All Scientific Workshops will be 1.5 hours long, and will be held on Sunday, June 3.

 

Tickets are $30, and registration is limited per workshop.

 

Sunday, June 3 – 0800-0930

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CONCURRENT WORKSHOPS 0800-0930

 

W101 Biotin: An Established Immunoassay Interferent Becomes a Critical Emerging Issue in the Clinical Diagnostic Lab
Sunday June 3, 0800-0930

 

Jessica Gifford, Calgary Laboratory Services

Hossein Sadrzadeh, Calgary Laboratory Services

 

Learning Objectives:

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

  • Describe the biochemistry of biotin.
  • Discuss the physiological role of biotin.
  • Discuss the role of biotin as a health product.
  • Describe recent advancements that place biotin as a drug of choice for diseases such as multiple sclerosis.
  • Describe how biotin interferes in affected immunoassays.
  • Discuss approaches to treat high biotin specimens in lab.
  • Describe strategies to educate clients such as patients and healthcare professionals about this interference.

Recently, biotin use as a high-dose (> 1mg/day) oral supplement has increased significantly among the general population. Biotin is a water soluble B-vitamin and is believed to improve the cosmetic appearance of hair, skin, and nails. In addition, high-dose biotin is prescribed to treat inborn errors of metabolism and multiple sclerosis. Many commercial immunoassays employ the high affinity interaction between biotin and streptavidin, a protein purified from bacteria, as part of the analyte capture mechanism. As such, these immunoassays are subject to this interference. The list of affected immunoassays is vendor specific but includes tests for troponin, serum and urine β-hCG, thyroid function, and tumor markers. The interference can be positive or negative in nature depending on the immunoassay. To address this issue, patients are recommended to abstain from taking high dose biotin for 48 hours, and laboratorians and clinicians must be familiar with the potential for biotin interference in performed lab tests. This workshop will cover the biochemistry and physiology of biotin; the mechanisms of biotin interference in immunoassays; strategies to treat high biotin specimens and make them suitable for testing; and approaches to educate patients, doctors, and other healthcare professionals. This workshop is aimed at clinical biochemists, clinical biochemistry fellows, general pathology residents, and medical laboratory technologists.

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W102 Interpretation of Anti-Nuclear Antibody Patterns by Immunofluorescence Microscopy
Sunday June 3, 0800-0930

 

Alex Chin, Calgary Laboratory Services

 

Learning Objectives:

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

  • Review the basics of anti-nuclear antibody (ANA) testing in diagnosing autoimmune diseases.
  • Identify current methods of ANA testing.
  • Contrast the advantages and disadvantages of the different ANA testing techniques.
  • Interpret ANA patterns by immunofluorescence microscopy.

For over 50 years, screening for anti-nuclear antibodies (ANA) associated with systemic autoimmune rheumatic diseases has been performed by indirect immunofluorescence assays (IIF) using cellular substrates followed by the interpretation of the staining patterns. This method has been favored as the first-line screening test or the “gold standard” method by the American College of Rheumatology while being the focus for the Choosing Wisely campaigns in North America. However, reduced technical laboratory expertise, limited laboratory resources, the increasing incidence of autoimmune diseases worldwide, increasing requests by non-rheumatologists, increase in diagnostic testing, and new standardization efforts by the International Consensus on ANA Patterns (ICAP) are posing challenges to the clinical laboratory. This workshop will discuss the clinical utility of ANA testing, recent advances in technology such as multiplex immunoassays and IIF interpretive digital software, and interpretation of ANA patterns promoted by the ICAP. The material discussed in this workshop is focused to help laboratory professionals make informed decisions regarding ANA method evaluations as well as provide appropriate consultations to ordering physicians and other healthcare professionals.

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CONCURRENT WORKSHOPS 0930-1100

 

W111 Point-Of-Care Testing: Best Practices and Quality Assurance Considerations
Sunday June 3, 0930-1100

 

Chris Cursio, University Health Network

Julie Shaw, The Ottawa Hospital, EORLA and The University of Ottawa

Paul Yip, University Health Network and The University of Toronto

 

Learning Objectives:

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

  • Identify resources that define analytical performance goals and specific validation studies for blood glucose testing by point-of-care (POC) devices.
  • Describe the risks and challenges associated with POC glucose testing in critically ill patients and discuss strategies to mitigate these risks.
  • Apply quality assurance requirements for mobile POC programs that operate outside the hospital environment.

This workshop is designed for laboratory and healthcare professionals who are responsible for the point-of-care (POC) testing in their institution with emphasis on the current state of glucose meter and mobile testing. The workshop will be divided into three sections starting with a summary of data from a recent patterns of practice survey conducted by the Institute for Quality Management in Healthcare (IQMH) as part of a proficiency testing challenge for POC glucose meters in Ontario. The survey asked about institutional practices for glucose meter validation, acceptance criteria for analytical performance goals, and the use of POC glucose measurements in critically ill patients. The second part of the workshop will highlight the experience of tightening precision targets for POCT glucose meters among sixteen hospitals part of the Eastern Ontario Regional Laboratories Association (EORLA). The workshop will conclude with a discussion on implementation of a home-based POC program at the University Health Network in Toronto. The Hospitals At Home is a pilot project program is aimed to reduce hospital admissions and instead provide acute-level care for conditions that could better be managed in the home environment. Quality assurance considerations related to POC testing performed in the home environment by a team of mobile nurses will be discussed.

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W112 Implementation of Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) in the Clinical Laboratory
Sunday June 3, 0930-1100

 

Jessica Boyd, Calgary Laboratory Services

Hossein Sadrzadeh, Calgary Laboratory Services

 

Learning Objectives:

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

  • Demonstrate how to prepare a business case to bring LC-MS/MS into their laboratory.
  • Describe the fundamentals of LC-MS/MS operation.
  • Demonstrate how to implement middleware connectivity for LC-MS/MS testing.
  • Describe common occupational health and safety concerns with LC-MS/MS implementation and how to mitigate them.

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has become an important component of modern clinical laboratories. LC-MS/MS provides many advantages including high sensitivity and selectivity, and low operational cost. For these reasons, LC-MS/MS has become a common technique for toxicology and therapeutic drug monitoring, and will become increasingly important for endocrinology testing. However, despite its many advantages, LC-MS/MS implementation can appear daunting due to the high initial instrument cost, manual method development, sophistication of the instrument and software, and relative lack of vendor supported automation solutions. This workshop covers the financial, technical and operational aspects of introducing LC-MS/MS technology to your laboratory, using examples from the author’s previous experience. This year, the focus will be new developments in this field such as automation, connectivity and safety. New middleware can automatically report LC-MS/MS results to laboratory information system; thus significantly reduce the staff time required to transfer results to the LIS manually. Common problems encountered during interfacing LC-MS/MS software with the LIS and strategies to solve those problems will be discussed. Also, occupational health and safety issues involved in LC-MS/MS implementation, specifically noise generation from roughing pumps and nitrogen generators will be discussed. Simple solutions to prevent noise from becoming hazardous to laboratory staff will be presented.

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CONCURRENT WORKSHOPS 1300-1430

 

W201 Evidenced Based Laboratory Medicine (EBLM); A Global Perspective
Sunday June 3, 1300-1430

 

Andrew Don-Wauchope, International Federation of Clinical Chemistry and Laboratory Medicine Committee of Evidence Based Laboratory Medicine

Karina Rodriguez-Capote, International Federation of Clinical Chemistry and Laboratory Medicine Committee of Evidence Based Laboratory Medicine

 

Learning Objectives:

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

  • Define the rationale for EBLM.
  • Discuss the drivers for EBLM.
  • Demonstrate the EBLM process through examples.
  • Summarize the perceptions of EBLM and training preferences from the global survey.

This is an initiative of the IFCC c-EBLM as part of our collaboration with national societies. The two speakers are active members of the IFCC c-EBLM. The educational material that will be presented has been fully developed and reviewed by our committee. The workshop will present the results from a global survey conducted by the IFCC c-EBLM regarding perceived competencies and need of training concerning the practice of EBM among medical laboratory professionals. We will also discuss the application of EBM principles and tools in the practice of laboratory medicine and its concerns with the rational and proper use of resources. The process of EBLM is defined by setting the right question, searching the literature, appraising the quality of studies, undertaking systematic reviews and meta-analyses, formulating guidelines, applying these in clinical practice and finally auditing the process. The case for supporting the introduction or elimination of laboratory tests, will depend upon its proven value to leverage clinically important decisions. In addition, the explosion of new knowledge with an escalating number of new publications per day, health professionals cannot keep up with all the new information and a more directed approach is needed. EBLM promotes consistency of practice and optimal outcomes, helps establish national standards for patient care, and sets criteria to measure and reward performance-based laboratory practice.

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W202 Emerging Roles of Mass Spectrometry in Laboratory Medicine
Sunday June 3, 1300-1430

 

Liana Kyriakopoulou, The Hospital for Sick Children

 

Learning Objectives:

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

  • Become familiar with technological developments in Mass Spectrometry that support emerging applications.
  • Understand the journey of implementation of laboratory-developed test by MS (standardization, validation and QC).
  • Review novel approaches to using mass spectrometry in the clinical setting.

Over the last 10 years, mass spectrometry (MS) has become an important testing platform in the clinical laboratory for the analysis of small molecules such as steroid hormones, toxicology, therapeutic drug monitoring, analysis of trace elements and metabolic genetic disorders. MS applications have a promising future in laboratory medicine as an increasing number of institutions are developing novel ways of using the technology. It has established a clear niche within most sub-disciplines of Laboratory Medicine for patient care (including biochemistry, molecular genetics, microbiology and anatomic pathology). It is anticipated that this type of technology, which is still emerging and improving, will provide unprecedented opportunities not only to understand the pathogenesis of many diseases but also determine disease risk (predisposition), select appropriate therapies or preventative measures and achieve early diagnosis and effective monitoring of just about every human disease. The scope of this workshop is to provide an overview of the role of MS for protein quantification and proteome profiling applications, uses of MALDI-TOF technology for assessment of M-proteins, tissue imaging and pharmacogenomics. Participants will hear about the latest practices on proteomics and genomics and quality control, new developments in clinical practices, and future applications. The workshop is designed for laboratory scientists, medical technologists, lab directors, managers, and pathologists who are interested in learning more about MS to guide their decisions in implementing the technology in the lab.

This 1.5 hour session will be based on 2 presentations. Throughout the session participants will be exposed to the key components of validating and using mass spectrometry. The workshop offers participants a learning opportunity designed to increase their knowledge in the integration of Mass Spectrometry into clinical practice, the validation of MS technology in a clinical laboratory, and to explore the related clinical and laboratory considerations.

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CONCURRENT WORKSHOPS 1430-1600

 

W211 Investigation of Interferences in Immunoassays
Sunday June 3, 1430-1600

 

Lei Fu, Sunnybrook Health Sciences Centre and University of Toronto

Nicole White-Al Habeeb,

Felix Leung, University, of Toronto

 

Learning Objectives:

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

  • Identify the various types of interferences that affect immunoassays and how they impact patient care.
  • Recognize the complexity of immunoassay interference and explore strategies to identify the interfering substances including macro-TSH and biotin.
  • Discuss interactively investigation strategies to identify immunoassay interference in clinical samples.

Immunoassays are commonly used in clinical laboratories to measure a wide range of analytes in different matrices. However, they can be affected by interferences which can lead to falsely elevated or falsely decreased results depending on the nature of the interfering substances and the test principles. These misleading results may cause wrong diagnosis with unnecessary and potentially harmful investigations and treatment. This session will use a case-based approach to discuss immunoassay interferences and how they impact patient care. Strategies to identify interferences and prevent misdiagnosis will be outlined using case studies. Biotin, Vitamin B7, is a water-soluble vitamin occurring naturally in many foods including wheat germ, whole grain cereal, eggs, and dairy products, among others. Biotin functions physiologically as a co-factor for carboxylases involved in the metabolism of carbohydrates, amino acids, and fatty acids. Recently, the use of biotin supplementation for therapeutic and nutraceutical purposes has increased, where patients are taking hundreds to thousands of times the recommended daily dose. High biotin concentrations cause interference in clinical assays utilizing the biotin-streptavidin system. Our clinical cases illustrate how high biotin can lead to the biochemical finding of hyperthyroidism in the absence of clinical symptoms. Macro-TSH, although a rare finding, is a potential interferant with TSH assays and confounder for interpretation of thyroid function tests. A unique entity from heterophilic antibodies or human anti-mouse antibodies, macro-TSH often consists of a complex of IgG immunoglobulins and native TSH molecule. Detecting and confirming the presence of macro-TSH interference is unique in its analytical challenges and our clinical case will highlight such issues involved with isolating and confirming the presence of this rare interferant.

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W212 Opioids – What Everyone Needs to Know
Sunday June 3, 1430-1600

 

Loralie Langman, Mayo Clinic

Curtis Oleschuk, University of Manitoba

 

Learning Objectives:

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

  • Describe the pharmacology of opioid medications.
  • Describe the metabolism of commonly prescribed opioids.
  • Correctly interpret urine drug testing results from patients prescribed opioid medications.

The “Opioid Crisis” is a significant national health issue. This workshop will review the difference between opiates and opioids and the pharmacology and addictive nature of currently prescribed medications in each class. Review the complex and interrelated nature of opiate metabolism.

The widespread use and misuse of the medications has come hand in hand with drug testing strategies to assess compliance to prescribed drug regimens. Guidelines for drug testing, the advantages and disadvantages of various testing methodologies, and using case studies, the complexities of interpreting urine drug testing results will be discussed.

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