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Pathologist Uses Power of Electron Microscope to Detect Rare Blood Disorders

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LOUISVILLE Jessica Hata, MD, says she feels like a detective. A pathologist for Norton Healthcare in Louisville, Hata breaks the stereotype of a meek and quiet laboratory researcher. In fact, Hata is highly enthusiastic about her job. “Every single case is a puzzle, whether it’s looking at a blood smear or a tumor,” says Hata. “It’s the cerebral aspect of the work, the behind-the-scenes that is appealing to me.”

Hata graduated medical school at Wake Forest, and then completed her residency at Vanderbilt in Nashville, followed by a fellowship at Cincinnati Children’s Hospital. Specializing in pediatric pathology and renal pathology, she was thrilled to return to her native Louisville three years ago to be part of the Norton Healthcare team.

“With Electron Microscopy, I can see inside the cell to the mitochondria and other organelles.”— Jessica Hata, MD.

About the same time Hata returned to the city, Norton Healthcare invested in a new state-of-the-art transmission electron microscope. According to Hata, having an electron microscope in-house allows for a much faster diagnosis because samples do not have to be sent out. In addition, some disorders can only be detected through electron microscopy (EM). “It’s a very specialized part of pathology,” says Hata. “The electron microscope and high-powered camera was very expensive. Not every institution is lucky enough to have one.”

Hata goes on to explain the difference that having this highly sophisticated piece of equipment has made on her ability to diagnose and serve patients. “With a regular light microscope, I look at my slides and manually focus the knobs bending the photons of light to view the slide,” she says. “With EM, we use a high-powered electron beam, controlled digitally, to visualize the cells so I can see inside the cell to the mitochondria and other organelles.”

In-house Testing Saves Time and Money

In the past, Norton’s lab sent some specimens that required EM for diagnosis out to other institutions, such as the Mayo Clinic and Toledo, at a cost. Now, they have the ability to make the diagnosis on site. “There were so many reasons to bring these tests in-house,” says Hata. “We save the patient money, improve the turnaround time for patients and clinicians, and we utilize this microscope that costs so much money. It was a win-win.”

Hata says before the group brought the platelet electron microscopy in-house, they researched to see how many specimens were being sent out. “Now that we’ve brought platelets in-house, the volume has increased by more than fifty percent. It’s awesome that clinicians are ordering platelet EM more now that it’s available in Louisville.”

According to Hata, the specimens the electron microscopy lab recently brought in house are cilia, platelet, and muscle EM, though she hopes to do even more as Norton expands the lab.

“Cilia are little biopsies of the mucosa inside your nose. We are looking for a special disorder called primary cilia dyskinesia,” says Hata. “Usually this is diagnosed in children who are frequently sick and the EM is the gold standard for diagnosis.”

Norton Healthcare’s special coagulation laboratory also offers sophisticated testing of platelets for patients who present with unexplained bleeding such as excessive menstrual bleeding, recurrent nosebleeds, or excessive bleeding after dental work.

“Some disorders can only be detected through electron microscopy. It’s a very specialized part of pathology.”— Jessica Hata, MD

Hata and her partner, Beth Jewell, an electron microscopy technician, embarked on this project together and ventured to Denver Children’s Hospital for specialized training on electron microscopy. The growing team now use EM to assess the number of dense granules in platelets. A lack of dense granules can indicate a disorder called delta storage pool deficiency.

Hata explained how EM may catch something that could have fallen through the cracks. “Usually EM is the end of the line. They’ve tried other tests for Von Willebrand disease or hemophilia, and there is still no explanation while these people bleed, so they send me specimens to look at by EM.”

“We apply the patient’s serum on a specialized grid and can visualize ‘black dots’ (delta granules) in the platelets. You can count them and compare them to normal numbers. But here we go the extra mile. We take a thin section and re-examine. The counts may all look normal, but with the thin section we can see. These delta granules are abnormal and this is why the patient is bleeding.” Hata adds, “There have been some instances where we caught things that would have been missed. In addition, we do platelet EM in cases of suspected child abuse as bleeding disorders need to be ruled out.”

Hata hopes to get news out to clinicians in Kentucky that Norton Healthcare is offering these tests now for cilia, platelets, and muscle. “We want them to consider sending to us versus other places.”

The pathologist said sometimes EM is forgotten. “Most doctors learn about electron microscopy in their first two years of medical school and may not think about it again. They may not be aware that there is this untapped resource here to help them diagnose patients.”