Clinical Pathology | Pathology Residency | Loyola Medicine

Clinical Pathology

Clinical Chemistry

The Clinical Chemistry rotations include all areas of the division: General Chemistry, Toxicology, Endocrinology, Immunoserology, and several areas related to near-patient testing. The rotations are highly structured and involve bench rotations, weekly conferences, journal clubs, and the investigation of a series of clinical chemistry problems. The resident learns basic and advanced aspects of laboratory management through problem-based learning exercises in areas such as applications of statistics, informatics, quality management, and adherence to regulatory requirements. Opportunities for applied and clinical research activities are also open to the residents. Residents are expected to take clinical calls for the department.

 

The division of Clinical Chemistry is organized into sections that encompass key aspects of general, special, endocrinologic, and toxicologic chemistry. Staff and faculty members within this division are also actively involved in the evolution of point-of-care and near-patient testing as well as stat laboratories in the neonatal intensive care unit and outpatient clinic. Each section within the division of Clinical Chemistry is actively engaged in development and application of the most current and relevant methodologies for optimal patient care.

 

The faculty members within the division of Clinical Chemistry encompass a wide and diverse range of research interests.

 

Opportunities for research exist in the faculties' areas of interest which include toxicology (especially issues relating to the newborn patient), diagnostic markers of tissue injury (particularly cardiac markers), protein metabolism, interferon-induced gene expression, assessment of gastrointestinal permeability, establishment of reference intervals, the effect of pre-analytical variables on laboratory tests, endocrinology, clinical applications of high performance liquid chromatography (HPLC), clinical laboratory utilization, and the impact of government regulation on laboratory medicine.

 

The technology and equipment utilized throughout this division ranges from state-of-the-art to cutting edge. The section of general chemistry employs both wet and dry chemistry analytical equipment and is currently expanding into a wider range of whole blood critical care chemistry techniques to effectively meet the needs of the acutely ill patient. The special chemistry section offers a full range of automated electrophoretic, HPLC, immunofixation, and flameless atomic absorption spectroscopic techniques. The endocrinology section offers a variety of techniques ranging from radioimmunoassay to time-resolved fluoroimmunoassay, and enzyme immunoassay techniques. The toxicology section uses an enzymatic immunoassay for detection of drugs of abuse.

 

 


 

 

Flow cytometry is a technique which includes characterization of cells via their surface and intracellular antigens with fluorescence-tagged monoclonal antibodies. This technique is used to study and monitor lymphocyte subpopulations in infectious diseases (CD4+/CD8+ T cells), transplantation (T cells), immunological deficiencies (B and T cell defects), and hematologic malignancies.

The flow cytometry laboratory performs service and teaching functions. Residents get hands-on experience in processing, staining of specimens, and standardization and use of the flow cytometer. Residents participate in the interpretation of the flow cytometry data and correlation of results with cytochemistry, cell morphology, molecular genetics, and clinical presentation.

 

 

Hematopathology

The Hematopathology rotation uses a wealth of pathologic material including blood smears, bone marrow specimens, and lymph nodes not only from Loyola and Hines VA but also from those received in consultation from many other regional and national facilities. Morphologic aspects of the discipline are stressed. The use of monoclonal antibodies, flow cytometry, and polymerase chain reaction (PCR) is an essential part of the diagnostic evaluation and is stressed during the rotation. Daily resident teaching sessions are conducted at a multiheaded microscope. Residents also learn to perform aspirations and biopsies in conjunction with the hematology services.

The Loyola University Medical Center and Edward Hines, Jr. VA Hospital are major research centers for the study of antithrombotic and thrombolytic agents. Coagulation testing and investigation of thrombogenesis and other coagulation disorders are also the focus of basic and applied research. Residents spend a month in coagulation, rotating through both the clinical sections and the research areas. The option for advanced coagulation studies and potential for research developed around individual interests is available. 

The Loyola University Medical Center is a major referral center for lymphomas, leukemias, and disorders of the hematopoietic system in both adult and pediatric patients. Residents spend their first month of the four to five month hematopathology rotation in learning basic hematology and microscopy of body fluids. A major emphasis is placed on morphology and clinical laboratory testing methods.

 

The human leukocyte antigen (HLA) complex, located on Chromosome 6q21, comprises genes encode two distinct classes of highly polymorphic cell surface antigen. Class I HLA-A, -B, -C antigens are expressed ubiquitously on nucleated cells, whereas the class II HLA-DR, -DQ, -DP antigens are normally expressed on B cells, monocytes, macrophage, dendritic cells and on activated T cells. An extensive sequence polymorphism is present in the second exon of Class II loci and in the second and third exons of Class I loci. These polymorphic regions encode the peptide-binding groove of the HLA molecules and are important to transplantation, disease susceptibility and drug hypersensitivity.

The Clinical Histocompatibility (HLA) Laboratory at Loyola University Medical Center is accredited by College of American Pathologists (CAP) and American Society of Histocompatibility and Immunogenetics (ASHI). The laboratory provides the state-of-art immunogenetics testing services to support comprehensive transplant programs and other clinical services at Loyola University Medical Center, including:

  • Solid organ (Kidney, Liver, Heart, Lung and Pancreas and combined organs) transplantation

  • Allogeneic Hematopoietic stem cell/bone marrow  transplantation

  • Other clinical purposes: disease associations, drug hypersensitivity and platelet transfusions, etc.

In addition, the laboratory provides the massive educational opportunities including observations, hands-on experiences, lectures and case studies for medical students, residents and fellows in Stritch School of Medicine, Loyola University Chicago. The trainees acquire knowledge on Immunogenetics and transplant immunology in clinical applications during their rotations and selective courses.  

Diversity of HLA molecules represents a major barrier to organ and tissue transplantation between individuals and also has been implicated in susceptibility or resistance to a variety of autoimmune, infectious, and oncologic disorders. HLA typing identifies the unique constellation of HLA antigens for an individual. HLA-class I (A, B, C) and class II (DR, DQ, DP) typing is performed by DNA-based molecular diagnostic techniques.  At the current stage, the laboratory provides low/intermediate HLA typing using PCR-sequence-specific oligonucleotide probe hybridization (SSOP) in house. High resolution HLA typing is sent out now.   

HLA antibody Screening (PRA)

Preformed anti-HLA antibodies are associated with acute rejection of mismatched solid organ and stem cell grafts, failure of platelet transfusions. Patients may become sensitized to HLA antigens through pregnancies, blood transfusions or previous transplantations and develop HLA antibodies. The laboratory performs this test on Luminex phenotype antigen platform that uses a panel of HLA class I and class II antigens isolated from human cell lines coupled to microbeads. These HLA antigens are common and frequent HLA antigens in human populations.  Any HLA antibodies present in the test serum bind to the antigens on the microbeads will be detected by a Luminex analyzer. Results are reported as percentage of panel reactive antibodies (PRA) which indicate the breadth of HLA antibody reactivity in populations and give an estimate of the likelihood of finding a suitable donor.

HLA antibody identification

HLA class I and class II antibody specificity identification is critical in transplant patients. They are tested by Luminex single antigen platform that uses a panel of recombinant allele specific HLA class I and class II antigens coated on microbeads.  Any HLA antibodies present in the test serum bind to the specific HLA single antigens on the microbeads will be detected by a Luminex analyzer.  Thus, HLA class I and class II antibody specificities can be detected accurately. The Class I and Class II antibody screening and identification tests help to identify the most compatible donors for a patient need organ, mismatch stem cell transplantation or platelet transfusion.

Donor Specific HLA antibodies (DSA)
Pre-formed or de novo donor specific antibodies (DSA) is the major risk factor of acute and chronic graft rejection. Using Luminex single antigen platform to accurately detect HLA antibody identification, DSA can be defined for specific donors with the avialbale donor HLA typing. This testing will help clinician to monitor the patient’s under immunomodulation and post-transplant immune status for therapeutic purposes.

T- and B-cell Flow cytometry crossmatch
Crossmatches detect donor specific antibodies by incubating a donor’s lymphocytes with a recipient’s serum. Positive crossmatches detected by flow cytometry suggest the presence of preformed anti-donor antibodies and indicate a risk of acute rejection and damage to the graft. Crossmatch results are interpreted in combination of the patient's disease status, sensitization history, HLA antibody testing and the quality of the donor cells.  

Director, Technical Supervisor and Clinical Consultant
Zeying Du, MD, PhD, D(ABHI)
Phone: 708-216-9028

General Supervisor
Jaishree Patel CHS(ABHI)
Phone: 708-216-3626

 

During the second year of training, the pathology resident will rotate through the Immunoserology Laboratory. The objectives of this rotation represent the knowledge and experience in immunoserology that a pathology resident should have to practice clinical laboratory medicine and to successfully pass clinical pathology boards in this area. The topics covered in this rotation include Infectious Disease Testing, Autoimmune Disease Testing, Complement Analysis, Quality Control, Quality Assurance, and Management. Training is facilitated through the use of bench rotations, practical exercises, and didactic sessions with the faculty and staff. Examples of some of the exercises the resident may be asked to perform are fluorescent anti-nuclear antigen (ANA) and anti-neutrophil cytoplasmic (ANCA) antibody pattern analysis, complement measurements to establish which complement pathway is affected by a disease, measurement of viral load by fluorescent antigen titration, and design of a quality assurance monitor to help maintain quality patient care. The residents will also participate in Journal Club and weekly case conferences during their time in Immunoserology.

 

Residents rotate through the laboratory information systems area, specimen handling area, and the management offices of the chairman to develop an understanding of the complexity of information systems as they relate to hospital information systems and to laboratory-specific quality management issues.

 

In addition, residents experience and study basic management issues in the laboratories to better grasp the numerous quality issues necessary to manage both anatomic and clinical laboratories. This rotation is supplemented by a year-long didactic sequence focusing on the principles of management.

 

 

One goal of the training of residents is to incorporate increasing levels of graduated responsibility throughout all aspects of the training program. In clinical pathology a significant component is that the fourth year requires a 1-2-month rotation of a Laboratory Directorship. In this role the senior resident will synthesize and apply knowledge acquired from all areas of clinical, practical, and management throughout their training. During this rotation the senior resident will make independent management, clinical, and consultative decisions on a daily basis throughout every clinical pathology area. This effort will be integrated in a fashion so that faculty and senior managers will be available to counsel the senior resident. The senior resident will also be expected to mentor the junior residents rotating in specific clinical pathology areas.

Dr. Gail Reid, Assistant Professor of Medicine (in the section of infectious diseases) takes you on a tour of our microbiology laboratory here:

The microbiology section offers a complete range of diagnostic services in bacteriology, mycology, mycobacteriology, and parasitology. The resident is exposed to the most up-to-date instrumentation for blood cultures and automated identification and susceptibility testing. In addition, molecular techniques in microbiology are explored. The resident participates in identifying both clinical and "unknown" specimens as well as performing microscopic examination, isolation, identification, and antibiotic susceptibility testing of pathogens. The laboratory works closely with the Infectious Disease Department, and residents participate in the infectious disease service as well as perform consultative functions. The management aspects of infection control, quality assurance, and quality control are emphasized.

 

The Molecular Pathology rotation teaches fundamental concepts in the design and execution of molecular diagnostic assays used in oncology, infectious diseases, and genetic diseases. Medical relevance of such testing and proper test utilization is stressed during the rotation.

Emphasis is placed on understanding the principles of molecular biology used in each test and the characteristics of the gene involved in each disease. Residents are therefore provided the opportunity to read pertinent literature and review critical concepts with the laboratory Director. Residents also learn how each test is performed. Detailed protocols are reviewed, and residents carry out representative assays using patient material. They interpret data and study alternative clinical applications for each test. The rotation is complemented by lectures on selected topics in Molecular Pathology presented during the clinical pathology lecture series.

Typical diagnostic assays run include:

  • Molecular Oncology:
    Use of Southern blot analysis and polymerase chain reaction (PCR) to detect immunoglobulin heavy chain rearrangements of PCR to detect bcl-1 and bcl-2 translocations in the diagnosis of mantle cell and follicular center cell lymphomas, respectively; use of reverse-transcription PCR (RT/PCR) to detect c-abl translocations in the diagnosis of CML and ALL; and use of in-situ hybridization to detect Epstein-Barr viral infection in B-cell lymphoproliferative disease.

  • Infectious disease
    Use of PCR to confirm infection with mycobacteria spp; and use of RT/PCR to identify infection with hepatitis C virus and HIV viral load qualifications.

  • Genetic Disease
    Use of Southern blot analysis and PCR to detect mutations in Fragile X Syndrome. PCR for detection of factor V Leiden mutation.

Blood Bank/Transfusion Medicine

The transfusion service is responsible for approximately 48,000 transfusions of blood and blood components annually at the Loyola University Medical Center.  The LUMC Blood Bank supports active renal, cardiac, pulmonary, and bone marrow transplant programs.  It also supports an active pediatric/neonatal service, a trauma center, and an adult hematology/oncology service.  The resident's rotation is structured to provide basic knowledge and experience in the application of transfusion medicine to the clinical setting so that they can function as future consultants.  The rotation addresses blood donor requirements as well as the acquisition, preparation, testing, and storage of blood and its components.  Residents learn the proper administration of blood products, pre-transfusion testing, and the management and prevention of adverse consequences of transfusion therapy.  They learn to solve antibody problems and are expected to participate in case presentations and assigned topics for discussion.  A large part of training focuses on blood bank accrediting agencies' expectations.  Guidelines for therapeutic pheresis and plasmapheresis are presented and practiced.  Blood usage evaluation is emphasized.  Residents become involved in the auditing process.  During their rotation through the Blood Bank, they are expected to attend a meeting of the Blood Bank Usage Committee and Bone Marrow Transplant Rounds.  Arrangements are made for residents to visit Life Source, our blood supplier.