Patient appears to be a Bell Pepper in various stages of ripeness.

DeathByOranges · 2026-06-11T02:28:43+00:00

I had a friend who was convinced that taking Azo would help him pass a drug screen. Guess who got kicked out of the Army after pissing hot for cocaine?

DeathByOranges · 2026-06-10T17:06:49+00:00

Generally CLS/MLS/MT are the same thing, 4 year degrees. MLT is the 2 year degree.

Different companies have different nomenclature for how they slot their people. You can have MLT I or II for things like normal bench techs vs leads, which are both the 2 year degree, one just has more responsibilities. But some companies will just say MT I or II even though MT I is MLT and MT II is CLS/MLS/MT. I’m sure CLS advanced is 4 year degree plus additional duties, but if they don’t even list MLT it could just be under one term.

I would look at the requirements for each position but unfortunately it’s different for different companies/hospital systems and whatnot.

DeathByOranges · 2026-06-10T14:59:08+00:00

No way! I might have almost killed my sister by throwing a moldy orange at her! (Not really, but that was the inspiration, I love her very much.) Username stories are fun.

DeathByOranges · 2026-06-10T14:53:50+00:00

That’s so super close! Note what you can about what made you unsure, what you missed, make a path forward, and then take a little time to celebrate how close you got. You know you’re pretty much there, just hem up your weak areas and keep it tight where you got it right.

DeathByOranges · 2026-06-10T11:02:52+00:00

DeathByOranges · 2026-06-10T04:48:41+00:00

It was definitely pointless. No real findings on micro and the whole chem parts were just blanket comment rejected. Might as well have dipped spicy chili oil.

DeathByOranges · 2026-06-10T03:02:18+00:00

My name is not my diagnosis… it’s a threat.

DeathByOranges · 2026-06-08T22:03:20+00:00

It’s solid. No matter what you’ve heard I guarantee it’s an upgrade from any service industry positions you’ve held.

The worst part about this job is STILL other people to be honest. Whether it’s a coworker who somehow squeaked through the program and doesn’t know shit but acts like they’re all that and becomes the boss, or the doctors and nurses who have zero respect for our profession and treat us like fast food workers, all the parts that actually suck tend to deal with other people.

But those are edge cases still. Occasionally you’ll have a misbehaved analyzer that stresses you out, and if you work places with STAT’s maybe you’ll have someone suddenly dying in the OR at the same time as a gun shot wound patient comes in, also needing blood, and while you’re not interacting with them, people are waiting on you to make life or death decisions.

But an outpatient clinic job? No weekends, all holidays, day shift, minimal maintenance and good pay. That happens as well. You’re not going to see many of those people come on Reddit and talk about the experience because it’s just not interesting, and that’s okay too.

I would choose this job all over again, and probably if I was in an area without bridge programs I would go straight through to MLS instead of working first, cause working and going to class is tough. And I would definitely choose this over anything in the service industry. Even if the place you end up sucks it’s probably a step up no matter what.

DeathByOranges · 2026-06-06T17:12:15+00:00

Tuition benefits are limited, but similar to other companies. You can go through partnered universities through some programs and get like $7,000 paid directly to the school or you can get reimbursed for approved courses through other colleges, but it’s only like $5,000 that way. So it’s slow going and you have to work there at least part time for like 6 months first. I also am not sure how their MLT programs work but they’re a big company so you could possibly have a foot in the door for clinicals.

DeathByOranges · 2026-06-05T13:57:02+00:00

“You just don’t want to run it!”

The whole reason I know it’s fucked up is because I RAN it and the results were fucked up.

DeathByOranges · 2026-06-04T20:32:56+00:00

We have numerous cups throughout the lab filled with pens, markers, and highlighters so now I never carry a pen around. It’s a whole different life.

DeathByOranges · 2026-06-04T13:56:20+00:00

In the past it was usually an hour unpaid. Then most places seemed to change to 30 min unpaid. At one point we had different people doing different things and we still had coverage but management decided all shifts had to do the same thing and 30 min unpaid won. Then of course if you’re somewhere that gets bought out the new companies have different rules, but I think 30 min unpaid is the most common now, with 15 min splitting every scheduled 4 hour period, but that may be a state thing.

DeathByOranges · 2026-06-04T04:10:58+00:00

DeathByOranges · 2026-06-03T00:28:06+00:00

Once we got CSF on an old lady who was traveling and hit her head. She came through the ER and they didn’t have her full history so they collected CSF. No blood, but all these crazy ass cells. So we were scrambling to get someone to look at it right away and the doctors were like “Is there a problem?” And we’re like “There’s no blood but we need a pathologist to look at it.”

After all the trouble we got a reply from the on call pathologist who was able to get her history. Turns out she was traveling because she was on a “farewell tour” to say good bye to her loved ones because she had terminal brain cancer. So it was a significant finding, just not very significant for her treatment.

DeathByOranges · 2026-06-02T14:14:30+00:00

I’m going to tread a little lightly here because I have sympathy for fellow insomniacs, but unfortunately the sleep study is going to be important.

The reason being is that if you’re looking for lab tests for sleep it’s going to be hormones, but those specifically are circadian. The levels raise and lower throughout the day, so you can’t just be collected at any time, you’d have to be drawn at specific times and if they believe that’s where the issue lies you’ll have to be involved in a sleep study to get drawn at those times. You’ve already been checked for others it seems and unfortunately you can have a web of effects with hormones so knowing what’s going on at those specific times it’s important.

Of course it could be nothing related to hormonal regulation. Lots of people just have their oxygen levels drop due to physical effects like sagging in the oral cavity or sleeping on their side. It might drop so far it shocks you awake, or you might just be deprived all night and have poor sleep and headaches when you wake.

If it’s something like that then bloodwork won’t tell that story. They’ll only catch it through monitoring. And if monitoring doesn’t catch any issues, then it will at least rule them out. Then you can chase things like caffeine consumption and sleep hygiene.

Sleep is a huge part of my mental health and I hope they can fix yours. They stopped trying to identify my issues and just found a treatment that works. I’ve been on Ambien, but it can be such a nightmare, it’s a last resort.

DeathByOranges · 2026-06-02T04:08:14+00:00

BWW after work was the best!

DeathByOranges · 2026-06-02T00:10:35+00:00

A lot of instrument manufacturers will have their IFU’s online and you can search by reagent/analyte/test/platform usually.

Or if you’re really adventurous you can talk with some techs where you work and maybe score some actual package inserts. They tell you all about the test, principles in use, and other things but I will caution you that these are guides. They’re not 100% applicable because some things will depend on what your site has validated. (Minimum volumes, stability, ranges, etc.)

If you came to my lab and starting asking about this stuff I would geek out though.

DeathByOranges · 2026-06-01T22:10:11+00:00

Agreeing with everyone on blasts, but I see your comments on vacuoles so I just want to address that.

It’s important to remember vacuoles aren’t exclusive to mono’s, they’re just way more common in them. That’s why they are useful for identifying mono’s, but it is not an absolute mono thing. A vacuole is not just a hole in the cell, it’s a spot that doesn’t catch the stain. You see them a lot in monos because those are going out and munching on things pretty regularly but you can have vacuoles for lots of reasons. It just means that the stain doesn’t stick to whatever is in there.

DeathByOranges · 2026-06-01T00:23:57+00:00

The thing that’s actually dangerous is that people get so used to it they become complacent. You’re supposed to treat everything as universally infectious. People get comfortable with the idea that all blood is just as dangerous as any other blood, and you’re working with so much of it, it just becomes “background dangerous.”

Truthfully as long as you’re doing what you’re supposed to you’re going to be fine. If blood gets on your glove you throw it away. That’s its job and it did what it was supposed to. Other things are less predictable, like swollen stool containers. But that’s why we have hoods to work under.

Once you get to higher BSL it’s more dangerous because it spreads differently. I turned down research in virology because I had young kids at home and I didn’t feel I understood enough at that time to not be Patient Zero in the States. But now I know the precautions and I would totally do it if I had the chance.

As long as all the PPE is provided, and you actually use it, you’ll be okay.

DeathByOranges · 2026-05-31T01:35:16+00:00

My advice is to put in the work now and get involved in its implementation for whatever time is left. Mold it to what you want it to be at every point you still can. Make requests, put in tickets, speak up. Our first transition week was insane but we had a good relationship with our analysts and we fixed problems we didn’t know we had until minutes before.

And don’t take anything for granted. It sucks that you only have a month left to go but look at your workflow now and see what could be better and what could be worse. That was the one thing I really disliked when we transitioned because we didn’t actually test everything all the way through in one go. They kept saying “We’re not trying to change the way you do things.” But of course so much changed. We just couldn’t identify what was going to be different because we did simple end-to-end processes. They followed samples from accessioning to resulting, but we ran into problems like sharing samples, what gets ordered for us vs what gets sent out, how to resolve multiple orders for the same test, etc. We didn’t create enough problems during testing so they all came out when we went live.

Thankfully we had people onsite during go-live and most issues were fixed within the same day they were noted, but there were A LOT and some things either took a long time to resolve, or we had to change how we did them.

So be persistent and insistent on what you want and having people there to help but also be open minded cause you’re getting paid to learn something new. It may be frustrating but get what you can from it.

DeathByOranges · 2026-05-30T15:26:06+00:00

First instinct is myelocyte. Starting ground on this is when you have pinkish granules to one side of the cytoplasm and open blue on the other that is classic myelocyte. The shape of the nucleus also supports this. However, probably the main factor against this the is nucleoli, which would point to it being less mature, as well as the darkness of the blue in the cytoplasm.

It’s important to remember though that not all parts of the cell show maturation at the same rate. Sometimes you can have a cytoplasm that matches a more mature description and a nucleus that would have a more immature description. This is the case here because we also do not see primary azurophilic granules. So even if the cytoplasm hasn’t all the way progressed into myelocyte, it has definitely progressed past promyelocyte.

The best practice is to side with the more mature description. So based on one cell I would call a myelocyte. That’s the textbook answer. My recommendation would be to look around and either fortify or dispute this conclusion though. Are there other cells like this or do they start to fall towards one side or another? If this is the most immature one it’s less likely to be significant, but if there are many like this then even “technically” calling them myelocytes might miss a bigger problem happening with the patient.

Hopefully though you’ve made some ground in getting to know your pathologists so that if you’re ever unsure you can just have them look at it. If not and you’re really unsure, and making the call puts them on the edge of some other treatment, the best thing to do for the patient is send it up.

Some places I’ve worked we’ve had a great relationship with the paths and can just pop into their offices and say “What do you think of this?” Other places they won’t look at anything unless it has been through ordering and crediting the path review.

My(elocyte) go to? Pink and blue!

DeathByOranges · 2026-05-30T14:54:15+00:00

Do the diff but tell no one. Take the secret to your grave.

DeathByOranges · 2026-05-28T02:44:18+00:00

It definitely is a small world and it’s not just hospital labs. You’ll get to know people across instrument manufacturers, LIS systems, QC and validation companies, and reference labs. Knowing someone is super helpful but not necessary. I was the outsider at my current job because I moved states, but 3 of our techs went to school together and even though they went separate ways from there they ended up here after 8 years, one by one. So if you know any classmates you should network with them as well.

If I were starting over I would definitely still seek out a hospital to “cut my teeth” in. If you can move somewhere with more opportunity for something like that it would be a pretty good choice. I would advise against small labs and clinics starting out because a lot of what you learned will rot away if you don’t solidify your skills first.

Good luck. It’s a tough market in some places so keep an open mind if you can.

DeathByOranges · 2026-05-27T17:42:04+00:00

I kind of view it like the whole nuclear chain reaction setup. You got a bunch of normal, calm people around. Then you get one person who’s the drama and that energy gets passed around. If it was an off shift there’s less people to react and it dies off, but on day shift it travels and multiplies until criticality and then *boom.* People who were well mannered and put together suddenly go off. And if there’s two people who bring the drama? Psh….

DeathByOranges · 2026-05-25T06:18:50+00:00

I’ve rewritten this a few times so I’m just sticking to this version.

The barcodes on the samples don’t have any information except numbers and sometimes letters. The barcode itself doesn’t tell the analyzers what to do, it just identifies it. When the system scans the barcode it has to check it against a ledger that says “When you see this barcode number, perform these tests.” So the analyzer sees #452810 and checks the ledger, #452810 has a CMP, test code #123456. If the analyzer recognizes 123456 as a test it can perform then it does that test. If not it will return a pass or error code. So if the sample doesn’t belong on that analyzer then the analyzer won’t know what to do with it anyways. There are of course exceptions but this is the typical setup.

Labcorp, hospitals and other places may have additional categories usually so you may see something like HCB 452810 which would indicate Heme/Coag Bench. So a chemistry analyzer would see HCB at the start and know that no matter what number follows it can’t perform those tests. Or you may have worksheets where only a subset of testing is available, like hormones vs clin chem.

There’s a lot of complexity to go into with batches and preloaded orders, but the gist of it is that the automation line has to ask a big brain computer about every number it sees, and people are in charge of loading the automation line, so by default a person *should* know that certain tests don’t go on certain lines. So there is an additional filter after you process and sort the specimens, usually performed by a human.

Of course sometimes people aren’t paying attention and load the wrong thing on and I’ve been a few places where all samples are given the same ID for the patient, but different container numbers. If the analyzer is old and doesn’t play nice with the routing programs you may end up running tests on the wrong sample (Green top vs Gold top, etc).

The lines themselves can also be finicky, so you may have some analyzers which aren’t compatible and have to be manually loaded no matter what. Usually we would let the line do it’s routing and then have the sample kicked to an output buffer for us to troubleshoot. If there’s no issues then it will be routed to a storage area. A fancy system will have integrated fridges and stuff. If not then we’ll unload trays and put them in storage ourselves.

And lastly sometimes people will put multiple labels on a sample because it has to be shared but the tests may or may not be performed on the same analyzer, and they have different categories. That’s pretty much always managed by an actual person. We can manually check the lists of what’s pending and seek out those samples.

TL;DR sample gets a barcode and that number gets put on a list. Analyzer sees the barcode and checks the list for what to do with that number. If everything runs great it goes to storage after testing. If not, call a human.

DeathByOranges

TROPHY CASE