Hematology Rotation

Tech upgrades.. just think, there is a method out there today that uses a centrifuge and optical kinetic lazer reader to produce sed rates in 4 minutes... yes, 4 minutes.. and its awesome.. no more phone calls asking, "where is my sed rate results?"    Its called ESR Stat Plus by Hematechnologies.  %0d%0a%0d%0aAnd who doesn't love the Coulters?  I'm on Abbott Cell Dyn Ruby now, but I can't say which, if either, is superior.  Also can't help you with plt clump flags that are excessive, but I do know that if you get some "band" flags on neutrophils,  if you just let the freshly drawn sample rock an extra 5 minutes, allowing the cells and  EDTA to equilbrate, most band flags will go away relieving you from doing a manual differential.  %0d%0a%0d%0aAnd Stephanie,  the ECI isn't that much of a dinosaur.  You have to remember the methodology is what takes testing time so long, not the instrument.  Many infectious disease and hormone methods take increased time due to washes and incubations (ELISA or chemilluminescence assays)... don't be so short to pick on the ECI, because bayer ACS is a whole lot worse to work on and Beckman Coulter's Immage nephelometry isn't all that fast either.  And you'll never change the "we've always done it that way" attitude until you manage yourself, if you go that route.  %0d%0a%0d%0a

I worked with the Centaur at a couple of hospitals to which I traveled for three-month temporary assignments - in Bluefield, West Virginia and Bryan, TX (near Texas A&M) - as well as at WFUBMC (Winston Salem, NC) during my clinical MT training.  In Danville, we use the Beckman Coulter DxI (the large Access analyzer that's part of the UniCel system) for our thyroid, PSA, cardiac, BNP, intact PTH, and B12/folate testing.  

Our hepatitis and HIV testing is performed on a dinosaur otherwise known as the Vitros ECI (manufactured by Johnson and Johnson/Ortho Clinical Diagnostics), which I suspect was placed into service at least five years before I started working at that hospital in mid-October '08.  Testing on that analyzer always takes at least an hour and a half, as opposed to your nice OraSure manual HIV tests that take a mere 15 minutes.

The only explanation I've heard for why we use such a time-consuming methodology is "because our Chemistry technical specialist says so." (Can you tell that I don't think very highly of the "because we've always done it that way" rationale? LOL)

The Coulter did flag NRBC's we would always vortex the tubes and re-run them manually on the second machine. They error usually always went away.

I will keep you up to date on my rotations! I just completed Immunology and working with the Centaur. Now it's on to Micro! I'm really excited about it! :)

So you didn't get to count any 500-cell bone marrow differentials? Oh man... :(

Our Coulter LH 780 here in Danville has a bad habit of flagging "platelet clumps" on slides that actually exhibit enlarged platelets with no clumping whatsoever.  

From the time I started working at this hospital until approximately a month ago, we had to examine slides on any patient that flagged "immature granulocytes 1," making us extremely busy with about 20-30 slides during our "morning run," which starts with 3:00 AM collection here.  The day shift technologist who would come in at 6:00 AM (toward the end of my third shift) incessantly complained about how many of these "Imm Grans 1" patients had completely normal-looking WBCs on their slides.  Finally, our technical specialist in Hematology changed our rules recently, requiring a slide to be examined on "Imm Grans 2" patients, but not "Imm Grans 1," cutting the morning workload to about 10 slides or so on a busy morning - YES!!!

Did the Coulter you worked with in Nashville flag "NRBCs" on occasional patients that end up having none of those whatsoever on their slides, by any chance? :P Some of these specimens turn out to behave just fine with 0% NRBCs after we let them sit on the rocker for at least 5-10 minutes.

When we actually do count any NRBCs on our manual differentials,  they are considered a "critical" value that has to be called to the patient's nurse here in Danville, VA - even on babies. (One of our little idiosyncrasies in this hospital's lab - LOL!)

I worked with a 5-minute STAT sed rate analyzer, which used little capillary tubes and looked like a centrifuge, at Wake Forest University Baptist Medical Center as a MT student in 2004.  The quickest sed rate machine we have here in Danville, however, takes 30 minutes; it is manufactured by Streck and uses skinny tubes with black tops.

I love Microbiology to death, and miss working in it very much now that I only load new blood culture bottles and read a rare CSF Gram stain on third shift in Danville, so please do not leave out any details of your rotation in that department!