The Nairobi Hospital Laboratory Services
We have one of the best equipped and staffed laboratories, offering the most specialized tests in the region. In the quest for access to quality services for all our clients, we acquired an ISO 15189 accreditation from Kenya Accreditation Services (KENAS). Through a quality coordinator, we ensure to maintain the ISO standard and uphold all quality Assurance programs. Like the rest of the hospital, we have been certified for ISO 14001: 2004 and ISO 22000: 2005.
The Laboratory is headed by a consultant Pathologist/Manager with each section supervised by a Senior Technologist and a consultant Pathologist reviewing all the results. Before any testing starts, daily internal quality controls and calibrations are run to assure quality of the reports. We are enrolled on several International External Quality Assurance Schemes for international peer reviews.
The Laboratory is devolved to different locations in Nairobi as listed below:
- The Doctors’ Plaza Laboratory - Ground floor of the Doctors Plaza Building in the main hospital.
- The Upper Hill Medical Center (UHMC) Laboratory - First floor of the UHMC Building on Ralph Bunche Road, 100 meters from the main hospital.
- The Warwick Laboratory - Basement floor of Warwick Outpatient Center at Gigiri, opposite the United Nations.
- The Galleria Laboratory - Second floor of Galleria Shopping Mall in the Galleria Outpatient Centre opposite the Bomas of Kenya.
- The Southfield Laboratory - Southfield Mall along Mombasa Road.
- The Capital Centre Laboratory - Capital Centre also along Mombasa Road.
- Kiambu Laboratory - Kiambu Mall, about 200 meters from Kiambu District Hospital.
- Rosslyn Laboratory - Rosslyn Riviera Mall, near Runda on the way to Ruaka.
The Nairobi Hospital Lab consists of the following sections with state-of-the-art analyzers.
The Nairobi Hospital’s Hematology Laboratory offers routine hematological tests in addition to other specialized tests as listed below:
- IMMUNO-PHENOTYPING BY FLOW CYTOMETRY
This is a process that uses antibodies to identify cells based on the types of antigens or markers on the surface of the cells. This process is used in basic research and to help diagnose diseases such as specific types of leukemia and lymphoma. e.g. Flow Cytometry For AML/ALL and CLL.
- PHILADELPHIA CHROMOSOME (BCR-ABL) BY PCR QUANTITATIVE
The BCR-ABL RNA quantitative assay is intended to monitor the level of minimal residual disease in TKI –treated Philadelphia chromosome positive leukemia. (CML or ALL)
- THROMBOPHILIA SCREENING TESTS
Thrombophilia (or hypercoagulability) is the condition where an individual is at an increased risk of abnormal blood clotting or thrombosis. Inherited mutations are potential causes of thrombophilia. Tests include Protein S, Protein C, Anti-thrombin III, Factor V Leyden, Lupus anticoagulant etc.
- HEMOGLOBIN ELECTROPHORESIS
This is a test that measures the different types of hemoglobin in the blood and also looks for abnormal types of hemoglobin. It’s often used to diagnose hemoglobin disorders such as sickle cell disease among others.
- APHERESIS PLATELETS COLLECTION
Apheresis technology is used to selectively collect platelets, RBC, plasma and any combination of all three concurrently from donors. This section also has a blood donor unit where we encourage everyone to visit and donate blood to save lives.
BIOCHEMISTRY AND SPECIAL CHEMISTRY SECTION
This section is equipped with ultra-modern state-of-the-art analyzers such as the Alinity ci, a fully automated analyzer with the capacity to perform 1200 tests per hour and offer a broad test menu. It is backed by the Cobas Pro integrated system with an ability to run 900 tests per hour. Both systems utilize the latest top-notch technologies and are highly efficient and accurate. The general chemistry test menu is extensive and includes tests such as liver functions tests, renal profile, lipid profile, cardiac biomarkers, bone metabolism biomarkers, lithium, immunoglobulins, complement factors, and more.
In addition to the section’s general chemistry menu, the lab offers specialized tests in Endocrinology, drug abuse, therapeutic drug monitoring and serology. The Hospital management continuously updates the scope of testing to ensure clinical demands are met. The laboratory has partnered with internationally accredited external labs to serve as referral centers for highly specialized tests.
Some of the newly added tests include:
- Complement C3 and C4.
- Varicella Zoster (Chicken Pox) IgG & IgM
- Measles IgG & IgM
- Cardiolipin antibodies IgG & IgM
- Thyroid autoimmune antibodies
The Cobas pro chemistry analyzer is the latest highly efficient chemistry analyzer from Roche, with reduced turnaround time for tests. It is designed to achieve more than 300 days between unplanned repair visits, meaning less unplanned interruptions and smooth workflows.
Launched in 2016, the Cobas e 801 analytical unit combines excellence in results with the speed and efficiency that is required to fulfil the highest expectations, especially during peak hours.
The Cobas c 503 analytical unit sets new standards in reliability, maintenance and efficiency with 1,000 tests per hour and 60 reagent channels onboard.
The Sonic Wash cleans the sample probe with ultrasound technology so thoroughly that only a few parts per billion are detectable. In addition, the Sonic Wash eliminates the daily maintenance of the sample probe and reduces clot events.
The new and smart concept of self-operating automatic maintenance reduces the manual burden of daily maintenance to zero for the Cobas c 503 analytical unit, and to only five minutes for the Cobas e 801 analytical unit.
Features to highlight:
- Up to 1,000 samples per hour in processing capacity
- Up to 300 samples direct loading
- Up to 300 samples direct unloading
- Bi-directional connectivity to lab automation
- ISE analytical unit - 900 tests per hour
- Cobas c 503 analytical unit - Up to 1,000 tests per hour and 60 reagent positions
- Cobas e 801 analytical unit - Up to 300 tests per hour and 48 reagent positions
In this section, we use the latest technology to perform an array of autoimmune antibody tests. Autoimmune diseases affect any organ or system in the body, with varying symptoms among disease types. These disorders are characterized by production of autoantibodies against an individual’s own body. There are numerous types of autoimmune diseases such as rheumatoid arthritis, lupus, celiac disease, multiple sclerosis and type 1 diabetes. The development of novel biomarkers has resulted in improved diagnosis of these diseases.
The identification of specific autoantibodies in important in diagnosing different autoimmune disorders, some of which present with vague symptoms, making diagnosis a challenge. The Nairobi Hospital Laboratory is equipped with automated analyzers with an enhanced capacity to identify most of the autoantibodies of clinical significance.
At the Immunology Section we offer the following tests:
This is Indirect immunofluorescence test (IIFT) combined with automated microscopy to give both titers and patterns for positive tests. Recommended reflex testing as guided by patterns identified in the ANA test aid further in diagnosis and better evidence-based management of a wide range of autoimmune conditions.
Here we use a high sensitivity IIFT method for more specific capture of this antibody which if present aids in the management of SLE. Results are given in titers to further aid response to treatment and clinical management during flares.
A panel of 14 antibodies to further aid identification of specific antibodies in ANA positivity (n RNP/Sm, Sm, SS-A, Ro-52, SS-B, Scl-70, PM100, Jo-1, CENP B, PCNA, nucleosomes, histones, ribosomal P-Prot, DFS70)
both p-ANCA and c-ANCA in one report.
A panel of 11 antibodies (Anti-Amphiphysin, Anti-CV2, PNMA2 (Ma2/Ta), Anti-Ri, Anti-Yo antibodies, Anti-Hu, Recoverin, Anti-Sox 1 antibodies, Titin, Zic4 and GAD65)
This is done by IIFT method using BIOCHIP technology (HEp2010, liver, kidney, and stomach tissue as substrates for each sample providing differential diagnosis for both ASMA and AMA). Anti-Liver-Kidney-Macrosomia (LKM), Liver Cytosol (LC), and soluble liver antigen/ liver-pancreas antigen (SLA/LP) whose predictive value for AIH is almost 100%.
Β2_glycoprotein test along with Anti-Cardiolipin antibody and Lupus anticoagulant.
A panel of 11 antibodies (Mi-2β, Ku, PM-Scl100, PM-Scl75, Jo-1, SRP, PL-7, PL-12, EJ, OJ, and Ro-52)
In-house capacity to a panel of liver auto-antibody tests that can guide differential diagnosis for
- AIH – Autoimmune hepatitis
- PBC - Primary biliary cholangitis
- PSC- Primary sclerosing cholangitis
- AIH-PBC overlap syndrome
For more information on tests, contact The Nairobi Hospital Immunology Laboratory on 020 284 5715/ 716/ 780
Histopathology & Cytopathology
This section specializes in routine biopsies diagnosis, pap smears, fluid cytology and Fine Needle Aspirations (FNA). Four highly qualified pathologists run this unit, availing quality results within 1 - 3 days and are available for consultation with clinicians. As a pioneer in diagnostic immunohistochemistry since the early 1990s, immunophenotyping of cancers is performed here with high quality diagnostic standards. The section also performs Human Papilloma Virus (HPV) DNA tests and is equipped with a cryostat. All frozen sections are routinely reported as surgery takes place on the surgeon’s request. Our newest technique is Hologic liquid based cytology for pap smears and fluid cytology.
The Microbiology Section is tasked with propagating and identifying micro-organisms of clinical interest through a variety of methods such as microscopy and culture. Rapid identification of pathogenic micro-organisms from patients’ samples is critical for prompt clinical interventions. In this regard, the laboratory is rolling out a hi-tech MALDI-TOF biotyper equipment which will drastically reduce the time needed to identify bacteria and fungi from culture agar plates to less than two hours. The MALDI-TOF also has the capacity to identify certain antimicrobial resistance mechanisms and this is highly informative in guiding antimicrobial therapy. The Vitek 2 compact analyzer is the mainstay for antimicrobial susceptibility testing and has enhanced the capacity to test multiple antimicrobial agents used for therapy in bacterial and fungal infections. The laboratory also has panel-based multiplex PCR tests through the Biofire Film Array platform. This equipment allows for identification of multiple pathogens of interest from one patient’s sample. This is achieved through the use of pre-defined panels such as gastrointestinal, respiratory and meningitis/encephalitis panels. The updated respiratory panel now allows for detection of SARS-CoV-2 among many other respiratory pathogens.
Detection of blood-borne pathogens is key. The new Automated BD BACTEC™ FX system utilizes fluorescent technology allowing for improved detection of growth of organisms in blood culture bottles. The section also has a TB lab that is equipped with BACTEC MGIT equipment for TB culture as well as GeneXpert for TB PCR.
Molecular diagnostics is a rapidly evolving area of laboratory medicine that investigates human, viral and microbial genomes and the products they encode. Molecular diagnostic tests are increasingly being used in many areas of laboratory medicine including oncology, infectious diseases, clinical chemistry and clinical genetics. Tests done in the molecular section Include: SARS-CoV-2 PCR, TB Hain PCR, HSV 1 & 2 DNA PCR, HIV DNA PCR, tropical fever screening PCR, pneumocystis jirovecii (PCP) PCR, ASPERGILLUS PCR, CANDIDA PCR, HIV/HBV/HCV viral load, HPV PCR, brucella PCR and MRSA PCR.
Molecular testing involves sample preparation, nucleic acid extraction, amplification of the genomic target region, results analysis and interpretation. At TNH molecular section, a streamlined PCR workflow ensures that quality, safety and timeliness are achieved for excellent patient care.
This is the pre-analytical step which involves the inactivation of infectious agents by exposing the samples to physical conditions such as high temperatures or chemical methods.
This entails extracting the genome of the suspected pathogens by deploying optimum conditions of varying temperature and chaotrophic chemicals which purify the target nucleic acid material. For every extraction an internal control is incorporated to the sample for quality assurance. The laboratory has embraced automation in order to improve quality of results and shorten the turn-around time of test results. Some of these automated systems include:
- Kingfisher flex
A high throughput platform with a capacity for extracting 96 samples within half an hour, ensuring testing TAT is achieved within much shorter time. The unit employs magnetic extraction technology with a higher percentage of nucleic acid purity.
- Qiasymphony SP/AS
A modular high throughput platform with a capacity for extracting 96 samples within 5 hours. The unit employs magnetic extraction technology with a higher percentage of nucleic acid purity. The modular capability enables extraction of different sample types to purify nucleic acids and proteins for diagnostic, research and forensic purposes.
A semi-automated platform for nucleic acids extraction with a capacity for extracting 12 samples in one and a half hours using spin column technology.
- Cobas Ampliprep/Taqman
This is another automated platform for HIV, HCV and HBV RNA extraction, amplification and quantification. It can extract 48 samples with minimal human intervention.<>/p
This involves the multiplication of a single copy of nucleic acid into millions of copies, allowing for accurate qualitative and quantitative detection of pathogens or markers of disease. The following platforms are employed:
- Rotagene Q
This is a real-time PCR cycler which combines multiple optimized design features to provide qualitative and quantitative results, enabling a streamlined analysis for a wide range of diagnostic testing. The unit can handle 72 samples per run whose time varies according to the kit used. It also has the capacity to conduct mutation analysis, high resolution melt analysis and methylation analysis.
- QuantStudio 5
QuantStudio 5 Real-Time PCR System is designed for superior performance, maximum dye versatility, and security. It is affordable and easy to use. It can handle 96 samples with on-board time dependent on the kit used.
- COBAS TaqMan Analyzer
This platform is used for the automated Hepatitis B Virus and HIV viral load testing. This is done to assess patient prognosis by measuring the baseline HIV-1 RNA level or to monitor the HIV viral load testing. This is critical in monitoring the effectiveness of antiretroviral therapy during antiretroviral treatment.
- Applied Biosystems thermocycler
The Applied Biosystems 2720 Thermal Cycler is a conventional 96-well thermal cycler ideal for both basic PCR and cycle-sequencing applications, using 0.2 mL reaction tubes or 96-well reaction plates. This is an open modular system that can handle various molecular biology diagnostics.
Results analysis and interpretation
The analysis and interpretation of results is performed by a team of experienced laboratory technologists who are guided by a clinical pathologist.