ACB News
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In this issue

The Editor is responsible for the final content. Views expressed are not necessarily those of the ACB.
Editor
Dr Jonathan Berg
Department of Clinical Biochemistry
City Hospital
Dudley Road
Birmingham B18 7QH
Tel: 07973-379050/0121-507-5353
Fax: 0121-507-5290
Email: jon@bergfamily.co.uk
Associate Editors
Mrs Sophie Barnes
Department of Clinical Biochemistry
12th Floor, Lab Block
Charing Cross Hospital
Fulham Palace Road
London W6 8RF
Email: sophie.barnes@imperial.nhs.uk
Mr Ian Hanning
Department of Clinical Biochemistry
Hull Royal Infirmary
Anlaby Road
Hull HU3 2JZ
Email: ian.hanning@hey.nhs.uk
Dr Derren Ready
Microbial Diseases
Eastman Dental Hospital
University College London Hospitals (UCLH)
256 Gray’s Inn Road
London WC1X 8LD
Email: derren.ready@phe.gov.uk
Mrs Louise Tilbrook
Department of Clinical Biochemistry
Broomfield Hospital
Chelmsford
Essex CM1 5ET
Email: louise.tilbrook@meht.nhs.uk
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ACB
News
Front cover: Dr Henk Goldschmidt with Dr Mike Thomas at Focus 2013.
Henk gave the ACB International Lecture
Issue 601 | May 2013 | ACB News

4 |
Congratulations to Phillip Monaghan from
Christie Hospital who was recently awarded the RCPath 2012 Specialty Research Medal in
Clinical Biochemistry for his paper on the comparison of serum cortisol measurement by different techniques in patients receiving the
11
β
-hydroxylase inhibitor metyrapone.
The College Research Medal is awarded on an annual basis and is open to Trainees in the profession. The intention is to promote the practice of research, which is a key component in the role of the Clinical Scientist.
See: Monaghan et al.
Comparison of serum cortisol measurement by immunoassay and liquid chromatography-tandem mass spectrometry in patients receiving the
11
β
-hydroxylase inhibitor metyrapone.
Ann Clin Biochem.
2011 Sep; 48: 441-6.
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We have recently been informed of the death of Dr John Cook at the age of 83. John was a
Consultant Biochemist at the Royal Sussex
County Hospital in Brighton and an active member of the ACB before his retirement.
We also sadly report the death of John
Morton, formerly Consultant Clinical Scientist at Poole and also Hazel Wilkinson who was formerly Head of Department in York.
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Dr Archie Prentice, President of RCPath, presents
Phillip with the Medal
ACB News | Issue 601 | May 2013

6 |
The Annals of Clinical Biochemistry
(www.acb.rsmjournals.com) is seeking a new
Associate Editor to join the current dynamic team. This exciting role provides an opportunity for an experienced member of the profession to become involved with, and gain experience of, scientific publishing and contribute to the success of the journal.
The Annals continues to evolve as one of the world’s leading journals in the field of clinical biochemistry. Now in its 50th volume, the journal is in good health, receiving approximately 300 submissions a year with an acceptance rate around 50% and an impact factor of 2.2.
All applicants will be considered although typically you will have an active publication record, and therefore a broad understanding of the publishing process, and be working at a fairly senior level in the profession.
To discuss this role, please contact the
Editor-in-Chief, Dr Edmund Lamb;
Tel: 01227 864112 or Email: elamb@nhs.net
We also require an active junior member of the profession to act as Co-ordinator of the
Journal Watch feature. The aim of Journal
Watch is to highlight to members of the profession important research being published in other speciality journals. It also gives junior members of the profession an opportunity to develop their writing skills and get involved in the Annals.
The Co-ordinator should have good organisational and communication skills and ideally be able to draw upon a wide network of colleagues across the country to act as contributors.
To discuss this role informally please contact the current co-ordinator,
Dr Sally Stock: Tel: 01233 651865 or
Email: sally.stock@nhs.net
Interested applicants for either role should send their CV with a covering letter to Edmund before 28th June 2013.
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ACB News | Issue 601 | May 2013

| 7
There is all sorts of scientific networking at
Focus and this is a vital part of our Annual
National Meeting. After the excellent
Professors’ Prize Award, Martyn Knapp from
Basingstoke grabbed hold of Professor Bill
Fraser, to check latest thinking on Vitamin D reference intervals.
Bill’s recommended Vitamin D ranges, soon to be published in the BMJ are:
Vitamin D Category
Severe deficiency
Deficient
Insufficient
Sufficient
Vitamin D Level
(nmol/L)
<15
15-30
31-50
>50
In Bill’s view there is no evidence to justify using a >75 nmol/L cut-off to define an
‘optimal’ vitamin D level. The best time to measure serum vitamin D in the United
Kingdom is in January-February when levels will be at their lowest. Bill is also concerned by those who recommend much higher levels of vitamin D. In terms of toxicity Bill pointed out that the high dose intermittent 300,000 and
500,000 unit bolus administration studies resulted in increased adverse effects in the treated group, versus placebo, and that the
Scandinavians have suggested longer term detrimental effects.
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MDA/2013/012
Diagnostic test strips and cassettes for urinalysis, pregnancy testing, menopause testing and opiates testing manufactured by: IND Diagnostics, Canada; Alere
International; Barrier Healthcare Ltd; E-Pharm Ltd.
Health Canada (the Canadian regulatory authority for medical devices) has suspended sale of these kits in Canada due to concerns about the manufacturer’s quality systems.
Users should report any incidents of false results involving these products to the MHRA and the supplier, to enable the
MHRA to monitor the situation in the UK.
Note: the MHRA will consider the need to issue further advice based upon information received from UK users.
Action by:
N Personnel treating patients based on results from test strips.
N Healthcare personnel using, supplying, supervising, quality assuring or distributing these test strips.
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If you have something you want to say about any aspect of clinical sciences then do contact the Editor.
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Issue 601 | May 2013 | ACB News

8 |
You are provided with brief details of a method to measure peptide-X. If the mean result of assaying a re-dissolved extract of peptide-X gives a result of 8 fmol/tube, calculate the concentration of peptide-X in the original sample, expressing the answer in appropriate units.
Immunoassay method for peptide-X:
Extract 1 mL serum with 5 mL of methanol.
Evaporate methanol to dryness under nitrogen and re-dissolve the residue in 250 µL of assay buffer.
Assay aliquots (100 µL) of this solution in duplicate.
Calibrate the assay against non-extracted standards to give a result in terms of femtomoles
(fmol) per assay tube.
Average expected recovery for peptide-X extraction is 80%.
FRCPath, Spring 2012
During the assay the peptide-X in 1 mL serum ends up in 0.25 mL assay buffer. 0.1 mL of this then used in the assay and was found to contain 8 fmol.
Therefore 0.25 mL dissolved residue (equivalent to 1 mL serum) contains
8 x 0.25 fmol of peptide-X
0.1
so 1L of serum contains 8 x 0.25 x 1,000 fmol of peptide-X
0.1
Multiply by 100 and divide by 80 to correct for the 80% yield of the extraction step:
Concentration = 8 x 0.25 x 1,000 x 100 = 25,000 fmol/L
0.1 x 80
Divide by 1,000 to convert to the more convenient units of pmol/L:
Concentration of peptide-X = 25,000
1,000
= 25 pmol/L
It is proposed to screen men for prostate cancer using single PSA measurement. Your urology colleagues locally wish to calculate the potential impact of the proposed screening programme on clinic numbers.
Assume that all patients with values >4 µg/L will be referred to the clinic. Using the information provided:
(1) How many patients will be referred?
(2) How many of these will have prostate cancer?
(3) What is the diagnostic efficiency of PSA >4 µg/L?
(4) What is the negative predictive value of PSA
≤
4 µg/L?
The best local estimates available are an eligible population to be screened of 20,000 men and a prevalence of prostate cancer of 3%. The diagnostic sensitivity for prostate cancer of a PSA >4 µg/L is quoted to be 67% and the specificity 97%.
FRCPath, Spring 2012
ACB News | Issue 601 | May 2013

| 9
Question 1. Your Department is merging with the department of another hospital 15 miles away. Both hospitals have busy Emergency and Intensive Care Departments. One hospital is to host the main Pathology Department covering both hospital sites; the other is to host a laboratory proving essential services to that hospital site only. You have been asked to lead on the development of the Essential
Services laboratory. Describe the repertoire of
Biochemistry tests you intend to provide and the reasons underlying your choice.
This question was popular, but was not well answered; disappointingly so in view of its topicality. There was little discussion about ascertaining actual requirements and consulting with clinicians; and little debate on constituents of profiles (U&E, LFT) or their appropriateness. Often a complete automated analyser shopping list was given with no discrimination of day versus night/weekend services. Many answers considered thyroid, cortisol and digoxin as essential urgent tests, despite 3-hour run times and lack of availability of these tests at many DGH sites outside normal working hours. Likewise, xanthochromia and drugs of abuse were included by some as essential. There was little consideration of POCT beyond arterial blood gas. There was a lack of discussion on QC, pathology catalogue, reference ranges, standardisation, inter-site assessment, or CPA implications; and minimal coverage of logistics, turnround times (NHS A&E 4 hour waits; 6 hour admission deadlines, urgent CCU transfer), finances, staff and IT issues.
Question 2. Discuss the optimisation of assays for enzyme activity, using examples as appropriate.
This was an unpopular question, being attempted by only 7 candidates; but was answered reasonably well by those who attempted it. Some candidates left out the theoretical basis of enzyme kinetics. The basics
(substrate and enzyme concentration, pH, temperature, buffers) were usually covered, but little on inhibitors/accelerators or matrix effects. Good answers supplied clinically relevant examples, where errors in assay results were due to problems with the features mentioned above.
Question 3. Write a critical discussion on the methods available for measurement of the different forms of bilirubin.
This question was generally well answered, with a full coverage of major method groups including laboratory, POCT and reflectance meters. Better candidates added advantages and disadvantages of methods and where certain specific techniques are most clinically relevant.
Question 4. Describe the process of reverse cholesterol transport, and the inherited and acquired factors that can affect this.
This was an unpopular question, only 11 candidates attempting it. Most gave good explanations of HDL/apoA-I metabolism, but often did not use diagrams to save time.
The section on factors affecting HDL was moderately well answered. Many missed physiological variation in HDL (e.g. exercise;
Issue 601 | May 2013 | ACB News

10 |
weight changes; menopause) and the significance of low HDL-C in metabolic syndrome and dysfunction of small dense particles for atherosclerosis. Tangier disease and LCAT deficiencies for low HDL were mentioned, and also CETP inhibition and high
HDL. Answers were often poor on drug effects in diabetes or on the effect of weight loss; and often missed fibrates or niacin as HDLaffecting drugs but thought (incorrectly) that statins did have a large effect.
Question 5. Discuss the biochemical assessment of infertility in a 30-year old woman, whose partner has normally-functioning spermatozoa.
Almost all candidates attempted this question, and it was generally well answered.
Candidates usually gave a full description of different types of ovarian function defects, but some omitted clinically relevant definitions of infertility. Usually PCOS was well described, but only a few mentioned the Rotterdam criteria or gave methods for assessing insulin resistance (e.g. GTT, HOMA or HbA1c).
Androgenaemia sorted the answers. Many candidates mentioned FAI but did not give its derivation and then gave FAI using a crude formula. Only good candidates described the use of androstenedione or DHEAS. Some missed adult onset CAH as a differential diagnosis. Many omitted methods of assessing ovarian function/reserve (FSH, anti-mullerian hormone, autoantibodies).
Question 6. Describe the pathogenesis and the biochemical and metabolic features of acute hyperglycaemia in diabetes. Outline its management, including the management of any complications that may arise.
Every candidate attempted this question.
The pathogenesis was usually well described but many candidates omitted a tabular or diagrammatic view of basic changes. Some failed to mention the key role of total body potassium deficiency, or many factors beyond glucose involved in diabetic ketoacidosis and hyperosmolar non-ketotic hyperglycaemia.
Clinical management plans, while given in general principle, were often very vague and lacking key biochemical or management plan details. No candidate mentioned a fluid balance chart, and only one mentioned monitoring urine output. Few mentioned regular assessment of U&E, glucose or POCT for ketone bodies; or critical values for insulin infusion, switch of fluid replacement strategies, the need for additional potassium supplementation, or critical rates of correction of glucose, potassium and sodium to avoid complications. Few adequately differentiated the role of additional fluid depletion in HONK as opposed to DKA.
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Frances Boa @BoaFrances
Remember the reTweet!
pic.twitter.com/GC1qC3L0FC
Retweeted by ACB President
View photo
17 Apr
ACB President @ACBPresident 17 Apr
#ACBFocus: Kayleigh has only gone and won the Trainees Quiz pic.twitter.com/PNR3J7Ap4S
View photo
ACB President @ACBPresident
Mike Thomas awarded the Presidentʼs Shield to Brian Smith at
19 Apr
#ACBFocus Closing Ceremony for his unstinting work supporting the
FCS
Expand
ACB President @ACBPresident 19 Apr
ACB Medal Award #ACBFocus won by Gina Sanki, Merthyr Tydfil.
Laura Ghandi, Leicester, runner up. All 6 talks worthy of the award.
Expand
ACB News | Issue 601 | May 2013

| 11
We are pleased to welcome you to the new
Immunology page of ACB News, which is being co-ordinated by Sarah Beck.
Immunology Clinical Scientists have been part of the ACB since 2006 when Mike Kerr and
Jo Sheldon did a great job of negotiating on behalf of the Immunologists to join forces with the ACB and we have not looked back since. As Immunologists we greatly value being part of the ACB.
We recognise that it is a tremendous organisation with a great future and we want to play our part in helping to shape that future. Within these pages we hope to keep
Immunology Clinical Scientists up to date with news and developments within Clinical
Immunology.
We will aim to keep you up to date with issues that concern us all such as:
N Training: Dates of training days, for STP,
FRCPath.
N Modernising Scientific Careers: new initiatives, Immunology Trainees,
Immunology centres.
N News from the Immunology Professional
Committee.
N Local and national meetings and conferences of interest to us.
N What is happening in Immunology UK-PIN,
BSI-CIAS, BSACI, Autoimmunity forums,
ESID.
N Information on Grants and Awards.
N Information on individual Immunologists around the country.
N Information on positions and opportunities for Immunology Clinical Scientists.
N
N
New assays in Immunology.
Important new papers in our field.
N
N
Feedback from conferences and meetings.
New initiatives from laboratories and clinics.
ACB News continued vibrancy is founded on participation of ACB Members, so do write in to Sarah with comments, information, news of events, training days, awards, conferences, new assays, anything you think will be of interest to our community of scientists.
We are updating our workforce data and at present we are currently made up of 10
Consultant Scientists, 35 Grade Bs, 19 Grade A
Trainees and 13 STPs in Clinical Immunology.
Four more STP places in Immunology have been advertised nationally for 2013 intake.
Recent achievements in the last eighteen months include five scientists having successfully passed FRCPath Part I, one having passed FRCPath part II exams, with another having achieved full Fellowship. Contact with all Clinical Scientists in Immunology can only help take our discipline forward.
• If anyone would like to submit an item for publication please contact Sarah Beck at sarah.beck1@nhs.net
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Issue 601 | May 2013 | ACB News

12 |
Two excellent speakers at the Spotlight meeting in March presented extensive independent data sets which put forward the case for the use of calculated globulin to identify patients with likely immune deficiencies. At present the classical use of calculated globulin is to identify patients with a potential lymphoid malignancy such as myeloma, based on concentration above the upper normal limit.
Primary immune deficiencies (PID), although rare, result in significant morbidity and mortality for patients who remain undiagnosed. The average diagnostic delay for
PID is 6.7 years.
A potential issue is that immune deficiencies have not been included in the differential diagnosis of the patient from clinical symptoms alone, thus relevant tests such as
Immunoglobulin enumeration may not be requested. A potential way the laboratory can pick up these patients is from the Calculated
Globulin (total protein-albumin). As the gamma globulin fraction equates to about a
3rd of the calculated globulin, significant immune deficiency should readily be detected.
Two audits were presented. The first was based on three years’ data from all laboratories in Wales, then the Hull Group presented cumulative data since 2007.
The two study groups both came to the same conclusion, that a calculated globulin cut-off of <17 g/L represents a significant number of patients with a clinically significant reduction in IgG. The Welsh group identified over 800 patients with <17 g/L, of which 89% had IgG
<6 g/L. The Hull group found a positive predictive value of 25% for IgG <4 g/L using this cut-off. Patients with low IgG included primary immune deficiency, secondary immune deficiency and haematological malignancies with immune poresis.
The two centres who now routinely use this cut-off have implemented different actions based on results of <17 g/L. In Wales the result is flagged to clinician as possible immune deficiency, should it fit with the clinical picture. In Hull additional immunoglobulin measurement has been included. In Hull 25% of the chronic variable immune deficiency
(CVID) patients on IvIg in their centre have come to the Clinical Immunologist as a result of this action.
Interestingly, recent pathology harmonisation strategies do not include the use of calculated globulins in test repertoire.
1-2
It was agreed from the data presented that from a viewpoint of screening for immunodeficiency alone, this test is vital even without taking into account the impact it has on exposing malignancy. Use of a calculated globulin of <17 g/L could have a significant impact on reducing the diagnostic delay in
PID.
1 Smellie WS; Association for Clinical
Biochemistry’s Clinical Practice Section.
Time to harmonise common laboratory test profiles BMJ . 2012 Mar 20; 344: e1169
2 Harmonisation of Reference Intervals,
Pathology Harmony Group, Clinical
Biochemistry Outcomes.
www.pathologyharmony.org.uk
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ACB News | Issue 601 | May 2013

| 13
The first topic of the day at the March Council meeting was ACB meetings. A very useful discussion was led by the National Meetings
Secretary, Ian Godber. Ian advised Council that the ACB will be hosting the EFLM/UEMS meeting in Liverpool from the 7th-11th
October 2014. The meeting will incorporate
Focus next year, which means that the
Association and FCS AGMs will be held earlier in the year during a one day national meeting to be held in either Manchester or
Birmingham. The current series of Spotlight meetings organised by Graham Groom has been very successful. However, members have expressed concern that some of these
Spotlight meetings have clashed with regional meetings in terms of dates and topics and that attendance in London is prohibitively expensive if accommodation is required. It has therefore been decided to reduce the number of Spotlight meetings to 4 a year. In future topics will be organised by the Clinical Practice
Section, Scientific Committee, Immunology and Microbiology Professional Committees.
Further joint meetings with the Royal College of Pathologists will also be explored. It was suggested that more could be done to coordinate meetings throughout the year,
National, Spotlight and Regional, with meeting organisers liaising with Ian on an annual basis and making better use of the meetings calendar maintained by the ACB
Office. In addition it was agreed that each region should review their terms of reference and rules & regulations to reduce the number of meetings they are required to hold each year to a minimum of one.
The second topic of the day was the annual review of the accounts. This is a requirement of the Directors of the Association before they are presented to members at the AGM.
William Marshall acknowledged the hard work of the office team, particularly Nic Law and
Cheryl Taylor in helping produce the accounts.
He reported a slight deficit and recommended a modest increase in subscriptions for 2014.
It was acknowledged that although this might be difficult for some members financially, it would not be prudent to leave unchanged for a further year. The accounts and the proposal to raise subscriptions were endorsed.
The final topic for discussion was Pathology
Modernisation. However there was very little information available on progress from members on either the East of England or the
East and West Midlands tender.
We upgraded Ruth to OBE last month – in fact she received the MBE.
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The 2013 Federation and Council AGMs took place on the final day of Focus with lunch provided in the meeting room
Issue 601 | May 2013 | ACB News

14 |
Glyn Davies, one of our founder members, looks back over the sixty years of the
ACB. Glyn retired in July 1988 and returned to live in North
Wales. In retirement he has been involved in voluntary work, including Citizen’s
Advice, Meals on Wheels, and secretary of a Community
Chest which distributes small grants in Clwyd. He is also part of a team which publishes a local monthly
Welsh language newspaper.
In a small country town there are all sorts of activities one can get involved in, and of course even holidays to look forward to!
Glyn Davies in his Ruthin garden in
Wales freestanding tables.
We had quite a number of children being investigated for possible coeliac disease.
Their five day faecal stool collections were stored under one of the tables and analysed for faecal fat. The whole process was carried out in the open laboratory as there were no fume cupboards. The smell certainly did not raise an appetite for lunch!
Blood samples were collected by heel prick for babies and by finger prick from older children. The needles used were essentially sewing needles, the top end embedded in a rubber bung and the sharp end immersed in alcohol in a small bottle, sharpened from time to time on a pumice stone.
Micro methods were employed for the biochemical tests, usually scaled down versions of the macro methods. There were few
As the ACB approaches its
Diamond Jubilee let me take you back to my early days in the NHS. I started as a
Research Assistant in the
Queen Elizabeth Hospital for
Children in Hackney Road,
London in July 1951. The
Pathology Department comprised rooms acquired from the hospital laundry situated in the basement.
It was approached from the main entrance, the ceiling of which was a mass of pipe work, leading from the boiler house, The main laboratory had a bench about twenty-five feet long, which handled Haematology and
Microbiology, and a slightly larger section for
Biochemistry, with two
ACB News | Issue 601 | May 2013

| 15 commercially available micro pipettes at that time so we used to make our own by heating and drawing out glass tubing and calibrating them with water by weighing, but it was rather hit and miss to get the right size!
Most assay methods were colorimetric, using a single cell Eel colorimeter. Calculations were carried out using a slide rule.
This was almost pre-endocrine testing and
24 hour urine collections were mainly for total
17-ketosteroid and 17-hydroxy steroids.
A major development in 1951 was the introduction of the flame photometer, enabling us to measure sodium and potassium rapidly. This replaced the existing chemical method which involved an overnight precipitation! The publication of a simple method for the electrophoresis of serum proteins by A V Flynn from University College used filter paper for the separation, a Perspex box with carbon electrodes and a power pack.
Once commercial scanners became available it was far less labour intensive to get a quantitative protein result.
Collecting blood samples from babies and children was challenging and for my work about 0.5 mL of serum was needed. In effect this meant collecting 0.8-1 mL of whole blood into a small glass tube. Children of all ages, accompanied by a parent, came into the laboratory to have their blood samples taken and the screaming, and occasional fainting of the adult guaranteed a noisy background.
In 1957 I moved to Liverpool. Just like now jobs were scarce, but I eventually got a post as
Senior Biochemist in the Pathology department at the Liverpool Radium Institute.
It sounded OK but actually I was the only one in the Biochemistry Department. It was a small specialised hospital dealing with cancer patients from Merseyside and North Wales.
Biochemistry was a single room situated on the ground floor of a converted coach house.
Rodney St in Liverpool was the equivalent of
Harley St, with large Victorian terraced houses occupied by many of the medical consultants in the city for their private practices. All the houses had a small garden at the rear and with what used to be in days gone by, stables for their horses. One of these houses, about
200 yards from the main hospital, had been taken over as the administrative offices for the hospital and the coach house had been converted into a laboratory, Histology upstairs and Biochemistry on the ground floor.
Demand for biochemical tests was low and there was a minimum of equipment, the piece de resistance being a Unicam SP 500
Issue 601 | May 2013 | ACB News

16 |
spectrophotometer. Some of my work involved preparing I132 labelled albumin for use in blood volume studies. In the late 1950s the
Schilling Test was being introduced as a diagnostic test for pernicious anaemia and malabsorption and we used to provide a service for various hospitals.
In 1963 I moved to Broadgreen, a busy 600 bed general hospital on the outskirts of
Liverpool, which also contained the
Merseyside and North Wales Regional Cardiac and Chest Unit. Pathology was housed in a number of small rooms in a building which was originally part of the hospital Engineering
Department. The Biochemistry section was a small room through which access was gained to Histology, so that there was a constant flow of people through it. Again, the equipment was basic; I can remember blood sugars were done by the Folin Wu colorimetric method with constant washing and drying of the tubes to keep up with the demand. As Biochemist in charge, I had a small room with a bench where some of the more specialised tests were carried out. As workload expanded, the set-up was totally inadequate, but there were high hopes because a new, interim laboratory was being built in the hospital grounds and was due to be finished within six months.
Needless to say the building was behind schedule but when we finally moved in there was certainly more bench space and a better working environment. Unfortunately, there was very little money for equipment. The main acquisition was a Hilger UV
Spectrophotometer. In the ensuing years we had to fight to try and equip the laboratory to a reasonable standard. In the 1960s we went through the era of semi-automation, using
Hook and Tucker auto diluters. This certainly speeded up the manual methods in use at the time; especially preparing dilutions for the flame photometric assay of sodium and potassium. Along with nearly everyone else we acquired a Technicon single channel autoanalyser in 1968. One of the special benefits was a week’s training course at
Technicon in Chertsey, with accommodation provided at the Rembrandt Hotel in
Knightsbridge! Ultimately automation increased to a 10 channel Technicon SMA analyser and 5 channel electrolyte system.
With the introduction of RIA it soon became apparent that we needed more space and this resulted in several extensions. This was supposed to be an interim laboratory but we were still in it when I retired in 1988. Within a few years the Pathology service was centralised to the Royal Liverpool Hospital and our laboratory demolished. Looking back at my entire career I never worked in what could be called a custom-built laboratory building.
I would probably describe myself as a grass roots member of the ACB. Apart from being a member of the North West Committee for a time, I did not hold office of note in the organisation. Over the years I attended dozens of meetings in all parts of the country, including the annual national meetings.
The one we organised in Liverpool in July 1982 was probably one of the last of the old type held in Uuniversity Halls of Residence before moving on to the Focus-style conferences.
Associate Editor’s comment: The wheel turns full circle, with Focus 2013 returning to
University accommodation in York).
When I worked in London I attended the early ACB meetings and was certainly present at the inaugural meeting in 1953, held in a lecture theatre in the Hammersmith Hospital.
As a junior Biochemist I sat in the back row, while in the front row were some of the big names of the time such as E J King, Professor
Maclagan and Professor Wootton. Early meetings were held on Saturday afternoons, with the occasional evening meeting held at various hospitals in London. After moving to
Liverpool I attended meetings of the North
West region, which at that time extended east over the Pennines, to York, Leeds and
Scarborough. Meetings were held on Saturday afternoons at various hospitals and could involve a lot of travelling. Finding hospitals was a problem and we often aimed for a tall chimney, which was usually the hospital boiler
ACB News | Issue 601 | May 2013

| 17 house. This could prove misleading at times amongst the Lancashire mills!
The scientific part of the meeting usually consisted of member’s papers, often presenting new methods which had been developed, with the occasional guest speaker.
After tea there would be a professional meeting when various topics would be discussed, with varying degrees of passion.
Salary scales, on call duties, the role of laboratory staff, these all came up for discussion on a regular basis.
My travelling companion to most of these meetings was Joe Ireland from Alder Hey
Hospital, about a mile from Broadgreen. I used to pop over quite often for a chat. It was rumoured that he had a car but it never left his garage!
In the early days of automation Joe built his own variant of a Technicon analyser, designed for micro samples. It looked like a Heath
Robinson invention but worked when he was around to “nurse” it! Joe was the ACB
Business Manager and spent a lot of his own time preparing the News Letter which was originally a typewritten duplicated publication.
Yes, in those early days the ACB was a fairly simple organisation and I don’t cease to wonder at the fact that in the current
Handbook there are 16 pages devoted to
Officials, Committees etc. That’s how we have progressed and developed over
60 years!
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Issue 601 | May 2013 | ACB News

18 |
Acute kidney injury (AKI) is a common, life threatening condition associated with poor outcomes. The RCPE UK Consensus Conference focused on three main themes in the management of AKI: the role of fluid therapy, e-alerts and biomarkers. After two days of lectures and several lively discussions, the panel released their consensus statement
(available in full from www.rcpe.ac.uk/pressreleases/2012/kidney-care-statement.php).
Key points are highlighted below.
Marion Kerr set the scene, highlighting the large financial burden of AKI (and its consequences) on the NHS – estimated to be greater than for prostate, bowel and lung cancer combined. AKI is not well managed and
20-30% of cases are potentially avoidable; as well as saving up to 12,000 lives per year, optimal care could produce substantial financial savings.
In addressing the first key question, several speakers discussed the difficulties in assessing volume status, and the relative merits of different IV solutions. Fluid therapy is often administered by junior doctors, and the need for greater emphasis on fluid administration in undergraduate and postgraduate education was a common argument.
N Summary: Fluid therapy should be guided
N by repeated evaluation of volume status.
A balanced salt solution should be the usual fluid for volume replacement.
Patients with AKI receiving intravenous fluid therapy require regular monitoring of creatinine and electrolytes (including chloride and bicarbonate).
Electronic alerts (e-alerts) aim to systematically detect and flag AKI to prevent delayed recognition and treatment (a criticism of AKI care in the 2009 NCEPOD report). Dr Nicholas
Selby and Dr Mark Devonald described sophisticated e-alert systems in operation in
Derby and Nottingham. Several posters
(including one which I presented) described simple e-alerts that may not be as comprehensive, but could easily be implemented by laboratories with very little effort.
N Summary: Identification of AKI in both primary and secondary care should be facilitated through introduction of e-alert systems.
N At present, systems are being developed ad hoc. A national group should be established to develop agreed standards for e-alert systems recognising the need for some system-dependent local flexibility.
There is desire for biomarkers that directly reflect renal injury, rather than relying on subsequent functional changes such as increases in creatinine. Dr Edmund Lamb provided a laboratory perspective and highlighted that pre-analytical and analytical characteristics of biomarkers should be well established before embarking on expensive trials.
N Summary: It is premature to recommend the use of novel biomarkers of AKI in current clinical practice.
ACB News | Issue 601 | May 2013

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N Further research should evaluate the role of novel biomarkers in multicentre clinical intervention studies throughout the patient pathway. Future studies require better integration between laboratory scientists and clinicians.
The second day of the conference included talks on various aspects of AKI while the consensus panel prepared their statement.
Michael Wise, an AKI survivor, provided a moving account of his experiences of AKI, from his acute illness, through intensive care, dialysis, kidney transplantation and gradual recovery to today. A summary of his presentation can be viewed at londonaki.net
and is highly recommended.
In conclusion, this was a fascinating meeting that I felt very lucky to be able to attend.
It was clear from discussions that the laboratory could play a key role in improving outcomes in AKI, not just in the future with the introduction of novel biomarkers, but with simple systems of e-alerts that laboratories can implement today.
I
Friday 14th June 2013 10.30-17.00
To apply: Send a CV and short cover letter to Victoria Murphy at email: vmurphy@senseaboutscience.org, by Friday 31st May 2013. Please state in your application that you are a
Member of the ACB which, as a sponsor, has five guaranteed places.
Issue 601 | May 2013 | ACB News

20 |
In late snowy January, The Royal College of
Pathologists provided an excellent medical
Virology Training Day for over fifty delegates from UK hospitals. The teaching began with the Keynote Lecture titled ‘An update on
Clinical Virology’ and was provided by Dr Ken
Mutton from the Central Manchester Trust
Foundation. The session covered the national concerns such as current increases in measles, mumps and rubella cases to the international challenge of noval human coronavirus. The session finished with an interesting update on the future of virology training.
The second lecture by Professor Paul Kellem from the Wellcome Trust Sanger Institute was titled ‘Pathogen and host whole genome sequencing’. The session was a fascinating journey describing the application of next generation sequencing for both the host and the viral pathogen. The data can be used in epidemiology providing directed public health interventions in pandemics such as influenza
A H1N1 and the future potential of better understanding disease potential of a virus depending on the hosts genetics.
Small groups then had the opportunity to attend three interactive workshops. Dr Chris
Smith led a discussion of clinical cases. One of the cases described a needlestick injury in a parent of an intravenous drug user with hepatitis and led to a useful discussion on patient confidentially. Professor Dick Madeley shared his knowledge and diagnostic experience of virus culture, electron microscopy and immunofluorescence.
The group discussed the value of these
‘out of favour’ techniques and compared them with molecular and serological diagnostics, highlighting the importance of these techniques for the detection of novel viral and bio-terrorism agents. The third session was provided by Dr Erasmus Smit who demystified antiviral susceptibility. He discussed generation of viral quasispecies in RNA viruses due to high mutation rates, antiviral therapy pressure and host immune response. Also very interesting was his explanation of a genetic archive of drug resistant mutants that reduce the opportunity of reusing antiviral agents, even if the dominant clone is susceptible.
The interactive sessions are such that presentation, diagnosis and treatment of viral diseases were considered. Special attention was given to subject areas that may not be observed in normal practice, for example, electron microscopic identification of viruses.
The teaching is aimed at Medical Microbiology
Specialist Registrars, but as a Clinical Scientist working towards FRCPath examinations,
I found it particularly useful and may be of interest to those requiring an update on
Clinical Virology.
I
ACB News | Issue 601 | May 2013

| 21
Prize Visit to Editor’s Apiary
After running out of honey as a crossword prize we are now offering a visit to an apiary as the prize for winning entries to the ACB News crossword. This will take place on Sunday 7th July and will take the form of a garden party along with a guided tour of some of the nine hives which are located in gardens around Olton Mere in Solihull. If you would like to come then simply ‘wing’ your completed crossword on an email to the Editor. The prize includes both you and a partner/friend.
Mandy and Fran are both trying to win the Apiary visit prize. Mandy has already won three pots of honey and wants to meet the bees that produced it!
3 Brit - free without penalty (4)
4 Injured playmates not yet for possible transfusion (6)
5 Chemical link 014? (6,4)
6 Regulate commercial fair (6)
7 Bird splashes about tail first (7)
12 Completely destroy uninhabitable structure without first breaking up (10)
13 No helpful advice turned up describing climbing implement (5)
16 Contemplate treatment of
28 with spirit dressing (8)
18 Gas about domain name without end (7)
20 Cross-examine doctor, screen out self-evident statements (6)
21 Agrees to allocations (6)
25 Stone jar (4)
26 Secure state (4)
Across
7 Customarily retains opening made by surgeon (5)
8 Cold holds dispersed oil in stable suspension (7)
9 Seventeen elements make up the arrears (4,6)
10 Turn in bad data transmission rate (4)
11 Base gangster meets Hindu goddess (6)
13 Post bearing thanks for shared composite organ (8)
14 Match secured by left-winger (4)
15 Result of condensation in
Chesterfield lab (5)
17 Type of examination of the mouth (4)
19 Course has zero information re an infectious agent (8)
22 Data transmitters could be decommissioned but decision lacking (6)
23 Execute while away (4)
24 Learned in a fashion about a neurotransmitter (10)
27 Difficult competition (not open) related to division (7)
28 Fungal infection resulting from asthenia has gone (5)
Down
1 Single fish (4)
2 A situation below standard for cadger (8)
Issue 601 | May 2013 | ACB News

22 |
Training Posts: When applying for such posts you should ensure that appropriate supervision and training support will be available to enable you to proceed towards HPC registration and the FRCPath examinations. For advice, contact your Regional Tutor.
The editor reserves the right to amend or reject advertisements deemed unacceptable to the Association.
Advertising rates are available on request.
Winners from Last Month:
: AN Other, AN Other, AN OtherAN
Other, AN Other
ACB News | Issue 601 | May 2013