The pathologist is your friend

When in doubt or when you think you are torn between releasing an unsure result, stop and think before doing it. You're not alone! That's why pathologists come to help.

What could be more alarming when you released it right away and someone will question?You've got to defend and protect your license. Your pathologist will defend you.

If you're confused between what's a blast cell or not, always refer to the pathologist. They are assigned in the laboratory as the experts of these fields. There's nothing to be afraid of them. A thorough diff count with immature cells noted from a cancer patient can help the hematologist monitor the patient's condition. By this, the pathologist can teach you more on how to distinguish the WBC precursors as well as the RBCs.

It's a nice thing to know that in the hospital that I'm working, pathologists are so approachable and very open to junior lab technologists like me. It's also our hospital's protocol to always refer questionable CBC results with various flaggings to pathologist before releasing (with our initial manual diff counts of course). 

I'm talking not just in hematology but other departments as well such as in blood banking where ABO discrepancies are encountered and other special procedures too. They serve as the judge if you really know the procedures and its principles so you have to be knowledgeable.

But then, make sure you're prepared and at least studied. A prepared MT marks an impression to the pathologist that at least you made an effort and you never stop learning. Show your worth. That's why this profession never fails to amaze me. There are still lots of things I need to learn being a medical laboratory scientist!

How important are the microtainer™ tubes?

Each hospital labs and free-standing laboratories must have EDTA and plain microtainers™in their phlebo area.

Why is this so? Because with the baby's smaller veins, would you be able to fill 2cc of baby's blood to a 2cc EDTA tube with another 3cc for its chem test? Hmm..maybe! But it really depends on the baby's vein (if it could withstand the syringe method of draw). I know some of us depend on dripping method where you squeeze the baby's hand as the blood drips from the needle. I know the feeling that you have to get the right amount of blood before it starts to clot. It might even add trouble as you deliver it to the lab and it happened it was hemolyzed or platelets clumped. Tsk2. That's why microtainers™ are a big help for us to an easier blood collection.

REMEMBER: Don't compromise QUALITY over QUANTITY.

Microtainers™ are small blood collection containers designed for collecting a minimum volume enough for running lab tests. Be it thru venipuncture or capillary puncture. Additives such as the EDTA are added in proportion to the blood where you just need to fill a minimum of 0.5cc up to 1 cc. Even plain microtainer tubes can yield up to 300ul of serum enough to run electrolytes or bilirubin.

Microtainers™ can even compensate short draws from your venipuncture. A microtainer™ for CBC can save up more blood to be used for chemistry or other tests requiring serum.

But then, just a friendly reminder... conserve your microtainers™:-) Use it when necessary. It's more expensive than the usual ones. This may give a burden to the ones assigned in hematology because these tubes should be fed manually. So, if you think the blood is adequate, use the regular tubes.

The more microtainers™ you submit (even those who are from adult patients) would reflect your phlebotomy skill.

SYRINGE VS. EVACUATED TUBE SYSTEM: Pros and Cons

Just before I get blood from my patients, I always ask myself on what method should I use to ensure a successful venipuncture. It's after vein assessment that I decide what to use and based from my experience, I've come to realize that both the syringe method and ETS (evacuated tube system) have their own advantages and drawbacks. Check this out!

I've always loved using syringes. I feel safe when using them. This is when I hear compliments such as "It's not painful' or 'I didn't feel anything..Thank you'..

SYRINGE

Registered trademark of Terumo Corporation

1. PROS

• with backflow
• less painful
• you can change the needle gauge for smaller/thinner veins
• can be maneuvered

    2. CONS

• limited amount of blood 
• time consuming in transfering blood from one tube to another
• 10cc plungers are hard to pull and agent for short draws
• needle pricks
• cause for platelet clumps if blood is not transferred immediately

On the other hand, when times are busy, I use ETS! I realize you have to be sure when doing ETS method or else YOU'LL BE SORRY it didn't turn out so well.

EVACUATED TUBE SYSTEM

Registered trademark of Becton-Dickinson Company

1. PROS

• faster way of collecting blood
• with safety feature included
• recommended for multi-sample draws
• suitable for tests requiring closed system method of venipuncture (eg Ammonia, Carbon dioxide)
• reduces the risk of hemolysis

    2. CONS

• proper order of draw should be strictly observed
• not recommended for newborn or pedia patients
• not suitable for easily collapsed veins
• might not get the appropriate amount if vacuum tubes are expired or opened already
• would mostly leave hematoma on the skin

It's all in your hands what to use during your shift but one must consider convenience both for you and to the patient, It's always been like that from the start. So think and use these weapons wisely :-)

Night life of a junior medtech

Night shifts (for me) are the most anticipated shift of the week. While others are sleeping, this is when you have to work as fast as you could to finish all the things on time. So let the COFFEE PARTY get started!

Night shifts had never been easy for me. Setting spooky stories aside coz Micro lab is kinda scary. Before going up for warding, we have to prepare things for the next day by running controls to machines. Reconstituting controls can be stressful at times when the controls don't go well as expected. This is where our pipeting techniques developed.

When I'm assigned in warding department, I really need to be quick in getting in and out of the patient's room for blood extraction. Waking them up can be time consuming so you gotta have a loud voice with a gentle tone to let them know. Each of us has a game plan on how to get all the patient's blood before the time runs out just like what floor comes first or should you prioritize the nursery rooms but in situations when some patients are difficult to extract esp babies or those in ICUs, we take our time..

Well, at the end of the shift you will realize you've survived. But one thing that I don't like from the night shift is that I keep on worrying if everything is OK after I left from work. That wears me out. After that, the day off is spent for the whole day of rest. That's how a night life of a medtech looks like.