Department of Laboratory Medicine

The Department of Laboratory Medicine provides two basic services: (1) all routine test procedures necessary to evaluate and maintain the general health of M. D. Anderson's cancer patients and (2) those test procedures useful in the diagnosis and management of neoplastic disease. The clinical laboratory performs over 1,820 different tests and assays, all of which have immediate impact on the clinical management of the cancer patient. To adequately handle this large volume of tests, the department uses sophisticated automated analyzers, most of which interface directly with the laboratory computer system. Highly trained and certified technologists perform the microscopic and analytical procedures necessary to provide accurate test results. Specialized clinical pathologists interpret those results and consult with the medical staff. In addition, the Transfusion Medicine Section supplies all blood components necessary to support the medical and surgical management of Anderson's cancer patients. The Section of Microbiology maintains an active infection control program that covers all hospital areas.

The Department of Laboratory Medicine has evolved into a multidisciplinary organization containing the following major sections: Administration, Clinical Chemistry, General Services (Specimen Collection, Specimen Processing, Stat Laboratories), Hematology, Microbiology, and Transfusion Medicine. Each of these laboratory sections carries a heavy patient care service load in addition to various types of research and development as well as educational activities. The department also provides laboratory support for most of the clinical research protocols in all the other clinical divisions in the institution. Several members of the departmental staff also maintain their own clinical research programs supported by government and/or private grants.

Clinical Research Overview
Research and development projects in the Department of Laboratory Medicine are aimed primarily at establishing new or improved methodologies and procedures for clinical laboratory testing. The department has successfully developed and implemented new test procedures resulting in shorter turnaround times and cost effectiveness. Evaluation of prototypes for new analytic instruments is also a large part of this effort. Support of these programs is obtained from outside sources, primarily governmental agencies in the form of grants and also through private organizations.

The research objective in Clinical Chemistry is to develop and validate the clinical utility of cancer diagnostic tests. The following projects are in progress:

• Implementation of new tumor marker tests which will improve programs for the early detection of prostate cancer.
  
• Planning to implement a pilot study for the early detection of ovarian cancer.
• Planning to evaluate a panel of tumor tests that may aid in the early detection of lung cancer.
  
• Other diagnostic tests in development are aimed at improving the prognostic assessment of breast cancer patients and to improve the selection of chemotherapeutic drugs and monitor their effectiveness.
  

Educational Activities Overview
The department's educational activities at the professional level comprise two programs: fellowships in Chemical Pathology and Transfusion Medicine. Future plans include a fellowship in Clinical Microbiology. The fellowship programs are highly specialized and consist of one to two years training each. All programs are approved and accredited by the ACGME. The first year of the program is a core rotation consistent with the requirements of the American Board of Pathology. The first year of training is therefore designed to provide eligibility for special competency examinations in the respective areas. The second year is available to the selective candidate who successfully completes the first year and is interested in one area of research or patient care activity agreed upon by the fellow, the program director and other faculty members in the department. All of the educational fellowships provide comprehensive training for pathologists while allowing individual development in a targeted research and/or clinical area.

The department also actively participates in the Allied Health Education Programs, such as the Program in Medical Technology and the Program in Cytogenetic Technology. Other training programs that it participates in are the medical assistant program and the laboratory liaison technician. In addition, several of the division's professional staff are faculty members of the Graduate School of Biomedical Sciences (GSBS) at The University of Texas Health Science Center and participate in the GSBS's graduate educational and training programs. There is also an active departmental effort to sponsor educational and research conferences for technical and professional staff members. Teleconferences, seminars in the Texas Medical Center, and regional or local workshops are attended by many staff. In addition, the department participates in a weekly conference sponsored by the Division of Pathology and Laboratory Medicine every Friday morning. Included are such topics as current clinical and basic science research projects, updates on new drugs, and new technical methodologies.

The department also sponsors an annual international conference. The "Encuentro de Inmunohematologia y Medicina Transfusional" is presented totally in Spanish, and the majority of its attendees are scientists from Latin American countries. This conference covers intermediate/advanced level concepts and practices in the fields of Immunohematology and Transfusion Medicine for Spanish-speaking medical audiences. The purpose of the event is to update the knowledge base and to promote the implementation of the latest technological advances, treatment concepts and educational theories for non-English speaking audiences. A highlight of the event is the symposium "Transfusion Medicine in Latin America" which presents an overview of blood banking practices, services, laws and a state-of-the-industry report. The conferences emphasize the practical aspects of the selected topics by using an interactive workshop format that allows more active participation by the attendees. Topics include, but are not limited to, Continuous Quality Improvement, Ethical Problems in Transfusion Medicine, Error Detection and Analysis, Legal Aspects of Transfusion and Leukoreduction. Other topics are Advanced Neonatal Transfusion Practices, Regulatory Compliance Plan Implementation, Development of a Database in Bone Marrow Transplantation and Donor Collection Activities.

Section of Clinical Chemistry
The primary goal of the Section of Clinical Chemistry is to provide the patient care services which are required for the diagnosis and clinical management of cancer patients in a timely, yet cost-effective manner. The patient care activities center around the following laboratories: High Volume Chemistry, Urinalysis, and Special Chemistry Laboratory. These laboratories perform approximately 2,858,441 chemistry test procedures per year.

• The High Volume Chemistry service is responsible for urinalysis, tests for therapeutic drug monitoring, referral laboratory tests and a variety of routine procedures for enzymes, electrolytes, proteins, lipids, and carbohydrates.
• The Special Chemistry laboratory performs tests for protein electrophoresis, isoenzyme determinations, quantitation of immunoglobulins, typing of immunoglobulin abnormalities, thyroid function tests, and immunoassay procedures including cortisols, various hormones and tumor markers. The Special Chemistry area also performs point-of-care testing for IO-PTH.

Section of General Services
The Section of General Services includes the specimen collecting service (inpatient and outpatient) and the Stat Laboratories. All specimen collections for laboratory tests on blood and urine are coordinated by personnel in these areas on a 24-hour basis. Specially trained individuals are scheduled to coordinate and perform venous and arterial punctures, collect blood from central venous catheters (CVCs), and perform glucose screening. The responsibility of the General Services Section is not only to collect and transport specimens on a routine basis but also evaluate new specimen collection devices and transport receptacles.

Section of Laboratory Hematology
The Hematology and Coagulation laboratories are high volume computerized laboratories that process up to 900 hematology and 450 coagulation samples daily. These computerized instruments provide knowledge of the cellular components of the blood, including number and composition of the white blood cells, number and quality of the red blood cells, and the number and size of the platelets, while the coagulation tests provide quantitative measurement of the clotting abilities of the blood. Services are provided in three different sites depending on the patient location (inpatient vs. outpatient) and the type of malignancy (hematologic vs. nonhematologic). Fast track services are provided in some settings where immediate management decisions require knowledge of particular test parameters.

Of the 900 hematology tests performed daily, most require manual morphologic examination by highly skilled technologists. Approximately 5% of these tests require review by hematopathologists to identify, quantify and classify the abnormal cells identified by the technologists. In addition to morphologic classification of peripheral blood and body fluid cells, the hematopathologists provide consultations on esoteric laboratory testing for identification and classification of coagulation abnormalities present in the M. D. Anderson patient population.

Section of Clinical Microbiology
The Section of Clinical Microbiology provides diagnostic services for all areas of microbiology including isolation and identification of all pathogenic organisms (aerobic and anaerobic bacteria, mycobacteria, parasites, fungi, and viruses). The section also provides pertinent in vitro susceptibility data on all significant bacterial isolates, and diagnostic serologic services for documentation of infectious diseases. The section provides surveillance data for documentation of nosocomial infection rates and extensive educational in-services to the clinical departments.

Section of Transfusion Medicine
The Section of Transfusion Medicine is a multifunctional area. This section consists of the Transfusion Service Laboratory, HLA Laboratory, Donor Recruitment, and Donor Collections. The goals of the section are to provide efficient, reliable, consistent diagnosis to allow the attending physician to reach the proper decision for therapy and management of each patient. The section provides the most effective therapeutic support for cancer patients and provides close intercommunication with all medical and surgical services. The scope of the patient care services of the Section of Transfusion Medicine include the following: donor recruitment, blood collection at fixed rates, mobile drives, donor apheresis services, transfusion services (including donor blood processing), hepatitis, HIV, CMV and RPR testing services, a histocompatibility testing laboratory, an autologous blood program.

The Section of Transfusion Medicine functions in an interactive fashion with the various services requiring hemotherapeutic support. This is achieved through our long-standing philosophy and policy to become fully informed of the patients disease states, therapies instituted and modalities of treatment.

• Donor Recruitment: The role of this area is to promote blood/platelet donations through direct appeals, mailings, radio/TV campaigns, etc., that are directed to industrial plants, offices, schools/universities, churches and other volunteer organizations.
• Apheresis Service: This activity is dedicated exclusively to recruit and actually obtain platelet donations by apheresis for supply to our patient population.
  
• Serologic Testing Laboratory: This area is wholly dedicated to patient testing for infectious disease screening. The results obtained are integrated into a comprehensive consultative report that advises and guides the clinician on the correct course of action for a particular patient.
• Histocompatibility Testing Laboratory: This service provides necessary laboratory support through testing and interpretation/consultation for transplantation and blood/blood component therapy. This activity includes participation in patient case discussion meetings and planning clinics. It provides serologic testing and interpretations/consultation for platelet antibodies in alloimmunized patients or patients with autoimmune thrombocytopenia. Screening testing for autoimmune disorders is also performed by this laboratory.
• Autologous Blood Program: This option was implemented mainly in response to patient concern regarding AIDS and transfusions. The attending physician refers the patient to the Blood Donor Room where they are evaluated by the Transfusion Medicine Physician for suitability to donate.