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Focus 2018in Manchester

Grow Your OwnTrainees

RegionalMeeting Reports from Wales,Northern Ireland andScotland

ACB Managementand LeadershipCourse Report

The Association for Clinical Biochemistry & Laboratory Medicine | Issue 651 | February 2018

ACBNews

About ACB NewsThe Editor is responsible for the finalcontent; advertisers are responsible for thecontent of adverts. Views expressed are not necessarily those of the ACB.

Lead EditorMr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]

Associate Editors Mrs Sophie BarnesDepartment of Clinical Biochemistry12th Floor, Lab BlockCharing Cross HospitalFulham Palace RoadLondon W6 8RFEmail: [email protected]

Dr Gina Frederick Pathology Laboratory, Level 5Royal Derby HospitalUttoxeter RoadDerby DE22 3NEEmail: [email protected]

Dr Derren Ready Public Health England National Infection ServiceMicrobiology Reference Services61 Colindale AvenueLondon NW9 5EQ Email: [email protected]

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ACB Home Pagehttp://www.acb.org.uk

Printed by Swan Print Ltd, BedfordISSN 1461 0337© Association for Clinical Biochemistry &Laboratory Medicine 2018

ACBNews

General News page 4

Microbiology News page 9

Practice FRCPath Style Calculations page 10

Focus News page 12

Current Topics page 14

Meeting Reports page 16

ACB News Crossword page 29

Situations Vacant page 30

Issue 651 • February 2018

The bi-monthly magazine for clinical science

Issue 651 | February 2018 | ACB News

Front cover: (left to right): Craig Livie, Alana Burns (winner of the John King Award) and John Wadsworth (see meetingsreport, p26)

News from the Chief Scientific Officer

4 | General News


Sudoku This month’s puzzleSolution for December

NHS England has announced fiveHealthcare Scientists who have beensuccessfully appointed onto the 2018Clinical Entrepreneur Training Programme.Almost 200 applications were received

from doctors, dentists and healthcareprofessionals. The 12 month programme – run by NHS

England and Health Education England –provides mentoring and coachingopportunities for doctors and otherhealthcare professionals to develop arange of entrepreneurial projects anddevices linked to their clinical roles. Congratulations to:

� Professor Paul White, HealthcareScientist of the year 2017, Head of

Clinical Engineering, CambridgeUniversity Hospitals

� Mr Bala Sirigireddy, Head ofHaematology and Blood Transfusion,Homerton University HospitalFoundation Trust

� Ms Aliya Kaaba, Locum SpecialisedRespiratory Physiologist, King’s CollegeHospital Foundation Trust

� Mr Uthman Adesina, AdvancedSpecialist Biomedical Scientist,Histocompatibility andImmunogenetics, NHS Blood andTransplant, Tooting Laboratory

� Dr Anthony RowbottomConsultant Immunologist, Lancashire Teaching Hospitals �

CondolencesIt is with regret that we must inform you of the sad news of the passing of the followingACB Retired Members:Dr William Connell Alston died in May 2017 at the age of 82. Dr Alston joined the

Association in 1967. He was based in Farnborough and retired from full-time employmentat Frimley Park Hospital in 1999. Dr Bridget Jackson died in August 2017 at the age of 75. She joined the Association in

1972, was based in Worksop, and retired from full time employment at Northern GeneralHospital NHS Trust, Sheffield in 2007. �

6 | General News


Do you have an original, high quality research project?Every year the ACB, via the ScientificCommittee, awards Scholarships to ACB Members across all disciplines. This year we can again offer up to £9000for up to 3 exceptional projects.Last year we managed to secure extra

funding due to the high quality ofapplications and funded four projects. The successful research projects were:

� Development and validation of aquantitative molecular viability assay for N. gonorrhoeaVictoria Miari

� Biochemical and epigenetic footprintsof HPA activation in pregnanciescomplicated with antenatal depressionand associated comorbiditiesEmma Frith

� A stable-isotope study of tyrosinedegradation in Alkaptonuria patients,

before and after nitisinone, compared to healthy volunteersMilad Khedr

� Development of an LC-MS method for free thyroxine to investigateinterference in routine immunoassaysChris Maynard

If you have an innovative research project that will have a positive impact onpatient outcomes please do considerpreparing an application for considerationby July 2nd 2018.Applications will be sent for peer review

before consideration by the ScientificCommittee in September 2018.If you have any questions regarding

eligibility or suitability of your proposedwork please either get in touch [email protected] see ACB Scientific CommitteeScholarships – Guidance for Applicants in the document section of the ACBwebsite. �

Call for ACB Scientific ScholarshipsAlexandra Yates, Deputy Director Scientific Committee

The Education Committee are pleased to inform you that the ACB Residential TrainingCourse for 2018 is now open for registration. The Training Course will be held in theEngineering & Sciences Learning Centre (ESLC) at the University of Nottingham on 2nd-4th July 2018.The Course is being organised by Dr Donna Fullerton and Dr Stephanie Barber and the

following topics will be covered:� Business and Finance – What do we need to know?

� Screening – Present and Future

� Nutrition

� The Legality Complications of Toxicology/Forensic Service

This event will be lecture and workshop based. These courses aim to provide knowledgethat is not easily available in textbooks but is vital to our role as Healthcare Scientists andenable passing the FRCPath examinations.Registration is now open and closes on 23rd May 2018. Places are limited.

Visit the ACB website for the full programme:http://www.acb.org.uk/whatwedo/events/training_courses.aspx

ACB Training Course: Nottingham

ACB South West & Wessex Regional Scientific Meeting9th March 2018Royal Devon and Exeter Hospital,Research, Innovation, Learning & Development (RILD) Building

09:15-09:45 Registration and Tea/Coffee09:45-10:15 ACB SW&W Regional AGM10:15-10:45 What is Audit?

Mary Stapleton, North Devon District Hospital10:45-11:30 National Audit of Contaminated Samples

Michael Cornes, Worcestershire Royal Hospital11:30-12:30 Local Audits12:30-13:30 Lunch, networking and meeting our Sponsors13:30-14:00 Regional Audit – CF Sweat Testing

Mary Stapleton, North Devon District Hospital 14:00-14:45 National Calprotectin Audit and Using Calprotectin in Primary Care

James Turvill, York Hospital14:45-15:15 PANTS Update TBC

Tariq Ahmad, Royal Devon & Exeter TBC15:15-15:45 Prescribing Healthcare Scientists

Gwyn McCreanor, Kettering General Hospital15:45 Regional ‘Meet and Greet’

(Drinks & nibbles provided) 17:00-17:30 Close

Registration is now open via the ACB Regional Meetings webpage:http://www.acb.org.uk/whatwedo/events/regional_meetings.aspx

Closing date for registration is Friday 2nd March –registration on the day will not be available. �

8 | General News


Future Meetings23rd March 2018

ACB Southern Region Scientific Meeting to be held in Worthing

27th April 2018ACB Northern Ireland Scientific Meeting to be held at Wellington Park Hotel, Belfast

27th April 2018ACB Scotland Spring Scientific Meeting

to be held at IET Glasgow: Teacher Building, Glasgow

Further information on these meetings will be available in due course.

Microbiology News | 9


The Diggle Microbiology ChallengeThese multiple-choice questions, set by Dr Mathew Diggle, are designed withTrainees in mind and will help with preparation for the Microbiology Part 1FRCPath exam.

Question 5 from DecemberA staff member is HepBsAg negative but is anti-HepBc and anti-HepBs positive. Thisbest fits with:

A) No immunity to HBV B) Prior vaccination C) Prior infection D) Active infection

AnswerC) Prior infection – as there are antibodies to core and surface antigen present. There isdetectable immunity to HBV as the HepBsAg is negative and anti-HepBs and anti-HepBcare positive, demonstrating an immune response to HBV in the absence of circulating Ag.Prior vaccination would be established by anti-HBs positivity only (anti-core negative &HBsAg negative). There is unlikely to be active infection as there is no detectable HepBsantigen present in the sample.

Question 6Which of the following is not a virulence factor of Staphylococcus aureus?

A) PVL B) Enterotoxin C) TSST D) Lecithinase

The answer to Question 6 will appear in the next issue of ACB News – enjoy! �

10 | Practice FRCPath Style Calculations


A GP asks your help interpreting plasma creatinine results obtained on a 56 year oldhypertensive patient. At diagnosis his plasma creatinine was 85 µmol/L. Six months laterhis plasma creatinine had risen to 110 µmol/L. Although the eGFR on both specimens wasreported as >60 mL/min/1.73m2 he is concerned that the patient may be developing renaldisease. Is this increase significant? Your laboratory quotes a reference range (95%confidence limits for a Gaussian distribution) of 60-120 µmol/L with an analytical CV of6.3% at all concentrations above 80 µmol/L. Assume an index of individuality of 0.46.

Table of z-distribution:

P (two sided) 0.10 0.05 0.02 0.01 0.002 0.001z 1.65 1.96 2.33 2.58 3.09 3.29

The first task is to calculate the combined analytical and intra-individual CV.

The reference range covers a 4SD range (mean±2SD). Therefore SD = (120 - 60)/4 = 15 µmol/L. At a mean of 90 µmol/L this corresponds to a CV of 15 x 100/90 = 16.7%.

CVTotal2 = CVBiological2 + CVAnalytical2

Substituting CVTotal = 16.7%, CVAnalytical = 6.3% and solving for CVBiological:

16.72 = CVBiological2 + 6.32

CVBiological = √ (16.72 - 6.32) = √(278.9 - 39.7) = √239.2 = 15.5%

This is the total biological variation and will be composed of the intra-individual CV (CVIntra) and inter-individual CV (CVInter):

Total CVBiological2 = CVIntra2 + CVInter2

The CVIntra and CVInter are related by the index of individuality (in this case 0.46):

Index of individuality = CVIntra = 0.46 CVInter

Therefore substitute CVInter = CVIntra/0.46 and total CVBiological = 15.5% and solve forCVIntra:

15.52 = CVIntra2 + (CVIntra/0.46)2 = CVIntra2 + CVIntra2/0.212

15.52 x 0.212 = 0.212CVIntra2 + CVIntra2

50.9 = 1.212CVIntra2

CVIntra = √(50.9/1.212) = √42.0 = 6.5%

Next use the CVIntra and CVAnalytical to calculate the total CV for an individual’s result:

Deacon’s Challenge No 194 - Answer

Practice FRCPath Style Calculations | 11


Question 195A male anuric patient with a body weight of 84 Kg undergoes haemodialysis for 3 h.His plasma urea concentration was initially 20.5 mmol/L and after dialysis 5.4 mmol/L.Estimate the dialyser urea clearance in mL/min stating any assumptions that youmake.

Individual’s CVTotal = √(CVAnalytical2 + CVIntra2)

= √(6.32 + 6.52) = √(39.7 + 42.3) = √82 = 9.1%

In order to compare the two creatinine values (C1 and C2) calculate the z-score:

z = Change in creatinine = C2 - C1SD of the change SD of (C2 - C1)

SD of C2 (110 µmol/L) = 110 x 9.1/100 = 10 µmol/L, SD of C1 (85 µmol/L) = 85 x 9.1/100 = 7.7 mmol/L

SD of (C2 - C1) = √(102 + 7.72) = √(100 + 59.3) = √159.3 = 12.6 µmol/L

Substitute this SD of the difference to calculate z:

z = 110 - 85 = 25 = 2.012.6 12.6

Since we are only interested in detecting an increase in creatinine a value for z above 1.65will only be obtained on 5% of occasions if no real increase has occurred, 2.0 is in excessof this supporting the hypothesis that the increase in plasma creatinine is statisticallysignificant. If the index of individuality is ignored (so that a population SD of 15 µmol/L isused) then the z-score becomes 1.2 which is insignificant. The increase in creatinine issignificant even though the value remains well inside the reference range and both eGFRresults are greater than 60 mL/min/1.73m2.

12 | Focus News


The Values and Vision of thisYear’s ConferenceAs we enter the 70th year of the NHS, the overarching values and visions of thisyear’s Organising and ScientificCommittees are focussed ondemonstrating collaborative science,excellence across medicine disciplines, andhow this makes a difference to patients.The Conference will be accessible to

everyone whatever their background andneeds and, focussing on sustainability, willbe as carbon-light as possible.

The VenueManchester is a youthful, diverse,energetic city bursting with character,where, thanks to the famous friendlynorthern spirit, everybody and anybody iswarmly welcomed. It is known throughoutthe world as the birthplace of theindustrial revolution, and also has a proud

history in science, politics, music, arts andsport. Manchester is one of the most accessible

cities in the UK for both national andinternational visitors thanks to its rail andmotorway networks and largeinternational airport.Focus will be held at the Brooks Building

on the Manchester MetropolitanUniversity Birley Campus close to the citycentre, where the Conference and Eventsteam are fully committed to sustainabilityand low environmental impact, and holdthe highest possible accreditation underthe Green Tourism Business Scheme (theleading industry sustainability standardand the largest accreditation scheme of itskind).

The ProgrammeWednesday evening will feature anexciting talk of general scientific interestto precede the opening reception.

How Will we Focus onValue in Manchester?Sarah Robinson, Mid Cheshire Hospitals NHS Foundation Trust

Focus News | 13


Professor Ian Burney, from the Centre forthe History of Science, Technology andMedicine at the University of Manchester,will give a talk on the topic of his book‘Murder and the Making of English CSI”.The scientific programme builds on the

themes of adding value and of access to allin a number of areas; whether that beDGH laboratories adding value to theirpaediatric service, specialist drug screeninglaboratories adding value to theirscreening services, ensuring our demandoptimisation strategies are fit for purpose,looking at new markers to add value toour service or ensuring parity of access toall of our patients, what is our impact onpatient outcomes?Does POCT add value to patient

outcomes in acute and primary caresettings? – join the debate!There is also an opportunity to attend

FiLM at Focus – highlights of the 2018 FiLMmeeting presented within the Focusprogramme. Now that’s value!

The EveningCarrying through the focus onsustainability, the beautiful Monastery,saved and protected by a charitable Trust,will be the venue for the ConferenceDinner on the evening of Thursday 7thJune. This former Franciscan monastery has

been transformed into a spectacularevents venue and is winner of the eventsindustry’s Most Unusual Venue ‘Oscar’.

� Registration is now open and earlybooking discounts are available until8th May. Make sure you book yourplace at the main event for laboratorymedicine in 2018! �

14 | Current Topics


The National School for Healthcare Sciencehas been successfully producing HealthcareScientist Trainees for many years now.However, upon review of the 2016 ACBWorkforce Survey the numbers enteringthe STP programme are unlikely to besufficient for the number of posts that willbecome vacant in the future. Getting funding to support an STP

Trainee can be challenging depending onlocal education budgets and furthercomplicated with the requirement forplacements, which are becoming moredifficult with increased collaboration. Whilst entering the STP is the most direct

approach to producing a TraineeHealthcare Scientist, there are otheroptions available. Equivalence processesexist to enable hospitals to identifypositions and people who they can trainin-house to become Clinical Scientists.Funding tends to be identified fromconversion of another post or by putting abusiness case for succession planning tothe host Trust. There are two main equivalence bodies

that award equivalence certification: The Association for Clinical Scientists (ACS)and the Academy for Healthcare Science(AHCS). Following demonstration ofequivalence these bodies awardcertificates that can be submitted to theHealth and Care Professions Council(HCPC) for acceptance onto theprofessional register. Both the ACS and theAHCS require individuals to submitevidence that will then form part of anassessment process to ensure the

knowledge and skills are of ademonstrable equivalence to the relevantstandard. The main difference betweenthe two routes is that ACS tends to be in asingle topic i.e. immunology, microbiologyor biochemistry, whereas AHCS is assessingequivalence to the STP programme so willcover blood sciences or infection sciences.To facilitate equivalence via ACS,

the competencies can be found on the ACS website (http://www.assclinsci.org).For Clinical Biochemistry candidates, the ACB Education Committee hasupdated the pre-registration ClinicalBiochemistry Log Book. This Log Bookfollows the Royal College of Pathologists(RCPath) curriculum and is available via theACB website. All aspects of the RCPathcurriculum is covered in depth as well asthe analytical experience and knowledgerequired to produce a well-roundedcompetent Clinical Scientist. Whilst it maybe advantageous for the Trainee to beenrolled on an MSc to cover theoreticalknowledge this is not essential providingevidence is demonstrated to show thedepth of knowledge obtained. The ACSsuggest that this process on average willtake 4 years, which is akin to the previoustime taken for grade A pre-registrationTrainees to gain their certificate ofcompletion for submission to the HCPC. The equivalence process for AHCS is

described on the AHCS website(https://www.ahcs.ac.uk/equivalence/equivalence-guidance/). The website details theAcademy’s ‘Good Scientific PracticePortfolio Mapping Template’.

Future Proofing theProfession: Grow YourOwn TraineesHazel Borthwick, ACB Director of Education, Training and Workforce

Current Topics | 15


The portfolio maps to the STP programmeand again an assessment is required priorto award of the Certificate of Equivalence.Reference should be made to the clinicaland scientific content of the STPprogramme when following this route toensure all clinical and technical aspects arecovered in sufficient depth. This is arelatively new equivalence route but itwould be expected to take the sameamount of time as the ACS route todemonstrate competency to the same

standard as a newly registered ClinicalScientist. Whilst growing your own Trainees may

seem like a daunting process, there areplenty of resources and support to assist.There is a network of ACB Regional Tutorsand the ACB Education Committee andACS is on hand to provide advice toanyone who may be considering this an option to future proofing theprofession. �

Delegates from as near as London and asfar as Oman gathered in Guildford on 24th-28th July for the 2017 ACBManagement and Leadership Course. The course comprised lectures, workshops,Q&A sessions and group work. It beganwith an historical perspective of the NHS,followed by an evening of negotiation.The task was to negotiate which charitywe would give money to, how much andby what mechanism. After three rounds ofnegotiation, the recipient of the collected£320 (plus Gift Aid!) was Marie Curie, whowere very grateful for the donation.

TuesdayTuesday's programme focussed on NHS structure, commissioning andprocurement. Particularly striking was theexperience of being in the position of thecommissioner. This highlighted how thepriorities of the commissioner may differ

to that expected by the laboratory,particularly that quality (and UKASaccreditation) is often expected, not aselling point. The session on procurement gave an

overview of the legal requirements andpracticalities of procurement andmanaged service contracts. It wasemphasised that the most important itemis the advert in the Official Journal of theEuropean Union (OJEU) and that givingsufficient time for companies to respond,particularly around summer and Christmasholidays, will improve the quality of theresponses.

WednesdayWednesday morning’s session gave anoverview of finance within the NHS,including costing, budget managementand business cases. Group workshopsallowed us to put what we’d learnt into

ACB Management andLeadership Course Dr Sarah Pitkin, Barts Health NHS Trust and Victoria Clough, Barking, Havering & Redbridge University Hospitals NHS Trust

16 | Meeting Reports


practice. Each group was given a casestudy, for example assessing the costs ofnew analysers as part of a tenderingprocess, and brainstorming factors toinclude in a business case. In the afternoon the focus switched to

‘people’ with a session led by Geoff Lester(FCS). We discussed what we had learntfrom Monday night’s negotiation exercisebefore moving on to employment law. This was followed by a thought-

provoking workshop looking at ourapproach to managing staff problems thatmay arise in the laboratory. In the evening we attended a Question

Time event where delegates had theopportunity to put their questions to thepanel: Dougie Dryburgh (CEO of Viapath),Paula Head (CEO of The Royal SurreyCounty Hospital NHS Foundation Trust),Professor Jo Martin (President Elect of The Royal College of Pathologists) and Ian Sturdgess (President of the IBMS). The questions led to some interestingdebate on areas such as pathologyprivatisation and flexible working.

ThursdayThe morning session focussed on clinicalleadership. Delegates received the results

of their Myers-Briggs Type Indicator test,which we had completed prior to thecourse, and discussed how our personalitytype might influence our leadership style.This was followed by an overview oforganisational structures in pathology and a session on service improvementwhich included a workshop covering sixsigma, lean and process mapping.

Meeting Reports | 17


The penultimate day of the courseended with the course dinner which was achance to unwind and get to know theother delegates.

FridayThroughout the week we had to findspare time in our busy schedule to preparegroup presentations to be given on thefinal morning. Each of the four groups hadbeen assigned a different project with achallenging scenario that required us to

apply the knowledge we’d gained over theweek and work together to produce a 20minute presentation. Following ourpresentations, each group had to answerquestions from the panel, which includedthe President of the National Associationfor Patient Participation and the ScientificDirector for London, NHS England. We would like to thank the course

organisers for putting together anexcellent programme. �



ACB Wales AutumnScientific Meeting 2017Joanna Flatt, University Hospital of Wales, Cardiff



The ACB Wales Autumn Scientific meeting washeld on 24th November2017 at the Keir HardieMedical Education Centrein Merthyr Tydfil.

Morning Session: All-Wales Audit and SponsorPresentationsThe programme kicked off with Dr HelenCordy from Cardiff and Vale, whopresented the results of her All-Walesaudit on HbA1c reporting in the presenceof haemoglobin variants and otherinterfering factors. The survey was carriedout in the first 3 months of 2017 andparticipants in 6 of the 7 Health Boardsresponded. The most popular method ofHbA1c measurement was ion exchangechromatography, with just one respondentusing capillary electrophoresis. A variety ofcut-offs were used for percentage of HbFbeyond which an HbA1c result would notbe reported, despite most participantsusing the same method. There was alsosome discrepancy between respondentsregarding whether consent was requiredfor investigation of variants when theseare detected. Additionally, the presence ofa variant haemoglobin in patients was notalways recorded for future reference,leading to unnecessary duplication ofinvestigations on repeat HbA1c analysis.These findings are perhaps unsurprising asHelen reminded us that there are nopublished guidelines for reporting HbA1c

in the presence of Hb variants and otherinterferences. This was followed by two presentations

from sponsors of the meeting. The firstwas given by Ronan Hines fromImmunoDiagnosticSystems (IDS) aboutvascular calcification and the relatedimmunoassays that they offer. Ronantalked about the new biomarker ofvascular calcification, matrix Gla-protein,and the IDS assay which measures theunphosphorylated and decarboxylatedforms.The second sponsor presentation was

from James Russell of Chromsystems, who talked about their LC-MS/MS assay for measuring MMA in serum and urine.James covered some background ofvitamin B12 deficiency, the pros and consof measuring MMA, and hinted that MMAis likely to be “the new vitamin D”.

Big DataAfter the coffee break we heard from Alan Dodd (Cwm Taf), who talked about“Big data in Wales – an unmissableopportunity?” A big part of our role asclinical scientists is to make sure that thenumbers mean something, and referenceranges are an important aspect of this.Sodium reference ranges were cited as agood example, in which locally-derivedranges are much tighter than thePathology Harmonisation ranges, and differ with hormonal changes such asat puberty and the menopause. As anillustration of the importance of referenceranges we heard about a soberingexample of a case of Addison’s disease inwhich the child’s sodium result wassignificantly below the locally-derived

reference interval, but was almost withinPathology Harmony limits. Alan thenspoke about some previous work he haddone to establish alkaline phosphatasereference ranges, and that modelling hadshown the presence of dual populations inteenagers. On a similar theme, thechallenge of deriving thyroid hormonereference ranges was tackled. This iscomplicated by the existence of dualpopulations of patients – those onthyroxine treatment and those not –especially when this information is notprovided. Using a population of patientspresumed not to be on treatment,modelling was performed assuming dualpopulations – those that were onthyroxine and those that were not. This allowed the calculation of a referencerange using data only from the populationof patients not on thyroid hormonetherapy. Alan finished by reminding usthat laboratory data can be used for morethan just reference ranges – we can drilldown into subgroups in the populationand look at the relationships betweenanalytes.

ACB Wales Members’ AwardNext up were the Members’ Awardpresentations, this year kindly sponsoredby Roche, given by four Trainees in theprofession.The first talk was a presentation by

Joanna Flatt (Cardiff and Vale) entitled“An audit of bloodspot phenylalaninemonitoring in phenylketonuria patients”.The audit showed a large amount ofvariability in monitoring frequencybetween patients and found that the 6-11 year age group was most affected by recent changes in the recommendedtarget blood phenylalanineconcentrations. Adolescent patientsshowed the least compliance of all agegroups. The second talk, “A case of severelactic acidosis caused by metforminoverdose”, was given by Freya Hassall(Cwm Taf). The patient presented with anextremely high anion and osmolar gap,but denied any overdose. Her pH was 6.74and lactate reached 35 mmol/L duringadmission. Following a full toxicologyscreen, a recent or high dose of metformin



Carol Evans presents the ACB Wales Members’ Award to Freya Hassall

was identified as a likely cause of the lacticacidosis, from which she made a fullrecovery. The third talk was given by Gina Sanki (Cwm Taf), who presented“Management of myxoedema coma”. An interactive polling system was well-employed in the presentation of thiscase as we were taken through thepresentation, initial testing andmanagement of this elderly patient with ahistory of hypothyroidism. She had beenadmitted having been found on the floorwith a TSH >100 mU/L and fT4 of 1.5pmol/L. Interestingly, her last TFTs hadshown a picture of poorcompliance/inadequate dose that was notfollowed up by Primary Care. The finalspeaker in the session was AnthonyJackson-Crawford (Aneurin Bevan) whotackled the question, “Reflex testing ofserum electrophoresis: are we doing toomany”. Anthony’s audit of discretionarytests added on by biochemistry showedthat they made up 7% of allelectrophoresis tests. Of these, 5.4% leadto the identification of a novelparaprotein, of which a third weremyeloma. The data suggested thatabnormalities in IgG, IgA or IgM were the best indication for discretionaryparaprotein screens.All of the talks in this session provoked

interesting discussions and debate. Afterdeliberation by the judges, the winner wasdeclared as Freya Hassall for her excellentpresentation of the metformin overdosecase.

Afternoon Session: AKIFollowing the lunch break there was areturn to the floor by our sponsors, with a presentation from Gordon Avery ofAbbott. We returned to the topic ofdiagnosing vitamin B12 deficiency andheard about Abbott’s assay for “activeB12”. This measures the B12 that is boundto transcobalamin (holotranscobalamin),rather than that bound to haptocorrin,

which is biologically inert.We then heard from Dr Vikas Lodhi, who

gave us a Cwm Taf perspective of AKI andtheir experience in implementing e-Alerts.Electronic AKI alerts were implemented indifferent Health Boards across Walesbetween November 2013 and March 2015.Unfortunately, the AKI mortality rate of18.8% has not improved since. However,Dr Lodhi pointed out that the data wehave available to us can be used to helpimprove outcomes. We heard of the initialresistance of primary care to the newsystem, where it was eventually agreedthat AKI notifications should be made thesame day for stage 2 and 3, but could bemade the next morning for stage 1identified out of hours. We also heardabout the AKI education programme inCwm Taf, which has successfully improvedward staff’s knowledge as well as that ofundergraduate medical students. An AKIimprovement pathway has beenintroduced, including the use of a “STOPAKI” sticker on individual patient’s notes.This prompted staff to consider certainaspects of AKI such as optimising bloodpressure, recording the results ofappropriate tests and ultimately improveoutcomes. Each ward now has its own AKIchampion with the aim of continuing thisbehavioural change.Following on, Dr Tim Scale from

Abertawe Bro Morgannwg gave us anexcellent overview of the clinical aspects ofAKI. A fifth of hospital admissions haveAKI and although it is associated with asignificant mortality rate, in most cases thecause of death is the underlying disease. A key aspect of AKI is its recognition, andthe question was asked whether e-Alertsare acted upon. Disruptive alerts, such astelephoning, are more effective thancomments appended to reports but thiswould have a large impact on laboratorystaff time. The correct treatment isimportant and we heard that giving toomuch fluid can often see discharged



patients returning as emergency cases ofpulmonary oedema. Management of thepatient’s medications was also identified asan area of concern, as Dr Scale pointed outthat nephrotoxic drugs continue to beprescribed to patients who have had aprevious AKI. Potential improvementscould be seen with the introduction ofpersonalised AKI alerts which include thepatient’s medication list, to assist cliniciansin their management of patients.

Iron Deficiency AnaemiaThe final talk of the day was delivered byDr Umakant Dave and Sister HelenThompson-Jones, also from Abertawe BroMorgannwg, who described theirexperience in setting up a nurse-led clinic for iron deficiency anaemia. This is anew service comprising one session perweek, which started in March 2016.Gastroenterology have experienced a

significant increase in the number ofreferrals they receive for investigation ofurgent suspected cancer (USC) that mustbe prioritised. Since 4-13% of referrals togastroenterology are for iron deficiencyanaemia, it was decided to introduce anurse-led clinic to reduce waiting timesand unnecessary investigations. They havealso seen an increase in the number ofpatients discharged to Primary Care as aresult of the clinic. Ferritin is used as themain biomarker, with inflammation takeninto consideration in its interpretation.Iron replacement is reviewed or initiated,and follow up investigations, such ascolonoscopy, are arranged if necessary.This was an excellent meeting with very

stimulating talks and discussion. Thanksmust go to Kelly Mitchem and the rest ofthe organising committee for puttingtogether a great programme and day! �



UK Newborn Screening Laboratories Network

Annual Scientific Meeting Friday 16th March 2018Nowgen Centre, Meeting Room 1, 29 Grafton Street, Manchester M13 9WU

10:00-10:30 Registration/Tea and Coffee10:30-11:10 Screening for Severe Combined Immunodeficiency (SCID)

Prof Bobby Gaspar, UCL Great Ormond Street Institute of Child Health11:10-11:50 SCID Screening in the Netherlands

Maartje Blom, RIVM and Leiden University Medical Center, Netherlands11:50-12:15 UK Update: SCID Screening Evaluation Oversight Group

Lesley Tetlow, Manchester 12:15-12:30 SCID Screening: Questions and Discussion12:30-13:30 Lunch 13:30-14:00 Newborn Screening for Sickle Cell and Thalassaemia Using MS/MS

Prof Stuart Moat, Cardiff14:00-14:30 UKAS: Screening Standards Mapping: An Inspector’s View

Dr Mandy Pickersgill, Manchester14:30-15:00 Programme Centre Update

Evaluation of IMD Patient AppProf Jim Bonham, PHE/ Sheffield

15:00-16:00 Business Meeting (AGM) – UKNSLN Members only The meeting includes refreshments and lunch. Cost of meeting £25Please email Beverly Hird for further details: [email protected]



The day began with a warm welcome forall of the delegates and some openingcomments from Mrs Margaret McDonnell,the outgoing ACB NI Chair and Chair ofthe morning session.The first speaker of the day was

Professor Ian Young, ACB President Electand Chief Scientific Officer for NorthernIreland. Professor Young’s thoughtprovoking presentation, which used theACB’s strapline “Better science, Bettertesting, Better care” as a title, was anexcellent keynote to the meeting.Professor Young focused the audience onthe important role laboratory scientistswill continue to have in an ever-evolvinghealthcare service. By using examples,both local and international, ProfessorYoung reminded the audience that scienceand clinical medicine are the products ofinnovation and that as a profession,laboratory scientists must assertively leadsuch innovations. Delegates wereencouraged to work co-operatively with

clinical colleagues in leading change forpatient’s interests while being mindful oftheir duty to prevent the widening of anexisting health inequality gap.The second speaker, Dr Johnny Cash,

Consultant Hepatologist, Belfast HospitalsSocial Care Trust (BHSCT), presented hisfindings from a pilot study aimed atreducing unnecessary laboratory testing.The study, which was initially carried out inthe Hepatology wards of the RoyalVictoria Hospital, was subsequentlyretested in a Hepatology ward in adifferent hospital within the Trust. The study demonstrated that betterutilisation of laboratory tests was achievedafter requesting clinicians were providedwith helpful resources such as a bloodprojects toolkit signposting to the mostappropriate panels of tests for commonclinical scenarios. Dr Cash reported thatthe success of the pilot study, whichobserved a sustained reduction inunnecessary testing at both locations,

ACB NI Regional SpringScientific Meeting Kathryn Ryan, Mater Hospital, Belfast Hospitals

Professor Ian Young, Mrs Margaret McDonnell and Professor Peter Maxwell

Dr Marta Lapsley, Mrs Margaret McDonnell and Dr Mark Lynch

has gained the interest of several otherclinical areas. With continued engagementit is hoped that the resources developed aspart of this study will be rolled outelsewhere.The theme of best practice in laboratory

testing was continued by the third speakerof the day, Dr Mark Lynch, ConsultantClinical Scientist in Biochemistry, WesternHealth and Social Care Trust. Dr Lynch’stalk on reflex and reflective testingcomprehensively discussed both theusefulness and potential adversity of suchtesting. Dr Lynch highlighted the lack ofevidence supporting an often-assumedadded value of reflex and reflective testingand emphasised the requirement fordedicated guidelines on such testing toensure harmonious practice betweenlaboratories.Dr Marta Lapsley, Consultant Chemical

Pathologist, Epsom and St Helier NHSTrust, gave an excellent overview of kidneystone pathology, epidemiology andmedical management. Amongst manygems of wisdom, Dr Lapsley explained theintricate inverse relationship betweencalcium intake and stone formation,demonstrating the role of dietary calciumin reducing oxalate uptake. Dr Lapsley also

discussed a continued change in stoneprevalence, in particular the increases ofuric acid containing stones, seen indiabetic and metabolic syndrome patients,emphasising the importance ofmultidisciplinary teams in the medicalmanagement of patients with co-morbidities.Professor Peter Maxwell, Consultant

Nephrologist, Belfast Hospitals, andHonorary Professor, Queens’ UniversityBelfast (QUB), gave the final talk of themorning session. He had the unenvied taskof holding the audience’s attention priorto lunch and did so with ease givingdelegates food for thought on all past,present and future lunch choices as hediscussed the well documentedphenomenon of metabolic memory as aresult of poor glycaemic control. Professor Maxwell’s presentation mainlyfocused on chronic kidney disease (CKD)and enlightened delegates of themagnitude of contributing factorsinvolved in the development of CKDincluding: genetic disposition andenvironmental factors such as diet andsmoking. CKD is highly inheritable, withepigenetic contributions, but this isconfounded by the fact that different



tissues will express different epigenomes.The afternoon session was jointly chaired

by Dr Graham Lee, Chair of the ACB ROIRegion, and Dr Elinor Hanna, ConsultantChemical Pathologist, Northern HealthSocial Care Trust. Dr Nigel Hart, GP, andSenior Clinical Lecturer, Queen’s University,Belfast was the first speaker of theafternoon session and gave a veryinsightful presentation on qualityimprovement. Delegates were reminded ofthe value of inclusive organisationalquality improvement, driven from thebottom up rather than enforced from thetop down. Dr Hart’s presentation also gavea window into how quality improvementmodels established in industry are easilyadaptable for use in a healthcare setting.The second speaker of the afternoon

session was Dr Hamish Courtney, BHSCT,with an excellent overview of transgenderendocrinology. He gave the audience aninsight into gender dysphoria, the stagesin gender transitioning and in particularhis role as an Endocrinologist in thetransitioning process. Dr Courtneyexplained that as with the rest of the UK,referrals for gender transitioning inNorthern Ireland continue to increase on ayearly basis and that continued andincreasing financial support will berequired to support the cohesivemultidisciplinary approach required toensure the best provision for service users.Dr Godfrey Gillett, Consultant Chemical

Pathologist, Sheffield Teaching Hospital,educated the audience on Wilson’s disease,a rare autosomal recessive disorder. Dr Gillett explained that coppermetabolism is normally a tightly regulatedand conserved process which goes awry inpatients with Wilson’s disease due to a loss of function of the protein, copper-transporting ATPase 2. While thedisease is characterised by a pathologicbuild-up of copper in organs such as theliver and brain, paradoxically reducedcirculating levels of copper are a

diagnostic marker of the disease. In addition to an excellent overview of thedisease aetiology and medicalmanagement, Dr Gillett also highlightedsome diagnostic anomalies of which to beaware of such as haemolytic anaemiawhich may incorrectly exclude a diagnosisdue to normal copper levels and theimportance of excluding nephroticsyndrome as a cause of low copper.The final two talks of the afternoon

session were complementary presentationsfocused on the topic of drugs of abuse.The first talk, presented by Dr MichaelTrimble, Clinical Lecturer QUB and BHSCT,explained the magnitude and complexityof the problem giving an overview of theburgeoning range of drugs of abusecurrently on the market. In his talk, Dr Trimble alluded to the difficulties facedin maintaining a satisfactory legalframework capable of dealing with thecurrent exponential and evolvingproduction of new psychoactive substances(NPS) and the continued misuse ofprescription only medicines. The finalspeaker of the day Dr Jenny Hamilton,BHSCT, a Clinical Scientist specialising inToxicology, continued on the theme ofdrugs of abuse, this time looking from aToxicology laboratory perspective. She described the modernisation processthe Belfast Toxicology laboratory hasundergone since its initial set-up in 1984when it had an annual sample number of400, to its current format which analyseson average 10,000 samples annually. In herpresentation, Dr Hamilton also describedthe challenges currently faced by allToxicology laboratories, which arecontinuously required to modify anddevelop their assays to ensure theprovision of a testing repertoire thatreflects the evolving drug use climate.The meeting was brought to a close by

Mrs Margaret McDonnell, who thanked allof the speakers and delegates inattendance. �



The 2017 ACB Scotland Meeting was held at Norton House, a beautifulvenue with scenic surroundings on the outskirts of Edinburgh. A varied programme wasplanned over two daysDay one started with the Junior Members’Papers session. Trainee participants wereeligible for the John King Award. Dr AlanaBurns spoke about the usefulness offunctional markers, her work indeveloping an assay using a functionalmarker of vitamin B1 (transketolase),

and also addressed the challenges of sucha test. Dr Craig Livie’s case of adrenocorticocarcinoma (ACC) wasunusual in its presentation of a verysignificantly raised testosterone. He highlighted urinary steroid profiles asbeing a good investigation in some cases,especially for differentiating betweenadenoma and ACC. The session wasrounded off with Dr John Wadsworth’stalk about the introduction of a newchromogranin A assay for Scotland, whichwould offer the main benefits of improvedturnaround times and reduced costs. Congratulations to Alana for being the

recipient of the John King Award thisyear! She was presented with thedistinctive ‘King chess piece’ trophy by

ACB Scotland AutumnMeetingLouisa Lee and Kirsten Grant, Glasgow Royal Infirmary



Left to right: Chris King (John King’s son), his wife, Alana Burns, Craig Livie and John Wadsworth

Chris King (John King’s son) at the eveningdinner, which made this year’s meeting aparticularly special one. The main themes of the remainder of

the first day were ReproductiveEndocrinology and Renal Biochemistry/Fluid Balance. The uses of AMH wereoutlined in detail by Professor RichardAnderson, including diagnosis ofPCOS/POI, prediction of fertility inoncology patients, as well as guiding IVFtreatments. Dr Heather Currie’sinformative presentation covered thediagnosis and management of menopause.She emphasised many benefits of HRT andshowed evidence that HRT is an effectivetreatment strategy for younger women inparticular. Interpretation of serumtestosterone was the final topic of thesession; Dr Julian Barth touched onmeasurement of free testosterone andtotal testosterone. He advocated repeatingmorning testosterone tests (fasting) inassessments, and interpretation in light ofindividual symptoms. Dr Edmund Lamb and Dr Heather

Maxwell gave presentations in theafternoon’s renal biochemistry/fluidbalance session. Dr Lamb provided anoverview of clinical biochemistry issuesaffecting the diagnosis of chronic kidneydisease. He addressed differences inanalytical performance between the Jafféand enzymatic methods, and talked aboutcystatin C as a better marker thancreatinine for determining low GFR. Dr Maxwell spoke at length aboutmeasurement of creatinine in paediatrics.There are limitations associated with useof formulas to estimate GFR, and she putout the question of whether we should beperforming more measured GFRs forpaediatric cases. The Inter-regional Biochemistry Quiz

rounded off the daytime schedule!Knowledge of movie/television scientists,biochemistry analytes and recognisinglaboratory equipment were crucial!

Day 2 of the meeting was kick-started byDr Nick Mills of Queens Medical ResearchInstitute, Edinburgh, who provided anupdate on cardiac biomarkers with a focuson high sensitivity troponin (hsTn) assays.Dr Mills was involved in developing theHigh-STEACS pathway (High-SensitivityTroponin in the Evaluation of Patients withAcute Coronary Syndrome) which proposesthe use of very low cardiac troponinconcentrations to further risk stratifypatients at presentation. Current researchis centered on improving the efficiency ofthe existing NICE recommended pathways.It is evident that hsTn assays will continueto change the way we risk assess anddiagnose patients with suspected MI in the future. Dr Bernie Croal provided an interactive

workshop on the introduction of a newtest in the laboratory. This was anextremely useful session in whichattendees discussed the implementation ofa fictional screening test. Delegatesassumed the role of an individual who maybe involved in the decision-makingprocess, such as Clinical Director or patientrepresentative, and considered thedistribution of services model versus thecentralisation of services model – a subjectthat is highly topical within the profession!After lunch, the audit session included

presentations from Dr James Logie ofEdinburgh Royal Infirmary on pancreaticenzymes, and Dr Neil Greig on criticalreporting of potassium results. The hot topics session was opened by

Dr Ian Godber (NHS Lanarkshire), whodiscussed the implementation of a faecalimmunochemical test (FIT) service for theinvestigation of patients with lowerabdominal symptoms of colorectal disease.GP practices across Lanarkshire and Taysidehave been provided with FIT test packs asa pilot study, to assess the viability of thetest in measurement of faecalhaemoglobin concentration in the primarycare setting. In many ways, FIT has many



advantages over faecal occult bloodtesting, and Dr Godber provided a goodintroduction to this topic. The hot topics session was rounded-off

with stimulating presentations from Dr Jonathan MacDonald (QEUH, Glasgow)on the use of biological therapies ingastroenterology, and Dr Christopher Boot(Royal Victoria Infirmary, Newcastle) whodiscussed the advantages of measuringcopeptin (CT-ProAVP) in the investigationof polyuria/polydipsia. The improvedstability of copeptin over AVP makes it anattractive analyte to measure in the clinicallaboratory. The plenary lecture was given by

Dr Craig Webster on the communication of laboratory results. This was a thought-provoking presentationhighlighting the different ways that resultscould be reported to clinicians andpatients. He provided numerous examplesof results that were provided in a visualformat to ease the understanding forpatients. As there is a move tocommunicate results directly to patients,this talk was a timely reminder of theimportance of doing this in a way that isaccessible to patients. Over the course of the two day meeting,

the attendees were an eager audience fortalks that covered topics fundamental toclinical biochemistry, challenges andlaboratory issues, examples ofdevelopment and innovation as well asinteractive sessions. It was also anopportunity to meet new faces and catchup with others! The National Autumnmeeting at Norton House was yet anothersuccessful event organised by the ACBCommittee! �



Chris King was presented with a replica of theJohn King Award as a momento. Left to right:Kevin Deans (Secretary of ACB Scotland Regionand Consultant in NHS Grampian), Chris King andhis wife

Crossword | 29


ACB News CrosswordSet by Rugosa

Solution for December Crossword

Across 1 Botanical doctor loses time describing

tissue-building process (8)5 Ill humour about perennials lacking rain (6)9 Leaving out not a single assignment (8)10 Unusual chaste little pouch (6)12 Conductor upset director-general raring

to go (9)13 Hidden in a steel chest or softwood trunk (5)14 Infamous centre for operations (4)16 Chemical group delayed holding

presentation (7)19 One reused scattered remains (7)21 “Ancient Mariner” back in stock at last (4)24 Morning batting, got a duck for chemical

group (5)25 I leave confused geriatric head of department

to get equipment module (9)27 Delighted by return of French short story (6)28 Far less botched refractures for treatment (4-4)29 First traffic hold-up in North America for

religious person (6)30 Extraordinary sounds unacceptable (8)

Down1 One’s short promotion about positive types of

12 (6)2 End of term ideas about organic groups in

early antibiotics (6)3 Beginning among the scenery and props? (5)4 So I drink to excess in one form or

another? (7)6 Sensible kind of exam (9)7 Fine, subtle and elegant kind of solution (8)8 Mix egg drink with inert gas (8)11 Long inaugural lecture held group back (4)15 Hormones affecting end organs (9)17 Ordnance is not part of mainstream

production (8)18 Inspire in buccaneer style? (8)20 Every one achieved content (4)21 Encourage offspring to embrace clinical

career (7)22 Move towards middle compound (6)23 Caption explaining setting of foot? (6)26 Fraction endlessly caught out (5)


30 | Situations Vacant

PRINCIPAL CLINICAL SCIENTIST(Band 8B)

SENIOR/PRINCIPAL CLINICAL SCIENTIST(Band 7/8A depending upon the stage of training)

Hull & East Yorkshire Hospitals NHS Trust has opportunities for two enthusiastic ClinicalScientists specialising in Biochemistry to contribute to the ongoing success of the BloodSciences domain of Pathology.

We provide a centralised service located within a state-of-the-art facility, providing clinicalsupport to two major Teaching Hospital sites covering the City of Hull as well as EastYorkshire. The Trust provides specialist services in all major medical domains with tertiaryservices across large geographical areas.

The first vacancy is for a Principal Clinical Scientist (8B). Candidates must be HCPC registeredas a Clinical Scientist and hold FRCPath, or equivalent. Ideally you will have experience intandem mass spectrometry. The second is a progressive role requiring a commitment totraining towards FRCPath in Clinical Biochemistry; candidates must be HCPC registered as aClinical Scientist. Appointment will depend upon the stage of training; for appointment atBand 8A you will require knowledge/equivalence evidenced by Part 1 FRCPath or equivalentand for Band 7 will require registration/equivalence as an HCPC Registered Clinical Scientist.For both posts a PhD is desirable, though not essential.

Our Consultant led team includes scientific and medical Consultants, staff in Registrar andSTP training, and close association with Immunology and Haematology Clinical Scientists.Liaison between these service areas is a key requirement of the Blood Sciences Department.Regular duties will involve clinical authorisation and clinical liaison on a rostered basis. Othersignificant duties include scientific service development using research methods, and workingalongside clinical areas to evaluate and implement better quality diagnostic strategies.Research will be encouraged.

Our department processes over 8.5 million tests per year with growth and development in allareas from POCT to LCMSMS. We have an excellent track record for training and retentionfor substantive posts. We are an accredited training centre for STP/HSST training with greatopportunities to get involved. Support for training and development is seen as a priority, aswe recognise that it provides mutual benefit to the department and the job holder.

The Hospital has a central location within this City of Culture and is easily reached from allareas of the City and the many rural towns and villages in surrounding areas. There is alwaysparking, and free bus routes also operate. We also have a choice of very good schools, plusexcellent transport links to the wider world.

These are full-time posts, but applications for part-time and job share are welcome. We organise our time using a flexitime policy.

We encourage enquiries and visits to see the full benefit of the opportunities we can offer. Forfurther information, please contact: Mr John Shepherd, Consultant Clinical Scientist, E-mail [email protected], Tel 01482 607707 or Dr Rachel Wilmot, Consultant ClinicalScientist, Clinical Lead for Blood Sciences, E-mail [email protected], Tel 01482 607821.

Closing date: Wednesday 28th February 2018

Situations Vacant | 31


To advertise your vacancy contact:ACB Administrative Office,

130-132 Tooley Street, London SE1 2TUTel: 0207 403 8001 Fax: 0207 403 8006

Email: [email protected]: 26th of the month prior to the month of publication

Training Posts: When applying for such posts you should ensure that appropriate supervision and training support will be available to enable you to proceed towards HCPC registration and the FRCPath examinations.

For advice, contact your Regional Tutor.

The Editor reserves the right to amend or reject advertisements deemed unacceptable to the Association.

Advertising rates are available on request.

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