Chemistry

CMPN: Complete Metabolic Panel. You've all gotten one of those.
MP: Basic Metabolic Panel. Less tests involved. I'll write an article on the panels later.

CK or CPK: Creatinine phosphokinase tests for muscle damage. Usually it's stored in muscles, so if the muscles get damaged, they would leak into the blood.
CK-MB: Creatine Kinase MB: heart and muscle. If both CK and CK-MB are high, then you had heart damage, such as from a heart attack. But if this is low and CK is high, then other muscles have been damaged.
1TROP: Troponin, a protein found only in the heart muscle, is released when the heart is damaged, usually from a heart attack. It's more specific to heart, not just skeletal muscle, damage than other tests and it stays elevated for a longer period of time. High troponin signals that a heart attack happened, or, in the case of angina (chest pain), is likely to happen. It could also indicate various other types of heart damage, like myocarditis (heart inflammation) or cardiomyopathy (weakened heart).
PBNP: (long name for protein) It diagnoses congestive heart failure (heart can't pump blood like it used to and has to work harder) because it's secreted by the heart to regulate blood pressure and fluid balance, in response to ventricle expansion and/or pressure overload. It increases if your heart isn't working properly.
Mg Magnesium. An abnormal level says that you are having problems. Too much could be kidney failure, dehydration, diabetic ketoacidosis (body breaks down fat, releasing toxic ketones), Addison's (bad adrenal glands, which control stress and blood pressure). Too little could be problems related to alcoholism, digestive issues, parathyroid or adrenal glands not functioning, too much insulin.
K Potassium. People on diuretics or with kidney or adrenal damage might have out of wack potassium levels. It also check nutrition and whether cancer treatments are causing cell lysis, which could make potassium levels high in the blood. More info on Potassium test

TSH: Thyroid stimulating hormone. The thyroid controls metabolism, how fast your body works, and growth. Too little TSH signals overactive thyroid, from Graves disease or too much iodine in the body.
GTT: Glucose tolerance testing, especially used with diabetes, is when the person fasts for a while, then drinks something really sugary to tell how fast glucose is broken down by the body.
BUN: Blood Urea Nitrogen, test for kidney failure. Protein is broken down into amino acids which has the nitrogen removed by the liver, forming urea. Urea is carried through the blood stream to the kidneys, where it's filtered out of the blood and expelled as urine.
Creatinine: Blood test for kidney failure. Creatinine is a waste product from an energy creating process in the muscles. It's released constantly, then expelled by the kidneys. If the kidneys aren't working, it builds up in the blood.
BAC: Blood Alcohol Concentration
ANA: Antinuclear Antibody, antibodies which attack the nucleus of the cell, attach self not just nonself. Their presence indicates an autoimmune disease, like lupus.

From my mentor person, a cardiologist, "BNP levels rise with heart failure and are used to diagnose heart failure. However, they rise to a lesser degree with a heart attack, or really with anything that causes a big stress on the body (like a really bad infection, or kidney failure). But they rise the most with heart failure.

Someone who has a big heart attack, or many small ones, could go into heart failure. So, heart attacks are one of the big causes of heart failure.  Heart failure doesn't really cause a heart attack, but it could certainly stress the heart (and make troponin go up a tiny bit.)

The best uses for BNP are to 1) diagnose heart failure, and 2) monitor patients who have heart failure to try to treat them better, using the BNP to help know when they still have too much fluid in their bodies and need more medicine."

This is interesting. I usually just see the lavender topped tube. They have a holish thing on the top (the blood can go in, but not out), where I guess blood is pulled in through a vacuum. Maybe I'll ask some phlebotomists the next time I'm in the lab how blood drawing works.

Information from medicineplus.gov, healthline, and labtestsonline

Pathology Lab

In the pathology department, I worked with the surgical pathology assistant. The pathology department is a lot less computer-based than the lab. The slide labels are written by hand. The filing system is mostly by hand. Each specimen is given an ID that conveys information; such as this specimen is the 400th specimen of the year at this hospital. The pathology lab goes through about 5000 specimens a year or about 17 a day, while the lab goes through a few hundred a week. 

While the lab normally has four lab technicians and four phlebotomists at any time of the day or night, the pathology department contains the pathology assistant and the pathologist and is only open during normal working hours. In the morning, rings of -25 degrees Celsius ice are made in case slides need to be made quickly. The specimen would be frozen within ice, and then a grinder would take off thin shavings until it reached the right piece of the tissue. The sliver would be put in a slide. 

There is also a procession of dipping juices to self-dye specimens. Usually, intriguing tissue pieces are put in tiny hole punched boxes called cassettes to be dumped in formalin, which will eventually be sent off to become slides. If slides need to be made quickly, they’re dipped in water, various alcohols and dyes, in a specific order, for specific times, until they eventually become dyed in purples and pinks. 

Slides need to be made very fast during procedures such as cancer surgeries where the surgeon needs to know how far the cancer spread so that they know how much they need to remove. After slides are made, the pathologist looks at them either in the tissue room or at their desk, under a microscope, and look for signals of disease.

Usually, there are sigmoid colons with diverticulitis, gastrointestinal scrapings from esophageal cancer (for example), placentas from pregnancies that were strange or didn’t go as planned, appendixes with appendicitis, gallbladders with gallstones and swollen to twice their normal size. The colons are cleaned out and pinned to wax while they sit in formalin for a few hours. Placentas stay in their bucket. Everything else goes in a Ziploc bag with formalin to wait for the pathologist to do a macroscopic inspection.   slide of placenta lining  sigmoid colon

Blood Tubes

Blood is in various color tubes, which denote coagulants, anticoagulants, etc.
Green is for most things. They have sodium heparin or lithium heparin to turn off thrombin and thromboplastin, which clot blood. Inside your body, they make scabs to keep you from bleeding out. Heparin is an anticoagulation thing. Complete metabolic panels are done in green tubes.
Lavender is for CBCs, or complete blood counts, and blood typing. They have K2EDTA on them and go to Hematology. CBCs measure how many red blood cells, white blood cells, and platelets you have and what proportion of the blood they are. It’s one of the most common tests.
Blue is for PT, PTT, and DDQ. They contain Sodium Citrate and go to Coagulation. Sodium Citrate is a reversible anticoagulant. PT and PTT check how fast blood clots. They are ordered for people with clotting issues or people who are on blood thinners, like heparin and warfarin. For PT, blue tops are centrifuged, then kept in a water bath, then calcium chloride is added to counteract the citrate, and finally they test how long it takes for the blood to clot. It should take 11-15 seconds. In PTT, after centrifugation, Calcium, kaolin, and cephalin are added to start the clotting process. A clot usually forms in 35 seconds. Vitamin K deficiencies, liver disease, or other clotting problems would have different results and take longer to clot. DDQ (D-dimer) tries to rule out blood clots as the cause of an issue. If the test is positive, then there’s a big clot building up and breaking down somewhere in the body, but it doesn’t say where or why.
Yellow has a clot activator and gel. It’s spun in a centrifuge, and then the serum is removed and put into a different container. It’s sent to a different lab for blood donor screening or to test for infectious diseases.
Red-brown stoppered are for weird things. They have clot activators and are silicone coated. They’re like yellows because the serum is removed and can be tested for the same things.
Gel separates plasma and blood cells. It has a density between the two, so when centrifuging separates the blood, the gel moves to the middle and keeps it separated. After blood is collected, if there’s a coating on the container, the blood is tipped and flipped a few times to mix the blood. 

How to Be a Laboratory Volunteer

1. Make sure that labels match.
2. Ask more questions.
3. If the test starts with an H, don't spin it if it's blue. (It makes them go bad faster)
4. Always balance the green tubes (same amount in each). You can put four tubes in a centrifuge, but then it's more likely to shake, and if it shakes too much, then it's more likely to break the centrifuge. Folding the label over makes it easier to see the amount of blood for balancing, but only do that for greens, not any other color tube, especially yellows which get sent out.
5. Yellow tubes usually stay in central. They will tell you if they need to go to chemistry instead, but no big deal if you put those in the wrong place.
6. Dark green tops go to chemistry, too. Make sure that they come on ice. If the label says lactic acid, you spin it. If it says ammo (ammonia) or anything other than lactv, ask.
7. Blues are coags. Pinks are hematology. Greens are chemistry. Urines, stool, sputum go to microbiology
8. Blood cultures (bactens) go in the big rectangular boxy thing that you have to pull on the handle pretty hard to pull out. First scan the bar code for the bottle, then the laboratory's bar code for the test.
9. If a tube comes down through the pneumatic chute, open it and get someone to add it to the system. If it's labeled "Blood Bank Only," open it to check if there's a yellow slip. If there's a yellow slip, then it goes straight to blood bank so that they can get a blood transfusion ready to send up.
10. Other things that go to blood bank are (I believe) core samples, which check what the baby's blood type is. They have a blue top and have a baby's name written on them, like Smith, Babyboy. Also magenta, dark pink tops with an extra, yellow ended, label goes to Blood Bank. The purpose of Blood Bank is to make sure that all of the blood types are exactly what the label says, so they blood type the people, the samples, the blood bags to prevent any errors.

It's been a while since I volunteered in pathology, but pretty much, change your gloves whenever they get bloody, which will be often. Label everything. Add enough formalin to cover at least half of it. Placentas need their own special setup bag, with a special towel, a plastic cylinder about the size of cat food containers which you add something like formalin but different, and a few other things. The pathology assistant does the macroscopic inspection of liquids, not the pathologists. Most pathologists do not particularly like to talk. Make cassettes.
I feel like there's more, but I forgot the rest, so this will have to do.

PS. Here's an interesting website on blood tests: ProProfs List of tests and additives in tubes

Pneumatic Tubes

People in the Lab

There are two groups of people in the lab. There's the clinical laboratory scientists (CLS). They do all of the tests on the blood and put it in the machines. They're generally a pretty introverted group. They usually have a bachelor's degree in CLS, although some of them are lab technicians, in between phlebotomists and CLSs for training.
Then there are the phlebotomists. I mostly spend my time with them. There are three shifts: a.m. (4:30 a.m. to 12:30 p.m.), p.m. (12:30 p.m. to 8:30 p.m.), night (8:30 p.m. to 4:30 a.m.). I work with the a.m. shift on Saturday mornings. There are career phlebotomists, and there are people who are phlebotomists while they go to school, or to get 1000 hours or so of patient interaction time for graduate school.
I spend most of my time with:

• a former teacher in Afghanistan who immigrated in 1993. Her husband works in another part of the hospital, watching patient's vitals. 
• a woman whose son is a genius with machines and is going to the best diesel mechanic school in the country.
• another woman who is Filipino and whose son is on the football team at his high school
• a last woman who's Creationist and conservative (honestly can't think of anything else that I know about her, probably because she is so hardworking that I haven't tried to interrupt her for a long conversation)

I've been volunteering for a year, around 130 hours. I've learned some interesting things. Phlebotomists don't like wet dark green LACTV tubes which have to be kept on ice, but the labels peel off if they get too wet, so they prefer if the tubes are in a glove or the outer pocket of the biohazard bag, with the ice in a separate compartment. They also don't like leaky specimens, like urines for example (sort of obvious), and they can't do tests on tubes from the ER that come in without a time that the blood was collected. They also dislike unnecessary blood cultures (Bactens), which are cultures where bacteria/fungi in the blood can grow so that they can be identified, but anyways, they take a lot of processing. They're not being lazy; they're just buried in work and need to get on to the next specimen. On the other hand, they don't mind unnecessary blood. Actually, extra blood lets them add on extra tests to the same set of vials instead of having to stick (draw blood from) the person again. Speaking of sticking, one time they told me that they love when doctors let them stick someplace other than the arm when someone's a hard stick. Hard sticks are when the vessels in someone's arm are hard to get blood out of because they've had so many IVs and blood drawn from veins. Other possible places to draw blood are the wrist, the legs, and sometimes the neck.

http://ascendreferencemanual.com/ref/images/stories/large/bactec-culture-bottles.jpg

Bacten: aerobic and anaerobic. Blood goes in the bottle. Bottle goes in a machine for 2-10 days. If bacteria or fungi start growing, there's something wrong with you.

This Required Last Thing From A Really Long Time Ago

First: What is in my Genius Project TED Talk?

Genius Project TED Talk Your Genius Project will culminate in a final, live TED style presentation in which you address the following: What was your initial project and where did you end up? Initially it was making a mentorship website, but now it’s blogging about my volunteering. What were the basics of your intent and idea, and how did that morph into your final product? Look good for colleges. Not too much to do. What have you learned about your passion? Still want to be a pathologist Did your passion change throughout this? What caused that change? Nope What have you learned about your challenges? Try to avoid them What was difficult about this project? What surprised you about what was most difficult? What have you learned about how to impact a community? Did that through other things. Who was the community you intended to reach? Did you reach them? Why or why not?

Now: Plan it out, starting with the end in mind.

Genius Project Plan

Deadline	Tasks to Complete A to-do list of what you need to do to complete your project.	Notes: Who do I need to talk to? What’s their contact info?
April 2017: 4B Winter and Spring Presentations to all juniors and seniors	Memorize TedTalk	Don’t mess up.
March 2017	Make Ted Talk
February 2017	Work on Ted Talk
January 2017	Add a few more posts to blog	Start early and plan it out escessively
December 2016	Check in with my mentor Design a logo for my event using Canva. Is this required?	Call (not email or text) my mentor because I haven’t heard back from them via email in months
November 2016	Blog #6: Where I’m at, what I’m missing, where I need to go from here to be successful in April

I'll put a few more posts maybe. I'm going to include making a giant spreadsheet of Rocks and Minerals in my Genius Project because Science olympiad is next week. I'm going to make that Ted-like talk that we're required to do. Really, I'm pretty much done. I might add a few random shoot offs to my Genius Project because I feel like it, such as: according to my random school surveys, my school is 2/3 white and 86% of seniors have taken an AP. I'm very random. Just pretend that this is part of the blog post that comes before it. I definitely have 6 blog posts.

This is my Genius Project

Plan:
This blog is part of our school's Genius Project, where you do something super amazing that's a challenge, helps society, and you are passionate about.
My plan is to summarize what I learned from volunteering in the lab and pathology departments for the last year in a blog. That's about it. I want to be a pathologist, so I am using this blog to tell all the colleges out there that I'm serious about going into medicine, as in, "see, look what I've learned, I think it's awesome!" I am not an eloquent writer, so this is a challenge. I have bad phrasing, I go off on tangents, and I am too colloquial, although I can have a colossal vocabulary when I please. I usually write like I think/talk, but punctuation does not always function like I hope.
In summary, the benefit to society is that you get to learn about the hospital laboratory. The challenge is that I can't write. I'm passionate because I want to be a pathologist.

I volunteered in the pathology department the summer of 2015 for 3 hours on Monday mornings. I'm going to do a post or two about that. Since school started in 2015, I've been working in the lab for 3.5 hours on Saturday mornings. I've seen a lot of grossly awesome body parts and learned a bit about how the lab and pathology departments functioned.

I was planning on writing one blog post a week for the summer, but I didn't. See below for details.

Status Update:
I have done next to nothing so far. This summer has been way too busy, so that is a problem that I have run into. I am also worried about HIPAA, a law about how healthcare workers have doctor patient confidentiality, so you cannot tell anyone unrelated to the case about what you know. I do not know if I signed anything saying that I could not talk about my volunteering experiences, but I definitely signed something saying that I understood HIPPAA. Just in case, I am not saying any identifying information about me or the hospital. Not to mention, public displays of identifying information make my parents . . . uncomfortable.

 I just have to fit writing in with 5 college level courses, tennis until 5 pm, MUN, 5 Science Olympiad events, Academic League, volunteering, studying for the Chemistry SAT in October, writing college essays, and applying to colleges. Easy-peasy. So, you might be wondering why I was not proactive enough to do this project over the summer. Last summer, I did nothing because I was worried about AP summer assignments and wanted to relax. I got bored, so I decided that this year I was going to be "entertained" all summer and take advantage of all opportunities. I got a job as a summer camp counselor, volunteered in the lab of the hospital, volunteered at the library, took an online psychology class, and worked on summer assignments. It was very productive and has the added benefit of making school look easy in comparison. In conclusion, that is why this is not done yet and is going to stress me out excessively, but not that much, because I'll be too stressed about everything else to be stressed about this.

PS Teacher: I wrote this one over the summer, so it turns out that my adjusted plans are the same as our updated blog post plans. The Genius Project summer assignment page was freaking me out, so I tried to write a few posts before school started just in case 4 posts were due on the first day of school (I only got two done though). I think the stress paragraph still applies, though. It is a summary of authentic challenges.

Photo of a lab

Biteable video pitch. My plan in pretty pictures (and a few ugly ones).