Events in 2023

The idea of generating blood cells in vitro for transfusion is not new but only now we are reaching the point where the concept is reaching clinical trials. In vitro derived blood cells (namely platelets and red cells at this stage) are complementary to blood donor-derived products but with distinct advantages: biological safety, more resilient supply line and potentially less immunogenicity.

We have developed a forward programming approach relying on the overexpression of transcription factors in pluripotent stem cells to produce the platelet mother cells, the megakaryocytes, conferring added efficiency and purity to the culture system. The challenges that remain to be addressed are related to transition to GMP production, optimising platelet release in the culture and quality control of the final product. The power of genome editing has also allowed us to explore the production of platelets with added clinical benefit (immune silent, added thrombotic potential).

Red cell production from primary CD34+ progenitors has been demonstrated in academic laboratories about a decade ago. We are now mid-way through a first in human study to look at the potential of using in vitro derived red cells for transfusion. One of the main benefits would be a potentially longer survival of the manufactured red cells in the circulation than their donor-derived counterpart. This would allow spacing out transfusion intervals for patients on chronic transfusion programme, thereby reducing iron overload.

A person's immune response to previous antigen exposure is one of the most useful measures of how well their immune system is functioning. Vaccination provides a controlled and standardised exposure to an antigen, with the ability to assess immune responses prior to and after exposure. Different vaccine types can be used to explore different aspects of immune function.

Traditionally, antibody levels have been used to interrogate these responses, and it is possible to explore the quality of the antibody response and also cellular responses. A wide variability in the response to vaccination in healthy individuals can complicate interpretation of vaccine responses in patients with recurrent infections. Protection from infection is multifactorial, and while our ability to assess vaccine responses is improving, this alone is often not enough to assess an individual's immunity.

Thrombophilia is defined as hereditary and/or acquired conditions associated with an increased predisposition to thrombosis. The previous British Society for Haematology guideline on thrombophilia testing (2012) focused only heritable thrombophilia testing. The updated guideline published in 2022 (1) has a widened scope to include both heritable and acquired thrombophilia especially antiphospholipid antibodies, paroxysmal nocturnal haemoglobinuria, myeloproliferative neoplasm (MPN) and the presence of a JAK2 mutation in the absence of an MPN phenotype. Disorders such as cancer, inflammatory conditions and obesity are associated with thrombosis through multiple mechanisms, but these are not included in the guideline which focuses only the factors identified from laboratory testing.

The key principle in the guideline is that when clinical utility of testing is not clear, thrombophilia testing is not mandatory, and testing should be done only if the result will alter the management of the patient. These guidelines emphasise the importance of identifying antiphospholipid syndrome and JAK2 +/- MPN phenotype because they have a significant impact on management. The guidelines confirm the limited utility of testing for hereditary thrombophilia testing in venous thromboembolism, arterial thrombosis and recurrent pregnancy loss.

1. Arachchillage, DJ, Mackillop, L, Chandratheva, A, Motawani, J, MacCallum, P, Laffan, M. Thrombophilia testing: A British Society for Haematology guideline. Br J Haematol. 2022; 198: 443– 458. https://doi.org/10.1111/bjh.18239

The aim of this presentation is to explain the growing importance of the use of cytopathology cell blocks in the diagnostic process and how this has evolved over recent years. In the past they were used as an 'extra' to the traditional Papanicolaou and Romanowsky stains whereas now they have an essential role in providing material for ancillary testing - immunocytochemistry and molecular studies.

The variety of methods of cell block preparation will be covered and why it is important that a department choses what method, or methods, are best suited to what is required from the finished result.

Understanding your laboratories baseline data is the most important first step to identify where to improve services. Data is key to understanding preanalytical processes, simple things such as the location of phlebotomy clinics, the timings of transport collections, the number of paper requests all have an impact on specimen reception workflows and specimen turnaround times.

Many labs still continue to measure a specimen's turnaround time from the moment it arrives at the lab, which is too late.

We will demonstrate how data modelling and innovative transport solutions will improve system workflows, reduce specimen rejections, smooth out specimen arrivals, reduce the output of CO2 and meet the preanalytical quality requirements for your next UKAS inspection.

To explore the molecular profiles of Acanthamoeba from laboratory-confirmed Acanthamoeba keratitis (AK) cases reported within the United Kingdom (UK) using DNA taken directly from clinical samples.

Acanthamoeba species are free-living organisms responsible for causing a debilitating, sight-threatening disease of the cornea. Of the 24 known Acanthamoeba species, 14 cause AK.

Thirty-five Acanthamoeba DNA-positive corneal samples from the Scottish Microbiology Reference Laboratories (SMiRL), Glasgow collection were selected from cases reported from 2017 - 2019. Following extraction of the DNA directly from each clinical specimen, the DNA was subjected to in-depth molecular typing using a nested PCR / bi-directional sequencing approach.

Molecular profiling was successful for 32 samples which comprised of two genotypes namely T3 and T4. The T4 genotype were further sub-typed; five sub-types existed namely; T4A, T4B, T4C, T4E and T4F.

Using a molecular typing assay applied directly to corneal tissue, this study highlights the T4 genotype and the T4A subtype are the predominant molecular variants of Acanthamoeba to cause ocular disease in the UK. Gaining in-depth information on the molecular profiling of Acanthamoeba is essential to increase our knowledge and understanding of the epidemiology, transmission pathways and potential associations with clinical outcomes for this rare, yet potentially debilitating ocular disease.

Ovarian Hyperstimulation Syndrome is one of the most dangerous complications associated with assisted conception using invitro fertilisation (IVF). If not managed appropriately it can even lead to death of the women developing ovarian hyperstimulation syndrome. Clinical Biochemistry aids significantly in the diagnosis and management of ovarian hyperstimulation syndrome.

This presentation aims to summarise the role of various biochemical parameters that are used routinely in the diagnosis and management of ovarian hyperstimulation syndrome.

The dynamic of virological diagnosis has transformed dramatically over the past few years in light of the Covid-19 pandemic, with significant changes to equipment and technology, workforce, workload and expertise. This presentation looks at those changes and focuses on the challenges observed and how these will continue over the coming years for virology departments across the country.

Guided relaxation session

Whats new in Diagnostic Cytology (Reporting systems; biomarker testing)