Events in 2023

Join your network workforce leads/practice educators for a solution focused discussion around workforce challenges. Find out about current education and development opportunities with specific emphasis on support workers, advanced clinical practice and leadership. We welcome your participation in helping to shape the future of your pathology workforce.

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Amyloidosis is disease caused by extracellular deposition in the tissues of abnormal protein in a characteristic fibrillar form known as amyloid. Early and correct diagnosis is essential so that patients benefit from appropriate and timely treatment.

The presentation will highlight the need for rigour in the demonstration of amyloid, new techniques, research, diagnosis and treatment.

This interactive presentation will discuss general demonstration techniques, troubleshooting, and how to make the best out of the feedback you receive from your UK NEQAS CPT Results reports. The content will also cover – how to manage SOPs, importance of understanding mechanisms of action and uses of stains, recording, monitoring, and trending of IQC failures and use of UK NEQAS CPT resources to help improve staining.

There will also be an opportunity for delegates to join in and score examples of stained slides against the UK NEQAS CPT assessment criteria.

Polio – why has it reappeared?

Cell blocks from Diagnostic Cytopathology (DC) samples have always had value in the diagnostic process as a complement to the traditional cytology stains – Papanicolaou and Romanowsky. It has become more important to provide material for Immunocytochemistry to refine malignant diagnosis, and more recently, the use of molecular testing to aid in the choice of tailored chemotherapy regimens. If this information can be obtained from DC samples, which are less invasive than biopsy samples, the patient will benefit.

External Quality Assurance of cell block preparations has up to now been covered by the Tissue Diagnostic scheme. However, this is not entirely appropriate as cytopathology departments use a variety of cell block preparation methods and fixatives. The increase in number of cell block Haematoxylin and Eosin slides submitted to our evaluation service and the queries we receive regarding advice on best preparation methods suggested there was a need for a separate scheme for evaluation of cell blocks. A circulated survey indicated that there is a need for such a scheme. In response to this we performed 2 pilot studies which were well supported and successful, leading to the launch of the live scheme in April 2023.

This presentation covers the development of the scheme and the results of the 2 pilots. As an ongoing process the scheme will be able to garner information about ‘best methods’ and this can be passed on to laboratories experiencing problems and improve standards. UKNEQAS CPT is not just a ‘tick box’ service for UKAS, it is also an advisory service which aims to improve diagnostic practices.

Postpartum haemorrhage is caused by obstetric complications but may be exacerbated by haemostatic impairment. It is a common observation that placental abruption and amniotic fluid embolism are associated with a severe and early coagulopathy characterised by hypofibrinogenaemia and increased fibrinolysis.

In Cardiff, a programme of research has been undertaken investigating the early detection and replacement of fibrinogen based on viscoelastic haemostatic assays. This culminated in the development of a care bundle for postpartum haemorrhage called the Obstetric Bleeding Strategy for Wales (OBS Cymru). Introduction of the OBS Cymru intervention across Wales resulted in fewer women experiencing massive postpartum haemorrhage (defined as >2500 mL) and decreased need for blood transfusion. The intervention is being investigated further in a NIHR supported study.

At term, women have increased levels of procoagulant clotting factors and reduced anticoagulants leading to a prothrombotic state. Our study confirmed these findings and demonstrated significantly raised thrombin generation. We identified two main types of coagulopathy; a dilutional coagulopathy with coagulation factors and platelets falling progressively with bleed size. However, clinically significant reductions in clotting factors were not seen until bleeds of 3000-4000 mL had occurred due to the high starting levels. Despite this, thrombin generation did not decrease due to increased levels of factor VIII during bleeds. Similar dilution-related falls were seen with fibrinogen levels. The exception was factor XIII which falls at term and decreases further with bleed size. The clinical significance of this finding has not been investigated but could suggest a role for cryoprecipitate.

In a subgroup of women we identified an early and severe consumptive coagulopathy caused by hyperfibrinolysis with very high D-dimer and plasmin/antiplasmin complexes which we termed acute obstetric coagulopathy (AOC). In addition, women with AOC had low levels of fibrinogen and evidence of an acquired dysfibrinogenaemia demonstrated by a reduced Clauss/antigenic ratio. The coagulopathy caused depletion of factor V and factor VIII but other clotting factors and thrombin generation was preserved. An increase in activated protein C was observed but no increase in soluble thrombomodulin demonstrating similarities and differences to trauma-induced coagulopathy.

AOC occurred in about 1/1000 deliveries and was associated with a high rate of fetal and neonatal deaths. It was most commonly associated with placental abruption but occurred with all underlying causes of postpartum haemorrhage.

There are complex regulatory changes taking place across the UK and the EU, which could have a significant impact on laboratory services. This session will cover what you need to know to keep on top of this and know what actions you should be taking for compliance.

Diphtheria is a potentially fatal disease caused by strains of Corynebacterium diphtheriae, C. ulcerans or C. pseudotubercolosis that express the diphtheria toxin. It can present as a respiratory infection or as non-healing skin wounds. Diphtheria was historically most likely to be caused by C. diphtheriae. It is very rare in England (typically <10 cases per year) due to a successful routine immunisation programme. However, there has been a recent gradual increase in cases over several years, particularly cutaneous infections and those caused by toxigenic C. ulcerans strains (which can be carried by household pets).

In 2022, there was a particulary large increase in diphtheria in England, with 87 cases and 3 deaths. This included 72 toxigenic C. diphtheriae infections in asylum seekers, thought to be aquired during their travel to the UK. Symptoms ranged from severe respiratory diphtheria to cutaneous infections and asymptomatic carriage. Similar increases of C. diphtheriae infections in travelling migrants have been seen in several European countries. Some of these isolates are multidrug resistant, including to macrolides, the default recommendation for treatment, and this will require careful monitoring.

This presentation is based on a case study used for a portfolio of Higher Specialist Diploma awarded by the IBMS. The presentation will look at how blood cultures taken on admission helped with diagnosis and appropriate treatment of a patient. It will also go in to brief detail on the organism isolated, Streptobacillus moniliformis.

Changing and expanding roles in Cellular Pathology