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Breakfast Roundtables will be held on Monday, June 3 and Wednesday June 5:

 

Monday June 3 – 0730-0830

Wednesday June 5 – 0730-0830

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RM101 The Effective Use of Delta Checks in the Clinical Laboratory
Monday June 3, 0730-0830

 

Edward Randell, Eastern Health Authority

 

Learning Objectives:

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

  • Describe the main methods for calculating delta checks.
  • Describe why and how delta checks are used and their effectiveness.
  • Describe criteria for developing effective delta check strategies customized to local patient populations.
  • Describe how to verify and monitor the costs, safety and usefulness of delta checks.

Delta checks involve monitoring changes in analyte concentrations over time and for two main purposes: 1) to identify error; or 2) to assist clinicians in identifying disease. The session will cover different ways delta checks are determined, and describes the results of studies into their effectiveness. A decision to use deltas checks requires first identification of the purpose, and from there determining which analyte(s) to monitor, which delta check type or calculation to use, which alert thresholds to use, over what time interval should the strategy be applied, and what specific action(s) should occur once there is a delta check alert. Use of delta checks always come at a cost. Also, to be discussed will be practical approaches to selecting which analytes and situations to apply delta checks, and how the costs, usefulness, and safety of this tool should be verified and improved.

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RM102 Neuroimmunology for the Clinical Chemist
Monday June 3, 0730-0830

 

Hans Frykman, UBC Neuroimmunology Lab and Neurocode Labs

 

Learning Objectives:

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

  • Describe antibody driven neuroimmunological disorders and what tests are useful.
  • List different test platforms used and understand their own advantages and disadvantages with respect to turn around time, robustness, sensitivity and specificity.

Clinical neuroimmunology is an area of rapid development in recent years. The clinical chemist is increasingly facing the responsibility to approve or decline these expensive and potentially important tests.
An overview of the different neuroimmunological disorders and which antibody is useful in which disorder. Also, different testing platforms and the advantages and disadvantages in terms of turn around time, robustness, sensitivity, and specificity will be reviewed in briefly.

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RM103 Towards Reference Interval Harmonization Across Canada: A Novel Statistical Approach
Monday June 3, 0730-0830

 

Jake Cosme, University of Toronto

 

Learning Objectives:

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

  • Identify current methods of reference interval establishment.
  • Describe the importance of using common reference intervals in clinical practice across Canada.
  • Discuss key challenges associated with reference interval harmonization.
  • Describe an indirect statistical method used to calculate inter-provincial reference intervals.

Reference interval harmonization in clinical laboratories across Canada is an important element of laboratory quality assurance, contributing to improved patient safety and diagnostic rigor. The Canadian Society of Clinical Chemists (CSCC) Harmonized Reference Interval (hRI) Working Group aims to highlight the importance of reference interval harmonization through a combination of direct reference value data in healthy Canadians and indirect analysis of patient data. We are leveraging large provincial laboratory data on community outpatients to assess provincial reference value distributions across different provinces and determine the feasibility of developing common reference intervals. This roundtable will focus on recent application of advanced statistical approaches for indirect analysis of large patient datasets by the CSCC hRI Working Group, the benefits and limitations of this approach, and the technical and methodological challenges that were overcome in analyzing large inter-provincial laboratory data.

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RM104 Diurnal Variation in Clinical Chemistry: An Underappreciated Source of Pre-Analytical Error
Monday June 3, 0730-0830

 

Mohamed Abouelhassan, Dalhousie University; LifeLabs

 

Learning Objectives:

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

  • Appreciate circadian rhythm in clinical chemistry.
  • Recognize the need to standardize experimental protocols for studying diurnal variation of analytes.
  • Appreciate the significance of diurnal rhythm as a major source of biological variation.
  • Discuss the value of timed specimen collection for analytes that undergo diurnal variation.
  • Identify strategies to alleviate the effect of diurnal variation as a significant source of pre-analytical error in cases where timed specimen collection is not possible.

A recent meta-analysis concluded that diurnal variation is common in clinical chemistry and showed that at least 30 analytes undergo diurnal variation (Abou El Hassan et al., Critical Reviews in Clinical Lab Science, 2109). The magnitude of diurnal variation is significant and is equal to or larger than published within-subject biological variation. Importantly, timed specimen collection is required for the optimal clinical utility of multiple analytes which undergo diurnal changes such as fasting plasma glucose, TSH and cTnI (reviewed in Abou El Hassan et al., Critical Reviews in Clinical Lab Science, 2109). Nevertheless, websites of major laboratories in USA and UK do not consistently instruct collection at specified times for analytes with appreciable diurnal variation. This reflects a gap of knowledge about diurnal variation in clinical chemistry and underscores the need for increasing the awareness of this important source of variation among medical laboratory professionals.

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RM105 Accuracy of Urine Albumin – Could Laboratory Testing Be So Wrong for So Long?
Monday June 3, 0730-0830

 

Paul Yip, University of Toronto; Sunnybrook Health Sciences Centre

 

Learning Objectives:

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

  • Explain the challenges of reporting accurate urine albumin results.
  • State the latest reference materials for human albumin.
  • Describe the proposed reference measurement system to support its standardization.

The role of laboratories to support the assessment of chronic kidney disease requires accurate results for two important biomarkers, plasma creatinine and urine albumin. Although less attention has been paid to the latter, the accuracy of urine albumin results is equally necessary for positive patient outcomes. This roundtable will include a discussion of current practices that could impact the quality of results for urine albumin and the albumin-creatinine ratio. Participants will engage in a critical appraisal of the total testing process from physiological to analytical factors that impact on the test. The remainder of the session will provide an update on the current status of global efforts to standardize urine albumin measurements through the development of reference materials and a LC-MS/MS reference measurement procedure.

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RM106 Back to the Basics – Enzyme Assay Design and Optimization for Thiopurine Methyltransferase (TPMT) by LC-MS
Monday June 3, 0730-0830

 

Dennis Orton, University of British Columbia; Royal Columbian Hospital

 

Learning Objectives:

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

  • Run through the parameters required to optimize a robust enzyme assay (pH, time, temperature, substrate selection and cofactor concentration).
  • Review of enzyme kinetics and terminology (Lineweaver–Burk plot, Vmax, Km, first- and zero-order rate kinetics).
  • Review some lived-experience on development of the TPMT enzyme assay with LC-MS detection.

The clinical laboratory routinely employs numerous enzymatic assays with a variety of detection strategies for a broad number of analytes. Ironically, as these enzyme assays have become more common in the lab, automation and the “plug-and-play” nature of reagent kits have begun to eat away at our familiarity with how these assays actually function. As Clinical Chemists, we gain a foundational knowledge of enzyme kinetics and assay principles during training; however when it comes to development and validation of a new enzymatic assay from scratch, this task may be very daunting.

Thiopurine methyltransferase (TPMT) is an enzyme within red blood cells that metabolizes thiopurine medications such as azathioprine to non-toxic metabolites. The TPMT gene contains polymorphisms which may present as either a complete or partial loss in enzymatic function, and defective enzymatic activity causes an elevation in toxic metabolites of thiopurine drugs. For this reason, screening for TPMT deficiency is recommended in some patients prior to initiating azathioprine dose. This roundtable is meant to walk through the steps required for development and validation of an enzyme assay in the clinical lab, with focus on my experiences while developing an assay for TPMT phenotyping.

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RM107 Unusual Cases in Pediatric Clinical Chemistry
Monday June 3, 0730-0830

 

Lawrence de Koning, University of Calgary; Alberta Public Laboratories

 

Learning Objectives:

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

  • Discuss unusual pediatric clinical chemistry cases identified by review of critically high and low patient results from an acute care pediatric clinical chemistry laboratory.
  • Review stages of the testing process that can cause unusual results.
  • Describe unique physiologic aspects of children and rare pediatric conditions that can cause unusual results.

Pediatric clinical chemistry is an extremely stimulating area of laboratory medicine. The dynamic, ever-changing physiology of children can lead to surprising and unusual results which can challenge the comfort levels of clinical chemists. This roundtable will review several cases identified during review of critical results at the Alberta Children’s Hospital chemistry lab. These cases will focus on laboratory errors, analytical interferences and rare conditions leading to unusual results in children. This roundtable seeks to generate interest and awareness about pediatric clinical chemistry, and pediatric lab medicine in general.

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RM108 Interesting Cases in Toxicology
Monday June 3, 0730-0830

 

Catherine Cheng,

 

Learning Objectives:

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

  • Review the clinical presentation of less common toxidromes.
  • Discuss the role of the clinical laboratory in the investigation of clinically challenging toxicology cases.

This session will discuss some of the interesting and clinically challenging toxicity cases that have been encountered in British Columbia and the role of the lab in the workup and management of these cases. Topics discussed will include cases of heavy metal toxicity and adverse reactions to medications and supplements among others. Participants are encouraged to bring challenging cases that they have encountered for discussion.

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RW201 POCT Quality Control Based on Risk Management
Wednesday June 5, 0730-0830

 

Yun Huang, Kingston Health Sciences Centre

 

Learning Objectives:

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

  • Understand the error sources of POCT.
  • Understand the benefit of risk management in POCT quality control.
  • Explore the use of risk management in POCT quality control.

The Point of care testing (POCT) is performed at or near patient bedside and by non-laboratory professional; increased errors in the process of POCT have been noticed in the wide use of POCT in clinical service. Errors can occur at any steps of testing, which are usually described as pre-analytical, analytical and post-analytical errors. The traditional internal quality control can only identify and monitor the systematic error in analytical stage.

Risk management is defined as the systematic application of management policies, procedures and practices to the tasks of analyzing, evaluating, controlling and monitoring risk. The quality control established based on risk management includes a set of procedures for monitoring the entire testing system and process to ensure that the quality results are produced for intended clinical use. It covers much more than traditional internal quality control.

In 2012, CLSI approved EP23-A as a guideline for setting up the quality control for core lab testing based on risk management. Including the key concepts from EP-23, the Centers for Medicare and Medicaid Services (CMS) in USA revised the Clinical and Laboratory Improvement Amendments (CLIA) interpretive guidelines in 2016 to establish individualized quality control plan for non-waived POCT in order to implement manufacturer recommended liquid external quality control frequency in conjunction with the built-in internal control in test device.

In this roundtable session the basic risk management principle and approach will be reviewed and discussed. An example of risk assessment conducted for POCT device at Eastern Health, St. John’s will be presented.

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RW202 Practical Aspects of the Fecal Calprotectin Test
Wednesday June 5, 0730-0830

 

Benjamin Jung, University of British Columbia; Children’s and Women’s Health Centre of British Columbia

 

Learning Objectives:

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

  • Become familiar with the different FCAL commercial assays available.
  • Understand the differences in sample extraction devices and methodologies.
  • Learn about practical aspects and considerations for validation and implementation.

Fecal calprotectin (FCAL) has been recognized as a good non-invasive biomarker to help discern Inflammatory Bowel Disease (IBD) from functional bowel disorders like Irritable Bowel Syndrome. Also, because FCAL levels reflect disease activity in IBD patients, it is a useful test for monitoring for remission and assessing the effectiveness of therapeutic treatments, and for optimizing clinical management. Despite the strong evidence of its clinical utility, laboratories in Canada have been relatively slow to offer this test. Several commercial assays for FCAL are available from different vendors that differ with respect to sample extraction, assay format (i.e. ELISA, automated immunoassay), and more. The co-presenters of the roundtable will share their practical experiences with a few commercial assays and will discuss considerations that are important for labs thinking to set up fecal calprotectin in-house.

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RW203 Harmonized Lipid Reporting in Canada: One Step Closer
Wednesday June 5, 0730-0830

 

Nicole White-Al Habeeb, Western University

 

Learning Objectives:

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

  • Recognize the need for harmonizing reference intervals and decision limits.
  • Understand and assess the differences in adult and pediatric lipid reporting across Canada.
  • Summarize the considerations and process used by the CSCC hRI working group to develop recommendations for adult and pediatric lipid reporting.
  • Appreciate the importance of clinical consultation when developing laboratory recommendations.
  • Understand and discuss the proposed adult and pediatric common lipid report recommendations.

A previous study by the Canadian Society of Clinical Chemists (CSCC) Harmonized Reference Interval (hRI) Working Group showed significant inter-laboratory variation in reference intervals for common laboratory tests. The difference was often greater than the variation in test results and was evident between laboratories using the same instrument. Despite published Canadian Cardiovascular Society (CCS) guidelines for the management of dyslipidemia, lipid reporting across Canadian laboratories is inconsistent, and often not up to date. A recent Canada-wide survey showed vast differences in current pediatric and adult lipid reporting practices, including differences in the lipid parameters reported, decision limits, and interpretative comments. This roundtable will focus on the efforts of the hRI Working Group to harmonize lipid reporting for adults and pediatrics in Canadian laboratories. The CSCC hRI Working Group is proposing a common lipid report for adults that is primarily based on the latest CCS Guidelines and includes a decision limit for non-fasting triglycerides. The proposed harmonized pediatric lipid report has been updated to include decision limits derived from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) data. Collaboration with the CCS guideline committee and other leading pediatric and adult lipid medical experts will ensure that the proposed common lipid report will agree with the most current recommendations for management of dyslipidemia in Canada, and will promote laboratory harmonization and improve patient care.

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RW204 Critical Thinking in Medicine – Education and Service Applications
Wednesday June 5, 0730-0830

 

Lori Beach, IWK Health Centre

 

Learning Objectives:

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

  • Determine definitions for critical thinking in medicine and in laboratory medicine.
  • Identify situations where critical thinking has a positive impact at laboratory level as well as for our clinical colleagues. Perceived barriers and the roll of intuition are also discussed.
  • Discuss how teaching and/or modeling critical thinking is carried out and what improvements can be made.

In this roundtable we’ll seek to understand critical thinking in the context of medicine. By appreciating the processes by which clinicians think and reason, and comparing this to our own training, areas for improving service and communication may be identified.

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RW205 Pragmatic Strategies for Reducing Preanalytical Errors in Stat Testing
Wednesday June 5, 0730-0830

 

Aparna Ahuji, BD Life Sciences

 

Learning Objectives:

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

  • Identify the sources of preanalytical errors in stat testing.
  • Define the potential clinical impact of these errors on test results.
  • Attain strategies to reduce or eliminate these errors in their facilities.

Preanalytical errors account for the majority of laboratory errors. These errors may be particularly detrimental in stat tests, as these tests are often requested for critical care patients who undergo frequent testing to monitor their condition (e.g., blood gases, glucose, hemoglobin). The consequences of these errors include specimen recollection, delay in result receipt and incorrect test results sent to the provider. This session will review some of the most commonly observed errors, as well as their potential impact on specimen quality, and ultimately on test results. Detection and remediation of preanalytical errors in stat testing will be illustrated through real life case studies, which will aid participants in identifying and eliminating some of the root causes of these errors. Strategies will also be offered which laboratory professionals can use to minimize these errors (e.g., implementation of quality indicators as performance monitoring tools). Additionally, the concepts of “big data” analysis will be introduced to demonstrate measurable reduction in preanalytical error.

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RW206 Importance of Tumor Marker Dual Reporting: PSA High-Dose Hook Effect Detected
Wednesday June 5, 0730-0830

 

Saranya Arnoldo, William Osler Health System

 

Learning Objectives:

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

  • Appreciate the within and between assay variability of prostate-specific antigen (PSA).
  • Illustrate the challenges associated with providing crucial tumour marker results.
  • Recognize the importance of communication to clinicians and re-determination of PSA baseline when switching platforms.

One of the most important utilities of using tumour markers is monitoring cancer patients undergoing treatment. The level of the tumour marker is crucial in determining the efficacy of treatments. The long-term monitoring of tumour marker levels in patients can be challenging, specifically when patients change hospitals or if the laboratory changes its assay method and/or analyzer platform. In general, tumour marker results from different manufacturers can have substantial differences due to variations in processes such as sample collection, handling, storage, as well as, the use of non-standardized antibodies (or proprietary antibodies) in immunoassays.

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RW207 Biostatistics Primer for Clinical Biochemists
Wednesday June 5, 0730-0830

 

Lawrence de Koning, University of Calgary; Alberta Public Laboratories

 

Learning Objectives:

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

  • Introduce the concept of statistical inference.
  • Describe worked examples of common statistical tests using program code.

Clinical biochemists are expected to understand basic statistical techniques and how to use them. However the amount of statistical training clinical chemists receive varies, as does the opportunity to practice these techniques. This roundtable will provide a practical overview of common statistical tests and how they can be used in laboratory medicine.

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