- For one of my classes this summer, I have to keep a reflective journal of what I'm learning.... I decided that I'll just post updates online each day (for 6 weeks) so you guys know what I'm doing too. I'll try and not be too scientific, and post links to what I'm talking about. So, here's to a day in the life!
Currently I'm doing my clinical rotations through ARUP, an enormous reference laboratory. Apparently, they're in the same league as the Mayo Health Clinic; before I moved to Utah, I'd never heard of ARUP, but my mom used to diagnose us out of the Mayo Health Clinic book! haha So, here's a summer filled with diagnosing...in a different way then you'd think. I think of myself as a Medical Researcher. For a moment, think of a doctor as a consultant - you present to the Dr., tell him what's wrong, and he deicdes to order a battery of tests. The nurse comes in and draws the necessary sample. The doctor peaces out and the nurse sends the samples off. Where do your lab tests go? Right to me. A good friend of mine once quoted a famous surgeon, saying "If you want to change one life at a time, become a Dr. If you want to change thousands of lives, become a researcher." My role is to figure out why you're sick, how sick you really are, how you got that way (in a sense), and what will make you all better. When the medical field/staff are working correctly, we should all confer together - lab, dr, nursing staff. This ensures best treatment for the patient. And, here's a look at what I do allllllll day long!
This month, I'm rotating through the University of Utah Hospital's laboratories. This includes the University Hospital and the Hunstman Cancer Institute. Since both of my parents have had cancer, its really interesting to see the clinical viewpoint, having been on the patient end. I'm in hematology this month - that's the study of blood. And, its way more interesting then you'll ever know!
Today, we trekked over to ARUP labs to investigate hemoglobin electrophoresis. Hemoglobin is what comprises your red blood cells. We receive samples from all over the world, and this is where it gets interesting. There's a fancy machine abbreviated HPLC (high pressure liquid chromatography) that separates hemoglobin content out by charge, dependent upon pH, etc.
HPLC machine!
There are over 900 hemoglobin variants - when we say that people are unique, we're not kidding. Each hemoglobin molecule is compsed differently, and this can be dependent upon race. You may have a certain composition and I may have another - and you and I are totally normal. Some people aren't - disorders and diseases can arise from deletions in the genome (and I'm getting really scientific here, aren't I?!) and make life miserable. So anyway, back to HPLC. We run the blood through this machine, and it prints out super cool graphs - which we have to interpret. Peaks come off the machine at certain times. Peak correlations with time tell us what hemoglobin variants make up your blood. HbF (hemoglobin F), for instance, is called Fetal Hemoglobin. You have a ton of this as a baby, yet by the time you reach adulthood, you've only got 2% left and your bone marrow has switched to making HbA.
Some people inherit blood disorders because of their ethnicity - so when you fill out that medical questionaire, don't think about race in a negative sense - you're giving us vital info! For instance, if you're of African descent, you have a high probability of inheriting HbS. This stands for Sickle Cell Anemia. Remember reading about that in biology?
See the regular, round red blood cells? They carry oxygen to your tissues, etc. The sickle shape, or cresent, has some issues. They can congregate in your capilaries and cause "vaso-occlusive crisis" which is extremely painful. Its like cutting off an arm...well, maybe not that bad, but its no picnic either.
So, we look at those peaks, and lets say you have a peak in the S window, indicating to us that we've got to do another test for Sickle Cell. We do a fun, simple test called sickle sol, which stands for solubilty. You add some buffer to a tube with come chemicals in it, add 50 lambda of your patient sample, mix and wha-la! Compare. If you can read through the tube, you don't have sickle cell! Congrats! If you're like the tube on the right, you're a pretty good looking candidate for having Sickle Cell.
Electrophoresis (running a sample through a gel mechanism) follows as well. Its like the confimatory test, and we run an acid and an alkaline gel - different hemoglobins migrate differently. And they can be tricky! HbS, D, G, & LePore all migrate the same on an Alkaine gel...so how do you know which one you have? Run an acid, and they'll separate. The HbD and G will migrate towards the A region...and you've got 'em caught.
This week we've also spent countless hours looking through a microscope, looking at blood smears from cancer patients.
This is a picture of a patient's blood smear - we count all of those purple things, called neutrophils, and we have to classify 100 cells. Then we look at those fleshy-red looking cells, or the red blood cells, and classify their morphology. This is extremely informative. For instance, the arrow there is pointing to a BAND neutrophil. That's not good to see in someone; well, if you only have 1, not a big deal. Bands usually accompany other immautre cells, like "blasts" which mean -CANCER- like a leukemia, etc. They're really interesting to see, but as excited as you get, you also feel a pang of sadness for the patient.
INTERESTING: Today, we were processing samples in the hematology area of the lab when we received a notice for a intrauterine transfusion hematocrit. What the heck is that? Well, "intrauterine" deals with the fetus that's still present in the mom... transfusion? They're going to infuse blood into the fetus to prevent distress, HDN, etc. Hematocrit? This deals with the amount of RBC inside the fetus. We measure all of these things in order to ensure welfare of the baby. Today, the nurse ran down with the sample in her hand, and it was a STAT test because the mom was still up in the Operating Room, with a needle stuck in her belly...scary enough for me to run that sample soooo fast. Everything turned out to be ok! Hooray! Way to go baby!
Anyway, hope you enjoy today's day in the life.... Hopefully, tomorow will bring another exciting event! I'll keep you posted!!! Any comments would be great (espeically since I have to hand this in! haha)!!!!!!
This is what sputum is - you're coughing up all of the gunk in your lungs, putting it in a transport tube and we get to plate it. Below is what bacteria looks like on agar. Seriously, we get all sorts of nasty, nasty, nasty crap in Microbiology.
Today I saw some nice runny, green-yellowish stool (aka poo). I told my teaching specialist I wasn't going to plate it. Ew. I let him do it.
You can identify bacteria sometimes by their hemolysis - the bacteria lyses or busts apart the sheep blood agar (heme = blood, lyse = burst); there are three kinds. Beta (the B up there on the plate shows a clear zone around the bacteria - sometimes you can see all the way through the plate), Alpha (the green-bruised color; its harder to see), and gamma which means there really isn't any. These hemolytic characteristics are really important to notice as a technologist - this helps you figure out what the patient is colonized with.
This is Streptococcus penumoniae, and if you enlarge the picture, you can view the beta hemolysis around the tanish-mucoid colonies. Some of these bugs have distincitive smells/odors also - Pseudomonas aeurginosa smells like grape kool-aid or tortilla chips :D Its easy to distinguish from CF patients, because its all mucoid and it has a metallic sheen on the colonies, appearing like an oil slick.
This is a pretty exaggerated picture, but you can see the sheen across the top of the colonies. If the bug on the plate has the metallic sheen, characteristic odor, and zone of hemolysis, then the technologist can go ahead and report out that we have P. aeruginosa. This helps the physician - imagine having that slimey stuff in your lungs....not fun.
