Art and Science of Laboratory Medicine

Art and Science of Laboratory Medicine

Thursday, December 31, 2015

Preanalytical Case of Thyroid Screening

Case: 35 years old marketing manager from Oulu, Finland was sent to a laboratory for blood draw of thyroid fuction screening. TSH, and FT4 were requested. Specimen were collected 28th of December, 2015 at 15:00. Patient were don´t have any medication.

Do you find any preanalytical errors based on case description and image of the blood draw? 

Correct answer is below the image

(Click image to enlarge)


Correct answer: Preanalytical errors: Wrong tube (EDTA) and wrong timing for TSH (diurnal variation:Thyroid stimulatin hormone levels fluctuate during the day ) Sample should have been taken in the morning (before 14:00). New sample should have been requested.

Other notes. The tournique is tight during the blood draw (should have been released) and the phlebotomist do not hve gloves to protect her (requirement in some countries).

Free eBook - Advanced Techniques in Diagnostic Microbiology

Advanced Techniques in Diagnostic Microbiology provides a comprehensive description of advanced methods that have evolved for the diagnosis of infectious diseases in the routine clinical microbiology laboratory.

This eBook is published on internet by PMTA.

Download here:
Advanced Techniques in Diagnostic Microbiology.pdf

Source: PMTA

Wednesday, December 30, 2015

New Year Party Set for The Laboratory Scientists

Med Lab Supply 10 piece Chemistry Bar Beaker Cocktail Glass Set. Whip up fab cocktails and signature drinks and serve them in chemistry beakers with this 10-Piece Glass Chemistry Bar Beaker Cocktail Glass Set

Read more:
Med Lab Supply 10 piece Chemistry Bar Beaker Cocktail Glass Set

Source: MedLab Supply

Happy New Year 2016

Beautiful New Year Plate via Microbe World

Medium: SA Select Agar, Paints: Green= Staphylococcus xylosus, Red= Staphylococcus aureus,
Yellow-Golden= Corynebacterium glutanicum, White = Staphyloccus hyicus

Read more:
Happy New Year 2016 from Microbe World

Source: Microbeworld
Image credits: Md Zohorul Islam, Statens Serum Institute, University of Copenhagen, and Chittagong Veterinary and Animal Sciences University

Feliz 2016 - Happy New Year

A beautiful welcome to the coming new year 2016 by Suny Collado. Suny is a collaegue who is having FB page for laboratory professionals in Spain and other Spanish speaking countries.

Read more:
Yo también soy técnico de laboratorio

Happy New Year Suny and colleagues all over the world!

Source: Yo también soy técnico de laboratorio
Image credits:  Suny Collado

Gram Stain Challenge

Case: 68 years old lady from Dublin, Ireland has high fever and bad headace. She is very weak and she has lost her appetite. Family doctor sent her to the hospital for tests. Cerebrospinal fluid sample was taken and gram stain was made immediately. Findings are in the image below.

What are the findings in this CSF gram stain?

Correct answeris below the image.

(Click the image to enlarge)


CORRECT ANSWER: PMNs 3+, no microbes

This image is very sharp (look at the neutrophils). If there would be any bacteria or fungus, those would be clearly visible.

Free online gallery of bacteria

Photogallery of medically important bacteria.

Open gallery here:
Gallery of bacteria - photo gallery of bacterial species.

Source: Bacteria in Photos

Trichomania shampoo for your "hair"

LUSH Trichomania a solid shampoo, never having tried one earlier. Feel all those little flagella scrubbing your hair for you.....  

Read more:
LUSH Trichomania Solid Shampoo 

Source: Mad Woman in The Attic

The Great Wave of Candida

The Great Wave of Candida by Cristina Marcos, Candida albicans, Candida glabrata, Candida parapsilosis.

The American Society for Microbiologists recently hosted its first international ‘Agar Art’ challenge in which microbiologists from around the world used various microbes and germs to create beautiful works of art in petri dishes. The submissions included recognizable paintings like Van Gogh’s ‘Starry Night’ as well as original microbe paintings.

View more petri dish art here:
Microbiologists Create ‘Starry Night’ And Other Art With Bacteria

Image credits: Cristina Marcos

The Great Wave at Kanagawa (from a Series of Thirty–Six Views of Mount Fuji), Edo period (1615–1868), ca. 1831–33
Katsushika Hokusai (Japanese, 1760–1849)
Read more:

Tuesday, December 29, 2015

Free Online Atlas of Human Parasitology

Web Atlas of Medical Parasitology aims to provide educational materials for medical students primarily, but professional workers in medical or paramedical fields may also refer to this site covering the significant parasites in the world. Each database of protozoans, nematodes, trematodes, cestodes and arthropods contains information on the morphology, life cycle, geographical distribution, symptoms, prevention, etc.

Open atlas here:
atlas of human parasitology

Source: Ministry of Health and Welfare, Korea

Human Stool Parasites Challenge

Case: 46 years old tourist guide from Philippines has weight loss and chronic abdominal pain. Stool specimen for parasites were taken and the findings are in the image below. The size of the found particles is around 140 x 80micrometers.

Can you identify these particles? 

Correct answer is below the image.

Correct answer: Eggs of Fasciola hepatica or Fasciolopsis buski.

The size of eggs is an important feature in differentiating F. hepatica/F. buski eggs from the similar-appearing but smaller eggs of Diphyllobothrium and Paragonimus. Unfortunately it is not possible to reliably differentiate the eggs of F. hepatica and F. buski by morphology alone. 

Source: Creepy dreathful wonderful parasites
Image credits: Bobbi Pritt

Monday, December 28, 2015

Limitations of Hemoglobin A1c

Hemoglobin A1c is the measurement of glycated hemoglobin and can aid in both the diagnosis and continued management of diabetes mellitus. Accurate glycosylated hemoglobin A1c (A1c) measurements are an essential part of decision making in the diagnosis and treatment of type 2 diabetes mellitus. Although national standards exist to eliminate technical error with A1c testing, multiple patient conditions can falsely decrease or elevate the A1c. In this review, we discuss the methods to measure A1c and the corresponding conditions that can affect the clinical utility of the test. Conditions that affect the A1c can be either those that impair erythrocyte production or alter the normal process of glycation. Some variation also has been associated with patient ethnicity and even with normal aging. We describe alternatives to A1c testing for the above clinical scenarios in an effort to make the practicing clinician aware of alternatives for glucose evaluation.

Main limitations:
  • Methods to Measure Hemoglobin A1c
  • Erythrocyte Production
  • Ethnicity and Hemoglobin Variants
  • Chemically Modified Hemoglobin
  • Altered Rate of Glycation
  • Aging

Click to enlarge the table.

Many factors exist that may affect a patient's A1c. When A1c and self monitoring blood glucose (SMBG) results do not correlate, it is especially important to consider these patient-specific factors. The 2015 American Diabetes Association (ADA) Standards of Care state that discrepancies between a patient's A1c and SMBG levels should warrant exploration of the reasons for these discrepancies. Considerations should include testing method, hemoglobinopathies, conditions affecting red blood cell turnover, chemically modified hemoglobin, altered rates of glycation, race, and age. If a healthcare provider decides A1c is unreliable in a particular patient, alternative strategies for assessment of glycemic control should include more frequent or different timing of SMBG and continued glucose monitoring, as recommended by the ADA. In addition, clinicians can consider evaluation of fructosamine, glycolated albumin, and 1,5-AG; however, there are no consensus guidelines for their use.

Read more:
Limitations of A1c Interpretation (Free registration to the site is needed)

Source: Medscape

Preanalytical Errors in Clinical Chemistry Laboratory

There are many factors that contribute to accurate test results in the chemistry laboratory. These factors can be broken down into three areas: preanalytical, analytical and post analytical. Preanalytical variables account for 32-75% of laboratory errors, and encompass the time from
when the test is ordered by the physician until the sample is ready for analysis. The focus of this article will be preanalytical variables that can occur during a venipuncture and specimen processing and how they relate to testing in the clinical chemistry laboratory.

There are many variables that can contribute to the quality of a chemistry specimen. This article will investigate the variables that may have contributed to the gelatinous specimen in the case of the cardiac patient, as well as the other variables that are important to specimen quality. The focus will be on the preanalytical phase of the blood collection and sample handling, up until the time that the sample is to be run on the chemistry instrument.

Preanalytical variables:
  • Patient Identification
  • Patient Preparation
  • Selecting the Site
  • Site Preparation
  • Tourniquet Application and Time
  • Proper Venipuncture Technique
  • Order of Draw
  • Proper Tube Mixing
  • Correct Specimen Volume
  • Proper Tube Handling and Specimen Processing
  • Centrifugation
  • Special Handling of Blood Specimens
  • Stability for Whole Blood, Serum and Plasma             

Read more:
Preanalytical Variables in the Chemistry Laboratory

Source: BD

Pseudo Christmas Tree

Christmas Tree made of P. aeruginosa & M. luteus
From: Manatí, Puerto Rico (Clinical Microbiology Laboratory)

Read more:
Pseudo Christmas Tree

Source: Microbeworld
Image credits: Zamayra Sotomayor-Roi

Sunday, December 27, 2015

Free Online Blood Cell Image Gallery

Sysmex scientific image gallery includes 191 pictures of blood cells from bone marrow and peripheral blood. Every image includes als a description of a cell. The image gallery is part of the Sysmex Academy and it is completely free. Enjoy.

Segmented neutrophil
Size: 12-15 µm
Nucleus: clumped chromatin and mostly divided into 2-5 distinct segments connected with filaments. Cytoplasm: acidophilic with many fine reddish granules spread evenly. Function: phagocytosis, play an important role in the unspecific immune defense, in the tissue they defend the mucosa against bacteria and fungi.

Size: 15-25 µm
Nucleus: oval with identifiable nucleoli and diffuse chromatin structure Cytoplasm: basophilic with visible golgi-zone and eye-catching azurophil granula (primary granulation).

Open gallery here:
Sysmex Scientific Image Gallery

Medical laboratory sciences are my true love

I <3 lab

Blood cell identification challenge

Case: 2 years old girl from Spain has been in fever over a week. She is very tired and crying a lot. In primary health care center basic blood count, peripheral blood smear and CRP was taken. CRP was 12 mg/L. In BBC leukocytes were: 17,0 x 10E3/μL, etytrocytes 4,2 x 10E6/μL and Hb 100 g/L. Blood smear was seent to central laboratory and the findings are in the image below. Those mononuclear cells covered 70% of all leukocytes in the smear.

Can you identify these mononuclear cells?

Correct answer is below the image.

CORRECT ANSWER: Monocyte (left) and lymphocyte, LGL (right). Both cells are mature and normal. Monocyte is a little bit activated. This little girl has a flu. CRP is just above the decision limit and basci blood count parameters within the reference ranges of 2 year baby.

Saturday, December 26, 2015

Community of 100 000 Medical Laboratory Scientists

100 000 medical laboratory scientists cannot be wrong. Our community is awesome. Join us, share the latest news and have fun.

Find us also from:

Facebook: LaboratoryEQAS
Twitter: @LaboratoryEQAS

Pap smear Christmas Tree

Pappy Chrismas by I <3 Histo

Read more:
Pappy Christmas


Friday, December 25, 2015

Preanalytical Challenge

What do you say about this sample?
by Marcin Balasa‎

CORRECT ANSWER: This sample was taken to open tube among with other samples. The phlebotomists mixed the caps by mistake after filling the tubes. This is a plasma separating tube (PST). The gele is clearly visible between the serum and cells.

As a conclusion new sample is requested because of potential potassium contamination of K2EDTA tube cap.

Source: Facebook via
Image credits: Marcin Balasa

Microbiology - It´s my life

Tattoo your passion and enjoy it forever

Happy Holidays from Italy

Cute little lab winter mascot
by Barbara Montaruli‎

Source: Facebook
Image credits: Barbara Montaruli

Merry Chrismas Laboratory Scientists

Christmas greetings from Lebanon
by Nisrine Zeinoun Saad‎

Source Facebook via Lebanese Medical Laboratory Technologists
Image credits: Nisrine Zeinoun Saad

Thursday, December 24, 2015

The most beautiful petri dish Christmas tree

What is the most beautiful Christmas tree?

Here are the candidates. Vote your favourite!

And the winner is three number 1. 41% of all the votes.

Thank you for participating to this Christmas survey.

Biomedical Christmas Tree

Merry Christamas colleagues!

Wednesday, December 23, 2015

Season´s Greetings from Pathology Department

Santa is lurking in the histology sample

Happy Holidays from Blood Bank

Blood Needed Over Holidays

Santa helps fill up another Christmas stocking ... this time with life-giving Type O blood (Photo: Australian Red Cross Blood Service)

Read more:
Blood Needed Over Holidays - |

Merry Christmas from Phlebotomy Unit

Blood tube Christmas tree

Original image:
Merry christmas from Denmark, Aarhus university hospital

Source: Facebook
Image credits: Camilla Schibler Nielsen

Season´s Greetings from Microbiology Lab

Happy holidays and excellent New Year 2016

Tuesday, December 22, 2015

Eppendorf the red nose reindeer

A Christmas creation of a Friend and Mary using Eppendorf tubes

Source: Pinterest via

Laboratory Christmas Lights

Merry Christmas scientists!

Monday, December 21, 2015

Gingerbread Lab Scientists

 Excellent idea for the holiday season. Just must for the Christmas of lab scientists.

Read more:
Gingerbread Scientists Amuse Me

Source: Not so humble pie

Winter fun for lab scientists

How are real scientists spending their winter vacations?

Sunday, December 20, 2015

Tiny Lab Beaker

Amazing 1mL beaker for  lab geeks

Original image
lab beaker

Source: Imgur

Pipette Tip Reindeer

Holiday season on my mind...

Hilarious Gram Stain Video

This gram stain procedure video may not be the most accurate, but it sure is the most entertaining.

Original video:
BEST Gram Staining Video Ever!!! 

Source: Youtube

Double helix ring for a scientist

Double Helix Ring, 22k Gold Granulation, 18 Palladium White Gold
by Kate Short, custom designer

Read more:
Double Helix

Source: Kate Short; Goldsmith

Simple point-of-care tests are error proof, right?

As a laboratory professionals, we struggle with the concept of point-of-care testing. The majority of point-of-care tests are performed by non-laboratorians who may not appreciate the nuances of lab testing. Laboratory testing matters whoever is performing the test. In our quest to deliver rapid, actionable test results, have we lost the essential emphasis on quality? Just because a test is simple to perform doesn’t mean it should be done in a cavalier way. Every test, every time, for every patient no matter how simple the test may be should be done with attention to quality, competency and learning from errors.

Why does lab testing matter? Because patient care decisions are frequently based on lab test results. Quality is not just important; it’s essential. Our patients deserve nothing less.

Read more:
Simple Tests are Error Proof, Right?

Holiday season in microbiology lab

This holiday deer is a beautiful Christmas gift from Standford Hospital microbiology department. It was drawn with live bacteria: S. marcescens, S. aureus and S. epidermidis. 

Read more:
Holiday deer

Source: Microbeworld

Saturday, December 19, 2015

Born to be a laboratory scientist

Medical Laboratory Scientists (MLS) and Medical Laboratory Technicians (MLT) — also known as Clinical Laboratory Scientists (CLS) — perform laboratory tests on patient samples to provide information needed to diagnose or monitor treatment. Examples of common laboratory tests include tests to detect anemia, diagnose diabetes and strep throat, and provide a transfusion to an accident victim.

Doctors rely on laboratory test results to make informed patient diagnoses. Patient history along with physical signs and symptoms are vital, but most diagnoses need confirmation that only laboratory tests can provide. The laboratory professionals also contribute to wellness testing, guiding treatment, and monitoring patient progress.

Read more:
The hidden profession that saves lives

Christmas Blood Bags

Amazing blood bag desing. Don´t forget to donate blood during the holiday seasons.

View more:
Pek Darah Santa Claus 

New test will replace PSA in prostate cancer screening in Sweden?

The prostate-specific antigen (PSA) test is used to screen for prostate cancer but has a high false-positive rate that translates into unnecessary prostate biopsies and overdiagnosis of low-risk prostate cancers. We aimed to develop and validate a model to identify high-risk prostate cancer (with a Gleason score of at least 7) with better test characteristics than that provided by PSA screening alone.

The Stockholm 3 (STHLM3) study is a prospective, population-based, paired, screen-positive, diagnostic study of men without prostate cancer aged 50–69 years randomly invited by date of birth from the Swedish Population Register kept by the Swedish Tax Agency.

The STHLM3 model could reduce unnecessary biopsies without compromising the ability to diagnose prostate cancer with a Gleason score of at least 7, and could be a step towards personalised risk-based prostate cancer diagnostic programmes.

Read more:
Prostate cancer screening in men aged 50–69 years (STHLM3): a prospective population-based diagnostic study

Source: The Lancet Oncology

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