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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 1: INTRODUCTION
1. Human Health and Clinical Diagnosis in Developing Countries 3
Kanai L Mukheriee, Swarajit Ghosh and Chhotelaal Pande
Human Body in Health and Disease 3 Medical Care in India 4
Healthcare in India 6
Clinical Laboratories and Laboratory Personnel in India 7 Status of Medical Laboratories in Developing Countries 11 Commonly Requested Laboratory Tests in India and Other Developing Countries 12
Review Questions 14
2. Introduction to Clinical Laboratories 16
Ashoke Khanwalkar and Chhotelaal Pande
Introduction to Clinical Laboratories 16 Organization of Clinical Laboratories 17 Ethics and Laboratory Medicine 24 Automation in Clinical Laboratories 25
Review Questions 28
3. Laboratory Safety and First Aid 29
Monisha Bhatia
Clinical Laboratory Environment 30 Laboratory Safety Policies 30 Biohazard and Safety Precautions 37 Radiation Hazard 40 Fire Hazard and Explosion 40 Specialized Equipment 43 Laboratory Hygiene and Housekeeping 45 Personal Safety of Laboratory Workers 45
Warning Signs 47
Accident Record and Training 47 First Aid Kits and Procedures 48 Poisoning with Strong Acids and Caustic Alkalis 51 Guide to Standard Precautions 53
Review Questions 53
xii
Medical Laboratory Technology: Volume I
4. Introduction to Laboratory Equipment and Basic Laboratory Operations 54
Kanai L Mukherjee and Piyali Basu
Overview 55 Identification and Use of Common Laboratory Glassware and Equipment 55 Use and Care of Laboratory Glassware and Plastic Ware 58 Techniques of Simple Laboratory Operation 59 Storage, Handling and Preparation of Laboratory Reagents 87 Techniques for Heating a Liquid in a Test Tube 92 Graphical Presentation of Data 93 Use and Care of Common Laboratory Instruments 95 Laboratory Water 122 Water for Human Consumption 127 Common Laboratory Equipment 129 Special Laboratory Equipment 132
Review Questions 139
5. Specimen Handling and Laboratory Records 140
Chhotelaal Pande, Anant Kumar Pandey
Overview 141 Collection and Pre-Analytical Handling of Specimens 141 Procedures for Common Laboratory Specimens 145 Mailing Laboratory Specimen 170 Reporting of Laboratory Results 171 Discarding Specimens after Use 174 Clinical Laboratory Records 174
Review Questions 180 Appendix: Sample Copies of Laboratory Forms and Records 182
6. Units of Measurement and Preparation of Reagent Solutions 196
Tara Chattoraj
International System of Measurement: The Metric System 196 Units of Measurement 198 Preparation of Reagent Solutions 203 Laboratory Calculations 207
Review Questions 210
7. Good Laboratory Practices and Statistical Quality Control 212
Aloka Chakravarty
Sources of Common Errors in Laboratory 213 Proficiency Testing 214 Statistical Quality Control of Quantitative Data 218
Basic Statistics 218
Summary 226 Review Questions 226
SECTION 2: HAEMATOLOGY AND COAGULATION
8. Introduction to Haematology 229
Anuradha Chakravarthy
Introduction 229
Components of Blood and Their Functions 230 Haematopoietic System of the Body 232
Review Questions 235
Contents
xiii
9. Basic Laboratory Procedures in Haematology 236
Anuradha Chakravarthy
Overview 236 Collection and Processing of Blood Specimen 236 Preparation of Blood Films 238 Cleaning of Laboratory Glassware in Haematology 241
Review Questions 241
10. Routine Haematological Tests 242
Anuradha Chakravarthy and Volkmar Dierolf
Determination of Haemoglobin Concentration 243 Determination of Haematocrit 252 Red Blood Cell Indices 258 Interpretation of Abnormal Findings 261 Erythrocyte Sedimentation Rate (ESR) 262 Enumeration of Formed Elements 266 Microscopic Study of Blood Smear 271 Automated Systems in Haematology 292 Reticulocyte Count 296 Absolute Platelet Count 300
Review Questions 304
11. Special Haematological Test 306
Anuradha Chakravarthy
Laboratory Diagnosis of Haemoglobinopathies 306 Screening Test for Sickle Cell Anaemia 307 Laboratory Diagnosis of Blood Parasite Infection 313
Review Questions 331
12. Interpretation of Laboratory Findings in Haematology 332
Anuradha Chakravarthy
Overview 333 Anaemias 333
Leukaemias 334 Miscellaneous Disorders 336
Review Questions 337
13. Introduction to Haemostasis and Haemostatic Disorders 338
Ritwik Bhatia
Haemostasis (Stoppage of Bleeding) 339 Mechanism of Blood Coagulation 341 Fibrinolysis 342 Disorders of Haemostasis 343 Control Mechanisms of Haemostasis 345 Laboratory Tests for Haemostatic Function 346
Review Questions 346
14. Laboratory Investigation of Bleeding Disorders 348
Ritwik Bhatia
Basic Screening Tests for Bleeding Disorders 349 Coagulation Tests 356 Determination of Activated Partial Thromboplastin Time 363 Rapid Haemostatic Tests and Point-of-Care Instruments 364
xiv
Tests for Fibrin Degradation Products (FDP) or D-Dimer 365 Protamine Sulphate Test 366 Laboratory Diagnosis of Bleeding Disorders 366 Therapy of Bleeding Disorders 369
Review Questions 370
Medical Laboratory Technology: Volume I
SECTION 3: IMMUNOHAEMATOLOGY OR BLOOD BANKING
15. Introduction to Blood Transfusion Therapy 373
Pampee Paul Young and Jay S Raval
Basic Concepts of Immunology and Immunohaematology 374 Discovery of Basic Human Blood Groups (ABO) 376 Principles of Immunohaematology 378 Red Cell Antigens 378 Recognition of Immunologic Reactions of Red Cells 380 Laboratory Methods in Detecting Antibodies 381 Human Blood Group Systems 382 Basic Blood Group System: ABO 382 Rhesus (Rh) Blood Group System and Immune Antibodies 385 Other Blood Group Systems 388 Pretransfusion Testing 389 Antibody Screen 389 Compatible Blood Groups 391
Review Questions 392
16. Collection and Processing of Blood for Transfusion 393
Pampee Paul Young and Jay S Raval
Selection of Blood Donors 394 Method of Blood Collection 398 Transportation of Blood After Collection 404 Storage of Blood 405 Common Equipment in a Blood Bank 406 Reagents 410 Preparation of Blood Components 411 Autotransfusion 417
Plasmapheresis 417
Transportation of Blood 417 Delivery of Blood and Blood Components to Clinical Areas 418
Review Questions 419
17. Routine Laboratory Procedures in Blood Bank 420
Pampee Paul Young and Jay S Raval
Significance of Quality Control in Blood Bank 421 Specimen Collection for Blood Bank 421 General Laboratory Preparations in Blood Bank 422 Preparation of Laboratory Reagents in Blood Bank 424 Reporting of Haemagglutination Reaction 426 ABO Blood Grouping 427 Rh Blood Typing 437 Antihuman Globulin (AHG) or Coombs’ Test 441 Major Cross-Match 446 Antibody Screening Test 452 Identification of Unexpected Antibodies 453
Contents
Titration of Anti-D 454 Review Questions 456 Appendix 17.1: Request for Blood Transfusion 458
xv
18. Blood Transfusion Services and Clinical Approach to
Haemolytic Disease of the Newborn 459
Pampee Paul Young and Jay S Raval
Introduction to Blood Transfusion Services 459 Pretransfusion Testing 460 Release of Blood for Transfusion 461 Blood Transfusion Therapy 462 Transfusion Reactions 462 Haemolytic Disease of the Foetus and/or Newborn 464
Review Questions 468
Laboratory Information Systems i
Phlebotomy/Venipuncture Procedure ix
Index I.1
CONTENTS OF VOLUME 2
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 Himan Parasites xi
Index I.1
xvi
Medical Laboratory Technology: Volume I
CONTENTS OF VOLUME 3
SECTION 7: CLINICAL BIOCHEMISTRY
29. Biochemical Processes of the Body Under Normal and Pathogenic Conditions 901
30. Specimen Collection and Processing for Biochemical Analyses 920
31. Techniques of Analytical Chemistry 932
32. Automation in Clinical Biochemistry 961
33. Routine Biochemical Test Procedures 985
34. Biochemical Test Profiles 1081
35. Therapeutic Drug Monitoring and Clinical Toxicology 1102
SECTION 8: HISTOLOGY AND CYTOLOGY
36. Introduction to Histotechnology and Cytotechnology 1127
37. Laboratory Techniques in Histology 1147
38. Laboratory Techniques in Diagnostic Exfoliative Cytology 1206
39. Basics of Immunohistochemistry 1222
40. Polymerase Chain Reacion in Clinical Diagnosis 1240
Medical Terminology 1387
Glossary and Technical Terms 1391
Appendices 1421
Index 1441

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 I
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
)