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Introduction to the Principles of Laboratory Medicine

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Introduction to the Principles of Laboratory Medicine – PowerPoint PPT presentation

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Title: Introduction to the Principles of Laboratory Medicine


1
Introduction to the Principles of Laboratory
Medicine
2
Module 1
  • What is laboratory medicine?

3
Case Scenario 1
  • A 77-year old man presents to the emergency
    department with fevers and chills. He has had
    multiple urinary tract infections in the past and
    feels that this is another one. He has a
    history of diabetes mellitus, type 2 with
    diabetic nephropathy and chronic kidney disease.
    Physical exam is notable for an ill-appearing man
    with right flank tenderness.
  • How will the medical laboratory impact this
    patients care?

4
Case Scenario 1Discussion
  • Confirm clinical diagnosis
  • Urinalysis
  • Guide appropriate dosing of antibiotics
  • Dose adjustment for reduced GFR based on
    variables including serum creatinine
  • Guide selection of appropriate antibiotic therapy
  • With multiple course of treatment in the past
    there may be issues with antibiotic resistance

Photo by Elizabeth Wantuch, MD
5
Call the lab.
  • Todays clinical laboratory is a complex arena
    offering an expansive menu of tests which
    continues to grow
  • Hundreds of millions of laboratory tests are
    performed every year in the United States

6
Influence of Laboratory Medicine on the quality
and cost of healthcare
  • Lab tests consume about 2.3 of annual health
    care costs in the United States
  • It is noted in the literature that gt70 of the
    objective data in a patients medical record
    comes from the clinical laboratory

7
WHAT is Laboratory Medicine?
  • Laboratory medicine (clinical pathology) is the
    medical discipline that specializes in the
    performance, reporting and interpretation of
    clinical laboratory tests in the provision of
    high quality patient care

8
WHO is Laboratory Medicine
  • Comprised of pathologists, doctoral-level
    laboratory scientists, technologists, and
    technicians
  • The laboratory medicine workforce has a vital
    role in the health care system managing and
    applying evidence-based, scientific testing
    techniques to support patient care

9
  • The specific types of clinical laboratories in
    health care institutions varies greatly from one
    place to another.

10
Listed below is a partial list of types of
individual clinical laboratories
  • Blood Bank/Apheresis
  • Chemistry/Immunoassay
  • Hematology and Coagulation
  • Urinalysis, Fluid Analysis and Medical Microscopy
  • Cytogenetics
  • Endocrinology
  • Immunoserology
  • Microbiology (including Bacteriology, Virology,
    Parasitology, etc.)
  • Molecular Pathology
  • Tissue Typing/HLA
  • Toxicology

11
  • Each lab may have one medical director and one
    technical specialist responsible for testing
    services and quality of the lab
  • Some labs require a combined leadership group of
    2-3 directors and multiple technical specialists

12
Additional Terms
Photo by Theresa Kristopaitis, MD
13
Reference lab
  • In our medical center the lab tests performed at
    reference labs are often called send out labs
  • Clinical reference laboratories provide testing
    services for patients and healthcare providers
  • The labs performed are generally specialized
    tests that are infrequently ordered or that
    require specialized equipment

14
Point of Care Testing
Photo by Theresa Kristopaitis, MD
Point of Care Testing (POCT) is laboratory
testing performed on simpler devices at the
point of care (e.g., the bedside) and often by
non-laboratory personnel
15
Case Scenario 2
  • A 5-year old boy is at his physicians office
    with fever, sore throat and severe pain with
    swallowing x 2 days. On physical exam his
    temperature is 390C. There is tonsillar erythema
    and swelling with white exudates.
  • What point of care test do you think was
    performed?
  • A rapid Streptococcal antigen test
  • The test is positive. How does this impact the
    care of the patient?
  • Appropriate antibiotics are prescribed
  • What if the test were negative?
  • The physician understands the sensitivity and
    predictive value of the rapid antigen test. If
    the clinical suspicion for Streptococcal
    pharyngitis is high a throat culture would be
    submitted

16
Case Scenario 3
  • A 5-year old boy is at his physicians office
    with low grade fevers, sore throat, runny nose,
    watery eyes for the past week. On physical exam
    he is afebrile. There is minimal tonsillar
    swelling and erythema without exudates. The boys
    parents insist that he be treated with
    antibiotics.
  • The physician has a low clinical suspicion for
    Streptococcal pharyngitis but does perform a POCT
    Strep antigen screen. The result is negative. How
    does this impact patient care?
  • Support to not provide unnecessary antibiotic
    therapy for what is likely a viral upper
    respiratory tract infection

17
What is the Point of POCT?
  • The key objective of POCT is to produce a result
    more quickly
  • Therefore the utility of POCT is in the immediacy
    of response and effect on medical decision
    making
  • Due to advances in technology, clinical needs and
    a number of other factors, POCT may be the most
    rapidly growing segment of laboratory testing
    worldwide

18
What POCT is available for the following patients?
  • 24-year old woman with amenorrhea x 2 months?
  • Urine HCG
  • 42-year old man with diabetes mellitus?
  • Glucose, HgbA1c, urine microalbumin
  • 63-year old woman with atrial fibrillation on
    warfarin
  • INR
  • 78-year old man presenting to the ED with 10/10
    crushing chest pain
  • Troponin

19
  • Proceed to Module 2 The Diagnostic Testing
    Process
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