医学英语教学课件：Introduction to Basic Laboratory Test

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1、Introduction to Basic Laboratory Test-Clinical Laboratory DiagnosisTable of Content Introduction Objectives of laboratory Test Current trend in laboratory Test Basics in English Medical Terminology Microbiologic Studies Blood Studies Urine Studies Stool Studies Chemistry Studies Immunodiagnostic Stu

2、diesMy Research Philosophy and Focus知行合一知行合一/学以致用学以致用耐药细菌耐药细菌/病原菌的病原菌的研究研究(种类种类:药和菌药和菌, 机理机理/基因）基因）传播与变迁传播与变迁(时间时间/空间空间)微生态微生态(大环境大环境/小环境小环境)病原微生物病原微生物（细菌（细菌/病毒）病毒）快速/准确检测（对症下药/合理使用）临床指针国家政策生活方式改变生活方式改变/社会科技进步社会科技进步替代与减少替代与减少(Probiotics, 下一代药物开发）合理有效使合理有效使用抗生素用抗生素感染性疾病的治感染性疾病的治疗农业农业/养殖业养殖业/环境应用环境应用黄

3、色为我的第黄色为我的第一研究方向一研究方向红色为我的第二研究方红色为我的第二研究方向旨在创立：社会病原微生物学旨在创立：社会病原微生物学 Socio-Pathogenology.知行合一，知行合一， 学以致用学以致用Communication in English is Important Some Personal Experience Case 1: Postdoc Case 2: With P&G Emphasizing on leadership and communication skills Case 3: Negotiation in UCLAWide Definition of

4、 Content of Laboratory Tests 1.Conducted at Clinical Diagnosis Sector:Blood Studies Microbiologic Studies Urine Studies Stool Studies Cerebrospinal Fluid StudiesChemistry Studies Immunodiagnostic Studies2.Conducted in other specific labsNuclear Medicine StudiesX-ray StudiesCytology, Histology, and G

5、enetic StudiesEndoscopic StudiesUltrasound StudiesPulmonary Function and Blood Gas StudiesPrenatal Diagnosis and Tests of Fetal Well-BeingSpecial Systems, Organ Functions, and Postmortem St Objectives of Laboratory Tests Examples: Link 1 Basic screening (frequently used with wellness groups and case

6、 finding) Establishing (initial) diagnosis Differential diagnosis Evaluating current medical case management and outcomes Evaluating disease severity Monitoring course of illness and response to treatment Group and panel testing Regularly scheduled screening tests as part of ongoing care Testing rel

7、ated to specific events, certain signs and symptoms, or other exceptional situations (eg, infection and inflammation, sexual assault, drug screening, Prenatal Diagnosis, postmortem tests etc) Trends in laboratory Test (1) From “Laboratory” to “Point-of-Care” Test Requirement of patient side Possible

8、 due to technology development Comprehensive, multi-technology/methods Computer aided tomography with various scanning methods (Sound, Light, MRI, EPR, CT/PET, X-ray) Combination of imaging (physico-chemical) methods with analysis (biology/immuno/microbio methods) From diagnosis of single disease to

9、 whole health-care procedure Entire period of patient care Preventive, predictive diagnosis of diseaseTrends in laboratory Test (2) Full-Line automation & Individual Tests Automation for routine tests Personalized Medicine Molecular Diagnosis: UCLA service Molecular Oncology testing, including the c

10、ereal genes and mutation relevant to the diagnosis and consequent therapy for different cancers. Molecular Testing for Orphan Diseases Other Molecular Testing Relation of Cancer therapy with molecular genotypes :paper1, 2, 3,4, 5, 6, 7 Personalized drug effectiveness and sensitivity: To increase the

11、 effectiveness and to reduce toxicity To provide best cost/effeciency ratio Example of Saladex 5-FluouracilBasics in Medical English Terminology Formula 1:Word Root + SuffixWord Root + combining vowel + Suffix Fomula 2:Root1 + Vowel + Root2 + Suffix Formula 3:Prefix + Root + SuffixPrefix + Rt1 + Vow

12、el + SuffixPrefix + Root1 + Vowel + Root2 + SuffixWord RootsWord root is usually derived from Greek or Latins, and is a part of body, organ, tissues, cells/function etc.Examples 1: cephal, cerebrum, encephal, cervical, throacic, pecto, masto/mammo, cubit, lumbar,vertebro,laparo, costoExamples 2: nep

13、hro/reno, hepato, cardio, gastro, spleno, pancreato, stoma,dento, gingiv, gloss, naso/rhino, esophago, pharyngo, laryngo,dudeno, procto, recto, colon, colit, uro, uretero, urethrao, cysto/vesico, trachea, ophthalmo/oculo, retino, otoExamples 3: osteo, sialo, alvelo, adreno, glomerulo,lympho, myelo,

14、parathyroidoExamples 4: cyto, chromo, leuko, erythro, albino, adipo, hemo/hemato, morpho, karyo/nucleo,kerato/corneo, eosino, granulo, sidero, reticulo, thrombo, phago, immuno,adeno, angio,arthro, albumino, pyo, vesculo, spermato, prostato, orchido, galacto/lacto, gluco/glyco, andro, hystero/utero,

15、gyneco,somato, thymo, neuro, ventriculo, meningo, narco, opto,aqueo,audioSuffix Suffix usually indicates a disease, procedure, operation/surgery, conditiona/status Examples 1: -itis, -emia, -osis, -philia, -penia,-algia,-dynia, -emesis,-cele,-oma, -megaly, -pathy, -ptosis, -lith, -iasis, -ectasis, -

16、blast, -clast, Examples 2: -gen, -genesis, -poiesis, -rrhage, -rrhea, -scope, -scopy, -trophy, -lysis, -phil, pepsia, -parandial, Examples 3: -gram, -graph, -graphy, -gnosis, -meter, -metry, -logy, -logist, Examples 4: -centesis,- ectomy,-stomy, -tome, tomy, -pexy, -plasty, -therapy, Examples 5: adj

17、ectives (-ac, -ic, -ical, -ory, -ous,-tic), Noun (-ia, -iatry, -ism, -ist, -y), diminutives (-ole, -icle, ula,-ule), Plural (-ae, -aces-, -ina, -ices, -ies etc.)Prefix Prefix usually indicates a number, time, position, direction, negation: Examples 1 (Position/time/direction): ante-/pre-/pro-, epi-,

18、 hypo-/infra-/sub-, inter-, meso-/medi, post-, retro-, ab-, ad-, circum-/peri-, ec-/ex-, dia-/trans, ecto-/exo-/extra-, endo-/intra-, para-, meta-, ortho- Examples 2 (number): bi-, dipl-/diplo, hemi-/semi-, hyper-, macro-, micro-, mono-/uni-, multi-/poly-, primi-, quadri-, tri-, Examples 3 (negation

19、): a-, an-, im-, in-, Examples 4: dys-, anti-/contra-, brady-, eu-, hetero-, homo-, mal-, pan-, pseudo-, syn-, tachy-PretestIntratestPosttestTest background information Actual description of procedures Patient aftercare Normal (reference values) Specimen collection and transport Clinical, education,

20、 and procedure alerts Explanation of test Clinical implications of abnormal results Special cautions Indications for testing Interfering factors Interpretation of test results ; Actions to risk valueCares and intervention during different stagesMicrobiological StudiesTable of Content in Microbiologi

21、c Studies General overview Features; Basics in bacteria Key terminologies: Name of pathogens & antibiotics Sampling collection Evolution of mainstream technology in microbiology studies Recent progress in microbiology identification MALDI-TOF Molecular Biological methods Detection and Identification

22、 of MycobacteriaFeatures in Microbiologic Studies (1) Wide sample sources: Nasopharynx and Oropharynx, Sputum, Feces, Urine , Skin, Ear, Cerebrospinal Fluid, Vaginal Discharge, Urethral Discharge, Pus, Blood, any tissue/debris of organs. Involved in various disease; Daily monitoring for in-patients

23、Various pathogens: Virus, Protoza, Rickettsia, Bacteria (aerobes and anaerobes), Fungal, Parasites. Spirals, Mycoplasma;Features in Microbiologic Studies (2) Various Methods: Culture (different conditions: aerobic/anaerobic, Blood, automatic), mycobacterium (slow growth), staining, identification, m

24、olecular biological methods, serological methods, immunological methods, etc. Special requirement for specimen collection and handling Requires knowledge, techniques and experienceTerminology in Microbiology (1) Name of Pathogens Gram positive, Staphylococcus aureus, Coagulase-negative staphylococci

25、 Streptococcus pyogenes, Streptococcus agalactiae , Streptococcus pneumoniae, Staphylococcus epidermidis Enterococcus faecalis, Enterococcus faecium, Propionibacteriaceae acne, P. granulosom Gram NegativesShigella spp.Pseudomonas aegenosaStenotrophomonas maltophiliaAcinetobacter baumanniiHaemophilus

26、 influenzaeMoraxella catarrhalis黏膜炎莫拉菌Neisseria gonorrhoeae淋病奈瑟菌Eikenella corrodens 啮蚀艾肯菌Pasteurella multocida多杀巴斯德杆菌病Escherichia coliKlebsiella pneumoniaeKlebsiella oxytocaCitrobacter freundiiCitrobacter diversusEnterobacter cloacaeEnterobacter aerogenesSalmonella spp.Terminology in Microbiology (2

27、) Name of Pathogens Anaerobics AtypicalsBacteroides fragilis Group 脆弱拟杆菌Prevotella spp.普雷沃氏菌属Peptostreptococcus spp.消化链球菌属Clostridium perfringens产气荚膜梭菌Clostridium difficile 艰难艰难梭菌梭菌Mycoplasma pneumoniae肺炎支原体Ureaplasma spp.Chlamydia pneumoniae 沙眼沙眼支原体Mycobacterium abscessus脓肿分枝杆菌Mycobacterium chelona

28、e 龟龟分枝杆菌Mycobacterium fortuitum 偶偶发发分支杆菌分支杆菌Terminology in Microbiology (3) Names of Antibiotics 常用抗生素中英文对照表格 Other Terms MRSA, VRE, MDR, MIC, CFU, ESBL, Specimen collection and handlingSources: blood, pus or wound exudates or drainage, urine, sputum, feces, genital discharges or secretions, cerebro

29、spinal fluid (CSF), and eye or ear drainage.Avoid contaminating the specimen; maintain aseptic or sterile sterile syringe aspiration of pus or other body fluid; Anaerobic transport containers for tissue specimens.Appropriate temperature: usually refrigerated; but for CSF need quick incubation (menin

30、gococci do not withstand refrigeration) Salmonella and Shigella should be placed in a special transport medium, such as Cary-Blair.Specimen should be collected before antibioticsSpecimen should be collected timely and during the “window period”: e.g Influenza virus during 24-73 hrs after fever; duri

31、ng the fever.Care must be taken to avoid comtamination from environment and humanCare must be taken for biological safety during specimen collection, handling and shipment/.transportationDiagnosis of Bacterial Disease 1) Are bacteria responsible for this disease? (2) Is antimicrobial therapy indicat

32、ed? Susceptibility of Bacteria to Antimicrobial Agents: disk diffusion; Solution MIC; etc. resistant genes/enzymes.Detection of bacteria: Comparison of methods enumerating active bacteriaTotal direct countingMethodsVital stainingMicrocolonyDirect viable countingColony forming unit(plate counting)Cel

33、l numberStrainLowEstimation of viabilitySpeciesGenusStrain typingPFGERFLPDiversity of bacterial communityPCR-DGGEPCR-T-RFLPEnumeration of total cellTotal direct countingKingdomDiscrimination power(in situ PCR)Fluorescent antibodyFISHEnumeration of specific bacteriaCombined methodsEnumeration of viab

34、le cellMicrocolonyMicroautoradiographyDirect viable countingVital staining Serotype by agglunination test Latex agglutination Immunochromatography and other immuno methods Molecular Diagnosis MALDI-TOF Other methodsApplication of Matrix-assisted laser desorption/ionization-time of flight mass spectr

35、ometry (MALDI-TOF MS) in the Identification of clinical pathogensFlow Chart of MALDI Biotyper Bacterial Identification SystemBiotyperTM Software and database to identify the bacterialUnknown bacteria and other pathoggens?02000400060005000600070008000900010000m/zE. ColiPick single colony and load on

36、to the sample plateMALDI-TOFBacterial SpectrumFeatures： Accuracy Rapid Low running costClin Infect Dis. Use of MALDI-TOF in the identification of Anaerobic bacteriaMany reports of such case for different pathogensUse of MALDI-TOF to detect porin loss Carbapenem resistance for Gram-negatives are main

37、ly attributed to the produvtion of carbapenamase and high production of AmpC emzymes in combination of the loss of porins. Other factors including efflux pump and alterations in the target molevules. OmpK36 porins-deficient KP20878.83516096.02835962.67838702.08417973.703 19341.900?ATCC138830.00.51.0

38、1.54x10Intens.?a.u.24114.68516093.31520890.61836017.07817990.288?Z21100.00.51.01.52.04x10Intens.?a.u.16138.65536077.83620939.53918047.560?Z25540.00.51.01.52.04x10Intens.?a.u.20890.96837978.21216116.15036145.24518071.377?K102000400060008000Intens.?a.u.16093.66220886.92336104.43818072.630?K10010002000

39、300040005000Intens.?a.u.1500017500200002250025000275003000032500350003750040000m /zCai et al. JCM, 2012MALDI-TOF is able to identify and distinguish bacteria that were unable to be distinguished by the traditional bacteria identification methods Vitek 鉴定菌株鉴定菌株（数量）（数量）鉴定结果鉴定结果hisA基因测序基因测序16SrRNA 基因基因

40、测序测序MALDI-TOF MS洋葱伯克霍尔德洋葱伯克霍尔德菌菌 （118）B. cencepacia（94）B. cencepaciaB. cencepacia洋葱伯克霍尔德洋葱伯克霍尔德菌（菌（9）洋葱伯克霍尔洋葱伯克霍尔德菌德菌/稳定伯稳定伯克霍尔德菌克霍尔德菌洋葱伯克霍尔德菌洋葱伯克霍尔德菌多嗜伯克霍尔德多嗜伯克霍尔德菌（菌（11）多嗜伯克霍尔多嗜伯克霍尔德菌德菌多嗜伯克霍尔德菌多嗜伯克霍尔德菌越南伯克霍尔德越南伯克霍尔德菌（菌（3）越南伯克霍尔越南伯克霍尔德菌德菌越南伯克霍尔德菌越南伯克霍尔德菌吡咯伯克霍尔德吡咯伯克霍尔德菌（菌（1）多嗜伯克霍尔多嗜伯克霍尔德菌德菌吡咯伯克霍尔德菌吡

41、咯伯克霍尔德菌来源：本实验室未发表数据来源：本实验室未发表数据B. cencepaciaB. cepaciaSource: Unpublished data from our lab.Multiple Gene-Chip which requires no nucleotide amplification： Verigene from NanosphereTGCTTarget bacterial DNAMediator oligo-nucleotideCapture oligo-nucleotideACGAThe Verigene BC-GP TestPrinciples of the BC-

42、GP testHYBRIDIZATION USING MICROARRAY TECHNOLOGY Bacterial DNA detection process overview: primary hybridization36HYBRIDIZATION USING MICROARRAY TECHNOLOGY Nanospheres technology utilizes functionalized gold nanoparticles for signal amplification. The proprietary chemistry allows for the stable atta

43、chment of different functional groups to the nanoparticles, including oligonucleotides or proteins (antibodies). Characteristics of a gold nanoparticle oligonucleotide probe:Contains a high-density (200) of sequence specific oligonucleotidesHigh-affinity for complementary DNA, which allows for very

44、efficient hybridization kineticsThe Verigene BC-GP TestPrinciples of the BC-GP test37Mediator oligo-nucleotideGold nanoparticle oligonucleotide probeTGCTTarget bacterial DNAACGAThe Verigene BC-GP TestPrinciples of the BC-GP testHYBRIDIZATION USING MICROARRAY TECHNOLOGY Bacterial DNA detection proces

45、s overview: secondary hybridizationHYBRIDIZATION USING MICROARRAY TECHNOLOGY Bacterial DNA detection signal amplification by silver enhancement of gold nanoparticles Analysis of results via a light-scattering technique (array scanning) The Verigene BC-GP TestPrinciples of the BC-GP test39Sample trea

46、tment: Sample WellPrinciple of The Verigene Nanosphere Gene ChipGram-Negative Blood Culture (BC-GN) TestGenusAcinetobacter spp.SpeciesEscherichia coli1Proteus spp.Klebsiella pneumoniaeCitrobacter spp.Klebsiella oxytocaEnterobacter spp.Pseudomonas aeruginosaResistanceKPCSerratia marcescensNDMCTX-MVIM

47、IMPOXA1. BC-GN will not distinguish Escherichia coli from Shigella spp. including S. dysenteriae, S. flexneri, S. boydii, and S. sonnei 来源：nanosphere 公司Target of Detection: GenusStaphylococcus spp.Streptococcus spp.Micrococcus spp.Listeria spp.SpeciesStaphylococcus aureusStaphylococcus epidermidisSt

48、aphylococcus lugdunensisStreptococcus pneumoniae Streptococcus anginosus GroupStreptococcus agalactiaeStreptococcus pyogenesEnterococcus faecalis Enterococcus faeciumResistancemecAvanAvanB来源：nanosphere 公司Target of Detection:Diagnosis of Mycobacterial Infections Mycobacterium tuberculosis: lung and o

49、ther organs Mycobacteria Other Than tuberculosis (MOTT) Mycobacteria avium-intrcellulare (MAI) complex in AIDS patients: Disease developed within weeksMembers of Genus Mycobacterium Common Disease caused by Mycobacteria Other Than TurberculosislM. avium complex (MAC)lpneumonialdisseminated infection

50、 (positive blood culture)lOther specieslskin lesionsllymph node infectionslwound infectionslLymphadenitis in childrenlM. avium complex, M. scrofulaceumlDisseminated infection in AIDs patientslM. avium complexlChronic pulmonary infectionslM. intracellulare, M. kansasiilCutaneous infectionslM. marinum

51、, M. ulceransFast Growth MycobacteriaSlow growth Mycobacteria细菌学名中文译名细菌学名中文译名M.arupenseM.kansasii堪萨斯分枝杆菌M.asiatium亚洲分枝杆菌M.kubicaeM.axium鸟分枝杆菌M.lentiflaxum缓黄分枝杆菌M.branderi布分枝杆菌M.malmoense玛尔摩分枝杆菌M.celatum隐藏分枝杆菌M.palustreM.chimaeraM.saskatcheuanseM.florentinumM.scrofulaceum瘰疬分枝杆菌M.gordonae戈登分枝杆菌M.shimo

52、deiM.heckeshornenseM.simiae猿分枝杆菌M.interjectum插入分枝杆菌M.szulgai苏尔加分枝杆菌M.intermedium中间分枝杆菌M.triplex三重分枝杆菌M.Intracellulare胞内分枝杆菌M.xenopi蟾分枝杆菌 Table 1 Mycobacteria that cause lung infections注:M.为Mycobacterium的缩写Fast growth MycbacteriaSlow Growth Mycobacteria细菌学名中文译名细菌学名中文译名M.abcessus脓肿分枝杆菌M.mageritenseM.a

53、lxei河床分枝杆菌M.massilienseM.boenickeiM.mucogenicum黏液分枝杆菌M.bollettiiM.peregrinum外来分枝杆菌M.brumae雾分枝杆菌M.phocaicumM.chelonea龟分枝杆菌M.septicum脓毒性分枝杆菌M.confluentis汇合分枝杆菌M.thermoresistible耐热分枝杆菌M.elephantisM.fortuitum偶发分枝杆菌M.goodii戈地分枝杆菌M.holsaticumTable 1 Mycobacteria that cause lung infections (continued)注:M.为

54、Mycobacterium的缩写Isolations of Mycobacteria (TB, 71%; NTM, 29%)SpeciesNo. of isolatesM. tuberculosis513M. avium complex 84M. abscessus 38M. fortuitum 30M. chelonae 23M. godonae 14M. marinum 8M. kansasii 7M. scrofulaceum 4M. xenopi, M. triviale, M. vaccae, M. szulgai (1)Distribution of Mycobacteria Is

55、olated from Different sourcesSourcesMTBn=740MACn=144Othersn=151Sputum554100122Pleural effusion 55 3 2Ascites 20 0 1Urine 17 2 0CSF 15 1 0Lung aspirate 14 3 0Pus, wound 14 2 4Lymph node 13 3 2Skin, soft tissue 11 4 8Blood, bone marrow 8a 13a 1Stool 0 7a 2Cornea 0 0 9bOthersc 9 7 01996.41998.3AIDS:bra

56、pid growers; csynovial fluid, pericardial effusion, liverMolecular Characters of Mycobacterium Genes5352342Strain Identification5353422Strain 1Strain 2Typing VNTRTyping VNTR Accurate, Rapid, and High-through-put Michelle 等鉴定了等鉴定了13个种、个种、5个亚种的个亚种的37株分支杆菌，结株分支杆菌，结果符合率为果符合率为97.3%； Amel 等在等在2.5个小时鉴定了个小时

57、鉴定了124株细菌，其中株细菌，其中87株结核分株结核分枝杆菌、枝杆菌、25株鸟分枝杆菌、株鸟分枝杆菌、12株非结核分支杆菌均鉴定株非结核分支杆菌均鉴定到种。到到种。到2013年初，年初，BRUKER的分支杆菌的数据库已达的分支杆菌的数据库已达92种种 Idetification + Subtyping 2012年年6月月Shitikov E利用特征质谱图做了分支杆菌的间利用特征质谱图做了分支杆菌的间隔区寡核苷酸隔区寡核苷酸 (MIRU-VNTR)分型，发现与传统的间隔区分型，发现与传统的间隔区寡核苷酸分型的结果完全相符。寡核苷酸分型的结果完全相符。Diagnosis of Viral and

58、 Mycoplasmal Disease Disease or Syndrome Suspected Viral AgentsUpper respiratory Rhinovirus, coronavirus, parainfluenza, adenovirus, respiratory syncytial virus, influenza Pharyngitis Adenovirus, coxsackie A, herpes simplex, Epstein-Barr, rhinovirus, parainfluenza, influenzaCroup Parainfluenza, resp

59、iratory syncytial Bronchitis Parainfluenza, respiratory syncytial Bronchiolitis Respiratory syncytial, parainfluenzaPneumonia Respiratory syncytial, adenovirus, influenza, parainfluenzaGastroenteritis Rotavirus, adenoviruses 4041, calicivirus, astrovirus, Norwalk-likeParotitisMumps, parainfluenzaMyo

60、carditis/pericarditisCoxsackie and echovirusesKeratitis/conjunctivitisHerpes simplex, varicella-zoster, adenovirusPleurodyniaCoxsackie BHerpanginaCoxsackie AFebrile illness with rashEcho and coxsackie virusesInfectious mononucleosisEpstein-Barr, cytomegalovirusMeningitisEcho and coxsackie viruses, l

61、ymphocytic choriomeningitis,herpes simplex virusEncephalitisHerpes simplex, togaviruses, bunyaviruses, flaviviruses, rabies, enteroviruses, measles, human immunodeficiency virus (HIV), JC virusHepatitisHepatitis A, B, C, non-A, non-B; delta agent; EHemorrhagic cystitisAdenovirus, BK virusCutaneous i

62、nfection with rashHerpes simplex, varicella-zoster, enteroviruses, Epstein-Barr, measles, rubella, parvovirus, human herpes virus 6Hemorrhagic feverEbola, Marburg, Lassa, hantavirusAcute respiratory failureHantavirusDisease or Syndrome Suspected Viral AgentsMethods for Viral Diagnosis Methods: Tissu

63、e culture Direct detection in specimens Identification through specific cytopathic effect Use of immunofluorescence and immunoperoxidase, latex agglutination, or enzyme-linked immunosorbent assay (ELISA), Immuno-chromatography to identify Visualization through an electron microscope Direct nucleic a

64、cid probe and PCR technology Serologic studies for antigen-antibody detection Culture is cell line/virus specific: human embryonic kidney (HEK) or monkey kidney (1 MK) can be used for adenovirus, enterovirus, herpes simplex, measles, influenza, parainfluenza, and rubella; however, HEK cannot be used

65、 for cytomegalovirus (CMV) or influenza. Specimen: timely and proper collection of specimens Test PlateS a m p l i n g StickExtraction bottleExtraction Buffer 2 Bands appeared: PositiveInfluenza A Influenza B 3 DropsAbout（ml)C TExample: Test Kit for Influenza VirusBlood Studies, Hematology and Coagg

66、ulationComposition of Blood: 5 L (3L plasma, 2 L cells), Leukocytes (WBC), Erythrocytes (RBC), Thrombocytes (platelets) Granulocytes, Lymphocytes, Monocytes, Eosinophils, Basophils Objectives of Blood Studies: Disorders in Hemoglobins, hematopoiesis (cell production); synthesis and functions Blood disorders: anemias, leukemia and porphyrias disorders, abnormal bleeding and clotting; inflammation, infection and inherited disorders of red blood cells, white blood cells, and platelets . Specimen:ca