Instrument

1. Urinometer 

1. A glass cylinder with a bulb containing mercury and a stem

2. Stem has a scale with a reading from 1.000 – 1.060

3. Used to measure urine specific gravity at room temperature.

2. Esbach’s Albuminometer

1. Glass tube has U (urine), R (Esbach’s reagent) markings.

2. Has graduation from 6 to 12.

3. Used for quantitative estimation of proteins.

3. Sahli’s Haemoglobinometer

a. Sahli’s haemoglobinometer - comparator 

1. Used in haemoglobin estimation to match the colour.

 2. Consists of rack with standard, fixed in front of ground glass. 

b. Graduated diluting tube of Sahli’s haemoglobinometer

1. A graduated tube with markings in gms (2 to22gms) and percentage (10 to 160%)

2. Used in estimation of haemoglobin in gm%.

c. Sahli’s haemoglobinometer pipette

1. A glass pipette with 20 cu mm capacity. 

2. Used to pipette blood for haemoglobin estimation.

4. WBC Pipette

1. Pipette with small bulb and a white bead in it. 

2. Markings on pipette are 0.5 and 1.0 and marking on the stem above the bulb is 11.

3. Used for total WBC count. 

5. Neubauer’s counting chamber

1. Improved Neubauer’s chamber has shiny surface which makes the lines very clearly visible even after charging it.  It has a total area of 3mm X 3 mm with central ruled area of 1mm x 1mm. 

2. The central area consists of 25groups of 16 small squares separated by bold lines.  Corner 1mm X 1mm squares have 1y smaller squares each, which are used for TLC 

3. Depth of the chamber is 0.1mm

4. It is used for RBC, WBC, Eosinophils and platelet count. 

6. Westergren’s pipette

1. Straight 30cm long pipette open at both ends.

2. Graduated from 0-200 ml from top to bottom.

3. Used to estimate Erythrocyte sedimentation Rate (ESR)

7. Wintrobe’s tube 

1. Short 11mm glass tube closed at one end

2. Graduated on both sides from 0-10 on end and from 10 -0 on the other end.

3. Used to estimate ESR and PCV. 

8. Jamshedi Bone Marrow Aspiration and Biopsy Needle

Wide bore steel needle with adjustable guard, usually 7-8 cms. Used for bone marrow aspiration and biopsy.

Bone  marrow  examination  may be necessary  to Diagnose, to note the prognosis and/ or to evaluate  the therapeutic response for a variety of hematologic  & non hematologic problems. 

Common sites used for BMA & Biopsy

1)  Most  marrow  specimens  are taken from  the posterior superior iliac  spine.

2)  The sternum  & anterior iliac  crest are occasionally  used in adults.

3)  In children  less than 2 yrs.  anteromedial surface  of tibia is used.

4)  Occasionally  the spines of  the lumbar vertebral  bodies of L1 & L2 are  used in older children

Indications for BMA and BM Biopsy

1) Primary diagnosis of hematolymphoid malignancies:

• Acute  leukemias 

• Chronic  MPDs

• Chronic lymphoproliferative  disorders

• MDS

• Hodgkin’s  & non-Hodgkin’s lymphoma

• Multiple Myeloma. 

2)  Staging of lymphoid malignancies & solid tumors 

3) Post treatment follow up 

• Post chemotherapy & Radiotherapy

• Post bone marrow transplant

4)  Detection of infection & /or source of fever of unknown origin

•  Mycobacterium  & Fungal infection

•  Granulomas 

•  Unknown infectious agents using cultures & special stains. 

5) Primary diagnosis of systemic diseases                   

Metabolic disorders (Gaucher”s disease etc.)               

Systemic mastocytosis.

6) Miscellaneous

•  Evaluation  of storage iron

•  Evaluation  of unexplained  cytopenias 

Contraindications:

• Local  infections

• Coagulation  disorders

9. Lumbar puncture needle

1. Consists of steel needle about 10cm long with a bore of 1.0 to 1.5 mm

2. Used to aspirate cerebrospinal flid (CSF)

3. Site of aspiration: The spinal cord usually ends at the inferior border of L1 or the superior border of L2. Therefore, inserting the needle between L3 and L4 or L4 and L5 is relatively safe. This level corresponds to the lumbar cistern. During a lumbar puncture, the syringe needle is inserted in the midline and within the median plane.

4. Indications: i.Diagnosis of serious infections such as meningitis 

ii.Disorders of the central nervous system, such as Guillain-Barre syndrome and multiple sclerosis

iii.Cancers of the brain or spinal cord

10.  Ryle’s tube 

1. Length 75cm

2. 4 black rings:  1st ring – at 40cm from incisors at cardiac orifice of stomach

2nd ring -  at 50cm in the gastric cavity.

3rd ring – at 57cm at the pyloric orifice

4th ring – at 65cm at the first part of duodenum.

3. Blunt tip to prevent trauma.  

4. Lead shots or beads enclosed at the distal end of the tube: helps in introduction and fluoroscopic monitoring the position of the tube. 

5. Indications: gastric lavage, feeding in unconscious patients, administering drugs

 6. Contraindications: Aortic aneurysms, oesophageal stenosis and oesophageal varices in patients with cirrhosis. 

11. Blood Bag: Blood bags are designed for the collection, processing and storage of whole blood and blood components. They help in providing aseptic conditions for the separation of blood components. It acts as a closed system reducing the chances of contamination

Single Blood Bag:

1. For whole blood collection

2. The bag contains CPDA solution as anticoagulant

3. Available in capacity of 350ml and 450ml

Triple Blood Bag: 

• Triple Blood Bag with SAGM, for whole blood collection 

• Separation of 3 different blood components (red blood cells, plasma and platelets). 

• The primary bag contains CPD and one satellite bag contains SAGM. 

12. FNAC Gun: 

Fine needle aspiration cytology is a diagnostic procedure used to investigate lumps or masses under the skin and deep seated masses can be approached with ultra sound or CT guidance.

In this technique, a thin, hollow needle is inserted into the mass and cells are aspirated by creating negative pressure. The cells obtained are spread over glass slides, stained and examined under microscope to diagnose the underlying pathology based on the cytological features. 

Advantages: It is a safe, rapid, minimally invasive, less traumatic, inexpensive method.  The procedure has low risk of complications and can be performed as an outpatient procedure. It is readily repeatable and allows biopsy of multiple lesions in one session. The procedure provides a preliminary or differential diagnosis within minutes to guide further investigation and management. Cytological material for many techniques such as bacterial culture, immunocytochemistry, flow cytometry, cytogenetics, polymerase chain reaction, etc. can be obtained.

Limitations: As there are only few cells obtained the main diagnosis could be missed and could result in false negative results. Architecture cannot be assessed and considerable training is needed for accurate interpretation. 

13. Core Biopsy needle:

Core needle biopsy is the procedure to remove a small amount of suspicious tissue from a lesion with a larger “core” (meaning “hollow”) needle. A core needle biopsy provides significantly more information as it obtains much more tissue for evaluation.The core needle biopsy can be performed on most parts of the body. Common locations include the lymph nodes, breast masses, bone lesions, and the prostate.

The most important risk associated with a core needle biopsy is bleeding and hematoma formation at the site of the biopsy.