I just got back from LabCon 2012! What a blast that was. Lots of stories and presentations from laboratory professionals across the country and many insights. Not just bench technologists of course; many pathologists, lab managers, internationally trained technologists, quality specialists, lab vendors, lab assistants, you name it! If you ever get a chance to go, I highly recommend it. I got to play with some incredible new technology that toes the line of frighteningly high tech (I’m looking at you, Beckman-Coulter). They also feed you (a lot; at one point there was an ice cream float bar!!), and as a former university student, how can I deny free food?

But as for the blog, for the next little bit, I am going to do a series on preanalytics (one from each discipline) and why they are so important in patient care. After all, you may be the best bench tech in the world, but if the specimen you got was no good, your results will be no good. And a very large majority of laboratory errors are the result of a preanalytic error, sadly.

So anyways, this is just a post saying that I am… Finally returning to tumblr (for real this time). Thank you, followers, for sticking around!

Today, I gained a new horror story to add to my belt of weird clinical oddities. I received a tube full of kidney stones, probably post lithotripsy since it was pretty ground up. This is not weird at all since we get about 3-4 stones a day for composition analysis. 

However, when I looked at the requisition, it said on there, “?worms in kidney”. I had no idea what that meant since I didn’t know worms could be in kidneys, but when I shook the tube and examined more closely, I saw a bunch of tiny bugs that looked like half a centimeter long millipedes crawling around. Perfectly alive.

I think felt some sympathy kidney pains. 

Long time no see, Tumblr! I have been busy with personal things and I apologize.

The first of our month of Instrument Shenanigans, the Tigris, our gen-probe analyzer, is a qualitative nucleic acid test based on transcription-mediated amplification which we use for gonorrhea and chlamydia testing in chemistry. At some point in our run, the instrument got contaminated and about 40 patients all tested positive for chlamydia in a batch run. Chlamydia is pictured above in the vacuoles of a cell off a pap smear (we were actually running urines). 

Luckily, the tech on the bench was astute enough to notice this before results were filed, so it was all resolved in the end.

Cysts of Pneumocystis jiroveci (formerly carinii) in bronchoalveolar lavage, Grocott’s methenamine silver stain.

In this induced argentaffin reaction, chromic acid oxidation forms aldehydes from fungal cell wall polysaccharide components. The reaction is similar to the Periodic acid Schiff reaction, but since the chromic acid is a much stronger oxidizer, background staining by collagen and basement membrane is suppressed (they are oxidized past the aldehyde stage).  The aldehyde groups then react with the silver nitrate, reducing it to a metallic silver, thus blackening the site.

It can be a bit tricky to time since different organisms take up stain at different rates. Pneumocystis can be missed if you understain, but other organisms will come out a black blob (thus making it impossible to see the internal structure) if you overstain.

SEM of fibroblast cells infected by the herpes simplex virus. Fibroblasts are normally long and star-shaped. The HSV2 infected the cells 24 hours earlier, causing them to shrink and become rounded. HSV2 is a DNA-containing virus that causes genital herpes, an important sexually- transmitted disease.

I have a friend who is a virologist and was doing work with adenovirus at one point. Once, he held up a tube after ultracentrifuging a tube to purify the virus and a drop of it had splashed into his eye (and that is why you wear goggles).

He went down into emergency (after flushing at the eyewash station) and the first thing they asked was, “It’s not Herpes Simplex is it?” because herpes keratitis is the leading cause of adult blindness in North America. He didn’t go blind because it was adeno, but it was a ferocious case of conjunctivitis regardless. Ironically, he now researches HSV.