Wednesday, November 30, 2011

Stagnation vs. Incubation

Sometimes inspiration can come from the most unlikely sources; say for instance from a discarded book at a library sale. The novel in questions is an autobiography of Michelangelo called the ” The Agony and the Ecstasy”, by Irving Stone. Currently it is ranked #29147 on the Amazon bestseller list, not bad for being published in 1961. In 1965 it was made into an Academy Award nominated movie starring Charlton Heston and Rex Harris.
So what does the forty year biography of a Renaissance artist have to do with Medical Laboratory Science?
How about the story of how Michelangelo Buonarroti began his career as an artist?
We automatically assume that one day he picked up a paintbrush, started painting, and the rest is history. After all, back then things were simpler, less government bureaucracy, more individual freedom, right?
Imagine the reader’s surprise to find out the opposite to be true. First of all, the profession of a painter was highly regulated in Medieval Florence. Before Michelangelo could even start, he needed a master to apprentice under. Luckily for Michelangelo a friend was able to get him into the studio of Domenico Ghirlandaio.
But that was the first hurdle for Michelangelo. The second hurdle was to convince his father, Ludovico, to enter the profession. Ludovico regarded the career of an artist below his son since it would provide an income. Ghirlandaio was so impressed with Michelangelo’s talent, that he made the unheard offer to pay his apprentice.
The rest is history, right? Later comes the ceiling of the Sistine Chapel and Michelangelo lives happily ever after.
True, eventually Michelangelo would later on paint that masterpiece. But here’s the truly ironic part. Michelangelo did not become an apprentice in Ghirlandaio’s studio to become a painter. Michelangelo became Ghirlandaio’s apprentice to become a sculptor.
But becoming a sculptor was not an option at the time. Sculptures were not in vogue at the time, and Michelangelo was told not to waste his time. So what did Michelangelo do? Did he complain about being in a dead end job that was wasting his talents? Did Michelangelo..stagnate?
Anyone who loves art will tell you that eventually he did become a sculptor as well, one of the history’s best to be exact. Maybe that time spent as a painter helped his talent as a sculptor incubate.
How many of us go to our jobs to stagnate? Do any of us look at our jobs as an incubator instead of a prison? Certainly we make choices that we wish we hadn’t, but maybe if you take a second look at that decision’s merits, you can try a different approach to make it the right one.
Incubation is about growth, stagnation is not. That is the choice of how you want to spend your career.

Tuesday, November 29, 2011

New Perspective on Smudge Cells


What exactly are smudge cells (also known as basket cells)? In patients with Chronic Lymphocytic Leukemia (CLL), it is a comment used to describe cells that look exactly like that, a cell that has been run over by a steam roller and flattened out. They are formed as a result of the action of the blood being spread out over the glass slide used to make the differential. There are apoptotic lymphocytes , more fragile than regular lymphocytes.
Conventional wisdom was that they were an artefact and only the presence of them was all that was needed to be reported. Some labs went even further by adding a drop of bovine albumin to the blood before making a smear, since this additive preventing the lymphocytes from becoming damaged while the smear was made. Since it is possible for smudge cells to be present in a normal blood smear, the presence of smudge cells by itself do not indicate a pathological condition. Before CLL can be diagnosed, flow cytometry is required.
For patients with diagnosed CLL, the presence of smudge cells was noted, but no measurement of them was done.
Two recent articles may change that:

Johansson P. Et al , ‘Percentage of smudge cells determined on routine blood smears is a novel prognostic factor in Chronic Lymphocytic Leukemia, Leuk Res 2010:34:892-8.

Nowakovski, GS et al, Percentage of smudge cells on routine blood smears predicts survival in chronid lymphocytic leukemia.

Basically a smudge cell is a lymphocyte lacking a protein called vimentin in its cytoskeleton. Vimentin is responsible for the rigidity and integrity of cells, as well as playing a role in activation and transduction. Leukemic cells that are ZAP70/CD38 positive will have vimentin and be resistant to becoming smudge cells and be virulent . Leukemic cells that lack vimentin will become smudge cells and be less virulent.
Therefore a smear from a patient with a high percentage of smudge cells will have less virulent cells and a better outcome than a patient with few smudge cells.
The challenge will be twofold, determining how to consistently identify smudge cells, and how to present the data in a consistent form.