A medical laboratory or clinical laboratory is a laboratory where tests are conducted out on clinical specimens (e.g. Blood, urine, stool, sputum and other body tissues) to obtain information about the health of a patient to aid in diagnosis, treatment, and prevention of disease. Clinical medical laboratories are an example of applied science, as opposed to research laboratories that focus on basic science, such as found in some academic institutions.
Medical laboratories vary in size and complexity and so offer a variety of testing services. More comprehensive services can be found in acute-care hospitals and medical centers, where 70% of clinical decisions are based on laboratory testing. Doctors offices and clinics, as well as skilled nursing and long-term care facilities, may have laboratories that provide more basic testing services. Commercial medical laboratories operate as independent businesses and provide testing that is otherwise not provided in other settings due to low test volume or complexity.
Departments In hospitals and other patient-care settings, laboratory medicine is provided by the Department of Pathology and Medical Laboratory, and generally divided into two sections, each of which will be subdivided into multiple specialty areas. The two sections are:
Anatomic pathology: areas included here are histopathology, cytopathology, electron microscopy, and gross pathology. Medical Laboratory or clinical pathology, which typically includes the following areas: Clinical microbiology: This encompasses several different sciences, including bacteriology, virology, parasitology, immunology, and mycology. Clinical chemistry: This area typically includes automated analysis of blood specimens, including tests related to enzymology, toxicology and endocrinology. Hematology: This area includes automated and manual analysis of blood cells. It also often includes coagulation. Blood bank involves the testing of blood specimens in order to provide blood transfusion and related services. Molecular diagnostics DNA testing may be done here, along with a subspecialty known as cytogenetics. Reproductive biology testing is available in some laboratories, including Semen analysis, Sperm bank and assisted reproductive technology. Layouts of clinical laboratories in health institutions vary greatly from one facility to another. For instance, some health facilities have a single laboratory for the microbiology section, while others have a separate lab for each specialty area.
The testing in the laboratory is traditionally categorized by the clinical purpose of the test, which determines how the test should be used throughout the spectrum of diagnosis and care. There are four major categories namely screening tests, diagnostic tests, monitoring tests and follow-up tests.
Screening tests are offered to the asymptomatic people to reveal possible diseases. On the contrary, diagnostic tests are used to prove or disapprove certain conditions. To follow the course of the disease or the reaction to treatment, monitoring tests are presented. Lastly, there are tests during the follow-up to determine the results following treatment.
The following is an example of a typical breakdown of the responsibilities of each area: Microbiology includes culturing of the bacteria in clinical specimens, such as feces, urine, blood, sputum, cerebrospinal fluid, and synovial fluid, as well as possible infected tissue. The work here is mainly concerned with cultures, to look for suspected pathogens which, if found, are further identified based on biochemical tests. Also, sensitivity testing is carried out to determine whether the pathogen is sensitive or resistant to a suggested medicine. Results are reported with the identified organism(s) and the type and amount of drug(s) that should be prescribed for the patient. Parasitology is where specimens are examined for parasites. For example, fecal samples may be examined for evidence of intestinal parasites such as tapeworms or hookworms. Virology is concerned with identification of viruses in specimens such as blood, urine, and cerebrospinal fluid. Hematology analyzes whole blood specimens to perform full blood counts and includes the examination of blood films. Other specialized tests include cell counts on various bodily fluids. Coagulation testing determines various blood clotting times, coagulation factors, and platelet function. Clinical biochemistry commonly performs dozens of different tests on serum or plasma. These tests, mostly automated, includes quantitative testing for a wide array of substances, such as lipids, blood sugar, enzymes, and hormones. Toxicology is mainly focused on testing for pharmaceutical and recreational drugs. Urine and blood samples are the common specimens. Immunology/Serology uses the process of antigen-antibody interaction as a diagnostic tool. Compatibility of transplanted organs may also be determined with these methods. Immunohematology, or blood bank determines blood groups, and performs compatibility testing on donor blood and recipients. It also prepares blood components, derivatives, and products for transfusion. This area determines a patient's blood type and Rh status, checks for antibodies to common antigens found on red blood cells, and cross matches units that are negative for the antigen. Urinalysis tests urine for many analytes, including microscopically. If more precise quantification of urine chemicals is required, the specimen is processed in the clinical biochemistry lab. Histopathology processes solid tissue removed from the body (biopsies) for evaluation at the microscopic level. Cytopathology examines smears of cells from all over the body (such as from the cervix) for evidence of inflammation, cancer, and other conditions. Molecular diagnostics includes specialized tests involving DNA and RNA analysis. Cytogenetics involves using blood and other cells to produce a DNA karyotype. This can be helpful in cases of prenatal diagnosis (e.g. Down's syndrome) as well as in some cancers which can be identified by the presence of abnormal chromosomes. Surgical pathology examines organs, limbs, tumors, fetuses, and other tissues biopsied in surgery such as breast mastectomies.
Medical Laboratory Staff
Pathologist: A physician who specializes in diagnosing disease through the examination of human tissues and bodily fluids. Pathologists' Assistant: A master's level, certified professional with specialized training in human anatomy. These professionals perform autopsies, screen histopathology slides, and create physical descriptions of surgical specimen. Scientists/Technologists: Certified laboratory professionals with at least a Bachelor's degree level of education. Scientists in the fields of Blood Banking, Microbiology, Cytogenetics, Chemistry, Hematology, Molecular Biology, Andrology, etc. Medical Technologist, Medical Laboratory Scientist, Clinical Laboratory Scientist (MT, MLS or CLS). Histotechnologist: Scientists who specialize in the analysis of human tissues. Cytotechnologist: Scientists who specialize in the analysis of human cells. Technicians: Certified laboratory professionals with an Associate's level of education. Medical Laboratory Technician or Clinical Laboratory Technician (MLT or CLT) Histotechnicians Grossing Technician Phlebotomist (PBT): A certified healthcare professional who performs venipuncture. Medical Laboratory Assistant or Laboratory Assistant (MLA, LA): Medical laboratory assistants play a critical role in assisting with laboratory operations. They are often responsible for interacting with interdisciplinary healthcare professionals and maintaining specimen integrity Transcriptionist
Labor shortages
The United States has a documented shortage of working laboratory professionals. For example, vacancy rates for Medical Laboratory Scientists ranged from 5% to 9% for various departments. The decline is primarily due to retirements, and to at-capacity educational programs that cannot expand which limits the number of new graduates. Professional organizations and some state educational systems are responding by developing ways to promote the lab professions in an effort to combat this shortage. In addition, the vacancy rates for the MLS were tested again in 2018. The percentage range for the various departments has developed a broader range of 4% to as high as 13%. The higher numbers were seen in the Phlebotomy and Immunology. Microbiology was another department that has had a struggle with vacancies. Their average in the 2018 survey was around 10-11% vacancy rate across the United States. Recruitment campaigns, funding for college programs, and better salaries for the laboratory workers are a few ways they are focusing to decrease the vacancy rate. The National Center For Workforce Analysis has estimated that by 2025 there will be a 24% increase in demand for lab professionals. Highlighted by the COVID-19 pandemic, work is being done to address this shortage including bringing pathology and laboratory medicine into the conversation surrounding access to healthcare. COVID-19 brought the laboratory to the attention of the government and the media, thus giving opportunity for the staffing shortages as well as the resource challenges to be heard and dealt with.
Types of laboratory
In most developed countries, there are two main types of lab processing the majority of medical specimens. Hospital laboratories are attached to a hospital, and perform tests on their patients. Private (or community) laboratories receive samples from general practitioners, insurance companies, clinical research sites and other health clinics for analysis. For extremely specialised tests, samples may go to a research laboratory. Some tests involve specimens sent between different labs for uncommon tests. For example, in some cases it may be more cost effective if a particular laboratory specializes in a less common tests, receiving specimens (and payment) from other labs, while sending other specimens to other labs for those tests they do not perform.
In many countries there are specialized types of medical laboratories according to the types of investigations carried out. Organisations that provide blood products for transfusion to hospitals, such as the Red Cross, will provide access to their reference laboratory for their customers. Some laboratories specialize in Molecular diagnostic and cytogenetic testing, in order to provide information regarding diagnosis and treatment of genetic or cancer-related disorders.
Laboratory equipments and machines
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Specimen processing and work flow
In a hospital setting, sample processing will usually start with a set of samples arriving with a test request, either on a form or electronically via the laboratory information system (LIS). Inpatient specimens will already be labeled with patient and testing information provided by the LIS. Entry of test requests onto the LIS system involves typing (or scanning where barcodes are used) in the laboratory number, and entering the patient identification, as well as any tests requested. This allows laboratory analyzers, computers and staff to recognize what tests are pending, and also gives a location (such as a hospital department, doctor or other customer) for results reporting.
Once the specimens are assigned a laboratory number by the LIS, a sticker is typically printed that can be placed on the tubes or specimen containers. This label has a barcode that can be scanned by automated analyzers and test requests uploaded to the analyzer from the LIS.
Specimens are prepared for analysis in various ways. For example, chemistry samples are usually centrifuged and the serum or plasma is separated and tested. If the specimen needs to go on more than one analyzer, it can be divided into separate tubes.