Week 18-my final entry =)

Subject title: Clinical Chem/Micro
Name of test: Urea Breath Test

Principle:
-This test is carried out for diagnosis of Helicobacter pylori (H pylori) infection
-H pylori is a gram-negative bacillus which is highly motile due to its multiple unipolar flagella

Retrieved 21 October, 2008, from http://images.google.com.sg/imgres?imgurl=http://www.science.org.au/nobel/2005/images/invasion.jpg&imgrefurl=http://www.science.org.au/nobel/2005/05diagram4.htm&h=329&w=321&sz=30&hl=en&start=2&um=1&usg=__Xjdem48HW8H_C711OrWmzPSMn7g=&tbnid=0Tjg0gylcn5OMM:&tbnh=119&tbnw=116&prev=/images%3Fq%3DH%2Bpylori%26um%3D1%26hl%3Den%26sa%3DN

*thread-like things=flagella
-They produce the enzyme urease which converts urea to ammonium and bicarbonate
-Some of the diseases caused by H pylori infection are:
1. Gastritis and dyspepsia
2. Stomach ulcers
3. Duodenal ulcers
4. Stomach cancer
5. Lymphoma

-The UBIT Tablet taken by the patient contains 100 mg of 13 C-Urea
-If the patient has Helicobacter pylori infection, H. pylori will produce the enzyme urease. The enzyme urease will convert the 13 C-Urea to 13 CO2 and NH4+
-The 13 CO2 is then absorbed in the blood, diffused into the blood and exhaled
-In our laboratory, we use the 13 CO2 Urea Breath Analyzer UBiT-IR300 by Otsuka electronics to analyse our UBT samples
-The machine will measure the 13 CO2 in both the *pre-dose and post dose breath samples
-The difference of the 13 CO2 levels in both breath samples will also be calculated
-This measurement is done via infrared spectroscopy

Materials:

2 UBT bags
1 UBIT tablet
100mL of water


Method:
Preparation for the test:
Patient must:
1.Fast for 8-9 hours before the test
2.Stop taking Proton Pump Inhibitors one week before the test
3.Stop taking antibiotics 4 weeks before the test

During the test:
1. The patient has to breathe into the “Pre-dose” bag without taking the UBIT tablet.
2. Within 5 sec, the patient has to swallow the UBIT tablet on an empty stomach with 100 mL of water. The tablet is not to be chewed, crushed or dissolved.
3. After taking the tablet, the patient has to lie down on his left side for 5 minutes.
4. Then, he has to remain seated for another 15 minutes.
5. After that, the patient has to breathe into the “Post-dose” bag.
6. These two bags with the request form will be sent our lab for analysis.


In the lab:
The medical technologists will:
1.Check the labels
2.Insert “Pre-dose” bag into the “Pre-dose” inlet
3.Insert “Post-dose” bag into the “Post-dose” inlet
4.Verify results

Results:
A value of 2.5% or higher indicates that the patient is positive for H.pylori infection

*pre-dose: sample before taking tablet

*post-dose:sample after taking tablet

Nur Farhana
0604834B

week 17

Well for the past week, i was assigned to do shift work.
i had to work from 10am till 7pm. the slot was either for Haematology section or CP.
CP stands for Corporates and Poly section.
For haematology, the workflow remain the same. i will just have to assist the medtech that is posted there and cover the section from 5pm-7pm or until the next shift staffs are in.

However i was new to CP section. So i was asked to observe the workflow first.
The specimens from the polys will arrived at the lab around 10.30am. That will be the first batch of specimens. In total, 3 batches of specimens are send to the lab within the expected timings. Upon receiving the specimens, the poly clerk will have to check the specimen sent, wether it matches will the ones indicated in the forms. Once checked, the clerk will have to 'ech' the specimen into our system. If 'ech' is not done, the specimen cannot be run as the the machines will not be able to recognise them. After which the poly medtech will take over. He/ She will then have to process the specimen according to the test requested.
Usually the bloods are sent in plain tubes and fluoride tubes.
For plain tubes, we can load it into MPA ( a machine in chemistry) directly. For fluoride tubes however, we have to spin them using centrifuge before loading them into either SWA or COBAS for processing.
The tubes are then archive into a special rack for easy indentification.
After the processing of the first batch is done, we have to check for any test that are not run. We do so by checking the incomplete log. In this system, we can check for any outstanding test that are not yet done.
If there is indeed any test that are not run, we have to find the specimen and run it.
That's for poly specimens.

For corporate specimens, the workflow remains the same. The only difference is that the specimen are not 'ech' into our system but are ordered as corporate screening specimen. What we do here is, we ordered the tests that are required like how we do order entry but the location for the test are change into their respective companies.
The workflow henceforth are similar to the polys.

After all the specimens are received and processed, we have to check the incomplte log again in case we missed out any test. If everything is smooth sailing then we can print the corporates results which are then reported back to the companies.

So that's basically the roles of a CP medtech.
till then...

sutiana
0604651j
to1

Week 16

hello! Since the past two weeks, i have been assigned to be at the special stains station, alongside with a senior medical technologist. The special stains station consist of a machine responsible for stains such as GMS(Gomori's Methenanine Silver Nitrate), PAS(Periodic Acid Schiff), PASD(Periodic Acid Schiff Diastase), Fe(iron), Alcian Blue, Giemsa, Steiner, Retic.

Picture taken from: http://www.ventanamed.com/

The Nexes Special Stain machine is barcode-driven and has optimizes protocols to help ameliorate productivity and consistency. The tray in the machine can hold up to 20 slides while the reagent tray can take up to 25 reagents.

1) The sections are fished from the floatation bath and onto the slide.
2) The biopsy number and the name of the special stain required is labeled on the slide.
(ie. 08/12345 GMS)
3) The slide is heated on the hot plate.
4) The barcode label is keyed in and the protocol of the test required for the slide is chosen.
5) The label is pasted on the slide.
6) The slide is sent for dewaxing.
7) The slide is placed in the slide tray in Nexes.
8) The section on the slide is hydrated with a wash solution to prevent drying up of the section and to prevent unwanted solution in the machine to dirty parts of the slide.
9) The reagents required are loaded.
10) The liquid coverslip solution is filled up if it is insufficient.
(The liquid coverslip acts as a temporary protection while the slide is still in the machine after staining)
11) The RUN button is clicked
12) The run time will be shown
13) When staining is done, the reagents are removed from the tray.
14) The slide is removed from the slide tray and sent for dehydration(70%, 80%, 95%, absolute alcohol)
15) The slide is cleared, by dipping it into xylene.
16) The slide is mounted.


So far, i have performed two stains manually, without the help of the Nexes Special Stain machine. The stains are PAS and PASD. PAS stain is used to stain carbohydrates. The difference between the two stains is, PASD uses diastase to digest glycogen. This stain is used to differentiate glycogen from other carbohydrates. Under microscopic examination, the tissues stained with PAS will consist of clusters of glycogen, stained dark pink / magenta.

1) The section of interest is fished onto the slide.
2) The slide is heated on the hotplate for 3 minutes.
3) Dewax the slide and bring the sections to water.
4) For PASD stains, treat the sections with thawed diastase for 30 minutes and subsequently, wash the slide with water.
5) For PAS stains, treat it immediately with 1% aqueous periodic acid for 5 mins.
6) Treat the slides with Schiff's reagent for 3 mins, until sections turn light pink.
6) Wash the slides in water
7) Counterstain the nuclei with alum haematoxylin for 1 min.
8) Blue the slides in water
9) Dehydrate the slides by dipping them into 70%, 80%, 95&, absolute alcohol.
10) Clear the slides by dipping them into xylene
11) Mount the slides

PAS stain- note the clusters of magenta

Picture taken from: http://www.path.utah.edu/casepath/PM%20Cases/PMCase6/ALL6_files/image046.jpg

Nurathirah
0606561I

Week 15 Of SIP

Topic: Processing Section

To all my muslim friends, Selamat Hari Raya! And to all my non-muslims friends, hang in there...5 weeks left. Sorry fot the late blog entry. My computer is not working well these days.

For the last 5 weeks, I have been attached at the processing section. Some feels that the processing section is rather simple yet boring job. But I feel that it is the MOST important section in the laboratory. Every specimen will have to undergo the processing section before the requested tests are performed. Here’s what I have learnt I have pick up along the way…

When a test is requested by physicians, specimens are collected in appropriate tubes/ containers and sent to the lab together with a request form. In the lab that I am attached to, there are four types of tests forms. Such includes the

1. External form-specimens will be sent to external laboratory upon request as test are not available in our lab.
2. Interlaboratory form- request for tests done in the clinical lab.
3. Microbiology lab form-request for test done in the micro lab.
4. Histopathology form-request for test done in histo lab.

Thus upon arrival of specimens to the processing section, it will be sort as according to the forms. Those interlaboratory tests are then further arranged. The interlaboratory test specimens usually come from wards, specialist clinics, accident and emergency section. Those ‘URGENT’ cases from any of the above department will be prioritized. All A&E tests and MICU and SICU cases are also prioritized, followed by clinics, and wards.

The laboratory admin clerk will then order tests requested in the LIS and print out the barcode for the tests requested. The barcode labels are pasted in the sample tubes. When pasting the barcode labels, one must check that the label which was already pasted by the physician tally with the name on the requested form and that the barcode labels are pasted on the right sample tubes for the right tests. E.g. Test for full blood count, specimen must be placed in the EDTA tube and not plain tube.

Medical Technologies must ensure that barcodes are labeled neatly and appropriately so that the analyzers are able to scan the barcode. The specimens are then spin (if required like plain blood tubes) and/or delivered to the respective section.

The processing section is also in charge of rejecting specimens and cancellation of tests. Here are some common reasons that specimens are rejected:
1. blood in EDTA tubes are clotted
2. insufficient specimen
3. specimen leaked
4. empty container sent
5. specimen sent in wrong tube
6. no name label on specimen
7. name/ NRIC mismatch between request form and specimen

Alrite people.Thanks for reading.See you guys soon...

Dyana
0605169B