Date 

 Presenter(s)

 Topic

 9.  Rolling out the indices
Dr. Isolde Seiden-Long, Chemistry, Gamma Dynacare Medical Laboratories, Brampton ON

Reporting of the presence of common interferences hemolysis (H), lipemia (L) and icterus (I) to physicians is crucial for the accurate interpretation of laboratory results.  Both the reporting of the interference as well as an interpretation of how the test result is affected is mandated by regulatory organizations (eg. QMPLS in Ontario).  Numerous chemistry analyzers on the market now offer applications to detect the degree of hemolysis, lipemia and icterus in clinical samples in an automated fashion.  Additionally, both instrument vendors’ technical bulletins and independently published literature is available to correlate the numerical values reported from the instrument to the degree of interference for each chemistry or immunoassay test.  Implementing a fully automated reporting  solution for HIL remains a challenge for many clinical laboratories.   This session will review key considerations for designing a fully automated reporting system for HIL.

Learning Objectives:
At the end of this session, participants will be able to:

1.  Describe approaches for standardizing the reporting process for common interferents hemolysis, icterus and lipemia
2.  Understand the benefits and limitations of automated HIL reporting
3.  Be aware of LIS considerations involved in automating HIL reporting.

Learning Objectives
At the conclusion of this session, participants will

1.  describe clinical laboratory audit
2.  know how to set criteria and standards
3.  explain the audit cycle
4.  identify how audit fits into the Quality process

7. Pseudohyperkalemia causes, investigations, and prevention
Dr. Qing Meng, Pathology and Laboratory Medicine, Royal University Hsspital and University of Saskatchewan, Saskatoon SK

Severe hyperkalemia is a potentially life-threatening condition which needs immediate medical intervention. Pseudohyperkalemia can be misleading and result in wrong interpretation and inappropriate patient management. Immediate recognition and appropriate interpretation of pseudohyperkalemia would, on the other hand, prevent misdiagnosis and unnecessary intervention. Pseudohyperkalemia occurs due to excessive leakage of potassium from cells, during or after blood is drawn. Pseudohyperkalemia is usually induced by hemolysis due to mechanical stress during venipuncture and transportation, excessive tourniquet time or fist clenching during phlebotomy. Pseudohyperkalemia has been increasingly seen in many hematological disorders such as leukocytosis and thrombocytosis. Reverse pseudohyperkalemia has recently been reported in leukemic patients in whom the plasma potassium levels are greater than the serum potassium levels due to heparin-induced cell membrane damage. Measures should be taken to investigate and prevent pseudohyperkalemia in laboratory setting.

Learning Objectives
At the conclusion of this session, participants will be able to:

1. Recognize the common causes of pseudohyperkalemia
2. Understand the causes of uncommon fictitious and reverse pseudohperkalemia
3. Interpret, investigate, and prevent pseudohyperkalemia.

6. Primary aldosteronism screening pearls, no problemo!
Dr. Daniel Holmes, Division Head, Clinical Chemistry, St. Paul's Hospital, Vancouver BC

Primary Aldosteronism is a common, treatable and often curable form of secondary hypertension characterized by antihypertensive resistance, hypokalemia and metabolic alkalosis. The screening and diagnostic process is heavily dependent on the analytical determination of plasma aldosterone and plasma renin activity (or mass) and the calculation of their ratio. However, both aldosterone and renin suffer a great deal of method-dependent bias making the ascertainment of the optimal screening threshold for the aldosterone to renin ratio a non-trivial task. By overseeing the screening and diagnostic analytical process, the Clinical Chemist and/or Clinical Pathologist can have a very significant and positive impact on health care. Additionally, a number of other medical conditions manifest themselves with derangements to the renin-angiotensin-aldosterone system and these can be "caught" through careful professional oversight.

Learning Objectives
At the conclusion of this session participants should be able to:

1. Understand what patient population should be screened for primary aldosteronism
2. Understand the causes of primary aldosteronism
3. Understand the analytical pitfalls with aldosterone methods and how they affect the screening process
4. Describe how primary aldosteronism is definitively diagnosed
5. Describe the role of the Clinical Chemist/Clinical Pathologist in the screening diagnostic process
6. Describe how aldosterone producing tumors are localized and the role that Clinical Chemists and Clinical Pathologists can play.
7. Describe the advantages and disadvantages of migration of aldosterone to LC-MS/MS

5. Journal Club: Improving porphyria diagnosis: a European EQA Initiative
Dr.Fiona Bamforth, Dept. of Laboratory Medicine and Pathology, University of Alberta Hospitals, Edmonton AB

Aarsand A, Villangwer J, Stole E, Deybach J, Marsden J, To-Figueras J, Badminton M, Elder G, Sandberg S. European Specialist Porphyria Laboratories: Diagnostic Strategies, Analytical Quality, Clinical Interpretation, and Reporting as Assessed by an External Quality Assurance Program.  Clin Chem (2011) 57; 11:1514-152

Learning Objectives
At the conclusion of this session, participants will:

1.  be acquainted with the family of porphyrias
2.  understand testing strategies for diagnosing porphyrias
3.  be familiar with the external quality assurance program for porphyria testing described in the publication
4.  know the outcome of the initiative in terms of its impact on laboratory testing and diagnosis of porphyria.

4. Adventures in the ER 
Dr. Loralie Langman, Mayo Clinic, Rochester MN

Drug screen interpretation and ordering is complex and confusing.  This session will use case examples to showcase common issues and difficulties in interpretations that Emergency Room physicians encounter in their cases.  This session will also use the same cases to show the limitations and strengths of current drug testing methods.

Learning Objectives
At the conclusion of this session, you will be able to:

1. Explain why we use screening and confirmation assays
2. Know advantages and limitations of testing methodologies
3. Interpret results (screening vs. confirmation)
4. Suggest which tests to order (drug screens vs. specific assays)

3. Interpretation of biochemical tests in the elderly
Dr. Cynthia Balion, Hamilton Health Sciences Centre, Hamilton ON

Older persons represent the fastest rising age group in world. Differentiation between age-related changes and disease-related biochemical changes is difficult and not well understood. Although some studies have sought to define reference intervals for older persons there is a limitation in this approach as there is more heterogeneity in this group compared to the younger adults. This presentation will provide an overview of the issues and evidence on test interpretation in this older age group. pan>

Learning objectives:
1. Appreciate the complexity of acquiring and defining reference intervals in older persons.
2. Identify biochemical tests which require different interpretation in the elderly compared to younger adults.
3. Recognize the need for geriatric biochemist.

2. Fetal Lung Maturity Testing: Current challenges and considerations
Dr. David G. Grenache, Associate Professor of Pathology, University of Utah
Medical Director, Special Chemistry, ARUP Laboratories, Salt Lake City UT

This presentation will describe the neonatal respiratory distress syndrome including its pathophysiology, management, and treatment, and provide a review of currently available laboratory tests for the assessment of fetal lung maturity.  Contemporary issues that affect both laboratorians and physicians will also be described.

Learning Objectives:
1. Describe the pathophysiology and treatment of respiratory distress syndrome.
2. Compare and contrast the different types of fetal lung maturity tests and discuss their clinical utility.
3. Discuss contemporary issues facing fetal lung maturity tests.

1. Update on lipids from the clinical perspective
Dr. Tony Chetty, St. Joseph's Hospital, Hamilton ON

Learning Objectives
1) approach to patients with dyslipidemia
2) review the highlights of the 2009 Canadian Lipid Guidelines
3) discuss some challenging cases
    • elevated LDL-cholesterol
    • mixed dyslipidemia
    • CRP
    • low HDL
    • combination therapy
    • med intolerant patient