Events in 2023

This presentation will:

Summarise the key points within the BSH guideines for blood grouping and antibody testing in pregnancy
Give an overview of the main updates to the BSH guideline for blood grouping and antibody testing in pregnancy

Despite major advances in investigating haematological abnormalities, the blood film can still be crucial in diagnosis and patient management. The first major role is the validation of an abnormal blood count and, when it is found to be invalid, finding an explanation for factitious results. Factitiously low platelet counts and factitiously high MCVs are well recognized examples.

When the count is found to be valid, an explanation might be revealed. A blood film may indicate a likely diagnosis within minutes; this can be of vital importance as in acute promyelocytic leukaemia, thrombotic thrombocytopenic purpura, Burkitt lymphoma and certain infections. Sometimes the blood film suggests an uncommon or rare condition the diagnosis of which is important but would otherwise be delayed or elusive.

We are living through a world of change. COVID has had a long-lasting impact on how the next generation learn and the skills they have when entering higher education. Black Lives Matter emphasises once again the barriers to learning faced by so many marginalised members of our communities. An inclusive curriculum aims at eliminating barriers by embracing difference and fostering a strong sense of belonging. It enriches the learning experience to enable students to develop empathy, cultural competence, and responsibility for social cohesion.

ISO15189:2012 had reached its periodic review date and there was international consensus that it needed revision. The new version was published on 6th December 2022 and there are some key changes which include an emphasis on a patient-focused approach and to promote the welfare of patients - i.e. putting the patient at the heart of the service. There is also more emphasis on a risk-based approach to the Quality Management system. In addition, ISO 22870 (POCT) has been incorporated into ISO 15189:2022.

This presentation will review POCT definitions, highlight key considerations for currently accredited POCT services and also for organisations considering applying for accreditation to include (or extend) POCT in their scope.

POCT is referenced implicitly throughout ISO 15189:2022 and with additional distinct requirements as an Annex A.

The presentation will discuss generic POCT services, and highlight considerations on both current POCT services and also emphasise considerations for planning new POCT services, and that overall, when compared with ISO 22870:2016, things have not changed as much as one would think. Principles are similar, and POCT could even be considered as another specialty within pathology, regardless of where it is or managed from.

Semen analyses is essential to understand male factor infertility and to allow planning for treatment options. Absence or low numbers of viable sperm become a challenge and to define whether obstruction removal surgery is needed or whether it would be possible to possible to boost sperm numbers if hormonally related problems exist.

Semen diagnostic analyses is used to define which treatment modality, timed sexual intercourse, intrauterine insemination (IUI) or in vitro fertilisation (IVF) or if intracytoplasmic sperm injection (ICSI) is needed. Despite all efforts, around 70% of women remain barren after treatment and little understanding exists especially on male factor which forms almost half the problem. Poor to very poor sperm quality relating to multiple factors such as counts, motility and morphology are increasingly associated with declining embryo quality, pregnancy outcomes and recurrent miscarriage. Asthenozoospermia/asthenospermia) is related to reduced sperm motility, whereas teratozoospermia refers to morphology condition. For the first time the field of diagnostic andrology has a chance to make substantial male factor contribution towards the knowledge of poor success rates and have available a numeral encompassed in `teratozoospermia index’ (TZI). The TZI has a maximum of four defects per abnormal spermatozoon: one each for head, midpiece and principal piece, and one for excess residual cytoplasm. The TZI is the sum of all abnormalities divided by the sum of abnormal spermatozoa, thus always giving a result between 1.00 and 4.00.

Ordinary semen analyses so far have had limited predictive value, but TZI will form a meaningful and constructive contribution to reproductive medicine, allowing for less invasive and less commercially driven and unnecessary expensive ICSI treatments. To derive the TZI numeral does not require significantly more investment other than performing a simple calculation to reach this index numeral, while conforming to WHO standards. There are sufficient parallels between poor sperm quality and DNA damage and recurrent miscarriage for instance, and morphology deficit evidence is beginning to emerge, adding TZI potential substantially to diagnostic andrology analyses as well as in providing clinical steers.

The Teratozoospermia Index (TZI) is a recent addition to WHO guidelines. The interpretation of the guidelines and whether laboratories should/should not undertake this test is contentious and may cause issues for many services.

This debate will involve two speakers: one for and one against TZI implementation. This will give attendees a rounded review of this area and support their decisions in undertaking this examination.

The Teratozoospermia Index (TZI) is a recent addition to WHO guidelines. The interpretation of the guidelines and whether laboratories should/should not undertake this test is contentious and may cause issues for many services. This debate will involve two speakers: one for and one against TZI implementation.

Sperm morphology assessment is part of a basic semen analysis. Accurate assessment of the percentage of normal-shaped sperm can help in diagnosing male factor infertility and in signposting to the most effective assisted conception therapy if needed.

Beyond classifying whether or not a sperm shape is normal, the introduction of the teratozoospermia index (TZI) requires us to now look at each sperm in far more detail. We are asked to assess the percentage of specific abnormalities such as head shape (is it too thin or amorphous?), midpiece (is it slightly asymmetric?) and tail (is it a little too short?). However, such assessments require additional time-consuming work for the biomedical andrologist and is it really of any clinical relevance?

Most sperm shape defects are easy to detect by the basic analysis without this extra work. Examples include globozoospermia, macrocephaly, decapitated sperm syndrome and fibrous sheath dysplasia, all of which are simply diagnosed, as often the vast majority of sperm affected.

Antimicrobial resistance is a major concern with mortality rates growing exponentially. Current ASTs used clinically can take 24-48hrs to report results, ensuing in initial treatment with broad spectrum antibiotics. The novel iFAST method can report results within 2 hours of exposure to an antibiotic. The main objective of this study was to measure the impedance signal of resistant and sensitive isolates of Staphylococcus aureus that had been exposed to cefoxitin. Sequentially collected bacterial isolates were accessed from the clinical microbiology laboratory to determine susceptibility.

50 methicillin resistant/sensitive isolates of S. aureus were taken from the middle of the clinical workflow and tested on the iFAST. The isolates were streaked onto blood plates and incubated at 37 degrees for 2 hours. The bacteria were then exposed to cefoxitin for 2 hours at the EUCAST breakpoint concentration of 8mg/L. Following exposure, the samples were measured on the iFAST.

The impedance cytometer measures the electrical signal of bacterial cells as they individually flow through a microfluidic channel, via electrodes driven by an AC current of multiple frequencies. This is interpreted as a read-out of cell volume and opacity. Exposure to antibiotics can change the electrical characteristics of the bacterial cell in size and opacity compared to the control sample. The number of exposed cells within the contour defined by the control sample can measure how the cells have altered in opacity and size following exposure.

iFAST results showed 100% concordance with disk diffusion sensitivity testing carried out by the clinical laboratory. The data showed different electrical impedance changes for both resistant and sensitive strains of S. aureus. Sensitive strains showed a decrease in cell size and resistant strains showed an increase in cell size following exposure to cefoxitin.

The bacterial impedance cytometer was able to rapidly differentiate between MRSA and MSSA isolates in concordance with current susceptibility testing in the clinical setting. The results help to show how the iFAST could reduce the time taken to provide critical and accurate antibiotic treatment to patients.

"Don’t worry, you’ll be next" – have you ever said, or heard this phrase when it comes to training opportunities?

Should you have a queue? Should you make promises? Or do you risk losing staff if you don’t?

This session will discuss considerations to ensure fairness in training opportunities, from an individual and organisational perspective. It will also look at how to ensure your opportunities and training are inclusive, and support diversity.

Expanding your role into Point-of-Care Testing – a career opportunity to consider

The principles of validation and verification have long been established and laboratories are generally familiar with these although there remain some issues which are commonly seen within verification reports during assessments. Some of these require some further attention and discussion, including consideration of sample type, verification across multiple sites and approaches used when upgrading analysers. Alongside these common issues, ISO 15189:2022 has now been issued with assessments to become mandatory to the new standard from January 2024 and whilst the principles of validation and verification are generally unchanged, there are some differences which will require review of internal procedures and approaches to verification. Awareness of these changes will form a part of the presentation, along with issues commonly seen, being hoped these will promote some thought as to how laboratories can consider the local approaches used.

Histopathology has numerous stages in the production of a digital image and its subsequent use. Each of the stages can introduce variations that are compounded resulting in a net variation in image quality for nominally the same tissue. Humans are tolerant of variation so this variation in quality has minimal impact on outcomes, which are additionally validated by EQA services.

But AI is in some cases being negatively impacted by variation and highlights the need for quality metrics and subsequently standards for each stage, where possible. But currently there are few independent QC tools for digital histopathology. This presentation will present the results of our work in NPIC were we have developed QC tools for staining, digitisation and display in digital histopathology.