#lab tech life

[dearearlyarchaeologists]

Dear early archaeologists,

Please do no bequeath all of your earthly possessions to a university archive.

We get it. Your “possessions” included ancient artifacts that need to be preserved and cared for.

However, no undergrad employee wants to be assigned the task of archiving your 1955 family vacation.

Sincerely,

Said undergrad

[bbgunkelly]

Masks aren’t that bad, actually

[biologyweeps]

Alright, since people are into the idea: My top two horror stories as a labtech (mind you I’ve been a labtech here for just over 3 years so more will mount, no doubt)

Warning for Death, limited gore and well, medicine. I’ll try to keep the jargon light but please bear with me. 

Case 1: 60 year old female, arrived via ambulance, admitted with transvaginal bleeding.

Patient arrived at approx. 2pm. Full clinical chemistry panel + blood grouping was drawn immediately and sent to the lab as emergency. Now, no matter how emergency you make it, we cannot do a clinical chem faster than 20 to 30 minutes because we gotta spin everything down in the centrifuge first. A full blood group takes ~45 minute because we cannot speed the reactions up. We can give out un-crossed blood (O- in that case) but the doctors are weary of doing that because it’s a risky move anyways.

I start the blood grouping, prepping as much as I can to cut down on time were possible. We also pop in the clinical chem already to try and get that as speedy as possible to either. Results are bad. Hb (hemoglobin, which is what lets your blood carry oxygen) is 6.something (should be >10), platelets are in the low double digits (should be >100), coagulation is ~30 (should be >80 if not on medication), CRP (inflammation marker) is >200 (should be <10). Liver parameters aren’t looking hot either, electrolytes completely out of whack. 

The amount of ordered units of blood gets upped from 2 to 4, doc also orders two units of plasma. Those we can give out immediately with VERY low risk, since they’re AB (universally accepted plasma) and don’t need crossing. So you can use them to put coagulation factors and volume into your patient while you wait for the blood to be ready. So we put the two units of plasma on. I manage to get two units of blood out. Doc sends down another CBC (cellular blood count) and coagulation. 

Hb even lower now, platelets down in single digit range, coagulation now below detection level of the machine. It’s shortly before 3pm. PANIC sets in. Doctor has me order units of platelets from the Red Cross. We don’t have those on hand because they can only be used for 2 days after being drawn, and we don’t need them. It takes about an 60 to 90 minutes for the units to get here from the Red Cross. 

So I call them immediately and get things started while the additional two units are crossing. Doc ups the order again. We’re now at 6 units ordered. I start on those two, hand out the next two (units 3 and 4 of blood to the patient) and another unit of plasma (number 3).

Another set of clinical chem comes in to monitor progression. It’s cherry red when it comes out the centrifuge, meaning the blood cells aren’t intact anymore and instead have exploded and are now tinging the plasma red. 

Ten minutes later the doc calls, tells me that the patient has passed. We didn’t get the final clinical chem in before she died. We didn’t get those last two units of blood or plasma into her. Call to the Red Cross to cancel the platelets fruitless as they’re already on the road.

Final time from admission to passing of patient: 2h and change. Final diagnosis: septic hemorrhage. The immune system literally had the blood fall apart inside the patient, with most bleeding internal. We literally couldn’t funnel in blood fast enough to compensate.

Case 2:

Male, in his fifties, walks into ER under own power, admitted with slight fever and feelings of malaise. It’s friday evening. 

initial lab results are mostly nonsuspicious. Slightly elevated leukocyte (white blood cells), slightly elevated CRP (to be expected with a fever), elevated LDH. This one can be a marker that something serious is afoot, but without any of the other parameters falling out of the ordinary, it’s also very vague. But patient is admitted, just in case, because higher LDH can also be a marker for a cardiac event so better safe than sorry

Saturday morning, new blood draw: patient blood looks normal still, values slightly worsened than the day before, but not out of the ordinary for a progressing infection yet.

Saturday noon: patient DRAMATICALLY worsens in condition, moved to ICU. New blood draw. Blood now visibly ikteric after centrifugation. ‘Ikteric’ means that the plasma is having an orange or brownish tint. This comes from elevated bilirubin levels. That means that something’s up in the liver. Liver parameters have indeed significantly worsened. Bilirubin has gone from the normal <1 to ‘approaching 10′. Special lab parameters are drawn and send out, but on the weekend, they take a long time to get done (and indeed as a direct consequence, we’ll likely now get an in-house version of at least one of them).

Oncall MTA gets blood units ready to transfer in case the patients starts on hemolysis (destruction of red blood cells) as well. 

Saturday afternoon: patient continues to worsen despite speedy application of antibiotics and monitoring. New blood draw. Blood looks... bad when it comes out the centrifuge. Plasma VERY ikteric. Like, the stuff should be light yellow. It is burnt umbra. Small globules of fat as collecting on the top. Even in very fatty blood, having distinct globules is BAD. There’s literally fat droplets of considerable size floating around in the patient. Both are strong indicators that patient is entering liver failure and doing so fast. Closer inspection reveals that inside the plasma we got fibrin-threads. Fibrin is one of the things your body uses to clot wounds, and it shouldn’t trigger inside the body. It certainly shouldn’t inside a vial filled with an anticoagulant (Li-Heparin. We’re using this because in emergency situations it means you can cut down the spin time from 10 minutes to 5-7 and sometimes that’s vital). Something’s setting off the coagulation cascade inside the patient. This is also very bad. 

Clinical parameters have worsened yet. Bilirubin values are approaching the 30 mark. 

Coworker gives out two units of blood as Hb is dropping also. Kidney parameters now also worsening, likely a knock-on effect from the liver damage. Multi-organ failure is starting to look very very possible. 

Saturday evening: Patient declared dead at 10pm. Final time from admission to passing: ~36h. Patient degraded from ‘basically fine, lil feverish, potential cardiac event’ to ‘fulminant liver failure’ within 24h.

Final diagnosis: systemic infection with antibiotic resistant bacteria, likely picked up from his father, who is diabetic and has open sores on his feet. No distinct ‘nest’ of infection found upon autopsy. No entry wound found either. 

As mentioned, this case will in the near future lead to us doing the procalcitonin (another, more detailed infection marker than CRP) test in house to cut down on diagnosis time especially on the weekend. Might not have helped in this specific case, as the bacteria in question were resistant to many antibiotics, and we cannot make cultures grow any quicker to run resistance tests on, but we’ll never know for sure. 

And both those cases are septic ones. This is what infection can and will do to your body if your immune system cannot get a grip on it by itself, or overshoots. Injection yourself with things that you cooked up in your kitchen can, worst case, end like that. Not with gangrene slowly eating your limbs, though that’s also a possibility. But it can just as much end with you bleeding out of your orifices as your blood self-destructs. It can end with your organs shutting down on you within a ridiculous short time. 

So when I tell people to let a doctor look at the suspicious looking thing, I really, SERIOUSLY mean it. Sure most of the time it’ll be nothing, but you don’t wanna be Case 3. 

If you take care of family members with known resistant germs on them, take the necessary hygenic precautions. Don’t randomly stab things into yourself. GO TO THE FUCKING DOCTOR IF YOU FEEL ILL. Don’t be another one for the statistic.

[awkweirdlymajestic]

Quality Assurance checks at the lab, aka playing with food coloring and pure strain nasty bacterias.

Each month we have to check to make sure our tray sealer, affectionately named Chewbacca since it makes noises like an angry wookie when lots of samples are pushed through it, works correctly. Hence the colored dye to make sure all the well seal adequately.

Then we have to check our purchased media to make sure it still reacts correctly in the presence of certain bacteria. Mmmmmm mmmmm, nothing like some good old pseusdomonas, klebsiella, and e. coli to have a good time. All in a day’s work, I suppose.

[biologyweeps]

Do you have any (lab or otherwise) horror stories specifically to illustrate what a stunningly bad idea it is to not finish a course of antibiotics? I've seen people talking about "cheating" and "saving up" stuff for the next infection and I can just scream in incoherent rage...

Not really, since I usually don’t see the bacterial cultures we do (they’re send to the microbio lab)

BUT that said:

We currently have a patient on ICU who’s… likely not going to leave the hospital again, to be frank. 

And she’s settled with at least two multi-resistant germs, one of which has resulted in an open sore on the lower body that’s required multiple skin grafts and they just can’t get a grip on the infection because she’s pretty old already and the germs are resistant to…well not everything under the sun, but most of it. So there’s not much treatment to be done anymore, sadly.

And that’s the result, at least in part, of people not running their course of antibiotics. Because if you don’t run them through then there’s a larger chance that you will get a resistant pathogen and if you’re otherwise healthy, then hey, maybe that won’t be a problem. But if you’re not? If you’re already old and maybe a little frail? Then this can be devastating. 

And the same thing happens if you ‘save for the next infection’ because who knows if the next infection even is a bacterial one, and every exposure of a bacteria population to an antibiotic runs the risk of a resistant strain coming out the other side.

There’s currently an ad being run on German TV that advocates for cutting down the use of antibiotics for things like colds, because most common colds are viral and anti-biotics don’t do shit to them anyways and instead only up the risk of resistances. 

[biologyweeps]

how did you become a lab tech/what qualifications/experience do you need? also what do you do/what do you enjoy about being one?

‘what qualifications’ oh man

Ok so as you know, my actual qualification is ‘Bachelor of Science: Biology’ and after that I was pretty sure that if I did the additional two years for a Masters degree was gonna die. My mental health really tanked over the course of my study.

So I decided to go get a job, and while looking for offers found one that was aimed at ‘lab techs or biologists’ and I applied there and lo, I got in. I…didn’t have a lot of hospital lab tech experience aside from a two weeks practical back in 10th grade, but I was willing to do weekend/night oncall shifts (so basically 24h in the hospital), and being willing to put in the work and learn got me in. I got most of my qualifications as extra training after being hired, which worked probably because biologists do have a solid idea on what things are, but there was still a steep learning curve. So most of my qualification was ‘rough idea of thing, willing to learn, willing to work’ and that was good enough. Been at it for 3 years now so I think nobody’s been regretting it yet. 

What I do is…well, the lab does ‘basic parameters’, so blood cell counts both on the machine and manually if necessary, coagulation, the basic clinical parameters, urine analysis and blood grouping, as well as a number of quick tests and ready-made PCRs for influence, norwalk virus and MRSA. 

What I enjoy: it’s very rewarding work, imo. The lab is fairly small, so you’re not stuck working ‘just’ the CBC or just the blood grouping all day, you do a bit of everything. You make a direct impact on helping people by supplying the information that the doctors need to make a diagnosis and start the needed treatments. Since the hospital is fairly small, it does get stressy but they’re not rushing you off your feet all day every day, it’s a good mix of stressy and laid back and my coworkers and boss are all darlings so the work atmosphere is pretty damn pleasant, too.

It’s close enough to my chosen field that I can relate things from work back into the framework, but also learn new things. There’s always a bit if problem solving in trying to work out things with the machines, or the IT or the doctors. There’s business as usual, but things aren’t identical, so there’s always enough variety to not let you fall into a rut, at least not for long. 

[biologyweeps]

Putting this submission under a cut cause death, and child death and people don’t gotta be smacked in the face with that.

Ok so I mostly work in our core lab, which is chem, hemo, coag, and urinalysis so most of my stories come from that perspective. So. It looks like we got a patient that was directly admitted to ICU. 87 female with basically heart failure. Nothing was out of the ordinary, chems slightly elevated and CBC aut verifying. Then the our instrument calls left shift and sure enough I do see an increase in bands. But after that we realize she was getting CBC with diff every two hours.

Slowly over a week and a half her CBCs keep getting worse, because we were doing her diff every two hours. It gradually went from slight bands to about half of her neutrophils being bands, a good amount of NRBCs, and immature grans.

By the time of her death it was almost all left shift, had toxic gran, dohle bodies, vacuole, pros, and NRBCs. Turns out she was on ECMO, and I was doing a dif on someone just about dead at that point.

Another one is about a 23 day old who was in the ER about two weeks ago before being admitted to PICU and ended up passing a few days ago. We’re a children’s hospital, so we get cases like this sometimes and its always rough.

They came to the ER because the baby was unresponsive when the mother went to wake him from his nap. Lactic acid crazy high but CBC is fine but no bacteria in urine based on UA. Diagnosis is neonatal septic shock. A hour later we get an announcement of a code in PICU. Lactic still high, chems a little off and CBC still fine. Coags all normal.

Over the past two weeks before his death, it continued this way. However all blood cultures were negative and the stool sent out also came back negative for any organism.

Only found out he passed because gift of hope called asking if we had admission blood, but it was was two weeks at that point and we only keep blood for a week before tossing it.

Looking into his chart, because I was curious, he had an MRI done, and they found a subdural hemorrhage and DCFS has been called to investigate.

So vocab explanation:

‘left shift’: when your neutrophiles (a kind of white blood cell) show up in juvenile/immature forms. Comes from the time when they were listed from immature to mature stages in left to right so the more ‘left’ stages you had. A certain amount if normal, by anything below a Metamyelocyte is bad news bears. You never wanna see a blast (most immature, should never leave the bone marrow) in normal blood

‘Bands’: the juvenile form right before it’s a proper granulocyte neutrophile. A few show up normally, and you tend to get them in increased numbers during infections (when your body pumps out WBCs and the less mature ones come along), but anything about 10 is suspicious even then

Tox.Gran: short for ‘toxic granula’. They’re little basophile (dark blue, in the pappenheim stain) ‘dots’ that show up on the neutrophiles if they’re ‘irritated’ by something. Can be infectious, can be something else.

Dohle Bodies: similar but larger than tox.gran. They often show up together and can have a number of sources. 

ECMO: Extra Cellar Membrane Oxygenation. Basically a machine that replaces your lung. 

(we keep blood a little longer but only the inhouse stuff, it’s normally around for two weeks because we happen to shove it all in the bottom of the fridge. Our Out-of-house docs we forward to main-lab in another city and they keep it ten days)

[biologyweeps]

My lab rotation includes microbiology, and I'm afraid there aren't any real bad horror stories for antibiotic resistance, except when everything you try on the bacteria is resistant, and sensitivity testing takes a day; so each new antibiotic the doctor requests means an extra day for the report to come out, which means the patient's stay is extended, and the patient may suffer the side effects of various antibiotics. Then hope you don't get blood sepsis.