07732 - Clinical Pathology

Learning outcomes

At the end of the course, the student acquires the knowledge and the ability to understand the fundamental concepts needed for a critical evaluation and for the interpretation of the results of the main laboratory diagnostic tests, in particular of those related to pregnancy.

Course contents

PRINCIPLES OF LABORATORY DATA INTERPRETATION

Laboratory tests and biomarkers. Appropriateness in laboratory medicine. Precision medicine. Sensitivity and specificity, precision and accuracy, diagnostic and biological variability, errors and methodology controls in laboratory clinical tests; reference intervals. Validation of diagnostic systems.

THE BLOOD

Haematopoiesis; erythtropoiesis, erythrocytes, erythropoietin; structure and function of hemoglobin, dissociation curve of hemoglobin. Leucocytes and platelets: functions and analysis. Plasmatic proteins. Blood count: parameters (haematocrit, MCV, MCH, MCHC, RDW, reticolocytes count) and their diagnostic role. Hematological changes in pregnancy.

ANEMIA

Signs, symptoms and lab parameters for the diagnosis of anemia. Classification of anemias. Megaloblastic anemias (B12 and folates deficiency). Iron deficiency and anemia: diagnosis and therapy. Lab parameters for the evaluation of iron metabolism. Hemoglobinopathies. Hemolytic anemias.

BLOOD GROUPS

Biochemistry and functions of blood group antigens. ABO blood group system: antigens function and development; ABO compatibility in tranfusion setting. Other blood groups: P, Lewis, Ii, MNSs. Rh system, Rh antigen variants. Kell, Duffy and Kidd blood group systems.

Anti-erythrocytes antibodies, agglutination. Immunohematological test for blood group typing and identification of irregular antibodies. Direct Coombs Test. Indirect Coombs Test. Molecular typing of blood groups.

HAEMOLYTIC DISEASE OF THE FOETUS AND THE NEWBORN

History, phisiopathology, prevention, diagnosis and therapy. Foeto-maternal incompatibility. Immunoprophylaxis. Immunohematological tests during pregnancy and at birth.

THE TRANSFUSION PROCESS

The blood donation; emocomponents and blood products. Donor-recipient compatibility in transfusion setting. Pre-transfusion tests. Recommendation for blood component transfusion.

Critical issues of the transfusion process. Adverse events. Principles and tools for haemovigilance.

STEM CELLS

Stem cells: chacteristics and clinical use. Cord blood selection and collection, fields of use. Hemopoietic stem cell transplant.

HAEMOSTASIS AND THROMBOSIS

The vasculo-platelet phase, the coagulation cascade, physiological inhibitors and fibrinolysis. Tests for the evaluation of platelet functionality, of the coagulation plasmatic phase and of the fibrinolitic system. Congenital hemorrhagic diseases. Trombosis and trombophilia: lab tests for the definition of hypercoagulability states. Alterations of coagulation during pregnancy. Disseminated Intravascular Coagulation (DIC).

NEONATAL SCREENING

Principles and main application for phenylketonuria, congenital hypothyroidism, cystic fibrosis, widened screening.

PRENATAL DIAGNOSTIC TESTS

Screening tests (Bi and Tri- tests); NIPT (non invasive prenatal testing)

GLUCIDIC METABOLISM

Physiology and markers of glucidic metabolism. Glucose, glucose tolerance curves; lab exams for the diagnosis of gestational diabetes.

LIVER FUNCTION

Liver function markers: transaminases, gGT, ALP, bilirubin, proteins. Jaundice: causes and diagnosis.

KIDNEY FUNCTION

Kidney function markers: creatinin, urea, urine analyses (chemical, physical and morphological)

Readings/Bibliography

• Widmann: interpretazione clinica degli esami di laboratorio. Ronald A. Sacher e Richard A. McPherson. 2001 Undicesima edizione. Mc Graw Hill libri Italia (Milano)
• Italo Antonozzi e Elio Gulletta: Medicina di Laboratorio: Logica & Patologia Clinica. 2013, Piccin Nuova Libraria S.p.A. Padova.
• Technical Manual, AABB (edizioni dalla 17°, sia in lingua italiana sia in lingua inglese)
• Gronowski, Ann M. (Ed.): Handbook of Clinical Laboratory Testing During Pregnancy (testo in lingua inglese)
• S.Tura. M.Baccarani. Corso di malattie del sangue e degli organi emolinfopoietici. 2011, Esculapio, Bologna.
• M.Ciaccio Elementi di biochimica clinica e medicina di laboratorio.2020, Edises
• Recent articles published about some contents

Teaching methods

Frontal classes, discussion of clinical cases.

Assessment methods

Oral examination. The final mark of the integrated course of Microbiology and Pathology will be the average of the tests of General Pathology, Microbiology and Clinical Pathology.

Teaching tools

PDF files and recent articles used in support of teaching will be available online on the Professor's website

Office hours

See the website of Silvia Manfroi