Pathology for clinicians and medical students - Revision history

Mikael Häggström: Sampling

2024-04-09T20:12:17Z

Sampling

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	~~Important~~ points for everyone who may ~~send specimens~~ to pathology:		Following are important points for everyone working clinically, and who may therefore be involved with pathology. Still, the main advice is to '''ask a pathologist''' if unsure about anything pathology-related.

	==Notice==		==Notice==
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	*Advance notice also generally gives you a better reply to '''any questions''', such as before a tumor conference rather than putting the pathologist on the spot during it.		*Advance notice also generally gives you a better reply to '''any questions''', such as before a tumor conference rather than putting the pathologist on the spot during it.
	*For tumor specimens, state significant cuts or other '''iatrogenic disruptions''' in the vicinity of the tumor if they may otherwise be misinterpreted as tumor perforation.		*For tumor specimens, state significant cuts or other '''iatrogenic disruptions''' in the vicinity of the tumor if they may otherwise be misinterpreted as tumor perforation.

			==Biopsy versus aspiration==
			Generally order biopsy rather than aspiration, unless you know from the pathology department that they approve of the latter for the purpose at hand. Even if there are studies of promising aspiration results for any particular purpose, such studies are generally performed by subspecialty enthusiasts in the subject at hand, and their expertise and enthusiasm is not to be compared to that of your local cytotechnicians and pathologists.

			==Sampling==
			For cystic lesions, it is generally the ''cyst lining'' that is most helpful for the pathologist to make an optimal diagnosis, especially if there are nodules on the lining. Likewise, for seemingly necrotic lesions, try to find adjacent viable material to sample.

	==Staples==		==Staples==
	[[File:True and reported surgical margin.jpg\|thumb\|220px\|Margins of a [[lobectomy]]. A stapled portion is being cut off from the true bronchial margin, in order to take sections for microscopy from the underlying tissue, which therefore will be a few millimeters more proximal on the specimen than the true margin.]]		[[File:True and reported surgical margin.jpg\|thumb\|220px\|Margins of a [[lobectomy]]. A stapled portion is being cut off from the true bronchial margin, in order to take sections for microscopy from the underlying tissue, which therefore will be a few millimeters more proximal on the specimen than the true margin.]]
	If feasible, limit the amount of staples in essential diagnostic tissue if there is a limited amount thereof (as staples need to be removed before microtomy, and the removal may tear the tissue). If multiple staples are necessary on a surgical margin (such as both ends of an intestinal segment), keep in mind that the pathologist may have to cut away the entire stapled portion before taking sections, and therefore the section for microscopy is a few millimeters more proximal on the specimen than the true margin.		If feasible, limit the amount of staples in essential diagnostic tissue if there is a limited amount thereof (as staples need to be removed before microtomy, and the removal may tear the tissue). If multiple staples are necessary on a surgical margin (such as both ends of an intestinal segment), keep in mind that the pathologist may have to cut away the entire stapled portion before taking sections, and therefore the section for microscopy is a few millimeters more proximal on the specimen than the true margin.

	~~==Biopsy versus aspiration==~~
	Generally order biopsy rather than aspiration, unless you know from the pathology department that they approve of the latter for the purpose at hand. Even if there are studies of promising aspiration results for any particular purpose, such studies are generally performed by subspecialty enthusiasts in the subject at hand, and their expertise and enthusiasm is not to be compared to that of your local cytotechnicians and pathologists.

	==Fixation==		==Fixation==

Mikael Häggström: /* Report interpretation */ ''

2024-04-09T20:00:59Z

Report interpretation: ''

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	==Report interpretation==		==Report interpretation==
	*Longer discussions in the report and/or the presence of "Correlate clinically" essentially mean that the pathologist is not sure. Still, "~~correlate~~ clinically" implies that the pathologist has hope that a specific diagnosis can be reached by considering the whole clinical picture.		*Longer discussions in the report and/or the presence of ''"Correlate clinically"'' essentially mean that the pathologist is not sure. Still, ''"Correlate clinically"'' implies that the pathologist has hope that a specific diagnosis can be reached by considering the whole clinical picture.

	==Clinical pathology==		==Clinical pathology==

Mikael Häggström: /* Report interpretation */ Still

2024-04-09T20:00:34Z

Report interpretation: Still

← Older revision		Revision as of 16:00, 9 April 2024
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	==Report interpretation==		==Report interpretation==
	*Longer discussions in the report and/or the presence of "Correlate clinically" essentially mean that the pathologist is not sure.		*Longer discussions in the report and/or the presence of "Correlate clinically" essentially mean that the pathologist is not sure. Still, "correlate clinically" implies that the pathologist has hope that a specific diagnosis can be reached by considering the whole clinical picture.

	==Clinical pathology==		==Clinical pathology==

Mikael Häggström: /* Staples */ Biopsy vs aspiration

2024-03-26T01:33:18Z

Staples: Biopsy vs aspiration

← Older revision		Revision as of 21:33, 25 March 2024
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	[[File:True and reported surgical margin.jpg\|thumb\|220px\|Margins of a [[lobectomy]]. A stapled portion is being cut off from the true bronchial margin, in order to take sections for microscopy from the underlying tissue, which therefore will be a few millimeters more proximal on the specimen than the true margin.]]		[[File:True and reported surgical margin.jpg\|thumb\|220px\|Margins of a [[lobectomy]]. A stapled portion is being cut off from the true bronchial margin, in order to take sections for microscopy from the underlying tissue, which therefore will be a few millimeters more proximal on the specimen than the true margin.]]
	If feasible, limit the amount of staples in essential diagnostic tissue if there is a limited amount thereof (as staples need to be removed before microtomy, and the removal may tear the tissue). If multiple staples are necessary on a surgical margin (such as both ends of an intestinal segment), keep in mind that the pathologist may have to cut away the entire stapled portion before taking sections, and therefore the section for microscopy is a few millimeters more proximal on the specimen than the true margin.		If feasible, limit the amount of staples in essential diagnostic tissue if there is a limited amount thereof (as staples need to be removed before microtomy, and the removal may tear the tissue). If multiple staples are necessary on a surgical margin (such as both ends of an intestinal segment), keep in mind that the pathologist may have to cut away the entire stapled portion before taking sections, and therefore the section for microscopy is a few millimeters more proximal on the specimen than the true margin.

			==Biopsy versus aspiration==
			Generally order biopsy rather than aspiration, unless you know from the pathology department that they approve of the latter for the purpose at hand. Even if there are studies of promising aspiration results for any particular purpose, such studies are generally performed by subspecialty enthusiasts in the subject at hand, and their expertise and enthusiasm is not to be compared to that of your local cytotechnicians and pathologists.

	==Fixation==		==Fixation==

Mikael Häggström: /* Clinical pathology */ Organized

2024-02-08T17:37:45Z

Clinical pathology: Organized

← Older revision		Revision as of 13:37, 8 February 2024
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	*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.		*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.
	*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>		*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>
			*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]
	*When ordering '''platelets''' or '''red blood cells''', the patient will generally be transfused faster if you abide by the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.		*When ordering '''platelets''' or '''red blood cells''', the patient will generally be transfused faster if you abide by the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.
	*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]
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Mikael Häggström: /* Clinical pathology */ abide

2024-02-08T17:36:52Z

Clinical pathology: abide

← Older revision		Revision as of 13:36, 8 February 2024
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	*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.		*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.
	*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>		*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>
	*When ordering '''platelets''' or '''red blood cells''', the patient will generally be transfused faster if you ~~stick to~~ the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.		*When ordering '''platelets''' or '''red blood cells''', the patient will generally be transfused faster if you abide by the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.
	*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]		*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]
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Mikael Häggström: /* Clinical pathology */ d

2024-02-08T16:49:06Z

Clinical pathology: d

← Older revision		Revision as of 12:49, 8 February 2024
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	*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.		*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.
	*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>		*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>
	*When ordering '''platelets''' or '''~~ref~~ blood cells''', the patient will generally be transfused faster if you stick to the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.		*When ordering '''platelets''' or '''red blood cells''', the patient will generally be transfused faster if you stick to the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.
	*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]		*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]
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Mikael Häggström: /* Clinical pathology */ generally

2024-02-08T16:30:35Z

Clinical pathology: generally

← Older revision		Revision as of 12:30, 8 February 2024
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	*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.		*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.
	*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>		*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>
	*When ordering '''platelets''' or '''ref blood cells''', the patient will be transfused faster if you stick to the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.		*When ordering '''platelets''' or '''ref blood cells''', the patient will generally be transfused faster if you stick to the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.
	*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]		*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]
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Mikael Häggström: /* Clinical pathology */ Recommended dose

2024-02-08T16:29:31Z

Clinical pathology: Recommended dose

← Older revision		Revision as of 12:29, 8 February 2024
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	*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.		*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.
	*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>		*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web\|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/\|title=Post-transfusion HbA1c\|author=Jennifer E. Frank, MD\|website=ClinicalAdvisor}}</ref>
			*When ordering '''platelets''' or '''ref blood cells''', the patient will be transfused faster if you stick to the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.
	*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]		*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]
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Mikael Häggström: /* Notice */ Main

2023-11-09T22:18:26Z

Notice: Main

← Older revision		Revision as of 18:18, 9 November 2023
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	==Notice==		==Notice==
	Advance notice allows the pathologist to prepare accordingly.		Advance notice allows the pathologist to prepare accordingly.
			*Provide the main condition(s) or feature(s) that you want the pathologist to '''look for''' whenever feasible.
	*Whenever there is a specimen type or circumstances thereof that is presumably '''unusual''', give advance notice to the pathology department so that they can prepare accordingly.		*Whenever there is a specimen type or circumstances thereof that is presumably '''unusual''', give advance notice to the pathology department so that they can prepare accordingly.
	*Advance notice also generally gives you a better reply to '''any questions''', such as before a tumor conference rather than putting the pathologist on the spot during it.		*Advance notice also generally gives you a better reply to '''any questions''', such as before a tumor conference rather than putting the pathologist on the spot during it.