N. In

Date: 29.06.2020

A large number of existing diseases, the individual degree of different people complicate the diagnostic process. Often, in practice, it is not enough to apply only the knowledge and skills of a doctor. In this case, clinical laboratory diagnostics helps to make the correct diagnosis. With its help, pathologies are detected at an early stage, the development of the disease is monitored, its possible course is assessed and the effectiveness of the prescribed treatment is determined. Today, medical laboratory diagnostics is one of the most rapidly developing areas of medicine.

Concept

Laboratory diagnostics is a medical discipline that applies in practice standard methods for detecting and monitoring diseases, as well as looking for and studying new methods.

Clinical laboratory diagnostics greatly facilitates and allows you to choose the most effective therapy regimen.

Sub-branches of laboratory diagnostics are:

Information obtained using various methods of clinical laboratory diagnostics reflects the course of the disease at the organ, cellular and molecular levels. Due to this, the doctor has the opportunity to diagnose pathology in a timely manner or evaluate the result after the treatment.

Tasks

Laboratory diagnostics is designed to solve the following tasks:

continuous search and study of new methods of analysis of biomaterial;
analysis of the functioning of all human organs and systems using existing methods;
detection of a pathological process at all its stages;
control over the development of pathology;
evaluation of the result of therapy;
precise definition of the diagnosis.

The main function of the clinical laboratory is to provide the doctor with information about the analysis of biomaterial, comparing the results with normal indicators.

Today, 80% of all information important for diagnosis and treatment monitoring is provided by the clinical laboratory.

Types of test material

Laboratory diagnostics is a way to obtain reliable information by examining one or several types of human biological material:

Venous blood is taken from a large vein (mainly at the bend of the elbow).
Arterial blood - most often taken to assess CBS from large veins (mainly from the thigh or the area under the collarbone).
Capillary blood is taken from a finger for a variety of studies.
Plasma - it is obtained by centrifuging blood (i.e., separating it into its components).
Serum - blood plasma after separation of fibrinogen (a component that is an indicator of blood clotting).
Morning urine - collected immediately after waking up, is intended for general analysis.
Daily urine output is urine that is collected in one container during the day.

Stages

Laboratory diagnostics includes the following steps:

preanalytic;
analytical;
post-analytical.

The preanalytical stage implies:

Compliance by a person with the necessary rules for preparing for analysis.
Documentary registration of the patient upon arrival at the medical institution.
Signature of tubes and other containers (for example, with urine) in the presence of the patient. The name and type of analysis are applied on them by the hand of a medical worker - he must pronounce these data aloud to confirm their reliability by the patient.
Subsequent processing of the taken biomaterial.
Storage.
Transportation.

The analytical stage is the process of direct examination of the obtained biological material in the laboratory.

The post-analytical stage includes:

Documentary registration of results.
Interpretation of results.
Formation of a report containing: data of the patient, the person who conducted the study, the medical institution, the laboratory, the date and time of sampling of the biomaterial, normal clinical limits, the results with the corresponding conclusions and comments.

Methods

The main methods of laboratory diagnostics are physical and chemical. Their essence lies in the study of the material taken for the relationship of its various properties.

Physicochemical methods are subdivided into:

optical;
electrochemical;
chromatographic;
kinetic.

The optical method is most commonly used in clinical practice. It consists in fixing changes in the light beam passing through the biomaterial prepared for research.

In second place in terms of the number of analyzes carried out is the chromatographic method.

Probability of errors

It is important to understand that clinical laboratory diagnostics is a type of research in which mistakes can be made.

Each laboratory must be equipped with quality instruments, analyzes must be performed by highly qualified specialists.

According to statistics, the main share of errors occurs at the preanalytical stage - 50-75%, at the analytical stage - 13-23%, at the post-analytical stage - 9-30%. Regular measures should be taken to reduce the likelihood of errors at each stage of laboratory research.

Clinical laboratory diagnostics is one of the most informative and reliable ways to obtain information about the health of the body. With its help, it is possible to identify any pathologies at an early stage and take timely measures to eliminate them.

Completed a 4th year student

of the Faculty of General Medicine of the 7th group

Vitaly Kazakov

Grodno 2012

For the study of urine, modern technologies are based on the use of mono- and polyfunctional test strips "dry chemistry" with subsequent semi-quantitative determination of urine parameters on reflective photometers. Recently, urine sediment analyzers based on the analysis of video images have appeared. As practice shows, automated analyzers help a lot at screening general clinical and hematological analyzes, significantly expanding the range of research and introducing quantitative indicators for evaluating the results. The task of domestic manufacturers of medical equipment is to establish the production of modern hematological analyzers. At the same time, the doctor of clinical laboratory diagnostics should gradually get rid of the routine analysis of the shaft of screening studies, switching to the exploratory analysis of complex, complicated and non-trivial analyzes, introducing methods of cytochemical, immunochemical, molecular analyzes in general clinical and hematological studies. A separate area is oncohematology, which develops research to identify differentiation markers. The diagnosis and treatment of lymphoproliferative diseases is increasingly switching to examination and treatment protocols, in which targeted therapy does not begin without an accurate diagnosis using phenotyping of cell clones. This approach needs to be implemented throughout Russia, using the principles of centralization and continuity of laboratory research. Biochemical technologies enriched with new methods of kinetic measurements of not only enzyme activity, but also the concentration of substrates. Increasing the sensitivity and specificity of methods contributes to the expansion of the objects of biochemical analysis, in addition to the traditional analysis of serum and urine, exhaled air condensate, exudative, lacrimal fluid, cerebrospinal fluid, cellular elements, etc. are increasingly used for diagnostic purposes. smaller volume of biological sample. The current level of biochemical research requires the introduction of calibrators to determine the activity of enzymes, develop standards and obtain domestic standard samples for the study of blood, urine, and other biofluids.

The priority is given to the professional training of doctors involved in cytological diagnostics and their experience. To improve professional skills, it is proposed in this type of laboratory diagnostics, first of all, to introduce systems of teleconsultations, teleconferences, make extensive use of professionally prepared image archives, and promote the publication of cytological atlases and manuals. To reduce subjectivity, it is proposed to develop and officially approve programs for intralaboratory and interlaboratory control of the quality of cytological studies, forms of a standardized cytological conclusion, etc. Given the importance of a cytological conclusion, it is recommended to widely disseminate the existing experience of intraoperative cytodiagnostics, to conduct biopsy of internal organs under the control of ultrasound, X-ray and other diagnostic methods, to contribute to the development of objective quantitative methods for assessing the parameters of cells and tissues under study. Microbiological research should have priority development among other types of laboratory diagnostics. This is due to the massive spread of infectious diseases affecting all contingents of the population, the uncontrolled use of antibiotics and antiseptics, the demand for this type of laboratory diagnosis in almost all types of medical care. At the same time, the level of development of microbiological research in Russia remains at a low level, does not meet modern needs and does not fulfill one of the main tasks - microbiological control of the sensitivity of pathogenic microflora to drugs. In Russia, the level of automation of microbiological research remains at one of the lowest among European countries. The results are issued with a long delay, do not correspond to the requests of clinicians. The country has practically destroyed the industry of providing bacteriological laboratories with specialized media. The leapfrog with the departmental and industry affiliation of bacteriological research has led to the fact that this type of diagnosis occupies a negligible share among other types of laboratory research. Research in sanitary microbiology is carried out by third-party organizations, without taking into account the specifics of medical institutions. At the same time, in a number of countries of the European Union, bacteriological studies account for up to half of all laboratory tests; they are carried out using bacteriological analyzers, commercial ready-made nutrient media, express diagnostic systems, expert systems, devices for the cultivation of gem cultures, cell cultures, etc. Low level of classical bacteriological research has contributed to the fact that in laboratory diagnostics methods of molecular diagnostics are unreasonably widespread, which are difficult to control and often contribute to overdiagnosis, especially of sexually transmitted infections (STIs). Revision of indications for microbiological laboratory research, standardization of microbiological diagnostics, development of expert systems, introduction of high-performance automated techniques for identifying microorganisms and determining sensitivity to drugs, strengthening the material base of bacteriological laboratories are the urgent tasks of mycobiological research in clinical laboratory diagnostics. Molecular biological research are a new extremely promising type of laboratory research. The development of molecular biological research is associated with a significant breakthrough in the diagnosis and treatment of hereditary, infectious, oncological and other types of diseases. A complete description of the human genome is the immediate and real prospect of molecular biological research. At the same time, the highest sensitivity makes this method susceptible to biased conclusions with a non-professional approach. Currently, there is a period of accumulation of data on the diagnostic capabilities of this approach, therefore, its hasty harm to widespread laboratory practice, replacing traditional microbiological, cytological and other types of research, can discredit the methodology of molecular biological research. The stage-by-stage implementation of technologies such as polymerase chain reaction (PCR), other methods of molecular diagnostics for STI identification, blood bank control, etc., is relevant, combined with other types of laboratory research.

Coagulology- a specific type of laboratory research, which is becoming more widespread due to the widespread introduction of invasive, surgical, intravascular interventions, the use of a wide range of the latest generations of drugs that affect vascular platelet, plasma hemostasis, fibrinolysis, and anticoaculant activity. An urgent task is the standardization of diagnostic methods, the development of programs for monitoring the effectiveness of anticoagulant, thrombolytic, fibrinolytic therapy. Due to the large number of factors affecting blood coagulation, it is necessary to develop diagnostic algorithms for screening, in-depth research and control of the treatment of hemostasis disorders. The instrumental park for diagnosing hemostasis disorders requires a significant improvement. The production base of reagents, control materials, standards used in studies of hemostasis disorders requires state support. Special attention should be paid to the directions for the rapid diagnosis of hemostasis disorders, the creation of domestic thromboelastographs, optical-mechanical coagulographs, and other laboratory equipment.

Toxicological studies- are also becoming more widespread among the types of laboratory approaches. This is primarily due to the widespread use of drugs, alcohol and other stimulants, including drugs that have a toxic effect in case of overdose. Toxicological research has traditionally been concentrated in specialized laboratories, often in forensic science. However, screening diagnostics of drug addiction has recently become relevant. In some territories, programs are being developed for anonymous drug screening of young populations and the creation of a medical data bank based on laboratory research. A legal study of such programs is required. Nevertheless, the assessment of patients' drug addiction is an urgent task, without which it is impossible to develop effective medical technologies for treating patients. In this regard, it is required as an instrumental base, reagent support, reliable calibrators and control materials, examination protocols.

Lecture No. 1 Laboratory research methods. Organization of laboratory services.

Introduction

Modern medicine is impossible without laboratory diagnostics. It is an indicator of the patient's health status. High-quality diagnostics helps the doctor in making the correct diagnosis and prescribing effective treatment. Modern laboratory diagnostics allows solving the problems of doctors of different specialties and areas of medicine. At the same time, the timely and high-quality performance of medical tests allows not only to make a diagnosis as accurately as possible, but also to monitor the effectiveness of the treatment being carried out. At the same time, laboratory diagnostics is one of the fastest growing branches of medical science - the creation and implementation of new equipment, the development of new research methods, the range of possible tests - all this is progressing every day.

The rapid development of biology and the revolutionary transformation of scientific instrumentation at the beginning of the 21st century radically changed the arsenal of diagnostic capabilities in medicine.

The analytical progress of the scientific discipline aimed at studying the composition and properties of biological materials from the human body - in vitro diagnostics - provided it, in essence, a breakthrough to the leading positions in the treatment and diagnostic process, which changed the degree of responsibility of this area of clinical medicine.

The effectiveness of the laboratory link is determined by the quality of interaction between the laboratory and the clinic.

Despite the implementation of national programs with significant financial investments in medicine and the implementation of measures aimed at modernizing the laboratory service, until now a number of issues related to the activities of a modern laboratory remain without due attention or require the adoption of administrative decisions at the federal level. The following problems reduce the efficiency of the work of medical institutions and restrain the diagnostic potential of the laboratory.

Despite the fact that the number of CDLs in our country is decreasing, nevertheless, their number exceeds that in the developed countries of the world. So, in the USA, the population of which exceeds the population of the Russian Federation by more than 2 times, there are 8560 hospital CDLs, 4936 commercial laboratories and 105089 laboratories in medical offices. In Germany, only 2,150 CDLs, of which 82% are hospital and 18% are private laboratories. In the Russian Federation, CDLs performed 3.2 billion analyzes in 2008, in the USA - more than 8 billion, in Germany - about 2 billion. According to statistics, it seems that in our country CDLs are doing quite a lot of analyzes. However, if we use a pan-European approach to calculating the number of studies, then in reality in our country there will be not 3.2 billion laboratory tests, but at best about 1 billion. This is due to the fact that almost every indicator that is obtained with the help of hematology or urinary analyzers counts as a separate test. ( A.A. Kishkun Journal of Laboratory Medicine No. 11, year of publication: 2011, Relevance of the problem of centralization of clinical laboratory research for the country's health care system).

One of the key challenges in the institution is the quality of medical care, which is regulated by normative acts: from the fundamentals of the legislation of the Russian Federation on the protection of citizens' health to departmental and interdepartmental normative documents. The new SanPiN 2.1.3.2630-10 "Sanitary and Epidemiological Requirements for Organizations Carrying out Medical Activities" also came into effect. However, to date, there are no uniform requirements and a rationally operating quality system, the purpose of which is to ensure the rights of patients to receive care of the required volume and proper quality based on the use of advanced medical (laboratory) technologies. This problem entails a second problem - problem control over its provision, implying a system of criteria to determine timeliness, adequacy, completeness and the effectiveness of medical care.

* In the system of the Ministry of Health of Russia, according to data for 2012, there are 15.5 thousand diagnostic laboratories, of which there are about 13 thousand clinical diagnostic laboratories (CDL), 1012 bacteriological, 616 serological, 730 biochemical, 329 cytological, 48 coagulological laboratories, of which centralized 1125 laboratories. Over the past 5 years, there has been a slight decrease in the number of general purpose CDTs, mainly due to the closure of rural health facilities. At the same time, the number of specialized bacteriological, serological, and biochemical laboratories tended to increase. More or less large laboratories have hospitals with a capacity of over 400 beds. In total, there are several more than 900 such institutions in the country. Large laboratory units have diagnostic centers of the general type and for the diagnosis of AIDS and viral hepatitis.

* At the same time, 28% of independent outpatient clinics, 12.9% of tuberculosis sanatoriums, 14.2% of local hospitals do not have clinical diagnostic laboratories at all. In addition, 3570 hospitals and other institutions, which is 26.7% of their total number, according to the staffing table, cannot have the position of a doctor of clinical laboratory diagnostics. They are content with a small laboratory with a laboratory assistant (medical laboratory technician).

* The laboratory diagnostics service has significant human resources. In the system of the Ministry of Health of Russia, about 18 thousand specialists with higher education work in the CDL, the overwhelming majority are doctors of clinical laboratory diagnostics. Of these, about half have a medical degree and the other half have a university degree in biology. About 45% of doctors in clinical laboratory diagnostics have a category.

The position of a biologist has been introduced into the staffing table of the CDL, for which specialists who graduated from universities and have a diploma with the qualification of "biologist" are hired, but this position has not yet become widespread.

* The CDL employs 75.5 thousand specialists with secondary medical education in the positions of laboratory assistant, medical technician (paramedic laboratory assistant), medical laboratory technologist. The ratio of doctors / workers with a secondary specialized education is on average 1: 4.3., The norm is 1: 2.8 (due to the fact that in many small subdivisions, medium-sized specialists work independently).

* Human and material resources of the clinical laboratory service allow to carry out 2.6-2.7 billion laboratory tests annually. In the outpatient health care unit:

About 120 laboratory tests are performed per 100 visits,

There are about 42 analyzes for 1 inpatient.

Every year there is an increase in research by 2-3%. (For comparison, 7 other services performing objective diagnostic studies, taken together, performed 238.3 million studies in 2012, i.e., 11.1 times less research volume).

* Based on the number of individuals with higher and secondary education, per 1 KDL employee (based on the number of individuals with higher and secondary education), an average of 130-140 analyzes are performed per 1 working day.

The difference in labor productivity between laboratories with automated equipment and laboratories using manual methods can be up to 10-15 times.

Despite significant quantitative indicators of the scale of the structure and scope of work, the clinical laboratory diagnostics service does not work effectively enough, experiencing significant difficulties due to the presence of a number of serious unresolved problems.

Examples of the organization of diagnostic laboratories in the Stavropol region and the city of Togliatti.

* The history of the development of public health services in the Stavropol region goes back to the past centuries. The first mention of qualified medical care is at the beginning of the 19th century. There was one hospital with 15 beds in Stavropol and the district. The doctor traveled to the villages once every two months, while he did not have a permanent place for receiving patients. (more details can be found in the work).

* Municipal district Stavropolsky is located on the territory of 3697.5 sq. Km. The district includes 24 rural settlements uniting 51 settlements.

The population of the district has a steady tendency to increase from year to year. So, as of 01.01.2013. the number was 63,360 people, which is 5.3% more than in 2010 (54,545 people). The population density in the district is 17 people per 1 sq. Km. area (in the Samara region as a whole, this indicator is 60 people per 1 sq. km. of area). The age composition of the population is characterized by the predominance of older age groups. The share of people over 18 years old is 83% of the total population, people over working age - 1/4 of the total population (24%).

The State Budgetary Institution of Health of the Samara Region "Stavropol Central District Hospital" (GBUZ SO "Stavropol Central District Hospital") is a huge network of medical and preventive institutions of the district, uniting all settlements of the district.

At the moment, it is a multidisciplinary medical budgetary health care institution, which has structural subdivisions, financed from the compulsory medical insurance funds and partly from the municipal budget.

The head laboratory is located in the Central Regional Hospital, in addition, laboratory diagnostics is carried out in 13 departments of general medical (family) practice.

Laboratory diagnostics is performed in 8 main areas, more than 70 types of analyzes.

The CDL CRH includes 3 therapeutic departments, 12 offices and 6 outpatient clinics, which are located in the villages adjacent to the Stavropol region, in which one laboratory assistant works.

The very first office was opened in the village. Zelenovka in 2010.

It consists of one general clinical office. In the office, patients are received from 8:00 to 10:00 hours. The number of patients per day is approximately 20 people. There is one laboratory assistant in the staff. The laboratory assistant takes all analyzes in the direction of the doctor, in which the full name, age, and the alleged diagnosis are indicated.

His work includes: blood sampling at the UAC (setting ESR, preparing a blood smear), taking blood for sugar, OAM. The laboratory assistant takes unstained blood smears every day to the CDL of the Central District Hospital, where they are then fixed and stained, then the doctor looks at them.

The office has equipment: statfax, microscope, centrifuge, thermostat, refrigerator, glucometer.

The cabinet area is divided into three honors. In the first zone there is a table for urine on OAM, on which the laboratory assistant does the analysis (determines the amount of urine, color, turbidity, relative density, shaped elements: protein and glucose, prepares urine sediment for microcopying. Here is also a centrifuge and a thermostat.

In the second zone there is a refrigerator for solutions and drugs, a table at which blood is taken at the UAC, on the same table there is a microscope, sterile instruments, sterile cotton wool, sterile tweezers; disposable scarifiers; sterile glass slides; sterile capillaries of Panchenkov; 5% solution of sodium citrate (citrate); rubber gloves; 70% solution of ethyl alcohol; a rack with test tubes for taking blood for ESR, microvet for taking blood for erythrocytes, hemoglobin, leukocytes; blood collection tablet; Petri dish with polished glass for making a blood smear; container for prepared blood smears.

In the third zone there are disinfecting solutions for surface treatment (6% solution of hydrogen peroxide, 0.6% solution of calcium hypochlorite, etc.), a container with cotton swabs for gloves, storage containers - containers for waste: used cotton wool, scarifiers , capillaries, container for used gloves. In this zone, the utilization of biomaterial takes place.

The post-analytical stage is divided into in-laboratory and out-of-laboratory parts. The main element of the intra-laboratory part is the verification of the analysis result by a qualified laboratory doctor for its analytical reliability, biological probability, as well as comparison of each result with reference intervals. After the completed stage, the laboratory assistant confirms the results and transmits them to the clinician or patient.

The out-of-laboratory part is an assessment by the attending physician of the clinical significance of information about the patient's condition obtained as a result of laboratory research and interpretation of the obtained laboratory information. The main form of quality control of the post-analytical stage is regular external and internal checks.

To the preanalytical the stage accounts for up to 60% of the time spent on laboratory research. Errors at this stage inevitably lead to distortion of the analysis results. In addition to the fact that laboratory errors are fraught with the loss of time and money for repeated studies, their more serious consequence can be misdiagnosis and inappropriate treatment.

The results of laboratory tests can be influenced by factors related to the individual characteristics and physiological state of the patient's body, such as: age; race; floor; diet and fasting; smoking and drinking alcoholic beverages; menstrual cycle, pregnancy, menopausal status; physical exercises; emotional state and mental stress; circadian and seasonal rhythms; climatic and meteorological conditions; the position of the patient at the time of blood sampling; taking pharmacological drugs, etc.

The accuracy and correctness of the results is also influenced by the technique of taking blood, the instruments used (needles, scarifiers, etc.), the test tubes into which the blood is taken and subsequently stored and transported, as well as the conditions of storage and preparation of the sample for analysis.

In principle, there are two ways to collect venous blood for analysis. Open systems (hollow needle, glass tube) have been used since time immemorial. This method involves contact of blood with air, in the case of a closed method, there is no contact with air, blood collection is carried out in a closed mode.

Currently, in 65% of cases, blood is taken from a vein by an open method, i.e. either with a syringe or with a hollow needle, into a test tube - by gravity. When taking blood in this way, a number of difficulties often happen: this is blood thrombosis in the needle, and hemolysis caused by the double passage of blood through the needle, since during the syringe set, blood cells are twice injured due to squeezing through the narrow needle of the syringe, the cell walls are torn, which greatly reduces the accuracy of the results due to mixing with the cellular contents. If it is necessary to fill several tubes with blood, the duration of blood sampling increases. Various difficulties also occur when delivering glass test tubes with blood to the laboratory: test tubes are broken, blood samples may spill, some of the blood has been absorbed into a cotton swab that closes the test tube, etc.

These and many other problems are easily solved by using the so-called “closed” or vacuum systems for taking blood.

The first “closed” system (Vacutainer) was invented in 1947 by Joseph Kleiner and released to the market in 1949. In its modern form (plastic shatterproof tube), the Vakutainer system experienced a rebirth in 1991. The system works according to the following principle: a vacuum of a certain strength is created in the test tube; when the test tube is filled, it allows blood to flow into the test tube until it is filled to the required volume. In addition to more accurate dosing of blood volume, modern test tubes allow to increase the accuracy of the content of the desired reagent in a test tube, in comparison with glass reusable tubes, the reagent to which was added not in production, but manually. Also, modern closed vacuum systems allow you to completely eliminate the risk of blood splatter and accidental needle sticking, which makes them a safer solution. (in more detail about the fence by closed systems, we will talk in practical classes). Source: Pr-consulta.ru

General clinical research:

Complete blood count and ESR
Blood type and Rh factor
General urine analysis and Nechiporenko test
Feces for determining helminth eggs
Scraping for enterobiasis

General blood analysis

Almost any visit to the therapist ends with the fact that he sends us for a blood test from the finger. Why do we pass this analysis so often? What he can tell the attending physician.

Blood is a highly variable tissue in the body. (Yes, blood is a tissue, albeit liquid.) So, its composition subtly reflects the state of the whole organism and reacts to any deviations in health. That is why the doctor sends you for a blood test. So he manages to quickly collect a huge array of valuable information about what is happening with your body.

The clinical minimum includes examinations of a patient admitted to the clinic. The analysis determines the components of blood (erythrocytes, leukocytes, lymphocytes), ESR (erythrocyte sedimentation rate), hemoglobin and other blood characteristics

The analysis procedure is known to everyone: in the laboratory, a puncture is made in the fingertip with a scarifier needle. A drop of blood appears at this point. Usually, her size does not satisfy the laboratory assistant and she massages her finger so that there is enough blood to fill a special pipette.

GENERAL BLOOD AND ESR ANALYSIS

The material for research is venous blood, which is taken from the cubital vein.
For general analysis, blood is taken into a vacuum tube with a purple cap (with K 3 EDTA). For an accurate blood-anticoagulant ratio it is necessary to collect the entire tube to the mark or indicated blood volume!
Blood on ESR is also taken from the cubital vein by a vacuum system, but into a thin tube with black lid! When both the CBC and the ESR are prescribed, both tubes of one patient (purple and black) are signed with one and the same number! And this number is fixed in the direction.
On test tubes, it is mandatory to indicate patient identification number and name of the medical institution. The identification number must be kept in the register of the institution.
The patient's blood must be stored in the refrigerator before being handed over to the courier. (+2 - + 4 ° С) or in a container with refrigerant.
Blood tubes are given to the courier together with directions. The tube numbers must match the numbers on the directions.
The blood is sent to the laboratory on the day of collection. Blood cannot be stored until the next day!

Not everyone knows what happens next. The analysis can be carried out either by old laboratory methods, using a microscope and chemicals, or a pipette will be loaded into a clever apparatus that will print out the answer in a minute.

In any case, the analysis results are abbreviated designations of various parameters and their numerical values. So, let's take a look at these parameters:

Hemoglobin - Hb. The norm for men is 120–160 g / l, the norm for women is 120–140 g / l. Hemoglobin is a proteinaceous substance concentrated in red blood cells - erythrocytes and is responsible for the transport of oxygen and carbon dioxide between the lungs and tissues of the body. With a lack of hemoglobin, difficulties arise in supplying oxygen to the cells. The person may experience a feeling of suffocation despite vigorous breathing. A decrease in the level of hemoglobin occurs with anemia, after blood loss, and also due to a number of hereditary diseases.

Hematocrit - Нt... The norm for men is 40–45%, the norm for women is 36–42%. It is an indicator of the percentage of blood cell elements (erythrocytes, leukocytes and platelets) of the total blood volume. A drop in hematocrit (a decrease in the number of cells per liter of blood) may indicate blood loss (including internal) or suppression of hematopoietic function (severe infections, autoimmune diseases, exposure to radiation). A high hematocrit is also bad. Thick blood passes through the vessels worse, and the risk of blood clots increases.

Erythrocytes - RBC, the norm for men is 4-5 * 10 ^ 12 per liter, for women - 3-4 * 10 ^ 12 per liter. Erythrocytes are precisely the cells in which hemoglobin is concentrated. The change in their number is closely related to the concentration of hemoglobin and accompanies similar diseases.

Color Index - CPU, in the norm is 0.85-1.05. It is the ratio of the concentration of hemoglobin to the number of red blood cells. Its change indicates the development of various forms of anemia. It increases with B12, folate deficiency, aplastic and autoimmune anemias. A decrease in the color index occurs with iron deficiency anemia.

Leukocytes - WBC. The norm of leukocytes is 3-8 * 10 ^ 9 per liter. Leukocytes are our body's defenders against infection. With the penetration of pathogens, their number should increase. In severe infections, oncological and autoimmune pathologies, the number of leukocytes decreases.

Neutrophils - NEU. This is the most numerous group of leukocytes (up to 70% of their total number). They are cells of a nonspecific immune response. Their main function is phagocytosis (swallowing) of everything foreign that has entered the body. That is why there are a lot of them in the mucous membranes. An increase in the number of neutrophils indicates purulent inflammatory processes. But it is even worse if the purulent process is, as they say, "on the face", but there are no neutrophils.

Lymphocytes - LYM make up 19-30% of leukocytes. Lymphocytes are responsible for specific (targeted to certain microorganisms) immunity. If, against the background of the inflammatory process, the percentage of lymphocytes falls to 15% and below, then their number should be estimated per 1 μl of blood. It is necessary to sound the alarm if it turns out to be less than 1200 - 1500 cells.

Platelets - PLT. The normal platelet count is 170-320 * 10 ^ 9 per liter. Platelets are the cells that stop bleeding. In addition, they select the weapon of immune cells, which they used in the fight against microorganisms - the remnants of immune complexes circulating in the blood. Therefore, a decrease in the number of platelets indicates immunological diseases or severe inflammation.

Erythrocyte sedimentation rate - ESR (ROE). The ESR rate for men is up to 10 mm / h, for women - up to 15 mm / h. An increase in ESR cannot be ignored. This may indicate inflammation of certain organs, or it may be a pleasant signal notifying a woman of pregnancy.

Preparing the patient for the blood donation procedure and the main preanalytical factors that may affect the result

Ø Medicines (the influence of drugs on laboratory test results is diverse and not always predictable).

Ø Eating (it is possible both a direct effect due to the absorption of food components, and an indirect one - shifts in the level of hormones in response to food intake, the effect of turbidity of the sample associated with an increased content of fat particles).

Ø Physical and emotional overload (cause hormonal and biochemical changes).

Ø Alcohol (has acute and chronic effects on many metabolic processes).

Ø Smoking (changes the secretion of some biologically active substances).

Ø Physiotherapy, instrumental examinations (may cause temporary changes in some laboratory parameters).

Ø The phase of the menstrual cycle in women (significant for a number of hormonal studies, before the study, you should check with the doctor about the optimal days for taking a sample to determine the level of FSH, LH, prolactin, progesterone, estradiol, 17-OH-progesterone, androstenedione).

Ø Time of day when taking blood (there are daily rhythms of human activity and, accordingly, daily fluctuations of many hormonal and biochemical parameters, expressed to a greater or lesser extent for different indicators; reference values - the boundaries of the "norm" - usually reflect statistical data obtained under standard conditions, when taking blood in morning time).

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M .: Labora, 2009 .-- 880 p.

Valkov V.V., Ivanova E.S. New possibilities of modern complex urine analysis: from ph measurement to immunoturbidimetry of specific proteins

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added September 28, 2011

Reference manual. Pushchino, 2007; 79 pages Authors-compilers: Candidate of Biological Sciences Vel'kov V.V., Ivanova E.S., Candidate of Biological Sciences Kononova S.V., Reznikova O.I., Candidate of Biological Sciences. Solovieva I.V., Travkin A.V. Annotation. This information material is a short reference guide intended primarily for specialists in the field of clinical laboratory diagnostics, as well as for medical professionals specializing in the field of nephro ...

Zupanets I.A. (ed) Clinical laboratory diagnostics: research methods. Tutorial

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Ed. prof. IA Zupantsa, Kharkov, 2005. The methods of clinical research (general clinical analysis of blood, urine, sputum examination), which are most widely used in medical practice, are considered. the principles and methods of determining the indicators, the values of indicators in the norm and their changes depending on the pathology are presented, a section on the effect of drugs on the indicators of clinical and laboratory research has been introduced. Laboratory and and ...

Lifshits V.M., Sidelnikova V.I. Medical laboratory tests. Reference manual

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Moscow, "Triada-X", 2000 - 312 p. (OCR) ISBN 5-8249-0026-4 The authors set themselves the task of a brief description of clinical and biochemical parameters used in modern clinical practice, as well as a generalization of information on some topical issues of laboratory medicine. With a large number of excellent reference books and manuals for laboratory diagnostics, there is still a noticeable deficit in this literature. The book "Medical laboratories ...

Menshikov V.V. (ed.) Clinical and laboratory analytical technologies and equipment

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Moscow Publishing Center "Academy" 2007, 238s. Analytical technologies and equipment used in clinical diagnostic laboratories of healthcare institutions are considered. The principles of research methods are described in detail, procedures for preparing samples of biomaterials for analysis are described, the features and sequence of analytical procedures for various types of laboratory studies are described in detail. Presented by constructive ...

Menshikov V.V. Clinical laboratory analytics. Volume 1 - Fundamentals of Clinical Laboratory Analysis

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M. Agat-Med. 2002 .-- 860 p. The book "Clinical laboratory analytics" presents data on the main components of work in a modern clinical laboratory: on elementary laboratory procedures (weighing, preparation of solutions and their dosing, calibration), on the types of laboratory reagents and the rules for working with them, on the main analytical technologies and applied for their implementation, equipment, modern technical equipment ...

Moshkin A.V., Dolgov V.V. Quality assurance in clinical laboratory diagnostics. A practical guide

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Authors: Kamyshnikov V.S. (ed.)
Publisher: MEDpress-inform
Year of publication: 2015
Annotation: The book provides modern information about the structure and function of vital organs, about clinical and laboratory tests reflecting the features of their condition, methods of laboratory diagnostic research, about the peculiarities of changes in the biochemical and morphological composition of blood, urine, gastric contents, cerebrospinal fluid, sputum, discharge genitals and other biological material in widespread diseases, as well as on the performance of quality control of laboratory tests, interpretation of the results. The methods of biochemical, coagulological, serological, immunological, morphological, mycological, cytological studies of human body fluids are described. The description of each method includes information about the principle, the course of the study and the clinical and diagnostic value of the test. The book can be successfully used in the training and practical activities of specialists in clinical laboratory diagnostics with secondary and higher medical education.
Keywords: Lipid metabolism Enzymes Biochemical analyzes Leukemoid reactions Hemoblastosis Anemias Examination of sputum
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TABLE OF CONTENTS
Foreword (B.C. Kamyshnikov)
Introduction to the specialty (B.C. Kamyshnikov)

Section I. GENERAL CLINICAL RESEARCH
Chapter 1. Urinary system (O. Volotovskaya)
1.1. The structure and function of the kidneys
1.2. Physiology of urine formation
1.3. General urine analysis
1.3.1. Physical properties of urine
1.3.2. Chemical properties of urine
1.3.3. Microscopic examination of urine

Chapter 2. Study of the gastrointestinal tract (O. A. Volotovskaya)
2.1. Anatomical and histological structure of the stomach
2.2. Stomach functions
2.3. Phases of gastric secretion
2.4. Methods for obtaining gastric contents
2.5. Chemical examination of gastric contents
2.6. Probeless methods for determining the acidity of gastric juice
2.7. Determination of the enzyme-forming function of the stomach
2.8. Microscopic examination of gastric contents

Chapter 3. Study of duodenal contents (O. A. Volotovskaya)
3.1. Physiology of bile formation
3.2. Methods for obtaining duodenal content
3.3. Physical properties and microscopic examination of bile

Chapter 4. Study of intestinal contents (O.A. Volotovskaya)
4.1. Intestine structure
4.2. Bowel functions
4.3. General properties of feces
4.4. Chemical examination of feces
4.5. Stool microscopic examination
4.6. Scatological syndromes
4.7. Disinfection of biological material

Chapter 5. Examination of sputum (A.B. Khodyukova)
5.1. Anatomical and cytological structure of the respiratory system
5.2. Collection and disinfection of material
5.3. Determination of physical properties
5.4. Microscopic examination
5.4.1. Preparation and study of native drugs
5.4.2. Cellular elements
5.4.3. Fibrous formations
5.4.4. Crystalline formations
5.4.5. Study of stained preparations
5.5. Bacterioscopic examination
5.5.1. Technique of preparation and coloring of preparations
5.5.2. Ziehl-Nielsen staining
5.5.3. Microscopic examination
5.5.4. Pottinger flotation method
5.5.5. Luminescence microscopy method
5.6. Sputum for various diseases

Chapter 6. Research of cerebrospinal fluid (A.B. Khodyukova)
6.1. Physiology of liquor formation
6.2. Physical properties of cerebrospinal fluid
6.3. Microscopic examination
6.3.1. Differentiation of cell elements in the chamber
6.3.2. Study of stained preparations
6.3.3. Morphology of cellular elements
6.3.4. Bacteriological examination
6.4. Chemical research of cerebrospinal fluid
6.5. Cerebrospinal fluid syndromes
6.6. Changes in cerebrospinal fluid in some diseases

Chapter 7. Laboratory diagnostics of diseases of female genital organs (A.B. Khodyukova)
7.1. General information
7.2. Hormonal colpocytological studies
7.3. Morphological features of the vaginal epithelium
7.4. Cytological evaluation of vaginal smears
7.5. Cytogram of the normal menstrual cycle
7.6. Assessment of the degree of proliferation and progesterone activity
7.7. Registration of research results
7.8. Diseases of the female genital organs
7.8.1. Bacterial vaginosis
7.8.2. Gonorrhea
7.8.3. Trichomoniasis
7.8.4. Urogenital chlamydia
7.8.5. Urogenital candidiasis
7.8.6. Syphilis

Chapter 8. Study of discharge from male genital organs (A.B. Khodyukova)
8.1. The structure of the male genital organs
8.2. Physicochemical properties of semen
8.3. Microscopic examination of native preparations
8.4. Microscopic examination of stained preparations (Pappenheim staining)
8.5. Study of the secretion of the prostate gland

Chapter 9. Research of transudates and exudates (A.B. Khodyukova)
9.1. Serous cavities and their contents
9.2. Determination of physical and chemical properties
9.3. Microscopic examination

Chapter 10. Cytological diagnosis of tumors (A.B. Khodyukova)
10.1. The causes of the tumor
10.2. Tumor structure
10.3. Laboratory diagnostics of malignant neoplasms
10.4. Cytological criteria for malignancy

Chapter 11. Laboratory diagnostics of mycoses (A.B. Khodyukova)
11.1. General understanding of the structure of the skin and its individual appendages
11.2. Dermatomycosis
11.3. Material taking technique
11.4. Preparation technique
11.5. Laboratory diagnostics of skin diseases
11.5.1. Trichomycosis
11.5.2. Microsporia
11.5.3. Epidermomycosis
11.5.4. Candidiasis
11.5.5. Morphological features of causative agents of some deep mold mycoses
11.5.6. Pseudomycosis

Section II. HEMATOLOGICAL STUDIES
Chapter 1. Hemopoiesis. Blood cells (T.S. Dalnova, S.G. Vashshu-Svetlitskaya)
1.1. Modern ideas about hematopoiesis
1.2. Bone marrow hematopoiesis
1.3. Erythropoiesis. Cell morphology and function
1.4. Changes in the morphology of erythrocytes in pathology
1.4.1. Change in the size of red blood cells
1.4.2. Clinical and diagnostic value of anisocytosis
1.4.3. Change in the shape of red blood cells
1.4.4. Changes in the color of red blood cells
1.4.5. Inclusions in erythrocytes
1.5. Granulocytopoiesis. Morphology and function of neutrophils, eosinophils, basophils
1.5.1. Functions of neutrophils
1.5.2. Eosinophil functions
1.5.3. Basophil functions
1.6. Changes in the number and morphology of granulocytes in pathology
1.7. Monocytopoiesis. Morphology and function of monocytes and macrophages
1.8. Changes in the number and morphology of monocytes in pathology
1.9. Hereditary leukocyte abnormalities
1.10. Lymphocytopoiesis. Morphology and function of lymphoid cells
1.11. Changes in the number and morphology of lymphoid cells in pathology
1.12. Thrombocytopoiesis. Cell morphology and function

Chapter 2. Anemia (S.G. Vashshu-Svetlitskaya)
2.1. Classifications of anemias
2.2. Basic laboratory data for the diagnosis of anemia
2.3. Acute post-hemorrhagic anemia
2.4. Anemias associated with impaired iron metabolism
2.4.1. Metabolism and the role of iron in the body
2.4.2. Iron deficiency anemias
2.4.3. Laboratory diagnostics of iron deficiency anemias
2.5. Anemias associated with impaired synthesis or utilization of porphyrins
2.6. Megaloblastic anemias
2.6.1. Metabolism and the role of vitamin B12 in the body
2.6.2. Laboratory diagnostics of vitamin B12-deficiency anemia
2.6.3. Folic acid deficiency anemias
2.7. Hemolytic anemias
2.7.1. Causes and signs of hemolytic anemias
2.7.2. Classification of hemolytic anemias (Idelson L.I., 1979)
2.7.3. Hereditary microspherocytosis
2.7.4. Hemolytic anemias associated with impaired erythrocyte enzyme activity (fermentopathy)
2.7.5. Hemolytic anemias associated with impaired hemoglobin synthesis (hemoglobinopathies)
2.7.6. Hemolytic disease of the newborn
2.7.7. Autoimmune hemolytic anemias
2.8. Aplastic anemias
2.9. Agranulocytosis

Chapter 3. Hemoblastosis (T.S. Dadnov)
3.1. Etiology, pathogenesis, classification of hemoblastoses
3.2. Chronic myeloproliferative diseases
3.2.1. Chronic myeloid leukemia
3.2.2. Polycythemia vera (erythremia)
3.2.3. Idiopathic myelofibrosis (benign subleukemic myelofibrosis)
3.2.4. Chronic monocytic leukemia
3.2.5. Chronic myelomonocytic leukemia
3.2.6. Myelodysplastic syndromes
3.3. Lymphoproliferative Disorders
3.3.1. Chronic lymphocytic leukemia
3.3.2. Paraproteinemic hemoblastosis
3.4. Acute leukemia

Chapter 4. Leukemoid reactions (TS Dalnova)
4.1. Leukemoid reactions of the myeloid type
4.2. Leukemoid reactions of the lymphoid type
4.3. Infectious mononucleosis

Chapter 5. Radiation sickness (S.G. Vasiliu-Svetlitskaya)
5.1. Acute radiation sickness
5.2. Chronic radiation sickness

Chapter 6. Methods of hematological research (T.S.Dalnova, S.G. Vasiliu-Svetlitskaya)
6.1. Taking blood for research
6.2. Determination of blood hemoglobin
6.2.1. Hemiglobincyanide method using acetonecyanohydrin
6.3. Counting the number of blood cells
6.3.1. Determination of the number of red blood cells in the chamber
6.3.2. Determination of the color index
6.3.3. Calculation of the average hemoglobin content in one erythrocyte
6.3.4. Determination of the number of leukocytes
6.4. Calculation of the leukocyte formula. Investigation of the morphology of blood cells
6.5. Features of the leukocyte formula in children
6.6. Determination of the erythrocyte sedimentation rate (ESR)
6.7. Counting the number of platelets
6.7.1. Direct methods of counting the number of platelets
6.7.2. Indirect methods of counting the number of platelets
6.8. Counting the number of reticulocytes
6.9. Revealing basophilic granularity (basophilic puncture) of erythrocytes
6.10. Staining smears to identify siderocytes
6.11. Identification of Heinz-Ehrlich bodies
6.12. Erythrocyte resistance
6.12.1. Photometric method for determining the osmotic resistance of erythrocytes
6.12.2. Macroscopic method of Limbeck and Ribière
6.13. Measurement of the diameter of red blood cells (erythrocytometry)
6.14. Bone marrow examination
6.14.1. Bone marrow puncture
6.14.2. Counting megakaryocytes
6.14.3. Counting myelokaryocytes (bone marrow nucleated cells) in 1 liter of bone marrow punctate
6.14.4. Bone marrow cytological examination with myelogram count
6.15. Lupus erythematosus cells

Chapter 7. Automatic methods of blood cell analysis (TS Dalnova)
7.1. Analyzer types
7.2. Hemoglobin concentration (HGB)
7.3. Red blood cell count per unit of blood volume (RBC)
7.4. Hematocrit (HCT)
7.5. Mean erythrocyte volume (MCV)
7.6. Average hemoglobin content in erythrocyte (MCH)
7.7. Average concentration of hemoglobin in erythrocyte (MCHC)
7.8. Red blood cell anisotropy coefficient (RDW)
7.9. White blood cell count (WBC)
7.10. Platelet count (PLT)
7.11. Mean Platelet Volume (MPV)

Chapter 8. Antigens of blood cells (TS Dalnova)
8.1. Antigens and blood groups
8.2. AB0 system
8.3. Determination of blood group using standard isohemagglutinating sera and cross method
8.4. Errors in determining blood groups
8.5. Determination of the blood group of the AB0 system using monoclonal antibodies (tsoliclones)
8.6. Rhesus system (Rh-Hr)
8.6.1. Determination of Rh-affiliation of blood
8.6.2. Determination of the Rh factor RHO (d) using a standard universal reagent

Section III. BIOCHEMICAL RESEARCH
Chapter 1. Biochemical analyzes in clinical medicine (E. T. Zubovskaya, L. I. Alekhnovich)
1.1. Rules for taking and storing biological material
1.2. Quantitative analysis methods
1.3. Calculations of research results
1.4. Modern technologies of automated clinical and biochemical studies
1.4.1. Classification of autoanalyzers
1.4.2. Classification of autoanalyzers depending on the characteristics of the technology for performing clinical and laboratory studies
1.4.3. Selected representatives of modern automated devices for performing clinical and biochemical studies
1.4.4. Automated systems for clinical chemistry
OLYMPUS (biochemical analyzers AU 400, AU 600, AU 2700, AU 5400)
1.5. "Dry" chemistry technology

Chapter 2. Quality control of laboratory tests (E. T. Zubovskaya)
2.1. Internal laboratory quality control
2.2. Reproducibility control to assess the quality of the laboratory technician's work
2.3. Control of the correctness of research results

Chapter 3. Research of protein metabolism (B.C. Kamyshnikov)
3.1. General properties of proteins
3.2. Amino acid classification
3.3. Protein molecule structure
3.4. Protein classification
3.5. Digestion and absorption of proteins
3.6. Protein biosynthesis
3.7. Deamination, decarboxylation and transamination of amino acids
3.8. Biological functions of proteins
3.9. Determination of proteins in serum (plasma) blood
3.9.1. Determination of total protein
3.9.2. Determination of total protein in serum (plasma) of blood by the biuret method (Kingsley-Weixelbaum)
3.9.3. Determination of the content of albumin in serum (plasma) of blood by reaction with bromcresol green
3.9.4. Colloid resistance samples
3.9.5. Thymol test
3.9.6. Determination of the content of beta and prebeta lipoproteins (apo-B-LP) of blood serum by the turbidimetric method (according to Burstein and Samay)
3.9.7. Study of the protein spectrum of blood
3.9.8. Serum protein electrophoresis
3.9.9. Clinical and diagnostic value of the study of proteinograms

Chapter 4. Residual nitrogen and its components (E. T. Zubovskaya, L. I. Alekhnovich)
4.1. Urea and methods for its determination
4.1.1. Determination of urea by diacetyl monooxime method
4.1.2. Determination of urea in blood serum and urine by the enzymatic method
4.1.3. Clinical and diagnostic value of the study of the content of urea and other nitrogen-containing components of blood plasma
4.2. Determination of creatinine in blood and urine
4.2.1. Determination of creatinine in serum and urine by Jaffe color reaction (Popper et al. Method)
4.2.2. Kinetic version of creatinine determination
4.2.3. Clinical and diagnostic value of the study of creatinine concentration in blood serum and urine
4.2.4. Hemorenal tests (creatinine clearance test)
4.3. Uric acid
4.3.1. Determination of uric acid content by the colorimetric method of Müller-Seifert
4.3.2. Determination of uric acid content by ultraviolet photometry
4.3.3. Determination of the concentration of uric acid in biological fluids by the enzymatic colorimetric method
4.3.4. Clinical and diagnostic value of the study of the content of uric acid

Chapter 5. Enzymes (E. T. Zubovskaya)
5.1. Determination and properties of enzyme activity
5.2. Enzyme classification
5.3. Enzyme activity units
5.4. Clinical and diagnostic value of enzyme activity determination
5.5. Enzyme research methods
5.5.1. Determination of aminotransferase activity
5.5.2. Colorimetric dinitrophenylhydrazine method for studying the activity of aminotransferases in blood serum (according to Reitman, Frenkel, 1957)
5.5.3. Kinetic method for determining the activity of AST
5.5.4. Kinetic method for determining the activity of ALT
5.5.5. Clinical and diagnostic value of determining the activity of aminotransferases in blood serum
5.6. Determination of phosphatase activity
5.6.1. Determination of alkaline phosphatase activity
5.6.2. Clinical and diagnostic value of determining the activity of phosphatases
5.7. Determination of the activity of a-amylase in blood serum and urine
5.7.1. Determination of the activity of a-amylase by the Karavey method (micromethod)
5.7.2. Determination of the activity of a-amylase in biological fluids by the enzymatic method by the endpoint
5.7.3. Clinical and diagnostic value of determining the activity of a-amylase in blood and urine
5.8. Determination of the total activity of lactate dehydrogenase
5.8.1. Kinetic method for determining LDH activity
5.8.2. Clinical and diagnostic value of determining the total activity of LDH and its isoenzymes
5.9. Determination of serum creatine kinase activity
5.9.1. Clinical and diagnostic value of determining the activity of QC
5.10. Determination of cholinesterase activity
5.10.1. Determination of serum cholinesterase activity by express method using indicator test strips
5.10.2. Clinical and diagnostic value of the study of serum cholinesterase activity
5.11. Study of the activity of γ-glutamyl transpeptidase
5.11.1. Clinical and diagnostic value of determining the activity of GGTP

Chapter 6. Research of carbohydrate metabolism (E. T. Zubovskaya, L. I. Alekhnovich)
6.1. The biological role of carbohydrates
6.2. Classification of carbohydrates
6.3. Digestion and absorption of carbohydrates
6.4. Intermediate carbohydrate metabolism
6.5. Regulation of carbohydrate metabolism
6.6. Pathology of carbohydrate metabolism
6.7. Determination of blood glucose
6.7.1. Conditions for increasing the reliability of analytical determination
6.7.2. Determination of glucose in blood and urine by color reaction with orthotoluidine
6.7.3. Determination of glucose content by enzymatic method (using the example of using the traditional methodological approach associated with the use of certified reagent kits)
6.7.4. Clinical and diagnostic value of glucose determination in blood and urine
6.8. Glucose Tolerance Tests
6.8.1. Pathophysiological mechanisms of changes in glucose concentration during TSH
6.9. Methods for studying carbohydrate-containing proteins and their components in the blood
6.9.1. Turbidimetric method for determining the level of seroglycoids in blood serum
6.9.2. Clinical and diagnostic value of determination of seroglycoids and glycoprotein fractions in blood serum
6.9.3. Individual representatives of glycoproteins
6.9.4. Determination of the level of haptoglobin in blood serum (Karinek method)
6.9.5. Clinical and diagnostic value of haptoglobin determination
6.10. Determination of ceruloplasmin content
6.10.1. Determination of the level of ceruloplasmin in serum by the method of Ravin
6.10.2. Clinical and diagnostic value of ceruloplasmin determination in blood serum
6.11. Study of the content of sialic acids

Chapter 7. Lipid metabolism (B.C. Kamyshnikov, L.I. Alekhnovich)
7.1. Lipid classification
7.2. Plasma lipoproteins
7.3. Digestion and absorption of lipids
7.4. Interstitial lipid metabolism
7.5. Theory of b-oxidation of fatty acids
7.6. Regulation of lipid metabolism
7.7. Lipid metabolism pathology
7.8. Determination of the level of total lipids in blood serum by color reaction with sulfophosphovaniline reagent
7.9. Clinical and diagnostic value of determining the level of total lipids
7.10. Cholesterol
7.10.1. Method for determining the level of total cholesterol in blood serum, based on the Liebermann-Burchard reaction (Ilk method)
7.10.2. Determination of total cholesterol concentration in serum and blood plasma by enzymatic colorimetric method
7.10.3. Clinical and diagnostic value of the study of cholesterol
7.10.4. Method for determining the level of high-density lipoprotein cholesterol (a-cholesterol)
7.10.5. Clinical and diagnostic value of a-cholesterol
7.11. Phenotyping of dyslipoproteinemias
7.12. Lipid peroxidation

Chapter 8. Research of pigment metabolism (B.C. Kamyshnikov, E. T. Zubovskaya)
8.1. Methods for determination of bilirubin in blood serum
8.1.1. Determination of bilirubin content by colorimetric diazo method by Jendrashik-Cleggorn-Grof
8.1.2. Clinical and diagnostic value of the study of indicators of pigment metabolism
8.2. Physiological jaundice of newborns
8.3. Exchange of porphyrins in normal and pathological conditions
8.4. Semi-quantitative method for determination of coproporphyrins according to Ya.B. Reznik and G.M. Fedorov

Chapter 9. General concepts of metabolism and energy (E. T. Zubovskaya, L. I. Alekhnovich)
9.1. Metabolism
9.2. Interrelation of protein, fat and carbohydrate metabolism
9.3. Bioenergetics of the cell
9.4. The role of the liver in metabolism

Chapter 10. Vitamins (L.I. Alekhnovich)
10.1. Fat-soluble vitamins
10.2. Water-soluble vitamins

Chapter 11. Hormones (E. T. Zubovskaya)
11.1. Understanding hormones
11.2. The mechanism of action of hormones
11.3. Thyroid hormones
11.4. Parathyroid hormones
11.5. Adrenal hormones
11.5.1. Adrenal medulla hormones
11.5.2. Adrenal cortex hormones
11.6. Pancreatic hormones
11.7. Sex hormones
11.8. Pituitary hormones
11.9. Thymus
11.10. Epiphysis (pineal gland)
11.11. Tissue hormones
11.12. Methods for determining hormones

Chapter 12. Water-electrolyte exchange (V.S. Kamyshnikov)
12.1. Water metabolism disorders (dyshydria)
12.2. Determination of the content of electrolytes (potassium, sodium, calcium)
12.2.1. Clinical and diagnostic value of the study of potassium and sodium
12.2.2. Methods for determining the level of calcium in serum (plasma) blood
12.2.3. Determination of the level of total calcium in blood serum by a photometric method based on the reaction with glyoxal-bis- (2-hydroxyanyl)
12.2.4. Clinical and diagnostic value of determining the level of calcium
12.3. Clinical and diagnostic value of magnesium content determination
12.4. Determination of the content of chlorine ions in blood serum, urine and cerebrospinal fluid by the mercurimetric method with the indicator diphenylcarbazone
12.5. Clinical and diagnostic value of the determination of chloride ions in biological fluids
12.6. Clinical and diagnostic value of determining the level of inorganic phosphorus in blood serum and urine
12.7. Study of the level of iron and iron-binding capacity of blood serum
12.7.1. Batophenanthroline method for determination of blood serum iron content
12.7.2. Determination of total and unsaturated iron-binding capacity of blood serum
12.7.3. Clinical and diagnostic value of determination of iron and iron-binding capacity of blood serum

Chapter 13. Acid-base state (B.C. Kamyshnikov)
13.1. Violation of the acid-base state
13.2. Determination of the acid-base state

Chapter 14. The system of hemostasis (E. T. Zubovskaya)
14.1. Characterization of plasma factors
14.2. Pathology of the hemostasis system
14.3. Study of the hemostasis system
14.3.1. Collection and processing of blood
14.3.2. Appliances and utensils
14.3.3. Reagents
14.4. Research methods of primary hemostasis
14.4.1. Determination of the duration of capillary bleeding according to Duke
14.4.2. Platelet aggregation
14.5. Secondary hemostasis research methods
14.5.1. Determination of the coagulation time of venous blood according to Lee-White
14.5.2. Determination of the clotting time of capillary blood by the method of Sukharev
14.6. Quality control of coagulogram tests
14.7. Determination of activated partial thromboplastin time (APTT)
14.8. Determination of prothrombin time
14.8.1. Quick method
14.8.2. Tugolukov's method
14.8.3. Lehmann method
14.9. Determination of the content of fibrinogen in blood plasma by the Rutberg method
14.10. Determination of natural (spontaneous) lysis and retraction of the fibrin clot

Security questions for sections

II. Hematological studies (T.S. Dalnova, S.G. Vashshu-Svetlitskaya)

Tests for paramedic laboratory assistants
I. General clinical research (A.B. Khodyukova)
II. Hematological studies (T.S. Dalnova, S. G. Vashshu-Svetlitskaya)
III. Biochemical research (E.T. Zubovskaya, L.I. Alekhnovin, B.C. Kamyshnikov)

Rules for compliance with the sanitary and epidemiological regime in clinical diagnostic laboratories
Conclusion (V.S. Kamyshnikov)
Literature