Hematopathology Services

The appearance of cells and their relationship to one another under the microscope is the cornerstone of pathology. When abnormal cell proliferations arise, identification of the cell of origin is vital for proper disease classification and management. Cells may have a wide variety of morphologies, and their sizes, shapes, colors, nuclear and cytoplasmic features, and the company they keep often disclose their origin.

Utilizing many different histological stains, including routine stains (H&E and Wright-Giemsa), special stains (iron, trichrome, Congo Red, etc.), and immunohistochemical stains (AE1/AE3, SOX11, CD45RB, etc.), cell features can be accentuated to improve their characterization. Microscopy allows for the visual evaluation of thousands of cells, and at GoPath, our experienced eyes and extensive stain menu (>120 stains) translate into timely, accurate diagnoses.

Cells express a multitude of antigens on their surface, in their cytoplasm, and in their nuclei. What cells express and don’t express are important cell characteristics, and rapid evaluation of each cell’s antigen profile allows for population assessment and the identification of aberrancy. Flow cytometry is a powerful approach to characterize disease and steer treatment, and its utility has had no greater impact than in hematopathology.

Flow cytometry utilizes a rainbow spectrum of antigen-specific fluorescent dyes to paint cells. When these painted cells are marched single file through an interrogation chamber and illuminated by three lasers, any attached dyes are excited and fluoresce, and 12 detectors collect parameters on each cell. A computer tabulates the data, and software permits for manipulation and interpretation. This extraordinary methodology can evaluate data from more than 500,000 cells in minutes.

At GoPath®, we have state-of-the-art Navios EX cytometers, DURAClone IM Count and ClearLLab 10C dry down tube systems, wet lab reflex tube capability, and Kaluza software that we have internally programmed and standardized for optimal interpretation. Our department has more than 100,000 flow cases of experience, and we offer global or TC/PC flow options.

FISH, or fluorescence in situ hybridization, is a more sensitive examination of DNA, utilizing probes to identify genetic abnormalities. A FISH probe is a fluorescent-labeled complementary DNA fragment that adheres, or hybridizes, to a specific DNA sequence in the patient’s cells. The fluorescence highlights the target sequence and permits microscopic detection of abnormal chromosome numbers, genetic rearrangements, genetic loss, or mutated genetic sequences. FISH's sensitivity and rapid results make it a powerful tool in the diagnosis of hematopoietic diseases; however, like the sport of fishing, one must first know what they're looking for in order to select the correct probe. GoPath offers a wide variety of individual probes and panels to complement the disease workup.

Chromosome analysis, or karyotyping, involves analyzing the number and structure of chromosomes to detect abnormalities. A live cell sample is collected and cultured to promote cell division. The cell cycle is arrested in metaphase, and the isolated chromosomes are placed on a slide and stained. Each chromosome has a unique fingerprint, and they are mapped and examined for changes in number and arrangement. Karyotyping looks for gross structural abnormalities in the DNA and is essential for the proper diagnosis of acute leukemias and myelodysplastic syndromes.

Molecular pathology has a fundamental role in hematopathology and has driven many of the most significant trends of late. More sensitive testing, more data at diagnosis, expansion of disease classification systems, recognition of more molecular-defined diseases, development of precision therapeutics, greater molecular prognostic focus, and more sensitive monitoring methods can all be attributed to advances in molecular pathology.

Molecular testing is the most sensitive inspection of DNA as it focuses on the DNA sequence and the identification of mutations. The days of "the diagnosis is the endpoint" have passed, and molecular testing plays an important role in the classification and management of hematologic disorders. GoPath offers single and multiple gene tests, as well as targeted next-generation sequencing panels to complete your hematopathology workup.