Smearing techniques: How good do you smear?

Back to the days when I was a third year medtech student, I struggled a lot making the so-called ideal blood smear. It is still fresh in my memory how I wipe again every failed smears just to save slides and how frustrated I am when instructors tell me that my smears are not good enough. I asked a lot of times when will I ever be adept in smearing until over the years I developed a technique on my own on how to make a good one and realized I learned much from it.

So basically, what is a good-quality blood smear?

• it should have a feathered end
• has a rainbow sheen when reflecting the light 
• length is 3/4 of the slide
• has margin; optional 

Factors to consider:

• Angle- around 30-40 degrees; adjust the angle higher if the blood is thin as seen in anemic patients or lower if the blood is thicker mostly evident from dehydrated patients
• Speed- requires a very smooth motion
• Amount of blood- one drop of blood is enough to create a monolayer 
• Pressure-  push the spreader completely across the slide. Avoid jerky movements.
• Spreader- it is better to check if the surface is still smooth to facilitate the spreading smoothly. 

First technique: Horizontal spreader approach

One disadvantage employed in this technique is the lack of margin. Make sure to tilt the horizontal spreader gently until the blood is evenly distributed to the sides before smearing. 

second technique: vertical spreader

Draw the spreader backwards. When the spreader is already in contact with the blood provided the blood spreads evenly on the spreader) gently push the spreader to make a smear

Third technique: This is what I call the 'Youtube style' as this is the frequently demonstrated technique from youtube tutorials. I think you have to learn the vertical approach first as prerequisite to this because you don't carry the slide and spreader up. Guide the spreader lightly while the slide is held on a flat surface and you'll make an evenly distributed smear with a nice feathery edge. My preferred technique.

To conclude, it is really essential that you master how to make good smears for your benefit and to the pathologist as well. Examination of blood smear is an integral part in hematological testing. Your differential count depends on your smear. Constant practice makes perfect so don't get frustrated if you can't make it today. Better yet, develop your own technique where you comfortable doing. Don't forget to label the patient's name on the slide.

Medtechs take the best CELL-fies during the Parasitology workshop

Reunited with my co-interns during the seminar. This is Mary Ann
and Arman, both working in a government hospital.

The need for standardization of reporting results in the field of parasitology has to be elucidated and if must, be established to ensure uniformity between hospitals and free-standing laboratories within the country. Thanks to PAMET-Cebu Chapter for the effort in organizing a two-day seminar entitled Quality Assurance and Reporting of Parasites for Standardized Routine Stool Examination held last August 14-17, 2017 in Gullas College of Medicine, Banilad Cebu City presided by Madame Lerma de la Llana-Paris, RMT, MSPH as the guest speaker. 

Preparing the Kato-katz smear

Hard to admit but it is disappointing to think that we give less importance in parasitology than we do to other departments in the laboratory. Hence, parasitology has been taken for granted in the corners of the clinical laboratory. While others do the routine stool examination wholeheartedly, some of our colleagues in the profession omit things that appallingly contradict to the standard operating procedures and this calls our attention to adhere to the protocols and improve ourselves particularly in the microscopy aspect. 

On the first day of the seminar which we call as the dry workshop, the lecturer gave us the overview and the status of parasite microscopy in the Philippines. The lecturer gave emphasis on how important the pre-analytical variables are such as the time the specimen was collected until it is submitted to the laboratory, the importance of microscopic exam and the microscopist’s proficiency in parasite identification. Concerns were raised regarding to the practices and problems encountered in reporting parasites in stool analysis. The World Health Organization (WHO) suggests that the standard reporting of ova or cysts should be quantitated per smear and it was agreed that upon reporting Entamoeba species, the remark should be E. histolytica/ E. dispar cyst or E. histolytica/ E. dispar trophozoite unless hematophagous E. histolytica trophozoite is confirmed. 

Fecal Ether Concentration Technique

On the second day which is the wet workshop, techniques such as the Kato-Katz, Kato Thick and Formalin-Ether Concentration Technique for food handlers were properly observed and performed by each of the participants. We had the chance to look up-close the eggs of the unholy three: Ascaris lumbricoides, Trichuris trichiura and the Hookworm and fed our eyes with the not-so-commonly encountered parasites such as Fasciola hepatica egg, Balantidium coli cyst and trophozoite, Heterophyid, Hymenolepis nana and Giardia lamblia cyst to name a few. Lugol’s iodine alongside with the NSS in direct fecal smear can definitely aid in observing the parasite’s morphology. An evaluation through the given post-test gauged the participant’s knowledge in identifying some clinically significant parasites prepared on slides. 

We may not become experts right after the seminar but as we get along, we will learn more through experience. What we’ve learned from the textbooks won’t suffice once we are in the practice. Continuing education in diagnostic parasitology through exposure to seminars and workshops like these can help establish the microscopist’s confidence and reliability to identify and distinguish one parasite after the other. 

As medical technologists, we must not let ourselves stagnate our knowledge and neglect what has been the necessary. One must appreciate his/her role in the delivery of quality healthcare even in routine stool analysis to meet the needs of public health.

With our completion certificate! With Madam Paris the guest speaker.

MUST-KNOW in DRUG TESTING

The information that you're going to read are based from the manual of operations for drug testing laboratories of the Department of Health. Please feel free to correct me if there are any
mistakes or changes on the protocol.

• Republic Act 9165 is known as Comprehensive Dangerous Drugs Act of 2002
• It is required to ask for a valid ID (with donor's picture on it) for verification purposes. 
• Custody and Control Forms should be completely filled up by the donor, ASC and the analyst each time the specimen to document the security of the urine specimen.
• Single specimen collection must contain 60 ml of the urine sample placed in a single container
• Split specimen collection must contain 30 ml in two separate containers
• Specimen container should be properly labeled with donor's name, date and time of collection with signature
• The collection site shouldn't have any access to water or other substances that could adulterate, dilute or substitute the sample.
• All specimen 
• Urine specimens for prolonged storage are stored in a freezer at -20 degrees celsius. It ISstored initially in ref temp between 2-6 degrees celsius for not more than 1 day.
• A positive initial screening result should be sent to a confirmatory laboratory with complete documents and ensuring the urine specimen for secure transport.

Medtech reliever: Part-time job in my day-off

working area is sometimes messy in a busy shift 

God only knows how I needed money these days. So I've been thankful that aside from my regular job in a hospital, I also work as a 'medtech reliever' in a free-standing laboratory in my available time. I don't think it's a conflict of interest since I work for them during my day-off.

Sometimes, I have to process 200 urine specimens!

A 'reliever' is someone who takes over an important position while the company is still looking for a permanent staff. I got this job when my workmate referred me to the management and I didn't hesitate to take the offer in an instant. 

I work as a generalist in this laboratory, that means I can take blood from patients, processing blood, urine and stool samples manually then release the results. I can have a chill shift if there are just a few walk-in patients or a busy shift if they organize a mobile drive in their partner establishments. 

What's the good thing in this laboratory are the people working on it. They are approachable, fun and easy-going people. They don't treat you an outsider hence they treat you as part of the family and endorse everything for me to avoid mistakes. 

For me, working here keeps me balance since I perform manual urinalysis, stool analysis and differential count. Although tiresome, but I see it as a learning experience everytime I see parasites in stools.

In regards to the pay, I receive more than the minimum wage after the shift and this is a life saver for me especially when I'm out of money already and the payday takes long to wait

How to get reliever/part time jobs?

There are several reliever jobs that you can choose from depending on the location, job description and sometimes, the pay that you want. You can find them in some posts in Facebook group pages. Establish trust with the management is a must and they will contact you whenever they need your service.

Looking for jobs other than what you have is not easy. In my case, I have to sacrifice my time in order for me to earn money and sustain the needs of my family. Lucky for those people who were born privileged because they can go places with the salary they have but I know my sacrifice will pay off through God's guidance.

How to pass the ASCP exam? Study Tips

Chance favors the prepared mind. - Louis Pasteur.

Preparing for the American Society of Clinical Pathology (ASCP) certification exam requires a lot of effort and discipline as compared from the preparations we did for the local board exam. At this point of time where we have our own careers to build, bigger responsibilities to shoulder and priorities to consider, I have noticed that my study habit when I was in college was gone and this was also a challenge for me to face now as a working individual.

We have our own reasons why we want to pass the exam. Mine is to look for better opportunities abroad and for career advancement as well. It took me three years to decide due to some hindrances like financial problems, stress from work and anxiety thinking what if I fail this exam.

But behold, if there's a will, there's a way!

Today, the cost of ASCP MLS certification is $200 (in the Philippines, around 11,000 php) so I need to work like a dog to earn that money (lol so true). You can pay it thru credit card or a debit card. To tell you, I was just self-studying and I found it hard to allocate time for studying because of our stressful shifting schedules and that include graveyard shifts. 

My first two years of working in the hospital were spent on reading (little by little) review materials like 

• Board of Certification (BOC)
• Harr, and 
• Polansky Q and A

The supplemental readings helped me a lot as I learned and understood more about the practical aspect.  I've had lots of 'Now I know...' moments when I was able to relate those information to my job as a medical technologist. Aside from that, I also collected and asked for recalls from my workmates who passed the exam. 

Well speaking about recalls, it gave me an idea what to study. They say that the more recalls you gathered, the more chances you pass! Although recalls can be of help for your preparation but it is still not a guarantee to your success. It's still in your hands since it's a computer-generated exam. You'll never know what question comes next. I would like to thank a colleague for a job well done in compiling those recalls all together. The recalls I've gathered have rationale in every answer and that helped me to understand each question. 

One thing that helped me passed the exam was setting a positive attitude. I was inspired by my colleagues who had MLS(ASCP)^I titles on their names already so I made it a habit of doodling that title after my name too (in my books and review materials) and that serves as my driving force to study on my vacant time. Having assigned in Blood bank is an advantage since I’ve got lots of blood banking questions esp. compatibility testing and that made it easier for me to analyze some discrepancies.

You have to familiarize principles, formulas, and normal values once again. 

THE DAY!!

On the exam day, I arrived at the testing center an hour before the scheduled time (Thursday, 8AM). That gave me time to check-in (presented a valid ID, palm scanning and put my valuables inside the locker) and listen to the instructions prior entering the exam room. I calmed myself as I read each items and answered them. I tried not to flag questions as much as possible. Calculations and dilutions were on my test but it was manageable. I spent my time in answering and reviewing all the 100 questions before clicking NEXT. When I saw PASS in my preliminary result, I couldn’t contain my happiness as I went out of the testing center WITH A BIG SMILE ON MY FACE. Thank God! All my efforts were worth it. My exam score came out a week after and I didn't expect my scores were higher than I aimed (minimum passing score is 400). I couldn't believe it!

Passing ASCP is a hard-earned achievement and if you already pass the exam, the more you inspire yourself to move forward and embark on your next journey to become an international medical laboratory scientist. I remember Jordin Sparks’ song, One step at a time. As the song goes, there’s no need to rush. Well, just keep pushing forward and ask guidance from God for a perfect timing. All things are possible when you believe in Him.

Now I am glad to say that it's official. This is it! It's really 
Cindy A. Escoba, RMT, MLS (ASCP) already!

Find out ASCP POINTERS TO STUDY by clicking here! 

Super Blue Bloody Moon

It was once in a 'blue moon' experience that I witnessed the lunar eclipse last January 31, 2018. I and my family marvelled the event as they never saw this since they exist! Luckily, the clouds didn't bother as the moon was slowly covered by the shadow.

SALARY INCREASE: A call of every medtech

We medical laboratory people oftentimes consider as the silent heroes in the hospital and true to that word, we always keep our mouths shut as we work overtime running complex tests for accurate results, fighting stress, facing the hazards....

but despite of our hardwork, we're sometimes given less respect . :-(

Yes, you heard it right. Medical technologists in the Philippines are paid less than any other medical practitioners in the country. You may think, a medtech wearing a lab gown in a microscope looks like a high-paid professional but don't be fooled. It is sad to think, we studied hard and pay expensive tuition for our education but in the end, we are paid less as compared to others.

Lucky for those medtechs working in a government hospital or under Department of Health because they'll receive lots of incentives but how about those medtechs working in free-standing laboratories and hospitals? As you know, our pay isn't that much. I would like to call it a 'salary for single individuals'.  That's why most Filipino medtechs consider working abroad for a better pay and that's the reason why our country is facing shortage of highly-skilled medical technologists.

I'm writing this not just for myself but in behalf of our colleagues in the profession. Yeah, we are frequently ranting for this! We are calling the attention of the concerned public for salary increase for us medtechs. We are dedicated to help patients also and we hope to get the same from our salary too. Give the profession some dignity!