Laboratory Standards
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LABORATORY STANDARDS GUFOR PRIMARIDELIY HEalth CARE CLINICSN IN IERAQ DISCLAIMER This guideline has made possible through support provided by the U.S. Agency for International Development (USAID) under Primary Health Care Project in Iraq (PHCPI) implemented by University Research Co,. LLC. This guideline has been developed in Iraq in close collaboration with the Ministry of Health (MoH) in 2013 Table of contents Table of contents ....................................................................................................................... 1 Acronyms .................................................................................................................................. 6 1. Introduction ........................................................................................................................... 9 2. Setting up a primary health care laboratory………………………………………..10 3. Safety in the Laboratory ...................................................................................................... 12 3.1 Physical Hazards ............................................................................................................12 3.2 Chemical Hazards ...........................................................................................................13 3.3 Biological Hazards .........................................................................................................14 3.4 Safety Measures ..............................................................................................................15 3.5 Cleaning, disinfection, sterilization and disposal of biohazard waste. ...........................19 3.6 Disposalof BiohazardWaste ...........................................................................................22 4. Hematology ......................................................................................................................... 26 4.1Collection & Handling of blood ......................................................................................26 4.2Part One: Automated Blood Count Techniques ..............................................................29 4.2.1 Hemoglobin Concentration ....................................................................... 30 4.2.2 Red Blood Cell Count ............................................................................... 30 4.2.3 Counting Systems ..................................................................................... 30 4.2.4 Reliability of Electronic Counters .............................................................. 32 4.2.6 Packed Cell Volume and Mean Cell Volume ............................................ 35 4.2.7 Variationin Red Cell Volumes: .................................................................. 36 4.2.8 Total White Blood Cell Count .................................................................... 37 4.2.9 AutomatedDifferential Count ..................................................................... 37 4.2.10 New White Cell Parameters .................................................................... 39 4.2.11 Platelet Count ......................................................................................... 39 4.2.12 Mean Platelet Volume ............................................................................. 40 4.2.13 Reticulocytes Count ................................................................................ 41 4.2.14 Immature Reticulocyte Fraction .............................................................. 41 4.2.15 Calibrationof Automated Blood Cell Counters ........................................ 42 4.2.16 Flagging of Automated Blood Counts ..................................................... 43 4.3 Part Two: Manual Techniques ........................................................................................44 4.3.1 Haemoglobin Estimation ........................................................................... 44 4.3.2 Packed Cell Volumeor Haematocrit .......................................................... 49 4.3.3 Total White Blood Cell Count .................................................................. 522 4.3.4 PlateletCount .......................................................................................... 566 4.3.5 Erythrocyte Sedimentation Rate ............................................................... 60 1 | Page PHCPI Laboratory Standards Guideline 4.3.6 ReticulocyteCount ................................................................................... 644 4.3.7 Preparation of blood films ....................................................................... 677 4.3.8. Antiglobulin or Coombs' Test ................................................................. 700 4.3.9. ABO & Rh Group ................................................................................... 722 5. Serology ………………………………………………………………………………...74 5.1Rapid Plasma Reagin (RPR) TEST ...............................................................................744 5.2 TPHA(Treponema pallidum Haemagglutination Assay ) TEST ..................................777 5.3Widal Test ((agglutination test))....................................................................................800 5.4Rose Bengal Test for Brucellosis ..................................................................................844 5.5C-Reactive Protein (CRP) Test ......................................................................................877 5.6ASO latex slide agglutination test ...................................................................................89 5.7 Rheumatoid Factor (RF) ...............................................................................................900 5.7 Toxoplasmosis Test ......................................................................................................... 933 5.8Infectious Mononucleosis test .......................................................................................977 5.9 Rota Virus Latex Test .....................................................................................................99 5.10Pregnancy Test ..........................................................................................................1000 5.10.1 Rapid test for detection of human Chorionic Gonadotrophin in Urine . 1000 5.10.2 Direct hCG Latex Pregnancy Kit ...........................................................................1011 6. Bacteriology .................................................................................................................... 1033 6.1General urine examination ..........................................................................................1033 6.1.1 Macroscopical Examination of Urine ................................................... 1055 Bilirubin Test .................................................................................................................. 10909 Bence - Jones protein Test.........................................................................................…...109 Specific gravity test ........................................................................................................10910 6.1.2 Microscopical Examination of Urine ...................................................... 1144 6.2 General Stool Examination .........................................................................................1266 6.2.1Macroscopical examination .................................................................... 1277 6.2.2 Microscopic Examination ...................................................................... 1300 6.3Urine Culture ...............................................................................................................1344 6.4Throat Swab.................................................................................................................1465 6.5 Nasal Swab .................................................................................................................1555 6.6. SMART Tests ............................................................................................................1600 6.6.1 Helicobacter pylori Serum/Whole Blood ............................................... 1600 6.6.2Salmonella TyphiAntigen………………………………………………………..1633 2 | Page PHCPI Laboratory Standards Guideline 6.6.3 Vibrio CholeraeRapid Visual Antigen Detection Test ............................ 1666 6.7Preparation of CultureMedia .......................................................................................1722 6.7.1 Blood agar: Tryptic Soya Agar(TSA) with 5% sheep blood .................. 1733 6.7.2 Chocolate agar with TSA base and growth supplement ....................... 1744 6.7.3 MacConkey agar (MAC) ....................................................................... 1755 6.7.4 Mueller-Hinton agar .............................................................................. 1766 6.7.5 Cary-Blair medium, Amies medium, and Stuarts medium .................... 1777 6.8 Staining of bacteriological smears ..............................................................................1777 6.8.1 Gram’s Stain ......................................................................................... 1777 6.8.2 Ziehl-Neelsen’s stain (for acid fast bacilli) ............................................. 1788 7 Parasitology ...................................................................................................................... 1800 7.1 Malaria parasite diagnosis ....................................................................................1800