Events in 2023

This cases study focusses on a paient that showed dual positivity for Anti-GBM and Anti-PLA2r antibodies. It will look at how testing was requested, the methods used for the investigations and how the results lead to the conclusions drawn.

It will also look at testing algorithms in the Immunology laboratory, related to these investigations and how these could be improved.

Emergency presentation of adenocarcinoma in a young female.



This case study was carried out as part of the Advanced Specialist Diploma in Histological Dissection of Lower GI Pathology. The patient was a 34-year-old female who presented at A&E with sudden onset of abdominal pain and constipation. A CT scan showed multiple colonic polyps and a likely descending colon tumour. The differential diagnosis of the tumour was of an inflammatory process, in view of her young age and negative family history of colorectal cancer. Endoscopic biopsies confirmed the diagnosis of a well to moderately differentiated mucinous adenocarcinoma. A stent was placed to relieve obstructive symptoms and a genetic questionnaire was completed. The patient subsequently underwent a subtotal colectomy in view of the large number of polyps. Histology of the resection specimen showed a circumferential mucinous adenocarcinoma multiple lymph node metastases and lymphovascular invasion, TNM 8 pT3 N2b R0 V0 L1 Pn0.

Routine Mismatch Repair (MMR) immunohistochemistry detected a loss of MSH2 and MSH6, indicating possible Lynch syndrome. Further molecular testing including Microsatellite Instability (MSI) showed that Lynch syndrome was not present, and no genetic explanation could be found as to why the patient developed bowel cancer at a young age. Detection of a KRAS mutation in the tumour cells suggests that treatment with anti-EGFR therapies such as Cetuximab may not be effective in this patient. After discussion of the histology at MDT, the patient was referred to oncology for adjuvant chemotherapy which consisted of 6 months Oxaliplatin and 5-Fluorouracil. The patient completed the course in 2019 and was referred to the surgical team for follow up with CT scans, endoscopy and CEA monitoring.

In summary, this case demonstrates the essential role of appropriate sampling and molecular testing of colonic cancer resection specimens in guiding decisions about the patient’s subsequent treatment.

The session will provide an overview of the Histopathology Reporting qualifications outlining the success so far and then will focus on the new limited scope Reporting qualification for those involved in Cervical Screening. It will provide guidance on the eligibility criteria for this qualification, the portfolio requirements and the support needed by candidates from colleagues in order to undertake the qualification.

Validation and Verification Workshop

A variety of virtual ward services are delivered across Oxfordshire through collaboration of Oxford University Hospitals NHS Foundation Trust, Oxford Health NHS Foundation Trust, and Principal Medical Ltd (PML) a GP led service. They include Hospital at Home, Children’s Virtual Ward (jointly with OHFT), Acute & Community Palliative/End of Life Care (Community – Sue Ryder Care).

The Point of Care Testing (PoCT) team at Oxford University Hospitals NHS Trust has supported the development and delivery of PoCT in community and ambulatory settings over the past 10 years.

Using a model developed around the requirements of ambulatory medicine; this has been delivered with limited resource, focussing on utilising existing resources wherever possible.

Commencing with the Acute Hospital at Home, the service has been successfully expanded to support mobile PoCT across Oxfordshire.

The laboratory acts as the distributor of instruments and supplies; facilitates connectivity, and testing, and coordinates delivery of training through a combination of remote and cascade routes.

Device selection and repertoire has been standardised. Up to this point mobile services have been limited to use of the Abbott i-Stat & Alinity systems (electrolytes/metabolites/blood gas). However, Hospital at Home, and other mobile services are requesting a greater repertoire of tests, particularly CRP. The LumiraDx platform provides us with an option for CRP that is portable, easy to operate, connectable and robust.

Challenges remain around connectivity and information management. This has been exacerbated by the cross-organisational nature of these services leading to the management of patients through multiple IT systems; and led to the development of indirect routes for result entry into the patient record.

Whilst we have been able to deliver connectivity in two rapid response vehicles, this was not a scalable solution and mobile devices are docked at the base location on return from visits.

Androgens are the naturally occurring or synthetic hormones which can increase lean body mass and decrease fat mass and are the most effective and widely abused ergogenic drugs in sport. The detection methodologies for the exogenous steroids is mostly based on the gas/liquid chromatography and mass spectrometry, while detection of the exogenous administration of endogenous steroids requires more complex methodologies including the longitudinal monitoring of individual urinary steroid concentrations/ratios and isotope ratio mass spectrometry. Although, urine has always been the first choice of sample matrix to detect androgens in sports. However, blood matrix is also now paving its way towards a complementary matrix for detection of androgens in sports. Dried blood spots (DBS) analysis is the latest tool in sports drug testing. DBS testing has advantages in the collection, shipment, and storage compared to traditional urine and blood-based procedures.

The World Anti-Doping Agency (WADA) has recently introduced DBS testing as an implementation for routine doping analysis during the recent Olympic and Paralympic Games in Tokyo and Beijing. DBS samples can be obtained with relatively little training and require minimal invasion at the collection site. A variety of devices based on micro-lancet and micro-needle approaches have been applied in the DBS collection.

Most androgens in DBS are stable at room temperature, so there are no specific requirements during transport. Also, considering the small size and weight of DBS, the DBS-based technique is more cost-effective compared to urine or blood samples. However, as a microscale sample, DBS require more sensitive and accurate analytical methods. The Drug Control Centre, King’s College London (a WADA accredited lab), we are currently investigating the use of DBS testing in our systematic regular analysis as a new methodology.

This presentation will discuss the current situation, perspectives, and challenges of implementing DBS testing for detecting androgens in sports.

Global travel and migration trends have meant a huge increase in the numbers of people exposed to tropical parasitic diseases. Thus, there is an increasing need for robust, reproducible and reliable screening as well as diagnostic techniques. These existing and emerging technologies all currently co-exist; each with their own specific and general pitfalls and limitations.

Thus, the need for fit-for-purpose qualitative EQAs or Proficiency Testing schemes for these parasite diagnostics remains pivotal and very timely. My talk at this congress will present findings and recommendations from Parasitology EQA schemes offered by UK NEQAS and will highlight the importance of quality management in the field.

A robust approach to Registration Training Portfolio verification is crucial to maintaining the high standards of confidence in the reputation of HCPC-registered biomedical scientists. The transition to a digital-only Registration Training Portfolio using the ePortfolio platform Onefile will provide a more streamlined approach to portfolio verification allowing verifiers to focus on what matters most… the assessment of a trainee’s competence.

This talk (the last of three) will demonstrate how verifiers can use Onefile to verify the evidence provided by the trainee and approved by their training officer or manager, using a number of tools to track evidence against the HCPC Standards of Proficiency. Onefile’s ePortfolio allows verifiers to gain a holistic view of the trainee’s understanding, enabling verifiers to scaffold the discussion during the verification visit and laboratory tour. We will see how Onefile provides a comprehensive system to arrange the verification visit (either virtually or in person), complete the verification report, and manage the final sign-off of the verified portfolio. Onefile’s inbuilt audit trail minimises the administration associated with portfolio verification, and we will show how this can be used to help improve the quality of education and training in the workplace.

We suggest that this talk will be most informative to post-registration staff involved in overseeing training, such as training officers/managers and verifiers.

Additional talks focusing on other elements of Onefile are scheduled for the lunchtime programme on Wednesday (Hall: 11) and the morning subsidiary programme on Thursday (Hall: 4).

EQA of Autoimmunity

The presentation gives an overview of the NHS Patient Safety Incident Response Framework, it’s principles and requirements. There is also a brief summary of the Systems Engineering Initiative for Patient Safety (SEIPS) and how this is different to previous models of investigation. The presentation then focusses on how PSIRF has been implemented at Northumbria Healthcare, an acute and community provider in the North East of England, with a focus on the phased implementation approach used by the PSIRF leads. The speaker will also cover the challenges in the implementation to date and the successes experienced so far.