Clinical Laboratory

70% of medical decisions in a hospital are made based on the evidence provided by clinical laboratories. Consequently, it is critical that the information required by healthcare professionals attending patients, arrives in a timely, reliable, complete and clinically useful manner. It is essential that central laboratories core has the capacity to provide a continuous service, focused on patient safety, in association with clinical care departments, and framed in a stringent process of quality assurance under international standards.

All outpatient and hospitalized patients treated in a medical center will undergo at least one routine study, provided by a clinical laboratory. Physicians must have appropriate tools to confirm, rule out, monitor, estimate risks or detect ways to therapeutically intervene their patients, which can be done with the help of hundreds of routine examinations provided by central laboratories.

• Immunochemistry.
• Hematology.
• Body fluids.
• Coagulation.
• Blood gases.
• Urine and stool examinations.

The Fundación Valle del Lili’s Central Laboratory offers the following services:

• Blood chemistry, tumor markers, cardiac biomarkers, renal function, liver function, infectious serology, hormones, drug levels and specific metabolic substances.
• Conventional hematology (cytology testing of blood), basic coagulation testing and erythrocyte, leukocyte and platelet parameters.
• Gases (venous or arterial blood, urine).
• Chemical and cytological tests in body fluids.
• Physical, chemical and urinary sediment tests.
• Microscopic and chemical examination of stool.

Why choosing Fundación Valle del Lili’s Central Laboratory?

• High performance in external Quality Control tests.
• Extensive portfolio of services, which is permanently available.
• Adherence to international standards of practice.
• Permanent support by clinical pathologists

Chromosomes examination using conventional methods, through the recent use of fluorescent molecular probes, has increased sensitivity, detection capacity and reproducibility to identify medium and large structural anomalies in congenital diseases, tumors, and in the management of infertility.

Cytogenetic technologies (karyotype, fluorescence in-situ hybridization, among others) are applicable in cases of newborn patients with physical abnormalities, congenital malformations or those with physical, motor or cognitive development deficiencies, as well as for patients with tumor diseases, especially in examinations for lymphoma and leukemia. It is further applied in the identification of adverse changes of chromosomes, which may be associated to functional or structural issues of a baby conceived by parents with risk factors (over 35 years of age, with occupational exposures to toxic agents, and certain previous diseases).

Fundación Valle del Lili’s Cytogenetic Laboratory offers the following services:

• Conventional karyotypes in peripheral blood.
• Karyotype in bone marrow samples.
• Cytogenetic examination of cell cultures.
• Cytogenetics using molecular probes for fluorescense hybridization.

Fundación Valle del Lili ‘s Cytogenetic Laboratory features the following characteristics:

• Highly trained medical staff (two professionals with Master and Doctorate degrees in laboratory genetics and clinical genetics).
• Automated processes for imaging analysis.
• High performance in external Quality Control tests.
• Team working among clinical groups.

Fundación Valle del Lili has been using this technology for several years and has been widely adopted by clinical services in the Institution and other institutions, as a result of innovation, adoption of international practice standards, and cutting-edge technology. Additionally a close collaboration exists among teams directly responsible for patient care, including participation in clinical groups

For patients with leukemia, lymphoma and other hemato-oncology diseases, this technology allows to identify specific characteristics of the cells under study, in high quantities and within a few minutes. Flow cytometry allows detection of molecular markers in cell membranes and inside cells. With flow cytometry, it is possible to identify one or multiple molecular characteristics in cell populations in a blood or bone marrow sample (even coming from dissociated tissues), allowing for more comprehensive, complex, representative and powerful examinations, complementing microscopic morphology analysis.

Flow Cytometry Laboratory:

• Characterization of cells subpopulations, including lymphocytes, monocytes and other cell lines.
• Classification of molecular characteristics, membrane receptors, nuclear receptors, and other cellular antigens in samples collected from patients with malignant blood diseases (lymphoma, lymphoproliferative disorders, myeloproliferative disorders, among others).
• Detection of minimal residual malignant disease.
• Detection of non-malignant cell populations causing other diseases.

Fundación Valle del Lili’s Flow Cytometry Laboratory is characterized by:

• Antibody panels in innovative combinations.
• Adherence to current practice standards.
• Pioneer technology among hospital laboratories (10-color-3 lasers cytometer)
• Team working among clinical groups.

Molecular techniques are methods that help in the identification of disease markers, long before the onset of clinical manifestations. They are capable of identifying molecular markers, help in the association of structure findings with functional alterations of the disease and allow for the proposal of potential therapeutic interventions in the future.

The Molecular Genetics Service is addressed to patients with malignant diseases, congenital chromosomal disorders, structural abnormalities affecting metabolic functions; growth anomalies, central nervous system anomalies and immune system anomalies with malignancy development.

Fundación Valle del Lili’s Molecular Genetics Laboratory of the offers the following services:

• Chimeric studies of B-cells (in bone marrow and other tissues pre- and post-transplant patients).
• Chimeric studies of T lymphocytes (in bone marrow and other tissues pre- and post-transplant patients).
• Detection of translocations and inversions in fusion genes by PCR analysis.
• Detection of ABL/BCR translocation t(9;22) by real-time PCR.
• Detection of translocation t(15;17) by Fluorescence In-Situ Hybridization [FISH].
• Microsatellite Instability in colorectal cancer study.
• Y-chromosome microdeletion in male infertility.
• BCR/ABL P190, P210, P230 quantitative genetic and translocation (monitoring).
• Loss of heterozygosity and PTEN in gliomas (paraffin-embedded tissue).
• BCR/ABL P210 quantitative genetic and translocation (monitoring).
• Detection of fetal gender in maternal blood.
• Detection of PML/RARa rearrangement by quantitative PCR.
• Detection of Janus Kinase 2 v617f mutation by PCR.

Why choosing Fundación Valle del Lili’s Cytogenetics Laboratory Service:

• Highly trained medical staff (two professionals with Master and Doctorate degrees in laboratory genetics and clinical genetics).
• High performance in external Quality Control tests.
• Team working among clinical and pathology groups.

Many diagnostic tests are excluded from service portfolios because they are sporadic. Our laboratory performs diagnostic tests that are used only few times a month, but are very valuable for patients needing them sporadically, ensuring continuous, or close to continuous availability, in order to support health care.

This service is addressed to patients with rare hematological diseases and coagulation disorders with a low incidence among the general population who have a low-frequency consultation to emergency services or who consult on a scheduled basis, for surgical interventions.

Fundación Valle del Lili’s Haemostasis and Special Hematology laboratory offers the following services:

• Coagulation Abnormalities (Prothrombin time – PT, Activated Partial Thromboplastin Time – aPTT, Thrombin Time TT, Fibrinogen, mixing studies for PT and aPTT.
• Primary Hemostasis – assessment of platelet function by platelet aggregation in a bleeding time study with 4 agonists: ADP, EPN, Collagen, Ristocetin.
• Platelet aggregation for hyperaggregability or thrombosis studies: ADP (2.3, 1.2 – 0.6 uM) – and EPN (11 uM, 1.1 uM, 0.6 uM).
• Platelet aggregation for von Willebrand disease study: RIPA (4 dilutions with Ristocetin: 1.2, 0.6, 0.5, 0.3).
• Platelet aggregation for follow-up of aspirin treatment: arachidonic acid.
• Platelet adhesiveness with Collagen/ADP, Collagen/EPN. Method: PFA-200.
• Secondary hemostasis – bleeding time study – determination of coagulation factor activity: factor II, V, VII, VIII, IX, X, XI.
• Secondary hemostasis – von Willebrand factor antigen, determination of von Willebrand factor activity (ristocetin cofactor).
• Heparin-induced thrombocytopenia (HIT IgG).
• Thrombophilia study: protein C and protein S activity, lupus anticoagulant (Screening and Confirmatory studies).
• Factor V-Leiden Mutation (resistance to activated protein C by PCR).
• G20210A mutation of the prothrombin gene.
• Viscoelastic tests (thromboelastography, platelet mapping (ADP/AA with/without heparinase).
• Monitoring of heparin-anticoagulated patients (UFH and LMWH – anti-Xa factor chromogenic assay for dosage).

Why choosing Fundación Valle del Lili’s Haemostasis and Special Hematology service?

• Advanced training of bacteriologists in a Nationally recognized center.
• High performance in external Quality Control tests.
• Extensive portfolio of services which is permanently available.
• Adherence to international practice standards.
• Permanent support by clinical pathologists.

One of the most important mainstays of clinical practice in Fundación Valle del Lili is organ and bone marrow transplantation. Throughout time, the diagnostic support provided by the Laboratory of Transplant Immunology and Immunogenetics has fostered progress in health care for hundreds of patients who have received solid organs, bone marrow transplants and various tissue grafts, transforming the lives of thousands of patients and their families, generating new knowledge, leading the adoption of advanced and safe practices at a national level.

This Service is addressed to patients with advanced diseases for whom no pharmacological options and no other interventions are available, other than replacing an organ in end-stage failure, due to congenital causes, or toxic, infectious or other type of diseases that require urgent organ transplant.

The Immunology of transplants and Immunogenetics Laboratory performs the following processes:

• Tissue typing for compatibility between two individuals (a donor and recipient) by low or medium resolution molecular techniques.
• Tissue typing for compatibility by high resolution techniques, using next generation sequencing (NGS).
• Biological detection of preformed anti-HLA antibodies by the complement-dependent cytotoxicity (CDC) technique using urgent serological tests (in the immediate transplant period).
• Detection of high sensitivity of pre-formed anti-HLA antibodies by flow cytometry.
• Detection of panel-reactive antibodies, in order to identify the level of sensitivity of a patient as well as immune modulation after transplantation.
• Single antigen detection by luminometry technique.

Why choosing Fundación Valle del Lili’s Laboratory of Transplant Immunology and Immunogenetics service?

• Highly qualified staff.
• EFI International Accreditation (European Federation for Immunogenetics).
• Pioneer technology in hospital laboratories.
• Team working among clinical groups.

As knowledge widens, it is clearer that despite antibiotics and other pharmacological therapies availability, the body’s ability to identify, stop and eradicate infectious agents is critical. Likewise, the immune system’s role (our bodies’ defenses) in various diseases and the way to control them is better understood nowadays. This laboratory focuses on the study of biological immune markers, as well as on the ability of defenses to act against pathogenic microorganisms.

This Service has a direct impact in cases where a patient does not respond as usual to antibiotic treatments. Frequently, these patients have recurrent infections with common germs, more than expected compared with the general population. It is in these cases where the laboratory performs diagnostic blood tests for patients with allergic syndromes and for those with autoimmune diseases (patients whose immune system attacks their own tissues).

Fundación Valle del Lili’s Immunology and Immunodeficiency Laboratory offers the following services:

• Detection of antibodies to cell components, which are autoimmune disease markers, by immunofluorescence techniques.
• Quantitative measurement of specific IgE antibodies to purified allergens in extracts by FEIA, which aids in the diagnosis and monitoring of intervention therapies in allergic patients.
• Quantitative measurement of specific IgE antibodies to recombinant allergen components by FEIA.
• Antigen-antibody common and high-complexity detection testing for the diagnostic algorithm of autoimmune diseases.
• Cell biology studies on stimulated lymphocyte cultures for the detection of deficiencies on cell immunity.
• Cell biology studies of cells oxidative stress by dihydrorhodamine technique (oxidative burst of granulocytes).
• Protein electrophoresis studies.

Why choosing Fundación Valle del Lili’s Immunology and Immunodeficiency Laboratory Service?

• Panels of recombinant allergens.
• Interpretation of results by a physician with a PhD in Immunology.
• The only center that offers cell biology studies in the region.
• Team working among clinical groups.

Several fields of Fundación Valle del Lili’s clinical practice involve healthcare to highly immune-suppressed patients. Consequently, our Microbiology laboratories (bacteriology, mycology, virology and molecular microbiology) have provided support for health care, health activity, research and training of undergraduate and graduate health professionals through the years.

This Service is addressed to patients who suffer a spontaneous infectious process or patients who need the support of a microbiology laboratory after treatment, in order to identify and define antimicrobial agents useful to eradicate an infection. Additionally, in the hospital it is usual to find especially susceptible patients, such as transplanted patients, cancer patients, neonates, pregnant women with multiple diseases, patients with HIV disease, among others.

It is essential that a hospital with these characteristics provides a prompt, reliable and fully available diagnostic service to timely detect pathogenic and high-risk germs in those patients with immune deficiency.

The following processes are available at Fundación Valle del Lili’s Microbiology Laboratory:

• Culturing, isolation, identification and antibiogram creation on fungal bacteria and mycobacteria with conventional methods.
• Proteomic identification of microorganisms by mass spectrometry (MALDI TOF), which allows the identification of a previously cultured infectious agent, including bacteria, fungi or mycobacteria, in less than one hour.
• Rapid detection by immunochromatographic methods of an infectious disease antigen markers.
• End-point molecular detection (PCR) of bacteria, fungi, viruses and parasites in several samples of high clinical value.
• Molecular-based methods (quantitative PCR) for quantifying viral load of several viral agents of pathological interest.

Why choosing Fundación Valle del Lili’s Microbiology Laboratory Service?:

• Highly controlled processes.
• Adherence to international standards and current standards of practice.
• Pioneer technology among hospital laboratories.
• Team working among clinical groups.

Advances in electronics, microfluidics and nanotechnology have made possible to create portable and equipment easy to use at the patient’s Point of care. This trend had started some decades ago, but only recently it achieved reliability performance levels comparable to those of central laboratories in some areas. These technologies are known worldwide with the acronym POCT, “Point of Care Testing”. Although it greatly contributes to improve timely results delivery and to potentially enhance clinical outcomes, it also involves an equally great challenge: to prevent risking the quality and safety of the patient. This may occur in cases where a health professional using these technologies, due to his/her particular training, may overlook the specific pre-analytical, analytical and post-analytical variables involved in support diagnostics. As a consequence, current international prudent practices indicate that this technology is to be implemented based on a formal and organized POCT Program.

This Service is addressed to hospitalized patients attended in the general hospitalization and intensive care services, the emergency surgery service and delivery room, as well as in the outpatient setting: the pneumology service and the anticoagulation clinic.

Fundación Valle del Lili’s Point of Care Testing Program (POCT) features the following characteristics:

• Application of good international practices.
• Adherence to ISO 22870 standard.
• Continuous training program for healthcare professionals directly using diagnostic support technologies.
• Monitoring of the analytical, technological and connectivity performance of biomedical equipment.
• Application of external quality controls.
• Availability of glucometers throughout the hospital.
• Availability of gasometers and electrolyte-meters in intensive care units and emergency resuscitation areas.
• Availability of coagulometers in the outpatient anticoagulation clinic.
• Availability of electrolyte iontophoresis equipment for perspiration-related analysis.
• Availability of portable gasometers.

Why choosing Fundación Valle del Lili’s Point of Care Testing Program?

• Bacteriologist with a Master degree in Education.
• Proficiency tests with the College of American Pathologists (ACP).
• Adherence to international practice standards.

After the Human Genome Project finished, which spelled out the genetic code contained in the chromosomes of human beings, researchers started to associate diseases and risk conditions with abnormalities in the genetic sequence. Sophisticated AI computer technology methods make the determination of the genetic sequence components of an individual or a diseased tissue (including tumors) more accessible.

The Sequencing Service is addressed to patients with malignant diseases and congenital chromosomal alterations; patients with structural abnormalities affecting metabolic functions, as well as growth anomalies and anomalies of the central nervous system and the immune system with malignancy development, with the purpose of finding germline mutations. Additionally, patients with malignant tumors may benefit from the service, for finding somatic mutations.

Fundación Valle del Lili’s Sequencing Laboratory offers the following services:

• Massive Parallel Sequencing (next-generation sequencing, NGS) for the study of gene combinations arranged in panels, with the purpose of covering the most frequently reported mutations in the suspected condition of the patient.
• Sequencing by Sanger method for known point mutations.
• Confirmatory sequencing of findings identified through NGS technology.

Why choosing Fundación Valle del Lili’s Sequencing Laboratory Service?

• Highly trained medical staff (three physicians with Master and Doctorate degrees in laboratory genetics and clinical genetics).
• Exclusive use of approved diagnostic technologies for clinical application (IVD-CE, RS INVIMA).
• Medical and academic alliance with a widely recognized European center (Sistemas Genómicos®).
• High performance in external Quality Control tests.
• Adherence to international practice standards.
• Team working with the molecular pathology group (somatic mutations).

Download the leaflet: “Next Generation Sequencing”