Careers in
Clinical Laboratory Science
Beth Marsing, MAOM, CLS, MT (ASCP)
Director, Laboratory Services
Alaina Whitaker, CLS, MLS (ASCP)
Marian Regional Medical Center
Santa Maria, CA
Clinical Laboratories
•
7-10 billion laboratory tests are performed annually by 328,100
Laboratory Professionals
•
Only two health care professions with larger numbers of practitioners
are physicians and nurses
•
Over ½ of these jobs are performed in the hospital setting
•
Bureau of Labor Statistics* reports that the demand for laboratory
professionals is expected to grow 14% from 2008-2018
*<http//www.bls/gov/oco/ocos096.htm>
Who is a Laboratory Professional?
•
Phlebotomist
•
Clinical Laboratory Scientist (CLS); aka
Medical Technologists (MT)
-Blood Bank Specialist (SBB)
-Technical Specialist
-Instrument Install Specialist
-Histology
-Sales/marketing
-Cytogenetics
•
Clinical Laboratory Technician (CLT); aka Medical Laboratory
Technician
What do Clinical Laboratory
Professionals Do ?
Responsible for the analysis of body fluids and other specimens to
aid in detecting, diagnosing, and treating disease, as well as
monitoring normal health.
Areas include:
Hematology
Microbiology
Urinalysis
Immunology
Chemistry
Immunohematology
 They provide 70-80% of the objective data used to
make clinical decisions.
Clinical Microbiology
Identify organisms
Determine antibiotic
sensitivity
Immunohematology
Medical technologists
in the Blood Bank
will determine your
blood type and any
antibodies present in
your plasma so a
compatible crossmatch can be found if
you need a blood
transfusion.
Hematology
Tubes are ran
on
analyzers
that count
the different
cells and
prints out
results
If the analyzer
flags any results,
blood smears are
examined using a
microscope.
Abnormal Blood Smears
Chronic
Myelogenous
Leukemia
Malaria
(Plasmodium
falciparum)
Infectious
Mononucleosis
(Reactive
Lymphocytes)
Clinical Chemistry
What does it take to be a Clinical
Laboratory Professional?
 Like Sciences
 Be a problem solver
 Accept challenge and
responsibility

Able to multi-task and
complete tasks on time

Communicate well, both in
writing and verbally

Set high personal standards
and expect quality in one’s
work

Like to work with automated
instruments
 Be accurate and precise
 Be able to work well under
pressure
 Like microscope work
What does it take to be a Clinical
Laboratory Professional?
Laboratory Skills
• ALL 4 YEARS (B.S.)
COURSE WORK
CENTERED ON
LABORATORY
APPLICATIONS
• PLACEMENT IN CLINICAL
LAB for Clinical Practicum - various lengths
4 Year College / Hospital /
University
• QUALIFIED TO TAKE
NATIONAL CERTIFICATION
EXAM AS CLINICAL
LABORATORY SCIENTIST
Jr. College / Comm. Coll.
• QUALIFIED TO TAKE
NATIONAL CERTIFICATION
EXAM AS CLINICAL
LABORATORY TECHNICIAN
How Does It All Add Up ? ? ?
 Get Involved!
 Volunteer at the local hospital
 Volunteer at the skilled assistant facilities
 Love your Science classes
 Job Shadow different areas to see what interests you
 Investigate colleges to see what programs are available
 Marian Medical Center partners with San Francisco State
University to provide internships to CLS trainees
What
Could
Be
Better
Than
This ?
Case Study #1
78 y.o. male with Pancytopenia
CBC DATA:
WBC 0.6 K/uL
Hgb 7.6 g/dL
MCV 100.5 fL
MCHC 34.8 g/dL
Platelet count 16 K/uL
RBC 2.2 M/uL
Hct 21.8%
MCH 35.0 pg
RDW 18%
Peripheral Blood
Questions:
1. What is the main CBC abnormality?
2. What are the main findings on the
peripheral smear?
3. What is the differential diagnosis?
4. What does the bone marrow biopsy
show?
Bone Marrow
Answers:
1. Pancytopenia
2. Focal atypical cells with
cytoplasmic projections
BM Core Biopsy
3. The differential diagnosis includes
a reactive pancytopenia (infection,
drug effect, liver
disease/splenomegaly etc.) and a
neoplastic hematologic process
(e.g. hairy cell leukemia, MDS,
acute leukemia etc.)
4. Bone marrow biopsy showed
extensive involvement by hairy
cell leukemia.
BM Core, H/E Stain
Flow Cytometry
Hairy cells in the
Monocyte gate
Flow Cytometry confirmed that the atypical cells
are monoclonal B-cells with a hairy cell
leukemia immunophenotype:
CD19/CD20/CD103/CD25/CD11c-positive and
CD5/CD10-negative
Hairy cells
express kappa
Hairy cells
express CD103
Hairy cells express
CD19 and CD10
Hairy cells
express CD11c
and CD25
Summary
•
78 year old male with pancytopenia
•
Rare hairy cells in blood. Bone marrow packed by the same cells.
•
Flow cytometry confirmed the diagnosis of hairy cell leukemia.
•
Hairy cell leukemia typically presents with pancytopenia. There is usually
fairly extensive involvement of spleen and bone marrow. Treatment with
2CDA (relatively non-toxic chemotherapy agent) usually results in fairly long
term durable remission and is one of the success stories in leukemia
therapies
Case Study #2
24 year old male with leukocytosis
CBC DATA:
WBC 220.3 K/uL
RBC 5.71 M/uL
Hgb 17.3 g/dL
Hct 50.2%
MCV 88 fL
MCH 30.2 pg
MCHC 34.4 g/dL
RDW 14.2%
Platelet count 55 K/uL
Questions:
1. What is the main CBC abnormality?
2. What are the main findings on the
peripheral smear?
3. What is the differential diagnosis?
Answers:
1. Prominent leukocytosis and
thrombocytopenia.
2. Most of the cells are atypical
intermediate-large mononuclear cells
with increased N:C ratios, immature
chromatin and faint nucleoli.
Morphologically these are compatible
with blasts. There are also circulating
nRBC’s and the platelets are reduced
without platelet clumping.
3. This is acute leukemia until proven
otherwise.
Blasts with
variable
CD45
Blasts express
CD4
Blasts
express CD3
and CD7
Blasts
express
CD2 and
CD7
Blasts
express
CD5
Blasts
express TdT
Flow Cytometry
confirmed that
the atypical cells
are
T-lymphoblasts
thus establishing
the diagnosis of
Tcell-acute
lymphoblastic
leukemia/lympho
ma
Summary
•
24 year old male with leukocytosis. Also noted to have a
mediastinal mass, splenomegaly and pleural effusions.
•
Marked leukocytosis composed of T-lymphoblasts
•
Good quality peripheral smear is critical for assessment of blast
morphology
•
Diagnosis: T-acute lymphoblastic leukemia/lymphoma (T-ALL)
Thank You
Alaina Whitaker
awhitaker@ccpathology.com
Email me any time if you have
any questions at all....
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