Happy New Year 2017

I wish a beautiful and successful New Year 2017 to all medical laboratory professionals.

Can you make a perfect blood smear?

A well-made blood smear is a beauty to behold, and likely to yield significant information. A poor slide is a torment. Here, the methods for making and stainingsmears are given

Blood films made on slides. (A) A well-made film. (B) An irregular patchy film on a dusty slide. (C) A film that is too thick. (D) A film that has been spread with inconsistent pressure and using an irregularly edged spreader, resulting in long tails. (E) A film made on a very greasy slide.


Wedge slide technique for preparation of a peripheral blood smear

 Source: uvm.edu

Red cell landscape architecture in Hamburg

Like the capillaries of a blood vessel system, the green well valleys pass through the area. In them, Birgitta Weimer places her 'globules', red blood cells. The red lacquered globules are an abstraction of red blood cells in 200,000-fold magnification.

Read moe:
IGS Hamburg 2013 | Terramanus Landschaftsarchitektur

Source: Terramanus

Me and my pipette

Very dedicted medical laboratory scientist

Source: yatush.com

The challenge of preventing overdiagnosis

Death itself comes to be regarded as a failure of medicine and doctors, rather than the inevitable culmination of every life.

Over the past several decades, the economic interests of the pharmaceutical and medical technology industries have both pressured and tempted medicine to overextend itself. The traditional moral commitment of the medical profession to relieve suffering and to care for the dying has been gradually displaced by a futile and misguided attempt to solve humanity’s most profound existential problems through biotechnical means. Doctors now apply more and more powerful treatments towards the end of life and try to prevent diseases by seeking out and correcting more and more risk factors. All this has led to an epidemic of overdiagnosis and overtreatment affecting us all, but perhaps particularly harming the old.

Doctors and other health professionals are gradually beginning to understand that they may now find themselves in the unfortunate position of doing harm while trying to do good; academic researchers are working to investigate the extent and effects of overdiagnosis, and how it might be mitigated; and journalists and policy-makers seem finally to be beginning to take the issue seriously by promoting greater public debate.

Read more:
The challenge of preventing overdiagnosis

Source: CMAJ Blogs

Case studies of blood draw

Most phlebotomists don’t think that a venipuncture can land them in the witness chair desperately defending their technique; most phlebotomy supervisors don’t realize they can be called as the next witness to defend their hiring and training practices. In today’s litigious society, it would be easy to discount phlebotomy-related lawsuits as the frivolous pursuit of ill-gotten gains. Many patients, however, are suffering and suing with just cause.

Phlebotomy is one of the most underestimated procedures in health care. It’s a heavily detailed invasive procedure requiring the collector to perform a complex sequence of maneuvers to be performed properly and safely.

Labortory Manager Magazine has collected 12 interesting case studies of phlebotomy and related legal issues.


Read more:
Phlebotomy Meets The Law

Source: Laboratory Manager

First genetically-modified human embryos could be created in Britain

The first genetically-modified human embryos could be created in Britain within weeks according to the scientists who are about to learn whether their research proposal has been approved by the fertility watchdog.

Although it will be illegal to allow the embryos to live beyond 14 days, and be implanted into the womb, the researchers accepted that the research could one day lead to the birth of the first GM babies should the existing ban be lifted for medical reasons.

A licence application to edit the genes of “spare” IVF embryos for research purposes only is to be discussed on 14 January by the Human Fertilisation and Embryology Authority (HFEA), with final approval likely to be given this month.

Read more:
IVF: First genetically-modified human embryos 'could be created in Britain within weeks' 

Source: The Independent

Twinkle twinkle little cell

Amazing starrycyte in peripheral blood smear

Source: Facebook via Stephanie Tanner King

Chemistry Xmas tree

A perfect Christmas tree for the laboratory scientists
by Sigrid Maria

Rudolf The Red Cell

Reindeer shaped erythrocyte in peripheral blood smear

Image by Kelly Pifer via Lab Humor

Merry QRS-T mas and a P new year

How laboratorians celebrate Christmas <3


Read more:
Christmas Crewneck Sweater

Sourse: Etsy via ShopNamuri

The Best Christmas Gift

Some of the best Christmas gifts fit in stockings and babies born around the holidays are no exception. That's why babies born at Magee-Women's Hospital at the University of Pittsburgh Medical Center get special stockings if they're in the hospital on Christmas Day.

Read more:
Holiday Newborns Go Home in Christmas Stockings 2014

Source: ABC News

Pathology goes Xmas

Beautiful Christmas slides by Ivan Rodrigues M.D

Christmas math

Merry Xmas

Petri plate art for Christmas

Happy Christmas by Debashree Samal Lakhera‎

Blood Tube Tree

Merry Christmas and Happy Holidays to all medical laboratory professionals.

Source: Facebook via Monica Cociasu‎

International Congress on Quality in Laboratory Medicine 2017

Welcome to International Congress on Quality in Laboratory Medicine!
9-10 February 2017 Helsinki

International Congress on Quality in Laboratory Medicine is an annual congress for clinical laboratory and quality management professionals organised by Labquality Ltd. Congress draws annually approximately 1,000 visitors to Helsinki.

The 2017 Congress themes are: Evidence-Based Laboratory Medicine (EBLM) and Impact of Total Quality Management (TQM)

Read more:
www.labqualitydays.com


Source: Youtube via Labquality

Petri Dish Cristmas Tree

Amazing pice of art

Petri Plate Raindeer

Petri dish art for the holiday season
by Cristian Michael Fernandez Galvez

Happy Holidays from Microbiology Lab

Amazing bacterial Christmas tree by Maria Anne‎‎

  

Blood draw and vacuum tube selection

AACC has created a slide share presentation about phlebotomy and how to select tube type.


Open presentation here::
Pearls of laboratory medicine

Source: AACC

Influenza Activity in Europe

Week 49/2016 (5–11 December 2016)

• Influenza activity remained low, but is increasing across the region.
• The proportion of virus detections among sentinel surveillance specimens increased to 28%.
• The majority of influenza viruses detected for this week was A(H3N2).
• Laboratory-confirmed influenza cases from hospital settings increased in some countries.

Read more:
Flu News Europe

Source: ECDC

Clinical Laboratory Safety

CLSI provides several standards to medical laboratories to keep laboratory safe.

CLSI clinical laboratory safety standards:

• Prepare your laboratory with one of our leading clinical laboratory safety standards
• Protect your staff from occupationally acquired infections
• Ensure your laboratory properly handles waste.
• Enhance emergency preparedness in your facility

Read more and get your own copy:
Laboratory Safety 

Source: CLSI

ISO15189 - The Four Components of a Quality Management System

Medical laboratories are a critical part of the healthcare system. A patient’s diagnosis and treatment are often based on test results, and an incorrect test result could lead to a misdiagnosis — which could have potentially fatal consequences. This is why accurate test results are critical — each and every time a test is conducted. In order to improve the accuracy of results, medical labs around the world have begun adopting ISO 15189: Medical laboratories—particular requirements for quality and competence. The standard requires medical labs to implement a quality management system. This requires them to document all their processes and procedures to ensure lab technologists always understand and follow the correct method when conducting a test.

This white paper provides an overview of the four main components of a quality management system:

1. Management Responsibility
2. Resource Management
3. Service Realization
4. Measurement, Analysis & Improvement

Download free white paper here (registration needed):
ISO 15189 Medical Laboratories: Understanding the Four Components of a Quality Management System

Source: Dark Daily

Point-of-care testing for blood cell count

With the arrival of the 21. Century we have witnessed automatisation on the market. Bringing machines and informatics to workplaces with a lot of people and/or samples circulating, we have made it both easier and faster to get the necessary results. That is the very reason the automatisation had to come to the laboratories. Even though in the laboratories there is laboratory staff specifically educated for maneuvering with machines designed for preanalytical and analytical parts of the analisis, today there are machines operating on laboratory samples outside of the laboratory. Glucometers and different opium detecting tests are very common these days, however, is there a way of detecting leukemias and infections from the ones home?

The answer has been brought to us by Athelas. Athelas is the first ever in – home blood diagnostic platform. Its base is counting white blood cells and facilitating the control over the progress of the disease of chemo patients, immunocompromised patients and ones submissive to different infections. The way Athelas works is similar to glucometers. Take a simple prick of blood with lancet, press against the Test Strip, and stick it into the system. Within a few minutes an integrated cell counting app will appear on your monitor.

From the Athelas Company they explain that Athelas is built on deep learning technology that uses machine vision to rapidly analyze blood cells and generate diagnostic reports. Instead of traditional coulter counting or flow based techniques (such as flow cytometry) Athelas is able to maintain a high degree of precision on drop samples; performing with greater accuracy than other existing technologies.

Blood cell counts enable a rapid analysis of a patient's various immune, hematological, and general conditions. Athelas is primary made for immunocompromised patients who aim to monitor their white blood cell counts more often and it forces them to visit the doctor and the laboratory frequently. With Athelas they'd be provided with technology to monitor their WBCs at home and better determine when it is really necessary to visit a doctor. WBCs offer a unique insight as to this - indicating anything from inflammatory response, all the way to leukemia based on cell count ranges.

However, Athelas is not providing us only with white blood cell counters, it also has the ability to count the erythrocytes, diagnosing the anemias and polycythemias; it offers differential blood count and hematocrit as well. In the Athelas Company they are working on the ability to analise UTI (urine tract infections) and pyurias from a single drop of urine.

Athelas is regulated as a Class 1 Exempt Device under Product Codes GHO and KPA by the FDA. They are in filing process for the a range of tests under the 510(k) product code GLK and GKZ. [1]

Athelas is currently still in the testing phase, it has been tested by 25 clinics, of which the first one was FEMAP (First Episode Mood and Anxiety Program) hospital. It has been approved for the in – home testing and people who decide to test it at home can do it for the price of 99$. The Athelas staff promises a 24 hour online support. You can get it on the Athelas official website: http://getathelas.com/index.html .

Author: Ines Poljak,  cand. for bacc. med. lab. diagn.
Images: Athelas


[1] http://getathelas.com/fda/index.html

DNA Extraction Protocol - Watch a Video

DNA extraction is crucial for acquiring an initial sample for techniques such as PCR, DNA sequencing, and electrophoresis. However, these processes require a high yield and the removal of impurities (such as cell debris) to successfully provide truthful findings. For example, the presence of contaminants such as DNases can lead to the breakdown of DNA and so reduce the overall yield, potentially below the required sample amount.

This video will help optimize your DNA extraction technique, clearly explaining and offering tips on how to achieve efficient, reliable results; avoiding contamination and poor yield.

Read more:
Protocol 1 DNA Extraction

Source: Youtube via  The Jackson Laboratory

Good morning scientists

A perfect coffee mug for a medical laboratory professionals

Original image:
A #pathologist is never finished. As the sun sets the cup fills. 

Peter Sadow, MD, PhD
Source: Tvitter via

A path to the perfect pipetting

Understanding Pipettes

Pipette terms:

• Adjustment - altering the pipette so that the dispensed volume is within the specifications.
• Air Displacement Pipettes - are meant for general use with aqueous solutions. In air displacement pipettes, a certain volume of air remains between the piston and the liquid.
• Aspirate - to draw up the sample.
• Blow-out - to empty the tip completely.
• Calibration check - checking the difference between the dispensed volume and the selected volume.
• Dispense - to deliver the sample.
• Positive Displacement Pipettes - are used for high viscosity and volatile liquids. In positive displacement pipettes, the piston is in direct contact with the liquid.

The effect of the pipetting position (image)

1. Pipette vertical, tip immersed about 1 cm into the liquid.
2. Pipette vertical, tip immersed about 3 cm into the liquid.
3. Pipette at a 30 - 40 degree angle; tip immersed about 3-4 cm into the liquid.

Find more useful hints here:
Pipettes, Calibration & Repair Service

Source: Pipette.com

Fungal Snowman

Beautiful petri plate snowman by Michelle Travis, UK


Original image:
Getting into to the Christmas spirit in York, UK

 Source: Facebook via Michelle Travis


‎

Whole genome sequencing cannot yet be used to determine antimicrobial susceptibility

EUCAST experts publish report where they show that whole genome sequencing (WGS) cannot yet be used to determine antimicrobial susceptibility of many important bacterial species.

Whole genome sequencing (WGS) offers the potential to predict antimicrobial susceptibility from a single assay. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) established a subcommittee to review the current development status of WGS for bacterial antimicrobial susceptibility testing (AST).

The published evidence for using WGS as a tool to infer antimicrobial susceptibility accurately is currently either poor or non-existent and the evidence / knowledge base requires significant expansion. The primary comparators for assessing genotypic-phenotypic concordance from WGS data should be changed to epidemiological cut-off values (ECOFFs) in order to improve differentiation of wild type from non-wild type isolates (harbouring an acquired resistance). Clinical breakpoints should be a secondary comparator. This assessment will reveal whether genetic predictions could also be used to guide clinical decision making. Internationally agreed principles and quality control (QC) metrics will facilitate early harmonization of analytical approaches and interpretative criteria for WGS-based predictive AST. Only datasets that pass agreed QC metrics should be used in AST predictions. Minimum performance standards should exist and comparative accuracies across different WGS laboratories and processes should be measured. In order to facilitate comparisons, a single public database of all known resistance loci should be established, regularly updated and strictly curated using minimum standards for the inclusion of resistance loci. For most bacterial species the major limitations to widespread adoption for WGS-based AST in clinical labs remain the current high-cost and limited speed of inferring antimicrobial susceptibility from WGS data as well as the dependency on prior culture since analysis directly on specimens remains challenging.

For most bacterial species there is currently insufficient evidence to support the use of WGS-inferred AST to guide clinical decision making. WGS-AST should be a funding priority if it is to become a rival to phenotypic AST. This report will be updated as the available evidence increases.

Read the report:
EUCAST_publication_WGS-AST.pdf

CMI, Clinical Microbiology and Infection

Study indicates a genetic test may show which chemotherapy patients are at risk for serious blood clots

Chemotherapy is known to carry a risk of venous thromboembolism in cancer patients, a particularly common risk in frequent cancers like breast cancer. But a genetic test may predict which of these patients are most likely to develop such serious blood clots, researchers report.

VTE is preventable through prophylaxis treatment with heparin, an anticoagulant. But because a side effect is less controllable bleeding, the drug is not routinely recommended to patients undergoing chemotherapy.

Researchers examined 4,261 Swedish women diagnosed with primary invasive breast cancer between 2001 and 2008. Risk stratification was based on chemotherapy use and genetic susceptibility, which was determined by a risk score assessing nine genes involved in VTE. Patients ranked in the highest 5 percent were classified as having a high genetic susceptibility.

Patients were followed for a median of 7.6 years, and 276 experienced a VTE during that time.

Read more:
Blood Clot Risk in Breast Cancer Patients Seen via Gene Test

Source: Breast cancer news

The good and bad of microbiology lab automation

Here is a summary of the potential quality benefits of “Total Lab Automation” (TLA) systems (e.g. Kiestra, Biomeurieux, Copan Wasp). You might be involved in a business case for one for your own laboratory.

Main advantages:

• Plate tracking
• Less menial tasks
• Better plate spreading
• Less plate contamination
• Storage of digital images of plates
• Standardised incubation times
• Less time out of the incubator
• Remote plate reading
• Plate checking
• Plate interpretation

Disadvantages:

• Redundancy of staff
• What happens if it breaks down<
  

Read more:
“The good and bad of lab automation….

Source: Microbiology matters
Image: Michael

MALDI-ToF - Benefits and Limitations in Microbiology

Helping clinicians quickly and effectively address the medical concerns of their patients should be the ultimate goal of any clinical microbiology laboratory. Delivering on this goal can be especially important when a patient presents with a bacterial or fungal infection. MALDI-ToF can help improve patient outcomes by speeding diagnosis and improving the quality of care.

There are many benefits to incorporating MALDI-ToF to aid in identification of microorganisms. Identification with MALDI-ToF is a relatively simple process. The process can reduce the time needed for identification and diagnosis from days to hours. There are, however, some limitations to MALDI-ToF. Some organisms may require repeat analysis and additional processing, and some closely related organisms are not differentiated and may cause challenges with identification. Also the initial purchase price of the equipment is high, which may limit the types of labs that can adopt it.

While not all laboratories are capable of widely adopting MALDI-ToF, those that can, probably should. MALDI-ToF may promote better patient outcomes through speedier diagnosis and information to influence efficacious treatment for many bacterial, yeast, and mycobacterial infections, greatly improving the quality of clinical management and patient care.

Read more:

MALDI-ToF is poised to speed diagnosis for bacterial and fungal infections(MLO)

MALDI-ToF principle (Frontiers Microbiology)

Source: MLO
Image: Juha Wahlstedt

Syphilis is coming back

Over the last few decades, an age-old infectious disease has been re-emerging globally: Syphilis. Using techniques to analyze low levels of DNA, an international research team headed by the University of Zurich has now shown that all syphilis strains from modern patient samples share a common ancestor from the 1700s. Furthermore, their research demonstrates that strains dominating infections today originate from a pandemic cluster that emerged after 1950, and these strains share a worrying trait: Resistance to the second-line antibiotic azithromycin.

Infection with the bacteria Treponema pallidum subsp. pallidum (TPA) has been re-emerging globally in the last few decades; more than 10 million cases are reported annually. Yet the reason for the resurgence of this sexually transmitted infection remains poorly understood.

Philipp Bosshard from the University Hospital Zurich is continuing to collect Swiss patient samples in order to further study the clinical aspects of the work. The researchers are convinced that this type of analysis will open new opportunities to develop a comprehensive understanding of the epidemiology of syphilis – a devastating disease that persists to this day, despite the availability of treatment.

Read more:
Re-emergence of Syphilis Traced to Pandemic Strain Cluster

Source: University of Zurich
Image: Microbeworld

Dog lovers have puppycytes in their blood

Amazing pudel shaped erythrocyte in peripheral blood smear

Source: Pinterest by
Chandra Kukas

Scientist´s path to the dark side

Educative cartoon by Skeching Science

Original image:
The dark side

Source: Skeching Science

Science Coloring Book

Thermo Fisher Scientific Beautiful Science Cell Imaging Colouring Book and Felt-Tip Marker Set.

Colour your way through 30 incredibly beautiful organic patterns inspired by actual cell images submitted by researchers around the world. True to the broad spectrum of cells and their complex structures, the pages include fantastically illustrated representations of tissues, plasma membranes, cytoskeletons, nuclei and everything in-between.

Complete the form below to download a copy of the Colouring Book now or check the box below to request a hard copy to be sent to you with a set of felt-tip markers and join millions of adults all around the world who are rediscovering the relaxation and bliss of colouring.

Get your coloring book here:
Color the achievements of your colleagues and have fun doing it 

Source: Thermo Fisher Scientific

From path with love

Amasing histology slide


Original image:
Good morning

Source: Facebook via Trust me I´m a "Medical Technologist"

The Never-ending Mannequin Challenge

 Every day is a mannequin challenge for ALS patients.


View in YouTube:
The never-ending Mannequin Challenge


Source: YouTube

Missing Link in Malaria Evolution Discovered in Historical Specimens

A family’s collection of antique microscope slides became a trove of genetic information about the eradicated European malaria pathogen. These slides of stained blood droplets date to the 1940s and contain strains of the malaria parasite that are now extinct (image).

Lalueza-Fox and his colleagues were left with the first genetic material of extinct European Plasmodium species ever studied. They recovered DNA from both P. falciparum, the predominant species in Africa and the species responsible for the majority of today’s malaria deaths, and P. vivax, a less virulent species found widely across the globe. Scientists have long debated how P. vivax arrived in the Americas, with one theory suggesting colonial Europeans brought the pathogen over, while another posits entry from the other direction, when early humans crossed the Bering Land Bridge from Asia. The two theories, notes Jane Carlton, a malaria researcher at New York University who was not involved in the study, are not necessarily mutually exclusive.

The extinct European P. vivax genome more closely resembled strains found today in South America than those found in East Asia, lending credibility to the theory of a more recent introduction by European colonists. The European P. falciparum genome, however, was starkly divergent from the modern South American subtype, supporting the theory that this more-deadly species came to South America directly from Africa during the slave trade.

Read more:
Missing Link in Malaria Evolution Discovered in Historical Specimens

Source: The Scientist Magazine®
Image: Charles Aranda

Cat people have meowcytes in their blood

Peripheral blood cell morphology. Meowcyte by Theresa Gonzales

Source: Facebook via Theresa Gonzalez

Where to test HIV or Hepatitis? - European Test Finder

 Almost every second person (47%) diagnosed in 2014 was a late presenter or with indication of advanced infection. This means that these individuals are only diagnosed when their immune system already starts to fail. Providing antiretroviral therapy at the early stages of HIV infection allows people with HIV to live longer and healthier lives, and reduces the risk of transmitting HIV to others.

With the newly created and mobile-optimised European Test Finder, it only takes a few seconds to locate a testing site near you – wherever you are in Europe.

Open search engine here:
European test finder

Source: ECDC

Hospital command center

The people who manage patient flow at hospitals might like a crystal ball that shows them when their resources are about to be overwhelmed. Hospitals are trying out what might be the next best thing. They're wiring command centers with monitors that display predictive analytics fueled by every conceivable data source that gives a glimpse of a patient's movement through the facility.

Taking a cue from other industries that assemble command centers to manage complex logistics, GE Healthcare equipped Johns Hopkins with the company's first Wall of Analytics, which features 22 information screens that can pull data from 14 sources, including the electronic health record, admission software and OR scheduling applications. GE is working with a handful of other hospitals to deploy the technology.

Although the command center at Johns Hopkins has been up and running for less than a year, the hospital has seen a 30% reduction in ER patients who have to wait for an inpatient bed and a roughly 70% reduction in patients who must be held in the OR because there's no recovery or inpatient bed for them, according to Jim Scheulen, Johns Hopkins Hospital's chief administrative officer for emergency medicine and capacity management.

Read more:
Hospital command centers help manage flow

Source: Modern Healthcare Modern Healthcare business news

New method to restore function of white blood cells in septic patients

New research findings published in the Journal of Leukocyte Biology, suggest that treating the white blood cells of sepsis patients with antibodies that block programmed cell death-1 (PD-1) and programmed cell death ligand (PD-L1) molecules may restore their function and ultimately their ability to eradicate deadly bacteria.

"We hope that this study will lead to a better understanding of why patients with sepsis are often unable to successfully eradicate invading microorganisms," said author Andriani C. Patera, Ph.D. "Furthermore, we hope that this study will stimulate new therapies to treat sepsis based on stimulating various components of the immune system."

Read more:
Scientists discover new method to restore function of white blood cells in septic patients

Source: EurekAlert! Science News