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The Hemato-pathology Laboratory at TMH is accredited by the National Accreditation Board for testing and calibration laboratories (NABL). It provides comprehensive hematology services for hemato-lymphoid malignancies like Leukemias, Lymphomas and Multiple Myeloma. The laboratory utilizes state of art facilities for the diagnosis of hematological malignancies. The policy of the laboratory is to provide reliable, accurate and timely diagnostic services to all our patients and referring clinicians.

The laboratory staff are highly skilled team of medical professionals, scientists, technicians, and supportive staff.

The laboratory has a large workload and processes an average of 700 hemograms and 150 coagulation samples per day. The laboratory also receives 5000 bone marrow aspiration samples annually. This laboratory also analyses 1500 flow cytometry samples in a year. These include assays for immunophenotyping of hematolymphoid malignancies (leukemia and lymphoma), CD34 stem cell enumeration for bone marrow transplants, molecular testing.

Service activities:

The Laboratory is accredited by NABL. The spectrum of services provided include primary diagnosis and monitoring of patients on therapy for hematological malignancies and also the preoperative and postoperative hematological evaluation in surgical patients. The laboratory does more than 200,000 tests annually which include complete Hemogram, coagulation studies, bone marrow examination, flow cytometry and molecular diagnostics. A detailed breakdown is given in the table.

Total number of tests done in hemato-Pathology laboratory in the year 2007

 

Name of the Tests

Total Number

1

Routine Hematology

1,93,405

 

Complete Hemogram

1,74,339

 

Manual Differential Counts/MP/Reticulocyte counts/ RBC Morphology

16,115

 

ESR

2951

2

Coagulation studies

71,130

 

Prothrombin time

35,353

 

Partial thromboplastin time

35,353

 

Fibrinogen degradation products

178

 

Fibrinogen

246

3

Bone Marrow Aspiration Smears

4773

4

Cytochemistry

2273

5

Immunophenotyping

1735

6

Molecular diagnostic Tests (RT-PCR)

2039

7

Body Fluids  for cell counts  & Morphology

1183

 

Trained laboratory staff is also well versed with the quality system manual of the diagnostic services and the quality control methods. Staff takes adequate precautionary measures regarding infection control. Laboratory participates in external quality assurance program for hemogram and coagulation tests. Vacutainers and microtainers are used for sample collection. Turn around time for hemogram test is 2 hours, for coagulation test is 4 hours, for bone marrow reporting is 3 days. Housekeeping and waste management is done as per the hospital waste management policy.

1. Blood collection

Sample collection is done by trained scientific officers, phlebotomists, technicians and nurses. There are two methods for blood collection for hematology tests.

Capillary method (finger prick method) - Microtainer
Blood is usually obtained by pricking a finger. In case of babies, the big toe or heel may be used. Microtainer tubes with flo-top collectors and closure plugs and with a capacity 500ul are used for blood collection by finger prick method.  Anticoagulant used is (K2) EDTA. Specimen can be stored in microtainer tubes (containing EDTA) for up to four hours prior to performing hematological determinations. 

Phlebotomy
The blood is withdrawn from a forearm vein by means of a prevaccumed tube. To minimize the possibility of infection of personnel, evacuated tube system is used for the collection of venous blood.  Tubes may contain anticoagulants in varying concentrations dependent upon the amount of vacuum and the required additives to blood ratio for the tube. The vacuum controls the amount of blood which enters the tube ensuring an adequate specimen for the subsequent tests and the correct proportion of anticoagulant when this is present. EDTA vacutainers are used for routine hemogram testing. Similarly samples are collected in respective containers for Biochemistry, Microbiology and other tests.

The skin is cleaned with spirit and allowed to dry before being punctured. Phlebotomist wears gloves during venipuncture and when handling blood collection tubes to minimize exposure hazard, then selects site for venipuncture, applies tourniquet, prepares venipuncture site with appropriate antiseptic. Thereafter phlebotomist places patients arm in downward position, remove needle shield, and performs venipuncture. Tourniquet is removed as soon as blood appears in the tube. When first tube has filled to its stated volume and blood flow ceases, it is removed from the holder. Used needles and syringes are disposed using an appropriate disposal device. Micro tape /sticker are applied at the puncture site.

2. Bone marrow aspirate and biopsy

Bone marrow procedures are performed by doctors from medical oncology in the minor operation theatre in Room Number 197, Third Floor, Golden Jubilee Building.

What is bone marrow?
In the center of most large bones there is a soft tissue (marrow) that makes all blood cells. Different types of blood cells are red blood cells, white blood cells, and platelets. Biopsy is done using a special needle. A local anesthetic agent is given before starting the procedure to reduce pain.  The bone marrow sample is sent to different labs with requisition forms for microscopic examination, histopathology, immunophenotyping, cytogenetics and molecular studies.

Why do we do it?
It is usually performed for diagnosing the disease or to know the extent of spread of disease (staging). The sample is evaluated in different laboratories for presence of any disease.

What are the common risks associated with this procedure?
As with any surgical procedure, complications can occur, however, these are usually minor and are easily managed. These could be bruising and discomfort, prolonged bleeding or infections near the biopsy site.

Points to note before the procedure:
Physician/phlebotomist will explain the procedure to patient and offer the opportunity to ask any questions about the procedure. Verbal consent is taken before the procedure. Patient must inform physician if he/she is sensitive to or allergic to any medications and anesthetic agents (local and general). Notify physician if there is any history of bleeding disorders or if taking any anticoagulant medications or aspirin. It may be necessary for patient to stop these medications prior to the procedure. Patient may receive a sedative prior to the procedure to help him/her relax. Because the sedative may have side effects like drowsiness, patient will need to arrange for a companion.

How do we do it?
It is performed both as an outpatient and on an indoor basis. A bone marrow biopsy is commonly performed on the pelvic bone (posterior superior iliac spine). In a child, a leg bone may be used. 
In the minor operation theatre (and in the wards), the patient is asked to lie on his side. The skin over the biopsy site is cleansed with an antiseptic solution. As the physician injects a local anesthetic to numb the area, patient feels a needle stick and a brief stinging sensation. A small incision may be made over the biopsy site and the biopsy needle is inserted into the bone marrow. A bone marrow aspiration is usually performed first. The physician uses a syringe to pull a small liquid sample of the bone marrow through the needle. The physician may remove a small, solid piece of bone marrow, called a core biopsy, using a special hollow needle. The biopsy needle is withdrawn and firm pressure is applied to the biopsy site for a few minutes, until the bleeding stops. A sterile bandage/dressing is applied. The bone marrow sample is divided and sent to different laboratories for examination. 
Care after the procedure:
Once patient is out of operation theatre, he is advised to keep the biopsy area clean and dry and leave the bandage in place for as long as instructed by his physician (usually until the next day, when it can be removed at the time of bath). The biopsy site may be tender or sore for several days after the bone marrow biopsy. A pain reliever may be taken. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. Patient must contact physician if he/she develops fever, redness, swelling, bleeding or increased pain around the biopsy site. Patient may resume usual diet and activities unless your physician advises him/her differently.

Report: 
The reports are dispatched to the respective wards/OPDs within the defined turn around time. Hemogram reports are attached to the case files within 2 hours of sample collection

Flow cytometer - FACS Calibur

This instrument helps us do immunophenotyping of peripheral blood and bone marrow samples in cases of leukemia and lymphomas helping us reach a correct diagnosis.

Academic activities:

The laboratory has an active academic program for ( MD) Pathology residents, ( DM) Medical Oncology residents, scientists and technical staff. In addition, qualified pathologists, scientists and UICC fellows from all over country and abroad are provided advanced training as observers. It conducts weekly academic sessions for MD and DM students and also for the technical staff. The laboratory conducts national and international meetings, with staff participation in talks and meetings at other centers.

Each year there are two posts advertised for senior residency in the laboratory starting in February. Minimal qualification is MD Pathology and selection is through a competitive interview. Candidates who wish to join us as an observer for one month may write to Officer In-charge, Hemato-pathology Laboratory with a brief bio-data.

Course Details

Research activities:

The laboratory research is primarily focused on Hemato-oncology, especially incorporating morphology, flow cytometry and molecular techniques, with regular publications in national and international peer reviewed journals. The Laboratory staff participates in conferences and continuing medical education programs thereby fostering greater awareness levels among staff. The laboratory conducts an inter-laboratory comparison program for immunophenotyping by flow cytometry in Mumbai city.

Tests done in the laboratory

Hemogram (complete blood counts), peripheral blood smear, ESR, reticulocyte count, body fluid cell count and morphology, coagulation tests, bone marrow examination, cytochemistry, immunophenotyping and molecular diagnostic tests. Turn around time for hemogram test is 4 hours, for coagulation test is 4 hours, for bone marrow reporting is 3 days.

Referred Samples from Outside Tata Memorial Hospital

Referred Samples for testing are accepted at Referral Counter No.37 at Main building near Private OPD.

Please contact 24177000 Extension: 4362/4367 for any queries regarding referral samples to be sent.

Blood collection is done at following stations

1. Out-patient department (OPD) room No. 33
a) 7th floor room no. 721 Annex building
b) 7th floor room no. 704 Annex building

2. Indoor patients (wards and ICU)

Sample analysis is done at following stations

 

Sr. No.

Location

Test

Timing

 1

Room No 33, Ground Floor, Main Building

Hemogram, ESR of Pvt OPD patients

8.00 am – 4.00 pm (Ext-4117)

 2

Room No 726, 7th Floor, Annexe Building

Hemogram Pvt OPD patients, all inpatients (Non-surgical).  ESR, peripheral blood smears, coagulation studies, body fluid cell count.

9.15 am – 8.00 pm (Ext-4554)

 3

Room No 727, 7th Floor, Annexe Building

Microscopy for peripheral blood, body fluids, bone marrow smears.  Cytochemistry and flow cytometry for surface marker studies (immunophenotyping) of leukemia.

9.30 am – 5.30 pm (Ext-4367,4362)

 4

Emergency Lab, OT complex, Second Floor, Main Building

Emergency hemogram and coagulation studies.

8.00 pm - 8.00 am (Ext-4040)

 

Phone: Department Office Number: (+9122) 24177000 / Ext.No. 4367, 4530, 4529

Address: Department of Hemato-Pathology, 8th Floor, Annexe Building 'B'

TATA MEMORIAL HOSPITAL, Dr.E.Borges Road, Parel, Mumbai-400-012

Maharashtra, India

Fax: Hospital Fax Number: (+9122) 24146937

Email-id: Email-id: hemato@tmc.gov.in

Contact Us

TATA MEMORIAL HOSPITAL
Dr. E Borges Road, Parel, Mumbai - 400 012 India
Phone: +91-22- 24177000, 24146750 - 55
Fax: +91-22-24146937
E-mail : msoffice@tmc.gov.in (for patient care and queries) / hrd@tmc.gov.in(for administrative - HRD matters)

650651 (230)