Medical Laboratory Scientist

Wayne: I’m Wayne, I’m 17 years old and I go to Elim Christian College. I’d like to find out more about being a medical laboratory scientist.

Clinton: Medical laboratory scientists are responsible for the testing performed on samples sent to them by medical practitioners. The results they produce are used by medical staff in the diagnosis and treatment of approximately 70% of all patient cases. Wayne has arranged to meet Kristen Kelly, a medical laboratory scientist with 27 years experience.

Kristen: I got into this career because I loved science at school, in particular biology and chemistry, and I knew I didn’t want to be a doctor or a nurse.

Kristen: Hello, Wayne? Kristen, Lab Plus Quality Manager.

Wayne: Hi.

Kristen: Come this way.

Clinton: Lab Plus is located at Auckland Hospital. It provides their laboratory services as well as performing work for outside agencies. Last year they processed 3.7 million patient results.

Kristen: It’s definitely an unseen science because as far as patients are concerned, they go to their doctor, they have some blood collected, or a swab taken, it goes off to the lab and then the results miraculously appear back. So there is definitely a whole science behind the scenes that people just don’t really know a lot about.

Kristen: OK Wayne, so these are some samples that have arrived. So I’m just going to show you what we do when they arrive in the laboratory and then we’ll take them on and do the processing on them.

Clinton: Kristen is going to take Wayne through a series of tests on a patient’s blood and urine samples.

Kristen: So I’ll take you down here to our haematology laboratory.

Wayne: So what does haematology cover?

Kristen: It actually is the study of cells in your blood – so we’re interested in white cells, red cells, and platelets.

Kristen: It may appear mechanised at first – a lot of our tests are a bit automated – but the skill comes into interpreting the results to help narrow down the diagnosis of that patient. So it’s all in the interpretation of the results.

Kristen: What we’re looking at here are the various cells of the blood. So what we’re interested in is the pattern of fluorescence in this screen here. And also, there are some abnormal cells flagged.

Clinton: To find out what the abnormal cells are, a microscope slide is made.

Kristen: What can you see down the microscope at the moment?

Wayne: There’s a small oval-looking purple cell.

Kristen: Aha. That is very good – and that is actually a malarial parasite. So what this means is our patient has got malaria and has probably just returned relatively recently from overseas, so it’s really important that we let the doctor know straight away.

Clinton: While in the haematology lab, Kristen showed Wayne some other interesting samples.

Kristen: You should be able to see a worm thrashing around amongst the red blood cells, and it's called wuchereria bancrofti. We occasionally see patients, especially from the Pacific Islands, that have got these worms in the bloodstream.

Wayne: What does this worm do in the bloodstream?

Kristen: Well it eventually invades the lymphatic system of the patient, and clogs up the lymphatic system. And you get side-effects such as your legs swelling up, and it becomes very, very uncomfortable and debilitating.

Clinton: The next step is biochemistry. The blood is spun in a centrifuge to separate its components, which are further analysed.

Kristen: If you look here in the screen we’ve got an unexpectedly high glucose result, and sadly we’re seeing more and more high glucose results coming through on younger and younger people. In other words, we’re seeing more and more diabetes and it’s a bit of a problem. It’s related to obesity and so probably the best way of reversing this trend is for people to exercise more and lose weight.

Kristen: All you need to do is just push send to host. So now it will be received in real time by the doctor.

Clinton: With the blood tests done, the next stop is microbiology, where the urine sample will be tested.

Kristen: OK, so now we have got our results here that we need to look at, and the interesting thing in these results here are that we have got some white cells present, which could indicate infection, so we will have to culture it to grow any bugs present in the sample.

Kristen: Right, now what we need to do is we need to put some of our urine sample on to some agar plates to see if there is any bacteria in the urine that might be causing a problem.

Wayne: What is in the agar?

Kristen: On this side here, this agar has sheep blood in it, it’s got all the nutrients that bacteria like to grow. And on this side of the agar this is a selective agar and some bacteria will grow on that side and some won’t.

Clinton: Wayne will leave the cultures to incubate overnight.

Clinton: Next day, Wayne was shown some of the other labs.

Kristen: Here we are in the mycology department, and here they grow fungi from all sorts of specimens – from skin cells, to toenails, to even brain tissue.

Clinton: The next stop is molecular cytogenetics and the ‘FISH’ lab.

Wayne: I notice the lights are pink-coloured. Why is that?

Kristen: Because FISH stands for fluorescent in situ hybridisation, which means that we’re looking at fluorescents in the cells, and normal light quenches fluorescence, so that’s why we have to have special lights in here.

Kristen: The cell we’re looking at here is about a 4000th of a millimetre, and we’ve got chromosomes that are tagged with a fluorescent marker and this particular marker marks up chromosome 21. And you can see in this patient’s cell they’ve got three copies of chromosome 21, which confirms that they’re a Downs patient.

Clinton: Yesterday’s cultures have now incubated, so Kristen can begin to narrow down the identity of the bacteria.

Kristen: So if you’d like to lift it up and we’ll see what’s grown.

Clinton: It’s at this point that Kristen’s experience comes into play. The way the bacteria react to different culture media – the colour, the size, the shape and even the smell are all clues.

Kristen: OK. Can you actually smell that one? It smells quite different. It smells earthy to me.

Clinton: The sample is then subjected to a further set of chemical tests.

Kristen: You can see that each of these chemical reaction patterns here is a bit different from each other and that helps us to narrow the field more. And by doing these follow-on tests in this pattern here we’ve been able to identify that our patient has got E. coli.

Clinton: Once the culprit bacterium has been narrowed down, it’s subjected to antibiotic testing to discover the best treatment.

Kristen: Wayne has been an excellent student, and he has been excellent because he has got a good inquisitive mind. He’s come with a very good background in science, and he’s exactly the sort of person we'd love to have joining this profession.

Wayne: Out of all of them I definitely enjoyed microbiology the most – watching the different types of bacteria that grow and analysing them was very fascinating. I would pursue this career because of the great variety in what you’re doing and also the satisfaction of helping patients.

Clinton: This is a specialist career and requires a specific degree – the four-year Bachelor of Medical Laboratory Science. Other science degrees do not qualify you for the job. Courses are available at Massey University, Otago University or Auckland University of Technology. It’s a fascinating career with plenty of scope to specialise in a particular field. The New Zealand qualification is recognised overseas, and there’s a great demand for graduates.