Week 1 SIP (Ernest)

Hello

I am posted to Histopathology department of a hospital. (Hospital name is confidential). This department involves everything we're learnt in Histological Technique, taught to us by Dr. Khin in year 2. My classmates who are in the same department as me are Ying chee and Athirah.

The whole process starts from obtaining the tissue, storing it in formalin, "passing" it into cassettes, stored in formalin again, processed, embedding, microtomy, staining, and finally sorting and sending out the glass slides. Is it confusing? I will go through it over the next few weeks. I haven't touched on everything yet in the lab.

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Ok, the first week, we have done fishing, labelling, heating, and staining.

Fishing is when the block is cut into 4um thin pieces, and placed on 40-50deg Celcius water bath. The slice of sample is then "fished" out using a glass slide. The first few times, it was hard to scoop up the tissue. But after 2 days of practising, we can easily fish it up easily, maybe even blind-folded. Haha.

Next the glass slide is labelled using a pencil. We need to write the biopsy number, batch number, year, and medical technologist's initials. It is important to label as it will be used for sorting, according to the doctor's request.

Heating the glass slide on a hot plate to remove the wax and to dry the specimen. The glass slide must be removed of all water first, otherwise the tissue will smudge when heated. To remove all the water on the slide first, we must place the slide only partially on the hot plate. So that the slide won't be too hot. The temperature of the hot plate is above 60 deg celcius, I'm not sure what is the exact temperature.

Then the glass slides are stained using an automated staining machine. However, this machine can only stain tissues with Haematoxylin and Eosin. If you want to stain with other types, you have to use other machines, eg to stain PAS, Perl's stain etc. The slide holder can hold 30 slides, and the machine can hold about 5+ holders. That means it can stain over 150 slides at a time! It can also mount a glass cover slip for you automatically. Very amazing machine, it saves the time of the med techs by staining alot of glass slides at any point of time.

After it is stained, it is sorted according to the batch number and biopsy number and sent to the doctor's in charge for microscopy. The glass slide is attached to the doctor's form.
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We have also assisted pathologists in trimming organs. Most of tissues or organs have tumours. The organs/tissues we have seen so far are breast, rectum, iluem, liver, uterus, prostate, and pancreas. We stand beside the pathologists while they cut. We assist them by labelling, giving them cassettes and showing them the patient's forms. Very interesting to see them dictate what they see.

Dictate means saying out the observation into a micophone. For example, the pathologist will say "Cyst measuring 6cm by 2cm by 3 cm is located at the upper quadrant of the right lobe". It is recorded into a computer, then sent to LIS (Lab information system - we learnt this in LMQA). An admin staff will then download the dictation and type it out and attach it to the patient's form.
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Histopathology department is rather fast paced as we handle about 500-700 slides in a day. Some are urgent while some are routine. Thus eventhough there are quite a number of staff, we need to work very fast.

By Ernest Lim
TG01 0606330I
5.45pm
29 June 2008 (Sunday)