MRI tech doing a fingerstick on a patient in JHOC.

Prior to January 2008, our patients at Hopkins had to get their blood drawn either prior to coming for their MRI or have it drawn when they got here.   If it was done the same day of the procedure, the patient had to go to Express Testing in JHOC to get their blood drawn and then wait for the results from the Lab, which can take up to an hour.   The logistics of this process were inconvenient.  Having patients scheduled to have their MRI in Nelson and their blood drawn in JHOC presented challenges for the elderly patients who would have to travel back and forth between buildings.  Thus, this also became a patient satisfaction issue.

It was then that the Point-of-Care Testing Office (POCT) received requests to have Creatinine testing available at the MRI sites.   Our office evaluated several meters and decided to purchase the Nova StatSensor.  We implemented the first meters in Nelson and JHOC MRI, and now have seven sites and about 40 operators certified to do testing.

With the Creatinine Point-of-Care device, renal function is assessed with a fingerstick and it takes approximately 20 seconds to get an answer.  It can then be determined if the patient should be getting a full dose of the contrast or none at all.
As part of our continuous Quality Assurance monitoring, we added these new Creatinine testing sites to our daily rounds.  We visit all the locations and review the QC and patients who have been tested on the meter.  Our office is also responsible for monitoring correlations with the Core Lab on a monthly basis, and investigating reasons for discrepant results.

MRI tech applies the blood to the strip
Daily rounds also give us an opportunity to interact with the end-users and sometimes the patients who find that getting the testing done right then and there and getting an answer right away is much better than waiting around.

“It makes a huge difference to the patient. They really like the idea of having it done much quicker,” says Melody Corbin from JHOC MRI. “It’s nice that they don’t have to go to the Lab.  It’s an easy and quick thing to do. We need more people trained to do it!” says Bill White also from JHOC MRI.

Carol Lonsdale RT, R MR CT, highlights how the testing process has actually changed. Before having POC Creatinine available, the patient had to go to the Lab and get drawn. As they waited for results, sometimes they would bring the patient in the MRI room and do the pre-contrast testing.  When the Lab results were available, they would bring the patient back in and finish with the post-contrast imaging.  “This was very inconvenient for the patient and it would also throw off our schedule.  We were late for the appointments and the patients just had to wait around too long.  This way is so much more convenient,” Carol said.

Implementation of Creatinine POC testing has helped improve the workflow for the MRI areas by giving them a fast and much more convenient way of assessing the patient’s renal function prior to applying contrast.   We also feel that patient satisfaction has improved significantly and after all, that’s what we are here for.

Point of Care Coordinators. From left to right, Karen Reilly, Leandra Soto, Lois Phelan. Not pictured, Sandy Humbertson.

Leandra Soto, MT(ASCP)
Lois Phelan, MT (ASCP)
Karen Reilly, MT (ASCP)
Sandy Humbertson, MT (ASCP)
Johns Hopkins Point-of-Care Office

But some of you may wonder — what is residency exactly?  Residency is specialized training that a physician receives after he or she completes medical school. Some come to residency after completing additional graduate work beyond an MD, most frequently a PhD. In fact, thirteen of 34 current residents have earned PhDs. Other residents have earned master’s degrees in a variety of academic disciplines.

Depending on the specialty a physician chooses, a residency can be as few as 3 years, or as many as 7 years. The combined anatomic and clinical pathology (AP/CP) training program is 4 years in length, while either AP or CP training is limited to 3 years. Another option, the combined anatomic and neuropathology (AP/NP) training program is also 4 years in length.

The Department of Pathology at Johns Hopkins provides residency training in anatomic pathology (AP) and clinical pathology (CP), either combined or individually. Residents enrolled in the training program complete rotations in the clinical pathology disciplines of clinical chemistry, cytogenetics, diagnostic immunology, hematology/coagulation, transfusion medicine, medical microbiology, molecular diagnostics, and laboratory management.  Rotations in anatomic pathology include autopsy, forensic pathology, surgical pathology, gynecologic/pediatric pathology, cytopathology, and gastrointestinal/liver pathology.

Outside of our required rotations, residents participate in Pathology Department Grand Rounds, weekly didactic conferences, journal clubs, and independent research projects.  Many residents’ projects have resulted in poster and oral presentations at national and international meetings, as well as countless publications in various academic journals.

When we’re not hard at work, the residents often enjoy socializing with each other and their families. Intern welcome dinners, picnics, outings to Orioles games, and a consistent stream of baby showers are just some of the ways the residents make time for each other outside of the Hospital. In short, the residents have established a support system for each other, both professionally and personally.

Julie Katz Karp, M.D.

Co-Chief Resident

“Dr. Seuss, if you were here, what would you say?”

I imagine a kitchen
where goodwill abides
Where love, compassion
and kindness reside,

Where I’d cook up a stew
with  all these ingredients
Set to a boil and
remove with expedience.

Just so we know
there is plenty for all,
We’ll use a big spoon
for those large and those small.

We’ll serve Tuscarorans
from Kalamazoo
And Grinches whose hearts
are the coldest -  it’s true,
And yes, we will serve some
to Cindy Lu Who.

So, when we look back on the
gift that we gave,
We’ll have walked into light,
from the dark of the cave.

Dedicated to my friend, Janice Alvarez
By Frank Barksdale

“Whatever you can give, gives hope.”
I have been a volunteer in the Baltimore and the State College, Pennsylvania communities for a number of years working with so many people- not only the poor and the homeless.  I also work through service organizations like the Lions Club International, working in communities to provide information and resources to improve the lives of those with vision deficiencies.  Many like me give their time and financial support through their church or through a civic organization.

In our day to day lives, we tend not to think much about those in need because we get wrapped up in the issues that surround and are a part of our lives.  I didn’t give it a thought.  And then, it happened to me.

Years ago I worked as a technician in research here at the University.  My children were very young and I needed to work two jobs to make ends meet …  only they didn’t.   It’s a humbling feeling when the holidays roll around and you are faced with the dilemma of paying the gas and electric bill or getting gifts for the kids.  As hard as I worked, I couldn’t make it.  It was because of my family and my church that I was able to meet my financial obligations.  Even then  – with their support-  it was a very hard, long climb to get to a point of stability.

Many of us have a safety net of family and friends that we can turn to in difficult times.   We have had that special person or special people in our lives to step in and fill the gaps. Mom and Dad may have helped with college.  They may have helped by paying a bill when you were in grad or med school. People have been there for us to give us a recommendation or connect us with someone in the network of friends and employers.   It’s a “who you know” world.  We have been blessed with opportunities that many cannot even begin to imagine, because they exist in a day to day struggle of getting food on the table, clothing their children, staying warm, and keeping a roof over their heads.

Throughout all of my years of service, I sincerely believe that people just like us truly want to help.  Given our obligations, I understand that it is not easy to get out into the community and give time. Yet by your donation to the United Way, you are doing just that very thing. You are giving those of us who are out there the means to assist those who really need your help.

Please take a moment to review your United Way information and make a pledge.
When you do, you really can make a difference.
Thank you.

Frank Barksdale
Clinical Manager
Johns Hopkins Medical Laboratories
Pathology Department
Immunopathology  Laboratory
ph: 410 614-6650
e-mail:  fbarksdale@jhmi.edu

Michelle and Edgar picking up donations from labs through out the hospital

Ms. Fannie collecting donations

Why did we choose this worthy cause?  Homelessness is a very complex problem with many variables, a major one being a lack of affordable housing.  The numbers are startling.  Over the course of a year, between 2.5 – 3.5 million people will live either on the streets or in an emergency shelter.  About 600,000 families and 1.35 million children experience homelessness in the U.S. each year.  It is estimated that 23-40% of the homeless adult population are veterans.  Homeless children go hungry twice as often as other children.  In rural areas, families, single mothers, and children make up the largest group of people who are homeless.  Only 20% of homeless families receive housing help and 43% of children living with homeless parents are under the age of 6.  With such compelling statistics, we decided to work with an organization near Johns Hopkins, to make a difference on the impact of homelessness in our immediate community.

Lisa and Wanda preparing donations for delivery to BEA GADDY

The Bea Gaddy Family Center is located a few blocks from Johns Hopkins Hospital, on 425 North Chester Street, making it a charity where we can see the direct impact of our donations.   The center provides housing for homeless women and children.  It offers self-development and job training.  The center also provides tutoring programs, medical support, HIV, AIDS, and lead testing.  They also distribute food and blankets to the homeless on a daily basis.  The center provides Thanksgiving, Christmas, and Easter dinners for thousands of Baltimore’s people annually.  Our food donations directly support the family food pantry and the annual Thanksgiving dinner for the homeless.  Our donations of gently used clothing go to “Bea Gaddy Fashions,” a part of the shelter where homeless families are able to select clothing.  Our donations of baby food, clothes, diapers, and furniture are given to families on a waiting list.  Generally these items are given to people as soon as the center gets them.  The demand exceeds the supply.

Loading donations for delivery

This year we once again ask for your help with donations of non-perishable food, used clothing, blankets, coats, gloves, hats, and personal care items for all ages.  Hunger and homelessness are very real problems affecting men, women and children.  With the recession, food banks and shelters do not have enough resources to help those affected by layoffs, cutbacks, foreclosures and the new poor. Your donations large and small will make such a difference for those who have nothing.

Our team will deliver donation boxes starting November 1^st-3^rd.   We will collect donation the entire month of November and have one major fund-raiser during the month.   Every Friday a team member will pickup donations and forward them to the Bea Gaddy Family Center.  Anyone needing help with unloading his or her car, or who wants to make special arrangements for pickups within Johns Hopkins Hospital, please call 443-287-8095 (ext. 7-8095) to make arrangements.  Our team will do our best to work with you.

JoyAnn, Edgar, Allen and Keith

RJ Malacas

I would like to give a “very special thank you and recognition” to Fannie Evans, Edgar Calderon, RJ Malacas, Keith Nguyen, Joyann Line, Allan Clarete, and the many dedicated people in the Core Laboratory who annually  collect from all Pathology drop-off boxes and sort, bag, box, and deliver donations to the Bea Gaddy Center.   I would also like to give a “very special thank you” to the many wonderful people in the individual Pathology laboratories who remind coworkers to bring donations and help with fund-raisers — your unselfish dedication and generous efforts are truly commendable, none of this would be possible without you.  Thank you all so very much!  You are truly the heart and soul of Pathology.

Lydia Nelson

Manager, Core Laboratory

The traditional respiratory virus season is principally during the colder winter months, typically October through March.  During this time, the predominant respiratory viruses seen are respiratory syncytial virus (RSV) and influenza A or B. Throughout the year, we see additional respiratory viruses such as adenoviruses, enteroviruses, parainfluenza virus types 1-4, human metapneumovirus (hMPV), and rhinoviruses.   RSV is the major cause of lower respiratory tract infection and hospital visits for young children.   Influenza A and influenza B, also called seasonal flu, result in 36,000 deaths and more than 200,000 hospitalizations nationwide each year.  The annual cost in the United States for influenza is estimated to be greater than $10 billion.  Adenoviruses, enteroviruses, parainfluenza viruses, rhinoviruses, and hMPV can be severe in some patient populations, but most patients are not hospitalized.

Processing respiratory viral samples for testing

Preparing the DFA slide

A variety of methods can be used to diagnose these viral infections in the Laboratory.  Ultra-rapid (15-minute) antigen detection assays that are similar to over-the-counter pregnancy tests are available for influenza A, influenza B and RSV.  Virus antigens can also be found by staining cells obtained from patient specimens with fluorescent-tagged anti-viral antibodies and examining stained preparations using a fluorescence microscope.  This method is known as the direct fluorescent antibody (DFA) test and it can be used to detect RSV, influenza A/B, parainfluenza virus types 1-3, adenoviruses, and hMPV.  Before the availability of sophisticated molecular tests such as PCR, viruses were amplified and detected the old-fashioned way, by culturing specimens in cells.  Two types of culture are available:  rapid (48-hour) culture, known as “shell vial” (SV), and the conventional tube culture that can take up to three weeks.  In the shell vial method, cells are grown on a coverslip that is placed in a small vial containing nutritive medium. The patient specimen is placed in the medium.  The vial is then centrifuged and placed in an incubator.  After 48 hours, the coverslip is removed from the vial and stained with fluorescently-tagged antiviral antibodies.  Tube cultures consist of cells that are placed in a single layer along the side of a glass test tube.  The tubes also contain nutritive medium that allows the cells to remain alive in culture.  The patient specimen is placed into the tube and the cultures are incubated for up to three weeks.  Virus is detected by examining the cells for changes in appearance that signal virus growth, termed “cytopathic effect.”  Different viruses produce different cytopathic effects.  Technologists are trained to identify these specific effects while examining cultures using light microscopes.   Analysis of JHH Clinical Virology Laboratory data indicates that 55% of infections are detectable by DFA.  An additional 35% of the respiratory viruses may be detected by the SV technique.  The remaining 10% are detected by tube culture.

Reading tissue culture tubes  under the inverted microscope

This past spring, a new influenza virus was found in patients with respiratory infections in Mexico and in two unrelated individuals in southern California. It was termed “Swine Flu” because its genetic material was found to be highly related to influenza strains that were grown from pigs.  This novel virus did not act like typical seasonal influenza virus.  It was occurring in warm weather months, it was spreading rapidly in school-aged children, and it was causing disease around the globe, eventually leading the World Health Organization to declare that the infection had become a pandemic.

Public anxiety grew over a rapidly advancing virus whose lethality was largely unknown, but increasingly feared, as Mexico was reporting high death rates.  Here in the U.S., the healthcare system was flooded with alarmed patients complaining of respiratory symptoms.  At JHH, plans that had been formulated to deal with a potential avian influenza outbreak were activated to cope with the large patient influx and to prepare for a potentially lethal pandemic.  The JHH Clinical Virology Laboratory was inundated with requests for respiratory virus testing.  Typically, the month of May is the beginning of the slow season for respiratory viruses and the Laboratory would normally process about 200 respiratory specimens.   In May 2009, well over 1,000 of these samples arrived for testing.

There was a silver lining to a workload that was so large that it drained resources and strained staffing, as it served as a catalyst for change.  Respiratory virus algorithms employing the full range of conventional tests were clearly no longer practical.   Although the Laboratory has shown that its algorithm is comparable in performance to highly sensitive molecular methods for viruses such as RSV and influenza A & B, the labor required to achieve this result was tremendous and unsustainable. In addition, patient results were frequently delayed due to the time required to recover viruses in tube cultures. In response and after extensive consultation with clinical colleagues, the staff in the Medical Microbiology Division has formulated a new set of respiratory virus algorithms that should offer sensitive detection, speedy diagnosis, and greatly streamlined workflow.

Beginning on November 2, 2009, at 11:00 a.m., the face of respiratory virus testing will change at JHH.  Two different respiratory virus detection panels, one for standard patients, and one for immunocompromised patients will be offered.  Care providers will be asked to provide the category that qualifies a patient for the immunocompromised panel (see Table below for Immunocompromised Panel Qualifying Categories).  The initial test in both panels will be the DFA test, the gold standard in rapid time-to-result respiratory virus tests.  If DFA is positive, the virus will be reported and no further testing will be performed.  If the DFA is negative, shell vial culture will be performed for standard patients, and multiplex PCR will be performed for immunocompromised patients.  The multiplex PCR will detect 10 respiratory viruses (RSV, influenza A, influenza B, parainfluenza virus types 1-4, hMPV, adenoviruses, and rhinoviruses). All respiratory virus test results should be finalized 48 hours after a specimen arrives in the Laboratory.  In addition, the Clinical Virology Laboratory will now also accept nasopharyngeal swabs collected with a Flocked Swab (SAP #114949) for both respiratory virus panels. Ultra-rapid antigen detection assays and tube cultures for respiratory viruses will be discontinued.

Multiplex PCR  instrumentation

These changes will have many advantages.  Improvements that should be obvious to patients and care providers include decreased time-to-result and more effective detection of certain viruses such as hMPV and rhinoviruses by PCR.  Compared to nasopharyngeal aspirates, nasopharyngeal swabs should be easier to collect by the provider and more comfortable for patients.  Swabs also minimize the potential for aerosolizing virus, eliminating the need for specialized collection environments.  From the Laboratory’s perspective, overall efficiency will improve due to workflow changes and eliminating tube inoculation and daily inspection.  These gains will allow DFAs to be performed 24/7 for the first time, with a time-to-result of up to 4 hours.  Swabs, which have less mucus than aspirates, will also be beneficial to the Laboratory as they are easier to process and result in fewer uninterpretable DFAs.

Virology Staff

Additional information on swab collection and the new respiratory virus test panels can be found on the JHH Medical Microbiology web site.

Ame’ Maters
Supervisor, Medical Microbiology Laboratory

Alexandra Valsamakis, M.D., Ph.D.
Director of Clinical Virology and Molecular Microbiology
Associate Professor of Pathology

Our perceptions affect our interactions.  Diversity is not just a matter of how we see others but is as much a matter of how we see ourselves.  In an institution where the core values encompass ideologies such as diversity and inclusion, it is important that we not only actively look for ways to encourage a diverse environment but also encourage each employee in that environment to perform to the best of his or her ability.  Only then will we be able to truly benefit from the great variety of information, insight and resources that diversity affords.   The Diversity Awareness Committee is part of the Departmental strategy for accomplishing this goal.

If you’ve taken the opportunity to look at the diversity awareness calendar for October, then you know that the month of October is filled with numerous opportunities to celebrate diversity.  Across cultures, there are a number of social, civil and religious days that will be celebrated in some way this month.  In an effort to highlight the diversity within our Department, and in conjunction with United Nations Day, the Department of Pathology will celebrate “Diversity Awareness Week” during the week of October 19-23.  This year we have chosen to highlight the nations of China, Russia, and Zimbabwe.   Each division is encouraged to find creative ways to educate its staff about the culture, history, and political structure of these nations.  Last year’s celebration was a great success, and we hope to improve this year by creatively making it an exciting and informative week for the entire faculty and staff.

Diversity Awareness Week is only one of the ways the Diversity Awareness Committee has promoted the value of diversity among staff within the Department of Pathology at Johns Hopkins Medical Institutions since its inception.  Other educational and interactive sessions sponsored by the Committee have included “Perry the Peacock,” “The Millenials are Coming,”  “A Class Divided,” and recent sessions of  “Campus Conversations on Diversity and Inclusion.”  These sessions have been thought-provoking and have hopefully helped heighten our awareness and foster some change.

The committee consists of a group of staff representatives across several divisions within the Department, including the Bayview and Howard County locations.  With valuable HR support and guidance, the committee plans educational and informational sessions designed to build awareness of the importance of recognizing and understanding similarities and differences among individuals and groups.  The committee’s goal is to help establish common ground for future development of our personal and professional relationships. This is fostered through the essential element of mutual respect for our differences.

The committee is actively looking for new and exciting ways to highlight and promote diversity.  Mark your calendars for upcoming brown bag lunch seminars beginning on Monday, October 19, 2009, from 11:30 am – 1:00 pm in Meyer B-105.  Our own SMILE group will discuss “The International Laboratory Experience.”

If the committee can assist you in any way, or if you have any ideas to share, please feel free to contact any member of the committee.  We are open to your input.  Contact information is available on the Pathology website.

The Pathology Diversity Awareness Committee
James Abrams, Debbie Aird,  Lois Anderson, Elaine Delman, Willie Ferrer, Greg Gerhardt, Laura Kissock, Trina McFadden, Doris Pendergrass, Sherin Shahegh, Leandra Soto, Sandra Thoman, and Meredith Timmermann

APHERESIS VERSUS WHOLE BLOOD PLATELETS: There are two types of platelet products, those derived from whole blood and those from an apheresis platelet collection. What is the difference?  Platelet products derived from whole blood require platelets from 6-8 different donors to make up a sufficient product for transfusion.  This means the patient is exposed to 6-8 different donors.

An apheresis platelet product will have 6-8 units, making the same amount of product, but, these are all from one donor.   So exposure to different donors is greatly reduced!   Also, it allows the Platelet Transfusion Coordinators (Dr. Platelet’s) to assign the patient a better matched product.  Concern for providing as little risk for the patient as possible is why only apheresis platelet products are used at JHH.

Whole blood is drawn directly into a bag via gravity.   Post-collection, it is taken into the lab and separated into components….plasma, red blood cells and platelets. In an apheresis blood collection, whole blood is drawn via an apheresis machine.   The blood is separated in the machine, and the platelets are collected while the donor is given back the red blood cells and plasma. It takes one needle stick and approximately 90-120 minutes.   The same method can be used to collect apheresis RBC – red cells are collected while plasma and platelets are returned to the donor.

Again, the benefits of an apheresis platelet donation are that it is a quick and efficient way to obtain large quantities of platelets, and it reduces the chance of reaction for the patient.  In addition, apheresis platelets provide a large dose of platelets in a small fluid volume, and most importantly (we cannot say this enough), it exposes the recipient to only one donor. Also, all apheresis platelet donors are HLA-typed which allows us to specifically match the product with the recipient (something that cannot be done with whole blood platelets). It is a better, higher quality product.

The benefits for the donor include time to relax by reading or watching a movie and most important, feel the satisfaction all blood donors get for saving a life.

Drawbacks of an apheresis platelet donation are that the donor can become chilled by the room temperature anticoagulant used in the procedure.  We provide a heating pad on the chair and blankets to cover the donor should they experience this.  Some donors experience tingling of the lips during the procedure which is resolved by pausing the procedure and, if requested, giving the donor two Tums.  As with whole blood, you can have bruising at the needle site and can faint.

New technology used in the HATS Blood Donor Center since April 2005 allows apheresis platelets and red blood cells to be collected from one donor at one collection.  Back in the 70s, at the start of this program, it took a needle in each arm and about 4 hours to donate, and the device only collected platelets. Apheresis technology has certainly advanced!

REQUIREMENTS FOR APHERESIS PLATELET DONORS:  The requirements for an apheresis donor are the same as for whole blood donors, as well as:

• No aspirin (even low dose) for 2 days before donation.
• No non-steroidal anti-inflammatory drugs within 24 hours.
• A good meal before donation with plenty of fluids is suggested.

FREQUENCY OF DONATION:   You can donate apheresis platelets every 14 days (RBC can only be donated every 56 days).   Platelets may be given safely up to 24 times per year with no adverse effects to the donor.   And, you can give platelets between whole blood donations.

WHAT TO EXPECT:  What can donors expect when they come to donate:

• A screening like that for whole blood donations:   medical history, blood pressure, temperature, pulse, and blood count.   A potential donor is asked about current medications, past travel as well as other health-related topics.   This form and questions are mandated by the FDA to be sure the donation is safe for the donor as well as the product that is collected is safe for the recipient.
• A cleaning of the intended needle site with iodine preparation.
• A needle insertion with a sterile, single-use needle.  Since the sterile needle is used only once and then discarded, you absolutely, positively cannot get AIDS or any other disease from giving apheresis platelets.
• A small bag of blood drawn for testing prior to starting the procedure for laboratory testing.
• One-on-one care from your provider while you are donating.  That is right!  The staff is with only one donor at a time…during the entire collection.
• Watch a movie, take a nap or just chat with your caregiver.
• A parking pass is provided to cover the cost of parking.
• Post-collection snacks, and sincere gratitude for giving the “gift of life”.

We want your experience to be a pleasant one and one worth repeating!

WHO DONATES BLOOD: Less than 5% of eligible healthy donors donate blood.   Statistically, blood donors tend to be more men than women, between 30-50 years of age and above average income.   Our experience in the JHH Donor Center is that we have more male than female donors, our donors are between 20 – 65+ years of age, donate once a year to once every 2 weeks, and are 1st time donors to one donor that is about to have his 396th donation!

WHAT HAPPENS TO THE PLATELETS POST-COLLECTION: All blood collected in the Blood Donor Center, stays in JHH and is used for our patients!   From the Donor Center the platelets go to Transfusion Medicine for processing and release to a JHH patient.

MAKING A DIFFERENCE WITH YOUR TIME: 4.5 million lives are saved each year with blood donations.  So, if you ever wondered if giving blood matters, it does!   Giving apheresis platelets is truly the “gift of life” for a patient in need. It allows JHH to offer the best care for every patient who needs it.

LOCATION: The JHH Blood Donor Center is located on the first floor in JHOC, between Express Testing and the Wilmer Eyeglass Store.
If you feel you would like to donate or would like to know more about apheresis blood collections, please call us at 410 955-TIME (8463) or stop by the Donor Center!  All donations are by appointment only.

Louanne Morell, Pat Kastel, Dr.  Karen King, and the entire Apheresis Staff at the Johns Hopkins Hospital

The CellaVision uses a peripheral blood smear to perform an automated differential cell count based on user-defined limits.  The scanning unit, consisting of a motorized microscope and camera, provides digital images that can examine for WBC, RBC, and platelet cell morphology.   The powerful computer program pre-classifies the white blood cells into cell types for technical review.  With the click of a mouse, a technologist can review all cell images, perform a platelet review, and document morphology in less than minute.   During increased work volumes, the Core Lab can use the remote analyzing station in the Oncology Hematology Lab to verify patient testing.  This is also a way for our labs to confer on difficult cell classifications without the need for slide transportation.

The technology used by the CellaVision is an important regulatory compliance tool, ensuring consistent cell classification among technical staff and providing on-line reference images for all cell classifications. For the busy hematologist and pathologist, the device and software permit distant viewing of slide images as if they were in our lab looking through a microscope.   Ergonomically, the CellaVision eliminates the need for manual microscopic reviews, thus decreasing staff eye fatigue, lower back stress, and wrist sprain.   All around the CellaVision is the perfect complement to the Core Lab’s automation system.  We are looking forward to adding upgrades for cytospin analysis and virtual slide applications in the coming months.

The Core Laboratory and Pathology would like to thank the Johns Hopkins Women’s Board for its generous financial support which was instrumental in bringing CellaVision technology to JHH.

Danna Anderson, MT (ACSP)
Technical/Operations Supervisor
Core Lab Hematology

Many of you may recall my earlier blog post about preparation for the inspection.

The peer inspection was performed by a team of pathologists and other laboratory professionals from Hershey Medical Center.  They were joined by molecular/genetics specialists from Children’s Hospital of Philadelphia and staff from CAP’s central office.  Twenty-three inspectors in all!

The inspection was guided by the CAP checklist questions organized by specific laboratory disciplines, as well as general  questions related to proficiency testing, quality management, human resources, space, etc.  All clinical laboratories were inspected and we did very well overall!   Considering the complexity of our test menus, our newness to this process, and the thousands of checklist questions, the number of deficiencies was relatively small.

We are in the process of evaluating all deficiencies which require further documentation and follow-up within 30 days of the inspection. Some deficiencies were corrected on site and need no further documentation.   Responses to our deficiencies will be reviewed by CAP technical specialists at their central office, a CAP regional commissioner, and an accreditation committee before an accreditation decision is issued.   All can be addressed, and we have full confidence that accreditation will be achieved within the required timeline.

At the end of the inspection, the CAP Team Leader and his team of inspectors summarized their findings to a large group of lab representatives.  Not only was this time allotted to review the results of the inspection process, they also shared recommendations for improvement and comments about our laboratory services.   It was encouraging to hear positive inspector comments that included:

“For a first- time CAP inspection – you did a wonderful job!”

“Laboratory directors showed personal responsibility and affection for their labs.”

“QC processes and procedures were excellent.”

“The lab was well run and well organized.”

“It was a positive experience and we shared ideas.”

Everyone in every laboratory should be congratulated on a positive outcome!

The process doesn’t stop here.  The next CAP inspection may be two years away, but we have to stay on top of our processes and systems to ensure compliance with laboratory standards.  The CAP checklists are updated regularly.  In fact, there are newly released CAP checklist questions that need to be reviewed.   Many groups like the one pictured below (QA Workgroup) will continue to meet and make recommendations for ongoing laboratory improvements that will ensure quality and compliance.

See how happy they are the inspection is over!

Barbara Parsons, MA, MT(ASCP)
Department of Pathology – CQI Office
Assistant Director, Quality Management

The Johns Hopkins SBB Program is a 52-week work-study program where the employed MT or BB certified technologist works in the Transfusion Medicine Lab gaining experience. The Program consists of immunohematology reference lab training, didactic lectures, student presentations, a research project, and student rotations to other Hopkins Labs like Immunogenetics (HLA) lab, Graft Engineering Lab (GEL), Immunology, Flow Cytometry, and more.  Students also visit the FDA in Rockville, the National Testing Lab at the Penn-Jersey Red Cross in Philadelphia, and attend the AABB and MAABB annual meetings and the NIH symposium.

2009-2010 SBB students from left to right:  Malea Pope, Justina Pangallo, and Marjorie Te

Upon successful completion of our SBB Program, students apply to take the Board of Registry SBB Certification Examination to become certified as a Specialist in Blood Banking Technology (SBB).  This examination is offered by the American Society for Clinical Pathology (ASCP) Board of Registry in collaboration with the AABB.

Specialists in Blood Banking may work in many types of facilities, including community blood centers, private hospital blood banks, university-affiliated blood banks, transfusion services, independent laboratories, and university staff and program directors.  Specialists in Blood Banking are knowledgeable in all aspects of blood banking, tissue banking, transfusion medicine, hematopoietic, cellular and gene therapies, and tissue transplantation. These individuals are subject matter experts on a variety of areas including regulatory and quality systems, genetics, immunology, blood groups, collection and storage of blood components, donor processing, immune mechanisms, component therapy, transfusion of the newborn and oncology patients, transfusion reactions and transfusion transmitted disease, laboratory management, computer system development and education.

SBB graduates from left to right, Yeo-Jin Kim and Judith Veterana, completed the program on August  31, 2009

Specialists in Blood Banking are desired to fill positions as regulatory experts, technical advisors, laboratory supervisors and managers, quality assessors, researchers and educators within their field of Transfusion Medicine.
The requirements for acceptance into the Johns Hopkins SBB Program are ASCP certification as a Medical Technologist or Technologist in Blood Banking and a minimum of two years full-time Blood Bank experience. The application deadline is April 30 for consideration in the class beginning in September of that year. There is no tuition for the program; students are full-time employees (with benefits) of Johns Hopkins Hospital who work 40 hours per week in the Transfusion Medicine Lab.

Additional Information:
www.aabb.org
www.caahep.org
www.ascp.org
www.asq.org

Lorraine N. Blagg, MT(ASCP)SBB
Education & Development Coordinator
Transfusion Medicine Division
Department of Pathology
Johns Hopkins Hospital