peaks at 6-9 hours.
• It returns to normal within 24 hours because it
  is rapidly excreted in the urine.

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What compounds are released by the damaged heart?

• Proteins
• Troponin-I and Troponin-T
• Troponins are structural proteins found in heart
  muscle.
• It only takes 2 to 4 hours after a heart attack
  before you find troponins in the blood.
• Troponin-I peaks at 24 hours.
• Troponin-T peaks at 12-48 hours.
• They remain elevated for 9-14 days.

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What compounds are released by the damaged heart?

• Enzymes
• Creatine Kinase (CK)
• It takes 4 to 10 hours before you find the CK
  enzyme in the blood
• It peaks at 24 hours
• It returns to normal levels in 2 or 3 days

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What compounds are released by the damaged heart?

• Creatine Kinase (CK), continued
• Different forms of CK, called isoenzymes, are
  found in different tissues.
• CK-MM occurs in high concentrations in skeletal
  muscle and heart.
• CK-MB is present in high concentrations in heart,
  but it is also present in lungs, small intestine,
  uterus, prostate, and healthy skeletal muscle.
• CK-BB occurs in high concentrations in the brain,
  but it is also found in lung, stomach, prostate,
  the gastrointestinal tract, and the bladder.

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What compounds are released by the damaged heart?

• Creatine Kinase (CK), continued
• The different isoenzymes of CK each have a
  different electrical charge.
• This difference in electrical charges allows the
  lab to separate the CK forms from each other and
  determine the amount of each form present in the
  blood by placing the sample in an electrical
  field. The forms with the greater charge will
  move the fastest and farthest.

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Creatine Kinase Electrophoresis Patterns
CK-BB is rarely seen in the blood.
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CK Concentrations in the Blood

• Normal Concentrations
• CK-MM 95
• (Muscle)
• CK-MB
• (Heart)
• CK-BB 0
• (Brain)

• Normally, there is a small amount of CK-MB in the
  blood, and almost no CK-BB.
• After a heart attack, there is more CK-MB in the
  blood.

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What compounds are released by the damaged heart?

• Enzymes
• Lactate Dehydrogenase (LD)
• It takes 6 to 12 hours to appear in the blood
• It peaks in 1 to 3 days
• Levels return to normal in 8 to 14 days

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Determining the amounts of these compounds in the
blood helps determine

• Whether or not a heart attack has occurred
• How long ago the heart attack occurred
• To some extent, how much damage the heart attack
  caused

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Cardiac Markers in Serum
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In the same way that each type of cell has its
own particular chemistry, each disease has its
own particular chemistry.
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What specimens usually go to the lab for a
physical exam?

• Two, three, or more tubes of blood
• Purple top
• Red top
• Blue top
• Urine specimen

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So why do labs need two (or more!) different
tubes of blood?Why cant they just use one tube?
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When blood leaves the veins, it will come in
contact with factors that will initiate the
formation of a blood clot.
26
The red top tube either contains nothing or
something to activate the formation of the
clot.The liquid portion is no longer called
plasma, but is called serum because it no longer
contains the clotting components.Serum is often
preferred for testing because all of the cellular
components are more easily removed so they cant
clog sensitive instruments.
27
The purple top tube contains an anticoagulant,
EDTA, which prevents the blood from clotting, so
cells remain separated. It also preserves the
cells so they can be identified by how they look
when using particular stains.
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The blue top tube also prevents blood from
clotting, but it uses a different anticoagulant,
sodium citrate, which preserves more of the
clotting factors.This is the tube used to
evaluate the ability of the blood to clot.
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Specimen Processing

• The red top tube is centrifuged to separate the
  serum from the cells.
• The blue top tube is also centrifuged and then
  sent to the coagulation laboratory.
• The purple top tube is not centrifuged, but sent
  to hematology so they can begin to prepare slides
  and look at the cells.

Centrifuge
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The Red Top Tube Goes to the Chemistry Lab
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The serum can now be tested for

• Cholesterol
• Blood glucose (sugar)
• Electrolytes (sodium,
• potassium, chloride)
• Enzymes from the heart,
• liver, pancreas, etc.
• Kidney function (blood
• urea nitrogen or creatinine)
• Hormones
• Vitamins
• Drug levels
• Hundreds of other compounds

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The Purple Top Tube Goes to the Hematology Lab

• This tube is mixed
• well, then placed
• in an instrument
• that determines
• Red blood cells
• White blood cells
• Platelets
• Hematocrit (percentage of blood that is cells)
• Hemoglobin (oxygen-carrying protein)

33
Blood smears are made onglass slides and then
stained so cell structures can be seen clearly.
34
Blood smears are usually examined using a light
microscope.
35
Red Blood Cell Size and Color are Studied
NORMAL RED BLOOD CELLS Normal area of central
pallor should be about one-third of the cells
diameter.
HYPOCHROMIC Decreased hemoglobin concentration
in pale cells.
ANISOCHROMIA Pale and filled cells can both be
seen following blood transfusion.
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Red Blood Cell Shape is Observed
Target Cells - Abnormal hemoglobins, liver
disease, thalassemias
Elliptocytes - Hereditary condition, some
anemias
Sickle Cells - Sickle cell anemia (Hb SS), Hb
SC. Hb S/thal
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More Red Blood Cell Shapes
Schistocytes - RBC fragments found in severe burn
patients, disseminated intravascular coagulation
Spherocytes - Red cells without a pale center are
seen in hereditary spherocytosis, some
immune-mediated hemolytic anemias
Acanthocytes - Spiked red cells are observed
in liver disease, asplenic patients (spleens
removed)
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White Blood Cells
Neutrophils - Engulf bacteria and cellular
debris 37-77
Basophils - Hypersensitivity, Release
histamine 0-1.6
Eosinophils - Parasitic infections, Allergic
response 1-7
Monocytes - Engulf cellular debris, antigen
processing 2-10
Lymphocytes - Produce antibodies, regulate the
immune response 10-44
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Abnormal Blood Smears
Chronic Myelogenous Leukemia
Infectious Mononucleosis (Reactive Lymphocytes)
Malaria (Plasmodium falciparum)
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The Blue Top Tube Goes to the Coagulation Lab

• These tubes are often drawn on people who are on
  anti-coagulant therapy (coumadin), also called
  blood thinners

The plasma is tested to determine how long it
takes blood to clot.
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The Urine Goes to the Urinalysis Lab
Urine can provide information about

• Kidney function
• Urinary tract disorders
• Diabetes
• Liver disorders
• Metabolic disorders
• Muscle trauma
• Hormonal disorders
• Drug use

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Urinalysis
A complete urinalysis consists of examining the
physical, chemical, and microscopic
characteristics of the urine.
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Chemical analysis is performed using a reagent
strip with pads containing chemicals specific for
each test.
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What chemicals do labs test for in urine?

• Sugar
• Normal urine should not contain glucose (blood
  sugar)
• Found in diabetes
• Ketones
• Normal urine should not have ketones
• Ketones form when you break down fats instead of
  sugar for energy
• Found in diabetes, starvation

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What chemicals do labs test for in urine?

• Protein
• Normal urine should contain very little protein
• Suggests possible kidney damage, certain cancers
• Hemoglobin
• Normal urine should not contain hemoglobin (from
  red blood cells)
• Seen in injury, kidney stones, infection

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What chemicals do labs test for in urine?

• Leukocyte esterase
• Normal urine should not contain this enzyme found
  in white blood cells
• Suggests urinary tract infection
• Nitrite
• Normal urine should not contain nitrites
• Nitrites form when bacteria convert urine
  nitrates to nitrite

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Urine MicroscopicExam
Yeast
Epithelial Cells
Calcium Oxalate Crystals
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Other Areas of the Clinical Laboratory
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Clinical Microbiology
Identify organisms
Determine antibiotic sensitivity
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The virology lab tests the serum for antibodies
directed against viruses such as HIV or
hepatitis.
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Medical technologists in the Blood Bank will
determine which antibodies are present in your
plasma so a compatible cross-match can be found
if you need a blood transfusion.
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The serum or plasma will be tested for
antibodies, and the red cells will be tested
for surface antigens.
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What is a clinical laboratory professional?

• A laboratory professional is a person who
  performs laboratory testing on blood, urine,
  feces, spinal fluid and other body fluids.
• They provide 70-80 of the objective data used to
  make clinical decisions.

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Laboratory Professionals Conduct Tests To

• Verify a potentially dangerous drug level
• Detect a cancerous tumor with DNA techniques
• Identify toxic agents, such as anthrax, in cases
  of bioterrorism
• Monitor the level of anti-rejection drugs in
  transplant patients
• Type and cross-match blood samples for
  transfusions
• Identify the causative microorganism in a blood
  or wound infection

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Who is a Laboratory Professional?

• Phlebotomist
• Clinical Laboratory Technician/Medical Laboratory
  Technician
• Clinical Laboratory Technologist/Medical
  Technologist
• Cytotechnologist
• Histotechnologist

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Skills and Abilities

• Good manual dexterity
• Enjoy problem solving
• Work independently
• Interest in science,
• especially biology
• Detail oriented
• Work well under pressure
• Organized
• Accurate and Precise
• Desire to help others

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Clinical Laboratories

• 7.25 billion tests
• are performed
• annually by
• 350,000
• laboratory
• professionals.
• Bureau of Labor
• Statistics reports
• the demand for
• laboratory will result in a 17 increase in
  testing
• from 1998-2008.

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Whats a phlebotomist?

• A person who has been trained to draw blood for
  laboratory tests.
• A phlebotomist goes through a training program,
  which is usually about three to four months long,
  or
• They can do on-the-job training at a hospital.
• Starting salaries are about 10-13/hour
  (23,000/year).

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How can I become a phlebotomist?

• Programs available at
• College of St. Catherines Phlebotomy Program
• Alexandria Technical College
• Lake Superior Community College
• Rochester Community and Technical College
• South Central Technical College
• Or call your local hospital to find out if they
  offer training.

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Whats an histology technician?

• An histology technician is a person who prepares
  solid tissues such as biopsy samples and tumors
  for examination under the microscope
• A person with an associate degree in
  histotechnology and certification as an histology
  technician.
• Starting salary for professionals with an
  associate degree in histotechnology is about
  13-16/ hour (30,000/year).

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How can I become an histology technician?

• Program available at
• Argosy University
• www.argosyu.edu

62
Whats a clinical laboratory technician/ medical
laboratory technician?

• A person with an associate degree and
  certification as a clinical laboratory technician
  (CLT) or medical laboratory technician (MLT).
• Starting salary for professionals with an
  associates degree is about 12-16/hour
  (30,000/year).

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Minnesotas CLT/MLT Programs

• St. Paul College
• North Hennepin Community College
• Alexandria Technical College
• Fergus Falls Community College
• Hibbing Community College

• Minnesota West, Worthington
• Lake Superior Community College
• Northwest Technical College
• South Central Technical College
• Argosy University

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Whats a clinical laboratory scientist/ medical
technologist?

• A person with a baccalaureate degree and
  certification as a clinical laboratory scientist
  (CLS) or medical technologist (MT).
• Starting salary for professionals with a
  baccalaureate degree is about 17-22/hour
  (41,500/year).

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General Job Duties

• Run Lab tests
• Develop and evaluate the tests
• Interpret data
• Analyze the results
• Communicate with physicians regarding test
  results

Medical technologists use a light microscope to
check blood smears for abnormalities
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Minnesotas CLS/MT Programs

• University of Minnesotas Medical Technology
  Program
• [phone]
• http//medtech.umn.edu

• Hennepin County Medical Centers Medical
  Technology Program
• [phone]
• http//www.hcmc.org/a_z/EducationPrograms/CLS.htm

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University of Minnesotas Medical Technology
Program

• The oldest baccalaureate medical technology
  program in the country (first graduates in 1923)
• Currently, about 32 graduates/year
• Admission in junior year (senior year if space
  available and prerequisite coursework is
  completed)
• 22 weeks of clinical experience

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Whats a cytotechnologist?

• A cytotechnologists prepares and examines slides
  of cells. They are best known for the
  performance of Pap tests for cervical cancer, but
  they examine many other types of specimens as
  well.
• A person with a baccalaureate degree and
  certification as a cytotechnologist
• Starting salary for professionals with a
  baccalaureate degree is about 19-20/hour
  (40,500/year).

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How can I become a cytotechnologist?

• Program available at
• Mayo Clinic School of Health Sciences
• www.mayo.edu/mshs

70
Whats the job market like?

• Currently, there is a 9-20 vacancy rate across
  the country.
• Increased testing demands and retirements will
  result in the need for 12,000 new lab
  professionals per year.
• There are currently only 4,100 new laboratory
  professional graduates per year.