The Association for Clinical Biochemistry

In this issue

Focus 2016App Details

NostalgiaCorner

STP ProgrammeReviewed

LC-MS/MSand UKASAccreditation

The Association for Clinical Biochemistry & Laboratory Medicine | Issue 636 | April 2016

ACBNews

About ACB NewsThe Editor is responsible for the finalcontent. Views expressed are not necessarily those of the ACB. EditorProfessor Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07792-912163/0121-507-5353Fax: 0121-507-5290Email: [email protected]

Associate Editors Mrs Sophie BarnesDepartment of Clinical Biochemistry12th Floor, Lab BlockCharing Cross HospitalFulham Palace RoadLondon W6 8RFEmail: [email protected]

Dr Gina Frederick Pathology Laboratory, Level 5Royal Derby HospitalUttoxeter RoadDerby DE22 3NEEmail: [email protected]

Mr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]

Dr Derren Ready Microbial DiseasesEastman Dental Hospital University College London Hospitals (UCLH) 256 Gray’s Inn Road London WC1X 8LD Email: [email protected]

Situations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

Display Advertising & InsertsPRC Associates Ltd1st Floor Offices115 Roebuck RoadChessingtonSurrey KT9 1JZTel: 0208-337-3749 Fax: 0208-337-7346Email: [email protected]

ACB Administrative OfficeAssociation for Clinical Biochemistry & Laboratory Medicine130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

ACB PresidentDr Gwyn McCreanorTel: 01536-492692Email: [email protected]: @ACBPresident

ACB Home Pagehttp://www.acb.org.uk

Printed by Swan Print Ltd, BedfordISSN 1461 0337© Association for Clinical Biochemistry &Laboratory Medicine 2016

ACBNews

General News page 4

Practice FRCPath Style Calculations page 10

Education Matters page 12

Meeting Reports page 14

ACB News Crossword page 21

Situations Vacant page 22

Issue 636 • April 2016

The monthly magazine for clinical science

Issue 636 | April 2016 | ACB News

Front cover: Mike Thomas,Professional Lead for Blood Sciences,outside the National School ofHealthcare Science in Birmingham in conversation with Jonathan Berg

http://www.focus-acb.org.uk/

Focus on SpRMasterclasses inWarwickSpR Masterclasses are aimed to take classicand common biochemical conditions andexplore beyond the usual problems to givean expert view of the complexities facedwhen reviewing patients with theseproblems. Though aimed at those withmedical backgrounds the sessions are openand all are welcome. Dr Dhatariya, anEndocrinologist and Diabetologist fromNorfolk & Norwich University Hospital, andauthor of multiple papers and guidelines, will be sharing his expertise on emergenciesrelating to diabetes. Dr Marta Lapsley will behelping us to detect tubulopathies in renalstone clinics based on her extensive role inboth management and research in thisfascinating area. We will also benefit from Dr Simon Gabe, a Gastroenterologist from St Mark’s – the specialist bowel hospital –on how to optimise benefits and reduce therisks of parenteral nutrition. To finish thesession Professor Philip Newsome, widelypublished expert in liver disease, will bespeaking on diagnosis and therapeuticoptions in non-alcoholic fatty liver disease.This promises to be an interesting and usefulsession covering a wide range of clinical areasthat we are all likely to experience within ourpractice. The SpR masterclass will be held onTuesday 19th April at 15:45. �

4 | General News

ACB News | Issue 636 | April 2016

SudokuThis month’s puzzle

Lastmonth’ssolution

Focus 2016 Mobile AppNavigate the event like a pro with the Focus 2016 mobile app which includes the ability to:

� Sync the app across all of your devices� Receive important real-time communications from the ACB� Build a personalised schedule and bookmark exhibitors� Take notes and download event handouts and presentations� Rate the sessions you attend and comment on them, too� Locate sessions and exhibitors on the Warwick Arts Centre maps� Find attendees and connect with your colleagues throughFriends

� Stay in-the-know and join in on social media with #ACBFocus2016

Don’t be left out – go to your app store right now and get in with the in-crowd! �

http://www.focus-acb.org.uk/focus-2016-mobile-app.html


6 | General News

ACP National Leadership Skills Programme:Continuous Quality Improvement and EssentialCoaching Skills Workshop

8th June 2016Hallam Conference Centre, London

Leading for Continuous Improvement10.00-10.15 Introduction: Leading, leaning and cleaning – 20 years of continuous quality

improvement in pathologyDr Bridget S Wilkins, RCPath Director of Clinical effectiveness and ACP LeadershipDevelopment Co-ordinator

10.15-11.00 Purpose, methods and measures; aligning what we do and how we do it with ourfundamental “why?”Andy Brogan, Vanguard Consulting (tbc)

11.00-11.15 Break for Tea/Coffee

Practical Lesson in Lean11.15-11.45 Workshop 1: The clean sweep; lean and the elimination of waste11.45-12.15 Workshop 2: Making improvement stick; define your problem and understand

its root cause12.15-12.45 Workshop 3: Plan for action, get it done, review and re-boot12.45-13.30 Lunch13.30-14.00 Hot Topic Discussion:

Implications of the Carter Review 2016 for the future of pathology

Build You Skills for Leading14.00-14.15 Introduction to team skills (Bridget Wilkins)14.15-15.00 Workshop 1: Chairing and participating in successful meetings 15.00-15.30 Break for Tea/Coffee15.30-15.45 Why coaching is a vital leadership skill (Bridget Wilkins) 15.45-16.45 Workshop 2: Essential Coaching skills16.45-17.00 Reflections and next steps (Iskander Chaudhry and Bridget Wilkins)

Priced at: Trainees £105, ACP members £225, Non-members £250

To book contact: Paulene Horrocks, Association of Clinical Pathologists, Tel: 01273 775700 or E-mail: [email protected]

www.pathologists.org.uk

8 | General News


Association of Clinical Pathologists30th ACP Senior Management and Leadership Course run by Pathologists for PathologistsWednesday 14th – Friday 16th September 2016Hardwick Hall Hotel, Sedgefield, County Durham

This is a wide ranging, residential, 3-day course introducing management issues relevant tothe running of a modern pathology service. It is intended for Specialist Registrars andTrainees in pathology in their final year of training, Clinical Scientists and those who haveheld their first Consultant post for less than 2 years.

Course organisers: Dr Gavin Spickett, Dr Helen Bourne and Dr Bridget Wilkins

The course will address the following subject areas:� Funding and Structure of the NHS � Clinical Governance� Financial Management� Business Planning� Demand Management� Leadership Skills and Team-Working� Future Organisation of Pathology Services in the UK

Course fee: £595.00 for ACP members and £620.00 for non-members. Free of charge places are available to ACP members

with more than 6 months membership at the time of registration. Includes a course information handbook, pre-course briefing materials, en-suite accommodation, all meals, refreshments and course dinner.

In previous years the course has been heavily oversubscribed and early application isencouraged. Full details from: Paulene Horrocks (Course Administrator),

Association of Clinical Pathologists: Tel: 01273 775700 Email: [email protected] form: www.pathologists.org.uk

“I was digging through some old files at homethe other day and came across thisphotograph which was taken at the firstNational ACB Meeting in Buxton in 1984. We called it IMPACT and I thought it would

be pretty cool to send it to ACB News under a“where are they now?” title. So manycolleagues are starting to retire lately that Ithought that it might induce a little nostalgiaamongst the senior members. Because of allthe retirements I thought this year I would goto Focus while there are some faces I stillrecognise. Cheers and hopefully I will see some of you in Warwick.” �

Nostalgia CornerProfessor Mike Bennett writes from Philadelphia:

General News | 9


Over the past few weeks those who submittedabstracts for Focus 2016 should have receivedan e-mail from the organisers stating whetheror not you have been successful in having yourabstracts accepted for the meeting. Thank youto all who submitted abstracts, they haveshown a huge breadth and depth of workbeing undertaken by laboratory professionalsacross the UK and abroad.This year we are offering attendees

presenting a poster the opportunity to get the posters printed on-site by Warwick Print(click for website). Poster printing isreasonably priced (£27 for a basic poster andlaminated posters at around £40) with postersavailable to collect from the reception of theWarwick Arts Centre on the day ofattendance. Submission is via the on-line portal and the deadline for sending yourposter is 4th April. If you wish to print your

poster using this service please put ACB FOCUS2016 in the additional notes when submittingyour work. In addition, we would like toencourage attendees to agree to having theirposters uploaded onto the Focus 2016 App.Posters will be viewable after the conferenceand remain live for one year after the closingceremony giving attendees the chance to fullyabsorb the excellent work being presented thisyear. Don’t forget to take advantage of ourdiscounted fees rates if you are presenting aposter. Details may be found on the Focus2016 website. Sharing of your work goes along way to making Focus the leadingpathology conference it is today.Entrance to the exhibition is included in all

delegates’ rates and is also free to those whojust wish to visit the exhibition bydownloading an Exhibition Visitor Ticket viathe Focus 2016 app! �

On-site Poster Printing and Exhibition at Focus

10 | Practice FRCPath Style Calculations


Recent work suggests that the incidence of Familial Hypercholesterolaemia (FH) in North-WestEurope is approximately 1 in 200 live births. Using current techniques, the detection rate ofdisease-associated mutations in FH is approximately 50%. Calculate (a) the incidence ofhomozygous FH, and (b) the probability that the child of a proband with genetically-confirmedFH has homozygous FH.

FRCPath, Spring 2015

FH is an autosomal dominant disorder with homozygotes being more seriously affected thanheterozygotes.

Let A be the dominant gene with frequency in the population p

Let a be the recessive gene with frequency in the population q

Therefore p + q = 1

If the Hardy-Weinberg equilibrium applies to the disorder then:

p2 + 2pq + q2 = 1

where p2 is the incidence of homozygotes with FH, 2pq the incidence of heterozygotes and q2

the incidence of individuals without the genetic defect.

As the disease associated mutations are only detected in a half of patients with FH and assumingthe figure for their incidence is based on genetic testing, then the true incidence of FH will betwice 1 in 200 i.e. 1 in 100 or 0.01.

Presumably the incidence of 0.01 for FH in the population includes both homozygotes andheterozygotes. Therefore:

p2 + 2pq = 0.01

Substituting this value into the Hardy-Weinberg equation enables calculation of q:

0.01 + q2 = 1q2 = 1 - 0.01 = 0.99q = √0.99 = 0.9950

by difference p = 1 - 0.9950 = 0.0050

and 2pq = 2 x 0.0050 x 0.9950 = 0.00995

a) The incidence of homozygous FH (i.e. AA) will be given by p2

p2 = 0.0052 = 0.000025

or 1/0.000025 = 1 in 40,000

b) The proband with FH must be either homozygous (AA) or heterozygous (Aa):

Probability of AA = Incidence of AA = p2

Incidence of AA + Aa p2 + 2pq

Deacon’s Challenge No 179 - Answer

= 0.000025 = 0.000025 = 0.002506 0.000025 + 0.00995 0.009975

And the probability of Aa = 1 - 0.002506 = 0.9975 (4 sig figs)

The probability that the proband donates the dominant gene is the sum of the probabilities ofthe gene arising from a homozygote or heterozygote in an individual with known FH:

Probability of donating A =

(Probability of AA genotype) + (Probability of Aa genotype x 0.5)

= 0.002506 + (0.9975 x 0.5)= 0.002506 + 0.49875 = 0.501 (to 3 sig figs)

The probability of the proband’s partner donating the dominant gene is the probability of Aarising from either AA or Aa genotype in the general population:

Probability of donating A =

(Probability of AA genotype) + (Probability of Aa genotype x 0.5)

p2 + 2pq x 0.5= 0.000025 + (0.00995 x 0.5)= 0.000025 + 0.004975= 0.0050

The probability of a child having homozygous FH is the product of the probability of eachparent donating the dominant gene.

Probability of homozygous FH (AA) = 0.501 x 0.0050 = 0.002505 (2 sig figs)

or 1/0.002505 = approx. 1 in 400

Practice FRCPath Style Calculations | 11


Question 180It has been suggested that measurement of Calprotectin in faeces can be used to distinguishbetween Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). Diagnosis ofIBD requires colonoscopy, diagnosis of IBS does not.

At present, all patients referred to your local Gastroenterologists’ clinic with either IBS orIBD undergo colonoscopy. They wish to restrict colonoscopy to patients with a faecalcalprotectin > 50 μg/g. Calculate the anticipated cost saving/patient of this strategy.

NB: At present, 48% of patients referred to the clinic are found to have IBD at colonoscopy.

Studies indicate a cut-off value of 50 μg/g faeces has a sensitivity of 99% and specificity of74% for distinguishing between IBS and IBD in the out-patient setting.

The total cost of a faecal calprotectin assay has been estimated at £22.79. The cost of acolonoscopy is £750 (for the purposes of this question, you should ignore the possible costsof any complications arising from colonoscopy)

(Broadly based on NICE DG11; October 2013)FRCPath, Spring 2015

ACB News visits Dr Mike Thomas in Birmingham

With interviews for the next round of ScientistTraining Programme (STP) training andapplications for Higher Specialist TrainingProgramme (HSST) open, ACB News headed toBirmingham to meet Dr Mike Thomas,Professional Lead for Blood Sciences at theNational School of Healthcare Science. Mikekindly agreed to talk on camera and hisinterview can be found on the YouTubechannel with some of the conversationreported here.Some three years ago Mike retired from the

Royal Free Hospital where he had worked inpathology for thirty years, the last ten asClinical Director. However, it was not long until the phone rang and he was back at work commuting to the School in Birmingham.The School is responsible for overseeing

and supporting the implementation and on-going delivery of training and educationprogrammes for Healthcare Science.

The Professional Lead supports thedevelopment of the Healthcare Sciencetraining programmes ensuring a cohesiveapproach to training delivery and regulationof the programmes. There are eight Professional Leads covering

the various specialisms and themes. Workincludes supporting and overseeing theassessment and quality assurance of the workbased programmes, ensuring that appropriateprocesses are in place to monitor traineeprogression and evaluate the placementprovision for both work based and academicproviders. Mike’s particular area of interest focuses on

the HSST and on recruitment. There is also asignificant workload associated withaccreditation of training centres and thedelivery of assessments. Mike usually travels to Birmingham once or twice a week butotherwise can be working from home. Mike explains that the Professional Leadsengage with the accreditation of training

12 | Education Matters


Scientist TrainingProgramme ReviewedJonathan Berg, Editor

Mike and Jonathan on camera in the Blood Sciences satellite laboratory. Click image to go to YouTube on theelectronic edition

https://www.youtube.com/watch?v=cRuHnjqL_DQ

centres and will visit laboratories for thatpurpose. The accreditation process itselfalways includes a confidential meeting withthe trainees, as well as contact with thestudents through the support we offer them.

The STP Programme Reviewed

The full Scientist Training Programme (STP)was introduced in the autumn of 2011. There has been recruitment every year sincethen into STP so that means we have had fivecohorts enter the programme and arecurrently about to start interviewing for thesixth. Prior to 2011 there was also the Geneticspilot, which looked at the feasibility ofintroducing the programme across alldisciplines. The number of STP trainees whohave entered the programme since 2011 is1,283 working across 33 healthcare specialists. In Blood numbers are: Clinical Biochemistry117, Clinical Immunology 22, and Microbiology43. We are also now supporting 120 ClinicalScientists on the HSST programme across 2014and 2015.We are currently looking at ways in which

we may create a student alumni body aspresently we have no formal information oncethey leave the programme on how their careerprogresses. Amongst our particular specialismsthere has only been one individual who hasbeen unsuccessful in getting a Certificate ofCompletion in the course.There has always been some loss from

these training programmes even before theintroduction of Modernising Scientific Careerswhen it was the Grade A scheme. The reasonswe lose trainees are many and varied but theattrition rate is a very low percentage andprobably around 2%. We do try and intervieweveryone who exits the scheme and since Ihave been involved we have undertakenmaybe only two or three exit interviews, noneof which were in biochemistry, immunology ormicrobiology.

Q&A from Supervisors . . .

Mike kindly answered a number of questions put by supervisors around thecountry. He points out that the STPprogramme is designed to produce a “morerounded individual better equipped for our

increasingly multi-disciplinary approach”. He accepts that the new scheme cannotcompare to the previous four years training ina single discipline but sees the newprogramme as better equipping those whowant to ultimately become Pathology Director. Regarding OLAT Mike suggests that this is

something that should not dominate trainees’experiences. Indeed the split the Schoolrecommends between academic andworkplace experience is 20:80 with theworkplace based assessments having a focuson undertaking practical skills in thelaboratory in real time. Professional leads arequite often asked to comment on theappropriateness of OLAT evidence and indeedMike thinks the School taking some time toaudit this area would be good. However,overall Mike clearly feels that the OLATprocess is an attempt to formalise traineeslearning and development and feels it must be more robust than previous ad hocarrangements.Regarding trainees in difficulty there is of

course a ‘policy’ and both the trainer andstudent need support when things getdifficult. Mike points out those trainees can be let down when training departments havefailed to appreciate just what taking on atrainee means at a local level. �

See the interview with Mike at ‘SWBHPathology TV News’ which you can reachby clicking here on the electronicversion.

Education Matters | 13


New intake of trainees at Aston Villa last September


14 | Meeting Reports


The November 2015 ACB WalesMeeting was held in the AngelHotel, Central Cardiff. The meetingwas opened by Professor JohnGeen from Cwm Taf UHB with retirement congratulations to John Tovey of Aneurin Bevan UHB.John has been a key figure withinACB Wales and his expertise will begreatly missed.

Members’ Award PresentationsThe first talks on the agenda were thosesubmitted for the Members’ Award. They werestarted by Jacqui Folkes, Clinical Scientist inABM UHB, who presented work on evaluationof the new Abbott active vitamin B12 assay andestablishing appropriate cut offs to detectvitamin B12 deficiency. The second talk was byRoanna George, Clinical Scientist in CAV UHB,who shared her FRCPath project on the effectof sample quality on dried blood spotscreening. Dr Liz Palmer, Clinical Scientist inABM UHB, then gave us a workshop on thedevelopment and troubleshooting of an LC-MS/MS assay for prednisolone, whichformed part of her MSc project during her STPtraining. The last talk was by Dr Rachel Brixey-McCann,

Clinical Scientist in CAV UHB, on the effect ofcortisol assay bias on the overnightdexamethasone suppression test, whichformed part of her MSc project. The Members’Prize, kindly sponsored by The Binding Site,was given to Roanna for her excellent talk, thehighlights of which were that insufficient (notsoaked through) and compressed (bloodcompressed onto the card by hand) samplesgave a 30-40% negative bias, whilst over-spotting/multi-spotting gave a positive bias.This confirms that sample quality is importantto avoid false results, prevent delay in referraland prevent re-bleeding of babies. Her work

has also contributed to the updated UK bloodspot screening guidelines, 2015.

All Wales LIMSFollowing a coffee break (and some excellentcookies), Dr Carol Evans, Consultant ClinicalScientist in CAV UHB, gave us an update onthe new All Wales LIMS, which has been rolledout across Wales over the last 2 years. Thefocus was on Endocrine results, and thedifficulties faced using an ‘All Wales’ systemwhen there are differing patient pathwaysbetween the Health Boards. Before themeeting, a short survey was sent around togauge users’ opinions of TFT clinical validation;users seemed happy with many aspects, suchas the demand management rules andmethod-dependent harmonised referenceranges, but it was thought that documentmanagement and the options for auto-comments could still be improved.Standardisation across the Health Boards hasbeen challenging and more complicated thanthought due to the differing opinionsregarding which results should appear in thevalidation queues. The All Wales LIMS is still awork in progress, but some benefits that havebeen identified include the ability to viewresults from different Health Boards and theease of referring tests to specialist centres.

Biochemistry in PregnancyDr Piero Baglioni, Consultant Endocrinologistfrom Cwm Taf UHB, spoke about diabetes inpregnancy. One in 20 pregnancies iscomplicated with diabetes, 85% of those dueto gestational diabetes. Dr Baglioni discussedthe complications of pregnancy for patientswith type 1 and type 2 diabetes, the mostcommon being foetal macrosomia. He thendiscussed the importance of monitoringglucose levels throughout pregnancy andmaintaining maternal normoglycaemia,as excess glucose may lead to adverse effects in the foetus and increased risk ofcomplications in the mother. He also discussed

ACB Wales MeetingRachel Brixey-McCann and Daniella Nice, Cardiff

Meeting Reports | 15


results of the HAPO trial, which monitoredpregnancy outcomes of women withgestational diabetes; the babies were morelikely to be bigger, with a higher risk ofrequiring interventions during birth or in thepostnatal period. Dr Onyebuchi Okosieme, another

Consultant Endocrinologist from Cwm TafUHB, gave his presentation on thyroidfunction in pregnancy. He introduced histalk by asking what the appropriatecomments/actions were for two patients, both in their first trimesters; one with low fT4,normal TSH and negative TPO-Abs, and theother euthyroid but positive TPO-Abs. Headmitted there was no correct answer,however, ‘do nothing’ or ‘refer to endocrineservice’ scored higher than repeating ormeasuring TRAbs. The rest of his presentationhighlighted that it can be difficult to diagnosethyroid problems due to overlap with normalsymptoms of pregnancy, and emphasised theneed for local reference ranges that aretrimester specific. Both maternal hyper- andhypothyroidism have been linked to poorfoetal outcomes so if treatment is required, it should be started as early as possible inpregnancy since the foetal thyroid gland isfully developed by 14 weeks. Following lunch, Dr Jyoti Singh, Consultant

Obstetrician and Gynaecologist in AneurinBevan UHB, began her presentation by giving an overview of the physiology of pre-eclampsia, explaining that it is a multi-system disorder presenting in pregnancy.However, due to the varied presentation, therecan be inconsistency in care, and as such is thesecond most common cause of maternaldeath. She explained there are few treatmentsavailable when a patient is diagnosed withpre-eclampsia, with the only definitetreatment being delivery of the baby. She alsodiscussed common testing performed duringthe differential diagnosis of pre-eclampsia,which should include FBC, U&E and LFT.Urinalysis is also needed to confirmproteinuria, but the concentration of protein

is not related to severity. Magnesium wouldalso need to be monitored if administered forseizure prophylaxis.

AuditsDr Rhodri Pyart, Renal Registrar in BCUHB,gave an interesting presentation about anaudit he conducted concerning reviewing theAKI e-alerts produced at Wrexham hospital. He explained how he reviewed the e-alertsthey were receiving, and the best way toensure that the appropriate patients werebeing followed up to enable the bestoutcomes for patients. He also highlighted theimportance he is now placing on the stage 1alerts; the patients have poorer outcomes ifpermitted to deteriorate into stages 2 and 3.The following talk was from Dr Brian

Tennant, Clinical Scientist at Cwm Taf UHB,regarding the guidelines for oral glucosetolerance testing. He audited the number ofpatients that would have been diagnosed withgestational diabetes according to the mostrecent NICE and WHO guidelines. He foundthat different cohorts of patients would bedefined by the differing guidelines; the latestNICE guidelines increased number of patientsdiagnosed, which will impact on the servicerequired to follow up these patients.The final audit of the day was from Dr Liz

Palmer, who retrospectively audited thyroidfunction testing and measurement of TPOantibodies in pregnancy. She highlighted thatthe foetus relies on maternal thyroxine untilthe foetal thyroid gland becomes active at 12-14 weeks gestation. This affects thedemand on the maternal thyroid gland so thethyroxine dose needs to be closely monitoredand titrated to the TSH concentrationthroughout pregnancy. She found that theThyroid Society guidelines were not beingfollowed, and there was need to monitor TFTs both during and after pregnancy.It was an excellent day with a great

programme of talks and an excellent venue.Our thanks go to Kelly Mitchem for organisingit all. �



The December 2015 issue of the ACB Newsincluded a meeting report entitled “MassSpectrometry in Austria”. As highlighted inthis article, the Association for MassSpectrometry: Applications to the ClinicalLaboratory, Inc. (MSACL) supports theadvancement of mass spectrometry in theclinical setting. The 2016 USA MSACLconference took place in Palm Springs,California in February and I was fortunateenough to secure funding to attend.The first two days were dedicated to

educational short courses that catered for all levels of mass spectrometry experience. I attended a two-day course entitled“Introduction to clinical mass spectrometrymethod development”, run by Bob Kobelski.Through this course I gained a much betterunderstanding of the fundamentals of massspectrometry and chromatographic separation.We also discussed the application of thisfundamental knowledge to methoddevelopment in real laboratory scenarios. The main three-day conference had a busy

schedule comprised of plenary lectures,scientific sessions, corporate workshops, posterpresentations, exhibitions and networkingevents. The standout presentation from theconference, for me, was Dr Kenneth Setchell’s

award lecture “What can we learn from a dropof urine”. He demonstrated the importance ofmass spectrometry developments in theinvestigation of bile acid synthesis disorders.Having been involved from the start, he wasable to show progress from the first massspectrum taken from a child with idiopathicfamilial intrahepatic cholestasis over twodecades ago, through to development of thefirst recognised treatment approved by theFDA in 2015. Scientific sessions were organised into six

tracks, offering something for everyone. I attended sessions on endocrinology, newbornscreening, ICP-MS, proteomics and massspectrometry in the operating theatre. Postersessions provided excellent opportunities toboth learn and network. I presented a posteron the measurement of urinary freecatecholamines by mass spectrometry, whichwas well received and I had some interestingdiscussions with other laboratories developingsimilar methods. I found MSACL to be an extremely useful

and relevant conference for anyone, at anylevel, working with mass spectrometry in theclinical environment. I have come away fromthe conference more knowledgeable and withsome useful contacts for the future. There areeducational travel grants available for boththe USA and European conferences and thenext European conference is scheduled forSeptember 2016, Salzburg. MSACL also usedthe US conference this year to introduce theirnew international journal “Clinical MassSpectrometry”; they are looking for abstractsubmissions from the mass spectrometrycommunity.I would like to thank MSACL and their

industry sponsors for providing me with theyoung investigator’s travel grant to attend theconference. I also give thanks to the ACB forfunding part of my travel. �

Mass Spectrometry in the DesertAnna Robson, Heart of England NHS Foundation Trust

The ACB Republic of Ireland Region ScientificMeeting was held on Friday 29th January 2016at the Education and Research Centre, St Vincent’s Hospital, Dublin. The meeting wasopened by Dr Graham Lee, Chair of theRepublic of Ireland Region ACB Committeewho welcomed attendees and set the scenefor the diverse programme that lay ahead.

Non-Invasive Cancer Diagnostics

Ruth O’Kelly, Principal Biochemist, CoombeWomen’s Hospital Dublin as Chair for themorning session introduced the first speaker,Dr Charlie Massie, Cancer Research UK, for histalk on cell free DNA – non-invasive cancerdiagnostics. Dr Massie provided us with an in-depth

insight into genomic analysis of circulatingtumour DNA; describing its origins, clinicalapplications and future research. He began his talk by citing the assay of foetal DNAfragments in maternal plasma in non-invasivepre-natal testing (NIPT) and how this hasrevolutionised the field of prenataldiagnostics.He then turned his focus to how circulating

tumour DNA (ctDNA) analysis opens up arange of applications in cancer managementincluding molecular stratification, highlightingits prognosis value and potential in monitoringtreatment response and relapse. He outlinedthe pre-analytical considerations and a varietyof non-invasive sampling methods available.Particular emphasis was attributed to thesample analysis methods employed and Dr Massie provided a description of thetechnique of targeted deep sequencing (Tam-Seq) of cell-free tumour DNA. Heconcluded by highlighting the potential ofctDNA as a biomarker for non-invasiveassessment of cancer burden and he thankedall of his collaborators at the CambridgeCancer Centre.

Tissue Microdialysis

Following Dr Massie’s highly informativepresentation, Professor William O’Connor,Head of Teaching and Research in Physiology,University of Limerick Graduate Entry MedicalSchool, was invited to present his talk on tissue microdialysis. Before beginning his talk,Professor O’Connor urged attendees to refer to the website he maintains, inside-the-brain.com! He provided the audience with an

enthusiastic overview of the technique oftissue microdialysis and its translation frompreclinical research to clinical treatments.Microdialysis is a minimally invasive diffusion-based separation method that allowsanalytes to freely diffuse across a hollow fibresemi-permeable dialysis membrane. Themembrane is perfused with a liquid, whichequilibrates with the fluid outside themembrane by diffusion in both directions.Microdialysis in combination with a suitabledetection technique allows monitoring oftime–dependent changes in local tissuechemistry. Microdialysis also achieves near-continuous monitoring of tissue statusand negates the need for repeated bloodsampling. Professor O’Connor provided examples of

how this technique of measuring/monitoringchanges in simple biochemical markers, such as the lactate/pyruvate ratio, glucose andglycerol aids in diagnosis of tissue ischaemialeading to early and effective clinicalinterventions. In plastic surgery, microdialysisprovides a sensitive and specific diagnosis offlap ischaemia, with earlier interventioneliminating the cost involved in flapreplacement, according to Professor O’Connor. Finally, he shared with attendees some of

his recent research which involved the rapidquantification of histamine in human psoriaticplaques using microdialysis and ultra-high



ACB Republic of IrelandRegion Scientific MeetingMicheál Ryan, Limerick

Meeting Reports | 19


performance liquid chromatography withfluorescence detection.

Gestational Diabetes Mellitus

The third speaker of the morning session wasMary Stapleton, Senior Clinical Biochemist,Coombe Women’s Hospital Dublin, whoprovided us with a thought-provokingoverview of gestational diabetes and sharedsome results of her recent research in this area.She traced the gestational diabetes

‘cut-offs’/criteria from the 1960’s (O’Sullivanand Mahan) to those currently advocated byThe International Association of the Diabetesand Pregnancy Study Groups (IADPSG), whichhave also been endorsed by the AmericanDiabetes Association (ADA). As indicated by Miss Stapleton the current

diagnostic criteria are based on theHyperglycaemia and Adverse PregnancyOutcome (HAPO) study. As part of MissStapleton’s research, she decided to mimic thepre-analytical requirements of the HAPO studyon a local patient cohort to investigate theimpact on glucose tolerance test results andpatient categorisation based on thegestational diabetes diagnostic criteria.

She presented the results of her researchwhich highlighted the under-diagnosis ofgestational diabetes among the patient cohort using existing pre-analyticalprocedures. These findings when extrapolatednationally reveal a major issue in correctlyidentifying patients with gestational diabetes.The current practices for the pre-analyticalhandling of maternal glucose samples need to be reviewed and standards improved.Keep an eye out for Miss Stapleton’s

presentation of her valuable research findingsat Focus this coming April!

National Rare Disease Plan

The afternoon session was chaired by OrlaMaguire, Principal Biochemist, St Vincent’sUniversity Hospital, Dublin and opened withProfessor Eileen Treacy, Clinical Lead for theNational Centre for Inherited MetabolicDisorders providing an overview of theRepublic of Ireland National Rare Disease Plan2014-2018, outlining its key recommendations.One of these recommendations was theestablishment of a National ClinicalProgramme for Rare Diseases. Such a clinicalprogramme supports work on treatment

programmes, accessing clinical trials, thedesignation of centres of expertise and theprovision of information for patients and theircarers. The National Rare Disease Office was

officially opened in June 2015, at MaterMisericordiae University Hospital Dublin, tofurther enhance the implementation of theNational Clinical Programme for Rare Diseases.Professor Treacy proceeded to outline the

functions of the National Rare Disease Office.These include building links with EuropeanRare Disease Networks, centralisation of up-to-date Irish rare disease informationthrough Orphanet Ireland (www.orpha.net),to maintain a helpline to provide patients,families and health care providers withinformation and support relating to rarediseases and development of national raredisease care pathways.For further information and useful links,

Eileen encouraged those in attendance to visitthe Health Service Executive webpage(www.hse.ie/rarediseases/).Professor Treacy concluded by detailing the

criteria that diagnostic laboratories must meetif they are providing a genetic testing servicefor rare diseases. The diagnostic laboratorymust ensure it has the required level ofexpertise and can assure its quality throughISO accreditation.

Heart-type Fatty Acid Binding Protein

Following Professor Treacy’s informativepresentation, Dr Derek McKillop, ConsultantClinical Scientist, Craigavon Area Hospital, was invited to discuss the potential clinicalutility of Heart-type Fatty Acid Binding Protein(H-FABP). He began his talk by giving thebackground to coronary heart disease and thetypical pathway of a chest pain patient. Heindicated the diagnostic concerns with thepotential for false positives and false negativesand the desirable outcomes if a multi cardiacmarker strategy is to be utilised.Dr McKillop then referred to the RApid

Diagnosis and Risk stratification (RADAR) ofacute coronary syndrome observational study,

outlining the clinical parameters and a varietyof different biomarkers measured. This trialfound that of all of the biomarkers that weremeasured, H-FABP measured with hs troponinT (hsTnT) and ECG on presentation in chestpain patients resulted in the highest sensitivity(98%) and achieved a negative predictivevalue (NPV) of >98%.To further elucidate the clinical value of

H-FABP, Dr McKillop performed an auditinvolving an investigation of 69 patients withmeasurement of H-FABP in addition to hsTnT.The results indicated that the additionalmeasurement of F-HABP at presentationresults in a change of management in >40% of patients.Dr McKillop concluded that H-FABP has

utility in rule-out, rule-in and risk stratificationof chest pain patients with the potential ofmajor healthcare cost savings. However, hecautioned that there needs to be moreinvestigation into the optimal cut-off used forH-FABP and how H-FABP will be incorporatedinto future guidelines for the management ofacute coronary syndrome.

Procurement

Moving away from biochemical science to the‘science’ of procurement, the final speaker ofthe meeting Dr Paul Davis, provided us with aflavour of the new approaches for procuringeffective healthcare solutions. He underlinedthe need to balance sustainable health systemsagainst limited budgets and dwindling publicresources.He emphasised the need for Laboratory

management to challenge procurementprocesses to achieve the most economicallyadvantageous solutions for the laboratory.Dr Davis also advocated for pre-commercial

procurement (PCP) in the laboratory setting.This is the procurement of research anddevelopment of new innovative solutionsbefore they are commercially available. Closing the meeting, Dr Graham Lee

thanked all of the speakers for their valuablecontributions and all those that attended fortheir continued support of the ACB in theRepublic of Ireland Region. �



Crossword | 21


Last month’s solution

Across 1 Mean description of spotty child (6)4 Perhaps phage not always an

infectious agent? (8)10 Syndrome following initial heavy

chain protein synthesis (9)11 No gain in measuring incorrectly

this kind of sample (5)12 Invigorating 100 informally,

99 formally (5)13 Laboratory method of the

recalcitrant traditionalist – no dials! (9)

14 “Exceptional positions rule it out”noted author of statistical model (7)

16 Present a biased view of revolution (4)

19 Alternate puerperal metabolicproduct (4)

21 Original presentation made on a growth (7)

24 High-spirited tipsy Texan ringspersonal transportation provider (9)

25 Agree to allocation (5)26 Good defence: I get bail (5)27 Engineer, for example, names an

element (9)28 Doctor is in to specify stain for

computer-produced section (8)29 Organ question, doctor

investigates, gave in, left (6)Down 1 Unusual eponym given to only

one of its kind (8)2 User’s software sorted index

supplement (8)

3 Type of poem, richly effected butnot hard (5)

5 A leading surgeon quotes areference for fluid accumulation (7)

6 Biochemical belonging to him,appreciation belonging to me (9)

7 Pet rodent Free French return toGerman (6)

8 Nominating appellative (6)9 Drug to be taken straight away

at home (6)15 A method for disease detection

that could potentially recognisenormality, missing nothing (9)

17 Unhappily can’t love, might sort of bond (8)

18 Smartest presentation for dormantsupporting case construct (8)

20 An Emergency Department raised target for haematologicaldiagnosis (7)

21 Provisional performance (6)22 Collation about finished (6)23 Point out false imputations of

developmental disorder diagnosis (6)

25 Classify degree (5)

ACB News CrosswordSet by RugosaStart at the Top . . .It is very hard to do extra stuff in a pathology laboratory at present. Pressure ison with lack of staff, budget cuts and all that. However, “hey ho”, need tokeep at it. So, that is what we have done, and we concentrated last month ongetting out a couple of YouTube interviews with Dr Mike Thomas. The first onelooks at STP training and is featured in this issue and the second concentrateson HSST. Electronic links here . . . of course the Editor has also knocked out oneabout his cycle journey to work which includes a heroin abuser shooting up . . . see here!


22 | Situations Vacant

To advertise your vacancy contact:ACB Administrative Office,

130-132 Tooley Street, London SE1 2TUTel: 0207 403 8001 Fax: 0207 403 8006 Email: [email protected]

Deadline: 26th of the month prior to the month of publicationTraining Posts: When applying for such posts you should ensure that appropriate supervision and training support will be

available to enable you to proceed towards HCPC registration and the FRCPath examinations. For advice, contact your Regional Tutor. The Editor reserves the right to amend or reject advertisements deemed unacceptable to the Association.

Advertising rates are available on request.


The Association for Clinical Biochemistry

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Transcript of The Association for Clinical Biochemistry