Dow Diagnostic Research & Reference Laboratory (DDRRL)

The Dow Clinical & Research Laboratory is a core diagnostic lab associated with 800-bedded tertiary care Dow University Hospital & Dow International Medical College. It has separate sections of Histopathology, Molecular Pathology, Chemical Pathology, Hematology, Microbiology, Clinical Chemistry, Blood bank, Cytology and Biochemistry. Currently, it has over a dozen of Collection points across and outside Karachi metropolis while planning to open more sample pickup points soon in order to enable easy access for the patients in far flung areas. It also provides testing facilities to Postgraduates, MPhil and PhD students for conducting their research. To provide reliable, high quality diagnostic services of international standard for routine and specialized tests at extremely economical rates (approx. at 30% as compared to private ones) for all socioeconomic segments of population.

DDRRL is the fastest growing lab in Pakistan. Monthly about 25,000 tests are performed and up till now more than one million tests have been performed. Internal quality assurance is guaranteed by daily controls. Provisions of online electronic reporting & image transfer facilities also exist. More than 100 researchers have conducted various tests. DDRRL proactively collaborates in Research &Academics with AKU, KU, NED, AIDA control, TB and Hep-C control programs. The DDRRL has international collaborations with Caglin University, South Coarolina USA &Cardif University UK.

The research facilities help postgraduates of MPhil and PhD. All related departments of DDRRL provide State of Art facilities.

Collection Points

Besides the main lab, presently there are five collection centers of Dow lab, near Civil Hospital, Jinnah Hospital, Malir, Nazimabad and Federal B Area, to provide easy accessibility to the clients for diagnostic laboratory services.

Collection Points/Main Labs in Sindh

S. No.
COLLECTION POINTS
1 CPU-01 (NILGID)
2 CPU-02 (MALIR)
3 CPU-03(Civil Hospital)
4 CPU-04(NAZIMABAD)
5 CPU-05(FB-AREA)
6 CPU-06(HIGH COURT)
7 CPU-07(NEW TOWN)
8 CPU-08 (GULSHAN CP)
9 CPU-09 (HYDRI LT)
10 CPU-10 (HYDRI SB)
11 CPU-11 (CH-GOTH)
12 CPU-12 (SHAH FAISAL)
13 CPU-13 (GULSHAN-E-MAYMAR)
14 CPU-17 (CITY COURT)
15 CPU-18 (NORTH KARACHI)
16 CPU-19 (GULSHAN-E-HADEED)
17 CPU-20 (GUIISTAN-E-JOHAR)
18 CPU-14(SUKKUR)
19 CPU-15 (MORO)
20 CPU-16 (MIRPUR KHAS)

Histopathology Department

The Histopathology Department performs special and immunological stains for conclusive biopsy reporting including FISH by hybridization.

S. No.
Equipment
Quantity
1 Tissue Processor 2
2 Embedding Center 2
3 Gross Station 3
4 Cryotome 1
5 Centrifuge Machine 1
6 Cytospin 1
7 Microtome 4
8 Tissue Drying Oven 2
9 Tissue Flotation Bath 2
10 Refrigerator 2
11 Incubator 1
12 Microwave 1
13 Steamer 1
14 Water Bath 1
15 Warm Plate 1
16 Vortex Mixer 1
17 Weighing Machine 1
18 Ups 5
19 PH Meter 1
20 Pressure Cooker 2
21 Bone Cutter 2
22 Hot Plate/Stirrer 1
23 Microscope 12
24 Auto ImmunoStainer 1

S. No.
Test
1 Biopsy
2 Cytology
3 IHC
4 ER, PR
5 Her 2
6 Slide Preparation
7 Second Opinion
8 BMT

Microbiology Department

The Microbiology Department provides routine and specialized diagnostic and research services.

The Dow lab also provides TB culture and sensitivity Rifampicin and INH resistance by Molecular techniques.

S. No.
Equipment
Quantity
1 ATMOSPHERIC INCUBATOR(BINDER 4
2 DIGITAL HOT PLATE STIRRER 1
3 ELECTRIC BALANCE 1
4 MICROSCOPE 5
5 TYPE A2 BIOLOGICAL SAFETY CABINET 1
6 TYPE A2 BIOLOGICAL SAFETY CABINET(THERMO) 1
7 AUTOCLAVE 1
8 CENTRIFUGE HERMLE Z323 2
9 CENTRIFUGE METTICH 1
10 CO2 INCUBATOR WITH CO2 CYLINDER &HEATED REGULATOR 1
11 REFRIGRATOR 8
12 DEEP FREZERS 2
13 OVEN (BINDER) 1
14 THERMO SCIENTIFIC MICRO PIPETTE 10-100 UL 10
15 VORTEX 2
16 ELICA PR 3100(BIORED) 1
17 ELISA WASHER 1
18 BACT/ALERT 3D MICROBIAL DETECTION SYSTEM 1
19 READER 1
20 EVOLIS (BIORAD 1
21 SHAKER (LABORATECHNIK. MATERIATECHNIQ) 1
22 WATER BATH 1
23 COBAS E411 1
24 URINE ANALYZER 1

Molecular Pathology Department

The Molecular Pathology Department offer Qualitative and Quantitative PCR testing of Hepatitis B, C, and D viruses along with their Genotyping. This lab facility is equipped with state of art technique i.e. conventional and automated systems of PCR machines, Fluorescence in-Situ Hybridization technique, and Gel Electrophoresis and Documentation system.

S. No.
Equipment
Quantity
1. Biological safety cabinet 7
2. Centrifuge 22
3. Dcode System 3
4. Deepfreezer 7
5. Distillation Plant 1
6. Electrophoresis instruments 6
7. Heating block 15
8. Incubator 2
9. Liquid Nitrogen Tank 1
10. MicroScope 1
11. Microwave 2
12. PCR Instrument 17
13. pH meter 2
14. Power Supply 2
15. Refrigerator 3
16. Rocker 1
17. Shaker 1
18. So Safe Filtration 1
19. Ultra Low Temperature Freezer 8
20. UPS 19
21. UV Crosslinker 7
22. UV Spectrophotometer 1
23. Vacume Pump 2
24. Vortex Mixture 7
25. Water Bath 5
26. Weighing Balance 2

S. No.
Parameters in Molecular Pathology
1. HCV Qualitative PCR
2. HCV Quantitative/Viral Load PCR
3. HCV Genotyping PCR
4. HCV Subtyping PCR
5. HBV Qualitative PCR
6. HBV Quantitative/Viral Load PCR
7. HBV Genotyping PCR
8. HDV Viral Load/ Quantitative PCR
9. MTB PCR
10. HSV PCR
11. ANA Profile
12. FISH
11. ANA Profile
12. FISH

Total Lab Automation

The Lab currently performs on average around one million Immunochemistry tests (834,000) per year. The volume is growing rapidly day by day, and approximately 13,20,000 patients are attended by the Dow Lab per month. The machines have 14 times capacity than the current production rate. In order to cope up with the increasing workload and provide state-of-the-art quality results to masses irrespective of their socioeconomic class, the Dow Management has joined hands with one of the world’s leading laboratory solution providers, the Abbott Diagnostics to install its Accelerator Automated Processing (APS) System with the capability to streamline testing process and enable accurate reporting with efficient turnaround time while dealing with high volume of tests at a time.

Accelerator Automated Processing System:

This full automation brings a number of benefits for the lab. For Dow, it consolidates about 98% of the total test load onto what we regard as a single platform. For us the ACCELERATOR is one instrument. We get all tests from one sample.

If we look at staff interaction with the APS system on a day-to-day basis, the most important point to pick up on is that it is a single point of entry that is the Input output module. That means for all samples, whether it would be STAT, routine, capped, uncapped—they are all entered at the single point of entry. This also means that samples which are sorted for secondary analysis are presented at the same point. In other words, samples that have to be sent on to another hospital, another laboratory, or for in-house testing are all presented at the same point, sealed, and ready for transportation to its next destination.

Refrigerated Centrifuges:

The TLA system is equipped with two refrigerated centrifuges with total capacity of more than 600 tubes per hour. Once the samples are spun, they move to the decapper so that the cap can be removed and discarded. Those tubes which are loaded as already spun, bypass the centrifuges and are straightaway decapped. Now the tubes are ready for analysis on the analyzers.

Abbott Architect Analyzers:

The Abbott Architect analyzers themselves are robust and easy-to-use. We have two analyzers each for Clinical Chemistry & Immunoassay attached to the track. With the analytic capacity of upto 400 Immunoassay and 2400 clinical chemistry tests per hour, these not only provide for our increasing capacity needs but also serve as back up of each other to keep us smoothly running all the time. At the chemistry level, the chemistries are stable and have extended linear ranges. If we look to the immunoassays, they too have exceptional sensitivity such as for TSH, Infectious disease markers, and particularly for tumor markers. This is an area where we had mainly manual dilutions. It just does not happen anymore. They are dealt with on-board by the instrument with accuracy and precision.

Resealer Module:

Once the analysis is complete, the sample tubes go to the resealer module to be sealed with an aluminium foil. Finally, we get into storage. The full automation gives us refrigerated storage which can hold 15000+ tubes at one time. We’ve never had anything like that before. As we also didnot have any cold room, people used to have to go to several different refrigerators, to store and then to retrieve samples for any repeats and/or add on tests requested by the physicians and patients. That is all now done automatically.

Automatic recall from a storage unit—we can even recall from the laboratory LIS if we want to. After one week or so, samples will be automatically discarded from the system.

Aliquotting Module:

Apart from these very essential process steps, we have also got an online aliquotting module, which is used for producing as many as 4 secondary tubes from the primary sample to send out to other departments, for performing manual tests or for sending out to other hospitals and labs. All these secondary tubes are duly barcoded by the aliquotting unit and sorted out in the Input output module in designated racks for distribution to the desired destination.

If we look to the information flow around this system, we key in the patient demographics and tests information into our LIS system just once. We put the barcode on his or her sample tube, and leave the rest to Accelerator. It retrieves all the information belonging to that barcode, gets its requested tests done and sends the results in return to the LIS. This bidirectional interfacing between the Dow LIS and Abbott IT engine, Instrument Manager, using primary sample identification and data communication through barcode makes it an efficient and error-free process.

As we have this automation system in our lab now, we expect to see remarkable improvements in our processing capacity, overall turnaround times, quality and consistency in our reporting. We now know from hour to hour how long the average sample is going to take. One very important and interesting aspect is incorporating our urgent sample analysis into the ACCELERATOR. We have many requests from Emergency and Inpatient Departments esp. ICU, who are looking for a very quick turnaround on results. This system allows us to stream those separately into the STAT port and deliver very acceptable turnaround times to this group of customers in a more efficient and consistent manner.

The Dow’s highly qualified and well-experienced staff is fully trained and capable of running this system now round the clock support to ensure smooth running of the system and uninterrupted patient reporting.

The Department of Radiology

The Department of Diagnostic Radiology incorporates all aspects of oncological imaging and includes CT scanning, MRI, ultrasound, general radiology, mammography and interventional radiology. The Department of Diagnostic Radiology emphasizes high quality of radiological health care, efficient and cost-effective diagnostic medical imaging and imaging-related therapy. Departments imaging and research protocols are developed by the relevant modality superintendent radiographers and radiation and MRI physicists at both campuses. The Department of Diagnostic Radiology offers round-the-clock services that provide accommodations to the needs of inpatients, outpatients and outside referrals by providing the best possible and modern diagnostic facilities in main Radiology (DUHS-Ojha) and tertiary campus of (LEJ).It is fully equipped with state of the art equipment from General Electric (GE) USA. The diagnostic modalities installed at Dow-Rad, are providing prompt and accurate diagnosis of different diseases at highly competitive rates which has made use of imaging modalities by general public possible. Department aims to advance the field of radiology and radiological sciences by basic, applied and clinical research.

Services:

The department caters to approximately 24000 patients a month. It is fortified with a team of radiologists, research faculty, medical physicists, trained/certified radiographers and IT including support staff. The service offers a full range of imaging examinations and treatments.

The Department offers the following diagnostic services during scheduled timings:

  • General/Special Radiography
  • Fluoroscopy
  • Orthopantomography (Opg) And Cephalometry
  • Ultrasound With Color Doppler Facility
  • Computerised Tomography (Ct Scan)
  • Nuclear Medicine And Bone Densitometry (Dexa Scan)
  • Whole Body Scanning
  • Cerebral Coiling
  • Vascular Angiography
  • Hepatobiliary, Urologic, Neuro Intervention, Digital Subtraction Angiography
  • Interventional Radiology
  • Paediatric Radiology
  • Women Imaging (Mammography) 
  • Magnetic Resonance Imaging (Mri)
  • Vascular And Interventional Radiology (Vir)
  • Intra-Venous Pyelography (Ivp)
  • Bone Densitometer

Equipment

The department is constantly striving to improve imaging in oncology and is committed to utilising new technology and updating the department’s equipment in order to do this.

S. No.
Equipment
Quantity
1. MRI 3
2. CT-Scan (16 slicer) 3
3. X-Ray (Digital Machine) 2
4. Fluoroscopy 1
5. Dexa-Scan (BMD) 1
6. Ultrasound 15
7. Mammography 1
 
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