KHSC's Laboratory Services department provides very important tools that are used by health care teams to help make a diagnosis, decisions on treatment and to help monitor diseases in their patients. As a fully accredited, licensed, academic hospital laboratory, KHSC's Laboratory Services department provides leadership, education, and research in laboratory medicine across five main disciplines. They are:
- Anatomical Pathology
- Clinical Biochemistry
- Laboratory Genetics
- Clinical Microbiology
- Point of Care testing (POCT)
- Laboratory Phlebotomy Services/Blood Work
The Division of Anatomical Pathology includes the disciplines of Surgical Pathology, Cytology, and Autopsy/Forensic Pathology. As a group, we interpret tissues and/or cells sampled or removed by a physician, using the unaided eye, the microscope, and sometimes by using additional molecular analyses. A specimen (tissues and/or cells) can be removed using a variety of techniques (see below). Our technicians, technologists, and pathology assistants examine and prepare specimens for analysis and the pathologist then examines the specimen. Following the examination the pathologist will make a final diagnosis. This diagnosis is returned to your physician to allow them to tailor your treatment to your particular disease.
Pathologists are specially trained doctors with four years of medical school and a further five years of residency training. Many of our Pathologists also have an additional year of subspecialty training and are experts in a field such as Gastrointestinal pathology, Breast pathology, Genitourinary pathology, and Dermatopathology.
Surgical Pathology specimens are tissue samples taken either through office or clinic biopsies or from patients in the operating room. Each specimen is preserved, and then the pathologist's assistant or medical laboratory technologist will examine and dissect the specimen. A Histotechnologist then takes the specimen and embeds it in wax and cuts it into very thin sections. These thin sections are transferred to slides which are then examined under a microscope by a pathologist who makes the final diagnosis.
Cytopathology specimens, rather than being samples of intact tissue (see Surgical Pathology) are collections of individual cells. They can be gathered from body fluids like urine, or from samples gently scraped from a surface like the "Pap" smear, or from fine needle aspirations of mass lesions. These techniques are used because they are less painful and often give very useful information to guide the treating physician. These specimens are examined under the microscope by a cytotechnologist. The cytotechnologist indicates where the abnormal cells are on the slide and the pathologist conducts a final review of these areas and makes the final diagnosis.
Autopsy/Forensic Pathology is a discipline whose primary responsibility is to investigate deaths. The death may have occurred within the hospital or in the wider community and can include death which has resulted from natural disease, or injury associated with accident, suicide or homicide. Like the other areas of Anatomical Pathology, pathologist assistants help the pathologist with detailed examinations. Many other techniques including photography and evidence collection, molecular testing, toxicology, and biochemical and metabolic tests are used when necessary. All of this data is incorporated, by the pathologist, into a sometimes lengthy final report that offers a comprehensive opinion on the cause of death.
Mohs Surgery & Pathology
Mohs surgery, also known as Mohs micrographic surgery, is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. A Histotechnologist prepares a slide for examination and interpretation by the Mohs surgeon by freezing, cutting and staining tissue removed from the patient while the patient waits for confirmation from the surgeon that the cancer has been cleared.
The Clinical Biochemistry Laboratory provides tests for chemicals (both natural and unnatural) in blood, urine and other body fluid. Our dedicated team of medical laboratory technologists and medical laboratory assistants ensures that our state-of-the-art instruments produce reproducible and accurate results. Majority of laboratory reports are transmitted to physicians within 45 minutes. Test results are used to identify and confirm health problems. Chemistry laboratory data are essential in diagnosis, therapy and recovery monitoring of patients.
Clinical biochemists interpret reports and provide consultations which are essential for diagnosis and management of diseases. They also set quality standards and acceptance protocols on analytical instruments and results. Rigid laboratory quality management encompass every stage of laboratory work: pre-analytical, analytical and post-analytical. This ensures early identification of potential and developing problems.
Our laboratory provides a comprehensive service for assessments on:
- Liver and kidney functions
- Pulmonary and cardiac functions
- Endocrine and metabolic disorders
- Lipid metabolism
- Minerals and bone metabolism
- Transplantation pre-surgical and immunosuppression monitoring
- Tumour diagnosis and monitoring
- Protein investigation
- Drug toxicology and therapeutic drug monitoring
KHSC serves as a regional reference chemistry laboratory for hospitals and institutions across Southeastern Ontario. Following consultation with a clinical biochemist at KGH, some samples may be sent to another laboratory for special and esoteric tests as required.
Laboratory Genetics at KHSC offers complementary services in Cytogenetics and Molecular Genetics. The laboratories offer testing to identify DNA variants associated with disease, disease risk, response to therapy or disease outcome. The service caters to a broad range of people including expecting or new parents who would like to test their child for the potential of inherited diseases, carrier testing, predictive testing for disease risk, and testing for DNA variants associated with therapy response and risk in a variety of cancers.
The Cytogenetics service focuses on large variants and rearrangement of genetic information that may include partial or whole chromosome aberrations which may cause inherited disorders (such as Down Syndrome) or may be hallmarks of cancer cells and predict diseases. The Cytogenetics service offers a broad range of targeted fluorescence in situ hybridization (FISH) testing for constitutional microdeletion testing, familial rearrangements and cancer testing. Offering both traditional tests and techniques the laboratory is now beginning to use new technologies to further analyze difficult oncology (cancer) specimens. For Cytogenetics test list click here.
The Molecular Genetics service focuses on the identification of specific changes within genes at the level of DNA or RNA. While the lab maintains its historical testing portfolio around hereditary non-cancer single gene disorders (Fragile X, hemochromatosis, thrombosis, Huntington disease), the focus is shifting towards molecular pathology and the detection of DNA and RNA level variants in solid tumours and hematologic malignancy. For inherited cancers, the lab offers panel based testing to interrogate a large number of genes that, when mutated, may increase risk for a variety of hereditary cancer syndromes. For acquired or somatic cancers, the lab offers panel based testing to identify driver mutations in oncogenes and tumour suppressors that allow stratification patients into treatment and risk groups. Most recently, the laboratory has focused on providing comprehensive molecular profiling for a number of hematologic malignancies, further advancing the excellence at this center in this area. For Molecular Genetics test list click here.
The Hematopathology Division at KHSC is affiliated with Queen’s University Department of Pathology and Molecular Medicine. We provide a wide range of services including morphological interpretation of peripheral blood films and bone marrow examinations, hemoglobinopathy evaluation, blood transfusion services, coagulation testing, flow cytometry, tissue typing and molecular diagnostic services related to hematological disorders. We provide expertise and leadership in Hematological Pathology to our three Kingston hospitals and consultative services for many other hospitals across our region.
Routine and special Hematology testing is performed within the Core Laboratory at KGH. Approximately 600 complete blood counts are performed daily with review of peripheral blood films on abnormal samples. Bone marrow samples are also processed by this lab. Special testing for hemoglobinopathies and enzymopathies is also performed in the Hematology laboratory.
Routine and special hemostasis testing is performed within the Core Laboratory. Routine coagulation testing and anticoagulant monitoring are provided on a 24 hour basis. A variety of special hemostasis assays are performed including the investigation of inherited bleeding disorders and thrombophilia. There is special expertise in von Willebrand Disease testing and we are a referral centre for von Willebrand Factor Multimer analysis.
We operate and manage a very active transfusion medicine service that supports a wide range health care including: Autologous Stem Cell Transplant, Cardiovascular Surgery, Hematology and Oncology, Obstetrics and Gynecology, Pediatrics, Renal Transplantation, and Trauma services for the region. We transfuse over 10,000 units of blood products per-year and act as a referral laboratory for other regional hospitals. We strive towards safe and effective transfusion and support these goals through consultation with clinical departments with our Transfusion Safety Officer and Patient Blood Management/Blood Conservation Nurse.
The Immunology service involves two main areas: Flow Cytometry and Histocompatibility Testing. Flow Cytometry includes testing used for the diagnosis and monitoring of leukemia/lymphoma, quantitative lymphocyte subsets to diagnose and monitor immunodeficiency. The laboratory also performs CD34+ Stem Cell enumeration to support stem cell transplant program and flow cytometry lymphocyte crossmatch to support the renal transplantation program. Histocompatibility testing determines whether a potential organ donor will match the recipient, ensuring the safety of transplant from the immune system. The laboratory also supports the post-transplant evaluation of humoral immune rejection, and the evaluation of patient’s refractory to platelet transfusions. Pharmacogenetic assessment for Abacavir hypersensitivity and HLA typing for assessment for HLA-associated diseases are also performed by the laboratory.
Clinical Microbiology at KHSC encompasses the disciplines of Bacteriology, Virology, Mycology (fungi) and Diagnostic Molecular Microbiology. The laboratory provides the results from these various disciplines to aid in the diagnosis and treatment of patients. In an era of emerging infectious diseases and antibiotic resistance, the rapid detection of these organisms is vital to minimize their spread of. The Clinical Microbiology Laboratory works closely with Infection Prevention and Control and Pharmacy Services to ensure patient safety and appropriate patient care.
Point of Care Testing (POCT) is diagnostic testing performed near the patient by health care providers (e.g. nurses, respiratory therapists) and is generally conducted on handheld or portable instruments. POCT provides a patient’s clinical team with rapid test results, facilitating immediate medical decision-making and appropriate patient management.
At KHSC, POCT is available for the following tests in many patient areas:
- Activated clotting time
- Blood gases
- Fecal occult blood
- Hemoglobin A1c
- Nitrazine and Fern Testing
All POCT tests are licensed and the service is fully accredited. A POCT Advisory Committee provides direction and oversight over the selection, implementation and quality management of all POCT tests. Regular annual continuing education, training and quality control programs ensure that POCT results meet the needs and expectations of our patients and their clinical teams.
Laboratory tests are often part of a routine checkup to look for changes in your health. Laboratory test results help doctors diagnose medical conditions, plan or evaluate treatments, and monitor diseases. The phlebotomy teams at KHSC are trained and certified to collect blood specimens in a safe and patient focused manner. Specimens are collected following regulatory and accreditation standards to ensure patient safety and specimen integrity. Our teams can be found at both HDH and KGH sites.
At KGH the phlebotomy team services the various inpatient units as well as the Emergency Department, the Outpatient Clinic in the Armstrong Wing and at Cancer and Renal clinics in the Burr Wing. At HDH, Outpatient collection centres are found both in the Brock 1 Outpatient clinic as well as Jeanne Mance 5 Outpatient clinics, these 2 areas provide phlebotomy services for all HDH Clinics bloodwork requests.
- Armstrong 1 Phlebotomy Room (ext. 4437); 7:30 am to 4:30 pm Monday – Friday
- Cancer and Renal Centre Phlebotomy Room (ext. 6868); 7:30 am to 5:00 pm Monday – Friday
- Brock 1 Phlebotomy room (ext. 2191); 8:00 am to 4:45 pm Monday-Friday
- Jeanne Mance 5 Phlebotomy Room (ext. 3712); 8:30am to 4:00 pm Monday-Friday
Note: Phlebotomy Rooms are closed on Weekends and Statutory Holidays.
The Armstrong collection centre collects specimens for registered clinic patients seen at KGH. Appointments are not required for routine phlebotomy at any of our out-patient phlebotomy locations. Sweat Chlorides are performed at HDH, Brock 1 collection centre by appointment on Tuesday, Wednesday and Thursday only.