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12/27/23

 


Various means of diagnosis are available.

1. Most important: Clinical laboratory tests which include

any tissue or fluid obtained from the body.

2. Imaging sciences: X-rays, ultrasound, color Doppler,

computerized axial tomography (CAT) scan, magnetic

resonance imaging (MRI) scan and the latest positron

emission tomography (PET) scan.

3. Electrical signal processing techniques: ECG, EMG, EEG

and nerve transmission techniques, etc.

4. Direct visualization techniques: With the availability

of fiberoptic-based technologies, the clinician is

now capable of passing small tubes (called scopes)

through natural passage ways of the human body

(without actually surgically opening up the part),

e.g. gastroscopy, cystoscopy, etc. These techniques,

eventually culminate in taking small tissue samples

(biopsies) which are sent to histopathology laboratories.

So, whenever, any sample from a human body is taken

(either voided naturally or obtained by the clinician or the

laboratorian), it is referred to the clinical laboratory for

investigation. On receipt of a report from the laboratorian,

the clinician, then, makes up his mind and starts a

unidirectional or specific treatment against the disease

thus diagnosed. It would not be wrong to designate medical

laboratory personnel as the backbone of the clinicians. But,

for these technologists, the clinicians would forever grope

in the dark. Gone are the days when diabetes mellitus was

presented with the classical triad of symptoms—increased

thirst, hunger and urination; likewise, typhoid seldom

presents with a step-ladder pattern fever. Blood testing

is absolutely mandatory, to know that they exist, their

severity and eventually, after treatment; to know that they

are under control or cured. Investigations are diagnostic as

well as prognostic tools.

1

 


Gram Stainer 872

Quality Assurance in Bacteriology 872

Color Atlas—Media and Colonies 873

Chapter 28. Mycology 883

Intermediate Superficial Deep Mycoses 884

Deep or Systemic Mycoses 884

Fungi Usually Present as Contaminants but

Which Rarely Cause Disease—Usually in

Patients Chronically Ill from Other

Diseases 885

Mycological Methods 885

Chapter 29. Diagnostic Skin Test 886

Technique of Skin Tests 886

Immunologic Basic for Skin Tests 886

Common Skin Tests 887

Immediate Reaction Type of Skin Tests 887

Delayed Reaction Type of Skin Tests 889

Chapter 30. Cytogenetics 891

Blood Lymphocyte Culture 891

Karyotyping 893

G and Q Bandings 894

Importance of Chromosomal Studies 894

Barr Body Analysis and Buccal Smear for

Staining of Sex Chromatin Mass 895

Chapter 31. World’s Latest and Best

Technologies by Roche 896

Business Areas 896

Revaluating Diagnostics 896

Testing Efficiency and Medical Value 896

Effective Management of Infectious

Diseases 898

Cobas® Modular Platform 900

Your Benefit 900

Cobas® 8000 Modular Analyzer Series 901

Cobas® 8000 Modular Analyzer Series 902

Cobas® 6000 Analyzer Series 903

Cobas® 4000 Analyzer Series 906

Cobas C 311 Analyzer 906

Cobas E 411 Analyzer 906

Cobas C 111 Analyzer 907

Cobas Integra® 400 Plus 908

Cobas P 312 Pre-analytical System 910

Cobas P 512 Pre-analytical System 910

Cobas P 612 Pre-analytical System 911

Cobas P 501 and Cobas P 701

Modular® Pre-analytics Evo 912

Cobas® Connection Modules (Ccm) 913

Cobas® 8100 Automated Workflow Series 914

Cobas® It Solutions 916

Cobas® Middleware Solution 917

Cobas® Laboratory Information System 918

Cobas® Infinity It Solutions 920

Overview of Serum Work Area Tests 921

Ecl—Unique Immunoassay Technology 925

Technology for Homogeneous

Immunoassay Detection 926

Elecsys® Hbsag Ii Quant 926

Elecsys® Hiv Combi Pt 4th Generation (Ag+Ab

Test) 927

The Syphilis Assays 929

Elecsys® Syphilis Immunoassay 929

Elecsys® Torch Panel 930

Elecsys® Troponin T High Sensitive

(Tnt Hs) 931

xvi Concise Book of Medical Laboratory Technology: Methods and Interpretations

Key Benefit: Earlier Diagnosis of Ami 932

Elecsys® Nt-proPnB 932

Elecsys® Tumor Marker Portfolio 933

Elecsys® He4 935

Elecsys® Pro-grp 936

Elecsys® Calcitonin 937

Elecsys® Anti-Tshr 938

Elecsys® Tg Ii 939

Tina-Quant® Lipoprotein (A) Gen 2 Test 940

Tina-Quant® Immunoglobulin A and M

Csf 941

 


Tina-Quant® Hemoglobin A1c 942

Tina-Quant® Cystatin C Gen 2 942

Elecsys® Preeclampsia 943

Elecsys® Vitamin D Total 945

Elecsys® Il-6, Pct and Tina-Quant® Crp 945

Elecsys® Tacrolimus and Cyclosporine 947

Hemostasis Testing 949

Multiplate® Analyzer 949

Urinalysis 951

Urinalysis From Roche 951

Combur-Test® Strip 951

Urisys 1100® Analyzer 952

Cobas U 411 Urine Analyzer 953

Cobas® 6500 Urine Analyzer Series* 954

Point-of-Care Testing 956

Cobas Poc it Solution 958

Cobas bge Link Software 960

Cobas B 121 System 961

Cobas B 221 System 962

Cobas B 123 Poc System 963

Accu-Chek® Inform Ii System 964

Accu-Chek® Safe-T-Pro Plus 965

Cobas H 232 Poc System 966

Roche Cardiac® Trop T Sensitive Test 967

Coaguchek® Xs System 968

Coaguchek Xs Plus System 969

Accutrend® Plus System 970

Reflotron® Plus System 971

Cobas B 101 System 972

Molecular Diagnostics 974

Solutions from Roche for Molecular

Diagnostics 974

Cobas P 630 Instrument 977

Cobas® Ampliprep Instrument 978

Cobas® Taqman® Analyzer and Cobas®

Taqman® 48 Analyzer 979

Cobas® Ampliprep/Cobas® Taqman® Hcv

Qualitative and Quantitative Tests, V2.0 980

Cobas® Taqman® Mtb Test 981

Cobas P 480 Instrument 982

Cobas® 4800 System V2.0 983

The Cobas® Hpv Test 985

The Cobas® Oncology Tests 985

Cobas® Mrsa/Sa Test 987

Cobas® Cdiff Test 987

Cobas® Hsv 1 and 2 Test 988

Cobas S 201 System 988

Lightcycler® Systems 990

Lightcycler® 2.0 Instrument 991

Test Kits, Validated for Ivd 992

Lightcycler® Septifast Test 992

Lightcycler® Mrsa Advanced Test 993

Magna Pure Systems 993

Symphony System 996

Benchmark Special Stains 997

Primary Antibodies 999

Ihc Detection 1001

 


Automation in Turbidimetry 729

Chapter 24. The Endocrine System 731

Pituitary Gland 731

Anterior Lobe: Growth Hormone (Gh) 732

Method of Evaluation: StreptavidinBiotin Elisa 733

Corticotropin (Acth) 735

Other Anterior Pituitary Hormones 735

Intermediate Lobe (Pars Intermedia) 736

Posterior Pituitary (Neurohypophysis) 736

Disorders of the Pituitary System 738

Hypothalamus 738

Adrenal (Suprarenal) Gland 738

Mineralocorticoids 738

Glucocorticoids 739

Adrenal Medulla 742

Thyroid 742

Calcitonin 753

Parathyroid 754

Parathyroid Hormone (Intact) Elisa 756

Pancreas 757

Testes 758

Ovary 758

Pineal Gland 759

Hormones and Fertility 759

Male Fertility 760

Female Fertility 763

Algorithm for Evaluating Amenorrhea,

Immunoassays for Lh, Fsh and Prl 768

Adrenal Cortex 775

Adrenal Medulla 777

Testes 779

Steroids 781

17-Β-Estradiol 781

Dheas (Dehydroepiandrosterone Sulfate) 782

∆4-Androstenedione 782

Progesterone 782

17-Alpha-hydroxyprogesterone 783

Total Tri-iodothyronine (T3) 783

Cia™ Insulin (Chemiluminescence

Immunoassay) 788

Contents xv

Chapter 25. Histopathology 791

Preparation of Tissues 791

Routine Staining Procedures 794

Some Staining Techniques in Detail 799

Automation in Histopathology 805

Chapter 26. Cytology 808

Papanicolaou Method of Staining

Smears (Modified) 808

Fnac (Fine-Needle Aspiration Cytology) 809

Smearing Techniques 812

Requirements for Laboratory Set Up 812

Immunoperoxidase Staining for

Cyto and Histopathology 817

Automation in Cytology 818

Chapter 27. Microbiology and

Bacteriology 819

Classification 819

Culture 825

Ready to Pour, Sterilized Pouched Media

for Microbiological Applications

Instaprep 828

Easybact 833

General Instructions for Microbiology 837

Gram-positive Cocci 837

Gram-negative Cocci 839

Anaerobic Spore Bearing Bacilli 840

Aerobic Spore Forming Bacilli 842

Gram-positive Bacilli 842

Mycobacteria 843

Overview of M. tuberculosis: Diagnostic

Approach, Afb Staining, Culture

and Sensitivity 845

Mucolytic, Disinfectant, Specimen

Pretreatment and Buffering System

for Afb Staining and Culture 848

Rapid Two Step Cold Afb Stain 851

Ready to use Lj Solid Medium for

Mycobacterium tuberculosis Isolation 855

Combipack of Solid and Liquid Medium for

Mycobacterium tuberculosis Isolation 857

Primary/Secondary Drug Containing

Lowenstein-Jensen Media Panel Mtb

Sensitivity Tests 861

In Determination of Adenosine Deaminase

Activity in Serum, Plasma and Biological

Fluids 863

Gram-negative Bacilli 865

Spirochetes 871

 


Rapid Test for Detection of Antibodies

to Mycobacterium tuberculosis

(Device) Serocheck-Mtb 676

Tb Igg, Iga, Igm Ab, Mfd Anda 678

Tumor Markers 679

Tumor Markers Standard Methodologies Available on Elisa and Clia, as on Ria too 683

Ca 15-3 (Carcinogenic Antigen 15-3) 683

Ca 19-9 (Carbohydrate Ag 19-9, Gicam

Gastrointestinal Cancer Antigen)

Blood Mfd: Can Ag, 683

Ca 242 Mfd: Can Ag, 684

Ca 125 (Cancer Antigen 125) Mfd:

Monobind 684

Carcinoembryonic Antigen (Cea) Mfd:

Monobind 685

Prostate-specific Antigen (Psa) Total

Prostate Specific Antigen (Tpsa) Elisa,

Mfd: Monobind 685

Prostatic Acid Phosphates (Pap), Blood

Method: Biochemical Analysis 686

Elisa Troubleshooting Aspects 686

Technical Tips 690

Chapter 23. Diagnostic Immunology 693

Qualitative Determination of Plasma Proteins

by Immunoprecipitation 693

Fundamental Quantitative Considerations 698

Turbidimetry 699

An Example of Turbidimetric

Immunoassay 718

C-reactive Protein 720

Turbidimetric Immunoassay for Determination

of C-reactive Protein 722

Turbidimetric Immunoassay for Ultrasensitive

Determination of C-Reactive Protein 723

Turbidimetric Immunoassay for Determination

of Antistreptolysin ‘O’ in Human Serum 724

Turbidimetric Immunoassay for Determination

of Microalbuminuria 724

Immunoglobulins (Ig) 724

Turbidimetric Immunoassay for Estimation of

Immunoglobulin

Iga in Human Serum 725

Turbidimetric Immunoassay for Estimation of

Immunoglobulin Igg in Human Serum 726

Turbidimetric Immunoassay for Estimation of

Immunoglobulin Igm in Human Serum 726

Turbidimetric Immunoassay for Estimation of

Complement C3 in Human Serum 726

Turbidimetric Immunoassay for Estimation of

Complement C4 in Human Serum 727

Turbidimetric Immunoassay for Estimation of

Antithrombin Iii in Human Serum 727

Quantitative Immunoturbidimetric

Assay for Estimation of Fibrinogen 727

Turbidimetric Immunoassay for Estimation of

Lipoprotein (A) in Human Serum 727

Quantitative Turbidimetric

Immunoassay for Estimation of

Apolipoprotein A-I 728

Quantitative Turbidimetric

Immunoassay for Estimation

of Apolipoprotein B 728

 


Anti-human Igg Monospecific Coomb’s

Reagent for Direct and Indirect

Antiglobulin Test 353

Anti-human Globulin Reagent for Direct and

Indirect Antiglobulin Tests 356

Preparing Coomb’s Control Cells Agtrol® 358

Low Ionic Salt Solution for Serological

Applications 359

Stabilized, Activated Papain Enzyme Solution

for Serological Applications 361

Blood Transfusion 363

Trouble Shooting 372

Chapter 12. Cerebrospinal and Other

Body Fluids 382

Cerebrospinal Fluid 382

Synovial Fluid (Sf) 388

Pleural Fluid 389

Pericardial Fluid (Pf) 391

Peritoneal Fluid 392

Amniocentesis and Amniotic Fluid

Analysis, Diagnostic 394

Chapter 13. Semen Analysis 398

Semen Analysis 398

Chapter 14. Sputum Examination 405

Sputum 405

Common Respiratory Disorders 406

Chapter 15. Pregnancy Tests 411

Bioassays 411

Immunologic Methods 412

Slide Test for Pregnancy 412

Slide Test for Pregnancy 414

Elisa Pregnancy Test 416

Dipstick Ict Pregnancy Test 416

Device Ict Pregnancy Test 417

Dipstick Ict, Urine/Serum

Pregnancy Test 418

Device Ict Urine/Serum

Pregnancy Test 419

Troubleshooting 421

Rapid Formats 423

Chapter 16. Examination of

Gastrointestinal Contents 425

Normal Saliva—Constituents 425

Gastric Juice 425

Examination of Duodenal Contents 430

Composition of Bile 430

Pancreatic Function Tests 430

Sweat Electrolytes Pilocarpine

Iontophoresis 432

Contents xiii

Chapter 17. Diabetes Mellitus:

 


Laboratory Diagnosis 434

Diabetes Mellitus 434

Glycosylated Hemoglobin Kit (Ion Exchange

Resin Method) for the Quantitative

Determination of Glycohemoglobin in

Blood (for in Vitro Diagnostic use Only) 443

Rapid Diagnostics 448

Chapter 18. Liver Function Tests 454

Tests of Excretion by the Liver 454

Evaluation of Synthesis in Liver 457

Evaluation of Enzyme Activity 458

Suggested Liver Function Tests 458

Chapter 19. Clinical Chemistry 461

Colorimetry 461

Photometer 462

Clinical Chemistry 465

Total Proteins 478

Serum Albumin 479

Serum Cholesterol 481

Hdl Cholesterol 484

Blood Glucose 490

Uric Acid 492

Calcium 493

Phosphorus 497

Chloride 500

Serum Iron and Tibc 501

Trace Elements 503

Zinc 503

Zinc (Colorimetric Method) 503

Copper 504

Magnesium 506

Automation in Clinical Chemistry 508

Principles of Quality Assurance and

Standards for Clinical Chemistry 514

Chapter 20. Enzymology 519

Alpha-amylase 519

Lipase 520

Phosphatases 522

Transaminases 530

Gamma-glutamyl Transpeptidase (Ggtp)

Blood 536

Lactic Dehydrogenase 538

Automation in Clinical Chemistry: Random

Access Autoanalyzer 546

Chapter 21. Blood Gases and

Electrolytes 548

Blood Gases 548

Automation in Blood Gas Analysis 556

Avl Compact 2 Blood Gas Analyzer 557

Electrolyte Analysis by Flamephotometer 558

Rapid Diagnostics in Electrolyte Analysis 561

Chapter 22. Serology/Immunology 563

Basic Immunology 563

Technologies 568

Enzyme Immunoassay 572

Chemiluminescence: The Technology 585

Polymerase Chain Reaction 587

Ria 590

 


Fibroscreen Thrombin Time Test for Qualitative

Estimation of Fibrinogen Fibroscreen® 297

Fibrinogen Estimation-Quantitative

Fibroquant, Reagent for Quantitative

Estimation of Fibrinogen 299

Fibrinolytic Activity 301

Fdps A Qualitative and Semiquantitative Latex

Slide Test for Detecting Cross

Linked Fibrin Degradation Products in

Human Plasma X-L Fdp 302

Laboratory Diagnosis of Coagulation

Disorders 304

Automation in Coagulation Analysis 305

Troubleshooting 309

Prothrombin Time 310

Dptt/Pttk 312

Fibrinogen Estimation 314

Chapter 11. Blood Banking

(Immunohematology) 317

Blood Group Antibodies 317

Anti-A, Anti-B, Anti-Ab Blood Grouping

Antisera for Slide and Tube Tests 320

Anti-A, Anti-B, Anti-Ab Monoclonal }|Blood

Grouping Antibodies for Slide and Tube

Tests 321

Anti-A1 Lectin Dolichos Biflorus

Lectin for Slide and Tube Tests 322

Anti-H Lectin Ulex Europaeus Lectin

for Slide and Tube Tests 323

Physiological Saline Solution for Serological

Applications (Sodium Chloride 0.9%

W/V) 325

Bovine Serum Albumin 22% Solution

for Serological Applications 325

Concentrated Iso-Osmotic Phosphate Buffered

Saline for Serological Applications 327

Red Cell Preserving Solution for Serological

Applications 328

Abo Grouping 329

Rh Blood Group System 331

Anti-D (Rho) Human (Igg) Polyclonal Blood

Typing Antibodies for Slide

and Modified Tube Tests 333

Anti-D (Rho) (Igm) Monoclonal Blood Typing

Antibodies for Slide and Tube Tests 335

Anti-D (Rho) (Igg) Monoclonal Blood Typing

Antibodies for Slide and Modified Tube

Tests 336

Anti-D (Rho) (Igm + Igg) Monoclonal Blood

Typing Antibodies for Slide and Tube

Tests 338

 


Hematocrit/Packed Cell Volume (Pcv) 212

Blood Cell Counts 213

Erythrocyte Indices 216

Complete Blood Count (Cbc) 217

Erythrocyte Sedimentation Rate (Esr) 220

Blood Film Examination 222

Rapid Diagnostics 225

Development of Blood Cells and

Sites of Blood Formation 227

Morphological Types of Red Blood Cells 234

Qualitative Assessment of G6pd

Deficiency 240

Examination of Fetal Hemoglobin 244

Laboratory Diagnosis of Disorders Related to

Rbcs 248

Thalassemias (Reduced Synthesis Rate) 256

Normal White Cell Values and Physiological

Variations 259

White Blood Cells 263

Quality Control in Hematology 270

Chapter 10. Clinical Hematology:

Bleeding Disorders 272

Platelets, Coagulation and Bleeding Disorders:

Laboratory Investigations 272

Laboratory Diagnosis of Platelet Disorders 272

Quality Assurance for Routine Hemostasis

Laboratory 278

Buffered 3.2% Citrate Solution (Profact) 280

Prothrombin Time (Quick One-Stage Method)

Liquiplastin® 283

Sensitive Thromboplastin Reagent for

Prothrombin Time (Pt)

Determination (Isi = 1.0) Uniplastin® 285

xii Concise Book of Medical Laboratory Technology: Methods and Interpretations

Thromboplastin Reagent for

Prothrombin Time (Pt)

Determination, Lyoplastin®

(Lyophilized Reagent, Isi = 1.0) 287

Aptt/Pttk Cephaloplastin Reagent for Partial

Thromboplastin Time (Aptt)

Determination Using Ellagic Acid as

Activator Liquicelin-E® 293

Normal and Abnormal Control Plasmas for

Coagulation Assays Plasmatrol H-I/Ii

® 296

 


Preface to the Second Edition

I authored an exhaustive book entitled “Medical Laboratory Technology – Methods and Interpretations” that hit the stands

in mid-eighties in the previous century and is now running in its 6th edition. This was the first such book in the subcontinent and was much appreciated and used by technologists and pathologists alike. The book has seen testimonies in courts

and has been appreciated in the west too. However, in our subcontinent, I was requested by many technologists that they

wanted a little younger sister of the book popularly known as MLT authored by me.

And so was born the Concise Book of Medical Laboratory Technology: Methods and Interpretations. The book essentially

covers everything presented in MLT-6 but in an abridged/shortened and easy-to-digest format. The book is presented in

a flowing noninterrupted format and not in a cumbersome experiment-wise cascading flow. There is no break in the style

that runs smoothly and is easier to absorb and assimilate. As experiments are a part of any course, more stress has been

laid out in the book to understand the intricacies of relevant theories and even troubleshooting all experiments that you

would conduct during the course of your study. As I have written multiple modules for many Universities in India, I did not

have to think for too long to devise a style and format for this book. You will find everything from ESR to PCR and you will

find foam test for bile pigments as also complete automation in urinalysis. You will find basic biochemistry as also detailed

cytogenetics. So whatever be your course or query, you will find it within the covers of this short but sweet book now going

into its second edition.

The book is designed for you not to mug but to understand and elicit the answers from the book of all questions in your

mind. I am aware that this book is used by most of your teachers and tutors too.

Nothing wrong that you are holding now. It will help you all your life!

Ramnik Sood

 


The first book on Medical Laboratory Technology from the house of Jaypee’s came out in 1985 and has been the best seller

in its class till date. The title “Medical Laboratory Technology – Methods and Interpretations” has seen 6 editions. The latest

one hit the stands in January this year and was released in two volumes. It is a four-color book and has over 1670 pages. The

reader base of all editions of our vastly popular title “MLT” has been upcoming laboratorians, undergraduate and postgraduate

medical students. It was requested by a few institutes to produce a little smaller version of the two-volume set that would

be suitable for the upcoming Laboratory Technology students. So here it is! It is exhaustive yet precise and concise too.

The book will help you to appreciate things as they appear in real life under the microscope and otherwise. All current

technologies find a mention within the covers of this book. Gone are the days when we had to prepare reagents first thing

in the morning (or the days usage); therefore, the current trend of consuming ready-to-use reagents/kits is followed here

to make your job and understanding simpler. So, what is available in the market for all investigations, is what is presented

here. The Tulip Group has very kindly given us the rights to reproduce the text related to all their kits and reagents in this

book. Latest instruments are not forgotten too.

Most important—

Parasitology section is presented in ample detail as it is relevant to all the developing nations.

Quality control/assurance is mentioned in appropriate details. Working is not enough. Working properly and producing

nothing but the most accurate reports are the order of the day. This book will not fail you there. Follow the recommendations to the hilt and you would be running the most accurate laboratory available anywhere.

Should problems arise! The book has “Troubleshooting” section for every possible test mentioned inside. If this happens – then what! If that happens – then what! You will find all answers.

From ESR to PCR – you will find everything.

The book is based on most syllabi as applicable to most institutes in India and elsewhere internationally.

All necessary care has been taken to weed out any discrepancies/typographical errors at the time of going to press.

However, if anything has remained inadvertently, the publishers/author do not take any responsibility for the same in any

manner whatsoever.

Learning can be enjoyable experience, flip a few pages to experience that.

Ramnik Sood

Preface to the First Edition

 


This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or

services are required, the services of a competent medical professional should be sought.

Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any

have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.

Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com

Concise Book of Medical Laboratory Technology: Methods and Interpretations

First Edition: 2009

Second Edition: 2015

ISBN 978-93-5152-333-8

Printed at

Jaypee Brothers Medical Publishers (P) Ltd

Dedicated to

the Readers


 


Suite 835, Philadelphia, PA 19106, USA Bangladesh

Phone: +1 267-519-9789 Mobile: +08801912003485

Email: jpmed.us@gmail.com Email: jaypeedhaka@gmail.com

Jaypee Brothers Medical Publishers (P) Ltd

Bhotahity, Kathmandu, Nepal

Phone: +977-9741283608

Email: kathmandu@jaypeebrothers.com

Website: www.jaypeebrothers.com

Website: www.jaypeedigital.com

© 2015, Ramnik Sood

The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent

those of editor(s) of the book.

All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic,

mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.

All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their

respective owners. The publisher is not associated with any product or vendor mentioned in this book.

Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the

subject matter in question. However, readers are advised to check the most current information available on procedures included and

check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and

duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety

precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property

arising from or relate♥d to use of material in this book.

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