Ministry for Health and Active Ageing (MHA) - EUPHEM

Ministry for Health and Active Ageing (MHA) - EUPHEM

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Pathology Department - The Department

Mater Dei Hospital – Pathology Department

Contact person 

Christopher Barbara: christopher [dot] barbaragov [dot] mt (christopher[dot]barbara[at]gov[dot]mt)

Graziella Zahra: graziella [dot] zahragov [dot] mt (graziella[dot]zahra[at]gov[dot]mt)

Clinical Chemistry

The Clinical Chemistry Laboratories (CCL) include automated chemistry and immunoassay, manual assay, as well as andrology and a paediatric medicine discipline. They provide a comprehensive service for the biochemical analysis of clinically significant analytes in various body fluids by means of a vast repertoire of in-vitro tests. These are performed by varied methods on several standard fluid types (mainly serum, plasma, and urine), which are validated by the manufacturer or laboratory as being capable of producing precise and accurate results using the intended type of body fluid submitted for analysis. It must be appreciated that the test performance of different body fluids is affected by the unique chemical composition and nature of each body fluid type and any off-licence requests for analytes in non-validated body fluids may be waived at the discretion by the receiving laboratory. Some specialised tests not performed at a local level may be referred to reference laboratories. Our staff is available to provide advice on individual patients or to discuss the quality of the service provided.

Cytogenetics and Molecular Genetics

The Department of Clinical Genetics provides genetics analysis for inherited and acquired disorders both at the genetic (Laboratory of Molecular Genetics) and chromosomal (Laboratory of Cytogenetics) levels. The Molecular Genetics section provides diagnostic, carrier status (for individuals with family history) and screening services of single gene disorders as well as complex and multifactorial disorders that include but not limited to thalassaemia, bleeding disorders, familial and pre-conception screening, infertility, single point mutations, neurological disorders, intellectual disability, rare diseases, and various types of cancers. All tests are performed by a multidisciplinary laboratory team that keeps abreast with the latest methodologies in the field using modern technology such as real-time PCR and next generation sequencing among other methodologies. The Laboratory of Molecular Genetics is under the leadership of one Consultant Clinical Geneticist. The Cytogenetic Laboratory at Mater Dei Hospital provides services in post-natal conventional chromosome analysis for congenital anomalies, mental retardation, infertility, and haematological malignancies using the latest technology and methodologies. In addition, molecular cytogenetics by fluorescence in situ hybridization (FISH) is offered to complement chromosomal analysis. The laboratory is staffed by Consultant Medical Geneticists, Allied Health Practitioners MLS and Allied Health Professionals MLS.

Haematology and Coagulation

The Haematology and Coagulation laboratories provide services which relate to the assessment of blood cell composition, blood formation, and investigation of any disorders affecting these processes. The Laboratory provides a comprehensive list of tests, ranging from single tests to complete diagnostic workups, depending on the needs of the client. Results are issued online, thus providing efficient and accurate and timely services to our clients, namely clinicians and ultimately, patients. The laboratory is composed of four specialities/subsections: General Haematology, Coagulation, Flow cytometry and Haematology Molecular Diagnostics. All sections have a joint staffing arrangement. A Professional team is composed of fully trained Medical Laboratory Scientists (MLS), haematology trainee doctors and haematology consultants. MLSs provide the analytical services and are responsible for the day-to-day running of the laboratory. The consultant haematologists and haematology trainees provide clinical backup, whilst being mutually involved in the actual laboratory workup.

Hospital Blood Bank

The Hospital Blood Bank is a specialised laboratory equipped with the latest technology in Immunohaematology. Compatibility testing and specialised red cell serological testing is performed for hospital patients including antenatal patients and for the general community. To meet international standards, validation of results is carried out regularly through the use of External and Internal controls. Located in the centre of Mater Dei Hospital, this laboratory is also responsible for the storage of blood components including Red Cell Concentrates, Fresh Frozen Plasma and Therapeutic Doses of Platelets. These blood products are issued to the different wards within MDH, and to other hospitals and clinics that make use of this service. Traceability of blood components is managed within the Hospital Blood Bank in accordance with EU blood directives and local legislation. A National Haemovigilance program has been set up to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of blood products, with the intent to prevent their occurrence and recurrence. The Hospital Blood Bank also provides a therapeutic plasma aphaeresis service to different departments within MDH.

Immunology Laboratory

The Immunology Laboratory, within the Pathology Department at Mater Dei Hospital, consists of a team of professional laboratory personnel, together with a medical consultant, who strive for the utmost quality in providing extensive diagnostic and monitoring of all major chronic autoimmune diseases, using state of the art technology of nephelometry, electrophoresis, immunofluorescence, ELISA, and immunoblotting. All these techniques allow for the comprehensive assessment of the immune system such as coeliac disease, Grave's disease and thyroid disorders, Multiple Sclerosis, Rheumatoid Arthritis and systemic lupus erythematosus (SLE), kidney diseases, liver autoimmune disorders, systemic vasculitis, vast intolerance and allergy testing, gammopathies and quantitative determination of proteins in serum.

Molecular Diagnostics (Infectious Diseases)

Molecular Diagnostics-Infectious Diseases, provides sensitive, specific, and timely (i.e., relative to that of traditional culture-based methods) identification of various pathogens. Molecular methods used include real time PCR, Reverse hybridisation and Next Generation Sequencing (NGS). The laboratory specialises in the identification of respiratory pathogens, Human Papilloma virus, viral

/bacterial meningitis, and mycobacteria to mention a few. It also plays an important role in monitoring viral loads of chronic infections such as HBV/HCV and HIV, which can require such quantitative monitoring to determine if therapy is producing the intended reductions in circulating levels of virus. Furthermore, other techniques (NGS) are utilized in metagenomics i.e. the genomic analysis of micro-organisms and to assess antiviral resistance signatures for HIV-1 and hepatitis C, which allow therapy to be directed in response to such observed resistance markers.

Mycology

The Mycology laboratory provides a comprehensive service for the diagnosis of fungal infections. Diagnostic tests include culture and microscopy of various samples, including dermatology samples, fluids, aspirates, and other samples routinely sent for microbiology cultures. Cultured fungi are identified to the species level by various methods, including mass spectrometry and microscopic methods. Susceptibility testing can also be performed on cultured fungi when invasive disease is suspected. Fungal biomarkers including Galactomannan antigen, Beta D Glucan and Cryptococcal antigen are also offered to monitor patients susceptible to invasive fungal infections.

Toxicology

The Toxicology Unit offers a comprehensive list of clinical tests intended to assist clinicians in the exercise of their independent professional judgment to improve the clinical outcome of their patients. Briefly the categories of testing fall into three categories: Therapeutic drug monitoring (TDM) is the quantitative assessment of specific drug levels in blood. The patient is given specific treatment and the laboratory measures the blood levels of the medication at specific intervals.

This service may also be used to ensure compliance with the clinicians recommended treatment. Drug abuse (DAU) screening service is provided for the more commonly abused drugs. Screening is provided in a semi-quantitative manner and reported as positive/negative result based on cut-off values recommended by the European Laboratory Guidelines for Legally Defensible Workplace Drug Testing (EWDTS). In Suspected overdose cases (OD) the laboratory provides both qualitative and semi-quantitative analyses of a range of drugs. Analyses are typically conducted in two phases: An immunoassay test and a LC-MS/MS screen. The immunoassay test is intended to provide indications whether a particular drug or drug class is present. Confirmation analyses are typically conducted with methods that have greater specificity than do immunoassays and which examine the chemical structure of each substance as a means of identifying them. LC-MS/MS screen employed in MRM mode is currently employed for this purpose, though some analysis is still carried out by Gas chromatography (GC) with selective detectors. Many drugs are not detected by immunoassays so a general screen employing LC-MS/MS is often carried out. Positive findings are reported only when they are sufficiently confirmed.

Virology

A comprehensive virology service is provided by the Virology laboratory within the Microbiology Department. The service includes availability of clinical virology advice by both our resident doctors and biomedical staff on all our laboratory diagnostic services. The team provides clinical advice to Doctors and other Health Care Professionals on all aspects of virology, including diagnosis, management and prevention of viral infections, and vaccination. Where urgent clinical testing is required out-of-hours we run an on-call service as well. Virology is a rapidly evolving field. Recent years have seen massive advances in our ability to diagnose treat and prevent viral infections; add to this the discovery of new viral pathogens and emerging viral threats worldwide and virology can be seen as one of the most dynamic areas of modern medicine. Thus, we at the Virology serology laboratory provide a comprehensive viral diagnostic service either on individual assays or panels designed to detect a range of pathogens depending on sample type or clinical features. Our portfolio of diagnostic assays and testing algorithms are constantly reviewed and updated to ensure we offer the best service in line with recent advances in the specialty.