preview:• It is important to have an understanding of the different diseases we look at within medical biochemistry laboratories and the different diagnostic tests we perform but it is equally as important to understand the difference specimen types to understand which samples we require for whic...
It is important to have an understanding of the different diseases we look at within medical
biochemistry laboratories and the different diagnostic tests we perform but it is equally as
important to understand the difference specimen types to understand which samples we
require for which diagnostic tests, which samples we can't process and why that is and it's
also important as a BMS when you're analysing patient results as part of that to be able to
rule out that these results are real and they're not because an incorrect specimen has been
processed and maybe that's giving rise to an artificially high potassium for example and it's
not because the patient has high levels of potassium is because the incorrect sample tube
was requested or it was processed or maybe there was an error within sample collection.
Compliment your knowledge that you have of the different tests with the different
specimens that you require and why we require those specimen tubes.
Blood samples are the vast majority of samples we receive within the medical biochemistry
laboratory.
We have to collect specimens in a particular order to prevent interference between the
different additives that different tubes have and how that can lead to artificial erroneous
results.
Also to explain the importance of auditing particularly in relationship sample collection
because a lot of errors can occur outside of the biochemistry or outside of the pathology
laboratory, they can occur through processes that as BMSs we have no control over so
therefore it is important that we are able to determine that when we are receiving these
samples that we provide accurate results and we do everything we can as BMSs through
running quality controls, calibration and auditing within the lab but it is also important that
we follow similar quality assurance processes at the very beginning of this process which is
when we collect those samples otherwise there's a risk of giving add erroneous artificial
results.
To provide a patient with a diagnosis, BMSs are responsible for 70% of all diagnoses. It may
well be that a patient has had symptoms for a long time, and they want to know what's
wrong with them therefore a way which we can do that is to detect any particular changes
within blood samples for example or maybe in a urine sample to look at different
parameters to see whether they’re in a normal range whether they are abnormal.
It could be to look at the patient compliance they might have type 2 diabetes for example
and one way we can ensure that they are managing that correctly is to sample their body
fluids to measure the amount of glucose within their blood, that shows that the patient is
adhering to the treatment. If they're not what discussions can be had.
To also determine prognosis, we can measure different parameters within patients’ blood
sample, urine sample or a variety of other samples to determine their prognosis are they
actually healthier than they think they are and if they are very poorly we can use the
difference parameters that we measures to determine how poorly that patient is and make
the appropriate clinical decisions based on that in terms of making the patient comfortable,
what treatment can we provide, what else can we do.
Another thing is to monitor treatment and that overlaps with compliance and maybe
prognosis but it's also to monitor treatment, are patients receiving adequate treatment do
we need some change that treatment and are they actually taking the medication properly
, 8. Sampling Body Fluids
and if not, we can detect that within a variety of different types and as part of that make
clinical decisions for the benefit of the patient.
As BMSs we are interested in understanding molecular, cellular and organ system processes
at those different levels.
But in essence were also interested in the pathology and disease mechanisms, what happens
when things go wrong.
The clinical biochemistry provides a continual service 365 24,7.
We process around 150 million samples each year which again is phenomenal workload and
if you think that on average, we can process around 10 tests in some cases on one particular
sample you're talking about 1.1 billion tests each year.
It's a career that you're on the forefront of the latest science.
Heart function – listen to beats per minute using a stethoscope.
The ancient Greeks were reliant upon on their 4-humour theory – if they were unbalanced,
you’d need to balance them an example of that was bloodletting so a patient would be bled
into it into a cup, and it was believed by bleeding patient you would then restore the balance
Improved knowledge of anatomy was due to grave diggers and grave robbers who would
then look at the cadavers.
Joseph Lister Joseph Lister with his carbolic acid his way in which to perform surgery with
reducing the risk of developing surgery acquired infections this really brought down the rate
of infections that we saw prior to the advent of this methodology and therefore the ability
to use antiseptic within surgery was a breakthrough in one of the challenges we faced in
pathology.
More recently we discovered that we could detect diseases through looking at different
analyses within patient blood samples or urine samples we could look at persons
physiological state and whether they were healthy or diseased through looking at a range of
different analysts and bodily fluids.
Collection – which tubes, which sample i.e., midstream urine or random urine.
Labelling – electronic, attached to request form and sample.
Arrive at lab, check to see if minimum number of identifiers, labelled with a barcode so we
can track them in the laboratory diagnostic tests will be performed on so long as the samples
are suitable for the tests requested, could be manual tests, semi-automated tests or fully
automated tests and all the tests have been completed on those samples.
You then have the post analytical phase this is where there's all the testing has been
completed, the results will then be reported out and those samples will be stored in
accordance with sample storage times depending upon the nature of the sample and how
long we will store that particular sample in relation to viability.
Ideal to take from the median cubital vein (inner fold of forearm) but can be taken from
other sites such as the back of hand.
The heel prick is particularly reserved for small babies.
Depending on how easy you are to believe maybe you are dehydrated maybe it's just the
phlebotomist is having a hard time it really depends upon where those samples are taken
from.
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