October 2019

October 2019—Rarely (as waggish folks like to remind us) is it necessary to reinvent the wheel. Many times it’s better to take existing wheels and stick them on, say, a suitcase. Suddenly, maneuvering through airports becomes 1,000 times easier. Improvement can be that simple, so obvious in retrospect. At least that’s what kidney experts, both inside and outside the laboratory, are hoping as they promote use of the kidney profile lab order to diagnose and monitor chronic kidney disease. Transformation doesn’t always require the thrill of the new. While new markers are always welcome, two stalwart tests—estimated glomerular filtration rate and urine albumin-creatinine ratio—can do plenty.

October 2019—You may not be curling up next to the fire with a cup of hot chocolate to read your copy of the new Digestive System Tumours, part of the World Health Organization Classification of Tumours Series.

October 2019—Histocompatibility laboratories that provide services for cellular therapy transplant patients have one more inspection option to consider, thanks to a new edition of the CAP’s histocompatibility checklist released in September.

October 2019—The requirement revisions in the new edition of the Biorepository Accreditation Program checklist, published last month, are aimed at accommodating a growing overlap between clinical diagnostic activity and biomedical research.

October 2019—Chlorinated lipids have been shown to be new potential biomarkers for sepsis, and continuing research into their role could lead to faster diagnosis, said David A. Ford, PhD, of Saint Louis University School of Medicine, at this year’s AACC annual meeting. Dr. Ford, a professor of biochemistry and molecular biology, discovered chlorinated lipids in 2002, and at the AACC meeting he shared recent research on the association between chlorinated lipids and lung injury and death in sepsis patients.

October 2019—How well can analytics predict the risk for sepsis? T. Scott Isbell, PhD, DABCC, director of clinical chemistry and point-of-care testing, SSM Health, Saint Louis University Hospital, at this year’s AACC annual meeting shared his hospital’s experi-ence with Epic’s sepsis predictive tool. Launched in 2017, the tool uses predictive analytics to produce a sepsis score for ad-mitted patients based on regular scans of key data elements in the electronic health record.

October 2019—Primary intraocular lymphoma (PIOL) is a rare but aggressive B-cell malignancy usually considered as a subtype of primary central nervous system lymphoma. The most common form of PIOL is primary vitreoretinal lymphoma. PIOL is also known as the masquerade syndrome because it frequently mimics other ocular conditions such as chronic uveitis, which may be steroid-resistant. Its diagnosis is challenging and requires a high degree of suspicion. Here, we present a case of PIOL, the diagnosis of which was clinched based on the identification of a mutation in the myeloid differentiation factor 88 (MYD88) gene.

October 2019—Automation, the workforce shortage, manual review rates, and Laboratory 2.0 were some of what came up in CAP TODAY’s latest gathering of hematology experts for a roundtable on what’s new, pressing, and in play. CAP TODAY publisher Bob McGonnagle convened a panel in August consisting of Cordelia Sever, MD, of TriCore Reference Laboratories; Olga Pozdnyakova, MD, PhD, of Brigham and Women’s Hospital; Danette Godfrey and Simon Shorter of Sysmex; and Matt Rhyner, PhD, MBA, and Rachel Burnside, PhD, MBA, of Beckman Coulter. What they said follows.

October 2019—As payments to laboratories decline and labs look for costs to cut, drawing on Lean and CAP 15189 know-how is the path to stronger productivity, workflow, and quality, “and all of that is eventually going to help,” says Mike Black, MBA, MT(ASCP), DLM, laboratory assistant VP of Avera McKennan Hospital and University Health Center, Sioux Falls, SD, and Avera laboratory service line administrator.

Sysmex joins Lab 2.0
October 2019—Sysmex America has joined the Clinical Lab 2.0 movement to support collaboration around value-based health care. The company said it is providing a grant focused on a multi-institutional demonstration project to develop actionable clinical strategies for anemia early detection, intervention, and prevention. Clinical Lab 2.0 is a Project Santa Fe Foundation initiative established to help develop the evidence base for the valuation of clinical laboratory services. It is a call for laboratory leadership in managing population health and enabling value-based care to evolve. Sysmex is the first corporate sponsor. “The Clinical Lab 2.0 movement, with its critical measurable and actionable attributes, promotes the clinical and business model of the future for clinical laboratories,” Khosrow Shotorbani, president and executive director of Project Santa Fe Foundation, said in a statement. The third annual Clinical Lab 2.0 Workshop will take place Nov. 3–5 in Chicago (www.cl2lab.org/clinical-lab-2-0-3rd-annual-workshop-registration-2-2/).

Q. What are your recommendations for using viscoelastic assays to perform platelet mapping studies? What is the clinical value of obtaining these test results? Read answer. Q. Would the results of tests for routine and special coagulation studies be affected if I thawed frozen plasma samples using a dry heating block? Are we allowed to use dry heating blocks? Read answer.

October 2019—I have two goals as a pathologist, and I suspect that my colleagues share them. First, I want to be the best physician—the best pathologist—so I can give the best possible care to my patients. Second, I want to get paid fairly for the service I provide. Being the best pathologist comes with a number of requirements: staying up to date on the latest information and protocols, practicing in a quality lab, and working with great pathologists.

Digital health education: imperfect to imperative: October 2019—Arlen Meyers, MD, MBA, is a passionate advocate for educating medical students and practicing physicians about digital health technologies and their role in patient care. Without increased emphasis on organized digital health education, the medical field cannot fully embrace such technologies, says Dr. Meyers, president and CEO of the Society of Physician Entrepreneurs and co-editor of Digital Health Entrepreneurship, released this year by Springer Books.

Cardiovascular events and mortality in white coat hypertension
October 2019—Hypertension is the most common preventable cause of disability and premature mortality worldwide. It is often diagnosed using in-office blood pressure measurements. More recent guidelines encourage out-of-office blood pressure monitoring, such as at-home self-monitoring, for diagnosing and managing hypertension.

Keratin 17: a sensitive and specific biomarker of urothelial neoplasia
October 2019—There is a clinical need to identify novel biomarkers to improve diagnostic accuracy for detecting urothelial tumors. The authors conducted a study to evaluate keratin 17 (K17), an oncoprotein that drives cell cycle progression in cancers of multiple anatomic sites, as a diagnostic biomarker of urothelial neoplasia in bladder biopsies and urine cytology specimens. The authors evaluated K17 expression using IHC in formalin-fixed, paraffin-embedded tissue specimens of nonpapillary invasive urothelial carcinoma (UC; classical histological cases), high-grade papillary UC (PUC-HG), low-grade papillary UC (PUC-LG), papillary urothelial neoplasia of low malignant potential (PUNLMP), and normal bladder mucosa.

Circulating tumor DNA as a clinical test in resected pancreatic cancer
October 2019—Pancreatic ductal adenocarcinomas are associated with high rates of mortality due, in part, to a lack of effective screening strategies and advanced disease at diagnosis. Residual occult disease is thought to contribute to disease recurrence in up to 80 percent of patients treated surgically for localized disease. These findings highlight the critical need for biomarkers for detecting disease early and monitoring tumor dynamics. Current strategies involve a combination of serum markers (carbohydrate antigen [CA] 19–9) and imaging modalities, both of which have limitations, particularly for detecting early disease recurrence postoperatively.