A medical laboratory is a laboratory where tests are done on human clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.
Medical laboratories may be classified as free-standing laboratory or hospital-based laboratory based on its facilities, target clientele, and hospital affiliation.
Laboratory medicine is generally divided into two fields, and each of which is further divided into a number of sections. These two broad fields are:
Anatomic Pathology: units included here are histopathology, cytopathology, and electron microscopy. Academically, each unit is studied alone in one course. Other courses pertaining to this section include anatomy, physiology, histology, pathology, and pathophysiology.
Clinical Pathology which includes:
Clinical Microbiology: This encompasses five different sciences (units or sections). These include bacteriology, virology, parasitology, immunology, and mycology.
Clinical Chemistry: Units under this busy section include instrumental analysis of blood components, enzymology, toxicology and endocrinology.
Hematology: This section consists of automated and manual analysis of blood cells. It includes two subunits, which are coagulation and cellular hematology.
Genetics or Molecular Biology is also studied along with a subspecialty known as cytogenetics.
Reproductive biology : Semen analysis, Sperm bank and assisted reproductive technology.
Distribution and Field of Specializations
Distribution of clinical laboratories in health institutions varies greatly from one place to another. Take for example microbiology, some health facilities have a single laboratory for microbiology, while others have a separate lab for each unit, with nothing called a "microbiology" lab.
Here's a detailed breakdown of the responsibilities of each unit:
Microbiology receives almost any clinical specimen, including swabs, feces, urine, blood, sputum, cerebrospinal fluid, synovial fluid, as well as possible infected tissue. The work here is mainly concerned with cultures, to look for suspected pathogens which, if found, are further identified based on biochemical tests. Also, sensitivity testing is carried out to determine whether the pathogen is sensitive or resistant to suggested antibiotics. Results are reported with the identified organism(s) and the type and amount of drug(s) that should be prescribed for the patient.
Parasitology is a microbiology subunit that investigates parasites. The most frequently encountered specimen here is feces. However, blood, urine, sputum, and other samples may also contain parasites.
Virology is concerned with identification of viruses in specimens such as blood, urine, and cerebrospinal fluid.
Hematology works with whole blood to do full blood counts, and blood films as well as many other specialized tests.
Coagulation as a hematology subunit requires citrated blood samples to analyze blood clotting times and coagulation factors.
Clinical Biochemistry usually receives serum or plasma. They test the serum for chemicals present in blood. These include a wide array of substances, such as lipids, blood sugar, enzymes, and hormones.
Toxicology mainly tests for pharmaceutical and recreational drugs. Urine and blood samples are submitted to this lab.
Immunology/Serology uses the concept of antigen-antibody interaction as a diagnostic tool. Compatibility of transplanted organs is also determined.
Immunohematology, or Blood bank determines blood groups, and performs compatibility testing on donor blood and recipients. It also prepares blood components, derivatives, and products for transfusion. This unit determines a patient's blood type and Rh status, checks for antibodies to common antigens found on red blood cells, and cross matches units that are negative for the antigen.
Urinalysis tests urine for many analytes. Some health care providers have a urinalysis laboratory, while others don't. Instead, each component of the urinalysis is performed at the corresponding unit. If measuring urine chemicals is required, the specimen is processed in the clinical biochemistry lab, but if cell studies are indicated, the specimen should be submitted to the cytopathology lab, and so on.
Histopathology processes solid tissue removed from the body (biopsies) for evaluation at the microscopic level.
Cytopathology examines smears of cells from all over the body (such as from the cervix) for evidence of inflammation, cancer, and other conditions.
Electron microscopy prepares specimens and takes micrographs of very fine details by means of TEM (Transmission Electron Microscopy) and SEM (Scanning Electron Microscopy).
Genetics mainly performs DNA analysis.
Cytogenetics involves using blood and other cells to get a karyotype. This can be helpful in prenatal and cancer diagnosis.
Surgical pathology examines organs, limbs, tumors, fetuses, and other tissues biopsied in surgery such as breast mastectomy.
Staffing
A medical laboratory is required to have:
- Pathologist (Licensed medical doctors with certification from PSP if from the Philippines)
- Pathology Medical Resident (Licensed medical doctor
- Medical Laboratory Scientist or Medical Technologist (Licensed Medical Technologist or Public Health) in specialization:
- Phlebotomy
- Clinical Microscopy
- Hematology and Coagulation
- Clinical Chemistry
- Immunology
- Molecular Biology (Genetics)
- Microbiology
- Tissue and Cellular Pathology
4. Laboratory Technician
5. Laboratory Aid
6. Laboratory Clerk (as transcriptionist and secretarial)
Management
Policies, Memorandum and Procedure Manuals
Policy is a statement or memo that outlines the institution’s position on an administrative or operational issue. A procedure is an instructional document that provides explanations and step-by-step directions on how to perform a task, test or process.
The primary objective of policy and procedure manuals is to ensure effective communication between the members of the organization. The manuals must attempt to remove any ambiguities and allow smooth, uniform and consistent application of laboratory policies and procedures.
To accomplish this goal, manuals must be living documents that continuously adjusts to the rapidly changing circumstances generated by the social, technological, and legal environment in which the laboratory operates.
These are examples of activities that are tied directly to the contents of policy and procedure manuals:
- Responsibility and control
- Performance appraisals
- Completion of tasks and duties
- Quality standards and monitoring indexes (indicators)
- Job description
- Work flow and job analysis
- Productivity measurement
- Financial accountability
Article sources:
Clinical Laboratory in Pakistan
Central Laboratory London
Medical Matters Wiki: Clinical Laboratory Science
Vernadoe’s Medical Laboratory Management and Supervision
ech.ucr.edu
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