Doctors request a vaginal smear on their patients for different reasons especially for symptoms of vaginosis. These symptoms include vaginal itching, burning sensation in the vagina, rash, unusual or strong odor or atypical discharge. It helps assess patients for yeast infection, bacterial vaginosis and parasitosis caused by Trichomonas vaginalis.
Is there only one type of vaginal smear?
No. The vaginal wet mount smear involves observing the wet mount microscopy characteristics of a vaginal discharge by placing the specimen on a glass slide and mixing with a salt solution. Whereas, another type (vaginal Pap smear) involves a smear taken from the vaginal mucosa and stained for cytological analysis.
What should a patient avoid before getting a vaginal smear?
The patient should abstain from sexual activities at least 24 hours before having a vaginal smear done. Likewise, the patient should stop vaginal irrigation or douching, use of tampon and vaginal medications. For douching, tampon use and medications, especially non-prescription vaginal yeast medication, the patient should stop using these two to three days prior to the test. Sexual activities alter the vaginal pH and thus, the results. An authorized person to perform the vaginal smear must not do so during the menstrual period of the patient. The presence of blood on the smear causes erroneous and misleading results.
How does the authorized medical practitioner perform the test?
The person who will collect the vaginal smear (usually a doctor) will ask the patient to assume the lithotomy position. The doctor then uses a speculum to open the vagina while using a swab or other device to obtain the sample inside the vagina. The test causes no serious side effects after the specimen collection. However, some patients experience mild bleeding within the day. This is no cause for worry and it comes normally with a vaginal smear.
The semen or seminal fluid of a human male serves to transport the sperm into the vaginal canal in order for fertilization to occur. It provides lubrication, nutritive substances, enzymes and motility to the sperm cells. Seminal Analysis, also known as semen analysis or seminal fluid analysis consists of analyzing the macroscopic, chemical and microscopic characteristics of the semen. Doctors request this test on a patient for several reasons. This article outlines important facts and reminders for both the patient who will undergo the test and the medical laboratory scientist who will perform the assays.
Common reasons for performing seminal analysis
Four fractions compose the semen or seminal fluid. Structures such as the seminal vesicle, testicles, prostate, epididymis, vas deferens, bulbourethral glands and urethral glands contribute to the formation of these fractions. If there is anything wrong with any of these structures, something goes wrong with the ability of the semen to perform its function. A seminal analysis will therefore aid the doctor in pinpointing diseases or conditions. In addition, results of this test ensure effectiveness of vasectomy, determine probability of infertility, and evaluate qualifications for assisted reproductive technology methods. Forensic experts also use this test for investigation of rape and paternity allegations.
Precautions to follow during specimen collection and processing
The patient performs the specimen collection via masturbation or the use of Silastic condoms after at least two days of abstinence from intercourse and masturbation. Ordinary commercially available condoms cause errors in the test. The patient must place the specimen in a warm, sterile, wide-mouthed, and labeled plastic container. It should reach the laboratory for seminal analysis within an hour after collection, maintained at a temperature between 20 to 40°C.
The results of a single test will not suffice
The doctor interprets the Seminal analysis based on result of several specimens (usually three) combined. More often than not, (except in forensic studies) it is not enough to perform only a single seminal analysis to arrive at a decision.
If you suspect you have hepatitis, the hepatitis laboratory tests will help you confirm your suspicions. The liver problem is due to virus but alcohol, drugs, chemicals and autoimmune and inherited disease can also cause the inflammation. Although the illness can go for several years untreated, if you keep on ignoring the symptoms, it can worsen to liver cirrhosis, cancer and even death. To prevent the complications, here are the possible hepatitis laboratory tests you can requests.
Blood Chemistry
When you see the yellowish discoloration in your skin or feel pain in the right upper quadrant of your abdomen, your physician may request for hepatitis laboratory tests to rule out liver problems. Some of the important blood tests include serum bilirubin determination, proteins, the liver enzyme levels and test for coagulation. During a liver problem, you will expect an elevated level of these substances. When correlated with the signs and symptoms you present, they help your doctor make a better diagnosis on your condition.
Serological Tests
To make a more definite diagnosis, the serological types of hepatitis laboratory tests are more confirmatory than the blood chemistry tests. They detect for the presence of the antigen of the virus or for the antibodies produced in response to the microorganisms. Different kits are available from manufacturers to detect the specific virus causing the inflammation. The test requires blood specimen extracted by a qualified medical technologist. You just have to wait for a few minutes to get the result of your hepatitis laboratory tests.
Biopsy
If the two hepatitis laboratory tests remain inconclusive, your doctor may use liver biopsy as another option to detect the cause of the problem. The doctor will insert a needle to aspirate a sample of the liver cells and the pathologist will do the microscopic examination. Because the procedure is an invasive method, it is very seldom requested.
If you think you have hepatitis, consult your doctor at once to get an accurate diagnosis.
The process of manufacturing a drug substance involves several stages before it can be marketed and one area of such importance is the implementation of drug laboratory quality control. Standard operating procedures of drug manufacturing include quality check and quality assurance from the raw materials used to the finished products. It includes the checking of the specification standards of raw materials, packaging and labeling materials, and the random sampling of finished products.
Drug laboratory quality control is an assurance check that all drugs being manufacture pass quality standards set by different drug regulatory boards. Quality control is necessary in every phase of drug development. The most important purpose of quality control in drug manufacturing is to make sure that the public can avail of safe and therapeutically effective medicines.
The impactof poor drug laboratory quality control will be low quality drugs or below standard quality medicines. This can lead to:
Lack or minimal therapeutic effect – If drugs have not gone quality checks, the major consequence is that they cannot exert their maximum therapeutic effects. The active constituent content of the drug may be minimal or does not comply with the labeled claim of the drug.
Adverse or toxic effects may occur- The worst result of poor quality control can result to death because of the drugs adverse effects or toxicities brought about by poor aseptic techniques implemented in the production process.
Loss of credibility of the drug firm- Poor quality drug can backfire to the company that manufactured them. If drug laboratory quality control protocols are not followed, drug regulatory boards can order closure of the company.
Doctors request for a laboratory test to help them confirm a medical diagnosis. If they have doubts about the possible illness of their patients, the laboratory tests will confirm or negate their initial diagnosis. Laboratory results are useful documents for your physicians. However, if you are the patient, the fear of undergoing the examination can cause undue stress. If as adults, you feel the discomforts brought about by the procedure, then children experience triple apprehensions. Children fear seeing people in white gowns approaching them with a syringe in hand. Just the thought of this can cause trauma to a child. To help your kid get through this anxiety, here are the things you can do.
Talk to the Child
The most important laboratory preparation is talking to the child. Explain the need for the laboratory test. Tell him about its importance and its effect on his health. Use words appropriate to their level of understanding. Before explaining everything to them, make sure that you do a research about the procedure. This is to prepare yourself for their potential questions. If it is possible, you can also request the laboratory personnel or the doctor to explain the procedure to the child. With information, they can understand better and be more cooperative during the laboratory test.
Do not Give False Assurance
A big no in preparing your child for laboratory test is by giving him false assurance. Never assure him that the procedure will not hurt if you know that it will. False information is not a good way to appease his fear. If you deceive him with little things, he/she will lose his trust in you. The next time he has to undergo another laboratory procedure, his fear will only be greater. To help him release the tension, explain the whole procedure and the feeling associated with it. Tell him what to expect during the laboratory test. Stay as honest as possible in explaining.
Give them a Laboratory Tour
Providing a time for the child to meet the medical technologist can help reduce his fear. Bring your child to the laboratory and introduce him to the medical technologist on duty. You can also ask the staff if it is possible to give your kid a tour in the area. Familiarization is an effective way to take away his anxiety. Introduce him to other patients who undergo the same procedure.
Address their Fears
A child has his own fears. When he voices out his worries, listen to him, never ignore his fears,.. Do not simply say that everything will be fine. Explain that the fear is a common feeling but he has to face it. Assure him that you will be with him throughout the laboratory test. He does not have to face his fears alone. You are just around in case he needs your support.
An anxious child during a laboratory test are common is a scenario. For parents, helping your child cope with it reduces their trepidation. When you follow the tips, you can be sure that your child will be more cooperative.
Arterial puncture is one method of blood collection. Licensed and skilled personnel should perform it. Laboratory technologists usually use arterial blood in blood gas analysis (BGA) or analysis of blood gas (ABG).
The procedure is similar to venipucture but should be done under anaerobic (no exposure to air) conditions to avoid escape of gas and shift from intracellular to extracellular fluid.
Materials needed
Luer lock syringe or appropriate syringe
Dry and sterile cotton
Wet and sterile cotton
Test tube rack
Test tube (optional depending on the type of collection vessel)
PPE
Here are the steps in performing arterial puncture.
Step 1
Wear your personal protective equipment properly.
Step 2
Prepare materials by checking each item and arranging them within arm’s reach. Do not place near the patient, especially if patient is a child.
Step 3
Select the best site of puncture. Arterial puncture sites are at the radial artery, femoral artery or brachial artery. Be certain that it is an artery instead of a vein, by feeling for the pulsations, which is characterized by a strong beating pulse. Veins usually disappear when you push hard.
Step 4
Puncture the artery at about 90 degrees angle. When you have correctly hit the vein, blood will push the plunger upwards. You just have to be ready to remove the needle from the artery when done the collecting the needed volume of arterial blood.
Step 5
After collection, remove the needle smoothly and apply pressure with sterile, dry cotton for 10 to 20 minutes. You could ask assistance from the patient, and then leave the cotton and place micropore.
Step 6
Depending upon the type of syringe used, you must seal the specimen container to ensure anaerobic exposure. Dispense in sealed containers.
Step 7
The blood sample or arterial blood should be covered at all times. Label the specimen properly. If you are not testing the blood immediately then keep it in chilled ice. Even when transporting, it should be placed in an icebox with crushed ice.
Step 8
Check the wound of the patient. Be certain there is no bleeding, before you allow him to stand.
Step 9
Dispose your used materials in specified containers. Clean your working area.
Step 10
Wash your hands thoroughly after the procedure.
Licensed personnel should do arterial puncture, as there is the danger of hitting major nerves, which can debilitate or paralyze a person. It may also cause hemorrhage if there is no correct patient’s after care.
Neisseria gonorrhea is the causative agent of gonorrhea a sexually transmitted disease (STD). They are coffee-bean shaped cocci occurring in pairs. They are gram-negative, intracellular diplococci and they are stained using gram staining.
Identification of Neisseria gonorrhea is easy with a simple smear.
Materials needed
Clean and dry glass slide
Applicator stick with cotton
Grams stain
Personal protective equipment
Procedure
Step 1
Wear your personal protective equipment (PPE), gloves, masks and laboratory gown. Neisseria gonorrhea could infect the eyes and your throat. They could cause gonorrheal blindness and throat infections if not diagnosed immediately.
Step 2
With an applicator stick, collect the specimen from the cervical or vaginal area. Sometimes the doctor collects the specimen during his examination.
Step 3
Make a smear of the secretion on the clean and dry glass slide, not too thick or too thin. Identification of Neisseria gonorrhea is facilitated when the simple smear is properly prepared.
Step 4
Allow to air dry or through exposure to direct flame. This will allow the smear to stick to the slide and not washed off during staining.
Step 5
Place in a staining rack and add crystal violet until all the smear is exposed to the stain. The time will depend upon the staining kit’s instructions. The time varies with newly developed kits.
Step 6
Wash the slide and add acid alcohol to decolorize. The gram-positive bacteria will take up the crystal violet while the gram-negative bacteria like Neisseria gonorrhea will decolorize.
Step 7
Wash with distilled water and add safranin. The gram-negative bacteria will take up this stain and will be colored pink. While the gram positive bacteria will be stained purple or violet, taking up the color of crystal violet.
Step 8
Wash again with distilled water and allow to dry.
Step 9
Focus in the microscope using the low power objective (LPO), then shift to the high power objective (HPO) or shift straight to the oil immersion objective (OIO). When using the OIO, place a drop of oil into the slide to be able to see clearly.
Step 10
Following a four field meander, scan the slide for the presence of gram-negative intracellular, diplococci. You should scan the whole slide, as you may not see them immediately. A large amount of pus cells is usually one indication of the infection. Do not report however as positive unless you have observed the diploccoci in the smear itself. Step 10 Record and report your findings.
Capillary puncture is one of the three general methods of blood specimen collection. Called capillary puncture because blood comes from the capillaries, it is usually the preferred method of collection in infants and in adults when venipuncture is not feasible.
Materials needed
Sterile dry cotton
Sterile wet cotton
Lancet or penlet
Capillary tube of capillette or an appropriate collection vessel
Steps
Step 1
Prepare your materials and place it within your reach.
Step 2
Identify your patient properly b y asking his/her name.
Step 3
Select a suitable site, usually the ring finger of the left hand for adults and the big heel or big too for infants.
Step 4
Sterilize the site of puncture from the center going outwards in a circular manner.
Step 5
With a smooth and deliberate manner, puncture the site.
Step 6
Wipe the first blood and collect your specimen making use of your capillary tubes or other appropriate container.
Step 7
Press the wound for 3-5 minutes and apply sterile dry cotton and a micropore.
Tips
* Smile and introduce yourself before asking the name of the patient.
* Give a brief description of the test to be done.
* Children 5 years old and below, most likely would need a restraining blanket or device.
* Older children would understand if you explain why you need to perform the procedure. You have to make them an active participant by making them understand that you need their cooperation for the success of the blood collection.
* The other pads of the fingers and the earlobes are other alternative capillary puncture sites. Determine which is best for your patient by examining the site.
* Say thank you after the procedure.
Precautions
* Do not state his name but let him state it. The patient may not hear correctly and still say yes or no. He may state it, him spell it out, or best if he can write it down; and then patient identification would be done properly.
* Your material should not be near the patient, especially if the patient is a child. Children can pull your material.
* Do not underestimate children, they become stronger when intimidated and afraid. Restrain them properly.
* Do not puncture sites, which have hematoma or bruises.
* Wipe the first drop of blood, as it contains mainly tissue juices and may yield inaccurate results.
* If the test is bleeding time (BT) or clotting time (CT) then do not wipe the first drop of blood. Refer to the protocol with these two tests.
* All materials should be sterile and dry to prevent infecting the patient and contaminating your blood samples.
The venipuncture or phlebotomy procedure is one method of blood collection that allows multi-collection with a larger volume of blood. You can do it with the use of a syringe or a vacutainer whichever you find easier. Not anyone can perform a venipuncture because of some complications that can occur in the process. Skilled phlebotomists or Medical Technologists usually perform the procedure.
photo by Fatima Al Ribh
Materials needed
Sterile and dry syringe
Sterile dry cotton
Sterile wet cotton
Test tubes
Needle
Test tube rack
Labeling tape
Pentel pen or labeling pen
Parafilm
Tourniquet
Procedure
Step 1
Prepare your materials by arranging them in an area within your arm’s reach. Check the needle and syringe if they are working well, by pulling and pushing the plunger and examining the needle. Do not remove the cap of the needle unnecessarily.
Step 2
Select the most appropriate site of puncture. A vein that is not too small or too big is ideal. Big veins have the propensity to roll and small veins are less likely visible. Take time in your selection process. The most common site of puncture is the antecubital fossa at the bend of the arm. There are three veins you could select from, the cephalic, basilica and mid-cubital veins.
Step 3
When you have selected the best vein, sterilize it in a circular motion, starting from the site of puncture going outwards. Do not reuse dirty cotton. Sterilize until clean.
Step 4
Let it dry for a few seconds and with your syringe and needle, puncture the site smoothly and deliberately. There should be no hesitation, as this would inflict more pain to the patient. Enter the vein in one smooth movement.
Step 5
As blood enter the hub of the needle, pull the plunger smoothly taking care not to pull the needle out of the vein.
Step 6
After you have drawn the required amount of blood, withdraw the needle smoothly, not too fast, nor too slow to avoid severing the vein.
Step 7
Apply pressure to the wound for about 3-5 minutes. You could allow the patient to do it, if he cannot, then apply micropore. Be sure to check the wound after 5 minutes to make certain that there is no bleeding.
Step 8
Remove the needle from the syringe and transfer the blood to a test tube by allowing the blood to flow at the sides of the tube to avoid hemolysis. Be sure that your test tube is also dry and clean to avoid hemolysis and contamination. Cover the tube and label it properly.
Step 9
Dispose your used materials properly into appropriate trash bags or cans. Clean your working area properly,
Step 10
Check the wound of the patient and thank him/her for cooperating.
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