Laboratory medicine

A.Y. 2021/2022
Overall hours
BIO/12 MED/07
Learning objectives
The course aims to provide students with the knowledge on:
i) role, purpose, potential, limits of laboratory medicine in health protection;
ii) ability to correctly propose the different laboratory tests in relation to the cost / benefit ratio;
iii) criteria for interpretation of laboratory reports.
Expected learning outcomes
The students:
i) know the intervention levels of the biochemistry, microbiology and clinical pathology laboratory;
ii) are able to request laboratory tests and interpret the reports.
Course syllabus and organization

Single session

More specific information on the delivery modes of training activities for academic year 2021/22 will be provided over the coming months, based on the evolution of the public health situation.
Prerequisites for admission
The student must have complete mastery of the concepts covered in the courses of Propaedeutic Chemistry and Biochemistry, Biology, Microbiology and Pathology
Assessment methods and Criteria
The exam consists of a written test with 60 multiple-choice questions on the topics covered by this program divided into disciplinary modules (15 for each ECTS). For each form you are asked to briefly explain the answer to 5 questions. If the correct justification is not provided, the answer will be considered null and void. Questions with explanation (if given correctly) will weigh twice as much as the others. The vote obtained is the result of the weighted average of the votes reported for each form. To pass the exam you must report a score of 18/30 for each module: the wrong questions do not give negative score.
Clinical biochemistry and molecular biology
Course syllabus
Biochemistry General Clinic
Introduction, purpose, potential and limits of laboratory tests. Levels of laboratory intervention. Diagnostic test concepts and their purposes (screening, in-depth diagnostic, disease monitoring). Analytical profile concept. Examination of organ or apparatus function. Operation of a centralized laboratory and Point-of-Care; organizational, technical and economic aspects.
The pre-analytic phase and its sources of variability. The preparation of the patient. Collection of treatment and storage of biological samples for diagnostic purposes: blood, urine and faeces, Cephalorachidian fluid (liquor), fluids of discharge into the serous cavities, synovial fluid, amniotic fluid, seminal fluid, gastric juice, sweat. Acceptability criteria for biological samples by the analytical laboratory.
Post-analytical Variability: the Laboratory' report.
Analytical variability and biological variability. Types of errors. Reliability of a dosing method. Analytical variability and factors influencing it (accuracy, precision, sensitivity and analytical specificity). Intra- and extra-individual biological variability and factors that influence it. Analytical goals. Overview of quality control.
Interpretation of data: reference ranges, desirable levels, decision levels and critical values, critical difference.
Diagnostic logic: sensitivity and clinical specificity predictive values, ROC curves
Systemic Clinical Biochemistry
Diagnostic examinations as an example, chosen by the Teacher:
. Interpretation of complete urinalysis for diagnostic use
. Interpretation of the results of the main diagnostic investigations in cardiovascular disease
. Interpretation of biochemical-clinical alterations in states of dyslipidemia
. Interpretation and meaning of tumor markers
. Interpretation of clinical biochemical changes in kidney diseases
. Role of the laboratory in the diagnosis and surveillance of diabetes
. Role of the laboratory in the diagnosis of liver diseases
. Role of the laboratory in the diagnosis of jaundice.
. Principles and applications of the main techniques used in clinical biochemistry
. Diagnostic potential of plasma proteins.

Clinical Pathology:
Diagnostics of major blood cell abnormalities (4h)
Coagulation and diagnosis of its alterations (2h)
Diagnostics of thyroid diseases (2h)
Seminal fluid diagnostics (2h)
Bone turnover biomarkers (2h)
Teaching methods
The course (2 ECTS) total) will be delivered through lectures with power point presentation (PPT) and professional activities (1 ECTS in the laboratory and on mannequin). The teaching material will be available on the ARIEL platform of the course. If transmitted electronically the lesson will be recorded and the registration made available on the site Ariel. A part of the hours available will be provided by an alternative method chosen by the teacher (tests, videos, in-depth articles) to facilitate the learning in itinere of the contents explained
Teaching Resources
The following texts are recommended for the Biochemistry module:
· Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. 8th Edition- Nader Rifai-Ed. Elsevier
· Biochimica Clinica e Medicina di Laboratorio -M. Ciaccio, G. Lippi-Ed. Edises
· Trattato Italiano di Medicina di Laboratorio. Fondato da Angelo Burlina. Vol- VII Interpretazione degli Esami di Laboratorio, Panteghini -Ed. Piccin.
· Medicina di laboratorio - G Federici - Ed. McGraw-Hill
· Interpretazione clinica degli esami di laboratorio - Ronald A. Sacher - Ed. McGraw-Hill

Tietz. Fundamentals of Clinical Chemistry and Molecular Diagnostics 8th Edition ISBN: 9780323530446 Imprint: Saunders
Laposata M. Medicina di laboratorio - La diagnosi della malattia nel laboratorio clinico, Piccin, Torino. ISBN: 978-88-299-3127-9
Antonozzi, Gulletta. Medicina di laboratorio Logica & Patologia Clinica 2019 ISBN: 978-88-299-2973-3. Piccin.
Microbiology and clinical microbiology
Course syllabus
Diagnosis of infection
· Direct and indirect diagnosis of infection
· The diagnostic suspicion for the request of the microbiological investigation
· How the characteristics of infectious agents influence a correct processing of microbiological samples
· Knowledge of the main methods of direct and indirect microbiological investigations
· Timing of reporting
· Interpretation of the microbiological report in relation to the infection phase (recent, previous or chronic for serological investigations) and therapeutic orientation (sensitivity tests to antimicrobial drugs)

Diagnostic investigations, direct and indirect, and interpretation of the report for:
· Viral hepatitis (HBV, HCV, HAV, HEV, HDV)
· HIV and related opportunistic infections
· Blood cultures for bacterial and fungal systemic or disseminated infections
· Meningitis
· Sexually transmitted infections
· Infections of the respiratory and genitourinary system

Infection control
· Concept of nosocomial infections, related to health and community care
· Main nosocomial infectious agents and related problems
· TORCH complex and preventive methodologies
Teaching methods
The module (1 ECTS) will be delivered through lectures with powerpoint presentation (PPT). Lecture slides will be available on the ARIEL platform of the course. If the lecture will be held in distance learning, it will be recorded and the file uploaded on the Ariel platform.
Teaching Resources
Microbiologia Clinica
· Antonelli G., M. Clementi, G. Pozzi, G.M. Rossolini - Principi di Microbiologia Medica - Casa Editrice Ambrosiana, Rozzano (MI);
· Murray P.R., K.S. Rosenthal, M.A. Pfaller - Microbiologia Medica, EDRA, Milano).
o in alternativa/alternatively:
· Lanciotti E, Microbiologia Clinica, Casa Editrice Ambrosiana, Rozzano
Clinical biochemistry and molecular biology
Lessons: 36 hours
Microbiology and clinical microbiology
Lessons: 12 hours
Professor: Borghi Elisa
by appointment
San Paolo Hospital, blocco C, 8° floor