Clinical Chemistry
Programme sponsor
Making Science Sustainable – Laboratory Efficiency Assessment Framework (LEAF) and Clinical Laboratories
Making Science Sustainable – Laboratory Efficiency Assessment Framework (LEAF) and Clinical Laboratories
Clinical Chemistry
Abstract
Nations, institutions, and now the NHS have made net-zero commitments, but how will this affect scientific operations, and what would net-zero science look like? Laboratories are recognising their energy intensive nature, and assessing their immense consumption of consumables. More green lab efforts are growing around the world, though more standards are needed.
This talk will include:
- An introduction to sustainable and green labs
- A look at what net-zero laboratories might resemble in the future
- An introduction to Sustainability standards, and what programmes are developing regarding the sustainability of clinical, research, and all kinds of labs
- Questions!
Learning outcomes
Delegates attending this presentation will:
- Understand why sustainability is relevant in specialist areas like clinical laboratories
- Gain knowledge on LEAF, and what took place in the pilot within clinical labs
- Be aware of what the learnings were from the pilot, resources available, and next steps
Speakers
Sheri Scott
Metabolic complications posttraumatic brain injury (TBI)
Metabolic complications posttraumatic brain injury (TBI)
Clinical Chemistry
Abstract
Chronic pituitary dysfunction can occur following traumatic brain injury (TBI), especially growth hormone deficiency and hypogonadotrophic hypogonadism, and less commonly central adrenal insufficiency, hyperprolactinaemia, TSH deficiency, and syndrome of inappropriate ADH.
Earlier reports of high prevalence rates of pituitary dysfunction were misplaced in part because of over-reliance of dynamic endocrine tests with poor specificity such as the glucagon stimulation test. More realistic prevalence rates are up to around 10-15% after moderate-severe TBI. Risk factors for pituitary dysfunction include severity of TBI and exposure to blast TBI.
This talk will review the methods of assessment of pituitary dysfunction after TBI, potential diagnostic pitfalls, and its consequences, natural history and management.
Learning outcomes
This presentation will:
- Overview of some aspects of common metabolic complications that can be triggered by TBI e.g. diabetes mellitus, obesity and thyroid dysfunction.
- How complex endocrine networks are related to the responses to sudden changes after TBI.
- Discuss the potential mechanisms that, separately or synergistically, can influence outcomes after TBI.
Speakers
Dr Tony Goldstone
Clinical and economic evaluation of the clinical utility of UCH-L1 and GFAP in mild TBI
Clinical and economic evaluation of the clinical utility of UCH-L1 and GFAP in mild TBI
Clinical Chemistry
Abstract
There are 1.4 million UK ED attendances for head injury every year. Up to 2/3 of these are in adult patients. The severity of head injury associated traumatic brain injury (TBI) is assessed clinically using the Glasgow Coma Score (GCS). The majority of fatal outcomes occur in moderate TBI (GCS 9-12) or severe TBI (GCS≤8), which account for only 5% of attenders.
The presence of severe TBI is usually clinically clear cut and prompt evaluation using computed tomography (CT) imaging of the brain is performed, followed by hospital admission with further detailed evaluation. This is also often the case where moderate TBI is suspected. There is clearly a need to identify patients that account for the remaining 95% of attenders, with minor or mild head injuries, who will go on to have serious intracranial lesions.
In patients with GCS 13-15, however, only 1/10 demonstrate evidence of pathology on CT scan.
The measurement of serum biomarkers of brain injury has been proposed as a method to accurately differentiate those patients with GCS 13-15 who are likely to have underlying pathology from those with GCS 13-15 with no underlying pathology.
Among the most studied biomarkers are Ubiquitin C-terminal hydroxylase-L1 (UCH-L1) and Glial Fibrillary Acidic Protein (GFAP). UCH-L1 GFAP have been shown to correlate with TBI severity and clinical outcomes. Current evidence indicates that both serum GFAP and UCH-L1 are detectable in serum in less than 1 hour following a mTBI. GFAP and UCH-L1 levels are significantly elevated in patients with TBI with intracranial lesions on computed tomography (CT) and, in patients with mTBI, can distinguish between those with a normal and an abnormal CT scan of the brain.
Patients with mild TBI are at low risk of clinically significant brain injury in the absence of raised serum GFAP and UCH-L1 and other associated risk factors. They do not require a CT head scan and may be safely discharged providing there is a safe support system of care. It is anticipated that this could reduce head CT in these patients by 40%.
Methodology and preliminary results form an ongoing clinical and economic evaluation of the FDA approved serum GFAP and UCH-L1 on the Abbott Alinity platform in patients with mTBI will be presented.
Learning outcomes
Delegates will learn:
- What these new markers are.
- How they can be used in the clinical management of the patient.
- The fiscal aspects of introducing these assays.
Speakers
Dr Hayley Sharrod-Cole
Reflection on a Journey from Trainee Biomedical Scientist to Consultant Clinical Scientist
Moving from a Biomedical Scientist to research and PhD and finishing as a Consultant Clinical Scientist
Ovarian hyperstimulation syndrome (OHSS) – how does the clinical biochemistry laboratory inform clinical decisions?
The role of a Regional Newborn Screening laboratory
The role of a Regional Newborn Screening laboratory
Clinical Chemistry
Abstract
Newborn screening (NBS) is an essential public health strategy aimed at identifying newborn babies that are affected by certain genetic, metabolic and infectious conditions. NBS enables the early detection and management of several congenital disorders, which if left untreated, may lead to mental retardation and/or death. Early diagnosis and instigation of treatment, along with appropriate long-term care help ensure normal growth and development of the affected individual.
The Sheffield Regional NBS Laboratory is one of the largest newborn screening laboratories in the UK testing around 65,000 newborn bloodspot samples per year and has been an integral part of routine newborn care for the region of South Yorkshire, Lincolnshire and East Midlands. Newborn screening in the United Kingdom now includes screening for 10 conditions including multiple metabolic, haemoglobinopathies and only recently severe combined immunodeficiency - all detectable though multiplex laboratory procedures.
This presentation will briefly review the implementation of newborn screening in the region, including a brief history and justification for newborn screening, laboratory detection and diagnosis of the screening condition, the referral pathway/notification to a regional consultant paediatrician for initiation of treatment of the condition/follow up testing and conclude with a case study.
Learning outcomes
Delegates attending this presentation will:
- Gain knowledge on the history of Newborn Screening (NBS)
- Understand the justification for including conditions/disorders on the NBS programme
- Describe the disorders detected by NBS and understand the referral pathway(s)
Speakers
Dr Ben Sholademi
Your career in Clinical Biochemistry: IBMS qualifications and the role of the Advisory Panel
Molar pregnancy and gestational trophoblastic disease – why the hCG assay matters
Molar pregnancy and gestational trophoblastic disease – why the hCG assay matters
Clinical Chemistry
Abstract
In this presentation, Imran Jabbar, will delve into the crucial topic of measuring human chorionic gonadotrophin (hCG) in gestational trophoblastic disease (GTD). With a focus on trophoblastic tumours, Imran will explore the significance of hCG as a diagnostic and monitoring tool in GTD. The presentation will cover the principles behind hCG measurement techniques, including immunoassays and molecular methods.
Imran will highlight the challenges and advancements in accurately quantifying hCG levels, and discuss their clinical implications. Attendees will gain insights into the role of hCG measurement in early detection, disease monitoring, and prognostic evaluation, ultimately contributing to improved patient outcomes in GTD management.
Learning outcomes
Delegates will:
- Understand the pathophysiology of molar pregnancy and gestational trophoblastic disease.
- Understand the use of serum and uring hCG in diagnosis and monitoring of molar pregnancy, choriocarcinoma and other forms of gestational trophoblastic disease.
- Understand the purpose of the National GTD Screening Service.
- Understand why it is important that the hCG measurements are carried out on an identified assay.
- Be aware of the use of hCG measurements in predicting chemotherapy resistance.
Speakers
Imran Jabbar
Implementing the GIRFT national recommendations to reduce unwarranted variation in pathology
Reporting direct to the patient
Reporting direct to the patient
Clinical Chemistry
Abstract
In recent years, healthcare policy has been moving towards the concept of patients being able to receive their pathology test results directly, it is likely that pathology providers may need to consider the communication of some laboratory test results directly to patients.
This is a very different group of people to what pathology providers are used to. Expansion of concepts such as reference intervals and what is significant need to be explored in the context of a more general audience.
Speakers
Craig Webster
Androgens and Sports: Conventional urine and modern dried blood sample testing methodologies
Androgens and Sports: Conventional urine and modern dried blood sample testing methodologies
Clinical Chemistry
Abstract
Androgens are the naturally occurring or synthetic hormones which can increase lean body mass and decrease fat mass and are the most effective and widely abused ergogenic drugs in sport. The detection methodologies for the exogenous steroids is mostly based on the gas/liquid chromatography and mass spectrometry, while detection of the exogenous administration of endogenous steroids requires more complex methodologies including the longitudinal monitoring of individual urinary steroid concentrations/ratios and isotope ratio mass spectrometry. Although, urine has always been the first choice of sample matrix to detect androgens in sports. However, blood matrix is also now paving its way towards a complementary matrix for detection of androgens in sports. Dried blood spots (DBS) analysis is the latest tool in sports drug testing. DBS testing has advantages in the collection, shipment, and storage compared to traditional urine and blood-based procedures.
The World Anti-Doping Agency (WADA) has recently introduced DBS testing as an implementation for routine doping analysis during the recent Olympic and Paralympic Games in Tokyo and Beijing. DBS samples can be obtained with relatively little training and require minimal invasion at the collection site. A variety of devices based on micro-lancet and micro-needle approaches have been applied in the DBS collection.
Most androgens in DBS are stable at room temperature, so there are no specific requirements during transport. Also, considering the small size and weight of DBS, the DBS-based technique is more cost-effective compared to urine or blood samples. However, as a microscale sample, DBS require more sensitive and accurate analytical methods. The Drug Control Centre, King’s College London (a WADA accredited lab), we are currently investigating the use of DBS testing in our systematic regular analysis as a new methodology.
This presentation will discuss the current situation, perspectives, and challenges of implementing DBS testing for detecting androgens in sports.
Learning outcomes
Delegates attending this presentation will learn:
- Which androgens are tested for in sport
- The problems with current sample collection techniques
- Comparison of conventional urine with dried blood spots.
Speakers
Dr Shoba Ahi
From the laboratory to headlines. How to validate laboratory methods to screen and measure novel drugs
From the laboratory to headlines. How to validate laboratory methods to screen and measure novel drugs
Clinical Chemistry
Learning outcomes
Delegates attending this presentation will understand:
- How to develop methods for Liquid chromatography tandem mass spectrometry (LCMSMS) / Gas chromatography tandem mass spectrometry (GCMSMS)
- An overview of validation
- Problems with finding EQA for newly developed novel assays
Abstract
In the US, the death rate from drug overdoses more than tripled between 1999 and 2017, this was driven by increase use of opioids. This opioid epidemic had three phases: the first was dominated by prescription opioids such as oxycodone, the second by heroin, and the third by cheaper but more potent synthetic opioids such as fentanyl.
Despite a few outbreaks of synthetic opioids (such as fentanyl analogues) causing death is particular geographic areas, the UK has not faced the same epidemic as the US. However, over the past 2-3 years the UK has seen an increase in the detection of 2-benzyl benzimidazole (‘nitazene’) type opioids. These are found mixed with heroin or purchased online, typically sold as oxycodone. This talk will give a brief overview of novel opioids, discuss the potential for harm and highlight the analytical strategies to develop validated assays to detect and measure both novel opioids and other novel psychoactive substances.
Speakers
Dr Alexander Lawson
Development of a new EQA programme
Decision support in clinical chemistry – progress and pitfalls
Decision support in clinical chemistry – progress and pitfalls
Clinical Chemistry
Abstract
Decision support tools in laboratory medicine allow for the development of problem based requesting models, where laboratory tests can be tailored and cascaded based on a patients presenting symptoms and clinical history. This talk will look at options which are available to laboratory professionals, utilising current Laboratory Information Management Systems (LIMS), Middleware solutions and Order Communication Systems (OCS).
The development of such systems relies of the use of effective and evidence-based patient pathways and guidance documents, and these will be reviewed as well as initiatives currently in place in Scotland covering demand optimisation and the concept of Realistic Medicine.
Whilst looking at the advantages of such systems, problems such as the potential generation of extra tests, and subsequent cost implications will be covered as well as the issue of communication between various IT systems and the human input which may be required when systems don't necessarily work as planned.
Learning outcomes
This presentation will look at developments in rule based logic which follow clinical pathways to enable the requesting, resulting and interpretation of appropriate tests.
As well as covering new developments, we’ll also look at the rationale for implementing this sort of technology as well as covering the problems faced when trying to change laboratory processes.
Speakers
