Introduction to Pathology

Lourdes T. M. Dominguez, MD, DPSP Faculty of Pharmacy University of Santo Tomas

Definition of Terms
Pathology
Greek pathos = pain and logos = study  Also called pathobiology  It is a form of science and a branch of medicine that involves testing samples and diagnosing physical health problems from their evidence.


Definition of Terms
Pathology


Study of the nature, causes, processes, development, consequences of disease and the modifications in cellular function and changes in cellular structure produced in any cell, organ, or part of the body by disease.  Pathology addresses 4 components of disease:
1. Cause/etiology 2. Mechanisms of development (pathogenesis) 3. Structural alterations of cells (morphologic changes) 4. Consequences of changes (clinical manifestations)

Definition of Terms
**The microscope is an important factor in detecting tissue changes, especially in the examination of small sections of tissue removed for diagnosis; for this reason real progress in pathology was not made until the 19th century.

Definition of Terms
Pathogenesis


The development of a diseased or morbid condition.

Pathologist


A physician who interprets and diagnoses the changes cause by disease in the body. A physician who interprets and diagnoses the changes cause by disease in the body.

Definition of Terms
Pathologist
A specialist physician expert in the origin and development of disease and the microscopic analysis of body tissues.  A doctor who studies all aspects of disease with an emphasis on the nature, causes, and development of abnormal conditions, as well as the structural and functional changes that result from disease processes.  The laboratory expert behind the front-line clinical team.


Definition of Terms
Medical Technologist


An Allied Health Professional who performs diagnostic analysis on human blood, urine, and body fluids such as cerebral spinal fluid, peritoneal, pericardial, and synovial, as well as other specimens such as stool and sputum.

Definition of Terms
Autopsy
In Greek, a seeing for oneself : auto-, auto- + opsis, sight  Also called necropsy, postmortem examination.  Systematic examination of a cadaver for study or for determining the cause of death.  Uses many methodical procedures to determine the etiology and pathogenesis of diseases, for epidemiologic purposes, for establishment of genetic causes, for family counsel, and for improvement of safety standards for the living.


Definition of Terms
Biopsy


Examination of cells or tissues from a living organism. Excised material may be studied in order to diagnose disease or to confirm findings of normality. Incisions may be made and total or partial lesions removed in the form of wedges or cylindrical pieces, or scrapings of the surface membranes of internal organs may be collected. Tumors are routinely biopsied in order to determine whether they are benign or malignant.

Divisions of Pathology
I. Gross Pathology & Microscopic Pathology II. Anatomic Pathology III. Clinical Pathology

I. Gross Pathology & Microscopic Pathology

Gross Pathology


The recognition of disease based on macroscopic examination of surgical specimens generated at the time of surgery or at autopsy.

Microscopic Pathology


The recognition of disease based on microscopic examination of surgical specimens generated at the time of surgery or at autopsy.

II. Anatomic Pathology

Anatomic Pathology
The study of changes in the function, structure, or appearance of organs or tissues, including postmortem examinations and the study of biopsy specimens.  Sections: A. Surgical Pathology B. Autopsy Pathology C. Exfoliative Cytology


II. Anatomic Pathology

A. Surgical Pathology
The pathology of disease processes that are surgically accessible for diagnosis or treatment.  The study of gross appearance and histology of tissues removed during surgery.


II. Anatomic Pathology

B. Autopsy Pathology
It involves the external and internal examination of a human body after death.  The study of gross appearance and histology of tissues removed following death.


The most important task is to identify the cause of death.

II. Anatomic Pathology

C. Exfoliative Cytology
Also known as cytopathology  The study of desquamated cells from a body surface or lesion to detect malignancy.  Cells are collected from lesions, sputum, urine, secretions or any body fluid accumulation.  The cells may be collected through aspiration, brushing, washing, smear and scraping.


III. Clinical Pathology

Clinical Pathology


The branch of general pathology directed to the diagnosis and monitoring of diseases through the examination of blood, body fluids, secretions, and tissue biopsy specimens for chemical, morphological, microbiological, and immunological abnormalities.

III. Clinical Pathology

Identifies and interprets changes that characterize different diseases or disease states in cells, tissues, and fluids of the body  Monitor the metabolic status of patients under medical therapy  Decipher specific markers that characterize individual patients for purposes such as transfusion or transplantation


III. Clinical Pathology

A. B. C. D. E. F.

Clinical Chemistry (incl. Toxicology) Hematology Clinical Microscopy Blood Banking (incl. Transfusion Medicine) Microbiology Clinical Immunology & Serology

III. Clinical Pathology

A. Clinical Chemistry (incl. Toxicology)


Division of clinical pathology involving biochemical analysis performed on human samples (blood, fluids, tissues) outside the body (in vitro).
Substances which could be assayed include sugars, lipids, proteins, antibodies, enzymes, hormones, vitamins, metals, electrolytes.

III. Clinical Pathology

A. Clinical Chemistry (incl. Toxicology)
Methods employed are spectrophotometry, fluorometry, enzyme kinetics, enzyme immunoassay (EIA), electrophoresis, flame photometry, ion selective electrodes, HPLC, gas chromatography, mass spectrometry, and atomic absorption spectrometry. Most instruments are however almost completely automated.

III. Clinical Pathology

A. Clinical Chemistry (incl. Toxicology)
In the toxicology subsection, the blood, urine, and other body fluids are analyzed for the presence of drugs and substances of abuse.  An equally important application of toxicology testing is to measure the blood levels of therapeutic drugs to assure that concentrations are adequate to treat the disease but not so high as to cause toxic side effects.


III. Clinical Pathology

B. Hematology
Involves assessment of the cellular elements (red blood cells, white blood cells, and platelets) in blood samples.  The blood cells may be enumerated, either by manual cell-counting techniques or by automated particle-sensing and particle-sizing instruments.


III. Clinical Pathology

B. Hematology


Microscopic observation of stained peripheral blood smear is limited to assessing the morphology of atypical cells as they may appear in cases of dysplastic syndromes and overt leukemias.

III. Clinical Pathology

B. Hematology


Pathologists specialized in this field i.e. hematopathologists also examine bone marrow and lymph node biopsies. They are expert in the field of anemia, leukemia and lymphomas.
In complicated cases where the diagnosis of a hematological disorder cannot be made by study of the peripheral blood smear, a bone marrow examination may be necessary.

III. Clinical Pathology

C. Clinical Microscopy
Deals with the processing and analysis of body fluids such as urine, stool, CSF etc.  The laboratory identification of parasites involves detecting microscopically the typical forms in body fluids and secretions


III. Clinical Pathology

D. Blood Banking (incl. Transfusion Medicine)
Also called Immunohematology  Deals with collection, storage, compatibility and safety of blood and its various components for the purpose of human transfusion.


III. Clinical Pathology

D. Blood Banking (incl. Transfusion Medicine)
Specific tasks include: 1. Blood collection after donor screening 2. Chemical and serologic tests to exclude transmission of infective diseases 3. Component preparation and proper storage 4. Blood typing, screening for antibodies against red cells and compatibility testing 5. Immunophenotyping of blood cells 6. Investigation into transfusion reactions

III. Clinical Pathology

D. Blood Banking (incl. Transfusion Medicine)
Specific tasks include: 7. Apheresis & Plasmapheresis  A procedure where plasma or platelets can be separated from the withdrawn blood and the formed elements (red cells and platelets).

III. Clinical Pathology

E. Microbiology


A division of clinical pathology involved in isolation, culture, and identification, of microorganisms (parasites, fungi, bacteria & viruses) in biological samples. In addition to conventional microscopic and biochemical methods for identification, DNA/RNA based assays (including PCR) and immunoassays are increasingly being used.

III. Clinical Pathology

E. Microbiology
Subdivisions include bacteriology, parasitology, mycology (fungi) and virology.  Presumptive identification of microbes can be made by microscopically examining direct mounts of an appropriate portion of the specimen or thin smears that have been stained with one of a variety of dyes.  Rapid presumptive diagnoses can also be made by directly testing specimens with a variety of immunological reagents.


III. Clinical Pathology

E. Microbiology


Specimens are applied to the surface of a variety of agar culture media for the purpose of recovering in pure culture any bacterial species that may be clinically significant. Gram stains may determine the cellular morphology and staining characteristics of the bacteria, and a variety of rapid, direct tests can be performed to provide an early identification.

III. Clinical Pathology

E. Microbiology


Bacterial identifications and antibiotic susceptibility tests may be performed in a variety of packaged systems.

III. Clinical Pathology

E. Microbiology
The laboratory identification of fungi and the diagnosis of fungal infections is similar to that described for the bacteria.  Specimens are inoculated on special fungal media, the plates are incubated for periods as long as 4 weeks, and the growth of any mold or yeast is identified morphologically and biochemically.  Nucleic acid probes are available to quickly confirm any fungus colony suspected of being one of the dangerous pathogens


III. Clinical Pathology

E. Microbiology
Viruses can live only in viable cells and, for the most part, can survive briefly outside human or animal hosts.  Culture techniques must use embryonated eggs, cell culture suspensions, thin cell sheets called monolayers, or laboratory animals.  Species of viruses are identified by observing their ability to produce certain cytopathic effects in the cells where they are growing or to cause recognizable diseases in laboratory animals.


III. Clinical Pathology

F. Clinical Immunology and Serology
The discipline in which infectious diseases are diagnosed by detecting antibodies in serum and other body fluids.  In practice, immunologic and serologic techniques are used to diagnose an infectious disease when the agent may be too difficult to recover in culture.


The Medical Technologist's Role in the Healthcare Process

A Medical Technologist's role in the healthcare process is to provide accurate results in a timely manner.  These results will ultimately be used to help make a diagnosis or monitor treatment.


The Medical Technologist's Role in the Healthcare Process



Observe details of cells, ova and cysts of parasitic infections. Test whether the blood of the donor is compatible with the blood of patient-recipient. Utilize special stains to identify microorganisms. Measure substances in blood and other body substance

The Medical Technologist's Role in the Healthcare Process

    

Reagent preparation Collect specimen for study Preparation of specimen Quality control Water testing

End of Presentation