Art and Science of Laboratory Medicine

Art and Science of Laboratory Medicine

Friday, August 29, 2014

Hypersegmentation of neutrophils, eosinophils, and basophils

The patient was a 72-year-old man who had a diagnosis of polycythemia vera in 2010. A JAK2 V617F mutation was positive. Hydroxycarbamide (hydroxyurea) was started at 500 mg and gradually increased to 1250 mg daily. A review of the peripheral blood smear identified 5% circulating blasts, macrocytosis, and marked megaloblastic changes in WBCs. Interestingly, nuclear hypersegmentation was identified in eosinophils (panels A-C), basophils (panels D-F), and neutrophils (panels G-I).

Read more:
Nuclear hypersegmentation of neutrophils, eosinophils, and basophils due to hydroxycarbamide (hydroxyurea)

Source: Blood Journal
Image credits: ASH Image Bank

Thursday, August 28, 2014

Canadian Flag Drawn Using Serratia marcescens

For Canada Day, microbiologists decided to perform a little bit of science art. It’s the maple leaf and the Canada flag using bacteria grown on agar plates. Even bacteria can show national pride! 

View more:
Canadian Flag Drawn Using Serratia marcescens

Source: Ultra fresh

Contaminated Blood Cultures May Offer Life-Saving Information

Some 30 percent of all positive hospital blood culture samples are discarded every day because they're "contaminated" — they reflect the presence of skin germs instead of specific disease-causing bacteria.

In the study, the researchers processed the demographic information, hospital records, blood culture results, and date of death of all patients at the Rabin Medical Center with positive blood cultures from 2009-12. They found that out of 2,518 patients, 1,664 blood cultures drawn from 1,124 patients reflected the presence of a common skin contaminant, coagulase-negative staphylococci (CoNS). High overall CoNS resistance predicted high overall resistance of the bacteria causing disease or infection. Most importantly perhaps, highly resistant CoNS isolates were found to be associated with higher short-term mortality.

The researchers hope their conclusions will cause clinicians to pause before discarding contaminated blood test results.

Read more:
Weblog (Medicine & Health) 

Source: Tel Aviv University
Image credits: Wikimedia commons

Wednesday, August 27, 2014

Continuous Monitoring of Glucose

The researchers developed a new continuous glucose monitoring material that changes color as glucose levels fluctuate, and the wavelength shift is so precise that doctors and patients may be able to use it for automatic insulin dosing – something not possible using current point measurements like test strips.

Read more:
A glucose meter of a different color provides continuous monitoring 

Source: University of Illinois

Tuesday, August 26, 2014

Digital Image Based in Your Own DNA Profile

You can customise nearly everything - your coffee mug, computer, phone, or even your living room table! Perfect for a scientist.

Read more:
Woblab - Digital DNA Image


Source: Woblab

A Beautiful Buffy Coat

Elevated leukocytes by Erin Miller


Source: Facebook via Lab Humor
Image credits: Erin Miller

Pathologist´s Best Friend

The only friend of a lonely pathologist


View more:
Ok I am not pathogenic..http://t.co/tf7UnCuCMG

Source: Twitter
Image credits: Pushing Glass, MD

Sunday, August 24, 2014

Blood Cell Quiz

Peripheral blood cell morphology

Case: 72 years old female from Greece is in relatively good ccondtion and has no special symptoms to complain. Blood smear was taken during the annual healt check and an example of findings are in the image. Cells like this were counted around 6% of total white blood cells.

Can you identify this leukocyte?


CORRECT ANSWER: Normal, mature monocyte. This patient is healthy and strong.

View all given answers here.

Senior and Junior Scientist

Microtube art
by Balaji Damodaran

























Source: Facebook via Trust Me I´m Biologist

Saturday, August 23, 2014

Laboratory

Laboratory, hospital wing of Eastern State Penitentiary

View more:
Laboratory (Eastern State Penitentiary)

Source: Flickr
Image credits: James Mundie


Blood Cell Bottle

A beautiful bottle for a laboratory scientist

Awailable:
Blood Type: (Either A, B, O, or AB)
Positive/Negative: (Choose one)
Stuck in place/Free floating: (Choose one)


Read more and order here:
Blood Cells Bottle Charm

Source: ETSY
Image credits: SheepPeep

The Platelet Party

Blood cloth. They are stuck :)

Read more:
The Awkward Yeti

Source: The Awkward Yeti
Image credits: Nick Seluk

Wednesday, August 20, 2014

Thinking of Introducing POCT – Things to Consider

The aim of the IFCC Task Force for Point of Care Testing is to promote quality in the use, performance, interpretation and reporting of point of care testing across the full spectrum of clinical chemistry and laboratory medicine; to create a forum for high level discussion on a wide range of related topics; and to provide international leadership for developing the clinical practice of POCT in Laboratory Medicine. The PoCT Satellite Meeting held in Istanbul in June 2014 brought together international experts in the field to discuss the concept of PoCT Enabling Patient-Centred Care. Presentations from this meeting are now available for those who were unable to attend this event.

Read more and view the presentations from IFCC meeting:
Point of Care Testing Resources

Source: IFCC

Natural Killer Cells Battle Pediatric Leukemia

Researchers at Children’s Hospital Los Angeles have shown that a select team of immune-system cells from patients with leukemia can be multiplied in the lab, creating an army of natural killer cells that can be used to destroy the cancer cells. Results of their in vitro study, published August 19 in the journal Leukemia, could one day provide a less toxic and more effective way to battle this cancer in children.

As a way to avoid these adverse effects, investigators have been researching how to supercharge the body’s innate cancer-fighting ability– a technique called immunotherapy. One branch of the immune system – and a possible component of immunotherapy – includes a class of cells called natural killer (NK) cells. These specialized white blood cells police the body and destroy abnormal cells before they turn cancerous.

Read more:
Natural (Born) Killer Cells Battle Pediatric Leukemia

Source: Childrens Hospital Los Angeles





Monday, August 18, 2014

The Future of Quality

Want to know the future of Quality? Keep your ear close to the ground and listen to what your customers, your workers, and the public are talking and maybe even complaining about.

Read more:
The sine wave of Quality change

Source: Making Medical Lab Quality Relevant

Image credits: Michael Noble


Thyroid hormone differential

As with all of the pituitary axises, the thyroid one is a little confusing when people talk about it but really quite simple when it’s drawn out. Free T4 is what normally gets measured to determine if someone is hypo- or hyperthyroid, but if you are just doing a basic screening test, you only need to measure TSH.

Read more:

Thyroid hormone differential 





Source: Sketchy Medicine

Sunday, August 17, 2014

When a Laboratory Scientist Falls in Love

 Love is everywhere. Even in vacuum tubes.

View more:
Benim kalbim, benim işim,






















Source: Biyoloji Günlüğü
Image credits: Büşra Tığlı


Mercedes Benzene - The Scientist´s Choice

Creative biochemistry





















Source: Playing doctor

Peripheral Blood Cell Morphology Challenge

Sunday Quiz

Case: 62 years old dairy worker from Denmar has been complaining bone pain and abdominal disconfort for some time. Now she has bruises all over her body and her nose is bleeding very easily.
Basic blood count shows anemia, leukopenia and severe trombocytopenia. Blood smear was taken and the findings are in the image.

Can you identify these three particles and what could be the diagnosis?
















Correct answer: 1. Megacaryocyte nukleus, 2. Blast and 3. Megtrombocyte. Thios patient has myelofibrosis.

View all comments and suggestions here (FB site)


Saturday, August 16, 2014

Revolutionary new blood test could detect all types of cancer

Early results have shown the simple test can diagnose cancer and pre-cancerous conditions from the blood of patients with melanoma, colon cancer and lung cancer with a high degree of accuracy. The test centres around damage to white blood cells. The researchers say there is a clear distinction between the damage to the cells or those with or without cancer. The longer the tail, the more DNA damage. And these measurements correlated to those patients who were ultimately diagnosed with cancer (58), those with pre-cancerous conditions (56) and those who were healthy (94).

Read more:
Revolutionary new blood test ‘could detect ALL types of cancer’

















Source: Nwo Report
Image credits: Nature.com

Friday, August 15, 2014

Auer rods in dysplastic granulocyte

This is a rare and unique case of AML with the characteristic presence of Auer rods in myeloblast and dysplastic granulocyte in association with loss of the Y chromosome. The loss of the Y chromosome is widely reported in myeloid malignancies, whereas presence of Auer rods in mature and dysplastic granulocytes is rare and has been described in AML with maturation. Presence of Auer rods in AML is associated with good prognosis, whereas its significance in dysplastic granulocyte has yet to be determined.

Read more:
Auer rods in dysplastic granulocyte


















Source: Blood Journal
Image credits: ASH Image Bank

Thursday, August 14, 2014

The Mystery of Stem Cell Generation Solved

A cure for a range of blood disorders and immune diseases is in sight, according to scientists who have unraveled the mystery of stem cell generation. Found in the bone marrow and in umbilical cord blood, HSCs are critically important because they can replenish the body's supply of blood cells. Leukemia patients have been successfully treated using HSC transplants, but medical experts believe blood stem cells have the potential to be used more widely.

Read more:
Cell discovery brings blood disorder cure closer


















Source: Science Daily
Image credits: Interactive Biology

Wednesday, August 13, 2014

The viruses that spread antibiotic resistance

Bacteriophages are viruses that infect bacteria, and in the great war between humans and pathogenic bacteria they can act as allies for both sides. Phages that destroy their host bacteria can be used as antimicrobial therapy, complementing or replacing antibiotics. On the other hand as phages are essentially little capsules that carry DNA from one bacteria to another, they can spread the genes that make bacteria resistant to antibiotics.

The image below shows a stylised drawing of a bacteriophage. The DNA is the swirl contained in the icosahedral head at the top. Bacteriophages work in different ways; some enter their bacterial host and incorporate their genome into the bacterial DNA, happy to settle down and replicate with the host. Others multiply inside the bacteria to create new phage genomes, which then burst out of the host and spread. Other phages incorporate both strategies at different stages in their lifecycle – replicating with the bacteria when times are good, and spreading and destroying the host at any sign of stress.

Read more:
The viruses that spread antibiotic resistance
























Source: Lab Rat, Scientific American

Spotlight on breast cancer

Breast cancer – the most common type of cancer affecting women – is often thought of as a single disease. However, mounting evidence suggests that there are multiple subtypes, all of which occur at different rates, have varying levels of aggressiveness, and respond to different types of treatment. One of the better understood subtypes is HER2-positive breast cancer, defined by high expression of the HER2 protein. Women with HER2-positive breast cancer are often treated with targeted therapies such as trastuzumab, which has dramatically improved survival rates from HER2-positive breast cancer in the past decade.

Read more:
Spotlight on breast cancer: progress, challenges and controversies
















Source: BioMed Central
Image credits: Johns Hopkins

Monday, August 11, 2014

Pre-analytical Variables in Coagulation Testing

The use of modern laboratory instrumentation with high levels of test reliability and appropriate quality assurance measures will lead to very few analytical errors within hemostasis testing. Nevertheless, incorrect or inappropriate test results are still reported, often due to events outside the control of the laboratories performing the tests. This is due primarily to pre-analytical events associated with sample collection and processing, as well as post-analytical events related to the reporting and interpretation of test results. This review focuses on the pre-analytical phase, highlighting contributory elements and providing suggestions on how problems can be minimized or prevented, thereby improving the likelihood that reported test results actually represent the true clinical status of the patient rather than that of an inappropriate sample. This review should be of value to both laboratory personnel and clinicians because an appreciation of these issues will enable the optimal clinical management of patients.

Read more:
Pre-analytical Variables in Coagulation Testing Associated With Diagnostic Errors in Hemostasis
























Source: Lab Medicine
Image credits: Renegedhealth

Sunday, August 10, 2014

Test tubes necklace

Proclaim your love of chemistry with this charmingly geeky test tube necklace. Handcrafted and hand painted, it comes strung on a 40cm (16") black leather cord with silver coloured fittings and screw barrel clasp. This piece is approximately 3cm (1.25") wide. Perfect for the fashionable chemist or science geek in your life!

View more:
Test tubes clay pendant necklace geek fashion

Source: Etsy
Image credits: theVexedMuddler

Work atmosphere in the lab

I can´t stand those funny guys in the lab...




























Source: Livejournal
Image credits: Kyasuriin

What Does Turnaround Time Say About Your Lab?

Every lab knows that their colleagues in medicine see turnaround time (TAT) as something almost as important as the quality of test results themselves. In fact, surveys have found that 80% of labs get complaints about TAT. However, TAT can mean much more than just keeping physicians happy.

On the same day patients arrive for a chemotherapy infusion—up to 80 a day—oncologists routinely order complete blood counts (CBC) and comprehensive metabolic panels (CPNL) to discern whether the patient is healthy enough for treatment. Chemotherapy drugs are so toxic that they can destroy red blood cells and damage the liver and kidneys.

After studying the problem and tracking the exact path of samples, lab team came up with a plan that reduced the median collection-to-result turnaround time for CBCs from 50 minutes to 20, and for CPNLs from 74 minutes to 54. 

Read more:
What Does Turnaround Time Say About Your Lab?

 Source: AACC

Sunday Parasitology Quiz

Case: 12 years old male from Florida, US has lost weight and felt himself very weak lately. Now he has abdominal pain and fewer. Stool sample for parasites was taken and the findings are in the image. The size of the particle is 125 x 85 micrometers.

Can you identify this particle?



















Correct answer: Artifact (plant cell).

Lego Lab of Louis Pasteur

Louis Pasteur was one of the forefathers of microbiology, what he is most know for was his technique of heating liquids such as milk just enough to kill bacteria making it less likely that people would get sick from drinking it. The technique was called pasteurization and is depicted in this image.

View more:
Reasonably Clever! Wasting your workday since 1995

Source: Flickr
Image credits: rknum

Saturday, August 9, 2014

SOP for Tube Storage

There are only two kinds of people in the lab....


Source: facebook
Image credits: Michelle Erin Wilcox

Preanalytical Best Practice Posters

Specimencare provides a series of posters giving best practice guidance and education around key aspects of the preanalytical phase of laboratory medicine. These posters are designed  to be used by patients and medical professionals.

Download poster here:
Preanalytical Best Practice Posters























Source: Specimencare

Friday, August 8, 2014

Blood Smear App

A team has developed an app and small lens add-on that allows blood-cell analysis via a smartphone.

The team says it can detect diseases such as malaria and cancers in seconds, through so-called predictive cell counting. Users take a picture of their blood using the lens attachment, which is then sent to the app's servers, and the results are then sent back to them.

But experts warned of the difficulty of reproducing the quality of medical labs results using just a smartphone. Also in a laboratory diagnosis, there is a lot of regulation that goes on behind the scenes to make sure that your results are meaningful.

Read more:
Blood diagnosis app 'can detect diseases'




















Source: BBC NEWS

Massive hemolysis and erythrophagocytosis in severe sepsis

A 61-year-old female patient with an uneventful medical history was admitted to the emergency department because of icterus and abdominal discomfort. Upon arrival, she was hemodynamically stable. No laboratory tests could be performed because of a massive hemolysis, so the decision was made to perform a direct blood smear, which showed 2 species of bacteria and erythrophagocytosis.

Read more:
Massive hemolysis and erythrophagocytosis in severe sepsis

Soure: Blood Journal
Image credits: ASH imagebank

Thursday, August 7, 2014

Lab Rat Mascot

This clever little mouse spends most of his time in the lab inventing new and wonderful things. With his white lab coat with and test tubes at the ready he is ready to mix things up.


Read more:
Handmade felt mouse a fun keepsake and adorable 

Source: Etsy
Image credits: AsNiceAsMice

Significance of borderline hCG levels in urine

Qualitative urine visual pregnancy tests are increasingly being replaced by analyzer-read chromatographic immunoassay (CIA) tests that determine human chorionic gonadotropin (hCG) in specimens. Accurate and consistent analyzer-read pregnancy test results offer significant advantages over traditional methodology and reporting. Since no visual interpretation or manually transcribed documentation is required, the chance for error is greatly diminished. hCG test instrumentation connected via laboratory or hospital information systems (LIS/HIS) automatically report hCG results that can be reviewed immediately and acted upon, thus facilitating the current trend towards testing and immediate healthcare provision in decentralized, ambulatory settings.

Although analyzer-read hCG tests are not intended to detect conditions other than pregnancy, a number of conditions other than pregnancy, including trophoblastic disease and certain non-trophoblastic neoplasms, can cause borderline levels of hCG. Borderline hCG results are in no sense diagnostic, but may, especially when results do not fit a clinical picture, indicate to clinicians that further investigation is needed.

Read more:
Analyzer-interpreted pregnancy tests: the significance of borderline hCG levels in urine specimens

Source: MLO
Image credits: Bayer, Clinitec

Wednesday, August 6, 2014

Digital Pathology Has A Solution

"This image shows massive tissue damage in your kidney. But don´t worry. Our pathologists will fix it with Photoshop"

























Juha Wahlstedt
@LaboratoryEQAS




Should You Be Worried About Ebola?

Here for spreading far and wide is a flow chart for stemming the tide of undue Ebola panic on social media. 

View more:
Should You Be Worried About Ebola? A Helpful Chart.

























Source: io9
Image credits: Maggie Koerth-Baker

Monday, August 4, 2014

Measurements for 8 Common Analytes in Native Sera

External quality assessment (EQA) with commutable samples is essential for assessing the quality of assays performed by laboratories, particularly when the emphasis is on their standardization status and interchangeability of results.

In this study a panel of 20 fresh-frozen single-donation serum samples were used to assess assays for the measurement of creatinine, glucose, phosphate, uric acid, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. The commercial random access platforms included: Abbott Architect, Beckman Coulter AU, Ortho Vitros, Roche Cobas, Siemens Advia, and Thermo Scientific Konelab.

Most assays showed excellent peer performance attributes, except for HDL- and LDL cholesterol. Cases in which individual assays had biases exceeding the used limits were the Siemens Advia creatinine (−4.2%), Ortho Vitros phosphate (8.9%), Beckman Coulter AU triglycerides (5.4%), and Thermo Scientific Konelab uric acid (6.4%), which lead to considerable interassay discrepancies. Additionally, large laboratory effects were observed that caused interlaboratory differences of >30%.

Read more:
Measurements for 8 Common Analytes in Native Sera Identify Inadequate Standardization among 6 Routine Laboratory Assays

Source: Clinical Chemistry
Image credits: Labquality

How to use your smartphone to capture and share microscopic images

Smart phone microscopic photography entails using the third through fifth fingers of the left hand to steady the hand on the left microscope eyepiece, holding the camera between the thumb and second finger of the left hand and second through fifth fingers of the right hand, to leave the right thumb free. By looking through the smart phone screen while focusing on the light in the ocular of the right eyepiece and slowly bringing the phone closer to the microscope, the view beneath the microscope lens will eventually fill the screen. The right thumb is free to focus the camera and capture the image. The camera's zoom function can remove vignetting (the circular frame around the image). Additional basic smart phone camera functions can be used to produce high-quality images suitable for use in presentations, posters, and publications. Successful smart phone microscopic photography is dependent on the ability to hold the camera steady and, while initially frustrating to learn, the technique can be readily mastered.

A video tutorial is available at http://www.youtube.com/watch?v=cfd9ViHBlR4

Read more:
Archives of Pathology & Laboratory Medicine Online - Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees

Source: Archives of Pathology and Laboratory Medicine

Haemolysis: a pre-analytical challenge in the lab

Haemolysis is defined as the release of haemoglobin and other intracellular components from erythrocytes, thrombocytes and leukocytes into the extracellular fluid i.e. the plasma or serum, following damage or disruption of cell membranes. Haemolysed specimen is the most common reason for rejection of specimens in the lab. Studies have shown that out of the total specimens received in the lab, 3.3% are found to be haemolysed, and out of the total rejected; 40-70% has been identified to be due to haemolysis. The American Society of Clinical Pathology has established a 2%, or lower, benchmark for haemolysis rates amongst laboratory blood samples.

Read more:
Haemolysis: a major challenge in the lab



Source: Medlab Magazine

Sunday, August 3, 2014

Basics of Statistics

Normal and paranormal distributions




Needle-stick injuries among health care workers

Around 600000 - 800000 injuries in every year occur in USA. Half of cases are not reported. Half of all hepatitis B and C in some parts of Africa and Asia are due to contaminated sharps. 2/3 of hepatitis B and C in Eastern Mediterranean are due to contaminated sharps. Over 2/3 of hepatitis B in Central and South American are due to occupational exposure

Read more:
14 needle-stick injuries among health care workers

Source: Mgh Cetd

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