Clinical Pathology

Overview
Doctors & Specialists

Clinical Pathology at UVM Medical Center

Chemistry

The Chemistry section is a large area of the Clinical Laboratory which houses both the High Volume and the Special Chemistry testing areas. The diagnostic testing performed in this section is a mix of highly automated assays and more specialized manually performed tests. A recent addition to the department is the Vitros Automation Solutions System which includes automated sample handling modules and a rack delivery system, both which increase efficiency and improve area turn around times.

The High Volume area operates 24-7 and analyzes hundreds of samples per day. Assays include:

Complete metabolic panels
Thyroid assays
Lipid panels
Liver panels
Cardiac markers
Arterial and venous blood gas measurements
Fluid osmolality
Urinalysis
Urine drugs of abuse screening

The Special Chemistry area operates Mon-Fri, 8 am-430 pm, with the exception of a few assays which are available via STAT requests. The testing mix in this area includes:

Hepatitis and HIV(4^th generation) screening, Hepatitis C by PCR, HIV Quantitation by PCR
Endocrine testing
Fertility hormone levels
Tumor marker assays(PSA, CEA, Ca125, C199, C2729)
Whole Blood Lead quantitation
Therapeutic drug monitoring
Immunosuppressant drug monitoring
Volatile screen by GLC
Serum, urine, and hemoglobin electrophoresis
A variety of other viral and infectious disease markers including LYME antibody

Contacts

Chemistry Medical Director: Clayton Wilburn, MD
Manager: Monica Sullivan, MT (ASCP)
Supervisor: Judy Schwenn, MSA, MT (ASCP)
Technical Specialist High Volume Chemistry-1: Ashley Holtz, MT (ASCP)
Technical Specialist Special Chemistry-2: Jocelyn Stocker, MT (ASCP)

Coagulation

The Coagulation and Special Coagulation sections are one of the region's foremost resources for coagulation studies. State of the art tests performed enhance diagnostic capabilities for congenital and aquired bleeding disorders, hyper coagulable evaluations, platelet disorders, and autoimmune coagulation disorders. The services provided by our laboratory support the Thrombosis and Hemostasis Program and our Hemophilia Treatment Center.

Routine coagulation including Protime, PTT, Fibrinogen, D-Dimer, and Mixing Studies
Therapeutic monitoring for low molecular weight and unfractionated heparin
Advanced coagulation testing including: coagulation factors, von Willebrand factor antigen and activity and thrombin time
Bethesda assays (measure the amount of factor specific inhibitor)
Advanced Hypercoagulability studies including: antithrombin III activity, functional protein C and protein S activity
Platelet dysfunction testing (PFA, platelet aggregation and secretion, platelet mapping)
Lupus anticoagulant cascade to detect antiphospholipid antibodies and interference
Use the thrombelastograph (TEG) analyzer to assist in the assessment of patient clinical hemostasis conditions in the operating room by providing a live quantitative and qualitative indication of the coagulation state of a blood sample

Contacts

Coagulation Medical Director: Andrew Goodwin, MD
Manager: Cindy Nelson, MT (ASCP)
Supervisor: Lisa Reste, MT (ASCP)
Coagulation Technical Specialist: Kristin Lundy, CLS

Cytogenetics

Cytogenetics is the study of human chromosomes. Chromosome analysis provides an overview of the genome and the ability to identify chromosome rearrangements and numeric abnormalities. Karyotyping is essential in diagnosis and classification of both constitutional disorders and many malignancies. Chromosome analysis and fluorescence in situ hybridization (FISH) analysis are available for peripheral or cord blood, bone marrow, solid tumors, lymph nodes, fine needle aspirates and fetal tissue (products of conception, fascia).

The Cytogenetics Laboratory is open Monday - Friday 8:00 am - 4:30 pm and Saturday 8:00 am - 12:00 pm.

Fish

Fluorescence in situ hybridization for a variety of constitutional and neoplastic conditions

Peripheral Blood Analysis

Evaluation of a couple with recurrent miscarriage or infertility
Evaluation of parents of an offspring with a chromosome abnormality
Evaluation of a child with suspected aneuploidy, such as Turner Syndrome and Klinefelter Syndrome

Cancer Analysis

Evaluation of Lymphomas, Leukemia, and other hematologic disorders
Evaluation of solid tumors, especially sarcomas, renal cell carcinomas, and lipomas

Products of Conception/Stillbirth Analysis

Recurrent Miscarriage
Fetal death

Contacts

Cytogenetics Medical Director: Juli-Anne Gardner, MD
Manager: Cindy Nelson, MT (ASCP)
Supervisor: Paulette Hammond, MT (ASCP)
Technical Specialist: Catherine Buck, CG (ASCP)

Flow Cytometry

Flow Cytometry allows for the simultaneous multiparametric analysis for the qualitative measurement of the biological and physical properties of cells. Our section performs test such as Lymphocyte Subset Analysis (T-cell, B-cell, and NK subsets) which may be used as aids to evaluate the immune competency underlying known or unknown disease states and to monitor lymphocyte levels following organ transplantation. We also perform a test to monitor CD20 depletion in Rituximab therapy. Flow Cytometry also performs leukemia and lymphoma immunophenotyping to aid in the diagnosis of hematologic malignancy. CD34 Stem Cell Enumeration is also performed on peripheral blood and apheresis samples in the setting of stem cell transplantation.

Leukemia/Lymphoma Panels
T-Cell Subset Analysis
T-Cell, B-Cell, and NK Subset analysis
Absolute CD3 Monitoring
CD1920 Panel for Rituximab Monitoring
CD34 Stem Cell Enumeration

Contacts

Flow Cytometry Medical Director: Katherine Devitt, MD
Manager: Cindy Nelson, MT (ASCP)
Supervisor: Lisa Reste, MT (ASCP)
Technical Specialist Flow Cytometry: Amanda Chamberlain, MT (ASCP)

Hematopathology

The Clinical Hematology Laboratory provides many routine and advanced services. We work closely with our attending pathologists and residents to aid in the diagnosis of hematologic disorders such as iron deficiency anemia, sickle cell disease, and leukemia. We strive to provide high quality service for our hospital and others in the region and work closely with the Hematology/Oncology Clinic.

Routine hematology testing including complete blood counts, blood cell differentials, sedimentation rates, and bone marrow processing and staining
Body fluid analysis and cell counts
Cerebrospinal fluid cell counts
Differentials are performed on slides of peripheral blood, body fluids, and cerebrospinal fluids which are examined under the microscope to detect abnormal white blood cells and /or red blood cells and cell morphology
Screening tests for sickle cell disease and sperm screens
Manual hematology testing which includes manual white blood cell counts, manual platelet counts, crystal analysis for synovial fluids and spun hematocrits
Kleihauer-Betke Test (quantitates fetal/maternal hemorrhage)
Lamellar Body Counts (indicator of fetal lung maturity)

Contacts

Hematopathology Medical Director: John Lunde, MD
Manager: Cindy Nelson, MT (ASCP)
Supervisor: Lisa Reste, MT (ASCP)
Technical Specialist Hematopathology: Russell Brown, MT (ASCP)

Immunology

The Immunology Laboratory performs tests that aid in the diagnosis of autoimmune and infectious disease. Methodologies utilized include enzyme-linked immunosorbent assays (ELISA) and indirect immunofluorescence Assays (IFA). We are a fully automated and integrated Immunology Laboratory. For IFA we utilize the QUANTA-Lyser automated IFA analyzer platform, the NOVA View automated digital IFA microscope, and the QUANTA Link software which provides full traceability of patient samples from processing through reporting and significantly reduces hands-on time and improves workflow efficiencies. For ELISA we utilize the DSX which is a high-performance walk-away ELISA processing system.

Autoimmune Disease Testing

Anti-Nuclear Antibody (IFA)
Anti-Neutrophil Cytoplasmic Antibody (IFA
Anti-Cardiolipin IgG and IgM (ELISA)
Anti ds-DNA IgG (ELISA)
Anti-Tissue Transglutaminase, IgA (ELISA)
Anti-SSA, Anti-SSB, Anti Sm, and Anti RNP IgG (ELISA)

Infectious Disease Testing

QuantiFERON-TB Gold (ELISA)
H. Pylori Stool Antigen (ELISA)

Contacts

Immunology Medical Director: Clayton Wilburn, MD
Manager: Cindy Nelson, MT (ASCP)
Supervisor: Lisa Reste, MT (ASCP)
Technical Specialist Immunology: Amanda Chamberlain, MT (ASCP)

Microbiology

The faculty of the Medical Microbiology Laboratory conducts and interprets testing for patients with viral, bacterial, fungal, and parasitic infections at the University of Vermont Medical Center. In addition, we serve as a resource to hospitals in the University of Vermont healthcare network as well as outpatient facilities.

We provide consulting services and work closely with our clinicians to ensure appropriate test utilization and the acquisition of quality specimens. If we cannot perform a test in our laboratory, we ensure shipment of specimens to reference labs in a timely fashion.

In addition to clinical testing, we are involved in research, the training of infectious disease fellows, medical students, pathology residents, dermatology fellows and bio-medical technology students from the University of Vermont. Services include:

Identification of aerobic and anaerobic bacteria with appropriate susceptibility testing
Screening for Methicillin resistant Staphylococci
Bacterial PCR testing for Bordetella pertussis, bacterial enteric pathogens, Group B strep, C. difficile
"Special Microbiology" testing includes Virology PCR for respiratory viruses, Herpes Simplex 1 & 2, Varicella Zoster, and Cytomegalovirus, HPV DNA, Chlamydia and Gonorrhea RNA by Transcription Mediated Amplification. Mycology (culture, smear, Cryptococcal antigen), Mycobacteriology (culture, smear and DNA probes for culture confirmation), and Parasitology (routine, antigen detection, blood parasite exams, arthropod and worm identification)
Ongoing collaborative research with pharmaceutical companies, diagnostic companies, and other universities
Regional reference testing for esoteric Microbiology

Contacts

Microbiology Medical Director: Christina Wojewoda, MD
Manager: Monica Sullivan, MT (ASCP)
Supervisor: Roberta Francis, MT (ASCP)
Technical Specialist Microbiology-1: Debra Reardon, MT (ASCP)
Technical Specialist Microbiology-2: Sharon Weisburgh, MT (ASCP)

Night Testing

The night shift in the laboratory is staffed by 4 -5 technologists each night. these technologists are responsible for a wide variety of testing in Blood Bank, Chemistry, Hematology, and Microbiology. Unlike other areas of the laboratory where technologists generally perform testing in one area, the night technologists are able to work in multiple areas and often spend time in many areas in one night.

Basic chemistry analysis
Basic hematology and coagulation analysis
therapeutic drug monitoring on ED patient and inpatients
urinalysis
Special coagulation testing and support UVMMC being a hemophilia treatment center
Appropriately analyze positive blood cultures in order to report bacteremia to clinicians ASAP
Flu/RSV testing
Wide variety of Blood Bank testing necessary to support a level I trauma center

Contacts

Nights Medical Director: Andrew Goodwin, MD
Manager: Cindy Nelson, MT (ASCP)
Supervisor: Judy Schwenn, MSA, MT (ASCP)
Charge Technologist Nights: Leigh Guerin, MT (ASCP)

Phlebotomy

The Phlebotomy section is committed to providing the highest quality speicmen collection services to the community. We offer a variety of locations throughout Chittenden County for your convenience. Our nationally certified staff are trained to collect blood and other specimens from patients of all ages in accordance with Clinical Laboratory Standards.

Specific Services

Questions & Answers

Q. Do I need an appointment?
A. No

Q. Do I need orders from my doctor?
A. Yes

Q. My doctor is not a UVM Medical Center Provider, can I still have my blood drawn here?
A. Yes! We are able to collect samples ordered by any provider.

Contacts

Medical Director: Clayton Wilburn, MD
Manager: Monica Sullivan, MT (ASCP)
Supervisor Inpatient Phlebotomy: Michele Baker, MT (ASCP)
Supervisor Outpatient Phlebotomy: Susan Antell, MT (ASCP)
Technical Specialist Phlebotomy: Leah Briggs, PBT (ASCP)
Technical Specialist Phlebotomy: Amber Foote, PBT (ASCP)

Specimen Receiving

Patient samples from physician offices in Chittenden County and hospitals from Vermont, New York, and New Hampshire arrive in our lab to be triaged and processed. Laboratory Specimen Processing Technicians triage, deliver, unpack, and accession patient samples in the computer system. Samples are processed and sent to the appropriate laboratory areas to be tested.

Specific Services

Triage, deliver, unpack, accession, and prepare patient samples for testing
Responsible for selecting the correct patient, ordering tests, and bar code labeling, and processing patient samples
Load patient samples onto the Ortho TCA track system to be run by Ortho Vitros Chemistry Analyzer and/or Sysmex Hematology Analyzer
Send out patient samples to specialized testing facilities such as Aspenti Health, Mayo Clinical Laboratories, and many other accredited reference laboratories
Handle approximately 90,000 patient tubes per month

Contacts

Medical Director: Clayton Wilburn, MD
Manager: Monica Sullivan, MT (ASCP)
Supervisor: ,Cindy Cruickshank,MT (ASCP)
Charge Technologist: Elizabeh Manning, MT (ASCP)

Transfusion Medicine

The Transfusion Medicine section is comprised of Blood Bank and Stem Cell Processing. The Blood Bank performs compatibility testing of blood and its components between donor and recipient for transfusion. Testing is performed using automated gel-technology and manual methods. The blood Bank is also responsible for patient blood management and blood inventory management, transfusing approximately 10,000 products a year. The Stem Cell area focuses on the processing of autologous stem cell collections for cellular therapy. The Blood Bank supports different areas of medicine including trauma, surgery, maternal-fetal-medicine, neonatal ICU, dialysis, and Hematology/Oncology. Blood Bank and Stem Cell are accredited by the FDA, College of American Pathologists, AABB, and FACT. Blood Bank services are available 24 hours a day, 7 days a week.

Blood Products

Red Blood Cells
Plasma
Cryoprecipitate
Platelets

Transfusion Medicine Services

Red blood cell typing
Detection of antibodies to red blood cell antigens
Compatibility testing
Maternal-fetal testing
Direct antibody testing
Autologous stem cell processing and storage for re-infusion

Contacts

Transfusion Medicine Medical Director: Sarah Harm, MD
Manager: Cindy Nelson, MT (ASCP)
Supervisor: Paulette Hammond, MT (ASCP)
Technical Specialist Blood Bank: Lynn Griswold, MT (ASCP)
Technical Specialist Blood Bank and Stem Cell: Raymond Bissonnette, MT (ASCP)

Laborarory Contact Information

If you have any questions about Pathology & Laboratory Medicine, please contact Laboratory Customer Service, at 847-5121 or 1-800-991-2799. University of Vermont Medical Center, Pathology and Laboratory Medicine –MP-103, Burlington VT, 05401<