diagnostic parasitology clinical laboratory manual
LINK 1 ENTER SITE >>> Download PDF
LINK 2 ENTER SITE >>> Download PDF
File Name:diagnostic parasitology clinical laboratory manual.pdf
Size: 1728 KB
Type: PDF, ePub, eBook
Category: Book
Uploaded: 28 May 2019, 22:31 PM
Rating: 4.6/5 from 821 votes.
Status: AVAILABLE
Last checked: 14 Minutes ago!
In order to read or download diagnostic parasitology clinical laboratory manual ebook, you need to create a FREE account.
eBook includes PDF, ePub and Kindle version
✔ Register a free 1 month Trial Account.
✔ Download as many books as you like (Personal use)
✔ Cancel the membership at any time if not satisfied.
✔ Join Over 80000 Happy Readers
diagnostic parasitology clinical laboratory manualPMCID: PMC1237335 DIAGNOSTIC PARASITOLOGY—Clinical Laboratory Manual Reviewed by A. L. Barry, Ph D Copyright and License information Disclaimer Copyright notice Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (217K), or click on a page image below to browse page by page. 338 Associated Data Supplementary Materials Articles from The Western Journal of Medicine are provided here courtesy of BMJ Publishing Group. Please try again.Please try again.Please try again. Please try your request again later. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. In order to navigate out of this carousel please use your heading shortcut key to navigate to the next or previous heading. Register a free business account To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzes reviews to verify trustworthiness. Used: Very GoodVery minimal writing or notations in margins not affecting the text. Possible clean ex-library copy, with their stickers and or stamp(s).Please try again.Please try again.Please try again. Please try your request again later. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. In order to navigate out of this carousel please use your heading shortcut key to navigate to the next or previous heading. Register a free business account To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. In the latter case, pleaseHow are we doing. Europe PMC is part of the ELIXIR infrastructureEurope PMC is a service of theIt includes content provided to the. Some features of WorldCat will not be available.http://adepotcustom.com/UploadFiles/20200829130101154.xml
- Tags:
- diagnostic parasitology clinical laboratory manual pdf, 1.0, diagnostic parasitology clinical laboratory manual pdf.
By continuing to use the site, you are agreeing to OCLC’s placement of cookies on your device. Find out more here. Numerous and frequently-updated resource results are available from this WorldCat.org search. OCLC’s WebJunction has pulled together information and resources to assist library staff as they consider how to handle coronavirus issues in their communities.However, formatting rules can vary widely between applications and fields of interest or study. The specific requirements or preferences of your reviewing publisher, classroom teacher, institution or organization should be applied. Please enter recipient e-mail address(es). Please re-enter recipient e-mail address(es). Please enter your name. Please enter the subject. Please enter the message. Author: Lynne Shore Garcia; Lawrence R Ash. Publisher: St. Louis: C.V. Mosby Co., 1979.Diagnostic parasitology. St. Louis: C.V. Mosby Co., 1979 (OCoLC)606415547 Please select Ok if you would like to proceed with this request anyway. All rights reserved. You can easily create a free account. Light rubbing wear to cover, spine and page edges. Very minimal writing or notations in margins not affecting the text. Possible clean ex-library copy, with their stickers and or stamp(s).Large Soft Cover. Condition: Fine. First Edition First Printing. Very light surface wear. Previous owners name inside front cover.Green softcover Spiral. Condition: Fine. Dust Jacket Condition: None. 1st Edition. 0801617405 First Edition C. 1975 And First Printing With The Full Number-Line. Contains 71 Illustrations. No Marks Or Damage From Past Owners, Not A Former Library Book. Summary: The Recognition Of Parasitic Diseases Is To A Large Extent Dependent On Laboratory Diagnostic Procedures That Serve To Establish, Confirm, Or Rule Out Diagnoses Made Or Suggested By Clinical Examination.http://chinawin-invest.com/upload/brauniger-competino-manual.xml With The Prevalence Of Most Indigenous Parasitic Diseases In The United States There Has Been A Similar Downward Trend In The Training Of Clinical Laboratory Personnel In The Area Of Diagnostic Parasitology. All Books Shipped Within 24 Hours With U.S. Postal Service Delivery Confirmation, Each Order Is Packaged In A New Box With Bubble Wrap, And Always Your Satisfaction Is Guaranteed.All Rights Reserved. Issue 2Clinical Laboratory ManualArticleArticleGarcia and Ash have succeeded in meeting their objective. This second edition is a thorough revision and expansion of the first edition. The manual is arranged in 12 chapters, an appendix, glossary and references, general and supplemental. Advantages and disadvantages of methods cited are discussed and the reader is informed why it is necessary to do specific procedures. References are cited for each technique as an aid if problems are encountered or detailed information is desired. All Books Shipped Within 24 Hours With U.S. Postal Service Delivery Confirmation, Each Order Is Packaged In A New Box With Bubble Wrap, And Always Your Satisfaction Is Guaranteed.Inventory currently 230,000 books, 9,000 books onlineIf you've changed your mind about a book that you've ordered, please use the Ask bookseller a question link to contact us and we'll respond within no more than 3 business days. Shipping costs are based on books weighing 2.2 LB, or 1 KG. If your book order is heavy or oversized, we may contact you to let you know extra shipping is required. All Rights Reserved. I have read and accept the Wiley Online Library Terms and Conditions of Use Shareable Link Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. Copy URL The majority of diagnostic parasitology procedures can be performed either within the hospital setting or in an offsite location.http://www.drupalitalia.org/node/78302 There are very few procedures within this discipline that must be performed and reported on a short turnaround time (STAT) basis. Two procedures fall into the STAT category: request for examination of blood films for the diagnosis of malaria and examination of cerebrospinal fluid for the presence of free?living amebae, primarily Naegleria fowleri. This is to ensure that we give you the best experience possible. If you would like to, you can learn more about the cookies we use. The text is purposely condensed and it is therefore surprising to find a good deal of repetition, some of it.Clinical laboratory manual. Clinical laboratory manual. The text is purposely condensed and it is therefore surprising to find a good deal of repetition, some of it verbatim. Nearly a third of the book is devoted to drawings of protozoa protozoa Subject Category: Organism Names see more details and their cysts and helminth ova helminth ova Subject Category: Anatomical and Morphological Structures see more details, which suffer from the usual problem of being unlikely to help the puzzled neophyte peering down the microscope at a vegetable cell. Very heavy stress is laid on the examination of stained faecal smears (described as mandatory for every stool sample) which some people would find hard to accept and some techniques are unnecessarily lengthy; for example, the formolether concentration method described includes two washing steps necessitated only by the extravagant amount of stool (half a teaspoon) recommended for sampling. But perhaps the biggest defect of the book is its relative neglect of blood and tissue parasites. Examination of blood for malaria parasites, surely one of the most common and important parasitological investigations, is poorly described and there is no hint that such examination may require an urgent, rapid method as in the investigation of suspected cerebral malaria cerebral malaria Subject Category: Diseases, Disorders, and Symptoms see more details.http://www.gongoff.com/images/boy-scout-leader-training-manual.pdf The accepted rapid method of staining staining Subject Category: Techniques, Methodologies and Equipment see more details thick blood films with Field's stain is not mentioned, and the differential points used in the recognition of malaria parasites are merely tabulated without explanation. Morphological features of other systemic protozoa are omitted completely. The book is obviously designed for American workers. This manifests itself not only in language, but also in technique preference, recommendation of textbooks and other source references and addresses of suppliers of specialist equipment. David Greenwood.NB: Records, to be exported, don’t need to be selected.) We use this information Creating a My CABI account lets you personalise CAB Direct and manage your saved searches and records.Don't have an account. Register for My CABI These items will be added to. Biological hazards are best contained within a class IIA or class IIB biological safety cabinet (BSC). BSCs operate at a negative air pressure with air passing through a HEPA filter, and the vertical airflow serves as a barrier between the cabinet and the user. However, specific quality assurance recommendations within the parasitology section of microbiology have not been well defined in the past, and the information in this chapter should help clarify these recommendations. In the current environment of managed-care dominance within the United States, clinical laboratories continue to change their focus of operations and mission in response to the continually changing landscape. Traditional laboratories that are unwilling to change and adapt to this environment will probably not survive.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.American Association of Blood Banks, Bethesda, Md. American Association of Blood Banks, Bethesda, Md. College of American Pathologists, Chicago, Ill.https://controlcert.se/wp-content/plugins/formcraft/file-upload/server/content/files/1627eec613e8eb---brother-serger-owners-manual.pdf ASM Press, Washington, D.C. Docket 91N-0405. Food and Drug Administration, Rockville, Md. ASM Press, Washington, D.C. Joint Commission for the Accreditation of Healthcare Organizations, Chicago, Ill. Thompson Publishing Group, New York, N.Y. Proposed guideline GP26-P. National Committee for Clinical Laboratory Standards, Wayne, Pa. Approved guideline GP5-A. National Committee for Clinical Laboratory Standards, Wayne, Pa. Approved guideline 3P2-3A. National Committee for Clinical Laboratory Standards, Wayne, Pa. Approved guideline M15-A. National Committee for Clinical Laboratory Standards, Wayne, Pa. Approved standard M29-A2. National Committee for Clinical Laboratory Standards, Wayne, Pa. National Committee for Clinical Laboratory Standards, Wayne, Pa. Standard X3-R. NCCLS, Wayne, Pa. National Institutes of Health, Bethesda, Md. National Sanitation Foundation, Ann Arbor, Mich. ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC.ASM Press, Washington, DC. CDC twenty four seven. Saving Lives, Protecting People Chicago (IL): American Society of Clinical Pathologists; 1991. The Primate Malarias. Bethesda (MD): US Department of Health, Education, and Welfare; 1971. Washington DC: American Society for Microbiology; 1999. Drugs For Parasitic Infections. Mark Abramowicz (Editor). New Rochelle (NY): The Medical Letter, Inc.; August 2004. Parasitology, Section 7. Washington DC: American Society for Microbiology; 1999. Laboratory Procedures for the Diagnosis of Intestinal Parasites. 3rd Edition. US Dept. of Health and Human Services publication no. (CDC) 82-8282. Atlanta (GA): Centers for Disease Control and Prevention; 1982.cnccat.com/products_img/files/comdial-phone-manual.pdf Procedures for the Recovery and Identification of Parasites from the Intestinal Tract. Approved Guideline M28-A. Wayne (PA): National Committee for Clinical Laboratory Standards; 1997. Laboratory Diagnosis of Blood-borne Parasitic Diseases. Approved Guideline M15-A. Wayne (PA): National Committee for Clinical Laboratory Standards; 2000. Bethesda (MD): US Department of Health, Education, and Welfare; 1960. Geneva: World Health Organization; 2000. Geneva: World Health Organization; 1994. Morphology of Diagnostic Stages of Intestinal Parasites of Humans. 2nd Edition. US Dept. of Health and Human Services publication no. (CDC) 89-8116, Atlanta (GA): Centers for Disease Control and Prevention; 1989. Color Atlas of Tropical Medicine and Parasitology. 4th Edition. London: Mosby-Wolfe; 1995. The Color Atlas of Intestinal Parasites. Springfield (IL): Charles C. Thomas Press; 1961. Bethesda (MD): US Department of Health, Education, and Welfare; 1960. Turin, Italy External. The document is based on a comprehensive literature review and expert consensus on relevant diagnostic methods. However, it does not include didactic information on human parasite life cycles, organism morphology, clinical disease, pathogenesis, treatment, or epidemiology and prevention. As greater emphasis is placed on neglected tropical diseases, it becomes highly probable that patients with gastrointestinal parasitic infections will become more widely recognized in areas where parasites are endemic and not endemic. Generally, these methods are nonautomated and require extensive bench experience for accurate performance and interpretation. INTRODUCTION This Practical Guidance for Clinical Microbiology document is intended to provide readers with practical information relevant to general hospital clinical microbiology laboratories for the recovery and identification of parasites from the gastrointestinal tract.http://www.mtpartnersfl.com/wp-content/plugins/formcraft/file-upload/server/content/files/1627eec7fd9770---brother-ql-650td-manual.pdf Although the document is not designed for reference or research laboratories, it is important for general clinical laboratories to be aware of all relevant procedures, even those for which specimens are submitted to a reference laboratory. The document is the result of a comprehensive literature review and expert consensus relevant to the topics under discussion; it also supports the education and training of microbiologists in clinical laboratories. However, it is not intended to provide didactic training related to human parasite life cycles, organism morphology, clinical disease, pathogenesis, treatment, or epidemiology and prevention. As the world continues to “shrink” in terms of exposure to infectious diseases, it becomes much more likely that patients with gastrointestinal parasitic infections will be seen in areas where parasites are not endemic and will continue to increase in number in areas where they are endemic. Most procedures performed in diagnostic parasitology require a great deal of judgment and interpretation and are classified by the Clinical Laboratory Improvement Amendments of 1988 ( 1 ) as high-complexity procedures. The majority of these procedures are not automated and require considerable practice to produce accurate, clinically relevant results. We have had extensive actual bench experience and bring to this project our accumulated knowledge and awareness of the many requirements necessary for excellence within a clinical laboratory. Although it is important to realize that not every laboratory will perform each procedure in exactly the same way, it is very important to understand the pros and cons of clinical procedure modifications. MEDICAL ASPECTS OF GASTROINTESTINAL PARASITIC DISEASES Clinical Manifestations of Parasitic Diseases There are many different clinical manifestations of parasitic infections of the gastrointestinal tract.http://lisahyatthealth.com/wp-content/plugins/formcraft/file-upload/server/content/files/1627eec919ca4b---brother-se-350-service-manual.pdf The presentations of these parasitoses vary depending on the infecting parasite, as well as on a variety of host factors that are incompletely understood. However, it is clear that the patients with severely compromised immune responses usually have more-severe disease. These patients are also at risk for infections by parasites that do not commonly cause disease in immunocompetent individuals ( 11 ). The duration of parasitosis and the load of parasites also affect the clinical manifestations of disease. Enteritis, diarrhea, and dysentery. Infections of the gastrointestinal tract in the form of gastroenteritis, enteritis, or enterocolitis are common for certain intestinal parasites, such as Giardia lamblia ( Giardia duodenalis, Giardia intestinalis ), Cryptosporidium parvum or Cryptosporidium hominis, and Entamoeba histolytica, among others. These infections usually manifest with some degree of abdominal pain, bloating, and diarrhea. The diarrhea ranges from stools with a watery consistency to dysentery. The types of diarrhea and consistency of the stool vary by pathogen. For example, Giardia lamblia ( G. duodenalis, G. intestinalis ) is classically associated with abundant, foul-smelling, watery diarrhea, whereas the presence of a dysenteric stool suggests a pathogen such as E. histolytica or Balantidium coli ( 12, 13 ). Symptoms can vary with certain pathogens, however. E. histolytica, for example, may be present in the stools of asymptomatic individuals (i.e., cyst shedders), may cause watery diarrhea, or may produce dysentery and bloody stool ( 13 ). Invasive disease. There are some gastrointestinal parasitic pathogens that may cause invasive disease, whereas there are others that, even in profoundly immunocompromised individuals, are usually not associated with tissue invasion. Ascarid parasites from other hosts, such as anisakids, burrow into the mucosa, which causes severe localized abdominal pain ( 14 ).www.cn-zsm.com/d/files/comdial-phone-manual-edge-120.pdf This condition is essentially a more localized form of visceral larva migrans, since the nematode is in a biologically inappropriate host and wanders. Less commonly, the worm may penetrate through the muscularis propria and adventitia of the stomach or small intestine, causing a perforation. The worms in such instances may be found free in the abdominal cavity or embedded in the omentum. Nematodes that have an indirect life cycle are by their nature invasive when the larvae penetrate the intestinal tract on their transpulmonary passage back to the intestines. Clinical pulmonary manifestations of primary infection and migration (i.e., Loffler's pneumonia) are not usually evident unless there is a large primary infection. Strongyloides stercoralis, however, establishes a chronic infection, which includes parthenogenic production of larvae that recapitulate the transpulmonary migration. This chronic infection is also usually subclinical, unless the infected individual becomes immunocompromised, and this subclinical condition includes the diminished immune response that occurs during normal aging. Transplant recipients are at risk for severe clinical disease. Strongyloides hyperinfection syndrome is a disease wherein there is uncontrolled replication of these helminths ( 15 ). Hyperinfection results in a substantial number of migrating larvae through the lungs and other organs, which, even with aggressive therapy, may result in death. Some of the protozoal parasites, such as E. histolytica and B. coli, may produce locally invasive disease, with the penetration of the organism into the submucosa, forming the classic “flask-shaped ulcer” in histologic sections of the colon ( 16 ). Local invasive disease caused by E. histolytica may be contained by the inflammatory response, forming the so-called ameboma. The amoebae may also be transported to the liver via the portal vasculature to form an amebic liver abscess. Less commonly, a fistula may form between the hepatic abscess and the diaphragm and create a connection to the right pleural space, producing an amoebic empyema. Nutritional depletion. Nutritional depletion is another untoward consequence of gastrointestinal parasitic infections. The depletion of water and electrolytes is a danger in individuals with severe diarrhea. Immunocompromised individuals with infections caused by Cryptosporidium, Cystoisospora, and Giardia lamblia ( G. duodenalis, G. intestinalis ), among others, may have protracted voluminous diarrhea that results in severe dehydration and systemic electrolyte imbalance, which can cause death in these patients ( 17 ). Other intestinal parasites compete with the human host for the absorption of nutrients. The classic example is that of pernicious anemia caused by vitamin B 12 deficiency that results from the absorption of this nutrient by the large fish tapeworm, Diphyllobothrium latum ( 18 ). In other instances, it may be the competition for a variety of nutrients in food, which manifests as malnutrition ( 19 ). The effects include stunted growth, wasting, hunger, and more-specific signs of micronutrient deficiency. Malnutrition is more likely to occur in individuals with large burdens of worms that consume a substantial amount of the nutrients that are digested. Unfortunately, the individuals with the largest worm burdens are often people, commonly children, in resource-poor countries who already lack access to the recommended daily intake of food. Hookworms pose a particular problem, as these helminths attach to the mucosa and access by means of teeth or cutting plates the highly vascular lamina propria of the intestine. These parasites ingest human blood, which results in anemia. The greater the hookworm load, the greater the anemia ( 20 ). As noted above, the individuals most likely to have a greater hookworm load are also those who live in resource-limited settings and who likely also do not receive the recommended daily allowance of protein and other iron-containing substances in their diets. Iron deficiency is thought to be the most common nutritional deficiency worldwide. Individuals with iron deficiency anemia may develop pica, which contributes to the acquisition of other geohelminths. There are also concerning associations between iron deficiency anemia, impaired cognition and learning, and delayed behavioral and psychomotor development ( 20 ). Mechanical obstruction. The presence of worms in the gastrointestinal tract can result in a number of problems. Ascaris has been reported to, on occasion, block the biliary and pancreatic ducts ( 21, 22 ). Obstruction of the common bile duct may result in abdominal pain, vomiting, and biliary colic. Other laboratory findings in these patients include elevated bilirubin and liver enzymes. The blockage may allow for overgrowth of bacterial microbiota and cause pyogenic cholangitis. Similarly, if the helminth enters and blocks the pancreatic duct, then pancreatitis ensues. The pancreatitis ranges from mild to severe. The diagnosis of these types of obstructions is often accomplished using endoscopic retrograde cholangiopancreatography (ERCP). The appendix is a blind-pouch vestigial appendage of the colon. Occasionally, nematodes may enter the appendix. The mechanical movement of the worm may damage the mucosa, or overgrowth of the intestinal microbiota may result in appendicitis. Enterobius vermicularis has been shown to cause helminth-associated appendicitis, as has Ascaris lumbricoides ( 23 ). Less commonly, Taenia and other helminths have been associated with this disorder ( 24 ). Intussusception and obstruction of the intestinal lumen may also occur with helminthic infections ( 25, 26 ). Intussusception occurs when one portion of the intestine overlaps an adjacent portion during peristaltic motion. There are many causes for intussusception, and parasitic infection is one of the rarer causes. Intussusception has been associated with Anisakis infection ( 25 ). Veterinarians are well acquainted with this disorder, as it is more common in animals. Overwhelming infections, particularly with large nematodes like Ascaris lumbricoides, may also result in complete obstruction of the intestinal lumen, which must be addressed surgically ( 26 ). Parasitic Infections Acquired Abroad and Parasite Endemicity in the United States The prevalences of the different types of gastrointestinal parasitic infection that are encountered vary by locale. This variation is impacted largely by the mechanism of transmission, the number of parasitized individuals in the area, the adequacy of public health measures to handle human and animal waste, and the ability of public health measures to provide clean drinking water for inhabitants of the area ( 27, 28 ). The prevalence of many gastrointestinal parasitic infections is therefore great in resource-poor countries that have a high burden of disease and inadequate public health facilities to handle waste and provide clean drinking water ( 28 ). The mechanism of transmission is important for predicting which types of parasites are likely to be encountered. For example, one expects to encounter patients infected with Enterobius vermicularis in both resource-rich and resource-poor countries given that the eggs are infectious soon after passage and child-to-child transmission is possible either directly or through fomites (i.e., it does not matter if the children sharing toys are in Manhattan or in sub-Saharan Africa). In contrast, one is far less likely to encounter hookworm infections in locales where shoes are common than in areas where the citizens are often barefooted. The number of parasitized individuals in the community affects the likelihood of infection or reinfection due to the increased number of opportunities for infection. For example, a child with pica in an area of low endemicity is less likely to acquire an infection by a geohelminth, such as Trichuris or Ascaris, than a similar child in an area where parasites are highly endemic because they are more likely to encounter parasite eggs in the dirt. Additionally, the areas that have large numbers of infected individuals are often resource poor and unable to appropriately handle human waste, so contamination of the environment and subsequent infections become the norm. Resource-rich countries that adequately handle human waste significantly diminish the likelihood that parasitic cysts and eggs that originate from a human source will contaminate the environment, the food supply, or the drinking water. These countries forbid the use of human waste as fertilizer. There are nonhuman sources of some gastrointestinal pathogens (e.g., Cryptosporidium oocysts derived from animals) that may contaminate the water supply ( 29 ). Therefore, it is imperative that in addition to wastewater treatment being employed, modern drinking water treatment be employed. Failures in the system responsible for clean drinking water, which we often take for granted, demonstrate how important these systems are in public health. An often-cited example is that of the drinking water sources in Milwaukee, WI, in 1993 that were contaminated with Cryptosporidium hominis from human sewage effluent that impacted the drinking water facility intake, rather than water runoff from bovine feces ( 30 ). This contamination overwhelmed the clean drinking water facility's ability to inactivate the oocysts of Cryptosporidium and caused the largest waterborne outbreak by this parasite in U.S. history. When the factors described above are considered, the list of gastrointestinal pathogens that one may expect to find in a citizen of the United States or another resource-rich country is very different from those encountered in an infected individual from a resource-poor region of the world where parasites are highly endemic. Trends in immigration may bring patients from countries where parasites are endemic who present with otherwise-rare or -infrequent pathogens. Additionally, travel is easier than ever, and adventurous excursions can place individuals at risk for infections that are uncommon in their home locale. Thus, taking a thorough clinical history is key (see below). Medical Education and Consultation Related to Human Parasitic Infections The expansion of medical knowledge in the past decade is incredible. The medical profession has responded through increased specialization and subspecialization. In the past, a surgeon might specialize as an orthopedic surgeon, whereas now, it is common to find practices with individuals who specialize in only knee or hip disease. Therefore, it is unreasonable to expect individuals who are not subspecialty trained in microbiology or infectious diseases to keep abreast of changes in clinical microbiology, one of the fastest-paced fields. A clinical parasitologist or clinical microbiologist with expertise in parasitology is perfectly positioned to help educate physicians and provide guidance in test selection. These laboratorians, whenever possible, should participate in educating the next generation of physicians, not just to teach them at that point in their career but also to inform them that highly trained laboratorians remain available to assist them as needed throughout their professional careers. Practicing medical technologists are the “front lines” and can notify and work with the laboratory director when unsuspected findings are discovered or untoward events occur.