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Microbiology

HISS’S STAIN

DEMONSTRATION OF BACTERIAL CAPSULES BY HISS’S STAINING TECHNIQUE   Reagents- 1.  1% (w/v) crystal violet. 2   20% (w/v) copper sulfate. Procedure- 1.  Mix the organism suspension with one drop of normal saline (0.85 g/dl sodium chloride) (This helps to show the capsules). 2 . Prepare dry smear by using alcohol. 3 . Cover the smear with crystal violet stain and heat gently until steam begins to rise. Leave to stain for one minute. 4  . Wash off the stain with copper sulfate solution. 5. Dry the smear in air. 6. Examine the smear under oil immersion objective. Result- 1. Bacterial                 Dark purple 2. Capsule outline     Pale blue  

Microbiology

CULTURE MEDIA INTRODUCTION AND PREPARATION

  INTRODUCTION OF CULTURE MEDIA Most bacteria can be cultured artificially on culture media containing required nutrients, pH and osmotic pressure. The microorganisms grow in an atmosphere and temperature most suited to their metabolic reactions. The pathogens are isolated in pure culture so that they can be identified and tested for their sensitivity to antimicrobials. The specimens are cultured in known volumes, and the number of bacterial colonies appearing after incubation can be counted. Operation room requirements and blood from blood bank are frequently checked for sterility by using pure culture methods. Vaccines and antitoxins require the growing of bacteria under controlled conditions. Stock cultures are also useful for the teaching institutes for practical training purposes. COMPOSITION OF CULTURE MEDIA The basic ingredients, which are common to the many ofthe frequently used media are as follows: 1.     Water:It allows fluids to enter and leave cells more readily and to enhance thechemical reactions. 2.     Sodiumchloride: Presence of sodium chloride maintains the isotonicityof bacterial cells. 3.     Peptones:It is a source of readily available nitrogen. 4.     Buffers:They maintain a constant pH in culture media. 5.     Indicators:In culture media the indicators are useful in the detection of acid or alkaliproduction by microorganisms. Indicators such as phenol red, methyl red andBromocresol purple are used to adjust pH of the culture media. 6.     Solidifyingagents: Agar, gelatin, egg yolks and serum are used assolidifying agents of the culture media. 7.     Selectiveagents: These are special chemicals introduced into theculture media for inhibiting some types of bacteria, while allowing otherbacteria to grow. Examples: (a) Crystal violet inhibits Staphylococci but nottubercle bacilli (b) 6.5% (w/ v) sodium chloride is inhibitory to mostStreptococci but not S. faecalis. 8.     Additivefor enrichment: The substances such as sheep blood, horse blood,rabbit serum or calf’s ground hearts allow fastidious organisms to grow sincethese organisms, may not survive in ordinary culture media. 9.     Reducingsubstances: The substances such as thioglycollate are used toremove free oxygen from the medium for the growth of anaerobic bacteria.    THEDIFFERENT TYPES OF CULTURE MEDIA Basic Media:-These support the growth of microorganisms that do nothave special nutritional requirements. They are often used (a) To maintainstock cultures of control strains of bacteria and (b) For subculturingpathogens from selective media prior to performing biochemical and serologicalidentification tests. Examples: (1) Nutrient agar (2) Nutrient broth. Enriched Media:- These are enriched with (a) Whole blood (b) Lysed blood (c) Serum (d) Extra peptones and (e) Vitamins to support the growth of particular pathogens such as Hemophilus influenzae, Neisseria and Streptococcusspecies. Examples: (I) Blood agar (II) Tryptone soya media. Selective Media:- These media contain substances that accelerate the  growth of required pathogens only and prevent or slow down the growth of other  microorganisms. Example: XLD agar: It is used for the growth of Salmonellae and Shigellae. The bile salts present in this media inhibit the growth of many fecal commensals. Differential (Indicator) Media:- These contain indicators, dyes or other substances which help to differentiate microorganisms. Example: TCBS agar contains the indicator bromothymol blue which differentiates sucrose fermenting from non-sucrose fermenting vibrio species. Transport Media:- When specimens are not cultured soon after collection,to prevent overgrowth and also to ensure survival of pathogens, transport mediaare used. These are mainly used to transport microbiological specimens fromhealth centers to the district pathological laboratories. Example: (1) Amiestransport medium (2) Cary Blair medium. DIFFERENT FORMS OF CULTURE MEDIA 1.      Solid Culture Media:- This isused in petri dishes and in test tubes (slope cultures) and prepared by addingSolidifying agent  (1.0 – 1.5%) (w/v).Microorganisms grow on this and form colonies after multiplication. This helpsto identify the organism. 2.      Semisolid Culture Media :- This isprepared by adding Solidifying agent (0.4-0.5%) (w/v) to a fluid medium. Theseare used mainly as transport media and for the testing of motility of theorganisms. 3.      Fluid Culture Media:- These mediaare mainly used as biochemical testing media, blood culture media or theenrichment media. PREPARATION OF CULTURE MEDIA  Mostculture media are available commercially in readymade dehydrated form. It isless costly to use readymade media, since the ingredients are often required insmall amounts but available in large quantities if purchased. Some of thechemicals are also difficult to obtain. To ensuregood performance and reproducibility in the results the following must beperformed correctly- 1.    Weighing and dissolving of theingredients 2. Addition of heat sensitive material 3.  pH testing 4. Dispensing and sterilization 5. Sterility testing and qualitycontrol 6.storage  Note 1.      The heat sensitive ingredients such as blood or serum should be brought to room temperature and added when the medium has cooled to about 50°C. 2.      A fluid medium should be tested for accurate pH by using a narrow, range pH paper. 3.      For sterilizing culture media, it is necessary to use manufacturer’s instructions. The commonly used methods for sterilization are- a) Autoclaving (b) Steaming at 100°C and (c) Filtration. It is necessary to use correct temperature and correct length of time. Precautions ·  Autoclaving is used to sterilize most agar and fluid media. · Steaming at 100°C: Media such as Cary Blair transport medium contain ingredients that would break down above 100°C. Steaming can be performed in an autoclave with a loose lid. ·   Filtration: Serum and solutions containing carbohydrates, urea, etc. are heat sensitive and hence cannot be autoclaved. Hence, the media containing such substances are filtered to remove bacteria. ·  Sterility testing: Media in tubes and bottles: Incubate the entire batch at 37°C overnight. Contamination is indicated by appearance of turbidity in a fluid medium and growth on a solid medium. · Control of media: Appropriate control species are used to inoculate slants or plates of the medium (quarter part). After overnight incubation, the cultures are examined for (a) Degree of growth (b) Size of colonies and (c) Other characteristics. ·  Storage of culture media: Dehydrated culture media and dry ingredients (agars, peptones, bile salts, etc.) can be stored at room temperature (25°C ± 5°C) in a cool and dry place, away from direct light. Additives such as blood, serum, urea and carbohydrates in solution form are stored at 2-8°C in the refrigerator. Basic Method of Preparation of Culture Medium – Step by Step 1.      Weigh the solid ingredients by using an analytical balance. 2.      Add sufficient quantity of distilled water. 3.      Dissolve the

Microbiology

STAINING OF SPIROCHETES

STAINING OF SPIROCHETES Introduction- The three important groups of spirochetes are (1) Treponema (2) Leptospira and (3) Borrelia. These are motile, elongated, flexible and spiral organisms. They are not easily stained and can be demonstrated by silver impregnation method (Fontana’s method) or by dark field microscopy. 1. Treponema:  These are about 0.2 μm in width and 5 to 15 μm in length. 1.  Treponema pallidum: This is the causative or- ganism of syphilis which is transmitted by sex- ual contact. 2.    Treponema pertenue: In morphology it is iden- tical with Treponema pallidum and it is the caus- ative organism of yaws. It causes ulcerating papule on the arms or legs.  3.Treponema carateum: It causes nonulcerative papule and leads to the disease Pinta (predom- inantly occurs in Mexico). 4.Treponema microdentum: This organism is found in the secretions between the teeth and in the tartar. 5.  Treponema calligyrum: These organisms may occur in genital secretions. 2. Leptospira:  These vary from 5 to 15 um in length and about 0.1 um in width. Leptospira icterohem- orrhagiae causes Weil’s disease (infectious jaundice). It is transmitted through water or food contaminated through animal sources (infected rats, mice or dogs). Leptospira can be detected in blood by the dark field illumination. 3. Borrelia:  These are irregular wide open coils and are larger in length (10 to 30 μm). These can be    stained with aniline and Romanowsky stains. STAINING OF SPIROCHETES Principle- Since heat denatures the spirochetes, a chemical fixative such as absolute alcohol is used as a fixative. Afterwards silver impregnation method of Fontana is used. Deposition of silver salt in the organism makes them visible microscopically. Reagents- 1. Fixative A)           Glacial acetic acid               1 ml b)            Formalin                               2 ml c)            Distilled water to                100 ml 2. Mordant a  Phenol                                                   1g b) Tannic acid                                           5g c)Distilled water to                                 100 ml 3 .Ammoniated silver nitrate a)  10% (v/v) ammonia.                b)   0.5% (w/v) silver nitrate. 4.  Normal saline:  (0.85% (w/v) sodium chloride in distilled water. Note- In the case of solution 3, add solution (a)To solution (b) Until the precipitate formed just dissolves. Add solution (b)Dropwise till the precipitate returns. The precipitate should not redissolveagain. Procedure- 1.      Make a smear of tooth tartar ina drop of normal saline. 2.      Treat the film three times (30seconds each) with the fixative. 3.      Wash off with absolute alcoholand flood with alcohol for about 3 minutes. 4.      Drain alcohol completely andair dry the smear. 5.      Flood the smear with mordant.Heat it till steam rises for 30 seconds. 6.      Wash the smear under runningtap water. Dry the smear completely. 7.      Treat with ammoniated silvernitrate. Heat till steam rises for 30 seconds (The film should appear brown). 8.      Wash in distilled water and dryin air, 9.      Mount in Canada balsam undercoverslip (since some immersion oils cause the film to fade). 10.  Observe under oil immersionlens. Result- a)     Spirochetes                     Browinsh black b)    Background                     Brownish  yellow  

Biochemistry

CHOLESTROL

TOTAL CHOLESTEROL (CHOD/POD METHOD) INTERPRETATION:Enzymatic method for in-vitro quantitative determination of cholesterol. PRINCIPLE: Cholesterol esters are hydrolyzed by cholesterol esterase to free cholesterol.Cholesterol is then oxidized by cholesterol oxidase to form hydrogen peroxide.Hydrogen peroxide reacts with 4-aminoantipyrine and phenol in presence of peroxidase to form a red quinoneimine dye.The intensity of the color is proportional to cholesterol concentration. REACTION: Cholesterol esters + H₂O → Cholesterol + Fatty acidsCholesterol + O₂ → Cholest-4-en-3-one + H₂O₂H₂O₂ + 4-AAP + Phenol → Quinoneimine dye (red) MATERIAL REQUIRED BUT NOT PROVIDED: Test tubes Pipettes Analyzer Use serum. .Reagent:- R1 Buffer / Enzymes / Phenol R2 Cholesterol Standard 200 mg/dL PROCEDURE: Test Blank Standard Sample Working Reagent 1.0 ml 1.0 ml 1.0 ml Distilled Water 0.01 ml – – Standard – 0.01 ml – Sample – – 0.01 ml Mix and incubate for 5 minutes at 37°C.Read absorbance of Standard (S) and Sample (T) against Blank (B) at 505 nm. CALCULATION: Cholesterol (mg/dL)=TS×200text{Cholesterol (mg/dL)} = frac{T}{S} times 200 Cholesterol (mg/dL)=ST×200 NORMAL VALUES: 140–250 mg/dL(Values may vary by age, sex, population.) PRESERVATION / STABILITY:   • Do not use hemolyzed samples.• 7 days at 2–8°C. GENERAL SYSTEM PARAMETERS: (Values approx. may vary depending on instrumentation) Method: End Point Wavelength: 505 nm Temperature: 37°C Sample Volume: 0.01 ml Reagent Volume: 1 ml Linearity: Upto 1000 mg/dL Incubation: 5 min LIMITATIONS: Grossly lipemic or icteric samples may interfere.Avoid hemolyzed samples. HDL CHOLESTEROL INTERPRETATION: Enzymatic method for HDL-Cholesterol estimation.Based on PEG-modified enzymes. MATERIAL REQUIRED BUT NOT PROVIDED: Test tubes Analyzer Micropipettes • Serum or EDTA plasma (0.3 ml) PROCEDURE: Test Blank Standard Serum Enzyme Reagent 1 ml 1 ml 1 ml Distilled Water 0.01 ml – – Standard – 0.01 ml – Sample – – 0.01 ml Mix well and incubate for 5 minutes at 37°C.Read absorbance of Standard (S) and Test (T) at 600 nm. CALCULATION: HDL Cholesterol (mg/dL)=TS×50text{HDL Cholesterol (mg/dL)} = frac{T}{S} times 50 HDL Cholesterol (mg/dL)=ST×50 NORMAL VALUES: Male: 45–65 mg/dL Female: 35–80 mg/dL NOTES: • Do not use hemolyzed or icteric samples.• HDL precipitate may interfere.• Run control serum daily.

Biochemistry

CALCIUM

CALCIUM (Arsenazo III) TEST KIT (MONOTEST)INTENDED USE:Intended for in vitro quantitative determination of Calcium in Serum. PRINCIPLE Calcium forms a purple complex with Arsenazo III at neutral pH. Intensity of colour is proportional to calcium concentration and is measured photometrically. Calcium + Arsenazo III → Blue-purple complex CONTENTS Reagent 1: Calcium (ASIII) Reagent – 2 x 15 mL Reagent 2: Calcium Standard – 1 x 1 mL      SAMPLE COLLECTION & PRESERVATION Use serum. Calcium is stable 7 days at 2–8°C when stored in tightly closed glass vials. Avoid haemolysed specimens. REAGENT PREPARATION & STORAGE Store at 2–8°C. Stability up to expiry date when stored properly. Protect from direct light. Do not freeze. PROCEDURE Label test tubes: Blank (B), Standard (S), Sample (T) Add reagents: Reagent 1: 1000 µL to all Standard: 10 µL to S Sample: 10 µL to T Mix and incubate for 5 minutes at 37°C Measure absorbance of S and T against reagent blank at 650 nm  CALCULATION Calcium (mg/dL) = (Absorbance of Test / Absorbance of Standard) × 10 NORMAL VALUES  Serum calcium: 8.5 – 10.5 mg/dL (Values may vary by population and methodology) CLINICAL SIGNIFICANCE Calcium is found mainly in the bones (approx. 98%). In serum, calcium exists in three forms: Protein-bound Ionized (physiologically active) Complexed with anions Serum calcium levels may increase in: Hyperparathyroidism Hyperthyroidism Excess Vitamin D Malignancy Levels may decrease in: Hypoparathyroidism Renal failure Vitamin D deficiency Pancreatitis GENERAL SYSTEM PARAMETERS Reaction type: End point Wavelength: 650 nm (600–660 nm) Reaction temperature: 37°C Sample volume: 10 µL Reagent volume: 1000 µL Standard: 1 mmol/L Incubation: 5 minutes Read against reagent blank LINEARITY Linear up to 15 mg/dL.If sample >15 mg/dL, dilute and multiply result by dilution factor. NOTE Reagent is very stable; colour intensity develops uniformly. Avoid contaminated glassware. LABELING Code No. 317, Pack Size 2 × 15 mL, Standard 1 mL

Microbiology

COMPOSITION OF CULTURE MEDIA

1. Nutrient Agar Nutrient agar is a solid medium used in microbiology to grow a wide range of non-fastidious organisms, including bacteria and fungi. Composition of Nutrient Agar: Component Amount Peptone 0.5% Beef Extract 0.3% Sodium Chloride 0.85% Agar 1.5% Water 1000 ml 2. Blood Agar It is a general purpose, enriched and differential solid medium, which supports the growth of most ordinary bacteria. It is also useful to detect and differentiate hemolytic bacteria, especially Streptococcus species.Blood supplies a number of required nutrients for the growth of fastidious organisms. Composition of Blood Agar: Component Amount Nutrient agar 500 ml Sterile Defibrinated blood 25 ml Procedure: Transfer sterilized nutrient agar to 50°C water bath. When it is cooled to 50°C, add aseptically sterile defibrinated sheep or horse blood. Mix gently and dispense aseptically in sterile petri dishes. pH of the medium should be adjusted to 7.3.               Blood should be free from hemolysis. Sheep or rabbit blood can be used for most of the pathogens. Use of human blood should be avoided, since certain substances in human blood may be inhibitory to the growth of certain pathogens such as hemolytic Streptococci. Sheep blood inhibits the growth of Haemophilus haemolyticus (human throat commensal).       Note: 3. Chocolate (heated blood) agar It is used to grow Haemophilus influenzae and other pathogens which require highly nutritious medium, such as Neisseria meningitidis and Streptococcus pneumoniae. Formula and preparation: It is prepared by using the same procedure used for the preparation of blood agar except after adding blood, the medium is heated at 70°C in a water bath until it becomes brown in color. The medium should be mixed gently for about 10–15 minutes. Allow it to cool to about 45°C. Dispense aseptically in sterilized petri dishes. Note: The medium should not be overheated. The duration of heating should not be prolonged.   4.    Crystal violet blood agar This is used as a selective medium for Streptococcus pyogenes. • Principle:- At a concentration of 1:500,000 crystal violet inhibits the growth of Staphylococcus aureus and retards the growth of commensals (throat specimen). • Formula and preparation 1. Sterile blood agar:                       100 ml. 2. 0.02% (w/v) crystal violet:         1.0 ml. Mix well and dispense aseptically in sterile petri dishes. 5. Neomycin Blood Agar This is used as a selective medium for obligate anaerobes. Principle: Facultative anaerobic Gram-negative rods are inhibited at a concentration of 70 µg/ml neomycin sulfate. Formula and Preparation a) Prepare stock neomycin sulfate (70,000 µg/ml) Neomycin sulfate    →     0.5 g Sterile water             →      5 ml (This contains 0.35% neomycin base) b) Preparation of working neomycin (37500 µg/ml) Add 2 ml of 70,000 µg/ml stock neomycin solution to 8 ml sterile water. Blood agar               →        250 ml Working neomycin →        1.0 ml Mix well and pour aseptically in sterile Petri dishes.Concentration of solution C = 700 µg/ml neomycin/ml. 6. Brain Heart Infusion Broth and Agar It is an enriched medium used for the growth of fastidious bacteria, yeasts, and molds. Preparation of BHI (Liquid Medium) I. Beef heart infusion        →           250.0 gII. Calf brain infusion        →           200.0 gIII. Proteose peptone        →          10.0 gIV. Dextrose                        →          2.0 gV. Sodium chloride            →          5.0 gVI. Disodium phosphate  →          2.0 gVII. Distilled water            →          1000 ml Dissolve the contents in 800 ml of distilled water and make the final volume to 1000 ml. Sterilize the medium by autoclaving at 121°C for 15 minutes. Dispense aseptically after cooling the agar medium to 45–50°C. Note: With the addition of 1.5% agar, BHI agar can be used as a solid medium. 7. Bordet Gengou’s Medium It is a selective medium used for the isolation of the causative agent of whooping cough, Bordetella pertussis. Formula and Preparation I. Potato infusion          —              125.0 gII. Peptone                     —               10.0 gIII. Sodium chloride      —               5.0 gIV. Glycerol                     —               20.0 gV. Agar                            —               30.0 g Procedure Mix potato with glycerol and about 100 ml of distilled water; boil and strain through gauze. Add the filtrate to the mixture of other ingredients and keep for 5 minutes. Boil the solution to dissolve the agar. Make the final volume 1000 ml. pH of the medium should be adjusted to 6.4–6.6. Sterilize the medium in 100 ml volumes in bottles or flasks. Sterilize the containers by autoclaving at 121°C for 15 minutes. Store at 2–8°C. 8. Brilliant Green Agar This medium is used for the selective isolation of Salmonella. Formula and Preparation I. Proteose peptone  —               10.0 gII. Yeast extract          —               3.0 gIII. Sodium chloride   —               5.0 gIV. Lactose                  —              10.0 gV. Sucrose                   —              10.0 gVI. Phenol red             —              0.08 gVII. Brilliant green      —               0.0125 gVIII. Agar                 

Microbiology

ALBERT STAIN

It demonstrates the presence of metachromatic granules found in Corynebacterium diphtheriae. Smears of throat swab are useful in the diagnosis of diphtheria by Albert’s staining method. Reagents 1. Albert’s solution ‘A’ a) Add 1.0 ml of glacial acetic acid to 99 ml of distilled water. b) Add 0.15 g of toluidine blue and 0.2 g of malachite green in 2.0 ml of (95%) ethyl alcohol by grinding in a mortar. c) Mix solution (a) and solution (b). Keep for 24 hours and afterwards filter it and store in an amber colored dropping bottle. 2. Albert’s solution ‘B’ a) Add 3.0 g of potassium iodide in 100 ml of distilled water. b) Add 2.0 g of iodine in solution (a). Mix thoroughly and store in an amber colored dropping bottle. Stability of the Reagents The reagents are stable at room temperature (25°C ± 5°C). Procedure Flood the heat fixed smear with Albert’s staining solution ‘A’ for 5 minutes. Drain the staining solution but do not wash. Flood with solution ‘B’ and keep for 1 to 2 minutes. Wash carefully under running tap water, drain, blot dry and examine under oil immersion objective. Results Metachromatic granules: Bluish black. Bacillary body: Green or bluish green.

Microbiology

NEGATIVE STAINING

DEMONSTRATION OF BACTERIAL CAPSULES BY NEGATIVE STAINING METHOD Reagents –10 gm/dl nigrosine solution. Sample –A given culture. Procedure – Transfer aseptically a loopful of culture on a clean and dry slide. Mix it with a loopful of stain. Make a smear by using a glass slide. Allow it to dry slowly at room temperature (25°C ± 5°C). Observe under oil immersion lens. Results –   Observation Appearance Background Bluish black Organisms Colorless (hollow bodies)

Microbiology

SIMPLE STAINING

Simple Staining Simple staining is used to stain prokaryotic cells, e.g., microorganisms, to determine the shape, size, and arrangements. In this staining method, only a single dye is needed. It’s simple with the procedure which includes covering fixed smears with stain for a minute, and excess stain is washed off with water and blotted dry. In this case, basic dyes are used which are methylene blue, crystal violet, and carbolfuchsin. (a) Crystal violet stain of Escherichia coli(b) Methylene blue stain of Corynebacterium

Biochemistry, Uncategorized

CERATININE

CREATININE REAGENT KIT (Alkaline Picrate Method) INTENDED USE   This reagent kit is used for the in vitro quantitative determination of creatinine in serum and urine. SUMMARY Creatinine is the end product of creatine phosphate metabolism in muscles. It is excreted in urine.Serum creatinine level helps assess kidney (renal) function.Elevated creatinine indicates renal impairment, muscle damage, or muscular dystrophy. PRINCIPLE Creatinine reacts with alkaline picrate to form an orange-colored complex.The intensity of the color is directly proportional to the amount of creatinine present and is measured spectrophotometrically at 520 nm. Reaction:Creatinine + Alkaline Picrate → Orange-Coloured Complex CONTENTS Reagent 1: Creatinine Buffer Reagent Reagent 2: Creatinine Standard Reagent Reagent 3: Creatinine Picrate Reagent MATERIALS REQUIRED  Clean dry glassware Micropipettes & tips Colorimeter or Spectrophotometer Test tubes SPECIMEN Use serum or urine. Serum should be diluted (1:100) in saline. PREPARATION OF REAGENT & STABILITY Reagents are supplied ready-to-use. Store at 2–8°C. Working reagent is stable for 7 days at room temperature (R.T.) or 1 month at 2–8°C. PROCEDURE Pipette into Test Tubes Blank Standard Test Working Reagent 1.0 ml 1.0 ml 1.0 ml Standard – 0.1 ml – Sample – – 0.1 ml Mix well and read absorbance (A) of the Standard and Test after 30 seconds and again after 90 seconds at 520 nm. Distilled water is used as Blank. CALCULATION Creatinine (mg/dL)=ATAS×2text{Creatinine (mg/dL)} = frac{A_T}{A_S} times 2 Creatinine (mg/dL)=ASAT×2 Urine Creatinine (g/L)=ATAS×2×Dilution factortext{Urine Creatinine (g/L)} = frac{A_T}{A_S} times 2 times text{Dilution factor} Urine Creatinine (g/L)=ASAT×2×Dilution factor Where:Aₛ = Absorbance of StandardAₜ = Absorbance of Test NORMAL VALUES Serum: Male – 0.6–1.4 mg/dL; Female – 0.6–1.2 mg/dL Urine (24 hours): 1.0–2.0 g/24 hr (Note: Values may vary by method and laboratory.)                                                  QUALITY CONTROL Use normal and abnormal serum controls to check assay performance. LIMITATION & PRECAUTIONS Avoid hemolysed samples. Maintain precise timing and temperature. Do not use reagents after expiry date. For in vitro diagnostic use only.

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