MLS 401

7.1 PASMETH, PAMET, LAWS, SPECIMEN COLLECTION AND

HANDLING, CLINICAL MICROSCOPY
Prof. Edilon Liwag | October 7, 2021

I. THE PHILIPPINE ASSOCIATION OF SCHOOLS dignity the profession on September 15, 1963, at the
MEDICAL TECHNOLOGY AND PUBLIC HEALTH Manila Public Health Laboratory in Sta. Cruz, Manila
(PASMETH), INC. → It had its first convention and election of officers on
September 20, 1964 at the Far Eastern University
Objectives of PASMETH: wherein Mr. Charlemagne Tamondong became the
- To encourage a thorough study of the needs and first President.
problems of medical technology education and to
→ It was incorporated and registered at the Securities
offer solutions
and Exchange Commission on October 14, 1969
- To work for the enhancement and continuous
with Reg. No. 39570, during the presidency of Mr.
development of medical technology education to
Nardito D. Moraleta.
ensure that the profession will be of maximum
→ On June 21, 1969, RA 5527 (Philippine Medical
service to the country.
Technology Act of 1969) was enacted into law.
- To take a united stand in matters which affect
→ A few days before the declaration of Martial Law on
interests of medical technology education.
September 21, 1972, President Ferdinand Marcos
- To seek advice, aid, and assistance from any
declared the 3rd week of September as a celebration
government or private entity for the fulfillment of the
of the Medical Technology profession.
Association’ s aims and purposes.
→ On June 22, 1973, PD 223 was approved creating
PASMETH the Professional Regulation Commission (PRC).
→ It was formed in 1970 in the hopes of maintaining the PAMET was officially recognized as the only
highest standards of Medical Technology/Public Accredited Professional Organization (APO) of
Health education and to foster closer relations registered Medical Technologists in the Philippines.
among these schools. → Rolando E. Puno – President (2015-present)
→ On May 13, 1970, Director Narciso Albarracin
appointed Dr. Serafin Juliano and Dr. Gustavo U. PAMET is affiliated with other local professional
Reyes to organize an association of Deans/Heads of associations namely:
Schools of Medical Technology and Hygiene. • Council of Professional Health Associations
→ The first organizational meeting was held at the (COPHA)
University of Santo Tomas on June 22, 1970. • Philippine Federation of Professional Associations
(PFPA)
→ The first sets of officers were: • Council of Health Agencies of the Philippines
President Dr. Gustavo Reyes (CHAP)
Vice-President Dr. Serafin Juliano • Philippine Council for Quality Assurance in Clinical
Secretary/Treasurer Dr. Velia Trinidad Laboratories (PCQACL)
Press Relations Officer Dr. Faustino Sunico • Alliance of All Health Organizations of the Nation
→ The first annual meeting was held at the University (AAHON)
of Santo Tomas on May 17, 1971. • Philippine Association of Schools of Medical
→ The first set of officers was reelected for a second Technology and Public Health (PASMETH)
term on April 30, 1972.
→ It was formally registered with the Securities and PAMET is also linked with government agencies such as:
Exchange Commission on October 6, 1985 thru the • Department of Health (DOH)
Committee on Legislation chaired by Mr. Cirilo S. • Professional Regulation Commission (PRC)
Cajucom with the help of a legal counsel, Atty. Dexter • Commission on Higher Education (CHED)
Bihis.
→ Dr. Bernard Ebuen – current president Internationally, PAMET is affiliated with:
• ASEAN Association of Clinical Laboratory Sciences
II. PHILIPPINE SOCIETY OF MEDICAL TECHNOLOGY (AACLS), Asia Association of Medical Laboratory
STUDENTS (PHISMETS) Scientists (AAMLS)
• International Federation of Biomedical Laboratory
PHISMETHS Scientists (IFBLS)
→ It was organized in 2002 during the term of Dean • Asia Pacific Federation of Clinical Biochemistry
Zenaida Cajucom (PASMETH President). (APFCB)
→ It aims to establish camaraderie among students • International Federation in Clinical Chemistry.
through activities like research, contests, and • American Society for Clinical Pathology (ASCP) –
pageants. New
• Other linkages include PAMET-USA and PAMET
III. THE PHILIPPINE ASSOCIATION OF MEDICAL
Singapore.
TECHNOLOGIST(PAMET)

PAMET Core Values of PAMET

→ Organization of all registered medical technologists • Integrity – strict adherence to the moral code
in the Philippines • Professionalism – positive traits and values, moral
→ Organized by Mr. Crisanto Almario (Father of responsibility, social responsiveness and behavioral
PAMET) in an attempt to standardize and to give outlook which makes one highly respectable and
credible

Trans maker: Llido, A.Y. 1

Editor: Sacedon, A. & Ismael, Y.
 MLS 401
7.1 PASMETH, PAMET, LAWS, SPECIMEN COLLECTION AND
HANDLING, CLINICAL MICROSCOPY
Prof. Edilon Liwag | October 7, 2021

• Commitment – unconditional, unwavering, selfless RA 8504: Philippine AIDS Prevention and Control Act of
declaration 1998
• Excellence – high quality performance Date approved: February 13, 1998
• Unity President: Fidel Ramos
Significance
PAMET National President o Helps control the alarming rate of HIV/AIDS infection
Rommel F. Saceda in the country
→ Student of the Master of Science in Medical o Created the Philippine National AIDS Council
Technology Program of the Graduate School. He is
finishing the academic courses as requirements for RA 11166: Philippine HIV and AIDS Policy Act
the comprehensive examination. Establishes policies and programs to prevent the spread
→ As a department manager (chief medical of HIV and deliver treatment, care, and support services
technologist) of the Institute of Pathology in St. to Filipinos living with HIV
Luke’s Medical Center-Quezon City, Mr. Saceda is Adopt a multi-sectoral approach in responding to the
very supportive of the International Clinical Internship country’s HIV and AIDS situation
and the student development program of the TUA- Ensure access to HIV and AIDS related services
College of Medical Technology. He is an active Positively address and seek to eradicate conditions that
member of the consultative group of the CMT Dean aggravated the spread of HIV infection
on training and professional development.
RA 9165: Comprehensive Dangerous Drugs Act of 2002
→ Currently, Mr. Saceda is the Auditor of the Graduate
Date approved: June 7, 2002
School Student’s Association.
President: Gloria Macapagal-Arroyo
Significance
IV. LAWS RELATED TO MEDICAL TECHNOLOGY
o Addresses the problem of drug addiction in the
PRACTICE
country
RA 5527: Philippine Medical Technology Act of 1969 o Dangerous drug test and requirements
Approved: June 21, 1969
President: Ferdinand Marcos RA 9288: Newborn Screening Act of 2004
Significance: Date approved: April 7, 2004
o Requiring the registration of medical technologist President: Gloria Macapagal-Arroyo
o Established the Board of Medical Technology Significance:
o Defining the practice of Medical technologist-(Setting o Focused on the implementation of newborn
guidelines/Rules and Regulations) screening in the country

RA 4688: Clinical Laboratory Law RA 8981: PRC Modernization Act of 2000

Date approved: June 18, 1966 Date approved: December 5, 2000
President: Ferdinand Marcos President: Joseph Estrada
Significance: Significance
o Regulating the operation and maintenance of clinical o Repealed PD 223 & PD 657 (created the PRC)
laboratories and requiring the registration with the o Modernizing the Professional Regulation
DOH. Commission
o To prevent the operation of substandard, improperly o Discussed the vital role of the PRC in regulating local
managed and poorly equipped clinical laboratories professionals

RA 1517: Blood Bank Law RA 7170: Organ Donation Act of 1991

Date approved: January 7, 1992
Date approved: June 16, 1956
President: Ramon Magsaysay President: Corazon C. Aquino
Significance
Significance:
o Authorized the legacy or donation of all or part of the
o To safeguard and promote public health and welfare
by preventing unproper collection, processing and human body after death
o Emphasized the importance of laboratory tests to
sale of human blood or its product to the public.
ensure the safety and tissue compatibility of the
Repealed by RA 7719
organs
RA 7719: National Blood Services Act of 1994
Date approved: May 5, 1994
RA 10912: Continuing Professional Development Act of
President: Fidel Ramos
2016
Significance CDP programs are needed to enhance and upgrade the
o Highlights the importance of voluntary blood competencies and qualifications of professionals for the
donation practice of their professions
o Focuses on the prevention of blood-transmissible
diseases V. THE CLINICAL LABORATORY
o Careful conduct of blood banking practices
Republic Act No. 4688
→ An act regulating the operation and maintenance of
clinical laboratories and requiring the registration of
Trans maker: Llido, A.Y. 2
Editor: Sacedon, A. & Ismael, Y.
 MLS 401
7.1 PASMETH, PAMET, LAWS, SPECIMEN COLLECTION AND
HANDLING, CLINICAL MICROSCOPY
Prof. Edilon Liwag | October 7, 2021

the same with the department of health, providing → Regulated by the Bureau of Health Facilities and
penalty for the violation thereof, and for other Services under DOH which prevents the operation of
purposes substandard laboratories
→ Approved: June 18, 1966
→ President Ferdinand Edralin Marcos BASED ON OWNERSHIP:
o Government
Section 1 Operated and maintained by a government unit
→ Any person, firm or corporation, operating and o Private
maintaining a clinical laboratory in which body fluids, Owned, operated, and established by any individual,
tissues, secretions, excretions and radioactivity from corporation, association, or organization
beings or animals are analyzed for the determination
of the presence of pathologic organisms, processes BASED ON FUNCTION:
and/or conditions in the persons or animals from o Clinical Pathology (Laboratory)
which they were obtained, shall register and secure Clinical Chemistry, Hematology,
a license annually at the office of the Secretary of Immunohematology, etc.
Health: provided, that government hospital PCR Test
laboratories doing routine or minimum laboratory o Anatomic Pathology (Laboratory)
examinations shall be exempt from the provisions of Surgical Pathology, Immunohistopathology,
this section if their services are extensions of Cytology, Autopsy, Forensic Pathology, Molecular
government regional or central laboratories. Pathology

Section 2 BASED ON INSTITUTIONAL CHARACTER:

→ It shall be unlawful for any person to be o Institution-based
professionally in-charge of a registered clinical A laboratory that operates within the premises and is
laboratory unless he is a licensed physician duly a part of an institution
qualified in laboratory medicine and authorized by o Freestanding
the Secretary of Health, such authorization to be A laboratory that does not form part of any other
renewed annually. No license shall be granted or institution
renewed by the Secretary of Health for the operation
and maintenance of a clinical laboratory unless such BASED ON SERVICE CAPABILITY:
o Primary: 10 sq.m. (minimum space required)
laboratory is under the administration, direction and
Routine Hematology
supervision of an authorized physician, as provided
Routine Urinalysis
for in the preceding paragraph.
Routine Fecalysis
Section 3 Qualitative Platelet
→ The Secretary of Health, through the Bureau of Blood typing (hospital-based)
Research and Laboratories shall be charged with the o Secondary: 20 sq.m. (minimum space required)
responsibility of strictly enforcing the provisions of All tests in primary lab
this Act and shall be authorized to issue such rules Routine Chemistry
and regulations as may be necessary to carry out its Quantitative Platelet
provisions. Cross-matching; Gram staining; KOH (hospital-
based)
Section 4 o Tertiary: (60 sq.m.)
→ Any person, firm or corporation who violates any All tests in secondary lab
provisions of this Act or the rules and regulations Special Chemistry
issued thereunder by the Secretary of Health shall be Special Hematology
punished with imprisonment for not less than one Immunology-Serology (HIV)
month but not more than one year, or by a fine of not Microbiology (KOCH’S Postulate)
less than one thousand pesos nor more than five o Limited Service Capability
thousand pesos, or both such fine and imprisonment, Dialysis centers
at the discretion of the court. Social hygiene clinics

Implementing Rules and Regulation (IRR) Special Clinical Laboratories

→ A component of a health institution that provides → Provides highly specialized lab services not provided
accurate and reliable info to physicians for diagnosis, by a general clinical lab
prognosis, treatment and management of diseases
→ Actively involved in research, community, outreach National Reference Laboratory
programs, surveillance, infection control in hospital → A laboratory in a government hospital which is
and community, info dissemination and evaluation of designated to provide special functions and services
current and innovative diagnostic technologies such as:
→ A facility subdivided into different sections where • Confirmatory testing
common diagnostic procedures are done by • Surveillance
specialized health professionals • Resolution of conflicts
• Training and research
• Evaluation of kits and reagents
Trans maker: Llido, A.Y. 3
Editor: Sacedon, A. & Ismael, Y.
 MLS 401
7.1 PASMETH, PAMET, LAWS, SPECIMEN COLLECTION AND
HANDLING, CLINICAL MICROSCOPY
Prof. Edilon Liwag | October 7, 2021

• External quality assessment program

NRL in the Philippines

• National Kidney and Transplant Institute
→ Hematology, Immunohematology, Automated Factors that Contribute to Laboratory Errors
Urinalysis, Immunopathology o The most common errors are related to specimen
• East Avenue Medical Center collection and handling (pre-analytical stage)
→ Toxicology o Pre-analytical, Analytical, Post-analytical
• Lung Center of the Philippines errors(mistakes)
→ Clinical Chemistry o Errors/ Mistakes can be prevented when MT are well
• Research Institute for Tropical Medicine (CDC) trained and are aware of the sources of error.
• Brach of DOH equivalent to CDC in o When in doubt about the quality of collected
America specimen always recommend for repeat collection
→ Tuberculosis, Mycology, Transfusion- and refer and document the incident to your
transmissible infections, Bacterial Diseases, superiors.
Antimicrobial Resistance, Influenza, Malaria,
Patient Care Partnership
Measles and other exanthems, Rotavirus, Polio
Patient – term originating from the Latin patior meaning to
• San Lazaro Hospital/STD-AIDS Central
suffer; one who suffers or is ill and requires treatment.
Cooperative Laboratory:
→ A person under a physician's care for a particular
→ HIV/AIDS and other sexually-transmitted
disease or condition.
infections
→ In some institutional settings it is not used because it
is thought to denote a dependent relationship on the
Satellite Testing Site
part of the person undergoing treatment. The words
→ A testing site that performs lab examinations under
client, resident, and at times guest can also be used
the control of a licensed laboratory but outside the
to refer to a person receiving treatment.
physical confines of the laboratory
Patient’s Bill of Rights
Mobile Clinical Laboratory
→ a laboratory testing unit that moves from one testing → It is important that Healthcare workers should always
site to another consider the rights of the patient at all times.
→ Must have a base laboratory o Right to appropriate medical care and humane
treatment
→ Must collect specimens only
o Right to informed consent
→ Must operate only within a 100-km radius from its
o Right to privacy and confidentiality
base laboratory
o Right to information
o Right to choose healthcare provider and facility
VI. SPECIMEN COLLECTION AND HANDLING
o Right to self determination
o Right to religious beliefs
Assessing Quality of Specimen
o The accuracy of laboratory testing begins with the o Right to medical records
quality of specimen received by the laboratory o Right to leave
o This quality depends on how the specimen was o Right to express grievances
collected, transported and processed. o Right to correspondence and received visitors
o A laboratory assay will be no better than the o Right to participate in medical research
specimen on which it is performed. o Right to be informed of his rights and
o A specimen that is improperly collected, stored or responsibilities as a patient.
mishandled should not be tested and therefore the
results become invalid. Types of patients
o Pediatrics (Infants &children)
Reminders in Specimen Collection and Handling o Adolescent (teens)
o The proper handling of specimens (blood, Bf, Tissue o Adult
etc.) is critical to the accuracy of laboratory test o Geriatrics (old)
results
o Specimens should be transported to the laboratory Medical Technologist Role in PCR
immediately • You are expected to deliver unexcelled customer
o Label specimens correctly satisfaction
o Specimens must be collected in sealed (with lid • You have to understand and know the patient’s
/cap), leaked proof, disposable plastic containers. expectation
o Maintain specimens at correct temperature at all • Manage unrealistic expectations through patient
times and collect only the desired quantity education
o Never expose specimen to severe environmental • Be diplomatic with patient complaints
conditions • If the patient is unhappy
o PPE must always be worn at all times when handling → Should listen with interest
biologic specimens. → Express genuine concern by making attempts to
resolve the issue of concern

Trans maker: Llido, A.Y. 4

Editor: Sacedon, A. & Ismael, Y.
 MLS 401
7.1 PASMETH, PAMET, LAWS, SPECIMEN COLLECTION AND
HANDLING, CLINICAL MICROSCOPY
Prof. Edilon Liwag | October 7, 2021

→ If at fault an apology would be appropriate - If delayed: Ref at 2-8°C for not more than 8
→ Gentle and compassionate at all times hours
4. Effects of unpreserved urine
- Bacterial multiplication will cause false positive
VII. SECTIONS/DEPARTMENTS OVERVIEW (+) nitrite test = UTI
1. Hematology - pH alkalinization: leads to cast degeneration and
2. Immuno-hematology (BB) red cell lysis
3. Immuno-serology
4. Clinical Microscopy (Uri-Para)
5. Clinical Chemistry
6. Microbiology (Bacteriology) Procedures in Routine Urinalysis
7. Histo-pathology 1. Physical examination
• Color
VIII. CLINICAL MICROSCOPY → A rough indication of the state of hydration
of an individual
Urinalysis
- The darker the color of the urine, the
- For overall evaluation of renal function
more concentrated it will be
- Permits a detailed, in-depth assessment of renal
status with an easily obtained specimen
- Serves as a quick indicator of an individual’s glucose
status and hepatic or biliary function

Test Performed in Routine Urinalysis

- Specimen collection
- Physical examination
- Chemical examination
- Microscopic examination • Odor
→ Has little diagnostic significance and is not
Specimen Collection included in the routine laboratory result
1. Type of Specimen - Urine is aromatic
• Early morning urine - Suggestive of the freshness of the
→ Most preferred sample particularly for urine sample
protein analysis
→ Reason: more concentrated from overnight • Turbidity
retention in the bladder → Also known as clarity or transparency
→ Preferably in pregnancy test → Degree of cloudiness in a urine
• Random urine → Depends on the pH and the presence of
→ Collected any time of the day; for routine dissolved solids
analysis
• Fasting/post-prandial urine
→ For glucose determination
• Timed urine
→ For clearance test
2. Method of collection
• Clean midstream catch
→ Ambulatory patients
→ Middle portion of urine is being collected in
a plastic bottle
• Catheterization • Volume
→ Use of catheter → Indicates balance between fluid ingestion
and water lost from lungs, sweat and
intestines
Volume Description
10-12 mL aliquot Optimal volume for ru
750-2,000 mL/24 Normal adult volume
hour
Polyuria Excessive urine excretion
Oliguria Scanty urine excretion
Anuria Absence of urine output

• Specific gravity
3. Specimen handling
→ Normal values: 1.005 – 1.030
- Must be analyzed within 1 hour of collection
(room temperature)

Trans maker: Llido, A.Y. 5

Editor: Sacedon, A. & Ismael, Y.
 MLS 401
7.1 PASMETH, PAMET, LAWS, SPECIMEN COLLECTION AND
HANDLING, CLINICAL MICROSCOPY
Prof. Edilon Liwag | October 7, 2021

→ Indication of the density of a fluid depending a. RBC: “hematuria”

on the concentration of dissolved total - Average count per high power
solids field
→ Marker of the amount of - Glomerulonephritis, severe
hydration/dehydration of an individual exercise, menstrual blood
→ The darker the urine, the higher its specific contamination and renal calculi
gravity obstruction
→ Urinometer and Refractometer, Chemical
b. WBC: “pyuria”
Clinical Correlation - Average count per high power
 SG Diabetes mellitus, congestive heart field
failure, dehydration, adrenal - Pyelonephritis, UTI and
insufficiency, liver disease and inflammation
nephrosis c. Epithelial cells
 SG Diabetes insipidus, pyelonephritis and - Cells sloughed off the lining of the
glomerulonephritis nephrons and urinary tract
d. Crystals: “crystalluria”
• pH
- Formed by the precipitation of
→ Refers to the logarithm of the hydrogen ion urine salts subjected to changes in
concentration pH, temperature or concentration
→ Normal pH of urine: 4.5 – 8.0 - May collect and aggregate
→ Chemical Test together to form renal stone or
- Acidity (pH <7) “calculus”
- Alkalinity (pH >7)

2. Chemical examination
• Reagent Strip Method
→ Contains test pads impregnated with
reagents that specifically react with a test
analyte and register a specified color
change

e. Casts
- Formed within distal convoluted
tubule and collecting duct
- Hyaline, granular and cellular

Miscellaneous Elements
Spermatozoa Often encountered in urine of
both male and female but are
usually not reported (sexual
3. Microscopic examination intercourse or nocturnal
- 1 – 2 drops of urine sediment from a centrifuged emissions)
urine is placed on a glass slide Yeast cells Budding RBC-like cells (diabetes
- Cover slip is then placed on top of the slide (Candida mellitus and vaginal moniliasis)
- Both LPO and HPO are used albicans)
- WBC and RBC are counted Parasites Enterobius vermicularis,
Trichomonas vaginalis,
- Crystals and other elements are graded (count)
Schistosoma haematobium
- Cellular Elements
Bacteria Gram (-) coliforms Escherichia
• Average of at least 10 microscopic fields coli and Proteus sp.

Trans maker: Llido, A.Y. 6

Editor: Sacedon, A. & Ismael, Y.
 MLS 401
7.1 PASMETH, PAMET, LAWS, SPECIMEN COLLECTION AND
HANDLING, CLINICAL MICROSCOPY
Prof. Edilon Liwag | October 7, 2021

Mucus Threads Protein material produced by

glands and epithelial cells in the
genitourinary tract
Thread-like structures with low
refractive index requiring
observation under subdued light

Trans maker: Llido, A.Y. 7

Editor: Sacedon, A. & Ismael, Y.
 MLS 401
8.3 CLINICAL MICROSCOPY
Ed Liwag|October 13. 2021

I. CLINICAL MICROSCOPY • Color

→ A rough indication of the state of hydration
II. URINALYSIS of an individual
→ overall evaluation of renal function - The darker the color of the urine, the
→ detailed, in-depth assessment of renal status more concentrated it will be
with an easily obtained specimen - Lighter color = hydrated
→ Serves as a quick indicator of an individual’s - Darker color = dehydrated
glucose status and hepatic or biliary function

Test Performed in Routine Urinalysis

- Specimen collection
- Physical examination
- Chemical examination
- Microscopic examination

III. SPECIMEN COLLECTION

A. Type of Specimen:
• Early morning urine
- Most preferred sample for protein analysis
- Reason: more concentrated from • Odor
overnight retention in the bladder → Has little diagnostic significance and is not
- Preferably in pregnancy test included in the routine laboratory result
• Random urine - Urine is aromatic
- Collected any time of the day; for routine - Suggestive of the freshness of the
analysis urine sample
• Fasting/post-prandial urine - More protein, the more na mapanghi
- For glucose determination
- Kidney disease • Turbidity
• Timed urine → clarity or transparency
- For clearance test → Degree of cloudiness in a urine
→ Depends on the pH and the presence of
B. Method of collection: dissolved solids
• Clean midstream catch → Turbid = pathological condition
- Ambulatory patients
- Middle portion of urine is being collected
in a plastic bottle
- first and last re discarded
• Catheterization
→ Use of catheter

• Volume
→ balance between fluid ingestion and water
lost from lungs, sweat and intestines
→ routine analysis: 10 -12 mL; ½ - ¾ bottle
→ transfer to test tube then centrifuge
Volume Description
C. Specimen handling 10-12 mL aliquot Optimal volume for ru
- Must be analyzed within 1 hour of collection 750-2,000 mL/24 Normal adult volume
(room temperature) hour
- If delayed: Ref at 2-8°C for not more than 8 Polyuria Excessive urine excretion
hours Oliguria Scanty urine excretion
D. Effects of unpreserved urine Anuria Absence of urine output
- Bacterial multiplication will cause false positive
(+) nitrite test = UTI • Specific gravity
- pH alkalinization: leads to cast degeneration and → Normal values: 1.005 – 1.030
red cell lysis → Indication of the density of a fluid depending
- presence of CBC = pathologic condition on the concentration of dissolved total
solids
IV. PROCEDURES IN ROUTINE URINALYSIS → Marker of the amount of
1. Physical examination hydration/dehydration of an individual
→ The darker the urine, the higher its specific
gravity
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*name of editor*
 MLS 401
8.3 CLINICAL MICROSCOPY
Ed Liwag|October 13. 2021

→ Urinometer and Refractometer (old

method), Chemical (new)
→ Solvent
- Density of fluid
→ Solute
- Solid dissolved

Clinical Correlation
 SG Diabetes mellitus, congestive heart
failure, dehydration, adrenal
insufficiency, liver disease and
nephrosis
 SG Diabetes insipidus, pyelonephritis and
glomerulonephritis

• pH
→ Refers to the logarithm of the hydrogen ion
Additional Notes:
concentration
• 10 parameters sabi ni sir pero 11 gud
→ Normal pH of urine: 4.5 – 8.0 (slightly
hahahah from leukocyte to glucose)
acidic)
• Change in color – amount of solute
→ Chemical Test
• No change – negative
- Acidity (pH <7)
- Alkalinity (pH >7)
3. Microscopic examination
→ Hydrogen in concentration
- 1 – 2 drops of urine sediment from a centrifuged
→ Chemical Test
urine is placed on a glass slide
- Cover slip is then placed on top of the slide
- Both LPO and HPO are used
- WBC and RBC are counted
- Crystals and other elements are graded (count)
Additional Notes:
- Cellular Elements
• Mapanghi – multiplication of bacteria
• Average of at least 10 microscopic fields
• Urinate at least 3-4 times
• Ambiance temperature, liquid taken, and a. RBC: “hematuria”
physical activity – factors kung ilang times - Average count per high power field
ka mag ihi - Glomerulonephritis, severe exercise,
• Polyuria menstrual blood contamination and renal
- Pathologic condition calculi obstruction
- Diabetes - Donut-shaped
• Oliguria
- Scarity b. WBC: “pyuria”
- Kidney malfunction - Average count per high power field
• Amuria - Pyelonephritis, UTI and inflammation
- Absence
- Kidney malfunction c. Epithelial cells
- Cells sloughed off the lining of the nephrons
2. Chemical examination and urinary tract
• Reagent Strip Method - 3 types: squamous, transitional, renal
→ Contains test pads impregnated with - Squamous – mostly in women; sloughing of
reagents that specifically react with a test lining
analyte and register a specified color - Presence of transitional and renal should be
change reported; indicates toxicity, kidney disease
- It is encouraged to use clean midstream
catch for less obscure
- More squamous – collect sample again

d. Crystals: “crystalluria”

*name of transers* 2
*name of editor*
 MLS 401
8.3 CLINICAL MICROSCOPY
Ed Liwag|October 13. 2021

- Formed by the precipitation of urine salts Additional Notes:

subjected to changes in pH, temperature or • Presence of spermatozoa
concentration - Cases of rape
- May collect and aggregate together to form - Nocturnal emission (wet
renal stone or “calculus” dreams)
- Renal stone • Yeast cells
- Usually associated with diet (eating - Mostly in women
- Indicates Diabetes Miletus
tomatoes)
- Change of pH – fungi will grow
- Uric acid = gouty arthritis
causing infection
• Parasites
- Men & women
- Protozoa can be present
• Bacteria
- Tiny org that move around in
fresh urine sample – will be
sent to microbio
- More bacteria indicates urinary
tract infection
• Mucus threads
- No need to report

In urinalysis:
• Script reader
- Read color reaction
e. Casts - Accurate change in color
- Formed within distal convoluted tubule and • Automated Urine Analysis Machine
collecting duct - Detection of Cellular elements
- Hyaline, granular and cellular - RMT will still be the one who
- Aggregates of cellular elements will confirm the result.
- More cast – kidney malfunction/disease

Miscellaneous Elements
Spermatozoa Often encountered in urine of
both male and female but are
usually not reported (sexual
intercourse or nocturnal
emissions)
Yeast cells Budding RBC-like cells (diabetes
(Candida mellitus and vaginal moniliasis)
albicans)
Parasites Enterobius vermicularis,
Trichomonas vaginalis,
Schistosoma haematobium
Bacteria Gram (-) coliforms Escherichia
coli and Proteus sp.
Mucus Threads Protein material produced by
glands and epithelial cells in the
genitourinary tract
Thread-like structures with low
refractive index requiring
observation under subdued light

*name of transers* 3
*name of editor*
 MLS 401
9.1 PARASITOLOGY
Sir Ed Liwag| October 26, 2021

I. BASIC TERMINOLOGIES

Parasite
→ Any organism that depends on another organism
for shelter and nourishment
Host
→ An organism that supports the parasite
→ Varies according to whether it harbors the
different stages in the parasitic development

Types:
• Definitive Host DISEASES:
- Harbors the adult stage of the parasite o Amoebic colitis
- Undergoes sexual reproduction -Abdominal cramping, anorexia, fatigue,
• Intermediate Host and diarrhea
- Harbors the larval form o Intestinal Amoebiasis
- Manifests as dysentery
II. MODE OF TRANSMISSION - Dysentery = presence of blood and
How a parasite successfully enters a susceptible host mucus in stool
• Ingestion 2. Flagellates
• Inhalation - with whip-like structure
• Breastfeeding - locomotion inclusion bodies
• Insect bite - all demonstrate trophozoites (watery
• Sexual Transmission stool)
- not all are capable of encystation
III. TYPES OF PARASITES - thrive in the small intestine
• Pathogenic parasites
- Disease-causing • Trichomonas Vaginalis
- Harm the host - Most common
- Mostly in women
• Nonpathogenic parasites
- Sexually-transmitted
- Do not harm the host
- Usually live outside the body • T. hominis
• T. tenax
Classification based on how they inhabit: • D. fragilis
• Endoparasite
- Found inside the body of a host hemoflagellates
- Infection • Trypanosoma spp.
- More problematic and require special • Leishmania spp.
specimen prep
- Ex.: worms (in intestine) Trophozoite stage
• Ectoparasite → feeding stage
- Found outside the body of a host Cystic Stage
- Infestation → dormant stage
- Gross macroscopic
- Ex.: lice, fleece • Giardia lamblia
o Giardiasis
- Acute diarrhea, abdominal pain, and
Eosinophilia weight loss
→ Associate with parasitism - MODE OF TRANSMISSION: Ingestion
→ Increase in eosinophil count of contaminated food and water
→ Charcot-Leyden crystals (degraded eosinophils) - Water in river, raw/fresh food that are
→ ^ eosinophil count = infected by ectoparasites not washed properly
- DIAGNOSIS: stool exam
IV. MAJOR GROUPS OF MEDICALLY Trophozoite = symmetrical, “old
IMPORTANT PARASITES man’s glasses
Infective cyst = ovoidal and
1. Amoeba quadrinucleated
→ It has pseudopods (ectoplasmic extension)
that move during trophozoite stage (feeding
stage)

• Entamoeba histolytica
- Only pathogenic amoeba in the GIT
- Capable in converting into cyst
- MODE OF TRANSMISSION: infective
cysts passed in the stool/feces
- DIAGNOSIS: stool exam

3. Ciliates
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9.1 PARASITOLOGY
Sir Ed Liwag| October 26, 2021

- Cilia - Typical manifestation of the

- Trophozoites and cysts are part of the disease
cycle - Coincides with the bursting of
• Balantidium coli RBCs
- Only spp pathogenic to humans = pigs
= also invades tissues BODY TEMPERATURE: 40 degree Celsius
- Blood = intestinal lesions caused by 48 hrs = tertian malaria
parasites 36 – 48 hrs = subtertian malaria
o Balantadiasis 72 hrs = quartan malaria (P. malariae)
- Bloody, mucoid, diarrheic stool samples
- MODE OF TRANSMISSION: ingestion DIAGNOSIS:
of contaminated food or water • Giemsa-stained thick and thin smear
- DIAGNOSIS: stool exam - accurate
• Rapid diagnostic test and molecular
4. Malaria approach
- DEFINITIVE HOST: Mosquito - Not accurate
(Anopheles spp.)
- INTERMEDIATE HOST: Human
- MODE OF TRANSMISSION: bite of
infected female Anopheles mosquito

Anopheles Mosquito
- Carries gametocytes >> sporozoites >>
invades liver >> develop >> merozoites
>> schizogony cycle
Liver
- Preerythrocytic or exoerythrocytic
phase
RBC
- Erythrocytic phase Detailed morphological description and size of the
Sperozoite infected RBC = necessary to establish differentiation
- Infective stage
- Released during blood meal of the Platelets = may be a source of identification error
infected vector
V. NEMATODES

Phylum Nemathelminthes
→ Round worms
→ Adult worms: tapered, cylindrical bodies with an
esophagus and longitudinal muscles
→ Dioecious = separate male and female sexes
→ Male: smaller with posterior curve and may be
provided with copulatory spicules and bursa
→ DIAGNOSIS: adult larvae or egg morphology
→ MODE OF TRANSMISSION: ingestion of
embryonated egg, inhalation, larval skin
penetration, ingestion of intermediate hosts like
snail or fish

Different Species:
• Plasmodium falciparum
• P. vivax
• P. ovale
• P. knowlesi
• P. malariae

- High fever (pyrogenic metabolites),

anemia (red cell destruction), jaundice
(breakdown of haemoglobin), shaking,
chills, and flu-like illness

- Paroxysm • Ascaris lumbricoides

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9.1 PARASITOLOGY
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- Largest nematode in GIT → Tapeworms

- Giant intestinal roundworm → Dwell in small intestines
- DISEASE: → Parts:
o Ascariasis • Scolex (head)
- Bowel obstruction and • Neck
pancreatitis • Several proglottids (segment)
- MODE OF TRANSMISSION: eggs → Abdominal pain, dyspepsia, anorexia, nausea,
(infective stage) and diarrhea
→ MODE OF TRANSMISSION: ingestion of
cysticercus from undercooked meat
→ Looks like fettuccini noodles (ribbon-like, multi-
segmented and dwell as adults entirely in the
human small intestine

• Taenia saginata (Beef tapeworm)

• Taenia solium (Pork tapeworm)
VI. TREMATODES
DISEASE:
→ Flukes of flukeworm - Abdominal pain, vomiting, loss of
→ Two orders: monogenean and digenea appetite, weight loss, and mild diarrhea.
→ Flat, leaf-like, and hermaphroditic (except - Neurocysticercosis
Schistosoma spp.)
→ Digenetic flukes are usually medicaly important DIAGNOSIS:
→ Oral sucker: mouth - Stool exam
→ Ventral sucker (Acetabulum): attachment organ - Species identification through analysis
→ MODE OF TRANSMISSION: ingestion of of worm segments
Metacercaria (infective stage)
→ DIAGNOSIS: stool exam
→ Inhabits vital organs like intestines, liver, and
lungs

2 intermediate hosts:
1. Snail
2. Varies (plants, snails, or crabs)

• Schistosoma spp.
- MODE OF TRANSMISSION: skin
penetration of cercaria (infective stage)
- DIAGNOSIS: stool and urine exam, blood
sample (rare)
- DISEASE:
o Schistosomiasis
- Bloody diarrhea, abdominal pain,
hepatosplenomegaly, intestinal lesion,
and blockage

VIII. DIAGNOSTIC PARASITOLOGY

A. FECALYSIS
→ Stool examination
1. Collection of fecal specimens
- Thumb-sized stool specimen (2-4
grams)
- Placed in a dry, clean, wide-mouth
container with tight-fitting lid (comes
with built-in spoon)
- Label the stool container properly
- Sample must be free from any
contamination (toilet water)
- Defer for 1 week if patient took anti-
diarrheal medication, radio-opaque
VII. CESTODES compounds, or oily laxatives

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- Stool specimen shouldn’t be stored C. COLLECTION OF SCOTCH TAPE SWAB

at room temp for more than 2 hrs
- 10% formalin = preserves stool - Useful in cases of Enterobiasis =
specimen (maintain protozoan intense itchiness in perianal area
morphology and prevent further
development of certain helminths
eggs) • Swab
2. Method of Stool Examination – • Pre-cut scotch tape
Gross Examination • Tongue depressor
- Stool Color • Glass slide
• Brown – normal (storcobilin)
• Bright red blood – bleeding
hemorrhoids/lower GIT
• Bloody mucus (loose or liquid0 –
suggestive of ulceration in large
intestines
• Occult blood – more likely a sign of
other GIT disorder

-Stool consistency D. COLLECTION VIA VAGINAL SWABS

•Well-formed, semi-formed, mushy or
liquid
- Diagnosis of Trichomonas vaginalis
• Predictor for possible stages of
infection
parasite in the sample
- BD AffirmTM VPIII Ambient
• Normal pH: 7-7.5
Temperature Transport System (ATTS)
3. Method of Stool Examination – Molecular system for
Microscopic Examination detection of vaginitis
→ Wet mounts Speculum without
• Saline wet mount lubricant is used
- Normal saline (NSS) = fecal Mucosa is swabbed
emulsion
- Preserves protozoan trophozoites
• Iodine wet method
- Lugol’s Iodine
- Highlights the details of protozoan
cysts

• Direct Wet Method

- 1 or 2 drops of watery stool is

aspirated and transferred onto a
glass slide. Cover slip is placed on
top before examined under a
microscope

B. COLLECTION OF BLOOD SPECIMENS

- Detects Plasmodium, filarial worms,

Trypanosoma and Leishmania
- Definite time of collection = parasites
exhibit periodicity
- Palmar surface of the distal segment of
the third (middle) or fourth (ring) finger

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11.1 MICROBIOLOGY
Prof. Ed Liwag, RMT, MSMT | October 27,2021

• LAZZARO SPALLANZANI
I. MICROBIOLOGY - Observed that microbes move through the
→ The study of organisms too small to be seen by the air as possible source of contamination
unaided eye and can be destroyed by boiling.
• Clinical Microbiology Conditions Results
- Study of microbial pathogens considered Infusions heated in No microbial
health threats to people sealed vial growth
• Diagnostic Microbiology
- Examination and identification of • LOUIS PASTEUR
organisms through laboratory tests - Developed the principles of vaccination,
• Food Microbiology microbial fermentation, and pasteurization
- Practical application and use of beneficial
microorganisms in food processing • HANS CHRISTIAN GRAM
- - Credited for the Gram staining technique
II. BRANCHES OF MICROBIOLOGY which distinguishes two major groups of
• Parasitology bacteria: Gram-positive and Gram-
- The study of parasites negative
• Mycology
- The study of fungi • ALEXANDER FLEMING
• Bacteriology - Discovered the first antibiotic, Penicillin G,
- The study of bacteria from a mold, Penicillium notatum
• Virology
- The study of virus • ROBERT KOCH
III. PIONEERS IN MICROBIOLOGY - Established the theory of etiologic agents
• GIROLAMO FRACASTORO cause diseases by providing experimental
- Diseases are caused by different types of steps (Koch’s postulates) used to prove
rapidly multiplying minute body and that that a specific microbe causes a specific
these bodies are transferred from the disease.
infector to the infected in three ways: o Established the theory of etiologic
By direct contact agents cause diseases by providing
By carriers such as soiled experimental steps (Koch’s
clothing and linen postulates) used to prove that a
Through the air specific microbe causes a specific
• ANTON VAN LEEUWENHOEK disease.
- Father of Bacteriology and Protozoology
- Discovered many lives forms he called
‘animalcules’
- Made a single lens microscope which
enabled the study of minute organisms
• FRANCESCO REDI
- Disputed the Theory of Spontaneous
Generation
- Performed an experiment on decaying
meat in 1668
Conditions Results

3 covered jars No maggots IV. BACTERIAL CELL

3 open jars Maggots Appeared

• JOHN NEEDHAM
- There must be a “life force” that causes
inanimate matter to spontaneously come
to life
Conditions Results

Boiled nutrient fluids in a Microbial growth

flask then tightly sealed
with cork • CELL MEMBRANE
o The lipoprotein layer that surrounds
the cytoplasm
o Regulates the transport of solutes in
and out of the cell
• JOSEPH LISTER
- Pioneer of antiseptic surgery • CELL WALL
- Introduced the use of carbolic acid - The semi-rigid casing that provides structural
(phenol) as a chemical sterilizing agent for shape and support to the cell
surgical instruments
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• RIBOSOMES
- Site of protein synthesis
- Gives granular structure to the cytoplasm
• NUCLEOID
- The region where the DNA is concentrated
• CAPSULE
- Protective layer of a bacterium that resist
phagocytosis and desiccation
• PILI
- Hair-like proteinaceous structures that extend
from the cell membrane into the external
environment
- Neisseria gonorrhea has two types: somatic
pili for adhesion and sex pili for conjugation VI. COMMON BACTERIAL PATHOGENS

• FLAGELLUM
- The structure that allows the bacteria to move
o Atrichous: absence of flagellum
o Monotrichous: one polar flagellum
o Amphitrichous: single flagellum on both
ends
o Lophotrichous: tuft of flagella on either
end or both ends
o Peritrichous: flagella all around the
organism
VII. BACTERIAL METABOLISM AND GROWTH
OXYGEN
- Aerobes: require oxygen for growth (obligate,
facultative, microaerophilic)
- Anaerobes: grow best in an atmosphere of reduced
oxygen tension
CARBON DIOXIDE
- Capnophiles: need 5-10% carbon dioxide to live
- Placed in candle jars

VIII. BACTERIAL METABOLISM AND GROWTH

• NUTRIENTS
• INCLUSION BODIES o Autotrophs: able to make energy-
- Food reserves of the bacteria containing organic molecules from inorganic
o Babes-Ernst bodies: Corynebacterium raw material by using basic energy sources
diphtheriae such as sunlight
o Much’s granules: Mycobacterium tuberculosis o Heterotrophs: organisms must make use of
o Sulfur granules: Nocardia and Actinomyces food that comes from other organisms in the
species form of fats, carbohydrates and proteins
o Bipolar bodies: Yersinia pestis
• TEMPERATURE
• SPORES

o Psychrophile/cryophile: 0-15°C
o Mesophile: 20-45°C (human pathogens)
o Thermophile: 50-60°C
o Hyperthermophile: 80-113°C

• HYDROGEN AND ION CONCENTRATION (pH)

o Acidophile: pH 0-5.5 (Sulfolobus)

o Neutrophile: pH 5.5-8.0 (E. coli)
- Structures that allow the bacteria to resist
sterilization o Alkalophile: pH 8.5-11.5 (Vibrio cholerae)
- Composed of calcium dipicolinate
o Terminal: Clostridium tetani
o Subterminal: Clostridium botulinum
o Central: Bacillus anthracis

IX. BACTERIAL GROWTH

V. BACTERIAL FORMS
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- Inhibits cell wall, protein, and nucleic acid

synthesis
- Cell membrane destruction

XII. ANTIBIOTIC SUSCEPTIBILITY TESTING

- For therapeutic guidelines

- Indicates which antibiotic is effective in
killing the bacteria causing the infection or
disease

Types:
X. BACTERIAL STAINING
o Disk diffusion susceptibility test/Kirby-Bauer
Method
• SIMPLE STAIN
o Broth dilution susceptibility test

- One stain is used (e.g., methylene blue) XIII. BROTH DILUTION

- Organisms should only be observed for
size, shape, and uniformity of staining
• Minimal inhibitory concentration
• DIFFERENTIAL STAIN
- Lowest concentration of antimicrobial
agent that inhibits bacterial growth.
- Used to distinguish between groups of (bacteriostatic)
bacteria
- Gram staining, acid-fast staining
• Minimal bactericidal concentration

- Lowest antibiotic concentration that results

in 99.9% death of the bacterial population.
(bactericidal)

• ACID FAST STAINING

XI. ANTIBIOTICS

- Drugs administered to either kill bacteria or

inhibit their growth by preventing
reproduction

Types of Antibiotics:

BACTERIOSTATIC: agents that inhibit bacterial growth

BACTERICIDAL: agents that actively kill bacteria

Mechanisms of Action:
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11.1 HEMATOLOGY
Ed Liwag | October 26, 2021

I. HEMATOLOGY • Clear yellow liquid - intravascular/extracellular

• Water, sugar, fat, protein and salt solution
HEMATOLOGY: • 55% of a normal human’s blood volume
• Scientific study of blood and its component.
• Help physicians diagnose abnormalities in the
blood.

PHLEBOTOMY
- standard procedure of blood collection using lancets &
needles of varying gauges.

TYPES
• Skin puncture = capillaries

Function:
– transports RBC, WBC and
platelets through the blood
vessels
• Venipuncture = veins
– Remove waste products of
metabolism

II. RED BLOOD CELL

ERYTHROCYTE
• Arterial puncture = arteries • anucleated cells produced from the bone marrow
• Hemoglobin = gas transporting protein molecule

• Usually whole blood is used as sample in Functions:

hematology (esp. in CB) so no need to centrifuge. – Transport oxygen (lungs tissues)
– Transport carbon dioxide (back to lungs)

ASSOCIATED CONDETIONS:
• anemia = low number of RBCs
• polycythemia – high number of RBCs

III. WHITE BLOOD CELL

LEUKOCYTE
• Nucleated cells that lacks hemoglobin
• Acts as defense against infection

PLASMA:
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NEUTROPHIL
• Most numerous
• Multi-lobed nucleus
• Pale lilac granules
• Function: immune defense

IV. PLATELETS
THROMBOCYTES
• Cell fragments
• Function: form clots during injury to prevent blood
from leaking out

LYMPHOCYTE
• Spherical nucleus
• “robin’s egg blue” cytoplasm
Types:
– T-cell: cellular immune response
– B cell: antibody production
– NK cells: kills cancer cells V. TESTS PERFORMED IN HEMATOLOGY
SECTION

HEMATOLOGY SECTION:
• Sample: whole blood and blood films
• Complete Blood Count (CBC)
– hemoglobin
– hematocrit
– Red blood cell count
EOSINOPHIL – White blood cell count
• Usually with a bilobed nucleus – Platelet count/estimate
• Granules stain bright reddish-orange – Rbc indices (MCV, MCH, MCHC)
Function:
– defense against parasites PROCEDURES PERFORMED IN THE HEMA SECTION:
– Activate allergic response 1. Counting the number or concentration of cells
2. Determining the relative distribution of various types
of cells
3. Measuring biochemical abnormalities of the blood
4. Hemostasis and coagulation assays

HEMOGLOBIN DETERMINATION:
• Hemoglobin = iron-containing oxygen transport
metalloprotein in the red blood cells
BASOPHIL
• With purple-blue granules
Functions:
– Inflammatory response
– Involved in allergic response

METHODS:
a) Cyanmethemoglobin Method
– Reference Method
– Reagent: Drabkin’s Reagent
MONOCYTE – Principle: oxidation of ferrous iron
• Kidney-shaped or horse shoe-shaped nucleus to ferric by potassium ferricyanide
Types (in tissues): = methemoglobin converted to
– Dendritic cell: marks out cells that are cyanmethemoglobin with cyanide
antigens (foreign bodies) that should be ions
destroyed by lymphocytes – Instrument: Spectrophotometer
– Macrophage: act as antigen-presenting (540 nm)
cells
b) Automated Hemoglobinometry
– Utilizes cyanmethemoglobin
method with modified Drabkin’s
reagent

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c) Point-of-care (POC) Hemoglobin Assay

– HemoCue method
– Modified azidemethemoglobin
reaction
– Reagent: sodium nitrite and
sodium azide

HEMATOCRIT DETERMINATION:
• Also known as packed cell volume (PCV) or
erythrocyte volume fraction (EVF)
• For evaluation or treatment of anemia and
determine presence of nutritional deficiencies
METHODS:
a) Spun microhematocrit
– Manual procedure
– Blood collection method: skin puncture
– Spin a blood-filled capillary tube using a
microhematocrit centrifuge
BECKMAN COULTER AUTOMATED HEMATOLOGY
ANALYZER:

b) Automated
- Computed from the mean cell volume and the red
cell count

PERIPHERAL BLOOD SMEAR:

BLOOD CELL COUNT – automated:

1. Electrical Impedance
– also known as Coulter Principle
– sizing and counting of particles is based on
changes in electrical resistance creating voltage
pulses
Order of pics:
2. Optical detection 1. Proper way of making a smear. 2 glass slides
– Hydrodynamic focusing method (stationary and spreader slide)
– Uses laser light in cell counting and sizing 2. Stained vs Unstained
3. Locate an area where red blood cells barely overlap

VI. ADDITIONAL HEMATOLOGY PROCEEDURES

Reticulocyte count:

• Reticulocyte count
• Reticulocytes: young RBCs without nucleus but still
bears cytoplasmic RNA
• Determines how the bone marrow produce and
release new RBCs to compensate lost/damaged
RBCs
• Blood film is stained with supravital stain
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o Blood that is transfused into a recipient must be

tested first to ensure compatibility with the recipient’s
blood.
- To reduce the risk of transfusion reactions
- To ensure that the blood/blood components
are safe

VIII. ABO BLOOD GROUP SYSTEM

o Discovered by Karl Landsteiner (1900s) and
Erythrocyte sedimentation rate: received the Nobel Prize (1930).
o He categorized the blood groups as A, B, and O
• Rate at which RBCs fall in a column in known as - Based on the presence of agglutinating
erythrocyte sedimentation rate antibodies in the serum/plasma of
• Non-specific test for inflammation individuals who do not possess the
• Reference Method: Westergren Method corresponding ABO antigen.
• Anticoagulant: sodium citrate - AB – 4th major ABO blood type
• Time of testing: one hour - Discovered by Alfred Von De Castelo and
Adriano Sturli

ABO BLOOD GROUP SYSTEM:

PLASMA COAGULATION ASSAYS: ABO BLOOD TYPING:

• Prothrombin Time (PT) and Activated Partial • A test to determine the blood type of an
Thromboplastin Time (APTT) individual.
o Coagulation testing 1) Cell typing (Direct or Forward typing)
o Detect abnormalities in hemostasis – To determine antigens in the
o Anticoagulant: sodium citrate RBCs of an individual by using
o Sample: plasma only commercially prepared antisera of
known specificity
2) Serum typing (Backward, Indirect typing)
– To determine antibodies in the
serum/plasma of an individual by
using RBCs of known specificity

FORWARD TYPING:

VII. IMMUNOHEMATOLOGY/ BLOOD BANKING

– A branch of immunology which deals with the uses
of immunologic principles to study and identify the
different blood groups
– It reflects the importance of the blood bank and the
MT profession in ensuring the safety and welfare of
patients that require blood transfusion

BLOOD BANK:
o A separate area in a CLIN. Lab. hospital where blood
is collected from donors.
o Performs ABO and Rh typing
o Prepares blood and blood components for
transfusion
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BACKWARD TYPING: - Mother will produce anti-Rh antibodies

- In the next Rh-positive pregnancy, mother’s anti-Rh

antibodies will attack fetal red blood cells

IX. Rh BLOOD GROUP SYSTEM

– Discovered by Karl Landsteiner and Alexander

Weiner (1940)

• They injected rabbits with Rhesus macaque

monkey RBCs and Rh antibodies were produced.
- Rh antibodies + human RBCs = Rh FACTOR FREQUENCY DISTRIBUTION IN
AGGLUTINATION Rh POSITIVE POPULATION:
- Rh antibodies + human RBCs =
NO AGGLUTINATION Rh NEGATIVE

– 5 important Rh antigens: D, C, E, c, e
o D antigen = most important and
immunogenic antigen
o Rh Typing = based on the presence and
absence of the D antigen on the surface of
RBCs using commercially prepared anti-D
antisera

Rh Forward Typing:

HDN or ERYTHROBLASTORIS FETALIS:

- Rh-Positive Man

- Rh-Negative woman with Rh-positive fetus

- Rh- Positive fetus antigens can enter the mother’s

blood during delivery

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Ed Liwag | October 26, 2021

– Pregnant women: To support their growing babies,

pregnant women usually have anywhere from 30 to
50 percent more blood volume than women who are
not pregnant. This is about 0.3 to 0.4 additional
gallons of blood.
– If you lose too much blood, your brain doesn’t get
enough oxygen to support life. People who
experience major injury and trauma, such as a car
accident, may lose blood very quickly.
– Losing an excessive amount of blood is known as
hemorrhagic shock.
– If you lose more than 40 percent of your blood, you
will die. This is about 2,000 mL, or 0.53 gallons of
blood in the average adult.
– It’s important to get to a hospital to start
receiving blood transfusions to prevent this.

BLOOD COMPONENTS AND THEIR INDICATIONS:

1. WHOLE BLOOD
• Effect: volume replacement and
COMPATIBILITY TEST: restoration of oxygen-carrying capacity.
• Indications:
o It is a series of procedures designed to ensure the o acute blood loss
safety of transferring blood o exchange transfusions
o It must be performed before the transfusion of blood o emergency conditions (when
components there is no other option)
o Blood typing and crossmatching must be done to • Irradiated Whole Blood: avoidance GVHD
prevent harmful transfusion reactions between the
recipient blood and the donor blood

2 PARTS: 2. PACKED RED BLOOD CELL (PRBC)

1) MAJOR CROSSMATCHING • Effect: restoring oxygen carrying capacity
- Patient serum is mixed with the • Indication:
donor RBCs o anemic conditions with hypoxia
- Detects if there are antibodies in 3. WASHED PRBC
the patient serum that can • Indications:
destroy the transfused RBCs from o sensitivity to plasma proteins
the donor o IgA deficient patients
- PS-DR (anaphylaxis)
2) MINOR CROSSMATCHING o PNH / removal of complement
- Patient RBCs are mixed with the factors
donor serum 4. LEUKOCYTE-REDUCED PRBC
- Detects if there are antibodies in • Indications:
the donor serum that can destroy o febrile transfusion reactions
the patients RBCs o cytomegalovirus (CMV) infection
- PR-DS 5. FROZEN PRBC
• Indications:
o unusual blood types
X. BLOOD FACTS o multiple red cell antibodies
o autologous transfusion
– The amount of blood in the human body is generally 6. IRRADIATED PRBC
equivalent to 7 percent of body weight. The average • Indications:
amount of blood in your body is an estimate o Avoidance GVHD
because it can depend on how much you weigh, 7. FRESH FROZEN PLASMA (FFP)
your sex, even where you live. • Effect: replacement of plasma factors
– Babies: Babies born full-term have about 75 • Indications:
milliliters (mL) of blood per kilogram of their body o severe bleeding in unknown
weight. If a baby weighs about 8 pounds, they’ll factor deficiency
have about 270 mL of blood in their body, or 0.07 o complex coagulation factor
gallons. deficiency / DIC
– Children: The average 80-pound child will have o Thrombotic thrombocytopenic
about 2,650 mL of blood in their body, or 0.7 purpura (TTP)
gallons. 8. PLATELET CONCENTRATE
– Adults: The average adult weighing 150 to 180 • Indications:
pounds should have about 1.2 to 1.5 gallons of o thrombocytopenia
blood in their body. This is about 4,500 to 5,700 mL. o platelet dysfunction
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o DIC
9. CRYOPRECIPITATE
• Indications:
o fibrinogen and factor VIII
supplementation
o vonWillebrand disease
10. FACTOR VIII. CONCENTRATE
• Effects: stops the bleeding, prevents
haemorrhage and articular lesions
• Indications:
o Hemophilia A
11. FACTOR IX. CONCENTRATE
Indications:
o Hemophilia B

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