ACBI Scientific Meeting Galway
12 February 2010
Liam Blake, Principal Clinical Biochemist, Galway University Hospitals.
The first ACBI meeting of the new decade took place in the Radisson Hotel overlooking Lough Altalia in Galway city. 55 people attended, representing a good cross section of laboratory professionals, from Ireland and abroad.
The Implementation of IFCC Standardised HbA1c
Dr Ned Barrett, Consultant Clinical Biochemist,
Mid-Western Regional Hospital, Dooradoyle, Limerick.
Dr. Ned Barrett was the first speaker. He presented on the ongoing implementation of the IFCC standardised HbA1c. As chairman of the HSE’s Diabetes Expert Group subcommittee leading the introduction of the new HbA1c reporting system in Ireland, he is in a unique position to speak on the subject. There is a need to measure HbA1c accurately and precisely so that results for a person with diabetes can be directly related to published studies and consequently to outcome risks. Implementation of the IFCC standardisation will contribute to improving the measurement of HbA1c.
A requirement for measurement systems is metrological traceability. For HbA1c, the IFCC published a reference method in 2002 and measurements are traceable to the HbA1c mole and are expressed as mmol/mol. The management of the implementation of HbA1c methods traceable to the IFCC standard is complex involving many stakeholders across the health service including patients, clinicians, administrators and scientists.
Cat among the Pigeons!
Biochemical Diagnosis of Phaeochromocytoma.
Ms Alison Griffin, Medical Scientist,
Beaumont Hospital Dublin .
The Biochemical Diagnosis of Phaeochromocytoma was the title of the next presentation. Ms Alison Griffin provided a clear, concise and comprehensive overview of the subject. The relevant terminology and concepts were presented along with the appropriate required analyses. The sample requirements applicable and the reference ranges in use in the Beaumont Hospital HPLC laboratory, where Ms Griffin is part of the team, were also presented. Drug interference in the biochemical assessment of phaeochromocytoma can be avoided by stopping treatment for an appropriate time before samples are collected. The audience were advised to refer to the recommendations for clinical practice from the First International Symposium on Phaeochromocytoma for detailed information. Tandem Mass Spectroscopy (MS) for plasma free metanephrines is a highly sensitive method for diagnosis of phaeochromocytoma. At present the Beaumont service provides a strong link to the Clinical Biochemistry Department of the Freeman Hospital in Newcastle in the UK where Tandem MS is available. Recently the Beaumont laboratory purchased a Tandem MS system and the intention is to provide a service for plasma metanephrines.
Demand Management a Protocol Driven Approach
Ms Caroline Joyce, Principal Clinical Biochemist,
Cork University Hospital.
Ms Caroline Joyce was scheduled to present Demand Management a Protocol Driven Approach. She was, however, unable to attend and Dr. John O’Mullane spoke in her place. The recently commenced haemochromatosis genetic testing service in Cork University Hospital was chosen as a model for protocol driven demand management. As part of the Cork Kerry single health care system reconfiguration a haemochromatosis clinical sub group was formed to determine the evidence based guidelines for requesting genetic testing for the condition. The group consisted of stakeholders from all relevant areas of the health service and patients’ representatives. They worked quickly and efficiently to agree the guidelines and a protocol which was implemented promptly. The findings of a clinical and financial audit carried out after three months of the new service was presented. It showed significant financial savings and clinical benefits, for example the use of a standard approach to the testing, across the system. This presentation demonstrated that the sub group approach to developing protocols for demand management can be very successful with good clinical leadership and early involvement of the stakeholders.
Roche Biomedical Frontiers Award
Dr Leonard Marshall
After a nice lunch the afternoon talks started with Dr Leonard Marshall from Roche Diagnostics Limited. He announced the Roche Biomedical Frontiers Award which acknowledges and rewards excellence in the field of biomedical science research within medical sciences in Ireland. Calls for abstracts will be in May/June this year and the award will be presented at the Roche Irish Users Meeting in September.
Laboratory Modernisation: the Swansea Experience.
Dr Andar Gunneberg, Consultant Chemical Pathologist,
Appropriate for a meeting in the bilingual capital of Ireland, the guest speaker from abroad Dr. Andar Gunneberg opened his talk on Laboratory Modernisation: the Swansea Experience with cupla focal as Gaeilge. Dr Gunneberg presented an overview of three phases of clinical biochemistry laboratory modernisation in the Swansea area. In 1995 three departments were consolidated into one. A common LIMS across these departments and changes in work practices, which facilitated implementation of a shift system for biomedical scientists, helped this consolidation. A further phase of consolidation occurred in 2006 when a large clinical biochemistry laboratory merged with a smaller one. This process highlighted the differences in each, as newly agreed practices were implemented. The clinical biochemistry laboratory and the haematology laboratory are now consolidating into a blood sciences laboratory and this process started in 2009. The two departments have different LIMS and cultures. Multi-skilled biomedical scientists are required and their training takes some time.
Of these three consolidations, the latter two were for financial savings which were not retained by the biochemistry department. Dr. Gunneberg presented impressive on-site staff requirement figures for these consolidated services. The lessons from laboratory modernisation in Swansea are to have strong political support, comprehensive IT integration and good communication. Avoid patronising the participants and ensure discussions with all involved take place before announcements of mergers.
The Diagnosis and Management of Diabetes in Pregnancy
Professor Fidelma Dunne, Consultant Endocrinologist,
Head of School of Medicine,
National University of Ireland, Galway.
Professor Fidelma Dunne presented on The Diagnosis and Management of Diabetes in Pregnancy. Prof. Dunne leads the Atlantic DIP “Diabetes in Pregnancy” programme whose aim is to improve the outcomes in pregnancy for women with diabetes by promoting evidence based best practice before, during and after pregnancy. Diabetes in pregnancy has implications for the mother, the child and for future generations. Atlantic DIP examines pregnancy outcomes in women attending 5 hospitals in HSE West region. Data from the women is collected and evaluated using the DIAMOND software. Professor Dunne presented data from the Atlantic DIP studies which is concurs with data from the HAPO (Hyperglycaemia and Adverse Pregnancy Outcome) studies. She noted that pregnancy outcomes and service delivery could be improved by patient education, professional education, combined antenatal care and pre-pregnancy care clinics for women.
Acute Kidney Injury: Laboratory Aspects.
Dr David Lappin, Consultant Nephrologist,
Merlin Park Hospital, Galway.
Dr David Lappin presented on Laboratory Aspects of Acute Kidney Injury. Formerly referred to as acute renal failure, acute kidney injury (AKI) has no universal definition. The RILFE (Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage kidney disease) classification scheme for AKI was published in 2004 and uses separate criteria for serum creatinine and urine output. Some 5 to 20 % of hospital admissions are associated with AKI.
AKI can be classified as pre-renal, intrinsic and post renal. Routine laboratory tests used to aid discrimination between the former two presentations include urinary sodium concentration and osmolality, fractional excretion of sodium and the ratio of serum urea to creatinine. Some 30 to 40% of patients with rhabdomyolysis progress to acute renal failure. Creatine kinase is the best biomarker for rhabdomyolysis. AKI is an extremely morbid disorder with a significant proportion of patients progressing to end-stage renal failure requiring dialysis.
Serum creatinine is an insensitive and unreliable biomarker during acute changes in kidney function, performing poorly in the setting of AKI. Dr. Lappin reviewed cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and Interleukin-18 as novel biomarkers for use in AKI. He directed attendants to publications on urinary matrix metalloproteinase-9 (MMP-9), N-acetyl-β-D-glucosaminidase (NAG) and kidney injury molecule-1 (KIM-1) as biomarkers for the detection of AKI. To date, all of these biomarkers have been tested in small studies and specific clinical situations. Further studies in large cohorts with multiple clinical conditions might substantiate the utility of these biomarkers.
Evaluation of PSA service in Ireland.
Dr Ophelia Blake, Principal Clinical Biochemist,
St James’s Hospital, Dublin.
During the period 1994 to 2004 a dramatic increase in the incidence of prostate cancer occurred in Ireland. Prostate cancer mortality remained unchanged during this period. These patterns suggested there was likely to have been extensive and increasing use of prostate specific antigen (PSA) testing in Ireland. In 2007 the National Cancer Registry of Ireland (NCRI) published the results of a survey which investigated PSA services in Ireland. Dr. Ophelia Blake, presenting Evaluation of PSA Service in Ireland, reviewed the findings of the NCRI survey. Data on workload, source of requests, assay platforms used, pre and post analytical factors and EQA participation were presented. The cost for PSA testing in Ireland in 2007 was conservatively calculated to be over five million euro. The NCRI survey indicated the sources of PSA inter-lab variability in Ireland include differences in assays employed, sample handling, assay standardisation, antibody specificity and the PSA stability. The survey went on to recommend standardisation of PSA services as a matter of priority.
The National Cancer Control Program (NCCP) Prostate Cancer Subgroup was convened with the aim of standardising the PSA diagnostic service in Ireland. Dr. Blake, who serves on this sub-group, presented data collated by them. An overview of the PSA diagnostic service in Ireland and summary of the assay characteristics were reviewed. EQA and NHS Purchasing and supply agency findings for PSA were also reviewed. The importance of PSA assay equimolarity was highlighted. Further sources of variability in PSA measurement were discussed including the lack of a defined antigen and reference method for PSA and assay design differences. Dr. Blake concluded by reminding the audience that there are common immunoassay platforms in situ in Clinical Biochemistry laboratories in the majority of the designated centres, and that a consensus approach should be developed to address the harmonisation of the PSA diagnostic service.
Drummond FJ, Sharp L, Comber H. Major inter-laboratory variations in PSA testing practices: results from national surveys in Ireland in 2006 and 2007. Ir J Med Sci 2008;177:317-23.
Roddam AW, Price CP, Allen NE, Ward AM. Assessing the Clinical Impact of Prostate-Specific Antigen Assay Variability and Nonequimolarity: A Simulation Study Based on the Population of the United Kingdom. Clin Chem 2004;50:1012-6.
Drummond FJ, Carsin AE, Sharp L, Comber H. Trends in prostate specific antigen testing in Ireland: lessons from a country without guidelines. Ir J Med Sci 2010;179:43-9.
The meeting location proved popular with those travelling to Galway by train as it is close to Ceannt station. Feedback from the meeting was favourable and attendants had the opportunity for chat and networking, which is an enjoyable and integral part of our meetings
The organising team extend their thanks to Roche Diagnostics Limited for their generous sponsorship and to the chairpersons on the day. A special note of gratitude is extended to Dr. Helen Grimes and Niamh Cavanagh who provided invaluable help in running the registration desk and helping greatly in the administration of the meeting.
Consultant Clinical Biochemist
Principal Clinical Biochemist
Galway University Hospitals