Seventy percent of hospital diagnoses rely on scientists in pathology

Their tests and examinations on organs, tissues and bodily fluids help determine the diagnosis, how the patient is treated and ultimately, the prognosis.

Pathology involves biochemistry, haematology, blood transfusions, histology, cytology and microbiology.

The staff in the department at Salisbury District Hospital include 22 medical laboratory assistants (MLAs), two associate practitioners, 42 biomedical scientists, eight Biomedical Scientist (BMS) team leaders, who run sections of the lab, seven BMS laboratory managers, 12 phlebotomists, seven anticoagulant nurses, a transfusion nurse practitioner, three anatomical pathology technicians, two bereavement officers, two trainee doctors, five consultant pathologists and eight medical consultants.

Each of the biomedical scientists at the hospital specialise in one of the disciplines after completing a degree in biomedical science or healthcare science. Working alongside the scientists are the MLAs who can come into the field straight from GCSEs with qualifications in maths, English and science and can go onto gain an NVQ qualification and a foundation degree.

They do much of the preparation work in processing samples for analysis, assisting with analysers and equipment.

Pathology services manager Lee Phillips spent two years working in histopathology at Barts Hospital in London while doing a degree in biomedical science. He went onto study a masters in clinical biochemistry, working at the Royal Berkshire hospital before becoming the laboratory manager in the biochemistry department in Salisbury and then the pathology services manager 18 months ago.

He said: “Pathology is an absolutely fascinating subject. Most patients will have an interaction with the pathology department at some stage in their diagnosis or treatment."

"Many patients are monitored long term by the various teams in the pathology department, patients on anticoagulants for example.

“For anyone thinking of a career in this area, you need to have an interest in science and medicine, particularly human biology or chemistry, and want to find out how the body works and how all the systems work together.

“An attention to detail is important as is precision and accuracy.”

The Blood Science department 

The Blood Science department (Biochemistry, Haematology and Blood Transfusion) is called the department of Laboratory Medicine in Salisbury. It offers a vital service to the patients inside and outside the hospital. Tests are often required in an emergency and so the department works 24-hours-a-day seven-days-a-week with biomedical scientists working at all times of the day and night.

Biochemistry, Haematology and Blood Transfusion is the largest area within Pathology at the hospital with around 34 scientists and ten MLAs.

Biochemistry involves measuring the different chemical constituents of blood and body fluids such as hormones and cardiac markers. Also things like renal and liver function can be accurately assessed.

Haematology involves looking at the components of blood such as blood cells, measuring haemoglobin, cell morphology and blood clotting factors.

“If a patient is going for an operation, it’s important to know their blood clotting and haemoglobin is normal,” Lee says.

“They could potentially lose blood during the operation and if they have abnormal blood clotting, it may affect how the replacement blood is given.

“A lot of patients are on Warfarin which acts as a blood thinner. If you have had a heart attack, for example, Warfarin helps to take pressure off the heart and the vascular system by reducing the viscosity of the blood.

“We check the effects of this by looking at blood clotting.”

Scientists also look at cross-matching blood before transfusions are given. Blood transfusions can be given for many reasons including patients involved in trauma such as car accidents or surgery like hip operations.

“We make sure the blood matches as closely as possible," Lee says. "If not, it can be fatal - if the wrong blood group is used or an antibody is present, it can cause a serious reaction with the patients immune system.

”Similarly the scientists in the biochemistry department can check that patients’ kidneys, liver and other vital organs and systems are working as they should.

* Around 15,000 people a year will visit the hospital to have their blood taken by a phlebotomist.

The team of 12 phlebotomists are divided into two with one team working with GP patients and outpatients, and the other going onto the wards everyday to take blood from patients.

Once blood has been taken, samples go straight to the blood science department for analysis. Urgent samples are analysed within an hour, hospital samples within four hours and other routine tests by the end of the day. 

Histology and cytology

Histology and cytology involves the study of tissues and cells. Biomedical scientists examine samples from operating theatres and clinics within the hospital, as well as simple operations carried out in some GP practices.

“An example would include where a patient finds a lump or bump that their doctor thinks may be suspicious," Lee says. "This lump could be taken out in an operation and sent to the histopathology department for examination. The tissue would be dissected and very thin sections cut so that it can be viewed under a microscope.

"Microscopic examination would reveal what is causing the lump. The histopathology team would be looking for conditions such as cancer or inflammation.

“Within cytology, we look at individual cells to see if there any abnormal changes in them. Examples include looking at the cells in urine, sputum or bronchial (lung) washings. Cells are spread onto slides, stained and viewed under the microscope in a similar way to Histology (tissue) samples.”

Pathologists also do post-mortems on a daily basis, looking at the external appearance and internal organs to identify a cause of death.

There are around nine scientists and seven MLAs at the hospital working in Cellular pathology (Histology and Cytology).

Microbiology

The causes of infection are examined by 11 scientists and seven MLAs working in microbiology.

“Using the example of a urinary tract infection,” Lee explains, “we would take a urine sample that has been sent to us and carefully spread a small amount onto a culture plate, incubate it overnight to see what bacteria grow.

“We would look at whether the type of bacteria is abnormal or pathogenic and test it to find which antibiotics it is sensitive, or resistant, to - the findings are then passed onto doctors to allow for accurate treatment.”

It is important to know what type of bacteria is causing the infection so it can be treated most effectively.

Viral infections such as hepatitis are also diagnosed in this department.

Most of the viral assays use blood samples and modern techniques such as polymerase chain reaction which looks at viral DNA. Using these techniques viral infections can be diagnosed quickly and accurately allowing patients to start treatment as soon as possible.