Tag: lab week

Happy Medical laboratory Professionals Week! A Trip Down Memory Lane

When I think of Lab Week, I think of all the Lab Week celebrations we’ve had in the past: Food, games, from “Guess whose baby picture?” to word searches and coworker trivia, and of course, more food. I’ve seen the same games over and over, but with new coworkers they’re always fun. Probably the most unique game I’ve seen, was “whose sample is this?” Smushed chocolate candy bars were stuffed into sample cups (and looked like you know what) and we had to guess which ‘sample’ came from which candy bar. Lab week also helps us remember the techs we’ve worked with in the past and the good times we’ve had in the lab and outside. And, of course, Lab week always seems to bring up reminiscing, and the question “Remember when?”

As a nod to lab week, I’d like to take you on a little trip down memory lane. Those of us who have been around for a while can laugh and add our own stories. The new techs in the lab, the younger generation will look at us and say “No way!”” or “You’re joking, right?”

I work in a lab that is very fortunate to have a few wonderful techs in their late 60’s and 70’s who still work for us part time. But anyone who has passed through our lab in the past 60 years remembers Irene, who is over 80, and has been here since 1963. That’s before many of us were born! Now Irene doesn’t work every day, or even every month, but she’s there for our students and newly graduated employees when we can use her talents for a few days. She has boxes full of teaching slides and comes in to review WBCs and RBC morphology with them and shares many stories about ‘the old days’ in the lab. Recently she was talking to a new grad and mentioned the old lab and the rabbits they kept in the lab.

“Rabbits?’ he asked.

“Yes, youngster, let me tell you about it.”

Rabbits were used for the first pregnancy tests. The first HCG tests came out in the early 1970’s, but before then, the question “Did the rabbit die?” was associated with a positive pregnancy test. Young rabbits were injected with urine or blood from a woman, and several days later, the animals were dissected to look for enlarged ovaries, a sign that HCG was present in the injected specimen, and a positive pregnancy test. So, in reality the rabbit (or mouse, or frog) always died, whether the woman was pregnant or not.

I fortunately missed the live animals in the lab era. Now that I’m working with techs who are younger than my kids (and not that much older than my grandkids!), when us ‘old timers’ talk about what the lab used to be like, we get incredulous wide-eyed stares.

 “You didn’t wear gloves??”

“They drank coffee in the lab?”

“No computers?”

In my very first job out of college I worked in a hospital lab, and trained in Hematology, Chemistry and Blood Bank. It was the time of the rise in automation, and we had some great ‘new’ analyzers. We had a Coulter S in hematology, the first automated hematology analyzer. The Coulter S offered 7 parameters. In about 1 minute it could analyze and report the WBC, RBC, Hgb, Hct, MCV. MCH and MCHC. Before this we had to prepare samples, lyse RBCs to count WBCs, perform hemoglobin measurement on a spectrophotometer, and calculate the indices! If a physician wanted a differential, we stained slides by hand and counted a 100-cell diff. Platelet count counts fortunately were not ordered on every CBC because those were counted manually!

I remember training in the chemistry department with a lot of instruments which each did only one or 2 tests. Individual tests were done on single test analyzers. Which meant a lot of techs in the lab, and you could be assigned to a bench where you did just Na and K on the flame photometer or just Glucoses and BUNs on single test analyzers all day. We did have a STAT analyzer which did electrolytes, glucose and BUN, and a larger analyzer that did 12 test panels, but they were only used when the full panels were ordered. These multi test analyzers were new and exciting, but in 1980 we were still uncapping and pouring off all our samples by hand. Without gloves!

“What?? No gloves?”

No gloves. We drew blood and worked in the lab with no gloves. Analyzers had glass coils that techs changed with their bare hands, and there were accidents. Techs contracted hepatitis and in the 1980’s the fear of contracting HIV was real. It wasn’t until 1992, when the Occupational Health and Safety Administration (OHSA) published the Bloodborne Pathogens Standard. There was increased awareness of HIV, and OHSA implemented universal precautions to protect workers who may come in contact with bodily fluids. OSHA’s standard required employers to provide personal protective equipment, including disposable gloves.

I once read an article that said that medical technician/technologists were the profession that drinks the most coffee. Now, I don’t know about that because I don’t drink coffee, but what they didn’t mention in the article was that they used to drink it in the lab! Yes, the cup of coffee often sat next to the microscope while doing diffs. And remember, no one wore gloves. I remember a doctor walking through the lab smoking a cigar. And while I don’t remember if I ever saw eating in the lab, I’m pretty sure it happened. These things are so taboo to us now that sometimes we wish we were camels because we often go for hours without a sip of water! We may have been the profession who drinks the most coffee, but today we may be the most dehydrated because the closest ‘clean ‘area to get a drink is way down the hall! And we’re too busy to leave our work and go get a drink!

People often use the term ‘The Good Old Days’ when talking about the past, but in the lab, these times weren’t always ‘good’. Yes, we had good times. But there were also practices that weren’t what we would today consider safe. Besides the lack of gloves, and coffee in the lab, there was also mouth pipetting. Remember spit strings? Techs kept them in their pockets for use in mouth pipetting body fluids (shudder). We washed glassware, even literally rinsing blood out of test tubes and reusing them.

We also love to reminisce about obsolete lab tests. I remember when AST, LDH and CK were used for markers of myocardial infarction. Then we had a new test, the CK-MB, which is now designated antiquated and has been replaced by cardiac troponin I for diagnosing MI. Bleeding times were once widely used as a platelet function test. Today this rather crude test is rarely used and not even offered by many labs. Glass in the lab has been replaced by plastics from vacutainer tubes and blood bags to graduated cylinders and beakers. We no longer count platelets on a hemocytometer because our automated analyzers perform platelet counts. In Urinalysis, we used to do confirmatory tests for glucose, bilirubin and protein in urine. And so many more tests that have been replaced by newer and better testing. What is your favorite or no so favorite ‘obsolete’ lab test?

We’ve certainly come a long way in the last 60 years! Lab Week is a great time to generate new awareness and excitement about the laboratory medicine profession while having some fun with your lab coworkers. Thanks to everyone who is part of the laboratory team for your hard work and dedication. Happy Laboratory professionals Week!

DOWN
1. favorite drink to sip at the microscope while doing diffs
2. standard PPE that wasn’t so standard before 1990
3. standard set of guidelines for prevention of bloodborne pathogens

5. old confirmatory test for urine bilirubin
8. type of pipetting common in the old days
9. you probably won’t use one of these for heating in the lab today
10. historic method for testing for glucose in urine
11. animal kept in lab for pregnancy testing
12. old school test for MI
14. plastic blood collection bags have replaced these

ACROSS
4. used to draw blood before vacutainers
6. carried in your pocket as a pipetting aid
7. used for manual platelet counts
13. obsolete platelet function test
15. dark field microscopy was first test for diagnosis of this STD in 1906

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-Becky Socha, MS, MLS(ASCP)CMBBCM graduated from Merrimack College in N. Andover, Massachusetts with a BS in Medical Technology and completed her MS in Clinical Laboratory Sciences at the University of Massachusetts, Lowell. She has worked as a Medical Technologist for over 40 years and has taught as an adjunct faculty member at Merrimack College, UMass Lowell and Stevenson University for over 20 years.  She has worked in all areas of the clinical laboratory, but has a special interest in Hematology and Blood Banking. She currently works at Mercy Medical Center in Baltimore, Md. When she’s not busy being a mad scientist, she can be found outside riding her bicycle.

Not Your Grandmother’s Hematology

Last month we celebrated Lab Week, to recognize and show appreciation for Medical Laboratory Scientists and Technicians. Lab week is also a time to reminisce, and tell stories of the lab “in the old days.” I have worked with many technologists who have now been in the field for more than 50 years, and some who have worked in the same hospital all that time! Lab techs love to share stories about their experiences over the years, the days without computers, old methodologies, ancient lab equipment and manual testing. Listening to these stories always makes me think about just how far we have come in the field in the last 50- 60 years, and gives me a true appreciation for modern technology. It causes me to reflect on all the changes and developments that enable us to give physicians a wealth of knowledge that was previously unavailable.

During the first half of the 20th century, the complete blood count (CBC) was performed using exclusively manual techniques. Blood cell counts (erythrocytes, leukocytes, thrombocytes) were performed under the microscope using diluted blood samples and a hemocytometer. For each specimen, a technologist spent about 30 minutes at a microscope manually counting the cells and calculating the total count using a mathematical formula. A spectrophotometer was used to perform the hemoglobin by the cyanmethemoglobin method, and a spun hematocrit was performed. Indicies were calculated. A manual smear was made, stained, and cells were counted and differentiated under the microscope. To complete a CBC, all these procedures had to be performed individually, with duplicate testing and applying mathematical calculations, and could take over 2 hours. After all these tests were performed, results were reported on paper and sent to the patient’s doctor or the nursing floor.

In 1953 Wallace Coulter patented the Coulter Principle for counting and sizing microscopic particles. The Coulter Principle can be used for measuring any particles that can be suspended in an electrolyte solution, and has been used in the food and drug industry, in beer making, in the manufacture of construction materials and thousands of other applications. However, probably the most important application has been in the medical field where it has revolutionized the science of hematology. Coulter suspended red blood cells in a solution and, with an electrical current flowing, passed the solution through an aperture. As the cells pass through the current, the impedance between the terminals changes, and this change can be measured as a pulse. The first Coulter Counter measured the number of cells by counting the number of these pulses. The first Model A Coulter Counter was sold in 1956, manufactured in Coulter’s basement in Chicago. The Model A counted red blood cells in a sample in 10 minutes, a marked improvement over manual counting! The Coulter Counter was hailed for its speed, accuracy, and opportunities for reducing human error, tedium and eye strain.

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Image 1. Model A Coulter Counter, 1956. https://www.beckman.com/resources/discover/fundamentals/history-of-flow-cytometry/the-coulter-principle

During the 1960’s, an improved Model B Coulter Counter was developed and Model A and Model B were used to count both leukocytes and erythrocytes. Other Coulter Counter models soon followed, and competitors entered the market with their versions of cell counters. Within a decade, nearly every hospital in the United States had a Coulter Counter, and the new, advanced Coulter Model F was widely used. In 1968 the first fully automated hematology analyzer, The Coulter Counter Model S was introduced, and could perform a seven-parameter CBC. The Model S could perform not only WBC and RBC counts, but also reported Hemoglobin, Hematocrit, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC).  In 1955 it took one or several technologists 2 hours to perform a CBC, and in 1969 an automated hematology analyzer could analyze a sample in under 2 minutes.

Image 2. “Woman Using a Model F Coulter Counter Cell Counter,” 1969. Beckman Historical Collection, Box 58, Folder 94. Science History Institute. Philadelphia. https://digital.sciencehistory.org/works/736664585.

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Image 2. “Woman Using a Model F Coulter Counter Cell Counter,” 1969. Beckman Historical Collection, Box 58, Folder 94. Science History Institute. Philadelphia. https://digital.sciencehistory.org/works/736664585.

As these improvements and advancements continued, and Coulter patents expired, new manufacturers entered the field. Technicon Instruments Corporation, Ortho Diagnostics, Instrumentation Laboratories and Toa Medical Electronics, (presently Sysmex Corporation) were among the first Coulter competitors. From a simple automated blood cell count, to the first seven-parameter CBC, we saw hematology changing before our eyes. More reliable automated platelet counts were added in the 1970s. In the 1980s we saw the first hematology analyzers that could perform automated differentials and the first automated reticulocyte analyzers. In the late 1990’s, we saw the advent of digital cell images and automated manual differentials.

Today, modern automated cell counters sample blood, and quantify, classify, and describe cell populations. These instruments use optical light scatter, impedance methods based on the Coulter principle or a combination of both optical and impedance methods. Progressive improvement in these instruments has allowed the enumeration and evaluation of blood cells with great accuracy, precision, and speed, at a very low cost per test. The latest descendant of the Model A Coulter Counter, the LH 750, can determine 26 reportable hematological parameters. The Sysmex XN-9100 with four XN analyzers reports 30 parameters and has a throughput of up to 400 CBCs and 75 smears per hour. Today’s analyzers can accomplish more and more routine diagnostics, and the role of the hematology technologist continues to evolve and expand.

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Image 3. Sysmex XN-9100™ Automated Hematology System
https://www.sysmex.com/us/en/Brochures/XN9100ScalableAutomationBrochure_mkt-10-1177_10252017.pdf

This is not your grandmother’s hematology! We’ve truly come a very long way in 60 years. Modern hematology instruments not only perform a CBC, but they give us next generation diagnostics as well. Many give us advanced clinical parameters and other new parameters which provide physicians with additional information about the state of blood cells. We can report out immature granulocytes with every differential, automated nucleated red blood cell counts, immature platelet fractions and fluorescent platelet counts, and report the amount of hemoglobin in reticulocytes and the immature reticulocyte fraction. Future directions of hematology instrumentation include the addition of even more new parameters. In upcoming Hematology blogs I will be presenting case studies that highlight each of these advanced clinical parameters and discuss how physicians can use this new information in making diagnoses.

 

References

  1. Beckman Coulter, Inc. History http://www.fundinguniverse.com/company-histories/beckman-coulter-inc-history/
  2. https://www.beckman.com/resources/discover/fundamentals/history-of-flow-cytometry/the-coulter-principle 
  3. Clinics in laboratory Medicine. Development, history, and future of automated cell counters Green R, Wachsmann-Hogiu S. Clin Lab Med. 2015 Mar;35(1):1-10. doi: 10.1016/j.cll.2014.11.003. Epub 2015 Jan 5. March 25, Vol 35, Issue 1, p1-10
  4. Cytometry: Journal of Quantitative Cell Science. Wallace H. Coulter: Decades of invention and discovery Paul Robinson First published: 17 April 2013 https://onlinelibrary.wiley.com/doi/epdf/10.1002/cyto.a.22296
  5. J.clin.Path. An assessment of the Coulter counter model S P.H.Pinkerton,I.Spence, J.C. Ogilvie, W.A Ronald, Patricia Marchant, and P.K, Ray. 1970,23,68-76 http://jcp.bmj.com/content/jclinpath/23/1/68.full.pdf
  6. SLAS TECHNOLOGY: Translating Life Sciences Innovation. The Coulter Principle: Foundation of an Industry. Marshall Don, Ph.D., Beckman Coulter, Inc.. Volume: 8 issue: 6, page(s): 72-81. Issue published: December 1, 2003 https://doi.org/10.1016/s1535-5535(03)00023-6
  7. Medical Electronic Laboratory Equipment 1967-1968. G.W.A Dummer and J. MacKenzie Robertson. 1967 Pergamon Press

 

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-Becky Socha, MS, MLS(ASCP)CM BB CM graduated from Merrimack College in N. Andover, Massachusetts with a BS in Medical Technology and completed her MS in Clinical Laboratory Sciences at the University of Massachusetts, Lowell. She has worked as a Medical Technologist for over 30 years. She’s worked in all areas of the clinical laboratory, but has a special interest in Hematology and Blood Banking. When she’s not busy being a mad scientist, she can be found outside riding her bicycle.

Lab Week 2018

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Labs: the final frontier. These are the voyages of lab-techs everywhere. Our continuing mission: to explore strange new orders, to seek out new tests and new sero-preparations, to boldly notify floor clinicians about sample hemolysis for redraw…

Or at least that’s close enough to Gene Roddenberry’s vision for futurism in exploration—except instead of starships, we’re talking Star Labs. Happy 2018 Lab Week everybody, and thanks for checking back in!

Okay, so here’s something a little bit different. Different from my usual Zika or medical school posts, this piece is a celebration of several lab “truths” which I know many of us share. It seems like one of the overarching themes I’ve encountered regarding laboratory operation (and appreciation) is communication. Expectations and needs aren’t always communicated effectively across different medical disciplines and scopes. A while back I thought of 40 things every lab professional should know, but I’d like to expand on that a bit.

How many times have you said or encountered any of the following:

  • Why does the blue top have to be full, if the other ones weren’t as full?
  • I just put some blood from the lavender top into the tiger top—patient is a hard stick…
  • I’m checking on results for the patient in room 123…no, I don’t have their MRN…
  • There’s a trauma patient coming in via helicopter, I need crossmatched units before they’re here.
  • Can you please add on a serum lactic acid, there was a BMP from yesterday?
  • This C. Diff sample is solid…
  • Why are some hospitals’ rapid flu-tests done with just the swab of a swab kit, a little aliquot of saline from an IV push syringe, and a wasted no gel SST?
  • Are the results ready for the biopsy we did just now?
  • Do we have a critical value range for ESR?
  • We haven’t had an in-service on running POCT Glucose controls, so we haven’t done them yet
  • I didn’t want the tubes to leak in transit, so I used the labels as tape to keep the caps on!
  • In order to get SUPER GOLD STAR STROKE AND GOUT CENTER accreditation, we have to slash TATs by 40%

 

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Captain Hematologist Jean Luc Picard (front) pleads with a clinician that only wants the WBC and H/H from a clotted CBC. Second Officer Riker (bottom left) smiles because he knows clots are dangerous for most analyzers. Lt. Operations Officer Worf (top right) agrees firmly for the sake of honor and quality assurance. An ensign trains on urinalysis (top left). [Source: Star Trek TNG]
I’m sure by now you realize I could go on, and on, and on…There are always issues in laboratory medicine that don’t always translate well between floor clinicians and laboratory staff. It’s a tale as old as time. And, until we do develop universal translator technology, it will remain somewhat of a barrier to improving workflow. So how to we fix it? I argue it starts with Lab Week.

Lab Week is supposed to celebrate the clinicians, laboratory professionals, and ancillary staff that work diligently to produce results. Hundreds of thousands of laboratorians work throughout the country and are highly-trained, well educated professionals who use their expertise to diagnose and monitor treatments. Quality medical testing and exceptional care are part of the core values that each of us are celebrated for every year in April! Let me be clear, we are not support services for other clinical professionals—we’re all on the same team. Don’t be angered by the misinformed questions above, or by the stereotypes you might encounter in pathology, try and use them as teaching platforms within our community.

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Capt. Hematologist Jean Luc Picard (right) takes endorsement from Chief Instrument Engineer Geordi LaForge (left) and while examining active Laboratory Data (center) speaks with clinical staff regarding temporary procedural changes for sending and holding PTT mixing studies while maintenance is being completed.  [Source: Star Trek TNG]
The whole point is that we’re in this together. Not just interdisciplinary teamwork that makes this year’s Star Lab theme so poignant, but teamwork across scopes. Those calls and messages we get in our managers’ offices or various bench top phones are part of our team too. It’s about the patients. We already know we contribute over 70% of clinical relevant information in every patient’s chart—some diagnoses like cancer rely completely on pathologist interpretation for screening, diagnosis, staging, and treatment recommendations.

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While EMH Drs. Mark I and Mark II receive their “bad” results, it’s all part of a larger picture. As a note, “panic results” rarely illicit the expected reaction in the nurses and physicians we report them to. These doctors would think our current medical practice standards medieval, anyway… [Source: Star Trek Voyager]
Here are a few examples of effective communication you could keep in mind.

For any Laboratory Professionals reading:

  • Instead of this: “Our policy is to reject clotted CBCs, we need a redraw, sorry.”
  • Try this: “While policy says to reject clotted CBCs, it’s not just because it could affect your PLT count. Other cell counts may be affected, and micro-clots can jam up the sensitive lines in the analyzers shutting them down for a while and affecting other patients’ results.” Try and realize that clinicians really do rely on those results! First and foremost, many clinical decisions are made on that last pending result for the next step of treatment. Whether it’s a PLT count or an acetone level, every result matters.
  • Instead of: “Room numbers aren’t adequate for patient and sample identification, sorry.”
  • Try this: “Because room numbers can change so quickly, we can’t use them to properly identify a specimen or patient. Do you have any of the following information…?” Understand that doctors, nurses, etc. aren’t always calling the laboratory from a private area. Thus, with so many people walking around a medical unit, a name might not be an option for them to use—room numbers are a sort of code for HIPAA compliance.

For any Clinicians reading:

  • Instead of this: “I really need you to rush that type and cross, quickly.”
  • Try this: “What can I do to help facilitate quicker turn-around for getting these units available for my patient?” Not only will you have started a conversation with the bench tech working on crossmatches, but you’ll demonstrate awareness of the complex process of safety/reportability blood bank goes through. Understand that Blood Bank is one of the more highly regulated aspects of laboratory medicine; FDA guidelines treat blood products as both a controlled substance and a tissue transplant, effectively.
  • Instead of this: “You have to run these samples because the patient is a hard stick.”
  • Try this: “What would be the minimum amount sufficient to run a particular test?” and if you need more information, simply ask! You’d be surprised how much the lab scientist on the phone would know about a particular testing method. Understand that QNS guidelines for specimens are not arbitrary amounts for the sake of covering repeats or mistakes in analysis. They are there to ensure quality results based on research and efficacy for a given instrument or method.

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We all get angry. Especially at work, when our labs might be understaffed, overloaded, and dealing with instrument failures or evil advanced genetically modified arch-nemeses on the floors like Laboratory Manager Capt. Kirk (pictured). [Source: Star Trek the Wrath of Khan]
So, it’s okay to get frustrated. It’s human. But I’ve got to tell you, I have been on both sides of this now—as a laboratorian and a clinician—and what I see time after time are simple gaps in communication. If we want to get better, not just for us, but for our patients, we should play an active part in helping close that gap.

I gave a few examples above, but how do we really change anything? My answer: interdisciplinary collaboration—and that’s not just a buzz word from my finishing LMU! If we want to really change anything, we should start it. If you’re a bench tech, start a discussion with your senior staff, supervisors, and managers about what you feel could be improved. If you’re a manager, seek out those barriers and be an active advocate for your staff—you’re already an advocate for the lab. If you’re a clinical pathologist, coordinate with your colleagues on the floor, develop more relationships, reach out for more than just consults on sign-outs.

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Don’t be afraid to be a voice for change. Staff meetings, in-services, and self-aware improvement can be facilitated with good leadership, organization, and clear goals! Even if things look grim and you’re on downtime with a full ER, or stuck in the middle of a volatile asteroid field, noted barriers to improved communication will always GET RESULTS. [Source: Star Trek TNG]
Want to change the knowledge gaps between clinical staff and laboratory staff? Hold an in-service or distribute messages with the missing information. When I was at Northwestern Medicine’s Blood Bank, I was an instructor once a month for nursing staff regarding blood products and transfusion protocols. We walked through the process with new nurses from proper phlebotomy and labeling, to order sets, to transfusion, to dealing with transfusion reactions. It was excellent! It was a great time to answer many questions and also gain insight into the clinical side of transfusion medicine.

Want to make sure no more sideways or crooked labels get sent to your specimen receiving stations? Instead of relying on the shear number of rejections to speak for themselves, discuss policy changes with your management, find the barriers to this change of specimen labeling, even send flyers out with “best dressed” tube images—it’s worked, I’ve seen it!

Want to make sure pathology stereotypes aren’t continued into the future? Change them! I plan to! Everyday I think of new ways to facilitate a new model of inclusion for pathologists into clinical healthcare teams. They’re an integral member already, why not reach past that tumor board, or biopsy report?

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It takes a village to run a lab, or a space station. An interdisciplinary team is the only way healthcare can continue to improve. Shapeshifting flexibility, shrewd business deals, passion for quality assurance, creative license, and scientific knowledge are only as good as the teamwork they are a part of—even if you have religious emissaries on your staff. Sharing knowledge and effective communication are critical for labs, clinicians, and our patients. [Source: Star Trek DS9]
The bottom line: if laboratorians want to grow and advance into the changing fronts within healthcare, we should take this opportunity during Lab Week 2018 and really embrace our profession as part of an interdisciplinary team. We deliver exceptional care and advocate for patients through our quality work in detecting, reporting, and preventing illnesses. I recommended laboratory professionals become more actively involved with fellow clinicians to directly improve patient outcomes. Let’s teach, let’s change policies, let’s have interdisciplinary rounds, let’s have roundtable discussions, let’s advocate together.

Because, after all, aren’t we advocating for the same thing: our patients.

Thank you! See you next time, and Happy Lab Week!

 

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–Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Medical Laboratory Professionals Week Approaches

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In light of Medical Laboratory Professionals Week 2017, I wanted to take this quarter’s post and thank all of you who work hard in so many ways to get patients the results they need. You truly are “All Stars.” I thought it would be interesting to have an interactive sort of post; feel free to write in the comments examples of how you and your lab go above and beyond to help patients.

Here is just one example of how the Molecular Diagnostics Lab here at Nebraska Medicine continues to do our part to serve our patient population. Our hospital (University of Nebraska Medical Center) has become a participating center for the TAPUR trial. This stands for “Targeted Agent and Profiling Utilization Registry” study; it is a non-randomized clinical trial that is essentially matching anticancer drugs to genomic variants in the patient’s tumor. Currently, most drugs are given based first on what type of tumor it is, then by the genomic variants. For example, if a patient has a gastrointestinal stromal tumor (GIST), and that tumor has a duplication in the KIT gene (p.A502_Y503dup), that tumor is sensitive to a drug called Imatinib, among others, and that drug has been shown to help fight the GIST. The TAPUR study’s goal is to see if any tumor that presents with that KIT variant is sensitive to Imatinib, whether the tumor is a GIST or some other type of cancer.

What does this have to do with our lab? Well, there are certain criteria necessary for a patient to be eligible for this trial. In addition to being 18 years or older, not currently pregnant or planning to become pregnant, the patient must have a solid tumor, multiple myeloma, or B cell non-Hodgkin lymphoma that is not responding to standard anti-cancer treatment and they must be able to be active for at least half the day, every day. Lastly, they need to have had a genomic or molecular test performed on their tumor. I and the technologists that I work with have seen an increase in our testing since our hospital has become a center for this trial because of that last point. We run an assay that tests areas of 50 genes that are known to contain “hotspot” regions that are commonly mutated in different types of cancers, and we run this by next generation sequencing (more to come regarding this type of technology–stay tuned for next quarter’s post!). We have been testing tumors of patients that have not been responding to treatment, and we all realize that each one of the tests that we perform has an impact on how that patient’s tumor will be treated. And here I have to commend the techs in our lab for thriving when faced with the challenge of this increase in testing–they have done an excellent job with the added workload and with keeping up with the changes that are made in this rapidly evolving area of the lab. I think we all appreciate this aspect of our careers–knowing that the hard work we put in every day to do our jobs to the best of our abilities can and does have an effect on people’s lives. Thank you all for everything you do!

For more information on the TAPUR trial, follow this link: http://www.tapur.org/.

 

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-Sharleen Rapp, BS, MB (ASCP)CM is a Molecular Diagnostics Coordinator in the Molecular Diagnostics Laboratory at Nebraska Medicine. 

So, What Does MLPW Mean to Me?

So, I’m going to continue the thread from my previous blog post next week since this is Medical Laboratory Professionals Week (or what we affectionately refer to as Lab Week). Coincidentally, for a public health-oriented person like me, Earth Day (April 22) is also during this week; globally, some celebrate the entire week as Earth Week. So, I encourage you to celebrate both.

Pathology can be a hidden or invisible profession to many, even more so on the lab side. Even though we are dependent on lab results to guide clinical care (at least 70% of clinical decisions are guided by lab results), it’s easy to forget that there are lab professionals and pathologists working assiduously, sometimes late into the night, behind the scenes to make sure we receive timely and accurate, lab results for our patients.

So, what exactly is Lab Week? It’s the time each year when we celebrate and recognize these lab professionals and pathologists, a time where we recognize them as more than nameless faces but as team members who vitally and equally contribute to patient care. Many hospitals and health care centers will highlight the work of those in their clinical labs with poster sessions and talks on relevant topics this week. Some will also cater Lab Week celebrations for their staff as a thank you for all their diligent work that often goes unrecognized or taken for granted during the rest of the year.

So, as we residents, what can we do? Well, first, we can get to know our lab professionals and this week in particular, personally thank them for all their hard work. I’m pretty sure it’ll bring a smile to their faces if you make a deliberate effort to recognize and say “thank you” this week. We can learn their names and get to know them on a personal level and not just when we need a test result or to troubleshoot a lab related issue.

I’m on pretty friendly terms with most of the lab techs from my clinical rotations. They have invited me to department holiday celebrations (even when I’m not on their rotation), gave great feedback about me to my rotation director/attending (trust me, they often do get to comment on how you perform during a CP rotation), and gave me a heads up to help me out of potentially difficult situations. I’ve learned a lot from them and they’re always happy when we show interest in their work. Plus, I never treat anyone in a formal hierarchical manner (no one calls me “Dr. Chung” but rather “Dr. Betty” or just by my first name). I acknowledge that there is always something that they teach me and that I believe that we are colleagues working together on a team…not that I am the doctor and they are not. And often, lab professionals will be the first to detect a potential patient clinical issue, even if they have limited patient history access, so I totally give them props when they help me out in this way. And having a good attitude with your lab staff, as I mentioned, can go a long way for both your learning and advancement on the rotation.

As residents, CP rotations are often when we have the opportunity (as opposed to surgpath) to take vacation time and many look at these rotations as unofficial boards study time. But spending physical time in the lab is still learning. And for me, I learn better by doing as opposed to sitting in a lecture or sitting at my desk reading a textbook. The lab regulatory policies and management issues (and even the basic science concepts) we need to know to pass boards, we can learn more efficiently if we spend actual time IN the lab working alongside our lab professionals on these very issues. In the lab, we can also serve as consultants for our referring physicians on the intricacies and appropriateness of specific lab tests and help with regulatory (CAP/CLIA) inspections – even if your rotation doesn’t specifically require this, you can still ask to be more involved – trust me, you’ll learn more this way (and it is boards studying).

So, how are you planning to celebrate Lab Week and acknowledge those in the clinical labs this week? While you’re at all, you can help contribute to Earth Day/Earth Week as well by committing yourself to being more environmentally conscious (don’t forget to recycle!) from this week forth.

 

Chung

–Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

Laboratory Professionals Week Celebrations Around the World

Happy Laboratory Professionals Week! Lab week is celebrated not only in the United States but around the world as well. As in the United States, labs get in on the fun on an individual level as they recognize their employees and the importance of the lab, and larger organizations organize celebrations and community outreach events.

In Cote d’Ivoire, located in West Africa, there is a week’s worth of activities and celebrations planned. The activities include ceremonies recognizing laboratory professionals throughout the country, demonstration sessions, and community outreach to the general public via radio broadcasts, information pamphlets, and text messages, among other activities. The official lab week ceremony will take place on April 22nd in the largest city of Cote d’Ivoire, Abidjan, at INFAS (the Institut National de Formation des Agents de Sante or the National Institute for Training of Health Workers). Speeches will be given by high ranking government officials, including the Minister of Health, as well as representatives of CDC-PEPFAR, and the Association Ivoirienne de Biologie Technique (l’AIBT), the national lab association.

In Tanzania, located in East Africa, the Tanzanian laboratory professionals association, Medical Laboratory Scientists Association of Tanzania (MeLSAT) has organized awareness raising activities and celebrations as well. Throughout the week they will provide community outreach by offering testing and educational information on HIV, diabetes, and high blood pressure. They will also be collecting blood donations for the national blood bank. The lab week closing celebration will be a parade in the town of Sumbawanga to celebrate laboratory professionals and their achievements and to raise awareness among the community.

What are you doing to celebrate in your neck of the woods?

 

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Lab Week Fun

Since it’s National Medical Laboratory Professionals Week–aka Lab Week–we’d like to start off the week with a poll.

Happy Lab Week, everyone!

Edited 4/25/14 to add: Thanks for playing, everyone! The correct answer–which over 88 percent of you knew–is Saccharomyces cerevisiae.

Photo courtesy of Wikimedia Commons

 

Shout it from the Mountaintop

Even after working in the laboratory field for twenty years, I’ve always thought that one of the more interesting things I come across is how few people really know what we are and what we do. Laboratory Professionals Week is not only a chance for us to celebrate ourselves and the outstanding job we do every day, it can also be a prime opportunity to begin changing that worldly lack of knowledge about us. It’s a chance to Get the Word Out!

Here in Dallas we get creative every year for Lab Week. Each section of the Lab creates a poster board depicting what they do in their section. Usually we try to include both the usual, common things, as well as the things that non-laboratorians might not be aware of. Each part of the lab/pathology creates one. So we have not just Chemistry, Hematology, Microbiology/Virology and Blood Bank. We also have poster creations from our Metabolics Lab (inborn errors of metabolism testing), Client Services/Accessioning, Sendouts, Phlebotomy, Histology, Electron Microscopy and Advanced Diagnostics, our molecular diagnostic lab.

As those of us in the laboratory field know, laboratory professionals are really creative. We always end up with at least ten colorful and eye-catching posters depicting the whole range of services provided by the Laboratory/Pathology departments. During Lab Week, those posters are hung in the hallway coming into the Hospital. They are viewed daily for that week by hospital personnel and the public alike. It never ceases to amaze me when I walk past them, how many versions of “I had no idea they did that!” I hear, and how many times I hear it.

In our current healthcare climate, the Laboratory can no longer afford to be a hidden profession. With healthcare dollars becoming increasingly dear, we must make our worth known to other healthcare professionals and to the public. We need to keep ourselves situated as prominent and important players on the healthcare team. Laboratory Professionals Week can provide a wonderful time and place to begin working on those goals.

 

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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.

Think Globally, Act Locally

National Laboratory Professionals Week is April 20-25, 2014—and this year during the same week is Earth Day, on April 22, 2014. That is an interesting combination of things we should take time to contemplate—what does Earth Day have to do with laboratory medicine? Or vice versa?

Well, a number of things come to mind:

  • As laboratory professionals, we are committed and dedicated to being part of the healthcare team that discovers and cures peoples’ health and promotes well-being.
  • Laboratory professionals are also committed to using supplies efficiently and effectively, saving costs, and using/disposing of hazardous materials safely which parallels a strong commitment to our environment.
  • The health and well-being of the planet is directly proportional to the health and well-being of the inhabitants of the planet.

It seems to me there is a directly proportional relationship here; and a link to our present and future state, as we pursue health for both the people of the world and the planet we all occupy.

Laboratory professionals the world over act locally to take care of the patients who are our neighbors and friends and family in our communities…and we think globally to support the needs and resources and collegial relationships that take care of the patients and neighbors and friends on our planet. What better combination to celebrate, support and call world-wide attention to than National Laboratory Professionals Week and Earth Day? If your laboratory is doing something special that illustrates “thinking globally, acting locally,” please send me a note about your Lab Week Celebration Activities at bsumwalt@pacbell.net . I would love to consolidate and share those ideas!

Wishing everyone in the field and industry of Laboratory Medicine a great Lab Week—both locally, and globally!

 

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