Drivers of clinical lab technologies

As with much else in healthcare, change is the driver of clinical lab technologies today. Rapid advances in genetics, especially the game-changing promise of biomarkers and personalized medicine, have dramatically extended the traditional spectrum of clinical lab technologies. A snapshot of the specialties within a modern clinical lab and the key drivers of change within each is provided below.

Blood banking: Over the past decade, automation has halved serological testing times. Nevertheless, enduring safety concerns have led to new technologies such as CAT (Column Agglutination), along with remote, real-time and secure monitoring of equipment by technical service providers.

Clinical chemistry and microbiology: The choice and sequencing of chromatography, mass spectrometry, electrophoresis, thermocycling or radioisotopes have become quicker and more reliable due to the widespread use of testing protocols. New tools for microbiologists include phosphoimaging and fluorescence activated cell sorters. One of the most promising fields at present consist of new DNA-based techniques.

Cytotechnology: Still focused largely on cancers, cytotechnology has expanded its scope from diagnosis to prognosis. The key drivers here are molecular diagnostics and FISH (fluorescence in situ hybridization), with data warehousing support for tissue correlation. FISH is used to track specific DNA sequences on chromosomes, by using probes which bind only with specific fragments of the chromosome; these are then identified by fluorescence microscopes. FISH has proved to be indispensable in diagnosing rare diseases such as Cri-du-chat, certain kinds of childhood leukemias, as well as syndromes like Prader-Willi and Angelman.

Histotechnology: Traditionally associated with cutting and staining tissue specimens for the study of diseases at a microscopic level, histotechnicians are now branching out into one of the fastest growing areas of clinical lab technology, namely immunohistochemistry. This is the localization of antigens via the use of labelled antibodies, with antigen-antibody interactions subsequently visualized by markers. The 1950s era technology of using fluorescent dye was followed by enzyme labelling in the 1960s and 1970s (respectively peroxidase and phosphatase). Colloidal gold permitted electron microscopes to be deployed for multi-level staining, since gold particles can be manufactured in a vast range of sizes. Other techniques include autoradiography, using radioactive elements as labels for visualizing  immunoreactions.

Immunology: Rather than the painstaking, bottom-up process of examining individual cells under a microscope, immunology is now becoming top-down. Fuelled by the Human Genome Project, studies of tissues and organs and the molecular pathways of the immune system have led to a host of new waypoints in mapping the progress of a disease (e.g signal transduction mechanisms), along with innovative tools such as custom-built peptide probes, supermagnetic nanobeads, hybridomas, epitopes and tetramer assays, in brief – the new science of proteomics.

Molecular biology: Automated cell counting equipment and ultra-sophisticated electron microscopes have buttressed the arsenal of tools to conduct protein and nucleic acid tests, above all the identification of anomalies and abnormalities. Precision remains a key driver in a field where a margin of 1/1,000 can be a serious error, and destroy the integrity of a unique sample. Another enduring concern is sterility, especially RNAse contamination.