Breakfast Roundtables

Breakfast Roundtables will be held on Tuesday June 23 and Wednesday June 24.

 

TUESDAY ROUNDTABLES

Tuesday June 23 Breakfast – 0715-0815

 

WEDNESDAY ROUNDTABLES

Wednesday June 24 Breakfast – 0730-0830

 

 

RT2301 Choose the Most Suitable Blood Collection Tube for Routine Chemistry and Immunoassay Tests in Your Institution
Tuesday June 23, 0715-0815

 

Yu Chen, Horizon Health Network

 

Objectives:

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

  • Describe the pros and cons for serum and plasma specimen type for routine chemistry and immunoassay tests.
  • Describe the benefits and disadvantages of the Becton Dickinson Vacutainer® plasma separator tube.
  • Describe the benefits and disadvantages of the Becton Dickinson Vacutainer® rapid serum tube.

Completely clotted ‘cell free’ serum is the standard specimen for clinical chemistry and immunoassay testing. Serum tubes with gel separator are widely used in clinical laboratories, especially for those with a preanalytical automation. As with all other serum tubes, the Becton Dickinson (BD) serum separator tube requires a blood clotting time of at least 30 min. This practice does not meet the demand for faster laboratory result turn-around time in critical care units, such as emergency departments and intensive care units to reduce the time to make decisions, interventions, and shorten patient’s length of stay. Even for clinical programmes based outside the hospital (eg, Extramural Program) and remote blood collection sites, this clotting time may be excessive for a timely separation of samples in order to facilitate transport to the regional laboratory. Plasma has been proposed as an alternate specimen type for clinical chemistry testing, however, plasma has its well-known limitations, such as higher cell counts, reduced storage stability for certain analytes, potential interference from fibrinogen and anticoagulants among others. To provide laboratories with a fast turn-around time similar to a plasma specimen, and the quality of a properly clotted serum specimen, BD recently developed a Vacutainer® rapid serum tube containing bovine thrombin and gel technology to speed blood clotting time to 3–5 min. This session will discuss the pros and cons of serum and plasma for routine chemistry and immunoassay tests, and our recent experience on evaluation of the BD plasma separator tube and the rapid serum tube.

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RT2302 Decision Support for Urine Drug Testing for Pain Management
Tuesday June 23, 0715-0815

 

Hoi-Ying (Elsie) Yu, Geisinger Medical Laboratories

 

Objectives:

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

  • Describe the challenges face by providers in urine drug tests.
  • Describe the limitations of urine drug tests.
  • Apply decision support for pain medication compliance monitoring.

The use of urine drug test to monitor drug compliance and prevent diversion is a common practice for opioids prescriptions. However, providers are often not proficient at urine drug testing. This roundtable will discuss the challenges face by the providers and ways for the lab to provide decision support.

In Canada, abuse of prescription drugs has grown to epidemic proportions. Opioids and Benzodiazepines are the two most widely diverted classes of prescription drugs. Providers rely on the use of urine drug test to detect drug diversion and abuse, but are often not proficient at proper test ordering and results interpretation.

Traditionally, the lab solves this problem by providing educations and consultative services to providers. While this approach can be effective for some providers, most generalists in community practice continue to find it overwhelming with too much to keep up with. Another approach is to use custom-built lab order sets. However, it is quite impossible to build a single order set that can tailor to different medication regimens. In addition, this does not alleviate problems in results interpretation.

Earlier in 2014, our lab has launched a custom-built “compliance monitoring” test in the EMR that allows the lab to perform the “right” tests and provide a simple interpretive report for the results base on the medications listed by the providers as require for compliance monitoring. We will discuss the clinical and technical considerations in building this type of reflex test electronically.

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RT2303 Metal Toxicity and Hip Implants
Tuesday June 23, 0715-0815

 

Penny Colbourne, University of Alberta Hospital

 

Objectives:

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

  • Summarize why metal toxicity is a concern in patients receiving a metal-on-metal hip implant.
  • Identify the trace elements and the matrices that are analyzed in patients who have received metal-on-metal hip implants.
  • Describe the relationship between trace element results and management of those patients who have received a metal-on-metal hip implant.

Exposure to metal ions is a concern in patients with a metal-on-metal hip implant. Exposure to these metal ions has the potential to cause systemic effects including hypersensitivity reactions, osteolysis and pseudotumors. Both published reports and guidance documents are available with respect to the monitoring of biological samples for trace elements. Suggestions have been made as to what constitutes a level of concern and how the levels can be used in patient management.

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RT2304 Dry Blood Spots, Microfluids, Mini Mass Spec – The Future is Here
Tuesday June 23, 0715-0815

 

Bhushan Kapur, Sunnybrook Health Science Center

 

Objectives:

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

  • Know the advantages and limitations DBS in Clinical Chemistry and TDM/Toxicology.
  • Review the recent development in microfluidic technology in TDM and Toxicology.
  • Discuss for target analysis, a back-pack Mini-Mass Spectrometer that can do the job.

In the recent past, many publications have appeared using Dry Blood Spot (DBS) to do chemistries such as hormone and TDM drugs. This technology is very exciting, as it has the ability to bring various chemistries to the bedside. Hematocrit is a significant limitation of DBS.

Mass-spectrometer (MS) is a detector that is coupled with the separation device such as gas or liquid chromatograph. Chromatographic method act as bio-fluid separation device and introduce the analyte into the MS. If a reasonable method to introduce the analyte into the MS is available, and, target analyte analysis is the objective, then separation device is redundant.

Substantial advances in “microfluidic-chips” technology have been made. In situ enzymatic, ELISA and other reactions can be performed by loading microfluidic-chip with various reagents. The products of these reactions can be introduced into the MS, obviating the need for a separation device.

Significant advances in miniaturization of MS have been achieved, and mini-MS, the size of a backpack is now available. Adding, DBS or a drop of urine to a microfluidic-chip, we can now analyze for Drugs-of-Abuse or other analytes using a mini-MS as its detection and quantitation device.

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RT2305 Fluid Chemistry Analysis on Clinical Biochemistry Laboratories
Tuesday June 23, 0715-0815

 

AbdulRazaq Sokoro, Diagnostic Services of Manitoba Inc. (DSM Inc.)

 

Objectives:

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

  • Describe the challenges present in providing fluid chemistry analysis.
  • Report on the requirements and approaches to validate fluid chemistry analysis.
  • Express the guidelines available for fluid analysis of fluid chemistry analysis.

The purpose of the Fluids Interest Group Roundtable is to provide an opportunity to those with an interest in fluid chemistry analysis to discuss the requirements of such testing, approaches and available guidelines. Most of clinical laboratory analyzer methods do not necessarily does not include validated analysis of all body fluids. Clinical Laboratory analyzer manufactures do not necessarily market their instruments to include for all fluid type analysis, leaving laboratories to figure a way to do so. This has led to significant challenges to the analysis of body fluid chemistries despite the need for clinical care. The roundtable will discuss and provide an opportunity for participants to share their experiences in their own laboratories as well as present what the fluids interest group has done so far with respect to providing a guiding document for clinical laboratories for fluid analysis.

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RT2306 L’avenir des dosages salivaires dans les laboratories Clinique dans un avenir proche?
Tuesday June 23, 0715-0815

 

Guy Fink, Université de Sherbrooke

 

Objectifs d’apprentissage :

Au terme de la session, le participant sera en mesure de :

  • Comprendre les limites physiologiques et analytiques de l'utilisation de la salive comme fluide biologique.
  • Déterminer les molécules candidates pour le dosage salivaire en biologie clinique.
  • Discuter des prémisses nécessaires à leur mise en œuvre dans nos laboratoires.

Après avoir brièvement discuté de la composition et de l’utilité physiologique de la salive, cette table ronde permettra aux participants d’être en mesure d’évaluer les possibilités qu’offre ce fluide biologique comme outil diagnostic en biologie clinique. On passera en revue les grandes classes de molécules susceptibles d’être de bons candidats pour les laboratoires cliniques. De même, on discutera des défis analytiques et des limitations que représente le dosage de la salive pour ces molécules. On abordera aussi les conditions pré-analytiques et les avantages indéniables que la salive représente pour le prélèvement à domicile.

C’est un sujet d’avenir qui fait saliver.

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RT2401 Selecting Automation /Instrumentation for Clinical Laboratory – It’s More than just Finding the Right Technology
Wednesday June 24, 0730-0830

 

Hoi-Ying (Elsie) Yu, Geisinger Medical Laboratories

 

Objectives:

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

  • Evaluate and select new instrumentations in a methodological manner.
  • Describe how to avoid common pitfalls that happened during the selection / evaluation process.
  • Restate the importance of engaging bench technicians in addition to lead technicians, supervisors and managers.

At Geisinger Medical Laboratories, we had recently undergone an intense process of selecting new total lab automation system and are in the process of implementing it. This session will concretely outline our process, including what we have learned (both the to-do and the not-to-do) for others to use as reference.

Selecting new instrumentation, especially those that have major impact to workflow or huge section of the laboratory, can be time-consuming and challenging. Despite this being a regular duty of laboratorians, there is little being discussed on the process. Most learn it “on the go” as how this should be done. Depending on how big the project may be, an official “request for information” (RFI) and “request for proposal” (RFP) may be used to gather information. One can also rely on literatures that compare different instrumentations. However, selecting instrumentations based on technology is just one of the many key considerations. The evaluation process should engage all lab staffs (from bench technologists to, in some cases, senior management) to gain input from different perspective. This enhances employee engagement and also allow for more thorough evaluation that is key to success. Workflow, LIS/IT solution should also be taken into consideration to assure successful implementation.

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RT2402 The Accuracy of POCT Glucose Meters
Wednesday June 24, 0730-0830

 

Yun Huang, Eastern Health

 

Objectives:

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

  • Illustrate the factors that influence the accuracy of glucose meter measurement.
  • Name the updated accuracy requirements of glucose meter.
  • Distinguish the accuracy of currently used POCT glucose meters, especially in long term service.

Glucose meter has been used widely in glucose monitoring of diabetes to manage insulin dose and other therapies, and to identify hypoglycemia and hyperglycemia. The appropriate glycemic control of diabetic patients significantly reduces the risk of serious secondary clinical complications. Clinicians are interested in the accuracy of glucose meter measurement when it is compared to the glucose measurement in core laboratories.

Many factors affect the accuracy of glucose meter measurement, including pathophysiological situations and analytical issues such as methodology, calibration, sample type, sample source, sample stability, interference, operational and environmental factors.

There is considerable diversity on the accuracy requirements of glucose meter. ADA proposed the first standard for glucose meter in 1987 which recommended that the accuracy be within ±10% of the reference value for 100% reading of values at all glucose concentrations. It was revised to be ±5% to minimize the frequency and severity of hypoglycemia for those attempting to achieve tight glucose control in 1994. FDA and ISO proposed a less stringent standard, which recommended ±20% (≥5.6mmol/L) and ±1.1 mmol/L (<5.6mmol/L) for 95% glucose meter reading. In 2013, CLSI updated its accuracy standard to ±12.5% (≥5.6mmol/L) and ±0.67 mmol/L (<5.6mmol/L) for 95% glucose meter reading. Additionally, 98% reading should be within ±20% (≥4.2mmol/L) and ±0.83 mmol/L (<4.2mmol/L).

In this roundtable, we will also present and discuss the accuracy data of POCT glucose meters in initial validation and in long term monitoring in our province.

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RT2403 Autoverification: Why, How and Key Lessons Learned
Wednesday June 24, 0730-0830

 

Allison A. Venner, Red Deer Regional Hospital Centre

 

Objectives:

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

  • Describe what autoverification is and why a hospital laboratory would initiate the process.
  • Discuss how it can be implemented using a local Alberta Laboratory as an example.
  • Describe the risks and benefits of autoverification in a clinical laboratory.

Autoverification is a very important tool for the clinical laboratory. The laboratory is often faced with requests for improved turnaround times, while also reducing overall financial spending. Autoverification is one way that can bring greater consistency and efficiency, and it can ultimately lead to process improvement. The G.B.E.A.M. (Gather, Build, Evaluate, Action, Maintain) phases will be described to illustrate how autoverification can be implemented. Examples of the required team, rules and flow charts, as well as quantitative and qualitative outcomes for general chemistry analytes from a local Alberta laboratory will be provided. The risk and benefits will be discussed to help other laboratories successfully implement autoverification or improve their current autoverification practices.

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RT2404 Urine Drugs of Abuse (DOA) Testing in the Out-patient (non-ER) Setting
Wednesday June 24, 0730-0830

 

Danijela Konforte, LifeLabs Medical Laboratory Services

 

Objectives:

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

  • Describe advantages and limitations of screening and confirmation methods used for urine DOA testing in the out-patient setting (the focus will be on the clinical DOA testing only).
  • Discuss utilization of clinical urine DOA testing.
  • Identify and discuss major gaps within the clinical DOA testing in their institution/province.

Community- and hospital-based clinical laboratories have an important role in providing urine drugs of abuse testing for the clinical care of out-patient population especially in the context of chronic opioid therapy management, maintenance therapies for opioid addiction, and misuse of recreational drugs. Use of pain medications and misuse of new designer drugs is on the rise across Canada and the labs are continuously challenged to meet changes in client needs and changes in testing technologies in order to provide the appropriate quality of service. This roundtable will present current state of urine DOA tests offered, including immunoassay screens (IA) and GC-MS/LC-MS screening and targeted methods. Test menus, sample validity testing, detection cut-offs, quantitative vs. qualitative reporting, utilization of reflexive testing will be discussed. The involvement of clinical biochemists in client education through presentations, reporting comments, and interpretive aids will be discussed. The participants will be encouraged to share both the successes and challenges of the clinical DOA testing at their institutions.

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RT2405 Congenital Adrenal Hyperplasia – Diagnosis in the Mass Spectrometry Era
Wednesday June 24, 0730-0830

 

Benjamin Jung, BC Children’s Hospital

 

Objectives:

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

  • Describe the pathophysiology of Congenital Adrenal Hyperplasia (CAH) and the biochemical abnormalities that typify the different forms.
  • Identify the biochemical tests for CAH diagnosis in newborns and late onset patients.
  • Discuss the advantages of mass spectrometry-based measurement of adrenal steroids and the current challenges in interpreting test results for resolving the different forms.

Congenital Adrenal Hyperplasia (CAH) refers to a group of endocrine disorders arising from genetic defects in the various enzymes that participate in the synthetic pathways of steroids in the adrenal cortex. Most often, they lead to deficiencies in cortisol and mineralocorticoid production and increased androgen synthesis. The presentations range from severely critical (e.g. salt-wasting and ambiguous genitalia at birth) to mild (e.g infertility in adult females). The most common defect occurs in the gene encoding 21 hydroxylase, which converts 17-hydroxyprogesterone and progesterone to 11-deoxycortisol and deoxycorticosterone, respectively. Traditionally, the measurement of 17-hydroxyprogesterone has been used to diagnose CAH by radioimmunoassay. In the last decade, however, mass spectrometry methods have largely replaced radioimmunoassay. In addition to having greater analytical specificity and measuring range, mass spectrometry assays have the capability of simultaneously quantifying other adrenal steroids in the pathways. Measurement of multiple steroids enables the determination of an “adrenal steroid profile” in a single analysis, which expands the ability to investigate other less common CAH enzyme defects efficiently. The session will review these advantages, but will also discuss the diagnostic issues resulting from the dramatic difference in results obtained by mass spectrometry methods as compared to those by radioimmunoassay.

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RT2406 Dealing with the Emerging Drug Market
Wednesday June 24, 0730-0830

 

Curtis Oleschuk, Diagnostic Services of Manitoba Inc. (DSM Inc.)

 

Objectives:

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

  • Share approaches to clinical and forensic (occupational and post-mortem) drug testing in Canada.
  • Discuss the emerging psychoactive drug market.
  • Discuss an initiative to track drug use trends.

The purpose of this Toxicology Interest Group Roundtable is to provide an opportunity those with an interest in toxicology to discuss approaches and trends. The list of psychoactive drugs abused in recent years has quickly evolved in comparison to decades past. This has led to significant challenges to the toxicologist. The roundtable will discuss the emerging psychoactive drug market. It will be an opportunity for participants to share their experiences in their own jurisdictions. This is potentially important to capture these trends as the investment to stay current with international trends is great and often beyond the scope of most toxicology laboratories in Canada. As a final component to the roundtable, we will discuss a means going forward to share local experiences and changes in approaches to toxicology screening.

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RT2407 Biomarkers in COPD: Overview and Alpha1-Antitrypsin as a Paradigm
Wednesday June 24, 0730-0830

 

Brian Gilfix, McGill University

 

Objectives:

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

  • Discuss biomarkers of COPD.
  • Describe a1-antitrypsin as a paradigm of a biomarker for COPD.
  • State the role of the laboratory testing in the diagnosis of a1-antitrypsin deficiency.

A biomarker is anything that can be used as an indicator of a particular disease state or some other physiological state of an organism, the presence of the disease or its severity. The last decades have been marked by intense searches for biomarkers using both proteomic and genomic-based technologies. But rate of introduction of new FDA-cleared biomarkers has in fact been declining. We shall review some of the factors that explain this decline.

Pulmonary disease has not been an exception to this rule. We shall examine the ongoing efforts in this area by the research community. We shall next examine the characteristics on the one successful biomarker in pulmonary disease, alpha1-antitrypsin (ATT), and what makes it so. We shall review the biochemistry of alpha1-antitrypsin and of alpha1-antitrypsin deficiency. Lastly, we shall review in depth the role of laboratory methods in the diagnosis of alpha1-antitrypsin deficiency: AAT measurement, AAT phenotyping (IEF), AAT genotyping, and sequencing.

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