MODULE 1

Obtain consistently accurate and reproducible results

program of checks & balances to ensure the quality of a lab's services

A mechanism for error detection and an opportunity to improve services

1. Preanalytical
2. Analytical
3. Postanalytical

-Appropriate test, -Specimen collection/transport/storage/handling
-Pt education, prep, & instructions
-procedures for handling inappropriatenacceptable specimens
-documentation of any probs/situation
-adequate personnel training

1. Equipment/instrumentation
2. Reagents
3. Procedure manuals

Requires calibration, preventative maintenance, and monitoring documentation of these actions

-use of reagent-grade / analytical-grade reagents
-distilled of deionized water and quality monitoring
-verification of newly prepared reagents before use
-monitoring of analytical method/quality control

Procedure manuals are current, complete, and readily avail

Procedures that affect results reporting and interpretation

-effective t/effective communication of results
-standardized reporting format with ref ranges and informative comments
-immediately reporting critical values
-appropriate and evidence of review documentation

Standard operating procedure that lists every step of every test/process. Should not vary between personnel

How closely a measured value agrees with true value

How closely measured values agree with each other

1. Everyday ongoing activity to ensure precision
2. Continuous/immediate monitoring of lab work by personnel

Precise result

1. Periodic/ retrospective review of lab processes from outside accredited services
2. Indicates lab/staff areas of improvement

Maintains accuracy

They are used to assess and monitor analytical error by mimicking pt samples.
Monitor personnel's analysis of the same sample

Finding ST dev within the dataset, the range is +/- 2SD from the mean

The standard deviation from the expected mean value

control limits (mean+/- nSD)

The values resulting from previous measurements are subject to variation
-the variation follows a bell curve (normal distribution)

measures to monitor/eval a lab's performance compared to other facilities

programs which many labs use the same lot of QC materials

accredited labs

occupational health and safety act that formally regulates health and safety of all employees

standard precautions and transmission-based precautions

all body fluids, secretion, and excretions

apply to specific pts with known or suspected infections

airborne (pink)
contact (green)
droplet (yellow)

1. air droplet
2. fecal-oral
3. sexual
4. vector-borne
5. blood
6. unclean wound
7. mother to child

when handling body fluids

all specimens must be handled as if they are infectious and disposed of properly

lab surfaces should be decontaminated with 10% bleach daily

1. proper labeling of chemicals
2. lab safety manual
3. use of PPE
4. safety equipment such as eyewash and shower

req chemical manufacturers and suppliers to provide MSDS for each chemical and employers to make them avail to employees

ensures all employees are aware of potential chemical hazards in workplace

1. identify the spill and clear area
2. locate spill kit and use appropriate PPE
3. place barrier around spill
4. cover completely with absorbent material
5. sweep up any floor dry material
6. bag and tag for EHSO chem waste removal

flammable substances and fires
compressed gas tanks
electrical hazards

1. Location/operation of all safety equip (fire ext, alarms, showers, and eyewashes)
2. Exits and evacuation routes

diffusion

1. fluid
2. pump
3. vessels

fluid carries transported molecules and cells

to move fluids

to carry fluid between the pump and body tissues

1. hematocrit (cellular elements)
2. plasma

hematocrit is the percentage of blood volume occupied by cells

plasma is an aqueous medium for transport of inorganic ions, gases, and organic solutes

1. 90% water
2. plasma proteins
3. lipoproteins
4. others

plasma proteins are the most plentiful organic solutes (6-8% plasma)

lipoproteins carry energy lipids (triglycerides) and structural lipids (phospholipids and cholesterol)

electrolytes
hormones

Albumin (55%)

(4%)
proteins that help in blood coagulation

produced by immune cells
AKA ANTIBODIES!
(38%)

responds to immunity

blood coagulation

Red blood cells

to transport oxygen from lungsills to tissues

hemoglobin

molecule that is able to bind/hold on to O2 and release based on environmental conditions

oval

biconcave without nuclei/organelles

move around easily in the body and fit through capillaries that are much smaller through elasticity

removes old erythrocytes and stores healthy erythrocytes, platelets, and lymptocytes

red bone marrow in birds/mammals

to generate new erythrocytes (erthropoiesis)

The kidneys secrete erythropoietin (EPO) and it stimulates erythropoiesis

Generating new RBC (erythrocytes)

EPO

A hormone (a chemical messenger)

Low blood oxygen is the trigger for EPO

RBC production DECREASES

EPO, to stimulate RBC production

So there is more RBC (erythrocytes) to carry O2.

1. Low O2
2. Kidney senses low O2, releases EPO (erythropoietin)
3. EPO stimulates erythropoiesis in bone marrow
4. More RBC is released

White blood cells for immune system

Blood clotting

Cell fragments circulating in mammalian blood

Megakaryocytes (not stem cells) in bone marrow

TPO

EPO

Semilunar valves prevent blood from traveling backwards

To provide rapid passage of blood from the heart to the tissues

Large radii = little resistance to flow

blood flows at high velocity in arteries

the elasticity of arteries enables them to expand during ventricular systole,
the elastic recoil is the driving force for continued flow during diastole

5L of blood

against the blood (opp. directions)

parasympathetic, decreasing heart rate and pressure

elasticity allows the fiber to extend but retract back to normal shape to propel blood forward

the arteries are hardened, losing their elasticity.

aneurysm forms

the max pressure exerted on the arteries

minimum arterial pressure during diastole

Mean arterial pressure the is driving force of blood flow

MAP = diastolic pressure + 1/3 (systolic-diastolic pressure)

not enough pressure to perfuse through organs

smooth muscle contracts; increasing blood pressure
increased resistance in arteries, decreased flow through vessels

decreased contraction, decreased resistance, increased flow through vessels

1. ↑ myogenic activity
2. ↑O2
3. ↑CO2 & other metabolites
4. ↑endothelin
5. ↑sympathetic stimulation
6. vasopressin; angiotension II
7. cold

COMESVC

+CO2
+O2
+myogenic activity
+Endothelin
+sympathetic stim

vasopressin/angiotensin
cold

1. ↓ myogenic activity
2. ↓ O2
3. ↓ CO2
4. ↑ nitric oxide
5. ↓sympathetic stim
6. histamine release
7. heat

CHONSHM

-CO2
Histamine release
-O2
+Nitric oxide
-Sympathetic stim
Heat
-myogenic activity

larger proteins / molecules with negative charge

cannot maintain solute concentration inside the blood (?)

high to low

glucose + O2 → CO2 + H2O + ATP

facilitated diffusion by carrier

CO2

the metarteriole to the precapillary sphincter to the capillary

30L

oncotic pressure

Pressure through movement of water going from low to high concentration (of solutes?)

returns excess filtered fluid to the blood

An open system that collects and returns interstitial fluid to the blood.

Recycles interstitial fluid and monitors the blood for infection.

Interstitial fluid enters initial lymphatics (small blind-ended terminal vessels) to form lymph, which flows into the venous system near the heart.

Passage of lymph through lymph nodes aids in immune defense against disease

lymph vessels absorb fat from the digestive tract

the brain and the bone marrow don't have lymphatic systems

Released in response to
1. low blood volume or
2. increased blood osmolarity

increase water retention by the kidneys to reduce further reduction in blood volume

(essentially helps keep BP stable)

measure of solute concentration

1. dehydration ( a decreased blood volume )
2. salt ingestion

The osmoreceptors in hypothalamus is notified and message is sent to posterior pituitary

controls hunger and thirst

1. increases thirst, which leads to drinking, whihc leads to increased blood volume and decreased osmolarity
2. sends signal to post pituitary to secrete ADH

ADH = Antidiuretic hormone

ADH tells kidney to absorb more H2O from urine.

water retention by kidneys, leading to increased blood volume and decreased blood osmolarity

Aldosterone is secreted by the adrenal cortex in response to low BP and low blood flow to kidneys

to increase reabsorption of both water and salt by the kidneys
(prevents reduction of blood volume even if the salt volume is low)

In the liver and is present in blood but is inactivated until exposed to renin

juxtaglomerular apparatus of the kidney

Angiotensin converting enzyme (ACE) in lungs

-Increases aldosterone production in adrenal cortex
-vasoconstriction of arterioles, increased blood pressue

Aldosterone in the kidney absorbs sodium... absorption of sodium also means that water is increased, leading to salt and water retention by kidneys, increasing the blood volume