Clinical laboratory department of SIUT is one of the leading and multi-dimensional clinical laboratories in Pakistan. It is equipped with state-of-the-art equipment and is staffed with a qualified and skilled workforce to run it. From small beginnings at the start of SIUT, it has steadily grown to its present status as SIUT expanded its services over the past 50 years. Initially, it was designed to fulfill the essential diagnostic requirements for clinicians, but presently, it not only provides round-the-clock diagnostic services, but also participates in both undergraduate and postgraduate training and research.
The Clinical Laboratory has an effective internal and external quality control program to ensure that consistently precise and accurate laboratory results are provided for both short- and long-term clinical decision-making. Currently, the laboratory participates in external quality assurance program from RIQAS, UK and NEQAP, Pakistan. It is fully accredited for postgraduate training by the College of Physicians and Surgeons of Pakistan in the fields of Chemical Pathology, Haematology, Microbiology, Histopathology and Immunology. It comprises of six main departments and their ancillary branches.
The Department of Chemical Pathology was the first department established at SIUT. Initially, it was designed to fulfill the essential requirements for clinicians. With the passage of time, the department has evolved into a multi-dimensional service.
The department is fully computerized and equipped with state-of-the-art equipment. Over 2000 samples are processed every day including blood and other body fluids and analysis of stones from urinary and GI tracts. Apart from routine tests, special diagnostic markers, therapeutic drug monitoring, particularly for immunosuppressive agents, tumor markers, hormonal assays, protein electrophoresis, 24-hour urine metabolic studies, arterial blood gases, stone analysis by FTIR and tests required for renal and liver transplants are provided free of cost to every patient.
Haematology deals with etiology, diagnosis, treatment and prevention of the blood disorders. In 1975, the haematology laboratory situated in the Urology Ward of civil hospital was provided with a single microscope for peripheral film examination and haemoglobin estimation was performed manually. With the passage of time, the department expanded and blood bank was also established. Steadily, it has grown to its present status of the state-of-the-art, fully equipped, automated and computerized department.
The department provides 24/7 services to all in-patients. Haematological issues of the patients are resolved during ward rounds. Haematology department is subdivided into four sections which include; routine, coagulation, special section and blood bank.
The Special section includes Bone Marrow aspirate and trephine biopsy, special stains of Iron, PAS, Sudan black, Hemoglobin electrophoresis, Sickling test and body fluids analysis. The Coagulation section is equipped with fully automated coagulation analyzer. The tests performed include Prothrombin time, INR, APTT, Mixing studies, D-dimers and Factor assays. Thromobophilia Screening is done for the work up of thrombotic diathesis.
Blood bank provides 24-hour services to the institute. Blood donors are selected on the basis of donor history and screening for transfusion-transmitted diseases to provide safe blood transfusion. Only voluntary donors are selected and professional paid donors are not accepted.
Blood grouping, antibody screening and compatibility tests on gel method are performed in order to provide blood and blood products. Blood and blood products include whole blood, packed red cells, random platelets, FFP and cryoprecipitate. Apheresis by cell separator machine is processed for collection of single donor platelets and therapeutic plasma exchange.
Microbiology is the subdivision of pathology, which is the only living and ever growing science, which is constantly changing. The Microbiology department of SIUT was started in late 1980s with only urine DR then. In 1989, culture was introduced; initially with urine culture, followed by culture of other clinical specimens including culture and sensitivity of Mycobacterium.
The department deals with all types of clinical specimens such as urine, blood, stool, sputum aspirates, antimicrobial levels, fungal cultures, infection control, water and environmental analysis dealing with microorganisms. It is one of the busiest microbiological set-up in the country.
The Molecular Diagnostics and Immunology Laboratory (MDIL) at SIUT is an integrated program that provides molecular and serological diagnostic testing for infectious diseases, and a wide range of tests for diagnosing autoimmune disorders, immunodeficiencies, multiple myelomas and allergies. The range of testing includes tests that are crucial for the management of transplant patients such as Cytomegalovirus (CMV) antigenemia and PCR assays for diagnosing CMV infection in transplant recipients. The molecular diagnostic service uses polymerase chain reaction (PCR) based assays for diagnosing viral and bacterial infections, quantitation of viral loads and drug resistance typing using conventional and Real-Time PCR machines, automated nucleic acid extraction systems, Gene Expert system for tuberculosis diagnosis and more recently for COVID-19 and a second generation DNA sequencer.
Ongoing research at MDIL includes work on BK virus infection, cytokine gene polymorphisms, and determination of immune dysregulation and cell surface markers in patients with FSGS. MDIL was the focal laboratory for the Canada-Pakistan HIV/AIDS second generation surveillance program and has collaborated with The Global Fund and National AIDS Program in providing testing for monitoring of HIV/AIDS patients from Sindh and Baluchistan provinces, and HIV-drug resistance genotyping at the national level.
The department of transplant immunology was established in 1992 and since then it has grown at a steady rate to its current status of the most modern and well equipped department of the country. The department provides clinical and histocompatibility testing and immunologic monitoring for transplantation. The department conducts research in the field of immunology and provides support for research to other departments of institute. The services include HLA typing by DNA methods, antibody screening and identification by luminex, complement dependent cross-match (CDC), and flow cytometric cross-match. In addition to antibodies of HLA antigen, antibodies against endothelial cells, angiotensin II type I receptor antibodies and anti vimentin antibodies are also tested. Monitoring of CD3 count by flow cytometer is done for patients on anti-rejection therapy. Immunosuppressive drug monitoring for tacrolimus, cyclosporine and sirolimus is also performed.
The section has an effective external quality control program to ensure that accurate test results are provided. Currently, the department participates in external quality assurance program of UK NEQAS for Histocompatibility and immunogenetics. The department also actively collaborates with CTS registry at Heidelberg, Germany. The department has trained medical professionals from Nepal, Bangladesh, Sri Lanka, Afghanistan and from different centers of Pakistan.
Histopathology is the subspecialty of pathology which deals with the tissue or cellular diagnosis of disease based on biopsy or cytology material taken from the patient, or from the autopsy specimen. In addition to morphological examination by light microscope, histopathologists also use sophisticated immunohistochemical techniques to demonstrate specific antigens in a tissue or cells.
The histopathology department of SIUT was established in 1995 by late Prof. Javed I. Kazi, a pioneer in the field of renal and transplant pathology in Pakistan. The department has grown at a steady rate to its current status of one of the most modern and well equipped departments of the country. It is equipped with the state-of-the-art instruments with automated tissue processors and embedding equipment. Frozen section facility for urgent diagnosis and sectioning for immunoflourescence (IF) test on renal and graft biopsies and transmission electron microscope (TEM) for complete workup of native renal biopsy material are available.
The department has an effective internal and external quality control program to ensure that accurate test results are provided. It participates in NEQAPP, Pakistan for external quality assessment. The department conducts research in the field of renal and glomerular diseases and provides support for research to other departments of institute. It has published extensively in both local and international journals on the pathologic demography of native renal and kidney transplant diseases.
This department was established in 1998 as a subsection of Histopathology Department. It is equipped with both a scanning electron microscope (SEM) and a transmission electron microscope (TEM) and qualified staff. The former is used for stone analysis and research, while the latter is used for diagnosis of renal and transplant pathology. It is worth mentioning here that SIUT is the only center in Pakistan where diagnostic EM is regularly done on both native renal and renal allograft biopsy specimens and it is done free of cost.