The Division of Laboratory Medicine in the CHLA Department of Pathology and Laboratory Medicine is under the direction of the Chief of Laboratory Medicine, Dr. Maurice R.G. O’Gorman, and is composed of comprehensive full service laboratories, including 24/7 core laboratory services (hematology/coagulation, chemistry and microbiology), transfusion medicine (blood bank, donor center and therapeutic apheresis), and multiple highly specialized laboratories (immunology, flow cytometry, molecular virology, histocompatibility, bone marrow, special chemistry and biochemical genetics). The laboratories feature the latest technologies, which are integrated within the laboratory’s information system and the electronic medical record. More detailed descriptions of the services provided by each of the individual laboratory sections can be found below.
These laboratories operate around the clock and service the majority of emergency or “stat” test requests. The specifics of these laboratory sections are described below.
- Biochemical Genetics and Special Chemistry
- Bone Marrow
- Clinical Chemistry
- Diagnostic Immunology and Flow Cytometry Laboratory
- Hematology and Coagulation
- Histocompatability (HLA) and Immunogenetics Laboratory
The Biochemical Genetics and Special Chemistry Laboratory employs highly specialized chemistry testing technologies for the precise measurement of specific analytes. These technologies include ultra-high performance liquid chromatography (Ultra HPLC), specialized electrophoresis, fluorimetry, thin layer chromatography and tandem mass spectrometry (LC/MS/MS). The Biochemical Genetics component of the laboratory offers highly specialized diagnostic testing services for patients suspected of congenital metabolic diseases - often referred to as Inborn Errors of Metabolism (IEM). The services include the performance of confirmatory testing for newborn infants that have tested positive in the State of California’s newborn IEM screening program. In addition to biochemical genetics-based procedures for metabolic disease, the Special Chemistry component of the laboratory also supports several clinical programs, for example daily immunosuppressive drug measurements for the bone marrow and solid organ transplant programs. Other tests serve as screens for specific disorders, such as vitamin deficiency, (Vit A, E and D). Very specific highly specialized tests include plasma and CSF amino acids analyses, plasma carnitine levels, plasma methylmalonic acid, homocysteine, mucopolysaccharidosis screening, urinary catecholamine, urinary pterine profile, urinary orotic acid, Galactose-1-phosphate uridyltransferase activity and electrophoresis to diagnose different variants of Galactosemia, etc. More recently the laboratory has worked with the Infection Diseases clinicians to develop improved methods for measuring antifungal drug levels such as voricanozole. The laboratory provides research services including data for pharmacokinetic studies and the development of new procedures for the measurement of novel analytes such as urinary 2-Isoprostane (a new oxidative stress biomarker) and plasma bile acids profiling 20 species of primary and secondary bile acids.
The Bone Marrow Laboratory is a full service laboratory under the direction of Hematopathologist, Matthew Oberley, MD, PhD. This laboratory serves as the first line of service in the diagnosis and monitoring of treatment for benign hematopoietic diseases such as aplastic anemia/bone marrow failure, metabolic disease and the malignant hematopoietic diseases such as leukemia and lymphoma, as well as varieties of metastatic tumors including rhabdomyosarcoma and neuroblastoma.
With the provision of morphological assessment and special stains, the laboratory provides valuable information essential for the diagnosis of a variety of pediatric disorders, including acute leukemia, bone marrow failure syndromes, aplastic anemias and the presence of solid tumor metastases in the bone marrow. Dr. Oberley combines the morphologic and cytochemistry results from the bone marrow lab with results generated in other CHLA laboratories (Clinical Immunology, Microbiology, Cytogenetics, Center for Personalized Medicine, Anatomic Pathology) to generate a bone marrow report that includes a consolidated and integrated diagnosis.
Staffed by Clinical Laboratory Scientists, a board certified Hematopathologist and hematopathology fellows, the Bone Marrow Laboratory services approximately 700 bone marrow specimens per year and provides consultative pediatric hematopathology services for review of outside cases.
The CHLA Bone Marrow Laboratory is the pediatric site for the LAC+USC ACGME-accredited Hematopathology Fellowship program. Each fellow completes a four-month pediatric rotation providing Hematopathology Fellows exposure to a breadth of pediatric hematopathology largely not available to other Fellowship programs. Applications to this program should be directed to the LAC+USC fellowship coordinator through the USC-Keck School of Medicine Department of Pathology.
The Clinical Chemistry Laboratory is a state of the art full service laboratory that offers a comprehensive test menu for diagnosis, prognosis and disease monitoring. As the highest volume service of all of the laboratories, Clinical Chemistry’s operations are anchored around highly automated, fully IT-integrated, state of the art technologies allowing for the highest quality testing and rapid turn-around times. The services offered include general chemistries (e.g. Chem 8), thyroid panels, urine drug screening, therapeutic drug monitoring, HIV screening, hepatitis panel, blood lead, catecholamines, osmolality, sweat chloride testing (for cystic fibrosis), and other more highly specialized testing of esoteric analytes. The Clinical Chemistry Laboratory consistently exceeds the expectations of its clinicians, patients and their families with real time monitoring of urgent testing.
The Diagnostic Immunology and Flow Cytometry Laboratory provides a full range of clinical immunology testing services and is under the direction of Maurice R.G. O’Gorman, MBA, M.Sc., PhD, D(ABMLI). The laboratory has recently completed the automation and bi-directional interfacing of the entire immunoassay line of testing including autoantibody measurements and infectious disease serology and offers a complete line of allergy testing, hemoglobin electrophoresis and protein chemistry. The flow cytometry laboratory offers both routine and esoteric subset immunophenotyping for both primary and secondary immune evaluations, leukemia/lymphoma immunophenotyping for both diagnosis and minimal residual disease evaluations. The laboratory also offers in vitro lymphocyte proliferation testing to both mitogens and a variety of antigens. The Diagnostic Immunology and Flow Cytometry Laboratory serves as a local and regional reference laboratory and provides testing services for clinical trials involving new tests and new technologies.
The Hematology and Coagulation Lab offers both standard testing as well as novel esoteric procedures developed and implemented to service the diverse patient population seen at CHLA. Combined, the staff has over 100 years experience in routine blood cell morphology, a fundamental tool in the diagnosis of most blood disorders, ranging from anemia to acute leukemia and other red blood cell disorders including sickle cell disease and thalassemia. The operations of the hematology laboratory are anchored with a pair of high volume automated hematology analyzers aimed at delivering industry leading turn-around times for clinicians, patients and their families. Currently, the laboratory operates the new Sysmex XN-3000 hematology analyzers, offering the latest blood cell analytical innovations available. In addition to performing routine complete blood counts (CBCs) and differentials on peripheral blood, the laboratory is also experienced in the evaluation of the cellular content of cerebral spinal fluids, joint fluids, pericardial effusions and other body fluids. Following the preliminary evaluations of specimens by the lab’s clinical laboratory scientists, all abnormal observations are reviewed and signed out by the departmental pathologists.
The coagulation laboratory offers both routine and highly specialized laboratory services for the diagnosis and monitoring of patients with suspected bleeding disorders as well as the monitoring of patients with clotting disorders. Routine testing includes tests such as Prothrombin Time (PT), International Normalized Ratio (INR), Partial Thromboplastin Time (PTT) and Fibrinogen. Other special services include testing for Von Willebrand factor, Factor deficiencies (Factor II,V,VII,VIII,IX, X, XI, and XII), and factor inhibitors such as Factor VIII and IX inhibitors. In addition, the laboratory provides an essential service to CHLA surgeons with both routine anticoagulant therapy monitoring, such as anti-Xa, as well as real time thromboelastography, (which also ensures the appropriate use of blood products during surgery). Platelet aggregation testing, offered by appointment only, utilizes the Chrono-log Model 700 and PFA 100 to help in the diagnosis of platelet function disorders.
The CHLA Histocompatibility Laboratory, directed by Lee Ann Baxter-Lowe, PhD, D(ABHI), provides specialty testing to support allogeneic transplantation as well as HLA pharmacogenetics. The laboratory employs state-of-the art technology including DNA sequencing for HLA typing and microarrays for characterizing anti-HLA antibodies. The laboratory is taking advantage of leading edge next generation DNA sequencing in order to provide the most up to date HLA typing technology. Services for transplantation include low and high resolution HLA typing to determine HLA matching between recipients and their donors and to detect HLA antibodies that can cause graft rejection. The laboratory supports CHLA’s solid organ transplant programs (kidney, heart, liver, and intestine), blood and marrow transplant programs while also serving as a reference laboratory for other institutions. Pharmacogenetic testing includes testing B*57:01 (abacavir hypersensitivity), B27 (ankylosing spondylitis), and DQA1/DQB1 (celiac disease). Expert clinical consultation is available for all services including risk assessment, support for donor selection and test limitations. The laboratory also offers custom reports with detailed clinical interpretation and in-service education. The laboratory’s goals are to serve patients by providing the highest quality services in histocompatibility and Immunogenetics, educating clinicians and laboratory scientists, and advancing the field through clinical and translational research.
The Clinical Microbiology Laboratory, directed by Jennifer Dien Bard, PhD, D(ABMM), operates 24/7 and encompasses bacteriology, mycology and parasitology. This full service laboratory offers comprehensive testing for the isolation, identification and susceptibility testing of infectious pathogens. The laboratory has undergone a complete redeployment of the latest state of the art technologies over the past 4 years, including the adoption and implementation of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (otherwise known as MALDI-TOF MS) and molecular-based assays. Adoption of these technologies significantly improves not only the quality of testing but also the time required to identify infectious agents and test their susceptibilities resulting in significant improvements in the treatment and outcomes of patients.
The Point of Care (POC) service, which represents the highest volume service in the Clinical Laboratory, is under the direction of Paul Pattengale, MD. It is composed of interdisciplinary health care teams of physicians, nurses, respiratory care technologists and laboratory technologists that provide analytical testing services at or near the patient's bedside. Point of Care services are essential in the intensive care units, operating rooms, emergency and trauma transport vehicles, including ambulances and air support, and are also available in the cardiac laboratory and specific outpatient clinics. Tests performed at the patient's bedside enables the health care provider to receive test results within minutes allowing for key treatment decisions to be made in real time. Point of Care tests menu include key chemistries, blood gases, pregnancy tests, Streptococcus A, hemoglobin A1c, urinalysis and clotting times. Point of Care testing has grown significantly over the past decade, has seen rapid technological advances, and has been fully integrated into the electronic medical record at CHLA. The Point of Care team also provides essential training services for the proper deployment of POC testing in clinical trials.
The Clinical Virology Laboratory, directed by Jennifer Dien Bard, PhD, D(ABMM), operates Sunday through Friday. Viral cultures techniques have been replace with an “all molecular methodologies” approach for the detection and measurements of viruses. Superior technologies such as Real-time Polymerase Chain Reaction (RT-PCR) are now routinely utilized for the sensitive detection and quantification of nucleic acids (DNA and RNA) in viruses involved in respiratory disease, central nervous system infections, skin lesions, blood, gastrointestinal disease and other clinical conditions.
Molecular methods offer increased sensitivity and improved turnaround time for clinical testing. Our test menu includes:
- Respiratory Viral Panel PCR
- Cytomegalovirus and Epstein-Bar Virus PCR (Qualitative and Quantitative)
- Herpes Simplex Virus and Varicella Virus PCR
- Enterovirus and Parechovirus PCR
- Norovirus and Adenovirus PCR
- BKV and HHV-6 PCR
- Parvovirus PCR
The Transfusion Medicine Service is directed by Ajay Perumbeti, MD, board certified in Pediatrics, Hematology/Oncology and Transfusion Medicine. The section is composed of three separate services including the Blood Donor Center, Blood Bank, and Therapeutic Apheresis Services.
- Blood Donor Center
- Blood Bank
- Therapeutic Apheresis Services
More than 20,000 units of blood are needed each year by patients at Children's Hospital Los Angeles. The Blood Donor Center plays a vital role in the healing process of children with cancer, blood diseases and injuries, and those who need surgery. Successfully collecting enough blood for CHLA patients depends on generous blood donors. Click here to learn more about the Blood Donor Center.
The Blood Bank team receives all whole blood and plateletpheresis units collected by the Blood Donor Center staff at CHLA and on mobile blood drives. Staff further manufactures whole blood into packed red blood cells, fresh frozen plasma and cryoprecipitate. Once products have been manufactured, and quality control and infectious disease testing is complete, available blood products are transferred to the Transfusion Service where they are available to be tested and distributed for patient transfusion.
The Transfusion Service team performs testing to provide compatible blood products per physician order for all patient transfusions at CHLA. Transfusion Service maintains inventory of blood to be available for anticipated transfusion needs for in-patients and out-patients. Blood products include packed red blood cells, fresh frozen plasma, platelets and cryoprecipitate. In addition to finding compatible blood products, the Transfusion Service staff meets patients’ special needs based on best practice by providing products with additional attributes such as irradiation, CMV negative, and washed red cells.
Please contact us for information on our Therapeutic Apheresis services.