Haematology
Programme sponsor
Review of malaria rapid tests
Review of malaria rapid tests
Haematology
Abstract
Rapid antigen tests for malaria have been in routine use in UK haematology labs for many years now. However, interpretation of their results, especially in light of the accompanying blood film findings can still prove to be confusing.
The advantages and limitations of these tests will be explored and explained.
Learning outcomes
- Interpretation of malaria rapid test results
- Limitations of malaria rapid tests
- Where malaria rapid tests fit into the wider picture of lab diagnosis of malaria
Speakers
Emma Victory
Morphology Training
Morphology Training
Haematology
Learning outcomes
This presentation is an introduction to Morphology Training and how this can be achieved in-house and across a Pathology Network
Learning outcomes and points of discussion:
- Your Morphology Training Team
- What do you want to achieve with your morphology training programme?
- Who is it aimed at and how can it be tailored for different grades of staff?
- Different training methods and how are you going to deliver them
- Essential elements that must be included
- Morphology Training Resources available to your team
Speakers
Nicki Lawrence
Morphology Quiz
Morphology Quiz
Haematology
Learning outcomes
Interactive quiz on blood cell morphology with a of variety cases covering the everyday and the unexpected. Test your skills anonymously, aimed at those reporting films and those just starting their morphology journey - we are all still learning.
The quiz is multiple choice so anyone can participate. The morphology of the cases, the options and the answers and will be discussed at the session.
Speakers
Dr John Burthem
Dr Michelle Brereton
The Blood Film to the Rescue
The Blood Film to the Rescue
Haematology
Abstract
Despite major advances in investigating haematological abnormalities, the blood film can still be crucial in diagnosis and patient management. The first major role is the validation of an abnormal blood count and, when it is found to be invalid, finding an explanation for factitious results. Factitiously low platelet counts and factitiously high MCVs are well recognized examples.
When the count is found to be valid, an explanation might be revealed. A blood film may indicate a likely diagnosis within minutes; this can be of vital importance as in acute promyelocytic leukaemia, thrombotic thrombocytopenic purpura, Burkitt lymphoma and certain infections. Sometimes the blood film suggests an uncommon or rare condition the diagnosis of which is important but would otherwise be delayed or elusive.
Learning outcomes
Delegates attending this presentation will:
- Be alert to the unexpected finding on the blood film
- Recognise the unexpected finding
- Understand what is abnormal
- Be able to correlate the abnormality with the information it is providing.
Speakers
Professor Barbara Bain
Thrombophilia Guideline Update
Thrombophilia Guideline Update
Haematology
Abstract
Thrombophilia is defined as hereditary and/or acquired conditions associated with an increased predisposition to thrombosis. The previous British Society for Haematology guideline on thrombophilia testing (2012) focused only heritable thrombophilia testing. The updated guideline published in 2022 (1) has a widened scope to include both heritable and acquired thrombophilia especially antiphospholipid antibodies, paroxysmal nocturnal haemoglobinuria, myeloproliferative neoplasm (MPN) and the presence of a JAK2 mutation in the absence of an MPN phenotype. Disorders such as cancer, inflammatory conditions and obesity are associated with thrombosis through multiple mechanisms, but these are not included in the guideline which focuses only the factors identified from laboratory testing.
The key principle in the guideline is that when clinical utility of testing is not clear, thrombophilia testing is not mandatory, and testing should be done only if the result will alter the management of the patient. These guidelines emphasise the importance of identifying antiphospholipid syndrome and JAK2 +/- MPN phenotype because they have a significant impact on management. The guidelines confirm the limited utility of testing for hereditary thrombophilia testing in venous thromboembolism, arterial thrombosis and recurrent pregnancy loss.
1. Arachchillage, DJ, Mackillop, L, Chandratheva, A, Motawani, J, MacCallum, P, Laffan, M. Thrombophilia testing: A British Society for Haematology guideline. Br J Haematol. 2022; 198: 443– 458. https://doi.org/10.1111/bjh.18239
Learning outcomes
Delegates will understand:
- The value of thrombophilia testing in guiding anticoagulant therapy.
- When to request specific thrombophilia tests.
- The role of thrombophilia in determining pregnancy outcomes.
- When to test for thrombophilia in obstetric practice.
Speakers
Professor Mike Laffan
Effects of direct thrombin inhibitors [dabigatran/argatroban/bivalirudin] on tests of haemostasis
Meet your Haematology Portfolio examiners
Introduction of New D-dimer Assay in Response to the COVID-19 Pandemic (HSD Case Study)
Introduction of New D-dimer Assay in Response to the COVID-19 Pandemic (HSD Case Study)
Haematology
Abstract
Coagulopathy has been shown to play an important role in COVID 19 infection. Reported abnormal coagulation laboratory values in severe COVID-19 are most notably a 3-to-4-fold increase in D-Dimer (Yao et al., 2020).
Several studies showed that elevated D-dimer in COVID-19 patients is associated with higher mortality. A retrospective cohort study carried out by Zhou, et al. (2020) also associated D-Dimer > 1000ng/ml with higher odds of in-patient death.
At the onset of the COVID 19 pandemic, there was no consensus as to how D-Dimer levels should be used for the management of COVID-19 patients. In April 2020, PAHT decided to use a D-Dimer cut-off of 1000 ng/ml to determine anticoagulation dosage. The source of reference used by PAHT in their decision making employed a D-Dimer assay with a cut off value of 500 ng/ml for the exclusion of venous thromboembolism (VTE). This raised an issue as the source of reference used by PAHT at the time employed a D Dimer assay with a cut-off value of 230 ng/ml for the exclusion of VTE. This meant the trust was unable to implement the new COVID 19 care bundle at the time. The haematology laboratory wanting to do whatever possible to assist patient care agreed to change the current D-Dimer methodology immediately to support the trust COVID 19 care bundle.
The verification and implementation of the new D-Dimer assay with cut of 500 ng/ml for the exclusion of VTE was completed within four weeks. A risk assessment and a change control were put in place to ensure users were made aware of the change in cut-off limit.
This verification and implementation of the new assay was possible through the hard and collaborative work of the haematology technical team with shared vision, motivation coupled with team engagement and strong leadership.
Learning outcomes
Delegates will gain knowledge of:
- The key role the coagulation laboratory played in responding to the COVID 19 pandemic.
- The use of D-Dimer assay as a prognostic maker during the COVID 19 pandemic.
- The effectiveness of the werfen D-Dimer HS500 kit
- The importance of shared vision and team engagement in change management
Speakers
Eva Nkansah CSci FIBMS
Voxelotor in Sickle Cell Disease and its interference in haemoglobin analysis
Voxelotor in Sickle Cell Disease and its interference in haemoglobin analysis
Haematology
Abstract
Sickle cell disease is a monogenetic disorder caused by a mutation in the beta-chain of haemoglobin that leads to the generation of sickle haemoglobin(HbS) which, post deoxygenation state, undergoes polymerisation causing vaso-occlusion crisis .
Voxelotor, a recently approved novel therapeutic agent, modulates the Hb’s affinity for oxygen and thus increases the proportion of oxygenated Hb. This reduces the polymerisation of HbS and reduces the formation of sickle cells. Drug trials have demonstrated that Voxelotor leads an improvement in Hb level with decreased reticulocytes, bilirubin, LDH and decrease the frequency of sickle cell crisis.
One approach to monitor Voxelotor treatment is by quantifying HbS in the laboratory either by high performance of liquid chromatography(HPLC) or Capillary electrophoresis(CE). The aim of this study to assess influence of Voxelotor on the HPLC or CE chromatogram, electrophoregram respectively on HbS(%) level and the impact it can have on the management of the patient.
Analysis of patient blood on Biorad HPLC showed the appearance of a split band of HbS and D impacting significantly on HbS level. This will lead to reporting of lower level of HbS which will have impact on patient clinical management. When the same patient blood sample was analysed on Tosoh-G11 HPLC there was a split band of HbS and HbC but this time the impact was not significant on the HbS. In addition, when the same patient sample was analysed on the Sebia Minicap Capillary electrophoresis similar observation was made that a split band of HbS and another peak of varying level. If the HbS peak were reported as the total HbS level without including the modified HbS peak, then it could mitigate the total level of HbS% (underestimation) which may not instigate appropriate clinical management.
This study concludes that with patients on Voxelotor, HbS level evaluation may require HbS peak manipulation prior to reporting accurate total level of HbS% thus minimizing the impact of Voxelotor on the HbS level reporting. This will trigger as required appropriate clinical intervention.
Speakers
Dr Sukhjinder Marwah
Overview and Escalation of EQA
Overview and Escalation of EQA
Haematology
Abstract
Overview of Governance and Escalation of Persistent Poor Performers," we will be discussing the governance structure of EQA in the UK, as well as poor performance and escalation. We will provide three examples and encourage audience participation
Speakers
Rev Dr Gordon Sinclair
How to report staining intensity for flow cytometry EQA exercises
How to report staining intensity for flow cytometry EQA exercises
Haematology
Learning outcomes
The participant having attended this presentation will learn:
- The importance of staining intensity within haemato-oncology flow cytometry.
- Details of inter and intra laboratory variation.
- How UK NEQAS are trying to harmonise reporting on an EQA basis.
Speakers
Liam Whitby
Evaluation of Measurement Uncertainty – Where we were and where we are going
Evaluation of Measurement Uncertainty – Where we were and where we are going
Haematology
Abstract
Universal fear of the Guide to the Uncertainty of Measurement (GUM) document (JCGM 100:2008) drove medical laboratory scientists from engaging with the concept of measurement uncertainty (MU) for many years. Famed for its “mathematical rigour”, the complexity of the GUM document meant simpler approaches were favoured. Despite existing guidance (CLSI EP29-A) common practice was to define MU as a simple expansion of the coefficient of variation, but MU is not adequately characterised by reproducibility alone (Panteghini, 2022). A formal harmonisation of statistical frameworks followed to simplify the application of metrological principles in medical laboratories (ISOTS 20914:2019).
The top down method incorporates uncertainty throughout the traceability chain from reference material, through manufacturer calibration, local random variability to patient results. This requires engagement between, and within, national measurement institutes, providers of international standards, instruments and reagent manufacturers and medical laboratories. We also need engagement between clinicians and scientists. MU has a direct impact on our interpretation of patient results, and by extension patient outcome. In the laboratory we need to verify performance characteristics, themselves based on performance specifications. Clinically, the expectation is that we are compliant with these specifications to permit interpretation for their intended clinical use.
Using topical examples from haematology we will discuss some of the challenges with the laboratory and clinical application of measurement uncertainty. How do we set desirable performance? Once we have a number how do we know whether it is any good….? What do we do if we exceed it?
Of course, the release of ISO15189:2022 has updated our accreditation requirements, and MU plays a pivotal role. This is not only in the MU clauses. In this session we will discuss what is new in the 2022 standards, what remains from 15189:2012, and how MU is going to have a central role in laboratory practice for many years to come.
References
Braga F, Infusino I, Panteghini M. Performance criteria for combined uncertainty budget in the implementation of metrological traceability. Clin Chem Lab Med. 2015 May;53(6):905-12. doi: 10.1515/cclm-2014-1240. PMID: 25870964.
Panteghini M. The simple reproducibility of a measurement result does not equal its overall measurement uncertainty. Clin Chem Lab Med. 2022 Jul 11;60(10):e221-e222. doi: 10.1515/cclm-2022-0618. PMID: 35802464.
CLSI EP29-A. Expression of measurement Uncertainty in laboratory medicine; Approved Guideline, CLSI, 2012
ISOTS 20914:2019, Medical Laboratories – Practical guidance for the estimation of measurement uncertainty, 2019
Learning outcomes
The new ISO15189:2022 standard section on Measurement of Uncertainty has been updated. The speaker will review the updates and what they mean for laboratory practice.
Speakers
Dr Stephen MacDonald
Learnings from Parasitology EQAs: a discussion with UK NEQAS Parasitology
Learnings from Parasitology EQAs: a discussion with UK NEQAS Parasitology
Haematology
Abstract
Global travel and migration trends have meant a huge increase in the numbers of people exposed to tropical parasitic diseases. Thus, there is an increasing need for robust, reproducible and reliable screening as well as diagnostic techniques. These existing and emerging technologies all currently co-exist; each with their own specific and general pitfalls and limitations.
Thus, the need for fit-for-purpose qualitative EQAs or Proficiency Testing schemes for these parasite diagnostics remains pivotal and very timely. My talk at this congress will present findings and recommendations from Parasitology EQA schemes offered by UK NEQAS and will highlight the importance of quality management in the field.
Learning outcomes
The participant having attended this presentation will gain knowledge on the advances and changes in parasitology.
Speakers
Jaya Shrivastava
Digital Morphology for CPD. What can we learn about morphology reporting from the past 15 years?
Digital Morphology for CPD. What can we learn about morphology reporting from the past 15 years?
Haematology
Learning outcomes
The UK NEQAS(H) digital morphology scheme for CPD launched in 2008, since then more than 40 blood cell morphology cases distributed to participants, with more than 1000 laboratory-based professionals completing each case.
The morphology cases present participants with an image of blood cells and some limited clinical information and ask participants to prioritise the morphology features they consider relevant and suggest a morphological diagnosis. Aimed at all levels of morphology skill, the cases are varied and cover conditions staff may expect to see in their working practice.
Speakers
