几家代表性医院检验科现开展检验项目课件.ppt

1、几家代表性医院几家代表性医院检验科现开展检验项目检验科现开展检验项目 Johns Hopkins Medical Laboratories项目简介 华西医院检验科项目简介 协和医院检验科项目简介 中山达安基因项目简介 肿瘤个体化用药常用项目简介 我的思考 Johns Hopkins Medical Laboratories 600 North Wolfe Street Meyer B-130 Baltimore,MD 21287-7070 Phone 410-955-2405 Fax 410-614-0455 JHML Services Blood Disorders&Special Coag

2、ulation 临检和凝血 Clinical Chemistry 生化 Cytokine 细胞因子 HIV Specialty Services HIV筛查 Immunology 免疫 Medical Microbiology 医学微生物 Molecular Pathology&Cytogenetics分子病理和细胞基因 Neoplastic Hematopathology&Flow Cytometry血液病理和流式细胞仪 Transfusion Medicine 血库Cardiovascular Panel心血管项目组合 Test abnormalities in this panel co

3、rrelate with an increased risk of cardiovascular disorders.Factor VII ActivityFibrinogen ActivityHomocysteine(special collection)Lipoprotein(a)Plasminogen Activator Inhibitor-1(PAI-1)Prothrombin Fragment 1.2Tissue Plasminogen Activator AntigenCirculating Anticoagulant and Lupus Anticoagulant循环抗凝和狼疮抗

4、凝A basic screening panel for factor deficiencies and the detection of inhibitors.APTTMixing Studies(APTT)Mixing Studies(PT)PT(Prothrombin Time)Platelet Neutralizationd-RVVT,with confirmAnti-cardiolipen Antibody,IgG,IgM,IgAAnti-B2 GP1 antibodies,IgG,IgM,IgA Abnormal PT and/or APTT Evaluation一般凝血检查Thi

5、s panel is used to evaluate the cause of an abnormal protime or activated partial thromboplastin time.APTTAPTT Mixing StudiesHepzyme(Test for heparin contamination)PT(Prothrombin Time)PT(Prothrombin Time)Mixing StudiesPlatelet NeutralizationDDAVP Challenge血管加压素耐受性The panel is used to evaluate the re

6、sponse of mild hemophilia and von Willebrand disease patients to DDAVP.Factor VIII ActivityRistocetin CoFactor assayWF AntigenHEME-8(pre-post)DIC ScreenDIC筛查The DIC screen is useful in the diagnosis and follow-up of disseminated intravascular coagulation.APTTD-dimer(Quantitative)FibrinogenProthrombi

7、n TimeExtrinsic Pathway Panel外凝血通路组合Panel used to evaluate and identify the cause of an abnormal prothrombin time.Factor VII ActivityFactor X ActivityFactor V ActivityFactor II ActivityIntrinsic Pathway Panel内内 凝血通路组合Panel can be used to evaluate and identify the cause of an abnormal activated parti

8、al thromboplastin time.Factor XII ActivityFactor XI ActivityFactor IX ActivityFactor VIII ActivityFibrinolysis Panel纤维蛋白溶解组合The fibrinolysis panel may be used to monitor or diagnose acquired or congenital abnormalities of the fibrinolytic system.alpha-2-Antiplasmin D-dimer Quantitative Fibrinogen De

9、gradation Products Plasminogen Activator Inhibitor-1(PAI-1)Plasminogen Activity Tissue Plasminogen Activator AntigenLupus Anticoagulant(Antiphospholipid Screen)狼疮抗凝(抗磷脂筛查 A basic screening panel for the detection of lupus-like inhibitors.The profile may also be used for patients with an unexplained

10、prolonged prothrombin time or APTT.Anticardiolipin Antibody(ELISA)APTT and Mixing Studies D-RVVT(Dilute Russell Viper Venom)and Mixing Studies PT(Prothrombin Time)and Mixing Studies Platelet Neutralization Test if evidence for an inhibitorPlatelet Function Panel 血小板功能组合Panel used to identify platele

11、t function problems.PFA-100 Bleeding Time Clot Retraction Platelet Aggregation Platelet Secretion(ATP release)Flow cytometry studies if indicated Prothrombin Consumption TestThrombotic Risk Panel 血栓风险组合The thrombotic risk panel is a comprehensive group of tests for evaluating patients with hypercoag

12、ulable states.Activated Protein C Resistance and Factor V LeidenAntithrombin III ActivityDilute Russells Viper Venom(D-RVVT)Fibrinogen Activity,Fibrinogen AntigenHomocysteine(special collection)Lipoprotein(a)Lupus Anticoagulant ScreenPlasminogen Activator Inhibitor 1(PAI-1)Plasminogen ActivityC Acti

13、vityProtein C AntigenProtein S Activity Protein S Antigen TotalThrombin TimeTissue Plasminogen Activator AntigenProthrombin Gene MutationThrombotic Risk Screen血栓风险筛检 A group of basic tests used to screen patients for only the most common causes of thrombosis.Activated Protein C ResistanceAntithrombi

14、n III ActivityD-RVVTHomocysteine(special collection)Protein C ActivityProtein S Activityvon Willebrand Panel血管性血友病因子This panel is for the evaluation of suspected von Willebrand disease.APTTFactor VIII ActivityRistocetin CofactorvWF AntigenvWF Multimers as needed Markers of Hyper-Coagulation高凝状态标志物 P

15、rothrombin fragment 1,2Plasma p-SelectinThromboxaneBeta-ThromboglobulinPF4 Miscellaneous Bleeding Disorders各种出血紊乱 Factor XIII ActivityProtein Tests 特种蛋白特种蛋白Cryoglobulin Screen with reflex to immunofixation electrophoresis for positives CSF IgG Index by nephelometry CSF IgG(IgG/Total Protein as%)Elec

16、trophoresis,Protein,serum Electrophoresis,Protein,serum with immunoglobulin quantitations and immunofixation electrophoresis Electrophoresis,Protein,24-hour urine or random urine:includes total protein Electrophoresis,Protein,24-hour urine or random urine:includes total protein,immunoglobulin quanti

17、tations and immunofixation electrophoresis Electrophoresis,Bence Jones Protein,24-hour urine or random urine includes total protein and immunofixation electrophoresis Haptoglobin by nephelometry IgA,Serum by nephelometry IgG,Serum by nephelometry IgM,Serum by nephelometry Prealbumin by nephelometryA

18、utoimmune Disease Tests自身免疫自身免疫 ANA Screen with reflex to titer and pattern for positives by IFA C3 by nephelometry C4 by nephelometry Cyclic Citrullinated Peptide(CCP)IgG by EIA dsDNA Screen with reflex to titer for positives by IFA Jo-1 antibody by EIA Mitochondrial antibody with reflex to titer f

19、or positives by IFA Rheumatoid Factor by nephelometry Scleroderma antibody(Scl-70)by EIA Sjogrens antibody(SS-A)by EIA Sjogrens antibody(SS-B)by EIA Sm antibody by EIA RNP antibody by EIA Smooth Muscle antibody with reflex to titer for positives by IFAInfectious Disease Serology Tests各种传各种传染病细菌学检查染病

20、细菌学检查 Anti-Streptolysin O by nephelometry CMV IgG by EIA CMV IgM by MEIA EBV IgG(EA,VCA,EBNA)by EIA EBV IgM by IFA Helicobacter pylori IgG by EIA HSV IgG by EIA HSV IgM by EIA Lyme Disease by EIA with reflex to Western Blot for positive and equivocal results Mononucleosis Screen by agglutination Mum

21、ps IgG by EIA Rubella IgG by MEIA Rubeola IgG(measles)by EIA Syphilis Serology by RPR with reflex to titer and FTA if positive Toxoplasma IgG by MEIA Toxoplasma IgM by MEIA VZV(Varicella zoster)IgG by EIA VDRL by microflocculation West Nile IgM by EIA HIV-1 p24 Antigen Testing(Direct and ICD)Qualita

22、tive and Quantitative HIV-1 Plasma and PBMC Culture Test Qualitative DNA PCR Testing Quantitative HIV-1 RNA Testing Molecular Diagnostics LaboratoryWe provide a multitude of clinical testing for leukemia,lymphoma,solid tumors,colorectal cancer predisposition,and hematologic mutations.Leukemia白血病白血病

23、RFLP-This test is performed on bone marrow transplant(BMT)patients and their donors before BMT to identify an informative probe,and then after BMT on the patient to monitor the status of the graft.IgH PCR-This test identifies B-cell clonality in leukemia and lymphoma.TCR-Gamma PCR-This test identifi

24、es T-cell clonality in leukemia and lymphoma.BCR-ABL RT-PCR-This test identifies the t(9:22)BCR/abl gene translocation(Philadelphia chromosome)present in more than 99%of CML and frequently in all.Lymphoma淋巴瘤 BCL2/IgH PCR-This test identifies the t(14:18)BCL2/IgH gene translocation(major and minor br

25、eakpoint regions)seen in follicular lymphoma and large cell lymphoma.Specialty tests特殊检查 APC I1307K-This test identifies the hereditary predisposition for colorectal cancer in the Ashkenazi Jewish population.Leukemia白血病Flow Cytometry(Phenotypic Characterization,Residual Disease Detection)Morphology

26、Consultations-Blood and MarrowCytogenetics(in collaboration with the Cytogenetics Laboratory)Molecular Diagnostics(in collaboration with the Molecular Diagnostics Laboratory)Lymphoma淋巴瘤淋巴瘤Flow Cytometry(Phenotypic Characterization,Staging,Residual Disease Detection,Fine Needle Aspirates)Morphology C

27、onsultations-Lymph Node and other Tissue BiopsiesImmunohistochemistryMolecular diagnostics(in collaboration with the Molecular Diagnostic Laboratory)Specialty Tests特殊检查CD34 CountingPNH(Paroxysmal Nocturnal Hemoglobinuria)Diagnosis阵发性睡眠性血红蛋白尿 Bacteriology 细菌 Molecular Microbiology 分子微生物 Mycobacteriol

28、ogy 结核菌 Mycology 真菌 Parasitology 寄生虫 Virology 病毒 Special Pathogen Detection Actinomyces spp.:Culture;PCR Bordetella pertussis:Culture;PCR Legionella pneumophila:Culture;Direct fluorescent antibody;PCR Mycoplasma pneumoniae:PCR Mycoplasma hominis/Ureaplasma urealyticum:Culture Bartonella spp.:Culture

29、;PCR Chlamydia pneumoniae:PCR Chlamydia trachomatis:Culture;PCR Ehrlichia/Anaplasma:PCR Borrelia burgdorferi:Culture;PCR Neisseria gonorrheae:Culture;PCR Bacterial Identification Gas-liquid chromatography of glucose metabolic end products for anaerobe identification.Cell wall fatty acid analysis for

30、 speciation of non-fermenting or uncommon isolates.16S ribosomal RNA gene sequence analysis for identification.Toxin Testing Staphylococcus aureus Panton-Valentine leukocidin Shiga-like toxins 1 and 2 Clostridium difficile toxin by antigen and cytotoxic methods Antibiotic Susceptibility Testing and

31、Monitoring Agar dilution susceptibility testing(MIC)Antibiotic bacteriocidal determination(MIC/MBC)Antibiotic serum activity(Schlichter test-MID/MBD)Antibiotic synergy testing Antibiotic serum level determinations Molecular determination of antibiotic resistance genes Methicillin resistance(mecA)Van

32、comycin resistance(vanA;vanB;vanC)Molecular Epidemiology Pulsed-field gel electrophoresis(PFGE)Restriction fragment-length polymorphisms(RFLP)Epstein-Barr virus(EBV)detection and quantification by PCR Parvovirus B19 PCR detection BK virus detection and quantification by PCR JC virus detection by PCR

33、 Cytomegalovirus(CMV)PCR detection Varicella-Zoster virus(VZV)PCR detection Hepatitis C virus(HCV)quantification by PCR HCV genotype identification by direct sequencing Hepatitis B virus quantification by PCR Adenovirus detection by PCR Enterovirus detection by PCR High Risk HPV detection(HC-2,Digen

34、e)Ehrlichia chaffeensis and Anaplasma phagocytophila(HGE agent)PCR detection Atypical pneumonia pathogen detection by PCR(Mycoplasma pneumoniae,Legionella pneumophila,Chlamydia pneumoniae)Bacterial identification by 16S ribosomal RNA gene sequencing Molecular epidemiology by PFGE or RFLP Staphylococ

35、cus enterotoxin and TSST-1 gene and Shiga-like toxin gene identification by PCR Bordetella pertussis PCR Detection MycobacteriologyMycobacteria species identification and susceptibility testing,especially for patients with multiply resistant pathogens,is beyond the routine testing available in most

36、hospital laboratories.The Johns Hopkins Hospital Mycobacteriology Laboratory offers the following testing:Culture/smear Speciation Mycobacterial blood culture Routine susceptibility testing for M.tuberculosis Susceptibility testing for select non-specific mycobacteria upon request PCR for M.tubercul

37、osis from smear positive respiratory(only)specimensMycologyMost clinical laboratories can only identify common fungi,but the Hospitals diverse patient base gives the Microbiology Laboratory experience testing for speciation of unusual organisms and for performing yeast in vitro susceptibility testin

38、g.Fungal identification(yeast,dimorphics,filamentous)真菌鉴定 Cryptococcus antigen detection(隐球菌抗原检测）Fungal culture（真菌培养）Direct microscopic examination（直接镜检）KOH Calcofluor white（荧光染色，用于鉴别孢子虫)Giemsa Yeast in vitro susceptibility testing 酵母菌体外药敏试验Amphotericin B 二性霉素BItraconazole 伊曲康唑Voriconazole 伏立康唑Fluco

39、nazole 弗康唑5-fluorocytosine 5-弗胞嘧啶Caspofungin卡波芬净 Parasitology The Microbiology Laboratory has extensive experience diagnosing problems in international populations exposed to unfamiliar parasites,cancer patients who are immune-suppressed,and HIV-infected patients who are prone to develop unusual inf

40、ections.Malaria and other blood parasites detection and identification 疟原虫和其他血寄生虫的鉴别 Cryptosporidium and Isospora identification 隐孢子虫 Microsporidium ssp.identification 小孢子虫 Pneumocystis carinii identification 卡氏肺囊虫 Giardia lamblia identification肠兰伯式鞭毛虫肠兰伯式鞭毛虫 Virology The Virology Laboratory within

41、the Division of Medical Microbiology uses many different cell lines for culture,applies new methodologies for rapid and early identification of pathogenic viruses,and performs viral susceptibility determinations rarely performed in other laboratories.Respiratory virus(respiratory syncytial virus(RSV

42、),influenza A,influenza B,parainfluenza viruses 1-3,adenovirus)rapid antigen detection and culture 呼吸道病毒 Herpes simplex culture单纯疱疹单纯疱疹 Cytomegalovirus(CMV)culture巨细胞病毒巨细胞病毒 Cytomegalovirus(CMV)culture-early antigen Cytomegalovirus(CMV)quantification by PCR Varicella-Zoster virus(VZV)culture水水痘痘-带状疱

43、疹病毒带状疱疹病毒 Enterovirus culture 肠道病毒 Adenovirus culture 腺病毒 Other Viral cultures 其他病毒 Viral susceptibility 病毒药敏 Molecular Virology(see Molecular Microbiology)分子病毒学 华西医院检验科独特项目 游离脂肪酸（游离脂肪酸（Free fatty acids,FFA）3-甲氧基甲氧基-4羟基苦杏仁酸羟基苦杏仁酸（Vanillylmandelic acid,VMA）抗酒石酸酸性磷酸酶（抗酒石酸酸性磷酸酶（Tartrate resistant acid

44、phosphatase-5b,TRAP-5b）人巨细胞病毒载量（人巨细胞病毒载量（HCMV viral load）沙眼衣原体沙眼衣原体DNA（CT-DNA）淋球菌淋球菌DNA（NG-DNA）疱疹病毒疱疹病毒I、II DNA（HSV I&II-DNA）HLA抗体特异性试验抗体特异性试验（PRA）HLA抗体筛查试验抗体筛查试验(HLA I、II antibody screening test)HLA抗原抗原DNA分型（分型（HLA antigen detection）解脲支原体解脲支原体DNA（UU-DNA）B细胞（细胞（CD19CD5）转铁蛋白转铁蛋白(Transferrin，TRF)骨特异性碱

45、性磷酸酶（骨特异性碱性磷酸酶（-ALP）T细胞亚群细胞亚群(CD3,CD4,CD8)1抗胰蛋白酶抗胰蛋白酶(Alpha1-antitrypsin,AAT)1酸性糖蛋酸性糖蛋(Alpha1AcidGlycoprotein)(AAG)干扰素（干扰素（IFN）免疫固定电泳（免疫固定电泳（Immunofixation Electrophoresis,IFE）可溶性白细胞介素可溶性白细胞介素2受体（受体（sIL-2R）可溶性细胞凋亡因子配体（可溶性细胞凋亡因子配体（sFasL）可溶性细胞凋亡因子（可溶性细胞凋亡因子（sFas）可溶性细胞间粘附分子可溶性细胞间粘附分子1（sICAM-1）可溶性细胞间粘附分

46、子可溶性细胞间粘附分子3（sICAM-3）可溶性血管粘附分子可溶性血管粘附分子1（sVCAM-1）尿轻链定量（尿轻链定量（）循环免疫复合物（循环免疫复合物（circulating immune complex,CIC）抗凝血酶抗凝血酶3(Antithrombin,AT3)新碟呤（新碟呤（Neopterin）白细胞介素白细胞介素-2（IL-2）4,6,8,10,12,13 结合珠蛋白结合珠蛋白(Haptoglobin，HPT)自然杀伤细胞（自然杀伤细胞（Natural Killer Cells,NK）血管内皮生长因子（血管内皮生长因子（VEGF）肝纤肝纤 PC C LN HA MAO FN AL

47、A*-氨基氨基-酮戊酸（酮戊酸（-amino levulinic acid,ALA）亮氨酰氨基肽酶（亮氨酰氨基肽酶（leucine aminopeptidase，LAP）冷球蛋白（冷球蛋白（cryoglobulins cryo）酸性磷酸酶（酸性磷酸酶（acid phosphatase，ACP）磷脂（磷脂（phospholipid，PL）VWF胶原结合分析（胶原结合分析（vWF collogen binding assay）vWF抗原测定抗原测定(vWF antigen determination)X因子活性测定因子活性测定(factor X activity determination 因子活

48、性测定因子活性测定(factor II activity determination 因子活性测定因子活性测定(factor VII activity determination)因子活性测定因子活性测定(factor VIII activity determination)因子活性测定因子活性测定(factor IX activity determination)抗碱血红蛋白抗碱血红蛋白(Alkali-resistant hemoglobin)血红蛋白电泳和血红蛋白电泳和HbA2测定（测定（hemoglobin electrophoresis and mensuration for HbA2

49、）高铁血红蛋白还原试验高铁血红蛋白还原试验(methemoglobin reduction test)北京协和医院检验科项目 达安基因目录美国每年医学实验室检查 70-100亿个标本 其中TCT2.4亿，组织病理6千万个 大于97%癌症通过组织活检确诊，而不是肿瘤标志物，中华医学会检验分会肿瘤标志物委员会和美国NIH均有文件明确指出：肿瘤标志物不能用于肿瘤的普查 国家发改委已明确表示今后医疗付费模式是按病种付费 医疗机构与医保部门讨价还价的是临床路径 临床路径的实施的结果是今后大组合和与诊断关系不大项目肯定萎缩 IOM报告 每年医疗事故：科罗拉多州和犹他州44000例死亡，纽约州98000例死

50、亡 每年医疗事故导致死亡人数，超过车祸（44000），乳腺癌（43000）和艾滋病（17000）的总和 经济损失美元170-290亿 质量保证是基础，包括设备/试剂 Hepatitis B surface antigen mutant detection on four immunoassay analysers.ARCHITECTi2000 AXSYM Elecesys Vitros Mutant detection 12/12 12/12 7/12 6/12 Turn-around time 30m 30 m 20 m 38m Calibtation stability 28d 23d 2