The content on our site is reviewed by health professionals (including pathologists and medical scientists) and we partner with organisations such as Lab Tests Online Australia (LTO) to signpost you to additional trusted information about pathology testing.

There’s a lot going on behind the scenes to keep you up to date with what’s happening in the world of pathology, but you may not know that LTO now has an app you can use to get information about your tests whenever you need it.

There is also a video library on the LTO website that includes videos about reference ranges and specific tests such as Pap Smears and HPV testing or Thyroid Function Tests.

At KPKH we are always looking to provide you with interesting stories and informative content. If there’s a subject you’d like us to cover in an article or video, please get in touch using our contact form.

You can also see videos from the KPKH library on our Vimeo channel

The post Confused by pathology test results? There’s an app for that first appeared on Know Pathology Know Healthcare.

The blood test, also called a “liquid biopsy” is being trialled all across Australia and New Zealand at more than 40 hospitals, and is showing promising results.

What the test is able to determine is the risk of a cancer returning post-op, thus helping determine the correct dosage of chemotherapy a patient may need.

Chemotherapy, a common treatment for a number of cancers, is currently used post surgery to remove any “residue” of the cancer that may be left behind.

While some people are completely cancer free after having the tumour surgically removed, others are at risk of a recurrence. Currently patients are assessed using results from pathology testing of the tumour and evaluation of other risk factors.

This means chemotherapy is prescribed for patients who are considered high risk, without knowing whether it’s necessary, to ensure the cancer does not return.

So there are patients who are being administered anti-cancer drugs when they may not need them.

However, this new blood test could be the indicator that ensures that unnecessary chemotherapy treatments are a thing of the past.

What this blood test is able to do is look for fragments of tumour DNA that have spread to the bloodstream, something that was previously unachievable.

Chemotherapy, while effective, comes with a number of side effects such as; fatigue, nausea, hair loss, anaemia and nerve damage.

For any patient, these are side effects they would like to avoid if they are able to.

Dr Graeme Suthers, Director of Genetics at Sonic Healthcare, says that the research “is a great example of advances in pathology technology that promote accuracy and have clear benefit to patients”.

“It’s great that a trial like this is being conducted on a large scale because this is a technology that could be used to help the wider population across a number of different kinds of cancer.”

“When something like this can be accessed by more people, it not only benefits the patient by helping them avoid unnecessary negative side effects but it can save the health sector money by decreasing the number of chemotherapy treatments that are administered.”

“As further clinical uses of this type of testing are identified, we are likely to see more trials like this, that can offer insight into where testing is most appropriate and beneficial for patients, and the health system.”

The liquid biopsy trials began in 2015 for early-stage bowel cancer patients and were later extended to women with ovarian cancer in 2017. The next step in the trial will focus on pancreatic cancer.

More than 400 people are currently participating in the trial, but there is potential for this number to increase to more than 2000. It is expected to run until 2021 for bowel cancer and 2019 for ovarian cancer.

*Image: Bowel Cancer Australia

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Based on data from 2009-2013, the estimated 5 year survival rate for pancreatic cancer is shocking, just 7.7 per cent.

We all know that cancer kills but with other types of cancer, particularly more common cancers, we have a better understanding and more ways to treat the disease. For example the 5 year survival rate for breast cancer is 90 per cent and for prostate cancer is 95 per cent.

So, why is pancreatic cancer difficult to diagnose?

Firstly, as with many cancers, pancreatic cancer may not lead to symptoms in the early stages. Those that may appear are often non-specific such as nausea, a change in bowel habits and loss of appetite. These could be caused by other common conditions, for example indigestion or irritable bowel syndrome so it is difficult for doctors to make a fast cancer diagnosis, and they will need to rule out other, more likely, causes first.

The location of the cancer within the pancreas can also determine how quickly it may be diagnosed. Cancers at the top of the pancreas that cause interference with the bile duct for example, may lead to symptoms quicker than those located at the other end of the pancreas – meaning there is more chance they will be picked up at a more treatable stage.

Pancreatic cancer is diagnosed by first using medical imaging such as ultrasound, CT scans, MRIs to locate the tumour and then confirming the presence of cancer through analysis of a tissue sample in a pathology laboratory. The sample may come from a tumour removed during surgery or via a biopsy.

Because pancreatic cancer is not common and due to the nature of the disease, we don’t have widely available screening tests like those available for other cancers – think mammograms and pap smears.

Why is pancreatic cancer so hard to treat?

As most patients don’t experience symptoms until their cancer is in a late stage, the cancer may have grown large and can also have spread (metastasized) to other organs such as the liver or lymph nodes.

Surgery to remove a tumour is most effective in the early stages of the disease as once the tumour has grown to other areas it can interfere with major blood vessels and other organs making it harder to remove.

An exciting development in testing

A team in California have been working on a blood test that could help to increase early diagnosis and therefore improve outcomes for pancreatic cancer patients.

Researchers from UC San Diego developed a method where a drop of blood is a placed on a small electronic chip, the current is then turned on and after a wait of several minutes, fluorescent labels are added, and the sample is examined under a microscope. If the blood sample tests positive for the pancreatic cancer protein biomarkers glypican-1 and CD63, then bright fluorescent circles will appear.

The research is published in journal ACS Nano, and first author Jean Lewis, an assistant project scientist in the Department of Nanoengineering at UC San Diego said;

“An important step towards being able to cure diseases that come out of nowhere, like pancreatic cancer, is early detection. We envision that in the future, physicians might perform this type of test using a quick finger stick to diagnose patients who may not know they have the disease yet.”

It may be early days, but this is an encouraging first step towards the possibility of an accessible screening test for those at higher risk, which would help to catch pancreatic cancer early.

*Image credit: Pancreapedia https://www.pancreapedia.org/reviews/anatomy-and-histology-of-pancreas

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Dementia refers to a group of neurodegenerative diseases including Alzheimer’s disease, frontotemporal dementia, and vascular dementia. Neurodegeneration is the progressive loss of structure or function of neurons – the building blocks of the nervous system. The most common form of dementia, responsible for 60% – 80% of cases, is Alzheimer’s disease.

Alzheimer’s disease occurs when a protein called beta-amyloid accumulates in the brain.  When this protein reacts with copper and iron, which are found in high levels in the brain, a chemical reaction similar to rusting occurs and this damages brain cells so that they can no longer effectively transmit information.

Diagnosis and the role of research

A 100% accurate diagnosis of Alzheimer’s can only be made after death when brain tissue can be analysed under a microscope by a pathologist. There are tests that can diagnose early and fully-developed Alzheimer’s, including PET scans or a lumbar puncture, when a sample of spinal fluid is taken from a patient and measured for the beta-amyloid protein. But these are expensive and invasive procedures, so usually a diagnosis will be made without them, relying on a full medical and psychological assessment by a doctor.

Despite the increase in deaths we still don’t know enough about Alzheimer’s, and great effort is being taken around the world to research what contributes to the condition, possible preventative measures we could take, and potential new treatments.

For example, several studies have emerged recently about the positive effects of exercise in staving off Alzheimer’s. Ongoing research known as ‘the nun study’ is using the brains of a group of nuns to determine factors that may predict, contribute to, or protect against the development of the disease. This research is unique in having access to a group of people with almost identical lifestyles, diets and sleeping habits, providing near perfect control measures.

However, accurate, non-invasive, early detection of Alzheimer’s remains a vital area of research and Australia is leading the way.

A study published in Nature journal earlier this month by a team of Australian and Japanese researchers looked into a potential new blood test to diagnose the disease.

Although beta-amyloid protein build-up is one of the first signs of Alzheimer’s it only appears in the blood in very small amounts, so testing for it has historically proved difficult. The latest researchers used a process involving mass spectrometry which allowed them to more accurately measure very small fragments of the protein in blood samples. They found that the blood test results correlated well with the traditional methods of lumbar puncture and PET scan.

How does this finding help patients?

Initially the blood test will be most significant in recruiting patients for clinical trials. The ability to test volunteers with a blood test rather than an invasive procedure will make it easier to recruit more people, which is vital in the hunt for treatments.

Many major media outlets have been heralding the test as a new option for screening, but this is still a long way off. Firstly, it needs to be trialled over many years to see if it is accurate as a predictor. And secondly, given there is no cure for Alzheimer’s there is an ethical concern over telling a person they will develop a disease that they can do nothing about.

Laureate Professor Colin Masters of the Florey Institute of Neuroscience and Mental Health, and The University of Melbourne, co-led the research into the blood test. He said;

“Progress in developing new therapeutic strategies for Alzheimer’s disease has been disappointingly slow. New drugs are urgently required, and the only way to do that is to speed up the whole process.

Once you can diagnose the condition accurately and specifically, then it makes it so much easier to work on developing a specific therapy.”

The post Pathology and nuns’ brains; improving outcomes for Alzheimer’s patients first appeared on Know Pathology Know Healthcare.

Within the Rotterdam guidelines, a diagnosis of PCOS can be made when a woman has at least two of the three following features: menstrual dysfunction, polycystic ovaries and hyperandrogenism (high levels of ‘male’ hormones in the blood). Pathology tests support the diagnosis of PCOS by detecting androgen levels in the blood while ultrasonography is used to identify cysts on the ovaries.

PCOS can be a very challenging condition to diagnose as very few women will have the same set of symptoms. 70% of Australian women with the condition remain undiagnosed.

According to Professor Helena Teede, Professor of Women’s Heath at Monash University and Chair of NHMRC PCOS Centre for Excellence, delayed diagnosis is a source of frustration for women affected by PCOS.

In her recent international survey of 1,800 women, it was clear that women with PCOS were distressed by their condition and disappointed with delays in diagnosis. Over a third of women reported 2 years and three health professional reviews before a diagnosis was confirmed.

A simple blood test could provide a quicker, more accurate diagnosis for PCOS with potential to reduce confusion and anxiety for women affected.`

Anti-Mullerian Hormone (AMH) testing measures the level of AMH in a woman’s blood – a good indicator of her egg supply and future reproductive success. While it’s more commonly known for its use in family planning, the test is now being trialed as a marker for PCOS.

Measuring the ovarian reserve through ultrasound is one method of diagnosing PCOS. Ultrasound technology sometimes fails to accurately evaluate ovaries, particularly in adolescent and young women. AMH testing has been shown to offer a more precise diagnosis by assessing AMH levels secreted in excess by ovarian follicles – a common feature of PCOS.

Although the test has performed well in studies, further research is needed before it can become a routine part of diagnosis for PCOS.

AMH testing is one of the topics up for discussion at the AE-PCOS Society conference in San Antonio this November. Chaired by Professor Teede, the purpose of the conference is to consider evidence reviews to develop the first ever international guideline for the assessment and management of PCOS.

Due to be launched in 2018, the guideline will address the challenges of PCOS and inconsistency in care by exploring further opportunities in pathology for improved diagnosis.

[1] https://www.jeanhailes.org.au/health-a-z/pcos/symptoms-causes

[2] https://www.jeanhailes.org.au/health-a-z/pcos/fertility-and-pregnancy

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The bug in question was Burkholderia cepacia, a type of bacteria that is usually found in soil, water or other liquids. It is not commonly found in blood samples sent to pathology labs but in this case, it had been found in patient blood samples. ¹

The patients in question were in the hospital’s intensive care unit (ICU) and were quite unwell. It was suspected that they had contracted an infection in the ICU, which is why the blood samples were sent for bacterial culture.

However, the characteristics of the B. cepacia organism and the fact that both patients were getting better on antibiotics that wouldn’t have usually treated this organism led to a suspicion that the blood samples had somehow been contaminated.

This is a rare occurrence in pathology labs and an investigation swiftly commenced to find the source of contamination, beginning with testing equipment and materials in the laboratory environment.

Dr Maloney returned from leave and was surprised to discover that despite extensive testing the cause had not been found but several more cases of B. cepacia in blood had arisen.

Professor Ramon Shaban is Clinical Chair in the Department of Infection Control at Gold Coast Health and says staff were working hard to find the cause.

“This is an environmental, water-based organism, so it’s unusual to see it as a bacteraemia (bacteria in the blood). We tested IV fluids and non-sterile gels that have been associated with outbreaks around the world, and were working our way through products to find the cause. We also contacted our peers and soon learned that other cases had been identified across Queensland and interstate, which supported our working hypothesis that this was a point source outbreak.”

A point source outbreak is where patients are exposed to a single source of the bacteria in a brief time period and there is no spread from person to person.

The search intensified and widened, and the culprit was quickly identified, Dr Maloney said:

“Ramon and I went to see a doctor who had been treating one of the patients and put in a central line the day before, when a blood sample was also taken. We asked the doctor to show us what equipment he used and where he had got it. We collected all these items including the ultrasound gel and took everything back to the lab to be tested. The next day I was surprised when Brian Gorman, a senior scientist let me know that we had a suspicious organism growing from the ultrasound gel that was labelled ‘sterile’. This was the gel that was used during ultrasound guided cannulation, and the suspicious organism turned out to be Burkholderia cepacia.”

A central line is a catheter inserted into the vein of a patient needing supply of medication or fluids over an extended period. The process is called cannulation and when ultrasound imaging guides the process a gel is used.

The fact that this product, which was supposed to be sterile but was not, was manufactured internationally was a serious concern to the team, who immediately issued a formal alert to other hospitals across the country.

In-depth microbiological testing was able to establish that the patients from GCUH and the other cases were all affected by the same bacteria and that the ultrasound gel was the common cause.

The Gold Coast Health team notified the Australian Therapeutic Goods Administration (TGA). Approximately 1400 kits containing the gel had been distributed to a dozen hospitals across Australia and within 36 hours the TGA had issued a recall for all these kits.

Ultimately, at least 12 patients tested positive for the bacteria but only one person had symptoms that were directly attributed to B. capacia and they have since recovered.

Dr Maloney said; “In cases like these the doctor is sending a blood sample to pathology because their patient is ill and they need to know why. With an unusual organism like this it is less clear if that is what is causing the illness, so you need to use all the pathology results as well as any other investigations that might be relevant such as diagnostic imaging, to build a full picture of what could be causing symptoms to ensure the patient gets the right treatment.”

Prof Shaban noted that the process was challenging with an unusual bug affecting a range of patients:

“The patients had few common clinical characteristics, which made it more difficult to track down the cause of the infection.”

The fast and systematic approach of the team at Gold Coast Health may well have saved lives. Bacteraemia (bacteria in the blood) is a serious condition and can be life-threatening. Had the contaminated gel not been recalled many more patients would have been affected.

Reference

1. Shaban RZ, Maloney S, Gerrard J, Collignon P, Macbeth D, Cruickshank M, Hume A, Jennison AV, Graham RMA, Bergh H, Wilson HL, Derrington P. (2017). Outbreak of healthcare-associated Burkholderia cenocepacia bacteraemia and infection attributed to contaminated ‘sterile’ gel used for central line insertion under ultrasound guidance and other procedures.  American Journal of Infection Control, Accepted 24 June, 2017.

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Pathology tests showed protein in her urine, prompting doctors to urgently perform a kidney biopsy. A kidney biopsy involves taking one or more samples of kidney which are sent to a pathology lab to be analysed under special microscopes. Renal diseases can affect various components of the kidney and therefore samples need to be stained with multiple stains to assess various components of kidney tissue. Kidney biopsies are highly technical and very labour intensive, requiring a high level of expertise to obtain a rare diagnosis.

The anatomical pathologist diagnosed Linda with a rare form of nephrotic syndrome. She was told her options were transplant, dialysis or death.

“When doctors told me the news, it was a very hard pill to swallow but I knew I had to accept it. My inner-strength helped me to keep going”, said the mother of two.

Nephrotic Syndrome (NS) is a collection of symptoms that indicate kidney damage. It is characterised by excess proteins in the urine, exceptionally low levels of albumin in the blood and swelling caused by fluid trapped in the body’s tissues.

Despite the doctor’s prognosis, Linda managed to continue living normally for seven years. During that period, her kidney function decreased steadily until eventually doctors needed to intervene – it was time to begin the search for an organ donor.

Little did Linda know but her mother was preparing herself to become an organ donor.  At 62, Sylvana Crkovski knew she would need to be in good health for the operation so she revamped her diet and fitness regime and succeeded in losing 10kg. Linda’s nephrologist noticed the change and agreed to test if she was a match.

Compatibility testing for organ donors begins with a blood test to examine their blood type and determine if it will match the recipient’s blood. If their blood type is compatible with the recipient, they’ll receive further blood tests such as tissue typing and cross-matching to see if the recipient will react to their kidney. If there is no reaction, the transplant surgery can take place.

Sylvana underwent six months of health assessments, involving DNA and blood tests. Finally, pathology results gave Linda’s family the news they were hoping for: Sylvana was a perfect match.

On the day of their surgery at Royal Melbourne Hospital, Linda and her mother held each other’s hands as they were wheeled into the operating theatre. Linda will never forget the words her mother said to the surgeon just before the operation: “If the first kidney doesn’t work, take the other kidney”. Sylvana was willing to sacrifice both kidneys and endure dialysis if it meant saving her daughter’s life. The procedures went well and mother and daughter were released after five days.

Linda will need to take medication and undergo regular testing for the rest of her life but since the operation, she has vowed to live life to the fullest.

This July Linda competed in the Transplant World Games in Spain, where she won a gold medal in paddle tennis. When she’s not smashing it on the tennis court, Linda’s busy volunteering as a Fit for Life ambassador which sees her visiting patients in dialysis wards.

With the arrival of  Donate Life Week on the 31^st July, Linda wants to encourage more people to donate their organs. “I urge every Australian to make their donation decision count by heading to donatelife.gov.au and registering their donation decision.”

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After pathology tests showed liver inflammation, low platelet count and a large amount of protein in her blood, it was clear to doctors that Kate had HELLP syndrome –  without a moment’s delay she was transferred by ambulance to the Women’s and Children’s Hospital in Adelaide.

HELLP syndrome is a life-threatening pregnancy complication usually considered to be a more serious variation of pre-eclampsia. It normally occurs in the later stages of pregnancy, and sometimes after birth.

HELLP syndrome is named after its characteristics:

H (haemolysis, which is the breaking down of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count)

Platelets are needed for effective clotting of the blood and red blood cells carry oxygen and nutrients to the organs including the brain.

HELLP syndrome places mother and baby at risk. The flow of nutrients to the baby in utero can be affected, meaning the baby’s growth can be delayed. The mother is also at risk of organ damage, liver rupture and stroke.

Most often, the definitive treatment for women with HELLP Syndrome is the delivery of their baby however this was not possible for Kate due to the low platelet count of her blood, preventing it from clotting during birth. The only solution was to monitor her blood for 24 hours which required pathology testing every hour. Thanks to the speedy work of the hospital’s pathology team, her results were ready within 30 minutes.

At one point, Kate’s complications took a turn for the worse; not only was her liver failing but her kidneys were shutting down which led doctors to consider a blood transfusion. Much to everyone’s relief, Kate’s blood platelets eventually returned to a safer level and she was rushed into theatre for an emergency C-section to deliver her son, Theo.

“As soon as Theo was born my condition began to improve. I was admitted to the high-dependency unit while Theo was being monitored in the NICU. Luckily, his signs were good and doctors were confident he was going to make it – and so was I.”

Two years later, Kate was pregnant with her second child. She knew she had a 50/50 chance of developing HELLP syndrome again. At 24 weeks, doctors were performing blood tests every two days. After one of her tests revealed HELLP syndrome, Kate was admitted to hospital within half an hour. A combination of close monitoring, corticosteroids and further tests ensured a safe delivery for Kate’s daughter Tessa. Like her brother, Tessa weighed less than 600 grams, and after 6 months in the NICU, Kate was able to bring her home to meet the family.

Today, Kate enjoys a happy life with her Partner Simon and their three children in Mount Barker, SA. She looks back on her time in hospital with a mixture of awe and gratitude: “I will always be grateful to the amazing pathology teams at the Women’s and Children’s Hospital in Adelaide who saved mine and both my babies’ lives. With my bloods taken hourly in the lead up to both deliveries, pathology was one of the most important factors in the birthing process.”

HELLP syndrome, symptoms and diagnosis

 HELLP syndrome may be associated with other signs of pre-eclampsia, such as high blood pressure, protein in the urine and swelling of the hands, feet or face. However, this is not always the case, and this may make diagnosis more difficult. Women with HELLP syndrome often complain of a pain in the upper abdomen below the ribs, which is indicative of a tender liver. There may also be heartburn, vomiting and headache. The upper abdominal pain of HELLP syndrome can be very severe, and is not relieved by simple remedies such as antacids, which would be the case if heartburn, for example, was the cause of the pain.

The diagnosis of HELLP syndrome can be made by blood tests which examine liver enzymes, red blood cells and platelets. As with typical pre-eclampsia, delivery is required to cure HELLP syndrome, irrespective of the stage of the pregnancy and maturity of the baby.

HELLP syndrome can be associated with a bleeding tendency secondary to a deficiency of platelets, so it may be necessary to administer platelet transfusions. This can be particularly important before undertaking any surgery, such as a Caesarean section.

While this is a very dangerous condition, with early detection via pathology testing and quick treatment, the outcome can be fine for mother and baby.

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• Trimester 1
  • At 6-8 weeks’ pregnancy
  • After 10 weeks’ pregnancy
• Trimester 2
  • Between 15 and 17 weeks of pregnancy
• Trimester 3: Between 24 – 28 weeks
• Other tests

During pregnancy, it is common for women to experience a range of emotions and expectant mothers may feel overwhelmed by the many areas of antenatal care recommended.

Some aspects of your antenatal care involve medical tests to monitor the health of you and your baby. The following guide outlines the different tests available throughout each trimester, and the purpose of each test. Of course, every test is optional.

Trimester 1

At 6-8 weeks’ pregnancy

When you first visit your GP to confirm your pregnancy, you will be offered several blood tests. A full blood examination (FBE) will check for possible iron deficiency and thalassaemia risk. A ferritin level may be included and is more sensitive than the full blood alone to determine reduced iron stores, to make sure you’re not at risk of anaemia, which can make you tired and weak. A blood group test will determine not just the ABO group but more importantly identify individuals with a Rhesus negative blood type who should be offered therapy during pregnancy to prevent haemolytic disease of the fetus and new-born, which can lead to pregnancy loss and new-born jaundice.

You’ll also be screened for infectious disease exposure or immunity including HIV, and Hepatitis B and C which can put babies at risk of future liver disease if not treated. Testing for antibodies to rubella and chicken pox is conducted as exposure to these viruses during pregnancy can cause birth defects if you’re not immune. You can also talk to your doctor about whether testing for chlamydia, syphilis, thyroid disease and vitamin D is necessary.

After 10 weeks’ pregnancy

You will be offered the nuchal translucency test between the 10th and 14th week of the pregnancy to determine the chance of the baby being affected by certain chromosomal abnormalities such as Down syndrome, Edwards syndrome or Patau syndrome.

This combines information obtained by an ultrasound and blood tests.  The ultrasound is performed predominantly to assess nuchal translucency, the thickness of the fold at the back of the baby’s neck. Together with the maternal age, weight, gestation and blood test results, the chance of a baby affected by these abnormalities is determined. The test cannot accurately diagnose a fetus with a chromosomal condition.

Additional blood tests are also available for expectant parents with close blood relatives who carry other genetic disorders.

Trimester 2

Between 15 and 17 weeks of pregnancy

Multiple Marker Screening or Maternal Serum Screening involves a blood test that looks for Down syndrome, Edwards syndrome and neural tube defects such as spina bifida and anencephaly, in which the skull does not form properly. The screen looks for four chemicals in the blood: alpha-feto protein, unconjugated estriol, free beta hCG and dimeric inhibin A.

These results are combined with the results from the nuchal translucency test as well as other information about the pregnancy to assess the risk of a fetus having abnormalities. All tests have limitations and may not be diagnostic alone.

The full blood examination is usually repeated towards the end of the second trimester, looking for the development of iron deficiency anaemia, which is extremely high in pregnancy, as well as to check the platelet count which may sometimes fall as a result of pregnancy complications.

Non-invasive prenatal testing

Non-invasive prenatal testing (NIPT) can offer better accuracy in detecting chromosomal abnormalities. This is a blood test that tests fetal DNA released into the mother’s blood. Testing is recommended between 11 and 16 weeks and may be carried out after a woman has had the nuchal translucency test or following the results of other blood tests.

Tests such as amniocentesis or chorionic villus sampling (CVS) are also available. These are more invasive tests; amniocentesis tests fetal cells in the amniotic fluid and CVS tests cells taken directly from the placenta. Because of their invasive nature these tests carry a risk of miscarriage making NIPT a safer option.

Trimester 3: Between 24 – 28 weeks

Between three and eight percent of women will get gestational diabetes between the 24th and the 28th week of pregnancy, sometimes earlier. It usually goes away after the baby is born. A blood glucose tolerance test screens for gestational diabetes. The test uses three blood samples: the first sample is taken before a standardised glucose drink is consumed, the second sample one hour after and the third sample two hours after the glucose load. A pathology laboratory compares results from all samples to see if they indicate gestational diabetes. The condition can be managed with healthy eating, physical activity, monitoring your blood glucose levels and sometimes medication.

Rhesus negative women will also have their antibody status checked prior to receiving their first dose of anti-D at 28 weeks.

Other tests

Pregnant women may also be tested for Group B Streptococci (GBS) bacteria via a vaginal or anorectal swab at 35-37 weeks. These bacteria occur naturally in some women and are usually not harmful, however if passed on to a newborn in the birth canal, the baby can become very ill. Pregnant women carrying these bacteria can be offered antibiotic treatment during labour as a measure to help protect a baby from becoming infected.

Finally, women may also be offered pathology tests if they fall ill while pregnant or if they are in a high-risk group – particularly during the early stages of pregnancy. Certain conditions can affect the unborn baby such as cytomegalovirus (CMV), toxoplasmosis and herpes simplex virus (HSV) and pathology can diagnose these conditions so that steps can be taken to protect mother and baby.

References:

https://www.vcgs.org.au/tests/maternal-serum-screening

https://www.thewomens.org.au/health-information/pregnancy-and-birth/pregnancy-problems/pregnancy-problems-in-later-pregnancy/gestational-diabetes/

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Check if you need to fast for your test (but don’t skimp on the water)

This was by far the most common answer we heard from collectors. Some tests require that the patients fast for 8 hours before the test to ensure an accurate result. Indulging in a morning coffee is sadly not the same as fasting!

That said, it seems lots of patients aren’t exactly sure what they can have whilst fasting. In most cases, plain water is just fine. Drinking water as you normally do ensures you are hydrated, which makes the entire experience more pleasant for you. So drink up and treat yourself to that latte after the collection.

Different veins call for different collection tools

Collectors use a variety of collection systems including winged infusion sets or ‘butterflies’, vacutainers and syringes. They are trained to assess a person’s veins and select the appropriate system.

Which system they select depends on the number of tubes required, the types of tests requested or the state of your veins on that particular day. Veins can change depending on general health and hydration, so the collection system selected may vary between visits.

Each system has strengths. For instance, butterflies are a great choice when a lot of tubes must be taken. Syringes allow the collector to apply very gentle suction for people with extremely delicate veins. Ultimately, the vacutainer system is the safest for patients and collectors as the blood is contained in a closed system and it has the lowest risk of needlestick injuries.

We take more than blood samples

Pathology tests are performed on all forms of body tissue and bodily fluids so it’s worth checking with your doctor what’s involved in your tests ahead of time. Urinalysis is one of the most commonly requested tests and other collections can include sputum (phlegm) to test for infections in the lungs or breathing passages or stool samples to test for conditions affecting the digestive tract.

We know it’s daunting

As one collector put it, “A brave person tells us they need to lie down.” If you’re prone to fainting or dizziness, there’s absolutely no shame in letting your collector know. In fact, they’d much rather know in advance so they can accommodate you and make your experience as comfortable as possible.

Your phlebotomist is a trained health professional and they will have seen it all before – so there’s no need to feel nervous or embarrassed.

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