| Clinical Pathology
Chemistry
The Clinical Chemistry rotations include all areas of the division: General Chemistry, Toxicology, Endocrinology, Immunoserology, and several areas related to near-patient testing. The rotations are highly structured and involve bench rotations, weekly conferences, journal clubs, and the investigation of a series of clinical chemistry problems. The resident learns basic and advanced aspects of laboratory management through problem-based learning exercises in areas such as applications of statistics, informatics, quality management, and adherence to regulatory requirements. Opportunities for applied and clinical research activities are also open to the residents. Residents are expected to take clinical calls for the department.
The division of Clinical Chemistry is organized into sections that encompass key aspects of general, special, endocrinologic, and toxicologic chemistry. Staff and faculty members within this division are also actively involved in the evolution of point-of-care and near-patient testing as well as stat laboratories in the neonatal intensive care unit and outpatient clinic. Each section within the division of Clinical Chemistry is actively engaged in development and application of the most current and relevant methodologies for optimal patient care.
The faculty members within the division of Clinical Chemistry encompass a wide and diverse range of research interests.
Opportunities for research exist in the faculties' areas of interest which include toxicology (especially issues relating to the newborn patient), diagnostic markers of tissue injury (particularly cardiac markers), protein metabolism, interferon-induced gene expression, assessment of gastrointestinal permeability, establishment of reference intervals, the effect of pre-analytical variables on laboratory tests, endocrinology, clinical applications of high performance liquid chromatography (HPLC), clinical laboratory utilization, and the impact of government regulation on laboratory medicine.
The technology and equipment utilized throughout this division ranges from state-of-the-art to cutting edge. The section of general chemistry employs both wet and dry chemistry analytical equipment and is currently expanding into a wider range of whole blood critical care chemistry techniques to effectively meet the needs of the acutely ill patient. The special chemistry section offers a full range of automated electrophoretic, HPLC, immunofixation, and flameless atomic absorption spectroscopic techniques. The endocrinology section offers a variety of techniques ranging from radioimmunoassay to time-resolved fluoroimmunoassay, and enzyme immunoassay techniques. The toxicology section uses an enzymatic immunoassay for detection of drugs of abuse.
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Cytogenetics
Residents from Pathology, Pediatrics, and Obstetrics and Gynecology training programs rotate through the cytogenetics section. During the rotations, residents gain an understanding of the pathophysiology responsible for genetic disorders, birth defects, and malignancy as well as become proficient with chromosome analysis and diagnostic techniques applicable to the evaluation of genetic disorders. They perform complete karyotyping on peripheral blood specimens and learn to identify and correlate these chromosome studies with the clinical diagnosis and prognosis. By the end of the rotation, the resident has a clear understanding of the personal and social impact of genetic diseases and the indications for genetic testing and genetic screening.
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Flow Cytometry
Flow cytometry is a technique which includes characterization of cells via their surface and intracellular antigens with fluorescence-tagged monoclonal antibodies. This technique is used to study and monitor lymphocyte subpopulations in infectious diseases (CD4+/CD8+ T cells), transplantation (T cells), immunological deficiencies (B and T cell defects), and hematologic malignancies.
The flow cytometry laboratory performs service and teaching functions. Residents get hands-on experience in processing, staining of specimens, and standardization and use of the flow cytometer. Residents participate in the interpretation of the flow cytometry data and correlation of results with cytochemistry, cell morphology, molecular genetics, and clinical presentation.
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Hematopathology
The Hematopathology rotation uses a wealth of pathologic material including blood smears, bone marrow specimens, and lymph nodes not only from Loyola and Hines VA but also from those received in consultation from many other regional and national facilities. Morphologic aspects of the discipline are stressed. The use of monoclonal antibodies, flow cytometry, and polymerase chain reaction (PCR) is an essential part of the diagnostic evaluation and is stressed during the rotation. Daily resident teaching sessions are conducted at a multiheaded microscope. Residents also learn to perform aspirations and biopsies in conjunction with the hematology services.
The Loyola University Medical Center and Edward Hines, Jr. VA Hospital are major research centers for the study of antithrombotic and thrombolytic agents. Coagulation testing and investigation of thrombogenesis and other coagulation disorders are also the focus of basic and applied research. Residents spend a month in coagulation, rotating through both the clinical sections and the research areas. The option for advanced coagulation studies and potential for research developed around individual interests is available. Interdepartmental research programs in Cardiology, Surgery, Pediatric, and Obstetrics and Gynecology are currently available.
The Loyola University Medical Center is a major referral center for lymphomas, leukemias, and disorders of the hematopoietic system in both adult and pediatric patients. Residents spend their first month of the five-month hematopathology rotation in learning basic hematology, urine analysis, semen analysis, and microscopy of body fluids. A major emphasis is placed on morphology and clinical laboratory testing methods.
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HLA Laboratory
The HLA laboratory specializes in clinical histocompatibility and immunogenetics testing. HLA molecules play fundamental roles in the activation and regulation of the immune response. Because immune activation is a direct result of the interaction between HLA molecules and T cells, HLA polymorphisms can cause oxygen allograft rejection and increased susceptibility to certain illnesses. The HLA Laboratory serves the transplant programs at Loyola University Medical Center that perform kidney, heart, lung, liver, pancreas, and bone marrow transplants.
The resident gets hands-on experience in the methods used to identify and characterize HLA antigens, assess the degree of immunological compatibility between potential organ donors and recipients, evaluate their degree of immunological responsiveness, and correlate results to predict the outcome of the potential allograft. Molecular, flow cytometry, and ELISA techniques are also integral parts of this rotation. Furthermore, residents also receive training in facets of histocompatibility testing applicable to cadaveric donor evaluation/recipient pairing under the mandates of the national organ procurement network.
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Immunoserology
During the second year of training, the pathology resident will rotate through the Immunoserology Laboratory. The objectives of this rotation represent the knowledge and experience in immunoserology that a pathology resident should have to practice clinical laboratory medicine and to successfully pass clinical pathology boards in this area. The topics covered in this rotation include Infectious Disease Testing, Autoimmune Disease Testing, Complement Analysis, Quality Control, Quality Assurance, and Management. Training is facilitated through the use of bench rotations, practical exercises, and didactic sessions with the faculty and staff. Examples of some of the exercises the resident may be asked to perform are fluorescent anti-nuclear antigen (ANA) and anti-neutrophil cytoplasmic (ANCA) antibody pattern analysis, complement measurements to establish which complement pathway is affected by a disease, measurement of viral load by fluorescent antigen titration, and design of a quality assurance monitor to help maintain quality patient care. The residents will also participate in Journal Club and weekly case conferences during their time in Immunoserology.
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Informatics / Management
Residents rotate through the laboratory information systems area, specimen handling area, and the management offices of the chairman to develop an understanding of the complexity of information systems as they relate to hospital information systems and to laboratory-specific quality management issues.
In addition, residents experience and study basic management issues in the laboratories to better grasp the numerous quality issues necessary to manage both anatomic and clinical laboratories. This rotation is supplemented by a year-long didactic sequence focusing on the principles of management.
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Laboratory Directorship
One goal of the training of residents is to incorporate increasing levels of graduated responsibility throughout all aspects of the training program. In clinical pathology a significant component is that the fourth year requires a 1-2-month rotation of a Laboratory Directorship. In this role the senior resident will synthesize and apply knowledge acquired from all areas of clinical, practical, and management throughout their training. During this rotation the senior resident will make independent management, clinical, and consultative decisions on a daily basis throughout every clinical pathology area. This effort will be integrated in a fashion so that faculty and senior managers will be available to counsel the senior resident. The senior resident will also be expected to mentor the junior residents rotating in specific clinical pathology areas.
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Microbiology
The microbiology section offers a complete range of diagnostic services in bacteriology, mycology, mycobacteriology, and parasitology. The resident is exposed to the most up-to-date instrumentation for blood cultures and automated identification and susceptibility testing. In addition, molecular techniques in microbiology are explored. The resident participates in identifying both clinical and "unknown" specimens as well as performing microscopic examination, isolation, identification, and antibiotic susceptibility testing of pathogens. The laboratory works closely with the Infectious Disease Department, and residents participate in the infectious disease service as well as perform consultative functions. The management aspects of infection control, quality assurance, and quality control are emphasized.
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Molecular Pathology
The Molecular Pathology rotation teaches fundamental concepts in the design and execution of molecular diagnostic assays used in oncology, infectious diseases, and genetic diseases. Medical relevance of such testing is stressed during the rotation.
Emphasis is placed on understanding the principles of molecular biology used in each test and the characteristics of the gene involved in each disease. Residents are therefore provided the opportunity to read pertinent literature and review critical concepts with the laboratory Director. Residents also learn how each test is performed. Detailed protocols are reviewed, and residents carry out representative assays using patient material. They interpret data and study alternative clinical applications for each test. The rotation is complemented by lectures on selected topics in Molecular Pathology presented during the clinical pathology lecture series.
Typical diagnostic assays run include:
- Molecular Oncology:
Use of Southern blot analysis and polymerase chain reaction (PCR) to detect immunoglobulin heavy chain rearrangements of PCR to detect bcl-1 and bcl-2 translocations in the diagnosis of mantle cell and follicular center cell lymphomas, respectively; use of reverse-transcription PCR (RT/PCR) to detect c-abl translocations in the diagnosis of CML and ALL; and use of in-situ hybridization to detect Epstein-Barr viral infection in B-cell lymphoproliferative disease.
- Infectious diseases:
Use of PCR to confirm infection with mycobacteria spp; and use of RT/PCR to identify infection with hepatitis C virus and HIV viral load qualifications.
- Genetic Diseases:
Use of Southern blot analysis and PCR to detect mutations in Fragile X Syndrome. PCR for detection of factor V Leiden mutation.
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Research
The residents are encouraged and supported to become involved in investigative projects during their period of training. For residents who are in a combined anatomic and clinical pathology training, up to a six-month specialty elective time is available during the first four years of training. The fifth year of training can also be used for research activities. For residents enrolled solely in anatomic or clinical pathology training, up to one year of the four-year program can be used for research activities. Ample opportunity exists for engaging in clinicopathologic, morphologic, and basic research projects under the supervision of one or more faculty members.
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Transfusion Medicine
The transfusion service is responsible for approximately 48,000 transfusions of blood and blood components annually at the Loyola University Medical Center. The LUMC Blood Bank supports active renal, cardiac, pulmonary, and bone marrow transplant programs. It also supports an active pediatric/neonatal service, a trauma center, and an adult hematology/oncology service. The resident's rotation is structured to provide basic knowledge and experience in the application of transfusion medicine to the clinical setting so that they can function as future consultants. The rotation addresses blood donor requirements as well as the acquisition, preparation, testing, and storage of blood and its components. Residents learn the proper administration of blood products, pre-transfusion testing, and the management and prevention of adverse consequences of transfusion therapy. They learn to solve antibody problems and are expected to participate in case presentations and assigned topics for discussion. A large part of training focuses on blood bank accrediting agencies' expectations. Guidelines for therapeutic pheresis and plasmapheresis are presented and practiced. Blood usage evaluation is emphasized. Residents become involved in the auditing process. During their rotation through the Blood Bank, they are expected to attend a meeting of the Blood Bank Usage Committee and Bone Marrow Transplant Rounds. Arrangements are made for residents to visit Life Source, our blood supplier.
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Electives in Clinical Pathology
Advanced studies for senior residents in any of the areas of Clinical Pathology are available including, but not limited to, Chemistry, Microbiology, Immunoserology, Hematopathology, Transfusion Medicine, and Molecular Pathology. These electives are tailored to the specific needs and interests of the residents with the approval of the Department Chairman. In general, the elective rotations emphasize the practical application of the skills and knowledge acquired during the initial core rotations. By increased involvement at the managerial levels of the laboratory, broader call coverage, and overall greater service responsibility, the residents become proficient in the daily problem solving required from a competent laboratory director. Although the resident becomes fluent with the quality assurance, quality management, and utilization issues of laboratories in general, special emphasis is placed on the unique requirements of the particular section rotated through.
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