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Breakfast Roundtables

CSCC 2022 | June 5-8 | Niagara Falls Ontario > Breakfast Roundtables

Breakfast Roundtables will be held on Monday, June 6 and Wednesday June 8:

 

Monday June 6 – 0730-0830

Wednesday June 8 – 0730-0830

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R060730-A Earning Your Wings as a Manuscript Editor for a Scientific Journal
Monday June 6, 0730-0830

 

Joel Goodman, Ai Genetics

 

Learning Objectives:

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

  • Describe the problems as they exist today.
  • Explain why these problems are significant to the CSCC.
  • Use the available tools to rectify the problem.

Review and discuss illustrative cases to highlight key considerations surrounding test interpretation.

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R060730-B Cases in Pediatric Clinical Chemistry
Monday June 6, 0730-0830

 

Lawrence De Koning, Alberta Precision Labs, University of Calgary

 

Learning Objectives:

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

  • Discuss the benefits of a QA program that periodically assesses the appropriateness of critical values.
  • Describe pediatric-related issues in stages of the testing process that can cause unusual results.
  • Describe unique physiologic aspects of children, rare pediatric conditions and errors in care that can cause unusual results.

This ongoing series will review pediatric cases with highly unusual or unexpected chemistry test results. Errors in the testing process (e.g. specimen processing failure), important pediatric medical conditions (e.g. congenital defects, inborn errors of metabolism) and errors in clinical care that were responsible for these results will be discussed.

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R060730-C Alzheimer Disease (AD) Biomarkers in CSF and Plasma: Which Assay Performs Best to Diagnose AD and How They Correlate
Monday June 6, 0730-0830

 

Hans Frykman, BC Neuroimmunology Laboratory and Neurocode Lab; University of British Columbia

 

Learning Objectives:

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

  • Discuss the use of fluid biomarkers in Alzheimer’s disease.
  • Describe the difference between measuring the biomarker in CSF and blood.
  • Describe the different biomarkers for Alzheimer’s.

The treatment of Alzheimer’s is currently entering a new era with drugs that address the mechanism of the disease. Therefore, it is very important to diagnose Alzheimer’s correctly. The neurologist is only accurate to 70% but with the help of a biomarker that number goes up to over 95%.

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R060730-D Approaches to Prenatal Screening for Aneuploidy
Monday June 6, 0730-0830

 

Miranda Brun, Alberta Precision Laboratories

 

Learning Objectives:

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

  • Describe the current landscape of prenatal screening for common aneuploidies across the country.
  • Identify the considerations and challenges from a laboratory perspective in providing a prenatal screening program that fulfills current SOGC recommendations for screening.
  • Discuss how NIPS is being incorporated into prenatal screening programs and the role of NIPS in the future of prenatal screening.

Current guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommend that all pregnant women in Canada should have the option of prenatal screening for the most common fetal aneuploidies (Joint SOGC-CCMG Clinical Practice Guideline No. 348). Prenatal screening modalities vary widely across the country, including first trimester combined screening, second trimester maternal serum screening, integrated prenatal screening, serum integrated prenatal screening, and non-invasive prenatal screening (NIPS). This roundtable session will discuss the current state and challenges of prenatal screening in Alberta and across Canada. Discussion will center on: 1) benefits of different screening options, 2) impact of NIPS on prenatal screening programs, and 3) identifying and reducing barriers to access screening. The goal of this roundtable is to promote interactive discussion of prenatal screening in Canada.

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R060730-E Neural Antibody Testing in Patients with Suspected Autoimmune Encephalitis
Monday June 6, 0730-0830

 

Adrian Budhram, London Health Sciences Centre

 

Learning Objectives:

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

  • Describe the diagnosis of autoimmune encephalitis and the rationale behind panel-based neural antibody testing.
  • Discuss neural antibody test interpretation considerations as they pertain to paraneoplastic, GAD65, and cell-surface/synaptic antibodies.
  • Discuss illustrative cases to highlight key considerations surrounding test interpretation.

This roundtable will be an interactive session dedicated to discussing methodological approaches to neural antibody testing in patients with suspected autoimmune encephalitis, with the aim of helping laboratorians optimize diagnostic test performance.

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R060730-F Clinically Implemented sFlt-1 and PlGF Assays for Supporting Preeclampsia Diagnosis
Monday June 6, 0730-0830

 

Lei Fu, Sunnybrook Health Sciences Centre

 

Learning Objectives:

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

  • Discuss the analytical and clinical diagnostic evaluation of sFlt-1, PlGF and their ratio.
  • Describe the testing algorithm to optimize the utilization of these biomarkers.
  • Discuss the impact of these biomarkers on the PE diagnosis and patient management.

Preeclampsia (PE) is a multisystem hypertensive disorder that affects 3-5% of pregnancies. It is one of the leading causes of morbidity and mortality, including maternal, fetal or neonatal populations. Traditionally, PE is characterized by hypertension and proteinuria after 20 weeks of gestation. However, clinical signs are neither specific nor sensitive for PE. The currently available laboratory tests, such as serum uric acid, renal and hepatic markers, are not diagnostic for PE either. Missing or delayed diagnosis of severe PE may put women and fetus at risk of serious complications. Therefore, there is a great need for additional biomarkers to improve the diagnostic accuracy for PE. Literature and clinical trials showed that soluble FMS like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) are promising serum markers in PE diagnosis. The ratio of the anti-angiogenic factor, sFlt-1, to the pro-angiogenic factor, PlGF, is associated with increased risk of PE. Recently our hospital has clinically implemented the Roche Elecsys immunoassays, sFlt-1 and PlGF. The ratio of sFlt-1/PlGF is used for PE diagnosis in support of the institute’s high-risk obstetrical unit.

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R060730-G Protein Electrophoresis for Monoclonal Gammopathies Analysis
Monday June 6, 0730-0830

 

Jeili Shirley Li, The Ohio State University

 

Learning Objectives:

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

  • Discuss the advantages and limitations of various methodologies used for monoclonal gammopathies analysis.
  • Describe current free light chains measurement methodology.
  • Discuss up-to-date consensus/guidelines for diagnosis of monoclonal gammopathies.

The current available methods to detect M proteins include gel and capillary serum and urine protein electrophoresis (SPEP and UPEP), serum and urine immunofixation (sIFE and uIFE), immunosubstraction (ISUB) and mass spectrometry (MS). Despite an overall good performance on all laboratory procedures using current methodologies, mis- or false-diagnoses have been noticed, especially on cases with non-classic abnormal immunoglobulin profiles. This session will highlight the challenges of transition from traditional agarose gel to Capillary Electrophoresis, as well as cases with the challenging profiles and present solutions using multi-method approach address potential misdiagnosis. Immunoglobulin (Ig) D multiple myeloma (MM) is a rare variant of this disorder. More rarely, the light chains may not be detected using conventional immunofixation techniques. We will present the IgD lambda cases with “hidden” Lambda on agarose gel, likely due to the inaccessibility of the epitopes targeted by the antiserum. The approaches to make the “hidden” light chain more accessible included reduction technique and ISUB. In addition, the importance of serum free light chains will be discussed, as well as the discrepancies from three current sFLC assays and their utilization in clinical practice. In this session, we will also present and discuss a comprehensive overview of up-to-date consensus/guidelines for monoclonal gammopathies, such as 2021 CAP guidelines on initial diagnosis of monoclonal gammopathies, and 2020 guidelines on the diagnosis of MM in Canada, for clinical laboratory practice.

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R060730-H Laboratory Harmonization and Standardization: Friends or Foes?
Monday June 6, 0730-0830

 

Jessica Gifford, Alberta Precision Laboratories

 

Learning Objectives:

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

  • Address issues and challenges associated with laboratory standardization.
  • Learn strategies to successfully implement laboratory standardization and harmonization.
  • Apply strategies to the pre-analytical, analytical, and post-analytical factors of laboratory standardization.

Harmonization and/or standardization of laboratory services is becoming a common theme in Canada due to budgetary restriction and regional consolidation of laboratory services. However, harmonization/standardization is often initially met with fierce resistance due to concerns of job losses, vendor monopolies, reagent shortages or changes specific to one vendor, IT limitations, and inability to troubleshoot problem specimens or meet the needs of the local population. If done properly; however, harmonization/standardization can offer many opportunities to improve patient care through equalizing access to services and a continuity in results produced by laboratories within a city, zone, province or even country. Over the last four years laboratory services in Alberta have been brought under the umbrella of Alberta Precision Laboratories, which is mandated with harmonization/standardization of laboratory services provincially. These efforts have included changes at the pre-analytical, analytical, and post-analytical levels in order to serve laboratory testing needs in acute care ranging from tertiary care hospitals to small rural facilities, as well as in community laboratory testing. In this workshop we will address important issues related to and lessons learned from the consolidation of laboratory services in Alberta, specifically from a clinical chemistry perspective. Topics discussed will include standardization of laboratory requisition forms and test directory, a provincial request for proposal (RFP) for a singular general chemistry/immunoassay instrumentation vendor, provincial efforts to standardize troponin testing, reference interval harmonization, and the standardization of the laboratory information system (LIS). The impact of these changes on both medical and operations staff will be addressed. This workshop provides a unique learning opportunity that is otherwise not available to clinical laboratorians. The speakers will share their real-life experiences in harmonization and standardization, emphasizing the challenges and resource commitments that were required to meet these goals. This workshop is aimed at clinical biochemists, general pathologists, clinical biochemistry fellows, general pathology residents, medical laboratory technologists, and laboratory administrators. Following completion of this workshop the attendee will be able to address issues and challenges associated with standardization, as well as learning about strategies to successfully implement laboratory standardization and harmonization in the following areas: 1) pre-analytical factors: test directory, test requisition; 2) analytical factors: instrumentation, including lessons learned from a provincial RFP for general chemistry instrumentation; 3) post-analytical factors: reference interval harmonization, and provincial LIS implementation.

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R060730-I Methotrexate Immunoassay Interference After Glucarpidase Treatment
Monday June 6, 0730-0830

 

Benjamin Jung, Hospital for Sick Children

 

Learning Objectives:

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

  • Explain the clinical application and interpretation of MTX levels.
  • Describe the utility of LC-MS/MS measurement of MTX following glucarpidase treatment.
  • Describe how MTX levels by commercial immunoassays are impacted differently after glucarpidase treatment.

Methotrexate (MTX) is an antifolic acid that is used for chemotherapy. Daily measurement of MTX blood levels is required to monitor clearance to minimize toxicity to normal cells. In certain patients, clearance is inadequate with standard management protocols, which leads to high MTX levels that necessitate emergency administration of the drug glucarpidase to immediately convert all MTX to inactive metabolite. MTX measurement following glucarpidase treatment using commercial immunoassays will be invalid however, due to assay interference from the metabolite. Testing by LC-MS/MS based methods will be required until the interference disappears.

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R080730-A Applications of Cardiac Markers in Pediatrics
Wednesday June 8, 0730-0830

 

Lawrence De Koning, Alberta Precision Labs, University of Calgary

 

Learning Objectives:

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

  • Identify and describe common cardiac conditions in children.
  • Explain how cardiac troponin and and BNP/NT-ProBNP are frequently used in pediatrics.
  • Describe major knowledge gaps in the use of cardiac markers in pediatrics.

Cardiac markers such as high sensitivity cardiac troponin and NT-proBNP are critically important for diagnosing acute coronary syndromes and heart failure in adults, however their use children is not as well known. This roundtable will review the current state of knowledge regarding the use of cardiac markers in pediatrics.

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R080730-B Which Biofluid is Appropriate for Diagnosis of Autoimmune Encephalitis: CSF or Serum or Both?
Wednesday June 8, 0730-0830

 

Hans Frykman, BC Neuroimmunology Laboratory and Neurocode Lab; University of British Columbia

 

Learning Objectives:

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

  • Describe which biofluid (CSF or blood) to send for autoimmune encephalitis.
  • Describe how up lower the cost by up to 40%!
  • Describe when to contact neurology to discuss other options.

Autoimmune encephalitis is a severe disease and one of the most difficult diagnoses which rely on correct antibody detection. The testing is expensive and almost all results come back negative, creating a very high cost per diagnosis. This roundtable focus on saving money for the send-out lab by detailing which specimen to send.

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R080730-C Improving Nephrology Referral of Patients with Chronic Kidney Disease in Primary Care
Monday June 5, 0730-0830

 

Paul Yip, University of Toronto

 

Learning Objectives:

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

  • State the current recommendations for detection and monitoring of CKD in primary care.
  • Describe the Kidney Failure Risk Equation (KFRE).
  • Discuss issues in the implementation of KRFE in the community setting.

The incidence of Chronic Kidney Disease (CKD) is growing and would cause undue burden to society without better tools to predict progression to organ failure. While creatinine-based eGFR has become the mainstay of early detection of CKD in the primary care setting, the decision to prompt referral to nephrology is more challenging. Albuminuria is strong predictor of CKD progression, which has been incorporated into the Kidney Failure Risk Equation (KFRE) to calculate the likelihood of kidney failure in the next 2 to 5 years. Recently, automatic reporting of KFRE was introduced in a large community setting to support Ontario’s KidneyWise Clinical Toolkit aimed to better manage CKD in primary care.

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R080730-D Quality Assurance in the Total Testing Process of POC Blood Gas Analysis
Wednesday June 8, 0730-0830

 

Yun Huang, Kingston Health Sciences Centre

 

Learning Objectives:

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

  • Describe the advanced management functions of cartridge-based benchtop blood gas analyzers.
  • Explain the Six Sigma performance of the quality management system.
  • Identify the procedures or indicators that can be included in an effective quality control plan.

Blood gas analyzers are important instruments in critical care settings and are used in both Core Laboratory and Point of Care (POC) environments. Multiple tests in panels are provided to determine acid/base status, the balance of electrolytes and metabolites, and oxygen delivery capacity. Any errors in the total testing process of blood gas analysis may change medical decisions and impact patient safety. Cartridge-based blood gas analyzers have been developed for POC testing to reduce analytical variation and eliminate operation errors. In addition, manufacturers have also been developing new technologies to improve the measurement and quality monitoring of blood gas analyzers. For example, built-in quality management system, and error detection for sensors, samples or interferences. Errors related to blood gas analysis can occur at any step of the testing, not all of them can be monitored or mitigated by advanced analytical or management functions on the instruments. A quality control plan that covers the total testing process of blood gas analysis is necessary for quality assurance. In this roundtable session, issues and challenges in the quality management of cartridge-based blood gas analyzers (benchtop) will be reviewed and discussed.

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R080730-E Quality Management: Trends in Medical Error Disclosure and its Implications
Wednesday June 8, 0730-0830

 

Jay Kalra, Royal University Hospital; University of Saskatchewan

 

Learning Objectives:

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

  • Define the concept of Medical error, Quality care/patient safety in health care.
  • Identify dilemma of Error/Adverse Event and Ethical issues: the concept of disclosure.
  • Evaluate the barriers and incorporating cultural changes of disclosure.
  • Discuss current National and International disclosure policies.

Medical error has become a major issue around the globe. When errors occur, healthcare providers are faced with the ethical dilemma of if, and to whom to disclose the error. Disclosure of an adverse event is an important element in managing the consequences of a medical error. The issue of honest disclosure of a medical error to the patient or their family has been relatively unattended. We reviewed, compared, and will discuss the various medical error disclosure initiatives across the globe (USA, Australia, New Zealand, Canada, and United Kingdom) to analyze the progress made in this key area. Effective communication between health care providers, patients and their families throughout the disclosure process is integral in sustaining and developing the physician patient relationship. In conclusion, the designing of an error disclosure policy requires integration of various aspects including bioethics, physician-patient communication, quality of care, and team-based care delivery. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners are balancing the ethical complexities involved in error disclosure with other related fields. We suggest that a uniform policy centered on addressing errors in a non-punitive manner and respecting the patient’s right to an honest disclosure be implemented.

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R080730-F Selective Venous Sampling Procedures: a Collection of Interesting Cases
Wednesday June 8, 0730-0830

 

Angela Fung, St. Paul’s Hospital

 

Learning Objectives:

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

  • Identify clinical scenarios where selective venous sampling would, or would not, be useful.
  • Identify key references to guide the interpretation of selective venous sampling procedures.
  • Discuss the role of the clinical laboratory in the investigation of these cases with regard to all phases of the testing process.

Selective venous sampling is a diagnostic procedure that uses medical imaging guidance to insert a catheter into specific vein(s) and collect blood samples for hormonal analysis in the clinical biochemistry laboratory. Common procedures include adrenal venous sampling, parathyroid venous sampling, inferior petrosal sinus sampling, ovarian venous sampling, and arterial calcium stimulation venous sampling. These procedures are technically challenging in accurately locating specific veins, inserting and maintaining the catheter(s) during stimulation and collection, and collecting an adequate blood sample. Interpretation of hormone results can be complicated by various clinical and technical factors such as cessation of interfering medications or use of appropriate stimulating agents, catheterization success, and sample mis-labelling during a complex procedure. In this session, the clinical laboratory approach to facilitating and interpreting a range of selective venous sampling procedures will be reviewed. This approach will be based on quality assurance principles regarding all phases of the testing process including pre-test probability, pre-analytical considerations, sample collection, analysis and interpretation. The value of an interactive endocrine, laboratory, interventional radiology partnership in reviewing and reporting these cases will be described by showcasing clinically challenging selective venous sampling cases encountered in British Columbia.

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R080730-G Harmonized Adult Lipid Reporting
Wednesday June 8, 0730-0830

 

Nicole White-Al Habeeb, Dynacare

 

Learning Objectives:

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

  • Discuss the 2021 CCS Lipid Guidelines, putting them into context with previous guidelines (What is new?).
  • List the six recommendations for harmonized lipid reporting proposed by the CSCC hRI-WG and discuss the advantages and disadvantages of the proposed LIS approaches for their laboratory and main clinical users.
  • Develop a plan to locally implement harmonized lipid reporting based on consideration of anticipated challenges.
  • Collaborate with the CSCC hRI-WG to provide insight and updates on their experience of the implementation process.

This session will discuss the plans of the Canadian Society of Clinical Chemists (CSCC) Harmonized Reference Interval Working Group (hRI-WG) to harmonize adult lipid reporting across Canada, based on the 2021 Canadian Cardiovascular Society (CCS) Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Based on a 2018 nation-wide survey, significant variation in lipid reporting was identified including differences in lipid parameters reported, discrepancies in interpretative comments, and different references for lipid parameter thresholds. Harmonization of lipid reporting will facilitate standardized lipid assessment and clinical decision making, ultimately optimizing patient care and reducing risk. A subcommittee of the CSCC hRI-WG developed and published reporting recommendations which were then critically reviewed by 30 clinical and laboratory experts across Canada. Final consensus decisions were incorporated into the 2021 Harmonized Lipid Reporting Recommendations, which included six main recommendations: 1) availability of nonfasting and fasting testing; 2) lipid panel including total cholesterol, LDL-C, HDL-C, non-HDL-C and triglycerides, with ApoB and Lp(a) available as individually orderable tests; 3) minimal interpretive comments on the lipid report; 4) replace Friedewald LDL-C equation with the new NIH equation; 5) report Lp(a) in molar units (nmol/L) based on direct measurement of apo(a); and 6) preferred use of decision thresholds based on lipid screening in primary prevention of cardiovascular disease. In this session, we will: provide an overview of the 2021 CCS Lipid Guidelines, with the context of “What’s new?”; review the 2018 CSCC hRI-WG Canada-wide survey describing the variation in lipid reporting, and discuss potential implementation challenges; describe the development of the CSCC hRI-WG 2021 Harmonized Lipid Reporting Recommendations, outlining six recommendations, and the proposed formatting and interpretive comments options; and finally, discuss implementation planning, including some wins and lessons-learned from early adopters.

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R080730-H Canadian Academy of Clinical Biochemists Code of Ethics
Wednesday June 8, 0730-0830

 

Curtis Oleschuk, Kingston Health Sciences

 

Learning Objectives:

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

  • Discuss the background and needs for the Code of Ethics document.
  • Provide feedback on revisions to the Code of Ethics document to be used by CACB.

Canadian Academy of Clinical Biochemists Board has recently drafted a document to enhance awareness and adherence to key principles of professionalism. The document will be required of all Fellows to review and sign on an annual basis as a reminder of their commitment to these principles. During the Roundtable we will discuss the background and needs for the Code of Ethics document. The information in the code of ethics document will be reviewed in addition to open discussion of roundtable participants to allow for feedback.

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