Momshies gone to watersports adventure!

Finally, our long-awaited summer vacay has arrived! To tell you guys, we work in the laboratory almost everyday and we're stressed out after shifts. I think we really deserve a day off to a beach under the heat of the summer sun!

Honestly, a day is not enough to grasp our sweet escape from work but we made the most out of it. It's better to have one than to have nothing at all! Right? We were so thankful that the odds were on our favor as the nine of us were able to get in this exciting outing. This is what we've been craving for after one year in CDUH :-)

We took the opportunity to avail Serena Watersport's summer promo. Though a little bit pricey but it's already discounted so I thought it's worth a try the parasailing activity.

Here are the activities I didn't miss ....

JETSKI
At first, everyone was reluctant to drive it but when we had the chance to hold the grips of the jetski, it was enthralling and I hope it never stops. I pushed the button to the max as waves were created out from the motor. As I drove to the vast ocean, it was endless! I felt free! You can turn which way to go and no one's gonna bump your way. I realize you don't need to be a motor driver to ride a jetski.



PARASAILING...
This is my unforgettable and the highlight of today's activity. The thrill by the time you were up there makes you think you don't want to go down anymore. The 15-minute parasailing was never enough for a thrill seeker like me. You can get the bird's eye view of the whole LapuLapu, Cebu. It was awesome yet breathtaking. I found myself at peace as I saw the entire ocean. We shouted at the top of our lungs (no ones gonna hear us anyway) as I fed my eyes with the scenery above water. It was peaceful up there. We climbed all the way up to 800m above the sea.

BANANA BOAT RIDE...
I didn't expect riding a banana boat would be so much fun. It had a twist. We were towed by a rushing speedboat and we enjoyed ourselves for a ride. I just got nervous when they told Kuya driver to take the banana boat upside down which made me think will I ever survive after we plunge down the very deep water. As it happened, each of one struggled to get beneath the water and breathe.




Overall, I enjoyed the whole package. My money didn't go into waste and it was worth it. It's a one-of-a-kind experience that no money can ever buy. I had a wonderful time with my workmates and it truly build a stronger bond among us.

We thank Serena Watersports team for the wonderful accommodation especially to the Kuyas who guided us throughout the day and kept us safe from any untoward accidents. I also thank God for making this possible by providing us the good weather for the outing. Looking forward to more adventures with these people. I'm glad I've ticked off some things on my bucket list !

Phlebotomy 101: How to get blood from babies? Part 1

 Neonatal Phlebotomy is one of the challenging things a phlebotomist could encounter in nursery rooms and neonatal ICUs. Though dangerous, I prefer getting blood samples from babies than pediatric patients.

What's difficult in blood extraction of the babies is that their veins are still thin. You can not always use 3cc syringe to get the baby's blood from the arm. If possible, one should pull the plunger slowly so as to prevent the vein from collapsing. There should be an assistant to hold the baby's arm to secure the vein. Take note, the baby's veins are still movable and their skin tends to stretch.

THE SOLUTION...
To get blood samples for tests like CBC, Total and Direct Bilirubin for babies and the like, a passive blood collection technique called DRIPPING may be applied.

HOW TO DO DRIPPING

1. First and foremost, nursery rooms especially neonatal ICUs limit hand contacts to their babies. And for this reason, we should observe proper hand hygiene by washing our hands with soap and dry it thoroughly with a tissue/paper towel. Also, prepare the things you need. In our hospital, it is a policy to leave the warding trays outside the nursery rooms and bring only the things you only need.
2. It is an option whether you put gloves or not. As for me, I don't wear gloves until I have found the right vein for dripping.

3. VEIN ASSESSMENT: To choose the right vein for dripping, gently press the baby's dorsal hand with your index finger just like when Nurses are going to insert an IV needle. Take your time in finding the vein of your choice.
4. One of the ways to obtain a successful extraction is the way you hold the baby's hand. In order for you to easily squeeze the hand as the blood drops, make a circle around the baby's hand.
5. Clean the site: inner to outer motion. In this manner you can see your chosen vein clearly. Let it dry.
4. Taut the baby's skin. Hold it firmly. A 23-gauge needle can be used. As you insert the sterile needle (bevel up), don't let air get into it. Shallow angle of insertion at first then insert deeper until blood coming from the vein of choice comes to the needle's hub.
5. SQUEEZING TECHNIQUES...
As soon as the blood drops, squeeze the baby's hand gently by letting your index finger massage the baby's hand downward. This is to facilitate the blood to drop in the microtainer tube that you're holding in your other hand. It is advised to observe a 3-second interval after squeezing to avoid needle dislodge and to allow more blood to drop in the tube.
6. In case you observe any clots in the hub, gently remove it by using an alcohol swab. This should be removed immediately or else the blood flow will stop. Also, when you notice the blood stops dropping, adjust the needle inward or outward. Do it gently.
7. After collecting the right amount of blood. Cap all the microtainers and remove the needle with a cotton ball immediately covering the puncture site. Apply pressure for 1 minute then put a plaster.
8. Dispose the sharps in the sharps container and make sure the baby's bed is clean before leaving.

Dripping might be time-consuming but I personally prefer doing it than the syringe method. I hope this helps...
Stay tuned for my Part 2 of neonatal phlebotomy tips!

Iron staining of bone marrow aspirate smears

Iron staining for bone marrow aspirate smear is one of the special procedure a warding medtech is assigned to perform. 

This is one of the most sensitive histochemical tests and will demonstrate even single granules of iron in blood cells.The iron staining procedure utilizes the Prussian Blue stain for ferric iron to assess bone marrow iron stores. This procedure is particularly helpful when evaluating patients with anemia, iron overload, myelodysplasia, etc. In the adult setting, it is commonly performed on the bone marrow biopsy, but can be requested on the aspirates as well.

Principle: Small amounts of ferric iron are found normally in bone marrow. The reaction occurs with the treatment with acid ferrocyanide solution. Any ferric ion (Fe3+) in the tissue combines with ferrocyanide and results in the formaion of a bright blue pigment called “prussian blue” or ferric ferrocyanide.

It is important that you have this staining set to perform the procedure. Then, we ask the hematology dept. for a positive control and proceed to fixing. A bone marrow aspirate smear is fixed in a glutaraldehyde or methanol and after such time it is air dried we immersed to these reagents on the picture.

After the staining procedure is done, we refer it to the pathologist to examine.

Results :
1. Iron (ferric form) - bright blue
2. Nuclei - red
3. Cytoplasm - pink


References:
https://www.labce.com/spg448399_iron_staining.aspx
http://laboratoryinfo.com/perls-prussian-blue-staining/
http://www.inflathrace.gr/sites/default/files/Staining%20Protocol%20for%20Iron.pdf

What is MEDICAL TECHNOLOGY and why I chose it?

As I graduated from high school, I was really firm with my plan of choosing Information Technology course in a well-known university. It was a neat plan to start building my future career until suddenly.... fate have shifted its direction...it changed my life...and the next thing I knew, I found myself in a medical school taking this course I'm not so familiar with... the Bachelor of Science in Medical Technology. 

Let me introduce to you my chosen profession... 

What is Medical Technology? 

BS Medical Technology is a four year degree program that equips students with knowledge and skills in laboratory tests used in the detection, diagnosis, prevention, and treatment of diseases (finduniversity.ph).  Medical technologists also known as medical laboratory scientists work in hospitals or free standing laboratories to collect and analyze/process patient's blood samples and other body fluids. They are trained to operate the machines used in each sections. They are the key players in patient diagnosis by providing accurate results to the physician. 

They are well-trained in the areas of:

• clinical chemistry- where tests like lipid panel (cholesterol, triglycerides), fasting blood sugar, creatinine are performed
• hematology - CBC
• microbiology - identifying isolated bacteria, fungi, viruses in cultures
• immunology -  performing Hepatitis panel, HIV Test, Thyroid panel
• immunohematology (blood bank) - crossmatching, preparation of blood units, operating the platelet apheresis machine
•  urinalysis and body fluids - stool exam, semen analysis

Why did I choose this course?

My father wanted me to become a doctor and he told me that this is the best pre-med course to take. Also, I've always loved science and it made me realize that the course is not so common as compared to information technology. Because of that, I defied the odds and choose this interesting course.

About my college life...

Choosing medical technology was very challenging yet interesting. To add, I had a scholarship to maintain. There were times when I don't know what subject to prioritize. All of them are difficult but then I had friends who made medtech life fun for me. I learned that it's not just always memorization on terms but also you should be able to understand its concepts. This was the time I was not that good in phlebotomy but I got better as internship came. It was a balanced learning actually, as we were fed with lots of theories during lower years and immersed with its application during the internship

Am I using what I learned in college?

Yes. During school and internship, I was able to apply everything I learned.  In school, I learned the manual method in the microscopic examination of urine as well as manual differential counts already. The identification of each cells made easier because of the morphology our instructors taught us. It made me appreciate more  the concepts that I learned in books in the actual practice. 

How long did it take to find a job after graduation?

Since most of the laboratories prefer licensed medtechs, I spent 4 months of preparing for the licensure exam. After I passed the boards, it took me only one week to find my first job. I worked as a all-around medical technologist in a secondary primary laboratory with a good chief medtech that served as one of my mentors.

My current job?

I'm now working as a registered medical technologist in one of the private hospitals here in Cebu.

Do I recommend studying Bachelor of Science in Medical Technology?

Of course. The Philippines needs more medical technologists. Aside from being considered as the best course if you're going to pursue medicine, being medical technologist has a lot to offer.  This profession provides you a continuing education. The pursuit of learning new techniques regarding new clinical advancements are endless and so are the employment opportunities. 

Advice to people who are thinking of studying this course?

Be in mind that this course is a survival to the fittest. If you're already in it, you have to finish what you've started. Medical Technology entails sacrifice, dedication and confidence in your part, may it be while you're still studying or in a working scenario already. You have to possess a positive attitude that you will pass. Focus in your studies and learn to know the subject matter by heart. Theory and application should come together. The microscope is your friend so expect for practical tests on identification on various organisms. A licensed/registered medical technologist gets higher salary compared to those who are not so it is better if you pass the board exam.

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I hope this blog will enlighten your mind on choosing the right course. Good luck!

Newbies in Hema department..what to do?

As a newbie rotating in Hematology department, familiarizing the procedures in your respective institution is a must. A proper orientation by your senior MT can help you understand the workflow as well as to troubleshoot some problem that needs to be addressed immediately. Since you are a newbie in Hema (like me..lol), it is best to ask from your senior MT for clarifications and be open for any corrections. :-) Keep in mind that you are encouraged to ask/confirm if you are confused of something. Don't ever be afraid to approach. It is the senior MT's pleasure to help and guide you to become a self-equipped and independent MT in Hematology Department in the future...

But then, an extra effort is expected for us newbies. We have to do our part too and that is to go back to study again. The procedure manual in your department might be of help and at least will give you the overview of the different procedures to be done in hematology department,

Here are the things that I learned in Hema lately...these are just random pointers.

1. Learn how to use the hematology machine analyzer (Beckman Coulter): reviewing and troubleshooting problems, running the controls, and replacing empty reagents.
2. Familiarizing the RBC and WBC precursors.
3. Taking note to panic values and flaggings!
4. Getting to know the different cells (their characteristics) as well as if there are malignant cells in the differential count.
5. Adjusting the normal value with that of the patient's age: newborn, child, adult
6. Correlating patient's previous results (if there's any).
7. Total cell counts and differential counts on other body fluids (CSF, Peritoneal, Pleural, Synovial fluid)...the dilution and the manner of counting
8. Preparing blood smear to each patient
9. Indirect platelet counts below 100
10. PLATELET CLUMPS...patient's smear needs to be checked. If there are platelet clumps noted, a patient's citrated blood is used.

Now, tips number 2 and 3 are to be given much attention because there may be flaggings (such as MO blast, Left shift, Imm Grans) to show up and we may have mistaken these blasts as lymphocyte or monocyte. So, a referral to your pathologist of your manual diff count is advised before releasing the results. 

And lastly before you leave your working area, make sure you leave it clean and order as it is. You don't want your co-worker talking about how irresponsible you are. Also, observe a proper endorsement (even before and after) to the MT next to you. Double check the requests you've released. Through this, you'll gonna be out from any trouble in the future. Keep on counting cells folks!

CLINICAL MICROSCOPY DISCOVERIES!

Poor fella with so many uric acid crystals