DESCRIPTION:
The residency consists of a three year training program. The first two years consists of core rotations in six sections: Microbiology & Serology (6 months), Biochemistry & Endocrinology (4 months), Hematology (4 months), Special Procedures (4 months), Blood Banking (3 months), Cytogenetics (I month). Special procedures includes flow cytometry , coagulation, platelet aggregation, HLA typing, and determination of hemoglobin variants by HPLC. The third year is a flexible year in which the resident may concentrate on areas of interest and is expected to participate in a research project. This residency program satisfies the requirements set by the Lebanese government for obtaining a certification of specialty in Laboratory Medicine.
GENERAL OBJECTIVES:
The main objective of the training program is to give the residents a firm grasp of the methodologies, principles, and interpretation of clinical laboratory tests. They will also have the opportunity to acquire hands-on experience with specimen handling, laboratory procedures, and automation. Residents are expected to become familiar with quality control methods, troubleshooting, and laboratory safety rules. Proper reporting of test results and interaction with clinical colleagues are emphasized. In addition to service-oriented training, this program also encourages research and method development.
SEMINARS:
Residents will participate in a structured program of intradepartmental seminars (resident presentations, journal clubs, case discussion sessions). A series of lectures in laboratory medicine will also be given by the faculty. Residents are welcome to attend extra-departmental conferences provided that the timing does not conflict with their responsibilities in the department.
RESIDENT EVALUATION:
There will be a yearly standardized resident in-service exam (RISE) which is offered by the American Society of Clinical Pathology (ASCP). There will also be a separate annual evaluation of the residents by each faculty member based on performance in the various lab sections and on participation in the seminars.
Suggested Training Objectives and Duration in Clinical Microbiology Residents for Laboratory Medicine
The general training rotation should concentrate on acquiring practical (hands on) skills in various procedures and tests in addition to applying the practical knowledge in interpretation of tests results and their impact on patient care.
A summary of overall objectives are as follows:
· Exposure to overall operation flow of work at various sections.
· Acquire knowledge about the different and proper types of specimens needed and used in investigation by different test.
· Acquire technical skills in lab procedures performance and interpretation
· Identification of commonly occurring organisms
· Understanding basis of test and media reactions
· Be able to perform & interpret antimicrobial susceptibility tests
· Perform & interpret rapid procedure for detection and identification of organisms
· Have an insight on the interpretation and limitation of tests
· Be able to advise physicians on different tests and procedures related to lab aspects and their interpretation as well as to answer their inquiries.
The methods of training should involve different aspects as follows:
· Each trainee should be available in the section all through the duration of his training and should perform tests himself after adequate time of observation
· Use of unknowns
· Case discussions
· Involvement in projects and/or development of tests/procedures
The duration of training is suggested as follows:
· 2 1/2 months in Bacteriology section covering procedures and/or identification for aerobic and anaerobic bacteria, mycobacteriology, mycology, antimicrobial susceptibility testing and non cultural detection methods (1 1/2 months first year, 1 month second year)
· 1 1/2 months in serology section (1 month first year, '/2 month second year)
· 1 1/2 months in parasitology/microscopy section (1 month first year, 1/2 month second year)
· 1/2 in media preparation ( 1st year)
Note: Detailed guidelines of more specific rotation objectives are available to those currently rotating in clinical microbiology
SURGICAL PATHOLOGY
Neuropathology Scope of Service:
The neuropathology is a division of general pathology specialized in the study of the causes and effects of diseases of neuromuscular system (central and peripheral nervous systems and skeletal muscles). This is achieved through the study of surgical biopsies, cerebrospinal fluid or autopsy material done at AUBMC or referred to us from outside. Analysis is done using several methodologies including regular microscopy and immunohistochemical techniques.
The neuropathology division is also actively involved in teaching and training of medical students and residents specializing in pathology. Moreover, the division encourages research and continuous medical education in collaboration with pertinent services/departments.
The neuropathology is a division of general pathology specialized in the study of the causes and effects of diseases of neuromuscular system (central and peripheral nervous systems and skeletal muscles). This is achieved through the study of surgical biopsies, cerebrospinal fluid or autopsy material done at AUBMC or referred to us from outside. Analysis is done using several methodologies including regular microscopy and immunohistochemical techniques.
The neuropathology division is also actively involved in teaching and training of medical students and residents specializing in pathology. Moreover, the division encourages research and continuous medical education in collaboration with pertinent services/departments.
SPECIAL PROCEDURES
INTRODUCTION:
The special procedures section receives an average of 75 specimens a day. These are divided into the following categories:
· �Routine Coagulation,� encompassing prothrombin time, partial thromboplastin time, thrombin time, and fibrin split products.
· �Special coagulation,� including clotting factor assays, tests for hypercoagulable states, APC resistance, natural anticoagulant, lupus anticoagulant, and others.
· �Special hematology� including platelet aggregation, hemoglobin fractionation, osmotic fragility, HAM test, and related tests.
· HLA serologic typing for class I and class II and confirmation by DNA typing for class II.
· Flow cytometry for the phenotyping of leukemia and lymphoma, CD34 quantitation, T-cell subsets, and immunodeficiency evaluation.
Areas of special interest and strength have been in the consistent correlation of blood and bone marrow morphology with flow cytometry phenotyping in the final diagnosis of hematological neoplasms. We have a long term interest in increasing the consultation service in hemostasis and hypercoagulable disorders. Residents are encouraged to learn hand on testing and to actively become involved in the interpretation of multiple results and its clinical correlation and to help in establishing new procedures.
The special procedures section receives an average of 75 specimens a day. These are divided into the following categories:
· �Routine Coagulation,� encompassing prothrombin time, partial thromboplastin time, thrombin time, and fibrin split products.
· �Special coagulation,� including clotting factor assays, tests for hypercoagulable states, APC resistance, natural anticoagulant, lupus anticoagulant, and others.
· �Special hematology� including platelet aggregation, hemoglobin fractionation, osmotic fragility, HAM test, and related tests.
· HLA serologic typing for class I and class II and confirmation by DNA typing for class II.
· Flow cytometry for the phenotyping of leukemia and lymphoma, CD34 quantitation, T-cell subsets, and immunodeficiency evaluation.
Areas of special interest and strength have been in the consistent correlation of blood and bone marrow morphology with flow cytometry phenotyping in the final diagnosis of hematological neoplasms. We have a long term interest in increasing the consultation service in hemostasis and hypercoagulable disorders. Residents are encouraged to learn hand on testing and to actively become involved in the interpretation of multiple results and its clinical correlation and to help in establishing new procedures.
SEROLOGY
INTRODUCTION:
Serodiagnosis is one of the available means, approaches, used in the diagnosis of infectious and non-infectious diseases or conditions. Serology Section is one of the clinical Microbiology disciplines which is actively involved in helping to diagnose patients with infectious and non infectious diseases in a reliable and rapid way based on different serodiagnostic methods.
Several formats of serologic tests (procedures) are employed for such aim. These include agglutination, flocculation, precipitation, neutralisation, fluorescence and enzyme linked immunosorbent assays formats for the detection of either antibody or antigen molecules,associated with the involved agent/condition.
In our laboratory, the different serologic tests used are based on commercial kits/products. Thus, the manufacturer�s instructions are thoroughly followed and the test controls, extrapolation of results, and the limitation of the procedures are closely observed to ensure reliable testing with approprate quality documentation / verification.
In this context, the section is also enrolled in international proficiency testing program.
The spectrum of diseases /conditions investigated by different tests in this section include: Hepatitis, Rheumatic diseases, Autoimmune disease, Rickettsial diseases, Febrile illness, Allergy, Syphilis, Pregnancy and other viruses including HIV & TORCH agents.
In addition to providing laboratory diagnoses, the section is also involved in continuing education, and training of medical technology students and residents in Pathology and Laboratory Medicine. Moreover, the section supports personnel interested to do research.
Serology section working hours are from 7 am � 5 pm, Monday-Friday and 8 am � 1 pm Saturday.
COMMUNICATION OF CRITICAL RESULTS:
The doctor in charge of a patient or requesting the test will be directly informed by phone in case of any critical result such as positive IgM findings, positive hepatitis finding (which are indicative of infection) and positive HIV result.
Availability / turn around time of results depends on the requested test. This could vary from 2 hrs to within 10 days after receiving the specimen. Check with the laboratory (ext. 5227) concerning this aspects for each test.
Serodiagnosis is one of the available means, approaches, used in the diagnosis of infectious and non-infectious diseases or conditions. Serology Section is one of the clinical Microbiology disciplines which is actively involved in helping to diagnose patients with infectious and non infectious diseases in a reliable and rapid way based on different serodiagnostic methods.
Several formats of serologic tests (procedures) are employed for such aim. These include agglutination, flocculation, precipitation, neutralisation, fluorescence and enzyme linked immunosorbent assays formats for the detection of either antibody or antigen molecules,associated with the involved agent/condition.
In our laboratory, the different serologic tests used are based on commercial kits/products. Thus, the manufacturer�s instructions are thoroughly followed and the test controls, extrapolation of results, and the limitation of the procedures are closely observed to ensure reliable testing with approprate quality documentation / verification.
In this context, the section is also enrolled in international proficiency testing program.
The spectrum of diseases /conditions investigated by different tests in this section include: Hepatitis, Rheumatic diseases, Autoimmune disease, Rickettsial diseases, Febrile illness, Allergy, Syphilis, Pregnancy and other viruses including HIV & TORCH agents.
In addition to providing laboratory diagnoses, the section is also involved in continuing education, and training of medical technology students and residents in Pathology and Laboratory Medicine. Moreover, the section supports personnel interested to do research.
Serology section working hours are from 7 am � 5 pm, Monday-Friday and 8 am � 1 pm Saturday.
COMMUNICATION OF CRITICAL RESULTS:
The doctor in charge of a patient or requesting the test will be directly informed by phone in case of any critical result such as positive IgM findings, positive hepatitis finding (which are indicative of infection) and positive HIV result.
Availability / turn around time of results depends on the requested test. This could vary from 2 hrs to within 10 days after receiving the specimen. Check with the laboratory (ext. 5227) concerning this aspects for each test.
Scope of Work
I. Introduction:
The Department of Pathology & Laboratory Medicine serves patients of all age groups. It includes two major services: anatomic and clinical pathology.
II. Anatomic Pathology:
The Division of Anatomic Pathology is responsible for all anatomical specimens and consists of Surgical Pathology, Cytopathology, Neuropathology and Autopsy services.
Services are provided Monday through Friday from 8 am to 5 pm and Saturday from 8 am to 1 pm. On call faculty member and resident are available at all times
III. Clinical Pathology:
The Division of Clinical Pathology consists of the following sections:
a- Bacteriology:Provides services for identification of bacteria and other microorganisms causing human infections related to different body sites and organs. It also performs a variety of drug susceptibility testing to help in antimicrobial treatment This section also covers services related to mycobacterial (mycobacteriology) and fungal (Mycology) infections. Services are offered 24 hours, 7 days a week. (Section extension: 5211)
b- Blood Bank: Provides a broad range of blood product compatibility testing and transfusion services, blood component therapy. It offers a blood donor service which allows the performance of autologous/homologous blood collection, therapeutic phlebotomy and platelet and plasma pheresis. This service handles fully stem cell processing, storage and transfusion. Services are provided 24 hours daily, all week.( Section extension: 5228)
c- Clinical Chemistry: Offers a wide a variety of laboratory tests, which includes general chemistry profiling, enzyme determination, lipid profile, cardiac risk markers, liver function tests, kidney profile, endocrinology tests, tumor markers, individual protein quantitation and eletrophoresis, trace metals, therapeutic drug monitoring, biogenic amine, neonatal screening, prenatal diagnosis, amino acids, and biochemical genetic. The section operates 24 hours, 7 days a week. (Section extension: 5219)
d- Clinical Microbiology
e- Cytogenetics: Performs karyotype analysis on a variety of tissues, including prenatal and postnatal samples, for both constitutional and acquired chromosome abnormalities. Services are offered Monday through Friday from 8 am to 5 pm. (Section extension: 5245)
f- Hematology:Services include automated and manual blood counts, coagulation studies, flow cytometry, HLA compatibility , identification of thalassemia and sickle cell carriers, red blood cell disorders, as well as CSF and other body fluid analyses. This section operates 24 hours daily, all week (Section extension: 5214)
g- Microscopy-Parasitology:Provides services pertaining to investigating parasitic infections, detection of blood and reducing substance in stool. Another major test is urinalysis which incorporates chemical analysis and microscopy. Semen analysis is also handled in this unit. Services are provided 24 hours daily, all week. ( Section extension: 5213)
h- Serology:Offers a wide variety of tests that help in the diagnosis of infections and non-infections diseases by detecting antigen and antibody reaction. These are detected using agglutination, flocculation, precipitation, fluorescence and enzyme linked immunoserbent assays. Services are offered Monday through Friday from 8 am to 5 pm and Saturdays from 8 am to 1 pm. ( Section extension: 5227)
f- Molecular medicine (Dr. Mahfouz)
IV. Reference Laboratories
The Chairman, in consultation with the medical directors of the department and other physician clients, is responsible for selecting referral laboratories.
Our Laboratory has established links with recognized laboratories abroad such as CERBA laboratory, France, Bioscienta, Germany, and Mayo Clinic, Minnesota, USA. Under special conditions, the laboratory is prepared to handle specialized requests and assist in their shipment to other specialized laboratories.
V. Phlebotomy Services
Two types of services are available:
a- Outpatient Phlebotomy: All outpatient phlebotomy services are provided on a walk-in-first-come, first-served basis. Relevant specimen collection instructions are provided to patients. Outpatient service is open Monday through Friday from 8 am to pm and Saturday from 8 am to 1 pm
b- Inpatient Phlebotomy: Phlebotomists collect blood samples following physicians� requests according to the following schedule:
at any other time, requests are collected by house staff in charge of the patients and should be delivered promptly to the Receiving Area.
VI. Stat Testing:
�STAT� (short turn-around time) tests are requested only in situations where the patient�s clinical condition requires rapid response from the laboratory. Abuse of the � Stat� designation may delay testing in truly urgent clinical situations. The following test are available as � STAT� tests 24 hours, 7 days a week.
a- Bacteriology:
Cultures for Blood, Stool, Catheter Tips, and Smears and Culture for CSF, Respiratory, Body Fluids, Swabs, Urine and any other specimen obtained at surgical operation.
b- Blood Bank:
Grouping, Crossmatching, & Irradiation for Blood and Blood Components Transfusion, Donor Phlebotomy, Coombs Test, and Platelet Pheresis.
c- Chemistry:
Blood: Sodium, Potassium, Chloride, Carbon Dioxide, Glucose, BUN, Creatinine, Uric Acid, Bilirubin (T/D), T. Protein and A/G, Magnesium, Calcium, Phosphorous, Alkaline Phosphatase. Amylase, Lipase, SGOT, SGPT, LDH, GGT, CPK, CK-MB, Cholesterol, HDL-C Triglycerides, Fibrinogen, Osmolality, Acetaminophen, Ethanol, Salicylate, Cholinesterase, Ketones, Ammonia, Lactate, CRP, Cardiac Troponin T, Carbamazepine, Digoxin, Lithium,
Phenobarbital, Phenytoin, Theophylline.
Urine: Drugs of Abuse Screen, Amylase, Sodium, Potassium, Chloride, calcium, Phosphorous, Creatinine, Protein, Osmolality, Myoglobin.
Amniotic Fluid: Liley�s Curve (OD650) ,(OD450), Fetal Lung Maternity
d- Hematology:
CBC, Platelet Count, Cell Count and Cytology of CSF and other Body Fluids, Bleeding Time, Reticulocytes Count, Sickle Cell Preparation, Blood Film Inspection, Malaria Smear, ESR, PT, PTT.
e- Microscopy:
Urine Routine and Microscopy and Stool for Occult Blood.
f- Serology:
Pregnancy Test.
VII. Turnaround Time:
A turnaround time of 45-60 minutes should be generally expected from the time a sample is received in the specific laboratory sections for non-culture requests. STAT may vary according to the procedure requested; this depends on the number of STAT procedures already in process, available personnel and operating status of the equipment.
The Department of Pathology & Laboratory Medicine serves patients of all age groups. It includes two major services: anatomic and clinical pathology.
II. Anatomic Pathology:
The Division of Anatomic Pathology is responsible for all anatomical specimens and consists of Surgical Pathology, Cytopathology, Neuropathology and Autopsy services.
Services are provided Monday through Friday from 8 am to 5 pm and Saturday from 8 am to 1 pm. On call faculty member and resident are available at all times
III. Clinical Pathology:
The Division of Clinical Pathology consists of the following sections:
a- Bacteriology:Provides services for identification of bacteria and other microorganisms causing human infections related to different body sites and organs. It also performs a variety of drug susceptibility testing to help in antimicrobial treatment This section also covers services related to mycobacterial (mycobacteriology) and fungal (Mycology) infections. Services are offered 24 hours, 7 days a week. (Section extension: 5211)
b- Blood Bank: Provides a broad range of blood product compatibility testing and transfusion services, blood component therapy. It offers a blood donor service which allows the performance of autologous/homologous blood collection, therapeutic phlebotomy and platelet and plasma pheresis. This service handles fully stem cell processing, storage and transfusion. Services are provided 24 hours daily, all week.( Section extension: 5228)
c- Clinical Chemistry: Offers a wide a variety of laboratory tests, which includes general chemistry profiling, enzyme determination, lipid profile, cardiac risk markers, liver function tests, kidney profile, endocrinology tests, tumor markers, individual protein quantitation and eletrophoresis, trace metals, therapeutic drug monitoring, biogenic amine, neonatal screening, prenatal diagnosis, amino acids, and biochemical genetic. The section operates 24 hours, 7 days a week. (Section extension: 5219)
d- Clinical Microbiology
e- Cytogenetics: Performs karyotype analysis on a variety of tissues, including prenatal and postnatal samples, for both constitutional and acquired chromosome abnormalities. Services are offered Monday through Friday from 8 am to 5 pm. (Section extension: 5245)
f- Hematology:Services include automated and manual blood counts, coagulation studies, flow cytometry, HLA compatibility , identification of thalassemia and sickle cell carriers, red blood cell disorders, as well as CSF and other body fluid analyses. This section operates 24 hours daily, all week (Section extension: 5214)
g- Microscopy-Parasitology:Provides services pertaining to investigating parasitic infections, detection of blood and reducing substance in stool. Another major test is urinalysis which incorporates chemical analysis and microscopy. Semen analysis is also handled in this unit. Services are provided 24 hours daily, all week. ( Section extension: 5213)
h- Serology:Offers a wide variety of tests that help in the diagnosis of infections and non-infections diseases by detecting antigen and antibody reaction. These are detected using agglutination, flocculation, precipitation, fluorescence and enzyme linked immunoserbent assays. Services are offered Monday through Friday from 8 am to 5 pm and Saturdays from 8 am to 1 pm. ( Section extension: 5227)
f- Molecular medicine (Dr. Mahfouz)
IV. Reference Laboratories
The Chairman, in consultation with the medical directors of the department and other physician clients, is responsible for selecting referral laboratories.
Our Laboratory has established links with recognized laboratories abroad such as CERBA laboratory, France, Bioscienta, Germany, and Mayo Clinic, Minnesota, USA. Under special conditions, the laboratory is prepared to handle specialized requests and assist in their shipment to other specialized laboratories.
V. Phlebotomy Services
Two types of services are available:
a- Outpatient Phlebotomy: All outpatient phlebotomy services are provided on a walk-in-first-come, first-served basis. Relevant specimen collection instructions are provided to patients. Outpatient service is open Monday through Friday from 8 am to pm and Saturday from 8 am to 1 pm
b- Inpatient Phlebotomy: Phlebotomists collect blood samples following physicians� requests according to the following schedule:
at any other time, requests are collected by house staff in charge of the patients and should be delivered promptly to the Receiving Area.
VI. Stat Testing:
�STAT� (short turn-around time) tests are requested only in situations where the patient�s clinical condition requires rapid response from the laboratory. Abuse of the � Stat� designation may delay testing in truly urgent clinical situations. The following test are available as � STAT� tests 24 hours, 7 days a week.
a- Bacteriology:
Cultures for Blood, Stool, Catheter Tips, and Smears and Culture for CSF, Respiratory, Body Fluids, Swabs, Urine and any other specimen obtained at surgical operation.
b- Blood Bank:
Grouping, Crossmatching, & Irradiation for Blood and Blood Components Transfusion, Donor Phlebotomy, Coombs Test, and Platelet Pheresis.
c- Chemistry:
Blood: Sodium, Potassium, Chloride, Carbon Dioxide, Glucose, BUN, Creatinine, Uric Acid, Bilirubin (T/D), T. Protein and A/G, Magnesium, Calcium, Phosphorous, Alkaline Phosphatase. Amylase, Lipase, SGOT, SGPT, LDH, GGT, CPK, CK-MB, Cholesterol, HDL-C Triglycerides, Fibrinogen, Osmolality, Acetaminophen, Ethanol, Salicylate, Cholinesterase, Ketones, Ammonia, Lactate, CRP, Cardiac Troponin T, Carbamazepine, Digoxin, Lithium,
Phenobarbital, Phenytoin, Theophylline.
Urine: Drugs of Abuse Screen, Amylase, Sodium, Potassium, Chloride, calcium, Phosphorous, Creatinine, Protein, Osmolality, Myoglobin.
Amniotic Fluid: Liley�s Curve (OD650) ,(OD450), Fetal Lung Maternity
d- Hematology:
CBC, Platelet Count, Cell Count and Cytology of CSF and other Body Fluids, Bleeding Time, Reticulocytes Count, Sickle Cell Preparation, Blood Film Inspection, Malaria Smear, ESR, PT, PTT.
e- Microscopy:
Urine Routine and Microscopy and Stool for Occult Blood.
f- Serology:
Pregnancy Test.
VII. Turnaround Time:
A turnaround time of 45-60 minutes should be generally expected from the time a sample is received in the specific laboratory sections for non-culture requests. STAT may vary according to the procedure requested; this depends on the number of STAT procedures already in process, available personnel and operating status of the equipment.
Rotations
Bacteriology Section:
The general training rotation should concentrate on acquiring practical (hands on) skills in various procedures and tests in addition to applying the practical knowledge in interpretation of tests results and their impact on patient care.
A summary of overal objectives are as follows:
1. Exposure to overall operation flow of work at various sections.
2. Acquire knowledge about the different and proper types of specimens needed and used in investigation by different test.
3. Acquire technical skills in lab procedures performance and interpretation.
4. Identification of commonly occuring organisms.
5. Understanding basis of test and media reactions.
6. Be able to perform & interpret antimicrobial susceptibility tests.
7. Perform & interpret rapid procedure for detection and identification of organisms.
8. Have an insight on the interpretation and limitation of tests
9. Be able to advise physicians on different tests and procedures related to lab aspects and their interpretation as well as to answer their inquires.
The methods of training should involve different aspects as follows:
- Each trainee should be available in the section all through the duration of his training and should perform tests himself after adequate time of observation.
- Use of unknowns.
- case discussions.
- Involvement in projects and/ or development of tests/ procedures.
The duration of training is suggested as follows:
- 2 1/2 months in Bacteriology section covering procedures and/or identification for aerobic and anaerobic bacteria, mycobacteriology, mycology, antimicrobial susceptibility testing and non cultural detection methods (1 1/2 months first year, i month second year).
- 1 1/2 months in serology section ( 1 month first year, 1/2 month second year)
- 1 1/2 months in parasitology/microscopy section (1 month first year, 1/2 month second year)
- 1/2 in media preparation (1st year)
Note: Detailed guidelines of more specific rotation objectives are available to those currently rotating in clinical microbiology.
________________________________________
Blood Banking and Transfusion Medicine:
Practical Training with Theoretical Interpretation:
ABO blood group & Rh (D) typing
Resolution of ABO discrepancies
Direct Antiglobulin Test-Polyspecific and Monospecific AHG
Indirect Antiglobulin Test
Antibody Identification (Quantitative & Qualitative)
Compatibility Testing: Major Crossmatch and Immediate spin crossmatch
Cord blood studies
Neonatal testing: Immune anti-A and anti-B
Component preparation and preservation
Blood Donor selection and blood collection: allogeneic and autologous
Apheresis procedures (Adult & Pediatric):
Plateletpheresis
Granulocyte collection
Red cell exchange
Stem cell collection
Therapeutic plasmapheresis
Therapeutic plateletpheresis
Therapeutic leukapheresis
12. Collection & Processing of donor blood units
13. Gel test & Tube test tech niques
14. Quality control: reagents
15. Blood Utilization Review (Audits)
Theoretical:
1. Component Therapy
2. Transfusion Reactions: Types, Prevention, and Work-up
3. Hemolytic Disease of the Newborn (HDN): Types and Work-up
4. Types of transfusion (massive transfusion, exchange transfusion, intrauterine..)
5. Elution & Autoadsorption procedures: principles and interpretation
6. Extensive and Selective Phenotype of the other major blood group antigens
7. Preparation of least incompatible RBC unit (titers)
8. ABO discrepancies and resolution techniques
9. Variations of the Rh (D) antigen (the Du antigen)
10. Other major blood groups antigens
11. Irradiation, Filtration, washed RBCs: Indications
12. Enhancement techniques: Albumin, LISS, and Enzymes
13. Polyclonal and Monoclonal reagents
14. Quality control: reagents, instruments, and records
References:
American Association of Blood Banks: Technical Manual, 14th edition. AABB, Bethesda, 2002.
American Association of Blood Banks: Standards for Blood Banks and Transfusion Services, 21st edition. AABB, Bethesda, 2002.
Harmening D. Modern Blood Banking and Transfusion Practices, 4th edition. F.A.Davis Company. Philadelphia, 1999.
________________________________________
Chemistry Section:
1. Specimen acessioning and laboratory information system.
2. Automation (principle, maintenance, operation, trouble shooting):
· Hitachi 912
· Axsym
· Elecsys 2010
· Vitros 250
· BN ProSpec Nephelometer
3. Semi-automation (principle, maintenance, operation, trouble shooting):
· TDXFLX
· IMX
· Delfia
4. Proteins: Quantitation, electrophoresis & immunofixation, oligoclonal banding analysis and interpretation.
5. High Performance Liquid Chromatography - Amino Acids analysis and interpretation.
6. Special urine tests.
7. Trace metals analysis by ICP-MS.
8. Neonatal and prenatal screening.
9. Biochemical genetics and organic acids by GC-MS.
- Quality Control (QC)/ Quality Assurance (QA)/ Performance Improvement (PI):
a- Daily surveillance of Chemistry results.
b- Understanding and review of Chemistry QC and maintenance records.
c- Review proficiency testing records.
d- Other QC activities: Intermethod comparisons, Instrument carryover indicators for PI activities.
e- Review of incident reports and collection of raw data for certain indicators for PI activities.
f. Knowledge of Safety policies and procedures.
g- Review personnel records: training, competency, continuing medical education.
- Special projects- method development, valuation, and writing standard operating procedure (SOP).
- Research - abstracts, reviews, original projects, etc ...
- Duration: 1 1/2 months in Chemistry and 1/2 month in Endocrinology each in the first and second years.
- During all rotations residents will be involved in presenting continuing medical education for technological staff, follow up of unusual results, and trouble shooting activities when problems are encountered.
________________________________________
Cytogenetics Section:
During their rotation in the Cytogenetics Laboratory, the Residents can observe the following techniques:
Sample set-up: Blood samples
Amniotic Fluid samples
Chorionic Villi or Products of conception
Bone marrow or lymph node samples
Solid tumors
Culture maintenance
Harvesting and slide making
Chromosome banding techniques
In addition, they are introduced to chromosome analysis, by looking at photographed metaphases, prepared karyotypes and chromosomes under the light microscope.
They are encouraged to look at specific referrals in our log book and the corresponding result of chromosome analysis to establish correlations between the phenotype and the karyotype of the patient. Specific cases and their follow up can be discussed.
The Residents can also observe and discuss the technique of Fluorescence In Situ Hybridization (FISH) and view the results under the Fluorescent microscope.
________________________________________
Hematology Section:
Hematology and Coagulation Rotation:
I. Hematology Rotation:
A. Procedures
1. Peripheral blood smear:
-Preparation and stain -Interpretation and assessment
2. Microhematocrit 3. Manual cell counts 4. Body fluids: Count and differential 5. L.E. preparation 6. Inclusion bodies 7. Hemoglobin electrophoresis 8. Acid elusion test 9. PNH screen 10. Spherocyte screen 11. Bone marrow aspirate:
-Preparation and stains including cytochemical stains -Interpretation and differential
B. Instrumentation:
1. Hematology analyzers 2. Sedi system 3. Quality control
C. Flow cytometry:
1. Principle 2. Antibody panel selection
II. Coagulation:
A. Bleeding screen: (PT, a-PTT, Fibrinogen) B. Hypercoaguble state screen: (protein C, protein S, Antithrombin III, Lupus Anticoagulant, and APCR) C. Hypocoaguble State: (Factors quantitationlqualitation (FXIII) and inhibitors) D. DlC screen: (D-Dimer) E. Platelets aggregation and v. W .cofactor/antigen
III. BLA testing
A. Serotyping B. Serologic crossmatching
IV .Duration:
A. First year resident:
-2 months hematology -2 months coagulation/special
B. Second year
-2 months hematology -2 months coagulation/special
V. Research:
Each resident is encouraged to work on establishing new procedures whenever available and participate in research activity.
________________________________________
Molecular Diagnostics Laboratory
During their rotation in the Molecular Diagnostics Laboratory at AUBMC, the Pathology and Laboratory Medicine Residents, Medical Laboratory technology and elective students will have the opportunity to get exposed to the following aspects of the facility:
A brief introduction on �Why and How?� to establish and use a Molecular Laboratory with emphasis on role of research in Medicine and progress in treatment of several diseases.
A tour in the Lab to show them the equipment and different partition sections with emphasis on the flow of work from the minute a specimen reaches our section till its application on a thermocycler.
Introduction to the various tests performed (HLA typing, Leukemia panels, Molecular Coagulation Profile, Molecular Microbiology testing�.etc) and explanations of the technical principles and procedures.
A live demonstration for the various phases of a procedure (extracted and processed samples, PCR amplification in progress, a gel running, an X-rayed gel, and a stored final data for the patient) and interpretation of the corresponding result.
Problem solving: Participation of the students and residents in interpreting some tests on their own after performing the tests, thus will be acquiring hands-on-experience throughout their rotation. This is usually done under direct supervision of the Senior technologist in charge of the section or the Director of the section.
The general training rotation should concentrate on acquiring practical (hands on) skills in various procedures and tests in addition to applying the practical knowledge in interpretation of tests results and their impact on patient care.
A summary of overal objectives are as follows:
1. Exposure to overall operation flow of work at various sections.
2. Acquire knowledge about the different and proper types of specimens needed and used in investigation by different test.
3. Acquire technical skills in lab procedures performance and interpretation.
4. Identification of commonly occuring organisms.
5. Understanding basis of test and media reactions.
6. Be able to perform & interpret antimicrobial susceptibility tests.
7. Perform & interpret rapid procedure for detection and identification of organisms.
8. Have an insight on the interpretation and limitation of tests
9. Be able to advise physicians on different tests and procedures related to lab aspects and their interpretation as well as to answer their inquires.
The methods of training should involve different aspects as follows:
- Each trainee should be available in the section all through the duration of his training and should perform tests himself after adequate time of observation.
- Use of unknowns.
- case discussions.
- Involvement in projects and/ or development of tests/ procedures.
The duration of training is suggested as follows:
- 2 1/2 months in Bacteriology section covering procedures and/or identification for aerobic and anaerobic bacteria, mycobacteriology, mycology, antimicrobial susceptibility testing and non cultural detection methods (1 1/2 months first year, i month second year).
- 1 1/2 months in serology section ( 1 month first year, 1/2 month second year)
- 1 1/2 months in parasitology/microscopy section (1 month first year, 1/2 month second year)
- 1/2 in media preparation (1st year)
Note: Detailed guidelines of more specific rotation objectives are available to those currently rotating in clinical microbiology.
________________________________________
Blood Banking and Transfusion Medicine:
Practical Training with Theoretical Interpretation:
ABO blood group & Rh (D) typing
Resolution of ABO discrepancies
Direct Antiglobulin Test-Polyspecific and Monospecific AHG
Indirect Antiglobulin Test
Antibody Identification (Quantitative & Qualitative)
Compatibility Testing: Major Crossmatch and Immediate spin crossmatch
Cord blood studies
Neonatal testing: Immune anti-A and anti-B
Component preparation and preservation
Blood Donor selection and blood collection: allogeneic and autologous
Apheresis procedures (Adult & Pediatric):
Plateletpheresis
Granulocyte collection
Red cell exchange
Stem cell collection
Therapeutic plasmapheresis
Therapeutic plateletpheresis
Therapeutic leukapheresis
12. Collection & Processing of donor blood units
13. Gel test & Tube test tech niques
14. Quality control: reagents
15. Blood Utilization Review (Audits)
Theoretical:
1. Component Therapy
2. Transfusion Reactions: Types, Prevention, and Work-up
3. Hemolytic Disease of the Newborn (HDN): Types and Work-up
4. Types of transfusion (massive transfusion, exchange transfusion, intrauterine..)
5. Elution & Autoadsorption procedures: principles and interpretation
6. Extensive and Selective Phenotype of the other major blood group antigens
7. Preparation of least incompatible RBC unit (titers)
8. ABO discrepancies and resolution techniques
9. Variations of the Rh (D) antigen (the Du antigen)
10. Other major blood groups antigens
11. Irradiation, Filtration, washed RBCs: Indications
12. Enhancement techniques: Albumin, LISS, and Enzymes
13. Polyclonal and Monoclonal reagents
14. Quality control: reagents, instruments, and records
References:
American Association of Blood Banks: Technical Manual, 14th edition. AABB, Bethesda, 2002.
American Association of Blood Banks: Standards for Blood Banks and Transfusion Services, 21st edition. AABB, Bethesda, 2002.
Harmening D. Modern Blood Banking and Transfusion Practices, 4th edition. F.A.Davis Company. Philadelphia, 1999.
________________________________________
Chemistry Section:
1. Specimen acessioning and laboratory information system.
2. Automation (principle, maintenance, operation, trouble shooting):
· Hitachi 912
· Axsym
· Elecsys 2010
· Vitros 250
· BN ProSpec Nephelometer
3. Semi-automation (principle, maintenance, operation, trouble shooting):
· TDXFLX
· IMX
· Delfia
4. Proteins: Quantitation, electrophoresis & immunofixation, oligoclonal banding analysis and interpretation.
5. High Performance Liquid Chromatography - Amino Acids analysis and interpretation.
6. Special urine tests.
7. Trace metals analysis by ICP-MS.
8. Neonatal and prenatal screening.
9. Biochemical genetics and organic acids by GC-MS.
- Quality Control (QC)/ Quality Assurance (QA)/ Performance Improvement (PI):
a- Daily surveillance of Chemistry results.
b- Understanding and review of Chemistry QC and maintenance records.
c- Review proficiency testing records.
d- Other QC activities: Intermethod comparisons, Instrument carryover indicators for PI activities.
e- Review of incident reports and collection of raw data for certain indicators for PI activities.
f. Knowledge of Safety policies and procedures.
g- Review personnel records: training, competency, continuing medical education.
- Special projects- method development, valuation, and writing standard operating procedure (SOP).
- Research - abstracts, reviews, original projects, etc ...
- Duration: 1 1/2 months in Chemistry and 1/2 month in Endocrinology each in the first and second years.
- During all rotations residents will be involved in presenting continuing medical education for technological staff, follow up of unusual results, and trouble shooting activities when problems are encountered.
________________________________________
Cytogenetics Section:
During their rotation in the Cytogenetics Laboratory, the Residents can observe the following techniques:
Sample set-up: Blood samples
Amniotic Fluid samples
Chorionic Villi or Products of conception
Bone marrow or lymph node samples
Solid tumors
Culture maintenance
Harvesting and slide making
Chromosome banding techniques
In addition, they are introduced to chromosome analysis, by looking at photographed metaphases, prepared karyotypes and chromosomes under the light microscope.
They are encouraged to look at specific referrals in our log book and the corresponding result of chromosome analysis to establish correlations between the phenotype and the karyotype of the patient. Specific cases and their follow up can be discussed.
The Residents can also observe and discuss the technique of Fluorescence In Situ Hybridization (FISH) and view the results under the Fluorescent microscope.
________________________________________
Hematology Section:
Hematology and Coagulation Rotation:
I. Hematology Rotation:
A. Procedures
1. Peripheral blood smear:
-Preparation and stain -Interpretation and assessment
2. Microhematocrit 3. Manual cell counts 4. Body fluids: Count and differential 5. L.E. preparation 6. Inclusion bodies 7. Hemoglobin electrophoresis 8. Acid elusion test 9. PNH screen 10. Spherocyte screen 11. Bone marrow aspirate:
-Preparation and stains including cytochemical stains -Interpretation and differential
B. Instrumentation:
1. Hematology analyzers 2. Sedi system 3. Quality control
C. Flow cytometry:
1. Principle 2. Antibody panel selection
II. Coagulation:
A. Bleeding screen: (PT, a-PTT, Fibrinogen) B. Hypercoaguble state screen: (protein C, protein S, Antithrombin III, Lupus Anticoagulant, and APCR) C. Hypocoaguble State: (Factors quantitationlqualitation (FXIII) and inhibitors) D. DlC screen: (D-Dimer) E. Platelets aggregation and v. W .cofactor/antigen
III. BLA testing
A. Serotyping B. Serologic crossmatching
IV .Duration:
A. First year resident:
-2 months hematology -2 months coagulation/special
B. Second year
-2 months hematology -2 months coagulation/special
V. Research:
Each resident is encouraged to work on establishing new procedures whenever available and participate in research activity.
________________________________________
Molecular Diagnostics Laboratory
During their rotation in the Molecular Diagnostics Laboratory at AUBMC, the Pathology and Laboratory Medicine Residents, Medical Laboratory technology and elective students will have the opportunity to get exposed to the following aspects of the facility:
A brief introduction on �Why and How?� to establish and use a Molecular Laboratory with emphasis on role of research in Medicine and progress in treatment of several diseases.
A tour in the Lab to show them the equipment and different partition sections with emphasis on the flow of work from the minute a specimen reaches our section till its application on a thermocycler.
Introduction to the various tests performed (HLA typing, Leukemia panels, Molecular Coagulation Profile, Molecular Microbiology testing�.etc) and explanations of the technical principles and procedures.
A live demonstration for the various phases of a procedure (extracted and processed samples, PCR amplification in progress, a gel running, an X-rayed gel, and a stored final data for the patient) and interpretation of the corresponding result.
Problem solving: Participation of the students and residents in interpreting some tests on their own after performing the tests, thus will be acquiring hands-on-experience throughout their rotation. This is usually done under direct supervision of the Senior technologist in charge of the section or the Director of the section.
Parasitology
SCOPE OF SERVICES: Microscopy-parasitology section is one of the clinical microbiology disciplines involved in providing a spectrum of services pertaining to laboratory diagnosis of patients with parasitic and urinary tract infections and other diseases, as well as in providing continuing education and teaching to undergraduate and graduate students and residents.
The spectrum of clinical services provided in this section covers a wide range of tests pertaining to investigating a variety of diseases including: Parasitic infection of gastrointestinal tract by detection of ova and parasites in stool; the detection of hidden blood in stool by guaiac test, the detection of fat in stool by Sudan III and detection of reducing sugars in stool and urine. Other major test done pertain to urinalysis which includes routine chemical analysis and microscopy which is important in the medical examination because it provides information concerning diseases affecting the kidneys as well as other parts of the urinary tract, and other body sites.
Semen analysis is another assay done, in our section, to assess the fertility status of men by investigating several parameters related to the seminal fluids.
Other tests carried out are the RBC morphology, Bence Jones protein, and the polarizing microscopy (on joint fluid) to look for crystals related to gout disease. Critical results are conferred immediately to the concerned physician by phone. The section applies strict quality control measures to ensure reliability and is enrolled in an external proficiency testing program for this purpose.
The Staff of microscopy section is available for patient care services 24 hours a day, seven days a week.
The spectrum of clinical services provided in this section covers a wide range of tests pertaining to investigating a variety of diseases including: Parasitic infection of gastrointestinal tract by detection of ova and parasites in stool; the detection of hidden blood in stool by guaiac test, the detection of fat in stool by Sudan III and detection of reducing sugars in stool and urine. Other major test done pertain to urinalysis which includes routine chemical analysis and microscopy which is important in the medical examination because it provides information concerning diseases affecting the kidneys as well as other parts of the urinary tract, and other body sites.
Semen analysis is another assay done, in our section, to assess the fertility status of men by investigating several parameters related to the seminal fluids.
Other tests carried out are the RBC morphology, Bence Jones protein, and the polarizing microscopy (on joint fluid) to look for crystals related to gout disease. Critical results are conferred immediately to the concerned physician by phone. The section applies strict quality control measures to ensure reliability and is enrolled in an external proficiency testing program for this purpose.
The Staff of microscopy section is available for patient care services 24 hours a day, seven days a week.
Neuro Muscular
Introduction:
The Muhieddine M. Ahdab Neuromuscular Diagnostic Laboratory (MMA-NMD) is a newly established facility dedicated to the study and full diagnostic evaluation of muscle and nerve biopsies. Updated diagnostic methodology is currently available, and will improve understanding and therapy of muscle and nerve diseases. The laboratory is fully equipped with state of the art histological, histochemical, immunocytochemical and quantitative image analysis with morphometric evaluative techniques and instruments.
Diagnostic evaluation of biopsies is specifically adapted to each case, using the information obtained from clinical consultation with the referring physician.
Specific methodology is routinely used for the storage of biopsy tissue for possible further ultrastructural, biochemical, molecular and genetic studies, if needed to confirm diagnosis.
Available Routine Processing Techniques
� Processing of tissue through paraffin sections, microscopic evaluation of H&E stained sections and routine special stains for trichrome, elastic tissue, glycogen and amyloid.
� Rapid freezing of non-fixed portions of muscle and nerve biopsies at very low temperatures (-185oC), for diverse histochemical, trichrome, fat, glycogen and amyloid stains.
� Histochemical panel of mitochondrial enzymes to evaluate the five complexes of OXPHOS energy production.
� Immunocytochemical evaluation of inflammatory markers and cytokines whenever required for the diagnosis of inflammatory and immune neuropathies/myopathies.
� Immunocytochemical evaluation of sarcolemmal and cytoskeletal proteins in the study of dystrophies and other congenital myopathies and neuropathies.
� Quantitative morphometric evaluation of myofiber size, type and distribution in frozen and plastic embedded sections, for the differential diagnosis of congenital and acquired myopathies.
� Morphometric evaluation of myelinated nerve fiber density and distribution in one micron thick plastic sections of the nerve processed through metacrylate embedding.
� Teased nerve preparations to separate myelinated nerve fibers for the evaluation of myelin sheath and axonal damage.
The Muhieddine M. Ahdab Neuromuscular Diagnostic Laboratory (MMA-NMD) is a newly established facility dedicated to the study and full diagnostic evaluation of muscle and nerve biopsies. Updated diagnostic methodology is currently available, and will improve understanding and therapy of muscle and nerve diseases. The laboratory is fully equipped with state of the art histological, histochemical, immunocytochemical and quantitative image analysis with morphometric evaluative techniques and instruments.
Diagnostic evaluation of biopsies is specifically adapted to each case, using the information obtained from clinical consultation with the referring physician.
Specific methodology is routinely used for the storage of biopsy tissue for possible further ultrastructural, biochemical, molecular and genetic studies, if needed to confirm diagnosis.
Available Routine Processing Techniques
� Processing of tissue through paraffin sections, microscopic evaluation of H&E stained sections and routine special stains for trichrome, elastic tissue, glycogen and amyloid.
� Rapid freezing of non-fixed portions of muscle and nerve biopsies at very low temperatures (-185oC), for diverse histochemical, trichrome, fat, glycogen and amyloid stains.
� Histochemical panel of mitochondrial enzymes to evaluate the five complexes of OXPHOS energy production.
� Immunocytochemical evaluation of inflammatory markers and cytokines whenever required for the diagnosis of inflammatory and immune neuropathies/myopathies.
� Immunocytochemical evaluation of sarcolemmal and cytoskeletal proteins in the study of dystrophies and other congenital myopathies and neuropathies.
� Quantitative morphometric evaluation of myofiber size, type and distribution in frozen and plastic embedded sections, for the differential diagnosis of congenital and acquired myopathies.
� Morphometric evaluation of myelinated nerve fiber density and distribution in one micron thick plastic sections of the nerve processed through metacrylate embedding.
� Teased nerve preparations to separate myelinated nerve fibers for the evaluation of myelin sheath and axonal damage.
MOLECULAR DIAGNOSTICS LAB
Information related to the tests performed in the Molecular Pathology section:
1- HLA Class I
2- HLA Class II
3- HLA Class I & II
Histocompatibility testing using molecular diagnostic tools has replaced serology testing in most labs worldwide. Our procedure relies on the Sequence Specific Primers (SSP) technique in which internal controls are run simultaneously. All issued results are based on an advanced Gel Documentation System and Computer-assisted Data interpretation using a highly sophisticated Software that integrates the information into a comprehensive report. Please note that manual interpretation is always being performed in parallel.
It is preferable if we receive the specimen in a Citrated tube (4 mls are enough).
Please do call the section for appointments.
4- HLA B locus specific:
We are testing now specifically for the HLA B locus which is needed for your investigation of a patient suspected to have Ankylosing Spondylitis (HLA B27).
In addition, HLA B5 can be detected and it helps in Behcet�s Disease cases.
What is important about this locus-specific kit is that it costs less than running an HLA Class I procedure by around one-third its price.
It is preferable if we receive the specimen in a Citrated tube (4 mls are enough).
Please do call the section for appointments.
Note: The turnaround time for all the HLA procedures is around 4 days.
5- Molecular testing for Factor V Leiden, Prothrombin gene (Factor II) mutation, and Methylene Tetrahydrofolate Reductase (MTHFR) gene mutation.
The main etiological thrombosis factors known at this time, in decreasing order of frequency are:
� The activated Protein C Resistance associated with Factor V (Leiden) mutation
� Circulating anticoagulants and/or Cardiolipin antibodies
� Antithrombin III, Protein C, and Protein S deficiencies
� Prothrombin gene mutation G20210A
I- Factor V Leiden
The Arg 506 Gln mutation (or G1691A, Leiden) is known to be involved in the etiology of deep venous thrombosis, with Antithrombin III and Protein C and S deficiencies. In the presence of this mutation, whether heterozygous or homozygous, it is imperative to prescribe prophylactic treatment, if there is a risk of thrombosis. The diagnosis of an initial case must be followed by a family investigation.
II- Factor II (Prothrombin) gene mutation
We will be testing for the most common mutation involving the 3�-untranslated region of the Prothrombin gene (G20210A) that has been reported to be associated with elevated plasma Prothrombin levels and is estimated to increase the risk for venous thrombosis by 3 to 5-fold.
III- Methylene tetrahydrofolate Reductase (MTHFR) gene mutation
Elevated levels of plasma homocysteine (Hyperhomocysteinemia) are a well established risk factor for both arterial and venous thrombosis. Hyperhomocysteinemia may be caused by nutritional deficiencies or by defects in enzymes involved in homocysteine metabolism like 5,10-methylenetetrahydrofolate Reductase (MTHFR). We will be testing for the most common mutation (C677T) that leads to a thermolabile MTHFR enzyme variant with reduced activity.
Notes:
a. Our technique is based on the PCR-SSOP reverse hybridization technique (Polymerase Chain Reaction combined with Sequence Specific Oligonucleotide Probing).
b. Our protocol allows us to detect the mutations of the three genes in the SAME RUN. Therefore, we will provide you with the results for the three genes even if your aim was one of them! Please note that the price is the same for one, two, or three mutations!
c. It is preferable if we receive the specimen in an EDTA tube (2 mls are enough)
d. The turnaround time for all the procedures is 48 hours from the day we perform the run (We expect to run the procedure twice per week. No appointment is needed).
6- Cell processing and preservation
We are now ready to offer you the service of cell processing and preservation for your consultations outside Lebanon. Some of the labs worldwide do not accept to receive genomic material for testing but rather they prefer intact cells. This is because they prefer to manipulate the samples according to their own applied protocols for DNA or RNA extractions.
Our section will take the responsibility for a full processing technique that will allow the best preservation of the cells. We have also set some shipping standards and agreed upon them with our local agents to transport the processed samples in the most efficient and safe way.
Please call us at least 24 hours before you are ready to send a sample.
7- DNA extraction
For your consultations outside Lebanon or for your research, we are ready to extract and quantitate the DNA for you. The extracted DNA will be preserved at -800C till it is needed for use or shipping.
Please call us at least 24 hours before you are ready to send a sample.
8- RNA extraction
For your consultations outside Lebanon or for your research, we are ready to extract and quantitate the RNA for you. The extracted RNA will be preserved at -800C till it is needed for use or shipping.
Please call us at least 24 hours before you are ready to send a sample. This is very important especially if your aim is to perform a Gene Expression Profiling study using Microarray technology.
9- NEW:
Leukemia testing
t(8;21)
t(9;22)
inv16
t(9;11)
t(12;21)
t(1;19)
t(4;11)
t(15;17)
1- HLA Class I
2- HLA Class II
3- HLA Class I & II
Histocompatibility testing using molecular diagnostic tools has replaced serology testing in most labs worldwide. Our procedure relies on the Sequence Specific Primers (SSP) technique in which internal controls are run simultaneously. All issued results are based on an advanced Gel Documentation System and Computer-assisted Data interpretation using a highly sophisticated Software that integrates the information into a comprehensive report. Please note that manual interpretation is always being performed in parallel.
It is preferable if we receive the specimen in a Citrated tube (4 mls are enough).
Please do call the section for appointments.
4- HLA B locus specific:
We are testing now specifically for the HLA B locus which is needed for your investigation of a patient suspected to have Ankylosing Spondylitis (HLA B27).
In addition, HLA B5 can be detected and it helps in Behcet�s Disease cases.
What is important about this locus-specific kit is that it costs less than running an HLA Class I procedure by around one-third its price.
It is preferable if we receive the specimen in a Citrated tube (4 mls are enough).
Please do call the section for appointments.
Note: The turnaround time for all the HLA procedures is around 4 days.
5- Molecular testing for Factor V Leiden, Prothrombin gene (Factor II) mutation, and Methylene Tetrahydrofolate Reductase (MTHFR) gene mutation.
The main etiological thrombosis factors known at this time, in decreasing order of frequency are:
� The activated Protein C Resistance associated with Factor V (Leiden) mutation
� Circulating anticoagulants and/or Cardiolipin antibodies
� Antithrombin III, Protein C, and Protein S deficiencies
� Prothrombin gene mutation G20210A
I- Factor V Leiden
The Arg 506 Gln mutation (or G1691A, Leiden) is known to be involved in the etiology of deep venous thrombosis, with Antithrombin III and Protein C and S deficiencies. In the presence of this mutation, whether heterozygous or homozygous, it is imperative to prescribe prophylactic treatment, if there is a risk of thrombosis. The diagnosis of an initial case must be followed by a family investigation.
II- Factor II (Prothrombin) gene mutation
We will be testing for the most common mutation involving the 3�-untranslated region of the Prothrombin gene (G20210A) that has been reported to be associated with elevated plasma Prothrombin levels and is estimated to increase the risk for venous thrombosis by 3 to 5-fold.
III- Methylene tetrahydrofolate Reductase (MTHFR) gene mutation
Elevated levels of plasma homocysteine (Hyperhomocysteinemia) are a well established risk factor for both arterial and venous thrombosis. Hyperhomocysteinemia may be caused by nutritional deficiencies or by defects in enzymes involved in homocysteine metabolism like 5,10-methylenetetrahydrofolate Reductase (MTHFR). We will be testing for the most common mutation (C677T) that leads to a thermolabile MTHFR enzyme variant with reduced activity.
Notes:
a. Our technique is based on the PCR-SSOP reverse hybridization technique (Polymerase Chain Reaction combined with Sequence Specific Oligonucleotide Probing).
b. Our protocol allows us to detect the mutations of the three genes in the SAME RUN. Therefore, we will provide you with the results for the three genes even if your aim was one of them! Please note that the price is the same for one, two, or three mutations!
c. It is preferable if we receive the specimen in an EDTA tube (2 mls are enough)
d. The turnaround time for all the procedures is 48 hours from the day we perform the run (We expect to run the procedure twice per week. No appointment is needed).
6- Cell processing and preservation
We are now ready to offer you the service of cell processing and preservation for your consultations outside Lebanon. Some of the labs worldwide do not accept to receive genomic material for testing but rather they prefer intact cells. This is because they prefer to manipulate the samples according to their own applied protocols for DNA or RNA extractions.
Our section will take the responsibility for a full processing technique that will allow the best preservation of the cells. We have also set some shipping standards and agreed upon them with our local agents to transport the processed samples in the most efficient and safe way.
Please call us at least 24 hours before you are ready to send a sample.
7- DNA extraction
For your consultations outside Lebanon or for your research, we are ready to extract and quantitate the DNA for you. The extracted DNA will be preserved at -800C till it is needed for use or shipping.
Please call us at least 24 hours before you are ready to send a sample.
8- RNA extraction
For your consultations outside Lebanon or for your research, we are ready to extract and quantitate the RNA for you. The extracted RNA will be preserved at -800C till it is needed for use or shipping.
Please call us at least 24 hours before you are ready to send a sample. This is very important especially if your aim is to perform a Gene Expression Profiling study using Microarray technology.
9- NEW:
Leukemia testing
t(8;21)
t(9;22)
inv16
t(9;11)
t(12;21)
t(1;19)
t(4;11)
t(15;17)
Links
Links
1. American Society for Clinical Pathology
2. The Urbana Atlas of Pathology. University of Illinois College of Medicine:
3. American Journal of Pathology
4. Journals of the American Society for Investigative Pathology
5. United States and Canadian Academy of Pathology
6. Armed Forces Institute of Pathology (AFIP)
7. Molecular Pathology
8. American Society for Clinical Pathology
9. American Society of Clinical Pathologists
10. American Association of Neuropathologists
11. Association for Molecular Pathology
12. American Association of Pathologists' Assistants
13. British Neuropathological Society
14. American Society of Cytopathology
15. American Society of Crime Laboratory Directors
16. American Association for Clinical Chemistry (AACC)
17. American Society for Investigative Pathology
18. American Board of Forensic Anthropology
19. American Board of Forensic Odontology
20. American Board of Forensic Toxicology
21. American Board of Medicolegal Death Investigators
22. American Board of Pathology
23. American Society of Forensic Odontology
24. Association for Laboratory Automation
25. Association for Pathology Informatics
26. Association of Clinical Pathologists, UK
27. Association of Directors of Anatomic & Surgical Pathology
28. Association of Pathology Chairs
29. British Association for Forensic Odontology
30. Canadian Association of Neuropathologists
31. Canadian Association of Pathologists
32. Clinical Laboratory Management Association
33. College of American Pathologists
34. European Board of Pathology
35. European Society of Pathology
36. Forensic Science Society, UK
37. International Association for Identification
38. International Association of Forensic Mental Health Services
39. International Association of Forensic Toxicologists
40. Intersociety Committee on Pathology Information
41. IAP
42. United States and Canadian Academy of Pathology (USCAP) WWW ...
43. InternationalAcademy of Pathology German Division
44. InternationalAcademy of Pathology
45. IAP British Division Homepage
46. InternationalAcademy of Pathology
47. AIPdivFra
48. British IAP - Overseas Activities
49. History of the Lebanese Society of Anatomic Pathology
50. Pathology Organizations
51. School of Anatomy - Freeman Lab
52. Other Academic Sites of Interest, Department of Laboratory ...
53. Pathology Societies and Associations
54. Pathology and Laboratory Medicine, U Calgary, Links Page
55. The Internet Pathology Laboratory
56. The Internet Pathology Laboratory
57. Mid-Atlantic Association of Forensic Scientists
58. National Association of Medical Examiners
59. National Pathology Accreditation Advisory Council, Australia
60. National Prion Disease Pathology Surveillance Center
61. Northeastern Association of Forensic Scientists
62. Pathological Society of Great Britain & Ireland
63. Royal College of Pathologists of Australasia
64. Royal College of Pathologists, UK
65. Royal College of Pathology of Australasia
66. Society for Cardiovascular Pathology
67. Society for Hematopathology
68. Society for Pediatric Pathology
69. Society for Ultrastructural Pathology
70. Society of Forensic Toxicologists
71. Southern Association of Forensic Scientists
72. Southwestern Association of Forensic Scientists
73. State Pathology Associations
74. United States and Canadian Academy of Pathology
1. American Society for Clinical Pathology
2. The Urbana Atlas of Pathology. University of Illinois College of Medicine:
3. American Journal of Pathology
4. Journals of the American Society for Investigative Pathology
5. United States and Canadian Academy of Pathology
6. Armed Forces Institute of Pathology (AFIP)
7. Molecular Pathology
8. American Society for Clinical Pathology
9. American Society of Clinical Pathologists
10. American Association of Neuropathologists
11. Association for Molecular Pathology
12. American Association of Pathologists' Assistants
13. British Neuropathological Society
14. American Society of Cytopathology
15. American Society of Crime Laboratory Directors
16. American Association for Clinical Chemistry (AACC)
17. American Society for Investigative Pathology
18. American Board of Forensic Anthropology
19. American Board of Forensic Odontology
20. American Board of Forensic Toxicology
21. American Board of Medicolegal Death Investigators
22. American Board of Pathology
23. American Society of Forensic Odontology
24. Association for Laboratory Automation
25. Association for Pathology Informatics
26. Association of Clinical Pathologists, UK
27. Association of Directors of Anatomic & Surgical Pathology
28. Association of Pathology Chairs
29. British Association for Forensic Odontology
30. Canadian Association of Neuropathologists
31. Canadian Association of Pathologists
32. Clinical Laboratory Management Association
33. College of American Pathologists
34. European Board of Pathology
35. European Society of Pathology
36. Forensic Science Society, UK
37. International Association for Identification
38. International Association of Forensic Mental Health Services
39. International Association of Forensic Toxicologists
40. Intersociety Committee on Pathology Information
41. IAP
42. United States and Canadian Academy of Pathology (USCAP) WWW ...
43. InternationalAcademy of Pathology German Division
44. InternationalAcademy of Pathology
45. IAP British Division Homepage
46. InternationalAcademy of Pathology
47. AIPdivFra
48. British IAP - Overseas Activities
49. History of the Lebanese Society of Anatomic Pathology
50. Pathology Organizations
51. School of Anatomy - Freeman Lab
52. Other Academic Sites of Interest, Department of Laboratory ...
53. Pathology Societies and Associations
54. Pathology and Laboratory Medicine, U Calgary, Links Page
55. The Internet Pathology Laboratory
56. The Internet Pathology Laboratory
57. Mid-Atlantic Association of Forensic Scientists
58. National Association of Medical Examiners
59. National Pathology Accreditation Advisory Council, Australia
60. National Prion Disease Pathology Surveillance Center
61. Northeastern Association of Forensic Scientists
62. Pathological Society of Great Britain & Ireland
63. Royal College of Pathologists of Australasia
64. Royal College of Pathologists, UK
65. Royal College of Pathology of Australasia
66. Society for Cardiovascular Pathology
67. Society for Hematopathology
68. Society for Pediatric Pathology
69. Society for Ultrastructural Pathology
70. Society of Forensic Toxicologists
71. Southern Association of Forensic Scientists
72. Southwestern Association of Forensic Scientists
73. State Pathology Associations
74. United States and Canadian Academy of Pathology
History
In order to understand the history of the department of Pathology and Laboratory Medicine, it would be helpful to briefly review the history of the School of Medicine and its teaching hospital.
The School of Medicine, originally known as the "Medical Department", was established in 1867, one year after the founding of the Syrian Protestant College (SPC). From the outset, the Founding Fathers and the Trustees were keenly aware of the necessity for the College to have its own campus and teaching hospital. As neither was available, the College started out in rented premises in the Zokak el-Blat district of Beirut. A small building adjoining the school was set-up as a clinic and hospital of about eight beds. This was clearly recognized as a makeshift arrangement until more satisfactory hospital facilities became available. It is unlikely that a laboratory existed in such a set-up. This clinic and hospital were abandoned in 1871 when an �affiliation� agreement was made between the College and the Prussian Hospital that had been built by the Knights of the Order of St. John whereby the clinical teaching would be conducted at that hospital.
The Prussian Hospital was fairly well equipped, could house more than sixty patients, and probably had a laboratory. Besides, it was only five minutes walk from the new campus to which the College would move in 1873. The agreement was terminated on January 2,1918, by order of the Ottoman Sultan because the USA entered the war against Germany and its ally Turkey. With the advent of the French mandate in Lebanon the French authorities seized the hospital as war bounty, turned it into their own military hospital, and renamed it �Hopital Militaire Maurice Rottier�. It remained as such until the end of 1946 when French troops were withdrawn from Lebanon. However, the property remained French. It has since been used to house the French embassy and, more recently, the "Ecole Sup�rieure d'Administration (E.S.A.)".
From the outset the College wanted to have its own hospital. In the summer of 1902, it purchased the Adham (Azm) property which lay south and east of the medical gate This, added to a small plot already owned, provided a sizable area for future hospital buildings. The new property included a very large house (palace) which was remodeled and �served as administration building, superintendent�s and head nurse�s home, the pupil nurse�s home, the kitchen, and wards for gynecology and obstetrics, children�s diseases, and two beds allocated to dermatology. In addition to the palace there were three small buildings that would be put to good use by the future hospital.
Beginning in 1904, an active building program began; funds were raised and construction began after the necessary permits were obtained. The first facility designed and built as a hospital owned by SPC was the Women's Pavilion (1908), followed by the Eye Pavilion (1909) the Children's Pavilion (1910)., and the Hospital Gate. One of the small buildings was used for the polyclinics consisting of nine rooms: three examining, three demonstration, and three waiting rooms. The mortuary was set up in one of the other buildings. Later on, other buildings were built thanks to various grants: Dale Home, to house the School of Nursing and dormitories was built in 1924, the Pathology building in 1925, the former Out-Patient (OPD) building, in 1932, and the "New Wing" commonly known as "Building 56" in 1954. The first floor of this last building was named after Bayard Dodge Jr. the eldest son of president Bayard Dodge who was killed during World War II. By this time the hospital capacity had risen to two hundred twenty beds distributed in different pavilions (Internal Medicine, Surgery, Obstetrics and Gynecology, and Pediatrics). Of the old buildings only three remain in use at the time of writing: Building 56, Dale Home (the old Nursing School building) and the old OPD building. The present Medical Center was inaugurated in June 1970.
The Adham (Azm) house was destroyed by fire on December 30, 1939. At the time of its destruction it housed hospital administration, medical records, and living quarters of the interns. Fortunately no one was injured and only part of the patients records were totally destroyed.
The Beginning - A Polyvalent Faculty
As stated earlier, at the very beginning the College had only two "departments": the Literary and the Medical. The Medical department later became the School of Medicine and, more recently, the Faculty of Medicine and Medical Center. There were no academic departments as known today but the pathology museum is mentioned in the catalogues beginning with the year 1880.
Originally, three professors taught all the medical courses
Cornelius Van Alen Van Dyck M.D. professor of Internal Medicine and General Pathology and provisionally Ophthalmology (1867-1882)
John Wortabet M.D. professor of Anatomy and Physiology (1867-1882) and lecturer in Pathology and Practice of Medicine (1882-1885)
George Edward Post M.D. professor of Surgery, Materia Medica and Botany.
Dr. Van Dyck the first professor of pathology, resigned from the College in December 1882. To help the College ensure the continuity of pathology teaching, the Board of Missions were willing to release Dr. Calhoun from his Mission work in Tripoli to go to Beirut to temporarily replace Dr. Van Dyck. However, that was not necessary because Dr. Wortabet accepted to take on the additional load of pathology teaching. Thus it was no longer necessary for Dr. Calhoun to leave his work in Tripoli. A few months later a new professor of Pathology and Practice of Medicine was appointed. He was Dr. Charles Dight who occupied the chair for six years, 1883 to 1889. Dr. Harris Graham followed Dr. Dight in 1889. He was appointed as Professor of Pathology, Bacteriology and Practice of Medicine. He remained at that post until his death in Beirut on February 27, 1922. He also had the title of Pathologist to the Johaniter Hospital.
During the period between 1900 and 1920 eight teachers were appointed at different academic levels and for varying lengths. They are listed below. Some of these new staff were SPC graduates.
Harry G. Dorman MD, Professor of Histology, General Pathology and Pediatrics, from (1903 to 1910).
Nimeh Nucho MD (SPC), Assistant in Histology and General Pathology, (1904 - 1912).
Nechan Hampartsumian, MD (SPC), Clinical Assistant to the professor of pathology, (1904 -1905).
Nikula Constantine Rubeiz, MD (SPC), Clinical Assistant in Pathology, (1907).
Nejib Ardati, MD (SPC), Clinical Assistant to the professor of pathology; (1907 - 1908), Hospital Pathologist, and Instructor in Bacteriology, (1908- 1913).
Suleiman Salibi, MD (SPC), Bacteriologist in College Hospitals, (1913 1914).
Hovsep Yenikomshian, MD (SPC), Hospital Pathologist; and Instructor in Materia Medica, (1918 - 1921); Adjunct Professor Elect of Internal Medicine and Hospital Pathologist, (1922 - 1923).
Harry G. Thomas, MD, Adjunct Professor Allenby Foundation in charge of courses in General Pathology, Physical Diagnosis and Hygiene, (1920 - 1922).
Laboratory work was done manually. There existed in each pavilion a room where simple qualitative and semi quantitative tests were performed by the students, and, in one of the small buildings near the pavilions, a main laboratory for microscopy and the more advanced tests. This lab catered to both inpatients and outpatients.
Departments of study were listed for the first time in the College catalogue for the year 1920 - 1921. This would place the creation of departments in 1920. One of these was the department of "Bacteriology, Pathology, Hygiene and Parasitology". The Pathology building was built in 1925 to accommodate the department. Ample space became available for classroom work, for teaching, service, and research laboratories, a reception area for ambulatory patients, as well as a hundred-seat amphitheater, a museum, mortuary, and the necessary support services. Thus the organization changed from one department for the whole school as seen since 1867, to many departments in one school beginning in 1920. Pathology and the disciplines that are now called "Laboratory Medicine" were combined in one department under one chairman.
In 1929, the department was split into two departments: Pathology on one side, and Bacteriology, Hygiene and Parasitology on the other. In 1936, Hygiene was taken out and the department became department of Bacteriology and Parasitology. This department was responsible for supervising the clinical laboratories for both in-patient and out patient work until 1949 when a separate Department of Laboratory Studies was created with Dr. Krikor S. Krikorian as its first chairman. Dr. Krikorian remained in office until his death in 1957. Dr. Raif Nassif succeeded him until 1967 at which time Dr. Samih Alami became chairman. The name of the department was changed to Clinical Pathology in line with the appellation of the American Board of Pathology in 1955 then to "Laboratory Medicine" in 1978. Finally, in 1996, the two departments Pathology and Laboratory Medicine were combined and became the Department of Pathology and Laboratory Medicine with Dr. Ghazi Zaatari as chairman.
The new Pathology Building enabled the department to greatly improve its work both academic (teaching and research) and service (patients and the community at large). At first all the service laboratories were located in the new building for easy supervision by the department of Bacteriology-Parasitology or Pathology as the case may be (bacteriology, parasitology/clinical microscopy, and serology under the supervision of the department of Bacteriology-Parasitology, and hematology under the supervision of the department of Pathology). Only the clinical chemistry lab was located in Van Dyck Hall under the supervision of the chairman of the department of biochemistry. It was only in 1949 that supervision of all sections became the responsibility of the newly established department of Laboratory Studies later known as the department of Laboratory Medicine. The clinical chemistry lab moved to the Pathology Building with the appointment in the department of Clinical Pathology of a Hospital Biochemist.
From its very beginning the Department always aimed at excellence and spared no effort towards that end. Essential new equipment was obtained as soon as possible and, at times some was home-built pending availability of the funds needed for its purchase. There were serious shortages in many items during the Second World War. The department met the challenge head on: adequate quantities of spare parts were stocked and came to the rescue quickly when needed. Vaccines that were in short supply were prepared locally and the practice was continued until the early 1970s. AUB's TAB and small pox vaccines were well known and sought throughout the country.
Finally, only a few of the "first in Lebanon" and perhaps in the Near East in the recent past are listed as illustration:
Blood bank,
Quality control and quality assurance program,
Flame photometer,
Automatic tissue processor,
Endocrinology laboratory,
Continuous flow analyzer,
Fully automated random access analyzer,
Amino acid analyzer,
Gas chromatography for amino acid analysis,
Determination of intermediary enzymes of metabolism for inborn errors of metabolism,
Immunohistochemistry,
Tissue culture for cytogenetics,
Prenatal karyotyping.
APPENDIX
PATHOLOGY- LABORATORY MEDICINE FACULTY
(In chronological order by year of first appointment)
I - The original faculty
Cornelius Van Alen Van Dyck, MD: 1867 - 1882, Professor of Internal Medicine and General Pathology and, provisionally, Ophthalmology.
John Wortabet, MD: 1867 - 1882, Professor of Anatomy and Physiology; 1882 - 1885, Lecturer in Pathology and Practice of Medicine.
George Edward Post, MD: 1868 - 1909, Professor of Surgery, Materia Medica, and Botany.
II - Faculty prior to 1920
Charles Dight, MD: (1883 - 1889) Professor of Pathology and Practice of Medicine
Harris Graham, MD: (1889 - 1922) Professor of Pathology, Bacteriology and Practice of Medicine, (died Feb. 27, 1922).
Harry Dorman, MD: (1903 - 1910) Professor of Histology, General Pathology, and Pediatrics.
Nimeh Nucho, MD: (1904 - 1912) Assistant in Histology and General Pathology.
Nechan Hampartsumian, MD: (1904 -1905) Clinical Assistant to the professor of Pathology.
Nikula Constantine Rubeiz, MD: (1907) Clinical Assistant in Pathology.
Nejib Ardati, MD: (1907 - 1908) Clinical Assistant to the professor of Pathology; (1908 - 1913) Hospital Pathologist, and Instructor in Bacteriology (1925) Professor of Public Health and Hygiene and instructor in Clinical Microscopy.
Suleiman Salibi, MD: (1913 - 1914) Bacteriologist in College Hospitals.
Hovsep Yenikomshian, MD: (1918 - 1921) Hospital Pathologist; Hospital Pathologist and Instructor in Materia Medica; (1922 - 1923) Adjunct Professor Elect of Internal Medicine and Hospital Pathologist.
Harry G. Thomas, MD: (1920 - 1922) Adjunct Professor Allenby Foundation in charge of courses in General Pathology, Physical Diagnosis and Hygiene.
III - Faculty since 1920 - Departments Created
William T. Van Dyck, MD: (1922 - 1923) Professor of Zoology, Physiology and Parasitology.
Yervant Djanian, MD: (1922 -1924) Instructor in Parasitology.
William D. Cruikshank, MD: (1922 - 1925) Professor of Pathology.
Leland W. Parr, MD: (1923 - 1930) Associate Professor of Bacteriology and Hygiene.
Raif Shadid Bellama', PhD: (1923 - 1924) Lecturer in Tropical Medicine, Pathologist for Outpatient Department; (1924 - 1926) Adjunct Professor of Parasitology, Lecturer in Tropical Diseases, Instructor in Clinical Microscopy; (1926 - 1927) Director of Hospital Laboratory; (1933 - 1938) Adjunct Professor of Clinical Pathology.
Philip Sahyoun, MD: (1923 - 1927) Adjunct Professor of Pathology and Assistant Director of Hospital Laboratory; (1933 - 1969) Professor of Pathology, (1945 - 1969) Chairman.
Miss Marjorie Webster: (1923 - 1925) Hospital Bacteriologist.
III - 1 - Department of Bacteriology, Pathology, Hygiene and Parasito-logy, 1920.
William Topous Khan, MD: (1924 - 1925) Lecturer in Pathology and Morbid Anatomy.
Pierre Lepine, MD: (1925 - 1926) Adjunct Professor of Pathology.
Ellen E. Porter, M.S.: (1925 - 1927) Instructor in the Clinical Laboratory of the Hospital.
Raymond Goodale, MD: (1926 - 1927) Adjunct Professor of Pathology and Laboratory Director.
Margaret Avery: (1926 - 1927) Instructor in Clinical Laboratory of the University Hospital.
Horton C. Hinshaw, PhD (1928 - 1932) Associate Professor of Parasitology.
Harald Krischner, MD: (1928 - 1931) Adjunct Professor of Pathology and Laboratory Director.
III -2 - Creation of Department of Bacteriology, Hygiene and Parasitology and Department of Pathology 1929
Dikran Berberian, MD: (1930 - 1933) Assistant in Bacteriology and Parasitology; (1933 - 1947) Associate Professor of Bacteriology-Parasitology.
E. Westervelt Dennis, PhD: (1931 - 1941) Associate Professor of Bacteriology-Parasitology and chairman.
Hans Karl Gustav Homma, MD: (1933 - 1937) Professor of Pathology, Chairman.
Harutune Senekjian, MD: (1934 - 1937) Instructor in Bacteriology.
Edmund Mayer, MD: (1937 - 1941) Professor of Pathology, Chairman.
Edith Sproul, MD: (1946 - 1948) Professor of Pathology; (1954 - 1956) Visiting Professor of Pathology.
III - 3 - Hospital Laboratory set up as separate department of Laboratory Studies 1949
Krikor S. Krikorian, MD: (1949 - 1957) Director of Hospital Laboratories.
Frederic Roulet, MD: (1950 - 1951) Visiting Professor of Pathology.
Edmond Shwayri, MD: (1950 - 1952) Assistant Professor of Pathology.
Raif E. Nassif, MD: (1952 - 1994) Professor of Clinical Pathology (Laboratory Medicine); (1957 - 1967) Director of Hospital Laboratories and Chairman of the Department of Clinical Pathology.
III - 3 - Change of name of department of Laboratory Studies to Department of Clinical Pathology 1955. Pathology Department separate.
Nimr Tuqan, MD: (1952 - 1963) Associate Professor of Pathology.
Robert Matossian, MD: (1954 - 1956) acting director of the Blood Bank.
Henry Azar, MD: (1958 - 1960) Assistant Professor of Pathology; (July 1965 - December 1966, and May 8 - 19, 1978) Visiting Professor from University of South Florida College of Medicine.
Harry Sproat, MD: (1959 - 1962) Visiting Associate Professor of Pathology.
George Abu-Haidar, MS: (1959 - 1975) Hospital Biochemist, Lecturer in Clinical Pathology.
Samih Alami, PhD, MD: (1961 - 1963) Assistant Professor of Clinical Patho-logy, part time; (1968 - 1997) Professor of Laboratory Medicine; (1976 - 1996) Chairman and Director of Hospital Laboratories.
Latifeh Ghandour, MD: (1961 - 1976) Associate Professor of Pathology.
Alejandro Chediak, MD: (1962 - 1963) Lecturer in Clinical Pathology and Deputy Director of Hospital Laboratories.
Farid Khouri, MD: (1963 - 1995) Professor of Laboratory Medicine
Harry Smith, PhD: (1964 - 1965) Visiting Research Associate, Department of Clinical Pathology.
Leila Rafie, MD: (1964 - 1968) Instructor in Clinical Pathology.
William Shelley, MD: (Feb. 11 - May 11, 1965) Visiting Professor of Pathology from Johns Hopkins University..
Fred Stewart, MD: (Feb. 11 - May 11, 1965) Visiting Professor of Pathology from New York University Memorial Hospital.
Said Zu'bi, MD: (1966 - 1967) Instructor in Pathology.
Amin T. Nasr, MD: (1968 - 1970) Instructor in Pathology.
Jean Rebeiz, MD: (1968 ��) Professor of Internal Medicine (Neurology) and Pathology (Neuropathology); (1986 - 1995) Chairman.
Charles Allam, MD: (1968 -1975) Assistant Professor; (1976 - 1978) Associate Professor of Pathology and Clinical Pathology.
Wedad Riad, MD: (1969 - 1975) Visiting Assistant Professor of Pathology,
Janine Tomb, MD: (1969 - 1978) Assistant Professor of Pathology (Cytopath-
ology).
Harald Noltenius, MD: (1970 - 1973) Professor of Pathology, Chairman.
Ramez Azoury, MD: (1970 - 1978) Associate Professor of Obstetrics and Gynecology and Pathology (Gynecological Pathology).
Victor H. Nassar, MD: (1971 - 1975) Associate Professor of Pathology.
Nabil Wakid, PhD: (1972 - 1989) Clinical Chemist, Associate Professor of Laboratory Medicine.
Fawzi Abu Jamra, MD: (1967 - 1968) Instructor in Pathology (part time).
Zuheir Naib, MD: (June 15 - August 28, 1974) Visiting Professor of Pathology (Cytopathology) (Emory University, Atlanta GA).
Michael Gravanis, MD: (October 15 - December 15, 1974) Visiting Professor of Pathology from Emory University, Atlanta GA.
William Christopherson, MD: (February 1 - April 30, 1975) Visiting Professor of Pathology from University of Louisville, KY.
Abdur Rahman Sa'di, MD: (1975 - 1976) Visiting Assistant Professor of Pathology for 3 months.
Tanios Koussa, MLT: (1976 -1977) Instructor in Laboratory Medicine.
Zuheir Habbal, Ph.D. (1976 ��) Hospital Biochemist, Professor of Laboratory Medicine.
Joel Brunson, MD: (Sep.1, - March 31, 1977) Visiting Professor of Pathology from Jackson University.
Walter Sheldon, MD: (March 1 - June 30, 1977) Visiting Professor of Pathology from Johns Hopkins University.
III - 4 - Change name of Clinical Pathology to Laboratory Medicine, 1978.
Pathology Department separate.
Jean-Pierre de Chadarevian, MD: (1979 - 1980) Associate Professor of Pathology.
George Banayan, MD. (September 16 - October 31, 1979, and February 1 - May 31, 1980) Visiting Professor of Pathology from University of Texas at San Antonio.
Amira Mansour, MD: (1979 - 1991) Associate Professor of Pathology.
Patrice Hassoun, MD: (1981 - 1984) Assistant Professor of Pathology.
Ziad Salem, MD: (1981 - 1993) Assistant Professor of Laboratory Medicine (half time).
Ghazi Zaatari, MD: (1981 - 1984) (1995 ��) Professor of Pathology and Laboratory Medicine.
Amjad Mufarrij, MD: (1982 - 1986) Professor of Pathology.
Fadi Abdel Karim, MD: (1984 - 1987) Assistant Professor of Pathology.
Siham Fuleifil, MD: (1985 - 1988) Assistant Professor of Pathology.
Nina Salem Shabb, MD: (1991 ��) Associate Professor of Pathology.
Ayman Tawil,MD: (1991 ��) Associate Professor of Pathology.
George Araj, PhD: (1992 ��) Professor of Laboratory Medicine.
Hanna Kaspar, MD: (1993 ��) Associate Professor of Gynecological Pathology.
Leila Zahed, Ph.D. (1994 ��) Associate Professor of Laboratory Medicine.
Rose Daher, Ph.D. (1996 ��) Associate Professor of Laboratory Medicine
Joud Haidar, MD: (1996 ��) Assistant Professor of Laboratory Medicine.
III - 6 - Pathology and Laboratory Medicine combined into one department of Pathology and Laboratory Medicine 1996, composed as follows:
Samih Alami, Ph.D., M.D.
George Araj, Ph.D.
Rose Daher, Ph.D.
Zuheir Habbal, Ph.D.
Joud Haidar, M.D.
Hanna, Kaspar, M.D.
Amjad Mufarrij, M.D.
Raif Nassif, M.D. M.P.H. (emeritus)
Jean Rebeiz, M.D.
Ghazi Zaatari, M.D. (chairman).
Bibliography
American University of Beirut: Catalogues for the years 1880 - 1881 to 1939 - 1940, 1941- 1942, 1945 - 1946, 1951 - 1971, 1972 - 1973, 1974 to 1976,1978 to 1996.
Annual Reports of the Faculties of Medical Sciences, American University of Beirut, 1954 -1955 to 1977 - 1978.
Annual Reports of the Board of Managers of the Syrian Protestant College 1867 - 1902.
Mufarrij, Amjad A.: Pathology in Lebanon - The Role of the American University of Beirut, 1866 - 1985. Lebanese Medical Journal vol.36: 1, 1986.
Penrose, Stephen B.L.: That They May Have Life, 1941.Trustees of the American University of Beirut, publishers.
The School of Medicine, originally known as the "Medical Department", was established in 1867, one year after the founding of the Syrian Protestant College (SPC). From the outset, the Founding Fathers and the Trustees were keenly aware of the necessity for the College to have its own campus and teaching hospital. As neither was available, the College started out in rented premises in the Zokak el-Blat district of Beirut. A small building adjoining the school was set-up as a clinic and hospital of about eight beds. This was clearly recognized as a makeshift arrangement until more satisfactory hospital facilities became available. It is unlikely that a laboratory existed in such a set-up. This clinic and hospital were abandoned in 1871 when an �affiliation� agreement was made between the College and the Prussian Hospital that had been built by the Knights of the Order of St. John whereby the clinical teaching would be conducted at that hospital.
The Prussian Hospital was fairly well equipped, could house more than sixty patients, and probably had a laboratory. Besides, it was only five minutes walk from the new campus to which the College would move in 1873. The agreement was terminated on January 2,1918, by order of the Ottoman Sultan because the USA entered the war against Germany and its ally Turkey. With the advent of the French mandate in Lebanon the French authorities seized the hospital as war bounty, turned it into their own military hospital, and renamed it �Hopital Militaire Maurice Rottier�. It remained as such until the end of 1946 when French troops were withdrawn from Lebanon. However, the property remained French. It has since been used to house the French embassy and, more recently, the "Ecole Sup�rieure d'Administration (E.S.A.)".
From the outset the College wanted to have its own hospital. In the summer of 1902, it purchased the Adham (Azm) property which lay south and east of the medical gate This, added to a small plot already owned, provided a sizable area for future hospital buildings. The new property included a very large house (palace) which was remodeled and �served as administration building, superintendent�s and head nurse�s home, the pupil nurse�s home, the kitchen, and wards for gynecology and obstetrics, children�s diseases, and two beds allocated to dermatology. In addition to the palace there were three small buildings that would be put to good use by the future hospital.
Beginning in 1904, an active building program began; funds were raised and construction began after the necessary permits were obtained. The first facility designed and built as a hospital owned by SPC was the Women's Pavilion (1908), followed by the Eye Pavilion (1909) the Children's Pavilion (1910)., and the Hospital Gate. One of the small buildings was used for the polyclinics consisting of nine rooms: three examining, three demonstration, and three waiting rooms. The mortuary was set up in one of the other buildings. Later on, other buildings were built thanks to various grants: Dale Home, to house the School of Nursing and dormitories was built in 1924, the Pathology building in 1925, the former Out-Patient (OPD) building, in 1932, and the "New Wing" commonly known as "Building 56" in 1954. The first floor of this last building was named after Bayard Dodge Jr. the eldest son of president Bayard Dodge who was killed during World War II. By this time the hospital capacity had risen to two hundred twenty beds distributed in different pavilions (Internal Medicine, Surgery, Obstetrics and Gynecology, and Pediatrics). Of the old buildings only three remain in use at the time of writing: Building 56, Dale Home (the old Nursing School building) and the old OPD building. The present Medical Center was inaugurated in June 1970.
The Adham (Azm) house was destroyed by fire on December 30, 1939. At the time of its destruction it housed hospital administration, medical records, and living quarters of the interns. Fortunately no one was injured and only part of the patients records were totally destroyed.
The Beginning - A Polyvalent Faculty
As stated earlier, at the very beginning the College had only two "departments": the Literary and the Medical. The Medical department later became the School of Medicine and, more recently, the Faculty of Medicine and Medical Center. There were no academic departments as known today but the pathology museum is mentioned in the catalogues beginning with the year 1880.
Originally, three professors taught all the medical courses
Cornelius Van Alen Van Dyck M.D. professor of Internal Medicine and General Pathology and provisionally Ophthalmology (1867-1882)
John Wortabet M.D. professor of Anatomy and Physiology (1867-1882) and lecturer in Pathology and Practice of Medicine (1882-1885)
George Edward Post M.D. professor of Surgery, Materia Medica and Botany.
Dr. Van Dyck the first professor of pathology, resigned from the College in December 1882. To help the College ensure the continuity of pathology teaching, the Board of Missions were willing to release Dr. Calhoun from his Mission work in Tripoli to go to Beirut to temporarily replace Dr. Van Dyck. However, that was not necessary because Dr. Wortabet accepted to take on the additional load of pathology teaching. Thus it was no longer necessary for Dr. Calhoun to leave his work in Tripoli. A few months later a new professor of Pathology and Practice of Medicine was appointed. He was Dr. Charles Dight who occupied the chair for six years, 1883 to 1889. Dr. Harris Graham followed Dr. Dight in 1889. He was appointed as Professor of Pathology, Bacteriology and Practice of Medicine. He remained at that post until his death in Beirut on February 27, 1922. He also had the title of Pathologist to the Johaniter Hospital.
During the period between 1900 and 1920 eight teachers were appointed at different academic levels and for varying lengths. They are listed below. Some of these new staff were SPC graduates.
Harry G. Dorman MD, Professor of Histology, General Pathology and Pediatrics, from (1903 to 1910).
Nimeh Nucho MD (SPC), Assistant in Histology and General Pathology, (1904 - 1912).
Nechan Hampartsumian, MD (SPC), Clinical Assistant to the professor of pathology, (1904 -1905).
Nikula Constantine Rubeiz, MD (SPC), Clinical Assistant in Pathology, (1907).
Nejib Ardati, MD (SPC), Clinical Assistant to the professor of pathology; (1907 - 1908), Hospital Pathologist, and Instructor in Bacteriology, (1908- 1913).
Suleiman Salibi, MD (SPC), Bacteriologist in College Hospitals, (1913 1914).
Hovsep Yenikomshian, MD (SPC), Hospital Pathologist; and Instructor in Materia Medica, (1918 - 1921); Adjunct Professor Elect of Internal Medicine and Hospital Pathologist, (1922 - 1923).
Harry G. Thomas, MD, Adjunct Professor Allenby Foundation in charge of courses in General Pathology, Physical Diagnosis and Hygiene, (1920 - 1922).
Laboratory work was done manually. There existed in each pavilion a room where simple qualitative and semi quantitative tests were performed by the students, and, in one of the small buildings near the pavilions, a main laboratory for microscopy and the more advanced tests. This lab catered to both inpatients and outpatients.
Departments of study were listed for the first time in the College catalogue for the year 1920 - 1921. This would place the creation of departments in 1920. One of these was the department of "Bacteriology, Pathology, Hygiene and Parasitology". The Pathology building was built in 1925 to accommodate the department. Ample space became available for classroom work, for teaching, service, and research laboratories, a reception area for ambulatory patients, as well as a hundred-seat amphitheater, a museum, mortuary, and the necessary support services. Thus the organization changed from one department for the whole school as seen since 1867, to many departments in one school beginning in 1920. Pathology and the disciplines that are now called "Laboratory Medicine" were combined in one department under one chairman.
In 1929, the department was split into two departments: Pathology on one side, and Bacteriology, Hygiene and Parasitology on the other. In 1936, Hygiene was taken out and the department became department of Bacteriology and Parasitology. This department was responsible for supervising the clinical laboratories for both in-patient and out patient work until 1949 when a separate Department of Laboratory Studies was created with Dr. Krikor S. Krikorian as its first chairman. Dr. Krikorian remained in office until his death in 1957. Dr. Raif Nassif succeeded him until 1967 at which time Dr. Samih Alami became chairman. The name of the department was changed to Clinical Pathology in line with the appellation of the American Board of Pathology in 1955 then to "Laboratory Medicine" in 1978. Finally, in 1996, the two departments Pathology and Laboratory Medicine were combined and became the Department of Pathology and Laboratory Medicine with Dr. Ghazi Zaatari as chairman.
The new Pathology Building enabled the department to greatly improve its work both academic (teaching and research) and service (patients and the community at large). At first all the service laboratories were located in the new building for easy supervision by the department of Bacteriology-Parasitology or Pathology as the case may be (bacteriology, parasitology/clinical microscopy, and serology under the supervision of the department of Bacteriology-Parasitology, and hematology under the supervision of the department of Pathology). Only the clinical chemistry lab was located in Van Dyck Hall under the supervision of the chairman of the department of biochemistry. It was only in 1949 that supervision of all sections became the responsibility of the newly established department of Laboratory Studies later known as the department of Laboratory Medicine. The clinical chemistry lab moved to the Pathology Building with the appointment in the department of Clinical Pathology of a Hospital Biochemist.
From its very beginning the Department always aimed at excellence and spared no effort towards that end. Essential new equipment was obtained as soon as possible and, at times some was home-built pending availability of the funds needed for its purchase. There were serious shortages in many items during the Second World War. The department met the challenge head on: adequate quantities of spare parts were stocked and came to the rescue quickly when needed. Vaccines that were in short supply were prepared locally and the practice was continued until the early 1970s. AUB's TAB and small pox vaccines were well known and sought throughout the country.
Finally, only a few of the "first in Lebanon" and perhaps in the Near East in the recent past are listed as illustration:
Blood bank,
Quality control and quality assurance program,
Flame photometer,
Automatic tissue processor,
Endocrinology laboratory,
Continuous flow analyzer,
Fully automated random access analyzer,
Amino acid analyzer,
Gas chromatography for amino acid analysis,
Determination of intermediary enzymes of metabolism for inborn errors of metabolism,
Immunohistochemistry,
Tissue culture for cytogenetics,
Prenatal karyotyping.
APPENDIX
PATHOLOGY- LABORATORY MEDICINE FACULTY
(In chronological order by year of first appointment)
I - The original faculty
Cornelius Van Alen Van Dyck, MD: 1867 - 1882, Professor of Internal Medicine and General Pathology and, provisionally, Ophthalmology.
John Wortabet, MD: 1867 - 1882, Professor of Anatomy and Physiology; 1882 - 1885, Lecturer in Pathology and Practice of Medicine.
George Edward Post, MD: 1868 - 1909, Professor of Surgery, Materia Medica, and Botany.
II - Faculty prior to 1920
Charles Dight, MD: (1883 - 1889) Professor of Pathology and Practice of Medicine
Harris Graham, MD: (1889 - 1922) Professor of Pathology, Bacteriology and Practice of Medicine, (died Feb. 27, 1922).
Harry Dorman, MD: (1903 - 1910) Professor of Histology, General Pathology, and Pediatrics.
Nimeh Nucho, MD: (1904 - 1912) Assistant in Histology and General Pathology.
Nechan Hampartsumian, MD: (1904 -1905) Clinical Assistant to the professor of Pathology.
Nikula Constantine Rubeiz, MD: (1907) Clinical Assistant in Pathology.
Nejib Ardati, MD: (1907 - 1908) Clinical Assistant to the professor of Pathology; (1908 - 1913) Hospital Pathologist, and Instructor in Bacteriology (1925) Professor of Public Health and Hygiene and instructor in Clinical Microscopy.
Suleiman Salibi, MD: (1913 - 1914) Bacteriologist in College Hospitals.
Hovsep Yenikomshian, MD: (1918 - 1921) Hospital Pathologist; Hospital Pathologist and Instructor in Materia Medica; (1922 - 1923) Adjunct Professor Elect of Internal Medicine and Hospital Pathologist.
Harry G. Thomas, MD: (1920 - 1922) Adjunct Professor Allenby Foundation in charge of courses in General Pathology, Physical Diagnosis and Hygiene.
III - Faculty since 1920 - Departments Created
William T. Van Dyck, MD: (1922 - 1923) Professor of Zoology, Physiology and Parasitology.
Yervant Djanian, MD: (1922 -1924) Instructor in Parasitology.
William D. Cruikshank, MD: (1922 - 1925) Professor of Pathology.
Leland W. Parr, MD: (1923 - 1930) Associate Professor of Bacteriology and Hygiene.
Raif Shadid Bellama', PhD: (1923 - 1924) Lecturer in Tropical Medicine, Pathologist for Outpatient Department; (1924 - 1926) Adjunct Professor of Parasitology, Lecturer in Tropical Diseases, Instructor in Clinical Microscopy; (1926 - 1927) Director of Hospital Laboratory; (1933 - 1938) Adjunct Professor of Clinical Pathology.
Philip Sahyoun, MD: (1923 - 1927) Adjunct Professor of Pathology and Assistant Director of Hospital Laboratory; (1933 - 1969) Professor of Pathology, (1945 - 1969) Chairman.
Miss Marjorie Webster: (1923 - 1925) Hospital Bacteriologist.
III - 1 - Department of Bacteriology, Pathology, Hygiene and Parasito-logy, 1920.
William Topous Khan, MD: (1924 - 1925) Lecturer in Pathology and Morbid Anatomy.
Pierre Lepine, MD: (1925 - 1926) Adjunct Professor of Pathology.
Ellen E. Porter, M.S.: (1925 - 1927) Instructor in the Clinical Laboratory of the Hospital.
Raymond Goodale, MD: (1926 - 1927) Adjunct Professor of Pathology and Laboratory Director.
Margaret Avery: (1926 - 1927) Instructor in Clinical Laboratory of the University Hospital.
Horton C. Hinshaw, PhD (1928 - 1932) Associate Professor of Parasitology.
Harald Krischner, MD: (1928 - 1931) Adjunct Professor of Pathology and Laboratory Director.
III -2 - Creation of Department of Bacteriology, Hygiene and Parasitology and Department of Pathology 1929
Dikran Berberian, MD: (1930 - 1933) Assistant in Bacteriology and Parasitology; (1933 - 1947) Associate Professor of Bacteriology-Parasitology.
E. Westervelt Dennis, PhD: (1931 - 1941) Associate Professor of Bacteriology-Parasitology and chairman.
Hans Karl Gustav Homma, MD: (1933 - 1937) Professor of Pathology, Chairman.
Harutune Senekjian, MD: (1934 - 1937) Instructor in Bacteriology.
Edmund Mayer, MD: (1937 - 1941) Professor of Pathology, Chairman.
Edith Sproul, MD: (1946 - 1948) Professor of Pathology; (1954 - 1956) Visiting Professor of Pathology.
III - 3 - Hospital Laboratory set up as separate department of Laboratory Studies 1949
Krikor S. Krikorian, MD: (1949 - 1957) Director of Hospital Laboratories.
Frederic Roulet, MD: (1950 - 1951) Visiting Professor of Pathology.
Edmond Shwayri, MD: (1950 - 1952) Assistant Professor of Pathology.
Raif E. Nassif, MD: (1952 - 1994) Professor of Clinical Pathology (Laboratory Medicine); (1957 - 1967) Director of Hospital Laboratories and Chairman of the Department of Clinical Pathology.
III - 3 - Change of name of department of Laboratory Studies to Department of Clinical Pathology 1955. Pathology Department separate.
Nimr Tuqan, MD: (1952 - 1963) Associate Professor of Pathology.
Robert Matossian, MD: (1954 - 1956) acting director of the Blood Bank.
Henry Azar, MD: (1958 - 1960) Assistant Professor of Pathology; (July 1965 - December 1966, and May 8 - 19, 1978) Visiting Professor from University of South Florida College of Medicine.
Harry Sproat, MD: (1959 - 1962) Visiting Associate Professor of Pathology.
George Abu-Haidar, MS: (1959 - 1975) Hospital Biochemist, Lecturer in Clinical Pathology.
Samih Alami, PhD, MD: (1961 - 1963) Assistant Professor of Clinical Patho-logy, part time; (1968 - 1997) Professor of Laboratory Medicine; (1976 - 1996) Chairman and Director of Hospital Laboratories.
Latifeh Ghandour, MD: (1961 - 1976) Associate Professor of Pathology.
Alejandro Chediak, MD: (1962 - 1963) Lecturer in Clinical Pathology and Deputy Director of Hospital Laboratories.
Farid Khouri, MD: (1963 - 1995) Professor of Laboratory Medicine
Harry Smith, PhD: (1964 - 1965) Visiting Research Associate, Department of Clinical Pathology.
Leila Rafie, MD: (1964 - 1968) Instructor in Clinical Pathology.
William Shelley, MD: (Feb. 11 - May 11, 1965) Visiting Professor of Pathology from Johns Hopkins University..
Fred Stewart, MD: (Feb. 11 - May 11, 1965) Visiting Professor of Pathology from New York University Memorial Hospital.
Said Zu'bi, MD: (1966 - 1967) Instructor in Pathology.
Amin T. Nasr, MD: (1968 - 1970) Instructor in Pathology.
Jean Rebeiz, MD: (1968 ��) Professor of Internal Medicine (Neurology) and Pathology (Neuropathology); (1986 - 1995) Chairman.
Charles Allam, MD: (1968 -1975) Assistant Professor; (1976 - 1978) Associate Professor of Pathology and Clinical Pathology.
Wedad Riad, MD: (1969 - 1975) Visiting Assistant Professor of Pathology,
Janine Tomb, MD: (1969 - 1978) Assistant Professor of Pathology (Cytopath-
ology).
Harald Noltenius, MD: (1970 - 1973) Professor of Pathology, Chairman.
Ramez Azoury, MD: (1970 - 1978) Associate Professor of Obstetrics and Gynecology and Pathology (Gynecological Pathology).
Victor H. Nassar, MD: (1971 - 1975) Associate Professor of Pathology.
Nabil Wakid, PhD: (1972 - 1989) Clinical Chemist, Associate Professor of Laboratory Medicine.
Fawzi Abu Jamra, MD: (1967 - 1968) Instructor in Pathology (part time).
Zuheir Naib, MD: (June 15 - August 28, 1974) Visiting Professor of Pathology (Cytopathology) (Emory University, Atlanta GA).
Michael Gravanis, MD: (October 15 - December 15, 1974) Visiting Professor of Pathology from Emory University, Atlanta GA.
William Christopherson, MD: (February 1 - April 30, 1975) Visiting Professor of Pathology from University of Louisville, KY.
Abdur Rahman Sa'di, MD: (1975 - 1976) Visiting Assistant Professor of Pathology for 3 months.
Tanios Koussa, MLT: (1976 -1977) Instructor in Laboratory Medicine.
Zuheir Habbal, Ph.D. (1976 ��) Hospital Biochemist, Professor of Laboratory Medicine.
Joel Brunson, MD: (Sep.1, - March 31, 1977) Visiting Professor of Pathology from Jackson University.
Walter Sheldon, MD: (March 1 - June 30, 1977) Visiting Professor of Pathology from Johns Hopkins University.
III - 4 - Change name of Clinical Pathology to Laboratory Medicine, 1978.
Pathology Department separate.
Jean-Pierre de Chadarevian, MD: (1979 - 1980) Associate Professor of Pathology.
George Banayan, MD. (September 16 - October 31, 1979, and February 1 - May 31, 1980) Visiting Professor of Pathology from University of Texas at San Antonio.
Amira Mansour, MD: (1979 - 1991) Associate Professor of Pathology.
Patrice Hassoun, MD: (1981 - 1984) Assistant Professor of Pathology.
Ziad Salem, MD: (1981 - 1993) Assistant Professor of Laboratory Medicine (half time).
Ghazi Zaatari, MD: (1981 - 1984) (1995 ��) Professor of Pathology and Laboratory Medicine.
Amjad Mufarrij, MD: (1982 - 1986) Professor of Pathology.
Fadi Abdel Karim, MD: (1984 - 1987) Assistant Professor of Pathology.
Siham Fuleifil, MD: (1985 - 1988) Assistant Professor of Pathology.
Nina Salem Shabb, MD: (1991 ��) Associate Professor of Pathology.
Ayman Tawil,MD: (1991 ��) Associate Professor of Pathology.
George Araj, PhD: (1992 ��) Professor of Laboratory Medicine.
Hanna Kaspar, MD: (1993 ��) Associate Professor of Gynecological Pathology.
Leila Zahed, Ph.D. (1994 ��) Associate Professor of Laboratory Medicine.
Rose Daher, Ph.D. (1996 ��) Associate Professor of Laboratory Medicine
Joud Haidar, MD: (1996 ��) Assistant Professor of Laboratory Medicine.
III - 6 - Pathology and Laboratory Medicine combined into one department of Pathology and Laboratory Medicine 1996, composed as follows:
Samih Alami, Ph.D., M.D.
George Araj, Ph.D.
Rose Daher, Ph.D.
Zuheir Habbal, Ph.D.
Joud Haidar, M.D.
Hanna, Kaspar, M.D.
Amjad Mufarrij, M.D.
Raif Nassif, M.D. M.P.H. (emeritus)
Jean Rebeiz, M.D.
Ghazi Zaatari, M.D. (chairman).
Bibliography
American University of Beirut: Catalogues for the years 1880 - 1881 to 1939 - 1940, 1941- 1942, 1945 - 1946, 1951 - 1971, 1972 - 1973, 1974 to 1976,1978 to 1996.
Annual Reports of the Faculties of Medical Sciences, American University of Beirut, 1954 -1955 to 1977 - 1978.
Annual Reports of the Board of Managers of the Syrian Protestant College 1867 - 1902.
Mufarrij, Amjad A.: Pathology in Lebanon - The Role of the American University of Beirut, 1866 - 1985. Lebanese Medical Journal vol.36: 1, 1986.
Penrose, Stephen B.L.: That They May Have Life, 1941.Trustees of the American University of Beirut, publishers.
HEMATOLOGY
INTRODUCTION:
The hematology section receives an average of 350 specimens a day. These are divided into the following categories:
· �Routine,� encompassing complete blood counts, white cell differentials, reticulocyte counting, erythrocyte sedimentation rate, peripheral blood parasites, and related tests.
· �Body fluids analysis,� meaning cell count, morphology, and differential in cerebrospinal, pleural, peritoneal, joint fluids, and urine.
· Bone marrow aspirate diagnosis and differential counts.
· Special stains including cytochemical stains on bone marrow, hemosiderin on urine, and others.
Areas of special interest and strength have been blood and bone marrow morphology complemented with cytochemical stains, triaged for flow cytometry and other tests for the classification of hematological neoplasms. We have a long term interest in increasing the consultation service in the workup of anemia and neoplastic hematopathology. Residents are stimulated to actively become involved in the diagnosis of leukemia and to help in evolving new tests.
The hematology section receives an average of 350 specimens a day. These are divided into the following categories:
· �Routine,� encompassing complete blood counts, white cell differentials, reticulocyte counting, erythrocyte sedimentation rate, peripheral blood parasites, and related tests.
· �Body fluids analysis,� meaning cell count, morphology, and differential in cerebrospinal, pleural, peritoneal, joint fluids, and urine.
· Bone marrow aspirate diagnosis and differential counts.
· Special stains including cytochemical stains on bone marrow, hemosiderin on urine, and others.
Areas of special interest and strength have been blood and bone marrow morphology complemented with cytochemical stains, triaged for flow cytometry and other tests for the classification of hematological neoplasms. We have a long term interest in increasing the consultation service in the workup of anemia and neoplastic hematopathology. Residents are stimulated to actively become involved in the diagnosis of leukemia and to help in evolving new tests.
CYTOLOGY
INTRODUCTION:
The cytology laboratory is geared to the study of single cells mainly in detecting malignant and premalignant conditions as well as identifying infectious agents. The laboratory maintains ongoing proficiency testing and performance improvement programs. We follow a rigorous quality control and quality assessment program using the standards of the American College of Pathologists. The laboratory staff includes several American Board Certified pathologists, full-time cytotechnologist and assistant. Our cytology results are consistently correlated with surgical pathology results to insure continued accurate cytology reporting. Our aim is to give accurate and timely results and serve the needs of our patients and the medical staff.
SCOPE OF SERVICES:
The cytology laboratory is open Mondays through Fridays from 8am to 5pm. A pathology resident and attending pathologist are always on call in case of questions or emergencies.
The following specimens are examined:
A. Exfoliative cytology
a. Gynecologic cervico/vaginal smears
b. Non-Gynecologic specimens
i. Sputum
ii. Bronchial washings brushings and lavages
iii. Body cavity effusions
iv. Nipple discharge
v. Cerebrospinal fluid
vi. Urine
vii. Endoscopic brushings and washings
viii. Other
B. FINE NEEDLE ASPIRATIONS (FNA):
a. Palpable masses performed by the pathologist: These include any palpable mass such as breast, lymph node, thyroid, soft tissue, etc. FNAs can be done on a come and serve basis during the working hours of the department Monday-Friday 8am-5pm; however, it is preferable that the patient/clinician calls the laboratory to take an appointment to ensure smooth service.
b. Non palpable masses performed by the radiologist: These include �deep masses� such as lung, pancreas, liver, etc. The radiologist performs the FNA and sends the specimen to the laboratory for processing and interpretation.
The cytology laboratory is geared to the study of single cells mainly in detecting malignant and premalignant conditions as well as identifying infectious agents. The laboratory maintains ongoing proficiency testing and performance improvement programs. We follow a rigorous quality control and quality assessment program using the standards of the American College of Pathologists. The laboratory staff includes several American Board Certified pathologists, full-time cytotechnologist and assistant. Our cytology results are consistently correlated with surgical pathology results to insure continued accurate cytology reporting. Our aim is to give accurate and timely results and serve the needs of our patients and the medical staff.
SCOPE OF SERVICES:
The cytology laboratory is open Mondays through Fridays from 8am to 5pm. A pathology resident and attending pathologist are always on call in case of questions or emergencies.
The following specimens are examined:
A. Exfoliative cytology
a. Gynecologic cervico/vaginal smears
b. Non-Gynecologic specimens
i. Sputum
ii. Bronchial washings brushings and lavages
iii. Body cavity effusions
iv. Nipple discharge
v. Cerebrospinal fluid
vi. Urine
vii. Endoscopic brushings and washings
viii. Other
B. FINE NEEDLE ASPIRATIONS (FNA):
a. Palpable masses performed by the pathologist: These include any palpable mass such as breast, lymph node, thyroid, soft tissue, etc. FNAs can be done on a come and serve basis during the working hours of the department Monday-Friday 8am-5pm; however, it is preferable that the patient/clinician calls the laboratory to take an appointment to ensure smooth service.
b. Non palpable masses performed by the radiologist: These include �deep masses� such as lung, pancreas, liver, etc. The radiologist performs the FNA and sends the specimen to the laboratory for processing and interpretation.
CYTOGENETICS
INTRODUCTION:
The Cytogenetics Laboratory performs karyotype analysis on a variety of samples, which include the following:
� Postnatal constitutional chromosome analysis on blood lymphocytes and skin fibroblats
� Prenatal constitutional analysis on amniotic fluid, chorionic villi, fetal blood and products of conception
� Postnatal analysis of acquired chromosome abnormalities on blood, bone marrow, lymph nodes and solid tumors
In addition, the laboratory currently applies Fluorescent In Situ Hybridization (FISH) for the rapid, preliminary, prenatal screening of uncultured amniocytes or direct preparations of chorionic villi, or the detection of major chromosome translocations in leukemias.
The staff of the Cytogenetics Laboratory currently includes five technologists and a senior technologist, in addition to the laboratory director. The laboratory performs over 2000 karyotypes per year, providing and maintaining photographic records of all cases on an automated karyotyping system.
The Cytogenetics Laboratory performs karyotype analysis on a variety of samples, which include the following:
� Postnatal constitutional chromosome analysis on blood lymphocytes and skin fibroblats
� Prenatal constitutional analysis on amniotic fluid, chorionic villi, fetal blood and products of conception
� Postnatal analysis of acquired chromosome abnormalities on blood, bone marrow, lymph nodes and solid tumors
In addition, the laboratory currently applies Fluorescent In Situ Hybridization (FISH) for the rapid, preliminary, prenatal screening of uncultured amniocytes or direct preparations of chorionic villi, or the detection of major chromosome translocations in leukemias.
The staff of the Cytogenetics Laboratory currently includes five technologists and a senior technologist, in addition to the laboratory director. The laboratory performs over 2000 karyotypes per year, providing and maintaining photographic records of all cases on an automated karyotyping system.
CLINICAL CHEMISTRY
INTRODUCTION:
The Clinical Chemistry Laboratory, as a section of the Department of Pathology and Laboratory Medicine, was established over 40 years ago. It has developed considerably over the years and currently performs over 600,000 tests annually. The Laboratory maintains ongoing Quality Control, Proficiency Testing, and Performance Improvement programs designed to objectively and systemically monitor and evaluate the quality of its services. This program is based on and consistent with the standards established by the College of American Pathologists.
SCOPE OF SERVICES:
The Laboratory is available for patient (in and out) care services twenty-four hours a day, seven days a week, and provides the following diagnostic and therapeutic tests:
· Routine Blood and Urine Chemistry Analyses
· Therapeutic Drug Monitoring, Toxicology Screen, and Trace Metals
· Specialized Chemistry: Tumor Markers, Hormones, Vitamins, Biogenic Amines, Protein Electrophoresis and Related Tests
· Biochemical Genetics: Amino Acids, Organic Acids, Neonatal Screening, Sweat Chloride Analysis, and Lysosomal Enzymes
The Laboratory is equipped with state of the art technology: Highly automated Clinical Chemistry analyzers and Immunoanalyzers with the Laboratory Information System connectivity ensure better reliability and rapid turnaround time. Sophisticated techniques like High Performance Liquid Chromatography, Gas Chromatography / Mass Spectrometry (GC/MS), and Inductively Coupled Plasma Mass Spectrometry (ICPMS) are utilized for specialized applications.
The competency of our staff is maintained through supervised continuous medical education programs and the development of new procedures. Our Faculty consultation services include interpretation of plasma and CSF amino acids, urine organic acids, protein electrophoresis and related tests.
The laboratory strives to provide quality service through continuous evaluation of the needs of the medical staff and its patient population.
The Clinical Chemistry Laboratory, as a section of the Department of Pathology and Laboratory Medicine, was established over 40 years ago. It has developed considerably over the years and currently performs over 600,000 tests annually. The Laboratory maintains ongoing Quality Control, Proficiency Testing, and Performance Improvement programs designed to objectively and systemically monitor and evaluate the quality of its services. This program is based on and consistent with the standards established by the College of American Pathologists.
SCOPE OF SERVICES:
The Laboratory is available for patient (in and out) care services twenty-four hours a day, seven days a week, and provides the following diagnostic and therapeutic tests:
· Routine Blood and Urine Chemistry Analyses
· Therapeutic Drug Monitoring, Toxicology Screen, and Trace Metals
· Specialized Chemistry: Tumor Markers, Hormones, Vitamins, Biogenic Amines, Protein Electrophoresis and Related Tests
· Biochemical Genetics: Amino Acids, Organic Acids, Neonatal Screening, Sweat Chloride Analysis, and Lysosomal Enzymes
The Laboratory is equipped with state of the art technology: Highly automated Clinical Chemistry analyzers and Immunoanalyzers with the Laboratory Information System connectivity ensure better reliability and rapid turnaround time. Sophisticated techniques like High Performance Liquid Chromatography, Gas Chromatography / Mass Spectrometry (GC/MS), and Inductively Coupled Plasma Mass Spectrometry (ICPMS) are utilized for specialized applications.
The competency of our staff is maintained through supervised continuous medical education programs and the development of new procedures. Our Faculty consultation services include interpretation of plasma and CSF amino acids, urine organic acids, protein electrophoresis and related tests.
The laboratory strives to provide quality service through continuous evaluation of the needs of the medical staff and its patient population.
BLOOD BANK
PURPOSE:
The Blood Bank as a section of the Department of Pathology and Laboratory Medicine is committed to quality care services to the patients twenty-four (24) hours a day, seven (7) days a week all year round including official holidays. A well-trained staff provides the services and practices that are based on internationally accepted standards and regulations. The services are:
· Donor Blood Collection
· Blood Component Therapy
· Collection Apheresis
· Therapeutic Apheresis
· Peripheral Blood Stem Cell Collection and Storage
The Stem Cell Processing Laboratory, as part of the Blood Bank and under the jurisdiction of the Blood Bank Medical Director, provides the following services:
· Processing for the Cryopreservation of the Stem Cell Collect
· Storage by Cryopreservation
· Thawing and Release of the Stem Cell Collect
GOALS:
The Blood Bank has established goals with the intention of providing continuous quality patient-care, constant improvement, and quality management as well as continuing medical education (CME) to the Medical and House staff and the Blood Bank staff members. These goals aim:
1. 1. To maintain professional and technical competence by offering CME to the Blood Bank staff.
2. 2. To preserve quality while maintaining cost-effectiveness.
3. 3. To provide continuous performance improvement program.
4. 4. To stay abreast of and introduce new methodology, technology, standards and regulations.
5. 5. To assure quality patient care by blood transfusion audits.
6. 6. To provide CME to Medical, House and Nursing Staff.
TYPE AND AGES OF THE PATIENTS GIVEN CARE:
The Blood Bank provides care to patients of all ages and categories these include, but are not limited to: Age: Fetus Neonate Pediatric Adult Geriatric
Type: Intrauterine Medical Surgical Solid Organ Transplant Peripheral Blood Stem Cell Transplant Dialysis Trauma Whole blood Exchange transfusion Red blood cell Exchange transfusion Plasma exchange transfusion
SCOPE OF CURRENT AND PLANNED SERVICES/PRACTICE:
The Blood Bank is a Hospital-based transfusion service and donor unit, providing, but not exclusive to: blood collection, processing, storage and distribution. The Blood Bank includes a processing area, a donor room, an apheresis facility and a stem cell processing lab. The Blood Bank provides blood components for patients upon physician request. The Blood Bank provides its services twenty-four (24) hours a day, and can manage emergency situations, problematic transfusion recipients, massive transfusion, while providing irradiation, bed-side filtration, and quality products based on internationally accepted standards. The Blood Bank also offers an Autologous Blood Program and a Blood Donor Registry:
Autologous Program including:
· Pre-surgical blood deposit
· Induction hemodilution
· Intra-operative blood salvage
· Post-operative blood salvage
Blood Donation Registry:
Encourages healthy blood donors to altruistically donate whole blood every four (4) months to save patients.
The Departments serviced include:
· Emergency Unit
· Out patient Dept
· Operating room
· Recovery room
· Kidney room
· ICU
· CCU
· RCU
· Hospitalized patient, including, not exclusive to:1. Internal medicine
1. Internal medicine 2. Surgery 3. OB-GYN 4. Pediatrics 5. Oncology patients 6. Stem cell and solid organ transplant transfusion support 7. Therapeutic Apheresis
The patients serviced include:
· Community members
· Medical, House and Nursing Staff
· Internal Personnel
AVAILABILITY OF STAFF/STAFFING:
The Blood Bank is located on the third floor of the AUB medical center and is available for patient care services twenty-four (24) hours a day, seven (7) days a week, providing the following services:
General:
· Component therapy
· Storage of blood components
· Administration of components
· Massive Transfusion
· Emergency Transfusion
· Transfusion reactions
· Irradiation of cellular blood components
· Filtration of blood components
· Autologous blood transfusion
· Blood safety
· Documentation
Donor Room:
· Interview
· Vital signs, weight, and hemoglobin level
· Blood Collection
Blood Bank Processing Area:
· ABO blood group & Rh type
· Direct Antiglobulin test--DAT
· Indirect Antiglobulin test--IAT
· Identification of unexpected antibodies
· Quantitative IAT (Titer of unexpected antibodies)
· Infectious screening
· Phenotyping
· Crossmatching
· Component preparation
· Storage
· Irradiation
· Investigation of transfusion reactions
· Investigation of Hemolytic Disease of the Newborn and Fetus
· Documentation
· Quality management
Apheresis Facility:
· Plateletpheresis
· Granulocyte Collection
· Therapeutic Plateletpheresis
· Therapeutic Plasmapheresis
· Therapeutic Leukapheresis
· Therapeutic Red Cell exchange
· Peripheral Blood Stem Cell collection
All tests are performed on whole blood, serum or plasma. STAT samples are given priority over routine requisitions. In cases of multiple STAT orders the catastrophe policy is implemented.
The 24-hour Blood Bank services are covered by three (3) shifts:
· 7 am - 4 pm
· 4 pm - 11 pm
· 11 pm - 7 am
The Blood Bank services are provided by:
1. 1. Qualified competent staff members including: Medical Technologists
o 1 senior and 4 cover the day shift
o 1 supervisor and 2 technologists and 1 phlebotomist cover the evening shift
o 1 technologist covers the overnight shift
Phlebotomists
o 1 day shift
o 1 evening shift
Lab Aid
o 1 day shift
2. 2. Clinical Pathology Resident
3. 3. Clinical Pathologist Medical Director
METHODS USED TO ASSESS & MEET THE PATIENT NEEDS/SERVICES:
The Blood Bank is a hospital-based donor collection and transfusion center. It works on a blood replacement donor system, and promotes the recently implemented a blood donor registry. All blood donors are volunteers. The blood components are made available in the general inventory after a series of screening tests, during which they are kept in quarantine. The blood units are released upon a written request from the physician. The Blood Bank also provides therapeutic apheresis upon written request of the physician. The trained clinical pathology residents, under the direct supervision and guidance of the Blood Bank medical director, administer these procedures.
RECOGNIZED STANDARDS AND GUIDELINES USED:
The Blood Bank follows the American association of Blood Banks (AABB) standards, and the Medical Center, Department and Section Policies and regulations.
Quality Control:
Quality control is applied on all methodologies and equipment according to the AABB standards. The Blood Bank Director is responsible for the overall quality control plan of the Blood Bank. The Director authorizes and delegates participation in the program to all the Blood Bank personnel. The Senior Blood Bank technologist is responsible for writing, implementing, and reviewing the plan and the overall management of the Quality Control Program. The plan should be revised annually or as needed. The Senior Blood Bank technologist, under the supervision and approval of the Blood Bank Director, is responsible for staff training, evaluations and competencies. The Blood Bank Director is responsible for review of results, evaluations of problems, and review of actions taken to resolve issues. The Blood Bank Director must determine the needs for procedures. All actions should be carried out according to specifications of the manufacturer and/or inspection agencies requirement.
Proficiency Program
The proficiency program routinely applies proficiency testing to assess the efficiency and accuracy of the tests performed. The Blood Bank Medical Director is responsible for the Blood Bank monitoring. The Blood Bank Senior technologist is responsible for the implementation of the program. Blood Bank Senior technologist is responsible for the participation of the monitoring program, which includes:
· Reporting of results in a timely and accurate manner
· Review of the test results
· Evaluation of problems
· Implementation of corrective actions
The Blood Bank Medical Director will coordinate all survey data for the Blood Bank, and develop a plan to ensure that all the staff members working in a particular area of the service are routinely challenged by the testing material. The Blood Bank Medical Director will inform the staff members of proficiency failures and counsel the employees who performed the test.
DEPARTMENT PERFORMANCE IMPROVEMENT PLAN:
The Blood Bank participates in the performance improvement activities of the Department. The Blood Bank Medical Director is responsible for the overall Performance Improvement Plan (PIP) of the section, with the Blood Bank Senior technologist taking responsibility for organizing and overseeing data collection and analysis, and implementation of actions designed to improve quality of services. The Blood Bank Senior technologist, with the approval of the Blood Bank Medical Director, may assign a designated person from the staff members to assist in this plan (the delegate). The delegate will serve on the PI committee of the department.
The criteria used by the Blank Bank are:
· Appropriate utilization of the Blood Bank services
· Appropriate ordering of the Blood Bank services
· Appropriate collection and transport of the specimens
· Accurate identification including, but not exclusive to: blood units, technologists performing the tests, patients, donors, phlebotomist and transfusionist and witness
· Accurate specimen processing and handling
· Accurate reporting of results
· Accurate documentation
· Proficiency testing and competency evaluation
· Clinical Risk Management
· Client satisfaction, including but not exclusive to: Physician, Patient and Donor
The data sources come from the following:
· Laboratory meetings (Dept. Faculty meetings)
· Quality improvement checklists (CAP)
· Client complaints
· Staff observations
· Incident reports
· Laboratory requisitions
· Accession logs
· Report forms
· Proficiency results
· Policies and Procedures
The Blood Bank quality indicators include but are not exclusive to:
· Blood Bank documentation
· Turn around time of STAT procedures
Reporting:
The Blood Bank Medical Director will report the analyzed data monthly to the Chairman of the Department.
THE BLOOD UTILIZATION COMMITTEE:
The Blood Utilization Committee functions as an advisory body to the Blood Bank and reports to the Chief of Staff. Dilemmas, transfusion reactions, requirements, and incidents are brought to the attention of the committee. The committee reviews the charts brought forth by the blood audits.
The Blood Bank as a section of the Department of Pathology and Laboratory Medicine is committed to quality care services to the patients twenty-four (24) hours a day, seven (7) days a week all year round including official holidays. A well-trained staff provides the services and practices that are based on internationally accepted standards and regulations. The services are:
· Donor Blood Collection
· Blood Component Therapy
· Collection Apheresis
· Therapeutic Apheresis
· Peripheral Blood Stem Cell Collection and Storage
The Stem Cell Processing Laboratory, as part of the Blood Bank and under the jurisdiction of the Blood Bank Medical Director, provides the following services:
· Processing for the Cryopreservation of the Stem Cell Collect
· Storage by Cryopreservation
· Thawing and Release of the Stem Cell Collect
GOALS:
The Blood Bank has established goals with the intention of providing continuous quality patient-care, constant improvement, and quality management as well as continuing medical education (CME) to the Medical and House staff and the Blood Bank staff members. These goals aim:
1. 1. To maintain professional and technical competence by offering CME to the Blood Bank staff.
2. 2. To preserve quality while maintaining cost-effectiveness.
3. 3. To provide continuous performance improvement program.
4. 4. To stay abreast of and introduce new methodology, technology, standards and regulations.
5. 5. To assure quality patient care by blood transfusion audits.
6. 6. To provide CME to Medical, House and Nursing Staff.
TYPE AND AGES OF THE PATIENTS GIVEN CARE:
The Blood Bank provides care to patients of all ages and categories these include, but are not limited to: Age: Fetus Neonate Pediatric Adult Geriatric
Type: Intrauterine Medical Surgical Solid Organ Transplant Peripheral Blood Stem Cell Transplant Dialysis Trauma Whole blood Exchange transfusion Red blood cell Exchange transfusion Plasma exchange transfusion
SCOPE OF CURRENT AND PLANNED SERVICES/PRACTICE:
The Blood Bank is a Hospital-based transfusion service and donor unit, providing, but not exclusive to: blood collection, processing, storage and distribution. The Blood Bank includes a processing area, a donor room, an apheresis facility and a stem cell processing lab. The Blood Bank provides blood components for patients upon physician request. The Blood Bank provides its services twenty-four (24) hours a day, and can manage emergency situations, problematic transfusion recipients, massive transfusion, while providing irradiation, bed-side filtration, and quality products based on internationally accepted standards. The Blood Bank also offers an Autologous Blood Program and a Blood Donor Registry:
Autologous Program including:
· Pre-surgical blood deposit
· Induction hemodilution
· Intra-operative blood salvage
· Post-operative blood salvage
Blood Donation Registry:
Encourages healthy blood donors to altruistically donate whole blood every four (4) months to save patients.
The Departments serviced include:
· Emergency Unit
· Out patient Dept
· Operating room
· Recovery room
· Kidney room
· ICU
· CCU
· RCU
· Hospitalized patient, including, not exclusive to:1. Internal medicine
1. Internal medicine 2. Surgery 3. OB-GYN 4. Pediatrics 5. Oncology patients 6. Stem cell and solid organ transplant transfusion support 7. Therapeutic Apheresis
The patients serviced include:
· Community members
· Medical, House and Nursing Staff
· Internal Personnel
AVAILABILITY OF STAFF/STAFFING:
The Blood Bank is located on the third floor of the AUB medical center and is available for patient care services twenty-four (24) hours a day, seven (7) days a week, providing the following services:
General:
· Component therapy
· Storage of blood components
· Administration of components
· Massive Transfusion
· Emergency Transfusion
· Transfusion reactions
· Irradiation of cellular blood components
· Filtration of blood components
· Autologous blood transfusion
· Blood safety
· Documentation
Donor Room:
· Interview
· Vital signs, weight, and hemoglobin level
· Blood Collection
Blood Bank Processing Area:
· ABO blood group & Rh type
· Direct Antiglobulin test--DAT
· Indirect Antiglobulin test--IAT
· Identification of unexpected antibodies
· Quantitative IAT (Titer of unexpected antibodies)
· Infectious screening
· Phenotyping
· Crossmatching
· Component preparation
· Storage
· Irradiation
· Investigation of transfusion reactions
· Investigation of Hemolytic Disease of the Newborn and Fetus
· Documentation
· Quality management
Apheresis Facility:
· Plateletpheresis
· Granulocyte Collection
· Therapeutic Plateletpheresis
· Therapeutic Plasmapheresis
· Therapeutic Leukapheresis
· Therapeutic Red Cell exchange
· Peripheral Blood Stem Cell collection
All tests are performed on whole blood, serum or plasma. STAT samples are given priority over routine requisitions. In cases of multiple STAT orders the catastrophe policy is implemented.
The 24-hour Blood Bank services are covered by three (3) shifts:
· 7 am - 4 pm
· 4 pm - 11 pm
· 11 pm - 7 am
The Blood Bank services are provided by:
1. 1. Qualified competent staff members including: Medical Technologists
o 1 senior and 4 cover the day shift
o 1 supervisor and 2 technologists and 1 phlebotomist cover the evening shift
o 1 technologist covers the overnight shift
Phlebotomists
o 1 day shift
o 1 evening shift
Lab Aid
o 1 day shift
2. 2. Clinical Pathology Resident
3. 3. Clinical Pathologist Medical Director
METHODS USED TO ASSESS & MEET THE PATIENT NEEDS/SERVICES:
The Blood Bank is a hospital-based donor collection and transfusion center. It works on a blood replacement donor system, and promotes the recently implemented a blood donor registry. All blood donors are volunteers. The blood components are made available in the general inventory after a series of screening tests, during which they are kept in quarantine. The blood units are released upon a written request from the physician. The Blood Bank also provides therapeutic apheresis upon written request of the physician. The trained clinical pathology residents, under the direct supervision and guidance of the Blood Bank medical director, administer these procedures.
RECOGNIZED STANDARDS AND GUIDELINES USED:
The Blood Bank follows the American association of Blood Banks (AABB) standards, and the Medical Center, Department and Section Policies and regulations.
Quality Control:
Quality control is applied on all methodologies and equipment according to the AABB standards. The Blood Bank Director is responsible for the overall quality control plan of the Blood Bank. The Director authorizes and delegates participation in the program to all the Blood Bank personnel. The Senior Blood Bank technologist is responsible for writing, implementing, and reviewing the plan and the overall management of the Quality Control Program. The plan should be revised annually or as needed. The Senior Blood Bank technologist, under the supervision and approval of the Blood Bank Director, is responsible for staff training, evaluations and competencies. The Blood Bank Director is responsible for review of results, evaluations of problems, and review of actions taken to resolve issues. The Blood Bank Director must determine the needs for procedures. All actions should be carried out according to specifications of the manufacturer and/or inspection agencies requirement.
Proficiency Program
The proficiency program routinely applies proficiency testing to assess the efficiency and accuracy of the tests performed. The Blood Bank Medical Director is responsible for the Blood Bank monitoring. The Blood Bank Senior technologist is responsible for the implementation of the program. Blood Bank Senior technologist is responsible for the participation of the monitoring program, which includes:
· Reporting of results in a timely and accurate manner
· Review of the test results
· Evaluation of problems
· Implementation of corrective actions
The Blood Bank Medical Director will coordinate all survey data for the Blood Bank, and develop a plan to ensure that all the staff members working in a particular area of the service are routinely challenged by the testing material. The Blood Bank Medical Director will inform the staff members of proficiency failures and counsel the employees who performed the test.
DEPARTMENT PERFORMANCE IMPROVEMENT PLAN:
The Blood Bank participates in the performance improvement activities of the Department. The Blood Bank Medical Director is responsible for the overall Performance Improvement Plan (PIP) of the section, with the Blood Bank Senior technologist taking responsibility for organizing and overseeing data collection and analysis, and implementation of actions designed to improve quality of services. The Blood Bank Senior technologist, with the approval of the Blood Bank Medical Director, may assign a designated person from the staff members to assist in this plan (the delegate). The delegate will serve on the PI committee of the department.
The criteria used by the Blank Bank are:
· Appropriate utilization of the Blood Bank services
· Appropriate ordering of the Blood Bank services
· Appropriate collection and transport of the specimens
· Accurate identification including, but not exclusive to: blood units, technologists performing the tests, patients, donors, phlebotomist and transfusionist and witness
· Accurate specimen processing and handling
· Accurate reporting of results
· Accurate documentation
· Proficiency testing and competency evaluation
· Clinical Risk Management
· Client satisfaction, including but not exclusive to: Physician, Patient and Donor
The data sources come from the following:
· Laboratory meetings (Dept. Faculty meetings)
· Quality improvement checklists (CAP)
· Client complaints
· Staff observations
· Incident reports
· Laboratory requisitions
· Accession logs
· Report forms
· Proficiency results
· Policies and Procedures
The Blood Bank quality indicators include but are not exclusive to:
· Blood Bank documentation
· Turn around time of STAT procedures
Reporting:
The Blood Bank Medical Director will report the analyzed data monthly to the Chairman of the Department.
THE BLOOD UTILIZATION COMMITTEE:
The Blood Utilization Committee functions as an advisory body to the Blood Bank and reports to the Chief of Staff. Dilemmas, transfusion reactions, requirements, and incidents are brought to the attention of the committee. The committee reviews the charts brought forth by the blood audits.
Tests, Associated disorder, and Type of specimen
TESTS OFFERED
Associated Disorder
TYPE OF BODY FLUID OR CELL
1
N-acetyl-aspartic acid
Canavan disease
Urine
2
Acid 1,4 -α-Glucosidase
Pompe disease
Leukocytes
3
Amino acids single and total quantitation
Amino acidopathies
Plasma, CSF
4
d-Aminolevulinic acid
Porphyria
Urine
5
Arginase
Arginase deficiency
Red blood cells
6
Arylsulfatase A
Metachromatic Leukodystrophy (MLD)
Urine
7
Arylsulfatase A
Metachromatic Leukodystrophy (MLD)
Leukocytes
8
Arylsulfatase B
Maroteaux-Lamy syndrome
Leukocytes
9
Arylsulfatase A and B
Multiple sulfatase deficiency
Leukocytes
10
Acetoacetate and β-hydroxybutyrate
Primary and secondary ketoacidosis
Urine
11
Argininosuccinic acid
Argininosuccinic aciduria
Plasma
12
Biotinidase
Late onset (juvenile) multiple carboxylase deficiency
Serum
13
L-Carnitine
Fatty acid metabolic abnormality
Plasma
14
Cystine screen
Cystinuria
Urine
15
Glucose-6-P-dehydrogenase
G6PD deficiency
Red blood cells
16
a Galactosidase
Fabry disease
Leukocytes
17
b Galactocerebrosidase
Krabbe disease
Leukocytes
18
b Galactosidase
GM1 Gangliosisdosis or Morquio disease type B
Leukocytes
19
b Glucosidase
Gaucher�s disease
Leukocytes
20
b Glucuronidase
Mucopolysaccharidosis type VII (Sly syndrome)
Leukocytes
21
Galactose
Galactosemia
Serum and urine
22
Galactose-1-P uridyl transferase
Galactosemia
Red blood cells
23
Homocysteine
Homocystinuria
Plasma
24
Homocysteine
Molybdenum cofactor deficiency
Plasma
25
Hexosaminidase A and B
GM2 gangliosidoses (Tay-Sach disease and Sandhoff disease)
Serum
26
a Iduronidase
Hurler syndrome
Leukocytes
27
a Mannosidase
α-Mannosidosis
Leukocytes
28
Multiple lysosomal enzymes
Mucolipidosis II (I-Cell disease)
Plasma
29
Mono and disaccharides
Mono and disaccharidurias
Urine
30
Mucopolysaccharides, total
Mucopolysaccharidosis
Urine
31
Organic acids
Organic acidurias (65 entities)
Urine
32
Organic acids
Organic acidemia
Plasma
33
Oxalic acid
Primary hyperoxaluria Type I & II
Urine
34
Orotic acid
Orotic aciduria
Urine
35
Pyruvate kinase
Pyruvate kinase deficiency
Red blood cells
36
Sphingomyelinase
Niemann-Pick disease type A & B
Leukocytes
37
Succinylacetone
Tyrosinemia type I
Urine
38
Phytanic acid
Refsum's disease
Plasma
39
Very long chain fatty acids
Peroxisomal disorders
Plasma
TESTS OFFERED, SPECIMEN HANDLING AND SHIPMENT
TEST
SPECIMEN / VOLUME
SHIPMENT
Amino acids
1 ml plasma (heparinized blood)
Frozen in dry ice
δ-Aminolevulinic acid
10 ml urine from a 24 hr collection in a bottle containing10 ml 6N HCL
On Wet Ice
Arginase
2 ml heparinized blood
On Wet Ice
Arylsulfatase A
5 to 10 ml spot urine
Frozen in dry ice
Arylsulfatase A and B
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
Biotinidase
1 ml serum / plasma
Frozen in dry ice
L-Carnitine, free
1 ml serum / plasma
Frozen in dry ice
Citric acid
4 to 10 ml spot urine
Frozen in dry ice
Galactose
1 ml serum, plasma or spot urine
Frozen in dry ice
Gal-1-P-Uridyltransferase
1 ml whole blood in heparin or EDTA
On Wet Ice
α-Galactosidase
1 ml plasma
On Wet Ice. Prior contact with the laboratory is required
β-Galactoceribrosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
β-Galactosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
1-4-α-Glucosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with
the laboratory is required
β-Glucuronidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with
the laboratory is required
β-Glucosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
Hexosaminidase A and B
0.5 ml serum
On Wet Ice
α-L-Iduronidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
α-Mannosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
Mono and dissaccharides
5 ml spot urine
Frozen in dry ice
Mucopolysaccharides
20 ml from a 24 hr urine collected in a bottle containing NO PRESERVATIVE
Frozen in dry ice
Multiple lysosomal enzymes (β-glucuronidase, β-gluco-sidase and α-fucosidase)
1 ml whole blood (Heparin / EDTA)
On Wet Ice. Prior contact with
the laboratory is required
Organic acid
4 to 5 ml spot urine. DO NOT ADD PRESERVATIVE
Frozen in dry ice
Oxalic acid
10 ml urine from a 24 hr collection in a bottle containing10 ml 6N HCL
Frozen in dry ice
Porphyrins
20 ml urine from a 24 hr collection in a bottle containing 5 g Na2CO3. Protect from light. During collection refregirate
On Wet Ice
Phytanic acid
2 ml of plasma, heparin/EDTA
Frozen in dry ice
Very long chain fatty acids
2 ml of plasma, heparin/EDTA
Frozen in dry ice
Associated Disorder
TYPE OF BODY FLUID OR CELL
1
N-acetyl-aspartic acid
Canavan disease
Urine
2
Acid 1,4 -α-Glucosidase
Pompe disease
Leukocytes
3
Amino acids single and total quantitation
Amino acidopathies
Plasma, CSF
4
d-Aminolevulinic acid
Porphyria
Urine
5
Arginase
Arginase deficiency
Red blood cells
6
Arylsulfatase A
Metachromatic Leukodystrophy (MLD)
Urine
7
Arylsulfatase A
Metachromatic Leukodystrophy (MLD)
Leukocytes
8
Arylsulfatase B
Maroteaux-Lamy syndrome
Leukocytes
9
Arylsulfatase A and B
Multiple sulfatase deficiency
Leukocytes
10
Acetoacetate and β-hydroxybutyrate
Primary and secondary ketoacidosis
Urine
11
Argininosuccinic acid
Argininosuccinic aciduria
Plasma
12
Biotinidase
Late onset (juvenile) multiple carboxylase deficiency
Serum
13
L-Carnitine
Fatty acid metabolic abnormality
Plasma
14
Cystine screen
Cystinuria
Urine
15
Glucose-6-P-dehydrogenase
G6PD deficiency
Red blood cells
16
a Galactosidase
Fabry disease
Leukocytes
17
b Galactocerebrosidase
Krabbe disease
Leukocytes
18
b Galactosidase
GM1 Gangliosisdosis or Morquio disease type B
Leukocytes
19
b Glucosidase
Gaucher�s disease
Leukocytes
20
b Glucuronidase
Mucopolysaccharidosis type VII (Sly syndrome)
Leukocytes
21
Galactose
Galactosemia
Serum and urine
22
Galactose-1-P uridyl transferase
Galactosemia
Red blood cells
23
Homocysteine
Homocystinuria
Plasma
24
Homocysteine
Molybdenum cofactor deficiency
Plasma
25
Hexosaminidase A and B
GM2 gangliosidoses (Tay-Sach disease and Sandhoff disease)
Serum
26
a Iduronidase
Hurler syndrome
Leukocytes
27
a Mannosidase
α-Mannosidosis
Leukocytes
28
Multiple lysosomal enzymes
Mucolipidosis II (I-Cell disease)
Plasma
29
Mono and disaccharides
Mono and disaccharidurias
Urine
30
Mucopolysaccharides, total
Mucopolysaccharidosis
Urine
31
Organic acids
Organic acidurias (65 entities)
Urine
32
Organic acids
Organic acidemia
Plasma
33
Oxalic acid
Primary hyperoxaluria Type I & II
Urine
34
Orotic acid
Orotic aciduria
Urine
35
Pyruvate kinase
Pyruvate kinase deficiency
Red blood cells
36
Sphingomyelinase
Niemann-Pick disease type A & B
Leukocytes
37
Succinylacetone
Tyrosinemia type I
Urine
38
Phytanic acid
Refsum's disease
Plasma
39
Very long chain fatty acids
Peroxisomal disorders
Plasma
TESTS OFFERED, SPECIMEN HANDLING AND SHIPMENT
TEST
SPECIMEN / VOLUME
SHIPMENT
Amino acids
1 ml plasma (heparinized blood)
Frozen in dry ice
δ-Aminolevulinic acid
10 ml urine from a 24 hr collection in a bottle containing10 ml 6N HCL
On Wet Ice
Arginase
2 ml heparinized blood
On Wet Ice
Arylsulfatase A
5 to 10 ml spot urine
Frozen in dry ice
Arylsulfatase A and B
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
Biotinidase
1 ml serum / plasma
Frozen in dry ice
L-Carnitine, free
1 ml serum / plasma
Frozen in dry ice
Citric acid
4 to 10 ml spot urine
Frozen in dry ice
Galactose
1 ml serum, plasma or spot urine
Frozen in dry ice
Gal-1-P-Uridyltransferase
1 ml whole blood in heparin or EDTA
On Wet Ice
α-Galactosidase
1 ml plasma
On Wet Ice. Prior contact with the laboratory is required
β-Galactoceribrosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
β-Galactosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
1-4-α-Glucosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with
the laboratory is required
β-Glucuronidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with
the laboratory is required
β-Glucosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
Hexosaminidase A and B
0.5 ml serum
On Wet Ice
α-L-Iduronidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
α-Mannosidase
10 ml whole blood in heparin or EDTA
On Wet Ice. Prior contact with the laboratory is required
Mono and dissaccharides
5 ml spot urine
Frozen in dry ice
Mucopolysaccharides
20 ml from a 24 hr urine collected in a bottle containing NO PRESERVATIVE
Frozen in dry ice
Multiple lysosomal enzymes (β-glucuronidase, β-gluco-sidase and α-fucosidase)
1 ml whole blood (Heparin / EDTA)
On Wet Ice. Prior contact with
the laboratory is required
Organic acid
4 to 5 ml spot urine. DO NOT ADD PRESERVATIVE
Frozen in dry ice
Oxalic acid
10 ml urine from a 24 hr collection in a bottle containing10 ml 6N HCL
Frozen in dry ice
Porphyrins
20 ml urine from a 24 hr collection in a bottle containing 5 g Na2CO3. Protect from light. During collection refregirate
On Wet Ice
Phytanic acid
2 ml of plasma, heparin/EDTA
Frozen in dry ice
Very long chain fatty acids
2 ml of plasma, heparin/EDTA
Frozen in dry ice
BIOCHEMICAL GENETICS LAB
INTRODUCTION:
The Biochemical Genetics Laboratory of the department of Pathology and Laboratory Medicine at the School of Medicine, American University of Beirut was initiated twenty-five years ago to provide diagnostic services of inborn errors of metabolism to the medical community in Lebanon and neighboring countries at large. The services are concerned with the evaluation and diagnosis of patients as well as families with inherited metabolic diseases, monitoring of treatment, and distinguishing heterozygote carriers from non-carriers by metabolic and enzymatic analysis of physiologic fluids and tissues.
State of the art technology is utilized in analysis which include qualitative detection and quantitative determination of diagnostic markers based on a variety of manual, automated colorimetric, fluorometric, chromatographic methods particularly HPTLC, HPLC, and GC/MS.
In contrast with Clinical Chemistry Laboratory, the Biochemical Genetics Laboratory is much more involved with the interpretation of results so that those are meaningful to the clinician and eventually the patient. Over the years, testing for metabolic disorders has evolved from highly specialized and fragmented information done primarily by research-oriented biochemists to an important component of patient care for all ages.
All reports contain an interpretation provided by the director of the laboratory. Referring physician are provided access to the medical staff for consultation regarding further testing for confirmatory purposes or in management of patients with inborn errors of metabolism.
Reporting:
Written interpretation is provided with each report. In case of an abnormality, normal values are reported for comparison. In case of enzyme deficiency, values for normal control are included. Telephone or fax is available.
Specimen Submission:
The type of specimen to be submitted is test-specific.
Kindly contact the laboratory for full information on patient preparation and type of sample and of preservative and condition of transfer while in transit.
SCOPE OF SERVICES:
At the turn of the 20th century, Sir Archibald Garrod coined the phrase �inborn errors of metabolism� to describe a group of lifelong disorders of metabolism that apparently resulted from a deficiency of an enzyme. Later, this definition was expanded by Rosenberg to include biochemical disorders that are genetically determined resulting from defects in the structure and hence function of protein molecules.
Inborn errors of metabolism (IEM) are individually rare, but collectively common. The incidence of a particular disorder may vary among different ethnic groups, but is always lower than common diseases of adult life. The cumulative incidence of IEM is about 1/5000 live births. This is equivalent to the incidence of juvenile diabetes mellitus. It has been estimated that 20% of infants presenting with �sepsis� picture in the absence of risk factors (such as prematurity, chorioamnionitis, etc..) have an IEM.
Over the years, the number of IEM has increased sharply. The advent of chromatography methods, quantitative amino acids and organic acid analysis, electrophoretic techniques of separation of proteins, radioisotopic, flurometric methods of enzyme activity measurements, cell culture technology, gas chromatography and mass spectrometry all has contributed to our capacity in detecting new disorders, analysis of metabolic sequences and predicting their genetic basis. Furthermore, molecular biology has added another opportunity to examine these disorders at the DNA level.
Infants presenting acutely with an IEM frequently remain undiagnosed until late in the course of their illness. Since many of these entities are preventable or even curable, the delay in the recognition and treatment of an IEM may have tragic consequences. Therefore , early diagnosis of an IEM can not be overestimated.
The Biochemical Genetics Laboratory offers a number of tests for the detection and diagnosis of IEM. Some of these tests are of screening capabilities such as plasma amino acids, urine organic acids. Others represent advanced screening tests as in carnitine, very long chain fatty acids. Definitive diagnosis assay in physiological fluids or tissue is also offered, such as specific metabolites that are pathognomonic of some disorders, and specific lysosomal enzymes.
Table one covers the tests that are offered by our laboratory, the associated disorder and the anatomic sample used for diagnosis.
Table two is concerned with the type of specimen needed in each test, covering the preservative or the anticoagulants and conditions of shipment while the sample is in transit to the Lab.
The Biochemical Genetics Laboratory of the department of Pathology and Laboratory Medicine at the School of Medicine, American University of Beirut was initiated twenty-five years ago to provide diagnostic services of inborn errors of metabolism to the medical community in Lebanon and neighboring countries at large. The services are concerned with the evaluation and diagnosis of patients as well as families with inherited metabolic diseases, monitoring of treatment, and distinguishing heterozygote carriers from non-carriers by metabolic and enzymatic analysis of physiologic fluids and tissues.
State of the art technology is utilized in analysis which include qualitative detection and quantitative determination of diagnostic markers based on a variety of manual, automated colorimetric, fluorometric, chromatographic methods particularly HPTLC, HPLC, and GC/MS.
In contrast with Clinical Chemistry Laboratory, the Biochemical Genetics Laboratory is much more involved with the interpretation of results so that those are meaningful to the clinician and eventually the patient. Over the years, testing for metabolic disorders has evolved from highly specialized and fragmented information done primarily by research-oriented biochemists to an important component of patient care for all ages.
All reports contain an interpretation provided by the director of the laboratory. Referring physician are provided access to the medical staff for consultation regarding further testing for confirmatory purposes or in management of patients with inborn errors of metabolism.
Reporting:
Written interpretation is provided with each report. In case of an abnormality, normal values are reported for comparison. In case of enzyme deficiency, values for normal control are included. Telephone or fax is available.
Specimen Submission:
The type of specimen to be submitted is test-specific.
Kindly contact the laboratory for full information on patient preparation and type of sample and of preservative and condition of transfer while in transit.
SCOPE OF SERVICES:
At the turn of the 20th century, Sir Archibald Garrod coined the phrase �inborn errors of metabolism� to describe a group of lifelong disorders of metabolism that apparently resulted from a deficiency of an enzyme. Later, this definition was expanded by Rosenberg to include biochemical disorders that are genetically determined resulting from defects in the structure and hence function of protein molecules.
Inborn errors of metabolism (IEM) are individually rare, but collectively common. The incidence of a particular disorder may vary among different ethnic groups, but is always lower than common diseases of adult life. The cumulative incidence of IEM is about 1/5000 live births. This is equivalent to the incidence of juvenile diabetes mellitus. It has been estimated that 20% of infants presenting with �sepsis� picture in the absence of risk factors (such as prematurity, chorioamnionitis, etc..) have an IEM.
Over the years, the number of IEM has increased sharply. The advent of chromatography methods, quantitative amino acids and organic acid analysis, electrophoretic techniques of separation of proteins, radioisotopic, flurometric methods of enzyme activity measurements, cell culture technology, gas chromatography and mass spectrometry all has contributed to our capacity in detecting new disorders, analysis of metabolic sequences and predicting their genetic basis. Furthermore, molecular biology has added another opportunity to examine these disorders at the DNA level.
Infants presenting acutely with an IEM frequently remain undiagnosed until late in the course of their illness. Since many of these entities are preventable or even curable, the delay in the recognition and treatment of an IEM may have tragic consequences. Therefore , early diagnosis of an IEM can not be overestimated.
The Biochemical Genetics Laboratory offers a number of tests for the detection and diagnosis of IEM. Some of these tests are of screening capabilities such as plasma amino acids, urine organic acids. Others represent advanced screening tests as in carnitine, very long chain fatty acids. Definitive diagnosis assay in physiological fluids or tissue is also offered, such as specific metabolites that are pathognomonic of some disorders, and specific lysosomal enzymes.
Table one covers the tests that are offered by our laboratory, the associated disorder and the anatomic sample used for diagnosis.
Table two is concerned with the type of specimen needed in each test, covering the preservative or the anticoagulants and conditions of shipment while the sample is in transit to the Lab.
BACTERIOLOGY
SCOPE OF SERVICES:
Clinical Microbiology encompasses several disciplines including Bacteriology, Mycobacteriology, Mycology, Parasitology, Virology and Serology. The overall objective of these disciplines is to provide rapid and reliable Clinical Laboratory services that are helpful in diagnosing and treating patients with different infectious etiologies, taking into consideration the clinical relevance and cost effective value of the tests performed.
The bacteriology section utilizes a variety of tests based on microscopy, routine and special cultures, kit-methods ( based on detection of antigens related to the infectious etiology) as well as performing different antimicrobial susceptibility assays that are helpful for appropriate therapy. These methods are used in adequately controlled manner to diagnose a wide spectrum of infectious diseases including the central nervous system infection, bacteremia, pneumonia, surgical infection, skin and soft tissue infection, nosocomial infection, urinary tract infection, gastrointestinal and genital tract infections.
The spectrum of targeted microorganisms includes aerobic, anaerobic and microaerophilic bacteria, mycobacteria and fungi.
The section works closely with the medical staff especially those in infectious diseases and immediately relay critical results such as positive CSF smear or culture, blood culture, Acid Fast Stain or mycobacterial culture, Salmonella and Shigella culture in stool specimens.
The section also provides services in collaboration with the infection control program and public health authorities to investigate, detect and monitor for possible microbial outbreaks in order to control their spread.
The reliability of testing is emphasised based on applying a wide range of quality control procedures and results verification. Moreover, the section is enrolled in an external proficiency testing program for this endeavor.
The mission of the section includes also continuing education to medical and paramedical staff about a variety of topics including the proper collection and handling of clinical specimens. Moreover, the section is actively involved in training medical technologists, residents and other professionals, as well as in research and development that ultimately benefit patient care.
The working hours and staffing of shifts in the bacteriology section are as follows:
· Day duty shift, 8:00 am- 5:00 pm, Mon � Fri ( Full staff),
· Evening shift, 5:00 pm-12:00 pm ( one technologist),
· Night shift, 12:00 pm- 8:00am ( 1 technologist shared with other sections).
Skeletal staff are available on weekends and holidays to primarily process specimens from emergency/ urgent cases and new admissions.
Clinical Microbiology encompasses several disciplines including Bacteriology, Mycobacteriology, Mycology, Parasitology, Virology and Serology. The overall objective of these disciplines is to provide rapid and reliable Clinical Laboratory services that are helpful in diagnosing and treating patients with different infectious etiologies, taking into consideration the clinical relevance and cost effective value of the tests performed.
The bacteriology section utilizes a variety of tests based on microscopy, routine and special cultures, kit-methods ( based on detection of antigens related to the infectious etiology) as well as performing different antimicrobial susceptibility assays that are helpful for appropriate therapy. These methods are used in adequately controlled manner to diagnose a wide spectrum of infectious diseases including the central nervous system infection, bacteremia, pneumonia, surgical infection, skin and soft tissue infection, nosocomial infection, urinary tract infection, gastrointestinal and genital tract infections.
The spectrum of targeted microorganisms includes aerobic, anaerobic and microaerophilic bacteria, mycobacteria and fungi.
The section works closely with the medical staff especially those in infectious diseases and immediately relay critical results such as positive CSF smear or culture, blood culture, Acid Fast Stain or mycobacterial culture, Salmonella and Shigella culture in stool specimens.
The section also provides services in collaboration with the infection control program and public health authorities to investigate, detect and monitor for possible microbial outbreaks in order to control their spread.
The reliability of testing is emphasised based on applying a wide range of quality control procedures and results verification. Moreover, the section is enrolled in an external proficiency testing program for this endeavor.
The mission of the section includes also continuing education to medical and paramedical staff about a variety of topics including the proper collection and handling of clinical specimens. Moreover, the section is actively involved in training medical technologists, residents and other professionals, as well as in research and development that ultimately benefit patient care.
The working hours and staffing of shifts in the bacteriology section are as follows:
· Day duty shift, 8:00 am- 5:00 pm, Mon � Fri ( Full staff),
· Evening shift, 5:00 pm-12:00 pm ( one technologist),
· Night shift, 12:00 pm- 8:00am ( 1 technologist shared with other sections).
Skeletal staff are available on weekends and holidays to primarily process specimens from emergency/ urgent cases and new admissions.
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