Laboratory Medicine

A series of articles in the New England Journal of Medicine and the Lancet this week report on the clinical impact of deficiency alleles of CYP2C19. This cytochrome P450 is required for activation of the anti-platelet drug, clopidogrel. Deficiency alleles are common in the population and result in decreased activity of the P450 enzyme. Subjects who carried a deficiency allele(s) in these studies had worse clinical outcomes than did subjects with functional alleles. These findings make the case (again) that drug dosing often needs to be tailored to account for genetic differences between patients. We are used to thinking about genetic factors in the susceptibility to and causation of disease. Now we must increasingly think about them in a therapeutic context as well. Depending on the drug, some patients may need a lower or higher dose. In some patients, a drug may have no benefit or be highly toxic. The key is to make this determination in a timely way so that patients receive maximum benefit with minimum risk. Ideally, we would link results from laboratory genetic analysis with data on the likely phenotypic consequences and present this information in a useful way to the clinician at the "sweet spot", that is when a decision about choosing a drug or dosage is being made.

Posted by Anthony Killeen at 6:08 AM | Permalink | Comments (0)

Welcome to the Laboratory Medicine Course!

In this course, we will be introducing you to the clinical laboratory and providing you with practical exposure to some lab procedures that you will use frequently in your future medical practices. As with most courses, you get out of it in proportion to what you invest in it. You should attend all of the laboratory sessions and read the text. Many of the Course materials will be accessible at the Course website (built in Moodle) and accessible for registered students through myu.umn.edu.

The clinical laboratory plays a central role in modern health care. It has been estimated that at least two-thirds of all diagnoses rely to some extent on a laboratory finding. The clinical laboratories at the University of Minnesota Medical Center, Fairview, cover numerous sub-disciplines including clinical chemistry, microbiology, hematology, coagulation, blood banking, molecular and cytogenetics, and tissue typing. The professional field that is responsible for medical directorship of all of these areas is known as Clinical Pathology (sometimes called Laboratory Medicine or "CP"). In the organization of Pathology, the major fields are Anatomic Pathology ("AP") and Clinical Pathology.

Clinical Pathology at Minnesota
You might have noticed that our department has a double-barreled name, “Laboratory Medicine and Pathology". Originally those were two separate departments, with Laboratory Medicine being an offshoot of Internal Medicine, and one of the first such departments in the country. For the last few decades, these have been a unified department that covers all clinical laboratory testing at this medical center. We also serve as a reference laboratory for numerous physician office and hospital clients both in Minnesota and out-of-state. Our department is a highly rated academic department and our laboratories are known for their excellence. Please feel like you’re a member of our department during your course, and at any time, feel free to contact me or the Course Coordinator, Mary Ramey, with any questions or concerns.

Anthony A. Killeen, MD, PhD, FCAP
Associate Professor
Director of Clinical Pathology
Course Director

X.500: kille001

Posted by Anthony Killeen at 3:52 PM | Permalink | Comments (0)