Laboratory alliance for outpatient care

Science Article
March 4, 2004

Blood analysis, diagnostic testing and transfusion support are among state-of-the-art services of behind-the-scenes partnership team

Clay Bliss, a clinical research technician in the Alliance Laboratory, prepares one of thousands of blood samples analyzed each month. photo by Todd McNaught

By MEGAN LEWIS

On the first floor of the Seattle Cancer Care Alliance Outpatient Clinic, patients sit at a row of tables waiting for a nurse to draw their blood before they continue upstairs to see their doctor. A specimen-processing staff member waits in the neighboring lab, peering out a window that separates the two areas. He accepts the sample through the window, logs it into the laboratory computer system, prepares it for testing and then hands it off to a technologist. Once the technologist receives the blood sample, the testing process begins.

What resembles a routine check-up at a local physician's office is actually a procedure that is critical to the recovery of a cancer patient. Blood samples hold vital clues about the health of patients who receive chemotherapy prior to a bone-marrow or stem-cell transplant or to treat a solid tumor. While doctors, nurses and physician assistants work together at a patient's bedside, the less visible team in the Alliance Laboratory joins the forces to ensure the best possible treatment by tracking a patient's progress through clues in the blood. The lab performs rapid testing of blood samples which provide care providers with information about how patients respond to treatment.

Nurses and doctors, as well as physician assistants like Lisa Getzendaner, rely on the test results obtained by the Alliance lab to provide their patients the best care possible.

"Having the lab downstairs and being able to bring patients right in and get blood quickly allows us to deal with it by the light of day and not in the wee hours of the morning, which is much better for the patients," said Getzendaner, who cares for transplant patients. "Some of the stuff just can't wait."

Analyzing samples

Although the majority of a patient's time at the Alliance is spent with their doctor, patients also meet with another team of healthcare professionals in the lab one-hour before their appointments so blood samples can be taken and analyzed before their exams. The Alliance lab conducts about 5,250 chemistries, 300 urinalyses and 7,500 hematology tests each month. Most patients come to the lab for a blood draw, Hematology lead Crystol Lee said.

"Because this is a clinic and the patients are on their way to their doctor's appointments, they want their results pretty quickly and we try to get them out as fast as possible," Alliance lab manager Doug Howlett said.

From the vials of blood the lab receives each day, they are able to conduct tests to track any side effects that may have been caused from radiation or chemotherapy. From a simple blood smear, the lab is able to examine white and red blood cells using a Sysmex automated hematology analyzer. This device analyzes the size of the cells, number of cells, cell types and the hemoglobin, which is the oxygen-carrying molecule in the blood. A blood smear, made for each patient, is stained and then studied by a technologist who uses a microscope to identify the cells. Only one-third of the patient's smears can be differentiated using the analyzer.

By separating the cells from the blood and sending the plasma through an Olympus automated chemistry analyzer, the Alliance staff monitors the kidney, liver and other body functions of each patient. The lab also conducts urinalysis to look for signs of diabetes, bleeding in the urinary tract, infection and kidney damage.

Each test the lab performs takes about 30 minutes to an hour to reach the doctor.

"The patients that come to get their outpatient treatment here get state-of-the-art diagnostic testing and faster, more reliable results," Howlett said.

Transfusion-support services

Now the chemistry tests can be performed even faster due to a new chemistry analyzer used to process samples. The newer model is twice as fast with a higher throughput than the previous model. With the large volume of blood counts and chemistries each day, the new analyzer will help the work capacity match the lab's busy workload.

"It means that patients don't have to wait as long to get their results, and eventually it could mean that we could see more patients because we could process more samples quicker," Howlett said.

Another function the Alliance lab performs is the transfusion-support services. Once the lab collects a blood sample from a patient it is sent to the Puget Sound Blood Center where it is matched up with donated blood, preparing it for transfusion. The blood is sent back to the lab where it is stored until needed for the patient.

"I think it is unusual for a clinic like this to do that," Howlett said. "Generally you would associate that kind of function with a hospital, but we are performing it here. It's a more involved process to transfuse blood."

Experienced care

Many Alliance patients give blood samples using a needle, but due to vein damage from chemotherapy or from giving blood, a nurse may draw blood from a vein in the chest using a catheter. This procedure is easier on the vein, Howlett said.

Although the Alliance lab has only been open since Jan. 29, 2001, many of the 11 technologists, eight nurses and 10 specimen collection staff worked previously at the Fred Hutchinson Clinical Hemato-logy Lab-some with 20 to 30 years experience.

"We have staff that are quite familiar with the kind of patients that come here," Lee said.

The doctors and nurses who rely on the Alliance lab to provide the best care for their patients value this long-time experience.

"They are very familiar with our systems and how things move and just having that background makes a huge difference," Getzendaner said. "They are really able to troubleshoot things more effectively."

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