Clinical Laboratory Science

Laboratory personnel do not usually have contact with the patient. The laboratory provides a clean, well-lighted, and controlled working environment with regular hours. Most of the laboratory work is done while sitting. Excellent vision and manual dexterity are necessary to perform laboratory work. In 1988 the Clinical Laboratory Improvement Amendments standards were established by Congress to ensure quality laboratory testing. Facilities that perform testing on human specimens must comply with these standards and obtain a certificate from the Department of Health and Human Services. Among other requirements, the personnel of certified laboratories must meet specific educational qualifications.

The pathologist is a medical doctor who examines specimens of body tissue, fluids, and secretions to diagnose disease (Fig. 22-1). Other medical practitioners rely on the pathologist as a consultant who determines the effectiveness of treatments and the cause of death. The pathologist must first complete medical school and then obtain specialized education and training in this area. Hospitals, medical schools, all levels of government, and private industry employ pathologists. In many hospitals the pathologist supervises the laboratory.

The laboratory technologist, also called the clinical laboratory scientist, performs clinical laboratory testing and analyzes the results, using independent judgment. For example, the technologist cross-matches blood to be used for transfusion. The technologist calibrates the equipment and assists in determining the accuracy and utility of new tests and procedures under the supervision of the pathologist or laboratory supervisor. Technologists usually complete a bachelor’s degree followed by a training program of up to 1 year long (Table 22-2). The Board of Registry for Laboratory Technologists requires a baccalaureate degree and an examination to become a certified technologist. Licensure of technologists is required in some states.

Several areas of specialization are possible for the laboratory technologist. The microbiology technologist may collect the specimen directly from the patient or receive materials from an autopsy. The technologist then grows and isolates the microorganisms to assist with their identification (Fig. 22-2). Cytotechnologists specialize in the preparation and screening of cells for diagnosis after collection by scraping, brushing, or aspirating body cells from an organ or site (Fig. 22-3). These microscopic cells may be used to diagnose cancer, infectious agents, or inflammation. Chemistry technologists analyze body fluids and wastes. Other areas of specialization are the study of blood (hematology) and the study of resistance to pathogens (immunology).

Medical laboratory technicians (MLTs), also called clinical laboratory technicians, perform daily tasks under the supervision of the laboratory technologist or pathologist. The responsibilities include preparation of tissue slides and performance of simple blood tests. The MLT obtains blood samples, prepares tissue slides, analyzes body specimens, and performs cell counts and urinalysis. Technicians complete at least 2 years of training. To qualify for the MLT certification examination through the American Society for Certified Pathologists, an associate degree from an accredited college or university program or 5 years of full-time acceptable clinical laboratory experience is necessary. Some states require certification or licensure for technicians.

MLTs may specialize in one area, such as histology. This involves the preparation of tissues for diagnosis, research, and teaching purposes. Histology technicians may work in many different settings, including the hospital, forensics laboratories, immunopathology research, veterinary practice, or marine biology. Histology technicians may be certified and must be licensed in some states. The certified histologic technician must complete an associate degree and 1 year of acceptable experience in histopathology or 3 years of experience under the supervision of a certified pathologist.

Medical laboratory assistants (MLAs) perform routine tests under the supervision of the technologist or other qualified personnel. Areas of testing that are performed by the assistant may include urinalysis, hematology, serology, and bacteriology. MLAs complete 1 year of training in a hospital or 2 years in college or vocational programs. Certification is possible after successful completion of an accredited program and a registry examination. Phlebotomists obtain and process blood specimens to aid in the diagnosis and treatment of disease (Fig. 22-4). Phlebotomists may be trained on the job or in community college or vocational programs.

Blood Banking

Careers in blood banking include donor recruitment, collection, and processing of donor blood, testing and typing of blood, laboratory supervision, and teaching. Specialists in blood bank technology select donors, draw blood, classify (type) blood, and run pretransfusion tests to ensure the safety of the recipient. Blood bank specialists act as a resource in solving blood-related problems. Applicants as blood bank specialists must have a baccalaureate degree and certification as a medical technologist. The blood bank specialist program of study is 12 months long. After successful completion of the program and examination, the blood bank specialist may be qualified for certification.

Answers to Case Studies

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Life Science

Life scientists are researchers who study living organisms and life processes including growth and reproduction. Many areas of specialization are possible in research and development in the health care industry. The educational requirements for research are a master’s degree or doctoral-level preparation. Medical research is conducted in the areas of biology, anatomy, biochemistry, genetics, physics, physiology, and microbiology. Life scientists are responsible for the development of new drugs, plant varieties, methods of treatment, and methods of environmental protection. Biotechnologists or genetic engineers explore the genetic design of plants and animals. Chapter 35 provides more information regarding career opportunities in biotechnology. About one fourth of life scientists work for the federal government, and one third work in private industry. Universities and similar agencies employ others.

Microbiologists study bacteria, algae, viruses, and other microorganisms that cause disease or that may be used to prevent it. Some accomplishments of microbiological research include the development of vaccines for polio and other diseases. Microbiologists also help to determine the method of transmission of diseases. Clinical microbiologists work in a medical, veterinary, or laboratory setting to identify microorganisms in specimens. This may include the development of new drugs. Microbiologists usually work in a laboratory of a hospital or private industry such as pharmaceuticals. Microbiologists may begin work with a 4-year university degree. Higher salary offers are given to employees with a master’s or doctoral degree. Most researchers and supervisors in microbiology hold a doctoral degree. Licensure is not required of microbiologists. Specialty areas of microbiology include virology, mycology, and immunology.

Virologists specialize in researching the method by which viruses infect cells and cause disease. More recently, virologists have helped develop viruses that are used to transport and manipulate genetic material. Mycologists study fungal organisms such as molds and yeast.