Clinical pathology (US, UK, Commonwealth, Portugal, Italy), Laboratory Medicine (Germany, Romania, Poland, Eastern Europe), Clinical analysis (Spain) or Clinical/Medical Biology (France, Belgium, Netherlands, Austria, North and West Africa...),[1] is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as blood, urine, and tissues using the tools of chemistry, microbiology, hematology and molecular pathology. This specialty requires a medical residency and should not be confused with Biomedical science, which is not necessarily related to medicine.
Contents |
The American Board of Pathology certifies clinical pathologists, and recognizes the following secondary specialties of clinical pathology:
In some countries other subspecialties fall under certified Clinical Biologists responsibility [2] :
Clinical pathologists are often medical doctors. In some countries in South-America, Europe, Africa or Asia, this specialty can be practiced by non-physicians, such as Ph.D or Pharm.D after a variable number of years of residency.
Clinical pathologists work in close collaboration with clinical scientists (clinical biochemists, clinical microbiologists, etc.), medical technologists, hospital administrators, and referring physicians to ensure the accuracy and optimal utilization of laboratory testing.
Clinical pathology is one of the two major divisions of pathology, the other being anatomical pathology. Often, pathologists practice both anatomical and clinical pathology, a combination sometimes known as general pathology. Similar specialties exist in veterinary pathology.
Clinical pathology is itself divided in to subspecialties, the main ones being clinical chemistry, clinical hematology/blood banking, hematopathology and clinical microbiology and emerging subspecialities such as molecular diagnostics and proteomics. Many areas of clinical pathology overlap with anatomic pathology. Both can serve as medical directors of CLIA certified laboratories. This overlap includes immunoassays, flow cytometry, microbiology and cytogenetics and any assay done on tissue. Overlap between anatomic and clinical pathology is expanding to molecular diagnostics and proteomics as we move towards making the best use of new technologies for personalized medicine.[3]
Recently, EFCCLM has chosen the name of "Laboratory medicine specialist" to define all European Clinical pathologists, regardless of their training (M.D, Ph.D or Pharm.D) [4].
In France, Clinical Pathology is called Medical Biology ("Biologie médicale") and is practiced by both M.D.s and Pharm.Ds. The residency lasts four years. Specialists in this discipline are not called "Clinical pathologist" but "Clinical Biologist".[5]
See Medical laboratory.
Microscopes, analysers, strips, centrifugal machines...
The visual examination of the taken liquid is a first main indication for the pathologist or the physician. The aspect of the liquid, in addition, conditions the analytical assumption of responsibility that follow and the validity of the end-results.
The microscopic analysis is an important activity of the pathologist and the laboratory assistant. They have for that recourse to many different colourings (GRAM, MGG, Grocott, Ziehl-Neelsen…). The immunofluorescence, cytochemistry, the immunocytochimy and the FISH are also used in order to look further into the diagnosis.
This stage makes it possible to affirm the character “normal”, tumoral, inflammatory even infectious of the liquid. Indeed, the microscopic examination often makes it possible to identify a causal infectious agent, in general a bacterium, a mould, a yeast, or a parasite, more rarely a virus.
See Automated analyser.
The analysers, by the association of robotics and spectrophotometry, allowed these last decades a better reproducibility of the results of proportionings, in particular in medical biochemistry and hematology.
The companies of in vitro diagnosis henceforth try to sell chains of automats, i.e. a system allowing the automatic transfer of the tubes towards the various types of automats of the same mark. These systems can include the computer-assisted management of a serum library.
These analysers must undergo daily controls to guarantee a result just possible, one speaks about quality control. These analysers must also undergo daily, weekly and monthly maintenances.
A big part of the examinations of clinical pathology, primarily in medical microbiology, use culture media. Those allow, for example, the description of one or several infectious agents responsible of the clinical signs.
Detailed article: Reference range.
|
||||||||||||||