The President of the Academy of Clinical Science and Laboratory Medicine
09:50 – 10:00: The President of the ACSLM, Bernadette Jackson will open Labcon 2021
LabCon 2021: 9th-10th November 2021
LabCon 2021 - Tuesday 9th & Wednesday 10th November
Cellular Pathology, Tuesday, 9th Nov. 10.00 – 12.00. Webinar Video
Chair: Ciarán Love, Chief Medical Scientist, Cellular Pathology, Tallaght University Hospital
10:00 – 10:30 Two Case Studies
a) Incidental finding of High-Grade Anaplastic Meningioma in a GP Lipoma Excision.
Fiona Minogue, Medical Scientist, Connolly Hospital.
b) Merkel cell Carcinoma with a Concurrent Squamous Cell Carcinoma.
Danielle Scally, Medical Scientist, UHG.
10:30 – 10:50 Validation of BxChip™ Technology for Prostate Biopsies @TUH.
Shane Hanley, Medical Scientist, St James’s Hospital.
10:50 – 11:25 Efficiency v Effectiveness. Work Faster or Work Smarter: A Collaborative Approach to Reducing Turn Around Times Within a Cellular Pathology Department.
Aoife Madden, Senior Medical Scientist and Dr Kevin O’Hare, Consultant Histopathologist, TUH.
Webinar Video
Haematology Tuesday 9th November 13:00 – 14:50 – WEBINAR VIDEO
Haematology Chair: Mary Byrne, CMS in the National Coagulation Centre at St James’s Hospital
13:00 – 13:40 Investigation of TTP and HUS Related MAHA in Cork University Hospital.
Adam Korneluk, Medical Scientist and Dr Maeve Crowley, Consultant Haematologist, CUH.
13:40 – 14:00 Investigation of HIL Indices on the ACL TOP550 Instrument.
Gráinne O’Grady, Medical Scientist, MMUH.
14:00 – 14:15 Anticoagulation Clinic in a Pandemic.
Maura Hyland, CNM2 and Grace Ryan, RGN, Naas General Hospital.
14:15 – 14:35 A Panhaemocytometric Approach to COVID-19: A Retrospective Study on the Importance of Monocyte and Neutrophil Population Data.
James Harte, PhD Candidate UCC, Medical Scientist, CUH.
Bio: James Harte is an early-career scientist, with a strong desire to leave a positive, long-lasting impression on clinical decision-making through a combination of laboratory medicine, advanced practice, and academic research. In 2019, James graduated with distinction from Cork Institute of Technology and University College Cork, with a first-class honours degree in Biomedical Science. Awarded scholarships and honours for academic achievements, James was recognised as the Best Student in the Biomedical Science Programme and the School of Science and Informatics at graduation.
In 2020, James completed his Diploma in Clinical Laboratory Practice at Cork University Hospital and began working as a Medical Laboratory Scientist in the Department of Haematology during the peaks of the COVID-19 pandemic – specialising in haemostaseology. Therein, he conducted research on novel haemocytometric parameters in the diagnosis of COVID-19.
Most recently, James was awarded the Eli Lilly Research Scholarship and started his PhD candidacy in February 2021. James’ PhD research currently focuses on ACE2 – the cellular receptor for SARS-CoV-2 – and aims to expand on the pathophysiology of COVID-19, under the supervision of Prof. Justin McCarthy (University College Cork) and Dr. Caroline Vaughan (Munster Technological University). He continues to be a part-time Medical Scientist at Cork University Hospital.
Abstract: The SARS-CoV-2 pandemic remains a global health emergency. While the pathophysiology of COVID-19 infection is predominantly respiratory, patients with SARS-CoV-2 infection frequently present with haematological complications. Modern haematology analysers generate quantitative cell population data (CPD) on the morphological and functional characteristics of circulating blood cells as part of routine full blood counts, which are emerging as novel indices of disease.
Herein, we retrospectively studied the initial haemocytometric data of patients tested for COVID-19 (total cohort: n = 871; COVID-19-positive cohort: n = 81), extracted from the laboratory information system between March and May 2020. Furthermore, between October 2020 and January 2021, the haemocytometric data of patients with COVID-19 spanning admission to fourteen days post-admission was extracted, and analysed for dynamic changes in cell population data.
Patients with COVID-19 presented with distinct haemocytometric changes, including lymphocytopenia with significant increases in lymphocyte complexity and size. Considerable alterations in the monocyte compartment were also observed in patients with COVID-19. The internal complexity of monocytes was shown to be significantly increased, with a reduction in the corresponding distribution width and an increase in fluorescence intensity. When comparing patients with and without COVID-19, monocyte complexity had considerable diagnostic utility (AUC: 0.76; 95% confidence interval: 0.71 – 0.81). Dynamic CPD data also differentiated between patients with non-severe and severe COVID-19.
Our findings advocate the usefulness of a panhaemocytometric approach to COVID-19 from initial presentation. Further studies, including longitudinal profiling and multicentre validations, are now required to better understand the potential value of CPD in patients with SARS-CoV-2 infection.
Webinar Video
WEBINAR VIDEO
Immunology/Clinical Chemistry Tuesday 9th November 15:30 – 17:00 – WEBINAR VIDEO
Chair: Medical Scientist and PhD Student at the Lancaster Medical School.
15:30 – 16:00 Lipid Transfer Protein Syndrome.
Dr Hanaa Awad, Immunology specialist registrar, UHG.
Bio: Immunology specialist registrar, GUH. Part 1 FRCPath September 2019. I have been enrolled in Higher Specialist training (HST) at the faculty of pathology, Royal college of Physician of Ireland since July 2016. Registrar of Rheumatology, Mercy University hospital, 2014-2015. Basic specialist Training (BST) 2012-2014, General medicine at the Royal college of Physician of Ireland. A holder of membership of the Royal College of Physician)/UK (MRCP.UK) 2013. Registered at The Irish Medical council/ the specialist training section. Two years of emergency residency, Khartoum, Sudan 2010-2012. General medical practitioner, Khartoum, Sudan 2008-2010. Internship, Ministry of Health Khartoum, Sudan 2006-2008. MBBS Faculty of Medicine, University of Khartoum, 2005.
Abstract:
- Lipid transfer protein syndrome is a complex clinical syndrome of multiple allergies to food caused by sensitisation to non specific Lipid transfer protein (nsLTP).
- It has variable clinical presentations, ranging from mild contact urticaria to anaphylaxis.
- Presence of co- factors plays an essential role in the development of symptoms in most of the cases.
- Sensitivity to a wide range of allergens contributes to the complexity of it’s clinical picture, hence patient education is of paramount importance to encourage adherence, decrease anxiety and limit unnecessary avoidance of food.
- Its management is mainly by avoidance of specified allergens and triggering factors along with providing patients with the appropriate education and emergency medications.
16:00 – 16:30 “Investigating the Kinetics of the Humoral Immune Response to SARS-CoV-2 and the use of Antibody Testing in “long” COVID-19 diagnosis”.
Evan Brennan, Medical Scientist, SVUH.
Bio: Evan is a medical scientist working in the Immunology laboratory in St. Vincent’s Hospital Dublin and is also a recent masters graduate in Biomedical Sciences from Radboud Univerisity in the Netherlands, this being the reason why he undertook this project.
Abstract: Understanding the humoral response to coronavirus disease 19 (COVID-19) is an essential aspect in its disease management, especially when designing treatments and vaccines to combat the virus. In this study, we assessed the characteristics of the serological response generated against the severe acute respiratory virus-2 (SARS-CoV-2) including the IgG versus the IgM response, differences in the target antigen spike (S) versus nucleocapsid (N), and antibody levels versus the inflammatory marker C-reactive protein (CRP). This was investigated using four different immunoassays in hospitalised patients with SARS-CoV-2 infection (n=16) 10-80 days after a positive PCR result. These results informed the second aspect of this study, using SARS-CoV-2 antibody testing to inform whether patients presenting with “long” COVID-19 symptoms had evidence of previous SARS-CoV-2 infection. These patients (n=19) presented a median 207 days (191-234) after initial exposure, after being initially unable to obtain a polymerase chain reaction (PCR) test. These results demonstrated that the antibody assays have an overall specificity of 97.01%, with very few false positives, but a more limited sensitivity of between 70.5-78.6% ≤13 days after a PCR diagnosis. The SARS-CoV-2 antibody response appeared quite variable in a group of eight patients who were mapped in detail over 0-80 days; S-IgM seroconversion occurred approximately 2 days earlier than S-IgG and 7 days earlier than N-IgG levels with limited correlation of antibody levels with CRP seen. SARS-CoV-2 antibodies were detected in 11% (2/19) patients who presented with “long” COVID-19 symptoms and who had never had a positive PCR test. This suggests that another post-viral syndrome could be afflicting these patients. Overall, it is recommended that guidelines are put in place to ensure that COVID-19 antibody testing is performed using assays that are sensitive and specific, and only in the correct scenarios.
16:30 – 17:00 Active Vitamin B12.
Mick Amoruso, Senior Medical Scientist, NOH, Cappagh.
Bio: Mick Trained at University Hospital of Wales Cardiff, specialising in Clinical Biochemistry and qualified in 1985. Mick has gained many years’ experience working in busy Medical Laboratories both in the UK and Ireland. Gained promotion to Senior grade in 1995 and took on the role as Training and Education Officer for the laboratory after successfully completing post grad Certificate in Education. Was instrumental in developing an in-house, training programme for laboratory assistants and undergraduate students. Took part in various research projects which would prove to be of benefit to the laboratory, namely Troponin-T in 1997 and NT-ProBNP in 2006. Was involved as part of the quality team to prepare for CPA UK accreditation after laboratory centralisation.
Moving to Ireland in 2000 to take on the role as Quality Officer/ Senior Medical Scientist, for the dept of pathology and laboratory medicine at a Dublin maternity hospital. Engaged with the cross-Maternity Alliance in preparing for laboratory accreditation. He joined National Orthopaedic hospital Dublin in 2009 and focussed mainly on preparing the Biochemistry department for ISO 15189 laboratory accreditation. Mick took on a role as Journal club editor for organising staff CPD. He joined the Clinical Chemistry Advisory Body (CCAB) of the ACSLM and took on the role as chair for 3 years. CCAB team responsible for organising meetings, workshops and inviting guest speakers to present at national conferences.
Mick completed an MSc in Biomedical Science (Clin Chem) with University of Ulster and continues to work in a multidisciplinary laboratory developing and streamlining the service to meet the needs of users.
Abstract:Vitamin B12 status is routinely assessed biochemically by measurements in plasma or serum of total B12 without a differential assessment of each B12 fraction. Measurement of total B12 may be confounded by a number of analytical factors which affect accuracy in the diagnosis and monitoring of vitamin B12 deficiency. This study’s design included analytical verification, reference range evaluations and assessments of assay concordance and clinical utility following prospective and retrospective analysis. This study’s main objective was to provide analytical and clinical data that would help inform decision, regarding the feasibility of implementing Active B12 into routine diagnostic use in the future, including its most appropriate use as either a first- or second-line test, for all patients. The study included recruitment of 120 healthy hospital staff volunteers, to take part in the study. Blood analysis for all volunteers included the measurement of Total B12 analysed in parallel with Active B12. Active B12 exhibited total imprecision < 10% across the established RR for the B/C Access 2 method (29-198 pmol/L). Total imprecision CV was calculated as 9.8%, Sd ± 4.2 pmol/L. Concordance between both tests was high (80-86%), regardless of the RR combinations used for Active B12 and Total B12. In conclusion the Beckman Access Active B12 assay is analytically acceptable for use in the biochemical assessment of B12 status. Active B12 will give added value as a second line test with Total B12 for selected patients, particularly where Total B12 is <200 ng/L (148 pmol/L).
WEBINAR VIDEO
Transfusion Science Chair: Fergus Guilfoyle, Chief Medical Scientist, Coombe Women and Infants University Hospital – WEBINAR VIDEO
11:00 – 11:20 Cork University Hospital ‘Pre-Hospital’ Transfusion Project,
John Sheehy, Chief Medical Scientist, CUH.
Bio: John graduated with a BSc from Cork Institute of Technology / University College Cork biomedical science degree course in 1993 and attained his MSc from the University of the West of England (Bristol) in 2001. He commenced as a medical scientist in the Irish Blood Transfusion Service in 1993 and moved to the Cork University Hospital in 2001. He assumed the role of Haemovigilance co-ordinator in 2002 and took up the post of Chief Medical Scientist in the CUH Blood Transfusion Laboratory in 2012, the post he continues to hold presently
Abstract: An overview of the development and implementation of a ‘pre-hospital’ blood transfusion project in Cork University Hospital. This project required close collaboration with a large cohort of differing stakeholders e.g. Blood Transfusion Laboratory, Emergency Department, Irish Blood Transfusion Service, National Ambulance Service, West & East Cork Rapid Response services and Irish National Accreditation Board to ensure the delivery of such a project while continuing to comply with the relevant legislation.
11:20 – 11:40 A Tale of the Unexpected.
Marie Culliton, Laboratory Manager, NMH.
Bio: Marie is the Laboratory Manager at the National Maternity Hospital since 2004. Most of her earlier career was spent in the department of Endocrinology, St Vincents University Hospital where she developed assays for steroid measurements.
Marie has a specific interest in the disease Congenital Adrenal Hyperplasia. This formed the topic of her thesis while undertaking the MSc. in Clinical Biochemistry at Trinity College Dublin which was completed in 1990. Predominant research work concerned examining the relationship of Androgens with 17α OH Progesterone in the treatment of this disease.
In addition to her work in the National Maternity Hospital Marie has served as President of the Academy of Clinical Science and Laboratory Medicine, The European Association for Professions in Biomedical Science and is current President Elect of the International Federation of Biomedical Laboratory Scientists.
Abstract: It was a quiet Sunday afternoon. A young woman presented with a suspected ectopic pregnancy. An initial sample for blood group and hold was drawn. A decision was made to proceed to laparoscopy. At 16:56 an unexpected request was received for 6 crossmatched red cells, at 17:05 the major obstetric haemorrhage protocol was activated and within 5 minutes a further 10 red cells were requested. In total 33 red cells, 10 plasma, 8 platelets and 8 Fibrinogen were transfused. Tragically there was a vascular accident during surgery and, despite all efforts, this young woman died. This presentation considers the learnings from this tragic case. Learnings relate to sample triage, product choice in times of product shortage, communications between clinical arena, laboratory and blood centre. These learnings are incorporated into policies and training protocols.
Medical Scientists are a regulated profession and accountable for their actions. The scientists were part of the team attending at and giving evidence to the Coroners Court.
11:40 – 12:00 The Unexpected Intra-Operative Major Haemorrhage Guideline.
Patsy Kelleher, Senior Medical Scientist, TUH.
Bio: Patsy Kelleher is a senior medical scientist working at Tallaght University hospital since its opening in 1998. Patsy has always been interested in the promotion of the Blood Transfusion Laboratory role in education and in contribution to patient care. She has worked with laboratory management and Clinical areas within TUH to aid in the development of emergency transfusion protocols and delivery of training in laboratory, clinical and non-clinical areas.
Patsy has been a member of the guideline development group working on the national clinical guideline for Unexpected life threatening Haemorrhage, as the representative for the Academy of Clinical Science and Laboratory Medicine. Patsy also serves on the steering committee of IEQAS. 7
Abstract: This national clinical guideline has been developed by the unexpected intraoperative life threatening haemorrhage guidelines group (GDG). The NCEC was requested by the minister for health to commission this guideline arising from a significant patient safety/policy matter and RCSI were requested to lead the guidelines development process. This guideline applies to patients undergoing interventions and operations where a risk of an unexpected intraoperative life threatening haemorrhage can occur.
The aim and objective of this guideline is to reduce unnecessary variations in practice and provide evidence based recommendations for theatre and laboratory staff on the prevention, recognition and management of life threatening haemorrhage. Also to outline good practice points for each recommendation to provide additional information for healthcare professionals on how each recommendation can be implemented in their hospital environment.
The process in development of these guidelines began in April 2019, and had many steps the first being to identify the guidelines scope. HRB-CICER undertook a formal literature search for relevant international guidelines of interest. A survey was undertaken by GDG of all hospital transfusion blood banks across the country. The evidence obtained was screened and appraised and decisions regarding which recommendations from existing guidelines to adopt and/or adapt were based on GDG consensus. Through a series of meetings and workshops 17 recommendations were identified and graded to assess the quality of evidence for all recommendations. Once all recommendations and associated implementation plan were finalised, the costing associated with the recommendations was prepared-Budget Impact Analysis.
An advanced draft of the guideline was sent to key stakeholders for a 4 week consultation period, during this time a draft guideline was also sent to three international reviewers. The feedback received was collated and reviewed by the GDG. Following a series of meetings with various stakeholder groups the amended guideline was submitted to the DOH on Oct 14th 2021 for QA review. This QA report will be presented to the NCEC at a meeting on Nov 25th 2021 where a final decision on the guideline will be made.
WEBINAR VIDEO
LabCon: Microbiology and Virology Wednesday, 10th November 15:00 – 17:00 – WEBINAR VIDEO
Chair: Karen Hickey, Surveillance Scientist, Sligo University Hospital
15:00 – 15:20 Covering all the Bases: Whole Genome Sequencing and SARS-CoV-2.
Dr Jonathan Dean, NVRL, UCD.
15:20 – 15:40 The Emergence of Hypervirulent Klebsiella pneumoniae in Ireland.
Alma Tuohy, Medical Scientist, UHG.
Bio: Alma is working in the Galway Reference Laboratory, Microbiology Dept., Galway University Hospital
Abstract:
Background: Klebsiella pneumoniae is a known opportunist pathogen belonging to the Enterobacterales family. Classic K.pneumoniae (cKp) is associated with nosocomial infection. Hypervirulent K.pneumoniae (hvKp) can cause serious infection in otherwise healthy individuals. Hepatic abscesses and metastatic spread of infection are typical features of hvKp. Hypervirulent K.pneumoniae were initially reported in the Asian Pacific Rim. Research has shown the spread of hvKp worldwide.
Materials/Methods:Eight-hundred and twenty-three K.pneumoniae isolates were sequenced at the Galway Reference Laboratory Services during the period 2016 to March 2021. These isolates were screened for known hvKp virulence factors (VF). The isolates were identified by Maldi-TOF. Whole genome sequencing was performed using Nextera DNA Flex (Illumina) library preparation and MiSeq (Illumina). Results: Fifty-six isolates exhibited hvKp genotype including isolates from screening (n=36), general diagnostic (n=13) and blood cultures (n=7). Of the hvKp isolates detected 85.7% were Carbapenamase Producing Enterobacterales (CPE) producers and 14.3% non-CPE producers. Sequence Type (ST)23 (n=41) contained predictive hvKp biomarkers; iutA, iucABCD, iroBCDN (in one ST23 iroC was not detected and iroN was not detected in another ST23). ST86 (n=2) contained biomarkers; iutA, iucABCD, iroBCDN. ST22 (n=1), ST147 (n=3) ST307 (n=1) and ST395 (n=3); iutA, iucABCD. iucD was not detected in one ST395. ST25 (n=2), ST35 (n=1), ST231 (n=1) and ST2165 (n=1) all contained iutA, iucABC.
Conclusion: This data illustrates that hvKp is increasing in Ireland, in particular ST23. To date the hvKp isolates detected have been samples referred for CPE investigations. Currently the Galway reference laboratory are developing a real time PCR assay to screen for specific virulence genes.
15:40 – 16:00 WGS analysis of 2483 Irish and global vancomycin resistant and vancomycin susceptible Enterococcus faecium: emergence of a drug resistance trafficker.
Nicole Kavanagh Dublin Dental University Hospital (DDUH) and Trinity College Dublin
Abstract: Vancomycin-resistant Enterococcus faecium (VREfm) have emerged globally as important nosocomial pathogens with a 40% mortality associated with bloodstream infections. Enterococcus spp. have the capacity to readily acquire and transfer mobile genetic elements encoding antimicrobial resistance determinants such as the transposon-encoded van operon. Acquired resistance to vancomycin, and more recently linezolid, has been observed worldwide among hospital-associated clones of E. faecium limiting treatment options. For over a decade, the Republic of Ireland has reported one of the highest rates of invasive VREfm in Europe, yet virtually nothing is known about its epidemiology or population structure. Detailed studies of the characteristics of Irish VREfm and its population biology are required to identify transmission pathways and inform infection pevention strategies. This study used whole-genome sequencing (WGS) to address these issues. Enterococcus faecium isolates (n=648; 600 VREfm and 48 vancomycin-susceptible E. faecium (VSEfm)) from five Irish hospitals were investigated, including rectal screening samples (547) and blood culture isolates (101). WGS and core genome multi-locus sequence typing (cgMLST) were used to assess population structure. Genetic environments surrounding the vanA operon were resolved by hybrid assembly of short-read (Illumina) and long-read (Oxford Nanopore Technologies) WGS sequences. All 648 isolates belonged to the hospital adapted clade A1. The majority (435/648) belonged to ST80 based on conventional MLST, yet the population structure was highly polyclonal. cgMLST segregated isolates into 51 clusters of highly related isolates (mean average ≤16 allelic differences) containing mixtures of screening and bloodstream isolates, isolates from different hospitals and both VREfm and VSEfm. There was evidence of spread of individual clones throughout multiple hospital wards and different hospitals, reflecting the organism’s ability to survive in the environment for extended periods. The majority of VREfm (>95%) harboured highly similar vanA transposon regions located on congugative circular or linear plasmids with unique multiple IS1216E insertions, variable organisations of vanA operon genes and a unique truncated tnpA transposase. A comparative cgMLST analysis of Irish 1835 E. faecium isolates from 30 countries revealed little overlap, indicating local evolution is important in the epidemiology of VREfm. Irish VREfm are polyclonal, yet harbour a characteristic plasmid-located vanA-region with multiple IS1216E insertions that may facilitate spread
16:00 – 16:20 EUCAST Issues/Updates.
Isabelle O’Callaghan, Specialist Medical Scientist, CUH.
BIO: Isabelle O’Callaghan is a Specialist Medical Scientist with responsibility for Antimicrobial Susceptibility Testing in the Microbiology Department at Cork University Hospital. Isabelle holds a degree in Biomedical Science from Dublin Institute of Technology and a Master’s degree in Biomedical Science from University College Cork and Cork Institute of Technology. Isabelle has an active interest in research having contributed to several papers published in peer reviewed journals on molecular diagnostics in the clinical setting.
Isabelle is the chair of the ACSLM, EUCAST discussion group and is part of the Irish society of Clinical Microbiologists, subgroup for EUCAST implementation.
Abstract: The European Committee on Antimicrobial Susceptibility testing – EUCAST, is a standing committee which deals with breakpoints and technical aspects of phenotypic in vitro antimicrobial susceptibility testing and functions as the breakpoint committee of, the European Medicines Agency and the European Centre for Disease Prevention and Control.
There are changes in the EUCAST breakpoint tables every year. Some recent changes are proving challenging for Microbiology labs such as the introduction of:
- Area of Technical Uncertainty (ATU)
- The change from the old “intermediate” category to the new “Susceptible, increased exposure” category
- Separate breakpoints for meningitis and non-meningitis infections.
- Rapid AST from blood cultures
There are multiple factors to be considered when implementing these changes in the laboratory, including clinical concerns as well as technical and IT challenges. This has resulted in many laboratories across the country being hesitant to implement some or all these changes. It is important that we coordinate our efforts and work with our multidisciplinary colleagues to ensure that laboratories are following up-to-date guidelines. This will ensure both, patient safety and that our patients are being treated appropriately.
16:20 – 16:40 Case Study: Cluster of OXA-23 Acinetobacter baumanii.
Dr Anne Mac Lellan & Gráinne Bowens, Surveillance Scientists, Connolly Hospital.