PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1

Lecture Session 2 (midterm) October 27, 2021

NATURE OF CLINICAL LABORATORY Clinical Pathology Anatomic Pathology

Hematology Clinical Surgical Pathology
CLINICAL LABORATORY Chemistry Microbiology Immunohistopathology
✔ Refers to a facility subdivided into different Parasitology Mycology Cytology Autopsy
sections where common diagnostic procedures Clinical Microscopy Forensic Pathology
are done by specialized health professionals. Immunohematology
✔ MAIN TASK: to provide accurate and reliable Blood Banking
information to medical doctors for the diagnosis, Laboratory
prognosis, treatment, and management of Endocrinology
diseases Toxicology and
✔ The regulation of Clinical Laboratories in the Therapeutic Drugs
Philippines is governed by Republic Act 4688. Non-hospital Based
Hospital-Based (HB)
(NHB)
Republic Act 4688 - Laboratory that - Laboratory that
✔ An act regulating the operation and maintenance operates within a operates on its own
of clinical laboratories and requiring the hospital - Also known as
registration of the same with the department of - Also known as FREE-STANDING
health, providing penalty for the violation thereof, INSTITUTION-BASED LABORATORY
and for other purposes
✔ Approved: June 18, 1966.
Government-Owned Privately-Owned
Administrative Order No. 59 s. 2001 - Owned, stablish and
Rules & Regulation Governing the Establishment, - Owned by operated by an
Operation & Maintenance of Clinical Laboratories in national or local individual operator,
the Philippines government corporation,
✔ This Administrative Order shall be known as the units institution, association
"Rules and Regulations Governing the or an organization
Establishment, Operation and Maintenance of
Clinical Laboratories in the Philippines. “
✔ These rules and regulations are promulgated to ACCORDING TO SERVICE CAPABILITY (Examination
protect and promote the health of the people by Performed)
ensuring availability of clinical laboratories that Primary Secondary Tertiary
are properly managed with adequate resources, 1. Routine 1. Primary 1. Secondary
with effective and efficient performance through Hematology laboratory laboratory
compliance with quality standards. 2. Routine examination examination
urinalysis 2. Routine 2. Special
3. Routine chemistry chemistry
fecalysis 3. Blood typing 3. Special
4. Blood typing- and hematology
HB crossmatching 4. Immunology/
5. Quantitative - HB Serology
platelet 5. Microbiology
determination
- HB

Sections of the Clinical Laboratory

CLASSIFICATION OF CLINICAL LABORATORIES
(Based on AO 59 s. 2001) • Clinical Chemistry
• Hematology
ACCORDING TO FUNCTION: • Immunohematology/Blood Bank
 PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
Lecture Session 2 (midterm) October 27, 2021

• Immunology/Serology Alkaline phosphatase, acid

• Medical Microbiology phosphatase, Creatine
• Analysis of Urine and Blood Fluids (Clinical
Microscopy)
phosphokinase, Lactic acid
• Histopathology dehydrogenase, Glutamic-
Oxalacetic Transaminase,
Amylase, etc.
Clinical Chemistry
● This section is intended for the testing of blood
Total protein, Albumin,
and other body fluids to quantify essential
soluble chemicals including waste products useful Globulin, Pre-albumin, Alpha
Proteins
for the diagnosis of certain diseases. globulins, Beta-globulins,
● Test procedures are usually performed on serum Immunoglobulins, etc.
Plain/red tube – Tubes that no anti-coagulant
Anti-coagulant – Chemicals that prevents Organics Glucose, Urea, Uric acid,
coagulation/clotting
Creatinine, Cholesterol, etc.

Profile Type Composition of example profiles

Na+, K+, Cl-, HCO3-, PO4-3,
Renal (Kidney) Urea Nitrogen, Creatinine,
Uric acid, albumin

Total bilirubin, Direct

bilirubin, AST, ALT, ALP,
Hepatic (liver)
Cholesterol, Total protein,
albumin, globulin
- Cholesterol
- Glucose
CPK, LDH, Troponin I,
Cardiac (Heart)
Myoglobin

Cholesterol, HDL, LDL, VLDL,

Hypertensive
Triglycerides

Thyroid Thyroxin, Free thyroxin, TSH

Clinical Hematology and Coagulation Studies

Chemistry Clinical Significance ● This section deals with the enumeration or
Services counting of cells in the blood and other body
Na+, K+, Cl-, HCO3, PO4-3, fluids (e.g., CSF, pleural fluid, etc.).
Electrolytes ● Coagulation studies focus on blood testing for the
Ca+2, Mg+2, etc.
determination of various coagulation factors.
Enzymes
 PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
Lecture Session 2 (midterm) October 27, 2021

● Whole blood is used for the majority of test

procedures.
Lavender tube

Microbiology
● Study of microorganisms too small to be seen by
unaided eye.
● A broad term which includes virology, mycology,
parasitology, bacteriology.
● Responsible for growing and identifying the
organisms obtained from patient’s blood, urine,
or other body fluids, sputum, or wound.
● After the organism is grown out (culture),
susceptibility testing can be performed.

- Jelly like consistency

- Nutrients

Zone of
inhibition

Blood Bank
● Deals with the uses of immunologic principles to
Immunology/ Serology
study and identify the different blood groups
● Immunology is defined as the study of all the
● Separate area in a clinical laboratory where blood
aspects of the immune system, including its
is collected from donors.
structure and function.
● Prepares blood and blood components for
● Deals with the response of an organism to
transfusion
antigenic challenge and its recognition of what is
● Cross-matching
self and non self.
● Serology is a division of immunology that deals
with the specializes in the laboratory detection
and measurement of antigens and antibodies.
● Serological tests may be performed for
diagnostic purposes when an infection is
 PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
Lecture Session 2 (midterm) October 27, 2021

suspected and helps to diagnose patients with ● Patient registration 

immunodeficiencies associated with the lack of ● Laboratory test ordering 
antibodies. (HEPA-B, DENGUE, MALARIA) ● Phlebotomy draw lists 
(COVID-ANTIGEN) ● Bar-coded labels (collection tube / aliquot
● Cells, barriers, skin, tears, nose’ hair, tonsils labels) 
● Antigen and antibody ● Specimen Racking System
Analytic Phase
● Quality Control 
Clinical Microscopy
● Instrument worklist 
● Performs scientific analysis of non-blood body
● Manual worklist 
fluids such as urine, semen, and stool. ● Manual results entry 
● Automated results entry via interface 
Histopathology ● Validation of results 
● Refers to the microscopic examination of tissue in ● Release of results
order to study the manifestations of disease. Post-Analytic Phase
● Examination of a biopsy or surgical specimen by a ● Cumulative patient reports 
pathologist, after the specimen has been ● Corrected report 
processed and histological sections have been ● Results inquiry 
placed onto glass slides. ● Electronic reporting (billing) 
Two sources of specimens: ● Pending List
1. Autopsy specimen - Dead
2. Biopsy specimen - Living

Cycle of Clinical Laboratory Testing

Pre-analytic Phase
 PRINCIPLES OF MEDICAL LABORATORY SCIENCE 1
Lecture Session 2 (midterm) October 27, 2021

Quality Assurance in the Clinical Laboratory

✔ encompasses all activities performed by
laboratory personnel ensure reliability of test
results.
✔ It is organized, systematic, well-planned, and
regularly done with the results properly
documented and consistently reviewed.
TWO MAJOR COMPONENTS:
1. Internal Quality Assurance System (IQAS)
● includes day-to-day activities that are
undertaken in order to control factors or
variables that may affect test results.
● Regular review and audit of results are
done in order to identify weaknesses and
consequently perform corrective actions.
2. External Quality Assurance System (EQAS)
● a system for checking performance
among clinical laboratories and is
facilitated by designated external
agencies.
● The National Reference Laboratories
(NRL) is the DOH designated EQAS.

✔ At present, the designated NRL-EQAS are the

following:
1. National Kidney and Transplant Institute (NKTI) -
Hematology and Coagulation

2. Research Institute of Tropical Medicine (RITM) –

Microbiology (identification and antibiotic
susceptibility testing) and Parasitology
(identification of ova and quantitation of malaria)

3. Lung Center of the Philippines (LCP) - Clinical

Chemistry (for testing 10 analytes, namely
glucose, creatinine, total protein, albumin, blood
urea nitrogen, uric acid, cholesterol, sodium,
potassium, and chloride)

4. East Avenue Medical Center (EAMC) - Drugs of

abuse (methamphetamine and cannabinoids)

5. San Lazaro Hospital STD-AIDS Cooperative Center

Laboratory (SACCL) - Infectious immunology
hepatitis B surface antigen (HBsAg), human
immunodeficiencyvirus (HIV), hepatitis C virus
(HCV)