Events on 27 September 2023

The new molecular pathology Specialist Portfolio

The Higher Specialist Diploma (HSD) is the main route for gaining Fellowship (FIBMS) status. In this session I will provide a brief overview of the IBMS Higher Specialist Diploma (HSD) qualification explaining the disciplines that the HSD can be undertaken in, who the qualification is aimed at and how the qualification is assessed.

I will then provide advice and guidance on the completion of the portfolio element of the qualification and explain what a good portfolio looks like. I will also briefly explain how to prepare for the exam element of the qualification. There will also be an opportunity to ask questions about the HSD.

Myeloma screening is a high volume investigation pathway, performed by both Biochemsitry and Immunology laboratories. National audit data has shown there to be high variation between laboratories on the implementation of this workflow, leading to potentially inconsistent patient care geographically.

This talk will aim to cover the following areas:

Give brief foundation knowledge on serum electrophoresis/immunodisplacement/immunofixation
Introduce the Myeloma UK Best practice guidelines for Myeloma screening
Discuss Mass spec methods for analysing monoclonal protein
Discuss monitoring of myeloma patients and monitoring of Monoclonal gammopathy of undetermined significance (MGUS) patients.

EQA: What’s happening?

A myositis-related autoantibody can now be identified in the majority of patients with myositis. They identify homogeneous patient subgroups and are key tools in developing a personalised approach to disease management. There is substantial clinical interest in exploiting myositis autoantibodies as biomarkers, and consequently, a large number of commercial assays have been developed for their detection. Several different commercial assays have now been developed to detect myositis relevant autoantibodies. Many have been developed with the practicalities of clinical practice in mind, offering rapid, affordable, and often multiplex testing. Despite this progress, the perfect system has yet to be realised.

Commercial testing systems do not detect all known myositis relevant autoantibodies and concerns have been raised about the sensitivity and specificity of some assays, including to their ability detect some autoantibodies strongly associated with malignancy and ILD; important causes of mortality and morbidity.

The advantages and disadvantages of different myositis autoantibody testing systems will be discussed. Evidence for the reliability of different types of assays in comparison to immunoprecipitation, as the reference standard, will be reviewed along with testing strategies that make the most of existing technology.

Idiopathic Membranous Nephropathy: PLA2 and beyond

IIF and Artificial Intelligence

Food-induced immunotherapy has been practiced with varying success for over 100 years. Over the past 10 - 15 years it has gained a greater recognition in the potential management of children with food allergies. Food-induced immunotherapy can take the form of oral, epicutaneous or sublingual routes and usually results in a short-lived desensitisation rather than the acquisition of tolerance. For this reason, food immunotherapy is not a cure but relies on regular, usually daily, ingestion. Peanut immunotherapy lies mainly within the domain of clinic research however Palforzia (roasted peanut flour), was approved by NICE in February 2022 for the management of peanut allergy in children 4 to 17 years of age. The methodologies and factors associated with successful desensitisation to peanut will be discussed.

Vaccinations to Covid 19 virus have been at the forefront of news headlines. One of the issues highlighted was the risk of adverse reactions, both allergic and non-allergic. This caused an influx of queries to Allergy services regarding patients who had suffered potential allergic reactions and posed the question, 'how can they be investigated'?

The laboratory has limited commercial assays to the components and excipients of vaccines. However, tests can potentially be modified or developed in-house to provide evidence of a potential allergy. They could also be utilised to determine if an alternative vaccination can be used. The testing strategy may need to be adapted on a case by case basis.

There is the potential that this could be used to develop a service for allergic reaction investigation for all vaccine types.

Interpretation of ISAC