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Safe BUNs and other changes: we've come a long way in three decades.

The author is a management consultant and educator. d rector of Health Management Anaysts, Los Gates, Calif.; and laboratory operations advisor, Ernst & Whinney, Chicago,

I will celebrate my 35th anniversary in medical technology this year. With all the challenges, frustration, and uncertainties that are facing us as a new decade approaches, a nostalgic look back over those 35 years may help us appreciate what we have today. Many laboratorians are unaware of what laboratories were like years ago and how technological changes have improved laboratory practice.

Test methods and lab practices in the 1950s would be considered primitive in today's modern facilities. Chemistry procedures were performed by color comparison with a standard on a Duboscq colorimeter until the Klett-Summerson colorimeter brought electronics into the arena. A BUN was considered a dangerous procedure because it required heating a highly toxic reagent mix in an open tube over a Bunsen burner.

Environmentalists would have had a field day with the Van Slyke blood gas apparatus and its excessive use of free mercury. And testing for sodium and potassium required great courage to light the new Baird flame instrument. If it was operating correctly, you could sec a bright lavender or reddish-orange flame when the standards were tested.

Hematology had no instrumentation except for hematocrit centrifuges. Hemoglobins were done manually by color comparison on hemoglobinometers, and cells were counted by diluting oxalated whole blood and placing it on a calibrated glass hemacytometer. Simple coagulation procedures involved inserting a wire loop into a tube of blood with a coagulation reagent, then observing the degree of clotting visually.

Blood specimens were taken with syringes that were washed and reused after making sure the numbers on the barrel and plunger matched. Needies were washed, hand-sharpened, and sterilized for reuse. And differential slides were prewashed in alcohol and dried by hand before use.

Microbiology had not yet identified many organisms we know today. Laminar flow hoods were still on the drawing board, and few bIochemical reaction tests existed. Susceptibility tests were performed by using long needle forceps to carefully place a limited number of medicated disks on a streaked agar plate. Glass petri dishes were autoclaved, cleaned, and reused. The lab made all of its microbiology media.

The Kahn shaker was used 'in the Wassermann serological test for syphilis. The quality of results depended on the number of shakes performed in a given time period. All other serology testing required multiple dilutions of antigens and visual readings.

Blood banking procedures were limited to basic ABO/Rh grouping and typing and lengthy compatibility tests. Incompatibility was determined by the degree of clumping by tilting the tube over a microscope mirror. Antibody identification tests were performed at the local blood bank.

All medical technology students had to learn how to do basal metabolisms, oral intubation for gastric analysis, histological procedures, and ECGs. A baccalaureate was not a benchmark for certificateion or licensure, and on-thejob training was the rule rather than the exception. There were no clinical laboratory assistants, technicians, or phlebotomists, so technologists did everything, including cleaning, sterilizing, and preparing reagents.

The '60s and '70s brought rapid growth in the variety of testing procedures and methodologies such as RIA and fluorescent antibodies. Automation began to evolve in chemistry; hematology and coagulation testing became more sophisticated. Microbiology dealt with an ever-expanding list of new organisms, antibiotics, and biochemical identification procedures. And the blood bank became more complicated as more unusual antibodies were identified.

With the advent of Medicare, clinical laboratories faced a shortage of personnel. Government grants generated more medical technology schools, and we saw the development of programs for certified clinical laboratory assistants and technicians. As more complex testing procedures evolved, specialization began to emerge.

Nearing the close of the '80s, we now have even more sophisticated testing with monoclonal antibodies, immunoassays, bIotechnology, computerized and fully automated analyzers, and robotics. The traditional testing areas are becoming blurred as immunoassay procedures substitute for culture identification or bIochemical methods, among other changes.

Technologists fill many roles in 1989. They are responsible for interpretation and correlation of results. They also serve as managers and supervisors, instrumentation and electronic specialists, and computer experts. Today's laboratory is a far cry from the one where I first worked.

The historical perspective sheds light on the changes that many technologists have undergone in the last 30 or so years. When we face the challenges of the future, we know it is not the first time ideas and practices will have to be adapted to accept change.

Thomas Jefferson said, "I like the dreams of the future rather than the history of the past." I agree. But I also believe we need to understand the history of the past to fully appreciate the advantages of the future.

When 1990 rolls around, we should greet it with anticipation and not only seek to be part of what happens but also try to make things happen the way we want.
COPYRIGHT 1989 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989 Gale, Cengage Learning. All rights reserved.

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Title Annotation:blood urea nitrogen tests
Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Apr 1, 1989
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