Pathology Tour 2017 Sickle Cell Disease Malaria Blood Transfusion - - PowerPoint PPT Presentation

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Pathology Tour 2017 Sickle Cell Disease Malaria Blood Transfusion - - PowerPoint PPT Presentation

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Pathology Tour 2017 Sickle Cell Disease Malaria Blood Transfusion Biopsies Cancer Haematology Bilirubin Cellular Pathology Glucose Biochemistry Microbiology Urinary Tract MRSA Meningitis Thyroid Stimulation Infection Hormone Jan

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SLIDE 1

Cellular Pathology Microbiology Biochemistry Haematology

Pathology Tour 2017

Meningitis Cancer Urinary Tract Infection MRSA Biopsies Malaria Blood Transfusion Glucose Bilirubin Thyroid Stimulation Hormone Sickle Cell Disease

STHK Pathology Tours 2017 1 Jan 17

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SLIDE 2

STHK Pathology Department

Understanding of how pathology works:

  • Making better use of pathology services.
  • Provide feedback.
  • Any issues – contact the department and speak to

someone or email: pathology.support@sthk.nhs.uk

  • Pathology user guide: www.sthk.nhs.uk/pathology

Jan 17 2 STHK Pathology Tours 2017

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SLIDE 3

Phlebotomy Service

  • Requesting of Bloods: Using OCS
  • Blood test requests are ordered via OCS

(maxims)

  • Sample requirements > all samples taken

require 3 identifiers » Time of Collection » Date of Collection » Initials of Collector

The way the system is used may change as modifications are introduced

Jan 17 3 STHK Pathology Tours 2017

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SLIDE 4

Phlebotomy Service

  • Phlebotomy currently have 2 in house sites

St Helens and Whiston hospitals.

  • 7 day phlebotomy service to the wards.
  • Training of NHS professionals, working along side
  • ur Education & Training Department.
  • Phlebotomy also work along side pathology

specimen reception.

Jan 17 4 STHK Pathology Tours 2017

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SLIDE 5

Methods of Sample Transport to Pathology

  • Air Tube (POD System)
  • Hand deliver directly to Pathology Reception

Jan 17 5 STHK Pathology Tours 2017

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SLIDE 6

Specimen Reception

Jan 17 STHK Pathology Tours 2017 6

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SLIDE 7

Specimen Reception

  • Specimen Reception process in excess of 2000 Blood Science requests

per day, averaging about 5500 serum/urine samples

  • If you were to include the microbiology/histology/cytology requests on

top you’re looking at 10,000 samples per day as a Pathology wide figure

  • On average 50-100 requests per day are received where processing is

delayed or prevented due to errors in requesting or incorrectly labelled samples. With this in mind, samples/requests must be prepared in the correct manner every time

Jan 17 7 STHK Pathology Tours 2017

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SLIDE 8

How to label your OCS samples

Jan 17 8 STHK Pathology Tours 2017

  • One sample – One straight vertical label
  • Correct height – Not sticking to lid but

covering existing label

  • Applied vertically – not around the tube
  • Flat – no creases, bumps or rips
  • Perfectly straight
  • Correct label on correct sample type
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SLIDE 9

Jan 17 9 STHK Pathology Tours 2017

Haematology – Biochemistry Department

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SLIDE 10

Haematology

  • The haematology lab within Whiston Hospital is mainly responsible

for the testing of the following:

  • Blood (Plasma)
  • Bone marrow cells
  • Haemoglobin
  • Blood proteins
  • Blood associated diseases
  • (Sickle Cell Anaemia, Glandular Fever)
  • All samples are received from the hospital itself or from surrounding areas

e.g. GP clinics, other hospitals etc.

Jan 17 10 STHK Pathology Tours 2017

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SLIDE 11

Haematology

Most routine tests include:

  • FBC, ESR, Blood films
  • Bone marrow morphology
  • Glandular Fever & Sickle Cell screening

Specialist tests include:

  • Haemoglobinopathy & Thalassaemia screening
  • Malaria screening

Jan 17 11 STHK Pathology Tours 2017

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SLIDE 12

Full Blood Count

Jan 17 12 STHK Pathology Tours 2017

  • Uses Fluorescence Flow Cytometry to measure

Red Blood Cells Platelets White Blood Cells

  • Fast turn around times:

A&E FBC: 97% <1hour Ward FBC: 92% <1hour

  • 1900 FBCs processed daily
  • Use Red EDTA Sample Bottles
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SLIDE 13

Coagulation

Most routine tests include:

  • Coagulation Screen, INR, APTR
  • Fibrinogen, D-Dimer

Specialist tests include:

  • Thrombophilia, Lupus, FVIII Screens, AntiXa
  • Monitoring of new anticoagulant therapies

DOACs

Jan 17 13 STHK Pathology Tours 2017

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SLIDE 14

Coagulation

Jan 17 14 STHK Pathology Tours 2017

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SLIDE 15

Blood Transfusion

Jan 17 15 STHK Pathology Tours 2017

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SLIDE 16

Jan 17 16 STHK Pathology Tours 2017

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SLIDE 17

Biochemistry

  • The Biochemistry lab within Whiston Hospital is mainly

responsible for the testing of the following :

  • Blood (Serum)
  • Urine
  • Cerebrospinal fluid/other fluids
  • Faeces

Samples are received from:

  • Whiston/St Helens/Southport/Ormskirk hospitals and

the surrounding community

Jan 17 17 STHK Pathology Tours 2017

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SLIDE 18

Vital statistics

  • During 2016, Biochemistry processed more than 6 million tests and

650,000 samples and that figure is expected to increase.

  • This is a monthly average of 85,000 samples. Each of these

individual samples usually has multiple chemistry requests.

  • During Dec 2016 we ran 41,000 U&Es, 18,500 CRPs and 29,000 LFTs.

U&Es, CRPs and LFTs are just 3 of the 180 different tests we offer.

  • 1700 tests per month are referred on.
  • Biochemistry operates 24/7

Jan 17 18 STHK Pathology Tours 2017

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SLIDE 19

Biochemistry Analysis

Highly automated – to cope with high workload Sample types –

  • Serum
  • Plasma
  • Urine
  • Fluids

In 2016, the laboratory performed 2 million tests.

Jan 17 19 STHK Pathology Tours 2017

The lab has 3 Centaur XPs for the analysis of endocrine and serology tests

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SLIDE 20

Jan 17 20 STHK Pathology Tours 2017

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Specimen Rejection Criteria

  • Unlabelled samples
  • Insufficient patient information – 3 identifiers on form plus 2

identifiers on sample

  • Insufficient sample volume
  • Wrong sample tube used
  • Pro-longed transport
  • Contaminated sample
  • Haemolysed sample (no potassium/phosphate/folate...)
  • More than one patient sticker/request per form

Jan 17 21 STHK Pathology Tours 2017

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SLIDE 22

One form, 2 patients -

Example – this request would be rejected.

Jan 17 22 STHK Pathology Tours 2017

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SLIDE 23

Automation problems

  • Sample barcodes must be applied straight and

central.

  • Twisted barcodes cannot be read, leading to a

delay in results.

  • Barcode should be of a good print standard, poor

print quality – barcode can not be read

Jan 17 23 STHK Pathology Tours 2017

 

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SLIDE 24

Automation problems

  • Ensure that the correct

sample label is on the correct tube.

  • Barcodes for yellow

and brown blood bottles are sometimes put on the wrong coloured tube which may lead to incorrect results.

Jan 17 24 STHK Pathology Tours 2017

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SUMMARY

  • Highly automated system
  • Reliant on
  • Barcoded samples
  • Sufficient sample volume
  • Barcode links to patient sample type and tests

requested

  • Errors in sample tube barcode can lead to incorrect

results

Jan 17 25 STHK Pathology Tours 2017

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SLIDE 26

Jan 17 26 STHK Pathology Tours 2017

Microbiology Department

  • perational 24/7
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SLIDE 27

Microbiology

  • The Microbiology Laboratory tests the following sample types:
  • Urines
  • Faeces
  • Mucosal and soft tissue
  • Lower respiratory tract
  • Fluids
  • CSFs (Meningitis)
  • Blood cultures
  • Other swabs e.g. wounds
  • All samples are again received from the hospital itself or from surrounding

areas e.g. GP clinics, other hospitals etc.

The clinical details are extremely important – affects sample processing

Jan 17 27 STHK Pathology Tours 2017

Blood Cultures Swabs

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SLIDE 28

UTI(Urinary Tract Infection) Investigation

  • UF1000 examines urine samples (Micro result):
  • White Blood Cells
  • Bacteria
  • 600 urines processed daily. 95% resulted within 24hrs
  • Use Green urine bottles.
  • At least 5mls
  • Sensitivity testing involves the testing of antibiotic discs against the

bacteria present to determine:

  • Susceptible antibiotics (effective).
  • Resistant antibiotics (non-effective).

Jan 17 28 STHK Pathology Tours 2017

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MRSA Screening

  • Routinely processed (nasal or

full screens

  • Provisional culture results within

24 hours

  • Confirmed by PCR
  • Determine the source of an
  • utbreak (wards, community)

Jan 17 29 STHK Pathology Tours 2017

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SLIDE 30

CSF Analysis

  • CSF sent to the laboratory is analysed for the following:
  • Microbiology: (Samples 1 & 3)
  • Appearance
  • White Blood Cell Count
  • Red Blood Cell Count (RBC comparison ?SAH)
  • Gram Stain
  • Biochemistry: (Samples 2 & 4)
  • Glucose
  • Protein

Jan 17 30 STHK Pathology Tours 2017

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SLIDE 31

Faeces Testing

Tests involved:

  • C. difficile
  • H. pylori
  • Adeno/Rota/Norovirus
  • General culture plates
  • Parasitology

Jan 17 31 STHK Pathology Tours 2017

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SLIDE 32

Automated Microbiology

MALDI-TOF Analyser

  • Method for microorganism identification from clinical cultures
  • Process from sample loading to result takes 3 minutes per sample
  • Uses mass spectrometry to vaporise bacteria
  • Vaporised ions are accelerated through a flight

tube

  • Ions hitting the detector cause an electrical

signal which is recorded

  • measures the size and number of different

proteins by how fast they move through a vacuum to give an ID

  • Allows 24/7 identification of organisms
  • Quicker provisional identification of blood culture

isolates

Jan 17 32 STHK Pathology Tours 2017

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SLIDE 33

Automated Microbiology

Vitek2

  • Works alongside the MALDI-TOF
  • Automated sensitivity testing system
  • Detects phenotypes and analyses MIC patterns
  • Measures light passing through a well containing a mix of antibiotic and

bacteria

  • If cloudy, the bacteria is resistant to the antibiotic if clear the bacteria is sensitive.
  • Tests up to 60 isolates at one time with sensitivity results available between 6-8hrs.

Jan 17 33 STHK Pathology Tours 2017

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SLIDE 34

Jan 17 34 STHK Pathology Tours 2017

Cellular Pathology Department (Histology, Cytology & Mortuary)

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Cellular Pathology

  • There are 14 Consultant Cellular Pathologists

and 2 Specialist Registrars diagnosing disease in tissue. They also carry out post mortems.

  • There are currently 49 Scientific and 6 Support

Staff processing around 7,000 specimens per month.

  • Cellular Pathology operates 7 days a week.

Jan 17 35 STHK Pathology Tours 2017

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SLIDE 36

The Histology Laboratory processes tissue samples taken during both major and minor operations to identify disease

Adequate fixative is required All samples for Histology are fixed in formalin. This prevents autolysis and keeps the tissue in as life like a state as possible to allow further investigation. To be adequately fixed a sample needs to be immersed in 10x its volume of formalin.

Unfixed specimen Fixed specimen

Jan 17 STHK Pathology Tours 2017 36

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SLIDE 37

Patient and sample request details

  • Adequate PID:- due to the nature of Histology samples it is

vital to ensure that the sample is from the correct patient.

  • Adequate Clinical Details:- To ensure that the correct

diagnosis is made the Pathologist must be provided with the patient’s full clinical details.

  • Correct Patient Consent:- Some samples sent for

histological diagnosis are of a sensitive nature and require consent as to how any remaining tissue is handled e.g. products of conception samples (POC). Consent needs to be obtained by the clinical staff from the patient before the sample can be processed.

Jan 17 STHK Pathology Tours 2017 37

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SLIDE 38

Dissection

  • Larger samples are dissected and the tissue

for investigation is placed into cassettes

Jan 17 STHK Pathology Tours 2017 38

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SLIDE 39

Tissue Processing

  • Tissue cassettes are

processed overnight on a tissue processing machine.

  • Tissue is dehydrated

through a series of alcohols.

  • The alcohol is cleared from

the tissue by xylene and then impregnated with molten wax.

  • The following morning

these samples are manually embedded in wax.

Jan 17 STHK Pathology Tours 2017 39

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SLIDE 40

Embedding

Tissue is embedded into wax

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The tissue sample is placed into a mould, the labelled cassette is placed

  • n top & it is filled with molten wax.

The samples are placed onto the cold plate of the embedding centre to set. Once the wax has set the mould can be removed

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SLIDE 41

Microtomy

Tissue blocks are cut at 4μm (approximate section thickness

  • f one cell) on a microtome

Jan 17 STHK Pathology Tours 2017 41

Tissue blocks are cut at 4μm (approximate section thickness

  • f one cell) on a microtome
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SLIDE 42

Tissue Staining

Sections are routinely stained with haematoxylin and eosin

  • n an automated

machine. Between 500-800 slides per day are stained.

Jan 17 STHK Pathology Tours 2017 42

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SLIDE 43

Special Stains

  • Special stains can be performed on request to

highlight specific pathological conditions.

Orcein stain to show hepatitis B in liver cells Van Geison stain to show collagen distribution Perl’s Prussian blue stain to highlight haemosiderin deposits Reticulin stain to evaluate reticulin fibre distribution

Jan 17 STHK Pathology Tours 2017 43

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SLIDE 44

Immunohistochemistry

Specialised staining using antibody- antigen interactions

  • These are performed on an

automated machine which stains around 1000 slides per month.

  • Can be used to differentiate cancer

types, diagnose metastatic tumour cells and is useful in diagnosis, prognosis and treatment.

The presence of oestrogen, progesterone and Her2 receptors on breast cancer cells can result in more aggressive tumours. Drug therapies such as Tamoxifen target these receptors and inhibit growth of the

  • tumour. Immunohistochemistry can be used

to evaluate the oestrogen, progesterone and her2 receptor status of breast cancer cells. Negative

  • estrogen

immuno staining with an internal control Weak positive

  • estrogen

immuno staining Strong positive

  • estrogen

immuno staining

Jan 17 STHK Pathology Tours 2017 44

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Summary for Histology specimens

  • Correct PID on specimen container and

request card.

  • Adequate formalin fixation.
  • Relevant consent forms.
  • Clinical details.

Jan 17 STHK Pathology Tours 2017 45

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Cytology

Cytology focus on cells exfoliated from the body. Samples fall into two groups: Gynaecological:

  • Cervical Screening.

Non- gynaecological:

  • Urine, pleural and ascitic fluids. Fine needle aspirates

from areas such as breasts, thyroid glands, knees and lungs.

Jan 17 STHK Pathology Tours 2017 46

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SLIDE 47

Sample Processing

  • The samples are put into a mega-funnel with a slide

attached at one side.

  • The funnel is put into a centrifuge which causes all of the

cells within the sample to be drawn onto the slide.

  • The cells are then coloured with a Papanicolaou Stain which

has developed especially form this procedure.

Jan 17 STHK Pathology Tours 2017 47

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SLIDE 48

Mortuary

  • If there is a death within the hospital, the death is reported to

Medirest who collect the deceased patient and transport the patient to the mortuary, located in Nightingale House.

Jan 17 STHK Pathology Tours 2017 48

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SLIDE 49

Mortuary

  • Once the deceased patient reaches the mortuary, their

personal details are recorded in the Mortuary Register so they can be accurately identified. The patient is kept under controlled conditions until released to a Funeral Director by the mortuary staff.

  • The deceased's family may wish to view their relative. This

can be facilitated in our Bereavement Centre.

Jan 17 STHK Pathology Tours 2017 49

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SLIDE 50

Post Mortem

  • Most deaths dealt with by the hospital are of natural cause, but if

there are any suspicious circumstances or the cause of death is unknown, the coroner may request for a post mortem to be

  • performed. A Post Mortem will be carried out by the Pathologists

with assistance from Anatomical Pathology Technologists (APTs).

  • Samples of tissue may be taken from the deceased patient which

will then be given to the Histology staff to process.

Jan 17 STHK Pathology Tours 2017 50

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SLIDE 51

Summary

Any Questions

Jan 17 STHK Pathology Tours 2017 51