By Erin Lamson, Grace Cottage Lab Technician as originally appeared in the Brattleboro Reformer’s Graceful Health series, December 2, 2016
Have you ever visited a lab for blood tests and wondered what happens to your specimen? If you have, you’re not alone. Lab testing happens behind closed doors for obvious safety reasons, leaving the clinical laboratory nearly invisible to the public eye. As a result, clinical lab professionals have one of the least understood roles in health care, even though a recent estimate suggests there are roughly 300,000 laboratory professionals in the United States.
The Centers for Medicare and Medicaid (CMS) claim over 7 billion clinical lab tests are performed annually in the U.S. Tests range from relatively simple ones like finger-stick glucose tests, to highly complex ones requiring special expertise, such as molecular diagnostics. Most tests are considered moderately complex, including common tests like cholesterol levels. Regardless of complexity, test results provide helpful, sometimes critical information to healthcare providers and their patients.
Before arriving at the lab, you typically stop at registration and are asked your name and birthdate. You’re asked again by the phlebotomist who draws your blood. You may be surprised at how frequently you’re asked for this information. No, we’re not forgetful! Double and triple checking helps ensure proper identification. This is fundamental to the entire lab process. What good are accurate lab results if they’re not your results?
Patient identification is critical. At least two unique identifiers, such as name and birthdate, are required on all specimens prior to testing. These should be labeled in your presence, before you leave the lab. If you’re dropping specimens off, be certain to include your full name and date of birth on all specimen containers.
Lab tests are also labeled with a bar code number, but rest assured that no one in the lab thinks of you as a number. We know that critical decisions will rest on your test results. Even though lab tests are numbered for record keeping purposes, we always remember there is a person connected to that sample.
Once collected, blood specimens are routed to different areas within the lab. Specimens arriving from the emergency room are marked STAT and are given priority.
The majority of tests are performed within the highly automated “core lab” with machines that test chemistry, hematology, coagulation, and urinalysis. Chemistry and hematology equipment are the “workhorses,” handling the largest number of tests.
Most chemistry blood specimens require centrifugation prior to testing. Tubes of blood are spun at high speed, forcing cells to the bottom, separating them from the liquid which is required for many tests, including glucose, electrolyte, cholesterol, enzyme, vitamin, and mineral levels, and to determine the level of therapeutic drugs to see whether dosage needs to be adjusted.
While chemistry focuses on the liquid portion of blood, hematology uses whole blood to consider the cellular components. Basic hematology testing includes measuring the number of red cells, white cells, and amount of hemoglobin. A decrease in red cells or hemoglobin indicates anemia. The results sometimes lead the lab tech to make a smear of the blood so it can be examined with a microscope. When examined microscopically, sometimes the shape of red cells can hint at the cause behind the anemia, such as iron deficiency.
White cells are a vital part of our immune system and help fight off infections. An increase in the overall number of white cells may indicate infection, and higher percentages of certain types of white cells may be clues to the infection’s source, whether bacteria, viruses or parasites. When examined microscopically, white cells may also reveal the onset of various diseases.
Automation plays a vital role in the lab, but that role should not be overestimated. Interpreting the results requires special knowledge. Clinical lab professionals are often the first to observe unusual results that trigger the need for further investigation. Less automated areas of the lab, like microbiology and the blood bank, rely heavily on a lab tech’s experience. Microbiology involves interpreting the growth of bacteria and fungi in common infections like strep throat and uncommon infections like bacteria in the bloodstream. The lab’s blood bank requires very strict adherence to established procedure while also relying on a tech’s expertise.
All clinical labs in the U.S. are highly regulated by the federal government. They must hold a Clinical Lab Improvement Act (CLIA) license. All clinical labs undergo regular and rigorous inspections, insuring quality results and patient safety. Certified lab personnel pass board exams offered through national organizations such as the American Society of Clinical Pathology. Like other medical professionals, they are required to maintain their certification with continuing education. All testing personnel are continually required to perform proficiency testing, with results being compared nationally to their peers throughout the U.S. and reviewed by CMS. This level of scrutiny, along with mandatory quality control, should provide confidence in your test results.
Like all hospitals in our region, Grace Cottage cooperates with a network of reference labs. Not every lab performs every possible blood test. Unusual, esoteric testing is referred to large national labs like Mayo Medical Laboratories, where clinical labs and their patients from around the country can benefit from both staff expertise and economy of scale.
Grace Cottage can collect samples for any test your doctor orders, even if the sample must be sent elsewhere for testing.
Hopefully this article has provided a glimpse into the role of clinical lab in your healthcare. We’re kind of like detectives, working behind the scene to uncover valuable clues to your health!
Bio: Erin Lamson is an ASCP certified laboratory technician. She joined the lab team at Grace Cottage Hospital in 2010, and is a graduate of the University of Connecticut.
