Education Proposals for ASCP’s 2016 Annual Meeting

Are you interested in presenting an education course at ASCP’s 2016 Annual Meeting? If so, the call for proposals is now out. You can find it at the direct link below.

ASCP’s 2016 Annual Meeting will be held at the Mandalay Bay Hotel & Casino in Las Vegas, NV on September 14-16, 2016.

Click here to access the 2016 Call for Proposals submission site

Are We Creating Wisdom After Y2K?

We all remember the panic and drama over the centennial turn of the century? Well, here we are in the middle of the second month of the fifteenth year of this “new millennium.” Who could imagine we’d be this far into the future this fast?

As the world turns, we balance on the precipice of our “seasoned and experienced” laboratory professionals reinventing, repurposing, redefining their careers, or just moving on to enjoy life after laboratory service—and leaving the bench at a rate that looks like a diabetic insulin spike. We are also experiencing a surge of new laboratory interest, (thanks, CSI!) and it’s refreshing to see students eager to learn and practice in our labs and specialty departments. But there is a “gap” in the middle, a desert of years when schools closed, students went into nursing or pharmacy or radiology instead of laboratory science, and we didn’t “feel” it because we were in the prime years of our careers. This “gap” is very soon going to appear on the horizon and it’s looking a bit like the Olduvai Gorge…deep and wide with not too many ways to cross unscathed.

It is with urgency that those of us still active in the field begin to engage, mentor, sponsor and grow new laboratory professionals around the world. Seek out that student you don’t know yet, take that youngest tech to lunch, make friends with a student/young tech from another country, take a turn at teaching and training (yep, without the stipend or salary bonus—just do it because someone did it for you a long time ago, and I’m guessing they weren’t compensated either…) I’d like to challenge everyone to leave some knowledge behind as you take the next step on life’s path. There are so many ways to do it, find a way to give a little bit back, help complete the circle.

Just remember…the next generation of medical technologists and laboratory scientists are going to be performing tests and releasing results for us one of these days. Wouldn’t it be great if they were as good as I want them to be when they’re doing my CBC and chemistries, and cross matching that unit I hope I don’t need during surgery? I’ll be crossing my fingers, and counting on the fact that YOU were one of their mentors!

Here’s to the next 15 years in our Y2K world! Cheers!

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Clinical Laboratory Science Education

At a young age, children have an idea of what they want to be when they grow up. From lawyers, to doctors, to scientists, children believe they can do it all. However, clinical laboratory science is not for everyone. In fact, Courtney Lower, who graduated from the University of Illinois-Springfield in 2014 with a Bachelor of Science degree in CLS, would attest to that. She believes that for someone to succeed in this field, one “must have patience, a high level of problem solving skills, and a compassion for helping others.” Possessing all of those skills is necessary when providing laboratory information and services that are required for the diagnosis and treatment of disease.

A clinical laboratory scientist not only performs laboratory tests, but he or she must also be able to explain the significance of these tests to physicians and other health professionals. A CLS must also be able to evaluate new methods and determine the effectiveness of new laboratory tests. This intense problem solving, along with her love for science, was what attracted Lower to the degree in the first place – which has in turn opened up the door to several possibilities.

Receiving a CLS degree has the potential to set one up for a multitude of exciting careers. A graduate can work in laboratories in several different settings: hospital, clinic, reference, government, or commercial. Within those laboratories, one could work in areas such as microbiology, chemistry, blood bank, hematology, and virology. Opportunities also exist in stem cell laboratories and veterinary clinics. Graduates can also use the degree to propel themselves into graduate or medical school.

Typically, CLS students take several science courses—typically chemistry and biology—before starting their degree-specific coursework. Most students take a similar route of three years of undergraduate schooling followed by a year in a laboratory setting to finish out their degree. Students enjoy this short schooling because it means that they can get into laboratories sooner. In particular, Lower remarked that, “My favorite program was rotations. It prepared me for transitioning from the classroom to the laboratory and I was able to gain more hands-on knowledge.”

Receiving a clinical laboratory degree has never been better when it comes to the job search. Graduates are basically guaranteed a job, partly because the degree is so versatile and partly because of abundant vacancies in the field. Hopefully this will be a degree that inspires young students let their love for science grow and partake in this field, allowing them to truly be able to do it all. Children can grow up knowing that they can serve a wide variety of employment opportunities and that their dreams can grow right along with them.

-Shannon Little is from Stillwater, Minnesota and is currently a journalism student at the University of Missouri. She is the fundraising chairman for Autism Speaks U. and is active in her sorority. In her free time, she enjoys watching U of M football.

You Make the Diagnosis

A 42-year-old male presents with fever and fatigue. A CBC shows the following:

Hgb 14.2 g/dL (normal = 13.5 – 17.5 g/dL)
WBC 18 x 109/L (normal = 4.5 – 11 x 109/L)
Platelet count 320 x 109/L (normal = 150 – 450 x 109/L)

Differential:

  • Neutrophils and precursors: 80%
  • Lymphocytes: 16%
  • Monocytes: 2.5%
  • Eosinophils: 1.4%
  • Basophils: 0.1%

A review of the blood smear shows a slight left shift in the neutrophil series, with occasional metamyelocytes and rare myelocytes present. Several cells similar to the one shown below are noted.

toxic-gran

Which of the following is the most likely diagnosis?

A.  Acute myeloid leukemia
B. Chronic myeloid leukemia
C. Bacterial infection
D. Viral infection
E. Parasitic infection

The answer in this case is C, bacterial infection. The cell shown in the photo is a slightly immature neutrophil showing toxic granulation (heavy, dark azurophilic cytoplasmic granules), a morphologic sign seen most commonly in severe bacterial infections. The elevated neutrophil count with a left shift supports the diagnosis of bacterial infection.

Toxic granulation is thought to be a result of the bone marrow’s response to the need for neutrophils in the peripheral tissues. Promyelocytes are the last dividing stage of the neutrophil series (once a cell reaches the myelocyte stage, it can no longer divide, but only mature). Normally, as promyelocytes divide, their azurophilic granules are dispersed into daughter cells, the end result being a mature neutrophil with few azurophilic granules.

If there is an urgent need for increased numbers of neutrophils, like there is in a severe bacterial infection, promyelocytes may opt to simply mature, rather than divide. As a result, the azurophilic granules are not diluted among daughter cells, but retained in the maturing neutrophil, the end result being a mature neutrophil with many more azurophilic granules than usual.

The normal red cell and platelet count, as well as the lack of a significant number of very immature myeloid cells, rules out the presence of acute myeloid leukemia (AML). In AML, at least 20% of the nucleated cells in the blood or bone marrow must be composed of blast or blast equivalents.

Chronic myeloid leukemia (CML) is often a consideration in patients with an elevated neutrophil count and a left shift. In CML, however, the neutrophil count is usually quite high, and there is a marked left shift, with a particularly large number of myelocytes. In addition, a basophilia is almost always present.

Viral infection often presents with a lymphocytosis, sometimes with reactive changes in the lymphocytes. Finally, some parasitic infections present with an eosinophilia (but not a neutrophilia).

 

Krafts

-Kristine Krafts, MD, is an Assistant Professor of Pathology at the University of Minnesota School of Medicine and School of Dentistry and the founder of the educational website Pathology Student.

Educating the Doctors

If you had a chance to spend one day with a group of fourth year medical students who had already been accepted into residency programs, and you had the goal of providing them with the information any beginning doctor needs to know about the laboratory, where would you begin and what would you teach them?

I had this opportunity recently. The director of a medical school boot camp for Fourth-year medical students (MS4) who would start residency in two months approached me, wanting to know if I’d like this opportunity. Of course, I jumped at the chance. The hardest thing was deciding what information to leave out, to essentially focus the short course on the minimum information related to the lab that a doctor should know when they begin their career. I can honestly say that the opportunity was educational for me also – it showed me exactly how little a graduating doctor knows about the lab! Now in its third iteration, we learn and add and subtract as we go.

We do a brief introduction and overview of general lab structure and then start with phlebotomy. Most doctors (and I’m going to exclude everyone who entered medical school after being a medical technologist) have no idea that the tube top color indicates the type of anticoagulant, and for instance that every purple top tube everywhere in the world has EDTA anticoagulant in it.  We also covered basic phlebotomy technique. Then we rotated them in groups through the various sections of the lab, allowing each section to educate the group on the some of the items they considered the most important features of that section. Some of the topics that were covered include:

Client services/accessioning: some tests utilize a whole blood sample (CBC, blood gases), many, many samples require spinning and aliquotting while maintaining sample identity. Hemolyis, lipemia and icterus interfere with tests.

Chemistry: batch vs random access testing, main chemistry analyzer vs manual testing, pre-analytical affects on test results; reference intervals

Hematology: why clotted tubes can’t be used, how white cell differentials are performed (mostly manual in pediatric institutions)

Microbiology: blood culture bottles in the instrument vs plating and identification; how susceptibility testing works; likelihood of a false positive on a positive flu test run in the summer

Blood banking: what a type and crossmatch includes; how various blood products should be transported; uncrossmatched blood availability

Each section is also instructed to encourage questions and interaction with the MS4s as they tick off main points.

This is an educational opportunity I wish I were granted for all MS4s everywhere. Each year we run this program we refine it as we learn what they most need to know, as well as what they don’t know and what we don’t know. It’s a wonderful learning process.

 

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-Patti Jones PhD, DABCC, FACB, is the Clinical Director of the Chemistry and Metabolic Disease Laboratories at Children’s Medical Center in Dallas, TX and a Professor of Pathology at University of Texas Southwestern Medical Center in Dallas.

 

 

ASCP Annual and Resident Council Meetings from the Big Guava

I just spent most of this past week at the ASCP Annual Meeting in Tampa. Even though many of us had just met, every night we socialized over food and drinks (and for some, over a hockey game because the arena was just across the street from the convention center). Inevitably, our conversations would touch on our training, boards, fellowships, and the job market…slightly different journeys to similar destinations.

This past January, I served as the resident on the Annual Meeting Steering Committee Education Working Group. At that time, which was freezing in Chicago, I was glad to be in warm Tampa (during Gasparilla, their quasi-Mardi Gras-like pirate festival). Since I worked half a day and flew in late, I had missed the tour of the convention center and USF’s Center for Advanced Medical Learning and Simulation (CAMLS). But I was there representing the resident voice when we finalized and scheduled all the educational sessions that attendees enjoyed this past week at the Annual Meeting. Since I had also helped with making sure that the marketing was more resident-focused, I was glad to see many residents in attendance. It’s always nice to see the final product of the fruits of one’s labors so attending this past week meant a lot to me.

I usually don’t visit too many posters at conferences because I’m usually presenting a poster. But this time as a member of the AMSC EWG, I served as a poster judge and was able to speak with many of the poster presenters, even international ones from Spain and France! It was surreal to be on the other side and asking questions and thinking thoughts that judges probably once thought of me. Some even came up and asked for feedback after the judging was over and I hope I helped with my comments.

I also was able to be a resident attendee as well. I attended the Thyroid Ultrasound FNA CAMLS and performed ultrasound-guided FNAs of silicone slabs filled with “olives” as nodules. And I found that it’s much harder that I previously realized. But I was able to use my newly learned skill when I performed a breast FNA this week. Most of the talks I attended focused on hematopathology and molecular pathology topics. I also attended Dr. DeMay’s ‘basics of cytology’ session which was jam packed and even asked him to autograph my copy of “baby DeMay” after his talk (gosh, I’m such a groupie) which I had with me since I’m on cytology now. Others took selfies and pictures with the cytopathology rock star.

The Mixology Lab where the poster and oral presentation as well as the 40 under 40 winners were announced was a great hit – good food, free drinks, and a fun time where attending physicians and trainees mingled next to the azure, calm Hillsborough River. And the fun didn’t end there as we closed the conference with a Resident Reception at the sushi bar across the river that was attended trainees, attending physicians, lab professionals, and friends/spouses of attendees. I even saw a Conga line composed of attending physicians, resident council members, and fellow trainees!

After the meeting, I stayed for the ASCP resident council meeting. It always inspires me to see those committed to organized medicine (or any cause) at work. Everyone was passionate, not afraid to speak up, and brought different skills and experiences to the table. ASCP is always looking for new leaders. But I realize that it’s not always easy to find opportunities to become involved with so I’ll try to advertise those I hear about here on this blog. Feel free to email me to pass along your name within the organization. I promise that getting involved with organized medicine is always rewarding and you will develop leadership skills that will help for when you are a pathologist without even realizing it.

Fellow readers, for the next few weeks, I’ll be taking a break and you’ll be hearing from other trainees about their experiences at the Annual Meeting and with ASCP.

 

Chung

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

Getting Out of an Intellectual Laziness Slump

I’m currently listening to the Q&A session after a Big Data Analytics talk in the Grand Ballroom here at the American Association of Clinical Chemistry (AACC) Annual Meeting at the McCormick Place in Chicago. As a medical resident with an MPH and health economic and statistics training and someone who helped perform lab error analysis during my PGY1 year that culminated in a poster presentation at this meeting last year, I found this series of talks very interesting. I feel re-inspired. What I mean by this statement is this…I often find myself in intellectual laziness slumps and I need experiences like these to recharge – to find other people with similar interests who want to participate in such discussions and who can also support us through those times when we are uninspired (or lazy, which can depend on point of view).

I’m just over halfway through my residency training. I’m also preparing materials and gathering letters of recommendations to apply to fellowships very soon. I also have peripheral thoughts of needing to start studying for boards, but that’s lower on my list after fellowship applications and publication submissions that I’ve put off writing for far too long. It’s easy during this long journey to become overwhelmed in addition to uninspired or lazy.

During the day, I work hard to approach my residency service tasks because patient care seems more imminently involved. But I need to get back to devoting one day during the weekend on non-service but also important residency-related tasks on my things-to-do checklist because despite how it may seem, I’m also passionate about them as well. What gets me more excited than networking at conferences such as these, is the opportunity to talk with experts about shared interests and possible collaborative projects…or at least the start of a friendship/mentorship where we can help each other move our healthcare system forward.

On another note, at the end of the week, after AACC is over, I will remain in Chicago to serve as the junior (resident) member of the College of American Pathologists (CAP) Council on Education (COE). I’m looking forward to our Friday night meeting dinner where we also have discussions that re-energize me as well in terms of working together to transform our profession for the better. I always feel privileged to be able to “pick the brains” of others who are intimately and actively involved in this endeavor over the casual setting of a delicious meal.

So, are you in an intellectual slump? If you need encouragement, feel free to email me at chungbm@rwjms.rutgers.edu and I hope to pay it forward and help you out of your slump or connect (I’ve always been a consummate “connector”…a quality from my grassroots organizing days, I suppose) you with mentors who might inspire you. If you are going to be in Chicago in early September, I also recommend that you attend the CAP Residents Forum on September 9, 2014 – you can register at www.thepathologistsmeeting.org or better yet, contact Jan Glas, head of resident engagement for CAP, at jglas@cap.org  to become your program’s delegate and/or volunteer to serve on the credentialing committee and sign in delegates who attend the RF in September.

 

Chung

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.