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Medical Laboratory Science News

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Sunday, April 19 marks the beginning of Medical Laboratory Professionals Week, or put more simply, Lab Week.

This year's Lab Week comes at an unprecedented time in history, when healthcare professionals in Maryland, throughout the United States, and around the world are battling the global pandemic caused by the SARS-CoV-2 virus, which can result in the disease known as COVID-19.

The role of laboratory professionals in this fight has been brought to the forefront in the news, particularly as it relates to testing. Laboratory professionals throughout the United States and around the world are working, day and night, to bring in the new test kits, validate them, and then run patient samples to diagnose those that have the SARS-CoV-2 virus. Laboratory professionals have been at the forefront of investigating the use of convalescent plasma as a treatment option for those suffering from COVID-19. Eventually, the antibody tests will become available, and laboratory professionals will be responsible for performing those tests as well. Using these test results and considering the clinical presentation, physicians and nurses are better able to provide appropriate and timely care to these patients.

This year, Medical Laboratory Professionals Week comes at a time when the professionals who work in the clinical laboratory are more important than ever, though the work that they do is often mischaracterized or goes unnoticed. Those of us in higher education call this a “teachable moment”, and want the opportunity to correct those mischaracterizations.

First, Medical Laboratory Professionals are highly educated and board certified. In addition to our undergraduate degrees, many of us have Masters or Doctorate degrees and specialist certification. We have to study and be proficient in topics that many people have trouble understanding: Immunohematology, Flow Cytometric Studies, Virology, Mycology, Parasitology, Dyslipoproteinemia, Thrombotic Evaluation, Biochemistry and the list goes on.

Second, drive-thru or mobile “testing centers” for SARS-CoV-2 are actually specimen collection centers. There is absolutely no testing being performed at any of these centers. Rather, a sample is being collected, hopefully properly, and placed into a special viral transport medium. That sample is then transported to a facility, either a reference laboratory or a local hospital, staffed by medical laboratory professionals who then perform very advanced testing using RT-PCR on the sample detecting the presence of the virus. Laboratory professionals understand the theory behind this delicate technique and perform it using specific reagents and analyzers. Performed correctly, with appropriately calibrated analyzers and equipment, and with proper quality control measures in place, we are able to provide doctors and patients with the accurate results they require in order to make appropriate medical decisions. These tests did not exist six months ago. They were developed by laboratory professionals and are now being performed around the clock.

Finally, we don’t just read results from a “machine”. Laboratory professionals use highly complex and automated instruments and analyzers to perform testing. In addition, we are able to perform highly complex manual testing that requires years of study and interpretive skills to master. We can tell the difference between a promyelocyte and an immunoblast and distinguish Plasmodium falciparum from Babesia microti. Some of these analyses take longer than others. Rest assured, we are giving your sample the attention it deserves in order to provide the most accurate data that we possibly can. We know there is a patient behind every sample we receive. To us, you are more than a swab or a venipuncture. You are our parents, brothers and sisters, aunts, uncles, friends and colleagues. We give every sample the attention it deserves because we understand that most medical decisions are based on the data we provide.

We communicate regularly on technical and scientific matters with state and local health departments, the CDC and reference laboratories. Many Marylanders await the daily updates on the numbers of people infected with SARS-CoV-2. The laboratory professionals performing the testing take pride in providing the data that is being used to answer the question “are we flattening the curve?” and drive important decisions such as the reopening of our state.

This week, we recognize the current laboratory professionals, working day in and day out to not only fight the pandemic, but also perform other necessary testing for patients who are not affected by COVID-19.

We also recognize the students who have chosen this major and the profession. They are working hard at this extraordinarily unusual time to complete their degree requirements and enter the profession - when they are needed more than ever.

Happy Medical Laboratory Professionals Week to all laboratory professionals!

Apheresis

Mary Moorhouse (MLS ’07), Manager of the Blood and Tissue Banks at Sinai and Northwest Hospitals and Melissa Fisher (MLS ’17), Blood Bank, Sinai Hospital are making a difference for those infected with COVID-19.  The Sinai Hospital Blood Bank is part of an investigational study, along with the Mayo Clinic and the American Red Cross to utilize convalescent plasma from patients who have recovered from COVID-19.

Convalescent plasma is harvested from donors using a process called apheresis. Apheresis or in this case, more specifically plasmapheresis, is similar to a blood donation. However, only plasma is harvested. Red and white blood cells are then returned to the donor via a second needle placed in the donors other arm. Each donor has the potential to help up to three patients.

Convalescent plasma is rich in antibodies and those who’ve recovered from COVID-19 have antibodies to spare. Of course, donors will be screened for other infectious diseases such as HIV or Hepatitis and other proteins that could harm the recipient. Each patient will receive a unit, or about a cup, of the donor plasma in the form of a transfusion. As with blood transfusions, donor and recipient must have matching blood types.

Using convalescent plasma to treat patients is providing passive immunity and is not unusual. It’s most recently been used to treat those with Ebola, SARS and MERS. SARS and MERS are two other forms of Coronavirus. While the data supporting the use of convalescent antibodies in the SARS and MERS epidemics is anecdotal, there is hope that with more controlled studies and data collection, this could provide relief to those suffering with COVID-19. The US Food and Drug Administration has provided guidance for the investigational use of convalescent plasma and the American Red Cross has release guidance for donating plasma in those who've recovered from COVID-19.

Mary and Melissa are working tirelessly in support of this investigational study to identify those who’ve recovered from COVID-19, are able and willing to donate and to secure the donations. It is hoped that with controlled use and increased collection of data, the use of convalescent plasma will become a viable treatment option for those suffering the respiratory symptoms that accompany COVID-19 infection.

Thank you Mary and Melissa for showcasing the crucial and multi-faceted roles that medical laboratory professionals play in the healthcare setting, especially during this crisis.  The Stevenson University MLS Program is extremely proud of all of our alumni working on the front lines every day to ensure the health and safety of patients everywhere.

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Carter Center Pipe Filters

A 16-year-old female presents to the hospital with a burning sensation in her leg. There is a noted ulcer that she has been trying to alleviate with antibiotics. The ulcer keeps returning. Her travel history indicated she had traveled to a remote part of Africa the previous year to visit family. An x-ray is performed and shows subcutaneous linear calcification, typical of calcified Guinea Worm Disease. The calcified worm was surgically removed.

Guinea Worm Disease (GWD) comes from stagnant water sources where the larvae of the worm reside and are ingested by drinking the water. The larvae end up in the abdomen, where the female and male larvae come together, shortly after, the male dies and the female (as a round worm) migrates to subcutaneous tissue. She then releases her larvae through blisters in the skin. When infected individuals return to the water source with open ulcerations on the skin, the water is then re-contaminated with the larvae which starts the cycle over again. The parasite can be up to 1 meter long and cause horrible pain of the skin. The only way to get rid of it is to physically remove the worm from the site of infection. This is a painful process that can take months. Guinea Worm can incubate up to a year before causing ulcers in the tissue and can become calcified if not removed. Open sores are prone to secondary infections.

GWD, also known as Dracunculus medinensis or Dracunculiasis, is a nematode roundworm parasite that has almost been eradicated completely. Since 1986, infections with Guinea Worm Disease have dropped from over a staggering 3 million, to just 25 cases total in 2019.

There are still many ongoing efforts through the Carter Center which is an organization that helps to improve lives by preventing diseases. Founded by Former U.S. President Jimmy Carter and Former First Lady Rosalynn Carter, The Carter Center has built local, national, and international partnerships to help in the eradication of GWD. Eradication efforts are ongoing in five countries that are still affected by the disease which include South Sudan, Mali, Chad, Ethiopia, and Angola. Their strategy is to educate all affected communities about the transmission of Dracunculus medinensis and by providing community-based interventions to teach individuals safe drinking practices.

Currently a challenge that the Carter Center has faced in being able to completely eradicate GWD is the presence of GWD in domesticated dogs in Chad. They believe the dogs are getting infected through eating fish remains containing the Guinea worm larvae. To help decrease the numbers of dogs affected health volunteers have urged people in those areas to bury fish remains and are paying people cash rewards for reporting infected animals. Unfortunately, there are some areas of affected countries that do not have access to these programs and interventions due to conflict which makes it unsafe to travel. If those people cannot be reached and educated, eradication of the disease could become more challenging.

If GWD is ever fully eradicated it would become the second human disease in history to be eradicated and the first disease to ever be eradicated without the aid of a vaccine or medicine.

Written By:  Lauren Belcher and Emily Gates

Edited by:  Lara Biagiotti

Ancylostoma duodenale

Human infection with parasitic worms can be devastating.  Over a quarter of all humans are infected by parasites.  Infection can be chronic,"leading to pain, malnutrition, physical disabilities, delayed development, deformity, social stigma or a burden on family members caring for the afflicted."  Often affecting the poorest parts of the world, these diseases "impede economic development through human disability" affecting livestock and crops as well.  Few drugs treat parasitic infections and repeated use of the same therapies over and over has led to increasing resistance. 

In an attempt to discover new treatments, research was performed on worm species genomes which included collaboration between University of Edinburgh and Washington University in Saint Louis. The original research and results can be found on, Nature Genetics. The researchers studied parasitic and non-parasitic worm genomes to determine how the worms migrate and live inside humans and animals. The study included 36 roundworms and flatworms, and had 45 worm species’ genomes. By studying the genomes of these worms, possible new medications can be developed since there are few medications or vaccines for parasitic worms, or enhance the medicines already available. With this study there can be a better understanding of the affects these worms can have on humans and animals.

Through the research, it was discovered that there are many gene families and these genes families can expand into different ones as well. Some of the parasitic nematodes can be put into one or more gene families but then may not be seen in a different one. The genes that were observed demonstrated how different worm species are meant for different parts of the body for example some nematodes demonstrated genes for the gut. Also there were genes that showed how the nematodes migrate into tissue and out if tissue.

In the study, the researchers observed that out of 289 drug targets that are available, 40 drug targets were considered high priority. Those 40 were also associated with other drug-like compounds. With this information there can better development of medicine or more medicine can be available for successful treatment and better outcomes for those infected.

Written by Sindi Pereira

Edited by Lara Biagiotti

Photo credit

Histoplasma capsulatumIn November 2018, the Louisiana Department of Health received a call about two patients, one thought to have viral pneumonia and the other an unknown respiratory illness. Both were hospitalized and treated with medicines for pneumonia, yet their symptoms would not go away. After consultation with an infectious disease specialist, the patients were tested and diagnosed with histoplasmosis. Histoplasmosis is an infection caused by a fungus, Histoplasma capsulatum, that is found in the droppings of birds and bats in humid areas. Upon further investigation, the Louisiana Department of Health discovered that the two patients had recently been on a camping trip and found that half of the campers on the trip were sick with histoplasmosis.

With an outbreak at hand, Louisiana Department of Health teamed up with the Centers for Disease Control, Mycotic Diseases Branch, to find the cause of the histoplasmosis outbreak. To find out how the camper got sick, officials investigated the activities of the campers for possible cause, particularly any that would bring them into contact with bird or bat droppings. Most people who encounter the fungus, do so through soil that contains large amount of bird or bat poop. Once the soil is disturbed, spores from the fungus are inhaled. Once inside the lungs, a person’s body temperature stimulates the fungus to transform into a yeast. The yeast can then travel throughout the body. Activities that the campers participated in ranged from hiking, collecting firewood, digging soil and geocaching. Geocaching is like a digital scavenger hunt where players locate objects and sites using an app. After touring several of the geocaching sites, they found one where an object was hidden in the soil at the bottom of a hollow tree. When officials took a closer look, they found it to be the home of bats. They immediately tested the soil, and it came back positive for Histoplasma capsulatum.

After a high-risk area is identified there are several steps the department of health takes in order to prevent further outbreaks. First, they educate the campground staff about the risk and symptoms of histoplasmosis, such as people with weakened immune systems being at a higher risk of severe infection. The second is to recommend that campers avoid disturbing soil in areas that may contain bird or bat droppings. Finally, they recommended that public health officials and health care providers increase the awareness about histoplasmosis at campgrounds, particularly in Louisiana.

Written by Lauren Clabough

 
 
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