For Medical Laboratory Technology Students
LECTURE NOTESFor Medical Laboratory Technology StudentsIntroduction to Medical Laboratory TechnologyBerhanu SeyoumHaramaya UniversityIn collaboration with the Ethiopia Public Health Training Initiative, The Carter Center,the Ethiopia Ministry of Health, and the Ethiopia Ministry of EducationDecember 2006
Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00.Produced in collaboration with the Ethiopia Public Health Training Initiative, The CarterCenter, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education.Important Guidelines for Printing and PhotocopyingLimited permission is granted free of charge to print or photocopy all pages of thispublication for educational, not-for-profit use by health care workers, students orfaculty. All copies must retain all author credits and copyright notices included in theoriginal document. Under no circumstances is it permissible to sell or distribute on acommercial basis, or to claim authorship of, copies of material reproduced from thispublication. 2006 by Berhanu SeyoumAll rights reserved. Except as expressly provided above, no part of this publication maybe reproduced or transmitted in any form or by any means, electronic or mechanical,including photocopying, recording, or by any information storage and retrieval system,without written permission of the author or authors.This material is intended for educational use only by practicing health care workers orstudents and faculty in a health care field.
PREFACEThere is acute shortage of references and / or textbooks inhigher teaching institutions especially in newly openedinstitutions engaged in training of various health professionalsin the country. Hence, some of the strategies that are used tocircumvent these problems are developing of lecture notes onvarious subjects. Therefore, this lecture is developed to fill theexisting gap and strengthen the teaching -learning processes.This lecture note is primarily prepared for Medical LaboratoryTechnology students pursuing their studies at bachelorratelevel in various higher teaching institutions. It can also behelpful for those graduates who are in service. In thedevelopment of this lecture note, materials have beengathered and adapted from different standard books.This lecture note is divided into seven chapters coveringmajor and relevant topics of the subject matter. Within eachchapter, important topics are identified and discussed insimple language so as to facilitate rapid reading andunderstanding of important concepts. Each chapter is alsofollowed by review questions that can enable the reader touse them as self-assessment tools.The author strongly believes that this teaching material willplay a pivotal role in promoting the teaching – learningprocess through delivery of pertinent information to thei
stions from readers are welcome so as to furtherstrengthen this lecture note.Berhanu Seyoum (B.Sc, M.Sc)ii
ACKNOWLEDGEMENTSI wish to express my sincere appreciation and thanks to TheCarter Center (Ethiopian Public Health Training Imitative) forthe financial input, written materials and other valuable logisticsupports that were extremely important for the development ofthis lecture note.My special thanks also goes to professor Denis Carlson,Senior Consultant, The Carter Center, for his relentless effort,devotion and invaluable contribution for the initiation andlaying ground in the preparation of this lecture note.I would like to extend my special appreciation and thanks toProfessor Joyce Murrey, for her immense contribution in thedevelopment of this lecture note in various aspects.I also wish to extend my special thanks to the staff ofHaramaya University; Faculty of Health Sciences, Universityof Gondar; Department of Medical Laboratory Technology,Addis Ababa University; School of Medical LaboratoryTechnology, Jimma University; School of Medical LaboratoryTechnology, Hawass University; Department of MedicalLaboratory Technology and Defense University College fortheir reviewing and valuable professional comments.iii
My grateful acknowledgment is also made to nationalreviewers;Dr. Seyoum Taticheff and Ato Ibrahim Ali for their tremendousprofessional comments and suggestion in the preparation ofthis lecture note.I am also indebted to all teaching staff of HaramayaUniversity, Faculty of Health Sciences, Department of MedicalLaboratory Technology not only for numerous ideas andsuggestions, but for their arguments too. Their professionalsupport and encouragement are highly appreciated. Finally, Iam also very grateful to W/t Tigist Negga and W/t AschalechTemesgene for typing the final manuscript of this lecture note.iv
TABLE OF CONTENTSContentPagePrefaceiAcknowledgmentsiiiTable of contentvList of r: OneLaboratory11.1 General over view11.2 Classification of medical laboratories21.3 Organization of the laboratory41.4 Structure of medical laboratory service41.5 Role of medical laboratory services91.6 Role of medical laboratorytechnologist101.7 Lab. rules, ethics and professionalcode of conduct101.8 Laboratory policies141.9 Solutions used in medical Laboratory171.10 Expressing concentration of solutions211.11 Review questions24v
Chapter: Two2.1 Laboratory glass wares292.2 Plastic wares422.3 Review questions44Chapter: ThreeLaboratory instruments453.1 Balances453.2 Centrifuges493.3 Refrigerators533.4 Ovens543.5 Water bath553.6 Incubators563.7 Colorimeter (photometer)583.8 Desiccators64H3.9 Instruments and materials used for pdetermination653.10 Instrument for purifying water693.11 Microscope723.12 Instruments and materials used foradvanced laboratory techniques853.13 Review questions863.14 Automated analyzers863.15 Review Questions87Chapter: FourSterilization and disinfection884.1 Sterilization88vi
4.2 Disinfection and decontamination oflaboratory wastes954.3 Review questions101Chapter: FiveLaboratory accidents and safety5.1 Laboratory hazards and accidents1021025.2 Factors contributing to laboratoryhazards1085.3 Firs aid for laboratory hazards1095.4 Safe use and storage of chemicalsand reagents1145.5 Planning for safety1195.6 General precautions for the avoidanceof laboratory accidents5.7 Review questions121124Chapter: SixQuality assurance1256.1 Types and causes of errors in medicallaboratories1266.2 Review s143vii
LIST OF CONTRIBUTORS1. Tamirat Gebru(B.Sc, M.Sc)2. Jemal Seid,(B.Sc, M.Sc)3. Alemseged Abdissa, (B.Sc, M.Sc)4. Girum Tadesse,(B.Sc)5 Jemal Mohammed,(B.Sc)6. Dessalegn Admassu, (B.Sc)viii
LIST OF ABBREVIATIONS1. CSF:Cerebrospinal fluid2. DNA:Deoxy Ribos Nucleic Acid3. G:Gravitational force4. Gm:Gram5. Kg:Kilogram6. Lab:Laboratory7. M:Molar solution8. Ml:Milli liter9. MLT:Medical Laboratory Technology10. Mv:Milli volt11. Nm:Nano meter12. PTB:Pulmonary tuberculosis13. RPM:Revolution Per Minute.14. RCF:Relative Centrifugal Force15. UV:Ultra Violetix
INTRODUCTIONIn the era of modern technology, health care delivery systeminvolves so many different personnel and specialties that edge of other professional endeavors, including the roleof diagnostic evaluation. Basically, laboratory and diagnostictests are tools by and of themselves, they are not hysicalexamination, these tests can confirm a diagnosis or providevaluable information about a patient status and response totherapy. In addition to these, laboratory findings are essentialfor epidemiological surveillance and research purposes.If the entire network of a laboratory service is to be effectivelyutilized and contribute to health care and disease prevention,every member of its work force need to: Understand the role of the laboratory and its contributionto the nation’s health service; Appreciate the need to involve all members in theprovision of health service; Follow professional ethics and code of conduct; Experience job satisfaction and have professional loyalty.Medical laboratory science is a complex field embracing anumberofdifferentdisciplinesxsuchasMicrobiology,
Hematology, Clinical Chemistry, Urinalysis, Immunology,Serology, Histopathology, Immunohematology and Molecularbiology and others.Introduction to Medical Laboratory Technology is a basiccourse that equips the student with the most essentialknowledge and skill pertaining to medical laboratories suchas: Importance of laboratory services; Role of medical laboratory technologist; Use of laboratory wares, instruments and sterilizationtechniques; Prevention and control of laboratory accidents and; Institution of quality control system.Moreover, this course is extremely important for the studentas it paves the ways to easily understand various professionalcourses such as Hematology, Bacteriology, Urinalysis,Parasitology, and others. Hence, great emphasis should begiven to this subject matter so as to train qualified, competentand task oriented medical laboratory technologists.History of Medical Laboratory ScienceIt is difficult to exactly say when and where medial ricalreferences have shown that there was examination of bodyfluid around the era of Hippocrates. The most important eventxi
that contributes for the development of the profession was thediscovery of microscope by a German scientist Antony VanLeoun Hook. Previously one cannot talk about the field ofmedical laboratory science without also talking abut themedical specialty of pathology. Early laboratory practionerswere physicians, pathologists or both. But sooner medicallaboratory profession was developed into a separate disciplinehaving g its own educational requirements and standards.In Ethiopia, the Italians were the first to establish healthlaboratory during The Second World War. Immediately afterindependence, a British Scientists took over health laboratoryactivity in Addis Ababa. They were organized the laboratoryunder the name of Imperial Medical Research Institute. Aftershort period of time, they handed over the organization to theFrench Team on contractual basis. Then, the team developedthe first well organized the laboratory under the name eyestablished facilities for the production of vaccines and somediagnostic activities. Developing of rabies vaccine was themain research area for the team.The name of the institute was changed into opianprofessionals took over the responsibility. Mean while,laboratory technician training programme was launched atGondar Public Health College, The Minilik II Hospital andJimma Hospital.xii
CHAPTER ONELABORATORYLearning ObjectivesAfter completion of this chapter, the student will be able to:1. Define laboratory.2. Identify and enumerate the different kinds of medicallaboratories.3. Explain the role of medical laboratory services.4. State the laboratory rules, ethics, professional code ofconduct and polices.5. Describe and practice collection, handling and shipmentof medical laboratory specimens.6. Identify solutions used in medical laboratories.1.1 General overviewLaboratory is a place that is equipped with differentinstruments, equipments and chemicals (reagents) etc., forperforming experimental works, research activities andinvestigative procedures. Medical laboratory is one part of struments, equipments, materials and reagents (chemicals)for performing different laboratory investigative activities by1
using biological specimens (whole blood, serum, plasma,urine, stool, etc).1. 2 Classification of medical laboratoriesThe world Health Organization (WHO) lists four kinds of levelsof laboratories based on their biosafety.1. 2.1 Basic laboratory level IBasic laboratory level I is the simplest kind and adequate forwork with organisms which have low risk to the individuallaboratory personnel as well as to the members of thecommunity. Such organisms are categorized under RiskGroup I by WHO. These organisms are unlikely to causehuman diseases. Example, food spoilage bacteria, commonmolds and yeasts.1.2.2Basic laboratory level IIBasic laboratory level II is suitable for work with organismsthat predispose to moderate risk to the laboratory worker anda limited risk to the members of the community. Suchorganisms are categorized under Risk Group II by WHO.They can cause serious human diseases but not serioushazards due to the availability of effective preventivemeasures and treatment.Example, staphylococci, streptococci, entero bacteria except2
Salmonella typhi and others. Such laboratory should be clean,provide enough space, have adequate sanitary facilities andequipped with autoclave.1.2.3 Containment laboratory (Level III)Containment laboratory is more advanced and it is used forwork with infectious organisms that present a high risk to thelaboratory personnel but a lower risk to the community. Suchorganisms are categorized under Risk Group III by WHO.Example, Tubercle bacilli, Salmonella typhi, HIV, Yersina andothers. The principle is to remove from the basic cularlyhazardous. They are easily transmitted through airborne,ingestion of contaminated food or water and paranterally.Such laboratory should be a separate room with controlledaccess by authorized staff. It should also be fitted withmicrobial safety cabinet.1. 2. 4 Maximum containment laboratoryMaximum containment laboratory is intended for work withviruses, which predispose to a high risk for both ecategorized under Risk Group IV by WHO. Example, Smallpox, Ebola, Lassa fever and others. Most of these organismscause serious disease and readily transmitted from on person3
to another. These laboratories are usually a separate buildingwith strictly controlled access.1.3 Laboratory organizationOrganization: - is a system, an orderly structure, rangements for undertakings that involve cooperations. Theemphasis is on arrangements that enable peoples workingtogether and accomplishing common objectives in an efficient,planned and economic manner. In a single medical oforganizations. These are laboratory head and other staffhaving their own duties and responsibilities.1.4 Structure of medical laboratory servicesA laboratory service network consists uties To support primary health care in investigating, controllingand preventing major diseases in the country. Promoting health care by integrated health educationMain activities are to: Investigate by referral or testing on site, importantdiseases and health problems affecting the local4
l diseases, parasitic diseases and othercauses of illness. Assist health care worker in deciding the severity of apatient’s conditions. Collect and refer specimens for testing to the districtlaboratory. Notify the district hospital at an early stage of anylaboratory results of public health importance andsend specimens for confirmatory tests. Screen pregnant women for anemia, proteinuria,malaria, and refer serum for antibody testing. Promote health cares and assists in communityhealth education Keep records, which can be used by healthauthorities in health planning and for epidemiologicalpurposes. Keep an inventory of stocks and order supplies. Send an informative monthly report to the districthospital laboratory.1.4.2 District hospital laboratoryDuties:In addition to the works stated above, these laboratories havean important role in supervising the work of the peripheral5
community based laboratories, testing referred specimens,and performing a range of tests compatible with the work ofdistrict hospitalMain activities are to: Perform a range of tests relevant to the medical,surgical, and public health activities of the districthospital. Supporttheworkofthecommunity-basedlaboratories ols, standards, specimen containers, and otheressential laboratory supplies. And also visit eachprimary health care laboratory in their catchmentsarea to inspect and discuss the investigations beingperformed and, comment on their quality assurancesystem, record keeping, safety procedures, as well asthe status of equipment maintenance. Refer specimens to the regional laboratory for test (s)that cannot be performed in district laboratory. Notify the regional laboratory of any result of publichealth importance and to send specimens forconfirmatory tests. Participateintheexternalqualityassuranceprogramme organized by the regional laboratory. Prepare and send periodical reports to the regionallaboratory.6
1.4.3 Regional hospital laboratoryDuties:In addition to the duties done at the two above lower levels,the regional laboratory assists and supervises the districtlaboratories. It analyses referred specimens and performs arange of specialized and other tests as required by the workof the regional hospital.Main activities are to: Operate a regional blood transfusion center; Prepare reagents, controls, standard solutions andothers as found necessary; Investigate epidemics and perform tests of publichealth importance in the region; Superviseandsupporttheworkofdistrictlaboratories; Send specimens that require special investigation tothe central and public health laboratory; Prepare periodical reports and send to the central andpublic health laboratory.1.4.4Central and public health laboratoryThe central and public health laboratory is responsible for7
planning, advising and overall coordinating of medicallaboratory services in the region.Main activities are to: Formulate a professional code of conduct to medicallaboratory personnel. Perform a range of special tests not normallyundertaken in the regional laboratories such as viral,histopathological, cytological, immunological, forensicand genetic investigations. Carry out appropriate research of importance in orderto mitigate public health problems. Evaluatenewtechnologiesandstandardizetechniques. Purchase supplies and equipments for the nationallaboratory service and organize an efficient system nt. Communicate and collaborate with InternationalOrganizations in promoting laboratory standards. Organize laboratory-teaching seminars and preparetraining manuals for the different laboratory-trainingprogrammes. Support the work of the regional hospital laboratories. Organizerefreshmenttrainingandseminars/workshops for district and primary health care8
laboratory personnel. Prepare training manuals for the different laboratorytraining programmes. Participate in the prompt laboratory investigation ofepidemics and outbreaks of serious illness amongcommunities.1. 5Role of medical laboratory servicesThe medical laboratory services play a pivotal role in thepromotion, curative and preventive aspects of a nation’shealth delivery system.The service gives a scientific foundation by providing accurateinformation to those with the responsibility for: Treating patients and monitoring their response totreatment, Monitoring the development and spread of infectious anddangerous pathogens (disease causing organisms), Deciding effective control measures against majorprevalent disease,Deciding health priorities and allocating resources.Without reliable laboratory services:1. The source of a disease may not be identified correctly.2Patients are less likely to receive the best possible care.3. Resistance to essential drugs may develop and continue9
to spread.4. Epidemic diseases may not be identified on time and withconfidence.1.6 Role of med
For Medical Laboratory Technology Students Introduction to Medical Laboratory Technology Berhanu Seyoum Haramaya University In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education December 2006
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