Events during September 2023

Nations, institutions, and now the NHS have made net-zero commitments, but how will this affect scientific operations, and what would net-zero science look like? Laboratories are recognising their energy intensive nature, and assessing their immense consumption of consumables. More green lab efforts are growing around the world, though more standards are needed.

This talk will include:

An introduction to sustainable and green labs
A look at what net-zero laboratories might resemble in the future
An introduction to Sustainability standards, and what programmes are developing regarding the sustainability of clinical, research, and all kinds of labs
Questions!

NHS England established the Genomic Medicine Service (GMS) in 2018 to realise the potential of genomics in healthcare. The NHS GMS built upon the existing NHS infrastructure and used learnings from the 100,000 Genomes Project to embed genomics through a world leading innovative service model from primary and community care through to specialist and tertiary care.

A consolidated national genomic laboratory network was established with seven GMS Alliances working together to support the clinical leadership and embedding of genomic medicine in end-to-end pathways more broadly and the working with other key clinical specialties. Equitable genomic testing is delivered through a single mandated National Genomic Test Directory for improved outcomes in cancer, rare, inherited and common diseases, and in enabling precision medicine and reducing adverse drug reactions.

Working in partnership with Genomics England the delivery of the whole genome sequencing service and ongoing key research initiatives are integral in developing the genomic service. Ongoing evolution of the service through cutting-edge science, research and innovation to ensure that patients can benefit from rapid implementation of advances is critical.

This presentation will give delegates attending an:

Overview of the pre-analytical processing pathway and potential risks associated with each stage.
Historical/current/prospective optimisation of the pre-analytical pathway.
Understanding of the near-future perspectives for standardisation-will technologies such image analysis and spatial profiling affect the practice of pathology laboratories.

Despite effective treatments and vaccines viral hepatitis remains a massive burden on global health affecting the poorest counties disproportionately. Effective treatments and diagnostics for hepatitis remain outside the reach of most people in resource-poor regions.

In contrast, UK strategies against viral hepatitis have been relatively successful, in particular the prospect of HCV elimination, which is already showing improved outcomes in liver health.

Effective strategies depend on high quality epidemiological data which is gleaned from a wide variety of sources including diagnostic laboratory reporting, sentinel surveillance programs and prospective screening of high-risk groups.

The key components preventing transmission of blood-borne viruses such as donor screening, surveillance of susceptible groups and vaccination are now further enhanced by retrospective case finding from historical data, opt-out screening in emergency departments and high intensity test-and-treat events in prisons.

Biomedical Scientists can make a valuable contribution towards viral hepatitis management by sharing local-level data, enabling practical testing solutions for marginalised groups and working closely with clinical teams.

Postpartum haemorrhage is caused by obstetric complications but may be exacerbated by haemostatic impairment. It is a common observation that placental abruption and amniotic fluid embolism are associated with a severe and early coagulopathy characterised by hypofibrinogenaemia and increased fibrinolysis.

In Cardiff, a programme of research has been undertaken investigating the early detection and replacement of fibrinogen based on viscoelastic haemostatic assays. This culminated in the development of a care bundle for postpartum haemorrhage called the Obstetric Bleeding Strategy for Wales (OBS Cymru). Introduction of the OBS Cymru intervention across Wales resulted in fewer women experiencing massive postpartum haemorrhage (defined as >2500 mL) and decreased need for blood transfusion. The intervention is being investigated further in a NIHR supported study.

At term, women have increased levels of procoagulant clotting factors and reduced anticoagulants leading to a prothrombotic state. Our study confirmed these findings and demonstrated significantly raised thrombin generation. We identified two main types of coagulopathy; a dilutional coagulopathy with coagulation factors and platelets falling progressively with bleed size. However, clinically significant reductions in clotting factors were not seen until bleeds of 3000-4000 mL had occurred due to the high starting levels. Despite this, thrombin generation did not decrease due to increased levels of factor VIII during bleeds. Similar dilution-related falls were seen with fibrinogen levels. The exception was factor XIII which falls at term and decreases further with bleed size. The clinical significance of this finding has not been investigated but could suggest a role for cryoprecipitate.

In a subgroup of women we identified an early and severe consumptive coagulopathy caused by hyperfibrinolysis with very high D-dimer and plasmin/antiplasmin complexes which we termed acute obstetric coagulopathy (AOC). In addition, women with AOC had low levels of fibrinogen and evidence of an acquired dysfibrinogenaemia demonstrated by a reduced Clauss/antigenic ratio. The coagulopathy caused depletion of factor V and factor VIII but other clotting factors and thrombin generation was preserved. An increase in activated protein C was observed but no increase in soluble thrombomodulin demonstrating similarities and differences to trauma-induced coagulopathy.

AOC occurred in about 1/1000 deliveries and was associated with a high rate of fetal and neonatal deaths. It was most commonly associated with placental abruption but occurred with all underlying causes of postpartum haemorrhage.

The aim for this session is to carry on with the patient’s journey to final diagnosis. This presentation will discuss how the valuable material obtained from ROSE clinics are utilised in making a diagnosis and provide prognostic/treatment related information.

With the use of a number of examples, this presentation will illustrate how cytology impacts on patient’s management pathway, and how a standardised reporting system could be useful in unifying diagnostic pathways and performing future work on audit and quality improvement.

Finally, the strengths and limitations of head and neck cytology from the perceptive of a histo/cytopathologist will be discussed

Cell blocks from Diagnostic Cytopathology (DC) samples have always had value in the diagnostic process as a complement to the traditional cytology stains – Papanicolaou and Romanowsky. It has become more important to provide material for Immunocytochemistry to refine malignant diagnosis, and more recently, the use of molecular testing to aid in the choice of tailored chemotherapy regimens. If this information can be obtained from DC samples, which are less invasive than biopsy samples, the patient will benefit.

External Quality Assurance of cell block preparations has up to now been covered by the Tissue Diagnostic scheme. However, this is not entirely appropriate as cytopathology departments use a variety of cell block preparation methods and fixatives. The increase in number of cell block Haematoxylin and Eosin slides submitted to our evaluation service and the queries we receive regarding advice on best preparation methods suggested there was a need for a separate scheme for evaluation of cell blocks. A circulated survey indicated that there is a need for such a scheme. In response to this we performed 2 pilot studies which were well supported and successful, leading to the launch of the live scheme in April 2023.

This presentation covers the development of the scheme and the results of the 2 pilots. As an ongoing process the scheme will be able to garner information about ‘best methods’ and this can be passed on to laboratories experiencing problems and improve standards. UKNEQAS CPT is not just a ‘tick box’ service for UKAS, it is also an advisory service which aims to improve diagnostic practices.

IIF and Artificial Intelligence

Clinical Liaison Role in Wales – an update on the journey so far

Your career in Clinical Biochemistry: IBMS qualifications and the role of the Advisory Panel