Events in 2023

The lecture will include a basic introduction to a busy mixed urban and rural Helicopter Emergency Medical Service in the East of England and the logistics of carrying and administering blood products to multiply injured, major trauma patients. The types of patients that typically require a transfusion will be presented and we will hear from patients that have since recovered and how they feel about having received a prehospital transfusion.

The UK has the 4th highest prevalence rate of alcohol consumption in pregnancy in the world. Fetal Alcohol Spectrum Disorder (FASD) is the most common non-genetic learning disability in the UK with a prevalence rate of at least 5%, more than autism and ADHD combined. A high-profile public health campaign combined with effective antenatal and pre-conception care is urgently required.

Accurate and early identification of women at risk from alcohol consumption during pregnancy allows education and support to be targeted at those most in need. Self-report has limited sensitivity but is commonplace due to its acceptability and affordability. Biomarkers have the potential to provide an objective and reliable antenatal alcohol screening solution.

To explore the utility of blood biomarkers, we conducted a systematic review comparing the diagnostic accuracy of blood analysis and maternal self-report in detecting at antenatal alcohol exposure. We discovered that none of the biomarkers identified had both high sensitivity and specificity when compared to self-report. There was some evidence that a combination of biomarkers, or combining biomarkers with self-report, increases accuracy. Blood biomarkers examined were of limited use in screening for low and moderate alcohol consumption in pregnancy when compared to self-report. However, certain biomarkers, such as carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth) may complement self-report and help improve the accuracy of diagnosis.

We applied these findings to practice with two studies comparing the prevalence of alcohol consumption in the first trimester of pregnancy using self-report and blood biomarker analysis. The booking bloods were from women under the care of Northumbria Healthcare NHS Foundation Trust (NHCT) and North Tees and Hartlepool NHS Foundation Trust (NTHFT).

Six-hundred routine blood samples were anonymously analysed from each location for the presence of Carbohydrate Deficient Transferrin (CDT), a validated marker of chronic alcohol exposure (normalising 2–3 weeks from abstinence) and Gamma-glutamyltransferase (GGT), a liver enzyme elevated for up to 8 weeks after alcohol exposure. At NHCT, CDT analysis revealed a prevalence rate of 1.4% and GGT a prevalence rate of 3.5% in the first trimester of pregnancy. Although those with elevated CDT generally had high levels of GGT, only one person was positive for CDT and GGT. The NTHFT data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7–2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6–5.9). No overlapping cases were identified, or a significant correlation was demonstrated between CDT or GGT. Although CDT and GGT analysis are not sensitive to low levels of alcohol, prevalence rates were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.

We also took a full year's sample of data from the antenatal visits of women at NHCT, which documented the women's self-reported alcohol consumption. The percentage of women who reported alcohol intake in the first trimester was 0.8%, approximately half the rate of those identified by CDT. This compared to 74.1% of women who reported consuming alcohol before pregnancy, indicating the limited value of self-report in clinical practice.

This presentation will cover a case study completed as part of the IBMS Specialist Diploma in Immunology in 2022. It will be of interest to anyone considering completing the Higher Specialist Diploma in Immunology, or anyone who would like to learn more about the case study element. It will also be of interest to anyone who would like to learn more about the protocols used for reading and reporting methods including immunophenotyping by flow cytometry, serum protein electrophoresis and immunotyping, serum free light chains and Bence Jones protein analysis at Greater Manchester Immunology Service (GMIS).

The case is one of an elderly gentleman with who, like roughly a third of new myeloma cases in the UK, presented through A&E. The presentation will cover pre-analysis, analysis and post-analysis, considering how the tests performed in the Immunology laboratory assist in the differential diagnosis and where they fit in with the other tests ordered, both tests within and outside of the Immunology discipline. The presentation will cover the methods performed at GMIS and some of the reporting protocols, as well as discussing some of the relevant associated guidelines.

What’s new in antivirals? (Antivirals & Mabs as therapeutics)

Pandemics Present

This presentation will examine a specific case study submitted as part of the 'Advanced Specialist Diploma in Breast Pathology'. The case in question was a mastectomy sample for the treatment of diffuse multifocal invasive ductal carcinoma.

Within the presentation I intend to highlight the importance of pre-analysis and emphasise its correlation with macroscopic examination and block sampling. I will also highlight the importance of post analysis and the understanding of how the role of the Advanced Practitioner can directly impact patient treatment.

The Arenaviridae have the dubious distinction of containing among their members one of greatest proportions of hazard group 4 viruses of any recognised taxonomic family. These viruses cause persistent asymptomatic infections in their rodent reservoirs, however zoonotic spill over often results in viral haemorrhagic fever (VHF) and high mortality. Transmission to humans occurs via contact with infected rodent excreta, through contaminated food and inhalation of aerosols. Human to human transmission also occurs. In sub-Sharan West Africa, Lassa virus (LASV) has been identified as a VHF since 1969 and is endemic over much of rural Nigeria, the countries of Mano River Union, Ghana, Togo and Benin.

From a global health security perspective, it is of significant international interest since it the most commonly imported VHF into non-endemic countries. In nearly every imported circumstance, the cryptic nature of Lassa fever and related difficulties in diagnosis, places enormous demand on clinical, laboratory and public health resources of the recipient country. Given our current understanding of LASV and other evolving members of the genus, attention should be focused on other new and emerging mammarenaviruses which have similar incubation times and could result in similar human disease with a propensity to overburden public health systems.

From earlier work that I had done in a sexual health setting, I identified that there were barriers for women with a learning disability attending for cervical screening. I was invited to talk to a group of women about cervical screening as part of an initiative called 'The Josephine Project'. Josephine is an anatomically correct cloth doll which is used for health promotion purposes - she has body parts which can be detached and has a 'space' in her head where women can put ideas on paper. Within a mock up clinic, Josephine, along with her friends (the women in the group), attended the sexual health clinic to have a cervical sample taken. This work was very successful and led to several women taking up the offer of screening.

Myself and Jilly realised that as Nurse Colposcopists this work could be translated into a secondary care setting and so Josephine was invited to the colposcopy clinic following an abnormal cervical screening result. This presentation discusses some of the barriers for the women with a learning disability and how 'Josephine' came to life to help and support some of those women.

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.

Emerging Issues in Medical Mycology