HOLY NAME UNIVERSITY

COLLEGE OF HEALTH SCIENCES

GOV. CELESTINO GALLARES MEMORIAL HOSPITAL

Narrative Report in
CLINICAL CHEMISTRY
March 8 – 11, 2022

SUBMITTED BY:
CLARIZA M. ACEBES
MEDICAL TECHNOLOGY INTERN

SUBMITTED TO:
MR. DARWIN CRUZ, RMT
CLINICAL INSTRUCTOR/S
 Clinical Chemistry is the area of chemistry where it is mainly about the analysis of bodily
fluids for the diagnostic and therapeutic purposes. This is my second section that I was assigned
as a medical technology intern in the Gov. Celestino Gallares Memorial Hospital from March 8,
2022 to March 11, 2022. What I felt during my second laboratory rotation in the Clinical
Chemistry section was similar to what I felt during my first rotation in the Histopathology
section, I felt both nervous and anxious. Despite that, I was excited to learn new things that I was
not able to learn and immerse myself in the laboratory.

On my first day of my 2nd rotation, March 8, 2022, I arrived early in the hospital, I went
to the combined sections laboratory where the Clinical Chemistry section is located. When I
arrived, Ma’am Diane was there since she was on NOC shift and the intern from Silliman was
there. Maam Diane told the intern from Silliman to endorse me in all the procedures done in the
laboratory. The clinical chemistry section has various machines used for routine and special
chemistry testing. In routine chemistry, there is the Cardiac Panel, Lipid Panel, Creatinine,
TPAG and etc., the machines used in this type of tests are the Selectra ProM, Vitros 250 and
Snibe Maglumi 4000. In special chemistry, there are the electrolytes, ABG, CRP, Procalcitonin,
Ferritin, D-dimer and etc., the machines used are the Select Profile, i-Stat and Nycocard Reader
II. The intern from Silliman also endorsed me on how to do the order entry. When Ma’am Pau, a
chemist, arrived for her day shift, I greeted her and she welcomed me kindly. She then proceeded
to orient on things that I was not familiar with, such as the Nycocard Reader II for CRP, i-Stat
and Star Profile for ABG and Triage for D-dimer and Troponin I. When Sir Alberto, the Section
Head arrived in the laboratory, I greeted him and introduced myself. At first, I was nervous
thinking that he would be very strict, however, he was not, he was calm. Since it was my first
time, I was anxious about performing all of the tests and almost very confused with all the
request forms. Even on my first hour of my first day in the lab, the requisition forms of patients
pile up, especially for Cardiac Panel testing. The blood test in this section mostly uses serum for
routine and special chemistry, thus a yellow top tube that contains a serum separating gel or a red
top that contains a clot activator are used as a specimen tube container for the tests. The blood
specimen is left to clot before centrifuging for 5 to 6 minutes in order for the serum and red
blood cells to separate. In the afternoon, ma’am Pau let me do the order entry and write the
patient number on the requisition form. At first, I was very slow since I still needed to find the
tests but I slowly got the hang of it. I logged the results to the logbook, the logbook has 3
different kinds, the outpatient, inpatient and ABG results are separated. I performed multiple
tests for Routine Blood Chemistry and Special Chemistry. In routine blood chemistry, I
performed tests for Lipid panel, Cardiac Panel, TPAG, Creatinine and Liver Panel. In special
chemistry, I performed tests for Electrolytes, Arterial Blood Gas, C-reactive protein,
Procalcitonin, Ferritin, Troponin I and D-dimer. Sir Al and Ma’am Pau’s shift ends at 4 pm and
the next staff for NOC shift starts. Ma’am Pau introduced me to the next medical technologist.
Sir allowed me to perform the ABG and the logging of results to the logbook. Multiple
requisition forms arrived in the lab at 5-6 pm, so I kept performing the test, logging of results and
order entry until my shift ended at 7 pm. When my shift ended, I asked permission from the
medical technologist and bid my goodbye and then the next intern arrived to replace me.

On my second day in the Clinical Chemistry section, March 9, 2022, I arrived early in the
laboratory and greeted the medical technologist. I started my shift by disinfecting the area and
disposing of plastics, papers and used syringes in the work area to the proper waste disposals. I
logged all the piled-up test results in the logbook until the next staff shift starts. When Ma’am
Pau arrived, multiple patient requests arrived which then Ma’am asked me to centrifuge the test
tubes. After centrifuging the test tubes, I placed the requests in the order entry and wrote the
specimen numbers. Even on my second day, I was still struggling in dividing my time and
organizing requests in order not to mix tests and tubes. Operating the machines made me
nervous, thinking that I may cause some problems to the machine, however, Sir Al and Ma’am
Pau assured me that everything will be fine. After obtaining the specimen numbers, I then did the
specimen requests in the Selectra ProM for the routine chemistry. For the cardiac panel testing,
not all the tests included will not be performed by the Selectra ProM because of the unavailable
reagents. The tests that can’t be performed by the machine are HDL and AST so another
machine will be used which is the Vitros 250. The principle of the Vitros 250 is the same as the
Selectra ProM which is spectrophotometry. In Selectra ProM, a tube is placed into the machine
and is dispensed into an optical clear cuvette and mixed with accurately dispensed reagent. The
analyte in the sample will react with the reagent and a change in color will occur. The change in
color is directly proportional to the concentration of the analyte in the sample. Then, ma’am Pau
taught me how to add reagents when the machine warns to have insufficient amount of a specific
reagent. I performed electrolytes tests on multiple patient requests, it was the first procedure that
I easily performed. For the electrolytes, Stat Profile is the machine used in testing and uses the
principle of Ion Selective Electrode (ISE), it is used for tests on blood electrolytes and ABG. It
uses serum as a sample and the first thing to do is to input the label of the specimen, it can either
be the specimen number or the patients’ names, and then press start on the monitor, a probe will
appear and place it inside the tube, make sure the probe can fully aspirate the serum without
hitting the gel which can causes the gel to stick to the probe leading to damage to the machine.
When the probe is placed properly inside the tube, press aspirate and after it's done aspirating,
the probe will be placed back automatically into the machine and wait for the results. In the
afternoon I got the hang of doing all the procedures, I was faster and more precise in performing
the procedures. I performed the tests for D-dimer and Troponin I. In this test, whole blood in an
EDTA anticoagulated tube was used as a specimen in this test. A 100 ul of blood is dropped into
the cartridge and incubates for 10 minutes, after incubating, the cartridge is inserted into the
machine and read the results. Ma’am Pau also asked me to perform for the CRP test and since I
was not yet familiar with the procedure, she watched and looked out for me while doing the
procedure. CRP or C-reactive protein, the instrument used in the NycoCard Reader II and its
principle is the solid-phase, sandwich immunoassay. For the CRP, serum or whole blood can be
used for the test and the instrument should always be calibrated prior testing. 5 ul is aspirated
from the tube and dispensed into the diluent, and mixed properly. A 50 ul is then aspirated and
dispensed into the middle of the cartridge, and left it to dry prior applying one drop of the
reagent. After the reagent is dried, one drop of washing solution is then dropped and left to dry
prior placing the instrument at the center of the cartridge. When I am done performing all the test
samples, Ma’am pau or Sir Al will print the results and I will log the result into the logbook and
after logging, the paper is then folded and Sir Al would check and then sign the test results.
When Sir Al and Ma’am Pau’s shift ends, another medical technologist’s NOC shift will start,
which is Sir Miguel Abrin. There would be multiple requisition forms that would arrive in the
lab at 5-6 pm, where I performed, did the order entry and logged the results until my shift ends at
7 pm. When my shift ended, I asked permission from Sir Abrin and bid my goodbye and then the
next intern arrived to replace me.

My 3rd day in the Clinical Chemistry section, March 10, 2022, I arrived early as usual
and greeted the medical technologist. I then started my shift by disinfecting the area and
disposing of plastics, papers and used syringes on the work area to the proper waste disposals. I
logged all the piled-up test results in the logbook and performed special chemistry until the next
staff shift starts. I continued my usual daily intern activities and when Ma’am Pau arrived, I
greeted her good morning and she then asked me if she could perform venipuncture to obtain a
sample for her blood test. I was shocked, although she told me the day before that she would let
me extract blood from her. I then agreed and then went to a place where I can extract blood.
Many medical technologists gathered around me which made me even more nervous, however,
they assured me that they would guide me all throughout the procedure. After I got the
equipment needed, I then proceeded to sanitize my hand and wore gloves. I tied the tourniquet
around her arm and palpated a vein. When I felt the vein, I untied the tourniquet and disinfected
the area. While the alcohol is drying, I checked the screw and the plunger of the syringe. After
the alcohol had dried up, I then re-tied the tourniquet and proceeded to draw the sample. After
extracting the blood, I transferred it to the yellow top and lavender top tubes for testing. After
obtaining the sample, I went back to my station and continued logging the results to the logbook.
Sometime after that, Sir Al arrived and asked me to extract a blood sample from him since he
was also having a test which I willingly agreed to. I performed the same procedure on sir and
after I obtained blood from him, I let the specimen stay on the tube rack to clot along with other
blood samples. I then performed all the tests smoothly since I am now accustomed to the routine
in the Clinical Chemistry section. Then, Sir Al asked me to perform on SNIBE Maglumi 4000 to
which despite being taught how to do it, I was still nervous about using the machine. Thus, Sir
Al went with me to guide me on how I operate the machine. SNIBE Maglumi 4000 in the
laboratory is used for tests on suspected COVID samples, Ferritin and Procalcitonin. It uses the
principle of Chemiluminescence Immunoassay (CLIA) where the sample (serum in standard
sampling tubes or tubes containing separating gel (SST)), buffer, and magnetic microbeads
coated with anti-human IgM monoclonal antibody are mixed thoroughly and incubated, forming
immune-complexes. The Starter Buffer is added to initiate a chemiluminescent reaction. The
light signal is measured by a photomultiplier as relative light units (RLUs), which is proportional
to the concentration of IgM present in the sample. It has three modes of operation, random, batch
and stat and it can board 9 reagents with continuous loading. Since I was now accustomed to all
the procedures in the laboratory, I performed all the procedures until my shift ended. I asked
permission and bid my goodbye to the medical technologist.

On my final day in the Clinical Chemistry section, March 11, 2022, I arrived in the
laboratory, greeted the medical technologists and started my shift by disinfecting the area and
disposing of plastics, papers and used syringe on the work area to the proper waste disposal. I
logged all the piled-up test results in the logbook and performed all the special and routine
chemistry until the next staff shift starts. I performed every test without problems, 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 ends. The day was busier than the other days since Friday is
the day scheduled for dialysis patients. Before leaving the clinical chemistry section, I gathered
my things and placed them in my bag and then asked permission from the medical technologists
and bid my goodbyes.

Clinical Chemistry is a very busy section where even after finishing one whole rack of
specimen tubes, another batch of whole rack arrives for testing. Despite that, my time in the
laboratory was fun and fulfilling. I learned how to do order entries, release results, log results
and perform all the tests in the laboratory. With the help and guidance of Sir Al, Ma’am Pau and
the other medical technologists, I learned many things to which I am very thankful for the
experience and I will never forget my time and how I had fun while learning things inside the
laboratory.