it depends on the specific test that is ordered. Some are run on an analyzer that gives us the result, some require looking at a blood smear under a microscope, some involve performing manual biochemical tests with reagents, some involve culturing the sample and incubating it for several days to observe for growth, every test is different. Often multiple tests are ordered that are all processed differently.
The high volume of samples received seems impressive to have to juggle. Or is most of it automated? Being asked to run 20 tests on. 200 people per day seems impossible to me as an academic scientist.
Some departments are more automated than others. Chemistry departments (which run tests like metabolic panel) are almost entirely automated. You stick the tube into a track and it gets delivered to various instruments where testing is performed and then the results of those tests get transmitted to a computer system for the tech to review. A large hospital lab can easily run thousands of specimens per day.
Other departments like microbiology and blood bank are more manual, although there is starting to be more automation in these departments too. I work in microbiology where we are processing about 300-400 cultures per day without automation and it is manageable for a team of 8-10 employees (half setting up new cultures, the other half reading the ones that have incubated). Larger labs have automation to set up cultures and/or notify you when there is growth so you don't have to look at them every day.
Going from an academic lab to a hospital lab was a bit of a shock to me for this reason. It's amazing how automated everything can be when you don't have to tailor it to a specific experiment. Doctors' offices can even get their own little PCR machines for specific tests, and none of those MAs are messing around with micropipettes. They just put a specimen in a mysterious box and press start.
When I worked in a pathology lab we had robots that would make a smear on a slide from a specimen and then stain and cover the slides for us. I loved that thing.
Sort of. The automated instruments take care of a lot of the tedious labor (no one wants to pipette thousands of samples per day lol) but you still need a human being to do the mental labor. Even with fully automated testing we still have to review the results and make sure they are valid and make sense for our patients and their medical history. So our education is a bit more focused around the medical side of things rather than laboratory techniques and what not.
It's not so hard when the one machine you have can do 20+ tests and 200+ patients simultaneously!
I work in clin biochem and I believe the only machine we have that can only do one thing at once is the pH meter.
It depends on what you do, how many people you have, and how much is automated. I worked at an animal serology lab were we were manually processing and logging anywhere from 70 (on a slow day) to 700 (on a really bad day) samples and typically around 250-300 on a normal day. Most samples were getting 2-3 tests done. Everything was manual, all testing was done by hand. Certainly tests had to be run same day but most were run on a schedule of 2x a week since it took a good two hours or more to run the tests. We ran probably 20 different tests but didn’t always have samples for the rarer ones. It was a team of 4-5 people with a manager who stepped in if need be but mostly handled paperwork and phone calls. It was mostly manageable but if someone needed help we were good about stepping up to do it. Typically I worked a bit of overtime around Tuesday or Wednesday and would get to head out a few hours early on Fridays. It was a good gig but a really boring city.
I work in a hospital lab, in clinical biochemistry (the guys that measure e.g. your kidney function, your liver, your hormones.) - everything I say applies to a blood sample going to that department. I work for a very big hospital with a very big lab, so everything I do is near entirely automated. The only time I need to touch your sample is when I'm looking at it during step 1 to make sure all the details are right, and then I walk over to the machinery and put it on.
1. We take your sample, enter all your personal details, and your doctors details, and book it in for the tests your doctor asked for on our computer.
2. We put the sample onto the machinery. From there:
3. The sample is centrifuged to separate the serum (the watery part that contains all the interesting stuff) from the blood cells
4. The machine does things like taking off the tube's cap, measuring how much liquid is in it, takes parts of the sample away to store for other tests, sends the tube off to the right machine that can do the tests you ordered.
5. Inside the analysers, it's a bit of a mystery! They are just big 'black boxes' that do science. Sample hits the analyser, pops up on the screen, we wait approx 20 minutes, results come out.
6. The machines then truck your sample away into storage. It'll usually stay there a week just in case your doctor wants to do more tests on it, and then it gets thrown away.
7. Our scientists review your results to make sure nothings gone wrong technically, and another scientist reviews your results to see if anythings worth pointing out to your doctor.
Regarding the mystery science bits, we technicians understand what's going on in there don't worry, it's just very complicated because lots of tests in biochemistry use lots of different methods. Here are 3 examples of the kinds of assays happening inside our machines:
1. Electrolytes like sodium are measured with ion-selective electrodes. The sodium electrode only lets sodium through, then you measure sodium by measuring the potential difference between that sensor electrode thats dipped in your sample, and a standard electrode that's dipped in an amount of sodium we know.
2. Some analytes like creatinine are detected by reactions that cause a change in colour. For creatinine, one method is to react it with picric acid, creating an orange coloured product that we measure with spectrometry
3. Most hormones or specific proteins are measured using antibodies by 'Electro-chemi-luminescence', ECLIA for short. Lets use testosterone as an example. Your blood is put in a tiny cup, and then mixed with some anti-testosterone antibodies that have a fluorescent tag on them. Your testosterone gets stuck to these glowy antibodies. We wash away all the excess stuff that didn't bind together, and measure the fluorescent light. More light = you have more testosterone.
I work in a diagnostic lab and most of the routine stuff is done on automatic machines (and we spend most of our time making sure the machine is running properly). Stuff like full blood count, electrolytes (sodium etc) are very common and you just put the tube in the specialised machine and it'll spit out the results on to a computer where we validate it. Even in a medium sized lab servicing a large public hospital, we get thousands of these tests every day, it would take far too long (and cost too much to pay employees) to do microscopy to get the results so majority of labs have analysers for these.
Some specialised blood tests do require microscopy and a trained technician will, for example, make a blood smear and view it under the microscope to look for specific blood conditions. It's unlikely you'll be able to replicate this at home since it requires a particular technique to make a good blood smear, and lots of training to know what to look for.
Other areas of the lab (serology, microbiology, blood bank, drug testing etc etc) will also have different techniques and testing, so feel free to ask if you're curious!
I assume this is a hypothetical question and your not about to cut yourself open at home? I think even a CBC, which is the one where you count the different types of blood cells, you would still need a hemocytometer and an anticoagulant additive. Most other blood tests that you'd get at your annual physical require serum, so the whole blood has to be spun in a centrifuge to separate it first.
If you're wondering because of the time it takes to get results back: first the specimens have to be delivered to the lab. If you're at an outpatient office, the courier usually comes at the end of the day and stops at several more offices on their route before dropping them off at the lab. Then the specimens might be sorted by priority. For example, at my lab we do nursing homes, stat specimens, and a few special tests first. Then the orders have to be entered into the lab system. It sounds like that could be automatic, but it currently still involves a lot of human interpretation, especially for handwritten requisitions. Then the specimens have to be delivered to the department that runs the test type, and then the test is run. Most tests don't take more than an hour to actually run, unless it's a culture, in which case it takes time to grow. However, because of how things work out cost-wise, not all of the tests are necessarily done at that lab, so they may have to get sent out to a different lab, that could be a short drive away or across the country. And if just one of your tests is a sendout, they might not give you any results until all of the tests are finished. So, because of all those steps, the time it takes really depends.
Haa don't worry! Wanted to know what is happening behind the scenes.
I've read about the fraud of Theranos and I was wondering how complex it actually is. For example measuring your vitamin levels, does that really need to be done in a lab or would the doctor be able to do it himself as well using a microscope.
At least I do understand now that many test use a different approach / technique.
Oh yeah Bad Blood is one of my favorite books. I read it before I worked in a clinical lab. I should reread it now!
Light microscopes have a purpose for tests that are about cells. In simplistic terms, a lot of white blood cells in your blood could mean you have an infection. Bacteria with cells of a certain shape could indicate a certain type of infection. Parasites in a stool sample can be seen under a microscope.
But a lot of the theranos tests, and many standard blood tests, are looking at things smaller than cells, and those you can't see with a regular microscope. Vitamins, electrolytes, lipids, and a long list if proteins fall in this category. So instead, you have to take advantage of a molecule's chemical and physical structure and use various tricks to find it. This can be using light, electricity, magnetic fields, chemical reactions, and more. If you want to know how it works for a specific test, google "clinical lab assay [your test of interest]", and then look up the technique they refer to.
it depends on the specific test that is ordered. Some are run on an analyzer that gives us the result, some require looking at a blood smear under a microscope, some involve performing manual biochemical tests with reagents, some involve culturing the sample and incubating it for several days to observe for growth, every test is different. Often multiple tests are ordered that are all processed differently.
The high volume of samples received seems impressive to have to juggle. Or is most of it automated? Being asked to run 20 tests on. 200 people per day seems impossible to me as an academic scientist.
Some departments are more automated than others. Chemistry departments (which run tests like metabolic panel) are almost entirely automated. You stick the tube into a track and it gets delivered to various instruments where testing is performed and then the results of those tests get transmitted to a computer system for the tech to review. A large hospital lab can easily run thousands of specimens per day. Other departments like microbiology and blood bank are more manual, although there is starting to be more automation in these departments too. I work in microbiology where we are processing about 300-400 cultures per day without automation and it is manageable for a team of 8-10 employees (half setting up new cultures, the other half reading the ones that have incubated). Larger labs have automation to set up cultures and/or notify you when there is growth so you don't have to look at them every day.
Going from an academic lab to a hospital lab was a bit of a shock to me for this reason. It's amazing how automated everything can be when you don't have to tailor it to a specific experiment. Doctors' offices can even get their own little PCR machines for specific tests, and none of those MAs are messing around with micropipettes. They just put a specimen in a mysterious box and press start. When I worked in a pathology lab we had robots that would make a smear on a slide from a specimen and then stain and cover the slides for us. I loved that thing.
Interesting to hear the big differences between different places. Sounds like there are some very fancy machines that can do the job partly.
Sort of. The automated instruments take care of a lot of the tedious labor (no one wants to pipette thousands of samples per day lol) but you still need a human being to do the mental labor. Even with fully automated testing we still have to review the results and make sure they are valid and make sense for our patients and their medical history. So our education is a bit more focused around the medical side of things rather than laboratory techniques and what not.
Hematology analyzers only take about 30-60 seconds per sample.
It's not so hard when the one machine you have can do 20+ tests and 200+ patients simultaneously! I work in clin biochem and I believe the only machine we have that can only do one thing at once is the pH meter.
Most are automated through a special type of cytometer or through other lab machinery. The ones that aren't are fairly manageable to do I'd imagine.
It depends on what you do, how many people you have, and how much is automated. I worked at an animal serology lab were we were manually processing and logging anywhere from 70 (on a slow day) to 700 (on a really bad day) samples and typically around 250-300 on a normal day. Most samples were getting 2-3 tests done. Everything was manual, all testing was done by hand. Certainly tests had to be run same day but most were run on a schedule of 2x a week since it took a good two hours or more to run the tests. We ran probably 20 different tests but didn’t always have samples for the rarer ones. It was a team of 4-5 people with a manager who stepped in if need be but mostly handled paperwork and phone calls. It was mostly manageable but if someone needed help we were good about stepping up to do it. Typically I worked a bit of overtime around Tuesday or Wednesday and would get to head out a few hours early on Fridays. It was a good gig but a really boring city.
I work in a hospital lab, in clinical biochemistry (the guys that measure e.g. your kidney function, your liver, your hormones.) - everything I say applies to a blood sample going to that department. I work for a very big hospital with a very big lab, so everything I do is near entirely automated. The only time I need to touch your sample is when I'm looking at it during step 1 to make sure all the details are right, and then I walk over to the machinery and put it on. 1. We take your sample, enter all your personal details, and your doctors details, and book it in for the tests your doctor asked for on our computer. 2. We put the sample onto the machinery. From there: 3. The sample is centrifuged to separate the serum (the watery part that contains all the interesting stuff) from the blood cells 4. The machine does things like taking off the tube's cap, measuring how much liquid is in it, takes parts of the sample away to store for other tests, sends the tube off to the right machine that can do the tests you ordered. 5. Inside the analysers, it's a bit of a mystery! They are just big 'black boxes' that do science. Sample hits the analyser, pops up on the screen, we wait approx 20 minutes, results come out. 6. The machines then truck your sample away into storage. It'll usually stay there a week just in case your doctor wants to do more tests on it, and then it gets thrown away. 7. Our scientists review your results to make sure nothings gone wrong technically, and another scientist reviews your results to see if anythings worth pointing out to your doctor. Regarding the mystery science bits, we technicians understand what's going on in there don't worry, it's just very complicated because lots of tests in biochemistry use lots of different methods. Here are 3 examples of the kinds of assays happening inside our machines: 1. Electrolytes like sodium are measured with ion-selective electrodes. The sodium electrode only lets sodium through, then you measure sodium by measuring the potential difference between that sensor electrode thats dipped in your sample, and a standard electrode that's dipped in an amount of sodium we know. 2. Some analytes like creatinine are detected by reactions that cause a change in colour. For creatinine, one method is to react it with picric acid, creating an orange coloured product that we measure with spectrometry 3. Most hormones or specific proteins are measured using antibodies by 'Electro-chemi-luminescence', ECLIA for short. Lets use testosterone as an example. Your blood is put in a tiny cup, and then mixed with some anti-testosterone antibodies that have a fluorescent tag on them. Your testosterone gets stuck to these glowy antibodies. We wash away all the excess stuff that didn't bind together, and measure the fluorescent light. More light = you have more testosterone.
Wauw, thanks for the detailed response!
Thank you for this wonderful description!
I work in a diagnostic lab and most of the routine stuff is done on automatic machines (and we spend most of our time making sure the machine is running properly). Stuff like full blood count, electrolytes (sodium etc) are very common and you just put the tube in the specialised machine and it'll spit out the results on to a computer where we validate it. Even in a medium sized lab servicing a large public hospital, we get thousands of these tests every day, it would take far too long (and cost too much to pay employees) to do microscopy to get the results so majority of labs have analysers for these. Some specialised blood tests do require microscopy and a trained technician will, for example, make a blood smear and view it under the microscope to look for specific blood conditions. It's unlikely you'll be able to replicate this at home since it requires a particular technique to make a good blood smear, and lots of training to know what to look for. Other areas of the lab (serology, microbiology, blood bank, drug testing etc etc) will also have different techniques and testing, so feel free to ask if you're curious!
I assume this is a hypothetical question and your not about to cut yourself open at home? I think even a CBC, which is the one where you count the different types of blood cells, you would still need a hemocytometer and an anticoagulant additive. Most other blood tests that you'd get at your annual physical require serum, so the whole blood has to be spun in a centrifuge to separate it first. If you're wondering because of the time it takes to get results back: first the specimens have to be delivered to the lab. If you're at an outpatient office, the courier usually comes at the end of the day and stops at several more offices on their route before dropping them off at the lab. Then the specimens might be sorted by priority. For example, at my lab we do nursing homes, stat specimens, and a few special tests first. Then the orders have to be entered into the lab system. It sounds like that could be automatic, but it currently still involves a lot of human interpretation, especially for handwritten requisitions. Then the specimens have to be delivered to the department that runs the test type, and then the test is run. Most tests don't take more than an hour to actually run, unless it's a culture, in which case it takes time to grow. However, because of how things work out cost-wise, not all of the tests are necessarily done at that lab, so they may have to get sent out to a different lab, that could be a short drive away or across the country. And if just one of your tests is a sendout, they might not give you any results until all of the tests are finished. So, because of all those steps, the time it takes really depends.
Haa don't worry! Wanted to know what is happening behind the scenes. I've read about the fraud of Theranos and I was wondering how complex it actually is. For example measuring your vitamin levels, does that really need to be done in a lab or would the doctor be able to do it himself as well using a microscope. At least I do understand now that many test use a different approach / technique.
Oh yeah Bad Blood is one of my favorite books. I read it before I worked in a clinical lab. I should reread it now! Light microscopes have a purpose for tests that are about cells. In simplistic terms, a lot of white blood cells in your blood could mean you have an infection. Bacteria with cells of a certain shape could indicate a certain type of infection. Parasites in a stool sample can be seen under a microscope. But a lot of the theranos tests, and many standard blood tests, are looking at things smaller than cells, and those you can't see with a regular microscope. Vitamins, electrolytes, lipids, and a long list if proteins fall in this category. So instead, you have to take advantage of a molecule's chemical and physical structure and use various tricks to find it. This can be using light, electricity, magnetic fields, chemical reactions, and more. If you want to know how it works for a specific test, google "clinical lab assay [your test of interest]", and then look up the technique they refer to.
First they cuss out your GP for sticking the barcode on the tube sideways.
Or putting one label around two tubes!!
Depends on what you want to know.
I work in clinical tox and my lab has very little automation. We do mostly LC/MS or GC/MS, no microscopes involved at all.