the history of the objectives laboratory profession: then ... · 3 barber shop museum: manhattan,...

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The History of the

Laboratory Profession:

Then & Now

Michele B. Zitzmann, M.H.S., MLS(ASCP)

LSUHSC Dept. of Clinical Laboratory Sciences

New Orleans

CLPC Spring, 2019

Objectives

Discuss the history of the laboratory

profession, including phlebotomy and

several other areas of the lab.

Describe how laboratory testing has

advanced over the years.

History of Laboratory Science

THEN

NOW


THEN

NOW


NOW

&

THE

FUTURE

Ancient History of Blood

Egyptians

Bathed in blood for health

–“Resuscitate the sick and rejuvenate

the old and incapacitated”

–Cure for elephantiasis

Bleeding used for treatment

2


Hippocrates

–Human body filled with

4 basic substances

(“humors”)

• Blood

• Phlegm

• Black bile

• Yellow bile (~460-370 BC)


Each humor centered in a

particular organ & related

to a personality type

Needed to be kept in

balance to maintain

proper health

Often diagnosed with an

overabundance of blood

(fever, etc.)

History of Phlebotomy

Known as “blood-letting”

First practiced by Egyptians around 1000

BC

Believed releasing blood from the body

cured diseases

– Acne

– Sore throat

– Plague

Mayan Art - Bloodletting

Bloodletting

Became very popular

Spread to Greeks & Romans in

Medieval era

Believed that blood was stagnant in

extremities (not flowing); releasing

stagnant blood would cure patients by

forcing blood to move

Bloodletting

Middle Ages

– Not performed by physicians

– Barber-surgeons

• Also performed amputations & pulled teeth

– Red stripe on barber pole originated

– Symbolic of bloodletting

3

Barber Shop Museum:

Manhattan, New York Bloodletting

Thumb lancets

Fleams

– Customers brought

own blood bowl

Leeches

Bloodletting

Scarificator

Bloodletting

Scarificator

Bloodletting1860 George Washington (1799)

Developed fever & respiratory distress

Had been riding in snowy weather

His 3 physicians ordered bloodletting

Copious amounts of blood drawn

(9 pints)

Died following night

His treatment triggered controversy over

bloodletting

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Cupping

Cups placed over wound

– Suction devices

– Capture blood

Cupping

Bloodletting Today - Phlebotomy

Small puncture to withdraw blood

Trained professionals – phlebotomists

Invaluable tool to diagnose & treat

illnesses

Bloodletting Today - Phlebotomy

Treatment for:

– Hemochromatosis (abnormal accumulation

of iron)

– Polycythemia vera (increase in red blood

cells & possibly white blood cells &

platelets)

Leech Therapy Today

Known as Hirudotherapy (Hirudin)

1980’s: Popular practice by plastic surgeons

Leeches secrete biologically active

substances (hyaluronidase, fibrinase,

proteinase inhibitors, & anticoagulants)

Helps reduce venous congestion & prevent

tissue necrosis (skin grafts & replantation of

fingers, ears, toes)

Leech Therapy Today

New leech fad

– Modern hirudotherapists

– Claim leeches can cure migraines, heart

disease, joint disorders, & bronchitis

2004: U.S. FDA approved use of leeches

solely for venous congestion after surgery

5

Leech Therapy Today

Cost

– $350/day

– Average of 8 treatments, 1-2 times/week

– Acquired from Hungary or Sweden

– Most insurance companies won’t cover unless

prescribed by surgeon

Leech Therapy Today

University of Utah students – developed

“mechanical leech”

Advantages:

– Less chance of infection

– Don’t get full

– Stay in place

– More “attractive”

– Less expensive ($200 each)

Transfusion Medicine

Blood Bank

History of Transfusion Medicine

In what year did the first documented

human to human transfusion take

place?

– A. 1628

– B. 1755

– C. 1818

– D. 1903


1818

– James Blundell, British Obstetrician

– Successfully transfused human blood to

patient who hemorrhaged during childbirth

1901

– Karl Landsteiner, Austrian physician

– Discovered first human blood groups

– Helped transfusion become safer practice

History of Transfusion Medicine

Direct blood

transfusion during

difficult childbirth

(Paris, 1887)

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Most important developments over the

last 70 years

– Blood collected in reusable glass bottles

(first half of 20th century)

– 1949: Trials of plastic bags conducted by

American Red Cross

• Disposable; facilitated the separation of blood

components

Blood Collection

THEN NOW

Tourniquets

THEN

NOW Transfusion Medicine

1936: First blood bank opened in Chicago

1957: Citrate phosphate dextrose (CPD) extends

vitality of blood units to 28 days

1965: Cryoprecipitation discovered

1969: Platelets stored at room temperature

1987 – present: Screening of donated blood for

infectious diseases by more sensitive testing

Transfusion Medicine - Progress Transfusion Medicine Today

New instrumentation (NEO Iris)

– FDA granted marketing clearance

– Fully automated

– Up to 60 types & screens/hour

– ABO/Rh D typing, weak D testing, donor

confirmation, CMV screening, IgG DAT &

crossmatch, & antibody identification &

screening

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Transfusion Medicine Today

Blood Track Emerge

System - “Emma”

Refrigerator in

Emergency

Department

Used to house blood

products for

emergency

situationsAuthor: Zuzanna Lomnicka

CLS ‘19

Blood Track Emerge System

Blood Bank “vending machine”

Locked refrigerator in the ED

4 – O negative units

6 – O positive units

4 – AB plasma

6 – A plasma

Only certain nurses are trained to use

Decreased turn around time

– 7.5 min to 30 sec


Units scanned into Blood Bank then into “Emma”

– Segments remain in Blood Bank

– Duplicate label remain in Blood Bank

Computer software in the Blood Bank

– Tracks all units in “Emma”

Computer notifies Blood Bank when anyone

scans blood


Only certain patients can receive units from

“Emma”

Criteria is set by pathologist

Each patient who receives blood is reviewed by

pathologist

Limited number of units allowed

– Can only take 2 units of red cells and 2 units of

plasma at a time

– Can only go into “Emma” twice for each patient

Hematology

History of Hematology

1674: Antonie van Leeuwenhoek

discovered blood cells

1770: William Hewson described the

different cell types

Late 1920’s: Normal blood values were

established & the HCT was used to

characterize anemias based on RBC size

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History of Hematology Evolution of Microscopy

Evolution of Testing - CBC Evolution of Testing - ESR

Manual Peripheral Smears ?

What’s that ? Flow Cytometry

Wide range of applications

– Diagnose leukemias & lymphomas

– Monitor CD4 & CD8 counts in HIV + patients

– DNA analysis in solid tumors

– Reticulocyte counts

Important tool in the diagnosis, prognosis

& monitoring of treatment

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Urinalysis

History of Urine

History of Urinalysis

Oldest known medical test (“Uroscopy”)

Marks the beginning of laboratory medicine

Ancient physicians called urine a “divine fluid” or

“window to the body”

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Hippocrates’ Theories (460-355 BC)

Described bubbles on the surface of fresh

urine indicated kidney disease

– TRUE: due to proteinuria

Associated urinary sediment with fever

– TRUE: due to WBC’s & bacteria (UTI)

Blood in the urine caused by kidney or

bladder ulceration

– TRUE: can also be caused by other

conditions

Galen’s Theories (AD 129-200)

Used the phrase “diarrhea of urine” to

describe excessive urination & noted that

it was abnormal

– TRUE: polyuria is symptom of diabetes

Believed that liquid ingested equaled

urine expelled

– TRUE: dehydration causes decrease in

urine output (oliguria)

Evolution of Urinalysis

“Uroscopy” no longer practiced

Early 1900’s: First urine sugar test

Early 1940’s: First urinalysis test

Past 50 years: Numerous commercial tests

available

Past 20 years: Automated instruments to replace

microscopic analysis

Remains an effective diagnostic tool

Evolution of Urinalysis

Specific Gravity in the Past

Urinometer

Refractometer

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Nephro Check – Acute Kidney Injury Detection of Pancreatic Cancer

Researchers at Barts Cancer Institute in

London

– Discovered three proteins found at high

levels in urine

– Can distinguish between pancreatic cancer

and chronic pancreatitis

Three proteins are:

– LYVE1, REG1A, TFF1

Detection of Pancreatic Cancer

Patients with pancreatic cancer

– Increased levels when compared to healthy

patients

Patients suffering from pancreatitis

– Lower levels than cancer patients

When combined, the three proteins can

detect patients with stages I-II pancreatic

cancer with over 90% accuracy

New Urine Test for Preeclampsia


Congo Red Dot (CRD) Paper Test


Congo Red Dot (CRD) Paper Test

– Simple, 3-minute urine test

– Ohio State University Study

• 346 pregnant women

• 86% accuracy rate (far better than current tests)

• Currently waiting for FDA approval

– Potential to save thousands of lives

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Microbiology

History of Microbiology

1658: Kircher observed microbes in spoiled milk

1666: Robert Hooke observed molds under the

microscope

1676: van Leeuwenhoek experimented with

microorganisms under a microscope he designed

1800’s: Microbiology developed through work of

Louis Pasteur & Robert Koch


Golden Age of Microbiology (late 1800’s -

early 1900’s)

– Many agents of infectious diseases identified

– Ability to halt epidemics by interrupting

spread of microorganisms

– However, rarely possible to render life-saving

therapy to infected patients


Which antibiotic was the first to be

discovered?

– A. Keflex

– B. Bactrim

– C. Penicillin

– D. Zithromax


1928: Alexander Fleming discovered

the first antibiotic (Penicillin)


World War II (1940)

– Antibiotics introduced to medicine

– Incidence of pneumonia, tuberculosis,

meningitis, syphilis, & other diseases

declined

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1940’s

– Electron microscope developed

– Helped scientists study viruses

– Cultivation methods for viruses introduced

1950-1960’s

– Development of vaccines

– Polio, measles, mumps, & rubella were

controlled

Microbiology Today

Numerous reclassifications &

name changes

Challenges with resistant

organisms

Molecular Identification

MALDI-TOF

– Matrix-assisted laser

desorption/ionization time of

flight

Parasitology

History of Parasitology

Which parasite was the first to been

seen under the microscope?

– A. Giardia

– B. Malaria

– C. Cryptosporidium

– D. Enterobius (pinworm)


1681

Antonie van Leeuwenhoek

Observed & illustrated

Giardia lamblia

Linked it to his own “loose

stools”

First protozoan parasite of

humans to be seen under

a microscope


1835 Trichinella spiralis

1873 Entamoeba histolytica

1875 Human liver fluke

1876 Strongyloides sp.

1877 Microfilaria causing elephantiasis

1897 Plasmodium causes malaria &

transmitted by Anopheles

mosquitoes

14


Parasites very common

Thought to arise by

“spontaneous generation”

Later disproved in the late

19th century

Maggots & meat

Drucunculus medinensis

Guinea worm

History dates back to biblical times

– “Firery serpent” responsible for plague which

affected Israelites living by the Red Sea

Humans infected by ingesting larvae in

contaminated drinking water

Larvae mature & migrate to lower extremities &

form blister

Blister ruptures when exposed to water,

releasing larvae

15

Parasitology Today

Guinea Worm set to become the 2nd

human disease in history (after smallpox)

to be eradicated

Will be the 1st parasitic disease to be

eradicated

Will be the 1st disease to be eradicated

without the use of a vaccine or medicine

Guinea Worm Prevalence

1986

– Estimated 3.5 million people in 21 countries

in Africa & Asia affected

2016

– 25 cases

• Reduced by more than 99.9%

• Prevented at least 80 million new cases

Guinea Worm

Prevention

The Carter Center

– Worked with ministries of health to educate

people on how to stop the spread of disease

• CDC, WHO, & UNICEF

– Community-based interventions to educate &

change behavior

• Filter all drinking water

• Preventing infected persons from entering water

sources

Parasitology Today

Very few diagnosed

– Pinworm

– Trichomonas

– Giardia

Parasitology Today

Hygiene hypothesis (1989)

– Declining family size

– Improvements in household amenities

– Increase in personal cleanliness

– Increased access to clean water

– Improved sanitation

Have reduced exposure to many

infectious organisms

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Parasites & Immunity

Autoimmune diseases

– Overactive immune system

– Affects more than 23.5 million Americans

– Very rare in areas south of the equator

• Prevalence of parasitic infections are very high

– Decreasing parasitic infections in the U.S.

has caused an increase in autoimmune

diseases

Parasitology Today

Helminthic Therapy

Trichuris suis (pig whipworm) used to

treat several intestinal autoimmune

diseases (ulcerative colitis, Crohn’s

disease, celiac disease, asthma &

multiple sclerosis)

– Cannot survive inside human gut for long

Problems with worm therapy

Not approved for medical use by FDA

Not available in the U.S.

– Imported from United Kingdom or Thailand

– Quality can vary

Correct dosage is difficult

– Too many can cause adverse reactions

Treatment is temporary

– Must ingest worm eggs every 2 weeks

– May be lifelong

Trichuris: Egg Morphology

Trichuris: Adult Morphology Trichuris found on colonoscopy

17

Chemistry

History of Chemistry

1869

Dmitri Mendeleev

(Russian chemist)

Developed first

periodic table

More than 13 years

66 elements


1953

James Watson &

Francis Crick

Discovered the

double helical

structure of DNA


1916

Gilbert N. Lewis

Introduced the

“electron dot

diagrams” known as

Lewis structures

Discussed in every

Intro Chemisty book

Chemistry Lab Equipment Chemistry Lab - THEN

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1983

Kary Mullis

Devised method for

in-vitro amplification

of DNA (PCR)

Lead to the

sequencing of DNA

of organisms & the

Human Genome

Project

Chemistry Lab - NOW

Lab Requisitions & Reports -

THEN Lab Reports

Lab Requisitions & Reports -

NOWLab Requisitions & Reports -

NOW

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Specimen Transport

Drones to Deliver Blood Samples

Researchers from Johns Hopkins

Successfully delivered blood samples

161 miles across the Arizona desert

Three hour flight

Properly temperature controlled

Samples remained viable for analysis

when landed


Drone vs. car transport

Samples analyzed at Mayo Clinic in

Arizona

Both samples displayed similar results for

– WBC count

– RBC count

– Platelet count

– Sodium level


Advantage: no infrastructure required

Plans to implement in the next year

Trials for round trip pickup and drop off

needed

Future: organ transplant delivery?

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1896 First clinical laboratory, John Hopkins

1908 First textbook of laboratory medicine

1923 First school to train lab techs

(University of Minnesota)

1928 ASCP established

1930 First ASCP exams given

1936 ASMT established (first professional

organization)


1976 NCA established

1993 ASMT changed name to ASCLS

1995 Licensure law passed in Louisiana

2009 NCA merged with ASCP

NCA dissolved as a corporation

New credentials changed from

MT(ASCP) to MLS(ASCP)CM

Nation’s First Clinical

Pathologist Assistant Program

University of Alabama at Birmingham

(UAB)

Addressing the need for change

Established a program to embrace the

future of the clinical laboratory

Emphasizes the clinical aspects of lab

medicine

Nation’s First Clinical

Pathologist Assistant Program

Many over- and under-utilized tests

Leads to wasted money & resources and quality of

patient care

Over 7 billion laboratory tests are performed in the

U.S. each year

CPA graduates will alleviate some of the

communication problems

Serve as resources for clinicians & hospital staff

LSUHSC CLS

Class of 2003 Alumnus

First graduate of a doctoral program in CLS

in the nation (Rutgers School of Health

Professions)

DCLS degree

Questions?

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