Art and Science of Laboratory Medicine

Art and Science of Laboratory Medicine

Friday, May 30, 2014

History of the preanalytical phase

In the 70ies of the last century, ther term “preanalytical phase” was introduced in the literature. This term describes all actions and aspects of the “brain to brain circle” of the medical laboratory diagnostic procedure happening before the analytical phase. The author describes his personal experiences in the early seventies and the following history of increasing awareness of this phase as the main cause of “laboratory errors”. This includes the definitions of influence and interference factors as well as the first publications in book, internet, CD-Rom and recent App form over the past 40 years. In addition, a short summary of previous developments as prerequesits of laboratory diagnostic actions is described from the middle age matula for urine collection to the blood collection tubes, anticoagulants and centrifuges. The short review gives a personal view on the possible causes of missing awareness of preanalytical causes of error and future aspects of new techniques in regulation of requests to introduction of quality assurance programs for preanalytical factors.

Read more:
History of the preanalytical phase: a personal view



Source: Biochemia Medica
Image credits: Imram Akram

Comparison of Giemsa microscopy with nested PCR for the diagnosis of malaria

Malaria remains one of the leading communicable diseases in Ethiopia. Early diagnosis combined with prompt treatment is one of the main strategies for malaria prevention and control. Despite its limitation, Giemsa microscopy is still considered to be the gold standard for malaria diagnosis. This study aimed to compare the performance of Giemsa microscopy with nested polymerase chain reaction (nPCR) for the diagnosis of malaria in north-west Ethiopia.

Among the study participants, 61.6% (183/297) patients tested positive for malaria by Giemsa microscopy of which, 72.1% (132/183) and 27.9% (51/183) were diagnosed as Plasmodium falciparum and Plasmodium vivax, respectively. By nPCR, 73.1% (217/297) were malaria-positive. Among microscopy-negative samples, 13.1% (39/297) samples turned malaria-positive in nPCR. In nPCR, the rate of mixed Plasmodium infections was 4.7% (14/297) and 3.03% (9/297) were positive for Plasmodium ovale. Using nPCR as reference the sensitivity, specificity, positive predictive and negative predictive values of Giemsa microscopy were 82.0%, 93.8%, 97.3% and 65.8%, respectively, with a good agreement (κ = 0.668) to nested PCR. The sensitivity and specificity of Giemsa microscopy in identifying P. falciparium infections were 74.0% and 87.4% and 63.2% and 96.5% for P. vivax infections, respectively.

Although Giemsa microscopy remains the gold standard for malaria diagnosis in resource-limited environments, its sensitivity and specificity as compared to nPCR is limited suggesting exploration of novel rapid and simplified molecular techniques for malaria-endemic countries. A high rate of misclassification and misidentification highlights the importance of adequate training for staff involved in malaria diagnosis.

Read more:
Comparison of Giemsa microscopy with nested PCR for the diagnosis of malaria in North Gondar, north-west Ethiopia



Source: Malaria Journal

Tuesday, May 27, 2014

Red cell genotyping and the future of pretransfusion testing

Over the past 20 years the molecular bases of almost all the major blood group antigens have been determined. This research has enabled development of DNA-based methods for determining blood group genotype. The most notable application of these DNA-based methods has been for determining fetal blood group in pregnancies when the fetus is at risk for hemolytic disease of the fetus and newborn. The replacement of all conventional serologic methods for pretransfusion testing by molecular methods is not straightforward. For the majority of transfusion recipients matching beyond ABO and D type is unnecessary, and the minority of untransfused patients at risk of alloimmunization who would benefit from more extensively blood group–matched blood cannot be identified reliably. Even if a method to identify persons most likely to make alloantibodies were available, this would not of itself guarantee the provision of extensively phenotype-matched blood for these patients because this is determined by the size and racial composition of blood donations available for transfusion. However, routine use of DNA-based extended phenotyping to provide optimally matched donations for patients with preexisting antibodies or patients with a known predisposition to alloimmunization, such as those with sickle cell disease, is widely used.

Read more:
Red cell genotyping and the future of pretransfusion testing



Source: Blood Journal
Image credits: Lessons path

DNA Gel Electrophoresis

A video from Moshe Pritsker´s library, DNA Gel Electrophoresis, geared toward laboratorian education.

Watch the video:
DNA Gel Electrophoresis


Source: ADVANCE
Image credits: Philipe Pailly


I´m a Biomedical Laboratory Scientist

Important profession behind the scenes


Monday, May 26, 2014

How to Clean Microscope Optics

Unsatisfactory image quality can have various causes. If you can rule out wrong microscope settings such as inhomogeneous illumination or an incorrect diaphragm setting, the next step is to check the specimen. If the specimen is OK, inspect the specimen slide and the coverslip and clean if necessary. If you still cannot find the reason for the loss of quality, and are using the right immersion oil, the problem might be due to dirt in the microscope itself.
  • Causes of unsatisfactory image quality
  • Components accessible to the user
  • Locating the impurity
  • Removing the impurity
  • Remove loose dirt with compressed air, solid dirt with cleaning liquids
  • Avoid impurities in the first place, if possible
Read more:
How to Clean Microscope Optics
























Source: Leica Science Lab

A Very Cool Blood Smear

This blood is from the coolest person ever


Source: Facebook
Image credits: Marty Wills

Good Morning Lab Scientists!

Lab coffee mug

Source: Think Geek

Sunday, May 25, 2014

Techniques for faster discovery and isolation of human monoclonal antibodies

Monoclonal antibodies have long been powerful tools for basic research as well as for the diagnosis and treatment of disease. Traditionally, researchers obtained such antibodies from rodents using the technique pioneered by Nobel Prize-winners Georges Köhler and César Milstein in the mid-1970s. In this approach, researchers first collect antibody-producing cells from mice exposed to an antigen of interest and fuse them to myeloma cells, forming so-called hybridomas that can survive for a long time in culture. By screening single hybrid cells for those that produce the antibody of interest, researchers can develop a cell line generating virtually unlimited amounts of highly specific antibodies.

Read more:
Accelerating Antibody Discovery



Source: The Scientist Magazine
Image credits: The Scientist Staff

A Rare Cause of Lymphocytosis

An asymptomatic 49-year-old female presented with lymphocytosis (11.1 × 109/L lymphocytes) and thrombocytopenia (128 × 109/L platelets), with no additional cytopenias or physical findings. The blood film revealed lymphocytes of varying morphology, including unusual cells displaying bilobed nuclei. Bone marrow biopsy revealed mild interstitial B-cell lymphocytosis that included foci of intrasinusoidal localization highlighted by CD20. Flow cytometry revealed a predominance of polyclonal B cells lacking additional antigenic aberrancies (peripheral blood and bone marrow).

Read more:
A rare cause of lymphocytosis



Source: Blood Journal

Image credits: ASH Image Bank

A New Exciting Day in the Medical Lab

I <3 my profession


Source: Facebook
Image credits: Bob Collins

Sugars at Microbiology Lab

Glucose, lactose, maltose, mannitole, sucrose and indole.



















Source: Facebook via Medical Microbiologist

Wednesday, May 14, 2014

Identification of genetic mutations involved in human blood diseases

A study published today in Nature Genetics has revealed mutations that could have a major impact on the future diagnosis and treatment of many human diseases. Through an international collaboration, researchers at the Montreal Heart Institute (MHI) were able to identify a dozen mutations in the human genome that are involved in significant changes in complete blood counts and that explain the onset of sometimes severe biological disorders.

“Complete blood counts are a complex human trait, as the number of cells in the blood is controlled by our environment and the combined expression of many genes in our DNA,” explained Dr. Guillaume Lettre, a study co-author, an MHI researcher, and an Associate Professor at the Faculty of Medicine at Université de Montréal.

Read more:
Identification of genetic mutations involved in human blood diseases


Source: Montreal Heart Institute

IFBLS Awards Program 2014

IFBLS Awards

2014 dvta Continuing Education Award
2014 Elisabeth Pletscher Award
2014 Good Poster Award
2014 IFBLS Student Award
2014 JAMT Award
2014 Nordic Award
2014 Past President Award

The deadline for Award Applications is approaching very soon on June 1. To date, we have received only 5 applications for the 5 Awards available. Most of the awards will assist a member to attend the 2014 World Congress in Taipei, Taiwan. We also have the TMER training program, which has been a great success and its deadline is May 20. The Awards and TMER training program are both wonderful education opportunities and we want to ensure that all members who are interested will submit an application.

Read more:
IFBLS Awards Program 2014























Source: IFBLS

Monday, May 12, 2014

Recycling a Patient's Lost Blood During Surgery Better Than Using Banked Blood

Patients whose own red blood cells are recycled and given back to them during heart surgery have healthier blood cells better able to carry oxygen where it is most needed compared to those who get transfusions of blood stored in a blood bank, according to results of a small study at Johns Hopkins.

In a report for the June issue of the journal Anesthesia & Analgesia, the researchers say they found that the more units of banked blood a patient received, the more red cell damage they observed. The damage renders the cells less flexible and less able to squeeze through a body’s smallest capillaries and deliver oxygen to tissues. Among patients who received five or more units of red blood cells from a hospital blood bank during the study, the damage persisted for at least three days after surgery. In the past, studies have linked transfusions to increased risk of hospital-acquired infections, longer hospital stays and increased risk of death.

Read more:
Recycling a Patient's Lost Blood During Surgery Better Than Using Banked Blood 


Source: Johns Hopkins
Image credits: File Photo

Sunday, May 11, 2014

Cute Little Knitted Tube

Geeky Medical Laboratory stuff


Microbiology Online Lecture Library

The Online Lecture Library contains scientific and educational presentations from ESCMID events. Here you will find: Materials from ECCMIDs, ESCMID conferences and courses, audio, video, slides & transcripts from the actual presentations .

Open ESCMID library:
ESCMID: Online Lecture Library



Source: ESCMID

Appropriateness of cholesterol screening

Mortality for cardiovascular disease has declined steadily since the 1960s, but these disorders still remain the leading cause of death for both men and women of all races and ethnicities in Western countries. Given that several epidemiologic studies have identified a variety of risk factors, population screening plays an important role in an attempt to reduce onset, progression and complication of cardiovascular events. Abnormal serum lipids are thought to play a causative role in atherosclerosis and have received prominent attention in the attack on cardiovascular disease. In particular, serum cholesterol has received the most focus when a direct relationship could be demonstrated between the levels of total and low-density lipoprotein (LDL) cholesterol and the cardiovascular risk. Hence, cholesterol screening programmes have become commonplace worldwide.

Inappropriate testing in some circumstances would be associated with unjustified expenditures for national healthcare systems, even for a simple and nominally inexpensive laboratory test.

Read more: 
Appropriateness of cholesterol screening: From recommendation to clinical practice























Source: MEDLAB
Image credits: Jessica O’Brien

Happy Mother´s Day Scientists

Mother's Day Science (Video)

Pregnant women go through a lot to bring a baby into this world: 2 a.m. food cravings, hypersensitivity to certain smells and morning sickness, not to mention labor and delivery. In honor of Mother’s Day, the American Chemical Society’s (ACS’) newest Reactions video highlights the chemistry behind a pregnant woman’s altered sense of taste and smell, how mom’s diet influences baby’s favorite foods and other pregnancy phenomena.






Source: Youtube/American Chemical Society
Image credits: Etsy/ShopGibberish

Dancing Scientists at British Science Festival

The British Science Festival, this year hosted by Aston University, was kicked off by a flash mob of British Science Festival Assistants who donned lab coats and safety glasses and descended on St Phillip's Square, dancing to a medley of science themed songs.

Read more: 
British Science Association





Source:Youtube/Aston university

Saturday, May 10, 2014

Laboratory Scientists of the World

A scientist from King Fahd Medical Research Center in Jiddah, Saudi Arabia


Originally posted by:
Altmuslimah/Nadia Mohammad 






















Effect of HPV assay choice on perceived prevalence in a population-based sample.

Human papillomavirus (HPV) immunization programs clearly have considerable potential to reduce HPV-associated disease; they are also resource-intense; so, it is essential that their effectiveness is determined accurately and in a timely way. Measuring circulating HPV types in a population can provide an early measure of vaccine impact. We assessed he impact of HPV assay on the observed population prevalence of HPV in women who provided samples as part of a National HPV Immunisation Surveillance Exercise. A total of 1145 liquid-based cytology samples, 326 self-taken swabs, and 371 urine samples were tested with a line-blot assay (the Digene reverse hybridization HPV genotyping assay) and a luminex-based assay (the Mulitmetrix HPV genotyping assay).

This study indicates that assay choice has a significant impact on observed prevalence of HPV, including vaccine types. The impact of any change of assay during longitudinal surveillance programs should thus be taken into account to avoid confounding the assessment of any vaccine-induced changes.

Read more:
Effect of HPV assay choice on perceived prevalence in a population-based sample.



Source: PubFacts
Image credits: Luminex

Gender and the Active Smoking and High-Sensitivity C-Reactive Protein Relation in Late Adolescence

C-reactive protein (CRP), smoking, and oral contraceptive (OC) use are associated with cardiovascular disease risk in adults.

This study examines the effect of smoking on high-sensitivity CRP (hs-CRP) levels, and the interactive effects of sex and OC use on this relationship, in an adolescent cohort. A total of 1050 adolescents (mean age, 17±0.25 years) from the Western Australian Pregnancy Cohort (Raine) Study had anthropometric, lifestyle and metabolic measures recorded.

The association between smoking status and log-transformed hs-CRP was analysed using multivariable tobit linear regression models, with adjustment for adiposity, lifestyle, and early-life confounders. A three-level variable (girls not using OC, girls using OC, and boys) was employed to assess the interactive effects of sex, OC use, and smoking.

Smoking associated with higher hs-CRP levels in girls not using OC (b=0.571; p=0.001), but not in girls using OC (b= -0.117; p=0.598) or in boys (b=0.183; p=0.2). OC use in non-smoking girls was the strongest factor associated with higher hs-CRP levels (b=1.189; p<0.001). This study has demonstrated a more robust effect of smoking on hs-CRP levels in girls not using OC, compared with boys. The findings may explain why cardiovascular disease risk conferred by smoking is higher in women than in men.

Read more:
Gender and the Active Smoking and High-Sensitivity C-Reactive Protein Relation in Late Adolescence


Source: Journal of Lipid Research
Image credits: BLS

Malaria severity not determined solely by parasite levels in blood

Although malaria kills some 600,000 African children each year, most cases of the mosquito-borne parasitic disease in children are mild. Repeated infection does generate some immunity, and episodes of severe malaria are unusual once a child reaches age 5. However, the relative contributions of such factors as the level of malaria-causing parasites in a person’s blood—parasite density—to disease severity and to development of protective immunity are not well understood.

To clarify these issues, researchers from the United States and Tanzania regularly examined 882 Tanzanian children beginning at birth and continuing for an average of two years. No simple relationship between parasite density and malaria severity emerged. For example, 253 children had a total of 444 infections characterized by high parasite density and mild symptoms. Of the 102 children who did develop severe malaria at least once while enrolled in the study, almost two-thirds (67) had high parasite density but only mild disease either before or after the episode of severe malaria.

Read more:
Media Availability: Malaria Severity Not Determined Solely by Parasite Levels in Blood


Source: NIH
Image credits: Ed Uthman.

Friday, May 9, 2014

British Haematology Guidelines

CSH provides up to date evidence based guidelines for both clinical and laboratory haematologists on the diagnosis and treatment of haematological disease. The guidelines are written according to the BCSH process by a team of expert Consultants and clinical scientists currently practicing in the UK.

The Guidelines are organised by clinical area (haemato-oncology, general haematology, haemostasis and thrombosis and blood transfusion) and by status (whether they are current, archived or works in progress). They can be arranged either by date of publication OR alphabetically by 'topic' by clicking the arrows next to the column headings. The recommendations made by guidelines are reviewed regularly by the writing groups. They are updated as required and will be rewritten if changes are needed. Guidelines that are no longer valid will be archived.

Open guidelines:
BCSH - Haematology Guidelines



Source: BCSH

Thursday, May 8, 2014

Polycythemia

This patient has high HCT.

The term polycythemia is a literal translation from Greek, meaning “too many cells in the blood,” and refers to an increase in the red cell mass; it is frequently used interchangeably with the term erythrocytosis. Polycythemia may be due to a myriad of causes. The polycythemias can be classified as relative and absolute. Relative polycythemia is a disorder in which the patient characteristically has a modest elevation of the hematocrit level without an elevated red cell mass but rather due to contraction of the plasma volume, whereas the absolute polycythemias are accompanied by an actual increase in the circulating red cell mass. Polycythemias can also be classified according to the responsiveness of their erythroid progenitor cells to growth factors or the circulating levels of such growth factors. Expert consult























Source: Facebook
Image credits: Mary Couse Coulston

What matters more, multiplicity of infection or virus concentration?

Virology question of the week

"My professor recently said that really, the MOI doesn’t matter in a culture, it is the concentration of viral particles in the media that matters. Ie: if you have 10 million cells or one cell, but you are infecting the plate with 5mL of 100 million viral particles/mL, then the amount of virus interacting with each cell is not different in either scenario (pretending that it isn’t nearly impossible for that single cell to survive in culture alone). I argued with him, saying that the cytotoxicity to the single cell would certainly be increased. He then said that a student hadn’t argued with him about that in his 15 years of teaching and I promptly decided to get some evidence before I continued the discussion."

If you have two plates with equal numbers of cells, and you add 5 mL of media to one and 50mL of media to the other – assuming that the media is 100 million infectious particles/mL – would the higher MOI plate not result in more infectious events per cell?

Read more:
What matters more, multiplicity of infection or virus concentration?




Source: Virology blog
Image credits: Laboratory equipment

The Comeback Of Polio Is A Public Health Emergency

It is, says the World Health Organization, "an extraordinary event." Polio is spreading to a degree that constitutes a public health emergency.

The global drive to wipe out the virus had driven the number of polio cases down from 300,000 in the late 1980s to just 417 cases last year. The World Health Organization has set a goal of wiping out polio by 2018.

But this year, polio has been reported in 10 countries, and there are fears the number could rise. Bruce Aylward, the head of WHO's polio program, says if the international spread isn't halted, the virus could easily re-establish itself, particularly in conflict-torn countries like the Central African Republic and South Sudan. The unrest makes it difficult to sustain vaccination efforts, and poor sanitary conditions cause the disease to spread.

Read more:
The Comeback Of Polio Is A Public Health Emergency



Source: Health News : NPR
Image credits: Muhammed Muheisen/AP

Saturday, May 3, 2014

Lab Orders

Sometimes I feel like my job is only guessing and fixing lab orders what they supposed to be.

Do you know this feeling?



Image credits: Chronic health


The Beauty of Perfect Red Blood Cells

 Aren´t they perfect?



View more:
Gallery | Mission Statement























Source: NCMIR
Image credits:  National Center for Microscopy and Imaging Research

Friday, May 2, 2014

Mobile Blood Draw Station

Create a Draw Station Anywhere

If you’ve been a phlebotomist for very long, you know many patients are physically unable to make it to a draw room. As a result, these patients must be drawn in alternate locations that are often awkward and unsafe. The Mobile Draw Station was designed by a group of phlebotomists who wanted a portable “workstation” that could travel anywhere.

Read more:
Mobile Draw Station 























Source: Marketlab

New Virus Related To Smallpox Is Found In Republic Of Georgia

Two herdsmen in the country of Georgia have been infected with a brand-new virus, scientists from the Centers for Disease Control and Prevention said Thursday. The newly identified virus is a second cousin to smallpox. And, like smallpox, it causes painful blisters on the hands and arms‎. Other symptoms include a fever, swollen lymph nodes and overall weakness, CDC scientists at a meeting in Atlanta.

Since then, widespread vaccinations for smallpox have stopped. And this immunization gap seems to be opening the door for other viruses in the family — known as — to resurface, Vora says.

 "When you vaccinate a person with one of these viruses, it protects [against] other viruses in the family," Vora says. "Since smallpox vaccinations stopped, there's some indication that other ... orthopoxviruses have started to increase in their incidence because there's less immunity." Four other viruses in that family infect people: cowpox, monkeypox, vaccinia and smallpox. All but smallpox generally infect animals — cows, cats or monkeys — then jump to people opportunistically.

Read more:
New Virus Related To Smallpox Is Found In Republic Of Georgia



Source: Shots
Image credits: Darin Caroll/CDC

Supravital staining

A 20-year-old splenectomized woman with hemolytic anemia, diagnosed at the age of 3 years with congenital dyserythropoietic anemia type I, was referred to our institution for re-examination of 2 unusual features: high red blood cell (RBC) pyruvate kinase (PK) activity and methemoglobinemia.

"We performed supravital staining with brilliant cresyl blue to determine reticulocyte numbers. Many cells displayed the blue-stained reticulum characteristic of reticulocytes. In addition, inclusion bodies
reminiscent of Heinz bodies were noted"

Supravital staining is very rarely used in current hematological laboratory practice. In this case, it enabled us to reliably
estimate reticulocyte numbers and provided a clue toward revision of the diagnosis in this patient.

Read more:
Revision of the diagnosis of a case of hereditary hemolytic anemia by supravital staining

















Source: Blood
Image credits: ASH Image Bank

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