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Lab Detectives: The Journey of a Lab Specimen

April 20, 2015
Authored by Laura Wittenberg, DKH Laboratory

When your doctor orders a lab test, do you ever wonder where your blood or other specimen goes and what's involved in getting the results? It can be quite a journey, and involves lots of "detective" work that can make the job quite exciting. 

Here are just a couple examples of how I and my colleagues in the Laboratory at Day Kimball Healthcare work together with your physician to hunt down clues about what might be making you sick (and how we can get you well again!)...

The Case of the Sudden Lower Back Pain

A patient comes to the Emergency Department (ED) with terrible lower back pain.  She can’t even go to the bathroom without awful pain! But she hasn't done anything to injure her back... What could it be? To help find the answer, the ED physician orders blood and urine tests. 

Now, it's up to the lab to try and find the clues that will crack the case...

The lab receives the specimen from the ED.Investigation #1: The Bloodwork

The tubes of blood come from the ED to the Laboratory through a pneumatic tube (like the ones at the bank drive-through window) and get registered in the DKH Laboratory dispatch system. 

One tube gets "spun down." This means we put it into a centrifuge where it spins at 3000 rpm for 10 minutes. When it is done, all the red blood cells have settle down to the bottom of the tube and all the plasma sits on top. It is a good way to get the red blood cells and plasma well separated, since we use the different parts of the blood for different tests. This first tube gets sent to chemistry for a Chem14 (14 basic chemistry tests of the blood). The other tube goes to Hematology for a blood count.

Investigation #2: The Urinalysis

The urine sample collected from the patient in the ED is sent to the lab for a urinalysis. 




The Findings

The blood chemistries come back as showing kidney problems. In hematology, the blood count comes back showing lots of white blood cells, so to investigate further the tech stains the blood and looks at it under the microscope. 

Mostly neutrophils are visible, a type of white blood cell that acts as sort of a "first responder" when inflammation due to infection or injury is present in the body. 

Meanwhile the urinalysis comes back as abnormal as well, and the laboratory technician finds that it is loaded with bacteria and white blood cells. 

Looks like a urinary tract infection! 

To pinpoint exactly what type of bacteria is causing the infection, the tech streaks the urine on a plate and the next day it grows into a pretty pink E. Coli. 

This pure culture can now be tested against different antibiotics to see what will best help the patient.



The Case of the Mysterious Exhaustion

A teen comes into the lab for blood work ordered by his doctor’s office. He has been exhausted for days. His mom thought he was just up too late texting his buddies, but now he has a fever too. Time to search for clues about what's behind this mysterious malady....

The Investigation 

drawing bloodBlood is drawn and sent to DKH Laboratory dispatch to be registered. 

One tube is spun down and sent to chemistry for a Chem14 (14 basic chemistry tests of the blood). Another tube is sent to Hematology. 

The chemistries show elevated liver enzymes. 

Hematology finds that the blood count has lots of white blood cells. When the laboratory technician looks under the microscope, she sees mainly lymphocytes, a type of white blood cell that normally increases as a response to viral infection. 

So next, the Chemistry tube is sent to Immunology. A test is performed and the results come back...


The Findings

The blood tested positive for mononucleosis, a viral infection commonly called "mono" and often contracted by adolescents and teens.




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