Influenza Test

The swab that used to collect specimen for influenza testing.

How the specimen is collected from patient

How the test is carry out and interpretation of the result.

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WWF

Equipment:

6 types of reagent .

Procedure:

1. Add 8000μl of saline in a container.
2. Withdraw 100μl of the saline and replace it with the same amount of patient's serum. 
3. Add 1000μl of the diluted sample into 6 tests tubes which containing 6 different types of  reagents in it. (1 drop in each)
4. Incubate in water bath for 5 hours.

Result Interpretation:

• Positive result will shown in the sedimentation of the colored reagent.

Immunology department

Abbott i 1000 SR

Monitor Screen: " Patient order" page

Sample: Patient's blood serum.

Reagent reloading...

Checklist:

• Daily maintenance:
1. Check if any sample is running, if no, change the analyzer to "ready mode" by pausing it.
2. Press the "system" button and select "maintenance".
3. Fill the particular container with distill water and add 4 drops of saline.
4. Fit the container on a rack and place them to "position 12"
5. Click perform, OK and proceed 2 times.
• Reagent checking:
• All the reagents which have been calibrated can be load into the analyzer when the samples are running.
• However, only trigger and pre-trigger reagents must be reloaded during ready mode.
• Only when the analyzer is in running mode, the sample can gone through the test.
• Running the test:
1. Record and key in patient's detail with the requested tests according to the requisition form.
   Steps: Select "patient order" → C: " code of the rack"  P:"position"→ Select "patient details"

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Tests that performed:

FT4, FT3 and TSH are Thyroid hormones.

• When FT3 ↓ FT3 ↓, while TSH ↑    =  Hypothyroidism
• When FT3 ↑ FT3 ↑, while TSH ↓    =  Hyperthyroidism

AFP (Alpha-fetoprotein) is Liver Tumor Marker.

• Protein that produced by fetal liver.
• The concentration of AFP elevate when a baby is born and then decline rapidly until there is liver damage or certain cancer.
• Aids in detecting liver, testes and ovarian cancer.
• Monitor the patient with chronic liver diseases or monitor the patient's treatment against hepatocellular carcinoma.

CEA (Carcinoembryonic Antigen) is common Tumor Marker.

• Monitor the treatment against colon cancer
• Determine prognosis ( the likelihood a disease to be healed )
• To stage cancer.
• Determine the spreading of cancer into body cavity.

Ca125 is Ovarian Tumor Marker.

PSA (Prostate specific antigen) is Prostate Tumor Marker

• PSA is a type of protein which produced by the prostate cells and being released into the semen, however small amount of the PSA will also being released into the blood.
• There are two forms of PSA exist in the blood:  Free PSA (not bound) & Complexed PSA (cPSA) (bound to other proteins).
• We can measure either Free PSA or Total PSA (both bound and unbound) through lab tests.
• The range for PSA rises according to the man age.

HIV Ag/Ab

Anti-Hbs (HbsAb)

HBsAg - Hepatitis antigen

Anti-HCV

External test : 

Ca199 is the Tumor Marker for Pancreatic cancer.

Ca153 is the Tumor Marker for Breast Cancer.

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Reference:

https://labtestsonline.org/understanding/

Dengue IgM/IgG and NS1

• There are total 4 distinct serotypes of dengue virus (DV) namely, DV-1,-2,-3 and -4, which are mainly transmitted by the Aedes mosquitos.
  
  
• NS1 (nonstructural protein 1) is a highly-conserved glycoprotein which present at high concentration in the serum during early stage of the disease infection.
  
• NS1 antigen is detectable within the first to nine days following the onset of symptoms in the primary or secondary dengue infected patient.
  
• IgM will only be determined after 5 to 6 days of the onset of illness for primary infection while 4 to 5 days after the illness onset for secondary infection.
  
• IgG will only appear after 14 days in primary infection while for secondary infection, it rise within one or two days and will induce the release of IgM after 20 days of infection.

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There are two types of test devices we are using in this lab to identify the dengue virus infection, Dengue NS1 and Dengue IgG/IgM.

The former is the solid phase immunochromatographic assay for the detection of dengue antigen (NS1) while the latter aids in the detection and differentiation of antibodies (IgG/IgM) against dengue virus.

Both use patient's serum/plasma or whole blood as testing sample.

Dengue NS1 test device.

Procedure:

Result Interpretation: 

Dengue IgG/IgM test device.

Procedure:

 Result Interpretation:

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Reference:

1. http://www.biogatelab.com/uploads/3/1/1/5/3115507/dengue_ns1__cassette.pdf

Serology department.

In Serology department, the equipment which is commonly used in all of the tests is the timer.

There are some tests which will be performed on a background card placed on the rotater while the other tests are performed using the reagent containing test kits.

The rotater in 100 revs/min with 4 types of background cards and timer on top of it.

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Background card.

* VDRL test uses a white background while ASOT and ANF test use dark background*

*Monospot test uses transparent background*

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About the Tests:

ASOT (Antistreptolysin O (ASO) titer)
It is a blood test which used to determine whether the patient has been infected by the Streptococcus bacteria. The test is performed by measuring the antibodies (Antistreptolysin O) against the exotoxin (known as "Streptolysin O") which is produced by the group A Streptococcus bacteria.



Procedure:

1. 1 drop of sample and 1 drop of reagent are mixed evenly on a dark background card.
2. Placed the card on the rotator and wait for 3 minutes.

Interpretation of result:
Positive result will shown in agglutination of the sample with the reagent.

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ANF Anti-nuclear factor
Also known as ANA (Antinuclear antibody) test , is used to evaluate whether a patient is having any autoimmune disorder. 

ANA are a group of autoantibodies which produced by a person's immune system when it is unable to differentiate between own cells and external antigen.


Both ANF and ASOT tests are usually carry out  when the patient is having joint pain/arthritis.



Procedure:

1. 1 drop of sample and 1 drop of reagent are mixed evenly on a dark background card.
2. Placed the card on the rotater and wait for 3 minutes.

Interpretation of result:

Positive result will shown in agglutination of the sample with the reagent.

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VDRL (Venereal Disease Research Laboratory)
Or known as RPR (Rapid Plasma Reagin) test, is a serological screening test that use RPR Carbon antigen for the qualitative and semi-quantitative detection of syphilis in patient's serum or plasma.

This VDRL antigen test is a non-Treponemal test which means that the antibodies detected in the patient's sample are not specific to the Treponema pallidium. Therefore, when the test shown positive result, the doctor might ask us to do further testing on that sample with TPHA test which is more specific.

Treponema pallidium is a spirochaete microorganism that cause the venereal disease, Syphilis.


The VDRL test is functioned by measuring the antibodies which is produced in response to the lipoidal material released from damaged host cells and lipoprotein like substance that released by the bacteria.

In addition to screening, the RPR test can also be used to monitor the treatment of syphilis. In this case, the level(titer) of the antibodies presented will measured through dilution.


*Titer: A unit of measurement in the clinical laboratory, which is the lowest dilution of a substance for the particular reaction to take place. *



Procedure:

1. Place one drop (50μl) of the patient's sample on the white test card and allow one drop of the VDRL Carbon Particle Antigen to fall on it.
2. Spread the solution on the RPR test card to cover the test circle.
3. Rotate the test card for 8 minutes at 100 revolution/minutes.

Interpretation of result:

Positive result will shown in agglutination of the sample with the reagent.

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Monospot / Mononucleuosis test /Mono test

This test is used to determine whether the patient has infectious mononucleosis.

• use transparent test card

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Various test devices:

Mycoplasma Pneumoniae (MP) Antibody(IgM) Test

Introduction:
Mycoplasma pneumonia is associated with various non respiratory diseases such as meningitis, encephalitis, pancreatitis and arthritis. Culture of the organism can be used for the diagnosis of infection, however it will be difficult because it is insensitive and takes about 3 weeks for the result. For this reason, we only apply serological method for the diagnosis of M.pneumonia infection in our laboratory.



Principle of the test:

(Colloidal Gold Chromatography)
The Control region consist of HAMAs;
 Test region consists of MP antigen;
 Sample well consists of anti-human MP antibody.

If the sample containing MP antibody, it will form complexes with the anti-human MP antibody.
The complexes will then bind to the immobilized MP antigen and forms a red line at the test region while the unbounded complexes will be captured by the HAMAs at C region and form red line indicating the validity of the test kit.





Sample Preparation:
Fresh whole blood, plasma or serum is used as the cardiac proteins are relatively unstable.





Procedure:

1. Add 1 drop of the sample (30μl) and 2 drops of buffer to the sample well of the test panel.
2. Start the timer ( 15 minutes)    *if after 20 minutes, the result will be invalid.*

          

Interpretation:

• Solely Control line --- Negative
  
• Solely Test line --- Invalid
  
• Both Control and Test line --- Positive