KGH's Laboratory Services department provides very important tools that are used by health care teams to help make a diagnosis, decisions on treatment and to help monitor diseases in their patients. As a fully accredited, licensed, academic hospital laboratory, KGH's Laboratory Services department provides leadership, education, and research in laboratory medicine across five main disciplines. They are:
- Anatomical Pathology
- Clinical Biochemistry
- Laboratory Genetics
- Clinical Microbiology
The Division of Anatomical Pathology includes the disciplines of Surgical Pathology, Cytology, and Autopsy/Forensic Pathology. As a group, we interpret tissues and/or cells sampled or removed by a physician, using the unaided eye, the microscope, and sometimes by using additional molecular analyses. A specimen (tissues and/or cells) can be removed using a variety of techniques (see below). Our technicians, technologists, and pathology assistants examine and prepare specimens for analysis and the pathologist then examines the specimen. Following the examination the pathologist will make a final diagnosis. This diagnosis is returned to your physician to allow them to tailor your treatment to your particular disease.
Pathologists are specially trained doctors with four years of medical school and a further five years of residency training. Many of our Pathologists also have an additional year of subspecialty training and are experts in a field such as Gastrointestinal pathology, Breast pathology, Genitourinary pathology, and Dermatopathology.
Surgical Pathology specimens are tissue samples taken either through office or clinic biopsies or from patients in the operating room. Each specimen is preserved, then the pathologist's assistant or medical laboratory technologist will examine and dissect the specimen. A Histotechnologist then takes the specimen and embeds it in wax and cuts it into very thin sections. These thin sections are transferred to slides which are then examined under a microscope by a pathologist who makes the final diagnosis.
Cytopathology specimens, rather than being samples of intact tissue (see Surgical Pathology) are collections of individual cells. They can be gathered from body fluids like urine, or from samples gently scraped from a surface like the "Pap" smear, or from fine needle aspirations of mass lesions. These techniques are used because they are less painful and often give very useful information to guide the treating physician. These specimens are examined under the microscope by a cytotechnologist. The cytotechnologist indicates where the abnormal cells are on the slide and the pathologist conducts a final review of these areas and makes the final diagnosis.
Autopsy/Forensic Pathology is a discipline whose primary responsibility is to investigate deaths. The death may have occurred within the hospital or in the wider community and can include death which has resulted from natural disease, or injury associated with accident, suicide or homicide. Like the other areas of Anatomical Pathology, pathologist assistants help the pathologist with detailed examinations. Many other techniques including photography and evidence collection, molecular testing, toxicology, and biochemical and metabolic tests are used when necessary. All of this data is incorporated, by the pathologist, into a sometimes lengthy final report that offers a comprehensive opinion on the cause of death.
The Clinical Biochemistry service is located in the Core Laboratory on the first floor of the Douglas Wing at KGH. Medical laboratory technologists and medical laboratory assistants operate and monitor state-of-the-art instruments which complete most tests in 45 minutes. The laboratory uses strict protocols to ensure all laboratory results are accurate and reliable. Clinical biochemists consult and interpret reports for the diagnosis and management of diseases. We provide a comprehensive service for assessments on:
- Electrolytes and acid-base homeostasis
- Blood gases and pulmonary function
- Liver and kidney functions
- Cardiac profile
- Lipid metabolism
- Minerals and bone metabolism
- Protein investigation
- Endocrine disorders
- Clinical toxicology and therapeutic drug monitoring
- Tumour markers
- Urine and fecal analysis
KGH serves as a regional reference chemistry laboratory for hospitals and institutions across Southeastern Ontario. Following a consultation with a clinical biochemist at KGH, some samples may be sent to another laboratory for special and unusual tests that are required.
Laboratory Genetics at KGH offers services in Cytogenetics and Molecular Genetics. The laboratories offer testing that seeks to identify DNA variants associated with disease, disease risk, response to therapy or disease outcome. The service caters to a broad range of people including expecting or new parents who would like to test their child for the potential of inherited diseases, carrier testing, predictive testing for disease risk, and testing for DNA variants associated with therapy response and risk in a variety of cancers.
The Cytogenetics service focuses on large variants that may include partial or whole chromosome aberrations which may cause inherited disorders (such as Down Syndrome) or may be hallmarks of cancer cells and predict diseases. Offering traditional tests and techniques the laboratory is now beginning to use new technologies to further analyze difficult oncology (cancer) specimens.
The Molecular Genetics service focuses on specific DNA changes within genes, and offers testing for inherited that cause disease (such as Huntington’s) or occur in cancer cells and predict response to treatment. The laboratory uses a combination of traditional technologies and has recently added high throughput next generation sequencing to its capabilities, making it a leader in Ontario.
The Hematopathology Division at KGH is affiliated with Queen’s University Department of Pathology and Molecular Medicine. We provide a wide range of services including morphological interpretation of peripheral blood films and bone marrow examinations, hemoglobinopathy evaluation, blood transfusion services, coagulation testing, flow cytometry, tissue typing and autoimmune disease testing. Molecular diagnostic services and Genetics are also provided. We provide expertise and leadership in Hematological Pathology to our three Kingston hospitals and consultative services for many other hospitals across our region.
Routine and special Hematology testing is performed within the Core Laboratory at KGH. Approximately 600 complete blood counts are performed daily with review of peripheral blood films on abnormal samples. Bone marrow samples are also processed by this lab. Special testing for hemoglobinopathies and enzymopathies is also performed in the Hematology laboratory.
Routine and special hemostasis testing is performed within the Core Laboratory. Routine global assessments of coagulation and anticoagulant monitoring are provided on a 24 hour basis. A variety of special hemostasis assays are performed including the investigation of inherited bleeding disorders and thrombophilia testing. There is special expertise in von Willebrand Disease testing and we are a referral centre for von Willebrand Factor Multimer analysis.
We operate and manage a very active transfusion medicine service that supports a wide range health care including: Cardiovascular Surgery, Neurosurgery, Hematology and Oncology, Pediatrics, Obstetrics and Gynecology, Renal Transplantation, Autologous Stem Cell Transplant and Trauma services for the region. We transfuse approximately 10,000 packed red cell units per-year and act as a referral laboratory for other regional hospitals. Our blood products come to us from the Canadian Blood Services in Ottawa. We also have a Transfusion Safety Officer and a Blood management Program.
Our Immunology service involves three main areas – Flow Cytometry, HLA Tissue Typing and Serology.
Flow Cytometry - The Flow Cytometry department performs a wide variety of testing which includes, tests used for the diagnosis of leukemia/lymphoma, CD4 counts for persons living with HIV/AIDS, primary immunodeficiency investigation, population screens such as HLAB27 for Ankylosing Spondylitis and stem cell testing for bone marrow transplants.
HLA Tissue Typing - The Tissue Typing Lab determines whether a potential organ or bone marrow donor will match the recipient and prevent rejection of a transplant. This is done by using blood for a series of complex molecular tests. After a transplant has been completed the tissue typing lab may be involved in the ongoing monitoring of the transplant to ensure success. Population screens are also done looking for markers of specific diseases.
Serology - Autoimmune disorders are diseases caused by inappropriate immune responses where the body often reacts against its own tissues. Testing for autoimmune disorders by looking for specific antibodies in an individual’s blood is one of the important diagnostic tests which are done in our Serology lab.
Clinical Microbiology encompasses the disciplines of Bacteriology, Virology, and Mycology (fungi). The role of the laboratory is to make a diagnosis of patients with infections. Testing is done using a number of methods ranging from microscopy to complex molecular methods with advanced and sophisticated equipment. Physicians use the data provided by the laboratory to treat their patients with the most appropriate drugs. Services such as Infection Prevention and Control also rely on the Microbiology results to monitor and control the spread of potentially contagious diseases.
Point of Care Testing (POCT)
Point of Care Testing (POCT) is diagnostic test performed near the patient by health care providers (e.g. nurses, respiratory therapists) and is generally conducted on handheld or portable instruments. POCT provides a patient’s clinical team with quick test results, allowing health care teams to make immediate decisions and appropriately treat the patient.
At KGH, POCT is available in many patient areas to test the following:
- Activated clotting time
- Blood gases
- Fecal occult blood
All POCT tests are licensed and the service is fully accredited. Regular annual continuing education, training and quality control programs ensure that POCT results meet the needs and expectations of our patients and their clinical teams.
Laboratory tests are often part of a routine checkup to look for changes in your health. Laboratory test results help doctors diagnose medical conditions, plan or evaluate treatments, and monitor diseases. There are a number of ways that specimen procurement takes place at KGH:
- The phlebotomy team at KGH are trained and certified to collect blood specimens in a safe manner and are found on the various inpatient units as well as in the Emergency Department, the Outpatient Clinic in the Armstrong Wing and in KGH's Cancer and Renal clinics. Phlebotomists are available in the following areas at the following times:
- Armstrong 1 Phlebotomy Room (ext. 4437) - 7:30 a.m. to 4:30 p.m. Monday – Friday
- Cancer Centre Phlebotomy Room (ext. 6868) - 7:45 a.m. to 3:45 p.m. Monday – Friday
- Renal Clinic Phlebotomy Room (ext. 7934) - 8:30 a.m. to 4:30 p.m. - Monday - Wednesday; 12:30 p.m. to 4:30 p.m. – Thursday; 8:30 a.m. to 12:30 p.m. Friday
- Note: Phlebotomy Rooms are closed on Weekends and Statutory Holidays.
- The Armstrong collection centre collects specimens for registered clinic patients seen at KGH. Appointments are not required at the Cancer, Renal or Armstrong locations.
- An ECG is a test that checks for problems with the electrical activity of the heart. ECG technicians perform ECGs on KGH inpatients and KGH registered clinic patients. More sophisticated cardiac testing (e.g. echocardiogram) is performed by the Division of Cardiology.