Welcome to Think Tech on Spectrum OC16, Hawaii's weekly newscast on things that matter to tech and to Hawaii. I'm Arby Kelly. And I'm Cynthia Sinclair. In our show this time, we'll visit a conference called Lessons for Hawaii from the 2017 Atlantic Hurricane season. It was at the Alamoana Hotel. It was an important collaboration of the partnership of Pacific Resilience and the National Disaster Preparedness Training Center. We can't afford to ignore the very real possibility of extreme weather and weather-related disasters affecting our state. We're alone in a huge ocean 2,500 miles from the mainland, a long way from help. We're regularly exposed to hurricane risks, which we've been lucky to have avoided since the destruction of Hiva and Aniki years ago. And now this year, we not only have the repeating phenomenon of El Niño, we have the much more threatening phenomenon of climate change and the extreme weather that goes with it and is accelerating all over the world. Are we prepared for the extreme weather disasters that come from climate change? For that matter, are we prepared for man-made disasters? Yes, Hawaii is vulnerable, more vulnerable perhaps than many other places on the mainland and in the world. And yet Hawaii is largely unprepared for what might happen. Hawaii is loaded with academic and scientific talent that can understand what could happen and how we can protect ourselves from it and recover from it. So it's incumbent on us to raise public awareness about these disasters and what we can do to prepare for and recover from them. Awareness alone will not save us, but hopefully awareness will lead to action by government, industry and all of us. The National Disaster Preparedness Training Center is a national organization associated with the University of Hawaii. Carl Kim of UH is its director. NDPTC is dedicated to raising public awareness and readiness to deal with and recover from disasters. BINGTECH has had a great number of talk shows with NDPTC over the years and it has regularly covered NDPTC's annual Primo Conference. This is the Pacific Risk Management Ohana Conference. Just recently, NDPTC collaborated with the Partnership for Pacific Resilience in a program to examine what we can learn from the climate change disasters in the Atlantic and Caribbean. The conference assembled a number of officials and experts familiar with the storms and disasters in the Atlantic and Caribbean in 2017. So we can learn from them and improve our preparedness here at home. The program led off with remarks from its organizers, Jennifer Sabat, the chair of Partners for Pacific Resilience and Carl Kim, director of NDPTC. This was followed by a keynote from Tim Manning, former deputy administrator of FEMA, the Federal Emergency Management Agency. Then we heard from a panel entitled Regional Highlights of Issues in Recovery, modeled by Ray Tanabe of the National Weather Service. The panelists were Dennis Huang of Hawaii Sea Grant on what happened in Texas, Kevin Sir of the Ohio Emergency Management Agency on what happened in Florida, Irvin Mason of the Virgin Islands Emergency Management Agency on what happened in the Virgin Islands, and Carmen Concepcion of the University of Puerto Rico on the dreadful events that took place in Puerto Rico. Then there was a panel entitled Leading Recovery to Resilience, moderated by Connie Lau of H.E.I. and Toby Claremont of the Hawaii Emergency Management Agency. The panelists were Roy Amemiah of the City and County of Honolulu, Matt Cox of Mattson, Ron Cox of Hawaiian Electric, Chris Crabtree of the Hawaii Health Care Emergency Management Coalition, Jerry Doloch of Outrigger Resorts and the Hawaii Visitor Industry Security Association, Ernest Lau of the Honolulu Board of Water Supply, and John Wood of Paycom. Two great panels, including all the organizations you'd like to hear from in a discussion of what we can learn from the storms in the Atlantic to deal with the coming disasters in Hawaii. The luncheon speaker that day was Paxie Pastor, co-founder and co-chair of KeyStrong.org. He was introduced by Korolee Matayoshi of the American Red Cross in Hawaii. In the afternoon, there were reports from various breakout sessions, a summary of the proceedings by Jeff Payne of NOAA, final insights by Ron Kochi of the State Senate, and closing remarks by Susan Tai, regional director of Partners for Pacific Resilience. What a day, packed with notables, loaded with chilling stories, thoughtful analysis, and valuable lessons on what Hawaii should be doing. Think Tech was there, and we walked the floor as we always do. Here are some of the footage we got and the comments we heard at the conference. A couple of weeks ago, I was at the American Meteorological Society annual meeting, and in one of the presidential forums, there was a TV meteorologist from Puerto Rico that gave a speech about her experience when Maria was passing over the island. It was telling, it was touching. She ended the speech by saying, right as the hurricane was bearing down on the island, she looked at the entire audience, and her voice was quivering, and she said, I wasn't afraid of the wind, I wasn't afraid of the rain. I was afraid for Puerto Rico. And she broke into tears when she said that. And to some extent, that's what I want everybody to be here in this room. I want everyone here to be afraid of, afraid for Hawaii. If we were hit by a Category 4 or a Category 5 system, and not afraid in a bad way where we all panic, but afraid in a good way where we collectively as a group, all of the people here help Hawaii become better prepared, more resilient in the event that something happens here. We help community meetings in schools. We're sitting in a school room. We're sitting in a music room. There are trombones and trumpets and all these things all around us. But we as emergency managers need to be creative and all of you folks need to do the same. You need to be creative, think outside the box. Hold meetings at places that you would never have meetings. It's easy to say we're gonna meet in the grand ballroom and have everybody come by and ask questions. That's not the case. They're not gonna come here. You have to go in the communities. Left-hand side, we're in a fire station. I come from the fire service, so that was like home for me. But all these other folks had to go to the fire station, because that was a central point in the community that survived the direct hit. On the right-hand side, you see us at Home Depot. How many of you guys go to Home Depot? I go to Home Depot many times. I can't fix anything to save my life, so I gotta go once, twice. About the third or fourth time, the guy goes, hey, you know, maybe you might want to hire somebody at this point, right? But all that is all part of the repair side. And we were there in the communities, in Home Depot answering questions. People brought all kinds of stuff in, all kinds of questions. In fact, if you look closely, the lady brought her dog. So this picture is on FEMA's website. It's a great way for you folks to interact with your community and make sure that they're okay. Preparedness for extreme events is a critical aspect of the process and requires more attention from government officials. Many lessons from the Hurricane Maria experience reveal preparation shortcomings. Even though preparing for a phenomenon of this magnitude is not an easy task. After four months, there's still like half of the population without electricity. And you don't have an idea of what it is until you live through that. I remember my home experience having to organize my life according to the time where the generator was on for me to take a shower, to get to the elevators and things like that. It's very difficult to do it. I think we've already been hearing some pretty common themes. And maybe one of the goals of this organization would be the convener. And to pick maybe the top three or four, we heard about preparedness, we heard about communication, and maybe start to put some working groups together to make sure that the momentum isn't lost. And that we're not, as Puerto Rico said, six months out worrying about another hurricane season and not moving the dime forward. Puerto Rico shows us anything. It demonstrates how critical it is to have a interconnected multi-sector response to a major storm like that. And so our role here today is to talk and hear what the other parts of the sectors here, the other utilities, the government, both the city and the county and the state, how they're planning and how we can work together even better than we are today to prepare. Because if there's one theme that's flowing through the initial discussions, its preparation is key. And you can't wait until the storm is marching across the Pacific and then start preparing. The consistent message about preparedness and obviously the engagement of the public and being transparent with them, a lot of people from other places when we're tourism-based economies or real estate-based economies. I think a lot of what happens is quite understandably people try to talk about it not being so bad.  And if you're engaging the public and you can have an emotional connection, the beauty of, especially in this country, so many people care. And if there's a call to action and there's a clear pathway of how they can help a family, there's wonderful families all over the country. And we're seeing in the keys, which I'll talk about a little bit, people literally all over the country wanting to help. Every disaster brings our community together and we're lucky that we have a community that responds in that fashion when we face those kinds of crises. But if we don't prepare for those crises, we're not going to be able to respond adequately. And so I think that thinking ahead is important. This kind of conference helps make sure that we are thinking ahead. I think the big lesson here is that I don't think we think that the disaster is going to be as worse as it really will be. And so like the most catastrophic loss that you can prepare for is probably the best philosophy. And one thing that's standing out is that it's not a governmental response issue, it's more a community issue. So we'll have to respond and prepare for that kind of response because the worst case scenario is very difficult to plan for. We all saw what happened in the U.S. Virgin Islands and Puerto Rico, tremendous devastation and those hurricanes because of the isolated nature of the islands, makes it so much more difficult in recovery and response. And so all the folks that are gathered here today under the partnership for Pacific resilience are thinking about Hawaii. What does Hawaii need to learn from what happened in the 2017 hurricane season to make us prepared? How do we actually create the impetus for change that our entire community will actually realize that you do have to get prepared, not just the people in this room? So first of all, pre-existing personal relationships really are the key. You just can't wait for the disaster. You need to know who your right counterparts are in each of our organizations to call and you got to keep it current as Irving pointed out. I mean I've seen lots of plans where unfortunately when you look at that phone call tree, a lot of the people have moved on to other jobs. I mean I have to say, and Ron knows this, we're reorganizing all the time within Hawaiian Electric and Scott Sue who was originally my point of contact backing me up on the NIAC, he was running system ops when we started and now he's gone on to public affairs. So you just got to keep those lists current and you want to build personal relationships with them because that's what really counts when a disaster hits. Can you call on that person? Because sometimes frankly, you know, we haven't talked that much about bureaucracy but the legal system is set up in a certain way and the processes are set up in a certain way but sometimes if you're going to address a disaster, you got to just get it done. We've been spending a lot of time talking about and thinking about question is action about Hurricane Harvey when that came down, we started seeing things flood. We said, oh my goodness, we talked to people like Ray Tanabe and we said, hey, could this happen in Hawaii? And they, you know, you get the look like, yeah, it could. And then we had the Irma experience and Irma was amazing because this is a place where we want to be. Dennis was talking earlier about his guide and his knowledge about hardening homes and business structures. We don't do that here. We are generations behind in our building codes, generations behind. I have a wonderful slide if any of you would like to have it. A picture I took down at Key West had two homes. One home was built within the last five years. And this is the post-Hurricane Andrew period when Florida strengthened their building code. And that structure has a shingle missing from the roof. And I'm sure they were hopping mad why the shingle was missing. The house next to it was a pile of toothpicks, literally. And I found out later that was built in 1960s. And so here are two buildings sustained largely the same wind load. And one was completely destroyed. I mean almost unrecognizable. I could see the bathtub from the street. And the other one was somebody who was living in it. They didn't have any power, but they were living in it because the structure withstood the effects.  Based on Puerto Rico experience in Virgin Islands, you know, how are we positioned from the electric company perspective? And I would say that while we're by no means ready for that kind of storm, I think I'm not sure we would ever be really ready. There's more we can do. We are positioned in some ways better than Puerto Rico, Virgin Islands. And since that, you know, we have had a plan and been investing in our grid to harden it for some time now. Close to one and a half billion dollars have gone into strengthening those key structures, especially those ones that go over the mountains and deliver power to the other side of the island over time. So while we haven't been able to, I would say, replace all those structures that were built in the 70s, 60s, even 50s, we've gone a long way to try and improve our grid resilience to withstand stronger storms. This morning's session was quite sobering because there are so many parallels to what could happen here. We're an island state. We're actually further from the mainland than any other landmass on Earth. And as you heard, we only have a limited amount of food supply. Another thing that wasn't mentioned is that a lot of our infrastructure is on the coastline. Our largest sort of treatment plan is at San Island. Our airport is near the ocean. Connie and Ron have a couple of large power plants right on the ocean. And much of our transportation, Kamehameha Highway, goes right against the coast. So we have a lot of challenges. Dr. Kim mentioned that Honolulu was chosen as one of the hundred resilient cities by the Rockefeller Foundation. And this is something quite exciting for us, but it doesn't mean that we're resilient. The reason we got picked was because we're one of the 100 most vulnerable cities in the world. 2017, my phone rings, my buddies and the keys were really hurting. So Irma was a special case. So when we looked at Irma, I'm going to show you a video. This was shot from a drone. And remember that 17-foot storm surge on the Atlantic side, 9-foot on the Gulf side. This is what the intercostal looked like. And imagine what that's like in terms of just the spiritual impact that has, the emotional impact of a community. And you guys have seen a lot of things. But this one was heavy. This was heavy. And so when we look at what that does to a community, and I have to give FEMA credit, a lot of people yell at these poor guys, they have been so helpful and doing the best they can. When Harvey hits Houston, and then obviously we got whacked with Irma, and then it moves to Maria and this poor, lovely lady here helping with that community, the government can only do so much, folks. It's really about what we're all used about as Americans. We get stuff done. We step up and we get some challenges now, but we'll get it done. Certainly the conversation cannot end in a conference. It must lead to meaningful action. Otherwise, Hawaii and everyone in Hawaii will be at great risk going forward. Just as our many talk shows with the NDPTC have been instructive in learning about the risks of climate change disasters, so was this program. There is, of course, a lot to learn and do for us as a community to be prepared and save ourselves when the time comes. In the meantime, NDPTC is conducting a survey on experiences related to the recent missile alert false alarm in Hawaii. NDPTC is interested in learning about the use of social media and public trust and information sources regarding emergency alerts. They will present their findings here on Think Tech. Here's a link to the survey. It's on our daily advisory and we hope you will participate. We also hope that the follow-up to this conference in the 2018 Legislature and otherwise will be faithful to the advice of these speakers and panelists. In any event, on August 6, NDPTC will be presenting a program called Technology and Disaster Risk Reduction at its annual Primo Conference. Want to know more about NDPTC? Check it out at NDPTC.Hawaii.edu. Want to know more about the partnership for Pacific Resilience? Google it and you'll see what we mean. Or just watch our shows on ThinkTechHawaii.com and YouTube. Soon enough, you'll see more of our many shows on climate change, disasters and preparedness. And now let's check out our Think Tech schedule of events going forward. Think Tech broadcasts its talk shows live on the internet from 11 a.m. to 5 p.m. on weekdays. Then we broadcast our earlier shows all night long and on the weekends. And some people listen to them all night long and on the weekend. If you missed a show or if you want to replay or share any of our shows, throw our archive on demand on ThinkTechHawaii.com and YouTube. For our audio stream, go to ThinkTechHawaii.com slash audio. And we post all our shows as podcasts on iTunes. Visit ThinkTechHawaii.com for our weekly calendar and live streams and YouTube links. Or better yet, sign up on our email list and get our daily email advisories. ThinkTech has a high-tech green screen studio at Pioneer Plaza. If you want to see it or be part of our live audience or if you want to participate in our shows, contact shows at ThinkTechHawaii.com. If you want to pose a question or make a comment during the show, call<PHONE_NUMBER> and help us raise public awareness on ThinkTech. ThinkTech lives on the internet and on mobile devices. We're now streaming live on our Facebook page and we're building an app for Apple and Android devices that will let you view our videos live and through the night and let you search and view our thousands of videos on demand. Go ahead, give us a thumbs up on YouTube or send us a tweet at ThinkTechHI. We'd like to know how you feel about the issues and events that affect our lives in these islands and in this country. We want to stay in touch with you and we'd like you to stay in touch with us. Let's think together. And now, here's this week's ThinkTech commentary. Is anyone surprised that Honolulu Mayor Kirk Caldwell wants the city to use $44 million of bond debt to pay for administrative costs related to the construction of the rail system? You know, the proposal is a bad sign indicating once again that the city mega project is in poor financial health and clearly that the wildly over budget and behind schedule transit development needs a full deep audit for fraud, waste and abuse. Caldwell's proposal to use bond money to pay for administrative costs of the Honolulu area rapid transit was contained in his fiscal 2019 executive and capital programs budget, which he submitted to the Honolulu City Council on March 2nd. The requested funds would have to be paid back with interest and certainly add to the ever mounting costs of the project. One local budget analyst said the debt interest alone could eventually be almost as much as the principal amount borrowed. And that's assuming a 5% interest rate and dangerously set a precedent for using this kind of funding mechanism in future years. In addition, the proposed spending also goes against the Honolulu City Council's law banning itself from using city funds for the rail. Ordinance 07-001 section three states that rail expenses quote shall be paid entirely from general excise and use tax surcharge revenues. Interest earned on the revenues and any federal state or private revenues. Notice there's no word bond in there and also notice that the law does not say city revenues can be used. That's why some members of the council have been seeking for some time to change the law. Meanwhile, according to the most recent evaluation of Honolulu's finances by Moody's investor services, Honolulu's quote challenges related to construction of light rail end quote could lead to a downgrade of its AA1 credit rating if the city shows quote inability to manage escalating fixed costs end of quote. Yet the mayor and his cohorts on the council now want to borrow money not only for the capital construction costs of the rail but also for its administrative costs. After receiving criticism that the rail was well over budget last summer during the latest round to seek state tax aid, Caldwell and other boosters of the project indicated that the rail skyrocketing costs were now under control and that building and operating the rail would not place the city in an endless cycle of debt. Skeptics took those assurances with a grain of salt but this update underlines the questions that still dog the project. The only way to effectively address those concerns and restore public trust is through a full audit of the rail. Although the city passed a follow-up audit last year, that audit will not specifically look for fraud, waste and abuse. More transparency is needed. Whether folks are pro-rail or anti-rail, the funding realities demonstrate that city officials need to be more forthright with the public. Not only about its real costs but also about its long-term effect on Honolulu's finances. In the end, it's a question of accountability, transparency and the public trust. The first step is to provide a full investigation of the project. Ehana Kako, let's work together for greater transparency and accountability in government. We'll be right back to wrap up this week's edition of Think Tech but first, we wanna thank our underwriters. The Atherton Family Foundation, Castle and Cook, Hawaii. The Center for Microbial Oceanography Research and Education, Collateral Analytics, The Cook Foundation, The Hawaii Council of Associations of Apartment Owners, Hawaii Energy, The Hawaii Energy Policy Forum, The Hawaii Institute of Geophysics and Planetology, Hawaiian Electric Companies, The High Tech Development Corporation, Galen Ho of BAE Systems, Integrated Security Technologies, Kameha Meha Schools, Dwayne Kurisu, Kallamon Lee and the Friends of Think Tech, MW Group Limited, The Schuyler Family Foundation, The Sydney Stern Memorial Trust, The Volo Foundation, Yuriko J. Sugimura. Okay, Cynthia, that wraps up this week's edition of Think Tech. Remember, you can watch Think Tech on Spectrum OC16 several times every week. Can't get enough of it, just like Cynthia does. For additional times, check out oc16.tv. For lots more Think Tech videos and for underwriting and sponsorship opportunities on Think Tech, visit thinktechhawaii.com. Be a guest or a host, a producer or an intern and help us reach and have an impact on Hawaii. Thanks for being part of our Think Tech family and for supporting our open discussion of tech, energy, diversification and global awareness in Hawaii. And of course, the ongoing search for innovation wherever we can find it. You can watch the show throughout the week and tune in next Sunday evening for our next important weekly episode. I'm Marby Kelly. And I'm Cynthia Sinclair. Aloha everyone.


Can I just confirm? Can everybody see my slide? You can all see my slide. You can all hear me clearly. Okay, clear naman. Nag-concert-concertan kasi kong gabi, baka pausakong. So let's start our discussion. So hematological, routine hematological procedure. So when I say your routine, these are not the special ones. Routine meaning to say these are the day-to-day tests that is being requested inside the laboratory. So again, good afternoon to everyone. I hope everybody is already awake. So gising gising na. So let's start with the first one. Let's start with the first one and the most basic of them all, which is your peripheral blood films. Okay? Your peripheral blood films or peripheral blood smear. So peripheral blood smear are made from fresh drop of capillary blood without anticoagulant or anticoagulation. Or it can actually be prepared using a fresh venous sample collected in your EDTA within two to three hours of collection. So two to three hours of collection. Sir, why two to three hours of collection? I want you to write it down below your notes. It's because past three hours, okay, after three hours, your RBC, your cells in general will start to lose their shape. Okay? They will start to lose their shape. And that is very important. And if you are going to check your peripheral blood smear, why? Because your peripheral blood smear, as you all know, diba, what are the things that we're going to check on your peripheral blood smear? And aside from the count of your cells, we also do check about the presence of anisocytosis or the variation in their sizes. But above all, we also check on poikilosytosis. If there is a presence of poikilosytosis, what is poikilosytosis again? Poikilosytosis is the variation in your shapes. P shapes poikilosytosis. So please do take note that blood films from EDTA that remain at room temperature for more than five hours would now produce your artifacts. Sir, what artifacts are you talking about? Artifacts meaning to say it could be your RBC being deformed already. And if that happened, you can actually misdiagnose it for having poikilosytosis. So napakahalaga, for you to remember, EDTA is the way to go. Two to three hours after collection, it should already been prepared. As you can see, there are two ways on how you can prepare your peripheral blood smear. One, using your fresh capillary blood, and the other one is your peripheral blood smear. What is the advantages of preparing your peripheral blood smear using a fresh drop of capillary blood? So the first one. So first and foremost, it would give us the best evaluation of the blood cell morphology. The blood cell morphology. Remember that this doesn't contain any anticoagulan. This doesn't contain any anticoagulan. So wala yung factor ng anticoagulan to blood ratio, wala yung factor ng inversion. So all of those things could participate or can contribute to the errors in your peripheral blood smear. But if you're going to use your fresh capillary blood, then you can actually have the best blood cell morphology in that. Having said that, we can also prevent some artifacts by using your capillary blood and by not using your EDTA. Aside from that, it can be made bedside. Meaning to say, at the patient's side, you can perform the test immediately. But this is one thing that one of the greatest disadvantage of the capillary blood on the other hand. Remember that a capillary blood is just a one drop of blood. So it's a hit or miss. So lalo na ako, I'll be honest with you guys to say that I don't always make the perfect peripheral blood smear. I don't always make the best smear right at my first try. So usually talaga makakailang ulit pa ako. And you don't want that to your patient. Ilang ulit mo, sampuyong daliri niya. Lahat na prick mo kasi kailangan mo ng fresh capillary blood. Of course, that's not acceptable. So it's very important to remember that. So having said that now, sabi ni sir ang capillary blood, hindi ako pwede ang makagawa ng multiple peripheral blood smear. I cannot create multiple peripheral blood smear. And that is now the advantage that your EDTA is giving you. That is one of the advantage that your EDTA blood is providing you. Aside from it, you can prepare multiple slides from your EDTA tube. You can also prepare it at a later time. So what do I mean by a later time? Within two to three hours. Aside from all of those two, ano pa yung advantage ni EDTA, it prevents platelet clumping.  What do you mean by aggregate, sir? Syempre-sugat yan. Anong nangyari pag may sugat, nag-sisiil agad yan para iprevent ang further loss of blood. Much of those topics in your hematology too. And we will see each other there. The entire one to four. So we will see each other in hematology too. So do na lang natin yung pag-usapan. So your EDTA tubes prevents platelet clumping. It prevents platelet clumping. So even though it prevents platelet clumping, even though it prevents platelet clumping, meron naman problem na idiopathic by nature. Meaning to say wala talaga sang direct cost, although they are attributing it to EDTA. But it doesn't always happen to each and every individual. And what is that? We call it platelet-satellitism. And platelet-satellitism is one of the advantages of using EDTA in peripheral blood smear. Platelet-satellitism or platelet-satellitosis, those can be interchangeable guys. So this is EDTA-induced platelet clumping. This is a platelet-induced platelet clumping. Again, let me just clear the air for EDTA. This doesn't happen for every individual. So this is just a phenomenon where your platelets aggregate on your neutrophil. Your platelet aggregate on your neutrophil. Paki-ulit ang platelet-satellitism, platelet-satellitism is a phenomenon in which your platelets will actually surround your neutrophil. So it seems like your platelet surrounded your neutrophil. So this is how it looks like. So this is an animated figure. So as you can see, your platelet here and here to your neutrophil. Ato yung itchura niya under your peripheral blood smear. Can everybody see it on the screen right now? Can I just see a raise of hands on 0102? Kasi sa 01, wala ko. Wala naka-on ng cam. Okay, thank you so much. So there, you can see that your platelets surrounded your neutrophil. So this is what we call platelet-satellitism or platelet-satellitosis. Platelet-satellitism or platelet-satellitosis. Okay, guys, isang slide lang to pero ang dami ko nang pwedeng sabihin and let me go ahead and start with those things. So in platelet-satellitism, what will happen? Dahil dumikit, dahil dumikit yung platelet mo sa WBC on your automated machine that will count your platelet. Ano, what is the level of platelet I am expecting? Is it high or low? Thumbs up if high, thumbs down if low. Will it be high or will it be low? Okay, kawawa naman po yung mga naka-on yung camera. Kasi still like dinitig na niyo, sir. Okay, will it be high or will it be low? Okay, Jordan, thumbs down. Azi, thumbs down. Simikailo, wala ay. Nagtatago na, okay. Thumbs up, thumbs down. High or low? Okay, nag-grace ng Hanselouay. Okay, sila Alberto. The answer is it will be falsely low. Okay, it will be falsely low. And what do we call that? That is pseudo-trombo-sytopin niya which is false decrease in your platelet count. Sir, bakit po bumaba yung platelet count? Because your machine can no longer count your platelet individually. Okay? Your machine can no longer count your platelet individually. Bakit, sir? Saan ba na punta si platelet? Napunta siya kanino sa paligid ni neutrophil. Are we clear with that? Are we clear? Hello? Can I see a raise of hand if I'm clear? So I can move on sa platelet-satelliteosis. So remember that ha? In platelet-satelliteosis, my platelet adhere to the membrane of my neutrophil causing now a falsely low platelet count. Okay, causing now a falsely low platelet count. Sir, how can I prevent it? As a medical technologist, that is what you want to do to prevent platelet-satelliteosis. Number one on how you can prevent it is in cases na may platelet-satelliteosis in using your ADTA, you can re-extract blood. Okay? You have to recollect blood and if you're going to recollect blood, you will no longer use your ADTA. Instead, what we're going to use is your sodium citrate, your light blue top. Okay? Sir, ano po ulit? In cases na your peripheral blood smear had a platelet-satelliteosis when you use your ADTA, what you can do is to recollect the blood, scenario na yan para sa case study, to recollect the blood using your sodium citrate. Sir, when I measure it, iyon na siya agad. Hindi po. Okay?  Sodium citrate now will be used in counting my entire complete blood count or just my platelet. Anyone? Will I use the values? Di ba nag-collect ako ng ADTA? Nag-collect ako sa sodium citrate. Ang problem ko lang sa ADTA was the platelet. But now, sabi ko ha, mag-recollect ka ng blood. Ngayon, mayroon ka ng sodium citrate. That sodium citrate will be used in counting the complete blood count or just the platelet.  Okay? Di tingnan ko po. Okay, may sumagod. Sagot ni Gab is platelet count. How about the others? Sagot ni Gab platelet count now. What about the others? Ang sagot nila ay platelet count. Ang sagot nila ay platelet count. Which is correct. That is only for your platelet count. That is only for your platelet count. But please do remember that you have to multiply the platelet count with its correct, what do you call this? Correction factor. Okay? May correction factor tayo na 1.1. Okay? Na 1.1. Again, 1.1.  Okay? So, siyempre nilalabasko rin calculator ko na hindi ko siya mong mong multiply. Okay? So 90 times 1.1, yun yung magiging answer natin. That will be the final count of your platelet. Okay? So 90 times 1.1, asana po yung mga mathematician natin dyan. Okay? 90 times 1.1, the answer is 99. Okay? The correct answer is 99. Okay? And maybe some of you, sir, bakit po may correction factor? It is because of the dilution created by your sodium citrate. Okay? It is because of the dilution created by your sodium citrate. Okay? Are we clear so far? Are we clear? Hello? Hello? Are we clear? Okay? So nakakafalo pa ba? Okay, so moving forward now, after platelet satellite, so that is your peripheral blood smear. So there are different methods of how you can prepare your peripheral blood smear. It can be a manual wedge. It can be a covered glass method or an automated slide making and staining. So meron ng automated. Okay? Sir, bakit papukilangan namin matutunan? Bakit kilangan papun namin matutunan yung manual? Kasi hindi po lahat ng hospital, ay katulad ng St. Luke's na merong automated na smear preparator. Okay? So ang nangyayari, di, for example, when I was in, alam nyo ba, when I was in my internship, meron pa kong lock, meron pa kong sweating glass, parang ano siya? Glass slide. Yung glass slide na yun, yung smooth siya on both edges. Smooth siya on both edges so that I would use that in preparing my blood smear. Okay? In preparing my blood smear. So moving forward now, let's go to the different methods. We have three, the manual wedge technique cover glass method and the automated slide making and staining. So obviously, okay, obviously, the most commonly used in the laboratory is your wedge technique. Okay? Your manual wedge technique. In your manual wedge technique you are using two types. Okay? You're using two slides. Okay? One would be the spreader and one would be the blood film slide. Okay? One would be the blood film slide. So always remember this, guys. Okay? When it comes to manual wedge technique, okay, there should always be an angle of 30 to 45 degrees. Okay? 30 to 45 degrees angle for your manual wedge technique. Okay? 30 to 45 degrees. So later on, we will do some tawagito. We will actually do some comparison on when to increase it or when to decrease those angles. Okay? Mamaya, share ko sa inyong bakit kailangan ganito yung level. Okay? So makikisulat na lang po sa inyong mga notes or sa mga papers ninyo. Okay? That when doing your, when doing your peripheral blood smear, this is in general, whether manual, cover or automated, you have to look at the, you have to look at the hematocrit of the patient. Okay? You have to look at the hematocrit of the patient because sometimes, okay, the hematocrit of your patient would greatly affect whether or not you're gonna prepare a thick smear or a thin smear. Okay? A thick smear or a thin smear. Ano yung mga pagkakataon na kailangan, i-decrease or i-increase natin yung ating angle. Okay? Yung angle ng ating spreader against our blood film slide. So sometimes, number one, you have to decrease the angle if you have high hematocrit level. Padmatas na hematocrit inversely proportional si angle. Simple as that. Okay? So meaning to say, kung na re matas yung hematocrit mo, you have to lower down your angle as low as 25 degrees na angle. Are we clear? 25 degrees angle. But, okay, but on the other hand, if your hematocrit is so low, you have to increase the angle. Okay? So how can you remember it better? Ang angle and hematocrit are inversely proportional. Okay? If my hematocrit is high, I need to decrease the angle. If my hematocrit is low, like in anemia, I need to increase my angle. Okay? I need to increase my angle. So moving forward, that is one for your angles. Okay? That is one for your angle. So let us move on with your, let us move on first to your manual wedge technique. Okay? In your manual wedge technique, again, this is the most common and the most convenient one that is being used currently up-to-date. Up-to-date. So, one thing that I want you to remember with regards to, one thing that I want you to remember about manual wedge technique is that it employs a 2-3 inch to 1 inch glass slide. So the clean glass slide natin, yung gagami din natin. Again, dalawa yung glass slide na meron ka dyan. Okay? One is the spreader and the other one is your, is your blood film slide. And please, please, please, okay, write this down. Write these numbers down. All of these are numbers, but these are very important numbers that I want you to remember. Aside from the angle na 30 to 45 degrees, I also want you to remember number one. Okay? Wait lang, hinahanap ko yung reviewer ko mo yung boards. Okay? Number one. Okay? Number one. The drop of blood, okay, nakikita niyo yung drop of blood na nakalagay dito.  The drop, the drop of blood should be 1 centimeter away from your label. Okay? The drop of blood should be 1 centimeter away from your label. Okay? Another thing, the drop of blood should be approximately 2 to 3 millimeter in diameter. Sir, ganagawa pa ba yan talaga? Minimeshure pa na 2 to 3 millimeter, millimeter ha, 2 to 3 millimeter in diameter yung drop of blood. In reality, it's just an approximation. Okay? So, that's what you're going to do, ha? Okay? Aside from the 30, aside from the 30 to 45 degree angle, I need you to remember that the drop of blood should be 1 centimeter away from your label and the diameter of the drop of blood should be around 2 to 3 millimeter. 2 to 3 millimeter. Okay? So, moving forward, okay? So, moving forward, okay? Moving forward, did everybody nakuhaban natin lahat yan? Can I see a thumbs up if yes? Hello? Okay, thank you, thank you so much. Okay, so, ayan, so that is for your manual wedge technique, okay? For your manual wedge technique. Again, you can prepare both thick and thin near here. That is being used for your malaria. I don't know if you can still remember your CPH. Okay? But we are using your manual wedge technique and preparing that, okay? Next is we go now to your cover slip method or cover slip technique also known as your early age method. So, here, okay? It requires small drop of blood or a bone marrow. So, having said that now, this method is actually being commonly used for your bone marrow, bone marrow smear. Okay? In your bone marrow smear. I guess in your histopath, you did discuss some of this as well. Like yung impression smear, yung mga crush, yung mga ganon. So, this one is an example. If it is a bone marrow, crush siya. So, you're gonna put the specimen in between two slides and then ipagihwala yun nyo lang siya ganon. Then that's it. That's already the smear. Okay? So, the cover slip technique requires a small blood of blood or bone marrow. Place in one cover slip, okay? And then another cover slip on top. So, ganon lang and then you're gonna analang. You're gonna pull one cover slip, preferably the one on top, and then that's already your smear. Okay? That is already your smear. So, usually cover slip technique is done for your bone marrow smear preparation. Okay? Bone marrow preparation. So, there are two types. There are two types of cover slip technique. If you are using both two cover slip, if you're using two cover slip, we call it Erlich method. Okay? We call it Erlich method. So, not a cover slip to cover slip, Erlich method. But if it is a cover slip and if it is a glass slide and then on top of it is a cover slip, we call it your B-coms method. Okay? Your B-coms method. B-e-a-c-o-m B-coms method. Okay? B-coms method. So, Erlich and B-coms. Okay? So, that is for your peripheral smear. Moving forward now, is your automated one. Okay? The automated one is an example of this. Is your SYSMEX SP-10 that prepares smear after blood sample was analyzed. So, the amount of blood, the angle, speed are all based with your are all based with your what do you call this? Are all based with your hematocrit value. Okay? So, paki-kitandaan po ako noon, ha? It's based on your hematocrit. Okay? It's based on your hematocrit. Okay? Based on your hematocrit. So, having said that now, okay? Having said that now, let's just go through it quickly how does a blood film it being prepared. I guess if you answered your lab manual already, you'll be able to identify some of this. So, you have all your material. So, usually, ayan, you put a drop of blood to three millimeter in diameter one half inch from the frosted area of the clean glass slide that is approximately one centimeter. Okay? One centimeter away from your label. So, difference, you have your difference dispenser. So, if the drop is too large, okay? If you had a two, if your drop is too large, meaning to say, greater than three millimeter, okay? Greater than three millimeter, your peripheral blood smear would be longer and will be thicker. Okay? And you don't want that. Okay? Kasi, lalampas siya dun sa slide. Bamaya, mapapakita kung mga example sa inyo. If it is too small naman, it would be very thin and it will just be very short. Okay? And you also don't want that. That's why the optimum should around be, should be around two to three millimeters in diameter. Okay? In addition to that, with a 30 to 45 degree angle, ayyan, it should be a finger shape. Okay? A finger shape smear. Okay? A finger shape in rodak, it would actually even bullet shape or tongue shape. Okay? Tong shape or bullet shape. Okay? So, imagine your finger right now. Ayyan, if you make an impression on a surface, yung shape na yun, dapat ganan yung shape ng smear natin. Okay? Ganan yung smear natin.  So, she was performing, I think it's an O2ata, ay sa O2B na sa O1, basta yun. Diba, nakita niyo doon how difficult it is to prepare a perfect slide. Diba, ayyan. So again, fhematocrit is higher, lower, angle. So, ayyan, ito siguro ang kelahan kung isabihin pang- isa. The slide should be rapidly air-dried. Okay? Air-dried and stained with aromano-ski-stain, which is typically a right-gim sustain. Okay? A right-gim sustain. Later, pagusapan din natin yung stain na kailangan dito. When I say rapid air-dry, hindi po yung itatapat yan sa air-con at hindi niyo rin po itatapat, hindi niyo rin po hihipan. Okay?  So, don't blow-dry your, do not blow-dry your smear. Okay? So, this is how it looks like. Ayyan. So, the frosted area where your um, label will be please. So, one centimeter away, your two to three millimeter blood, and then you would um, you would prepare now your smear. Okay? This is the head, this is the body, and this is the tail. In the body, you would actually um, would have a hard time looking at um, at your cells. Kasi the cells here overlap. Okay? The cells here overlap. That's why, okay? That's why, the best, okay? The best area on where you can assess your peripheral blood smear is on your zone of morphology. Okay? In your zone of morphology. In some references, you would actually see this as the feathery edge. Okay? As the feathery edge. Makikisulak po ako doon as the feathery edge. So, you will be able to um, see each cell if properly, their morphology, in the overlap, in the patong-katong, on the zone of morphology, eh, or the feathery edge. Okay? On the feathery edge. So, the zone of morphology, ayad, should be at least two, two, two centimeter in length. This one, okay? So, this is where you would perform your um, peripheral blood smear reading. Okay? Dya magbabasa. Okay? So, um, please do remember, okay? Please do remember the features of a properly prepared, or a well-made, uh, a well-made peripheral blood smear. Number one, ayad, number one, it should occupy two to three fourths of your, of your, two to three fourths of your slide. Okay? Two to three fourths of your slide. Number four, parang daming susulatin. Kung bilang download may power point ang dun nyan sa notes. Nanghintan nyo ba yung sa notes? Kasi nandun nyan kay Roda. Nakay Roda, nakabox type nyan kay Roda. Eh, kung, ayad. So, two to three fourths dapat yung length. Okay? Two to three fourths yung length ng smear. Okay? Two to three fourth. The film, or the blood film should be, um, the blood film should be finger shape, finger shape, or, ayad pala, not bullet shape dapat yung sa nabi ko. So, finger shape siya dapat, masaparang, yung know, yung parang dulo nyan napaganon. Hindi siya pointed. So, the blood film should be finger shape, um, very slightly rounded on the feather edge, and not bullet shape. Ayad. Not bullet shape. So, let me retract my statement. Not bullet shape. Okay? The lateral edge, ayad, should be, of the film, should also be visible. Ayad.  They will try to compare everyone kung na re, mag-prepare ng blood mirror, tapos paano mag-prepare ng blood mirror? Pag yung tinanong mo sa internship na ko, ikaw na ang topic ng buong hematology section later. So again guys, paano mag-prepare ng blood mirror?  Usually para na tatan siya namin, yung applicator stick, sasa usawa namin applicator stick, tapos yung dulunon, yun na yung 2 to 3 millimeter. Letter A is a no no, letter B ay yun yung staggered. Hindi po to, para mukha siyang lipstick ano, yung pag nag-check ka ng mga lipstick, yung shade ng lipstick, hindi ganyan. Hindi rin po gan nito. This is not 2 to 3 fourths, especially this one. Upon looking at this one, I can say that the drop was less than 2 millimeter. I think this is less than 2 millimeter, because it didn't even reach the 3 fourths ng slide. Ito naman, hindi din po pwede. Why? Because you have to wait na mag-spread yung blood muna side by side. Ito may holes, hindi rin po pwede yan. Ito hindi siya finger shape, hindi siya tongue shape, hindi siya finger shape. Kung ahas yan, siguro ganyan yung dila ng ahas, pero hindi dila ng ahas, yung basehan natin kung dila ng tao. Hindi yan tongue, this is wrong, especially this is also wrong. You cannot perform, we cannot use this one. So all of this have different causes. So ninsan mali yung motion, masyadong ma-de-in, masyadong ma-gaan. There is a presence of oil in your slide. That would all be the causes of these peripheral blood smear abnormalities. I will not go into, I will not be reading the reasons of A to H anymore. I would just be sending you the page number later. I will just be sending you the page number of your page number in your Roda. Please do read the reasons to why such scenarios happen. Kasi pwede ko na itong ilabas sa exam. Diba, ilang items na yan, nine items na yan aga. So which of the following is the cause of what itch. So please take note of that. And of course, what are the different factors affecting your peripheral blood smear preparation? We have passed the pressure, the angle, the spread, and the speed rather, and the size of blood.  Parang anggaan-gaan, parang ayaw ko makaktan yung smear. So pag masyadong time pa bebe, masyadong thin naman yung thick yung smear naman pa-prepare natin. So if the angle naman, you will prepare a thick smear. If the pressure is low, the angle is too high. This is assuming na normal yung hematocrite natin dito. The spread is too far. Yung speed mo masyadong mabilis ay nagmamadali, diba? Start po kasi sir Roda, diba? Start ka din.  Thin smear naman, all of the opposite. All of the opposite. So again, please remember past. Please remember past, which are the four factors affecting your peripheral blood smear, which are pressure, angle, speed, and size of the drop of blood. So moving forward, let's go to the drying of your peripheral blood smear. The drying of your peripheral blood smear. So it should be dried as quickly as possible. You can use your fan, but not directly na dung fan tapos nilagay mo na dung slide. Cannot be. Do not blow on the slide kasi yung laway mo kapatid. Kung yung katabi mo nga, ayaw niyang kingahan mo siya. Lalo-lalo na rin yung peripheral blood smear. Water or drying artifacts could cause your RBC to deform. Water or drying artifacts could cause your RBC to also be pre-nated and makalos yung central pallor nila. So there are a lot of things to consider in drying. So kahit naman perfect ngayong nagawa mo, mali naman yung pagkakapatoyo mo. Wala rin. So after drying, naka-prepare ka na nang slide. Nag-collect ka na nang blood, naka-prepare ka na nang slide. Perfect yung slide mo, napatoyo mo na yung slide. Anong gagawin mo next? Syempre, you will stain your slide. Bakit kailangan natin siya stain? That para ma-identify mo yung mga blood cells. So dito na pupapasok si Salmon Pink ni Red Blood Cell. So moving forward, we have four solutions in your stain. We have your methanol. In general ganito nalang, we have your fixative, we have your acidic dye, we have your basic dye and we have your buffer, yun yung apat. And to be more specific, we have your methanol which is your wood alcohol. Tama ba in your isto path?  Your fixative is a methanol. The acidic dye is your Aucin. This is colored red. The methylene, the methylene blue obviously is colored blue and it is a basic dye. It's a basic dye. What about the buffer? The buffer can be a 0.05 molar of sodium phosphate which has a pH of 6.4 or you can have an age distilled water with a pH of arranging from 6.4 to 6.8. Sir, can you elaborate more on the age distilled water? Age distilled water is a distilled water na you let it stand lang for 24 hours or more. 24 hours or more. Age distilled water. Hindi yung ko na rin. Sir Bernard, ok ko na rin na nandong tayo sa lab. Sir Bernard wala po ang age distilled water. Hindi kakukuhan ng distilled water lang. You would get an age distilled water. Why age distilled water? Because the pH is very important. The pH is very important. So please do remember this guys. Please remember that your age in dye is your acidic dye. And this will be attracted by your basic alkaline component. Pag sinabi kung alkaline component, ito yung cytoplasm mo, yung mga gran, yung imang ko na rin. Yung, yung, nga rin mo ang example natin ng, ayan, ng mga basic yung proteins, yung mga granules mo, ang iabsorb nila is yung aosin, yung acidic dye natin. Basta din ito siya guys. Ok, parang clear lang tayo. It's always the opposite. Ok, it's always the opposite. If it is a basic component of the cell, ok, if it is a basic component of the cell, pagsinabi kung basic alkaline component of the cell, ang i-attract niya, ang iabsorb niya na stain is your aosin. Pag acidic naman yung component ng cell, like your nucleic acid, yung mga ganyan, ang i-attract naman niya is yung basic dye. That's why, as you can see, your nucleus is colored blue, ok? Your nucleus is colored blue, purple to blue. It's because of your, it's because of your methylene blue. Question. Ok, eto medyo malayo-layo natong recall question kung nang itatan ang sa inyong. Pero tingnan ko lang kung makakasago. What type of leucocytes is called the robin blue egg? Robin blue egg lymph leucocytes. Robin blue egg leucocytes. What is that? Chat box. O sige, yung makakasagot may plus one sa quiz. A-ha, may sumagot. Yung una lang ha, yung pinakauna lang. According to timestamp, ok. On the other section, kung na rin pag may dalawang, may sumagot dito, si Imperial at 348, lymphocytes ko ay 348, si Ejan, 348 din, ok? 348. So na variety 348, ok? Telebrico 348, Ordaneta 348, at lahat sila paray-parayat na 348. Olyon 348, Anghyles 348, Davis 348, Guevara 348. So ayan, Zayon, 349 yung lymphocytes mo. Ok, so cut off na po mga kapatid. 348, to lahat nang nag 348. May plus points dun sa quiz. Next meeting. May plus kayo sa score na din. So let me just jot it down, shorty na later nila. So ayan, so congratulation. So ganyan na lang para mag-resite yung lahat. So ayan, so moving forward and we have a manual, we also have a manual way of doing your smear. So you can flood the right stain. Ok, you can, pwna muna you will flood the slide with your fixative. Laging kanon guys ha, fixative, aosin, fixative, aosin, methylene blue and then your buffer. Ok, and then your buffer. If you have your bias pagdating sa gram stain, important din yung sequence na to pagdating sa peripheral God's sustaining. Ok, so you will, in the manual technique, you would allow 1 to 3 minutes na mag, 1 to 3 minutes dapat yung, 1 to 3 minutes dapat nag, nabababad yung slide. Ok, so you also have your automated. This is generally 5 to 10 minutes of stain per batch, per batch ito. So meaning to say it can prepare ato mga less than 20, less than 20, 20 and up na slides. Ok, and we also have your quick technique. The quick technique is a 1 minute process only. So ito naman dip, dip lang. Ok, dip lang. Ok, so 1, 2, 3, 4, 5. Lipat, 1, 2, 3, 4, 5. So the sequence in the quick technique is 5, 5, 25, 5. Ok, 5, 5, 25, 5. Sir, important pa po bang tandaan niyan? Ok, 5, 5, 25, 5. Yes, important po ang tandaan niyan. So moving forward, we also have here the different characteristic now of a well-stained smear. How will I be able? How will I be able to check if that is really a very good peripheral blood smear? How would I say that is a good peripheral smear? So number one, number one, ang unang-unang yung titignan is, of course, yung color ng smear mo itself. Yung color ng smear mo. Yung color ng smear mo should not be red and should not be blue. It should be something in the middle. It should be something in the middle. To be more specific, macroscopically, kung makikita niyong notes ko, kung makikita niyong notes ko, it should be a purple, pink to purple. Ganito yung ano niya. Transition siya na pink to purple. I don't know if you guys would can see it, but it is a pink to purple na, kita niyo ba, but hindi ka nalakas yung screen share, sir. Bata ganyan, pink to purple siya na, pink to purple yung color yung ating smear. Pink to purple. And guys, please do remember the colors of your, ay nan dito pala, macroscopic, pink to purple. Pink to purple. And then RBC should be Salmon pink to orange. Salmon pink for RBC. Bakit ganun ko pre-nopronounce? Kasi ganun siya pre-nopronounce ng professor ko ng Kimatology One datay. So na daladala ko siya hanggang ng board exam. So Salmon pink. So parang yung patalastas lang siya nang parang salon pas- ah tayo nabasa ganun. So WBC, the nuclei should be purple to blue. The cytoplasm should be pink to tan for the cytoplasm with violet or lilac granules. Ayyan, lymphocytes. Light blue cytoplasm, robin blue egg. Monocytes, gray ground glass cytoplasm with tiny red purple granules. Okay, and your hails in a fill, it should be colored bright orange. And your platelet should be purple to lilac cytoplasm. Hindi na kasama si Baisofill, but please make sure na yung double, yung granules ni yung granules ni Baisofills is from purple to black. Nearing black na yung color ng Baisofills. Okay? So please remember all of those things. And on box 16-1, sir do we need to grid this? Yes, you need to grid this. So these are the usual problems and causes of a poorly stained smear. A poorly stained blood smear. Poorly stained blood smear. So kung narit, RBCs are gray, so meaning to say may problem yung buffer mo either alkaline or it's too alkaline. So please read on box 16-1, everybody. Please read on box 16-1. So all of these are the problems and the different causes for your poorly stained blood smear. So let's go to the peripheral blood smear examination. So first and foremost, macroscopically, sabihin natin, the color should be transitioning to pink to purple, yung color natin, pink to purple. A bluer film meaning to say may increased blood proteins yan, okay? Increased blood proteins such as in infection, inflammation, increase of plasma proteins which we were just discussing last time in clinical chemistry and apag meron tang multiple myeloma or reluformation, okay? Another thing that I want you to put down on your nose, a bluer film could also be expected if you use your heparin as anticoagulant. Okay? If you use heparin as an anticoagulant, wala siya sa powerpoint, makikilagay nalang ako. If you use your heparin as an anticoagulant, you would expect a bluer, okay? A bluer, a bluer color ng peripheral blood smear, okay? A bluer color ng peripheral blood smear. Why? Because to start with everybody, okay? Your heparin is actually acidic by nature, okay? It is a type of I glide ko glide ko sa minoglycan, okay? I glide ko sa minoglycan and it is acidic, okay? Acidic yung ating heparin. Sumi nito say dahil, acidic siya anong color ang may impart sa kanya yung color ng basic dye which is your methylene blue, okay? Which is your methylene blue. So I will be entertaining questions by the end of the peripheral blood smear. So that would be a few slides from now, okay? A few slides from now. So yan yun, ha? So grainy appearance. So anong mga if your blood smear is grainy in appearance, meaning to say it has cold hemaglutinin. Sir, where can we see cold hemaglutinin in cases of kaya? Your cold autoimmune hemolytic aninya, okay? Your cold hemaglutinins in grainy appearance. Coals are all over the film if there is an increased lipid levels. A blue speck, okay? A blue speck at the feathery edge if you have a leucocytosis. Okay? Leucocytosis or trombocytosis. Meaning to say increase yung blood increase yung WBC and increase yung platelet count mo. That's why you have blue specks on the feathery edge. Okay? On the feathery edge. That is macroscopic. Meaning to say hini kapagumagamit ng iyong microscope. Okay? But now, let's go deeper and look into your microscope. Microscopically, okay? Again, where should be the area that I should optimally see? RBC singly distributed without overlapping with one another. That is your feathery edge or your zone of morphology. In your microscopic analysis we call that the optimal assessment area. Okay? And where can you see the optimal assessment area in your feathery edge? Okay? Please take note before anything else your blood film was focused under 10 times or 40 times objective. It is impossible to bring in to focus under 100 degree ay 100 degree. 100 times magnification. Okay? 100 degree magnification. So bakit hindi po pwede kasi diba pag 100 that is already for oil immersion na part? Okay? So look at this one. Look at this one. There is a non-uniform distribution of red blood cells over the smear dito. Kumakikitan nyo this is the side. Okay? Can you see this? Can everybody can I see lang? Can everybody see the picture? Can I see a race of hands if everybody can see the pictures in here right now? Okay?  And if you're going to look at this side you can see na tignan mo you can actually see that dikit dikit yung RBC I cannot even identify if I'm looking at this one you can simply just say ah may poikilositosis this one is ROLU formation as you can see your RBC was actually compressed with your white blood cells. These are all incorrect. You should not never ever look at this one, okay? Kumapapansin nyo this is near the feathery edge already. This is the end of the feathery edge. But if you're going to look closer on the farthest edge of your smear kiyohi hindi rin maganda yung morphology. So you have to look where every cell is like this. Okay? Yung nakikita ba on the upper right? Every cell should be singly. Hindi naman singly na in single na single n makakita mo merong iba dito may nag-overla minimal, okay? Very minimal. So one thing that you should also consider is that the RBC I can see them singly and I can see the central pallor, okay? I can see the central pallor of my RBC. So this is the perfect one, okay? Charan, okay? The color salmon pink for your RBC.  So looking at this one, sir, pwede mo ba yung gawing assignment? Bilangin lahat ang platelets. Ayyan, platelets to one, two, three, four, five, six, seven, eight, nine, ten, eleven. Sir, do we really count that in the laboratory? Yes. Okay? Mga kapanalik sa paniniwala. Binibilang mo yan isa-isa. Okay? That's why, okay? That's why you really have to, you really have to master. Another thing that I would request everybody know, please download all, download pictures of your white blood cells, of your platelets and your RBC. Gawin mo siyang screen saver. Okay? So tulukan yung isa-isa, yung EIG story nyo hanggang matapos yung finals para memorize ninyo yung itchura ng mga cells ninyo. Actually, that's just really the way it is. Alam nyo ba kami datin ng mga friends ko? Hindi kami, dati kasi nung time namin, hindi pa ang tanda ko ba masyato. Yung Instagram hindi pa siya hype na hype. So di ba, during our free time na yung nagskantay ng pictures ng ano, ng mga Instagram, nung sinong mga pinofalo natin. Kung ko, ayan, tulad ni Jericho, siguro si Jericho, si Lakit, nakita na nila yung 13th season, di ba, yung 13th season na yung sinachek ninyo yung mga yung feed ng 13th season ng RPDR, di ba, yung sinachek nila. Pero, okay, I want you to, I want you to take this talaga, seriously, you can download pictures, tapos, yun yung ano, yun yung panoorin ninyo, yun yung tignan ninyo every now and then. This would really help even in Gen Path, in Histo, yun yung ginagawa namin before. So moving forward, dal-dal mo sir. Okay, let's go to the peripheral blood meal, peripheral blood film examination, the microscopic. Okay, so at your times 10, 10 times objective, which is 10 times objective, LPO, HPO, or OIO. Nakoha, baka nakalimutan natang part nato. 10 times, LPO, HPO, OIO, or scanner. Hala hindi sumakasagot. Bigyan ko kaya yung pop quiz sa ano, sa microscope. That is your LPO, correct. So LPO yan. So overall, you can see the overall film quality using your LPO. Ano yung ginagawa mo, yung scan mo lang, scan scan, ganun ganun yan. If merong mga large artifacts, ayun, may fibrin strand, pag may mga large abnormal cell, like blasts, reactive lymphocytes, or even parasites, like in normal area, kung nara, yung mga pinag-aralan yung kay sir Jude and mambioli na mga parasite, yung mga philarial worms, yung mga kita nyo yan sa ano, sa peripheral blood smear. So you can automatically, you can tawag ito, you can detect them immediately in your LPO.  In your LPO. You can perform here your snowplow effect na you just simply go through the slide. Dinadaanan mo lang siya. Pero wag mo nga gawin snowplow effect, yung pag-aaral mo ng HEMA, kasi hindi mo pwede tinitignan-tignan mo lang yung letra sa libro at sa notes, hindi yan mga, that should not happen. So moving forward, if you're gonna look now, on a greater magnification, like for example, 10 times, 40 times, or 50 times, that is for your HPO, you are now selecting a correct area. Okay? Selecting a correct area of the film in which you will start your differential count. Where do we do your differential count? We do your differential count for your WBC. Okay? Your WBC differential count and to evaluate cellular morphology. And in this case, this is your, in your HPO, 40 times to 50 times, you can perform WBC estimate. Okay? WBC estimate. So before I go to OIO, let's just have a quick recap. If I am using my LPO, I am checking the overall quality of my slide. Chinachet ko kong maganda na ba siya, kong pasado na ba siya para sa aking. Another thing that you can see in your LPO are the three, the blast, reactive lymphocytes, and your parasites. Okay? The blast, reactive lymphocytes, and your, your parasites. When you go now to your HPO, preferably 50 times to 50 times magnification, what is your purpose? What is your purpose? To select, to select the area where you will be counting your WBC and where you will be performing your differential count. Yung pipili ka na ng tamang lugar. Okay? Nang tamang area sa slide. And aside from that, in your HPO, you can already perform your WBC estimation. Okay? WBC estimation. What about your OIO this time? In your OIO, 100 times objective magnification, you would now start to see your RBC, your WBC, and your platelet morphology. Okay? Dito mo nang makikita. Okay? Ang aking red blood cell may central pallor na, na two thirds, okay, two thirds of the red blood cell is the central pallor. And then I can see that it is colored salmon pink. And then eventually I can see that it is by concave yung mga ganon. Okay? It is already by concave. Did somebody raise their hands? May nakasban ang kamay. I didn't see that. So, ayan. So, ayan yung sa, anon natin ha. In your HPO, you can perform your WBC estimate. In your OIO, you can perform your platelet estimate. Okay? So, let's go now to your, ay actually have like a few slides na lang. Kanina pa ako a few slides. So let's go to the WBC differential count. Okay? WBC differential count. In general, let's just make it simple and straight to the point. What do you do in WBC differential count?  Remember that you have five types of WBC. What are those fives? Chat box. Faster. What are those five types of just give one? Ay nagihintay na plus one. Just give one. You have neutrophil. Okay? I can see monocyte, lymphocyte, entrial. Like neutrophils, eosinofil, basophils. Okay, what else? Sit. Ayyan. Mundi ko lang sabihin. Citibank. Kasi ang may nagtek sakin citibank. Okay. So thank you so much. So those are the five types. Okay. We have your neutrophil. Okay. Neutrophil, eosinofil, monocyte, eosinofils, and basophil. Sir, bakit ganun yung order? May purpose, bakong bakit ganun mo siya sinasabi? Lagi ko siyang binabasa ng NLMEB. NLMEB. Why? That is the most abundant to the list abundant. Okay? Neutrophil, most abundant, followed by your lymphocytes, and then your monocytes, and then your eosinofils, and the least of all the things that you can see is your basophils. Okay? Is your basophil. So, for your WBC count, normal WBC count, 100 WBC differential, laging yung tatandanser, ilang WBC po, ang kailangan kung bilangin, sa WBC differential count, ilang cells, ilang WBC dapat, ilan? Okay, yung una may plus one ulit sa quiz. Ahim, yung unisa lang tong pipiliin ko. Okay, yung pinaka top, yung pinakanan dun sa unahan-unahan. So, pasalamat sa internet, 409, para silang 409, pero yung pinaka-unay yung kukunin ko. Kasi baka wala nang mag-wisc, lahat kaya may puro plus point. Ayan. So, dito sa kabilang dako, siyung na una dito. Si Miss Van, si Jericho, Miss Vanjie, ang nauna sa kabila. So, dito naman, okay, si Jordan, okay, si Porpora. So, si Trombosaito Pinit, Porpora. Okay, Jordan, Porpora, for this side, and si Jericho. Okay? So, having said that, okay, you need to count a total of 100 WBC. Okay? A total of 100 WBC. So, siguro magtataka kaya, sir, paano po yung ginagawa? You will count in here, okay, the one that you can see here is your counter. Okay? This is your counter. Your counter here, okay, yung counter natin dito. So, nagamit natin na pang bilang ng WBC. Okay? Pang bilang ng WBC. So, each of that, represent, each button kumakakita nyo dito, represent your lymphocytes, monocyte, neutrophil, eosinophil, and even your base of fields. Okay? Even your base of fields. So, when counting your, when, have you discussed WBC differential count in the lab? Na-discuss na bang ninyo sa lab yung Okay? So, in your WBC differential count, ayang meron siya, meron tayong ibat-ibang, ibat-ibang process, let me just check kung, makapag-scrincher ako. And wala siya here. So, um, I'll just, I'll just add up na lang that and our other, so, eto, si Celevision, DM96, there are some, anong right now, okay? There are some, machines right now, na meron na siyang built-in na microscope. I don't know if you discuss this in your AUBF, pero meron na ding, di ba, dinuroan kay nila mga marawna nila, Sir Jude, on how you can read the crystals. Okay? Which is the envelope type, si Kaox, di ba, yung mga amorphous u-raids, di ba, yung mga phosphates natin, you'll, you're actually yung mga coffin lead, mga ganyan, you're able to look at those in the microscope. But now, with automation, meron ng automatic na, alam yung parang pinipicturan nila, lahat ng WBC. To take for example, I run the blood of, laspunya.   So, having said that now, okay, let's move on. So makakita niya dyan, ayan, ito yung mga different WBC natin. Hopefully, I'll be able to cover the WBC anomaly para talagang matapos natin yung hema. If not, we'll look for another date, probably, where I can, either I'll put it on hema 2, or I can just have a makeup class with everyone. Okay? So, to summarize everything before we move forward. Okay? So in phase one, you have to always, you have to always check the numbers and the descriptors generated by the testing, and summarize using appropriate terminology. Summarize according to appropriate terminology, which I will be showing shortly. And then, you have to recognize a certain pattern of the results per disease. Kasi mga rong mga disease na ano. There are certain diseases that would actually have unique CBC feature, CBC results. Like take for example, if it is a bacterial infection, it is neutrocyte, it should be neutrophilia. If it is bacterial infection, pero if it is a viral infection, it is lymphocytosis. If it is allergic reaction, it is aosinophilia. Okay? Aosinophilia. So, those different, ano, those different terminologies are very important. So, moving for a word, okay? Still talking about WBC. So WBC parameters, we have we have three, three lang yan. We have three. We have the total WBC kang, and we have your WBC differential kang and your WBC morphology. The WBC morphology would focus more when we go to your WBC anomaly. Okay? Kasi meron ding ibat-ibang shape yung mga WBC mo in different and abnormal situations. So let's talk about the total, the total WBC kang. The total WBC kang would reflect if it is, if you have leucocytosis or leucopenia. Okay? If you have leucocytosis or leucopenia. In your WBC differential kang, you, we have two types of kang. Okay? Makikitandaan po ako, we have two types of kang, the relative and the absolute. Okay? The relative and the absolute. So ano pinagkaiba ng relative at saka sa absolute? I will say it in tagalog para mas maintindihan natin. When you say relative, the relative doesn't ultimately reflect the state of your body. It's just relative. What do you mean it's just relative to the observation that was made? Why relative to the observation that was made? Imagine this. Okay? There is 5,000 people in a particular area. And then I would, sabi ko, I will count how many, how many, I will count how many boys and girls there is in the, there is in the stadium. So kung naray, I will just relatively count it. Anong gagawin ko? I will only count the first 100 tao na makakasalubong ko. Nag-gets baka doon sa scenario na sinasabi ko. So take for example, for this particular, in my relative count, nakita ko na mas madaming babae, ay mas madaming lalaki kesa sa babae. Kasi yung nabilang ko, 60 yung lalaki, 40 yung babae. Okay, 60 yung lalaki, 40 yung babae. So that is my relative count.  Nag-gets niyo ng poin ko with the relative and absolute. Sometimes relative depends on what type of cell did you first on your microscope. Ko narek nakita mo, anyo trofil, anyo trofil ulit, anyo trofil ulit, pero di mo narealize that is just a relative. That is just relative. Relative lang siya. So between the two, which is the most accurate, your absolute counts. But what are we doing in the laboratory are usually your relative counts. Relative count. That's why relative counts are in percentages. So bakit percent ulit? Bakit percent? Kasi 100 yung binilang mo WBC. Yung absolute count ko makakita mo times 10 raised to the ninth power per liter ulit. And of course, you also do, we'll check your WBC morphology. And then ayan. So these are the usual, ano? These are the usual terminology in the decrease and increase of your WBC. You have neutrophilia, neutropinia, eosinophilia, basophilia, lymphocytosis, lymphopinia, monocytosis and monocytopinia. Question. Okay. We didn't discuss WBC already. Okay. We didn't discuss WBC already. Um Why is it that we do not have, um, why is it that we do not have, what do you mean na, sir, hindi po ba neutrophils mag-uuna? Saan to? Which part is this? Like yung kanina po, sir, na ura po silinfocytes, tas na saan dolo po ng basophils, si neutrophils. Where? Is it now? Yung na sa slide nyo po. Sagay nyo po kasi Okay. Okay. Same thing, same concern tayo. Merong, I don't know if sinundi ko malalasin nag-email din sakin with regards sa immunoglobulin. Sometimes what I am saying sa inyo ha, let's take for example dito, hindi ko si, eto, arrangement lang yan sa picture. But kanina, Debye was mentioning to you. Ako, personally, when I memorized the WBC, I measure, I memorize it and nakalimutan ko taro. NL, Mem, NL Mem, so neutrophil, lymphocytes. So I would, neutrophil pa rin ang most abundant. Okay, it's just a picture. Okay, ang my problem. So actually di problem yung picture. I was just saying to you guys na I was just sharing how I memorized it para kahit konware, ayan, do not get confused with that. Kahit konware, hindi ko alam yung normal, yung normal values. Alam ko pinakamaramisin yung neutrophil. Okay, so, relative count, the representation, the relative count is actually affected by your observation, which is the first one you observe. Ang absolute talaga, that is the actual representation of the absolute. Absolute na, kung magapina katama.  Okay? So, having said that, where was I? Here. Okay, I was asking, why is it that we don't have terms such as eosinopinya and vasopinya? So can anyone, okay, can anyone explain why don't we have such terminologies? Okay, pinag-grace na hans, pero hindi ko makita, wait lang. Alam ay happy. Okay, ay may nag-chat pala. Okay, ayon nila mag-grace na hans, nag-chat na lang po sila. Okay, ang sagut. Okay, pinakaon-tina, ayan, pinakaon-tina, may question mark kasi o na. Masyado na malili at yung concentration nila. Rarely observe yung count nila. Difficult to count, too small amount to determine decrease. And, kabilang dako naman tayo, sagut nila here, O3 and O4. Because already decrease in the blood smear, normal person, mababa talaga. Mababa ang sa normal dahil low po talaga ang count nila. Kwanti talaga sila. Okay, and sometimes di po nakikita sa peripheral blood smear, correct. So there may be no-to-low count of AUC no-fills and base of fills, which is true. Okay, those are all correct. Okay, because your AUC no-fills and your base of fills only increase during certain conditions. Okay, and their decrease is ayan. Okay, I like the terminology misaavedra. Yung decrease ng AUC no-fills at ng base of fills mo is not clinically significant. Specifically if it is relative count. Okay, if it is your relative count. Okay, so thank you so much everyone. Okay, so tama ang inyong mga kasag-gutan. So moving forward, okay, I'll give you an example. Okay, I'll give you an example here. So looking at this one, okay, looking at this one, kita ninyo everybody, kita ninyo this is your WBC count and you have your relative differentials and your absolute differential count. Okay, so here, pagtinig na natin, okay, relative all are within normal range, all are within reference range rather, within reference range, but when you counted it absolute na, when you did your absolute count, you actually was able to see that there is an elevated neutrophil.  Sir, ibig sabihin po ba may relative neutrophilia? Yes. Take for example, you have increased in the relative count but normal in the absolute, you would need to say if it is relative or absolute neutrophilia. Okay? Sir, how would I be able to see, how would I be able to know that? Take for example, you gave us a diff count and then I would, I do not know if it is, I know that it is neutrophilia but I don't know if it is absolute or relative. Anong titignan mo para malaman mo if it is an absolute or a relative. Absolute or relative. What will I look, what should I look at? Okay, correct. It's the unit. Okay? Check the unit mommy. Okay, para lang yung label. Okay? So, check the label, check the label, check the unit. Okay? So, okay, pardon me for this appearing because I just have to plug in the charger. So, having said that now, okay, having said that now, ha, kontin na lang, kaya natin to. Having said that now, let's not summarize, okay, let's not summarize this one ha. Is this normal? This is elevated. So, makikita ninyo may leucocytosis sa and then may absolute neutrophilia. Sir, are you going to give us such examples in the exam? I will. Okay? I will. But sir, do we need to memorize pa da ano? Do we need to memorize pa da normal value? The question, the answer is, of course, no. Okay? Hindi na. Okay? No need anymore. So, I just want you to have an idea which is the most abundant, to the least abundant but with regards to the normal values, I will not ask you to do that today or rather, this semester. Okay? Hayaan ko na yung pag nag-boards kayo sa kanya na siya imememorize. Okay? So, moving forward, okay? So, as I end, okay, as I end, we finish the WBC na. Okay? We finish the WBC and now we're actually entering your RBC parameters.  And all of those things we're going to discuss shortly but before that, let me just answer some questions. So, I'll be ending the presentation for now, okay? I'll be ending the presentation for now and then I would entertain some questions muna before we proceed. With the red blood cells, okay? Before I proceed to the red blood cells. So, one moment. Let me just stop the recording. So, thank you so much guys for listening for that first part.