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Treatment Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Treatment and links to relevant pages within the course.

Learn more about laboratory continuing education for medical technologists to earn CE credit for AMT, ASCP, NCA, and state license renewal and recertification. Or get information about laboratory safety and compliance courses that deliver cost-effective OSHA safety training and continuing education to your laboratory's employees.

Laboratories Individuals

Cerebrospinal Fluid
Table of Conditions

The following table lists the various cell types and macroscopic descriptions of CSF, and the patient conditions that could cause those properties to be present in the patient's CSF: Predominant Cell Appearance Conditions lymphs variable; clear - turbid viral meningitis tubercular meningitis multiple sclerosis drug abuse lymphoma leukemia Guillain-Barré syndrome chronic alcoholism neutrophils variable; clear - turbid bacterial meningitis mycotic meningitis early tuberculosis hemorrhage cerebral abscess tumors monocytes variable chronic bacterial meningitis partial treatment of meningitis tumors macrophages clear - turbid or clear - xanthochromic bloody tuberculosis fungal meningitis following hemorrhage blood contamination eosinophils variable parasitic meningitis fungal meningitis allergic reaction medications shunts dyes tumor cells variable metastatic carcinoma blast cells variable leukemia lymphoma normal to increased lymphs clear - xanthochromic benign tumor spinal cord brain ependymal or orchoid cells (often clumped) variable; may be xanthochromic bloody trauma spinal tap Adapted from Saunders Manual of Clinical Laboratory Science. Craig A. Lehrmann, Ed. WB Saunders, 1998.

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Chemical Screening of Urine by Reagent Strip
Nitrite Test

The nitrites portion of the reagent strip provides a rapid screening test for the presence of gram-negative bacteria that are often responsible for urinary tract infections. Although urine cultures are still needed to confirm the diagnosis and monitor any urinary tract or kidney infection, the need for a culture may not be obvious because in some cases of early bladder infection, the symptoms may be vague or the patient may be asymptomatic. Diagnosis and treatment of cystitis (bladder infection) is important because if left untreated it may result in kidney damage, impairment of renal function, hypertension and/or septicemia.

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CLIA Chemistry / Urinalysis Review
Increases in blood ammonia levels would be expected in which of the following conditions:View Page
Which of the following is used primarily for the treatment of manic-depression:View Page
Tumor markers are especially valuable when used to:View Page
Which one of the following statements about acetominophen metabolism is false?View Page

CLIA Microbiology / Serology Review
Which one of the following tests should be used to monitor a patient's response to treatment for syphilis:View Page
Which of the following best describes the benefits of the RPR or VDRL tests:View Page

Confirmatory and Secondary Urinalysis Screening Tests
Correlation of Urine Glucose and Ketones

It is important to test for urinary (and plasma or serum) ketones when any patient shows a greater than normal excretion of sugar or reducing substances. Screening for ketonuria is useful in following the effects of treatment for diabetes and in judging the severity of acidosis. Large amounts of ketones will appear in the urine before serum ketone levels are elevated.

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Current Topics in Clinical Microbiology
ESBL Activity

Illustrated is the picture of the surface of a disk diffusion test including a ceftazidime disk (left) and a combintation ceftazidime/clavulanic acid disk (right).Observe in the photograph that the zone of inhibition around the the combination ceftazidime/clavulanic acid disk (right) is at least 5 mm larger than around the clavulanic acid disk (left).This observation that the presence of clavulanic acid, a beta-lactamase inhibitor, has resulted in such a large increase in the zone of inhibition indicates that an extended spectrum beta lactamase (ESBL)is being produced.When an organism is producing an ESBL, the susceptibility to individual cephalosporins cannot be predicted, thus requiring that each drug must be tested individually.It may be important to detect ESBL-producing stains of K. pneumoniae and E. coli as treatment failure may occur if the wrong cephalosporin is selected.

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Review 1

Garbutt JM. Littenberg B. Evanoff BA. Sahm D. Mundy LM. Enteric carriage of vancomycin-resistant Enterococcus faecium in patients tested for Clostridium difficile. Infection Control & Hospital Epidemiology. 20(10):664-70, 1999OBJECTIVE: To identify independent risk factors for enteric carriage of vancomycin-resistant Enterococcus faecium (VREF) in hospitalized patients tested for Clostridium difficile toxin.PATIENTS: Convenience sample of 215 adult inpatients who had stool tested for C. difficile between January 29 and February 25, 1996.RESULTS: 41 (19%) of 215 patients had enteric carriage of VREF. Five independent risk factors for enteric VREF were identified: (1) history of prior C. difficile infection, (2) parenteral treatment with vancomycin for > or = 5 days, (3) treatment with antimicrobials effective against gram-negative organisms, (4) admission from another institution, and (5) age > 60 years. These risk factors for enteric VREF were independent of the patient's current C. difficile status.CONCLUSIONS: Antimicrobial exposures are the most important modifiable independent risk factors for enteric carriage of VREF in hospitalized patients tested for C. difficile.

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Review 1

Piscitelli SC., Shwed J., Schreckenberger P., Danziger LH. Streptococcus milleri group: renewed interest in an elusive pathogen. European Journal of Clinical Microbiology & Infectious Diseases.11:491-8, 1992The following review examines the bacteriological characteristics, epidemiology, pathogenicity and antimicrobial susceptibility of the "Streptococcus milleri group". "Streptococcus milleri group" is a term for a large group of streptococci which includes Streptococcus intermedius, Streptococcus constellatus and Streptococcus anginosus.Usually considered commensals, these organisms are often associated with various pyogenic infections including cardiac, intra-abdominal, subcutaneous and central nervous system infections, particularly with the formation of abscesses.Organisms of the "Streptococcus milleri group" are often unrecognized pathogens due to the lack of uniformity in classifications and difficulties in microbiological identification. Penicillin G, cephalosporins, clindamycin and vancomycin all possess activity against these streptococci.Use of agents with poor activity may promote infections with "Streptococcus milleri group" and allow it to exhibit its pathogenicity. An understanding of these organisms may aid in their recognition and proper treatment.

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Review 2

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.

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Descriptive Statistics
Monitoring Methods

Coefficient of variation is commonly used as a means of measuring the variability of an instrument. The data are gathered by recording the values for the normal and abnormal controls for each test run. At the end of the month, the standard deviation, mean, and coefficient of variation are calculated. The testing data for a particular instrument might look like this: January February March Normal Control s CV 100.9 2.43 2.41 103.1 2.99 2.90 102.0 2.21 2.17 Abnormal Control s CV 209.5 4.41 2.11 211.6 4.00 1.89 206.8 3.95 1.91 The coefficient of variation stays fairly constant from month to month. If there is a sudden increase, there might be a problem with the method or the equipment.In the clinical laboratory, the use of CV as a measure of relative variability should not be confused with the use of the standard deviation as a measure of absolute variability. For example, support physicians agreed that for accurate patient treatment, the inherent variability in a glucose method should be less than 5 mg/dL. In this case, neither the hexokinase nor the orthotoluidine method is acceptable. It does not matter which is more precise if neither is precise enough to result in adequate patient care.

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First Aid
Introduction

An important component of safety training is a working knowledge of first aid and the medical services available to you.This program will explain several common injuries and their treatment.

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Fracture Treatment

If a fracture is suspected, prevent any movement of the victim's injured parts and get emergency medical assistance.

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Treatment of First and Second Degree

Submerge the affected part in cold water for 10 to 45 minutes. This will relieve pain and cool tissues to prevent further damage.Give aspirin or ibuprofen to relieve pain and reduce inflammation.Cover second degree burns with a dry nonstick sterile dressing.

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Treatment of Third Degree

Third degree burns or second degree burns involving more than 20% of body surface area must receive immediate emergency medical attention.

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Treatment of Chemical Burns of Eye

Keep the affected eye open using your fingers. Immediately begin flushing the eyes with water and continue for 15 minutes. Use an eyewash, safety shower, or water from the sink.Assist the victim by supporting the head so that water flows across the eyeball from the inside corner of the eye (nearest the nose), outward. This will prevent chemical from getting into the unaffected eye.Get immediate medical help.

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Treatment of Chemical Burns of Skin

If the chemical is a dry powder, first brush it off from the victim, taking care not to contaminate yourself, especially your eyes.Immediately flush exposed skin with large amounts of water.Remove contaminated clothing while continuing to flush the affected area with water.Continue flushing with water for 15 minutes or longer.Seek emergency medical attention.

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Fundamentals of Hemostasis
The difference between the coagulation disorders Hemophilia A and Hemophilia B lies in:View Page
Coagulation Disorders - Inherited

Inherited disorders are those which are considered to be inborn, and have some familial linkage. Hemophilia A is a deficiency of coagulation factor VIII. It is the most commonly encountered hereditary based coagulation disorder. Found almost exclusively in males, its pattern of inheritance is sex-linked recessive. This disorder presents clinically with hemorrhagic events ranging in severity from mild to severe. Patients often present with spontaneous bleeding into their joints, a classic symptom of this affliction. The treatment of Hemophilia A often involves the administration of commercial factor VIII products.

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Coagulation Disorders - Inherited

Hemophilia B is a deficiency of coagulation factor IX. Found almost exclusively in males, its pattern of inheritance is sex-linked recessive. This disorder presents almost identically to Hemophilia A in terms of symptoms, and has a very similar pattern of inheritance. Be sure to keep in mind that while similar, Hemophilia A and B are caused by a deficiency in different coagulation factors. The treatment of Hemophilia B involves therapeutic administration of Factor IX concentrates.

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Coagulation Disorders - Inherited

Von Willebrands Disease is a platelet disorder. This disorder is characterized by a functional defect in Von Willebrands factor (vWF) itself. This disease often clinically manifests with a concurrent deficiency of factor VIII, but will present with a normal platelet count. As far as genetics and inheritance, both men and women are affected equally. Von Willebrands factor is essential for platelet binding, therefore, a defect in vWF causes impaired platelet adhesion and aggregation. The treatment of Von Willebrands Disease involves the administration cryoprecipitate, as it is rich in vWF.

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Coagulation Disorders - Acquired

A lack of Vitamin K can cause a loss of functionality in Vitamin K dependant coagulation factors, specifically, factors II, VII, IX and X. Most often associated with a diet lacking in Vitamin K, it may also present in situations of broad spectrum antibiotic use, where normal flora in the gut have been eliminated. As one might expect, treatment involves a diet rich in Vitamin K containing foods, and judicious use of broad spectrum antibiotics.

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Coagulation Disorders - Acquired

Disseminated Intravascular Coagulation (DIC) is best described as a disorder of consumption, because clotting factors are depleted from the blood. Basically, clotting occurs randomly throughout the body, as opposed to just in the localized areas where vascular damage has occurred, consuming clotting factors and other components such as platelets in the process. Symptoms may range from a mild bleed, to severe, profuse bleeding, primarily dependant upon the availability of clotting factors. As more and more coagulation factors and components are consumed, the disorder progresses and symptoms worsen. Most heavily impacted are the levels of factors I, V, and VIII as well as the number of available platelets. Clinically, DIC is detected via an elevated (positive) FDP, positive D-dimer test, a prolonged PT and APTT, plus the manifestation of hemorrhagic episodes. DIC is diagnosed as two primary types, acute and chronic. Acute DIC manifests in a few hours or a few days, has a high mortality rate, and is seen in infections, obstetric complications, liver disease, and tissue injury. Chronic DIC is a secondary condition to some other disease state. Once you treat the primary disease, this type of DIC will go away. Treatment is often factor replacement therapy through the use of fresh frozen plasma and/or cryoprecipitate.

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Coagulation Disorders - Platelet Disorders

Bernard-Soulier Syndrome is a genetic platelet disorder characterized by abnormal platelet function tests, unusually large platelets, and a moderate decrease in platelet count. Clinically, patients present with mucotaneous bleeding of varying severity, as well as having gingival bleeds, epistaxis, purpura, and gastrointestinal hemorrhaging. Treatment can range from the administration of iron supplements up to red cell replacement therapy if the episodic bleeding is severe enough to warrant it.

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HIPAA Privacy and Security Regulations
Limiting Use and Disclosure of PHI

A covered entity may use or disclose PHI, without getting an individual's authorization, in order to:Perform requested tests and treatments.Bill for the services performed.Perform essential operations, including quality assessment, accreditation, and compliance.Meet legal reporting requirements, including those mandated by public health departments, workers' compensation, law enforcement agencies, and the US Department of Health and Human Services. Other uses and disclosures require written authorization.

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Minimum Necessary Use and Disclosure

Minimum Necessary means that the laboratory will use and disclose only the minimum PHI necessary to accomplish its intended purpose, such as resulting the requested test. The regulation recognizes that there are situations where all of the PHI on a patient can be released. These include: When releasing PHI to another covered entity for treatment. When releasing an individual's PHI to himself or herself. When an individual has signed an authorization to release the PHI. When required to do so by law.

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Authorization

The privacy regulations give covered entities permission to use and disclose PHI for treatment, payment, and health care operations (TPO), without obtaining specific authorization.A covered entity may disclose PHI to other covered entities such as reference laboratories, and homecare services, which are providing services to the primary covered entity.The service that the other covered entity is providing must fall within treatment, payment or health care operations (TPO).If the service being provided does not fall within TPO, an authorization is generally required.An authorization form must state the specific disclosures of PHI to be made, what the information will be used for, and must be signed and dated by the patient.

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Case Study: Limiting Use & Disclosure of PHI You are the customer service representative in a clinical laboratory. You get a call from someone at a local gastroenterologist's office, with whom you are personally familiar, requesting that you fax results on a patient, which the referring physician's office had failed to provide. The doctor needs the test results immediately. Under the HIPAA Privacy Regulations the you can comply with this request, without getting written authorization from the patient.View Page
Case Study: Incidental disclosures and safeguards. As a manager, you guided a group of high school students through your clinical laboratory during a field trip. You did not explain the laboratory's privacy policy to the teacher and students, because you thought they would have little access to PHI. However during the tour, the students overheard names of patients and blood tests, saw laboratory reports laying on desks, and viewed test results on computer screens. This is acceptable under the HIPAA Privacy Regulation since these were incidental disclosures that could not reasonably be prevented.View Page
Business Associate Agreement

A Business Associate is a separate organization, providing services to a covered entity, which require the exchange of PHI.An agreement must be in place between covered entities and their business associates.This agreement defines the processes that will be implemented to ensure the privacy and security of PHI.Examples of Business Associates may include collection agencies, attorneys, consultants, and accountants, requiring access to PHI.Business Associate agreements are not generally required between two covered entities involved in treatment, payment, or health care operations.

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HIV Safety for Florida
Evaluation and Treatment

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.

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Introduction to Bioterrorism
Disadvantages of using Biological Agents

They are not immediate. The delayed effect, for example, the long incubation period for some agents, may detract and limit their tactful usefulness as a political statement.They are hazardous to all who come in contact.There is the possibility that the biological agents could also affect the health of the aggressor forces. They are hard to control.The dependence of prevailing winds and other weather conditions such as temperature, sunlight, and desiccation may make it difficult to control distribution of the biological agent.  Potential long term effects beyond the initial attack.The persistence of some agents such as spore-forming anthrax in the environment may make an area uninhabitable to aggressor forces for long periods. Results are unpredictable.Morbidity secondary to a biological attack is unpredictable since casualties will be related to the quantity and manner of exposure plus the preventive and treatment measures available.

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Introduction to Bone Marrow
After Marrow Evaluation

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.

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Medical Error Prevention
Public Responsibility for Safety

People can help prevent errors in their medical care by understanding their treatment, keeping organized health records, and asking questions. They should feel comfortable talking with medical professionals when things do not seem right.

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Speak Up Campaign JCAHO also encourages people to do things themselves to prevent errors. It joined other groups in 2002 to launch the consumer Speak Up campaign. It encourages the public to become active participants in their healthcare and "speak up" when they have questions and concerns. As a healthcare professional, you should be aware that JCAHO has started a program to encourage patients and their families to become more involved in their medical care.View Page
Which of these actions can people do themselves to prevent medical errors?View Page
Medical Errors

The health community describes medical errors several ways: Failures of planned actionsMistakes of executionUse of wrong plans to achieve outcomes Sometimes peoples' plans and actions fail, and this create medical errors. Sometimes people make mistakes performing their duties, and this creates medical errors. Sometimes people use wrong plans and actions, and this creates medical errors. Medical errors are mistakes medical professionals make in patient testing, care, or treatment.

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Types of Medical Errors Medical errors usually belong to one or more of these categories:View Page
Postanalytic Medical Errors

Errors also occur after analyses are completed and reported. Postanalytic errors begin with the medical professionals who receive test results, and they include interpretation of the results. These errors can occur at--the bedside, chair-side, hospital, clinic-- wherever the patient and the medical professional are located. The possibility for postanalytic medical error continues through diagnosis and treatment procedures and processes. These medical errors occur during the time after the laboratory reports test results. Examples: Wrong test value associated with patient Wrong test interpretation Wrong diagnosis Wrong treatment Laboratory professional might believe they are not associated with postanalytic medical errors, but they can. One deadly example is fatal hemolytic transfusion reactions involving laboratory errors.

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Sources of Laboratory-Related ErrorsView Page

Medicare Compliance for Clinical Laboratories
Billing and medical necessity

Billing: Highest risk activity a laboratory has. All laboratory activities contribute to the billing process. Many of the risk areas included in this program are components of the billing function. Medical necessity: Medicare is only allowed, by law, to pay for tests that are reasonable and necessary for the diagnosis and treatment of disease. Medical necessity is an underlying principle of the Medicare program. Tests performed for screening or routine exams are not considered medically necessary by the Medicare program.

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Medical necessity

Medical necessity means that Medicare is not allowed by law to pay for any tests that are not necessary for diagnosis or treatment of disease.A laboratory may not submit a claim to Medicare or other government payers for any test it knows is not medically necessary except in certain cases: When the patient has signed an advance notice. When a patient has requested the lab to submit such a claim for a determination by Medicare. Medicare does not pay for screening tests or tests that are ordered in the absence of signs or symptoms.Billing department employees are responsible to follow all policies and procedures related to the submission of claims to reduce erroneous billings.

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Mycology: Hyaline and Dematiaceous Fungi
The differentiation between Aspergillus species and Scedosporium species may be difficult when only hyphal elements are observed in stained tissue sections. It is important to obtain a culture to make this differentiation when possible because Scedosporium species, in contrast to Aspergillus species, tend to be resistant to:View Page

OSHA Bloodborne Pathogens
Evaluation and Treatment

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.

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Pharmacology in the Clinical Lab: Therapeutic Drug Monitoring and Pharmacogenomics
Why TDM?

Pharmacologists determine a drug's pharmacokinetic characteristics empirically during clinical drug trials. From these studies, they are able to determine the solubility and distribution, the average half-life, the levels of protein binding, and the effective concentrations needed for treatment.

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TDM for Theophylline

Theophylline is used as a bronchodilator for treatment of moderate to severe asthma and chronic obstructive pulmonary disease (COPD). TDM is needed for theophylline because the kinetics of the drug are highly variable. It has a narrow therapeutic window, and overdose can result in elevated heart rate, arrhythmia, and CNS excitability. Clearance of the drug is increased in children, smokers, persons with cystic fibrosis, and persons with hyperthyroidism. Elimination is slowed in congestive heart failure and in the elderly.

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TDM for Immunosuppressants

Drugs used to inhibit the immune system are part of standard treatment after transplant surgeries. Regarding the use of TDM, there are some reports of hepatotoxicity and nephrotoxicity with some agents, but the main reason for TDM is to ensure that concentrations are adequate to suppress the immune response and prevent rejection. Examples of immunosuppressants that are monitored by TDM include: Cyclosporine Methotrexate Tacrolimus FK778

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Metabolizers

When discussing PGx, we classify a person according to his/her phenotype (metabolic capacity for a given enzyme).A poor metabolizer (PM) is a person who lacks the functional enzyme and therefore exhibits decreased metabolism of drugs. This person would require lower doses of a drug that is metabolized by that enzyme. A PM who receives a standard dose is more likely to experience unwanted side effects or toxicity. A PM can also experience diminished effects with drugs that need to be metabolized to active compounds by the enzyme in question.An ultrarapid metabolizer (UM) will require a higher dose than usual since he/she will eliminate the drug more quickly. A UM may be resistant to standard treatments, and it may take some time to adjust the dosage before therapy is achieved.An intermediate metabolizer (IM) has one wild-type (normal) copy of the gene and one absent or dysfunctional copy. The IM group is very heterogeneous.A person with normal enzyme activity is referred to as an extensive metabolizer (EM). This person should respond to standard dosages of a drug. Most people are EM's. This is the population in which most dosing regimens have been worked out in clinical trials.

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The Bottom Line

By knowing a patient's disposition to specific drugs, the physician should be able to start the patient on an appropriate regimen rather than perfecting treatment based on trial and error. Drugs whose metabolism may prove to be problematic can be avoided, and second-line therapies that are metabolized by different, unaffected enzymes can be chosen. Clinical chemists, pharmacologists, and physicians need to translate knowledge of CYP450 polymorphisms into clinically-validated treatment algorithms. Dosing recommendations for PM, EM, IM and UM patients are beginning to appear in the literature for various classes of drugs, and the FDA is encouraging the incorporation of pharmacogenomic testing in the development process for new drugs.

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Phlebotomy
Case

James Brown, a phlebotomist from the laboratory went to the second floor of Memorial Hospital to draw a STAT BMP (chem-8), CBC, and PT on a patient. The patient was in critical condition so the lab results were crucial for treatment. James quickened his pace in order to speed up the result time. He collected the specimens and took them back to the lab. However, the technologist in hematology and coagulation notified him that he would need to recollect the specimen because the CBC and PT were clotted.

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Work-flow cycle: test performance to treatment

Laboratory performs analytical tests. Lab results are returned to physician. Physician treats patient based on results of lab tests.

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One hour screening test for gestational diabetes

About 2-3% of women will develop gestational diabetes.Since women with gestational diabetes have a higher risk of losing their baby or having a baby with malformations, diagnosis and treatment of gestational diabetes is important.Pregnant women are screened for gestational diabetes at 28 weeks using a modified glucose tolerance test.Patients are given a 50 gm dose of Glucola, and blood is collected for glucose testing one hour later.If the glucose level is greater than 140 mg/dl, a 3 hour glucose tolerance test is required to confirm the diagnosis of gestational diabetes.

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Reading Gram Stained Direct Smears
Identification of bacteria

Identification of bacteria in direct smears may be of lifesaving importance. For example, a rapid diagnosis of bacterial meningitis, made after examining a gram stained smear of the patient's cerebrospinal fluid, allows the physician to begin treatment immediately.The appearance of bacteria on gram stained smears is suggestive of a certain species, but identification may not be made on the basis of the stain alone. An exception to this rule is the presence of gram negative intracellular diplococci from a male urogenital specimen, which is presumptive identification of Niesseria gonorrhoeae.In addition, culture results can be correlated with the direct smear report.

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Reading Gram Stained Smears From Cultures
Principle

The culture smear is used to determine the staining characteristic and shape of the unknown organism since this data helps the microbiologist to decide on additional culture and identification methods. By correlating the Gram stain reaction, colony morphology and growth requirements, the microbiologist may be able to tentatively identify the organism, which the physician may use to modify treatment, until definitive culture and antibiotic susceptibility results become available.

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A physician can use the information from a culture smear report to make a preliminary diagnosis and begin treatment.View Page
Culture, Isolation, and Identification of Microorganisms

The process of culture, isolation and identification of microorganisms is basic to medical microbiology. When a culture shows signs of growth, the process of identification includes examining the following characteristics:appearance of the colonies in the culture mediumstaining reactionappearance of stained organismssizeshapearrangement of bacterial cellsThis type of preliminary identification may help the physician to initiate the appropriate antibiotic treatment.

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Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions
Hemolytic disease of the newborn

Jaundice was recognized in a day-old infant. Notice particularly the size variation (anisocytosis) of the erythrocytes on the infant's peripheral smear. What does this observation mean? Does it provide immediate information that might serve as guidance in expediting diagnosis and treatment? Note that normal-sized red blood cells, microcytes, microspherocytes, macrocytes, and nucleated red blood cells are all present. Red cell variations are expected findings in healthy neonates, but the variations here are exaggerated. Hyposplenic functional features may appear, including acanthocytes, spherocytes, and possibly Howell-Jolly bodies, especially if hemolysis is particularly vigorous. A high (3-7%) reticulocyte count is not unusual during the first three or four days after birth, however, the marrow in this jaundiced infant is proliferating vigorously in response to hemolysis. A call for more red cells is urgent. Immature red cells (in the form of nucleated red cells) and red cells with stippling of RNA (basophilic stippling) are readily identified. Red cell maturation sequence has not been totally processed in the marrow nor is all residual red cell debris removed by the spleen. In the lower photograph are reticulocytes stained by supravital stain (new methylene blue). Basophilic stippling (specks of RNA) stains with both supravital stains and with routine Wright-Giemsa stain.

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Semen Analysis
Liquefaction

Immediately following ejaculation, semen is in a gel-like condition.Liquefaction, or resolution of the gel-like consistency, is expected within 15 minutes. If liquefaction does not occur within 60 minutes you should note this on the report sheet.Occasionally a specimen does not liquefy. If this occurs, mechanical mixing or enzyme treatment may be necessary in order for the sperm count, motility analysis and other microscopic aspects of semen analysis to be performed.

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Tuberculosis Awareness for Healthcare Workers
Infection Control

An effective TB infection control program achieves: prompt detection, airborne precautions, and treatment.

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High Risk Progression Groups

The following persons are at high risk for progression from LTBI to TB disease: Persons infected with HIV Persons infected with Mycobacterium tuberculosis within the past two years Persons with untreated or inadequately treated TB disease Infants and children <4 years of age Persons with chronic medical conditions or immunocompromising conditions

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Procedures with Increased TB Risk

Some procedures increase the potential for TB risk because they create aerosols. They include: Sputum induction and aerosol treatments Bronchoscopy Endotracheal intubation and suctioning Autopsy Microbiology processing TB specimens Surgical drainage of TB abscesses

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Fundamentals of TB infection control

TB infection controls include: standardized anti-tuberculosis treatment regimens in the initial phase of therapy; rapid drug susceptibility testing; directly observed therapy in which a health professional watches a patient swallow each dose of medication and records the date that the administration was observed; improved infection control practices.

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Variations in White Cell Morphology - Granulocytes
Normal Band Forms vs. Pelger-Huet Bands

Recognition and diagnosis of the inherited form is important because many of these Pelger-Huet neutrophils may be classified as bands, therefore; increased numbers of bands might be erroneously reported in these patients.Since increased bands frequently indicate infection, reporting Pelger-Huet cells as normal band forms could result in inappropriate treatment for infection.Pelger-Huet bands have more coarse chromatin than normal band forms.

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Auer Rods

Auer rods are red staining, needle-like bodies seen in the cytoplasm of myeloblasts, and/or progranulocytes in leukemia. Auer rods are cytoplasmic inclusions which result from an abnormal fusion of the primary (azurophilic) granules. Single or multiple Auer rods may be seen in the cytoplasm of a cell. If more than one is present, they are frequently close together and may even be overlapping. Their identification is very important because, if found, they can confirm the presence of myeloblasts indicating the presence of a myeloid (non-lymphoblastic) leukemia. They can also be seen in myeloid blast crisis in chronic granulocytic leukemia. Auer rods are never seen in lymphoblasts. This differentiation is important because the treatment of lymphoblastic and myeloblastic leukemia are different. Auer Rods always classified as pathological.

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