I have had a few people ask me when I would post this post. It has taken me a little while. I'm not going to make any excuses, I am just going to write!
I will fill you in on a few of my experiences since I last wrote, however. June was finals MONTH--a very intense 4 weeks of studying, exams, and training in blood bank. I had a couple weeks off to recover, attend a family reunion, and get my wisdom teeth removed. After these weeks, I dove into work, moved into a new house, traveled to attend two weddings and my BYU graduation. Now I am finally back and transitioning into my graveyard shift position in the next 2 weeks. What a couple of months!!
Here are some pictures of my travels:
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| Bingham Copper Mine, SLC |
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| Rain Clouds |
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| Grad Party at Melinda's! |
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| Nicole's Wedding (Feesh, you need to send me the one of us!) |
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| AZ sunset |
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| Happy after my graduation ceremony. |
Okay. Down to business. Hematology.
Hematology?? What is it, Precious? ...Why, the study of blood of course!
Even though we test blood in EVERY department of the laboratory, heme is the area where we actually look at the cellular components of blood. We count the cells, and look at their morphology to identify and aid in the diagnosis of disease states (technically you have to be a physician to diagnose anything, although most lab scientists could give you a pretty good idea after a few seconds at the microscope).
A typical day on the hematology bench begins similarly to a typical day in chemistry. All our heme samples are run through the analyzer. We have a Sysmex, which is pretty good. It takes up a small aliquot of blood, and uses flow cytometry and other science-y magic to count and analyze the cellular composition of the blood. Some of the main values essential to a CBC (Complete Blood Count) include: White cell count, red cell count, hemoglobin and hematocrit values, red cell distribution, RBC indicies, platelet counts, mean platelet volume, and the differential. The differential is the part of hematology that we still frequently do manually--but only on specimens the machine flags as abnormal. Techs look at a slide of the patient's blood cells and count 100 cells, classifying them into categories: Neutrophil (maturation stages included), Lymphocyte, Monocyte, Eosinophil, and Basophil. Variation from the normal distribution of percentages can indicate to a physician the cause of an infection, potential malignancy or proliferative disorder.
Cell counts on body fluids can also be run on the hematology analyzers--most of the time these tests are to rule out or identify bacterial infections and malignancy in the area from which the sample was drawn. It's a pretty lengthy and time consuming process to explain, so I won't go into it now. Essentially, the cell count is obtained by running the body fluid through the Sysmex similarly to how you would run a CBC. A cytospin slide is made of the body fluid and examined for unusual cell morphology or other causes of disease.
Here is a little view into what I see under the microscope on a differential. Normally you wouldn't see all the WBC cell lines in one field, but it is nice to have them all in one picture!
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| Erythrocytes=Red Blood Cells, All others are White Blood Cells (except the platelet!) |
That is pretty much it for running the Sysmex. But the hematology department also includes a few tests on different analyzers.
Most clinics and hospitals group hematology and coagulation studies together. Coag analysis determines how fast the blood is able to clot in order to determine if platelet function and the coagulation cascade are functioning properly. Many people have heard of the Protime and the INR tests, especially those on blood thinners or other medication. These tests fall under the coagulation area, and we run them on our Stago analyzer. I really enjoy the idea of these tests, because the theory really is simple and unchanged from manual to automatic. Patient serum is mixed with reagents and a small metal ball. The ball moves back and forth until the sample clots, at which point the timer stops and you have your result! Other than the PT/INR, we also run the PTT, Fibrinogen, and D-Dimer tests--all of which help shed light on the function of the coagulation and clot-breakdown processes.
Urinalysis is also grouped into hematology at the Salem hospital. It is usually either grouped with Chemistry or Hematology--just depending on the hospital. Urinalysis is a little bit of chemistry, mixed with some microscopic cell and crystal morphology/identification (similar to hematology), so it works well with both areas. In our lab, we also have a Sysmex for the urines, but we call it the AUWi. It is a complex of two machines--one that reads the macroscopic (chemistry) results, and another that analyzes the microscopic portion. The AUWi is pretty new to our lab, so we are still getting the kinks worked out. I know some of you might be slightly disgusted or repulsed by the idea of urine tests, but they are very important! Like they say, you can learn a lot about a person by going through the trash. Not the most pleasant metaphor perhaps, but what the body "throws away" can give a very good picture of what is going on inside. One of the body's main functions is to break down chemicals and compounds that are either ingested or created by the body. If something is wrong with that process, it can be very harmful to internal organs such as the liver and kidneys, which are the body's filters. If compounds are found in the urine that suggest that a certain compound is not being metabolized (broken down) properly, it can indicate to the physician the cause of disease.
Take a peek:
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| This is what RBCs in the urine look like as seen on the Phase setting of the microscope Blood in the urine is not normal and not a good sign! |
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| Urine and Body Fluids are examined for these crystals |
Stay tuned for the next installment! (And maybe some pictures of my house once it is a little more organized!)
So glad to get part two!! Hope to see you soon!
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