Introduction

Saydet Zgharta Hospital ,medical laboratory department ,has prepared this manual with the goal of providing  the necessary information for doctors ,medical centers and patients regarding the wide variety of tests available .

It is our policy to deliver test results accurately and without any delay. To do this,our laboratory is equipped with continuously innovated state-of-the-art analyzers that are operated by a highly skilled and experienced team of technologists,supervisors and managers,who work closely together to provide the most professional results possible.

Scope of Services

• Phlebotomy services
• Clinical chemistry
• Hematology/coagulation
• Serology
• Endocrinology
• Bacteriology
• Parasitology
• Blood bank
• Special procedures

Phlebotomy services

• Are available 24 hours / 7 days.
• House calls are also available upon request.

Turnaround time and results

• Are usually available within 1 -2 hours from receiving most of the samples.
• STAT (urgent) results-for cardiac markers,pregnancy,CBC,urine analysis and drug levels can be achieved within an hour.
• Panic values ,when present,are always communicated with the laboratory director after double checking,who in turn will call the referring physician on the subject.

Clinical chemistry

Offers a wide variety of tests including routine chemistry profiles ( lipid,liver function,kidney function…etc),cardiac markers,glucose tolerance testing,various enzymes,drug monitoring,trace metals levels,serum and urine protein quantification,and electrolyte levels.

Chemistry System

Speed Of Analysis

• 800 test/hour with ISE
• 400 photometric results/hour
• 400 ISE results/hour
• ~ 10 Min. from standby to the first result
• STAT profile in ~ 8 minutes
• continuous sample loading via racks

Olympus Methods & Applications

• Routine Methods
  • Acid Phosphatase
  • Albumin
  • ALP
  • ALT
  • Amylase
  • AST
  • Bicarbonate
  • Bilirubin, D
  • Bilirubin, T
  • Calcium
  • CHE
  • Cholesterol
  • CK-MB
  • CK-NAC
  • Creatinine
  • Glucose
  • GGT
  • HDL-Cholesterol
  • I. Phosphorus
  • Iron
  • LDH
  • LDL-Cholesterol
  • Lipase
  • Magnesium
  • Total Protein
  • Triglyceride
  • UIBC
  • Urea
  • Urinary Protein
  • Uric Acid
• Urine Methods
  • Amylase
  • Calcium
  • Chloride
  • Creatinine
  • Glucose
  • Magnesium
  • Phosphorus
  • Potassium
  • Sodium
  • Total Protein
  • Urea Nitrogen
  • Uric Acid
• DAU
  • Amphetamine
  • Barbiturate
  • Benzodiazepine
  • Cannabinoid
  • Cocaine Metabolite
  • Cotinine
  • Methadone
  • Methamphetamine
  • Opiates
  • PCP
  • urine pH
  • Thiazides
• TDM
  • Amikacin
  • Carbamazepine
  • Digitoxin
  • Digoxin
  • Gentamicin
  • Phenobarbital
  • Phenytoin
  • Theophylline
  • Tobramycin
  • Valproic Acid
•  Special Chemistry
  • Apolipoprotein A!
  • Apolipoprotein B
  • Ig A, Ig G, Ig M
  • C-reactive Protein (CRP)
  • Rheumatoid Factor (RF)
  • Anti-streptolysin 0 (ASO)
  • Ferritin
  • Transferrin
  • C3, C4
  • HbA1C

Endocrinology

Provides fast and accurate levels of various hormones,including all thyroid –related hormones,gonadotropic and sex hormones,ACTH,cortisol,renin,progesterone,macroprolactin,24-hr urine tests,estradiol,beta-hcG levels,with STAT results being out within 1 hour.

Main characteristics

• “Flash” chemiluminescence (ABEI) detection system
• Paramagnetic microparticle solid phase
• Sample and reagent continuous loading
• Random access or batch mode
• 2-point calibration
• STAT
• Auto-dilution, auto-reflex
• Maximum throughput: ~180 results/h

Sample management

• On board capability: 120 samples
• Continuous loading with barcode-recognized racks

Reagents

• On board refrigerated area
• On board capability: 15 analytes (1500 tests)
• Continuous loading of “reagent integrals” (recognition via barcode)

Hematology/Coagulation

• Services include automated and manual blood cell counts,peripheral smear and bone marrow aspirate reading,reticulocyte count,Hb fractionation for anemias , electrophoresis and blood group determination.
• Coagulation studies include PT, PTT, fibrinogen, D-dimers, protein C and S, Factors ( V,VIII,IX),vonwillbrand..

MEK-7300

• Automatic analyzer with 23 parameters and WBC 5 part diff
• Hematology Analyzer
• MEK-7300

Features

• Auto loader for 50 sample measurement
  • STAT measurement
  • Barcode & ID management
• Reliable data
  • Automatic recount for suspected samples
  • High reproducibility
• Cost effective
  • Low reagent consumption
• User-friendly operation
  • High resolution color TFT LCD touch screen
  • Automatic priming and self check
• Expansive data management capabilities (with optional Data Management Software, DMS-Pro)
  • Connection to LIS/HIS network
  • Additional research parameters, such as ImG, Band and Seg
  • Expanded data storage capability of 100,000 measurement data with scattergrams

Serology

• Includes manual screening tests and up-to-date automated analyses of various infectious and non-infectious diseases from viral ( HIV 1/2 + p24,hepatitis profiling,EBV,CMV,herpes,Rubella..etc) to bacterial and parasitic ( chlamydia,toxoplasma..etc) to autoimmune diseases ( celiac sprue,ANA,ANCA,TRAB..).
• Several methods for each test ensure that results are accurate.

Architect i1000SR/2008/U.S

• HIV Ag/Ab Combo, vitamin D, vitamin B12, folate, testosterone, HbA1c, HE-4, CA 125, CA 15-3, CA 19-9 XR, CEA, free PSA, Total PSA, BNP, CK-MB, troponin I, DHEA-S, estradiol, FSH, hCG (Total B-hCG), LH, progesterone, prolactin
• SHBG, anti-HAV IgM, Anti-HBc IgM, anti-HCV, anti-CCP, C-peptide, cortisol, ferritin, homocysteine, insulin, intact PTH, digoxin, phenobarbital, phenytoin, theophylline, valproic acid, vancomycin, anti-Tg, anti-TPO, many others..

Parasitology

Include urianalysis with microscopy, pregnancy testing, spermogram and spermo-cytograms, stool analysis for parasites and ova,occult blood and various toxins and plasmodium investigations.

Bacteriology

• Provides cultures,antibiogram and staining for all specimens in the clinical and non clinical setting.
• Clinical cultures include those from all areas of the body,from pus to throat to nails;special organisms such as Strepto B,Gardenerella,Mycoplasma/Ureaplasma,Tuberculosis and Listeria are identified .
• Non clinical specimens include water and food which are analysed and cultured to see if they are edible,contaminated or spoiled.

Blood bank

Components:

• Red blood cells
• Plasma
• Cryoprecipitated Antihemophilic Factor
• Platelets
• Granulocytes
• Mononuclear cells
• Hematopoietic progenitor cells

Blood Donation

• Types of donations
  • Allogeneic
  • Autologous
  • Directed
• Methods of blood collection
  • Whole blood
  • Apheresis

Note: all procedures are performed according to the the American Assoc of Blood Banks (AABB) standards

Donation by apheresis

Blood taken from a healthy donor can be separated into its component parts during blood donation, where the needed component is collected and the “unused” components are returned to the donor.

There are large categories of component collections:

• Plasmapheresis – blood plasma: Plasmapheresis is useful in collecting FFP (fresh frozen plasma) of a particular ABO group. The plasma can be removed to supply blood components such as clotting factors. Donors can give plasma via this mechanism more often than they can donate whole blood.
• Plateletpheresis (thrombapheresis, thrombocytapheresis) – blood platelets: Plateletpheresis, like it sounds, is the collection of platelets by apheresis; while returning the RBCs, WBCs, and component plasma. The yield is normally the equivalent of between six and ten random platelet concentrates. The products must be used within five days.
• Erythrocytapheresis- red blood cells : Erythrocytapheresis is the separation of erythrocytes from whole blood. It is most commonly accomplished using the method of centrifugal sedimentation. This process is used for red blood cell diseases such as sickle cell crises or severe malaria. The automated red blood cell collection procedure for donating erythrocytes is referred to as ‘Double Reds’ or ‘Double Red Cell Apheresis.
• Leukapheresis – leukocytes (white blood cells): Leukopheresis is the removal of PMNs, basophils, eosinophils for transfusion into patients whose PMNs are ineffective or where traditional therapy has failed. There is limited data to suggest the benefit of granulocyte infusion. The complications of this procedure are the difficulty in collection and short shelf life (24 hours at 20 to 24°C).
• Stem cell harvesting – circulating bone marrow cells are harvested to use in bone marrow transplantation

Quality Control

Our laboratory uses Randox International Quality Assessment Scheme (RIQAS,Acusera) as an external quality control. Randox is one of the largest manufacturers of laboratory Quality Controls across the globe. The Acusera range of Quality Controls and Calibrators covers over 300 parameters and guarantees an outstanding performance. Control products include Lipids, Immunoassay, Immunology / Proteins, Hematology, Cardiac, Toxicology, Coagulation, Tumor Markers , Urine chemistry and clinical chemistry.

RIQAS Randox International Quality Assessment Scheme (RIQAS) is Randox’s own external quality assessment (EQA) scheme. EQA is an essential aspect of any laboratory operation as it provides a way of assessing the analytical performance of a laboratory compared to other laboratories using the same methods and instruments. Being used by more than 22,000 laboratories in over 100 countries worldwide, RIQAS is the largest EQA scheme in the world.

RIQAS helps to maintain and improve analytical quality; improve inter-laboratory agreement; detect reagent and equipment problems; and compares different analytical methods. RIQAS is ISO 13485 and UKAS approved.

Reference Laboratories

The post-analytical procedures performed within the laboratory include verifying laboratory results, feeding them into the laboratory information system, and communicating them to the clinicians by producing a report.

Procesures Immunofluorescence

• Our lab offers you a complete service in Rheumatolgy and autoimmune diseases using the method of choice INDIRECT IMMUNOFLUORESCENCE MICROSCOPY.
• We can give you the right answer and help you confirm your diagnosis.
• However we are backed-up in this field by a reference laboratory of immunology EUROIMMUN that gives us a great help in difficult cases and supports us by high standard materials to satisfy your willigness to help your patient.

Applications

• Antinuclear antibodies : ANA
• Soluble antinuclear antibodies : ANA profile(immunoblot)
• Anti-ds DNA
• Antineutrophilic cytoplasmic antibodies (ANCA)
• Other antibodies: anti-parietal cells,antimitochondrial ,anti smooth muscle..

Allergy

• 1-IgE total
• 2-IgE specific: Respiratory panel

This is an enzyme immunoassay (EIA) for detection of inhalent allergen specific IgE in serum: insects,animals,plants

• 3-IgE specific: Alimentary panel

This is an enzyme immunoassay for detection of food allergen specific IgE in serum( soybean, peanut, milk, eggs, fish , tomato, wheat, hazelnut, corn..)

Toxicology

1. Comprehensive drug screen:
   • 400 chemicals are screened in one run
   • Specimens: serum,urine,tissues,gastric fluids..
2. Drugs of abuse screen (urine)
   • Amphetamines, barbiturates, cocaine, morphine, cannabis, benzodiazepines..
3. Medications overdose:
   • Panadol, aspirin, clomipramine, imipramine, benzodiazepine
4. Rare elements assay:
   • Zinc,copper,cobalt,arsenic..
5. Forensic toxicology:
   • Cyanides, pesticides..

Molecular

• HLA class I
• HLA class II (DR,DP,DQ)
• HLA–B27
• HLA-B5
• Flow cytometry Immune profile
• Flow cytometry Lymphoma profile
• Flow cytometry Leukemia profile
• Note:the above mentioned tests are done in Pasteur –Cerba labs ,Paris and Labconous (CIC) ,Spain.

Cytogenetics

• This is done in collaboration with University Saint-Joseph ( USJ )-cytogenetics lab.
• 1-Amniotic fluid karyotype
• 2-Blood karyotyope
• 3-Chorionic villi karyotype
• 4-Bone marrow karyotype