FEATURE ARTICLES

Blood Science is the next step on the road to a fully integrated pathology service. Core disciplines of haematology and biochemistry are merged, but many also see the inclusion of immunology in this new super-discipline. Its development is driven by the need for cost reductions, commonality in laboratory processing and by roles in clinical diagnosis and management. The new discipline will demand a new breed of scientist, as Andrew Blann, Ian Jennings and Nessar Ahmed explain. Historically, pathology has evolved into distinct disciplines, and training and practice has reflected this. The past decade has seen the birth and slow development of a new branch of pathology – blood science – which merges aspects of haematology, biochemistry and immunology.

A guidebook on cytogram interpretation, written by Graham Gibbs and published recently, should prove very useful to anyone who uses a haematology analyser. Assessment of blood film morphology following an abnormal full blood count (FBC) is a traditional and fundamental aspect of diagnostic haematology. Nationally, review rates vary from below 5% to as much as 100% in certain specialist laboratories. However, as boundaries between different sections of pathology disappear and workload and skill-mix change, the level of morphology skill often varies among staff members.

In recent years, clinical microbiology has turned to state-of-the-art technologies in order to automate workload. Here, Jamie Laughlin discusses the gradual transformation of his department, from traditional bench-based techniques to the Lean working principles of automation.

The Heatherwood and Wexham Park Hospitals NHS Foundation Trust in Slough serves a wide area of Berkshire from its base at Wexham Park Hospital, with satellite hospitals at the Heatherwood in Ascot and St Mark’s in Maidenhead. Pathology services are centralised at Wexham Park, and the microbiology department processes about 317,000 samples a year received from hospitals and GPs in the trust. Over the past few years, the microbiology department has undergone a programme of automation, taking a thorough look at workflow and the equipment options available, as well as learning from the experiences of other laboratories.

Cardiac and thrombosis testing in accident and emergency in Buckinghamshire has benefited from use of a point-of-care immunoassay system from Radiometer, saving time and resources and improving patient care. Instant bedside immunoassay testing for critical cardiac biomarkers can be crucial to the provision of swift and appropriate treatment in an acute care setting, allowing further assessment or urgent treatment of a patient to be ruled in or ruled out without delay. Buckinghamshire Healthcare NHS Trust has introduced point-of-care immunoassay analysis in the accident and emergency (A&E) department at Stoke Mandeville Hospital, improving turnaround times for troponin I (TnI) and D-dimer, and consequently patient flow. Unnecessary treatment has now been reduced, with corresponding time and cost savings.

The latest developments in automation will come to the aid of histopathology departments that offer fluorescence in situ hybridisation testing for HER2 gene amplification. Human epidermal growth factor 2 (HER2) is a transmembrane receptor with tyrosine kinase activity that exist in low levels on normal breast epithelial cells but is over-expressed in 20–30% of patients with invasive breast cancer. This is caused by amplification of the HER2 gene on chromosome 17, and there is a very good correlation between HER2 receptor protein over-expression and HER2 gene amplification in breast cancer.

Managed service contracts continue to provide a valuable asset in the provision of modern pathology services. Two years after introducing Beckman Coulter’s Three60 inventory management to the laboratory in Chester, the department comfortably meets and often exceeds expected service levels. The Countess of Chester Hospital NHS Trust decided to enter a partnership with laboratory automation expert Beckman Coulter when it developed one of the first combined blood science units in the NHS. Now, two years on, the impact is already recognised – workflow improvements, a consistently reduced turnaround time, increased revenue opportunities, and staff able to multitask in a less stressful environment.

A powerful but comopact NMR analysers has enabled one contract laboratory to eliminate bottlenecks associated with fat testing and dramatically increase sample throughput. The quickening pace of business has caused one of Europe’s leading independent testing laboratories to seek an alternative to the standard solvent extraction/acid hydrolysis (Soxhlet) method for testing the amount of fat in foods.

Nephelometry is used to measure the specific level immunoglobulins circulating in the blood. With 50 years’ experience, Siemens is one of the leaders in the field, as workers in hospitals in Cambridge and the south-east are able to testify. The BN II and the BN ProSpec allow laboratories to provide uncompromising performance in plasma proteins analysis, favoured by the majority of nephelometry users in the UK. The ease of use and comprehensive menu make the BN II and the BN ProSpec the ideal solution for any size of laboratory, including protein reference units and dedicated immunology departments, as well as special chemistry laboratories and clinical trials organisations.

The recently launched Congress programme clearly demonstrates the vital importance of the symbiotic relationship that exists between the commercial sector and the profession it supports. Attendance, however, offers so much more, and now is the most cost-effective time to book and pay.

As hospital admissions increase due to severe cases of influenza infection, so does the demand for isolation facilities. With the ever present threat of healthcare-associated infections, Michelle Holland explores the importance of the rapid diagnosis of Clostridium difficile infection as an aid to patient prioritisation and appropriate resource allocation.

The Sebia Capillarys instrument is an automated capillary electrophoresis (CE) system for serum protein analysis, and is now a popular platform for the routine analysis of serum proteins in the investigation of myeloma. Clinical interpretation of protein electrophoresis requires experience of pattern recognition and can be subjective.

A new cobas point-of-care blood gas analyser was previewed at the UK Roche Symposium last year. Destined to find application across the hospital setting, the cobas b 123 is compact, configurable and flexible in use. Diagnostic tests or associated pre-analytical steps are being performed increasing outside the confines of the medical laboratory on a point-of-care (POC) basis. In the hospital setting, such procedures include blood gas testing in theatre and intensive care units. Modern POC blood gas analysers also provide the facility to test for other critical care parameters, such as electrolytes and glucose, as the system introduced in this article demonstrates.

A new 10-minute nasal swab test for influenza has been introduced by Washington, Tyne & Wear-based diagnostics company CDx. It claims to allow A & E departments to triage incoming patients showing signs of influenza and allocate resources appropriately to treat each patient more effectively.

In a regular feature, Pathology in Practice will speak with leading personalities from the diagnostic industry to gain their views and opinions on current topical issues facing the profession. In the spotlight in this issue is Peter Nest, who is no stranger to the diagnostics industry, having been employed within it since 1987 following a 10-year career as a biomedical scientist at the Royal East Sussex Hospital in Hastings. Peter eventually left the NHS to commence work as a sales engineer for Clandon Scientific, following which he enjoyed a spell in sales at Roche, before forming a small company called Apex Diagnostics, selling Biotrol chemistry reagents to the UK market. Later he became a product manager for Alpha Laboratories, and then their UK sales manager (diagnostics), before joining IBG Immucor in 2003 as sales and marketing manager. Peter took up his present post as UK general manager for IBG Immucor in September 2009.

Recently Selly Oak Hospital added serology testing to its automated Roche serum work area platform running in the blood science laboratory. The result is an improved service to the trust’s transplantation programme. Increasingly over the past decade or so the boundaries between the distinct pathology disciplines has become blurred. Furthermore, the advantages of a more holistic, centralised approach to the provision of, for example clinical chemistry, haematology and immunology has seen the evolution of blood sciences as a 21st-century pathology specialty. An excellent exemplar of this service consolidation is reported in this article.

Routine first trimester Down’s syndrome screening supports an earlier decision-making process. Now, precise, specific and reliable results are available with the Roche Elescys PAPP-A and free ßhCG screening assays.

Oxoid and Remel are the specialty microbiology brands of Thermo Fisher Scientific. Within these brand ranges are some of the fastest identification tests available to clinical microbiologists today.

The Biomedical Science Congress is now less than 10 months away. More than just a scientific meeting, this complete experience clearly demonstrates the vital importance of the symbiotic relationship between the commercial sector and the profession it supports.

Biomedical scientist Barry Hill explains the value of point-of-care diagnostic testing schemes in primary care and explains how recently introduced web-based resources can enable users to take greater advantage of their local pathology services.

Addenbrooke’s Hospital recently evaluated an innovative antinuclear antibody screening test from Phadia. The assay offers Lean working, increased flexibility and fewer false-positive results, as Graham Wood explains.