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- •Foreword
- •Preface to the Fourth Edition
- •Preface to the Third Edition
- •Contributors
- •Commonly Used Abbreviations in Medical Laboratories
- •Contents
- •29. Biochemical Processes of the Body Under Normal and Pathogenic Conditions
- •Normal and Abnormal Biochemical Processes of the Body
- •Basic Physiology and Biochemistry of the Body
- •Interrelated Metabolic Processes of the Body
- •Functions of Various Organs
- •Biochemical Changes in the Body Under Pathologic Conditions
- •Basic Clinical Biochemistry
- •Diagnostic Biochemical Profiles
- •Review Questions
- •30. Specimen Collection and Processing for Biochemical Analyses
- •Specimens of Biochemistry and their Handling
- •Types of Specimens
- •Review Questions
- •31. Techniques of Analytical Chemistry
- •Introduction to Analytical Chemistry
- •Analytical Chemistry and Clinical Chemistry
- •Applications of the Principles of Analytical Chemistry
- •Instrumentation for Proteomics
- •Osmometry
- •Analytic Techniques for Point-of-Care Testing (POCT)
- •Review Questions
- •32. Automation in Clinical Biochemistry
- •Introduction
- •History of Laboratory Automation
- •Present State of Laboratory Automation
- •Benefits of Automation in Clinical Laboratories
- •Classification of Automated Systems
- •Steps of Automation in Biochemical Analysis
- •Quality Control and Preventive Maintenance
- •Computers in Clinical Laboratories
- •Automation in the Clinical Laboratories of Developing Countries
- •Point-of-Care Testing: A New Approach
- •Time-Saving Devices and Kits
- •Conclusion
- •Review Questions
- •33. Routine Biochemical Test Procedures
- •Introduction
- •Routine Diagnostic Tests in Clinical Chemistry
- •Blood Glucose
- •Serum Protein
- •Blood Urea Nitrogen (BUN)
- •Uric Acid
- •Creatinine
- •Bilirubin
- •Diagnostic Enzymology
- •Brain Natriuretic Peptide (BNP)
- •Lipid Profile
- •Thyroid Function Tests
- •Electrolytes
- •Acid–Base Balance and Blood Gases
- •Review Questions
- •34. Biochemical Test Profiles
- •Analytes Commonly Tested in Chemistry Profiles
- •Kidney (Renal) Function Tests
- •Liver Function Tests
- •Cardiac Function Tests
- •Lipid Metabolism
- •Carbohydrate Metabolism
- •Thyroid Function Tests
- •Other Tests of Organ Functions
- •Gastric Function Tests
- •Pancreatic Function Tests
- •Test for Malabsorption
- •Review Questions
- •35. Therapeutic Drug Monitoring and Clinical Toxicology
- •Drug and Drug Addiction
- •Diagnostic Screening in Emergency
- •Comments on Commonly used Drugs
- •Classification of Illegal Drugs and Their Uses
- •Toxicology Laboratory and Forensic Medicine
- •Drug Screening in Clinical Chemistry Laboratory
- •Laboratory Assay of Drugs and Poisoning
- •Laboratory Investigation of Drug Abuse
- •Investigation for New Illegal Drugs
- •Popularity of Immunoassay
- •Laboratory Screening for Heavy Metal Poisoning
- •Point-of-Care Testing
- •Review Questions
- •36. Introduction to Histotechnology and Cytotechnology
- •Introduction to Histophathology and Exfoliative Cytology
- •Basic Terminology
- •Histopathology Laboratory Equipment
- •Laboratory Supplies
- •Reagents
- •Routine and Special Staining: A Review
- •Review Questions
- •37. Laboratory Techniques in Histology
- •Overview
- •Logging in of Specimens
- •Preparation of Tissues
- •Processing of Tissues
- •Special Stains and Staining Techniques
- •Routine Staining Procedure in Histology
- •Post Staining Processes
- •Stains for Particular Substances
- •Stains for Microorganisms
- •Staining Kits from Commercial Companies
- •Frozen Section Technique
- •Handling and Embedding Small Tissue Fragments
- •Review Questions
- •38. Laboratory Techniques in Diagnostic Exfoliative Cytology
- •Introduction to Exfoliative Cytology
- •Four Phases of Exfoliative Cytology
- •Collection of Specimens
- •Preparation of Specimens
- •Cytological Stains and Staining Techniques
- •Identifying Characteristics of Benign and Malignant Cells
- •Review Questions
- •Evolution of Tissue/Cellular Level Diagnostics
- •Drying of Paraffin Sections
- •Postanalytical Phase of IHC
- •Panel Markers in IHC
- •Evolution of PCRs
- •Point of care PCR for Clinical Diagnosis
- •Medical Terminology
- •Suffixes and Prefixes in Medical Terminology
- •Glossary of Technical Terms
- •Appendices

Preface to the Third Edition
In the last 27 years, since the publication of the first edition of Medical Laboratory Technology, many
changes in the field of laboratory medicine have occurred. Although some of these updates were included
in our second edition (2010), we felt that the time has come for a thorough revision, and thus we bring forth
the current edition.
When I look back, at my age of ninety, I can see how far medical technology has come through these
years. I could never forget the limited facilities I had for teaching science in India early in my career. It
was only after I moved to the United States that I was exposed to advanced medical laboratory education.
After gaining years of teaching experience on the subject here, I felt compelled to share what I learned
with my people whom I had left behind. Endless support came from my new friends in the United States
as well as in India with whom I worked during my tenure as a Fulbright Professor to lecture on Medical
Laboratory Technology across India. The best support was from the readers and academic institutions of
developing countries, who honoured our honest efforts. This would have not been possible without the help
from numerous doctors from rural and urban regions of India and people who were associated with the most
advanced laboratories in the United States. Thus the book stands as a model of collaboration in the field of
medical technology between those who truly understand the needs of the developing world and those who
have the knowledge of the developed world. I acknowledge with a deep sense of gratitude, my friends,
colleagues, students and members of my own family who have contributed to this bold endeavour.
As I worked with two dozen young authors in this edition, I could feel their motivation and eagerness to
share their hard-earned experience with new students, no matter how far away they may be in the world. As
they worked with me, they inspired me at every step and I felt young again. We, as a team, kept in mind that
the economic condition of developing countries will not permit the clinical laboratories to run on par with
advanced laboratories. Yet, the needs of the sick must be addressed and a doctor needs accurate laboratory
information to make the correct diagnosis. Hence, the laboratories of developing countries, including
those located far away from urban centres, have to operate on a limited budget and depend on resourceful,
knowledgeable laboratory technologists, who may have limited training or education.
Unfortunately, as I have observed, there remains a significant lack of professionalism in the clinical
laboratories of many developing countries. This has resulted in unreliable laboratory reports that can then
lead to wrong diagnoses, and as a result, unnecessary illness and death. A firm understanding of the critical
role of laboratories in alleviating human suffering may help increase the care and diligence with which
laboratory technicians perform their jobs. I hope and pray that this book can help make that change.
Kanai L Mukherjее
Professor Emeritus
Fulbright Visiting Professor to India (1983-1984)
Essex Community College,

Contents
Foreword vii
Preface to the Fourth Edition ix
Preface to the Third Edition x
Contributors xvii
Commonly Used Abbreviations in Medical Laboratories xix
SECTION 7: CLINICAL BIOCHEMISTRY
29. Biochemical Processes of the Body Under Normal and Pathogenic Conditions 901
Vissagan Gopalakrishnan and Piyali Basu
Normal and Abnormal Biochemical Processes of the Body 901
Basic Physiology and Biochemistry of the Body 902
Interrelated Metabolic Processes of the Body 908
Functions of Various Organs 909
Biochemical Changes in the Body Under Pathologic Conditions 912
Basic Clinical Biochemistry 914
Diagnostic Biochemical Profiles 914
Review Questions 919
30. Specimen Collection and Processing for Biochemical Analyses 920
Chhotelaal Pandey and Anant Kumar Pande
Specimens of Biochemistry and their Handling 920
Types of Specimens 921
Review Questions 931
31. Techniques of Analytical Chemistry 932
Kanai L Mukherjee and lshita Bhattacharya
Introduction to Analytical Chemistry 932
Analytical Chemistry and Clinical Chemistry 933
Applications of the Principles of Analytical Chemistry 934
Instrumentation for Proteomics 956
Osmometry 957
Analytic Techniques for Point-of-Care Testing (POCT) 958
Review Questions 960
32. Automation in Clinical Biochemistry 961
Aurin Chakravarty, Dipto Chakravarty and Chhotelaal Pandey
Introduction 962
History of Laboratory Automation 962
Present State of Laboratory Automation 963
Benefits of Automation in Clinical Laboratories 963
Classification of Automated Systems 964

xii
Steps of Automation in Biochemical Analysis 965
Quality Control and Preventive Maintenance 968
Automated ‘Stat’ Testing 968
Computers in Clinical Laboratories 968
Automation in the Clinical Laboratories of Developing Countries 976
Point-of-Care Testing: A New Approach 983
Time-Saving Devices and Kits 983
Conclusion 983
Review Questions 984
Medical Laboratory Technology: Volume III
33. Routine Biochemical Test Procedures 985
Kanai L Mukherjee, Chhotelaal Pande and Rohini Chakravarthy
Introduction 986
Routine Diagnostic Tests in Clinical Chemistry 987
Blood Glucose 988
Serum Protein 998
Blood Urea Nitrogen (BUN) 1006
Uric Acid 1010
Creatinine 1012
Bilirubin 1015
Diagnostic Enzymology 1021
Brain Natriuretic Peptide (BNP) 1045
Lipid Profile 1048
Thyroid Function Tests 1053
Electrolytes 1064
Acid–Base Balance and Blood Gases 1073
Review Questions 1079
34. Biochemical Test Profiles 1081
Ashoke Khanwalkar
Diagnostic Clinical Chemistry 1082
Analytes Commonly Tested in Chemistry Profiles 1083
Kidney (Renal) Function Tests 1085
Liver Function Tests 1086
Cardiac Function Tests 1089
Lipid Metabolism 1089
Carbohydrate Metabolism 1090
Thyroid Function Tests 1090
Other Tests of Organ Functions 1090
Gastric Function Tests 1093
Pancreatic Function Tests 1096
Test for Malabsorption 1098
Review Questions 1101
35. Therapeutic Drug Monitoring and Clinical Toxicology 1102
Kanai L Mukherjee and Piyali Basu
Drug and Drug Addiction 1103
Diagnostic Screening in Emergency 1104
Comments on Commonly used Drugs 1105
Classification of Illegal Drugs and Their Uses 1106
Toxicology Laboratory and Forensic Medicine 1108
Drug Screening in Clinical Chemistry Laboratory 1108
Laboratory Assay of Drugs and Poisoning 1109
Laboratory Investigation of Drug Abuse 1116

Contents
Investigation for New Illegal Drugs 1118
Popularity of Immunoassay 1119
Laboratory Screening for Heavy Metal Poisoning 1120
Point-of-Care Testing 1123
Review Questions 1124
xiii
SECTION 8: HISTOLOGY AND CYTOLOGY
36. Introduction to Histotechnology and Cytotechnology 1127
Venk Mani and Surajit Ghosh
Introduction to Histophathology and Exfoliative Cytology 1128
Basic Terminology 1129
Histopathology Laboratory Equipment 1130
Laboratory Supplies 1139
Reagents 1140
Routine and Special Staining: A Review 1143
Review Questions 1145
37. Laboratory Techniques in Histology 1147
Venk Mani and Kanai L Mukherjee
Overview 1148
Logging in of Specimens 1148
Preparation of Tissues 1149
Processing of Tissues 1156
Routine Staining Procedure in Histology 1166
Post Staining Processes 1170
Special Stains and Staining Techniques 1170
Stains for Particular Substances 1178
Stains for Microorganisms 1186
Staining Kits from Commercial Companies 1193
Frozen Section Technique 1202
Handling and Embedding Small Tissue Fragments 1205
Review Questions 1205
38. Laboratory Techniques in Diagnostic Exfoliative Cytology 1206
Krishna Mallik and Kanai L Mukherjee
Introduction to Exfoliative Cytology 1206
Four Phases of Exfoliative Cytology 1207
Collection of Specimens 1208
Preparation of Specimens 1210
Cytological Stains and Staining Techniques 1213
Identifying Characteristics of Benign and Malignant Cells 1220
Review Questions 1221
39. Basics of Immunohistochemistry 1222
Evolution of Tissue/Cellular Level Diagnostics 1222
Preanalytical Phases of IHC 1223
Drying of Paraffin Sections 1226
Postanalytical Phase of IHC 1233
Panel Markers in IHC 1238
40. Polymerase Chain Reaction in Clinical Diagnosis 1240
Evolution of PCRs 1240
Principles of PCR 1241

xiv
Application of PCR 1246
Point of care PCR for Clinical Diagnosis 1247
Medical Laboratory Technology: Volume III
SECTION 9: MISCELLANEOUS INFORMATION
Medical Terminology 1251
Maya Chattoraj and Kanai L Mukherjee
Suffixes and Prefixes in Medical Terminology 1251
Glossary of Technical Terms 1254
Maya Chattoraj and Kanai L Mukherjee
Appendices 1284
Maya Chattoraj and Kanai L Mukherjee
Appendix A: Sources of Information and Readings 1284
Appendix B: Comments on Reporting of Test Results 1288
Appendix C: Miscellaneous Information 1291
Appendix D: Conversion of Conventional Units to International (SI) Units 1293
Appendix E: Table of Panic Values 1294
Appendix F: Diagnostic Test Panels 1295
Appendix G: Professional Organizations Connected with Indian Clinical Laboratories 1296
Appendix H: Suppliers of Clinical Laboratory Products 1296
Index I.1–I.8
CONTENTS OF VOLUME I
SECTION 1: INTRODUCTION
1. Human Health and Clinical Diagnosis in Developing Countries 3
2. Introduction to Clinical Laboratories 16
3. Laboratory Safety and First Aid 29
4. Introduction to Laboratory Equipment and Basic Laboratory Operations 54
5. Specimen Handling and Laboratory Records 140
6. Units of Measurement and Preparation of Reagent Solutions 196
7. Good Laboratory Practices and Statistical Quality Control 212
SECTION 2: HAEMATOLOGY AND COAGULATION
8. Introduction to Haematology 229
9. Basic Laboratory Procedures in Haematology 236
10. Routine Haematological Tests 242
11. Special Haematological Tests 306
12. Interpretation of Laboratory Findings in Haematology 332

Contents
xv
13. Introduction to Haemostasis and Haemostatic Disorders 338
14. Laboratory Investigation of Bleeding Disorders 348
SECTION 3: IMMUNOHAEMATOLOGY OR BLOOD BANKING
15. Introduction to Blood Transfusion Therapy 373
16. Collection and Processing of Blood for Transfusion 393
17. Routine Laboratory Procedures in Blood Bank 420
18. Blood Transfusion Services and Clinical Approach to
Haemolytic Disease of the Newborn 459
Laboratory Information Systems i
Phlebotomy/Venipuncture Procedure ix
Index I.1
CONTENTS OF VOLUME II
SECTION 4: MICROBIOLOGY AND VIROLOGY
19. Introduction to Diagnostic Microbiology 471
20. Identification of Pathogenic Bacteria 544
21. Laboratory Diagnosis of Mycotic Infections 644
22. Laboratory Diagnosis of Parasitic Infections 678
SECTION 5: SEROLOGY
23. Introduction to Immunology and Principles of Serodiagnosis 729
24. Laboratory Procedures in Serology 750
SECTION 6: CLINICAL PATHOLOGY
25. Urine Analysis 805
26. Laboratory Examination of Miscellaneous Body Fluids 845
27. Semen Analysis 872
28. Stool Examination 882
Molecular Pathology i
Morphology and Life Cycles of Human Parasites xi
Index I.1


Contributors
Bibhas Bandy, MD
Otolaryngologist (ENT Specialist)
Washington County Hospital
Hagerstown, MD, USA
Piyali Basu, MS
Research Associate
Kolkata University, India
Monisha C Bhatia
Vanderbilt University, USA
Ritwik Bhatia
Vanderbilt University, USA
Shovan Bhatia
Research Associate
Ransom Everglades School
Miami, Florida, USA
Ishita Bhattacharya, BS
Research Associate
Monmouth Medical Scholar
Monmouth University, New Jersey, USA
Rohini Chakravarthy
Research Associate
Vanderbilt University Medical Centre
Tennessee, USA
Anuradha Chakravarthy, MD
Professor, Department of Radiation Oncology
Vanderbilt University Medical Centre
Tennessee, USA
Aloka Chakravarthy, PhD
Head of Statistics Department
US Food and Drug Administration
Washington, DC, USA
Aurin Chakravarty, BS
Research Associate
Johns Hopkins University
Baltimore, MD, USA
Dipto Chakravarty, MS
Specialist in Computer Technology
Washington, DC, USA
Tara Chattoraj, BS
Research Associate
University of Illinois
Urbana Champaign, USA
Maya Chattoraj
Research Associate
Wheaton Warrenville South High School
Illinois, USA
Volkmar Dierolf, PhD
Professor and Head
Department of Physics
Lehigh University, Allentown,
Pennsylvania, USA
Swarajit Ghosh, MD
New Delhi, India
Vissagan Gopalakrishnan
Rush Medical College
Chicago, Illinois, USA
Ashoke Khanwalkar, MD
Northwestern University
Chicago, Illinois, USA
Krishna Maliik, MD
Specialist in Orthopaedic Surgery and Arthroscopy
Reconstruction, Mountain Vista Medical Centre
Mesa, Arizona, USA
Venk Mani, MD
Chief Pathologist
Dickson Medical Associates
Dickson, Tennessee, USA
Kanai L Mukherjee, MT, PhD
Fulbright Professor (1983),
Emeritus Retired Director of MLT Program (ECC)
Baltimore, MD, USA
Chhotelaal Pande, BSc, MLT (ASCP), CLSH (NCA),
CLSpH (NCA)
Formerly Clinical Laboratory Supervisor,
Dar es Salaam, Tanzania, and
Metropolis Clinical Pathology Laboratory
Mumbai, Maharashtra, India

xviii
Medical Laboratory Technology: Volume III
Anant Kumar Pandey, BS (Medical Biotechnology)
Amity University, Noida, Uttar Pradesh, India
Jay Raval, MD
Assistant Professor
Medical Director of Therapeutic Apheresis
Division of Transfusion Medicine
University of North Carolina School of Medicine
Pampee Paul Young, MD, PhD
Professor and Director
Blood Bank
Stem Cell Laboratory and Transfusion Services
Vanderbilt University Medical Centre
Nashville, Tennessee, USA

Commonly Used Abbreviations in Medical Laboratories
Rohini Chakravarthy
Abbreviation Expanded Version
A
Ab
ACT
AFB
Ag
AHG
AIDS
Absorbance
Antibody
Activated clotting time
Acid-fast bacillus
Antigen
Antihuman globulin
Acquired immunodeciency
syndrome
ALL
ALP, AP
ALT
AML
ANA
APTT
Acute lymphocytic leukemia
Alkaline phosphatase
Alanine aminotransferase
(formerly, SGPT)
Acute myelogenous leukaemia
Anti-nuclear antibody
Activated partial
thromboplastin
AST
Aspartate aminotransferase
(formerly, SGOT)
BA
BBP
BP
BSC
BSI
BT
BUN
С
CBC
cc
CGL
chol
CK
CLL
Blood agar
Blood borne pathogen
Blood pressure
Biological safety cabinet
Body substance isolation
Bleeding time
Blood urea nitrogen
Celsius, centigrade
Complete blood count
Cubic centimetre
Chronic granulocytic leukaemia
Cholesterol
Creatine kinase
Chronic lymphocytic leukaemia
Abbreviation Expanded Version
CLS
CLT
cm
CNS
CO
CO
CPD
CPK
crit
C&S
CSF
2
Clinical laboratory scientist
Clinical laboratory technician
Centimetre
Central nervous system
Carbon monoxide
Carbon dioxide
Citrate-phosphate-dextrose
Creatinine phosphokinase
Haematocrit
Culture and sensitivity
Cerebrospinal uid, colony
stimulating factor
cu mm
DAT
DIC
Cubic millimetre (mm
Direct antiglobulin test
Disseminated intravascular
coagulation
Di
EBV
EDTA
EIA
EMB
ESR
EU
F
FBS
FDP
Dierential count of WBC
Epstein-Barr virus
Ethylenediaminetetraacetic acid
Enzyme immunoassay
Enzyme immunoassay
Erythrocyte sedimentation rate
Ehrlich units
Farenheit
Fasting blood sugar
Fibrinogen degradation
products
FUO
G
g
GGT
GI
Fever of unknown origin
Gravitational force in dynes/cm
Gram
Gamma glutamyl transferase
Gastrointestinal
3
)
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