Clinical Laboratory Division

Introduction
The Clinical Laboratory has two divisions, namely, the clinical pathology and physiologic testing divisions. The clinical pathology division is composed of seven sections: 1) urinalysis, 2) immunology and tumor markers, 3) biochemistry and endocrinology, 4) hematology, 5) bacteriology and molecular diagnostics, 6)molecular hematopathology and 7) blood banking. The physiologic testing division has four sections: 1) ultra-sonography (US), 2) electrocardiography, 3) electroencephalography and 4) respiratory function. Each of these sections of the Clinical Laboratory help clinicians in their routine patient care by providing laboratory data.

Routine Activities
Nine doctors, 34 medical technologists, and 4 assistants are engaged in the routine service at the clinical pathology and physiologic testing laboratories. Meetings for laboratory management are scheduled from monthly to several weekly for the purposes of staff-education and quality control of the laboratory tests.
The Clinical Laboratory Division provides an important service as one of the in-hospital diagnostic divisions by examining routinely submitted laboratory specimens and screening for various disorders. Various urgently required tests are also conducted to help internists and surgeons in making therapeutic decisions. A large number of specimens for tumor markers or other tumor-associated tests are routinely submitted to the laboratories in this division. Evaluations of new tests are also performed in these laboratories.
The blood-drawing section accompanied by a satellite laboratory is located near the outpatient clinic. In this satellite laboratory, 3 full-time technologists draw blood, analyze blood samples, and report complete blood counts (CBC).
A laboratory automation system was introduced to the sections of biochemistry and endocrinology, immunology and tumor markers in 1999. Under this system blood specimens are automatically checked in, picked up and analyzed. Further, specimens for other automated analyzers are delivered automatically. Currently most of the tests are processed and their values are determined with automated analyzers. With these automated systems, technologists are freed to improve quality and quantity of routine laboratory tests.
The bacteriology section has two subdivisions: a traditional bacteriology section and a molecular diagnostics section. In the traditional section, cultures for identifying infectious agents are prepared and this section is also active at hospital infection control. In the molecular diagnostics section, detection of infectious agents is done with regular polymerase chain reaction (PCR), quantitative PCR, and direct sequencing. Additionally, quantitative chimerism analysis with the technique of short tandem repeat PCR is under optimization.
In the molecular hematopathology section, at least seven PCR based protocols and five southern blot based protocols are utilized as routine tests for detection of the various hematologic malignancies. Additionally, the technique of fluorescent in situ hybridization (FISH) is under optimization for future routine service.
The goal of the blood banking section is to verify blood types, to screen for irregular antibodies, and to supply blood related products promptly and effciently. One technologist at this section helps at collecting patientsi peripheral stem cells.
In the physiologic testing laboratory, US (ultra-sonography) is an indispensable modality in image diagnosis for the detection of the disorders of abdominal organs, breast, and thyroid gland. Also US examinations are frequently performed before and after chemotherapy or surgery.

Research Activities
Several research activities are being done by both medical technologists and doctors.
Under the strong demands for medical laboratory standardization and quality control, one government-aid program is in progress. The goal of this program is that every National Hospital clinical laboratory can provide well standardized and quality controlled laboratory tests.
On the clinical front, more prompt and patient oriented bedside laboratory tests are needed. For this purpose, the concept of point of care test (POCT) was introduced in the medical laboratory. In this laboratory, several medical technologists are now trying to find how to introduce new apparatuses based on this POCT concept to this hospital.
In the section of Immunology and tumor-markers, there are a number of ambiguities in routine test results because of the technological limitations of antibody-antigen based reaction. To overcome this problem, several members of this section are now researching a great number of test results and analyzing them statistically. The goal of this attempt is to clarify the key problems. A few tests have been greatly improved as a result this activity.
In addition to these activities, several collabo-rations are in progress. A breast cancer based program and a couple of stem cell transplantation based programs are in progress within in-house collaboration. A quantitative virus detection program is in progress with other universities in Japan. A tumor marker improvement program is also in progress in collaboration with a company in the laboratory medicine field.
We are continuously working to provide more useful laboratory information and services and to create more effective laboratory procedures.

K. FURUTA
R. TSUCHIYA

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