Evaluation Information and Courses from MediaLab, Inc.

Examination of CSF provides vital information which aids in the diagnosis of a wide variety of disorders: benign disordersmeningitisencephalitisbrain abscesssubarachnoid hemorrhagecerebral infract vs. intracerebral hemorrhagemultiple sclerosisGuillian-Barre's syndromespinal cord tumormalignant disordersleukemia CNS involvementmalignant tumors of the brain or spinal cordmetastasis of malignant tumors

Griego RD. Rosen T. Orengo IF. Wolf JE.: Dog, cat, and human bites: a review. Journal of the American Academy of Dermatology. 33:1019-29, 1995It is estimated that half of all Americans will be bitten by an animal or another human being during their lifetimes. The vast majority of the estimated 2 million annual mammalian bite wounds are minor, and the victims never seek medical attention. Nonetheless, bite wounds account for approximately 1% of all emergency department visits and more than $30 million in annual health care costs.Infection is the most common bite-associated complication; the relative risk is determined by the species of the inflicting animal, bite location, host factors, and local wound care. Most infections caused by mammalian bites are polymicrobial, with mixed aerobic and anaerobic species.The clinical presentation and appropriate treatment of infected bite wounds vary according to the causative organisms. Human bite wounds have long had a bad reputation for severe infection and frequent complication. However, recent data demonstrate that human bites occurring anywhere other than the hand present no more of a risk for infection than any other type of mammalian bite.The increased incidence of serious infections and complications associated with human bites to the hand warrants their consideration and management in three different categories: occlusional/simple, clenched fist injuries, and occlusional bites to the hand. This article reviews dogs, cat, and human bite wounds, risk factors for complications, evaluation components, bacteriology, antimicrobial susceptibility patterns, and recommended treatments. Epidemiology, clinical presentation, and treatment of infections caused by Pasteurella multocida, Capnocytophaga canimorsus, Eikenella corrodens, and rhabdovirus (rabies only) receive particular emphasis.

A platelet function assay (PFA) is a screening test for the evaluation of platelets/primary hemostasis. Common clinical applications include the following: Preoperative evaluation of platelet function Determining the presence of drug-induced platelet dysfunction Determining platelet functionality in high-risk pregnancy Evaluation of patients with suspected inherited or acquired platelet disorders such as von Willebrand disease Evaluation of a bleeding patientA PFA instrument is able to differentiate between drug-induced platelet defects and other platelet defects. PFA tests are superior to the bleeding time test. The bleeding time is often not reproducible and, in spite of attempts at standardization, remains prone to variations in test results between persons performing the test. It is also relatively insensitive to platelet function. The bleeding time cannot be used to identify patients who may have recently ingested aspirin or non-steroidal anti-inflammatory drugs or patients who may have a platelet defect attributable to these drugs. The bleeding time is used to assess platelet function, but may be affected by platelet quantity. NOTE: Aspirin, and some other drugs, may falsely prolong bleeding times. Patients must be asked about aspirin use, and be aspirin free for 7-10 days prior to testing, for valid results.

Your supervisor will refer you for an immediate evaluation and any necessary treatment. Confidentiality will be maintained.Your blood will be tested only with your consent.

If a package or envelope appears suspicious: DO NOT OPEN IT and if at all possible, DO NOT TOUCH IT any more than necessary! If powder has spilled, do not clean it up. Leave the area and close any doors, but stay near the area. The reason for this is to lessen the chance of contaminating others and to warn others not to enter the room. Make sure you supervisor and emergency personnel have been notified immediately. As soon as security is in place, wash your hands with soap and water. After evaluation and if so deemed, pre-designated personnel should shut down the air handling system in the building. Make a list of names, addresses, and telephone numbers of all persons who were in the area to share with law enforcement and emergency officials if requested. Follow decontamination procedures as instructed by emergency authorities.  

The sample in the first syringe is quickly delivered into a watchglass or onto a slide. After the technologist verifies the presence of white-gray marrow particles in the sample, push smears and/or coverslip smears from this unanticoagulated sample are made immediately. All films should be rapidly air dried. The appearance of fat as irregular holes in the films also give the assurance that marrow and not just blood has been obtained. This type of smear is referred to as a direct smear and is usually used to evaluate morphology. Although some evaluation of cellularity and M:E ratio is possible, particle smears or biopsy sections provide a more accurate representation of these factors.

After the marrow is evaluated, the diagnosis is established and extent of the disease is determined. Follow up bone marrow examinations may be needed to monitor changes in the marrow following treatment or when signs and symptoms of relapse occur. To summarize, a bone marrow examination can provide valuable information to aid in the diagnosis of a variety of disorders. Due to the expense involved and the discomfort to the patient, clear indications of need should be present before this examination is undertaken.

The biopsy section or particle smears are the preparations that are preferred for the evaluation of marrow cellularity and architecture. The low power objective is used to examine the slide and compare the cellular area to the amount of fat (fat cells appear as white circles interspersed among the cellular elements). On the biopsy section the specific type of cells present are difficult to determine but the cellularity can be clearly seen. The particle smear may be used to evaluate cellularity as well as morphology. The diagnostic significance of the evaluation of cellularity, is simply to see if there are too few, too many, or sufficient cell precursors present in the bone marrow.

The composite image shown on the right illustrates the ABO typing reactions that were obtained for a patient. This particular case illustrates an ABO discrepancy. An ABO discrepancy occurs when the results of forward and reverse typing do not match. The reactions shown are described below in descending order:Patient red cells with reagent anti-A: negative reaction.Patient red cells with reagent anti-B: 4+ agglutination.Patient red cells with reagent anti-D: 4+ agglutination.Patient serum with reagent A1 red cells: negative reaction.Patient serum with reagent B red cells: negative reaction.This patient forward types as a group B, but reverse types as a group AB. (A group B patient should have anti-A. This patient demonstrates neither anti-A nor anti-B, similar to an AB patient). Further workup is necessary to determine the ABO type since the forward and back typing do not match. In this case, incubation at 40 C demonstrated the presence of weakened anti-A. The patient was therefore typed as group B. This case is an example of an ABO discrepancy which was due to a "missing" anti-A antibody. This could be due to old age, severe illness or immunosuppression. Although evaluation of ABO discrepancies is beyond the scope of this course, it is important to note that all ABO discrepancies must be resolved before blood products can be released for transfusion.This patient is Rh (D) positive, as evidenced by the strong agglutination of his cells with reagent anti-D antibody.

Specialists in immunohematology perform all testing prior to blood transfusions and work to prevent transfusion infections. They also investigate any post-transfusion reactions. This specialty includes all lab procedures performed in the specialty of histocompatibility. Specialists in clinical chemistry analyze body fluids such as blood, urine, and spinal fluid to determine the chemical makeup, including the amount of carbohydrates, proteins, enzymes, and trace elements. The special covers urine microscopics and chemical evaluation of the liver, kidneys, lungs, heart, and other vital organ systems. This specialty also covers all testing performed in the specialties of radioassay and blood gas analysis. Specialists in blood banking can perform all immunohematology testing as well as testing from the specialties of clinical chemistry, hematology and serology/immunology that relates to donor blood. Specialists in immunohematology, clinical chemistry, hematology, and serology / immunology may perform all tests in the blood banking specialty.

Element 5: Every employee must understand that the standards, policies and procedures associated with the compliance program must be adhered to at all times. Employee will be disciplined up to terminations for violations. Employee can be disciplined or terminated for failing to report a problem or suspect activity. All employees are screened prior to being hired for previous actions against them by any law enforcement or government agency regarding any health care prosecution or exclusion from the Medicare or Medicaid program. Adherence to the compliance program's policies and procedures will be a component of every employees annual evaluation and performance review.

Your supervisor will refer you for an immediate evaluation and any necessary treatment. Confidentiality will be maintained.Your blood will be tested only with your consent.

Validated material for the different testing areas in a laboratory (such as chemistry, hematology, and microbiology) are provided several times a year. Participating laboratories test the specimens and return results to the proficiency testing source. The laboratory’s performance is then evaluated using the comparative method mean as the target value plus or minus a defined limit. In general, the evaluation report will show: number of laboratories comprising the peer groupcomparative mean of the group for that particular analyte the laboratory’s performance compared to the peer group whether the performance was satisfactory or unsatisfactory.

If stains and technique are adequate, S. aureus should be gram positive (blue) and E. coli should be gram negative (pink). If control slides do react appropriately, reliable results cannot be assured for the specimen smears. Check stains and technique and prepare more control smears until proper results are achieved, then remake and stain the new direct smears. If it is impossible to prepare a new smear, the poorly stained smear may still be salvaged. Remove immersion oil from the smear using xylol. Use appropriate procedures and personal protective equipment when using xylol, since it is hazardous chemical. If the smear is underdecolorized, repeat the decolorization and counterstain steps. If the smear is overdecolorized, the slide should be stained again.

The procedure for assessing red cell morphology includes examining the smear in the feathered (thinner) edge where the erythrocytes are randomly distributed and, for the most part, lie singly, with occasional doublets. This area is referred to as the "critical area." If the area is too thin, the red cells will appear flat and somewhat square (cobblestone effect) with no central pallor. If the area examined is too thick, the cells will be too close together to evaluate the morphology of individual cells. To begin the red cell morphology examination, use the low power (10X) objective to locate the "critical area." The oil immersion objective (100X) is used for the actual evaluation.

To examine sperm morphology a semen smear is prepared on a clean glass slide, much like making a blood smear. It is important that the sperm be spread evenly on this slide and that the concentration be such that individual sperm can be clearly viewed. Too many sperm per slide makes evaluation difficult. Too few, makes it hard to find enough sperm for an adequate count.The examination of morphology is made using one of several commonly used stains. These include: Papanicolaou stainDiff QuikShorr stainDetails of these staining methods are available in the WHO IV reference manual.Two slides are prepared and 100 sperm are counted per slide using a bright field 40X or 100X objective.

Some professionals believe that sperm counts done by hemacytometer are not accurate because of the need to dilute the viscous semen prior to counting. There are several other counting methods available to assess sperm concentration.The advantages of the following methods are: the specimen does not have to be diluted motile and non-motile sperm can both be counted avoiding the need for wet mount evaluation of motile cells. Note that counting moving sperm can be difficult and takes significant practice to avoid error. For each of these methods accurate counts are best obtained when at least 100 sperm per replicate are counted. Makler (Zygotek Systems, Inc.). An undiluted sample is placed on the chamber and covered with the coverglass. Ten squares on the grid contain 0.000001ml. CellVu (Millennium Sciences, Inc). Two sides of a special slide are loaded with a drop of undiluted semen. Coverslips with special grids are placed on top of the sperm according to manufacturer's directions. Sperm on both sides are counted. MicroCell (Conception Technologies) has two chambers on a single, disposable slide. A special eyepiece with a grid is needed for counting.

A wet mount evaluation of motility involves examining at least five fields and/or a minimum of 200 sperm using the high power objective. For very low counts, increased numbers of fields may have to be examined and the total number of sperm may be less than 100. Two different slides are made and the percent motility is determined using different aliquots of the specimen. Results should agree within 10% of each other or a third aliquot is used and the average of the three is taken as the result.

The microscopic examination was traditionally performed on all urine specimens after macroscopic exam, specific gravity and chemical tests were completed. Today, many laboratories perform a urine microscopic only if preliminary evaluation indicates the need for microscopic examination. Such laboratories must have criteria determining the specimens on which a urine microscopic will be determined. The microscopic exam is often important in detecting and evaluating renal and urinary tract disorders as well as other systemic diseases.

In most clinical hematology laboratories, an initial blood count is performed by an electronic instrument. Some of these instruments also produce a differential blood count, and a platelet count. Instruments that provide a 3-part differential indicate the percentage of neutrophils, lymphocytes, and a mixed field group that includes monocytes, eosinophils, basophils, immature and atypical cells. Thus, the atypical cells shown in the photograph would be counted as mixed cells and a smear review would be needed to make an identification. Instruments providing a 5-part differential count include monocytes and eosinophils. In cases where the mixed cell count is high, or there are other indications that atypical cells may be present, a hematologist's review of the smear is indicated.