Breakfast Roundtables will be held on Monday, June 4 and Wednesday, June 5.

 

Roundtables are interactive sessions that are 1 hour in length and comprise up to 9 registrants plus the leader who will facilitate an interactive discussion of the registrants.

 

Tickets are $30, and breakfast is included.

 

Monday June 4 – 0730-0830

Wednesday June 6 – 0730-0830

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CONCURRENT MONDAY BREAKFAST ROUNDTABLES

 

RM101 Provincial POCT Framework Development
Monday June 4, 0730-0830

 

Allison Venner, Calgary Laboratory Services

 

Learning Objectives:

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

  • Describe what POCT entails.
  • Discuss key components to a POCT Service Framework and who should be involved during document development.
  • Describe and discuss challenges and key questions to consider when forming a POCT Service Framework.

Point of Care Testing (POCT) is performed in clinical environments outside the walls of the clinical laboratory. Technologies applicable to POCT are continuing to advance and are becoming more robust. As such, new devices and programs are being looked at more closely to see if and how they can benefit patient care pathways. Laboratory oversight of POCT is very important; documentation of this and the expectations of how POCT will be overseen and supported must be clearly determined. This can be accomplished, in part, through a POCT Service Framework. Developing this Framework for an entire province is a major task and requires dedicated people across multiple disciplines to work together. This roundtable session will focus on why a Service Framework is needed, key components and people to include during the development phase, and early lessons learned.

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RM102 Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome
Monday June 4, 0730-0830

 

Peter Kavsak, McMaster University

 

Learning Objectives:

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

  • Discuss what laboratory procedures are needed for ensuring reliable results for contemporary cardiac troponin (cTn) and high-sensitivity cTn (hs-cTn) assays.
  • Appreciate that hs-cTn assays require additional analytical validation and monitoring as compared to contemporary cTn assays.
  • Realize that some of the Laboratory Medicine Practice Guideline (LMPG) recommendations have changed in the 2018 version as compared to the previous LMPGs

This session will provide an overview and an opportunity to discuss the 2018 Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome. This document is the third version of the National Academy of Clinical Biochemistry (NACB) guidelines on the use of cardiac biomarkers in coronary artery disease (previous iterations were published in Clinical Chemistry in 1999 and 2007). These recommendations focus on the analytical aspects and were derived from expert opinion from the Academy of the American Association for Clinical Chemistry (formerly the NACB) and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. For the first time, practice recommendations for high-sensitivity cardiac troponin are provided and will be discussed during this interactive session.

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RM103 Cases in Serum Protein Electrophoresis
Monday June 4, 0730-0830

 

Tracy Morrison, LifeLabs

 

Learning Objectives:

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

  • Describe key differences between capillary and gel electrophoresis technologies.
  • Demonstrate the differential migration of some IgA or IgM monoclonal proteins and multimer monoclonal proteins in capillary and gel electrophoresis.
  • Apply appropriate interpretation in cases with differential migration of monoclonal proteins on capillary and gel electrophoresis.

Gel electrophoresis is routinely used for both serum protein electrophoresis and immunofixation electrophoresis in the investigation and management of plasma cell dyscrasias. Capillary electrophoresis is a parallel technology for the same clinical application. While the electrophoretic pattern of serum protein electrophoresis is similar between the two techniques, there are marked differences between them that can potentially interfere with clinical interpretation and reporting. This roundtable will include a discussion of several cases where there is differential migration of monoclonal proteins on capillary and gel electrophoresis, and the impact it can potentially have on serum protein electrophoresis and immunofixation interpretation and reporting.

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RM104 Reporting of Urine Drug Tests
Monday June 4, 0730-0830

 

Danijela Konforte, LifeLabs

 

Learning Objectives:

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

  • Describe experiences from their own laboratories related to the reporting of urine drug screens.
  • Discuss pros and cons of different approaches in different lab environments.

Clinical urine drug testing is an important tool in monitoring compliance of patients who are on opioid therapy for chronic pain. Clinical challenges associated with managing patients on poly-pharmacy, continual emergence of new street drugs, and analytical tests that increasingly include mass spectrometry methods which generate different type of data compared to immunoassays, all create a need for improvements in drug test reporting beyond a “Detected” or “Not Detected” result. This roundtable will discuss the following strategies that can be applied to clinical drug screen reports to make them more informative and ensure accurate interpretation of results by health care providers: A) Different formats of urine drug screen reports B) Interpretive comments based on the metabolic pathways and pattern of drugs detected (i.e. criteria used to make a distinction between parent, metabolites, and contaminants) C) Warnings about sample tampering (i.e. parent drug detected without metabolite) D) Educational information about new designer drugs that healthcare providers are not familiar with.

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RM105 Addressing Analytical Constraints for Drug Identification in Times of Opioid Crisis: Insights into LC-HR/MS (Orbitrap) Solutions
Monday June 4, 0730-0830

 

Christina Stefan, Centre for Addiction and Mental Health (CAMH)

 

Learning Objectives:

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

  • Describe how HR/MS (Orbitrap-based) procedures can help overcome analytical constraints imposed by lack of and/or access to reference standards.
  • Discuss the identification of illicitly manufactured fentanyls (also known as fentanyl analogues) using combined analytical algorithms and subsequent validation with reference standards.
  • Appraise the impact of powerful, state-of-the-art high resolution technologies on patient care and/or public awareness in general, and in times of opioid crisis in Canada in particular.

Library-based targeted analysis of drugs using conventional (nominal mass, low resolution) mass spectrometry, GC- or LC-coupled, is the mainstay in routine drug screening and/or drug confirmation procedures. However, the identification of new street drugs in biological specimens can be substantially delayed by analytical constraints imposed by restrictive and/or timely access to certified standards in the controlled substances category. This workshop introduces the audience to high resolution (exact, isotopic or accurate mass) mass spectrometry (HR/MS) concepts and approaches to untargeted identification of new street drugs in the absence of pre-existing library data. Algorithms combining experimental LC-HR/MS retrospective and prospective data obtained with Orbitrap (Q-Exactive, ThermoFisher) instrumentation with published mass spectral information and/or knowledge of drug metabolism are discussed. Applications of such algorithms to the initial identification of many illicitly manufactured fentanyls (IMF) are presented. The subsequent validation of such algorithms using certified standards in commercially available formulations is also demonstrated for carfentanil/nor-carfentanil, furanyl-fentanyl, butyryl-fentanyl and other fentanyl analogues. IMFs are at the core of the current worldwide opioid crisis. The outcome of the untargeted identification algorithms utilized in our laboratory, the impact on clinical care as well as the contribution to public awareness for the opioid crisis in Canada will be outlined. Join us to learn more about new analytical developments in the clinical laboratory benefiting the healthcare and discuss their future.

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RM106 AMH Throughout the Ages
Monday June 4, 0730-0830

 

Vilte Barakauskas, AMH Throughout the Ages

 

Learning Objectives:

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

  • Review AMH biology and history of clinical testing.
  • Describe current methods and application of AMH testing in patients of varying age.
  • Discuss experience with AMH testing requests and interpretation.

This Roundtable session will describe the winding, and at times rocky, history of anti-mullarian assays and will discuss the application of AMH testing throughout a person’s lifespan. Participants will have an opportunity to review the biology and regulation of anti-mullarian hormone during fetal development, childhood and adulthood. Current methods and clinical applications of AMH testing in pediatric, oncology and fertility settings. Issues associated with result interpretation, reference intervals and method standardization will be raised. Participants are encouraged to bring and share their own experience with testing requests, interpretation and clinical application of this intriguing endocrine marker.

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CONCURRENT WEDNESDAY BREAKFAST ROUNDTABLES

 

 

RW201 What is this Weirdness? Interferences in Clinical Chemistry
Wednesday June 6, 0730-0830

 

Lori Beach, IWK Health Centre

 

Learning Objectives:

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

  • Summarize an approach to interference verification in clinical chemistry.
  • Define and discuss interferences due to hemolysis, icterus, and turbidity; as well as medication and excipients, natural remedies and supplements, etc.
  • Discuss the future trends of interferences in clinical chemistry and optimal communication of this important information.

Interferences are a relatively common occurrence in the clinical laboratory. While manufacturers often provide some data relating to hemolysis, icterus, and turbidity (HIT) or common medications, surprises still occur both in these and in unexpected other sources. In this roundtable, an approach to known interference verification will be briefly outlined. Discussion will focus on examples of surprise interferences from HIT, medications, excipients, etc. and the best means of communicating this information, both to clinicians and to other laboratory professionals. Participants are strongly encouraged to bring their own examples of “weirdness” from their practice for discussion.

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RW202 An Update on Consensus Testing of ANCAs and How to Implement Testing Algorithms in Your Laboratory
Wednesday June 6, 0730-0830

 

Maria Pasic, St. Joseph’s Health Centre

 

Learning Objectives:

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

  • Review the consensus recommendations on testing of ANCAs.
  • Describe the current methodologies used in ANCA testing.
  • Identify strategies for appropriate utilization of ANCA testing.
  • Recognize how a testing algorithm for ANCAs can improve utilization of laboratory resources and lead to better patient care.

This roundtable will review the most recent international consensus guidelines for ANCA testing in small vessel vasculitides. Current methods available for ANCA testing will be discussed, as well as their relevant uses for both screening and diagnosis of various disease states. We will also discuss how testing algorithms can be developed to ensure appropriate ordering and utilization of ANCA tests, using the experience at St. Joseph’s Health Centre and St. Michael’s Hospital as a case example.

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RW203 Direct to Consumer Testing: Managing Patient-Led Testing in the Choosing Wisely Landscape
Wednesday June 6, 0730-0830

 

Kristin Hauff, LifeLabs

 

Learning Objectives:

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

  • Define direct to consumer testing and test utilization in the context of Clinical Chemistry.
  • Identify major factors driving the direct to consumer testing.
  • Compare benefits and risks of embracing direct to consumer testing.
  • Predict whether direct to consumer testing can peacefully co-exist with Choosing Wisely.
  • Formulate a plan to manage direct to consumer testing in your organization.

More and more marketing is aimed at the patient as a consumer of clinical testing. Increasingly, the patient is empowered to make their own decisions and access their own testing, with or without physician intervention. In the context of test utilization, Choosing Wisely and evidence-based medicine, patient-pay testing seems an irreconcilable problem, but is it something we can combat or is it better to embrace the movement?

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RW204 Harmonized Lipid Profile Assessment and Interpretation in Canada
Wednesday June 6, 0730-0830

 

Victoria Higgins, SickKids Hospital

 

Learning Objectives:

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

  • Recognize the current state of harmonized reference intervals.
  • Assess differences in lipid reporting among laboratories and the need for harmonization.
  • Discuss various national cardiovascular risk assessment guidelines.
  • Review the process of harmonization of decision limits and interpretive comments for the lipid profile.
  • List the Canadian harmonized lipid reporting recommendations.

A national survey, conducted by the Canadian Society of Clinical Chemists (CSCC) harmonized reference interval (hRI) Working Group, showed profound inter-laboratory variation in reference intervals for common laboratory tests. Reference interval variation was often greater than the variation in test results and was even apparent between laboratories using the same instrument. To address this, the CSCC hRI Working Group is working towards harmonizing laboratory test interpretation, including reference intervals, decision limits, and interpretive comments. This roundtable will discuss efforts from the Working Group to harmonize decision limits and interpretive comments, specifically for the lipid profile. Various guidelines including those published by the Canadian Cardiovascular Society (CCS), the European Atherosclerosis Society (EAS) and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM), and the National Heart, Lung, and Blood Institute (NHLBI) for children and adolescents will first be described. Despite published CCS guidelines for dyslipidemia management for cardiovascular disease prevention, lipid reporting remains highly variable across Canadian laboratories. Laboratory lipid reporting differ in terms of lipid parameters reported, reference intervals and decision limits, as well as interpretive comments. The CSCC hRI Working Group has developed lipid reporting recommendations aligned with the 2016 CCS guidelines to promote laboratory harmonization and improve patient care.

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RW205 Clozapine-induced Myocarditis: Prevalence and Monitoring with Laboratory Tests
Wednesday June 6, 0730-0830

 

Christina Stefan, Centre for Addition and Mental Health (CAMH)

 

Learning Objectives:

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

  • Describe myocarditis as a fatal (although rare) adverse reaction of clozapine prescription.
  • Discuss the prevalence and available guidelines for monitoring clozapine-induced myocarditis with serum Troponin I and CRP and their introduction in clinical practice in Canada.
  • Evaluate the importance of screening for clozapine-induced myocarditis following the review of selected clinical cases.

Let’s get together at this roundtable to interactively discuss the clozapine-myocarditis relationship, its prevalence and its proposed monitoring in clinical practice with serum Troponin I and CRP. Clozapine has had a unique place in the history of antiphychotic medication and since 1989 has been available for treatment-resistant schizophrenia. Agranulocytosis is its most recognized adverse effect, which is strictly monitored with CBC and differential testing, but equally concerning, although often overlooked, is myocarditis. Discussion will include available data on prevalence, guidelines for monitoring clozapine-induced myocarditis with markers of myocardial injury (Troponin I) and inflammation (CRP), and the clinical and/or the laboratory practice adopted at the Centre for Addiction and Mental Health (CAMH) in Toronto, ON since 2015. A selection of published cases as well as those encountered at our organization or brought in by the participants will be included in our dialogue. What we will conclude at the end of our interaction? This topic is of interest to both community and hospital clinical biochemists and other health care providers.

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RW206 Personalize Medicine for Substance Use and Misuse
Wednesday June 6, 0730-0830

 

Manuela Neuman, In Vitro Drug Safety and Biotechnology

 

Learning Objectives:

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

  • What are personalized laboratory biomarkers for predicting the response of patients with CD and UC to treatment with medical Cannabis?
  • To understand the need of personalized medicine in IBD and the role of laboratory medicine to monitor the inflammation and repair of intestinal tissue when the patient uses medical Cannabis.
  • To monitor the combination of biological therapies and medical Cannabis in a clinical laboratory.

Inflammatory bowel diseases (IBD) are chronic inflammatory disorders of the gastrointestinal tract (GI), with two principal forms being Crohn’s Disease (CD) and Ulcerative Colitis (UC). By combining the data from biological therapies and medical Cannabis with an individual’s medical history, health care providers can develop targeted treatment and prevention of drug-Cannabis interactions. Idiosyncratic adverse reactions are frequent in patients after using therapeutics or herbal and alternative medicines. Drug-induced liver disease and herbal-induced liver injury cause significant morbidity and mortality in patients worldwide. The severity of the reaction is likely to result in liver failure, especially if the offending drug is not stopped. Serious hepatotoxicity refers to acute liver failure that leads to the need for a liver transplant. This round table will present mithochodrial toxicity tests that can be used to distinguish which therapeutic or health products lead to hepatotoxicity. Join us to learn more about contemporary issues in the use of medical Cannabis with relevance to the clinical laboratories. The round table will explore the most significant trends in laboratory medicine practices, science, and policy, and will guide the clinical chemists’ next steps in education on personalized medicine in the era of Cannabis legalization and medicinal use of Cannabis in laboratory and clinical practice.

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