Laboratory Report for 2003

Staff

The Department of Laboratory Medicine provides a 24 hour diagnostic service to the hospital. It is staffed by five Cambodians and an Australian volunteer.

Sarin Eng is the Laboratory Manager who manages the day to day running of the laboratory, stock control, ordering and trouble shooting. Eng has worked at the hospital since its inception.

Hor Putchhat is a Senior Laboratory Techician who has worked at the hospital since its inception.

Sin Reaksmey is a Laboratory Technician who has worked at the hospital for 2 years.

San Socheat is a Laboratory Technician who has worked at the hospital for 1 year.

Bun Sen is the Phlebotomist who provides a wonderful service as some of our paediatric patients are very difficult to bleed. He also takes care of all our blood donors.
He has worked at the hospital for 3 years.

Robyn Devenish a Senior Medical Scientist, from Australia, is the Director of the Laboratory. She has worked for the hospital since January 2001.

Clinical Chemistry

Reaksmey about to perform a chemistry test

Equipment:
Biomeriux Visual spectrophotometer
Medica Easylyte Calcium electrolyte analyser

Future equipment requirements:
Automated chemistry analyser (~ $US30,000)

Number of clinical chemistry tests performed in 2003

Grant

The Laboratory was successful in applying for a grant for a 3 year membership to the American Association for Clinical Chemistry.

Serology

The serology tests performed are all done manually using various techniques.

Future equipment requirements:
Automated immunoassay analyser.

Number of serology tests performed in 2003

Blood Donors

The laboratory collected and screened 798 blood donors in 2003

Number of serology tests performed on blood donors in 2002

Men with Two Halos

The Halo Trust is a British organization which trains and works with Cambodians to eridicate land mines. These men not only risk their lives every day, but are happy to donate blood when our stocks are running short. They are truly “men with two halos”

Blood Transfusion Medicine

Socheat has just finished a crossmatch

The laboratory provides blood products for patients requiring a transfusion. This year we have added cryoprecipitate to our blood products, which means we can now offer
treatment for our haemophilia patients.

Blood products:

Packed red blood cells
Whole blood
Fresh frozen plasma
Cryoprecipitate
Platelets

Number of tests performed in Transfusion Medicine 2003

Haematology

Eng about to analyse a sample on the Sysmex CA50
Donated to us by Dade/Behring Australia

Equipment:
Sysmex KX21 haematology analyser
Sysmex CA50 coagulation analyser.

Number of haematology tests performed in 2003

Microbiology

Putchhat about to do a Gram stain on a blood culture

Number of microbiology tests performed in 2003

Future requirements:
It is planned to eventually have this department fully functional with cultures to identify the bacterial organisms and antibiotic sensitivity testing.

Equipment on order:
Autoclave and safety work cabinet. Funding for these items has been provided by
Dr Caroline Deuger and Rotary International.

Blood Collection

The laboratory has a full time phlebotomist/laboratory assistant who bleeds all our inpatients, out patients and blood donors. The laboratory now has a dedicated room for
blood collection.

Sen getting ready to bleed a patient

Sen is also responsible for malaria counselling to the parents of children who are admitted with malaria. Many do not know that malaria is carried by a mosquito or why they should use a bed net. Those families who do not use a bed net are provided with one free of charge.

Multimedia

We have a digital microscope camera which is used to photograph the many microscopic abnormalities seen in our patients. As Robyn has a post graduate certificate in interactive multimedia technology she has been able to incorporate these images into teaching resources on CD-rom. The potential here is unlimited, with not only use here in Cambodia, but to sell to teaching institutions around the world.
It is also very useful to email photos of difficult cases, such as bone marrow slides,
to obtain another expert opinion from anywhere in the world.

A photograph of Acute Leukaemia taken with the microscope camera

Education

The laboratory staff received a lecture, by Robyn, every week on the laboratory diagnosis of diseases and the theoretical basis of the tests performed.

Laboratory staff from other provincial hospitals also received work experience at AHC, during 2003.

Collaborative Research Study

In April 2003 ethics approval was granted from the National Ethics Committee for Health Research, for a 300 patient research study at the AHC, in collaboration with

Dr Wendy Erber
Centre for Pathology and Medical Research
Perth, Western Australia

and

Prof. Alan Bittles
Edith Cowan University
Perth, Western Australia

“A study to determine the prevalence of inherited haemoglobin abnormalities in patients at the Angkor Hospital for Children”

The study was commenced in June 2003. The study is still in progress, and the data is being analysed. The final results will be presented and published in 2004.

This boy has untreated thalassaemia. It is hoped, from the study, that more can be done for the prevention and diagnosis of these hereditary blood disorders, which are prevalent in the Cambodian population.

Local Collaboration

Doctors Without Borders (MSF)

The laboratory performed tests on blood samples for the MSF Chronic Diseases Clinic
in Siem Reap and Sotnikom.

International Collaboration

Dr Supan Fuchareon
Khon Kaen University
Thailand

Performs PCR/DNA analysis to diagnose ?-thalassaemia mutations in our patients.

Publication:
From the collaboration with Dr Fuchareon an article was published in an international journal “Haematolgica” Volume 88, October 2003

“Interaction of haemoglobin E and several forms of ?-thalassaemia in Cambodian families”

Dr Narazah Yusoff
Universiity of Malaysia
Malaysia

Performs PCR/DNA analysis to diagnose G6PD deficiency in our patients

Ingalill Gumaelios
Kulstard University
Sweden

Brought two trainee Swedish medical technologists to our laboratory for four weeks work experience.

Conference Presentations

“Quality Assurance in the Department of Laboratory Medicine at the Angkor Hospital for Children” by Robyn Devenish and Sarin Eng

National Network of Health Laboratories in the Kingdom of Cambodia, Cambodia

“Laboratory Diagnosis of Dengue at the Angkor Hospital for Children”
by Robyn Devenish

National Workshop on the Classification of Dengue in Cambodia, Cambodia

“Blood Transfusion Medicine in a Developing Country” by Robyn Devenish

Annual Scientific Meeting of the Australian and New Zealand Blood Transfusion Society” Christchurch, New Zealand