Clinical pathology 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 tissue homogenates or extracts using the tools of chemistry, microbiology, hematology and molecular pathology. This specialty requires a medical residency.

Pathology is the medical specialty concerned with the study of the nature and causes of diseases. It underpins every aspect of medicine, from diagnostic testing and monitoring of chronic diseases to cutting-edge genetic research and blood transfusion technologies. Pathology is integral to the diagnosis of every cancer. Pathology plays a vital role across all facets of medicine throughout our lives, from pre-conception to post mortem. In fact it has been said that “Medicine IS Pathology”

Pathologists are specialist medical practitioners who study the cause of disease and the ways in which diseases affect our bodies by examining changes in the tissues and in blood and other body fluids. Some of these changes show the potential to develop a disease, while others show its presence, cause or severity or monitor its progress or the effects of treatment.

Cytology is the study of individual cells and cytopathology is the study of individual cells in disease. Sampled fluid/ tissue from a patient is smeared onto a slide and stained (see techniques). This is then examined under the microscope by the anatomical pathologist to look at the number of cells on the slide, what types of cells they are, how they are grouped together and what the cell details are (shape, size, nucleus etc). This information is useful in determining whether a disease is present and what is the likely diagnosis.

Cytology is most often used as a screening tool to look for disease and to decide whether or not more tests need to be performed. An example of screening would be the investigation of a breast lump. In combination with examination by the clinician and imaging tests, a needle aspirate of the lump submitted for cytology will show whether the breast cells are suspicious for cancer or look bland/ benign. If they look suspicious, a core biopsy with a larger needle may be performed which takes more tissue, allowing for a definitive diagnosis to be made before deciding what type of surgery is required (local removal of the lump or removal of the whole breast.

The endocrine system is a collection of glands in the human body such as pituitary, thyroid, parathyroid, adrenal, pancreatic, ovaries (females) and testes (males) that collectively regulate metabolism, growth, development, tissue function, reproduction, fertility, mood, and many other vital functions.

Doctor’s Laboratory provides complete range of testing for endocrine related disease conditions such as:

• Thyroid disorders
• Gestational diabetes
• Osteoporosis
• Obesity
• Infertility
• Sexual disorders
• Growth hormone disorders
• Adrenal and Pituitary problems

Endocrinology laboratory parameters available with Doctor’s Laboratory are:

• Aldosterone
• Androstenedione
• Androgen Free Index / FAI (Incl. SHBG + Testosterone)
• AMH (Anti Mullerian Hormone)
• Beta-HCG
• Cortisol
• DHEA-S
• Estradiol (E2)
• Estriol (E3)
• Free T3, Free T4
• Free Testosterone, Total Testosterone
• Follicle-Stimulating Hormone (FSH)
• Growth Hormone (STH)
• IGF-1
• Insulin, Fasting
• Insulin Resistance Test
• Luteinizing Hormone (LH)
• Prolactin
• Progesterone
• Sex Hormone Binding Globulin (SHBG)

The pathologists and scientists working in haematology specialise in the blood and bone marrow (where blood cells are formed). Some further specialise in areas such cancers of the blood, where they lead multi-disciplinary teams diagnosing and managing leukaemia and lymphoma. This includes looking for abnormal cells and cell patterns under the microscope. Others specialise in coagulation (blood clotting) – important in a range of illnesses from stroke, heart disease and post-surgery treatment to pulmonary embolism and Deep Vein Thrombosis.

The Full Blood Count, one of the most commonly-requested tests because it can tell so much about a patient’s health is performed here. Blood banking, blood typing and antibody testing are also part of haematology’s work.

Histopathology (or histology) involves the examination of sampled whole tissues under the microscope. Three main types of specimen are received by the pathology laboratory.

Specimens received by the pathology laboratory require tissue preparation then are treated and analysed using techniques appropriate to the type of tissue and the investigation required. For immediate diagnosis during a surgical procedure a frozen section is performed

Larger specimens include whole organs or parts thereof, which are removed during surgical operations. Examples include a uterus after a hysterectomy, the large bowel after a colectomy or tonsils after a tonsillectomy.

Pieces of tissue rather than whole organs are removed as biopsies, which often require smaller surgical procedures that can be performed whilst the patient is still awake but sedated. Biopsies include excision biopsies, in which tissue is removed with a scalpel (e.g. a skin excision for a suspicious mole) or a core biopsy, in which a needle is inserted into a suspicious mass to remove a slither or core of tissue that can be examined under the microscope (e.g. to investigate a breast lump).

Fluid and very small pieces of tissue (individual cells rather than groups of cells, e.g. within fluid from around the lung) can be obtained via a fine needle aspiration (FNA). This is performed using a thinner needle than that used in a core biopsy, but with a similar technique. This type of material is usually liquid rather than solid, and is submitted for cytology rather than histology (see Cytopathology).

The investigation of infectious diseases is carried out in microbiology. The pathologists and scientists working here look for specific bacteria, viruses, fungi and parasites that may be causing a patient’s symptoms.

The work can involve growing (or culturing) a particular bacteria in an incubator that mimics the perfect environment for the microorganism, then examining the results under the microscope (microscopy). This lab also measures the susceptibility of the bacteria to antibiotics to help decide on treatment.

In some diseases it’s not possible to identify the bacteria or virus that is causing an infection, instead, the antibodies produced by the immune response are investigated. The scientists working in serology examine blood serum for antibodies to infections such as colds and flu, Epstein Barr virus (glandular fever), rubella (measles) and Ross River fever.

Allergies are also tested in this way. One of the most common tasks performed in the serology lab is to measure levels of antibodies to find out if a patient has had a recent infection, a past infection, or a response to a vaccination. In some cases, antibody tests can help monitor a patient’s treatment to see if it is being effective.

Central to the body’s ability to fight infection is the production of antibodies – proteins produced in response to a foreign organism or substance. Without adequate levels of antibodies, the body’s defence is lowered but high levels of antibodies can be indicative of autoimmune disease.

Immunology specialises in disorders of the immune system including autoimmune disorders such as rheumatoid arthritis, SLE (lupus), Crohn’s disease and coeliac disease. It also performs tests to establish whether or not someone is immunodeficient. This can be inherited, the result of an infection or a disease, or produced as a side effect of drugs, such as those used to treat cancer.