Who runs those tests your doctor orders on you? We're medical laboratory professionals, AUA!

No question. Just sincere thanks for the work you do and one of the best AMAs I have ever read.

Thanks! It's always really nice to have people show some appreciation when most people don't even realize we exist.

So there is a lot of negativity in the medlabprofessionals subreddit (pay being the biggest gripe). Would you recommend this career to others trying to decide what they want to major in?

Yes, I would. I personally disagree with the negativity and I think that it's a big part of the reason why we can't find enough people who want to go into the field.

I love what I do. Med tech school is HARD (my flair is supposed to tell you I'm a student but it's MIA right now). I am graduating friday and have two finals due tomorrow- one of which is a cumulative clinical chemistry final which covers 10 credits of clinical chemistry over the last two semesters. I have poured my life, heart, and soul into tech school. Could I have gone a different path and be making more money? Sure. But every day I learn something new while saving lives. To me, that's worth a pay cut.

Plus, the pay isn't as bad as the gripers might lead you to believe.

What's the weirdest result you've gotten from a blood tests or any lab you've done?

One of the tests performed in the lab is the Prothrombin time. This test is used to typically monitor oral anti-coagulant therapy (blood thinners) the normal value is 0.8-1.1 for people not on anti-coagulants, and 2.0-3.5 for people who are at risk for clots. I had a value the other day of >20. What this means is that the blood, after the addition of reagents that are supposed to make it clot, never clotted. This patient had no ability to stop bleeding whatsoever.

I had a coworker who had worked in Hawaii that regularly saw INRs of >5 and the docs didn't care. People of Asian descent often have a mutated version of the enzyme which metabolizes warfarin.

Hopefully this is one that all of us respond to, but for me personally it was on a semen sample for fertility analysis. The sperm cells were all extremely immature, huge with bizarre morphology. It has been a while, but I believe the diagnosis ended up being testicular cancer.

How are cholesterol levels measured from a blood sample?

Different labs will use different methods. A common one is to use an enzyme which modifies the cholesterol molecule and produces a hydrogen peroxide molecule. The hydrogen peroxide molecule then reacts with another chemical present which produces a red color change. The "amount" of red pigment produced is proportional to the amount of cholesterol present, and a device called a spectrophotometer is able to measure this by shining light on the sample and recording how much of that light is absorbed. The computer then calculates the concentration of cholesterol.

Hey guys. Any tips for a high schooler on getting into the medical field? What's the most rewarding part of your job? What do you think is the most interesting part of the human body?

BTW - My parents are MD/PhDs. My mom's a practicing physician (Internal Medicine) and my dad does academic/research/administration stuff, he retired from practicing wayyy back in the day.

I'm going to be helping him out with research in and out of the lab/clinic this summer, and I want to go into medicine when I go to college. I love reading insightful stuff like this and interacting with medical professionals, so thank you for this opportunity.

Thanks for the AMA and thanks for the hard work you do!

The most rewarding part of my job is when I'm able to give the doc that last piece he or she needs to save the patient. My lab had a patient recently that came to the ER unconscious. The ER doc started treating for drug overdose until he got CBC results back and saw signs of an infection. Then, he sent us spinal fluid and we were able to show that the patient had no glucose in her CSF and our micro tech found gram negative diplococci in the gram stain. All the pieces fell into place and the doc was able to quickly diagnose meningitis and save the patient's life.

This is the perfect example of why we are so important.

One of my old coworkers had a t-shirt that said, "without us, the doctors are just guessing."

I would buy this. Next venture /r/medlabprofessionals clothing line?

I think ASCLS was selling that shirt for lab week a year or so ago. I bet you could find it.

Hi!

So do you sell blood specimens to vampires on the side to help make ends meet like in True Blood?

Nope! In most laboratories blood is kept for 7 days in case a doctor wants to order more tests or we need to rerun a test for some reason. After that it is incinerated as it is medical waste.

One exception- blood that is collected for transfusion may be used for industrial purposes if it's not used before its expiration date. One example would be special human blood agar plates we use in microbiology to culture Gardnarella, which is made from old blood bank blood.

Of course, if we really were selling it to vampires, I couldn't tell you now could I??

What if my friend Alexander Hamilton asked nicely?

And, wait, you've been making stuff out of my blood that my doc keeps siphoning off me every couple months? Freaky!

No, no, only blood that you have donated- like at the blood center.

If you (or someone you know) has ever donated plasma- that is made into products that are sold. They use it to make a lot of the samples that we use for quality control and such in the lab.

I know I asked already about weird blood work but I have one last one. Have you ever run into just almost purely contaminated blood? Like so many diseases it shocked you?

Well, unfortunately there are some diseases that tend to cluster together. If you have one STD, you are more likely to have others. HIV patients often have infections.

Also, in microbiology wounds on the legs and feet are often really gross- like five or six different organisms growing there many of which are probably normal flora but it can be really hard to sort out the bad guys from the ones that are just loitering.

Does your chosen profession make you germaphobes or at least hyper aware of germs around you?

Yes and no. I guess I am hyper aware of germs, but I feel like my education gave me the ability to know how to avoid getting sick so I feel pretty safe. Med techs usually have really strong stomachs, with all we've seen, so it makes us pretty hard to gross out.

What is the most accurate tv show/movie to portray your profession? Least accurate?

I don't know about most accurate, but House is REALLY inaccurate. The docs strolling into the lab to test their own stuff? No way.

Yeah, I had to stop watching House because of that. I actually read a book written by the physician who verified the medical stuff for that show on medical mysteries, and it was fascinating. But docs really don't know that much about what we do either.

All of the forensics dramas are bad too. Pull out a little handheld tool and scan something briefly... "It's cocaine residue! And what a crazy coincidence, it has a specific impurity which only comes from cocaine from this one drug dealer!"

Least accurate... every single one!

Actually, I seem to remember a scrubs episode which actually showed a lab tech working in a laboratory. Most other shows basically portray the lab as a dark room with a single microscope. Hence the assumption that many people have that doctors run the tests.

how old are the people you work with

Old. Like, so old. When I start working in August I will be the youngest tech in my lab by 20 years.

couple of questions because im starting university next year to pursue a medical lab science degree

-What is the daily life of a med lab tech? what is the first thing you do when you get there, what is the first thing you do when you receive a specimen

-is there a hierarchy sort of thing(least paid to most paid) - what are the duties?

-what can you do with a masters or phd in medical lab science

-what happens when you mess up. for example, you misidentify a microorganism

-what are your schedules like? 7am-7pm? 9am-4pm?

-do you plan on going back to school to pursue a masters or phd?

-when you were in high school, did you envision yourself to be a medical lab tech?

-would having a computer science background be helpful?

You might want to repost this to the subreddit later- this is a lot of questions to answer. We'd be happy to help but there are so many questions to answer here I don't think anyone's going to type out a long response right this second. ;)

No question.

I'm an Anaesthetist and get into some pretty hairy scrapes from time to time as we tend to. Big thanks to you guys everywhere for always sounding cheerful on the phone despite the 16th unit being x-matched that hour, for knocking some heads together to actually getting hold of more platelets than we initially thought we'd need, the notes saying "The K+ is 7 on the system but its clearly nonsense", and for occasionally phoning us up with the "You know this chaps got antibodies and the nearest PRC is 80 miles away?" warning!

Thanks! We love to hear this!

We also like homebaked brownies... Just sayin.

Believe me you wouldn't like mine! But as I'm on call this weekend I'll drop some chocolates into the lab before the first obstetric haemorrhage of the day

I sure hope by crazy coincidence you work at my hospital.

Thanks for everything you folks do. My question is have any of you ever thought of continuing your education and becoming a medical doctor (thinking pathologist)? My wife was a histotech for many years and after much encouragement from the pathologists she went to medical school and is finishing up her surgical pathology fellowship after 9 long years. She loves you guys and understand how hard you all work to make the lab work so well.

I occasionally think about medical school, but I am not really interested in all the other parts of medicine. I'm happy in the lab.

I got a really rare condition it seems like right now, I am just wondering is there any kind of test-bank where they store rare samples to crossreference too? Not sure how I was supposed to phrase it but, if you get a really weird blood test and cant make sense of it, is it somewhere you turn to find answers or cross-check with?

Lab testing, for the most part, does not rely on checking against other blood samples. Lab diagnostics are fine tuned to look for a specific thing, and that thing alone. This is referred to as specificity and sensitivity. Individual aspects about a sample are analyzed, and then that information is processed by ordering healthcare providers to rule out diseases, or confirm diagnoses. There are thousands and thousands of tests that can be done to narrow down what disease someone has.

Ahhh. I was clinging on to some hope for a miracle so I had to ask. :p So is there some kind of standard test you just run in case you don't know what you are looking for or is the labs just for when you know for sure what you are looking after?

Ideally, there should be a reason that a test is being run. As lab professionals, we do not choose which tests to run. The doctor/PA/NP has to place the order for the test. A lab test should be ordered to either rule something out, or to rule something in. There shouldn't be labs being ordered "just to see what we get".

That being said, there are routine tests that are often run.

• CBC - analyzes several parameters about your blood cells themselves. The number, size, density, % of different white blood cells, the number of platelets, etc.
• Chemistry panels - can come in basic, comprehensive, liver, kidney, lipid, etc. These analyze the basic chemical workings of your metabolism and are used to screen for some basic metabolic abnormality.

There a many different test that can look for things much more specific. There are tests that can detect whether your chromosomes are uneven, test to see how allergic you are to different things, tests to measure extremely small, yet important levels of different minerals in your body. To get an idea for the number of tests available, you can go to this site and just page through their test directory

Ah that makes sense, not waste any resources or just go on hunches.

I've made countless of blood test for my condition, checked my ANA which is crazy and other anti-something bloodtests. Filled more tubes than anyone should and just wait for them to want a tissue of my brain, or I maybe just watched too much House.

How much of this is a waiting game? I guess the time of each test can take a different amount of time but is it some test that really is time consuming? And also, why do you need so much blood ? I've heard that one drop is enough, in case you lose samples and need more?

And that site is crazy, if I did not mess up too badly with the search query... 3305 results! I can't even remember the name of the tests I've take, let alone 3305 of them. :p

I'm going to add here, that one of the major reasons we need so many tubes from you is that different tubes are for different tests. For example, your doc wants to know how many white blood cells you have. That test requires a "lavender top" tube. Lavender top tubes contain a special preservative that help your blood cells stay intact, and prevents the blood from getting all clotted up en route to the lab. Now say your doc ALSO wants to know what your potassium levels are. Unfortunately, we can't measure your potassium levels from a lavender top tube because that preservative contains potassium. If we were to measure a potassium level on a lavender top tube, the machine would read a lethal level. Which of course isn't actually true--it's the just preservative getting in the way. So to avoid this, another tube (gold or red top) is drawn.

All of us in the medical lab science profession are aware of this so-called one blood drop testing, and many of us are skeptical. We're not sure how this works yet, because even with the most advanced instruments that we all use, we still need 3 mL of blood in some cases.

Appreciate your input!

I have always wondered what kind of powder that is those tubes but never got around to ask, if I got it right a tube contains about 10 mL of blood right? Did a blood test a week ago where I was supposed to test my vitamin D levels and bloodsugar(?) but for some reasons they needed three tubes and I can't make the math go together at the moment.

Also while we are at one one drop testing subject, I haven't heard of it being used just that its as much of a size of the sample you need to figure out what is going on, wont a bigger sample give a more accurate result anyway? I mean if someone gonna bother poke a hole in me to get a drop of blood they might as well take more of it to get a reliable read?

The three tubes, possible explanation:

Vitamin D, probably a red topped tube. This allows the blood to clot leaving serum to be analyzed which is done with an impressively complex system called LC-MS/MS. Might have needed to be sent to another lab, so it was likely a dedicated tube.

Blood Sugar

Probably green or red topped, gray in some cases. This would measure your "right now" blood sugar.

Maybe also a lavender. Lavender is needed for a test called glycosylated hemoglobin. This test measures an average glucose over the last 90 days as the average amount amount of glucose in your blood correlates to the amount of glycosyl groups added to your hemoglobin A1 protein.

We do vitamin D serologically in my lab. We're able to do it on heparinized plasma, too.

The lavender could also have been an extra, the last lab I worked in drew a lavender even if no CBC/HBA1C was ordered because so frequently add ons were requested.

what was the biggest mistake you made?

As a student, I once approved a result that was falsely low due to instrument error. It seemed wrong and I checked the other results from that day, but I stupidly ignored my gut feeling and reported it. Only later did I mention it to a tech and we reran. I'm really embarrassed by it.

Not sure if you're still answering questions, but I am a nurse who draws blood daily, and have always been curious about a few things!

1. How much does the order of draw matter? For example I was always told that blue tubes (coags) go first, but when using a butterfly you have to use a discard tube d/t air getting in the tube. Sometimes I get a little anarchist and draw my CBC first, then my PTT to avoid using a discard tube. Am I throwing off some labs here?! Along the same vein, if I have a CBC and a BMP does it matter which comes first? I was told BMP then CBC, but sometimes I have reversed the order.

2. How much blood do you really need? For the PT/INRs we have to fill them pretty full (up to that black arrow), I know some MLTs that will accept one a smidgen below it and others that will call me and make me draw another. Same for the CBCs, sometimes they will accept like 1 ml or less, others will say it isnt enough. It really sucks when they have shit for veins that blow right away, so I try to fill them up as much as possible while still getting blood in all the tubes I need.

3. What is involved with reading a HgbA1c and why does it take so long to come back?

Thanks, if anyone takes the time to read and answer! On behalf of RNs, we love you lab peeps!

What is involved with reading a HgbA1c and why does it take so long to come back?

This drives me bonkers too. A1Cs take foreeeeever, like 45 minutes on our instrumentation. I know some labs batch them but I think there would be a mutiny among the docs if we batched. All I can say is I swear I'm not sitting around twiddling my thumbs- it's running!

One thing that can make A1Cs take longer is if you only send us one lavender top for both the CBC and A1C- it's not a problem but the CBC is considered a more important test so it goes there first. Then, the CBC analyzer has shaken it up a bunch and sometimes I have to manually pipette off all the bubbles or the chemistry analyzer will just give me an error.

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Yep, it's called the hygeine hypothesis.

I personally think it is interesting that the same type of antibody that is used to attack parasites is the antibody which mediates allergic reactions. As our parasite loads have gone down, allergies have increased. Make of that what you will.

How did you hear about the profession, and what made you decide to join?

I was a sophomore marine biology major living in Alaska. I was feeling really cooped up during the winter and not particularly satisfied with my major and for funsies was looking at the University of Hawaii's list of majors. MLS was there, and the more I read about it the more in love with it I was.

Tech school is definitely a labor of love, though.

Laid off in the Great Recession, looking at job-related stuff online, checked out a career-advice website for high school students on a whim. Found this. Low cost for school, minimal life investment, lots of jobs, significantly better pay than I was working at before, great job security/availability, SCIENCE!! (with "voice of God" echo), minimal public contact.

SCIENCE SCIENCE SCIENCE SCIence SCience science science

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In the US, it's often easier to get a job with a bachelors degree, the pay is higher, and the opportunities for upward mobility are greater. In most labs, the work is the same though.

My lab has more men than women, though I think that's not common.

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Not senior staff, but statistics have shown that HIV rates are steadily declining in all populations in the US except the men who have sex with men demographic.

Feel free to ask as many questions as you like!

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I wish it was less important. I'm a bit clumsy myself and have gotten myself into trouble.

You just have to practice over and over. Drawing blood may be your biggest challenge. Practice and practice and it becomes muscle memory. Also, slow down!

also, play jenga more

I flipping hate jenga.

^{^} Has bad manual dexterity

^ has a knack for stating the obvious

What's the most stressful part of your job? Is this the type of job you take home with you, i.e. always thinking about it?

I will say when I leave the hospital, I dump all my concerns and worries at the door. I don't stress about anything overnight.

Actually, I'll take that back. There is just one thing. My lab is hosting breakfast on Wednesday and I have to bring something. I have no idea what I'm going to do.

Eggstrata. So easy, so delicious.

The most stressful part is when we're really busy with tons of really sick patients and just then one of our instruments goes down! Or in blood bank with a massive bleeder, just getting enough blood out to keep the patient alive can be a challenge.

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I run animal samples from time to time. Our local veterinary hospital sends them over when it's too urgent to send it to the reference lab and wait several days for a result.

The issue is, we really don't have reference ranges setup for animals like vet-specialty labs would. The vet has to be pretty confident they can interpret without the help of a reference range.

It's cancer, isn't it? Oh God, I just know it's cancer.

Probably!

What kind of security do you use for the samples? Have you ever seen someone trying to get in? Why would someone want to steal samples?

At my lab (I think this is technically a JC violation), there is an open door between where patients are drawn and the lab itself. Sometimes patients wander back because they are curious or even just turned around and trying to get out. It's kind of fun to talk to them.

I once had a nurse try to sneak in and take back a sample that I had rejected because it was too full. I think she was going to try to empty it a bit and send it back like she had redrawn.

Shockingly, a lot of samples go through the mail. Here in Canada people send Vasectomy (semen) samples and FOCT (fecal smears) through Canada Post regularly.

I used to receive samples by floatplane when I worked in Alaska.