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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 immunodeciency
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
Dierential 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
)