Medical Laboratory Professionals Week 2023

 Many clinical decisions are based on lab results, and organizations like the American Society for Clinical Pathology (ASCP) and American Society for Clinical Laboratory Science (ASCLS) recognize the need to increase public awareness of the clinical lab. This year, that week of recognition occurs April 23rd through 29th. At the Richard L. Roudebush VA Medical Center, over 80 employees help operate the lab on a 24/7 basis to deliver high-quality laboratory results for our veterans. Let us recognize our dedicated staff in the following laboratory sections:

• Pathology & Laboratory Medicine Administration
• Chemistry
• Toxicology
• Hematology, Coagulation, and Blood Bank
• Microbiology
• Evenings & Nights Staff
• Send-Outs/Processing
• Molecular Biology
• Histology
• Cytology
• Laboratory Information Management
• Ancillary Testing (Point of Care)
  
   

Saved by the Lab – Celebrating Medical Laboratory Professionals Week 2023

Austin Ballard, MLS(ASCP)CM

 Staffed by over 80 employees with titles ranging from Medical Technicians to Medical Technologists, Cytotechnologists, Histotechnicians and Pathologists, among others, the Roudebush VA Laboratory works 24 hours a day, 7 days a week to deliver high-quality laboratory results for our veterans. While many of us who work in healthcare are familiar in some way with the lab, many may not know what all goes on within our many areas. For this year’s Medical Laboratory Professionals Week, we wanted to give a glimpse into our daily operations here in the lab.

 The collection of a specimen from a patient is only the beginning of the laboratory journey! From the moment a specimen is received by our Medical Technicians, it is accessioned, re-labeled, and sent to its respective section of the lab to be tested. Whether it is a COVID-19 swab going to microbiology, a comprehensive metabolic panel (CMP) going to chemistry, or a Type and Screen going to blood bank—there are many people involved in making sure that the results that we give are accurate and high-quality.

The first stop on a specimen’s journey in the laboratory begins with our Medical Technicians, or specimen processors, in the Send-Outs/Processing department. These team members are trained in knowing our testing options and specimen requirements and are available to answer questions 24/7. In addition, these important team members receive specimens from our 8 Community-Based Outpatient Clinics (CBOC’s). Once the samples are logged into the system, they are passed off to the appropriate department. From here, there are many possible routes a sample can take through the lab.

For chemistry tests, the specimens are loaded onto an automated track system that reads the barcode, pulls the patient information from the medical record, and even centrifuges (spins down) the specimen with very little intervention from a human! Depending on what tests are ordered, our many analyzers take a small sample of a patient’s serum or plasma to run the tests that have been ordered. Some chemistry tests can be done in as little as 10 minutes! Our chemistry technologists utilize our track system to analyze over 1,000 specimens daily! Once the tests are done and if the results are all within a normal range, they are automatically released into the patient’s chart. There are many “checks” that are performed to ensure accurate results are reported out, and if any of these checks fail then it is up to the Medical Laboratory Scientist to review those results for acceptability. We even have one of the VA’s few Toxicology laboratories on-site in which a Chemist and Medical Technologists perform confirmatory Liquid Chromatography-Mass Spectrometry (LCMS) drug and metabolite testing.

On the other side of the main laboratory is our hematology and coagulation laboratory. Here, specimens are loaded in a manner similar to chemistry. For a CBC, or a Complete Blood Count, our analyzer takes a sample of a patient’s blood and can print a report with all of the values for a tech to review. Much like chemistry, normal results are automatically released into the chart. Anything that flags as abnormal is “held” for a technologist to review. This may be checking for consistency between results, requiring a review of the slide for platelet clumping, or even requiring a manual differential to be performed! Our technologists are responsible for analyzing over 300 CBC’s daily! In the coagulation lab, our technologists utilize analyzers to check a patient’s ability to form a clot. This becomes useful in the monitoring of Coumadin patients and inpatients on anticoagulant therapies.

If a patient’s CBC indicates a low hemoglobin or platelet count, providers may order blood products from our blood bank to help correct those issues. Within our blood bank we have several products available including platelets, red blood cells, and plasma! Prior to giving out blood products, though, we require a specimen called a Type and Screen to be collected. This is imperative for safe patient care so we can ensure that the right blood goes to the right patient. Many checks are performed prior to the release of blood, including historical record checks across the entire VA system! If a patient has a positive antibody screen, additional testing can be performed by either our technologists or our blood center. During 2022, we issued over 1,640 units of packed red blood cells to our patients! A total of 2,305 blood products were issued which included our packed red blood cells, platelets, plasma, and cryoprecipitate!

Down the hall from the core lab is our microbiology laboratory. Here, specimens are cultured and observed for bacterial or fungal growth over the course of several days to weeks. Additionally, our technologists perform blood cultures to aid in sepsis management. In 2022, there were over 4,800 blood cultures performed by our technologists! In addition to cultures, our technologists also perform antibiotic susceptibility testing to help providers determine the appropriate antibiotics to use for an infection.

We all know someone who’s had a surgery. Whether it be an appendectomy for appendicitis or a lung biopsy for lung cancer, those specimens are delivered to our Pathology Laboratory. Staffed with a Pathologists’ Assistant, an expert in anatomy, who examines the specimens and prepares them for processing; and 7 Histotechnicians who process, embed, section (cut) and stain the specimens for the Pathologists. The final slides are given to the Pathologist, a physician who interprets and diagnoses the changes caused by disease in tissues and body fluids, who will examine and diagnose the specimen, often using specialized staining techniques that allow for a specific diagnosis. Histology is often referred to as an “art” for the precision it requires!

While Histology deals with whole organs and tissues, Cytology is the study of cells.  Fluids obtained from various sites within the body, such as around the lung and within the abdomen, as well as urines, are commonly processed in Cytology. Cytology also processes and examines approximately 150 pap smears each month. In addition to these specimens, Cytology is also responsible for preparing slides and determining adequacy during fine needle aspiration procedures. These procedures are used to obtain cells from tumors within the body. These procedures may be done using Ultrasound, Computed Tomography (CT) guidance or as a Pathologist performed procedure. Cytotechnologists examine the prepared slides and mark areas of interest for the Pathologist, who will issue a final diagnosis.

Our laboratory also has a Molecular Biology department. Molecular diagnostics is the rapidly developing area of laboratory medicine that investigates human, viral, and microbial genomes. Molecular diagnostic techniques and platforms are playing a larger and more critical role in all areas of anatomic and clinical pathology. In the last decade or so, the clinical laboratory has seen an explosion in the available menu of tests based upon DNA and RNA analysis. For the first time in the history of the diagnostic laboratory, molecular pathology and diagnostics are extending the range of information available to physicians, pharmacists, geneticists, forensic scientists, research scientists and other healthcare professionals. Our Molecular Biology department does the testing for HIV, Hepatitis, HCV Genotyping, MRSA testing, HPV typing, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) CT/NG, Hereditary Hemochromatosis, Factor V, & Factor II.  They also work with genetic counselors in Salt Lake City to report the various genetic tests utilized.  Molecular Biology also sends tissue and blood to Foundation Medicine, Tempus, Prevention Genetics for further oncology testing.

Lastly is our Ancillary Testing/Point of Care department. Our three Ancillary Testing Coordinators work to implement new point-of-care testing devices to be used at the patient bedside, vastly important to provide quick results for urgent needs. These coordinators also perform training and competency assessments for their over 1500 operators all over the facility and our off-sites.