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Chew Yu Mei
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Cornelyus Ng
Lau Leslie
hey guys! sorry bout the late post. I was trying to get some pictures to show you peeps. By the way, the pictures were taken with the permission of my lab head.
The past week, i was posted to the bone marrow lab. To me, i feel that its the most interesting lab as i get to go down with the med tech to the wards or the haematology centre. What do we do there you ask? The job of the med tech is to smear the bone marrow aspirate and to create an imprint of the trephine. Also, he would do a finger prick and perform an onsite smearing of the blood. After the slides are collected, they will be brought up to the lab to be stained, dried, labelled and mounted. The patient's particulars such as the name, hospital, ward, ic number, gender and age are recorded in the log book and entered into the LIS. I'll be elaborating more on the aspiration process which is done by the doctor.
Firstly, the area that the aspirate will be done on is cleaned by iodine and spirit. Usually, the doctor would choose a spot near the backside which the Iliac crest could be felt. The aspiration is done on the Iliac crest as the crest provides good anchorage and has a lot of bone marrow. An alternative spot is the sternum.
The picture above shows the whole aspiration set. The pair of red things at the bottom are used to hold the sharps after the aspiration is done. Once the sharps are inside, the whole thing is locked and cannot be taken out.
The red round thing is the cap while the green small thing above it is meant to guide the measurement needle to prevent the doctor from piercing himself.
The green needle is used to measure how deep the doctor has entered the bone.
The yellow needle is used to trap the trephine so as to retrieve it.
The T shaped thing is used to core into the bone.
Here's a closer look to the T shape thing.
After the whole thing is inserted into the patient, the top can be removed for the syringe to be attached to the white part. The syringe will suck the aspirate out.
This is the tip of the yellow needle. Its not very clear, but i hope you can see that the needle has 2 "legs" to trap the trephine and remove it from the body.
This is the green measurement needle. Notice the black line? It is used to measure how deep into the bone the doctor is.
Continuing on from the cleaning. The doctor will inject lignocaine, a type of local to the patient. The LA only serves to numb the area around the injection. Unfortunately, the bone is not numbed. Thus when the needle enters the bone, the patient will feel pain. After the LA is injected, the actual procedure begins. The T shaped thing is used to core into the bone using a cock screw motion. When the doctor is in, he will remove the thing on top and attach a syringe to it. Then, he will begin sucking the aspirate out. This part hurts damn badly. As med techs, what we are interested in are the fragments in the aspirate. Some patients that undergo chemotherapy to wipe out the bone marrow cells might not have or have very little fragments. If the 1st syringe has fragments, we will give the green light to the doctor to take more tubes for flow cytometry or cytogenetics, depending on the test ordered. After we're done with the aspirate, the doctor has to retrieve the trephine. He will cap the white part with the red cap and start boring further into the bone. When he feels that he has attain the best depth, he will remove the cap and insert the yellow needle. Next, he will rock the whole apparatus in an attempt to collect the trephine. It is then removed and the trephine is ejected from the yellow needle by pushing the green needle in throught the back of the yellow needle. If the trephine is not large enough, the doctor would have to perform the procedure again. The trephine is imprinted on a slide by simply pressing it between 2 slides and rubbing it together. It is then left in a container containing formaldehyde to fix the tissue.
cornelyus
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