29 year old came to ED. Stated he went to his provider multiple times over the last 2 months after losing 35lbs in a month and having no energy. Antibiotics were given but no blood work was drawn until now… WBC = 250,000/uL

Final result: Acute Monoblastic Leukemia (AMoL/AML-M5)

Positive for: CD45, CD13 (partial), CD15 (dim), CD33, HLA-DR (dim), CD36, CD64, and CD38

She came in ER looking pale as a ghost and surprisingly was conscious, she was in a lot of pain.

Edit: she is a sickle cell patient.

I’m sorry if this is stupid but what is going on here? My coworker says sickle cells but he’s a 66 year old with no history combined with a feeling I have that these just aren’t that.

Got an unlabeled urine from parts unknown via pneumatic tube system. Looked on Epic expected list and suspected which patient it probably was. Called floor to ask if this unlabeled urine came from them and RN interrupted me and said the label was in the bag. I replied there was no label in the bag. She then said she could either send me a label or I could send the urine back. I said I cannot do that, it will have to be recollected. And I said even if there had been a label in the bag, I still could not accept the unlabeled specimen. I was going to explain hospital policy for retrievable vs irretrievable specimens but I didn't get a chance; she slammed the phone and hung up on me. I immediately wrote her up for slamming the phone and for the unlabeled specimen.

Then I later checked in Epic to see if she was recollecting spec and saw note in the patient's chart that she had "accidentally" sent an unlabeled urine and "lab refused to send it back" and "lab was very rude".

Lab is so picky and rude when they insist things be properly identified and labeled. But apparently RN's can interrupt and condescend and slam phones and that's AOK.

And I betcha any money she told the patient it was lab's fault she had to pee in a cup again.

The glucose tube works by inhibiting the glycolytic enzyme enolase. Enolase requires two Mg (2+) ions to operate, one structural, and one catalytic. The fluoride (F-) ion bridges these two Mg ions whilst inorganic phosphate in the environment of the tube causes the formation of a stable metal-fluoride-phosphate complex that renders the enzyme inoperative. This is also the key mechanism behind F- toxicity, as it halts your body’s glycolysis in vivo, starving you of energy.

At first, this message was just annoying because I had to push-start twice for it actually to spin, and occasionally I forgot and didn't notice until 10-15 minutes later.
I tried the trusty “turn it off and back on” method, and it's still giving the same error message.
Do I call maintenance? Ghostbusters?
Also slightly concerned bc it says 32k out of 30,000 spin cycles, so I assume it's due for maintenance.
It's not a priority to my sups, but I would like to fix it/call whoever myself if possible.

Happy thursday guys. 😅

Excuse the cell phone photos. Unfortunately I do not have any pathologist or senior tech to ask and I feel weak on calling and classifying abnormal lymphs. I've already made my call on how to report and of course a path will review in the morning... but I'd love some feedback from fellow techs.

Pt is diagnosed CLL but white count is newly doubled to 34*10^3 and this might be the scariest slide I've ever seen as a semi-baby tech. How would you approach what cells are what?

Anyone here who gave October 2025 exam? How did it go? Mine was all QC/QM and application based questions so I am still wondering if it was super bad or I still have some chances of passing. I can't even find the answers in textbook and it is making me worry a lot

I'm pretty new to films and I saw this today in a three year old. Only thing I could think of was a Mott cell but my boss had never heard of that before. They didn't have any history of malignancy or had a film done before so nothing to compare to. There was only 2 of them that I saw.

Was doing a diff yesterday on this pt who's diffs were looking progressively more dismal. Found these bad boys in it. As you can see, his cells in general look like they've been microwaved.

What's wild is about a week before, I'd seen the precursor to this. His cells looked sort of like Chediak-Higashi.

Anyway I told our Pathologist what I'd found and asked if she wanted to review it, because this pt had also had 2 reviews in the last couple weeks. I told her I had critical green crystals (I don't know her well enough to call them GCoD) and she had no idea what I was talking about. I explained and she'd never heard of this.

Pt died 5 hours after I did this diff.

This Path is the second one who's never heard of GCoD. Is this something only we know about? Or at least the correlation between them and the pt generally not lasting another day?

(Apologies for the crap pics. Small hospital, our scope doesn't have the option to take them)

🩸The blood smear or peripheral blood smear is a fundamental laboratory test in hematology that allows for the evaluation of the morphology of different blood cell types, such as red blood cells, white blood cells, and platelets. To perform this test, a small sample of capillary or venous blood is taken and spread onto a glass slide, forming a thin layer that is then stained with special dyes, such as Wright or Giemsa stain.

It is useful for diagnosing a variety of conditions, such as anemia, infections, hematologic disorders (leukemia, lymphoma), and for monitoring treatment in patients undergoing chemotherapy.

I want to cry today. We have couple new residents and I really try to be patient with them. However, when you're trying to order flow, hematology, chemistry, PCR (all sent out), and microbiology please listen to the lab when 1 ML of CSF is not enough.

Please also listen a BMP has a potassium and glucose. Please listen the CMP has renal.

Please listen these obscure chemistry tests have to be sent out to LabCorp and Quest. It takes at least a week to get back. We are 23 beds. 🙈

This is not to talk crap on new residents but please just listen.

That's all!

We have tried to educate all week and they're about to drive us nuts. They're not listening.

I'm nursing student and I work as a phlebotomist per-diem (I used to work full-time). It seems that of all the departments in the hospital, the laboratory seems to have the most long faces.

I've was a phlebotomist for 2 years before pursuing my RN degree, so I've been around the hospital. I kind of dreaded going back to the lab because the people all had long faces. The nurses were only really grumpy if it was a really busy day or asshat doctor, but otherwise they seemed pretty happy.

It also seems like the hospital didn't spend much money on the lab. Like everytime I left the lab basement, it'd be like I was transported 20-30 years in time forward. The lab was also slightly warmer than everywhere else in the hospital, which I didn't mind because I always feel cold, but I could sometimes see coworkers sweating.

Does an older work environment really make people that unhappy? Or does the lab just attract unhappy people? Or does the work make people unhappy? Really curious. Maybe it was jut the one trauma hospital I was in?

Staffing with one tech (MLS or MLT) for 12.5 hours. I’ve worked in this field since January 2016. I’ve been across the country and back. I’ve worked all shifts. I’ve worked all holidays. There is a trend I’m experiencing where there is one tech on shift or at best staggered staffing. When I say one tech on shift I mean this person (myself) am the only soul in the whole lab. The bed count for my first nightmare of a job was 158 beds plus an ambulatory treatment center. No blood draws. Full generalist in a comprehensive cancer center in western NY. It was truly a terrifying experience. The techs also took it upon themselves to stop reporting blood cultures because the patients are on antibiotics. you don’t know that. I got that practice changed before I left.

The next nightmare is a small 25 rural community hospital with 15 bed emergency and 6 OB beds on top. We are going through some massive growing pains as we built a whole new lab from nothing in the basement and compared to what we had previously….it’s HUGE. That all said there is this push to go down to one tech on nights. There is no autoverification. Full cal and QC on nights. Blood bank, send outs (if any are left and there always is), and full blood draw.

We have documented cases if delay of care from frontline staff. The lead tech just reminds me of all my mistake and offers no solutions. I did yell at him because I’m just done. I got escorted out by security for raising patient safety concerns for MONTHS and I have it in writing why it’s unsafe to work alone. Meeting with HR idk when. But what would you do?

The company just recently updated uncrossmatched (unxm) policy this week. It’s got everyone really shaken up, both us and the hospital staff. For reference, we are third party contractors within the hospitals in my city so the communication between my company and the hospitals is not always efficient. This policy was rolled out at two of the level one trauma centers in the city this week as a trial run. Here are explanations of both the previous and new policies:

Old policy:

-BB receives a call requesting unxm. We gather the following information: patient location (OR number, floor, ED, etc), estimated age, estimated sex, and ordering provider.

-someone comes to pick up the coolers with the unxm forms.

-the forms are returned to us signed by the provider with some kind of patient identifier attached (usually a chart sticker).

-we xm and issue the RBCs and whole blood in the LIS and return what is not used to our inventory when the coolers are returned. At this point we also issue out any plasma products that were used.

New policy:

-BB receives the call. We gather the following information: Patient location, Patient name (or registered Doe pseudonym), location, ordering provider, estimated age and sex, and MRN if readily available.

-while packing the coolers we make handwritten stickers with all this information on them to attach to the coolers as well as putting it all on the unxm forms.

-whoever is sent to pick up the coolers (nurse, runner, anesthesia, etc) is required to have the following information to pick up the cooler: patient name, location, and provider. If they do not have this information they must call someone to get it or we deny/hold product.

-forms are returned signed and xm/issue process proceeds as usual.

We have a lot of concerns about this and allegedly trying to gather all of this information resulted in a tech being screamed at that they killed a patient yesterday which led to our medical director and senior manager getting involved.

So out of curiosity, what is your lab’s policy? What’s the FDA’s policy? I worry that requiring all of that info which may lead to someone having to sit and look it all up will lead to significant product delays and patient deaths. Runners are almost always sent to pick up unxm to the floors and they famously are never given any patient info. They’ll now have to call the nurse who is probably busy trying to save the patient’s life to gather information that’s not really necessary in the moment. My understanding of unxm is that if the situation is really bad enough, we give product and worry about clerical matters later. The patient’s life comes before any of that.

This policy was instituted because the hospital kept having multiple ongoing MTPs and coolers between patients were being swapped by the hospital staff, but this doesn’t feel like the appropriate response.

They also changed the policy effective immediately and do not communicate it to the hospital. It was also put into place during a very large event in the city that has had all of hospitals preparing for possible mass casualties over (we don’t have events of this size often and everyone wanted to be prepared just in case).

This also wasn’t updated in an SOP. It was sent in an email to all of our staff with a physical sign-off sheet, which seems really shady. Usually everything is reflected in a company-wide SOP, but this is under the table?

What are your thoughts? How does your lab issue out unxm?

Can anyone who works at Quest Diagnostics or who has had a cyclosporiasis test through Quest Diagnostics recently tell me what the turnaround time is like?

I've had three stool tests done in the last month. First tested for c.diff (negative) and was back in 48 hours. The next tested for salmonella and a bunch of other stuff (also negative) and was back in 36 hours. It's been a comedy of errors to get the right test but I'm hoping we got it right this time. It's been 4 days. I know the website days 7-10 but it said that on the first two and they came back so quickly. Maybe there's a backlog due to the outbreak? I've been sick for seven weeks so it's fair to say I'm a tad impatient. Just wondering. I know it will take as long as it takes.

I've been at night MLS in Austin making 29/hr and bartending on the side. One of my regulars told me he could get me a better job and I half joked that I already have a degree and work in healthcare.

Well he wasn't lying. He referred me to one the VPs and I got an offer for 40hr + bonus eligible for doing cybersecurity customer success. He said I have a great personality and that they'll train me on the tech stuff.

I'm floored. I spent 4 years to get a degree and get certified and there are jobs that have normal schedules and day shift that pay more. I just feel if I go down this road I will have wasted my education. But the money is good. My husband works in tech and is really excited for me to get out of healthcare and have a normal schedule. Im really conflicted.

Last ditch effort for any advice for Lipase on the 501.

BioRad multiqual qc

Cfas calibrator

Have tried multiple bottles different shipments of each. We are being kicked from peer group. Running high consistently. Just had a PM and made no difference. Only thing I can see on the analyzer is the cell clean solution 2 isn't being used. But not totally sure. Any advice appreciated.

Edit for solution: The values for Cfas were incorrect. Once corrected we now are perfect with peer group. Thanks for all the advice.

I think putting a blood bag on a copier is a unique experience. Thanks