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Criminal Poisoning of Children and Munchausen's by Proxy

Dr. Alphonse Poklis, Director of Toxicology, Virginia Commonwealth University Medical Center, presented Criminal Poisoning of Children and Munchausen's by Proxy, at the Pathology Club meeting, March 24, 2005.

Dr. Poklis, was introduced by Dr. Regina Burton.

Medical students at VCU Medical Center have a great opportunity to take advantage of opportunities to learn pathology by reviewing their patients' history with a pathologist or pathology resident; by shadowing a pathologist or pathology Resident; and by taking pathology electives or participating in pathology research. For more information and to shadow a pathologist or work in pathology research, please call the Department of Pathology at (804) 828-9746 and ask to speak with Dr. Sanford or email Dr. Sanford at ksanford@vcu.edu.

The Department of Pathology at VCUHS is composed of two major divisions: anatomic and clinical pathology. Anatomic pathology is made up of the cytopathology laboratory, the surgical pathology laboratory, and the autopsy room. Clinical pathology incorporates all other clinical testing laboratories--chemistry and toxicology, coagulation and hemostasis, microbiology and immunology, molecular diagnostics and the cytogenetics laboratories. It includes forensic pathology and transfusion medicine which houses the blood bank.

Pathologists' special training prepares them for many different roles and responsibilities in service to their patients and other medical professionals. One of those professionals is the laboratory technician. In surgical pathology at VCUHS, the day begins at the grossing station with biopsied tissue that is cut into cassettes. Inking is carefully applied to determine the surgical margins of lesions. A histotechnologist prepares histologic sections going through several detailed steps. Often, pathologists perform immunohistochemical staining to help determine a diagnosis. These special stains provide vital information about the diseased tissues.

Surgical pathologists also consult with surgeons. It's the pathologist's job to determine whether further surgery is needed. Because the patient is waiting, a quick decision is vital and usually made within 15 minutes. Surgical pathology collection materials and techniques include frozen sections, touch preps, gross examinations, and fine needle aspiration. When an organ needs evaluation before transplantation, it's the pathologist's job to evaluate and recommend the next step.

Clinical pathologist interpret challenging peripheral blood smears for diagnosis and recommended treatment in diseases and conditions like AIDS, hepatitis, leukemia, anemia, malaria, and lead poisoning. They perform and interpret bone marrow biopsies using new technologies in morphology, flow cytometry, clinical correlation, and molecular studies. They also evaluate patients with bleeding or clotting disorders, perform hemotherapy, including techniques in stem cell harvesting, plasmapheresis, leukopheresis, and red cell exchange. They coordinate blood transfusions, blood utilization and donation, and the identification of rare blood types. Most importantly, they oversee the care of trauma patients in need of massive transfusions.

Molecular pathologists are investigators of genetic structure and changes. They test for oncogenes in the diagnosis of cancer and for inherited genetic defects. They also provide DNA fingerprinting.

Research pathologists operate at the cutting edge of scientific inquiry into the cellular, molecular and genetic mechanisms behind aging, cancer, AIDs and other infectious diseases. At VCUHS we have pathology research programs in Aging & Cancer, Cellular & Molecular Pathogenesis, CTRF Cancer Genomics, Cytogenetics, Cytoproteomics, Functional Genomics, Molecular Diagnostics, Oncogenomics & Proteomics, and Paleopathology.