National Pathology Week - 4 to 10 November

Day in the life of Abbey Dixon, Biomedical Scientist

It is difficult to describe a typical ‘day in the life’ in my job when speaking about a 24/7 service since every day is different and there are always new challenges arising. The principle behind clinical biochemistry is determining the concentration of analytes present in blood and other bodily fluids / substances for diagnosing and monitoring disease. In biochemistry, we have a team of biomedical scientists and laboratory support workers working to meet the demands of our service users, processing almost 3,000 samples per day.

As one of the biomedical scientists, a large part of my role is centred around our analysers. Each analyser has a specialised method to accurately and precisely process the patient samples which we receive from across the Trust. One important responsibility includes ensuring that the patient results which we release from the lab are reliable as ultimately, they will be used to guide patient care. We frequently process and interpret quality controls on our analysers to verify that we can trust the results which they are producing. Additionally, we perform regular maintenance and participate in external quality control schemes to guarantee that our analysers are performing optimally and working as they should. 

Above are pictures of one of our Siemens Advia Chemistry XPT analysers, part of our automation section. Our automation analysers provide the testing capabilities for more than 90 different assays, running some of our most important tests such as renal, liver and bone profiles, CRP and high sensitivity troponin I (TNI). Essentially, these analysers are why we can provide a continuous laboratory service. 

Around the time spent looking after our analysers, some other responsibilities include telephoning critically abnormal patient results, answering telephone queries, processing additional testing requests, and overall helping the lab to process patient samples quickly without compromising reliability. 

If you have ever visited the pathology reception, you most likely have seen our Aptio Track Automation System which greatly benefits the lab by speeding up our turnaround times for results. This technology takes the bulk of our workload by carrying samples to the relevant analyser for testing, assisting workflow by managing samples both pre and post analysis, and even prioritises those samples which are urgent over routine.  

Although this insight has been focused on working with our automation system, the other aspects of biochemistry cannot be undermined. With HBA1c, xanthochromia, osmolality, immunology testing, and the myeloma screening plus more, biochemistry is always busy.

To finish, I would like to take this opportunity to thank all pathology staff for their consistent hard work behind the scenes of the hospital, and particularly thank the Biochemistry Team for their support since I first started here as a placement student during the height of Covid-19, I am honoured to be part of the department.  

Happy National Pathology Week! 

Point of Care Testing (POCT)

Point of Care Testing (POCT) is a vital part of the patient testing process throughout the hospitals. Whilst most samples and specimens are generally processed within the individual pathology departments, POCT is associated with analysis of samples at the point of care of the patient. This involves the use of a variety of devices and analysers that range in size and function, from simple handheld meters only slightly bigger than your phone, to blood gas analysers that can be found on benchtops across a number of wards. Availability of these devices allows for the testing to be brought to the patient, carried out by trained staff members on each ward, instead of waiting for results to be produced from lab analysis. 

Owing to the nature of the tests that were initially developed, POCT started life as an offshoot of clinical chemistry, which was also the case at WHH. Over time however, as research continues into POCT, various other tests from other pathology disciplines can now be offered in a POCT format, allowing for a broad range of tests to be carried out closer to patients. Some of the tests offered by the POCT team at WHH include glucose and ketone, blood gas analysis, urinalysis, HbA1c, and international normalised ratio (INR), amongst others. Several other devices and tests are currently being validated for use, which may offer future analysis of inflammatory and cardiac markers. These developments into other areas of biomarker monitoring show the ever-evolving nature of POCT, and how advancements in technology can bring the testing outside of the lab.

POCT at WHH is based in the Clinical Chemistry Department of Pathology, and consists of a POCT coordinator and two associate practitioners. We look after over 180 POCT devices and analysers that are in use across both Warrington and Halton hospital sites, ensuring that the devices work to the correct standards and assisting with any issues where needed. We also offer training sessions for all POCT devices, and any staff member who might need to use these devices for patient care can be trained- no limits!

What is Histopathology?

Histopathology is the diagnosis and study of diseases of the tissues, and involves examining tissues and / or cells under a microscope. Histopathologists are responsible for making tissue diagnoses and helping clinicians manage a patient's care.

We can use different types of stains to highlight different structures within human tissue to help the pathologist diagnose the patient.

When the sample is received into the histopathology laboratory, we cut it into smaller pieces, process it on machines that remove water from the tissue and replace that water with wax.

Wax provides support to the tissue that we then slice very thinly (approximately 3µm sections). Those sections are placed on the glass slide that goes through the staining process to highlight all the structures within tissue. The most routine staining used in histopathology laboratory is Haematoxylin and Eosin staining. It gives the pathologist overall overview of the tissue. Once the stained slide is microscopically or digitally reviewed, different stains can be requested by the pathologist to help them diagnose or treat the patient. 

We use variety of stains – immunohistochemical (for example ER, PR HER2 for breast tissue to help guide the patient treatment) or special (for example ZN that highlights presence of TB bacterium or Grocott that highlights presence of fungal infection). Tissue can also be sent for genetic testing for further analysis.

Working in histopathology department is very exciting. No two samples are ever the same, and no two stained slides are ever the same.

And with the new technology coming into the pathology we also use a digital scanner to review stained slides for patient diagnosis. So we are moving with the future and reviewing slides not only through the microscope but also on big screens which is very exciting.

There is even a possibility to use AI in the future to help the pathologists diagnose patients even faster.

Haematology overview

Haematology is available 24 hours a day, every day and is split into three sections:

Transfusion - Provides blood and blood products for patients.

Automated Haematology - Identify patients with conditions such as anaemia and leukaemia by looking at abnormal blood cells or raised / reduced blood cell numbers. 

Coagulation - Diagnoses patients with clotting disorders and monitors patients on anticoagulants (blood thinners).

Haematology in action

A patient is bleeding in theatre. Major haemorrhage. 

Transfusion identifies the patient’s blood group and issues red cells to replace the blood loss, with fresh frozen plasma, platelets and cryoprecipitate to help the patient stop bleeding. 

Automated haematology monitors the patient’s haemoglobin level and platelet numbers to assess whether further red cells and platelets are required.  

Coagulation monitors the patient's clotting and fibrinogen status to assess whether further fresh frozen plasma or cryoprecipitate are required.