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L i n n é & R i n g s r u d ’ s
C L I N I C A L
L A B O R A T O R Y
S C I E N C E
Concepts, Procedures, and
Clinical Applications
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L i n n é & R i n g s r u d ’ s
C L I N I C A L
L A B O R A T O R Y
S C I E N C E
Concepts, Procedures, and
Clinical Applications
Mary Louise Turgeon, EdD, MLS(ASCP)CM
Clinical Laboratory Education Consultant
Mary L. Turgeon & Associates
Boston, Massachusetts, and St. Petersburg, Florida
Adjunct Professor and Academic Consultant
Northeastern University
College of Professional Studies
Boston, Massachusetts
Professor
South University
Physician Assistant Program
Tampa, Florida
With 240 illustrations
7th edition
3251 Riverport Lane
St. Louis, Missouri 63043
LINNÉ & RINGSRUD’S CLINICAL LABORATORY SCIENCE: CONCEPTS, PROCEDURES, AND CLINICAL
APPLICATIONS, SEVENTH EDITION
ISBN: 978-0-323-22545-8
Copyright © 2016 by Mosby, an imprint of Elsevier Inc.
Copyright © 2012, 2007, 1999, 1992, 1979, 1970 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Details on how to seek permission, further information about
the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center
and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
Library of Congress Cataloging-in-Publication Data
Turgeon, Mary Louise, author.
Linné & Ringsrud’s clinical laboratory science: concepts, procedures, and clinical applications / Mary Louise
Turgeon. – Seventh edition.
p. ; cm.
Linné and Ringsrud’s clinical laboratory science
Clinical laboratory science
Includes bibliographical references and index.
ISBN 978-0-323-22545-8
I. Title. II. Title: Linné and Ringsrud’s clinical laboratory science. III. Title: Clinical laboratory science.
[DNLM: 1. Clinical Laboratory Techniques–methods. 2. Biomedical Technology–methods. QY 25]
RB37
616.07’56–dc23
2014045691
Content Development Specialist: Jennifer Wade/Matt Rosenquist
Traditional Content Development Manager: Laurie Gower
Executive Content Strategist: Kellie White
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Kiruthiga Kasthuriswamy
Book Designer: Brian Salisbury
Printed in China
Last digit is the print number: 9
8
7
6
5
4
3
2
1
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
PATRICIA TILLE, PhD, MLS(ASCP)CM
Medical Laboratory Science Program Director
Assistant Professor
University of South Dakota
Vermillion, South Dakota
Chapter 15, Introduction to Microbiology
C O N T R I BU TOR S
v
vi
Mary Louise Turgeon, EdD, MLS
(ASCP)CM is an author, professor, and
consultant
in
medical
laboratory
science. Her books are Basic & Applied
Clinical Laboratory Science, ed
7
(2015); Immunology and Serology in
Laboratory Medicine, ed 5 (2013);
Clinical Hematology, ed 5 (2012); and
Fundamentals of Immunohematology,
ed 2. Foreign language editions have
been published in Chinese, Spanish,
and Italian.
Dr. Turgeon has eighteen years of university and fifteen
years of community college teaching and program admin-
istration experience. She currently teaches undergraduate
and graduate students in online and on-the-ground formats
in Massachusetts and Florida. Guest speaking, scientific pre-
sentations, and technical workshops complement her teach-
ing and writing activities. Her consulting practice (www.
mlturgeon.com) focuses on new health professions program
development, curriculum revision, various types of course
development, and increasing teaching effectiveness in the
United States and internationally.
AB O UT T H E AUT H O R
Keith G. Bellinger PBT(ASCP); BA Biology Rutgers
College
Medical Technologist VANJ Healthcare System
Asst Professor Phlebotomy Rutgers (formerly UMDNJ/SHRP)
VANJ Healthcare System
Rutgers (Formerly UMDNJ/SHRP)
East Orange, New Jersey (VA)
Rutgers
Newark, New Jersey
Kathleen Doyle, PhD, MASCP, MLS(ASCP)CM
Medical Laboratory Scientist, Consultant, and Professor
Emeritus
University of Massachusetts Lowell
Lowell, Massachusetts
Kamil Haddad, MLT, BHA (Certified by the CSMLS,
OSMT, and CMLTO)
Program Chair, Medical Laboratory Assistant/Technician
Program
Everest College
Toronto, Ontario
Stephen M. Johnson, MS, MT(ASCP)
Program Director
Saint Vincent Health Center School of Medical Technology
Erie, Pennsylvania
Amy R. Kapanka, MS, MT(ASCP)SC
MLT Program Director
Hawkeye Community College
Waterloo, Iowa
Angela Njoku, MS, MT(ASCP)
Program Director
St. Louis Community College
St. Louis, Missouri
Susan M. Orton, PhD, D(ABMLI), MS, MT(ASCP)
Associate Professor
School of Medicine, The University of North Carolina
Chapel Hill, North Carolina
Tania Puro, CLS, MS, MT(ASCP)
California Clinical Lab Scientist
ASCP Medical Technologist
San Francisco State University
San Francisco, California
Carleen Van Siclen, MS, MT(ASCP)
Education Coordinator
Department of Laboratory Medicine and Pathology
Mayo Clinic
Jacksonville, Florida
R EVI EW ER S
vii
To Annie
March 19, 2000-April 29, 2013
ix
The intention of this seventh edition of Clinical Laboratory
Science: Concepts, Procedures, and Clinical Applications con-
tinues to fulfill the needs for a comprehensive textbook that
has the potential to meet multiple educational course needs.
This book is unique because input from reviewers and
field testing by instructors and undergraduate medical lab-
oratory technicians (MLT), undergraduate medical labora-
tory science (MLS) students, and graduate physician assistant
student end-users of the book contribute to the clarity and
vitality of the content.
The purpose of this edition continues to be to describe the
basic concepts in laboratory medicine, to outline the under-
lying theory of routine laboratory procedures done in clinical
laboratories of varying sizes and geographic locations, and
to present applicable case studies to help students integrate
theory and practice. The major topical areas are divided into
two sections: Part I: Basic Laboratory Techniques and Part II:
Clinical Laboratory Specializations.
This seventh edition capitalizes on the strengths of previous
editions. Every chapter has been critically reviewed and revised
as needed including references. The pedagogy of the book
remains the same with a topical outline and learning outcomes
at the beginning of each chapter. Key terms have been added
to each chapter. Laboratory exercises and review questions are
at the end of each chapter. Representative procedures use the
CLSI format to familiarize students with the recommended
procedural write-up encountered in a working clinical labora-
tory. Procedures published in the book are intended for student
laboratory use. Case studies are provided in every chapter of
the book. Illustrations and full-color photographs are used to
visually clarify concepts and arrange detailed information.
New to this edition for instructors on EVOLVE are leveled
learning outcomes and narrative answers to the critical think-
ing group discussion questions for each case study.
Highlights of the new general pedagogy features of this
new edition include:
•
Key terms for each chapter.
•
More higher level student learning outcomes objec-
tives and related multiple choice end-of-chapter review
questions.
•
More multiple choice questions for every chapter.
•
New group discussion critical thinking questions and
multiple choice questions for all case studies.
•
More redesigned laboratory procedures or exercise pre-
sentations for every chapter.
•
More tables and figures to explain concepts.
•
Laboratory-based written assignments.
•
Online certification style student test bank.
•
Enhanced and integrated web resources for instructors
and students.
•
Leveled student learning outcomes for instructors.
WHAT CONTENT IS SIGNIFICANTLY NEW
IN THE SEVENTH EDITION?
Highlights of Part I: Basic Laboratory Techniques
Chapter 1 Fundamentals of the Clinical Laboratory
This chapter features expanded coverage of medical ethics
with three new case studies, new top 10 CLIA lab deficiencies,
new regulations related to patient access to their laboratory
test results, and updated Clinical Laboratory Improvement
2013 information and expansion of content related to chain
of custody.
Chapter 2 Safety: Patient and Clinical Laboratory
Practices
This chapter has been extensively revised to reflect the newest
safety-related information. The newest OSHA 2013 Hazard
Communications updates are included, as are expanded cov-
erage of laboratory acquired infections, nail care and shoes
as safety issues in the laboratory, and a safety audit; new
Joint Commission National Patient Safety Goals Related to a
Laboratory Accreditation Program; content related to patient
safety, mitigating risk, and effective communications; and the
latest information on the Medical Waste Act—how to prop-
erly dispose of waste.
Chapter 3 Quality Assessment and Quality Control
in the Clinical Laboratory
This chapter expands content related to nonanalytical fac-
tors in quality assurance and monitoring quality control.
Emphasis is placed on Levey-Jennings charts. The latest top
10 CLIA deficiencies are included.
Chapter 4 Phlebotomy: Collecting and Processing
Patient Blood Specimens
This chapter evaluates the new 2014 American Hospital
Association Patient Care Partnership document. An expanded
discussion of evacuated blood collection tubes and bar codes
is presented.
Chapter 5 The Microscope
This chapter expands coverage of other types of microscopes
and illumination systems, and includes a discussion of digital
microscopy.
Chapter 6 Systems of Measurement, Laboratory
Equipment, and Reagents
This chapter adds the advantages and use of micropipettes,
volumetric pipettes, and serologic pipettes.
PR E FACE
x
Preface
Chapter 7 Laboratory Mathematics and Solution
Preparation
This chapter explains molality, molarity, osmolality, and
osmolarity. An example of a molality calculation is included.
Chapter 8 Basic and Contemporary Techniques in the
Clinical Laboratory
This chapter expands the content related to Beer’s law. In
addition, contemporary techniques are updated.
Chapter 9 Delivery of Laboratory Testing: From Point of
Care to Total Automation
This chapter features an updated instrument list. A new exer-
cise to perform a comparative analysis of competing instru-
ments or LIS systems is included.
Highlights of Part II: Clinical Laboratory
Specializations
Chapter 10 Introduction to Clinical Chemistry
New American Diabetic Association Guidelines for the
diagnosis of diabetes are included in the chapter. Emerging
glycemic biomarkers are presented. New American Heart
Association and the American College of Cardiology guide-
lines for measuring and treating cholesterol levels to prevent
cardiac disease are discussed.
Chapter 11 Principles and Practice of Clinical
Hematology
This chapter has been extensively reorganized to facilitate
the flow of content related to red blood cells and white blood
cells.
Chapter 12 Hemostasis and Blood Coagulation
This chapter includes the latest information related to ther-
apy and testing of new oral anticoagulants. Updates on plate-
let function testing and thromboelastometry are included.
Chapter 13 Renal Physiology and Urinalysis
Content related to urine cultures has been added.
Chapter 14 Examination of Body Fluids and
Miscellaneous Specimens
Content related to biomarkers for Alzheimer disease has been
added.
Chapter 15 Introduction to Microbiology
This chapter has been revised by a new contributor to reflect
the latest knowledge in the field of microbiology. A new sec-
tion on viruses has been added.
Chapter 16 Immunology and Serology
New content presented in this chapter includes comprehensive
content related to hypersensitivity. Allergies are discussed. Types
of antigens and reactions are presented. An extensive discussion
of Lyme disease and Epstein-Barr virus serology is included in
the chapter. Expanded content related to primary and second-
ary immunodeficiency disorders is presented. Autoimmune
disorders such as rheumatoid arthritis and systemic lupus ery-
thematosus are now included in the chapter. Gluten sensitivity
and celiac disease discussion have been added to the chapter.
Chapter 17 Immunohematology and Transfusion
Medicine
The newest Donor Questionnaire is included in this chapter.
Updated information on infectious disease screening of
donors is presented.
WAYS TO USE CLINICAL LABORATORY
SCIENCE, SEVENTH EDITION
Students can use Clinical Laboratory Science throughout their
two- or four-year curricula as either a principal or supplemen-
tary textbook. This comprehensive book is appropriate from
the beginning of a program to preparation after graduation
for Board of Certification and state licensure examinations.
Clinical Laboratory Science is used for medical laboratory
science courses such as Introduction to Clinical Laboratory
Science; Basic Laboratory Techniques and Core Laboratory;
Basics of Hematology, Clinical Chemistry, and Urinalysis.
Clinical Laboratory Science can be used for individual courses in
urinalysis and phlebotomy as well. The instructor EVOLVE site
has examples of course outlines for which the book can be used.
Clinical Laboratory Science also includes supplementary
content, multiple-choice questions, and case studies for spe-
cialty courses in clinical hematology, clinical microbiology,
clinical chemistry, immunology, and blood banking and
transfusion medicine.
Instructor and student feedback indicate that Clinical
Laboratory Science is a great book to use as a quick, additional
review source for Board of Certification and state licensure
examinations. The major content areas covered by medical
laboratory professional examinations are presented in Clinical
Laboratory Science. In addition, every chapter has numerous,
examination-style, multiple-choice questions.
Comments from instructors, other professionals, and stu-
dents are welcome at
