Laboratory Medicine

Department overview: The Department of Laboratory Medicine was established in 1958. It is a comprehensive laboratory integrating medical services, teaching, and research. Its first director was Professor Zhou Bochi of the Department of Hematology. After more than half a century of development, it has become the largest clinical laboratory in the Inner Mongolia Autonomous Region, with the most advanced equipment and technology and the most comprehensive range of equipment. The department has a usable area of 3,600 square meters, performs more than 500 routine laboratory tests and numerous special tests, and ranks first among the major hospitals in the region in terms of the testing services it provides. It undertakes clinical laboratory work for the hospital’s 3,000 inpatient beds, an average daily outpatient volume of more than 6,000 visits, and health examinations. More than 1.7 million specimens are tested annually. There are currently 83 professional and technical personnel, including 11 people with doctoral degrees, 1 doctoral student currently enrolled, and 10 people with master’s degrees. Twenty-four hold senior professional titles and 12 hold intermediate professional titles; 5 are laboratory physicians, 1 is a designated Grassland Talent, and 2 are autonomous-region 321 Talents. In the autonomous-region evaluations of leading or key disciplines and laboratories in 2009 and 2016, the department received the honor of being recognized as a key discipline in Clinical Laboratory Diagnostics of the autonomous region on both occasions, and it holds a leading position among its regional peers. In 2009, it obtained accreditation from the China National Accreditation Service for Conformity Assessment (CNAS) for medical laboratory quality and competence under ISO 15189. It was the 45th medical laboratory in China to obtain this accreditation; more than 200 medical laboratories in China have now obtained it. To date, it has passed six consecutive CNAS ISO 15189 assessments of medical laboratory quality and competence, including initial assessments, reassessments, and surveillance assessments. In 2009, it was designated by the Inner Mongolia Department of Health as the Inner Mongolia Clinical Laboratory Quality Control Center. It is responsible for quality control, management, technical guidance, and personnel training for the clinical laboratories of medical institutions throughout the autonomous region, and it also undertakes interlaboratory quality assessment of clinical testing for nearly 400 clinical laboratories in the region. In 2011, it was designated by the Inner Mongolia Department of Health as the responsible institution for the Inner Mongolia Bacterial Resistance Surveillance Network and undertook the network’s work. In 2013, it was authorized by the Rational Drug Use Expert Committee of the National Health and Family Planning Commission to serve as the Inner Mongolia Autonomous Region Monitoring Center of the National Bacterial Resistance Surveillance Network. It is also a member institution of the National Bacterial Resistance Surveillance Network. In 2014, it became the first institution in the region selected as a member institution of the Chinese CHINET Bacterial Resistance Surveillance Network. In 2014, it was approved as an Inner Mongolia Autonomous Region Grassland Talents Innovation Team for molecular testing and personalized diagnosis and treatment. In December 2016, following expert defense and on-site assessment, it was approved by the Inner Mongolia Department of Science and Technology to become the Key Laboratory of Clinical Pathogenic Microbiology of the Inner Mongolia Autonomous Region. It received the second prize for quality scientific and technological achievements of the Inner Mongolia Autonomous Region in 2016. In August 2017, it became the Inner Mongolia regional subcenter of the Chinese CHIF-NET Invasive Fungal Surveillance Network.

Medical services: In addition to routine clinical laboratory work, the department has achieved multiple technological breakthroughs and research results in various specialties in recent years. It has conducted a preliminary elucidation of the virulence characteristics of regional MRSA strains, clinical Brucella strains, and clinical Streptococcus agalactiae strains, as well as the epidemiological trends and characteristics of their predominant clones. It discovered a clinical Klebsiella pneumoniae strain simultaneously carrying the carbapenem-resistance genes KPC-2, NDM-1, and OXA-48. It was the first in China to conduct a preliminary investigation into the high-prevalence characteristics of multidrug-resistant Corynebacterium striatum and the pathogenic characteristics of its predominant clones. Its capabilities and technical level in culturing, identifying, and performing antimicrobial susceptibility testing of obligate anaerobes, as well as detecting their resistance genes, have reached an advanced national level. It also discovered multidrug-resistant Bacteroides fragilis, for which no related reports had yet appeared in China. Through continuous efforts in recent years, the department has successfully established a molecular diagnostic platform for TKI treatment of non-small-cell lung adenocarcinoma and colorectal cancer, as well as testing platforms for myeloproliferative neoplasms, leukemia, and other related diseases. It has made preliminary progress in exploring highly sensitive detection methods for hepatitis B and hepatitis C; the testing system is being further improved and promoted. Drug-metabolism testing has been implemented to guide the clinical use of antiplatelet agents.

Teaching: Since 1980, the department has successively undertaken graduation internships for laboratory classes at some health schools in the region. Beginning in 1985, it provided, for two consecutive years, supervised teaching and graduation internships in the professional courses Clinical Laboratory Testing, Biochemical Testing, and Microbiology Testing for the laboratory class of the health school of Inner Mongolia Medical College. In 2001, it established a Laboratory Diagnostics Teaching Group and began undertaking portions of the theoretical and practical courses in Laboratory Diagnostics for the undergraduate programs in clinical medicine, stomatology, anesthesiology, medical imaging, preventive medicine, and forensic medicine at the university. Beginning in 2005, it undertook the professional-course teaching duties for the university’s associate-degree program in laboratory medicine, including the theoretical courses, in-course practical sessions, and graduation internships for Clinical Laboratory Testing Fundamentals, Clinical Hematology Testing, Clinical Biochemistry Testing, Clinical Immunology Testing, Clinical Microbiology Testing, and Clinical Laboratory Management. For many years, it has continuously accepted undergraduate and associate-degree graduation interns in laboratory medicine from other medical colleges and universities in China. It also accepts trainees from clinical laboratories of medical institutions at all levels and of all types throughout the autonomous region, training a large number of medical laboratory professionals for the region. With the enrollment in 2013 of the first cohort in the newly added undergraduate program in Medical Laboratory Technology at Inner Mongolia Medical University, the Department of Clinical Laboratory Diagnostics was established in the same year. It is one of the 18 clinical teaching and research departments of the First Clinical Medical School of Inner Mongolia Medical University. Professor Han Yanqiu serves as the director of the department and the person responsible for the undergraduate Medical Laboratory Technology major. The department is responsible for and undertakes work related to formulating the training plan for this major and provides teaching in the theoretical and practical courses Clinical Basic Laboratory Testing Technology, Clinical Immunology Testing Technology, Clinical Microbiology Testing Technology, Clinical Laboratory Management, Clinical Hematology Testing Technology, Clinical Transfusion Testing Technology, Recent Advances in Laboratory Medicine, and other professional courses. All 49 students in the first cohort of undergraduate Medical Laboratory Technology students, enrolled in 2013, graduated in 2017. Beginning in 2014, Medical Laboratory Technology was upgraded to a first-batch undergraduate major at Inner Mongolia Medical University. For master’s education, the Department of Laboratory Medicine was approved in 2011 as a master’s degree-granting site in Clinical Laboratory Diagnostics at Inner Mongolia Medical University. It began enrolling master’s students in 2012. There are currently 5 graduate supervisors. By 2017, it had enrolled 16 graduate students, of whom 7 had graduated and 9 were still studying. Among the graduates, the university’s Outstanding Graduate Student honor was received on four occasions, and two supervisors received the university’s Outstanding Graduate Supervisor title on two occasions. The department undertakes the graduate course New Techniques and Advances in Clinical Laboratory Diagnostics. For standardized residency training, the Department of Laboratory Medicine is one of the first batch of sub-bases for standardized resident training in the autonomous region. It began enrollment in 2015 and undertakes standardized residency teaching in laboratory medicine.

Research: During the past five years, the department has undertaken 5 National Natural Science Foundation projects, 8 Inner Mongolia Natural Science Foundation projects, 7 Inner Mongolia science and technology plan projects, 2 Inner Mongolia Department of Education research projects, 1 Inner Mongolia Grassland Talents Innovation Team project, 1 Inner Mongolia Young Science and Technology Talents Support Program project, 1 autonomous-region science and technology innovation guidance award-fund project, and university- and hospital-level research projects, for a total of more than 30 projects, with total funding of 4.5 million yuan. It has received 5 awards, including the second prize of the Inner Mongolia Autonomous Region Natural Science Awards, the second prize for science and technology of the Inner Mongolia Medical Association, and the third prize for science and technology of the Inner Mongolia Medical Association. It has published 8 SCI papers as first or corresponding author. More than 160 papers are published each year in domestic core journals. It has served as chief editor of the Laboratory Diagnostics Practical Training Guide and the Guide to Clinical Applications of Modern Laboratory Medicine. Textbooks and monographs to which it has contributed include Clinical Hematology Testing, Clinical Microbiology Testing, Basic Clinical Laboratory Testing, Practical Training Guide to Basic Clinical Laboratory Testing, Laboratory Diagnostics, Diagnostic Medicine Practicum Guide, and Clinical Molecular Diagnostics.

Scope of services: The Department of Laboratory Medicine has six specialties: clinical laboratory testing, biochemistry, immunology, microbiology, molecular biology, and transfusion medicine. In addition to routine laboratory tests, the specialties have taken the lead in the autonomous region in introducing multiple specialized testing services.

Clinical laboratory testing: Routine tests include blood, urine, stool, and routine analyses of various puncture fluids; qualitative chyle testing of urine and pleural and ascitic fluids; qualitative urinary Bence Jones protein testing; reticulocytes; nucleated red blood cells; high-sensitivity C-reactive protein; erythrocyte sedimentation rate; a complete coagulation panel; tests for hemolytic diseases; platelet aggregation rate; hemorheology; and other tests. Specialized tests include von Willebrand factor activity (vWF), antithrombin III (ATIII), plasma and urine osmolality, urine red-cell morphology by phase-contrast microscopy (red-cell image analysis), arachidonic-acid-induced platelet aggregation rate, platelet-specific and histocompatibility antibody testing, stool testing for Helicobacter pylori, stool testing for rotavirus and adenovirus, and stool transferrin testing.

Biochemistry: Routine biochemical tests include liver function, renal function, a complete electrolyte panel, cardiac enzymes, a complete lipid panel, blood glucose, glucose tolerance testing, glycated hemoglobin, pancreatic islet function testing including insulin-release testing and C-peptide-release testing, parathyroid hormone, quantitative serum proteins, serum protein electrophoresis, N-terminal pro-brain natriuretic peptide, blood trace elements, amylase, lipase, blood ammonia, quantitative urinary protein, urinary microalbumin, urinary creatinine, urinary ions, quantitative urinary glucose, a three-item rheumatology panel, complement C3 and C4, a complete immunoglobulin panel, a four-item iron panel, biochemical testing of various puncture fluids, adenosine deaminase (ADA), and other tests. Specialized tests include acute myocardial injury markers such as troponin T, troponin I, myoglobin, and CK-MB by mass assay; procalcitonin; retinol-binding protein; total bile acids; total IgE; complement C1q; urinary N-acetyl-β-D-glucosaminidase (NAG); α1-microglobulin; β2-microglobulin; homocysteine; kappa light chains; lambda light chains; ceruloplasmin; osteocalcin; vitamin D3; total type I collagen N-terminal propeptide; β-collagen degradation products; lactate; urine iodine; ethanol; interleukin-6; cholesterol in pleural and ascitic fluids; cerebrospinal-fluid immunoglobulins; and other tests. Additional tests include blood lead, blood cadmium, the mitochondrial isoenzyme of aspartate aminotransferase, serum and urine immunofixation electrophoresis, Helicobacter pylori antibodies, urinary protein electrophoresis, glycated albumin, soluble transferrin receptor, α-L-fucosidase, free fatty acids, heart-type fatty-acid-binding protein, glycocholic acid, and therapeutic drug concentration testing for phenytoin, carbamazepine, digoxin, methotrexate, cyclosporine A, theophylline, mycophenolic acid, and valproic acid.

Immunology: More than 70 tests are performed, including serological testing for infectious diseases, prenatal and reproductive-health testing, tumor markers, and endocrine hormones. Specialized tests include: 1. three androgen tests, used to diagnose virilization and hirsutism in women; 2. human epididymis protein 4 (HE4), used in the diagnosis of ovarian cancer; and 3. squamous cell carcinoma antigen, used for the diagnosis of squamous cell carcinoma and for monitoring treatment efficacy. Additional new tests include gastrin-17 (G-17), vascular endothelial growth factor (VEGF), anti-Müllerian hormone (AMH), pro-gastrin-releasing peptide (ProGRP), hepatitis C virus antigen, carbohydrate antigen 50 (CA50), carbohydrate antigen 242 (CA242), anti-insulin antibody, and anti-β2-glycoprotein 1 antibody (β2-GP).

Microbiology: Routine services include culture, identification, and antimicrobial susceptibility testing of common bacteria; culture and identification of anaerobic bacteria; culture, identification, and antimicrobial susceptibility testing of fungi; culture of enteric pathogenic bacteria; microbial identification and antimicrobial susceptibility testing; culture and identification of Brucella; routine bacterial smears and microscopy; acid-fast bacillus smear microscopy; fungal smear microscopy; cerebrospinal-fluid cryptococcal India-ink staining and microscopy; and other tests. Specialized tests include: 1. Clostridioides difficile toxin A and B detection, which can markedly improve the sensitivity of laboratory diagnosis of C. difficile infection and significantly shorten reporting time; 2. colloidal-gold detection of cryptococcal capsular antigen, used for diagnosing cryptococcal infection and providing clinicians with faster and more accurate reports; and 3. the fungal G test, or 1,3-β-D-glucan test, and GM test, which enable early, rapid diagnosis of invasive fungal pathogens, dynamic monitoring of the course of infection, and evaluation of the effectiveness of antifungal treatment. The department also performs testing for Pneumocystis carinii, group A streptococcal antigen, and pneumococcal antigen. It routinely receives microbiology specimens submitted by medical institutions at all levels in Hohhot and surrounding areas for difficult-to-diagnose cases.

Molecular biology: Three major categories comprising 22 tests are offered, including pathogen gene testing. The department was the first in the autonomous region to introduce drug-metabolism gene testing and gene testing for targeted tumor-drug therapy. Services include EGFR gene mutation testing; KRAS and ALK mutation testing for targeted tumor-drug therapy; CYP2C19; MTHFR (C677T); nucleic-acid testing for group B streptococcus; nucleic-acid testing for rubella and measles viruses; HLA typing; lymphocytotoxicity testing; panel-reactive antibody determination testing; BCR-ABL p210 fusion-gene testing; BCR-ABL p190 fusion-gene testing; PML-RARA fusion-gene testing; gene-mutation testing for myeloproliferative neoplasms; human PIK3CA gene-mutation testing; and human BRAF V600E gene-mutation testing. TB-IGRA can detect smear-negative pulmonary tuberculosis and can help enable timely and accurate detection and improve the detection rate among patients with tuberculosis infection. Pathogen-testing services cover important departments including gynecology, pediatrics, obstetrics, the reproductive center, infectious diseases, respiratory medicine, nephrology, and hematology, providing a reliable basis for diagnosing and treating pathogen infections. Newly introduced instruments, including a sequencer, gradient PCR instrument, and cell-culture instrument, provide technical assurance for research.

Transfusion medicine: Test services include fully automated blood-group identification for the ABO and RhD blood groups, crossmatching, special-antigen testing, red-cell antigen testing, antibody-titer testing, blood-group antibody-titer testing for couples, testing for hemolytic disease of the newborn, irregular-antibody screening, thromboelastography testing, and other tests. Multiple blood products can be supplied to clinical departments, including suspended red blood cells, washed red blood cells, glycerolized and thawed red blood cells of rare blood groups, leukocyte-reduced suspended red blood cells, platelet suspensions, fresh frozen plasma, standard leukocyte-filtered frozen plasma, cryoprecipitate, and other products.

Introduction to medical equipment: In the late 1980s, the Department of Laboratory Medicine introduced Abbott fully automated biochemical analyzers and automated hematology analyzers from the United States. It subsequently introduced various automated analyzers, opening the way for automated clinical laboratory analysis in the autonomous region. It currently possesses more than 100 large analytical instruments, including a Beckman chemistry and immunoassay automation line that is among the most advanced in China, a Roche modular fully automated biochemical analyzer, an Abbott fully automated biochemical and immunoassay analyzer, a fully automated electrophoresis analyzer, a Roche electrochemiluminescence analyzer, an atomic absorption spectrometer, a fully automated blood and urine routine-testing line, a fully automated microbial identification and antimicrobial susceptibility system, a fully automated blood-culture instrument, a fully automated chip-hybridization instrument, a gel-imaging system, a gene sequencer, a gradient PCR instrument, a real-time fluorescence quantitative PCR instrument, a fully automated blood-group identification instrument, a thromboelastography analyzer, and a MALDI-TOF mass spectrometer. It has also purchased low-temperature freezers, cell-culture incubators, an inverted fluorescence microscope, a chromosome analyzer, a low-temperature high-speed centrifuge, and other equipment. The instruments and equipment were purchased from the United States, Germany, France, the Netherlands, Japan, and other countries, and provide first-class analytical and testing capabilities.

Quality management: The department strictly implements the former Ministry of Health’s 2006 Measures for the Administration of Clinical Laboratories of Medical Institutions, as well as the ISO 15189 medical-laboratory quality standards and management elements of the China National Accreditation Service for Conformity Assessment (CNAS). The coverage of internal quality-control items exceeds 90%; items for which no internal quality-control program is available are all compared with the corresponding items at hospitals of the same or a higher level. The coverage of the interlaboratory proficiency-testing programs of the Ministry of Health’s National Center for Clinical Laboratory is greater than the assessment requirements for tertiary grade-A hospitals, and more than 96% of the participating items received a PT score of 100%. The department also participates in the region-wide interlaboratory quality-assessment program of the Inner Mongolia Clinical Laboratory Quality Control Center, and some items participate in the global interlaboratory quality-assessment program of the College of American Pathologists (CAP). The department’s quality policy is ‘accuracy, timeliness, integrity, impartiality, improvement, and enhancement.’ Comprehensive quality management throughout the entire process ensures that laboratory results are timely, accurate, and reliable and provides higher-quality services to clinicians and patients.

Telephone numbers and locations of the department’s specialties: Emergency laboratory: 3451304/1048 — second floor, Outpatient and Inpatient Complex Building. Reception desk: 3451231 — east section, fifth floor, Outpatient and Inpatient Complex Building. Clinical laboratory, hematology: 3451230 — east section, fifth floor, Outpatient and Inpatient Complex Building. Clinical laboratory, body fluids: 3451786 — east section, fifth floor, Outpatient and Inpatient Complex Building. Biochemistry section: 3451232 — east section, fifth floor, Outpatient and Inpatient Complex Building. Immunology section: 3451233 — east section, fifth floor, Outpatient and Inpatient Complex Building. Microbiology section: 3451315 — west section, fifth floor, Outpatient and Inpatient Complex Building. Molecular biology: 3451781 — west section, fifth floor, Outpatient and Inpatient Complex Building. Blood bank: 3451513 — second floor, Surgical Building.