Book of Shadows

2008-11-10T19:10:00.003+08:00

20th posting~~

Hi again. This will be the last posting for my group about our SIP experience. This time, I will be talking about a particular new shift that I was assigned to a few weeks ago. It was called Corporate and Polyclinic section or CP for short. The shift starts at 10am and will finish at 7pm, with my lunch break at 2pm instead of the normal 1pm.

As I was new in doing that shift, I was asked to observe how the workflow is. For the poly samples, I was told that there are a total of 3 batches of samples that is sent every day. The first batch usually comes before 11am, the second batch after 1pm and the third one before 5pm. And for each batch, we would receive samples from 3 polyclinics. They are Bukit Batok, Chua Chu Kang and Jurong. Now let me explain the workflow.

The moment the samples arrive at the lab, the deliveryman will tell the poly clerk in-charge the maximum and minimum temperature of the samples. The poly clerk will take down the temperatures together with the time delivered. The poly clerk will then check that the samples sent matches with the ones that are in the form. After that, the clerk will have to ‘ech’ the specimens into our lab system. ‘ech’ is simple a method we use to manage the samples sent by the poly. It is necessary to ‘ech’ all the samples first before running them as if not, the machine would not recognize the sample and it would not run. After that, the samples are then passed on the med tech doing the CP shift.

The poly usually sent the samples either in plain, fluoride or edta tube. The plain tubes are usually used for the routine biochemistry tests. Thus, we just need to load the tubes into the MPA where all the pre-analytical processes like centrifuging will take place. It will then automatically run the samples into the adjacent machine called the swa or cobas. However, if the sample is insufficient, we will have to spin it down first using a centrifuge and then load it into mpa or swa. As for the fluoride tubes, we have to spin all of the tubes first before loading it into the machine. This is because if we load it into the mpa, the system is not able to transmit the result. For the edta tubes, we have to check if it is for type and screen or just for blood count. If it is for type and screen, we need to spin it down first before giving it to the blood bank section. If it is for blood count, we will straightaway pass it to the hematology section. The tubes are then archive into special racks. This is to make identification easier.

After each batch, the med tech needs to check the incomplete log for any incomplete test. If there is any not run tests, we need to locate the tube and run it again. That’s basically it for poly samples.

For corporate samples, it is only slightly different. Instead of ‘ech’, we need to order it as corporate screening samples. So, we are going to order the tests like how we order our in-house test. We just need to change the location to indicate where it came from. For example, those samples that came from the Institute of Mental Health, the location code is 1IMH. The corporate samples usually order the test in different packages. Therefore, instead of ordering each test one by one, we have a code that will include all the tests for that package. Thus, each package will have different code. We just need to make sure that we are ordering the correct packages as stated in the form. After ordering, the workflow from then on is similar to poly samples.

Then once again, the med tech needs to check the incomplete log for any miss out tests. After all the result is out, we need to print it out and sent it back to the companies together with the request form. And also, corporate samples will not be sent every day. It will only be sent on certain days as requested by the companies.

Hmm.. that’s basically the job of the CP person.

Toodles~

Done by: Nur Sofieyana
Class: TG02

2008-11-02T21:59:00.018+08:00

Week 19 entry

Seems like just yesterday we've started the first of SIP and now we're left with one more week to go. YAY! =D

So now, i would like to share with all of you my experience of being posted into a Cytology Laboratory. The Cytology Laboratory in the Hospital that I am attached to makes use of Liquid-Based Cytology for the diagnosis of cervical cancer.

Collection of Specimen for Pap Smear Test

First, a broom-like device is inserted into teh endocervical canal of patient to allow the shorter bristles of the device to fully contact the ectocervix. teh device is gently pushes iand rotted in a clockwise direction5 times. then, the broom is rinsed into the PreserCyt® Solution by pushing the broom into the bottom of the vial for 10 times (Figure 1), at the same time forcing the bristles apart. Finally the broom is swirled vigorously to furthe release any material into the vial. The collection device is discarded and the vial is tightly capped, corrected, labeled with the sticky label and sent down together with the patient’s form, to the Cytology Laboratory.

Figure 1(Image taken from http://www.moondragon.org/obgyn/procedures/papsmear.html)

The Thin Prep Process

In the Cytology Laboratory, Pap Smears are prepared via Liquid-Based Cytology. Patients samples that comes in vials are processed using the ThinPrep 2000 Processor(Figure 2.).

Figure 2. (Image taken from websites.labx.com)

The process involves 3 steps:
1. Dispersion of cells in the vial.
2. Cell collection onto the filter.
3. Cell transfer from the filter onto a glass slide to produce thin layer of cells onto the glass slide. (shown in Figure 3)

Figure 3. (Image taken from http://www.moondragon.org/obgyn/procedures/papsmear.html)

After the Pap Smear is obtained on the glass slide, it is fixed in 70% alcohol for 20 minutes minimum and then stained using the Pap stain. Basically, the stains involved in the Pap stains are the Haematoxylin stain (used to stain nucleus of cells), Orange-G and EA-60 (cytoplasmic stains). after staining, teh slides are mounted with Depex, dried and then read by Cytologists.

Comparison of Conventional Method and Liquid Based Cytology

Originally, Pap Smears are prepared using the Conventional Method which had many disadvantages compared to Liquid Based Cytology. This is shown in the table below.

This is my last blog post for SIP and i hope all of you have benefitted from reading my blog posts =D.

byebye!

Raihana.

WEEK NUMBER EIGHTEEN

2008-10-27T14:44:00.005+08:00

Hello everyone! A few weeks more and we're all back at school. This will be my last post for our SIP so, here it goes...

Before a person is allowed to donate blood, he or she has to undergo certain physical examinations. The donor centre representative evaluates the prospective donor with regard to general appearance, weight, temperature, pulse, blood pressure, pulse, blood pressure, haemoglobin, and presence of skin lesions.

In this post, I will be talking about donor haemoglobin testing.

One of the methods used at the blood bank to estimate the level of haemoglobin in a donor is by the copper sulphate method.

Principle

i. The method of haemoglobin estimation using copper sulphate method is based on the principle of specific gravity. If a drop of blood is dropped into copper sulphate solution, it becomes encased in a sac of copper proteinate which will prevent the specific gravity from changing for at least 15 seconds. If the specific gravity of the blood is higher than that of the solution, the drop will sink within 15 seconds. If not, the drop will hesitate, remain suspended, or rise to the top of the solution.

ii. A specific gravity of 1.053 corresponds to a haemoglobin concentration of approximately 12.5g/dL

iii. False positive results are rare and donors whose drop of blood sinks nearly always have an acceptable haemoglobin level. However, false negative reactions occur fairly commonly and can cause inappropriate deferral unless the haemoglobin level is checked using another method.

Specimen
Sample of blood obtained by finger prick.

Materials
i. Copper Sulphate Solution (specific gravity: 1.053)
ii. Glass beaker
iii. Cotton swabs, with 70% alcohol or spirit
iv. Sterile disposable lancets
v. Capillary tube
vi. Biohazard sharps box
vii. Disposable gloves
viii. Alcohol swab (individual pack)

Procedures

i. Make sure that the glass beaker (250ml) is clean and free of debris. Fill the beaker with copper sulphate solution until it is slightly above 200ml marking.

ii. Put on a pair of gloves.

iii. The donor’s middle or ring finger is normally chosen for the finger prick procedure. Avoid fingers with rings on. Clean the chosen finger using a piece of alcohol swab. Allow the alcohol to dry or wipe dry with a new piece of dry cotton swab. Discard the swabs in the biohazard waste bin. Do not re-use the swab.

iv. Prepare a disposable sterile lancet by pressing and turning the knob into the lancet until there is a ‘click’ sound.

v. Use your thumb to slightly press the donor’s finger from the top of the knuckle towards the tip. Puncture the finger firmly, near the end but slightly to the side, with the sterile disposable lancet. Ensure that there is a good free flow of blood. DO NOT SQUEEZE the puncture site repeatedly as this will dilute the drop of blood with excess tissue fluid and lower the specific gravity. Dispose off the lancet in the sharps box.

vi. Wipe away the first drop of blood from the punctured site with a new piece of cotton swab. Collect the second drop of blood in a capillary tube until it is at least three quarters full, without allowing air to enter the tube.

vii. Hold the capillary tube about 1cm above the surface of the copper sulphate solution in the glass beaker, and let one drop of blood fall gently by unassisted gravity from the tube into the solution. Dispose off the capillary tube in the sharps box. DO NOT FLICK the drop of blood out of the tube as this will lead to in accurate haemoglobin measurement.

viii. Observe the drop for 15seconds. If the blood drop has a higher specific gravity than the copper sulphate solution, it will sink within 15 seconds. If not, the sinking drop will hesitate, remain suspended or rise to the top of the solution.

ix. Discard the copper sulphate solution after every 20 tests or every 2-3 hour intervals or when the solution is turbid. If there is any floating blood residue on the surface, it should be removed with an applicator stick.

Interpretation

i. If the drop of blood sinks within 15 seconds, the haemoglobin is greater than 12.5g/dL which is acceptable for blood donation unless there are other conditions which require a higher pre-donation haemoglobin level.

ii. If the drop of blood does not sink or sinks very slowly, the haemoglobin is most likely less than 12.5g/dL, and the result must be rechecked using quantative haemoglobin estimation by the HemoCue haemoglobin test.

iii. Because the copper sulphate method is not a quantitative test, the quantitative method by the HemoCue haemoglobin test is necessary to check the exact level in donors who fail the test as it suggests that the haemoglobin is low and the donor may need medical advice

Limitations

i. This is not a quantitative test and it shows only whether the potential donor’s haemoglobin is below or above 12.5g/dL

ii. The copper sulphate solution must be stored in tightly capped containers to prevent evaporation. The solution should be kept at room temperature to brought to room temperature before it is used.

Rusydiana binte Kusni
0608485I
TG 02

WeeK 17!!!

2008-10-20T16:46:00.004+08:00

Oh my its Week 17 already!!!

Hello friends!! How are you guys doing?? I hope everything is fine especially with the projects. Well, this week Im doing on Quality Assurance. Theres not that much work to be done actually. We carry out QA tests on media and agars used in the laboratory. Here are 2 of the tests that I did for the week,

A. Citrate Test

Objective
· To determine the ability of an organism to utilize citrate as a sole source of carbon for metabolism and growth

Principle
· Certain organisms are able to utilise citrate, an intermediate metabolite in TCA (Kreb’s) cycle, as the sole source of carbon.
· In bacteria, cleavage of citrate involves an enzyme system without coenzyme A involvement
· Bacteria break the conjugate base salt of citrate into organic acids (formic acid and acetic acid) and carbon dioxide.
· An organism that can use citrate as its sole carbon source also uses ammonium salts as its sole nitrogen source.
· Simmon's citrate media contains ammonium salts and a pH indicator, bromthymol blue
· Bacteria extract nitrogen from ammonium salts with production of ammonia leading to alkalinisation of medium which causes the indicator, bromthymol blue to change to an intense blue or a Prussian blue colour when pH is above 7.6 showing a positive result

Materials
· Simmon’s citrate media
· Disposable inoculating loops
· Enterobacter aerogenes W 3/3/90 (positive control)
· Escherichia coli (E.coli) ATCC 25922 (negative control)

Procedure
1. Streak the surface of the Simmon’s citrate slant
2. Incubate at 35⁰C overnight (usually 18hrs)

Left: Negative, Right: Positive Picture taken dddddddddddddddddddddddddddddddfrom: http://www.ams.cmu.ac.th/mt/clinmcrb/CMBwebsite/Price%20list_media.htm

Results and Conclusion
· Positive result (Enterobacter aerogenes): Deep blue colour of agar
· Negative result (E.coli): Absence of growth or no colour change
· Citrate test can be use to differentiate members of the Enterobacteriaceae family and other Gram negative organisms

Possible errors
· Too heavy inoculums may give a false-positive result
· Preformed organic compounds from dying bacteria may release carbon and nitrogen which may result in false positive results

Urease Test

Objective
· To test the ability of an organism to break down urea by the action of the enzyme urease

Principle
· Urea which is often referred to as carbamide, a diamide of carbonic acid
· Due to the presence of amides, urea is readily hydrolyzed by a specific enzyme, urease
· Urease is an important microbial enzyme which is used in the decomposition of organic compounds
· Urease breaks the carbon-nitrogen bond of amides to form carbon dioxide, ammonia, and water
· Urease is detected by plating bacteria onto an amide containing medium, specifically urea
· Urea will be hydrolyzed into ammonium carbonate as the end product,
· Formation of ammonia alkalinises the medium causing a change in the phenol red indicator
· Urea agar is slanted with an adequate butt portion to allow gradation of positive reactions
· Proteus, Providencia and Morganella species produce urease in large quantities

Materials
· Christensen’s urea agar slant
· Disposable Inoculating loops

Procedure
1. Streak the surface of urea agar slant
2. Incubate aerobically at 35⁰C overnight (usually 18hrs)
Left:Negative, Right: Positive Picture taken from: www.nhlmmcgym.com/culture.htm
Conclusion
· Positive result: urea slant change to an intense pink-red to red-violet colourchange Positive result
· Negative result: no colour change; urea slant remain yellow
· Some organisms like Pseudomonas aeruginosa may produce ammonia by breaking down peptones present in the agar slant à False positive results
· Presence of glucose in the Christensen’s medium prevent organisms from using ammonia produced as its sole source of nitrogen which will lead to inaccurate results
· Organism like Helicobacter pylori are able to hydrolyze urea rapidly, producing a positive reaction within 1 to 2 hours

So thats all! Any questions just ask me aites!! Bye! Take care!!

week 16...!!!!

2008-10-11T01:27:00.003+08:00

Well..... For the past 2 weeks i was attached to the Specimen Reception (SR)department. It is the pre-analytical part of the whole laboratory, where the specimens are received and labelled.

It is here, in this department where I found out that mistakes are simply not tolerated. The personnels must be constantly on their toes, fast and at the same time, do their work accurately. A simple mistake of not tallying up the names on the specimens to the name on the form, can spell disaster.

There's no tests involved, but I am to include the workflow of the SR department.

The dispatch crew will arrive with the samples from the various clinics. The samples are received by the personnels there, where the number of samples and specimens are counted and tallied with those counted by the dispatch crew.

The samples are then passed over to another group of personnels who will open the samples. Here, they will check that the names on the specimens tally with those in the request form, and write down the number and type of specimens that they receive for that request form only.

For example: 2 long plain tubes, 1 EDTA tube and 1 urine will be written as 'LP x 2, E, U' in a vertical fashion.

Then, they would sign their initials before seprating the samples into single profile (includes only HIV, VDRL and tests for malaria parasites) and profile (which is all the other tests other than those previously named).

The seperated samples are then subjected to primary barcoding, where the request forms and specimens are labelled with their own individual barcode, and allocated into baskets according to the tests that are requested (such as HIV samples are placed into the HIV basket, and so forth). Plain tubes, fluoride tubes, and certain EDTA tubes and urine (which are already poured into 5ml test tubes) are centrifuged. The rest are collected by the respective departments, such as Microbiology collecting the urine, stool and swab samples.

The centrifuged samples then goes through secondary barcoding, where certain specimens' serum are required to be aliquoted out due to the type of tests involved. The specimens are then loaded onto a sample tray, where they will be placed in the Sample Manager (explained in my earlier posts). The sample manager will then sort the specimens according to the type of tests to be run, and send them to the various machines via the transportation track.

At the end of the day, the specimens will undergo allocation and be placed in the cold room, where the will be kept for a week to 10days. This is so that if there is any additional tests that is to be run, we can still use the specimen and not bother the patient to go for another blood-taking session.

Mayafirhana

TG02

2008-10-05T16:45:00.005+08:00

Hello everyone!! Before i start talking about my attachment, i would like to wish all my Muslim frenz Selamat Hari Raya!! We shall go visiting one day alryte??

So this week, i am going to talk about the stool occult blood test and OC Light test.

Stool occult blood test

Introduction – To detect occult blood in stool

Principle of analysis - When stool specimens containing occult blood are applied to Hemoccult SENSA test paper, which is impregnated with guaiac, the hemoglobin portion of the occult blood comes in contact with the guaiac. When the Hemoccult SENSA peroxide developing solution is added, a guaiac peroxidase like reaction occurs. Oxidation of guaiac becomes visible by the appearance of a blue color within 30 seconds. A food that contains substances with peroxidase activity may cause false positive results.

Specimen – Stool

Reagents –

Hemoccult SENSA test slides
Hemoccult developing reagent

Retrieved from : http://www.beckman.com/products/rapidtestkits/hemoccultsensa.asp

Method –

1) Apply a very thin smear of stool inside section 1 and 2 with an applicator stick.

2) After 3-5 minutes, open the perforated section on the back of the slide.

3) Apply 1 drop of Hemoccult SCREEN developing reagent to the positive and negative well each and 2 drops to the reaction wells.

4) Read results after 30 seconds and before 1 minute.

Interpretation –

Read the results only when the controls give the correct color after the addition of the developing reagent.

Positive – Traces of blue colors in either one or both of the reaction wells

Negative – No indication of blue color in either one or both of the reaction wells

Positive stool samples are confirmed using the OC Light Occult Blood Method.

Limitations of procedure –

Hemoglobin is not usually found in the stool of healthy individuals. Its presence indicates bleeding in the gastrointestinal tract. Causes include tumors. Tumors are common in the elderly and this test is used as a screen to select patients for further invasive investigation.

Stool OC Light

Introduction – The OC Light method is used to confirm the positive cases by the Hemoccult SENSA method.

Principle of analysis – The OC Light is designed to measure human hemoglobin in fecal samples. The OC Light immunochromatographic test has a test detection range from 10µg to 100mg/g of feces. The test strip reacts only with human hemoglobin and does not react with hemoglobin of other animal origin.

Specimen - Stool

Reagents -

OC Light Sampling Bottles

OC Light Strips

Retrieved from : http://www.eiken.co.jp/en/product/index.html

Method -

1) Remove the green cap from the sampling bottle and dilute the stool inside the bottle.

2) Remove the white cone nozzle.

3) Insert the strip into the sampling bottle from the dip slide.

4) Read test result, presence of a blue line at the lower and upper center of the strip after 5 minutes.

Interpretation –

Read the result only when the controls give the correct color after the addition of the developing reagent.

Positive result – Presence of blue line at the lower and upper center of the strip may be considered positive.

Negative result – Presence of blue line only at the upper center of the strip is negative.

Equivocal result – No blue in line in both the lower and upper center of the strip or at the lower center of the strip only should be considered equivocal. Such samples should be retested by changing OC Light test strip.

That's all for now peepz!!

Before i sign off, i would like to say sorry if i have not answered any of your questions regarding my last two posts.. It's been hard for me to get access to the internet. I will try my best to reply to all the questions ASAP.. Really sorry especially to Ms Chew. I hope i have not been penalized by my lack of participation. I will try to participate more often once i got my laptop soon.. Sorry once again..

Toodles~~

** Sofie **

2008-09-26T11:53:00.007+08:00

week 14th.

I am going to explain a test which I had the oppotunity to view for myself during my placement at Haematology Laboratory.

Bleeding Time using Surgicutt

This test is to estimate the integrity of the hemostatic plug. It is a screening test for
qualitative and quantitative platelet functions and generally helps to diagnose hemostatic defects and platelet dysfunctions.

Principle

When a minor standardized incision is made on the forearm, time between the infliction of the incision and the moment the bleeding stops is taken. A hemostatic plug is formed after the incision to stop the bleeding. This plug formation depends on adequate platelets to adhere to the subendothelium to form aggregates.
For this test is a screening test, an increased bleeding time would not qualitatively or quantatively diagnose an underlying platelet disorders. However, it is indicative of the need for more quantifiable testing such as platelet counts, APPT, TT testing etc.

Image of Surgicutt Bleeding device taken from http://www.medcompare.com/

Procedure

1. First, a sphygmomanometer is used to cuff the upper hand of the patient. The pressure is raised to 40 mm Hg.This is the standard pressure for children and adults. For infants, the pressure would be dependant on the weight. Patient’s blood pressure was to remain at such throughout the duration of the test.
2. The volar surface of the forearm, where the incision is to be made, is rubbed with alcohol swab.
3. The incision is made using Surgicutt bleeding time device and the timer is started simultaneously. There are three different devices to suit different age group, mainly infants, children and adults. This is shown below.

Age group :1 - 4 months
Device:Surgicutt Newborn
Depth of blade (mm) :0.50

Age Group:5 months to 15 yrs
Device: Surgicutt Junior
Depth of blade (mm): 1.00

Age Group: 16 years and above
Device: Surgicutt
Depth of blade(mm): 1.00

4. Every 30 seconds, a blotting paper was used to wick the blood close to the incision without touching the incision itself.
5. The timer is stopped when the bleeding stopped.
6. Reading on timer is recorded down.

The following are the reference values for normal bleeding time:

Infants (1-4 months) :
0.85- 1.65 mins

Children (5 months to 15 years) :
1.3- 8.99 mins

Adults (16 years and above) :
2-8 mins

For neonates whose bleeding does not stop after 5 minutes, time is reported as >5 mins. For adults whose bleeding does not stop for more than 20 minutes, time is reported as >20 mins.

Raihana~

WEEK NUMBER THIRTEEN

2008-09-21T02:27:00.004+08:00

HELLO EVERYONE!!!!
Hope you guys are doing well.

This week, I will be touching on a topic which may be foreign to some of you. It will be on glycerolization/freezing and deglycerolization/thawing of red blood cells. This process is done in the cryopreservation lab of the blood bank.

Glycerolization/Freezing
Freezing RBCs with glycerol dates back to the 1950s. Frozen RBCs can be stored for up to 10 years for:
1. Patients with rare phenotypes
2. Autologous use
3. In case of national emergencies in which blood cannot be dispositioned out to hospitals quickly enough to prevent expiration.

The resulting deglycerolized product is free of leucocytes, platelets, and plasma due to washing process. Cryoprotective agents can be categorized as penetrating and nonpenetrating. A penetrating agent involves small molecules that cross the cell membrane into the cytoplasm. The osmotic force of the agent prevents water from migrating outward as extracellular ice is formed, preventing intracellular dehydration. An example of a penetrating agent is glycerol. An example of a non-penetrating agent is hydroxyethyl starch (HES). This comprises large molecules that do not enter the cell but instead form a shell around the cell, preventing loss of water and subsequent dehydration.

Two procedures used for glycerolizing RBCs are high glycerol and low glycerol methods. The methods differ in the equipment used, the temperature storage and the rate of freezing. Most blood centres practice the high glycerol method.

High Glycerol (40% w/v)
This method increases the cryoprotective power of the glycerol, thus allowing a slow, uncontrolled freezing process. The freezer is generally a mechanical freezer that provides storage at -80oC. This particular procedure is probably the most widely used because the equipment is fairly simple and the products require less delicate handling. It does however require a large volume of wash solution for deglycerolization. RBCs are frozen within 6 days of collection when the preservative is CPD or CPDA-1 and up to 42 days when preserved in AS-1, AS-3 and AS-5. AABB Standards states RBCs must be placed in the freezer within 4 hours of opening the system. It is advisable to freeze a sample of donor serum in the event additional testing is required for donor screening.

Low Glycerol (20% w/v)
In this method, the cryoprotection of the glycerol is minimal, and very rapid, more controlled freezing procedure is required. Liquid nitrogen (N2) is routinely used for this method. The frozen units must be stored at about -120oC, which is the temperature of liquid N2 vapour. Because of the minimal amount of protection by the glycerol, temperature fluctuations during storage can cause RBC destruction.

Deglycerolization/Thawing
Red cells that have been frozen require thawing and deglycerolization before they can be safely transfused. Glycerol will be removed from RBC to avoid in vivo and/or in vitro heamolysis.

The thawing process takes approximately 30 minutes and involves immersion of units into a 37oC water bath and washing the RBCs with solutions of decreasing osmolarity (eg. 12% NaCl, 1.6% NaCl, 0.9% NaCl, + 0.2% dextrose). An exception to this rule is a donor with sickle cell trait in which RBCs would haemolyze upon suspension in hypertonic solutions; in this case the cells would be washed in 12% NaCl and then 0.9% NaCl with 0.2% dextrose, omitting the 1.6% solution. Automated continuous-flow instruments can be utilized for washing. In our blood bank, a machine called the Haemonetic 215 is used. Once the RBCs have been deglycerolized, the unit is considered an open system with an expiration date of 24hrs and is stored at 1oC to 6oC.

Hope my post this week has enlightened you on some of the processes that occurs in a blood bank. Till next time..... Adios!!!

Rusydiana binte Kusni
TG02
0608485I

AMir's back...and its week 12!!!

2008-09-14T13:10:00.007+08:00

How is everyone doing?.. wah 3 months of attachment already..thats fast.. 2 more months and we can meet up already..ok what shall i say about this week.. hmmmmmm

PARASITOLOGY!!

For last week I was posted at parasite lab.. In this lab, they mainly deal with protozoans and helminths(i hope you guys remember what we learn in BMic).. if not nvm i shall give a brief intro...

Parasite are organisms that live on or in a host organism, usually causing it some harm. They are relatively smaller in size and are dependent on their host for nourishment. There are many forms of parasites like, arthropod parasites (ticks), plant parasites (mistletoe), single-celled protozoan (amoebas) and even viruses. Numerous parasites live in the gastrointestinal tract, known as intestinal parasites which are common human pathogens. Parasite are subdivided into protozoans (unicellular) and helminths ova/larva (multicellular)

Eg of protozoans include: Amoeba histolytica, Giardia lamblia, Cryptosporidium
Eg of helminths include: Roundworms (Ascaris lumbricoides), tapeworm, flatworms

Parasite infections in Singapore is not as common as bacterial infections. So, we do not recieve much specimens. There are many different tests carried out: Ova and Parasite Exam, Silver stain for Pneumocystis jirovecii (PCP), leukocytes examination and occult blood. For this blog i will focus more on Ova and Parasite exam

Ova & Parasite exam

Ova and parasite exam is basically analysis of stool to check for the presence of a parasite or worm-like infection of the intestine. Most of the specimens, or i shall say ALL of the specimens are stool specimens, as intestinal parasites there will be released in the stool of infected humans. There will be a large population of parasites in the stool, there it will be easier to detect the presence of this parasites.

Principle

Ova and parasite exam is the most common performed procedure in diagnostic parasitology
For identification of intestinal protozoan parasites, it is based on the recognition of their cyst or trophozoites stages or even both
Cysts are spherical with smooth uniform walls formed during the dormant resting stage
Trophozoites have thin limiting membrane with variations in size and shape, they are formed during active feeding stage

image taken from:

http://www.stanford.edu/group/parasites/ParaSites2006/Giardiasis/images/Giardia_LifeCycle%20cdc.gif

For Helminthic infections, it is based on identification of eggs, larvae or proglottids in faeces
Eggs or ova are usually found in stool specimen as it is passed out in faeces
Ova and parasite exam consists of 3 separate protocols: Direct wet mount, Concentration and Permanent stained smear
Direct wet mount allows detection of motile protozoans tryphozoites and helminth worms
Concentration is designed to facilitate recovery of protozoan cysts, coccidian oocysts, microsporidial spores, and helminth eggs and larvae.
Formalin-ethyl acetate sedimentation method is used to prepare concentrated specimen for direct wet mount.
Permanent stained smear is used to identify intestinal protozoa, using the common Trichrome stain method
It is the most important procedure as it aids in the confirmation of any suspicious objects seen in the direct wet mount

Materials

Para-Pak® ULTRA Zn-PVA fixative

Para-Pak® Macro-Con® Kit
- Surfactant bottle (30ml)
- Conical 50ml centrifuge tubes with filtration units and screw caps

Disposable ice-cream stick and applicator sticks

Disposable Pasteur’s pipette

Paper towel

Microscopic slides

Timer

10% Formalin

Ethyl acetate (Clearance)
Disposable cotton swabs
Normal saline

Trichrome stain
· For destaining: 10% acetic acid in water, 50% and 70% ethyl alcohol

Procedures

A. Preparation of material for Trichrome staining

1. Using a disposable ice-cream stick, place fresh faeces into the PVA fixative in the
Slides ready to be stained ratio of 3 parts PVA fixatives to 1 part faeces.
2. Mix thoroughly so that it appears homogenous
3. Allow the faeces to fix for a minimum of 30mins; overnight fixation is acceptable
4. Pipette out some of the well-mixed PVA-faecal mixture onto a paper towel using a disposable Pasteur’s pipette and allow to stand for 3mins to absorb out the excess PVA (This step is critical to obtain the best possible stain)
5. With an applicator stick, apply some of the faeces from the paper towel onto a clean slide (Spread the material onto the edge of the slide for better adherence)
6. Dry the slides for 3 hours or overnight at room temperature (Slide must be dried thoroughly to prevent material from being washed off during staining)

B. Concentration procedure
1. Add 10 drops of surfactant into the ParaPak specimen vial
2. Insert the filtration tightly into the specimen vial
3. Invert assembled unit, tapping sharply to force the solution into the conical tube
4. Unscrew the filtration unit and discard appropriately
5. Add 10% Formalin to the dotted line, plus 5 ml of Ethyl Acetate (Clearance)
6. Tightly screw the cap and shake vigorously for 1min
7. Centrifuge at 1500xg for 10mins
8. After centrifugation the specimen is clearly separated into four layers
9. Using an applicator stick, rim the debris layer. Pour off the debris and supernatant fluid, leaving the sediment
10. With the tube still inverted, use a cotton swab to clean and remove the remaining debris
11. Return the tube to upright position and add a few drops of saline to mix the sediment

C. Wet Mount
1. Using an applicator stick, prepare a coverslip preparation from the sediment
2. Examine microscopically

D. Trichrome Staining
1. Place slide in Trichrome stain solution for 10mins
2. Destain by placing the slide in acidified alcohol for 1-3sec (Do not allow slides to remain in this solution)
3. Dip slide several times in 100% ethyl alcohol
4. Place slide in 2 additional changes of 100% ethyl alcohol for 5mins each
5. Place slide in 2 changes of xylene substitute for 5mins each
6. Mount in immersion oil, using a No.1 thickness cover glass
7. Examine microscopically

Conclusion

In Trichrome stain, cytoplasm of cysts and trophozoites will stain blue-green tinged with purple. Parasite eggs and larvae usually stain red. All ova, pathogenic protozoan trophozoites or cysts seen must be reported. The reports will be sent to the doctors, and they will decide whether to do any further confirmatory tests depending on the patient's clinical symptoms. image taken from: http://www.med-chem.com/Para/prob%20of%20month/IMAGES/Giardia,%20trophs%20(2)%20in%20mucus%20string,fixed%20great.jpg

So, thats about all!!!.. I shall be back sooon!!.. take care peeps!!

AmiR

TG02

week 11 already people!!

2008-09-06T20:05:00.007+08:00

Know what? I'm really having a hard time finding what to blog about, considering most of the tests have already been posted. Haha.

Well anyways, I've finally decided to write about a test to detect anti-Mycoplasma pneumoniae antibodies, using SERODIA-MYCO II (also known as MPA), since now I'm currently in serology department. Alot of manual tests, if I may say.

First of all, Mycoplasma pneumoniae is a very small kind of bacterium that is usually associated with upper respiratory tract infections, together with fever, headaches, cough and malaise. It may lead to tracheobronchitis, which is a common respiratory infection characterized by inflammation of the trachea and bronchi. Its mode of transmission is person-to-person transmission by direct contact with the infected respiratory secretions, and it will usually take about 1-4 weeks before the symptoms will develop.

Principle
SERODIA-MYCO II is used in the detection of antibodies to Mycoplasma pneumoniae. It uses gelatin particles which are sensitized with extracted cell membrane components of Mycoplasma pneumoniae. Serum containing specific antibodies will react with the sensitized couloured gekatin particles to form a smooth mat of agglutinated particles in the microtitration tray.

Reagents
SERODIA-MYCO II kit, which includes:

Sensitized particles
Unsensitized partiles
Positive control
Sample diluent

Procedures

6 wells are required for a patient's sample

4 wells are required for control

Label the wells (ID number or Control)
Add 100ul of sample diluent to the first wells
Add 25ul of sample diluent to the rest of the wells
Add 25ul of positive control to the first well and mix well
Bring 25ul of the mixed solution to the next well and mix well
Repeat Step 5 until the last well, where 25ul will be discarded after mixing
Repeat Steps 4-6 with patient's sample
Add one drop of unsensitized particles into the second wells
Add one drop of sensitized psricles into the rest of the wells starting from well 3
Tap at the sides of the microtitration plate gentle to ensure proper mixing
Cover the plate and incubate at room temperature
Results to be read 3 hours later

Interpretation

Negative (-):

Definite compact button in the center of well with smooth round outer margin

Positive (+):

Definite large ring with firmly agglutinated particles spread within the circle

Positive (++):

Agglutinated particles spread out to cover th bottom of the well entirely

MAYAFIRHANA

TG02

2008-08-30T09:34:00.002+08:00

Hello my fellow peepz!! How have all of you been doing? I’m sure everyone is going through different experiences every single day right? For me, so far, I have learnt more than what I have expected. Even if it is tiring me out almost everyday.

So for this post, I will be talking about what I have been learning in the Clinical Chemistry section.

The basic thing that we need to do is to label and load the samples correctly. Thus, we need to know what tubes is needed for which tests as different tubes is different. For EDTA tubes, it is mainly used for hematology section and GHB. Heparin, Gel and plain tubes can be use for many of the tests. Fluoride tube is used mainly for glucose, particularly fasting.

Before we label, we are to check if the specimens is sufficient to be load onto the machines. If it is more than half of the tube, it is considered sufficient. For the sufficient samples, after labeling, we can load directly into the pre-analytical machine which will be explained in further detail later on.

In this section, there are three main machines or equipments that are used to process the samples. They are the MPA, SWA and Cobas where MPA is used for the pre-analytical processing and SWA and Cobas are used for analysis. Examples of pre-analytical process done on the MPA are centrifugation, aliquoting and labeling. After going through the MPA, the samples will either proceed to the SWA or be aliquot out to be process in the Cobas. So what determines the samples to be run in the SWA or Cobas respectively? Well, it all depends on the different types ordered for that specific samples. Most of the tests can be run on either machines. However, there are some tests that are only specific to SWA or Cobas. Some examples are shown below:

Tests that can only be run in SWA:

- Hepatitis panel

- Cortisol(Serum)

- AFP

- CEA

- PSA

- Pro-BNP

- AHAV total

- HIV

Tests that can only be run in Cobas:

- TDM

- CRP

- GHB

- Anaemia panel 1 & 2

- Magnesium

- Amylase

- Urine tests

- Fluid tests

- C3 & C4

- Direct Bilirubin

- RF

Other tests like renal panel and liver function test can be load on both machines.

There are several circumstances when we are not able to use the MPA for the pre-analytical processing. It could be due to some technical breakdown or when the sample given is insufficient for the MPA to process.

If it is less than half, we are to spin it down and aliquot the serum into the secondary tube. If it is too little, we will use the hitachi cups. Then, we have to load the tube or cups directly to either the SWA or Cobas, depending on the tests ordered. One thing to take note during putting of tubes to each machine manually is that the tubes must not be capped.

For samples requesting for special chemistry tests, the serum is required to be stored in the fridge or freezer. These also depend on the different tests requested. Some examples are shown below:

In freezer – ACTH, PTH and TRAB

In fridge – HbsAg, HCV, HIV, TPO, CA199, Syphillis and Cortisol(urine)

For samples that request for HbsAg, HIV and cortisol(urine), the request form is needed to be kept in the special chemistry bench.

Well, that's all for now.
See you all soon!!
Anw, happy fasting to all of my muslim frens!! Shall meet up to break fast together aite??

Nur Sofieyana
TG02

week 9 of SIP.

2008-08-24T21:19:00.006+08:00

hello future med techs. hehe....
hope ur attachment's going fine, mine's okay =)

So now, i would like to share with you a test that is simple but yet important that is done in the Biochemistry Lab.

Test name: G6PD Screening

First, lets just briefly recap on what G6PD is. Glucose-6-phosphate dehydrogenase, G6PD, is a key enzyme needed for the hexose monophosphate pathway which produces NADPH, essential for erythrocyte membrane integrity.This condition might result to destruction of RBCs, leading to hemolytic anemia, followed by jaundice. Thus, for newborns with jaundice, they have their blood sampled to check if the baby's jaundice is caused by G6PD deficiency.

How the test is done:
Patient's sample collected in EDTA tube to prevent clotting.
Patient's tube is overturned 2-3 times to ensure a homogenous composition when sample is taken out.
Using a pipette, 5 microlit of patients whole blood was transferred onto a seperate tube containing 100 microlit of reagent that contains G6-P and NADP.
The mixture is left to sit for 5 minutes.
Below is an equation for the reaction that should take place in the presence of G6PD:

10 microlit of mixture is pipetted out and transferred onto a filter paper.
The filter paper is dried for ten minutes and then viewed under long UV wave in the ulraviolet viewing cabinet.

As seen from the equation above, G6PD is needed for the reaction to take place. The presence of G6PD can be known by viewin the filter paper under the UV light in the ultraviolet viewing cabinet. NADPH flouresces under long wave UV light and a flourescence would indicate the presence of G6PD. In contrast, a sample that does not contain G6PD would not give out any flourescence when viewed under the long wave UV light.

4 controls are set up at the same time:
1. G6PD deficient
2. Intermediate G6PD deficient
3. Bblank (only reagent present)
4. G6PD present

The controls are used as a guide for the patient's results.
For example, a G6PD deficient control does not flouresce at all while an intermediate G6PD control floureses slightly. From the controls, we can gauge the if the patient is completely deficient of G6PD or an intermediate case.

However, this test is just a screen. Samples of patients with positive results are sent out to another laboratory in a hospital for further testing.

feel free to ask ny questions. hope you like my post =)

raihana~

Week Number Eight

2008-08-17T00:20:00.008+08:00

Hellohello!!! How are you ppl doing? I hope you guys are doing great. This week, it is my turn again to share my experience. For the past few weeks, I have been rotating about, going to a different lab every week. Quite a lot to absorb for such a short period, but I’ll manage.

I was posted to an infectious disease testing lab one of the weeks. For your information, upon donation, a few samples of blood will be collected from donors to undergo testing, such as infectious disease testing, blood group testing and antibody screening. Under infectious disease itself, it is further divided into a few sections. And the section I am going to explain is TPHA lab.

TPHA is the short form for Treponema pallidum (TP) haemagglutination assay. TP causes Syphilis which is a sexually transmitted disease. The route of transmission is almost always through sexual contact. However, it can also be transmitted through blood transfusions. Therefore, it is important to screen all donors for TP so as to prevent any harmful transmissions and transfusions.

In the TPHA lab, the machine used is the ABBOTT ARCHITECT Syphilis TP. Its intended use is for the diagnosis of Syphilis.

PRINCIPLE OF ASSAY

The ABBOTT ARCHITECT Syphilis TP assay is a two-step immunoassay for the qualitative detection of antibody to Treponema Pallidum (TP) in human serum or plasma using Chemiluminescence Microparticle Immunoassay (CMIA) technology with flexible assay protocols, referred to as Chemiflex.
In the initial step, sample and microparticle coated with recombinant TP antigens (TPN15, TPN17, TPN47) together with the Assay Diluent are combined. Anti-TP antibodies present in the sample bind to the TP coated microparticles. After washing, the acridinium-labelled anti-human IgG and IgM conjugate is added in the second step. Following another wash cycle, Pre-Trigger and Trigger Solutions are added to the reaction mixture.
The resulting chemiluminescent reaction is measured in relative light units (RLUs). A direct relationship exists between the amount of Anti-TP antibodies in the sample and the RLUs detected by the ABBOTT ARCHITECT i optical system.
The presence or absence of Anti-TP antibodies in the sample is determined by comparing the chemiluminescent signal in the reaction to the cutoff signal determined from the ABBOTT ARCHITECT Syphilis TP calibration. If the chemiluminescent signal in the sample is greater than or equal to the cutoff signal, the sample is considered reactive for Anti-TP.

The specimen used for this assay is either serum or plasma. Haemolysed samples should not be used and all fibrin clots or bubbles must be removed before loading of samples

In the event where there is a positive result, confirmatory tests must be performed. Serum or plasma samples will be collected in a tube and sent to the Serology Laboratory, Department of Pathology, Singapore General Hospital (Reference Laboratory).

The following confirmatory tests are ordered for the determination of the donor’s infection status:

a) Treponema pallidum Particle Agglutination (TPPA) test – an alternative treponemal screening test
b) Venereal Disease Research Laboratory (VDRL) test – a non-treponemal test to determine current or recently treated infection status
c) LIA(Line Immuno Assay) – Syphilis (LIA) – as the confirmatory test for the presence of treponemal antibodies

I hope what I have shared this time round has been a beneficial one. 12 more weeks to go and back to school!! Alright, time to go... see ya

Rusydiana binte Kusni
0608485I
TG02

WEEK 7!!!

2008-08-10T23:27:00.008+08:00

Hello everyone!! HOw are your SIP??.. I hope everything's okay, Well I'm having a great in my Micro Lab. For now, I'm in the investigation lab for 1 month where they try to identify the microganisms in the patient's samples. There are quite a number of tests carried out, especially all the biochemical tests( i hope you guys remember). For this week, I learn more about Streptex. I know you guys will be like, "HUH What is Streptex??" . Ok let me tell you...

Streptococcus Latex Agglutination (Streptex)

Streptex is used to identify the Lancefield groups of Streptococci growing on agar plates

Principle

Lancefield showed that the soluble extracted antigens can be identified by precipitation reactions with homologous antisera. Now, latex agglutination or coagglutination methods have largely superseded precipitation method in determining the different groups. A simple enzyme extraction procedure is carried out. Antigen in the resulting extract is identified using polystyrene latex particles which have been coated with group-specific antibodies. These latex particles agglutinate strongly in the presence of homologous antigen and remain in smooth suspension in the absence of homologous antigen.

Materials Streptex Kit

Streptex Kit contents:Latex for Group A,B,C,D,F,G, extraction enzyme, disposable mixing sticks, disposable reaction cards,

Disposable Pasteur pipette

Disposable inoculum loops

Procedure

Preparation of extract from culture growing on solid medium:
1. Dispense 0.4ml Extraction Enzyme into an appropriately labelled test tube for each culture to be grouped. (Usually around 20-30 tubes of 0.4ml Extraction Enzyme are prepared at the same time)
2. Using a disposable inoculums loop, make a light suspension of the culture in a tube containing the enzyme solution.( A single sweep of growth or > 5 large colonies will be sufficient to obtain a result)
3. Incubate the suspension at 35⁰C in an incubator for at least 10 minutes

Group Identification:
1. Resuspend each of the latex suspensions by shaking vigorously for about 5 sec (The kit contains 6 bottles, one specific for each of the groups A,B,C,D,F and G)
2. Expel the contents of the in-dwelling droppers to ensure complete mixing.
3. Dispense one drop (20µl) of each latex suspension onto a separate circle on a clean reaction card.
Note: Dropper bottle should be held vertically to ensure that the drops form at the tip of the nozzle. If the nozzle becomes wet, an incorrect volume will be form around the end and not at the tip.
4. Using a Pasteur pipette, place 1 drop of extract in each of the 6 circles on the reaction card.
5. Mix the contents in each circle in turn with a mixing stick, and spread to cover the complete area of the circle. Use a separate stick for each circle and discard it for safe disposal after use.
6. Rock the card gently for a maximum of 1 min, holding it at a normal reading distance (30cm) from the eyes.
7. Discard the card for safe disposal

8. Keep the reagents back into the refrigerator, using the storage rack provided.

Positive result showing agglutination clumps:

Conclusion

Positive result will show development of an agglutinated pattern showing
clearly visible clumping of the latex particles. Speed and quality of agglutination appearance depends on the strength of the antigen extract. Strong antigen extract will give large clumps of latex particles within a few seconds after mixing. Negative result will show no agglutination and the milky appearance remains unchanged throughout the test. There should only be one latex suspensions showing strong rapid agglutination.

So thats about all!! SEE YOU SOON!!!

AmiR ArshaD

TG02

6th week!!!

2008-08-03T16:21:00.006+08:00

Olla to all yew gorgeous people! 6 weeks have already gone by and here i am again. Let's cut to the chase shall we?

This week is about....
JENG JENG JENG

SERUM BILIRUBIN~
or at least, testing for bilirubin level in neonatal serum.

As all of us know, babies (especially newborns) have a high probability to be jaundiced. Jaundice during the first 24hrs are usually pathological and are most lkely to be due to either blood group incompatibility or infection. An increase in destruction of RBCs will cause an increase in unconjugated bilirubin, which, in the circulation, will bind to albumin. Once all albumin are fully saturated, the excess unconjugated bilirubin -being lipophillic- can enter the cells. They can also cross the blood brain barrier. There, they can bind to proteins in the brain where it is neurotoxic, and therefore, may result in death or severe mental handicap.

Neonatal jaundice occurs as the liver of the newborns are still incapable of metabolizing the bilirubin. Jaundice in full-term babies usually resolves rapidly. In premature babies, however, the jaundice may be more severe as their liver function is not fully mature.

In the lab I'm attached to, we measure the serum bilirubin using
Wako - Bilirubin Tester II

Analysis Principles:-
Total bilirubin concentration is obtained by measuring the absorbance in the serum. The wavelength is set at 455nm.

Range:-
0 - 1 day 2.0 - 6.0 mg/dL
2 - 5 days 3.9 - 6.0 mg/dL
5 - 127 days 0.3 - 1.7 mg/dL

Specimen:-
2 fully filled heparinized capillary tubes

Equipment:-
Wako-bilirubin Tester II
Centrifuge (3500 rpm/min, 10minutes)

Procedure:-

Turn power to ON position & allow 10minutes for lamp to stabilize (Temperature control procedure).
Pull out the cell holder and insert a capillary tube (containing distilled water) in front of the slit. Push the cell holder back into the bilirubin tester.
Turn the ANA-SET change-over switch to the SET position.
Set the Digital Display to ZERO by adjusting the Zero-adjustment control for the 455nm (Filter Selection Lever in the upper position).
Using the left hand, push down & hold the Filter Selection Lever in the 575nm (lower position). Set the Digital Display to ZERO by adjusting the zero-adjustment control for 575nm with the right hand.
Release the Filter Selection Lever and allow it to return to 455nm position.
Pull out the cell holder and set the Digital Display to the standard value by adjusting the Span-adjustment control.
Turn the AVA-SET chenge-over switch to the ANA position.
Insert a capillary tube filled with sample (already centrifuged) into the cell holder.

Push down & hold the Filter Selection Lever into the 575nm posititon. Confirm that the Digital Display at ZERO, then allow level to return back to 455nm position.
Read the Digital Display & read results.
To measure subsequent samples, repeat steps 9 - 11.

All pictures taken with permission from supervisor.

So, there you go. Seems complicated, but very simple really. Any doubts, feel free to ask =)

Enjoy your SIPs people!!!!

Name: Mayafirhana

Class: TG02

LMQA

2008-08-01T22:12:00.003+08:00

Name: Mayafirhana Bte Hairulhassan
Subject title: Laboratory Management and Quality Assurance
Topic: Organization or regulatory bodies that regulate the operations of local laboratories in Singapore

The Workplace Safety and Health (WSH) Council collaborates with the Ministry of Manpower (MOM) to help other industries to achieve 'A safe and healthy workplace for everyone; and a country reowned for best practices in workplace safety and health'.1

The WSH Council:

- Help recognize and practice proper safety and health in the employees when working.2

- Created the Construction Safety Audit Scoring System (ConSASS) which offers an independent evaluation of the safety and health management system at the company.3

- Provides surveillance to keep track and control the health of the employees, and the hazards found at the worksite.4

Workplace Safety and Health Strategy 2015. (2008). Retrieved 31 July, 2008, from: http://www.wshc.gov.sg/WSH2015.html

The Expansion of the WSH Act. (2008). Retrieved 31 July, 2008, from: http://www.wshc.gov.sg/pub_guidelines.html

About ConSASS. (2008). Retrieved 31 July, 2008, from: http://www.wshc.gov.sg/ConSASS.html

Health and Environmental Surveillance. (2007). Retrieved 31 July, 2008, from: http://mom.gov.sg/publish/momportal/en/communities/workplace_safety_and_health/maintaining_a_safe_workplace/health_and_environmental.html

Laboratory Management and Quality Assurance

2008-08-01T00:23:00.003+08:00

Name: Mohamed Amir bin Mohamed Arshad

Subject Title: Laboratory Management and Quality Assurance

Topic: Organization or regulatory bodies that regulate the operations of local laboratories in Singapore

Ministry of Health (MOH) regulates clinical laboratory in Singapore, providing consistent, safe and affordable healthcare services(1) to all Singaporeans by implying to various Legislative Acts.

The regulating acts ranges from healthcare professional to related medicinal substances.(2)
There is the Medicines Act which consists of suitable administration, quality and analysis of drugs, and good clinical practices. (3)

MOH implements new regulatory framework to make sure Singaporeans are updated on healthcare services. For example, in the recent liposuction cases, MOH maintains the safety and confidentiality of the patients. Hence any clinic that carries out liposuction must acquire approval from the Ministry. (4)

1. About MOH. (2007). Retrieved 31 July, 2008, from: http://www.moh.gov.sg/mohcorp/about.aspx?id=82

2.Legislation. (2007). Retrieved 31 July, 2008, from: http://www.moh.gov.sg/mohcorp/legislations.aspx?id=214

3.Medicine Acts (2008). Retrieved 31 July 2008, from:
http://statutes.agc.gov.sg/non_version/cgi-bin/cgi_retrieve.pl?actno=REVED-176&doctitle=MEDICINES%20ACT%0A&date=latest&method=part

4.Liposuction Regulatory Framework (2008). Retrieved 31 July 2008, from:
http://www.moh.gov.sg/mohcorp/default.aspx

Laboratory Management and Quality Assurance

2008-07-31T22:55:00.000+08:00

Name: Rusydiana binte Kusni

Subject Title: Laboratory Management and Quality Assurance

Topic: Organization or regulatory bodies that regulate the operations of local laboratories in Singapore

Being one of the 8 professional centres of Health Sciences Authority (HSA) 2, Centre for Transfusion Medicine (CTM) is responsible in regulation of the operations of the bloodbanking section of clinical laboratories. It provides clinical support for the blood banks in the various local hospitals 2. These include recommendations on the most appropriate use of blood products and components, antibody identification and blood grouping discrepancies 1. CTM also draws out guidelines for the proper management, usage and safety of blood products 1. By doing this, CTM is able to meet its objectives of accomplishing finest quality of blood products supplied, while maintaining service excellence 2.

1. Clinical Services. (2007) Retrieved July 30, 2008, from Health Sciences Authority website: http://www.hsa.gov.sg/publish/hsaportal/en/health_services/transfusion_medicine/clinical_services.html

2. About Centre for Transfusion Medicine. (2007) Retrieved July 30, 2008, from Health Sciences Authority website: http://www.hsa.gov.sg/publish/hsaportal/en/health_services/about_ctm.html

2008-07-31T13:05:00.003+08:00

Name: Raihana Binte Zainalabidin

Subject Title: Laboratory Management and Quality Assurance

Topic: Organization or regulatory bodies that regulate the operations of clinical laboratories in Singapore

The NEA (National Environmental Agency)
- formed in 2002, focuses on implementation of environmental policies
- branches out into 3 separate divisions that together helps ensure quality environment for Singaporeans
- Environmental Protection Division carries out programmes to help monitor, reduce and prevent environmental pollution 1
- controls disposal of waste from clinical laboratories in hospitals
o colour-coded bags, yellow, purple and red, are used for disposal of biohazardous,cytotoxic and radioactive wastes respectively
o 2 companies: Cramoil Singapore Pte Ltd and SembCorp Environmental Management Pte Ltd operates enclosed trucks that facilitate transport of wastes to hospital waste incinerators 2

1. About NEA. (2002). Retrieved 28 July, 2008, from: http://app.nea.gov.sg/cms/htdocs/category_sub.asp?cid=2

2. Toxic Wastes Control. (2002). Retrieved 28 July, 2008, from: http://app.nea.gov.sg/cms/htdocs/article.asp?pid=1531#CONTROL_OF_BIOHAZARDOUS_WASTES

2008-07-25T19:55:00.010+08:00

Hello everyone. Hope all of you are enjoying your SIP, even if you are separated from your friends. For the past 5 weeks, I have been attached to several sections in the clinical laboratory.

1st week: Hematology
2nd week: Hematology
3rd week: Blood Banking
4th week: Order entry and Urinalysis
5th week: Clinical Chemistry

For this post, I am going to talk about the Hematology section. There are several tests that are done in this section. Examples would be Full Blood Count (FBC), Erythrocytes Sedimentation Rate (ESR), Retic count and Malaria test.

Full Blood Count (FBC)

For patient’s samples that are requested to undergo FBC, bloods are to be collected in an EDTA tube. This is to prevent the blood from clotting, as it can produce inaccurate results. To check for any clots that may have occurred, we just use a normal applicator stick. If there is even a small clot, the clot will stick to the applicator stick. If a clot is detected, we will reject the sample and a new sample is requested. At the same time, we will check if the sample is sufficient to be run. If it is less than 1.5ml, the sample will also be rejected. After making sure that there is no clot, the sample will be spun for mixing for about 5 minutes. After that, we will arrange the tubes in a rack before putting it in the machine to be run. The machine, Sysmex XE-2100, will do the FBC and the results will be uploaded to the LIS. If the machine detects some abnormalities in the blood, it will ‘trigger’ another machine which will produce a blood slide for further observation by the medical technologist. This machine, Sysmex SP-1000i, is solely responsible for making blood smearing and staining. So, after the samples have been run through the first machine, the rack will automatically be directed to the 2nd machine. Only the samples that are required to produce a slide will be aspirate out by the machine.

XE-ALPHAN ( Sysmex XE-2100 & SP-100i)

Retrieve from: http://www.sysmex-ap.com/default.asp?pageid=110

After all the tubes have undergone both machines, the results will then have to be validated by the medical technologist. For those samples that have slides being processed, the medical technologists will have to observe the slide under the microscope to view any abnormalities before validating. Abnormalities include increase or decrease in the number of the different type of WBCs, presence of any reactive lymphocytes, etc. If there are abnormalities, a manual differential count is done and the results will be keyed into the LIS.

In scenario where there is not enough blood for the machine to make a slide, a manual smearing and staining is required. So, a blood smear is done manually on a glass slide using another glass slide as a slider. After that, a manual stain will be done where the slide is covered with Wright stain and buffer pH7.2 for 10 minutes. It is then washed using distilled water and left to dry for another 10 minutes. It is then ready for observation. Another alternative for staining is to use the Sysmex SP-1000i under its manual mode where the slide will be put inside the machine manually before staining is carried out.

Retic count

Another test that is carried out in this section is the Retic count. This is to find out the number of retics or reticulocytes present in the blood. Retics are immature red blood cells (RBCs) that have not matured yet. It takes generally one day for the retics to mature and become fully mature RBCs.

To perform this test, a single drop of patient’s blood is mixed with a drop of the retic stain. The retic stain used is actually methyl blue stain. It is then incubated for 15 minutes at 37°C. After that, it will then be manually smeared to a glass slide. The slide is then observed under the microscope where the number of retics is taken note. A retic can be differentiated from mature RBCs by the presence of dark blue granules in its cytoplasm.

Reticulocytes

Retrieve from: http://sg.wrs.yahoo.com/_ylt=A0S0zvgOt4lI0WgBfn4u4gt./SIG=11qi13bn9/EXP=1217071246/**http:/www.umm.edu/imagepages/1491.htm

Thus, a manual count will be carried out where the number or retic is being track down while counting 1000 red cells. The number of retics is reported as a percentage of the total red cells. The normal range of retics for a healthy individual is 0.5%-2%. If the percentage is lower, it indicates that the bone marrow is not producing a normal number of RBCs. It may be due to several reasons like lack of folic acid, iron or vitamin B12 in the diet. To confirm, further tests are needed to diagnose the specific cause. If the percentage is higher, it means that the bone marrow is producing more red cells in response to a blood loss or treatment of anemia.

Differential count

Besides doing the test required, I also learnt how to do a differential count using a DC counter. Before doing the test, I have to know how to differentiate the different types of WBCs like lymphocytes, neutrophils, basophils, monocyte and eosinophils.

Neutrophil
Retrieved from: http://sg.wrs.yahoo.com/_ylt=A0S0zu1YvYlIdBsA.iou4gt./SIG=129lakjtm/EXP=1217072856/**http:/www.technion.ac.il/~mdcourse/274203/lect9.html

Lymphocyte

Retrieved from: http://sg.wrs.yahoo.com/_ylt=A0S0zu5uvolI6fMAStEu4gt./SIG=126nhnksc/EXP=1217073134/**http:/www.niagaracc.suny.edu/val/lymphocytes.html

Basophil

Retrieved from: http://sg.wrs.yahoo.com/_ylt=A0S0zu6hvolI__MA.JIu4gt./SIG=11ue3sbaf/EXP=1217073185/**http:/www.carlalbert.edu/dwann/tissue.htm

Monocyte

Retrieved from: http://sg.wrs.yahoo.com/_ylt=A0S0zvnZvolIg2YBZyMu4gt./SIG=12l6hhp65/EXP=1217073241/**http:/www.montgomerycollege.edu/~wolexik/205_histology__page.htm

Eosinophil

Retrieved from: http://sg.wrs.yahoo.com/_ylt=A0S0zvj.volIwmgBc4wu4gt./SIG=12fm7tkp7/EXP=1217073278/**http:/cellbio.utmb.edu/microanatomy/blood/Question_1bl.htm

It is advisable to start counting the cells when the RBCs are just ‘touching’ each other and not stacked together. This makes the counting easier and more accurate. When the number of WBCs has reached 100 cells, the counter will sound a ring as an indicator. The numbers of cells for each type of WBCs are recorded as a percentage. Any increase or decrease of each type may indicate different illnesses or disease the patient is suffering. Further tests is needed to confirm the diagnosis.

With this, i hope all of you have learnt something from my attachment. Till next time friends..

Take care and don't forget to enjoy yourself!! =D

Name: Nur Sofieyana Bte M.D Ismaeil

Class: TG02

2008-07-20T16:45:00.010+08:00

Rai's SIP.

For the past 4 weeks, im attached to a Cytogenetics Laboratory. Written below is what i have learnt so far, enjoy =)

In a nutshell, the Cytogenetics lab processes patients sample to have their chromosomes analysed so as to conclude if patient has abnormalities in their chromosomes or not.

Basically, what I have learnt in the 4 weeks of my attachment to the Cytogenetics laboratory can be summarised into 5 parts.

Why perform cytogenetics test?
Why that certain sample is collected?
Summary of processes
Journey of my blood
Identification and karyotyping of chromosomes

Why perform cytogenetics test?

The few reasons include prenatal diagnosis where parents would want to find out if the baby in the womb is abnormal, diagnosis of neonates with abnormalities, diagnosing children with dysmorphic features/ developmental delay and couples who have frequent miscarriages who might want to know if they have any chromosomal abnormalities and patients with haematological malignant diseases.

Why that certain sample is collected?

For adults, peripheral blood is withdrawn from patient and used as a sample.
However, for pregnant women who wants to have a prenatal diagnosis, different type of sample is withdrawn for women of different gestation week due to several reasons.
For pregnant women between 10-12 weeks gestation, the sample ‘’chorionic villi’’ is extracted. U can know what is the ‘’chorionic villi’’ from the diagram below.

image taken from http://www.nwabr.org/studentbiotech/winners/studentwork/2007/WB_BA_TRONGTHAM/piccvs.jpg

Why this is extracted is because during this time, the chorionic villi are still new and small and would not cause serious bleeding to the mother when extracted. Also, the amniotic fluid cannot be withdrawn at this stage because the amniotic fluid is too little and if withdrawn, might cause dehydration to the fetus.

For pregnant women between 16-20 weeks gestation, amniocentesis is carried out. This is the withdrawing of amniotic fluid. At this stage, the amount of aminotic fluid is sufficient and this is confirmed by ultrasound.

For pregnant women of 22weeks gestation, fetal cord blood is extracted because by this time, the baby in the womb is already huge and taking up a lot of space in the womb, making it difficult to extract the amniotic fluid as there is a high risk of injuring the baby with the syringe.

Also, cord blood takes up to 7 days to obtain results, which is considered a short period of time compared to other samples, it is important that the lab technicians does not make a mistake in handling the sample tat might lead to wasting the sample because abortion can only be done up to 24th week gestation. This is especially critical for cases where the fetus is found to be abnormal and parents would want to consider aborting the child.
Here, we can see the importance of handling the samples with care, accuracy and precision. That is why the cytogenetics laboratory is a highly critical laboratory which could not afford to make mistakes and waste their samples and so, I am only allowed to observe the processes or try out the processes once or twice in cases where the samples are abundant.

Summary of processes

For each sample that comes into the laboratory, it will go through a common procedure that is

Cultured with cultured and colcemid is added. Colcemid is a mitotic inhibitor which causes the cells not to divide at metaphase. This is so that when the cells are analysed later on, the chromosomes would be seen and can be analysed.
Centrifugation and removal of growth medium. Changing of medium and cells are resuspend.
Cells are checked under microscope to check for growth. If sufficient amount of colonies are present, cells are ready for ‘’Harvest’’. If overcrowding os observed, cells are ‘tiffed’ (redistributed) and checked a few days later for growth.
Harvesting. Cells treated with hypotonic solution which increases the cell volume to allow the chromosomes to spread.
Cells fixed with fixative that draws out water out of cells so as to preserve them.
Cells transferred onto glass slide and allowed to dry.
Cells stained with Trypsin and Giemsa stain.
Slide is viewed under the microscope.
Using a microscope that is connected to the computer, an image of the desired metaphase can be captured and shown on the computer.
A specific programme is used to analyse the chromosome, karyotype, and analysed for any chromosomal abonormalities.

Journey of my Blood sample

Tuesday, 8th July
4pm:
Peripheral blood was withdrawn from my right arm and collected into a sodium heparin tube (anti-coagulant).

Blood set-up was done. This procedure includes centrifuging my blood sample for 5 minutes so that the buffy coat layer can be obtained. This is shown in the diagram below.

image taken from http://www.nsbri.org/HumanPhysSpace/index.html

The buffy coat layer is extracted from the tube and reconstituted into 2 separate tubes containing M199 media. 5 microliters of ‘PHA’ is added into each tube to stimulate the division of my T-lymphocytes present in the buffy coat layer.

Thursday 10th July
4pm:
50 microliters of MTX was added into each tube to synchronise the cells.

Friday 11th July
10am: 50 microliters of Thymidine added into each tube.

12pm: 50 microliters of Colcemid added to tube 1.

1.40pm: 50 microliters of Colcemid added into tube 2

*Colcemid, as mentioned earlier will allow chromosomes to be seen under the microscope later on. Exposure to colcemid for 2 hours will give rise to many metaphases with short chromosome fragments. Exposure to colcemid for 20 minutes will give rise to few metaphases with long chromosomes.

4pm: Harvesting. Addition of hypotonic solution and subsequently, fixative.

Monday 13th July

10am: Cells prepared on glass slide, stained and ready to be analysed using the computer system.

Below is the pictures of my chromosomes in a metaphase.

(u can click on the image to enlarge it, if u want to see my chromosomes =))

Then, I identified the chromosomes and place them in their respective groups, this is called "karyotyping" shown below. It is then analysed for any chromosomal abnormalities such as translocation, deletion and others.

It looks like my chromosomes are normal and I have no chromosomal abnormalities, Thank God. =) (I was a little nervous to analyse them)

Identification and Karyotyping

So how did I learn to identify the chromosomes one by one? =) That was really something. It couldn’t be learnt overnight and I had nightmares about chromosomes during the first week.
Altogether, it took me 3 weeks to practice everyday identifying chromosomes until I could get them all correct although sometimes there is still human error =).
During the 3 weeks, when I was struggling really hard to recognize the chromosomes, I prepared for myself a table which I could refer to during identification of chromosomes which can be seen below.

A little tedious, but hey, no pain no gain. I am happy now that I could identify chromosomes and I’m proud to say I’ve learnt something.

Hope all of u like my post.
Byebye. Take care everyone.

RUSY'S SIP

2008-07-13T00:00:00.006+08:00

Hey all of you out there!!! I hope you guys are doing great at your respective attachment sites. As for me, I’m attached to Centre for Transfusion Medicine (CTM). And I can tell you guys that I am having a great time at the blood bank.

For the first three weeks, I have been attached to the cross-match and red cell reference (serology) labs. And now, I shall share with you one of the important tests that I had observed.

Subject Title: Blood Banking
Name of Test/Topic: Antibody Screening

In the cross-match lab, AbSC is done on almost every new blood sample that arrives. This is because there may be samples from previous patients with a record of medical history. For these people, AbSC is done only if the previous screening was done more that three days from the current date.

For example: First sample of patient arrives on 1^st July (Tuesday), and AbSC is done. The next sample arrives on 3^rd July (Thursday). AbSC is not done for this sample, as the time period for this sample from the previous one is only two days. Another sample arrives on 5^th July (Saturday) and this sample is then allowed to run an AbSC.

The reagents needed for AbSC are SPO (Singapore Panel O) cells, and plasma/serum of the patient. The SPO cells are prepared in-house by one of the senior lab officers. In CTM, three panels are used, compared to the two panels that we use in school.

In this lab, antibody screening is automated with the help of a machine called Techno TwinStation. Blood sample is to be centrifuged upon arrival to separate the plasma from the cells. The samples are then loaded into the machine where antibody screening will automatically commence. The machine uses the principle of AHG phase AbSC (antibody sceening) as it uses gel cards, which contain coombs’ reagent. The incubation of the reagents is also done in the machine. As soon as the process is over, the machine will produce the results on the touch-screen attached to the machine.

In the serology lab, AbSC is done manually. There are two phases of AbSC: saline phase and AHG phase.

For saline phase, cells and serum are mixed in a tube in a ratio of 1:2 (1 drop SPO cells, 2 drops patient serum). The reagents are allowed to react in room temperature for 30minutes, before spinning them at 3000rpm for 15seconds. This phase is for detection of cold antibody, mainly IgM.

For AHG phase, the gel cards are also used. However, the reagents are manually pipette into the wells of the card, where sensitization occurs during a 15minute incubation at 37^oC. The ratio of cells to serum when using the gel card however is reversed 2:1 (50ml SPO cells to 25ml patient’s serum). This is because weak antigen may not be detected if there is a higher amount of cells than serum in the gel card. After incubation, the cards will be spin down at the speed of 1000rpm for 10minutes. RBC agglutinates will be filtered through the column of gel according to size. A negative reaction will show that all the red cells are settled to the bottom of the column, while positive reactions will produce cells within the gel. This phase is for detection of warm antibody, mainly IgG.

After antibody screening is complete, antibody identification can be done to identify presence of specific antibody.

Techno TwinStation

Retrieved from: http://www.diamed.com/product_detail.aspx?id=848&navvis=

Coombs Anti-IgG gel cards

Retrieved from: http://www.diamed.com/product_detail.aspx?id=82&navvis=

I hope that all of you readers have gained some knowledge from my entry. Just shoot any comments and I will try my best to reply as soon as possible.

taking cares
peace out

Name: Rusydiana binte Kusni

Class: Tg 02

AmiR's SIP

2008-07-07T00:30:00.008+08:00

Helllo my fellow med techs!! I hope you guys are having a great time during your attachments. Im in diagnostic bacteriology.. cool rite!! Hahaha for the 1st month I am in central processing area where the specimens are being processed. For this week, im assigned to do blood culture. It is a good experience as we get to go through the various types of microbiology cultures.

Blood culture is basically to test for any presence of microorganisms in the blood of the patients, usually fungal and bacteria infections. The blood taken from the patients is inserted into vials which will enter the BACTEC machine for incubation. What is a BACTEC machine??

Subject title: Blood culture
Topic : BACTEC machine

•BACTEC culture vials
•-Blue top is for aerobic bacteria culture
•-Yellow top is for anaerobic bacteria culture
•-Red top is for fungi culture
•-Sliver top is for blood culture for paedritic

What goes on inside the machine???

1) Presence of microorganisms causes metabolism of nutrients in the culture medium releasing CO2 into the medium
2) The CO2 produced will react with a dye in the vial sensor
3) Light Emitting Diodes (LEDs) modulated by the dye will illuminate the racks, activating the vial’s fluorescent sensors.
4) Instrument’s photo detectors take the readings of the fluorescence which corresponds to the amount of CO2 released by the organisms.
5) Raw data from detector is sent to rack microprocessor
6) Positivity analysis is performed in the microprocessor
7) Positive vial lamp illuminates, audible alarm sounds and positive station displayed on the monitor.

What happen when there is a postive result?

· When positive vials are identified, the lab technologist pulls them out of the incubation for further investigations.
· After the blood culture is flagged positive, a 6-fold dilution is made, with 0.2ml (8 drops) of blood to every 1 ml of saline, then subculture on appropriate plates
· For aerobic culture, we use blood agar plate(BAP) and maconkey agar plate(MAC)
· For anaerobic culture, we use BAP, MAC and anaerobic blood agar plate(ANA)
· The plates are incubated overnight.
· The culture is dispensed onto a glass slide and direct gram staining is done, using crystal violet, Gram’s iodine, acetone and safranin to see presence of gram positive cocci or gram negative bacilli.

Therefore, a positive result means that there is a bacterial or fungal infection in the patient’s bloodstream thus, needs to be treated immediately and a negative result means that there is a probability that a patient is suffering from an infection from other causes. Some microorganisms like viruses are more difficult to grow in culture and more testing may be required.

Okay now roughly i hope u guys understand what i am talking about. If you want to enquire about anything can just call me aites!! I guess this is where I say goodbye!! N i am awaiting for my next adventure this week!!!

Enjoy your SIP people!!!!!

Name: Mohamed Amir

Class: TG02

SIP

2008-06-28T21:41:00.006+08:00

Olla to all you med techs out there! So i am here, assignned to share my SIP experience with you for the first week. Background information here, I am attached to a private laboratory. I'm fortunate 'cause I get to rotate among the different sections. And for my first couple of weeks, I am attached to the immunology department.

In this department, it's mostly automated. But it uses only one machine, the great ADVIA Centaur Immunoassay System, by Bayer HealthCare.

Subject title: Immunology
Topic: ADVIA Centaur

Taken from http://www.blockscientific.com/advia-centaur-chemistry-analyzer.htm

The Centaur, as it is affectionately known to all my collegues, is an automated immunoassay analyzer which uses direct chemiluminescence as its principle technique. Chemiluminescence is actually a term to describe the emission of light from a chemical reaction in the sample that is being analyzed.

In the Centaur, acridinium ester (AE) is used as the chemiluminescence label. It was found out that AE is preffered and used as it does not require any addition of catalyst or substrate. It also cause the reaction to occur more rapidly, increase assay sensitivity and allow a longer reagent shelf life due to its dimethyl form.

OK, so in the Centaur, the AE is oxidized by hydrogen peroxide. The acidic environment is changed to basic in order to maximise the amount of light emitted. In this case, oxidation occurs super fast with its peak amount emitted in less than a second. This light is then measured to give the results for the sample that is being analyzed.

The Centaur can analyze for many constituents found in the blood, such as tumour markers ( CA 125, CA 199 ), thyroid stimulating hormone, Hepatitis A & B surface antigens or antibodies, cortisol, ferritin, testosterone, folate, vitamin B12, and many more. The most which is tested is for HIV.

The blood received from various clinics are centrifuged for 10minutes before they are labelled and barcoded. The tests to be done on the sample can either be pre-specified by the LIS or done manually.

Once the tests are selected, they are put in test-tube racks before they are inserted into the machine. Once all the samples are taken, the completed test-tube rack are pushed out while the samples are incubated and undergo the various tests. Its as simple as that, and that is done manually.

Those which are controlled by the LIS are just placed in the Sample Manager. The rest are fully automated, from selecting the right test-tube, to allocating the test-tube to the correct Centaur by the transportation track, to doing the various tests on its own, to going back into the Sample Manager after its all done. All the med techs have to do is to make sure everything runs smoothly, and validate the results.

Fantastic machine ain't it?

So that's all for now. Another week to get fully acquainted with the Centaur before I'm posted to another department.

Have fun for all your SIP!!!!

Name: Mayafirhana

Class: TG02

2008-06-16T21:37:00.002+08:00

Laboratory Management and Quality Assurance

Name: Raihana Binte Zainalabidin
Subject title: Laboratory Management and Quality Assurance
Topic: Organization of regulatory bodies that regulate the operations of clinical laboratories in Singapore

Clinical Trials Resource Centre

Established in May 1999, the Clinical Trials Resource Centre (CTRC) helps promote and co-ordinate high quality clinical trials in SGH. CTRC provides advice to Principal Investigators and their Sponsors on the policies and guidelines for conducting clinical trials.

Apart from maintaining database for SGH, CTRC keeps record of the progress and status of the trials and helps trains Principle investigators and study co-ordinators
Services CTRC provides includes provision of CGP trained co-ordinators, monitoring sites, carrying out audits and assist in collection and preliminary processing of samples at the laboratory to ensure quality samples to be sent to the central laboratory(Clinical Trials Resource Centre, Singapore General Hospital, 2008).

References:
Singapore General Hospital (2008). Division of Reseach: Clinical Trials Resource Centre, Retrieved on 15 June 2008 from http://www.sgh.com.sg/ForDoctorsnHealthcareProfessionals/Research/ClinicalTrialsResourceCentre/

Laboratory Management and Quality Assurance

2008-06-16T16:34:00.001+08:00

Name: Mayafirhana Bte Hairulhassan
Subject title: Laboratory Management and Quality Assurance
Topic: Organization of regulatory bodies that regulate the operations of clinical laboratories in Singapore

The Institutional Review Board (IRB) is formed mainly to ensure the rights, safety and privacy of the subjects in any Human Biomedical Research (HBR) projects that is to be conducted1,2. The IRB must contain at least five members who have the knowledge of the types of research that is usually done in the institution1.

Other obligations of the IRB include:
- The education of research investigators regarding the human subjects2
- Review and approval of HBR projects1,2
- Controlling of the approved HBR project1,2
- Report any unforeseen activities to their respective institutions1,2

1. Operational Guidelines for Institutional review Boards. (2007). Retrieved 16th June, 2008, from http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Guidelines/IRB%20Operational%20Guidelines_14-12-07_formatted.pdf

2. Institutional Review Board. (2007). Retrieved 16th June, 2008, from http://www.smu.edu.sg/research/IRB.asp

Laboratory Management and Quality Assurance

2008-06-16T16:24:00.005+08:00

Name: Mohammad Amir bin Mohammad Arshad
Subject Title: Laboratory Management and Quality Assurance
Topic: Organization or regulatory bodies that regulate the operations of clinical laboratories in Singapore

Singapore Good Clinical Practice Guidelines is launched by the Ministry of Health and the Asia Pacific Economic Co-operation (APEC) for GCP in Singapore in August 1998, together with Medicines (Clinical Trials) Amended Regulations 1998 regulates clinical trials.1 This allows APEC countries to form a regulatory framework in producing quality and efficient drug, attracting overseas companies to invest in Singapore.2

Principles
- Guarantees qualified investigators reporting information accurately.1
- Ensures safety and less risk to the trial subjects, by obtaining their consent.1
- Have sufficient data to support proposed trials.1
- Safe keeping of confidential records.1
- Follow closely to protocols.1

1. Conducting Clinical Trials in Singapore (1998). Retrieved June 16, 2008 from: http://www.sma.org.sg/smj/4004/articles/4004ra4.html

2. Active Promotion of Good Clinical Practice and Bio-Safety(2007). Retrieved June 16, 2008 from: http://www.biomed-singapore.com/bms/sg/en_uk/index/about_biomedical_sciences/regulatory_framework/research.html

Laboratory Management and Quality Assurance

2008-06-16T16:16:00.003+08:00

Name: Rusydiana binte Kusni
Subject Title: Laboratory Management and Quality Assurance
Topic: Organization or regulatory bodies that regulate the operations of clinical laboratories in Singapore

The Centre for Transfusion Medicine (CTM) is an internationally acclaimed organization for blood banking1. In addition to assisting World Health Organization (WHO) with promoting blood safety and quality, it is also responsible for the efficient processing of blood and blood components from point of collection to distribution to external bodies1. In order to maintain its quality, Health Sciences Authority (HSA) a regulatory body, overlooks the activities of CTM. It regulates the health products, in this case, blood, and ensures that Singapore does not lack in blood supply for any emergencies2. By doing this, HSA is responsible for safeguarding public health2.

1. (2007). About Centre for Transfusion Medicine. Retrieved June 16, 2008, from Health Sciences Authority. Website: http://www.hsa.gov.sg/publish/hsaportal/en/health_services/about_ctm.html
2. (2007). Mission and Vision. Retrieved June 16, 2008, from Health Sciences Authority. Website: http://www.hsa.gov.sg/publish/hsaportal/en/about_us/mission_and_vision.html

Laboratory Management and Quality Assurance

2008-06-16T15:34:00.007+08:00

Name: Nur Sofieyana Bte Muhammad Ismaeil
Subject: Laboratory Management and Quality Assurance
Title: Organization or regulatory bodies that regulate the operations of clinical laboratories in Singapore

SPRING Singapore is one of the member bodies of the International Organization of Standardization (ISO). It is the national standard authority that is accountable for the consistency of Singapore’s industry activities. 1, 3

The national Standard Council that supervises the country consistency program in areas, like biotechnology, will guide SPRING Singapore in ensuring that Singapore standards tally with international standards. 2, 3

Partly and fully automated machines are commonly used in laboratories particularly in the Clinical Chemistry section. For this reason, the application of ISO will guarantee that the laboratories operations are accurate and thus producing a good quality results.

1. International Standards Bodies/Regional Standards & Conformance Fora (2007). Retrieved 16 June, 2008, from Spring Singapore. Website: http://www.standards.org.sg/AboutUs.cfm?id=AU1001

2. The Singapore Standard Programme (2007). Retrieved 16 June, 2008, from Spring Singapore. Website: http://www.standards.org.sg/

3. National Standard Body (2007). Retrieved 16 June, 2008, from Spring Singapore. Website: http://www.spring.gov.sg/Content/WebPageleft.aspx?id=e6ff85fa-58ad-4dd3-b307-92efe370d03c