Breakfast Roundtables

Breakfast Roundtables will be held on Monday June 20 and Wednesday June 22.

 

MONDAY ROUNDTABLES

Monday June 20 Breakfast – 0715-0815

  • RM3001 Clinical Case ‘Pearls’ for Laboratory Professionals
  • RM3002 Clinical Utility of Time-of-Flight High Resolution Mass Spectrometry for Broad Spectrum Drug Screening in Urine
  • RM3003 Hemoglobinopathy Investigation for Chemists
  • RM3004 Malabsorption Testing: When and What to Test
  • RM3005 Choosing Thyroid Hormone Tests Wisely: A Rational Approach to Decrease Unnecessary T3/T4 Testing in a Large Academic Teaching Hospital Environment
  • RM3006 Pharmacogenetics for Drug Hypersensitivity Reactions
  • RM3007 The Cost of Quality: A Laboratorian’s Perspective

 

WEDNESDAY ROUNDTABLES

Wednesday June 22 Breakfast – 0715-0815

  • RW4001 Setting up LC-MS Testing in a Large Clinical Lab from the Ground Up – from RFP to Go-live
  • RW4002 Challenges in HbA1c Testing in 2016
  • RW4003 Sharing Tips and Tricks of Teachers
  • RW4004 Detection of Colorectal Disease: A New Paradigm Based on Faecal Haemoglobin Measurements
  • RW4005 Allergy Testing
  • RW4006 The Inconvenience Truth about Near Patient Testing at Doctor’s Office
  • RW4007 IgG4-related Disease: Lessons Learned from Investigating a Patient with a Serum IgG of 70 g/L

 

 

RM3001 Clinical Case ‘Pearls’ for Laboratory Professionals
Monday June 20, 0715-0815

 

Janet Simons, McMaster University

 

Objectives:

At the end of the session, the participants will be able to:

  • Describe the role of the laboratory in collaborating with physicians at the bedside.
  • Appreciate how laboratory results are used to influence patient care.
  • Understand a few unique situations when the clinical biochemist can have a particularly large impact on patient care.

Day-to-day, clinical biochemists help manage difficult samples and facilitate interesting test requests. Do you ever wonder what happens with those ‘interesting’ cases after the results have been released? This session will review several interesting clinical cases where the key to diagnosis required some special troubleshooting or direct involvement from the clinical biochemist in the laboratory. Follow the patient stories and see how the work done behind the bench influences the care provided to the patient in the ward or clinic. Cases will cover a broad spectrum of our experiences as laboratory based physicians. These will include a child with a complicated case of hypernatremia, a pregnant patient suspected of having cancer, a urine drug screen ordered for hypoglycemia and a sample so vicious that it could not be aspirated, leading to an unexpected diagnosis. This workshop will feature 10-12 case vignettes which will direct discussion around specific issues in sample handling, test utilization, assay selection and interferences, and result reporting. Audience participation in discussing each case will be encouraged. By attaching each learning point to a patient story, participants will leave with a good memory of these important ‘clinical pearls’ which may come up in future practice..

 

 

RM3002 Clinical Utility of Time-of-Flight High Resolution Mass Spectrometry for Broad Spectrum Drug Screening in Urine
Monday June 20, 0715-0815

 

Imir Metushi, University California, San Diego

 

Objectives:

At the end of the session, the participants will be able to:

  • Explain key differences between immunoassays, LC-MS/MS and TOF-HRMS when performing urine drug testing.
  • Create a validation plan for broad urine drugs screen using TOF-HRMS.
  • Understand the limitations behind the use of TOF-HRMS in the clinical.

Urine drug screening is among the most widely used procedures in the clinical/toxicology laboratories. Immunoassay technique is the frontline method used for drug screening followed by confirmation through liquid chromatography coupled to unit resolution tandem mass spectrometry (LC-MS/MS). LC-MS/MS isolates the protonated analyte [(M+H)+] of interest followed by fragmentation in the collision cell and monitoring of one or more product ions. However, this method is limited by: 1) co-eluting compounds of similar structure 2) fragmentation does not always produce product ions, and 3) it is difficult to perform non-targeted screening.

Recently, high resolution mass spectrometry (HRMS) such as time of flight-mass spectrometry (TOF-MS) has been proposed as an alternative for non-targeted drug screening.

TOF-MS offers several advantages to the traditional low-resolution tandem MS, some of which include: greater specificity and the ability to retrospectively analyze data without the need to have a reference standard. Therefore, HRMS has the ability to perform broad spectrum screening with superior specificity than immunoassay without the need for additional confirmation by LC-MS/MS. However, it is important that such methods be well evaluated before they are put into production in order to avoid any false positive or false negative results and to realize other limitations of the methodology. This session will discuss the applications of time-of-flight high resolution mass spectrometry (TOF-HRMS) in toxicology during drug testing. A comparison of TOF-HRMS vs. the traditional LC-MS/MS will be discussed. The approach that our institution has followed in validating a TOF-HRMS method for urine drug screening will be illustrated.

Back to top

 

RM3003 Hemoglobinopathy Investigation for Chemists
Monday June 20, 0715-0815

 

Mathew Estey, DynaLIFEDx

 

Objectives:

At the end of the session, the participants will be able to:

  • Identify the various types of mutations that can occur within the globin genes.
  • Describe the key laboratory components of a hemoglobinopathy investigation, and the expected results in patients with structural hemoglobin variants and/or thalassemia.
  • Diagnose structural hemoglobin variants and thalassemia given hemoglobinopathy investigation data.

Back to top

 

RM3004 Malabsorption Testing: When and What to Test
Monday June 20, 0715-0815

 

Lawrence de Koning, Alberta Children’s Hospital

 

Objectives:

At the end of the session, the participants will be able to:

  • Understand the pathophysiology underlying major types of nutrient malabsorption.
  • Describe laboratory tests that support malabsorption diagnoses.
  • Develop a plan to direct appropriate utilization of difficult tests.

Malabsorption is a condition resulting from impaired digestion, absorption, or transport of nutrients. The inability to utilize nutrients by any of these mechanisms results in malabsorption syndromes, which can be clinically complex. For example, fat malabsorption leads to steatorrhea and weight loss but also deficiencies in fat-soluble vitamins. Strategies for malabsorption diagnosis frequently utilize tests that are demanding for both the patient and laboratory. These include tolerance tests and labor-intensive manual procedures involving dangerous reagents. Malabsorption testing may therefore benefit from utilization management as well as testing algorithms that first involve simpler screening tests, clinical information and finally demanding confirmatory tests. This round-table will describe such strategies, providing a practical example involving 72-hour fecal fat testing.

Back to top

 

RM3005 Choosing Thyroid Hormone Tests Wisely: A Rational Approach to Decrease Unnecessary T3/T4 Testing in a Large Academic Teaching Hospital Environment
Monday June 20, 0715-0815

 

Paul Yip, University Health Network

 

Objectives:

At the end of the session, the participants will be able to:

  • Explain the current recommendations for appropriate utilization of routine thyroid hormone tests.
  • Describe the application of clinical decision support systems to guide ordering practices.
  • State key metrics for analysis and monitoring of ordering patterns to validate the design of test panels.

Back to top

 

RM3006 Pharmacogenetics for Drug Hypersensitivity Reactions
Monday June 20, 0715-0815

 

Elsie Yu, Geisinger Health System

 

Objectives:

At the end of the session, the participants will be able to:

  • Understand the difference between early onset and late onset drug hypersensitivity reactions.
  • Understand why certain drugs tend to cause hypersensitivity reactions in a sub-population.
  • Identify common pharmacogenetic makers for Drug Hypersensitivity Reactions.
  • Identify factors that are critical for successful implementation of pharmacogenetic screen to prevent drug hypersensitivity reaction.

Drug-induced hypersensitivity reactions remain to be serious public health issues. Clinical presentations vary from mild rash to severe cutaneous reactions or other single-organ (e.g. liver) drug hypersensitivity. Drug hypersensitivity reactions are typically triggered by either IgE or T-cell mediated immune response. In serious cases, they can be life-threatening. A number of genetic markers have been shown to associate with drug-induced hypersensitivity. One of the key discoveries is the association of specific HLA alleles with drug hypersensitivity reactions. This makes it promising that drug-hypersensitivity may be prevented with pharmacogenetic screening.

This session will describe early onset and late onset of drug-induced hypersensitivity reactions and provide an update on current knowledge of pharmacogenetic associations of drug-hypersensitivity. I will be using a few cases to explore factors needed for successful translation of pharmacogenetic findings to clinical use, and discuss how the use of pharmacogenetic testing prior to initiation of drug use may affect clinical management and prevent drug hypersensitivity.

Back to top

 

RM3007 The Cost of Quality: A Laboratorian’s Perspective
Monday June 20, 0715-0815

 

Raffick Bowen, Stanford Health Care

 

Objectives:

At the end of the session, the participants will be able to:

  • Name the four types of quality costs.
  • Identify some of examples of each type of quality costs in the clinical laboratory.
  • Understand how to use quality costs to improve laboratory operations and decrease costs.

Quality, or the lack of quality, affects a clinical laboratory from supplier to patient. A successful quality strategy starts with a clinical laboratory culture that fosters quality, followed by an understanding of the principles of quality, and engaging and empowering employees in the necessary activities to implement quality. When these things are done well, the clinical laboratory typically satisfies its suppliers and patients and obtains a competitive and reputational advantage. The concept of quality costs (COQ) was first described by Joseph M. Juran in 1951 and it was primarily implemented in the manufacturing industry. Juran strongly believed in top-management commitment, support, and involvement in quality initiatives. The cost of poor quality is the costs from defective parts or services. Studies have shown that poor COQ can be as much as 30% of all health care expenditures and one report indicated that ~ 25% of its total clinical laboratory expenditures were due to poor COQ. Many experts believe that poor COQ is consistently underestimated. Most organizations are not aware of their quality costs because it is not collected. However, with advanced information technologies, the identification, measurement, and monitoring of quality costs is easier and can have a significant impact on improving quality and reducing costs. Does your clinical laboratory monitor quality costs? Are COQ a line item in the budget? What method do you use to calculate COQ? What data are you using for benchmarks?

 

 

RW4001 Setting up LC-MS Testing in a Large Clinical Lab from the Ground Up – from RFP to Go-live
Wednesday June 22, 0715-0815

 

Danijela Konforte, Lifelabs

 

Objectives:

At the end of the session, the participants will be able to:

  • Identify major criteria to consider when selecting MS instrumentation for their laboratory.
  • Identify important questions and resources needed for MS method development and validation planning and execution.
  • Plan for key resources needed for successful project implementation.

 

 

RW4002 Challenges in HbA1c Testing in 2016
Wednesday June 22, 0715-0815

 

Trefor Higgins, DynaLIFEDx

 

Objectives:

At the end of the session, the participants will be able to:

  • The reasons for the substantial increase in hbA1c testing.
  • The effect of immigration on the incidence of Hb variants found.
  • The current goals for analytical performance.
  • Utilization strategies.

Requests for HbA1c measurements are increasing faster than any other single test in the laboratory. Reasons for this are the increase in the incidence of diabetes due to the aging population and sedentary lifestyle and the use of HbA1c to screen and diagnose diabetes. The increase in immigration from regions of high incidence of hemoglobin variants has provided challenges in the measurement of HbA1c in these individuals. Recent guidelines have narrowed the goals for analytical imprecision and this has presented a new challenge to both laboratories and manufacturers to meet these new goals. To cope with this increase in testing laboratories need to develop utilization guidelines, based on international and local guidelines to curb the excess ordering of HbA1c tests.

Back to top

 

RW4003 Sharing Tips and Tricks of Teachers
Wednesday June 22, 0715-0815

 

Vilte Barakauskas, BC Children’s and Women’s Health Centre

 

Objectives:

At the end of the session, the participants will be able to:

  • Recognize the importance of engaging students with varied learning styles when teaching.
  • Recall several interactive teaching and learning techniques.
  • Apply active learning strategies in both small-group and large-cohort classes.
  • Draw on others’ teaching experiences to improve their own teaching and learning skills.

“Teacher” is one of the permanent hats in a clinical chemist’s wardrobe. We teach all the time – in conventional settings like medical schools and med tech programs, to our peers during presentations and workshops, and informally with trainees and laboratory staff. Interestingly, teaching skills are often not explicitly cultivated during our training. Teaching and learning in laboratory medicine may be challenging due to varied teaching contexts and learner heterogeneity. This roundtable will provide an opportunity to share challenges you face when teaching. A brief background to the concept of interactive learning will be provided. Examples of strategies to engage learners in a variety of different ways will be available and of techniques applied in clinical chemistry courses will be shared. Participants should come ready to contribute their own teaching tips, tricks and flops. This session will provide a chance to share, swap and add techniques to your own teaching toolbox that you can bring home and use! Note: A brief survey will be circulated to participants prior to the workshop.

Back to top

 

RW4004 Detection of Colorectal Disease: A New Paradigm Based on Faecal Haemoglobin Measurements
Wednesday June 22, 0715-0815

 

Callum Fraser, Centre for Research into Cancer Prevention and Screening

 

Objectives:

At the end of the session, the participants will be able to:

  • List the disadvantages of traditional guaiac-based faecal occult blood tests.
  • Describe the advantages of faecal immunochemical tests for haemoglobin in asymptomatic population colorectal cancer screening.
  • Discuss the relationships between faecal haemoglobin concentration and age, sex, deprivation and other factors.
  • Describe, and justify, the use of faecal haemoglobin concentration measurements in assessment of patients with lower abdominal symptoms and other clinical settings.
  • List the advantages of faecal immunochemical tests for haemoglobin in colorectal cancer screening.
  • Discuss the relationship between faecal haemoglobin.

Fecal immunochemical tests (FIT) are regarded as best non-invasive asymptomatic population screening tests for colorectal cancer (CRC). Quantitative FIT give faecal haemoglobin concentrations (f-Hb). Choice of cut-off is complex. Many patients present with lower abdominal symptoms, although significant colorectal disease (SCD = CRC + advanced adenoma + inflammatory bowel disease) is rarer. In practice, f-Hb, at low cut-off, has very high sensitivity for CRC and potential as a rule-in test, with a positive test result requiring rapid referral. More importantly, f-Hb has high negative predictive value for SCD. A negative test result provides considerable reassurance that significant disease is absent.

Back to top

 

RW4005 Allergy Testing
Wednesday June 22, 0715-0815

 

Karina Rodriguez-Capote,

 

Objectives:

At the end of the session, the participants will be able to:

  • To discuss the clinical utility and performance of laboratory assays for allergy testing.
  • To discuss major allergens and testing performed at DL.
  • To present DL strategy to improve allergy test utilization.

Serum allergen specific IgE (sIgE) levels correlate with an increased likelihood of clinical allergy. The use of in vitro allergen specific IgE testing is increasing in primary care where the skin prick/puncture test is impractical and waiting times from patient referral to specialist consultation are often lengthy. Furthermore, serum sIgE is particularly relevant in patients with medical conditions contraindicating in vivo testing. Our institution is the sole laboratory performing allergy testing for a catchment area of 2 million people in Northern Alberta, Canada. We performed an audit of all the allergy testing performed on 2013. Processes, procedures, and policies for allergy testing were outdated and not in-line with new guidelines. Modifications on the positive screen reflex testing allowed a saving of 23,359 tests six months after implementation.

Back to top

 

RW4006 The Inconvenience Truth about Near Patient Testing at Doctor’s Office
Wednesday June 22, 0715-0815

 

Elsie Yu, Geisinger Health System

 

Objectives:

At the end of the session, the participants will be able to:

  • Understand the clinical roles of near patient testing at Doctor’s office.
  • Differentiate the clinical needs vs wants of near patient testing at Doctor’s office.
  • Identify common issues of near patient testing at Doctor’s office.

Performing laboratory testing at the Doctor’s office allows practitioners to provide immediate consultations, diagnosis and treatment. This could improve patient engagement and satisfaction. However, proper laboratory practice and regulatory compliance issues add a layer of complexity to the management of testing. In addition, performing near-patient testing at Doctor’s office may add additional cost to the operation. As healthcare budgets tightened, the overall cost vs benefit must be thoroughly evaluated.

In this session, we will look at a few examples to explore the clinical needs, potential advantages and disadvantages, of near patient testing at the primary care physician’s office. We will also discuss a few common laboratory issues relating to the use of point-of-care testing at the community clinic. Finally, we will examine the complexity of proper laboratory management at the Doctor’s office, including cost-effectiveness, regulatory compliance and proper laboratory practice.

Back to top

 

RW4007 IgG4-related Disease: Lessons Learned from Investigating a Patient with a Serum IgG of 70 g/L
Wednesday June 22, 0715-0815

 

PC Chan, Sunnybrook

 

Objectives:

At the end of the session, the participants will be able to:

  • Describe what IgG4-related diseases and their clinical presentations are.
  • Describe the diagnostic challenges of IgG4RD.
  • Describe the use and pitfalls of IgG subclass assays in the investigation of IgG4RD.

IgG4-related disease (IgG4RD) is a relatively newly appreciated disease that encompasses a host of conditions involving multi-organs previously regarded as separate entities. Frequent findings include elevated serum IgG4 concentrations and pathologic features such as lymphoplasmacytic IgG4 infiltrate, “storiform” fibrosis, tendency for obliterative phlebitis, and mild to moderate tissue eosinophilia.

This Round Table will focus discussion surrounding the presentation and investigation of a patient with a serum IgG concentration of 70 g/L, with particular reference to the challenges experienced in demonstrating elevated IgG4 concentrations and the involvement, if any, of a monoclonal gammopathy. Other hematological and pathological findings will also be presented to illustrate the diagnostic challenges and confusion experienced with this case.

Target audience includes Clinical Chemists, Hematopathologists and Medical Laboratory Technologists with some knowledge and experience in immunologic and monoclonal gammopathy investigations.