The history of pathology testing is dated back to the 3rd century BC, when Greek scholars such as Herophilos and Eriasistratus began systematically examining dead bodies. At the beginning of the first century AD, several Greek, Roman and Arabian physicists made significant developments in the understanding of the pathology of tumors. In the 18th century, Giovanni Morgangi correlated the symptoms of his patients with the pathological evaluations o the autopsies. The discovery of the circulation of blood by William Harvey and the emergence of microsby is regarded as the foundation of modern pathology. The 19th and 20th centuries experienced an accelerated pace of discoveries in pathology. The medical discipline of clinical; hematology has gained impetus in the recent years and focuses on the analysis of the numbers and morphology of the blood cells in diseases such as anemia.
The significance of clinical hematology testing is observed in the diagnosis of diseases like anemia, which is characterized by a lower than normal number of red blood cells, or less amount of hemoglobin in the RBCs, resulting in symptoms such as shortness of breath, dizziness, and headaches. The diagnosis of anemia begins with complete blood count, which quantifies hemoglobin, hematocrit (Hct) and means corpuscular volume (mcv). Hct is the measure of the volume of space occupied by the RBC’s, and Mcv is the average size of RBCs. RBC is determined by placing a drop of the patient’s blood over a glass slide, air dried and sustained with Romanofsky stain.
A case study demonstrates the importance of blood testing in the diagnosis and treatment of the iron deficiency anemia, which is caused due to the decreased number of RBC’s and iron levels in the body. Lack of energy and shortness of breath are the common symptoms of iron deficiency anemia. The blood tests of a 71-year-old Africa American lady with unusual fatigue, shortness of breath reveal lower levels of hemoglobin, iron binding protein ferritin, and MCV iron circulation. The physician suspects iron deficiency anemia, and she is immediately admitted to the hospital for the intravenous infusion of 1750 mg iron over 6 hours. Five weeks after discharge, her iron elated blood parameters are restored to normal, and her symptoms disappeared. From this case study, it is evident, that the laboratory analysis of iron related factors enabled he physician to make an appropriate diagnosis of iron deficiency anemia. Since low MCV is a characteristic feature of iron deficiency anemia, the physicians were able to diagnose and treat the patient promptly and specifically with iron supplementation.
In the period between 1950s and 1980s, there was considerable interest in the development of techniques for qualifications of analyze in biological samples like urine and blood, and the discipline of clinical biochemistry emerged. A case study of Type 1 Diabetes Mellitus (T1DM) of a 3-year clearly validates the implication of clinical biochemistry. T1 DM is an autoimmune disease in which the body generates antibodies against its own pancreatic cells that produce insulin. Following one week of bedwetting at night, frequent urination, and a marked increase in hunger and thirty, the patient’s urinalysis shows the presence of glucose and ketones, which is the byproduct of the metabolic breakdown of fats in the urine. Blood glucose examination reveals the presence of blood glucose, which is as high as 810 mg/dl. The pediatrician suspects T1DM with diabetic ketoacidosis (DKA). The patient is rushed to hospital for rehydration and insulin therapy. Patients with DKA are considered to be a medical emergency as they are at a high risk of coma, cerebral oedema and death. Once she is stabilized, a multidisciplinary team of nutritionist and endocrinologist assists her family in meal planning, assessment of blood glucose, insulin therapy, and management of the complications of T1DM. Periodic testing of her glucose levels and ketones enables the team to evaluate her health status and the efficiency of her treatment regimen.
Another example further highlights the usefulness of clinical biochemistry in diagnosis and nursing of a patient suffering with a urinary tract infection (UTI). Nursing intervention in this case largely depends on the laboratory examination of parameters such as electrolytes and blood urea nitrogen (BUN) (11). Urinary tract infection (UTI) is caused mostly by the infectious Escherichia coli, which colonizes the urethra and may further invade the urinary bladder and kidneys. The renal system is primarily responsible for regulating the electrolyte balance in the circulation.
A patient with electrolyte imbalance, low concentrations of electrolytes and high BUN is administered with a fluid intake of 1500 ml and intravenous fluid replacement therapy. The periodic results of the analysis of electrolyte status received from the laboratory indicates the improvement in the hydration of the patient by the end of the day. The nursing goals would include the administration of fluid replacement of saline 0.9 and electrolyte replacement therapy, as ordered, monitoring of output and intake ratios, further biochemical analysis of critical enzymes such as creatine and hepatitis enzymes. After the patient has stabilized, the doctor would instruct the patient for a regular follow-up. This, the pathology testing of electrolytes and hepatitis enzymes are significant for determining efficient medical goals and monitoring regimen for patients with UTI’s.
