Rheumatology

Pathology & Laboratory Medicine

Overview

Pathologist-in-Chief:

Thomas W. Bauer, MD, PhD

Visit the Department Page for the full faculty listing.

The mission of the Department of Pathology and Laboratory Medicine is to provide accurate, efficient and timely results to assist the medical and surgical staff in the diagnosis and treatment of our patients. Pathology performs close to 2 million laboratory examinations per year, touching virtually every patient at HSS.

Recent Achievements

Since the advent of the COVID-19 pandemic, each HSS lab section has responded to the need for rapid, high-quality testing. This has entailed, among other things, carefully monitoring our supply chain of testing reagents for two different SARS-CoV-2 polymerase chain reaction platforms as well as testing for antibodies to SARS-CoV-2. Staffing has been adjusted frequently to conform to guidelines from New York State and the CDC for testing patients, visitors and employees.

In February 2021, the Department went live with primary sign-out capabilities using digital pathology. HSS became the first in the country to integrate a high-resolution Aperio Scanner with the Epic (Beaker) Laboratory Information System and the Sectra PACS system. This allows us to share digital “whole slide images” of microscope slides with any HSS physician who has access to the PACS, similar to the way physicians view conventional radiographic imaging studies.

The conversion to digital does not affect the diagnostic integrity of the slides or impact the turnaround time of surgical pathology reports. Between our go-live date in February and the end of November 2021, we had prospectively digitized 11,188 cases, representing approximately 73% of all of the cases processed in our department during that time. This greatly surpassed our initial goal of digitizing 50% of all cases during our first year using the technology.

Additionally, we undertook several key activities focused on clinical pathology enhancements:

The reference ranges for Prothrombin Time and Activated Partial Thromboplastin Time were refined using HSS patient data to reduce the “false positive” rate as well as reduce unnecessary coagulation mixing studies. The platelet count reference range was also adjusted to reduce the proportion of results flagged as thrombocytopenic when the platelets were in fact normal for our patient population.
The mixing study workflow was enhanced to increase the sensitivity of a factor-specific inhibitor in the context of a concomitant Lupus Anticoagulant.
We established an agreement with NewYork-Presbyterian-Weill Cornell Medicine for them to supply platelets for emergency use, such as a Massive Transfusion Protocol (MTP). We also expanded our blood supplier from solely the New York Blood Center to now include Metro Blood Services.

Notable Studies

Avecilla ST, Boulad F, Yazdanbakhsh K, Sadelain M, Shi PA. Process and procedural adjustments to improve CD34+ collection efficiency of hematopoietic progenitor cell collections in sickle cell disease. Transfusion. 2021 Jun 23. doi: 10.1111/trf.16551. Epub ahead of print. PMID: 34160085.

Bauer TW, Zhang Y, Gao MA, Lin BQ, Koff MF. Reproducibility of pathologic scoring systems for revision total hip arthroplasty: A cross-sectional study. Pathology – Research and Practice 2021;228: https://doi.org/10.1016/j.prp.2021.153685.

Baumhoer D, Haefliger S, Ameline B, Hartmann W, Amary F, Cleven A, Klein MJ, Thompson LDR, Harder D, O’Donnell P. Ossifying Fibroma of non-odontogenic origin – a fibro-osseous lesion in the craniofacial skeleton to be reconsidered. Head and Neck Pathology June 2021 DOI: 10.1007/s12105-021-01351-3.

Hemmerling KJ, Weitzler L, Bauer TW, Padgett DE, Wright TM. Fretting and corrosion of metal liners from modular dual mobility constructs: a retrieval analysis. Bone Joint J 2021;103-B:1238-1246.

Jacob RP, Walsh EM, Maslak PG, Giralt SA, Avecilla ST. A Simplified CD34+ Based Preharvest Prediction tool for HPC(A) Collection. Transfusion. 2021 Mar 11. doi: 10.1111/trf.16356. Online ahead of print. PMID: 33694175.

Jacob RP, Flynn J, Devlin SM, Maloy M, Giralt SA, Maslak P, O'Reilly RJ, Tonon JA, Perales MA, Avecilla ST, Cho C. Universal Engraftment after Allogeneic Hematopoietic Cell Transplantation Using Cryopreserved CD34 Selected Grafts. Transplant Cell Ther. 2021 May 12:S2666-6367(21)00887-3. doi: 10.1016/j.jtct.2021.04.026. Epub ahead of print. PMID: 33991721.

Machine Learning Integration of Scleroderma Histology and Gene Expression Identifies Fibroblast Polarization as a Hallmark of Clinical Severity and Improvement. Showalter K, Spiera R, Magro C, Zhang Y. et al. Annals of the Rheumatic Diseases. 2021;80:228-237. http://dx.doi.org/10.1136/annrheumdis-2020-219264.

Looking Ahead

Work is under way to expand the current Lupus Anticoagulant panel to increase the sensitivity of the panel by the addition of the Silica Clotting Time.

Work is also under way to establish a workflow, in partnership with billing compliance, to provide focused education to ordering providers regarding appropriate documentation of diagnosis codes, which supports accurate billing and reimbursement.