Technology & Procedures
Our Core Lab, located in the hospital, is a state-of-the-art facility utilizing the latest in automation and technology. A major laboratory renovation project, which was completed in the Spring of 2010, has resulted in a laboratory that features the newest, most up-to-date analytical instrumentation and equipment.
The menu of tests that are performed in the laboratory has been greatly expanded, thus providing better service to our patients and physicians.
Our laboratories are staffed by a group of physicians (University Pathologists) with subspecialty expertise in Surgical Pathology, Clincal Pathology, Cytopathology, Urologic Pathology, GI Pathology, Hematopathology, Dermatopathology and Molecular Pathology.
The Core Lab operates 24 hours per day, 365 days per year.
An Administrative Director oversees laboratory operations, seven departmental supervisors, as well as more than 80 medical technologists, phlebotomists, and laboratory support personnel.
The Blood Bank provides blood components and performs laboratory testing for the 213 bed hospital with level 2 trauma responsibility. The quality of a blood bank can be no better than the quality of its staff. We are very proud of our 9 supervisor/ technologists having over 150 years of combined experience.
The Blood Bank is currently using the tube technique and gel technology to perform ABO typing and antibody screening (indirect antiglobulin test) for unexpected antibodies on over 8,000 samples per year. When a blood type and antibody screen are ordered together, the testing is referred to as Type and Screen.
The identification of unexpected anti bodies detected by the screening test is routinely performed in the event that the patient requires transfusion. Antibodies of this sort are generally identified using a panel of reagent red cells whose antigen expression is known. Several other confirmatory procedures may be employed if the panel workup is inconclusive.
Compatibility testing is done for approximately 10,000 red cell transfusions per year. A crossmatch is performed by combining the patient’s plasma with donor red cells and examining for agglutination.
DATs, more commonly called Direct Coombs, also take place in the Blood Bank. Samples of anticoagulated whole blood submitted for Coombs testing will be screened with a polyspecific antiglobulin test. If the sample is positive we then test with monoclonal reagents anti- IgG and anti- C3d. If the IgG is positive and there is evidence of accelerated red cell destruction, warm auto immune hemolytic anemia may be present. If the C3d alone is positive then the presence of a warm autoimmune hemolytic anemia is unlikely. The C3d may indicate the presence of an IgM but is not conclusive.
The blood bank routinely performs blood typing and a DAT on umbilical cord blood for newborns. If an Rh negative mother has had an Rh positive newborn, the mother’s blood is tested for the presence of fetal blood by the erythrocyte rosette test. If this test is positive the amount of feto-maternal hemorrhage is quantified using the Kliehauer-Betke method. The results of these tests can be used to determine how many vials of Rh immune globulin could be needed.
The Blood Bank also prepares fresh frozen plasma, cryoprecipitate and platelets for transfusion. FFP and cryoprecipitate are used in the treatment for deficiencies of coagulation factors. Platelets are transfused when there is excessive bleeding and a decreased platelet count or platelet defects.
The Hematology department is composed of three primary areas of testing: Hematology, Coagulation, and Urinalysis, and two sub-specialty areas: Special Coagulation and Immunology. Backus Hematology team members test over 800 samples per day utilizing state-of-the-art technologies and instrumentation.
The study of hematology is a crucial aid in diagnosing blood disorders, and monitoring disease treatments. The Main Hematology lab performs complete blood count (CBC) with cell differentials, reticulocyte counts, and erythrocyte sedimentation rates. Team members review blood slides to provide vital information to the physician for proper diagnosis and treatment of the patient.
The Hematology lab operates 24 hours per day, 7 days per week for routine and stat testing.
Additional tests performed by the Hematology lab include: cell counts and cell differentials on body fluids, crystal identification, semen analysis, and the preparation of bone marrow aspiration for pathologist review.
The Coagulation lab provides testing to monitor patients on coagulation therapy and assess the patient’s coagulation status. Testing includes PT, aPTT, Fibrinogen, Thrombin time, and Anti-Xa. Test results for the PT test allows the physician to monitor the patient’s Coumadin levels and monitor the extrinsic (or tissue factor) and common coagulation pathways. Test results for the aPTT test monitor the intrinsic (or contact activation) coagulation pathway. Patients receiving heparin and Lovenox are monitored using Anti-Xa. The Anti-Xa is used solely to measure patients receiving these medications. The coagulation section operates 24 hours per day, 7 days per week for routine and stat testing.
Additional tests performed by the coagulation lab include: mixing studies, platelet function testing, fibrin degradation products, and d-Dimer testing. All of these tests provide vital information to the physician for proper patient diagnosis.
The Urinalysis lab tests a patient’s urine for infection and/or kidney disease. Testing consists of: macroscopic evaluation, dipstick, or chemical analysis and when necessary microscopic evaluation of urine cellular components. The urinalysis section operates 24 hours per day, 7 days per week for routine and stat testing.
Additional tests performed by the urinalysis lab include: urine HCG, and evaluation of eosinophils in urine.
The Special Coagulation lab performs specialized coagulation assays to evaluate patients’ coagulation factors. This section operates Monday through Friday 7am – 300pm.
The Immunology lab performs basic ELISA testing providing the physician with timely patient results to aid in the diagnosis of autoimmune diseases. Additional areas of testing are currently being evaluated for future implementation.
The Backus hematology team members are a diverse group of medical technologists, providing the clinical lab and hospital staff with valuable expertise in the area of Hematology.
The Clinical Chemistry Department generates over 1.5 million tests results per year. The majority of these tests are performed on the latest available, state-of-the-art analyzers. Our newest acquisition is the ROCHE COBAS 6000 for high volume automated chemistry and immunoassay testing. During the next year we will be introducing front-end automation to the ROCHE analyzers to enhance our efficiency and provide more timely response to our physicians.
The Clinical Chemistry department also performs infectious disease testing on the ORTHO ECiQ analyzer, performing more than 10,000 tests per year. This analyzer allows us to provide routine test results faster for better patient care and treatment.
The staff of the Clinical Chemistry Department is comprised of a group of Medical Technologists with a collective experience of over 250 years in the field of laboratory medicine.
We also perform electrophoresis testing on the HELENA SPIFE 3000 for serum and urine testing. This testing requires our technologists to use techniques that involve a high degree of skill and complexity in order to provide detailed reports for interpretation by our Pathologists. Many other manual tests are also performed in our Clinical Chemistry department.
We are dedicated to providing our community with high quality results in a timely manner.
The Microbiology department is located on the first floor of the A-wing and is open 24 hours per day, 7 days per week, including weekends and holidays. Microbiology is a continuously changing field as organisms become more resistant to antibiotics and new technologies are implemented to give faster, more accurate results.
Services provided include gram stain and bacterial culture, fungal culture, rapid testing for Influenza and RSV, limited Mycobacterial testing, Ova and Parasite detection in stool, various Rapid Antigen testing, and Clostridium difficile toxin assays.
We perform over 5000 tests a month on both an inpatient and outpatient basis. Some of our technologists have been in the field for over 20 years and are a source for a wealth of knowledge.
In our serology area we perform nucleic acid hybridization for the detection of Gonorrhea and Chlamydia, RPR testing for Syphilis, Western blot for Lyme disease and Anti-nuclear Antibody titers by IFA.
Point of Care Testing
At The William W Backus Hospital Point of Care Testing is under the direction of the medical director of the laboratory and limited to the tests listed in the Point of Care Testing Manual.
Point of Care Testing POCT- A term used to describe laboratory testing performed at or near the patient site, usually by non-laboratory employees (e.g., nurses, respiratory therapists, PCT’s). The central criterion of POCT is that it does not require permanent dedicated space. Examples include kits and instruments that are hand carried or otherwise transported to the vicinity of the patient for immediate testing at that site.
Currently approximately 118,200 tests are performed annually at the point of care by 861 certified operators.
Mandatory Compliance by all health care providers is required; non compliance will result in elimination of the test sites or disapproval of user. The use of each point of care test (screening, diagnostic or monitoring is listed in the procedure for the test).
POC testing is regulated by the government and is inspected by JCAHO and CAP.
Quality Assurance Department
The William W. Backus Hospital laboratory has a documented quality management program that systematically ensures the quality of all laboratory services. The laboratory quality management program is fully integrated with the hospitals institutional program.
The QM program includes key indicators such as patient /specimen identification, test order accuracy,stat test turnaround time,critical value reporting, customer satisfaction, specimen acceptability, corrected reports, blood component wastage and blood culture contamination.
The overall quality control program for the laboratory includes policies and procedures for ongoing monitoring of QC materials establishment of tolerance limits for control testing assignment of responsibilities and corrective actions based on QC data.
The Histology and Cytology Laboratories at the William W. Backus Hospital utilize state-of-the-art equipment to provide the highest quality Anatomic Pathology services.
University Pathologists LLC provides access to a large number of board-certified subspecialists with expertise in surgical pathology, cytopathology, autopsy pathology, cytogenetics, molecular pathology, hematopathology, dermatopathology, genitourinary pathology, and GI pathology.