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Pathology in Practice

This section provides practical examples of the role of Pathology and Pathologists in the management of four common medical conditions and situations.

Appendicitis

Jason has just arrived home from school and complains to his mother that he has a bad pain in his right side and he feels quite sick. His mother notices that he has a slight fever and remembers he did not eat breakfast that morning nor did he eat the lunch she had packed for school that day. The family doctor is away on holidays so she decides to go to the local hospital.

Jason is seen by a doctor in the Emergency Department who asks him what the problem is and how long he has been sick, then examines him. He suspects acute appendicitis and contacts the surgical registrar. The registrar agrees with the diagnosis and discusses the need for an operation with Jason's mum. A white blood cell count done by the Haematology laboratory supports this diagnosis. She agrees that Jason needs to have an operation to remove his appendix.

Jason goes to theatre and has an inflamed appendix removed. The appendix is sent by the surgeon to Anatomical Pathology for examination under the microscope to confirm the diagnosis and to exclude any other conditions.

The specimen is prepared and placed on a glass slide ready for the pathologist to look at. The pathologist reviews the specimen under a microscope and confirms the diagnosis of acute appendicitis and notes that there are no other abnormalities of concern.

The pathologist then sends a written report of the findings to the surgeon. The surgeon will send a written report to Jason's local doctor and will discuss the situation with his patient.

Infected Wounds

Joe is a butcher. One day while filleting some meat he cuts his hand badly. He does not seek treatment. The wound becomes infected and he develops a fever and is quite ill.

He attends the local hospital and is admitted. A sample of the fluid discharging from the wound (a swab) and blood tests are taken.

The sample is sent to the Microbiology Laboratory. The sample is put onto a glass slide and analysed under a microscope to look for cells that indicate infection. The sample is spread on a culture medium "plate" to enable any bacteria present to grow. The Pathologist looks at the plate and identifies the particular bacteria causing the infection.

A number of antibiotics are tested on the bacteria to ensure that the antibiotic chosen to treat the infection is the correct one.

The report is sent back to the treating doctor. The treating doctor and the pathologist will discuss Joe's progress and response to treatment. Joe will then be counseled on his progress throughout his recovery period.

Iron Deficiency Anaemia

Helen, a 45-year-old woman, has been feeling constantly tired and worn out. She does not eat very well and has been having heavy periods for a number of years. She has no other symptoms and is not using any prescribed medication.

She goes to see her local doctor who observes that she looks pale. The doctor orders a blood test (a full blood count) to see if Helen might be anaemic.

The specimen is sent to the Haematology laboratory and is placed in a machine that automatically reads the level of haemoglobin. The result is below the normal range indicating that Helen is anaemic. The machine detects that the cells are smaller than they should be, which often suggests an iron deficiency anaemia. The pathologist (a Haematologist) confirms that the cells are "microcytic" by checking a smear of blood under the microscope. The report is sent back to Helen's local doctor who then wants to confirm whether the anaemia is due to low levels of iron in her blood.

A further blood test is sent to the Chemical Pathology department this time, which confirms the diagnosis of iron deficiency anaemia, the cause of Helen's tiredness. The GP will then discuss the situation with Helen so that he/she can establish the cause and start treatment.

Pap Smears

Effie goes to her local GP for a repeat prescription for a contraceptivepill. The GP checks her blood pressure and notices that she has not had a Pap smear for 2 years.

The GP performs a Pap smear and sends the smear to the pathology laboratory for assessment by an Anatomical Pathologist.

The Pap smear is received at the lab where it is stained so that the cells can be carefully analysed under the microscope.

A scientist initially screens the slide looking for atypical (abnormal) cells. (There are 50,000 to 100,000 cells on each smear). The screener finds some abnormal cells and refers the smear to the Anatomical Pathologist.

The Pathologist looks at the slide under the microscope and diagnoses a low-grade abnormality, which if not detected early would have progressed to cancer, and reports this to the GP.

Effie's doctor will discuss the situation with her so that the exact nature and extent of the abnormality can be established, and treatment considered.