INDUSTRIAL TRAINING REPORT

KUANTAN CLINICAL DIAGNOSTIC

CENTRE SDN. BHD.

REPORT SUBMITTED TO FULFILL THE PARTIAL

REQUIREMENTS FOR THE BACHELOR OF BIOMEDICAL
SCIENCE (HONS)

INSTITUTE OF MEDICAL SCIENCE TECHNOLOGY

UNIVERSITI KUALA LUMPUR

2022
 INDUSTRIAL TRAINING REPORT
KUANTAN CLINICAL DIAGNOSTIC
CENTRE SDN. BHD.

REPORT SUBMITTED TO FULFILL THE PARTIAL

REQUIREMENTS FOR THE BACHELOR OF BIOMEDICAL
SCIENCE (HONS)

INSTITUTE OF MEDICAL SCIENCE TECHNOLOGY

UNIVERSITI KUALA LUMPUR

2022

DECLARATION
I declare that this report is my original work and all references have been
cited adequately as required by the University.

ii
29 JUNE 2022 ………………………………..……………….

DATE

iii
 APPROVAL PAGE

This report was read and verified by :

Signature: ....................................

(UNIVERSITY SUPERVISOR) DATE

Signature: ……………… 29th JUNE 2022

(COMPANY SUPERVISOR) DATE

iv
 ACKNOWLEDGMENT

In the name of Allah, the Most Gracious, the Most Merciful

All gratifications are referred to Allah S.W.T

All praises to Allah and His blessing for His grace, I am able to complete this
research. I thank Him for the strength He blessed me to finish writing the report. I
gain valuable lessons academically, physically and mentally.

First and foremost, I would like to thank Ms…., HR, Head, of……, for providing me
with the opportunity to intern with the company. I'd also like to thank Ms……,
laboratory Department Head, for her constructive criticism throughout my internship.
I would like to convey my sincere thanks to Sir…., university internship coordinator
and……….., university supervisor, for their assistance and advice in obtaining and
completing an internship with the aforementioned organization.

I’d like to express my gratitude to my family for the emotional and financial support
given. I thank my dearest parents and siblings for their encouragement, prayers and
help during my training. I appreciate my encouraging friends who provided the
mental and physical support through this journey.

Last but not least, I extend my grateful thanks to the laboratory and hospital staff for
their moral and material support, as well as for sharing their knowledge with me in
order to improve my theoretical knowledge for real-world applications.

May Allah grace them with prosperities and virtues in their life

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 TABLE OF CONTENTS

DECLARATION.........................................................................................................iii

APPROVAL PAGE.....................................................................................................iv

ACKNOWLEDGMENT..............................................................................................v

TABLE OF CONTENTS............................................................................................vi

LIST OF FIGURES...................................................................................................viii

ABSTRACT................................................................................................................ix

CHAPTER 1: INTRODUCTION...........................................................................1

1.1 Objective Of INTRA......................................................................................1

1.2 Location Of INTRA.......................................................................................1

1.3 Person In Charged..........................................................................................2

1.4 Job/ Task Given.............................................................................................2

CHAPTER 2: GENERAL PRESENTATION OF THE COMPANY....................3

2.1 Company Profile............................................................................................3

2.1.1 History of the KCDC..............................................................................3

2.1.2 Mission...................................................................................................3

2.1.3 Vision......................................................................................................3

2.1.4 Main Product or Service Provided..........................................................4

CHAPTER 3: TASK/ JOB/ PROJECT REPORT..................................................5

3.1 Role of Laboratory Department.....................................................................5

3.2 Machines/ Tools used in Lab.........................................................................5

3.3 Lab Tests Available.......................................................................................5

3.3.1 Hematology.............................................................................................5

3.3.2 Biochemistry Test...................................................................................8

3.3.3 Serology..................................................................................................9

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 3.3.4 Tumor Marker.......................................................................................10

3.3.5 Thyroid Function Test..........................................................................10

3.3.6 Fever screening.....................................................................................10

3.3.7 Miscellaneous tests...............................................................................13

3.3.8 Microbiology/ Culture and Sensitivity (C&S)......................................15

CHAPTER 4: CONCLUSION AND RECOMMENDATION............................17

APPENDICES............................................................................................................18

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 LIST OF FIGURES

Figure 1: Location of KCDC from Google Maps.........................................................1

Figure 2: Company coporate logo................................................................................4
Figure 3: Result interpretation......................................................................................7
Figure 4: ESR tubes and rack.......................................................................................8
Figure 5: Dengue combo procedure and result interpretation....................................11
Figure 6: Typhi dot procedure and result interpretation............................................12
Figure 7: Leptospira rapid test proceedure.................................................................12
Figure 8: Leptospira result interpretation...................................................................13
Figure 9: Influenza Rapid Test procedure and interpretation.....................................13
Figure 10: RF result interpretation.............................................................................15
Figure 11: Trop-t rapid test kit....................................................................................15

viii
 ABSTRACT

The industrial training exposes students to professional skills and laboratory

experiences. Industrial training helps to produce biomedical science graduates with
technical and soft skills competency by preparing them for the real working
environment as biomedical scientists. The primary goal of industrial training is to
provide the most up-to-date and relevant theoretical knowledge in a short period of
time. Students must complete their industrial training within a minimum of 18 weeks
and pass the training assessment in order to graduate. It provides the liability for real-
life work and internships to choose career options with different work environments,
as well as exposure to the latest technologies that are currently being used by an
important and relevant industry, among other things. Students were given the
autonomy to choose which company they wish to complete their training with the
supervision and guidance from university INTRA program coordinator. Upon
completion of 18 weeks of physical training, students are required to write a full
report of the training session as a form of written proof of learning and to reflects on
the experience gained. To conclude, INTRA program are a necessity to produce a
well-trained biomedical graduates as this program prepares students to shift from
learning environment to practical knowledge applications.

ix
 CHAPTER 1: INTRODUCTION

1.1 Objective Of INTRA

The goals of industrial training are to expose students to a real-world working

environment. Students will have the opportunity to apply their theoretical knowledge
and skills to real-world work experience. INTRA also instils and fosters teamwork in
group projects. After completing INTRA, students will be able to demonstrate the
ability to work professionally with leadership qualities and group work skills while
keeping safety and health in mind. Students will also be able to complete tasks with
minimal supervision and to the required quality. Furthermore, students must be able
to use analytical and problem-solving skills to complete the tasks assigned during the
attachment. Students have no difficulty explaining knowledge and skills acquired
during the Industrial Attachment at the end of training. Finally, INTRA experience
enables students to effectively defend work experience learned orally and in writing.

1.2 Location Of INTRA

Kuantan Clinical Diagnostic Centre (KCDC) is located at A37 Jalan Dato Lim Hoe
Lek 25200 Kuantan, Pahang, Malaysia.

1
1.3 Person In Charged

Siti Farah Rosyamira has been appointed as the company supervisor. She is also the
head of laboratory department in Kuantan Clinical Diagnostic Centre.

1.4 Job/ Task Given

I. Assisting the completion of all laboratory testing related to KCDC laboratory

department.
II. Assisting the preparation of COVID-19 RTK and Rapid Molecular, RT-PCR
test kits
III. Simple laboratory and patients record filing

2
 CHAPTER 2: GENERAL PRESENTATION OF THE
COMPANY

1.5 Company Profile

A privately funded multidisciplinary medical centre offering wide ranging services

from high resolution total body MR scans to outpatient A&E services.

1.5.1 History of the KCDC

Kuantan Clinical Diagnostic Centre Sdn. Bhd. is an enterprise in Malaysia, with the
main office in Kuantan. The enterprise operates in the Ambulatory Health Care
Services industry. The company was established on June 24, 1999

1.5.2 Mission

I. To provide proficient, accessible, high-quality, all-inclusive healthcare

services that inspire trust in our patients and community.
II. To hold the hospital accountable to high standards that are observable,
measurable and apply to all hospital departments and staffs.
III. To foster a culture of trust, honesty, mutual respect, equality and ethics.

1.5.3 Vision

I. To serve the lives of the people through excellence in clinical care as well as
high-quality and efficient services.
II. Strive to offer patients the best outcomes possible in a welcoming and safe
setting.
III. Aspire to be at the cutting edge of modern general practise, providing a
diverse range of services and facilities

3
 Figure 2: Company coporate logo

1.5.4 Main Product or Service Provided

I. Ambulatory service
II. Clinical laboratory diagnostic
III. Pharmaceutical service
IV. Hemodialysis

4
 CHAPTER 3: TASK/ JOB/ PROJECT REPORT

1.6 Role of Laboratory Department

To provide comprehensive test reports, the Laboratory Department conducts a wide

range of lab investigations using cutting-edge methodology and modern analyzers. It
included serology, haematology, urinalysis, coagulation, biochemistry,
immunoassay, and COVID-19 Rapid test. The laboratory is staffed with
4 personnel who are in charge of handling all samples and tests in the lab.

1.7 Machines/ Tools used in Lab

There are 3 main machines used for laboratory testing. Cell Dyn Emerald 22 is a
machine used to perform full blood count. It measures the amount of blood
component such as red blood cells, haemoglobin and platelets. This machine is the
simplest machine and needs simple operating and maintenance. Next is RXL
Chemistry Dade Behring is available to run a wide range of biochemistry testing.
This machine operates renal function test, liver function test, lipid and iron profile.
Considering the complexities of this machine as it is able to run multiple samples all
at once, it needs regular maintenance by professional from machine provider. On the
other hand, Serological and tumor marker testing are done by Centaur Cp. This
machine is the most sensitive as it provides higher accuracy. It also needs regular
maintenance check-ups by professional engineers twice a year. Other significant
devices are centrifuge machine, biosafety hazard cabinet, rotor and water bath.

1.8 Lab Tests Available

1.8.1 Hematology

Full blood count

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The purpose of full blood count (FBC) is to measures the blood components and aid
in detecting abnormalities such as unusual high or low blood cells. FBC uses whole
blood collected in EDTA tube. Abnormal in FBC would help to indicate blood
deficiencies in patients such as neutrophilia, neutropenia, and anaemia.

ABO Blood Grouping

The ABO and Rh blood grouping system is based on agglutination reaction. When
red blood cells carrying one or both the antigens are exposed to the corresponding
antibodies, they interact with each other to form visible agglutination or clumping.
The ABO blood group antigens are O-linked glycoproteins in which the terminal
sugar residues exposed at the cell surface of the red blood cells determine whether
the antigen is A or B. Blood group A individuals have A antigens on RBCs and anti-
B antibodies in serum. Similarly, blood group B individuals have B antigens on
RBCs and anti-A antibodies in serum. Blood group AB individuals have both A and
B antigens on RBCs and neither anti-A nor anti-B antibodies in serum. Whereas
blood group O individuals have neither A antigens nor B antigens but possess both
anti-A and anti-B antibodies in serum. The Rh antigens are transmembrane proteins
in which the loops exposed on the surface of red blood cells interact with the
corresponding antibodies.

Briefly, the procedure for this test is by using a dropper, add the Anti-A, Anti-B and
Anti-D in the first, second and third circle respectively in a sequential order. Transfer
1 drop of blood with transfer pipette on each anti sera. Mix the blood sample gently
with the help of a toothpick and wait for a minute to observe the result.

6
 Figure 3: Result interpretation

Erythrocyte Sedimentation Rate (ESR)

ESR is used as a screening method for all diseases that are associated with a
modification of the plasma proteins, such as globulin, albumin and fibrinogen.
Although a rapid sedimentation rate is indicative of tissue destruction (whether
degenerative or inflammatory) and is found in most bacterial infections, the ESR is
not considered a very reliable screening method as it can be elevated when there is
no disease and can be normal when disease is present. It also does not indicate the
type of disease, but finds its greatest use in following the progress of a particular
illness rather than in its diagnosis. There are, however, several groups of patients
where the ESR is important, such as patients suspected of having temporal arteritis or
polymyalgia rheumatica, or those with rheumatoid arthritis, tuberculosis or
Hodgkin’s disease.

The Erythrocyte Sedimentation Rate (ESR) expresses in mm per hour the rate at
which red blood cells settle when anti-coagulated blood is allowed to stand in a

7
narrow tube (Westergren). It is measured by the height of the column of clear plasma
at the end of 30 minutes.

Figure 4: ESR tubes and rack

1.8.2 Biochemistry Test

Renal Function Test

The purpose of this test is to measure the renal systems function and find or rule out
potential kidney impairments. RFT parameters are urea, creatinine, uric acid,
calcium, phosphate, sodium, potassium, chloride, and glucose.

Liver Function Test

The purpose of LFT is to help diagnose abnormalities in the liver system, to monitor
liver related disease or damage. It measures certain enzymes and proteins in the
blood. LFT parameters are total protein, globulin, albumin, total bilirubin, direct
bilirubin, indirect bilirubin, alkaline phosphatase, gamma-glutamyl transferase,
aspartate-transaminase, alanine transaminase and amylase.

Lipid Profile

Lipid profile is done to measure and analyze cholesterol in blood. The component of
lipid profile are total cholesterol, LDL cholesterol, HDL cholesterol and
trigelyceride.

Iron Profile

8
Iron profile is conducted to test for iron deficiencies or iron overload in the blood.
The components that are measured are iron, UIBC, IBCT and ISAT.

1.8.3 Serology

Hepatitis B screening

Hepatitis B serologic testing involves measurement of several hepatitis B virus

(HBV)-specifi c antigens and antibodies. Different serologic “markers” or
combinations of markers are used to identify different phases of HBV infection and
to determine whether a patient has acute or chronic HBV infection, is immune to
HBV as a result of prior infection or vaccination, or is susceptible to infection.

Hepatitis B surface antigen (HBsAg): A protein on the surface of hepatitis B virus

can be detected in high levels in serum during acute or chronic hepatitis B virus
infection. The presence of HBsAg indicates that the person is infectious. The body
normally produces antibodies to HBsAg as part of the normal immune response to
infection. HBsAg is the antigen used to make hepatitis B vaccine.

Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs is generally

interpreted as indicating recovery and immunity from hepatitis B virus infection.
Anti-HBs also develops in a person who has been vaccinated against hepatitis B.

Hepatitis C (HCV)

The HCV Ab test is used for initial screening for hepatitis C. The test is performed
by enzyme immunoassays (EIAs), which detect the presence of hepatitis C
antibodies in serum. The result of the test is reported as positive or negative. Third-
generation EIAs have a sensitivity/specificity of approximately 99%. However, the
presence of HCV Ab does not indicate whether the infection is acute, chronic, or
resolved. A positive antibody test result should be followed up with an HCV RNA
test to confirm that viremia is present.

Human Immunodeficiency Virus (HIV)

9
An in vitro diagnostic immunoassay for the simultaneous qualitative detection of
human immunodeficiency virus p24 antigen and antibodies to human
immunodeficiency viruses type 1 (including group “O”) and type 2, in serum. The
assay is intended to be used as an aid in the diagnosis of HIV infection in pediatric
and adult populations, including pregnant women.

1.8.4 Tumor Marker

Tumor marker test measures the amount of substances called tumor markers in
tissue, blood, urine, or other body fluids. Most tumor markers are made by both
normal cells and cancer cells, but they are made in higher amounts by cancer cells. A
high level of a tumor marker may be a sign of cancer or certain benign
(noncancerous) conditions. A tumor marker test is usually done with other tests, such
as biopsies, to help diagnose some types of cancer. It may also be used to help plan
treatment or find out how well treatment is working or if cancer has come back.
Some of the tumor marker tested in KCDC lab are Carcino-embryonic Antigen
(CEA), Alpha-fetoprotein (AFP), Carbohydrate antigen 19-9 (CA 19-9), Cancer
antigen 125 (CA 125), Cancer antigen 15-3 (CA15-3), and Prostate-Specific Antigen
(PSA)

1.8.5 Thyroid Function Test

Thyroid function tests are a series of blood tests used to measure how well your
thyroid gland is working. Available tests include Free tri-iodothyronine (FT3), Free
Thyroxine (FT4), and Thyroid Stimulating Hormone (TSH)

1.8.6 Fever screening

Dengue serology/NS 1

Dengue Duo rapid test contains two test devices: one on the left side for dengue NS1
antigen testing and one on the right for dengue IgG/IgM testing. These kits were
developed on the premise that when a specimen is added to the sample well, anti-

10
dengue IgG and IgM in the specimen react with recombinant dengue virus envelope
proteins-colloidal gold conjugates, forming an antibody-antigen complex. When
migrated along the length of the test device by capillary action, this complex will be
captured by the relevant anti-human IgG and/or anti-human IgM immobilised on the
test device and will generate a coloured line. Similarly, the anti-dengue NS1 Ag-
colloid gold conjugate will migrate along the length of the device until it is captured.
Similarly, dengue NS1 antigen captured by the anti-dengue NS1 Ag-colloid gold
conjugate will migrate down the device until it is captured by the anti-dengue NS1
antigen immobilised on the membrane strips, resulting in a colour line. The
manufacturer's instructions were followed for all tests in this study.

Figure 5: Dengue combo procedure and result interpretation

Typhi Dot Rapid Test

The TYPHIDOT Rapid IgG/IgM (Combo) immunochromatographic assay is an
indirect solid phase immunochromatographic assay. As test lines, the specific S.
typhi OMP antigen is immobilized onto cellulose nitrate membrane. When the test
sample is placed on the sample pad, it rises. If anti-S Typhi IgG and IgM antibodies
are present in the test sample (serum or plasma), they will form a complex with
colloidal gold-anti-human IgG or gold-anti-human IgM. The complex will continue
to move on the cellulose nitrate membrane before being captured by the immobilized
specific S. typhi OMP antigen at the test window zone, resulting in a pink purplish
colored band. Rabbit anti-mouse IgG antibody binds to gold conjugated mouse anti-

11
human IgG or mouse antihuman IgM antibodies in the control line. The control band
serves as an indication

Figure 6: Typhi dot procedure and result interpretation

Leptospira Rapid Test

Leptospirosis is a zoonotic disease caused by an infection of Leptospira, and a
systemic disease with high fever as its main symptom which is clinically similar with
cold. The infection is also caused by directly contacting water, soil, grass, etc. that
are contaminated by the urine of infected animals, especially rodents. The other
infection symptoms are chills, fever, headache, red eye and muscle ache. In case of
severe infection, liver failure, kidney failure and systemic bleeding can occur. This
test is designed to detect and differentiate IgG and IgM antibodies to Leptospira
interrogans (L. interrogans) in human serum, plasma, or whole blood. It is intended
for professional use as a screening test and provides a preliminary test result to aid in
the diagnosis of L. interrogans infection. Any interpretation or application of this test
result must also consider other clinical findings as well as health care providers'
professional judgement.

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 Figure 7: Leptospira rapid test proceedure

Figure 8: Leptospira result interpretation

Influenza Rapid Test

Influenza rapid test kit (IRT) is a chromatographic immunoassay for the differential
and qualitative detection of Influenza virus type A, type B and A(H1N1) Pandemic
antigens directly from nasal / throat / nasopharyngeal swab or nasal/nasopharyngeal
aspirate specimens. IRT provides differential detection of Influenza virus type A,
type B and A(H1N1) pandemic antigen (4 lines). With highest specificity, the
samples tested positive can be determined as influenza H1N1 positive without
additional confirmation test.

13
 Figure 9: Influenza Rapid Test procedure and interpretation

1.8.7 Miscellaneous tests

Venereal Disease Laboratory Research

The venereal disease research laboratory (VDRL) test is a nonspecific micro

flocculation test for the screening of syphilis. It uses antigen-containing cardiolipin,
lecithin, and cholesterol and measures both IgG and IgM antibodies to lipoidal and
lipoproteins released as a result of damage to host cells and also to cardiolipin
released from treponemes. The basis of the VDRL test is that body produces
antibody when infected, and in this test the antibody is detected by subjecting the
serum to an antigen, which is composed of colorless alcoholic solution of beef
cardiolipin, cholesterol, and lecithin. It is a qualitative test for screening of syphilis,
and currently all nontreponemal tests are flocculation tests and both VDRL and RPR
tests are modifications of original Wasserman reaction. Unfortunately, in this test,
the antibody detects antigens, which are nonspecific, thereby yielding much false-
positive reaction.

Rheumatoid Factor Test

Rheumatoid factors (RF) are antibodies directed against antigenic sites in the Fc
fragment of human and animal IgG. Their frequent occurrence in rheumatoid arthritis

14
makes them useful for diagnosis and monitoring of the disease. One method used for
rheumatoid factor detection is based on the ability of rheumatoid arthritis sera to
agglutinate sensitized sheep red cells. A more sensitive reagent consisting of
biologically inert latex beads coated with human gamma globulin. The RF kit is
based on the principle of latex agglutination assay. The major advantage of this
method is rapid performance (2 minute reaction time) and lack of heterophile
antibody interference.

The RF reagent is a suspension of polystyrene latex particles sensitized with

specially prepared human IgG. The reagent is based on an immunological reaction
between human IgG bound to biologically inert latex particles and rheumatoid
factors in the test specimen. When serum containing rheumatoid factors is mixed
with the latex reagent, visible agglutination occurs.

Result interpretation:

Figure 10: RF result interpretation

Trop-T rapid test

Troponin T Quantitative test contains two monoclonal antibodies specific to

cardiac troponin T (cTnT): one gold-labelled, the other biotinylated. The antibodies
form a sandwich complex with the cTnT in the blood. Following removal of
erythrocytes from the sample, plasma passes through the detection zone in which the
gold-labelled cTnT sandwich complexes accumulate and the positive signal is
displayed as a reddish line (the signal line). Excess gold-labelled antibodies
accumulate along the control line, signalling that the test was valid. The intensity of
the signal line increases in proportion to the troponin T concentration. The optical
system of the instrument detects the two lines and measures the intensity of the

15
signal line. The integrated software converts the signal intensity to a quantitative
result and shows it in the display.

Figure 11: Trop-t rapid test kit

1.8.8 Microbiology/ Culture and Sensitivity (C&S)

Swab C&S

Usually ordered by doctors for patients with suspected wound infections. Swab is
taken on wound tissue rather than necrotic tissue or pus to avoid possibility for false
result and inappropriate antibiotic treatment. Swab is cultured on blood agar and Mac
Conkey agar.

Urine C&S

Ordered by doctor to identify pathogenic bacteria that causes urinary tract infections.
Sample is collected from mid-stream urine sample, preferably first time in the
morning. Urine C&S is cultured on CLED, blood agar and Mac Conkey agar.

Pus C&S

Collected from pus sample avoiding superficial microflora. Pus is cultured on blood
agar and Mac Conkey agar.

Throat C&S

Often used to diagnose strep throat and is cultured on blood agar and Mac Conkey
agar.

Blood C&S

A blood culture is a medical laboratory test used to detect bacteria or fungi in a

person's blood. Under normal conditions, the blood does not contain
microorganisms: their presence can indicate a bloodstream infection such as

16
bacteremia or fungemia, which in severe cases may result in sepsis. Sample is
collected in two type of bottles which are aerobic and anaerobic. Sample is incubated
in a special incubator (BACTEC DICKINSON 9050)

Handling C&S

1. Culture C&S according to sample types upon receiving sample on the first
day. Sample is incubated at 37’C for 24 hours.
2. Observe bacterial growth after 24 hours
3. Do gram stain for positive growth to identify bacterial gram and type.
4. Inoculate REMEL based on the obtained bacterial gram and type and
incubate to get a specific species.
5. Antibiotic sensitive plate is inoculated and left for 24 hour
6. On the 3rd day, read AST and release result to doctor in charge.

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 CHAPTER 4: CONCLUSION AND RECOMMENDATION

To wrap it up, INTRA allowed me the opportunity to acquire practical skills with
applying theoretical knowledge in real time experience. INTRA encouraged me to
improve my communication skills as well as build my confidence to work in
laboratory environment. The opportunity to complete my training in a well- equipped
hospital laboratory department has given me a lot of advantages as I learned quite a
lot as compared to laboratory practical in university.

However, there are some flaws that can be addressed in the future. For example, I
faced minor financial inconvenience while completing my INTRA as allowance are
not provided. I would like to suggest that the university make it necessary for the
company listed to clearly state if there is any allowance provided. Regardless, I reach
the conclusion that the industrial training programme has provided many benefits to
students. Despite of minor flaws that result in a quite distressing circumstance, it can
be corrected in the future.

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 APPENDICES

Blood C&S incubator, BACETEC 9050

Advia Centaur Cp Immunoassay System

19
 CELL-DYN Emerald 22 hematology analyzer

Dade Behring Dimension RXL Chemistry Analyzer

20
Patient samples and forms collection

Calibrator used in machine calibration

Gauze re-stocking

21
REMEL RapiID STR Color Guide for identification of Streptococcus sp

BACTEC aerobic and anaerobic sample bottles for blood C&S

22