Henry Laboratorio en el Diagnostico Clinico Homenajea TOdd-Sanford « Davidsohn John Bernard Henry, sv. Distinguised Service Professor Director, Pathology 200 College of Medicine Direcior, Transfusion Medicine and Transfusion Medicine Fellowship Program Attending Pathologist, University Hospital State University of New York Upstate Medical University Syracuse, New York Frederick R. Davey, "10. Professor and Chait, Department of Pathology. ‘State University of New York Upstate Medical University, Syracuse, New York Chester J. Herman, M0, Prd. Professor of Pathology, Emory University ‘School of Medicine; Director, Pathology, Grady Health System, Atlanta, Georgia Richard A. McPherson, 110. Professor of Pathology: Chau, Division of Clinica Pathology, Department of Pathology, ‘Medical College of Virginia, Virginia Commonwealth University: Director, Cinical Pathology, Medical College of Virginia Hospitals, Richmond, Virginia Matthew R. Pincus, 10. pmo. Professor of Pathology, State University of New York Downstate Medical Center; Chair Department of Pathology and Laboratory Medicine, Harbor Veterans Atfairs Modtcat Conter, Brooklyn, New York Gregory A. Threatte, 110 Professor of Pathology: Director of Core Laboratories and Outreach, Unstate Medical University, Syracuse, New York Gail L. Woods, 10. Professor of Pathology; Director, Ctnical Microbiology, University of Texas Medical Branch, Galveston, TexasContenido Secci6n |. Patologia clinica / Medicina de laboratorio Gregory A, Tetrault, MD., John Bernard Henry, M.D. 1. Laboratorio clinico: organizacién, objetivos y practica John Bernard Hen, #0, Anthony S. Kure MS, ASCP OAM Coe 2. Laboratorios de consulta médica GroguryATinete, 4. 3. Principios de instrumentacién ‘Andy ND. Nguyen, ns. mo, Raber, Suaeimer s.r scrsc. John Bernard Hem, ao 4, Automatizacién del laboratorio cli Rodney 5. Mackin, 0, M0 5. Interpretacién de los resultados de laboratorio, ‘Matthew R Pes, 0.0%, NoifZ Abraham je .0.F.0 6. Informatica, tratamiento de imagenes ¢ interoperabil Reymond D.Aler to, Udases Bas 0 7. Estadistica experimental Gingory A Ter 1 8. Garantia de calidad del laboratorio clinico Gregory Teruo Peer ed ‘Mathew R. Pincus, M.D, Ph.D, John Bernard Henry, M.D. 9. Evaluacién de la funcién renal, balance de agua, electrélitos, equilibrio acido-base y gases sanguineos D. Robert Dufour, 10, Intermediarios metabélicos, ionesinorganicos y marcadores bioquimico del metabolismo del hueso leno Nikolora Hristo, John Bernard Henry, 11. Hidratos de carbono Paul E. Knudson, a, Ruth Weinstock PO, jo Bernard Henry, Mo 12, Lipidos y ipoproteinemia Paul S. Bacher 0, Margo A, Denke, 0, Evan A. Stein, 10 FAP, Boxy M. Rfid, Ma, RCe 13, Proteinas especificas RichowtA McPherson 0. 14, Evaluacién de la funci6n y el dafto hepatico Robert Dufour, Mo. 15. Enzimologia clinica Robert Dufour, st, Jon A Lat, ho, John Bernard Henry. mo 16, Evaluaci6n de la funcién endoo Joan H. Howont, M0, fbn Bemaed Henry, 0 17.Toxicologia y monitorizacién terapéutica de farmacos Marte R Pines, 0.140, NoifZ Abraham J M.D O05 50 60 n 2 toa 138 148 159 180 au 224 249 264 281 304 335Contenido: Peek Gregory A. Threatte, M.D. John Bernard Henry, M0. 18, Examen basico de la orina 367 Oristine ule, 0, Gregory A Threat 9, fn Berard Henry M0 19, Liquido cefalorraquideo, sinovial y liquidos serosos del organismo 403, Gregory Smith. Can R.Kelsberg m2. 20. Laboratorio en andrologia y la evaluacién de la fertilidad 425 Siddhertha Sarkar, 0, J Bernard Henry 110 21, Tratamiento en el laboratorio de s tecnologias de reproduccién asistida 432 André Van Steiteghem, 40,0, 22, Aspectos del laboratorio en el tratamiento de la gestacién 446 Robert E Werk. 0.1, Miiom Bitzer, 0 23. Diagnéstico de laboratorio de las alteraciones gastrointestinales y pancreaticas 462 David G. Hesig 0, Gregory A.Theate, 40, ohn Bernard Henry, 0 Seccién IV. Hematologia, coagulacion y medicina transfusional Frederick R. Davey, M.D, John Bernard Henry, M.D. 24, Examen basico de la sangre 419 ‘Michael W. Moris, ws. bUNAscys, Frederick R. Davey 0 25, Hematopoyesis 520 Frederick R Dovey, m0, Robert E Hutchison, mo 26. Trastornos eritrocitarios 542 ‘M Tarek Elghetony, 0, Fedevck R Davey, sto 27. Alteraciones de los leucocitos 586 Robert E. Hutchison, ao, Fredrick R. Dovey, 0 28, Plaquetas en sangre 623 Jonathon L. Mile, tb, 50 29. Coagulacién, fibrindlisis e hipercoagulacién 642 Ezobeth M.Yon Cot, 0, Micoe!Laposat, m9. %.0 30. Inmunohematologia 660 Wendy. Beading ms. TiScnsee, Laure Cooling, 0, mc, Jn Bemard Heary, 31. Medicina transfusional 718 Leonerd I Boral 40,148, Edvardo Deafor Wes, 1, John Bernard Henry. >. 32, Hemaféresi 116 Jeffey L Winters, 42, Avro A, Pinedo 15 33. Almacenamiento de tejidos y células madre 806 CChariene A. Hubbell 25,7998, Jol Berard Hey, oa ane een ae ed Richard A, t4cPherson, M.D., John Bernard Henry, MD. 34. Vision general del sistema inmune y de los trastornos inmunolégicos Richard A. MePheraon, 35. Inmunoensayos e inmunoquimica Yoshio Ashhora, 0, Yasushi Keschora,up.o.mse, Robert M, Nokamurg, 36. Examen de laboratorio del sistema inmune celular “Helene MA, Paxton ss, arasch Susanna Cunningham Rundles, i, Maurice RG. O'Gorman, MS. mb, DA8NLH iv Bi7 82i 850Contenido 37. Evaluacién del funcionamiento de las inmunoglobulinas y la inmunidad humoral 878 Richard A MePherton, KO 38, Complemento y cininas: mediadores de la inflamacion 892 Er Wagner, mo, Hodong fang, 0. eno, Michael M. Fronk 2 39, Citocinas y moléculas de adhesion 914 H, Dov Maser 100.005, RehordA MePerson, MO 40. Antigeno leucocitario humano: complejo mayor de histocompatibilidad del hombre 7 “amned HJoson m0, Caryn Kotovch Harty m0, Robert Harman, 7 Mc UM, di A Wade 8 41, Complejo mayor de histocompatibilidad y enfermedad 949 Jato. Delgado, 2, Edmond Ys, > 42, Trastornos inmunodeficitarios 963 CChorotte Cunning: Rules, 0.20 43, Evaluacién clinica de laboratorio de las enfermedades reumaticas sistémicas 974 ‘Carlos Abert Yon Mie, 0,9, Robert M, Nokamuro, 0 44, Vasculitis 990 Rex M.McCalum, 0, Doni Byun, 0 45. Enfermedades autoinmunes organoespecificas 1000 David J Bjund, 0, Rabest M, Nokamura, Mo 46, Enfermedades alérgicas 1016 Henry. Homburg 47. Diagndstico y manejo del cancer mediante marcadores tumorales serolégicos 1028 omer TW m0. Gail . Woods, M.D, John Bernard Henry, M.0. 48. Infecciones viricas 1045 ‘Micha! Costeto, mo, Mangoes Yngbith no 49, Infecciones causadas por clamidias, Gai Woods, 0, Dod H Weer, 10 50, Bacteriologia médica 1088 Barbora S Reser m0, Gail L Woods, M0 1072 51, Pruebas de sensibilidad in vitro a los antimicrobianos mig ‘Michael 8 Seth 1, Gal L Woods, 19 52. Infecciones por espiroquetas 1131 ‘Michael 8. Soh, 4D, Randal Hoyden, Mb, Dovid H,Persing MP0. Gal 1. Woods. Mo. 53, Micobacterias 1144 Ga L Woods, 0, 54, Enfermedades micéticas 1158 Washington C Winn Je, MD. MBA, Fred Wi. Westen, srs 55, Parasitologia médica 1196 Thomas R Frtiche, 0,0, James W Smith, 40 56, Patologia molecular de enfermedades infecciosas 1241 ‘Martin G, Carmican, Mo, Michoel A fle, 0 57, Manejo y recogida de muestras para el diagnéstico de las enfermedades infecciosas 1254 Gol L Woods,Contenido Rr es (Chester J. Herman, M.D., Ph.D, John Bernard Henry, M.D. 58, Introduccién a la patologia molecular W273 Chester} Herman, to, Jon Bemord Henry, 0 59. Diagnésticos moleculares: técnicas y principios basicos las Ezabeth Unger, 0.40, Margort A. Phar, >, 81 60. Reaccién en cadena de la polimerasa y otras tecnologias de amplificacién . 1287 Joris C Zimring 0.0, Frederick S. Nolte, 10 61. Tecnologias de la hibridacién en serie 1296 ‘Jocques Schrenzel, Jonathan R Hibbs, so, Dowd H Persing, mo... 62, Aplicaciones de la citogenética en la patologia moderna 1304 Constance K Sten, m0 63. Organizando un laboratorio de diagnéstico molecular 1333 ‘Andes Ferrera Gonzle, 0, David A Wiinson 0.110. Calton Gare... 64. Oncoproteinas y deteccién tumoral precoz 1344 ‘Motew R Pics, st, , Poul W Band Rou to, m.1, Willam Koslshy, 0, Willam Appruzzese, 0 65. Técnicas moleculares en el diagnéstico de neoplasias hematopoyéticas 1355 Dowd 5 Viwonothe, nO, Richard S.Lorson, Mo, 2.0 66, Diagnéstico molecular de las enfermedades genéticas 1372 Wayne W. Gray, 0, m0, Waker We Nal mo, 67. Pruebas de paternidad: empleo del ADN, polimorfismo y otros marcadores genéticos 1390 Herbert F Poesy, 0 68, Pruebas forenses de identidad mediante analisis del ADN 1402 Vitor. Wed, 01, Renda Raby 3 |, Soluciones fisiologicas, tampones, indicadores acido-base, materiales de referencia estandar y tabla de conversion de temperaturas 1417 2. Pesos ideales, superficie corporal e indice de masa corporal (IMC) 1420 3. Calculo aproximado del volumen sanguineo total (VST) 1424 4. Tabla periédica de los elementos 1425 5. Unidades del sistema internacional (S!) 1426 Peter Leanne, Jot Bernard Henry, MoAutores Naif Z. Abraham, Jr., M0. Phd. Staff Pathologist, Veterans Affairs Medical Center; Assistant Professor, State University of New York Upstate Medical University, Syracuse, New York Raymond D. Aller, so. Clinical Professor. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; Vice President, Medical Affairs and Informatics, MDS Laboratory Services (United States), Nashville, Tennessee William Appruzzese, Pho. Statf Member and Clinical Assistant Professor, Department of Environmental Sciences, Columbia College of Physicians and Surgeons, ‘New York, New York Yoshihiro Ashihara, Pn.o. General Manager, Research Laboratories, Fujrebio Incorporated, Tokyo, Japan Paul S. Bachorick, Pn Professor (retired). The Johns Hopkins University ‘Schoo! of Medicine, Batimore, Maryland Ulysses J. Balis, M.0. Instructor in Pathology, Harvard Medical Schoo! and Massachusetts General Hospital, Boston, Massachusetts Wendy V. Beading, 1s. wTascrjse8 Assistant Professor, Department of Clinical Laboratory Science, State University of New York Upstate Medical University, Syracuse, New York Miriam Blitzer, Pho. Professor and Chiet, Division of Human Genetics, Department of Pediatrics, University of Maryland, Baltimore, Maryland Leonard I. Boral, no. MBA “Associate Professor of Clinical Laboratory Medicine land Pathology, University of Medicine and Dentistry of New Jersey, Newark; Staff Pathologist, Jersey Shore Medical Center, Neptune, New Jersey Paul W. Brandt-Rauf, Mo. Pi.0, OPH. Professor, Department of Environmental Sciences, Columbia College of Physicians and Surgeons, ‘New York, New York David J. Bylund, 1.0, Laboratory Director, Scripps Reference Laboratory, San Diego, California Laura Cooling, Wv.0, Se Assistant Professor, Department of Pathology, University of Michigan Medical School; Assistant Director, Blood Bank and Transfusion Medicine, University of Michigan Hospitals, Ann Arbor. Michigan Martin G. Cormican, mo. Professor of Bacteriology (Medical Microbiology), Department of Bacteriology, Clinical Sciences Uni, National University of Ireland, Galway: Consuttant ‘Microbiologist, University College Hospital Galway, Galway, Ireland thael Costello, Pho Technical Director, Advocate Shared Services Laboratory, Park Ridge, Minois Charlotte Cunningham-Rundles, ¥.0. °h0. Professor, Departments of Medicine, Pediatrics, and Immunobiology, Mount Sinai Schoo! of Medicine, ‘New York, New York ‘Susanna Cunningham-Rundles, P1.0. Professor of Immunology; Vice, Chair of Academic Atairs, Department of Pediatrics; Director, The Immunology Research Laboratory, Weill Medical College of Cornell University, New York, New York Frederick R. Davey, Mo. Professor and Chair, Department of Pathology, State University of New York Upstate Medical University. Syracuse, New York Julio C. Delgado, 1.0. Instructor, Department of Pathology, Harvard Medical School: Assistant Medical Director, HLA Laboratory, Dana-Farber Cancer Institute, Boston, Massachusetts Margo A. Denke, M0. ‘Associate Professor, University of Toxas Southwestem Medical Center, Dallas, Texas William K. Dettwyler, #7 Senior Consuitant, Health Systems Concepts, Incorporated, Longwood, Florida D. Robert Dufour, 1.0. Professor of Pathology, George Washington University Medical Center, Washington, D.C. Clinical Professor of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland: Chiet, Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Washington, 0.6. M. Tarek Eilghetany, m0 Associate Professor and Vice Chairman, Depariment of Pathology, University of Texas Medical Branch, Galveston, Texas Andrea Ferreira-Gonzalez, Pho. Associate Professor, Medical College of Virginia, Virginia Commonweafth University; Tectmical Director of Molecular Diagnostics, Medical College of Virginia Hospitals, Virginia Commonwealth, University Richmond, VirginiaAutores. - ™ rae Michael M. Frank, 1.0, ‘Samuel L. Katz Professor and Chairman of Pediatrics, and Professor of Immunology and Medicine, Duke University Medical Center, Durham, North Carolina Thomas R. Fritsche, 10, eno. Associate Professor, Department of Laboratory Medicine, University of Washington; Head, Clinical ‘Microbiology Division, University of Washington Medical Center, Seattle, Washington Christine E. Fuller, mo. Fellow, Department of Pathology, Washington University Schoo! of Medicine; Fellow, Department of Pathology, Barnes- Jewish Hospital, St. Louis, Missouri Carleton T. Garrett, m0, Pio. Professor of Pathology, Medical College of Virginia, Virginia Commonwealth University: Medical Director, ‘Molecular Diagnostics Laboratory, Department of Pathology, Medical College of Virginia Hospitals, Richmond, Virginia Wayne W. Grody, M.D., Ph.D Professor, Divisions of Molecular Pathology and Medical Genetics, Departments of Pathology and Laboratory Medicine and Pediatrics, UCLA Schoo! of Medicine: Director, Diagnostic Molecular Pathology Laboratory, UCLA Medical Center, Los Angeles, California Robert J. Hartzman, CAPT, MC, USN, M.D. Director, C.W. Bill Young Marrow Donor Recruitment Program and Research Program, Naval Medical and Research Insitute, Bethesda, Maryland Randall T. Hayden, M.D. Director, Clinical Microbiology, St. Judo Children's Research Hospital, Memphis, Tennessee David G. Heisig, 0. ‘Associate Professor of Medicine, Department of Medicine, State Universit of New York Upstate Medical University Syracuse, New York John Bernard Henry, M10. Director, Pathology 200, College of Medicine; Distinguished Service Professor; Director, Transfusion ‘Medicine & Transfusion Medicine Fellowship: Hemapheresis, HLA, Progenitor Cell and Parentage Testing Laboratories; Attending Pathologist, University Hospital, State University of New York Upstate Medical LUnivorsity, Syracuse, Now York Chester J. Herman, 0, Pho Professor of Pathology, Emory University School of Medicine; Director, Pathology, Grady Health System, Atlanta, Georgia Jonathan R. Hibbs, 140. Director, Bacteriology Laboratory Wadsworth Center New York State Department of Health, David Axelrod Institute, Albany, New York Henry A. Homburger, 1.0 Professor of Laboratory Medicine, Mayo Medical ‘School and Mayo Graduate School of Medicine, Rochester, Minnesota Joan H. Howanitz, 1.0. Vice Chair, Department of Pathology, State University ‘of New York at Brooklyn; Director of Laboratories, Kings County Hospital Center, Brooklyn, New York Elena Nikolova Hristova, mo. Resident in Anatomic and Clinical Pathology, State University of New York Upstate Medical Universiy. Syracuse, New York Charlene A. Hubbell, 8.5, wT(asce)sa6 Adjunct Assistant Professor, Clinical Laboratory Science, Collage of Health Professions; Supervisor, Histocompatibity, Immunogenetics and Progeniior Cell Bank, State University of New York Upstate Medical University, Syracuse, New York Carolyn Katovich Hurley, Po, Professor, Department of Microbiology. Georgetown University Medical Center, Washington, D.C. Robert E. Hutchison, “0. Professor of Pathology, Director of Clinical Pathology, and Director of Hematopathology, State University of New York Upstate Medical University, Syracuse, New York Haixiang Jiang, mo, Pro. Assistant Research Professor, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina Armead H. Johnson, Ph.D, Professor, Department of Pediatrics, Georgetown University Medical School, Washington, D.C. Yasushi Kasahara, pho, 0M Se Visiting Professor, Kyorin University Schoo! of Pubic Health: Research Fellow, Keio University of Medicine, Tokye, Japan Carl R. Kjeldsberg, 110. Professor and Chair, Department of Pathology, University of Utah: University Hospital (Laboratory Services) Chairman and Pediatric Pathology (Laboratory Services) Chairman, University of Utah Hospital and Primary Children's Medical Center, Salt Lake City, UtahAutores. Paul E. Knudson, M0. Associate Professar of Medicine, Division of Endocrinology, Diabetes and Metabolism: Jostin Diabetes Center, State University of New York Upstate ‘Medical University, Syracuse, New York William Koslosky, so. Consultant, Harbor Veterans Attairs Medical Center Brooklyn, New York Anthony S. Kuree, 115., HiASCP)DLM Clinical Associate Professor, Department of Clinical Laboratory Science, College of Health Professions; Administrator for Pathology Marketing and University Pathologists Laboratories, State University of New York Upstate Medical University, Syracuse, New York Michael Laposata, W.0., Ph. Professor, Department of Pathology; Director of Cinical Laboratories, Harvard Medical School, Boston, Massachusetts Richard S. Larson, 140, Ph. Assistant Professor, Department of Pathology. University of New Mexico Schoo! of Medicine; Laboratory Director, University Hospital Rapid Response Laboratories, University Hospital, Albuquerque, New Mexico H. Peter Lehmann, Pn.o. Professor Emeritus, Department of Pathology, Louisiana State University Medical Center, New Orleans, Louisiana John A. Lott, Po. Professor, Department of Pathology, The Ohio State University; Director of Clinical Chemistry, The Ohio State University Hospitals, Columbus, Ohio Rodney S. Markin, 0. Pno. Professor and Vice Chair, Department of Pathology and Meerobiology; Associate Dean for Clinical Atiairs, College of Medicine, University of Nebraska Meaical Center, Omaha, Nebraska H. Davis Massey, MD. Ph... 00S Chief Resident in Pathology, Medica! College of Vinginia, Virginia Commonwealth University, Richmond, Virginia Rex M. McCallum, mo. Associate Clinical Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, Duke University School of Medicine; Vice Chair for Clinical Services, Department of Modicine, Duke University School of Medicine and Hospital, Durham, North Carolina Richard A. McPherson, \ 0. Professor of Pathology; Chair, Division of Clinical Pathology, Department of Pathology, Medical College of Virginia, Virginia Commonwealth University; Director Clinical Pathology, Medical College of Virginia Hospitals, Richmond, Virginia Jonathan L. Miller, Mo. Pn.0. Professor of Pathology; Director of Academic Affairs, Department of Pathology: Director of Special Hematology Laboratory, University Hospital, State University of New York Upstate Meaical University Syracuse, New York Michael W. Morris, ws., DLM(ASCP)SH Professor, Department of Clinical Laboratory Science; ‘Manager, Department of Pathology, University Hospital, State University of New York Upstate Medical University, Syracuse, New York Robert M. Nakamura, »1o. Professor, Departments of Immunology and Experimental and Molecular Medicine. The Scripps Research Institute; Senior Consultant and Chairman Emeritus, Department of Pathology, Scripps Clinic and Research Foundation, La Jolla, California Andy N.D. Nguyen, sme, M0 ‘Associate Professor, Department of Pathology, University of Texas Medical School at Houston: Director, Hematology Laboratory and Chemistry Laboratory, Lyndon B. Johnson Hospital: Director, Coagulation Laboratory, Memorial Hermann Hospital, Houston, Texas Walter W. Noll, 1.0. Professor of Pathology, Dartmouth Medical School Hanover, New Hampshire; Director, Clinical Chemistry and Molecular Genetics Diagnostic Laboratories, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire Frederick S. Nolte, Pho. Associate Professor, Pathology and Laboratory Medicine, Emory University School of Medicine; Laboratory Director, Clinical Microbiology and Molecular Diagnostic Laboratories, Emory Medical Laboratories, Atlanta, Georgia Maurice R.G. O'Gorman, 4 Se. Ph.D. D(ABMLI) Associate Professor-Pediatrics, Northwestern University Medical Schoo!; Director, Diagnostic Immunology and Flow Cytometry Laboratories, The Children’s Memorial Hospital, Chicago. WinoisAutores Helene M.A. Paxton, 8, WT(ASCP) Vice President of Manufacturing, Regulatory Affairs and Research and Development, PanBio InDx, incorporated, Baltimore, Maryland David H. Persing, 0. pn. ‘Medical Director, infectious Disease Research Institute; Vice President, Diagnostics Research, Corixa Corporation, Seattle, Washington Michael A. Pfaller, 01.0. Professor, Department of Pathology; Director, ‘Molecular Epidemiology and Fungus Testing Laboratory, University of iowa College of Medicine, lowa City, Iowa Matthew R. Pincus, W., PhD. Professor of Pathology, State University of New York Downstate Medical Center; Chair, Department of Pathology and Laboratory Medicine, Harbor Veterans Affairs Medical Center, Brooklyn, New York Alvaro A. Pineda, 0, Professor of Laboratory Medicine and Director of Transfusion Medicine Fellowship Program, Mayo Medical Schoo! and Mayo Graduate School of ‘Medicine; Consultant, Transfusion Medicine, Mayo Clinic, Rochester, Minnesota Margaret A. Piper, Pn.0., MPH. ‘Senior Consultant, Technology Evaluation Center, BlueCross BlueShield Association, Chicago, Minois Herbert F. Polesky, mo. Professor (retired), Department of Laboratory Medicine land Pathology. University of Minnesota School of Medicine, Minneapolis, Minnesota; Formerly Director, ‘Memoria! Blood Centers of Minnesota, Minneapolis, Minnesota Barbara S. Reisner, P».v. Assistant Professor, Department of Pathology: Associate Director, Ctinical Microbiology Laboratory, University of Texas Medical Branch, Galveston, Texas Basil M. Rifkind, wo, FROP Special Assistant for Cinical Studies, National Institutes of Health, National Heart, Lung, and Blood institute, Division of Heart and Vascular Diseases, Bethesda, Maryland Rhonda K. Roby, 42H ‘Senior Forensic Specialist, Human Identification, Applied Biosystems, Foster City, California a Siddhartha Sarkar, Pho. Giinical Professor, Department of Pathology; Director, Andrology Service, University Hospital, State University of New York Upstate Medical University, Syracuse, New York Jacques Schrenzel, M10. Assistant Professor, Geneva University Medical School Consultant, Division of infectious Diseases, Geneva University Hospital, Geneva, Switzerland Gregory P. Smith, 10. Assistant Clinical Professor, Department of Pathology. University of Utah; Staff Pathologist, Department of Pathology, St. Mark's Hospiial, Salt Lake City, Utah James W. Smith, 610 Professor Emeritus, Department of Pathology ant Laboratory Medicine, Indiana University School of Medicine, Indlanapolis, tndiana Michael B. Smith, mo. Assistant Professor: Associate Director, Clinical Microbiology and Laboratory Information System, University of Texas Medical Branch, Galveston, Texas Constance K. Stein, pi.o. Associate Professor of Pathology and Pediatrics; Director of Cytogenetics and Associate Director of ‘Molecular Diagnostics, University Hospital, State University of New York Upstate Medical University Syracuse, New York Evan A. Stein, m0, Pho. FOAP Voluntary Professor, Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio: President and Chief Executive Officer, Medical Research Laboratories, Highland Heights, Kentucky Robert L. Sunheimer, MS, MTASCP)SC Associate Professor in Clinical Laboratory Science, State University of New York Upsate Medical University, Syracuse, New York Gregory A. Tetrault, 110 Medical Director, Shared Laboratory Services, L.C. Chesapeake, Virginia Gregory A. Threatte, 1.0 Professor of Pathology; Director of Core Laboratories and Outreach, Upstate Medical University, Syracuse, New York Elizabeth R. Unger, Pho. 140 ‘Acting Chief, Human Papillomavirus Section, Centers for Disease Control and Prevention; Cinical Associate Professor, Department of Pathology and Laboratory ‘Medicine, Emory University School of Medicine, Atlanta, GeorgiaAutores Elizabeth M. Van Cott, mo. Director, Coagulation Laboratory, Massachusetts, General Hospital, Harvard Medical School, Boston, Massachusetts André Van Steirteghem, M0. Ph.0. Full Professor, Medical School: Scientific and Laboratory Director, Center for Reproductive Medicine, Medical Schoo! and University Hospital, Dutch- Speaking Brussels Free University. Brussels, Belgium David S. Viswanatha, 0. Assistant Professor, Department of Pathology, University of New Mexico Schoo! of Medicine; Staft Hematopathologist, University of New Mexico Health Sciences Center, Albuquerque, New Mexico Carlos Alberto Von Miihlen, w.0, en. Full Professor of Rheumatology and internal Medicine, Pontifical Catholic University School of Medicine, Porto Alegre, RS, Brazil Judith A. Wade, 8 Sc. Professor, Department of Surgery, and Faculty of Medicine, University of Toronto; Formerly Head, Histocompatibiliy Laboratory, Toronto Hospital University Health Network, Toronto, Ontario, Canada Eric Wagner, Pro. Immunologist, Ste-Justine Hospital. Montréal, Quebec, Canada David H. Walker, »10. Professor and Chairman, Department of Pathology; Director, World Health Organization Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas Victor W. Weedn, M10. J. Principal Research Scientist and Director of Biotechnology and Health Initiatives, Carnegie Mellon University, Pittsburgh, Pennsylvania Ruth S. Weinstock, 010. Pho. Professor of Medicine: Chief, Endocrinology, Diabetes and Metabolism; Medical Director, Josiin Diabetes Conter, State University of New York Upstate Medical University; Chief, Endocrinology Veterans Affairs Medical Center, Syracuse, New York Eduardo Delatlor Weiss, 1.0 Altenaling Pathologist and Director, Transfusion Service, ‘Monmouth Medical Center, Long Branch, New Jersey Robert E. Wenk, mo. ms. Cinical Professor of Pathology, Pennsylvania State University, Hershey, Pennylvania; Clinical Associate Professor of Human Genetics, University of Maryland, Attending Pathologist, Division Head of Clinical Pathology, Sinai Hospital, Baltimore, Maryland Fred W. Westenfeld, mir(asop)si Clinical Faculty, University of Vermont; Microbiology ‘Manager (Chief Technologist) Fletcher Allen Health Care, Burlington, Vermont David S. Wilkinson, m0. PP.0. Professor and Chairman, Department of Pathology: Professor of Health Administration, Medical College of Virginia Campus, Virginia Commonwealth University Richmond, Virginia Washington C. Winn, Jt. W.0, MBA Professor of Pathology, University of Vermont College of Medicine: Director. Clinical Microbiology Laboratory, Fletcher Allen Health Care, Burlington, Vermont Jeffrey L. Winters, Mo. Assistant Professor, Department of Pathology and Laboratory Medicine; Associate Director of the Blood Bank, University of Kentucky Chandler Medical Center; Associate Medica! Director, Central Kentucky Blood Center; Director of Transfusion Service, Cooper Drive Division of the Veterans Affairs Medical Center, Lexington, Kentucky Hemapheresis Gail L. Woods, 0. Professor of Pathology; Director, Clinical Microbiology, University of Texas Medical Branch, Galveston, Texas James T. Wu, PhD Professor of Pathology, University of Utah Health Science Center; Director of Special Chemistry Laboratory, Associate Regional University Pathologists (ARUP), Sait Lake City, Via ‘Margaret Yungbluth, mo. Associate Professor of Clinical Pathology, Northwestern University Medical School, Chicago: Statt Pathologist, St. Francis Hospital, Evanston, iinois Edmond J. Yunis, 10 Professor, Department of Pathology, Harvard Medical ‘School; Director, HLA Laboratory, Dana-Farber Cancer Institute, Boston, Massachusetts James C. Zimring, M0, Pn. Pathology Resident, Department of Pathology and Laboratory Medicine, Emory University Atlanta, Georgiaseccion I Patologia clinica / medicina de laboratorio Gregory A. Threatte, M.D. John Bernard Henry, M.D.capituto 1 Laboratorio clinico: organizacién, objetivos y practica * John Bernard Henry, M.D. * Anthony S. Kurec, M.S., H(ASCP)DLM Con el apartado de Patologia y codifcacién del loboratorio y reembelso por William K. Dettwyler, MT ORGANIZACION Y FUNCIONAMIENTO DEL LABORATORIO 4 Normas de funcionamiento y organizacién Jefatura y gerencia REDISENDO DEL FLUJO DE TRABAJO. Y CAMBIOS TECNOLOGICOS 6 Funcién del faboratorio. Instalaciones y diserio Punto de atencién de andlis's (ubicacién altemativa de analisis) Direocin futura Laboratorio centralaboratorio de respuesta rapida Regionalizacion Islas de automatizacion Robbtica y automatizacion Telemedicina PRUEBAS PREANALITICAS Solicitud de andlsis y mediciones (test) Preparacién del paciente Antes de la recogida de la muestra Recogida de la muestra y procesamiento FASE ANALITICA Reactivos Agua Mediciones de masa 12 2 E objetivo y la funcibn de los trabejadores del laboratorio mediante la pato- logia y la medicna de laboratoro es ayudar a los médicos a 1) contirmar o escartar un diagndstico, 2) proporcionar ideas en el tratamiento de los pacientes. incluyendo la oportunidad de utiizar pruebas, 3) establecer un siagndstco, 4) detectar la enfermedad mediante o! dascubrimiento del caso yo haciendo una bisqueda y 5) montorzar la terapia de seguimiento. La saisaccion po la actuacién del labocatorio se consigue medante la garanta e calidad, quo ordona las maximas contibuciones para el benefcio de los pacientes y para ayudar al servicio nacional de salud y alas comparias ase {uradoras de forma efectva,efciene y econémica. S) bien la exacttud y a precsion han sid siempre esencials para la buena practica en el laborao fi Ia oportunidadlrapidez o ‘periado de tempo" (PDT) de un informe de resutados ciaros es igualmente citico para la excelencia global en la sani- ad. La generacion de valores de calidad en a laboratoro debe ser inrata Mediciones de volumen Control dela temperatura Evaporacin y concentracién de las muestras Filtracién Didlisis Extraccién Mezclado Deteccisn y respuesta anaitica SEGURIDAD EN EL LABORATORIO. 34 Psicologia de la seguridad Elementos biopeligrososiprecauciones universales ‘Seguridad frente a la exposicién a quimicos téxioos Ley de los americanos con discapacidades Trastornos trauméticos acumulativos IMPLICACIONES MEDICOLEGALES 36 Consentimiento Confidencialidad Cadena de custodia GESTION FINANCIERA 6 Balances, cuenta de pérdidas y ganancias, recursos propios y jo de efeativo Contabilidad de costes Analisis del equilbrio PATOLOGIA Y CODIFICACION DEL LABORATORIO Y REEMBOLSO “1 BIBLIOGRAFIA 48 cobservando expliclamente los valores basicos del laboratorio mediante la recogida corecta, la manipulacién y el tratamiento de la muestra de cada ppaciente. Esto se consigue mejor ejecutando programas apropiados de (arantias de calidad (véase Cap, 8) que identiquen la uilizacion dptima det ‘espacio, equpos. reactivas y personal con mediciones de resultados. Otros aspectos a considerarinduyen la contratacin de personal cuaificado, et empleo de practicas de direcoin sdidas y proporcionar un ambiente seguro y sano. Estas medidas se daben obsarvar por todos fs drectivs sanitarios partcpantes mediante un completo y total entondmienta y sensibiizacién a las medidas y examenes de! laboretoi Este capitulo analiza los conocimientos fundamentales que son importan tes en la manipulacion de las muestras de los pacientes que se presenian para su examen y andisis por el laboratori,teniendo en cuenta por qué se Dresentan estas muestras y cdmo las actividades dentro de un laboratoro4 Seccion| + ‘Tabla 1-1. Esquema general de actividades en la medicina de la- oratorio y patologia Direccién y gerencia | Servicios de atenci6n al paciente | Indicaciones y Tecnoiogia y Intereretacién y seleccion ‘generacion traduceion Formacién Investigacion ‘eakzan oste senici (Tabla 1-1). Se proporiona ademas una vision general

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