Posters and presentation cap off senior clinicals
Concluding their clinical practicum, 28 seniors from the UW-Stevens Point clinical laboratory science (CLS) program presented their case studies and research projects to hospital program directors and School of Health Care Professions faculty and staff at the annual Student Presentation Day on Monday, March 11, 2013. [Photo Gallery]
During students’ fourth year in the CLS program, they complete a full-time clinical practicum. This highly beneficial hands-on learning opportunity allows students to work under the supervision of experienced laboratory scientists and apply their knowledge in a professional setting.
The CLS program at the UWSP, one of the largest in the state and one of the few with national accreditation, has a 95 percent pass rate on the required national exam compared to 70 percent nationally.
Complete listing of presentations and location of clinical practicum:
Kristen Hackbarth, Aspirus Wausau Hospital, Wausau
Rabies virus: Why Old Yeller’s nemesis is still a public health concern today
Rabies virus is a zoonotic infection transmitted via the saliva of infected wildlife and domestic animal bites. The virus directly infects the central nervous system causing acute, fatal encephalitis in humans. Rabies virus can be prevented through avoiding exposure to rabid animals, vaccinating domestic animals against the virus, and through the use of post exposure prophylaxis (vaccination and immune globulin administration) for individuals who have experienced an animal bite. Since the mid 20th century, the U.S. has noticed a considerable decline in human rabies cases due to preventative measures. However, wildlife in developed countries and canine rabies in developing countries still causes human infection. This paper will delve into the disease process and public health concerns of rabies along with resources created to eliminate human infection.
Erin Boodry, Ministry St. Michael’s Hospital, Stevens Point
The Tired Twos: Iron Deficiency Anemia in Hmong Toddlers, a Case Study
Iron deficiency anemia (IDA) is the most common nutritional disorder in the world, estimated to affect approximately 2 billion people worldwide. The overwhelming cause of IDA is dietary in origin. Toddlers, especially 9 to 18 months olds, are at high risk for iron deficiency. In the Hmong American population 1 in 4 children are anemic. Cultural feeding practices are associated with this trend. This case study illustrates the laboratory findings consistent with iron deficiency anemia in a 15-month-old male of Hmong descent.
Lynsey Kimmins, UW-Health, University of WI Hospital & Clinic, Madison
Now You See Me, Now You Don’t: Transient Leukemia in Down Syndrome
Transient myeloproliferative disorder (TMD), transient leukemia, is a phenomenon that occurs in approximately ten percent of newborns with Down syndrome trisomy 21. This literary review discusses TMD disease presentation, treatment, mutation involvement, and intermittent development into acute megakaryoblastic leukemia (AMKL). TMD is characterized by a megakaryocytic-erythroid blast population of the peripheral blood. Most cases are asymptomatic and dissipate without treatment within three months of birth. However, some cases with severe organ involvement ultimately require treatment. The leukemogenic cause of TMD is correlated with mutation of the X-linked GATA1 gene in trisomy 21 cells. The current focus of TMD research is to establish when, why, and how some cases of TMD develop into AMKL. TMD offers a unique perspective on leukemic development and transformation applicable to TMD treatment and a broader understanding of leukemia.
Juan Carlos Cabrera-Abarca, Ministry St. Michael’s Hospital, Stevens Point
Making Peace with Your Retrovirus
Strongyloidiasis is a human intestinal infection caused by Strongyloides stercoralis. The purpose of the following was to compile five research studies in order to obtain a better understanding of chronic Strongyloidiasis infections affected by Human-T lymphotropic virus type-1 (HTLV-1). HTLV-1 viruses are retroviruses that affect lymphocytes, which are responsible for immune responses. Research studies conducted in Japan(1), Brazil(1), and Peru(3) revealed a relationship between HTLV-1 and Strongyloidiasis. Studies suggest that when Strongyloidiasis is confirmed, screening for HTLV-1 virus must be done in order to provide the appropriate treatment. People with HTLV-1 positive are prone to more chronic infections due to their weakened immune system. In this presentation, multiple research studies will be connected in order to get not only a conclusion, but also to raise awareness about the complication of HTLV-1 infection. The conclusions and results from the research studies conducted in Japan, Brazil, and Peru will be applied to a real case scenario in order to make more sense of the spectrum of HTLV-1.
Randal Rougeux, Sacred Heart Hospital, Eau Claire
Thrown for a Lupus
Systemic Lupus Erythematosus (SLE) is a complicated disease, because there are actually five different types. Lupus is an autoimmune, rheumatic disease, meaning the immune system of the body attacks its own cells and tissues, specifically: the joints, skin, kidneys, lungs, heart, and nervous system. Perhaps the most intriguing and frustrating part about this autoimmune disorder is that it is very complex to diagnose. Lupus is considered an unpredictable disease, with no two cases the same. Ten different criteria are used to help diagnose SLE. The unique pattern of symptoms associated with Lupus has caused some to say that Lupus is like a snowflake. No two cases are alike.
Denny Monfort, St. Vincent Hospital, Green Bay
Resistance is…Inevitable? “Superbugs” in the Making!
Extended-Spectrum β-Lactamase (ESBL) producing Gram-negative bacteria are emerging as significant pathogens in hospital acquired infections (HAI) due to their ability to inactivate the antibiotics typically used to treat them. Carbapenem Resistant Enterobacteriaceae (CRE) are the most difficult to treat since Carbapenems are the drug of choice for treating ESBL organisms. The Centers for Disease Control and Prevention (CDC) reports that CRE infections can have a mortality rate of up to 40%. To make matters worse, pharmaceutical companies are not making new antibiotics to fight multiple-drug resistant isolates. Hospitals around the country are now focusing on quickly identifying patients with these pathogens, taking proper isolation measures to prevent their spread, and making sure healthcare professionals follow strict hand hygiene guidelines to prevent an outbreak.
Crystal Schemenauer, Ministry St. Michael’s Hospital, Stevens Point
Weak D: A Weak Antigen with Strong Importance
The term weak D can be defined as: cells that are positive for the D antigen but have fewer D antigens per cell than normal Rhesus positive cells. The difference between D positive and weak D is quantitative, not qualitative. Expression of this weakened antigen is primarily caused by a single point mutation which encodes amino acid changes of the RhD protein. These changes affect the insertion efficiency of the RhD protein in the red cell membrane, which causes a decreased number of D antigen sites on the red blood cells, thus resulting in weak D expression. There are three different methods by which this weakened state occurs. The first cause is genetic, the second is a positional effect, termed C trans, and the third is a structural defect, known as mosaic or partial D. The most reliable way to detect weak D is to test for these cells specifically. The Weak D Test is an indirect antiglobulin test using the patient’s red cells, monoclonal Anti-D, and a type of antihuman-globulin. Clinically, the weak D antigen has three major areas of concern: detection of this antigen in blood donors, its immunogenicity in transfusion recipients, and its presence in pregnant women.
Jessica Dietzman, Monroe Clinic, Monroe
Polycythemia Vera First Stop on the AML Railroad
Leukemia is a word most of us have heard, whether it was in the media, in the classroom, at work, or a friend/family member was diagnosed. Did the topic leave you wondering things like; what is leukemia? Are there different types of leukemia? What are the risk factors for developing a leukemic cancer? What are the treatment options? These questions will be answered during my presentation following the progression of polycythemia vera to acute myelogenous leukemia. My hope for this presentation is to create a better understanding of polycythemia vera and/or acute myelogenous leukemia.
Diane Miller, ThedaCare Laboratories, Neenah
The Parathyroid: Could You Be Suffering from This Gland’s Malfunction?
The parathyroid glands are located in the neck behind the thyroid gland itself and resemble little, yellow globs smaller than a pea. These four tiny glands play a huge role in controlling some major body systems and when one of these glands goes bad, it can wreak havoc on a person’s body and mind. The parathyroids’ only function is to control all the calcium levels in the bones and blood. Calcium is essential to life as it affects the nervous system and musculoskeletal system. The most common disease of the parathyroids is over activity of at least one gland. This is hyperparathyroidism and it causes excessive calcium in the blood and low calcium in the bones. It affects 1 in 750 people and the initial symptoms can be so subtle that they are often ignored or mistaken for something else. Symptoms range from fatigue, headaches and grumpiness to kidney stones, heart arrhythmia, high blood pressure and osteoporosis. If left untreated, hyperparathyroidism will shorten life expectancy by 5 years due to increased rates of heart attack, stroke and several cancers making it deadlier than high cholesterol. Hyperparathyroidism is curable and treated patients can enjoy overall health and better quality of life.
Ryan Blackmore, Bellin Memorial Hospital, Green Bay
Big, Bad, Budding Blasto!
Blastomycosis is a pyogranulomatous disease caused by the thermally dimorphic fungus, Blastomyces dermatitidis. Thriving in the rich, moist soils of the Great Lakes region and Mississippi and Ohio River valleys, Blastomyces is commonly contracted through the inhalation of aerosolized conidia. Blastomycosis most often presents with pulmonary symptoms, but may hematogenously disseminate throughout the body. The clinical symptoms of blastomycosis are indistinguishable from other disease processes, and visual identification is the only reliable method available to the average laboratory. As such, diagnosis can be difficult and delayed with detrimental effects to the patient. In this case study, we examine a 66 year old female presenting with pain in the lower back and buttocks. As her symptoms continue to worsen, a diagnosis is reached of blastomycosis with pulmonary and osseous involvement, leading to eventual development of acute respiratory distress syndrome (ARDS).
Heidi Hall, Langlade Hospital, Antigo
Sole Survivor Beats Reed-Sternberg Cells for Immunity!
Hodgkin’s lymphoma is a cancer of the lymphatic system. Hodgkin’s lymphoma differs from Non-Hodgkin’s lymphoma by the involvement of Reed-Sternberg cells. Reed-Sternberg cells cause inflammatory infiltration inside lymph nodes. As the Reed-Sternberg cells proliferate and migrate to other lymph nodes, organs and bone tissue, the prognosis worsens. There are four prognostic stages of lymphoma, which is primarily based on number and location of the enlarged lymph nodes due to the increased number of the cancerous cells. Most cases of Hodgkin’s lymphoma is asymptomatic, however, some patients may present with B symptoms of lymphoma. B symptoms of lymphoma refers to weight loss, night sweats and fever. A few of the complications of Hodgkin’s lymphoma are bone metastasis, pericardial effusion and death. Patients undergo radiation and/or chemotherapy, depending on the stage of the disease.
Hannah Butzen, Black River Memorial Hospital, Black River Falls
It’s Not Fat You Are Seeing
The body’s coagulation system can be depicted as two factions locked in combat against one another. A hypercoagulation disorder occurs when one faction, who fights to build clots, is stronger than the other army, which fights to dissolve clots. Hypercoagulation disorders can remain asymptomatic and undetected for years before a thrombotic event is triggered. However, when a clot is dislodged and begins intravascular migration, the effects can be debilitating and life threatening. Obesity is listed as a risk factor for many diseases and disorders, including hypercoagulation. Patients with a BMI of greater than 30.0 are classified as obese. Obese persons often experience discrimination due to public opinion, which bestows sole responsibility onto individuals for their weight status. In health care, patients of higher weight report inadequate or insufficient medical treatment or even discrimination due to their weight. Misdiagnosis is the result of identifying the patient’s risk factor as the cause of symptoms. Physicians must acknowledge the existence of weight discrimination in health care, to improve diagnosis procedure and avoid continual misdiagnosis of hypercoagulation disorders.
Ronald Miller, ThedaCare Laboratories, Neenah
Phenylketonuria: No Meat to This Story
One in fifty people in the US are carriers for Phenylketonuria (PKU). Professionals in the medical field learn about the aminoacidopathies but rarely have first hand experience with them. As a future medical professional and father to a PKU child, this presentation addresses many questions sent in my direction over the last 13 years. How did you find out and what causes it? How is it treated and what can she still eat? Is there a cure or will she grow out of it? There are many challenges that you will have to face like what happens if her levels are high. PKU does not yet have a cure. However, proper diet and supplemental formula management leads to a normal life. Researchers are currently striving to find a way to cure or enhance the lives of people with PKU.
Amy Krzykowski, Aspirus Wausau Hospital, Wausau
Mutant Cells That Pack A Bone Punch (Literally)
Multiple Myeloma (MM) is a hematological malignancy (cancer that affects the blood, bone marrow, and/or the lymph nodes) that originates from abnormal plasma cells called myeloma cells. These cells grow rapidly, forming plasmacytomas (myeloma cell tumors mostly found in the bones), and crowd out other precursor hematopoietic cells (blood forming cells – red blood cells, white blood cells, and platelets), found in the bone marrow, causing numerous symptoms and problems that only cascade into more problems. These myeloma cells also secrete a specific antibody and fragments of that antibody creating “M-proteins.” These proteins also cause numerous problems that coincide with the excessive myeloma cells. Symptoms include weakened and painful bones, hypercalcemia (high calcium in the blood), anemia, lower immune system response, and many more. This disease is found mostly in those over the age of 65, has no cure, is difficult to treat, and in general has a poor and fatal prognosis.
Victoria Kingstad, Divine Savior Hospital, Portage
Personalized Meds to be for HCV
Hepatitis C Virus (HCV) is a major cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma, affecting more than 170 million individuals worldwide. According to the CDC, approximately 75% of those infected are unaware of their infection because in most cases there are no symptoms. The current standard of treatment, pegylated interferon alpha plus body-weighted ribavirin, has a low success rate and several treatment limiting side effects. Based on the prevalence of HCV and lack of treatment efficacy, it is of major interest for both patient care and economic approach to predict drug response before or at an early stage in treatment. Personalized medicine is a newer concept of looking at a patient’s genetic mapping in order to prevent or treat disease, and may be a useful tool in determining treatment response in patients with hepatitis C virus. Recent genome wide association studies (GWAS) have shown that single nucleotide polymorphisms (SNPs) near the interleukin (IL) 28B region on chromosome 19 are strongly associated with treatment response in patients affected with HCV genotype 1. Further analysis of the IL-28B gene might be useful in the development of personalized treatment plans.
Mathew Madden, Southwest Health Center, Platteville
Creutzfeldt-Jakob disease (CJD) is a rare form of Transmissible Spongiform Encephalopathies (TSE) that affects humans. CJD is caused by prions and does severe damage to the brain. There are four types of CJD: iatrogenic, familial, sporadic and variant. Each form has a different route of causation but all have similar symptoms and prognosis. CJD is characterized by having progressive decrease in muscle function and control, along with progressive decline in mental capacity, ultimately leading to death. There is no cure or effective treatment. Prion resilience and a lack of a complete comprehensive understanding of the disease and disease process cause further complications when dealing with CJD. These complications are being researched to further understand and hopefully cure CJD. This paper is intended to bring awareness and knowledge to the subject matter of Creutzfeldt-Jakob disease.
Kyle Christie, UW-Health, University of WI Hospital & Clinic, Madison
Importance of Diagnosis and Prophylactic Treatment for Catastrophic Antiphospholipid Syndrome
The ability to recognize and provide prophylactic treatment to individuals at risk for developing catastrophic antiphospholipid syndrome is crucial for patient survival as the mortality rate is roughly 50%. Clinicians should be aware of precursor signs and symptoms along with preventative treatment options for this condition. The patient discussed in this case study only had a very brief history of thrombotic symptoms before developing into a catastrophic antiphospholipid syndrome. Had the disorder been diagnosed swiftly and accurately, the patient may have survived. In summary, identifying early risk markers for catastrophic antiphospholipid syndrome and administering prophylactic treatment before it occurs can completely alter the prognosis of the patient.
Zahira Jadavji, Marshfield Clinic, Marshfield
The Fight or Flight Tumor: Pheochromocytoma
Pheochromoctyoma is a noncancerous tumor of the adrenal gland that causes excess secretion of epinephrine or norephinephrine. This tumor has a good prognostic output with the right treatment. Pheochromocytoma is usually diagnosed after an adrenal mass is found on a CT scan, performed for other reasons. Patients with pheochromocytoma can present with headaches and spells of hypertension because of the excess release of the flight or fight hormones. In some patients, pheochromocytoma can present itself along with other diseases. In this presentation, we explore the case of a patient diagnosed with pheochromocytoma and after treatment, discovered an underlying disease, Von Hippel-Lindau (VHL) syndrome, was present.
Jill Nelson, St. Mary’s Hospital, Green Bay
Autoimmune Hemolytic Anemia: When the Body Cannot Tell Friend from Foe
Chronic lymphocytic leukemia (CLL) is a disease of the immune system. As the disease develops it becomes harder for the body to recognize self and non-self; often attacking its red blood cells, the “good guys” and leaving the “bad guys” to roam free throughout the body. 30% of CLL cases are at risk of developing autoimmune hemolytic anemia (AIHA). A normal body is able to recognize self and non-self, in a CLL patient the antibodies produced by the cancerous cells don’t work correctly rendering it incapable of stopping the attack on the good self cells. Factors of CLL patients developing AIHA depend on tumor load and amount of antibodies being produced by cancerous cells. Controlling the tumor load with medication and intravenous immunoglobins may shift the balance enough to be in favor of the “good guys” once more.
Kelly Guderjohn, Aspirus Wausau Hospital, Wausau
True Life: I was Diagnosed with Non-Hodgkin Lymphoma
“I knew it could happen, but I never thought it’d happen to me.” Non-Hodgkin Lymphoma (NHL) is the most commonly occurring hematologic malignancy in the United States. They now represent 4-5% of all new cancer cases and are the fifth leading cause of cancer death in the United States and the second fastest growing cancer in terms of mortality. This will be a presentation on the ins and outs of a NHL patient’s true life experience.
Barry Small, Marshfield Clinic, Marshfield
Liver Abscesses and Hypermucoviscous Klebsiella pneumoniae
Since the 1980s many Pacific Rim countries have been showing an increasing incidence of monobacterial liver abscesses caused by a hypermucoviscous strain of Klebsiella pneumoniae. It has been shown to cause severe metastatic complications such as meningitis, endophthalmitis, and necrotizing fasciitis. No accurate, reliable diagnostic test exists to consistently identify the hypervirulent strain. Furthermore, with the rise of drug resistances in K. pneumoniae such as ampC, ESBL, and carbapenemases, it’s only a matter of time before conventional treatment options are challenged.
Amanda Proulx, Edward Hines, Jr. VA Hospital, Hines, IL
Genes You Do Not Want to Fit Into
BRCA1 and BRCA2 are harmful gene mutations that have undergone and are still continuing to be extensively researched as genetic testing continues to be a hot topic of healthcare. Specific mutations of BRCA1 and BRCA2 have been linked to hereditary breast and ovarian cancer. A woman who tests positive for these mutated genes is 5 times more likely to develop breast cancer and 10-28 times more likely to develop ovarian cancer when being compared to a woman in the general population who does not carry these mutations. However, testing positive for deleterious, mutated BRCA1 or BRCA2 is not a definitive pre-diagnosis of breast or ovarian cancer. There are several indications a woman may have an increased risk of carrying mutated BRCA1 and/or BRCA2 including having family members diagnosed with breast or ovarian cancer and being of Ashkenazi Jewish descent. Being tested for these harmful, mutated genes requires extensive genetic counseling both pre and post testing as the result outcome may be life-changing.
Elliot Sweeney, UW-Health, University of WI Hospital & Clinic, Madison
ALL Blast Out
I will describe what is involved in the diagnosis of Adult B cell acute lymphocytic leukemia (B-ALL). A case study of a seventy-three year old female patient who was admitted to the University of Wisconsin Hospital will be presented. Her symptoms, medical history, and laboratory workup, which included and hematology results, flow cytometry, bone marrow aspirate, and biopsy procedure that were used to diagnose B-ALL will be outlined. Molecular based studies, such as Fluorescence in situ hybridization and PCR for cancer markers that are conducted at reference-lab will be mentioned. Also, genetic abnormalities along with the treatment that was administered to the patient will be summarized. Statistics on the prevalence of B-ALL will also be mentioned.
Melanie Schommer, Wild Rose Community Memorial Hospital, Wild Rose
Clostridium Difficile- A “Super Bug”
Clostridium difficile is the most common identifiable bacterial cause of diarrhea in the United States. Clostridium difficile, often called C. difficile, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotic medications. Recent studies have shown a dramatic increase in C. difficile infection with more than double the rate from 1996 to 2003. In addition, a more virulent strain of Clostridium difficile has been identified which contains several unique properties that enhance virulence. Most types of health-care associated infections have been declining but Clostridium difficile remains at historically high levels. Clostridium difficile causes diarrhea linked to 14,000 American deaths each year.
A case study presents with an 89 year old female with fever, abdominal distention and diarrhea in the emergency room. She has just been discharged from the hospital the previous week because she had surgery for her hip fracture. Her surgical course was uneventful, and she was transferred to a rehabilitation center 4 days after surgery. Documentation from the rehabilitation center indicates that the patient has had diarrhea for the preceding 24 hours and had developed a distended abdomen approximately 12 hours before that. Could this be a Clostridium difficile infection? Has the infection turned for the worse? Discover what complications arise and how serious Clostridium difficile can be!
Raymond West, St. Mary’s Hospital, Madison
Have a HAART – Keeping an Eye on IRIS
Human immunodeficiency virus (HIV) causes an infection that gradually destroys the immune system, leaving the body susceptible to a wide variety of pathogens that leads to morbidity and mortality. The establishment of highly active antiretroviral therapy (HAART) in HIV-infected patients has reduced the prevalence of opportunistic infections and has prolonged survival by reestablishing immune responses. Unfortunately, some patients experience an immune response called immune reconstitution inflammatory syndrome (IRIS) that can also lead to short-term morbidity and possibly death. IRIS is characterized by a paradoxical worsening of an infection/disease or the appearance of a new infection/disease after the initiation of HAART. While our understanding of IRIS has increased, there are still many questions as to how to optimally care for HIV patients either potentially beginning or currently receiving HAART. Because the overall incidence of IRIS is based on the population being studied paradigm shifts in the management of HIV have occurred.
Kyle Wittwer, UW-Health, University of WI Hospital & Clinic, Madison
Fungi Can Be a Real Pain in the Back
This past summer, approximately 14,000 patients across the country went to their physicians and received a steroid injection for back pain. Of these 14,000 patients, approximately 650 of them were infected by an uncommon fungal element that developed into fungal meningitis. The fungal contamination came from unsanitary working conditions at a compound pharmaceutical company in Massachusetts. As of January 14th of this year, this cost the lives of 44 healthy individuals. Since clinical manifestations of this infection started to occur in early October, investigations have been taking place at the New England Compounding Center (NECC) facility. State legislations along with the Food and Drug Administration (FDA) are now compiling new government programs and brain storming stricter quality control protocols to prevent future outbreaks of this nature.
Ann Rozella, Richland Hospital, Richland Center
Be Careful Where You Strep
The following case study will follow a patient that was initially treated for a sinus infection that later developed into meningitis, caused by the microorganism Streptococcus pneumoniae. Streptococcus pneumoniae, the second most common cause of bacterial meningitis in adults and the second most common cause of meningitis in children older than two, will be discussed in this presentation. The treatment protocol for this patient at The Richland Hospital, Inc. and information related to the patients diagnosis and recovery will also be discussed. Also forms of treatment and techniques for preventing this illness will be discussed.
Zebulon Bandow, Ministry St. Mary’s Hospital, Rhinelander
“Beware the Bunnies”
Francisella tularensis is the causative agent of tularemia or “rabbit fever”. This subject was chosen because of the importance for laboratory personnel to have background knowledge of the organism and disease. The organism can be found in the environment, so the disease could be found in patients who come into area medical centers. The organism is also on the list of potential bioterrorism organisms (far less likely in northern Wisconsin), so again background knowledge is required. Information about the organism F. tularensis such as history, where it’s found in nature, morphology, and identification will be covered. The disease tularemia will also be discussed, such as methods and types of infections, prevalence, and areas where the disease in endemic. Its role as a potential weapon will also be discussed.