Events during September 2023

In 2022 the unthinkable happened - NHSBT was forced to declare an Amber Alert for red cells in England. But does that tell the whole story? This presentation will briefly examine the build-up to the shortage declaration but also consider its impact, provide evidence of the response within hospitals and consider the opportunities for future change in practices.

This presentation will provide an update Update to the clinical use of lipids and the laboratory role in lipid disorders.

Clostridioides difficile is responsible for the eponymous C. difficile infection (CDI). Faecal microbiota transplant (FMT), a NICE recommended treatment for recurrent CDI, is effective but logistic and safety concerns remain.

With the advent of non-donor derived products, the presentation will outline the principles and evidence related to correcting gut dysbiosis and explore whether there is a need for current or expanded FMT services in the future.

The requirement of extensive and complex testing on cytology samples is widely and routinely recognised. ROSE performed by scientists in the clinical setting provides a standardised, clinically effective, reproducible methodology for a variety of anatomical sites, some of which cytology is the only modality for sampling.

Real-time adequacy assessment eliminates the need for more invasive or repeat procedures by ensuring sufficient cell yield is obtained to conduct all the tests required for ancillary and molecular testing. This streamlines the patient pathway by reducing the referral to treatment time and reduces waiting list pressures, resulting in cost reduction for healthcare trusts and improved patient care and outcomes.

The presentation will explore the new IBMS ROSE qualification with the aim to inspire scientists to become skilled in ROSE.

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.

Nuisance Antibodies

The Royal College of Pathologists has led an initiative to improve the transparency and standardise the operation of external quality assurance for providers of clinical diagnostic testing in the UK. This project has resulted in the development of the EQA Governance Framework, bringing together the current system of the National Quality Assurance Advisory Panels and the other stakeholders. Most diagnostic service providers are aware of the Panels, to which the EQA providers report performance concerns relating to UK laboratories, but perhaps are less certain on the criteria for reporting and the involvement of other oversight bodies, e.g., the Medicines and Healthcare Regulatory Agency and the Care Quality Commission.

The EQA Governance Framework has been developed through four separate workstreams. Workstreams 1 and 2 cover the governance and description of the process and have developed a portfolio of documents designed to support a standardised approach to the investigation and resolution of performance concerns with individual laboratories and method related problems.

Fundamental to the management of laboratory performance is the definition of unsatisfactory or poor performance, for qualitative and quantitative testing, in terms applicable to all pathology disciplines, and the action points at which the EQA provider will consider the escalation of a performance concerns to the oversight process. A challenging aspect of the work has been the development of procedures to recognise and manage method-related performance concerns, especially when working with global providers of testing platforms.

This long-term project is intended to strengthen the oversight of diagnostic testing, ensure the sharing of learning points and best practice and benefit patient safety.

Transient Abnormal Myelopoiesis

Problems can happen when we least expect them. Loss of a key building, a cyber-attack or a system failure, interruption to a utility supply, severe weather, critical equipment failure, supply chain disruption or even a significant loss of staff. Sooner or later every organization will need to deal with issues like these and if there's no plan the outcomes could be far worse than they need to be. This is why services must maintain a critical incident response plan and a wide range of business continuity plans, having a structured approach for managing these unplanned disruptions.

Business continuity planning is just one part of a much bigger risk management process. We prepare for emergencies, not just because we're legally required to do so, but because patients, donors, and the wider NHS rely on our services being available every day.

There are four main scenarios all good business continuity plans should consider:

Loss of staff
Loss of the workplace
Loss of equipment and consumables and
Loss of ICT systems
The process should be one of a cycle of preparedness including

Risk Management or identification
Planning
Training
Exercising
Lessons identified

Electron microscopy is essential for the diagnosis of a range of medical renal disorders, and its use is detecting immune deposits and basement membranes changes in native kideny biopsies will be familiar to many biomedical scientists and pathologists. EM is also used in the assessment of renal transplant biopsies.

In cases of recurrent disease the features are similar to those seen in native kidneys, but there are also specific features only seen in the transplant setting. This talk will focus on the utility of EM in renal transplant biopsies, demonstrating examples from relevant cases.