South West and Wessex
Welcome to the ACB South West and Wessex section of the website.
Famed for its cider, surf and cream teas, our region stretches from Gloucestershire on the Welsh border, to Cornwall & Devon looking out to the Atlantic Ocean to Hampshire in the east meeting the Home Counties.
The aim of the SW&W regional committee is to provide support to the regional ACB members in terms of training, workforce planning, FCS issues and to encourage sharing of expertise and good laboratory practice by holding regional scientific meetings and providing feedback from national committee meetings.
- Roanna George, Chairperson, Derriford Hospital
- Katy Hedgethorne, Committee secretary, Derriford Hospital
- vacant, Wessex regional tutor
- Paul Thomas, SW regional tutor, Exeter
- Paul Thomas, Workforce committee, Bristol Royal Infirmary
- Daniel Isemede, Trainees representative, Torbay General Hospital
- Oliver Clifford-Mobley, Regional FCS representative, Southmead Hospital, Bristol
- David Sinclair, Regional FCS representative, Wessex Region
- Ryan Cooper, Webmaster, Poole Hospital
- George Allen, Meetings Sec/Treasurer, Exeter
- Roxanne Farnon, Meetings Sec/Treasurer, Truro
- Mandy Perry, Ordinary member, Exeter
- Anna Barton, Ordinary member, Truro
- Angela Cooper, Ordinary member, Exeter
- Mary Stapleton, Audit representative, North Devon
- Kristen Lilly, Immunology representative, Plymouth
- Gemma Vanstone, Microbiology representative, Truro
South West & Wessex Poster Competition
See below entries for the South West & Wessex Poster Competition.
The winners will be announced on 18th January 2021.
Authors: A. Abraham*, L. Hikin, J. Dave, P. Smith
Title: Optimisation and validation of a cannabinoid quantification method in PM blood by UPLC-MS/MS
Cannabis is a widely used recreational drug obtained from the plant Cannabis sativa. The plant produces chemicals of which the most psychoactive agent is Δ9-tetrahydrocannabinol (THC). THC is metabolized in the body to THC-OH and then to the psychotropically inactive metabolite THC-COOH. The current method using GC-MS requires extensive samples preparation and long run times. We have developed a method to measure THC and its metabolites on the LC-MS/MS for forensic use.
Authors: R. Biss*, V. Biggart, J. Lake and A. Dawnay
Title: Providing POCT Services at the NHS Nightingale Hospital London
Teaser: The NHS Nightingale Hospital London was set-up by NHS England in response to the COVID-19 pandemic to provide critical care for up to 4000 patients, with Barts Health providing pathology and POCT services. With five days to be patient-ready, installation and verification of essential equipment was prioritised, alongside the development and implementation of training. Subsequent devices were then verified to support increasing requirements and improve service resilience. The team rose to the challenge, establishing a safe POCT service to meet the needs of the new hospital.
Authors: A. Lomax, E. Leaper, B. Omonojo, L. Truykov, M. Perry, A. Cooper*
Title: Clinical Audit of NICE guidelines for Coeliac Disease Testing Pathway: Room for Quality Improvement?
Coeliac Disease is the most common cause of malabsorption worldwide. It affects ~1% of the UK population and is grossly under-diagnosed. Symptoms are primarily due to malabsorption. The Blood Sciences laboratory recognised it was not following NICE [NG20] guidelines. The laboratory performed a clinical audit to target quality improvements within the testing pathway. Reducing unnecessary tests offers estimated laboratory savings of ~£53,000/annum without compromising patient care.
Authors: L. Cornes*
Title: Galactose-1-phosphate uridyltransferase quantitation by HPLC-MS/MS
Galactose-1-phosphate uridyltransferase (Gal-1-PUT or GALT) quantitation is important in the diagnosis of Classical Galactosaemia. An HPLC-MS/MS assay has been set up, optimised and validated in our lab at North Bristol NHS Trust. Benefits include no radioactivity, smaller sample volume, larger batch sizes and improved precision. A summary of the method, its performance characteristics, and comparison with the previous assay is presented, alongside sample requirements and clinical indications.
Authors: C. Flannery*, M. Binhussein, F. Bukhari, B. Alharthi, A. Algethami, A. Khojah, J.P. O’Neill, M. Sherlock, C.J. Thompson, D. Smith, A. Hill, A. Mc Erlean, A. Agha
Title: Primary Hyperparathyroidism The Role of Biochemistry and MIBI SPECT CT
Localisation studies using technetium-labelled sestamibi scintigraphy (MIBI) facilitates selective parathyroidectomy in patients with primary hyperparathyroidism. However, the reported sensitivity of this technique varies considerably between studies. This study aims to determine the sensitivity of sestamibi SPECT/CT in localising parathyroid adenomas in primary hyperparathyroidism and to investigate the effects of biochemical and clinical parameters on this sensitivity.
Authors: K. Hedgethorne*
Title: To comment or not to comment? A review of Duty Biochemist commenting practices for primary care
A common dilemma faced by Clinical Biochemistry teams when establishing commenting practices is whether primary care requestors would like us to prioritise the speed of reporting abnormal results or the addition of interpretive comments to aid diagnosis and further investigation. Reported here are the findings of a GP survey completed as part of an ongoing review of the commenting practices at Derriford Combined Laboratory, which aimed to find a consensus from our users regarding the processing of abnormal sodium, potassium, and calcium results. The results show that although speed of reporting is often preferred to the addition of interpretive comments, surveys such as these are useful to identify those results where primary care requestors would value input from the Duty Biochemist to aid patient management.
Authors: M. Irving*
Title: Identifying a Surreptitiously Induced Hypoglycaemia in a Paediatric Patient
The limitations in commercial insulin assays require external referral to laboratories for a full biochemical investigation. Here a case is discussed that aptly portrays the limitations associated with the Roche Elecys Insulin assay when insulin is administered surreptitiously, resulting in a hyperinsulinism picture without the raised insulin concentration.
Authors: P. Thomas*, M. Wallage, T. McDonald & A. Cooper
Title: Introduction of Faecal Immunochemical (FIT) Testing in the SWAG and Peninsula Cancer Alliance Area
FIT testing was introduced following a request by the Cancer Alliances using a unique delivery model. Work load increased to 1600 tests / month over 18 months. The most common indication being “aged over 50 with unexplained abdominal pain or weight loss”. Patient survey results were very positive. The positive predictive value of the test was 8% and the negative predictive value 99.8%. Significant savings from introduction of the service were predicated from early diagnosis and reduced referral.
Authors: P. Thomas*, M. Wallage & E. Roberts
Title: Effect of the COVID-19 Pandemic on Faecal Immunochemical (FIT) Testing in the SWAG Cancer Alliance
Initially during COVID workload halved before increasing three fold due to expanded criteria and catch up testing. This put considerable strain on the laboratory. Reduced endoscopy capacity was manged by risk stratification of 2WW patients by FIT testing. The age criteria were widened increasing numbers by 6%. The % positive FIT tests was the same in primary and secondary care suggesting similar risk. Expanded FIT testing is likely to remain in place and is predicted to reduce endoscopy numbers.
Authors: T. Mazaheri*, K. Shipman
Title: Impact of LDL formula and apo B quantification on UK PCSK9i and ESC/EAS treatment thresholds in patients being investigated for familial combined hyperlipidaemia
Martin equation provides a greater estimation of LDL-C values. This could result in demonstrating suboptimal treatment for patients whom LDL-C levels are underestimated using Friedewald calculation and potentially make more people (at most 12%) eligible for PCSK9i therapy according to UK thresholds. Control as indicated by ApoB was better than LDL-C therefore ApoB targets do the converse in this population with suspected FCH i.e. they would suggest less need for treatment escalation and demonstrate that more of the population is treated to target than the LDL-C suggests.
Authors: J. Jeffery*
Title: Measurement of serum c-peptide in patients following simultaneous pancreas and kidney (SPK) transplants
Type I diabetes patients with end stage renal failure are suitable candidates for simultaneous pancreas and kidney (SPK) transplantation. C-peptide is used to monitor graft function. This study aimed to look at biological variation and determine a reference interval for c-peptide in SPK patients. 347 c-peptide results from 26 patients were obtained from the laboratory database. The quoted reference interval for c-peptide for a healthy fasting individual with normal blood glucose, is 350-1800 pmol/L. For SPK patients a reference interval of 441 – 3068 pmol/L may be more appropriate.
South West & Wessex Local and Regional Audits
We are interested in the local audits that are performed around the region and are keen to encourage members to share their audits via a brief audit report template.
The aim of this is to share improvement ideas and help identify useful regional audit topics.
Royal United Hospitals NHS Foundation Trust
North Bristol NHS Trust
University Hospitals Bristol NHS Foundation Trust
Clinical biochemistry department information
CHELTENHAM & GLOUCESTER:
Gloucestershire Hospitals NHS Foundation Trust
Royal Devon and Exeter NHS Foundation Trust
North Devon Healthcare NHS Trust
Plymouth Hospitals NHS Trust
Poole Hospital NHS Foundation Trust
Salisbury NHS Foundation Trust
University Hospital Southampton NHS Foundation Trust
Torbay and South Devon NHS Foundation Trust
Royal Cornwall Hospitals NHS Trust