Under the Microscope
Hospital laboratories are a little like a lab on the popular CSI (crime scene investigation) television shows. They are places where science provides clues to solve mysteries, in this case medical mysteries.
Hospital lab studies help diagnose diseases or rule them out, map treatment plans, measure the effectiveness of medications, and much more. They generate about 80 percent of the diagnostic information that goes into a patient medical chart, yet they can be something of a mystery themselves.
“Everybody knows about having a blood sample drawn, which is the face of our operation,” says Jay Wilkerson, director of Laboratory Services at Community Hospital of the Monterey Peninsula. “But then it seems that sample goes into a ‘black box’ somewhere and the patient doesn’t really know what happens next. The patient goes back to the doctor to find out he or she is anemic, or whatever the results may be. The black box is the considerable operation that goes on behind the scenes to be able to get that result to the doctor.
”What goes on in that black box? The clinical lab part of Laboratory Services runs diagnostic tests on blood, urine, and stools. The purpose may be something as basic as obtaining a cholesterol count or as advanced as determining which antibiotic is best at fighting a specific infection.
At Community Hospital, the work is carried out by a staff spread among the clinical laboratory, pathology, and the Blood Center. Many people come into contact with Laboratory Services through one of its satellite facilities, some through the lab at the main hospital, others at bedside, when a technologist comes to take a sample.
Once a specimen is received for analysis, Wilkerson says, it generally goes into automated testing. In the case of a whole blood sample, for instance, it goes through an instrument that actually counts cells.
“In the old days,” he says, “we looked into a microscope and counted cells ourselves. Most testing has evolved from manual methods to automation, which gives us increased accuracy, standardization, sensitivity, and specificity.”
Technology also has advanced to the point where laboratory testing can be administered at the bedside. This helps quickly provide doctors information they need to diagnose patients unable to visit the lab.
The pathology part of Laboratory Services diagnoses diseases at a cellular level — the mystery-solving similar to CSI.
“For example,” Wilkerson says, “let’s say the patient finds a lump. He goes to see his doctor, who wants to do a biopsy, in which tissue is surgically removed in the office or hospital setting, then that tissue sample is submitted to pathology for evaluation.“
The pathologist starts by preparing a general description of the tissue, which includes its appearance and what part of the body it came from. Next, the tissue is sent to the histology section of pathology, where the sample is prepared for review by a pathologist. Here, the tissue is sliced into fine layers that are put on a slide so the pathologist can study the sample at the cellular level to ascertain whether cancer or some other disease may be present.
“A transformation of the pathology department occurred with the advent of immunological stains,” Wilkerson continues. “We can now attach a stain or dye to a certain marker on a cell and then look at it under a microscope to see if it is recognizable. This helps pathologists determine, for example, what kind of cancer it might be.
“Although we tend to talk in general terms about, for example, breast cancer, in reality there are different kinds of breast cancers that manifest differently. Some are aggressive and some are not; some respond to one kind of treatment, while another will not. The markers take us beyond merely looking at a cell to a more exacting analysis, which aids not only in diagnosis but also in the development of a treatment plan specific to that cancer.”
The third part of Laboratory Services is the Blood Center, which supplies 99.9 percent of the blood needed at the hospital, thanks to blood donations from the community. Through mobile blood drives and visits to the Blood Center at Hartnell Professional Center in downtown Monterey, the public donates about 7,500 pints annually.“It is actually rare among community hospitals anymore to collect their own blood supply,” Wilkerson says. “But this is one of our big endeavors, and it currently costs less than buying blood the way other hospital do and ensures that we have blood when we need it. Donating blood is the ultimate gesture of community, and we’re fortunate that so many of the people who live here are so supportive.”
While the vast majority of Laboratory Services’ work involves humans, it occasionally has been called upon to help study non-human mysteries.“
Our pathology staff has, from time to time, responded to requests to prep tissue specimens for the Monterey Bay Aquarium and its research institute, as well as other research facilities,” Wilkerson says. “We’ve had the gambit of sea creatures, but my favorite was the shrimp antennae. We sectioned shrimp tissue, put it onto a slide and stained it, then gave it back to the researchers to study cellular changes in the shrimp antennae. It’s all very interesting, and one more way we can connect to the community.”