HOLY NAME UNIVERSITY

COLLEGE OF HEALTH SCIENCES

GOV. CELESTINO GALLARES MEMORIAL HOSPITAL

Narrative Report in
CLINICAL MICROSCOPY
March 22 – 25, 2022

SUBMITTED BY:
CLARIZA M. ACEBES
MEDICAL TECHNOLOGY INTERN

SUBMITTED TO:
PROF. KARL B. PADIERA, RMT
CLINICAL INSTRUCTOR/S
 Clinical Microscopy is the physical, chemical and microscopic examination of non-blood
bodily fluids such as urine, stool and semen. This section is my 3rd clinical laboratory rotation
after Clinical Chemistry where I was assigned from March 22 to 25, 2022, for a total of 4 days.
This section is headed by Mrs. Marjorie Evangelista, RMT.

On my first day of my 2nd rotation, March 22, 2022, Ma’am Marj oriented me on the
routine flow of the section and the routine tests which are the physical, chemical and microscopic
examination of bodily fluids. However, in the laboratory, the usual bodily fluids that were
examined are the urine and stool. In the GCGMH, urinalysis is performed by automated
machines such as FUS-2000 URINALYSIS HYBRID, Sysmex UF-5OOi, URISED 3 and
LABUMAT. However, in my 4 day-rotation in the section, I only used the FUS-2000
URINALYSIS HYBRID. This machine can efficiently and accurately perform chemical and
microscopic examination on urine with less time, only about a minute per test tube sample. The
machine uses the principle of photoelectric colorimetry for urine chemistry and flow imaging
technique for urine formed elements or sediments. When the urine arrives, staff from the
receiving area delivers the sample to the lab and placed it in the work area with the requisition
form. The label of the specimen containers and the requisition forms are to be checked carefully
to make sure the specimen label matches the patient’s request form. Test tubes are numbered
from 1 to 30 or to any number as long as they are enough for the specimens and if they are short,
you can add the test tubes and continue the numbering from where you left off. Prior to the
physical examination of the urine, the request form was numbered and also the specimen
container, both the container, request form’s number and the corresponding test tube must match
each other in order to not mix up the samples from other patients. The urine sample was poured
to the test tube and done the same with other samples until there are no samples left. When the
samples are done being transferred to the test tubes, they are placed in the test tube rack and their
physical description such as color and clarity are noted in their respective request forms. After
the physical examination of the urine, the numbered test tubes are placed in another rack that is
used to place inside the machine for processing. When the rack is placed into the machine, the
start button on the screen of the computer is pressed and a small window appears as to what
number the processing starts. After making sure the number corresponds to the first test tube
number on the rack, the “ok” button is pressed and the machine starts the processing. While the
machine was still processing the test samples, the order entry of the request forms was done.
Order entry is done in order to input the request for the matching of the results of the machine to
the patient’s lab request and for the printing of the results. After the input of the patient’s lab
request, the specimen numbers are placed to what request forms they correspond and then they
are checked in. Only the physical examination of urine was done manually. Despite the lab being
automated, the microscopic fecal analysis was done manually. In fecalysis, a slide, cover slip,
solutions and a microscope are needed to perform the procedure. A slide is placed on a level
work area and a drop of Normal Saline Solution (NSS) or Lugol’s solution placed on the slide
and according to Ma’am Marj, we are to use the Lugol’s solution for a proper identification and
view of the specimen. After placing a drop of the solution, a stick is used to stab different areas
of the stool sample in order to obtain enough sample for analysis. The tip of the stick with the
sample is mixed with the solution on the slide and making sure that there are no large artifacts
that can interfere with the view under the microscope. The cover slip is mounted over the sample
and before placing the slide under the microscope, the color and consistency of the stool should
be noted. Since I’m not yet good at identifying parasitic organisms, Ma’am Marj just let me
identify and then she will check after. In the afternoon, Ma’am Marj also taught me how to
perform the Micral test. Micral test is a strip based on an immunological test principle using
gold-labeled monoclonal antibodies with a chromogenic color indicator enabling confidence in
results and this test is used as an early diagnosis of microalbuminuria through the detection of
microalbumin in urine. The test is done by dipping the test strip into the urine for about 5
seconds and then placing the strip on a gauze pad to blot any excess urine, then, wait for 1
minutes and after a minute, the color results are compared to the color scale on the test strip
container or vial. After the tests were done and the results were released and logged in the
logbook, and since, Ma’am Marj’s shift ends at 4 pm, I continued performing the tests, however,
at 6 to 7 pm, specimen samples are usually less. So, I logged the remaining test results and when
my shift ended, I disinfected the work area before leaving the lab and bid my goodbye to the
assigned MedTech during the NOC shift.

On my second day of rotation, March 23, 2022, I immediately wore my lab gown and
gloves and then started disinfecting the area using the diluted sodium hypochlorite found near the
sink. Since at about 7 to 8 in the morning, there were not many specimen samples that arrived in
the lab, everything in the Clinical Microscopy section was slow paced and I just did my routine
in numbering test tubes, running urine samples to the machine, order entry and checking in of
specimens. However, at 9 am, specimens came rushing in and many patients lined up in the
receiving area which made me overwhelmed with the samples in the work area. The day before,
samples were many but not like my second day of rotation, they came rushing in from patients
for their medical examination for their jobs or their internships. So, I immediately started
numbering, processing and specimen order entry and check-in. Even after running the batch of
urine samples, another batch arrives from the receiving area. I got to perform FOBT or fecal
occult blood test. This test is to check if there is hidden (occult) blood in the stool to which could
indicate gastrointestinal bleeding or other bleeding disorders in the GI tract. In performing
FOBT, there are different kinds of tests used for this procedure but in the lab, it uses an
immunochemical method that uses the principle of lateral flow immunoassay. The materials
needed are the test devices, specimen collection tubes with extraction buffer, package insert,
specimen and timer. I started with unscrewing the specimen collection stick and then randomly
stabbed the specimen collection stick into the fecal specimen in at least 3 different sites, the fecal
specimen must not be scooped. Then, I screwed and tightened the cap onto the specimen
collection tube and shook the tube vigorously to mix the specimen and the extraction buffer.
After the specimen is mixed properly, the cap is unscrewed and 2 full drops of the extracted
specimen are transferred to the test and the timer for 10 minutes. After the time is up, check if
there is one colored line that appears in the control line region which is negative and if there is
another colored line that appears in the test line region which is negative. In the lab, urinalysis is
the majority of the tests being processed and run in the laboratory. I then also got to deliver
released results to the pathologist residency for their signature to release it to patients. After the
tests were done and the results were released and logged in the logbook, and since Ma'am Marj’s
shift ends at 4 pm, I continued performing the tests as I was accustomed to the routine in the lab,
however, at 6 to 7 pm, specimen samples are usually less. So, I logged the remaining test results
and when my shift ended, I disinfected the work area before leaving the lab and bid my goodbye
to the assigned MedTech during the NOC shift.

On my 3rd day of my rotation in Clinical Microscopy, March 24, 2022, the section head,
Ma’am Marj was pulled out from the Clinical Microscopy section, and was assigned to the
confirmatory section for crossmatching. So, the medical technologist assigned as a replacement
was Ma’am Iris. Ma’am Iris was kind and patient enough to teach an intern like myself. I told her
what things that I have already learned in the laboratory and what I have yet to learn in the
laboratory. I have not learned how to replace the chem strips in the FUS-2000 machine so
Ma’am taught me. First is to open the machine and another compartment for the strips and in
placing the strips, the black portion of the strip must not be inverted when placed in the
compartment in order to not mix the results to the other reagent pads. After placing the reagent
strips in the compartment, the compartment is closed and locked properly and the machine is also
closed properly. After that, ma’am also taught me how to identify WBCs, RBCS, Casts, Bacteria
and other Unclassified sediments in the computer. She taught me how to identify the unclassified
sediments and transfer to its proper classification and then how to save and match the
microscopic results from the chemical strip results. I then also performed a pregnancy test, in the
lab, the specimen that is used is urine. The urine pregnancy test is an easy and rapid
chromatographic immunoassay for the detection of hCG or human chorionic gonadotropin in
urine for an early detection of pregnancy in OB patients. I opened the pregnancy test strip from
its pouch and placed the device on a clean and flat surface. I aspirated an ample amount of urine
from the specimen container and transferred 3 to 4 drops into the test device and started the timer
for 3 to 5 minutes. After the timer goes off, if one colored line in the control region appears and
no apparent color change in the test region appears it means negative and if colored lines appear
in both control region and test regions it means there is a strong possibility that the patient is
pregnant; positive. After all that, I did all the procedures with Ma’am Iris supervision, I did my
routine activities and procedures and since Ma’am Iris’ shift ends at about 4 to 5 pm, I continued
performing tests that arrived in the lab. I ordered entry and checked in the specimens and then
logged the remaining test result and when my shift ended, I disinfected the work area before
leaving the lab and bid my goodbye to the assigned MedTech during the NOC shift.

On my last day in my rotation in Clinical Microscopy, March 25, 2022. I arrived in the
laboratory as usual and greeted the medical technologists and started my daily routine with
disinfecting the work area with the diluted sodium hypochlorite that is changed daily by the
housekeeping staff. I then also cut fresh new gauze pads for future use and for wiping spilled
fluids. I logged all the piled-up test results in the logbook from the NOC shift and performed all
new specimens that have arrived in the lab until the next staff shift starts. I performed every test
without problems, after 3 days in the laboratory, I was now able to organize time, the request
forms, performed all the tests without mixing with other request forms and also used the
machines confidently. I did my routine intern activities and performed all the tests until my shift
ended. After that I was pulled out for the exam and went back after completing my answers. I
then continued performing tests that arrived in the lab. I did an order entry and checked in the
specimens and then logged the remaining test results and when my shift ended, I disinfected the
work area before leaving the lab and bid my goodbye to the assigned MedTech during the NOC
shift.

During the pandemic, there are less patients that come in the hospital thus there are fewer
patient requests in the lab. But now, since schools are gradually opening for face-to-face classes
and jobs requiring physical examinations, specimen requests are piling up more than before and
it has become very busy in the lab. Despite that, in my time in the laboratory, I learned so much
with the guidance of Ma’am Marj, Ma’am Iris, Sir Charles, Sir Chan and other medical
technologists assigned in the Clinical Microscopy Section. All in all, my experience in my time
in the Clinical Microscopy section as a medical technology intern was exciting and I learned so
much as it was different when you have practical learning than only theoretical learning.