EXPERIENCE

needs experience:

there is a new doc at my workplace.  she asked when her stat sed rate was going to be finished.  i told her it would finish in appx 20 minutes.  she asked how long it takes to run.
*facepalm*
i kindly reminded her that it takes 60 minutes to run.  the whole principle of the test is amount of sedimentation of RBCs in 60 minutes.  she then said, "well, the blood was drawn 50 minutes ago so do you think it might be finished already?"
*facepalm*
all i could manage to say was "no, it will be finished in about 15 minutes, i will call you with the result, i am disappointed in you".


got experienced:

the other day i had a spinal fluid that came from a traumatic tap.  usually CSF is clear, colorless, and has less than a dozen cells in it.  a traumatic tap is very bloody and it's a pain to count the cells.  RBC i could run on a coulter (it had 70000+ RBC/dL) but for the white cells, there were too little.  i had to manually count on a hemocytometer.  however, it's hard to see WBC when there are thousands of RBC crowding the chamber!  if you dilute the RBC down, you are also diluting down the WBC which there should be less than 5 cells/dL anyway!
luckily, sheila was working that night and she showed me something super cool.  she has 30+ years of tech experience and knows all the little things they don't teach you in the text books.
one thing you might try is adding "zap" which lyses RBC but leaves WBC intact- however, our lab doesn't carry this any more.  instead, she pulled 1 mL of lyse solution from the coulter machine out.  then she got a capillary tube such as this:

see how small amount it is?  photo from: http://www.medicine.mcgill.ca/physio/vlab/bloodlab/hemat_n.htm
and put some lyse inside and rolled it back and forth in the tube, just to coat it.  then you blow out the lyse with a dispo pipette so its empty.  there is just enough lyse inside to work on the RBC but not enough to change the dilution factor of the count!  then, you proceed to adding the bloody fluid inside and roll it around in the tube until you see it has lysed the RBC.  then, add directly to the hemacytometer to count.  WORKS LIKE A CHARM!
i hope i don't have to work a bloody tap again (and think of the poor patient!) but if i do, this trick is going to be very useful.

hope everyone else ended last week on a high note and here's to this week being full of surprises.



PS-
i've been watching a lot of lyra videos here's a nice performance with a familiar song. :)




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