BIOMEDICAL LABORATORIES On the testing trail

By CATHY SECKMAN
VINDICATOR CORRESPONDENT
LIBERTY -- The patient at Biomedical Laboratories grimaces and turns her head. She hisses in through her teeth as a needle pierces the tender skin inside her elbow. She holds that breath until the needle is withdrawn, then sighs in relief. She carefully avoids looking at the vial of blood as she yanks down her sleeve and makes a quick exit from the lab's drawing room.
What about that vial of blood? Did you ever wonder where it goes, what happens to it? Follow along; you might be surprised.
To begin with, there are different kinds of vials.
Whole blood is collected in an anticoagulant vial. Blood that will be separated into red and white blood cells and serum is collected in a serum separator tube pre-loaded with barrier gel. Still another vial contains a preservative that keeps blood sugar from degrading. That's why the phlebotomist (person who "sticks" you) sometimes draws your blood into separate vials.
The first stop for the vial is at a computer, where handwritten information is logged in and bar codes are attached to the vial and its accompanying paperwork. Every machine and computer in the lab can read the codes to double-check that the right tests are being performed.
A 10-minute ride in the centrifuge is next for blood that needs to be separated.
More needles
In the chemistry department, Maggie Crowley, a medical technologist at the lab since 1978, sits behind a safety screen to remove rubber stoppers from vials of separated blood and load the vials into trays.
She checks each bar code against a printed list. The trays go to a machine the size of a chest freezer that looks like it belongs in an H.G. Wells novel.
Cogs turn, lasers flash to read the bar codes, vials are jerked away, and testing begins. A needle sinks into a vial, rises, spins, and spits the sample into curvettes (small test tubes) in a revolving tray. Depending on orders read from the bar code, that might happen several times until the vial is whisked aside and another takes its place.
Each needle and its tubing is disinfected by a washing system between vials of blood or serum.
Into each curvette, reagents are added by more small, spitting needles. Measurements are taken, reactions noted, and results scroll onto a computer screen.
Crowley is at the screen, checking the readout. Any abnormally high or low reading will be investigated, and the test repeated. She accepts or rejects each entry, and at that point accepted results can be faxed directly to the requesting physician or veterinarian at the touch of a button.
"For a routine test," says lab owner and medical technician Connie Parks, "once the sample is in the lab, we aim for a turnaround time of an hour. Our goals here are to be correct, to be efficient and to be quick."
Visible results
In the hematology department, medical technologist Denise Naughton works with whole blood. "My role is visual," she explains. "I make sure we have a viable specimen, make sure the paperwork matches, test the machine."
Lab machines are tested and calibrated before each shift. Commercial and in-house controls ensure each is operating accurately, and results are meticulously logged.
On this machine, the sampling needle goes right through the rubber stopper capping each vial. Blood is whisked through a tube and into a testing chamber, where it can be mixed with reagents for whichever test is listed in the vial's bar code. Washing fluid flows down the tube, and the next vial jerks into place. Naughton estimates they might move 100 to 150 vials through the machine at each shift.
On her screen, abnormal values are marked in pink or red. She orders the computer to repeat that test, and may add it to a panic log, a handwritten list for notifying physicians.
Microbiological testing is handled around the corner, where medical technologist Patty Rudolph tests blood and other body fluids with the Vitek Two, a state-of-the-art machine that, Rudolph says, "even hospitals wish they had." The Vitek not only identifies bacteria such as E. coli or strep, it reports on their susceptibility or resistance to various antibiotics.
Blood agar plates are used in this department, along with an old-fashioned microscope, for some testing.
After its almost surreal bar-coded trip through mazes of machinery, each vial of blood is refrigerated for one week in case additional tests are requested, then discarded as biohazardous waste.