It was a Monday morning at 8.50am and all biomedical students assembled in front of the general hospital where each student received an envelope which contains the programme for the week, the groups each student will be and the departments.
In my envelope was a letter of confidentiality that l had to sign and so did the rest of the other students. I was excited and nervous at the same times because l did not know what to expect and how l was going to cope with the pressure in the laboratories because l finally grasp the fact that it was not going to be all lectures and theoretical but more of Hands on.
At 9:00 am, the assistant manager of the haematology department took my group to the tea/break room at the haematology department where she welcomed us warmly, asked the group to sign in the visitors' book and then went through fire precautions, facilities and general Health and Safety.
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9:30am. She took us to the phlebotomy department which she explained to me that phlebotomy is the act of taking blood for diagnosis or transfusion by a nurse or a physician by a venipuncture from the intravenous veins which l witnessed a this department. From that department, l also learned that each blood collecting tube used in the haematology lab has different chemicals in it to preserve the sample collected and prevent any enzyme or chemical reaction. E.g. Potassium EDTA is an anticoagulant used to preserve Red cells and White cells as these cells die under hot conditions, Trisodium Citrate is used in thrombophilia test and ESR (Erythrocyte sedimentation rate) is used to test how far red cells drop to check for infection.
At 10:00 l had 15minutes tea break and reported at the Lab with the rest of the people in my group where a Senior Biomedical scientist took over and demonstrated how Full Blood Count can be tested using the haematology FBC analyser (Pentra DX120). She also briefly explained some of the principles of the Pentra DX120 and the factors that affect the results. The principles being:
- The Pentra lyses the cells
- Absorbent is directly proportional to haemoglobin at 550nm in the lyses chamber and is measured using the spectrophotometer.
- Red Blood Cells and impediment methods.
Some of the factors l recalls that can affect the result of the Full Blood Count test are:
- Wrong phlebotomy anticoagulant used
- Specimen transport
- Where and how samples are stored
At 10:30 l went on a tea break and returned to the Lab at 10.45 where another Biomedical Scientist assisted myself and the group in examining various blood films and discussed their morphologies.
After looking at the various slides, the Senior Biomedical scientist discussed with my group and l about haemoglobinopathy screening of some genetic diseases like sickle cell anaemia and thelassaemia (this is when there is an abnormal shape of the haemoglobin and the sickle cells carry at least l sickle gene).
12:00 l had a lunch at the cafeteria and my lunch break lasted an hour. I returned to the Lab where l met another Biomedical scientist who showed the group and l about blood transfusion, the blood grouping, where the various bloods are kept for emergency blood transfusions in the surgery and she also explained the importance of the audit trail so the hospital carry out accurate and attain quality results. At 15:30pm she also explained the use of coaglutometer and how clotting occurs which l did have a go on the coaglutometer by performing a PTT (Prothrombin Time) used to control Heparin as INR (international Normalised Ratio) which control Waferin.
The day ended at 17:00 after we had a discussion of each person in my group felt and l personally did enjoy myself in the haematology Lab as things became clearer to me after reading about certain topics e.g. Coagulation.
My only problem is, l wish l could have stayed a little longer or at least 2 days as there were too many information to take in within a short time limit but as far as l am concern, the staff were absolutely friendly and a day at the haematology lab went smoothly.
DAY TWO - MICROBIOLOGY
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My second day was at the Microbiology department and same like the day before, l had to wait at the Colchester general Hospital entrance where the assistant director of the Microbiology department (BOB) came to introduce himself to the group and he showed us where the Laboratory was. I was given a guideline along with my group on health and safety, data protection and most importantly patient confidentiality.
After the talk on confidentiality l was given a lab coat which l had to wear in all the laboratories except during breaks. I had my tea break around 10:00am. At 10:45am, l observed the flow of work through the department from when the samples are received and to when they have been tested and result issued onto a safe computer system. I realised the great deal of trouble all the departments go through to check and cross checking patient details so the right test and result is done for the right person as there might be different people with same or similar names.
There were about 10(ten) different work stations and because the department was under construction and refurbishing, some of the work stations were outside in a temporary building where l finally saw how the autoclave works and also observed a demonstration of Bactec 9240, Tritorius and a Vidas analyser in various work stations.
I spent most of the afternoon at the virology and serology section during which l learned that the whole idea of the virology and serology is to detect bacteria and viral antigens. Some of the specimen used is from serum from clotted Blood e.g. Hepatitis B surface antigen.
Also for various detection of antibodies that are produced to fight against bacteria and viral infection in a vaccination form, the specimen that is used is serum from clotted sample.
and these are detected by (ELISA) Enzyme Linked Immunoabsorbent Assay. I also found out that the more complicated tests such as HIV 1+2 , CMV lgG , Lyme lgG/lgM , Toxoplasma lgG/lgM etc. Is detected using the ELFA (Enzyme Linked immuno Fluorescent Assay) and the tests are carried out using the VIDAS analyser. The only difference between the ELISA and the ELFA test is the ELISA measures a visible colour change where as the ELFA measures a fluorescent signal.
During my day at the Microbiology department, l grew bacteria on an agar plate under the supervision of a Senior Biomedical Scientist. L also understood much about Hepatitis being any change, abnormalities or infection of the liver varying from asymptomatic to anicteric illness to acute illness of long term disease such as Jaundice and possibly lead to death.
Having spent a full day at Microbiology, l found it really interesting and could not expect nothing more as l did enjoy myself but unfortunately, could not find myself working in Microbiology for various reasons.
- I could not stand the smell from specimens and the chemical from all sections and
- The risks of handling nasty bacteria daily. But all in all, it was a wonderful experience and l did enjoy myself
DAY THREE - CELL PATHOLOGY
I have always been interested in Cellular Pathology so knowing that this day l would get the chance to spent time in that particular department could not make me any happier. I got to the meeting point at the general hospital entrance earlier and waited for the other students to arrive.
The Hospital provided us a transport to Chestnut villa which is where the Cell Pathology and Biochemistry Labs are.
Mr Ian Drury who is the head of the Histology department welcomed us and requested l sign in and same with the people in my group. He then talked us through the health and safety and also introduced us to the Histology team. He then also briefly talked about the role of Histology and Cytology within the Pathology services. From that talk, even though l knew and having read from my lecture notes, it did clarify certain about Cellular Pathology. The Cell pathology was Histology and Cytology together. Histology deals with larger tissues and organs and test sees in depth compared to cytology which deals with just cells to predict diseases and helps in diagnosing a disease e.g. cancer or tumour.
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At 10:00am Mr Drury took us to a tour at the Histology department to observe how tissues are fixed, stained and embedded. Small samples of specimen e.g. Skin are cut by the Biomedical Scientist but big samples are cut by the Pathologist.
Formaline completes the fixation and the cut samples are stored in this solution overnight. Xylene removes the alcohol and the lipid and impregnates the tissue. The tissue is then solidifies under -5oC and paraffin is used to remove the xylene.
Every specimen has at least one wax block and it is fixed to the cassette. Sections cut from the specimen in the wax are placed on water and the surface tension of the water extends the wax and gets rid of any creases.
LEICA AUTO STAINER XL does all the staining in larger quantity. Blue Haematoxylin stains the nuclei then inserts the slides into pink Eosin. It washes the stains with alcohol which dehydrates the tissue and makes the red cells bright. The LEICA then adds Xylene which makes the tissue very clear. The cells and tissues on the slides are seen under the electronic microscope.
After a long and interesting observation, l had a break at 10:30am and returned to the Lab at 11am. I spent the next two hours at the Cytology Lab where l went first to the Gynae section and then to the Non-Gynae section. For the Gynae section, l mostly observed and had a go on screening test of a cervical specimen (swab) using the ThinPrep 3000 processor.
Having done the test, l could tell from the results obtained, the abnormalities squamous cells and l had to work out weather it was a CINI and mild dyskaryosis, CINII and moderate dyskaryosis, or CINIII and sever dyskaryosis. I also spent some time at the non-gynae section which l found less interesting.
In the afternoon between 2pm and 4:30pm, l earned that formaldehyde solution preserves the tissue and stops enzyme reaction and also bacteria production after seeing different organs such as an amputated arm, surgically removed breast, testicle and a kidney all due to tumours or malignant cancers. I also learned about various dyes and stains.
DAY FOUR -BIOCHEMISTRY
I knew where to go on this day as Biochemistry department is also in chestnut villa. I got there at 9:00 am, signed in along with the people in my group. A senior Clinician gave us a 30minute introduction on health and safety, data protection, break times, fire and confidentiality as he handed out our Lab coats that we would be using the rest of that day.
Between 9.30 and 10am my group was shown was shown around the Biochemistry department and the flow of specimens from delivery till the carry out of the tests. The specimens are delivered on and out of working hours by special delivery in a well kept and indestructible box.
After my 15minutes tea break, l observed electrophoresis and micro albumin test carried out by on of the senior Biomedical Scientists. I learned that a little amount of albumin in the urine can show kidney damages in diabetics. I also learned that micro albumin can be assessed by measuring the (ARC) Albumin: Creatinine Ratio level through excretion within 24 hours period, as micro albumin is more sensitive. It is also a major blood protein and so can be used to test antigen-antibody reaction.
At 11:30am, a Senior Biomedical scientist explained to my group what HBA1c meant which is when glucose has bound to Haemoglobin and the reaction is irreversible as a result of diabetes. In Biochemistry, HBA1c is the only test done on a whole blood High Performance Spectrophotometer is used (HPS).
I spent the rest of the afternoon after lunch with my group observing various analysers such as AU2700 and Centaur. We also met and had a chat with the Biochemist and it was a very insightful chat with her as the information she gave out really helped me narrow down which department l want to be working and which route of carrier l want to choose. After that conversation with the Biochemist, l could see me working there although it is not just machines but requires lots of hard work.
DAY FIVE -THE FINAL DAY
The last day all Biomedical students who had their summer school had to meet at he conference room at chestnut Villa. There were four groups and four in a group so total of sixteen students and a representative from each of the four departments. We were lectured on how the NHS Foundation Trust works, the politics involved, the management and Budgeting of the departments.
The most interesting part of the day which l enjoyed the most was the case studies. We the students were presented with various diseases and we had to discus which tests for all the departments had to be done to help diagnose and treat the disease. There was also a situation where the students were presented with the results of various test and we had to come out with what the disease was.
We had about 1 hour lunch break and a long informal discussion from Biomedical Scientist who used to be student and so have idea and understands what we the student are going through. One of the biomedical scientists even went through the same route which l chose and made it and currently working at the haematology. We also had a discussion with a Clinical Scientist and a Mortuary manager which to me was a little creepy because l would not want to be working with dead people but hearing from people who had broken through and made it, helped me realise that l could also do it and it is all possible.
The last day of the summer school was a mixed feeling for me because some how l was happy because after my exams and then the experience, l needed a break but then also l did not want it to end as l really had great and not good times but l guessed the whole experience made me realise l can do it when l set my persevere and work hard. So l could say it was a step closer to my dream career of working in the Medical Laboratories to help the Doctor diagnose and research for diseases that have not yet a cure.