Pathology & Laboratory Medicine
Emory University School of Medicine
Emory University Hospital
1364 Clifton Road, NE
Atlanta, GA 30322, USA
The Division of Laboratory Medicine within the Department of Pathology
and Laboratory Medicine provides diagnostic laboratory testing services for
Emory University Hospital, Emory University Hospital Midtown, Wesley Woods
Hospital, Winship Cancer Institute and all locations of the Emory Clinic.
The division also provides professional oversight for the operations of
the Emory Medical Laboratory, which serves as a fully certified reference
laboratory and provides specialized, esoteric testing and consultative
expertise to hundreds of local, regional, national and international clients.
Overall, the Emory Medical Laboratory performs nearly 3.5 million tests
per year and employs over 400 laboratory professionals.
The Division of Laboratory Medicine is comprised of over 25 faculty members who actively participate in the clinical, research and education missions of Emory Healthcare. Faculty members oversee a broad range of clinical testing sections that include Core Labs, Transfusion Medicine and Hemapheresis, Flow Cytometry, Hematopathology, Molecular Diagnostics, Special Chemistry, Special Coagulation, HLA, Immunology, Microbiology and Oncology Cytogenetics. Accredited residency training is available in Clinical Pathology (CP), Anatomic Pathology (AP) and AP/CP with fellowship training available in Transfusion Medicine, Hematopathology, Medical Microbiology, Molecular Genetic Pathology, and Clinical Chemistry.
HIV Research - I have been working with HIV in Africa since the first recognition of the epidemic on that continent in 1985. My initial work was focused on the epidemiology, natural history, and manifestations of HIV infection in African men and women. Building on previous work, this grew to include collaborative studies of the virologic, immunologic, and immunogenetic correlates of transmission from men to women and women to men. In addition to the observational studies, I have also worked on development and testing of HIV prevention strategies including behavioral (couples; HIV testing, combined prevention of HIV and unplanned pregnancy) and biomedical interventions (HIV vaccine candidates, vaginal microbicides, acyclovir). Recently, I have added a translational aspect to the work, with an emphasis on implementation of evidence-based prevention programs in the public health sector.
My clinical service work is primarily focused on diagnostic hematopathology at Emory University Hospital, which includes signout of bone marrow, blood, spleen, lymph node, and extranodal hematopoietic specimens, as well as signout of flow cytometry and routine cytogenetic studies. I also provide consultative hematopathology services for external client pathologists. My clinical interests are in benign lymphoproliferative disorders such as HIV lymphadenitis, Castleman disease, and IgG4-related disease. Review of hematopathology/flow cytometry case material is performed concurrently with teaching of hematopathology fellows and residents rotating through the hematopathology service. In addition, I instruct Emory medical students and students in the Emory Medical Technology program.
- My research interests are primarily focused on pathology education and improving communication in the fields of hematopathology and surgical pathology, with an emphasis on improved cancer reporting. Other research activities include investigations into the diagnosis and pathogenesis of IgG4-related disease, and applications of ancillary studies, particularly immunophenotyping, in the diagnosis of benign and neoplastic lymphoproliferative disorders.
HLA and Transplantation
I co-direct, along with Dr. Howard Gebel, the busy HLA laboratory at Emory University Hospital, which provides histocompatibility testing to support transplantation services at Emory Healthcare and beyond.
Overview - - The thrust of my research has been almost exclusively applied. Since my training and clinical responsibilities encompass two quite distinct entities, my research has also moved in several directions. However, an underlying theme has been the application of "State-of-the-Art" technology, specifically Flow Cytometry, to advances in diagnostic testing. In the area of transplantation, my projects have focused on the flow cytometric crossmatch and flow cytometric detection of alloantibody in patients awaiting transplantation. Our research efforts have essentially helped "set the standard of practice" for flow cytometric crossmatching and antibody identification in the United States. Additionally, we were one of the first laboratories to pioneer the area of microbead technology and its applications in clinical histocompatibility testing. Work that has been published from this laboratory has not only changed laboratory practice, but has been the foundation for changes in government (CLIA) and society (ASHI and UNOS) standards which regulate histocompatibility testing laboratories. In the area of clinical diagnostic flow cytometry, we have focused on cutting-edge applied projects. Our work has been primarily aimed at the utility of cytometry in the detection and classification of hematopoietic disease. To this end, our laboratory has been one of the leaders in flow cytometric analysis, an interpretation of leukemia/ lymphoma immunophenotyping. Of special interest have Read more...
As director of the clinical microbiology laboratory, my clinical focus primarily involves overseeing testing of specimens related to the diagnosis and treatment of infectious diseases. In addition to routine bacteriology, the Microbiology Laboratory covers a wide range of disciplines inlcuding mycology, parasitology, virology and mycobacteriology. I am also responsible for overseeing the infectious disease serology testing done in the Immunology Laboratory and am involved in diagnostic testing using molecular assays. I interface with the Infectious Disease faculty and Pharmacy staff and have an active role in Infection Control and Antibiotic Subcommittee.
- My research interests generally focus on the evaluation of new tests and instrument platforms for the diagnosis and treatment of infectious diseases. Most of my current interest concerns bacterial resistance mechanisms, which have become increasingly complex and are sometimes difficult to detect in the clinical laboratory.
Hemostasis and Coagulation
Thrombophilia and Congenital & Acquired
Hemostasis- Complications of Pregnancy & Reproduction
Hemostasis - Complications of Pregnancy & Reproduction Dr. Duncan and his staff have identified several profiles that identify patients at higher risk for problems and in particular have recognized that a particular analyte Lipoprotein (a) has a much higher frequency in this population and may be an important predictor of future pregnancy problems. As a result of this work on infertility patients he has devised a protocol now used by all major IVF groups in Atlanta in which LMW heparin is started prior to embryo transfer and this has apparently improved the pregnancy success rate. He believes the whole infertility and early pregnancy failure area offers significant opportunity for further study on the involvement of the hemostasis system in diagnosis and monitoring of these patients in the first trimester.
Thrombophilia - Congenital & Acquired
Dr. Ross Fasano is an Assistant Professor of Pathology and Laboratory Medicine and Pediatric Hematology/Oncology at Emory University School of Medicine. He also has an adjunct appointment in Adult Hematology and provides comprehensive care to adult patients with sickle cell disease at Grady Memorial Hospital. His clinical expertise is in pediatric transfusion and hematology, with an emphasis on chronic transfusion therapy for children and adults with sickle cell disease. He is trained in Pediatrics, Pediatric Hematology/Oncology, and Blood Banking/Transfusion Medicine. He is the Assistant Director of the transfusion service and Director of Apheresis at Children's Healthcare of Atlanta. During his training and subsequent practice of medicine, he has had extensive clinical experience in managing heavily alloimmunized and iron overloaded patients with sickle cell disease.
Red blood cell alloimmunization - Dr. Fasano and his group are interested in understanding the immunologic mechanisms involved in RBC alloimmunization in patients with sickle cell disease (SCD). In collaboration with other investigators, Dr. Fasano has demonstrated a direct role of recipient inflammation on alloimmunization, and continues to investigate immunologic mechanisms involved in alloimmunization. Conceived from murine model data illustrating that transfusion in the presence of pro-inflammatory signals results in higher rates and magnitude of alloimmunization, his group published a large retrospective study in a large human SCD cohort demonstrating that that recipient pro-inflammatory state, most notably acute chest syndrome (ACS) at the time of transfusion, directly impacts RBC alloimmunization. In collaboration with other investigators at Emory, he is currently conducting two follow up translational research studies evaluating immunologic mechanisms involved in RBC alloimmunization overall, and specifically why the frequency is highest during SCD patients during ACS.
HLA and Transplantation
Dr. Robert Bray and I co-direct the HLA laboratory that provides histocompatibility testing for transplantation. My clinical focus revolves around increasing allocation of deceased donor kidneys to highly sensitized patients awaiting renal transplantation. My approach is to accurately identify and define HLA antibodies in such patients.
Transplantation Immunology - My main interest focuses on the clinical implications of donor specific HLA antibodies in renal transplant recipients.
Infectious Disease Pathology
Helicobacter pylori infections in children and adults. - When I was working at the National Cancer Institute in Mexico, I started studying the acute and chronic effects of Helicobacter pylori infection in adults. Together with Stanford University and a group in Chiapas State in Mexico, we did a case control trial to see if eradiaction of H. pylori decreased the amount of preneoplastic lesions. My interest has expanded to the study of this infection in children and I am currently involved in several projects in this population.
Emerging and Re-emerging infections - Upon arriving at the Centers for Disease Control and Prevention (CDC), I was integrally involved in high-prorfile outbreak investigations of emerging and re-emerging infectious diseases. The CDC pathology team has developed a variety of immunohistochemical and molecular assays to detect these patholgens. Detection of microbial antigens by immunohsitochemical methos in tissues has to be correlated with other laboratory tests. The combination of tissue and laboratory diagnosis of infectious agents is of vital importance to detect these emerging and re-emerging infections so that public health authorities place control and prevention measures.
I am engaged in development of clinical pharmacogenetic testing and molecular tumor diagnostics, as well as overseeing day-to-day operations of the molecular diagnostics laboratory. I am also involved in the clinical interpretation of protein electrophoresis and autoimmunity testing.
- I am participating in a variety of research projects centered on translating basic science research into clinical practice. We have been investigating the role of virally encoded oncogenes in aggressive behavior of laryngeal papillomatosis, the clinical utility and implementation of pharmacogenetics, and the development of tests for diagnosis or prognosis in a variety of malignanacies.
- Development of new clinical molecular diagnostic tests. Clinical application of pharmacognetics.
I serve as an attending physician on the Hematopathology service at Emory University Hospital and as a consultant at Children's Healthcare of Atlanta. My clinical focus encompasses use of morphologic analysis, flow cytometric immunophenotyping, molecular diagnostic and fluorescence in situ hybridization/cytogenetics studies that are relevant to the subspecialty of hematopathology.
Inflammation/ Hematopathology - I have 2 areas of ongoing investigation. One focus is a C-type lectin-family receptor (CD303) expressed uniquely on the surface of human plasmacytoid dendritic cells. Data suggest that this receptor impacts function of these cells in innate and adaptive immunity. We have developed unique biochemical tools to better understand the structure and function of CD303 including identification of natural binding targets whether of self or non-self origin. Specific efforts focus on identifying the specific counter-receptors on these targets and better characterizing the impact of receptor-ligand engagement. A second focus involves deciphering the role of the Bcl-6 interacting transcriptional co-repressor MTA3 and BCL6 in B cell lymphomas, work done in collaboration with Dr. P. Wade at NIEHS, and translating this knowledge into diagnostically useful tools.
Pediatric Transfusion Medicine
I am the Medical Director of the Blood, Tissue, and Apheresis Service at Children's Healthcare of Atlanta. I am also a Pediatric Hematologist/Oncologist who specializes in treating patients with hemostasis or thrombosis conditions.
Pediatric Transfusion Medicine, hemostasis, and hematology, oncology - My research focus is in transfusion medicine issues as they relate to pediatric hematology and hemostasis, specifically, with regard to sickle cell anemia, hemophilia, neonatology, and open heart surgery.
I serve as Director of Clinical Chemistry, Toxicology, and Point-of-Care Testing at Grady Memorial Hospital. My particular interests include the cost-effective utilization of laboratory medicine for patients with diabetes, cardiovascular problems, and toxicology applications, as well as the reduction of non-analytical sources of error. I am currently Secretary of the National Academy of Clinical Biochemistry.
Research Overview -
I engage in the following research activities:
1. The proper approach to and science behind the evaluation of clinical laboratory methods.
2. Investigation of novel biomarkers for diagnosis and monitoring of disease.
3. Method development and evaluation of clinical laboratory technology for new applications, and for diagnostic reagent and instrument companies.
I am the Medical Director of the Microbiology Laboratory, and the Program Director of the Medical Microbiology fellowship. I am a clinically trained adult Infectious Diseases physician, and see patients at Wesley Woods Geriatric Hospital and inpatients at Emory University Hospital.
Human Rhinovirus detection and phylogeny - With the severe respiratory season seen in 2009-2010, I became interested in adult patients with rhinovirus infection. I am currently sequencing these isolates and in collaboration with CDC and LANL, to determine potential biologic correlates of severe rhinoviral infections.
HIV-1 Superinfection - Under the mentorship of Eric Hunter, we have identified individuals in Susan Allen's cohort who have HIV-1 superinfection. We are currently looking at the impact of antibody neutralization in these patients that do not prevent superinfection.
Fecal transplant - Clinical and research applications
Genome sequencing of Staphylococcus aureus -
Hematopathology - morphology, flow cytometry and molecular diagnostics
Fluorescence in situ hybridization for hematolymphoid and solid organ tissue malignancies
Hematolymphoid malignancies - Using modern technology such as flow cytometry, fluorescent in situ hybridization, laser-captured microdissection and cDNA microarray, I am especially interested in (1) investigation of the underlying molecular mechanisms of leukemo/lymphomagenesis; (2) identification of new marker(s) to aid in diagnosis and in predicting the clinical outcome of malignant hematopoietic disorders; (3) development of new diagnostic tests in the field of hematopathology.
My clinical focus is in the area of neoplastic and non-neoplastic hematopathology of adults and children with an emphasis on a multifaceted approach including morphology, immunohistochemistry, flow cytometric immunophenotyping, fluorescence in situ hybridization, cytogenetics, and molecular testing. This approach is used to diagnosis the full range of hematopoietic malignancies and to evaluate for residual or recurrent disease following treatment. As Director of Molecular Hematopathology, I additionally have a leading role in supervising the development and evaluation of new molecular hematopathology tests in order to maintain a state-of-the-art diagnostic hematopathology laboratory.
Overview - - My research interests focus on the development of new molecular diagnostic tests and flow cytometric targets which can aid in the diagnosis, subclassification, determination of prognosis, and treatment monitoring in patients with hematopoietic neoplasms. In addition, I am interested in evaluation of the usefulness of newly identified mutations both as diagnostic targets as well as possible targets of directed therapies. I am also interested in the monitoring and significance of minimal residual disease in different hematopoietic disorders.
- My research laboratory is engaged in determing whether the regulation of extracellular peptidase activity plays a significant role in neuropeptide action. In another project, we are focusing on the pharmacokinetics/pharmacodynamics of antidepressants and anti-seizure medications during pregnancy. Finally I am actively pursuing investigations into the use of proteomics as a clinical diagnostic tool.
Improving the safety and efficacy of blood transfusion and hematopoietic stem cell transplantation. Current positions: Professor (tenured) in the Department of Pathology and Laboratory Medicine, Director of the Emory Center for Transfusion and Cellular Therapies, Director of the Emory University Hospital Blood Bank, and Director of the Stem Cell Processing Laboratory at Emory University Hospital, Vice-Chair of Clinical Pathology, and Medical Director of Emory Medical Laboratories. National leadership positions: Co-Chairman of the NIH/NHLBI Global Blood Safety and Availability Strategic Planning Committee, Chairman of the AABB Clinical Transfusion Medicine Committee, and Editor of the AABB Technical Manual.
Overview - I) Metabolomic phenotyping of RBC units during prestorage transfusion to support the development and validation of metabolic biomarkers, RBC storage limits, and optimized storage approaches that can be used to improve transfusion efficacy. II) Identification of vascular effects of stored RBCs in vitro and in vivo to better understand potential adverse consequences of transfusions on recipient outcomes. III) Dissection of mechanisms underlying antibody responses to transfused RBCs in order to develop approaches to prevent and/or manage RBC allo-immunization. IV) Approaches to prevent transfusion-transmitted CMV infections. And, V) other work in transfusion including development and validation of novel blood typing instruments and development of transfusion clinical practice guidelines
I am the Director of the Oncology Cytogenetics laboratory. My particular interest is studying the cytogenetics and Fluorescence in situ Hybridization (FISH) abnormalities in hematopathology and soft tissue malignancies.
I am in charge of the Clinical Microbiology, Immunology and Molecular Diagnostics Laboratory at Grady Memorial Hospital, the largest public hospital in the Southeast. I am responsible for rapid and cost effective laboratory diagnosis of infectious diseases, particularly in HIV, tuberculosis, and sexually transmitted disease.
Diagnostic and molecular microbiology - I am interested in and actively involved in rapid laboratory diagnosis of infectious diseases including tuberculosis, sexually transmitted disease, and HIV, by using molecular and immunologic methods. I am interested in antimicrobial susceptibility testing and resistance surveillance study. I am the editorial board member for the Journal of Clinical Microbiology, and the Emory Medical Care Foundation (EMCF) Research Committee member.
My clinical roles are generally as a clinical pathologist at the Atlanta VAMC as an assistant director of all clinical laboratories, including flow cytometry, blood bank, hematology, microbiology, chemistry, and immunology. The bulk of my signout assignments involve the fields of hematopathology, flow cytometry, and protein electrophoresis.
- I am interested in investigating flow cytometry as a means of assessing global platelet activation status. In addition, I also plan to investigate the utility of novel assays potentially applying flow cytometric techniques to the field of coagulation.
The Clinical Immunology Laboratory at Emory University Hospital performs a variety of immunology tests including protein electrophoresis and immunofixation, immunoglobulin and serum protein quantitation by nephelometry, cryoglobulin testing, miscellaneous protein testing, autoantibody detection, infectious disease serology testing, and measurement of a variety of analytes on automated immunoassay platforms. The laboratory also plays a major role in serological testing of samples from tissue and organ donors. A medical technician from the laboratory is on call at all times to perform stat infectious disease serology testing on samples from organ donors prior to transplantation. The immunology laboratory also supports specific types of surgery that require intraoperative immunoassays down with a short turn around time (most commonly this is testing for parathyroid hormone or PTH in patients with hyperparathyroidism).
In addition to my administrative role in the laboratory, I also do the physician interpretations of protein electrophoresis and immunofixation testing. Interpretation of protein electrophoresis and immunofixation tests as well as some autoantibody testing (primarily anti-neutrophil cytoplasmic antibody or ANCA testing) is done with the assistance of CP residents who rotate for one month on the clinical immunology service. Drs. Charlie Hill and Alexis Carter also take turns signing out these cases that need physician interpretations. Serum protein electrophoresis and immunofixation are performed to detect the presence of monoclonal immunoglobulin spec Read more...
Mucosal Immunology; Chemokine Receptors; Lymphoid Organogenesis - The major areas my laboratory studies are: (1) the role of chemokines and chemokine receptors including CCR6, CCR9, and CCR10 in mucosal immunity; and (2) the cellular interactions, cytokines, and chemokines involved in initiating the development of the lymphoid aggregates present in the small intestine including cryptopatches and isolated lymphoid follicles.
Molecular Genetic Pathology
I serve as an attending physician on the Hematopathology and Molecular Diagnostic Laboratory service at Emory University Hospital. My clinical focus includes diagnostic hematopathology integrating morphologic examination, flow cytometric immunophenotyping, cytogenetics, FISH, and microarray studies; and molecular diagnosis of solid tumors.
Genetic profiling of hematologic malignancies and solid tumors - It is now widely accepted that cancer is a genetic disorder. Whole genome profiling of human cancer, as well as genetic analysis by re-sequencing panels of genes associated with specific malignancies have not only become a major research tool of discovering new genetic abnormalities associated with individual disease and patient, but also been gradually adapted as routine diagnostic tests in clinical molecular laboratories. Hematopathology has been traditionally, and continued to be the leading field in novel research and discovery of clinically significant genetic abnormalities. I am interested in the genetic profiling of hematologic malignancies including myeloid neoplasms, lymphomas, multiple myeloma, and solid tumors, especially lung cancer and melanoma, using high resolution microarray, RNA-seq, and panel gene sequencing, aiming at bringing these into clinical laboratory as routine diagnostic tests.