Events in 2023

Clostridioides difficile is responsible for the eponymous C. difficile infection (CDI). Faecal microbiota transplant (FMT), a NICE recommended treatment for recurrent CDI, is effective but logistic and safety concerns remain.

With the advent of non-donor derived products, the presentation will outline the principles and evidence related to correcting gut dysbiosis and explore whether there is a need for current or expanded FMT services in the future.

The requirement of extensive and complex testing on cytology samples is widely and routinely recognised. ROSE performed by scientists in the clinical setting provides a standardised, clinically effective, reproducible methodology for a variety of anatomical sites, some of which cytology is the only modality for sampling.

Real-time adequacy assessment eliminates the need for more invasive or repeat procedures by ensuring sufficient cell yield is obtained to conduct all the tests required for ancillary and molecular testing. This streamlines the patient pathway by reducing the referral to treatment time and reduces waiting list pressures, resulting in cost reduction for healthcare trusts and improved patient care and outcomes.

The presentation will explore the new IBMS ROSE qualification with the aim to inspire scientists to become skilled in ROSE.

The effects of long COVID on coagulopathy

Meet your Haematology Portfolio examiners

Antimicrobial resistance (AMR) in anaerobic bacteria varies greatly between institutions and countries. It is crucial that we have robust and widely available methods and perform regular surveillance to raise awareness of AMR amongst laboratory and clinical teams.

The UKARU offers a UK-wide service for the identification and antimicrobial susceptibility testing (AST) of anaerobic clinical isolates. Since 2016, this service has included weekly AST by agar dilution. The MIC population distributions for isolates referred are presented in real time via the ARUMIC platform, facilitating continuous monitoring of the development of resistance and valuable data for the review and development of epidemiological cut-offs (ECOFFs) and species-specific breakpoints, alongside the European Committee for Antimicrobial Susceptibility Testing (EUCAST).

During 2017 – 2021 EUCAST and the UKARU reviewed the AST methodology and breakpoints for anaerobes and developed a standardised disk diffusion method. Fastidious Anaerobe Agar with horse blood (FAA-HB) was used to test the most commonly isolated anaerobic bacteria including Bacteroides spp (n=170), Prevotella spp. (n=49), Fusobacterium necrophorum (n=51), Clostridium perfringens (n=58) and Cutibacterium acnes(n=54). The antimicrobials included for the initial phase were benzylpenicillin, piperacillin-tazobactam, meropenem, metronidazole and clindamycin with vancomycin included for the Gram positive organisms. Breakpoints for additional agents have just been published on the EUCAST website.

This lecture will provide insights into the development of AMR in anaerobic bacteria, the available AST methodologies and the importance of surveillance for this important group of pathogens.

The debate about performance and sustainability of our healthcare services is often reduced to a questions of money and beds are there enough of either? Both are back ups to the more important question - are there enough staff?

The size and complexity of the workforce challenge means there will need to be concerted and sustained action across the system on workforce planning, training, retention, productivity, job roles and creating workplace cultures - that demonstrates staff are valued. For our sector, action is needed both in the short term and the long term to support the workforce and meet the needs of our service and how this will meet the wider healthcare service for patients.

This presentation will look at how leaders at all levels need to work collectively to address our workforce challenge and how we can together take action at a local, regional and national level.

Blood Transfusion follows binary guidelines designed to protect against the formation of allo red cell antibodies capable of causing Haemolytic Disease of the Foetus and Newborn. For the first time, in 2021, the England and Wales Census included a gender identity question, ‘Is the gender you identify with the same as your sex registered at birth?’. 0.5% of respondents answered ‘No’ (262 000 people) of which 48 000 identified as a trans man, 30 000 as non-binary and 18 000 as another gender identity. Thus, there is a small, but significant, population of Transgender and Gender Diverse (TGD) individuals in society.

What are the implications for Blood Transfusion? There are several scenarios:

The lab could receive a sample labelled male and issue blood components which fail to meet the requirements of Kell negative and, if applicable, CDE negative red cells to someone with childbearing potential.

The lab could receive an antenatal sample labelled male and the LIMS does not allow staff to perform all the same testing and product issuing as it would for a female.

Some TGD individuals who have transitioned may get a new NHS number. Lab staff may be unaware and lab records are not merged which means all future transfusion requests are relying solely on antibody screening results with no historical transfusion information.

The clinical consequences of these errors are missed incompatibilities, special requirements not met (SRNM) errors and immediate or delayed transfusion reactions with a potential for major morbidity or mortality.?All the circumstances described above illustrate that provision of healthcare is not uniform?for?all patients in the UK and could be described as indirect discrimination - a policy or practice that is identical for all people but has an unfair or disproportionate effect on a people with a protected characteristic.

Coagulopathy has been shown to play an important role in COVID 19 infection. Reported abnormal coagulation laboratory values in severe COVID-19 are most notably a 3-to-4-fold increase in D-Dimer (Yao et al., 2020).

Several studies showed that elevated D-dimer in COVID-19 patients is associated with higher mortality. A retrospective cohort study carried out by Zhou, et al. (2020) also associated D-Dimer > 1000ng/ml with higher odds of in-patient death.

At the onset of the COVID 19 pandemic, there was no consensus as to how D-Dimer levels should be used for the management of COVID-19 patients. In April 2020, PAHT decided to use a D-Dimer cut-off of 1000 ng/ml to determine anticoagulation dosage. The source of reference used by PAHT in their decision making employed a D-Dimer assay with a cut off value of 500 ng/ml for the exclusion of venous thromboembolism (VTE). This raised an issue as the source of reference used by PAHT at the time employed a D Dimer assay with a cut-off value of 230 ng/ml for the exclusion of VTE. This meant the trust was unable to implement the new COVID 19 care bundle at the time. The haematology laboratory wanting to do whatever possible to assist patient care agreed to change the current D-Dimer methodology immediately to support the trust COVID 19 care bundle.

The verification and implementation of the new D-Dimer assay with cut of 500 ng/ml for the exclusion of VTE was completed within four weeks. A risk assessment and a change control were put in place to ensure users were made aware of the change in cut-off limit.

This verification and implementation of the new assay was possible through the hard and collaborative work of the haematology technical team with shared vision, motivation coupled with team engagement and strong leadership.

As the climate health crisis continues to escalate, governments and key NHS leaders are recognising the need for change. There is growing sector awareness of the impact of the lab on the environment and it is now time for laboratory medicine to consider the role POCT can play in achieving NHS net zero carbon targets. Centres for Sustainable Healthcare propose four principles for sustainable healthcare: prevention, patient self-care, lean service delivery and low carbon alternatives.

This presentation considers the role GIRFT and POCT can have, in supporting these principles of sustainable healthcare and promoting greener diagnostic pathways.

In the US, the death rate from drug overdoses more than tripled between 1999 and 2017, this was driven by increase use of opioids. This opioid epidemic had three phases: the first was dominated by prescription opioids such as oxycodone, the second by heroin, and the third by cheaper but more potent synthetic opioids such as fentanyl.

Despite a few outbreaks of synthetic opioids (such as fentanyl analogues) causing death is particular geographic areas, the UK has not faced the same epidemic as the US. However, over the past 2-3 years the UK has seen an increase in the detection of 2-benzyl benzimidazole (‘nitazene’) type opioids. These are found mixed with heroin or purchased online, typically sold as oxycodone. This talk will give a brief overview of novel opioids, discuss the potential for harm and highlight the analytical strategies to develop validated assays to detect and measure both novel opioids and other novel psychoactive substances.