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Working in the central laboratory of the Kerckhoff Clinic in Bad Nauheim is the opposite of boring. A lot depends on the analysis results – for patients and doctors. And it has to be done quickly.
Bad Nauheim – “It’s like being on the motorway,” says Silke Focking as she explains the “Cobas road” in the laboratory of the Kerckhoff Clinic in Bad Nauheim. Blood samples are examined completely automatically in the long device. For each parameter, for example a certain liver value, the Cobas needs 25 microliters, a tenth of a drop. If there is an emergency on the motorway, the vehicles have to form an emergency lane so that the emergency doctor can get to the scene of the accident quickly. In urgent cases on the “Cobas road,” one sample overtakes the other, which then remains in standby mode for a short time. It’s fascinating what technology makes possible.
Kerckhoff Clinic in Bad Nauheim: The laboratory is required for 80 percent of diagnoses
In addition to the long “Cobas Street,” the Kerckhoff Clinic also has a smaller version in operation and a third as a backup in case the other two fail. “The laboratory is involved in around 80 percent of diagnoses,” says Dr. Katharina Madlener, director of the Laboratory Medicine and Hospital Hygiene Department. Together with Silke Focking, the head of the central laboratory, she presents what is done there every day. Clearly regulated procedures, sophisticated technology, great expertise and manual work ensure smooth processes.
Impressive technology: Silke Focking (left) and Katharina Madlener at the “Cobas Street” in the central laboratory. © Christoph AgelEvery patient admitted to the Kerckhoff Clinic has blood drawn and sent to the laboratory in a tube. The tube contains the patient’s name and a barcode containing information about the parameters for which the blood is to be tested.
A comparison with road traffic is also appropriate here, because a traffic light system applies when blood samples arrive at the laboratory. “Emergency is red,” says Focking of the markings on the tube. This way, every lab employee – with the exception of two men, they are women – knows that this is an urgent task. A routine test will not be put off until the next day.
Determine whether a heart attack has occurred – result must be available after 60 minutes
After the barcode has been scanned, the tube is placed in a centrifuge. This process separates the components of the blood from each other so that two layers can be seen afterwards: the liquid supernatant, the serum, and the solid components with the red blood cells (erythrocytes), the white defense cells (leukocytes) and the thrombocytes (platelets).
Blood and laboratory in numbers
One microliter of blood contains 150,000 to 450,000 platelets. These are renewed every ten days.
Every day, blood from 1,000 to 1,200 tubes is examined in the central laboratory of the Kerckhoff Clinic – multiplied by 20 to 30 individual analyses per sample.
Every day, blood from 1,000 to 1,200 tubes is examined in the central laboratory of the Kerckhoff Clinic – multiplied by 20 to 30 individual analyses per sample.
As a rule, every patient admitted to the Kerckhoff Clinic has a blood sample taken once a day; in the intensive care unit, this happens every four to six hours.
About 30 medical technologists (MT-L) work in the laboratory, equivalent to 22 full-time positions.
Three doctors share the shifts for a year. They don’t always have to be on site, but they have to be available around the clock.
The examinations are carried out on this basis. “If a heart attack is suspected, the result must be available within an hour at the latest,” explains Madlener. This can be read off from the troponin value. At the same time, the thyroid values are also analyzed so that we know straight away whether the patient can tolerate contrast medium – in case they need a catheter procedure.
Before surgery, coagulation values must be determined
A particular focus of the central laboratory is on coagulation tests. Samples are examined from the laboratory itself, as well as from practices and heart centers throughout Germany. “We receive samples for such special cases that only a few laboratories in Germany can handle,” says Focking. Put simply, the issue of coagulation is that the blood must not be too “thick” or too “thin.” Before an operation, the coagulation values must be determined so that it is known whether coagulation was inhibited beforehand by medication and which medication could be given in the event of bleeding.
Risk of thrombosis – an important issue
“The coagulation system is like a mobile that is finely tuned,” explains Madlener. The platelets take on the function of a plaster when you cut yourself, closing the wound. However, the platelets can also be dangerous: if the wall of a vein or artery is damaged, the platelets “think” they have to close a wound, rush to the spot, form a clot, which in turn can cause a blockage in the vessel.
Is a patient more at risk of thrombosis or – on the contrary – does he have a tendency to bleed? Two of countless important questions that are answered in the central laboratory of the Kerckhoff Clinic. Around the clock, 365 days a year. With the latest technology, expertise and manual work. The visit there showed: you can read more in a drop of blood than in a thick book. (Christoph Agel)
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