SILLIMAN UNIVERSITY

INSTITUTE OF CLINICAL LABORATORY SCIENCES

IMMUNOSEROLOGY & ER SATELLITE LABORATORY

PHILIPPINE HEART CENTER

JULY 1, 2017- JULY 15, 2017 (IS)

7am-4pm, 4pm-8am
JULY 16, 2017- JULY 31, 2017 (ERSL)
7am-4pm, 10am-7pm, 4pm-8am

SUBMITTED BY: JOANNA JOYCE E. TUBASES

SUBMITTED TO: JEFF NICOLO K. PALAD, RMT, ASCPi (MLS)
 Philippine Heart Center is like a new world for me. Everything was unfamiliar; from the

experiences, the environment, and the people. Yet, as compared to last month, I was much better

when it comes to dealing with my co-interns and the staff. I had somehow became adjusted to

how life as a medical technology intern was supposed to be in the said institution, and to the life

of being in Manila which added up to the pressure of my stay here in Quezon City distant from

everyone else including my family and friends. It practically made my first few days here quite

difficult. As two months had passed, I had finally learned to be more comfortable embracing the

life which was far away from my comfort zone without even noticing that the days in my

assigned posts, ImmunoSerology and ER Satellite Laboratory, had finally come to an end.

For the first half of July, the laboratory section I was assigned to was the Immunology

and Serology section. As explained by our staff, this section practically deals with a lesser

number of specimens or laboratory tests a day but is considered as one of the most important

thus requiring us interns to be more efficient, accurate, and careful when handling with

specimens and different tests. As an intern in the said section, we were given the responsibility to

receive patient specimens, to log the request in their corresponding log sheets, and to perform

their respective serological tests. Usually, we dealt with tests relating to cardiac markers most

especially the Troponin I and Pro-BNP together with Troponin T and Presage ST2 Assay which

were both done less frequently. Alongside with these are also tests for different tumor markers

such as the CA19-9 for the diagnosis of pancreatic cancer; CA125 for ovarian tumors; CA15-3

for breast cancers; Carcinoembryonic Antigen (CEA) for colon cancers; Prostate-Specific

Antigen (PSA) for prostatic cancers, and Alpha-fetoprotein (AFP) for liver tumors.

Procalcitonin, for bacterial infections or inflammations, and Ferritin, for Iron Deficiency Anemia

(IDA) diagnosis, were also measured. All of the aforementioned markers or proteins were
measured quantitatively using the VIDAS machine which uses the principle of Enzyme Linked

Fluorescent Assay (ELFA). Inflammatory indicators in serum were also measured with the

VITROS Fusion 5.0 machine quantitatively using a spectrophotometric method. Specifically

included were the Anti-Streptolysin O (ASO), which indicates group A streptococcal infection;

C-Reactive Protein (CRP), which detects general inflammation due to bacterial infections; and

the High Sensitive C-Reactive Protein (hs-CRP), which is specific for the heart indicating

cardiac inflammation. Qualitative testing, helpful for screening purposes, was also performed in

the laboratory. One of those performed were the Dengue Duo test which is able to detect both

IgG and IgM; and another would be the Dengue NS1. As I have learned, these two tests are

different having Dengue NS1 as the non-structural protein 1 which allows rapid detection on the

first day of fever before antibodies appear some time later. On the other hand, Dengue Duo test

is able to differentiate the primary dengue infection, predominantly with IgM antibodies, from

secondary dengue infection, which has detectable levels of IgG even in the acute phase. Other

qualitative test that we had performed in the laboratory was the Salmonella typhi IgG/IgM test

employing the principle of immunochromatography which is helpful to support diagnosis of

typhoid fever. Rheumatoid factor was also determined using Latex Agglutination, along with the

H. pylori Rapid Test with the use of a kit with immunochromatography assay. Rheumatoid

Factor test were usually ordered by physicians in cases where the patient is suspected to have an

autoimmune condition such as rheumatoid arthritis while the presence of H.pylori may indicate

an increased risk of developing ulcers, chronic gastritis, and gastric cancer. Titers for the

antigens and antibodies of Hepatitis A, B, and C virus were also performed by the interns with

the supervision of the staff. It is not new to everyone of how each individual in the medical field

emphasizes the fact of the importance of having hepatitis test. Hepatitis is a viral inflammation of
the liver commonly classified as Hepatitis A, B, and C wherein it could be chronic or acute. It is

done and determined quantitatively using the Advia Centaur CP applying the principle of

Chemimmunolescence Assay (CIA).

For the second half of July, I was then assigned to the ER Satellite Laboratory (ERSL).

This is a separate section in the laboratory which deals with laboratory tests for the Emergency

Room. Being in this post gave me experiences that were very different from those I had in the

main laboratory. Contrary to my previous section, the ERSL or POCT had a number of tests

which has to be done in a much quicker pace and time. Thus, we as interns should develop

reliability, accuracy, and efficiency doing different laboratory tests in a limited amount of time.

There should be less room for mistakes with a more organized work flow prioritizing tests that

requires more time when working inside this laboratory. In this section, we practically worked

similarly to the Immunoserology section wherein handling of a variety of machines and kits were

utilized when analyzing electrolytes such as the Sodium, Magnesium, Potassium, Chloride, and

Creatinine. These electrolytes were measured quantitatively from the patient’s anti-coagulated

blood in the green top tube with the IStat and Arkray SpotChem machine. Tropinin I was also

measured using both the machines of IStat and Pathfast. Complete Blood Cell count were also

performed inside the ERSL with the Beckman Coulter machine, aided by White Blood Cell

differential counting of stained smears performed and made by the staff or the interns. The

running of controls was done by the staff. Then, input of control results in the computer for the

construction of the Levy-Jennings Chart was done by the interns. This post also allowed us

interns to assist the staff during blood extraction, and occasionally would allow us to perform

blood extraction on our own. However, being able to encounter patients in the Emergency Room

gave me the opportunity to witness how patients of all ages in different health conditions were
being accommodated in the limited space within the Emergency Room. I was also able to

encounter numerous incidents wherein patients are being revived with the use of the medical

defibrillators. Each new day in the Emergency Room presents new medical cases, thus were new

experiences for me making us front-liners to different known or unknown infectious diseases of

different patients. One of the most unforgettable encounters I had was when we had extracted

blood from a patient that was not yet known to be suspected of meningococcemia not until the

patient had expired. We, interns together with the staff, were immediately aided with

Cirprofloxacin for prophylaxis.

It is of no doubt that the experiences I had and I will have in the future exposes me to

different forms of hazard that may affect me not only physically but also emotionally. So far, my

experiences, especially in the Emergency Room, had served as another turning point of my life

exposing me to the real world and the hazards that medical technologists are at risk of in the

work place. It basically taught me the importance of proper handling of specimens and the

application of different precautions within the laboratory. Another month had passed by, new

experiences, knowledge and skills had been developed but it had never changed the fact of me

wanting to become a better medical technologist in the future. In fact, it had even encouraged me

to do not just what is better, but the best of everything we do in the laboratory. It was another

stepping stone of my internship program, being able to encounter such an incident making me

feel as though I am officially a part of the real medical world, and the things we have to be

exposed of and we have to sacrifice in order to provide quality health care for our patients.

Surely, the things that I have learned for now will help me in my future endeavour.