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Lab Reporter
OSMH
170 Colborne St. W
Orillia, Ont.
L3V 2Z3
Lab STATs
April 2014
Issue 6
Inside this issue:
Written by Malery Tatone
There are over 1.2 million lab
tests performed on a daily
basis in Canada. That is
equivalent to approximately
one test done every day for
every person living in the city
of Ottawa. Laboratory tests
are valuable tools regularly
used by physicians to
diagnose, monitor, and treat
patients. Each test provides
vital information that guides
medical decisions. Canada Health
Infoway (https://www.infowayinforoute.ca/)
Medical Laboratory
professionals are one of the
largest groups of health care
professionals in Canada.
Approximately 70% of lab
results have a direct and
immediate impact on a
patient’s diagnosis.
Physicians rely on these
results in order to make
critical decisions, for the best
possible care of the patient.
According to the Canadian
Society for Medical
Laboratory Science (CSMLS),
approximately half of
Canada’s Medical
Laboratory Technologists are
expected to retire in the next
13 years. It is expected that
in the 2011-2020 period,
there will be an excess of job
openings to job seekers.
Canadian Occupational Projection System
(http://www23.hrsdc.gc.ca/occupationsum
marydetail.jsp?&tid=51).
Registered Medical
Laboratory Technologists
(MLTs) require postsecondary education from a
certified school that
encompasses supervised
practical training, and
successful completion of a
national certifying exam.
This group must be
registered with and licensed
by the College of Medical
Laboratory Technologists of
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Ontario (CMLTO) in order to
use the title “Medical
Laboratory Technologist”
while practicing in Ontario.
According to a new graduate
survey conducted by the
CSMLS in 2012, 90% of MLTs
and 97% of Medical
Laboratory Assistants
(MLAs) are employed, 83%
and 44% (respectively) work
in a hospital setting, 85% and
54% work at certification
level, 50% and 33% work in a
preferred discipline, and 57%
and 36% would choose this
profession again.
Body Fluid
Collections
2
LIS
2
Sudoku
2
Histology
Uncovered
3
ESBL Screening
3
2013 Board
Award
3
All About
Antibodies
4
For more information
regarding MLTs and MLAs,
please visit csmls.org.
A Visit from Bruce Stanton, M.P.
Written by Pam Calverley
The Canadian Society for Medical Laboratory Science is a
national certifying body for medical laboratory technologists
and medical laboratory assistants. It is a not-for-profit
organization that is funded entirely by membership dues.
Their purpose is to promote and maintain a nationally
accepted standard of medical laboratory technology by
which other health professionals and the public are assured
of effective and economical services and to promote,
maintain and protect the professional identify and interests
of the medical laboratory profession. Our Laboratory had
the opportunity to host Bruce Stanton, our Simcoe North
Member of Provincial Parliament, to demonstrate firsthand
the exceptional role that our profession plays within OSMH.
Don’t Delay…Send It Today!
Written by Malery Tatone
Infection of otherwise normally sterile
body fluids often results in severe
morbidity and mortality. Body Fluids
should be transported and analyzed
as soon as possible, in the correct
collection containers, as body fluid
components, such as cells, will
degenerate rapidly.
The Laboratory supplies body fluid
collection kits which contain
everything necessary for a successful
collection.
It is important that the appropriate
collection tubes/ containers are used
as they have different anticoagulants
to serve the different tests required.
Lavender tubes contain potassium
EDTA, which prevents clotting. This
allows for free-flowing cells in order
to obtain accurate cell counts. If a
clotted sample is received, it is
rejected as cell counts will be
erroneously low. This tube cannot be
used for Chemistry tests. Potassium
EDTA contains potassium which acts
to bind calcium to prevent clotting.
This interaction between the
anticoagulant and the whole blood
will therefore yield false Chemistry
results.
“All cancer is diagnosed
through detailed tissue
analysis through a
microscope. With
almost 500 cases a day,
that would be enough to
fill 7 and ½ city buses.”
Green top tubes are used for
Chemistry and crystal tests. They
Canadian Cancer Society
(www.cancer.ca)
also have an anticoagulant (lithium
heparin) so that the sample does
not clot, or interfere/ destroy
crystals, if present. This
anticoagulant will not interfere
with any Chemistry tests required.
Red tubes contain no anticoagulant
and are sterile for Microbiology.
This way the sample is not
contaminated, is a “neat” sample,
and if any bacteria are present,
they will be preserved. This tube is
unacceptable for other testing as
there is no additive to prevent
clotting of the sample.
The Cytology container provided
also contains an EDTA
anticoagulant. This provides freeflowing cells and cellular support
during slide preparation, allowing
cells to be examined individually
for any abnormalities, which is
essential for an accurate Cytology
report.
The sterile container is used for
large-volume fluids such as
dialysate fluids, to be sent to
Microbiology for culture. The
larger volume allows for a greater
chance of detecting the presence of
any bacteria that may be present.
LIS
Written by Margo Strachan
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Sudoku: Use the letters from the word
“CHEMISTRY” to complete the puzzle.
The workload for the testing done in the Laboratory is collected by the
Laboratory Information system (LIS). We undertook a review of all
workload over the past year. Extensive examination of the Canadian
Institute for Health Information (CIHI) standards and critical review
of all laboratory testing was done in each department. With the
assistance the Finance department and Decision Support, all LIS
workload has been reviewed and modified as appropriate by April 1st,
2014.
Access to all patient results in Meditech is available. Anyone wishing
access to these can contact the IT department.
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Histology Uncovered
Written by Margo Strachan
Most Laboratory
departments test blood and
body fluids, but the
Pathology department is
primarily interested in body
tissues.
It surprises people to learn
that the majority of our
samples do NOT come from
the OR. Most of our work is
collected in the Out Patient
Clinics, Endoscopy and in
the Diagnostic Imaging
department.
Small biopsies or skin lesion
excisions are taken from
suspicious areas and sent to
Pathology for examination.
The result of these biopsies
and excisions often
determine if further surgery
or treatment is required.
We also offer Cytology
service to the hospital.
Cytology is the study of
individual cells. The
Cytotechnologist prepares
and screens the sample for
abnormal cells before
submitting the slide to a
Pathologist.
We utilize 2 technologists in
the role of Pathology
Assistants. They perform the
gross dissection of tissues not
previously diagnosed as
malignant.
All samples received in
Pathology are reviewed
microscopically by a
Pathologist before being
reported.
ESBL Screening Written by Anne Cook
Last year, in accordance
with best practice, the
Microbiology department
at OSMH began screening
for ESBL producing
organisms. Those patients
meeting the criteria
established by Infection
Control, are now screened
for MRSA, VRE, and ESBL.
Extended-Spectrum BetaLactamases (ESBLs) are
enzymes that can be
produced by bacteria
making them resistant to
the commonly used betalactam antibiotics
(cephalosporins and
penicillins). The lack of
treatment options
combined with the
transmissible nature of
ESBL resistance
mechanisms, results in a
significant threat.
At OSMH we use a
chromogenic screening
agar, which prevents the
growth of most organisms
but enhances the look of
the ESBL producing
bacteria as they produce
distinctive colours on the
plate. Suspicious colonies
2013 Board Award
Written by Pam Calverley
The Laboratory was the
successful recipient of the
2013 Board of Directors
award in the category of
Sound Stewardship and
Operational Excellence.
Sue Johnstone, Graham
Richards and Amy
Calupig collectively
worked together as a team
to suggest, research and
implement a budget
initiative that will save the
department
approximately $10,000
annually.
are then tested against a
set of antibiotic disks.
The growth pattern
around these disks
confirms or disproves the
presence of an ESBL.
Fortunately, the vast
majority of the screens
are negative. When a
positive ESBL organism
is found, the Infection
Control protocol is
followed to prevent the
spread of the bacteria
within the hospital.
Considering all the tissues
and cells in your body, 25
million new cells are being
produced each second. That’s
a little less than the
population of Canada…every
second!
Med India Network for Health
http://www.medindia.net/facts/index.asp
?startpage=1
3
Antibodies are proteins
made by your body that are
found in your plasma and
serve to attack and destroy
red blood cells with certain
foreign markers, called
antigens, on them.
We naturally
make antibodies based on
our blood type. Type O has
antibodies against type A
and B, type A has antibodies
against type B, type B has
antibodies against type A,
and type AB does not
produce antibodies against
other ABO types.
Antibodies need to be
identified to find compatible
red cell units in order to
prevent mild to severe
transfusion reactions as a
result of your body
destroying the donated red
cells.
Blood type AB Positive can
receive any blood group.
If the antibody screen is
positive, the antibody must be
identified so that the patient’s
system does not destroy the
donated cells.
Rh is the largest of the blood
systems with more than 50
antigens residing in the RBC
membrane. Rh negative patients
have naturally occurring antibodies
to Rh positive cells. 0.03mL of Rh
positive red cells is enough to
cause antibody creation in an Rh
negative patient, and is the major
cause of Hemolytic Disease of the
Fetus and Newborn.
Your
risk of
developing
non-ABO
antibodies
increases
through
pregnancy
and blood
transfusions
due to increased
risk of exposure of
foreign antigens.
Antibody screens are used to
detect any unexpected antibodies
in the serum.
DSC. Blood Facts. Retrieved from http://www.dsclebanon.org/blood_facts-group_blood_basics.php.
Leslie Shepherd (2012). St. Michaels to Create Centre for Patiend Blood Management. Retrieved from
http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2012/20120913a_hn.
CBS (2014). Transfusion Related Acute Lung Injury (TRALI). Retrieved from
https://www.blood.ca/centreapps/internet/uw_v502_mainengine.nsf/page/Transfusion_Related_Acute_Lung_Injury-TRALI.
ORBCoN (2011). Bloody Easy 3.
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Antibody identification can be
a lengthy process, depending
on what reactions are seen on
the identification panel. Once
identified, compatible blood
can be located and
crossmatched.
Locating
compatible blood
can sometimes be
very difficult as
frequencies of
antigens vary, and
phenotyping red cell units can
also be time consuming.
When donated, whole blood is
separated into plasma, buffy
coat, and RBCs. Female
plasma fractionation is used
to manufacture albumin and
IVIG. Male plasma is used for
transfusion, and the
production of cryosupernatant
and cryoprecipitate.
Female plasma is not used for
donation as multiparous
women may have antibodies
with incompatible proteins,
which have a higher risk of
causing TRALI.
Ontario transfuses more than
400,000 units of
red cells every
year. In 2004/
2005 Candian
Blood Services
collected
approximately
850,000
units of
whole blood.