If your doctor has ordered laboratory tests, it s natural

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1 A Patient s Guide to Clinical oratory Testing at Kingman Regional Medical Center If your doctor has ordered laboratory tests, it s natural to have questions about why and how the tests are performed. This guide is to inform you of the laboratory testing process at Kingman Regional Medical Center (KRMC) and to answer some common questions. The KRMC Clinical oratory is certified by the Joint Commission on Accreditation of Healthcare Organizations, American Association of Blood Banks, and COLA (a premier clinical laboratory education, consultation, and accreditation organization). Our clinical laboratory is staffed with highly experienced professionals who use state-of-the-art instrumentation and comprehensive testing methods. oratory tests can help your physician make an accurate and timely diagnosis of your condition so that the right treatment can begin immediately. Depending on the type of tests your doctor orders, clinicians may take samples of your blood, body fluids, tissues, or by-products. Experts in our laboratory will analyze the samples to help your doctor: Diagnose medical conditions

2 Monitor treatment (lab tests can help show if a medication or treatment is working properly and whether there are side effects) Verify good health and the absence of disease oratory tests are useful because they can: Detect conditions that may have no symptoms Determine an exact health problem (some conditions can have similar symptoms) Enable treatment to begin early when it is most effective and damage to health is minimal Your doctor, who is familiar with your medical history and current condition, is in the best position to explain test results and their implications.

3 Tests Are Performed By Skilled Professionals The KRMC Clinical oratory staff includes skilled professionals with education in a variety of fields. Phlebotomists A phlebotomist is specially trained to draw blood samples for testing. A phlebotomist is often the only laboratory professional with whom the patient will have contact. Clinical oratory Scientists Once your sample has been collected, it is sent to the laboratory to be analyzed by clinical laboratory scientists (also known as medical technologists). Clinical laboratory scientists are nationally certified to perform complex chemical, biological, hematological, serological, and bacteriological tests. They also evaluate test results, develop procedures, and establish and monitor programs to ensure the accuracy of test results. The clinical laboratory scientists at KRMC have over 350 years of combined laboratory experience. Pathologists A pathologist is a physician who specializes in examining tissues. The pathologist serves as the medical director of the laboratory.

4 Different oratory Departments for Different Testing Functions The KRMC Clinical oratory is divided into specialized departments for different types of testing. These departments include: Hematology, Chemistry, Urinalysis, Blood Bank, Microbiology, and Anatomic Pathology. The following describes the types of tests performed in these departments: Hematology The hematology department performs different laboratory tests on blood. The most common test is the complete blood count (CBC), which indicates the number and the type of cells in a patient s blood. A CBC profile includes: Red Blood Cell Count (RBC) Red blood cells contain the vital protein hemoglobin, which is responsible for transport of oxygen and carbon dioxide between the lungs and body tissues. White Blood Cell Count (WBC) White blood cells are responsible for defending the body against bacteria and viruses. Hemoglobin (HGB) Hemoglobin is a protein-iron compound which is responsible for carrying oxygen and carbon dioxide between the lungs and body tissues. Hematocrit (HCT) Hematocrit is a measure of the packed volume of red blood cells in a given volume of blood.

5 Platelet Count (PCT) Platelets are round or oval structures in the blood, which are produced in the bone marrow. Platelets perform an important role in blood clotting. Differential (Diff) A differential is a count of the different types of white blood cells. Abnormal differential counts may mean allergies, infections, drug reactions, stress, leukemia, or other conditions. The hematology department also performs blood coagulation tests to detect bleeding and clotting problems or to monitor anticoagulant therapy. These tests include: Prothrombin Time (PT) This test measures how long it takes blood to clot. It can be used to check for bleeding problems and to check whether medicine to prevent blood clots (e.g., coumadin) is working. It is also used to screen for bleeding tendencies due to liver disease, vitamin K deficiency, factor deficiencies, or disseminated intravascular coagulation. Activated Partial Thromboplastin Time (APTT) An APTT also measures blood clotting time. It is often used after you take blood-thinners to see if the right dose of medicine is being used. If the test is done for this purpose, an APTT may be done every few hours. When the correct dose of medicine is found, you will not need so many tests. An APTT can also be used to screen for bleeding tendencies due to factor deficiencies or anti-factor antibodies. PT and APTT tests are often done at the same time to check for bleeding problems, especially before a surgical procedure. Chemistry KRMC s chemistry department studies substances carried in the blood. Our laboratory scientists use state-of-the-art instruments to test for these substances. Your doctor may instruct you to fast before having your blood drawn for chemistry tests. An eight-hour fast (no food or drink) is usually sufficient. Commonly, scientists will analyze the following chemical substances in a blood sample: Glucose is a type of sugar in your blood. Glucose tests are used to diagnose or monitor diabetes (high blood sugar) or hypoglycemia (low blood sugar). Creatinine is a waste product in your blood and urine. Creatinine tests measure the level of this waste product to determine if the kidneys are functioning normally.

6 Lipids are fats and fatty substances used as a source of energy by your body. Lipids include cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Lipid tests can help determine your risk of coronary heart disease or stroke. Electrolytes are minerals, such as sodium, calcium, and potassium that are found in the body. They keep your body s fluids in balance and help keep your body working normally, including your heart rhythm, muscle contraction, and brain function. Electrolyte tests can help determine a variety of health conditions, such as chronic heart or kidney disease, endocrine diseases (problems with the adrenal, pituitary, thyroid, or parathyroid glands), eating disorders, or bone disorders. Enzymes are proteins that speed up chemical reactions in the body. The body produces many different kinds of enzymes for many different body processes, such as digestion and blood clotting. Measurements of the levels of certain enzymes in a person s blood can detect disease or damage to body organs, such as the heart or liver, or can help doctors monitor the treatment of some diseases or medical conditions. Urinalysis KRMC s urinalysis department performs tests on urine samples. These tests can help in the diagnosis of a variety of conditions. A routine urinalysis involves testing for the following constituents in the sample: Ketones are substances that are produced by the body as it breaks down fats for energy. Abnormal levels may mean diabetes, dietary problems, or other conditions. Blood in urine may mean kidney problems, infection, or other conditions. However, blood may be normally present in women during their menstrual period. Bilirubin is produced when the liver breaks down old red blood cells. Bilirubin in the urine may mean liver disease, infections, or other conditions. Protein is normally not found in the urine. Fever, hard exercise, pregnancy, and some diseases, especially kidney disease, may cause protein to be in the urine. Microorganisms such as bacteria or yeast cells in the urine can be a sign of infection. Leukocytes (White Blood Cells) in the urine may mean infection or other conditions. Nitrites in urine may show that a urinary tract infection is present.

7 Blood Bank KRMC s Blood Bank is responsible for blood compatibility testing and for storing and maintaining blood and blood components for transfusions. You may have blood drawn for Blood Bank testing prior to surgery or as part of a pre-natal screen. Blood Transfusion A blood transfusion is a medical treatment to replace blood or portions of the blood lost through injury, surgery, or disease. If a transfusion is required, KRMC Blood Bank technicians will collect a blood sample from the transfusion recipient. The sample will be properly labeled to ensure safety. A corresponding armband will be completed with the patient s information. This armband will be placed around your wrist in addition to the hospital armband. This armband must remain on your arm until removed by a healthcare professional. Blood Typing and Crossmatch A person s blood type is determined by the antigens (or markers) on the surface of red blood cells. Blood-type testing is done to match correct blood types for blood transfusions or to detect differences between a mother s blood type and her unborn child. A crossmatch is the procedure for testing compatibility between a donor s and recipient s blood. In order to receive a blood transfusion, the blood donor s antigen must be compatible with the recipient s antigen. Antibody Screening The Blood Bank performs antibody screening tests to detect antibodies against red blood cells. Antibodies are substances produced by the immune system in response to foreign substances being introduced into the body, such as bacteria and viruses or donor tissue or blood. Pre-natal Screening During pregnancy or delivery, women with Rh negative blood may produce antibodies against Rh positive fetal red blood cells. This antibody response, depending on when it occurs, can destroy the fetus s red blood cells causing mild to severe problems. However, problems arising from Rh sensitization have become rare since the Rh Immune Globulin (RhoGam) vaccine was developed. KRMC s Blood Bank performs testing to determine if RhoGam is needed to neutralize a fetal-maternal bleed.

8 Microbiology Microbiology is the study of minute organisms or microbes, such as bacteria, fungi, viruses, and protozoa. Tests performed in the microbiology department include: Blood Culture This test is used to determine if the patient has an infection in the blood stream. The physician will often order more than one blood culture. Urine Culture Bacteria, parasites, and yeast cells in the urine are signs of infection. A catheterized or clean catch urine specimen is used for the culture (growing of the bacteria). Patients should follow the collection directions carefully. Throat Culture A sterile cotton tip stick is used to swab the throat to produce a sample. This sample is plated (wiped) onto plates of media used to grow bacteria. The bacteria are grown for identification. Throat cultures are used to confirm bacterial infections such as strep throat. Sputum Culture The patient is usually asked to obtain a deep cough specimen (sputum) from the lungs. The sample is used to detect certain infections and other conditions. Stool (Feces) Culture Different tests may be performed to check for bacteria, parasites, and other organisms, or for occult blood. Blood in the stool may indicate a problem with ulcers, hemorrhoids, colon cancer, or other conditions. The microbiology department offers several rapid diagnostic tests. The following rapid tests take from minutes to perform from the time the specimen is received in the laboratory. Rapid Strep is testing for Group A Beta Streptococci from throat specimens. Flu Screen is testing for influenza viruses A & B from nasal swabs or nasal washings.

9 RSV (respiratory syncytial virus) testing from nasal washings are usually done on infants & children less than 5 years old, but can include older immune-compromised patients. Other cultures may take much longer to produce results. Bacteria, fungi, mycobacterium (AFB), viruses, and other microorganisms all have different ways of growing. Some require special media and temperatures to grow. General time frames are as follows: Routine bacterial cultures take hours for final results Blood cultures take 5 days Fungi cultures take 4 weeks AFB cultures take 6-8 weeks Viral cultures take up to 14 days

10 Anatomic Pathology At KRMC, Anatomic Pathology includes the Histology and Cytology departments. The Histology department is the section of the laboratory that prepares tissue samples for microscopic examination and diagnosis by the Pathologist. The Cytology department prepares fluids for examination and diagnosis by the Pathologist. Tissue specimens may be taken by needle biopsy or by minor surgical techniques. Some common examples of biopsy specimens are small tissue samples from the breast, lung, or colon. The department can also examine larger tissue samples such as hysterectomy specimens (uterus, cervix, and ovaries), gallbladders, and tonsils. Pathologists can also perform and examine biopsies from the bone marrow to determine the cause of a patient s unexplained anemia (low blood count). An accurate and rapid diagnosis from a tissue biopsy will aid the physician in developing an appropriate treatment plan for the patient. The pathologist will determine if a tumor is malignant or benign. If a tumor is malignant, it will be classified so that the appropriate chemotherapy or radiation therapy can be initiated. 10

11 Common Questions from Patients Why do you take so much blood? Each test has certain specimen requirements. For example, blood culture tests require at least 10 cc of blood from adults and at least 1 cc from children. Therefore, different tubes may have to be drawn according to the tests your physician has ordered. You will notice the tubes have different colored caps, which denote the type or lack of anticoagulant in the tube. What are the health risks from lab tests? tests are not dangerous to your health. The minimum amount of blood is drawn for the testing that is ordered. Sterile, disposable equipment is used to draw the blood so that there is no chance of becoming infected from someone else. When will lab results be ready? The amount of time necessary to complete the test will depend on the complexity of the test. The laboratory monitors the time span between when a specimen is drawn and when the results are available. Every possible step is taken to insure accurate and timely results. Why are blood tests sometimes repeated? There could be several reasons why a blood test may have to be redrawn and repeated. Sometimes a blood specimen may clot or hemolize, which makes it difficult to analyze. In other instances, blood test results may be unexpected and may need to be verified by testing another sample. What can I do to help the process? You can help the lab testing process by cooperating with health-care personnel and by carefully following their instructions. If you are asked to fast, do not eat or drink for at least eight hours prior to testing. In addition, ask questions of your healthcare professionals until you feel satisfactorily informed. Lastly, try to remain calm before and during the test, since stress may affect certain tests. 11

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