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ACBNews
The Association for Clinical Biochemistry & Laboratory Medicine | Issue 664 | April 2020
In this issue
Coronavirus/
COVID-19
Update
Focus 2020
postponed
Women in
Science
UNIVANTS of
Healthcare
Excellence
Awards
Analyte
Monographs –
Past, Present
and Future
Farewell to
Mick and Julian
About ACB News
The Editor is responsible for the final
content; advertisers are responsible for the
content of adverts. Views expressed are not
necessarily those of the ACB.
Lead Editor
ACBNews
The bi-monthly magazine for clinical science
Mr Ian Hanning
Retired
Formerly Department of Clinical Chemistry
Issue 664 • April 2020
Hull Royal Infirmary
Email: editor.acbnews@acb.org.uk
Associate Editors Message from the President page 4
Mrs Sophie Barnes
Department of Clinical Biochemistry
Charing Cross Hospital Coronavirus/COVID-19 page 6
Email: sophiebarnes@nhs.net
Dr Gina Frederick
Pathology Laboratory General News page 11
Royal Derby Hospital
Email: gina.frederick1@nhs.net
Mrs Nicola Merrett Microbiology News page 18
Department of Laboratory Medicine
University Hospital Southampton NHS
Foundation Trust
Email: nicola.merrett@uhs.nhs.uk
Deacon’s Challenge Revisited page 20
Dr Christopher Pitt
Department of Biochemistry
NHS Ayrshire & Arran
Meeting Reports page 22
Email: christopher.pitt@aapct.scot.nhs.uk
Dr Derren Ready ACB News Crossword page 32
National Infection Service
Public Health England
Email: derren.ready@phe.gov.uk
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ISSN 1461 0337
© Association for Clinical Biochemistry & Front cover: Laboratory worker (Source: ‘The NIHR and the
Laboratory Medicine 2020 ACB membership’ article, ACB News, August 2018)
Issue 664 | April 2020 | ACB News
4 | Message from the President
Message from the ACB President
As you are aware the Government has ◆ Jane Pritchard – CEO – jane@acb.org.uk
advised everyone not to leave home and +44(0)7785 313053
unless absolutely necessary in order to ◆ Mike Lester – Membership
slow the progress of the COVID-19 Communications, Committee Meetings,
pandemic and allow the NHS time to AGM – mike@acb.org.uk
build its capacity. This has had a dramatic and +44(0)1732 369733
effect on ACB Members and the running
of the ACB. ◆ Cheryl Taylor – Finance, Expenses,
As already announced, we have taken Events – cheryl@acb.org.uk and
the difficult decision to postpone Focus +44(0)7707 731765
2020 scheduled for 13-15th May 2020 ◆ Dragana Landup-Horgan –
to a new date of 10th-12th March 2021. LabTests Online-UK, ACB Annals –
This will allow us to transfer all existing labtestsonlineuk@acb.org.uk;
bookings to the new date or make refunds annals@acb.org.uk and
if necessary. Delegates and speakers +44(0)7964 590778
should by now have been contacted by
◆ Christina Petzny – Remote meeting
CPI, our conference organiser, to make
support – christina.petzny@acb.org.uk
the necessary arrangements and to
and +44(0)7813 985606
offer advice regarding travel and
accommodation bookings. All shortlisted ◆ Eleanor Dalzell – Remote meeting
entries for awards and prizes and support – eleanor@acb.org.uk and
accepted posters are carried over to the +44(0)7387 564562
new date. The Executive, Council, the ACB team and
Committee Chairs are postponing I will ensure over the coming weeks that
meetings up to the end of May 2020 or you continue to receive a first class
running them remotely by telephone or membership service and are kept
online. The ACB Office team is supporting informed of developments. We continue
the facilitation of this. to drive forward on major projects such as
We will continue to monitor the the new website and membership system
situation and will determine the status of and are on track to have this work
meetings between June and September in completed towards the end of the summer.
due course. We expect to make a decision We will stay in touch through the
regarding these meetings by the end of ACB News, social media and Mailbase
May 2020. We are also making alternative and would welcome hearing from you,
arrangements for the ACB and FCS AGMs. whether it is about the excellent service
The ACB Office has closed and the land you are providing, your experience of
line number is not operational so we would self-isolation or to alert fellow members
ask that you use email as much as possible of publications and commentary around
to access services for the time being. COVID-19. Finally, I am sure you will join
To make communications easier we have me in recognising the remarkable efforts
listed below direct email addresses and of our members who are such a critical
telephone numbers for the ACB team part of this huge effort to keep the nation
and areas of responsibility over the well.
coming months:
Professor Neil Anderson ■
Issue 664 | April 2020 | ACB News
6 | Coronavirus/COVID-19 COVID-19: Royal College of Pathologists Resources Hub and Network Service Dr Rachael Liebmann, Vice President for Communications & Dr David Jenkins, Chair of the Medical Microbiology and Virology Specialty Advisory Committee The College has launched a resources hub NHS Networks newsletter. You must on their website: https://www.rcpath.org/ check the box stating that you have profession/coronavirus-resource-hub.html read and agree to abide by the terms with the latest College information and and conditions of NHS Networks guidance related to COVID-19, as well as membership. relevant links to Public Health England and 3. Click on the sign up button and an the Department of Health and Social Care. email will then be sent to you, They have also hosted a forum group on containing a link back to the networks NHS Networks to help members stay site. When you get the email, click on connected in matters related to COVID-19. the link. If you haven’t received an The members-only group has three email, please check your junk/spam forums, through which you can share and folder. discuss information related to COVID-19. 4. Clicking on the link takes you to a If you would like to join, please visit page with your email filled in, https://www.networks.nhs.uk/nhs- and two password boxes where you networks/rcpath-covid-19 and click ‘Apply set your own password. Fill in your to join’. The College will verify your password and confirm it, and click the membership of the College and grant you ‘Set my password’ button. access to the forums within 24 hours. 5. Your account is now activated. Please note: you will need to be logged Click the link on the next page to log into an NHS Networks account to view and in with your email and password. join the group. If you do not have an 6. Visit the RCPath forum page and click account on NHS Networks, please follow ‘Apply to join’. these steps: 1. Go to: https://www.networks.nhs.uk/ NHS Networks offers further guidance on register how to register and join networks on its 2. Fill in the personal details fields – name website: https://www.networks.nhs.uk/ and email (please register using your help-1 RCPath website login email address as this will make it easier to verify your If you have any queries or questions, College membership) – and decide you can email the College at: whether you would like to receive the covid-19@rcpath.org ■ Issue 664 | April 2020 | ACB News
Coronavirus/COVID-19 | 7
Statement from UK Chief
Allied Health Professions
Officers and the Health and
Care Professions Council
The following statement regarding The HCPC will be contacting former
returnees to the HCPC Register to registrants over the coming weeks to
respond to the coronavirus demand explain this process. There will also be more
was released on 19th March 2020: detailed information about HCPC’s policy,
guidance to those who choose to return,
The coronavirus has united the nation in
and FAQs at www.hcpc-uk.org/covid-19.
our efforts to delay the spread of the virus
Being placed on this temporary Register
and support vulnerable members of our
does not assume any obligation to offer
communities.
support as we appreciate not everyone will
Health and social care services will be
be able to do so for a variety of reasons.
under increasing pressure as the number of
To everyone who does offer to help in
cases increase.
this time of crisis we would like to express
We are proud that many Allied Health
our sincere appreciation. ■
Professionals (AHPs) who have recently left
the HCPC Register have expressed a Suzanne Rastrick, Chief Allied Health
willingness to come back and help during Professions Officer, NHS England; Jennifer
the national emergency. We thank you for Keane, Chief Allied Health Professions
this and are keen to ensure your temporary Officer, Department of Health Northern
return is as smooth as possible. Ireland; Carolyn MacDonald, Chief Allied
For this reason, we have agreed to Health Professions Officer, Scottish
automatically re-register all AHPs who have Government; Ruth Crowder, Chief
voluntarily left the HCPC Register over the Therapies (Allied Health Professions)
last three years onto a temporary COVID-19 Adviser, Welsh Government; John Barwick,
Register once the government has passed Chief Executive and Registrar, Health and
its emergency legislation. Care Professions Council ■
Issue 664 | April 2020 | ACB News
8 | Coronavirus/COVID-19
Coronavirus and COVID-19:
An Update for ACB Members
Dr David Gaze, Lecturer in Clinical Biochemistry, University of
Westminster; and Dr Adele McCormick, Senior Lecturer in Molecular
Biology, University of Westminster, on behalf of the ACB Scientific
Committee
In recent weeks we have witnessed an and on different surface materials3; with
unprecedented global outbreak of a novel the virus detectable in aerosols for 3 hours
coronavirus causing severe acute and longer on surfaces such as copper (4 h)
respiratory syndrome (SARS). This is the cardboard (24 h) and on plastic and
7th coronavirus known to infect humans. stainless steel up to 48 hrs and 72 hours.
The virus named SARS-CoV-2 (previously SARS-CoV-2 can be detected in saliva,
HCoV-19) causes the disease COVID-19. urine and the gastrointestinal tract so
With the outbreak occurring in Wuhan, other modes of transmission are possible
China in late 2019, it has spread globally and need to be investigated.
and has been designated as a pandemic
Clinical presentation
viral infection by the World Health
Organisation (WHO). At the time of The clinical presentation and severity of
writing (18/3/20, 14:00) the live situation symptoms is case dependent. The clinical
dashboard of the WHO reports 194,029 characteristics in the Chinese population
cases and 7,873 deaths in 164 countries, have been documented from 1099 cases4.
areas or territories; with 1,954 confirmed The virus has infected more males than
cases and 60 deaths in the United females. The common symptoms are fever
Kingdom. SARS-CoV-2 likely originated by and a persistent non-productive cough,
natural selection in an animal source, with although many present without fever.
SARS-CoV-2 demonstrating similar genetics The vast majority (>85%) do not
(86% based upon WGS analysis) to bat demonstrate radiographic abnormalities
SARS-CoV like coronaviruses. There is in the lung but ground-glass opacity
however, no evidence of direct bat to and bilateral shadowing has been
human transmission1 suggesting an demonstrated on computer tomography
intermediate host may be involved. in severe cases4.
This follows similar zoonotic infection Laboratory findings
routes of other coronaviruses into the
From the Chinese population, lympho-
human population.
cytopenia was observed in 83% of cases,
Incubation and transmission with thrombocytopenia in 36% and
The incubation period has been suggested leukopenia in 34%. Biochemically, patients
to be 5 days2. Transmission is dependent demonstrated high concentrations of CRP,
on variable individual infectiousness, less common elevations of AST, ALT, CK
population density and spatial distance. and D-dimer. Furthermore, in a systematic
The virus can be transmitted in respiratory analysis of 11 PUBMED articles, Giuseppi
aerosols and by direct surface contact. Lippi and Mario Plebani have documented
Recent data suggests the stability and laboratory abnormalities reported in cases
decay of the virus is variable in aerosols of COVID-195. In addition to the findings
Issue 664 | April 2020 | ACB News
Coronavirus/COVID-19 | 9
above from the Chinese cohort, patients available, please see the ACB Twitter feed
may also present with decreased albumin, (@TheACBNews), shared experience on
or increases in LDH, total bilirubin, the ACB Mailbase and the ACB website,
creatinine, procalcitonin and also which will help with the ever-changing
cardiac troponin and natriuretic peptides. information.
The latter occurs in the more severe
Resources
presentations of COVID-19 and is reflective
of a cardio-inflammatory response and has A number of national and international
been reported in fulminant myocarditis, organisations have dedicated online
successfully treated with glucocorticoid resources for healthcare professionals
and human Ig6. Cardiac biomarkers could relating to SARS-CoV-2 and COVID-19:
be utilised as a repeated metric of a ◆ Public Health England: www.gov.uk/
worsening clinical scenario or an government/organisations/public-
improving response due to health-england
Cardioprotective intervention. ◆ Royal College of Pathologists:
www.rcpath.org/profession/coronavirus
Developing diagnostic tests for -resource-hub.html
COVID-19 infection caused by ◆ World Health Organisation:
SARS-CoV-2 www.who.int/emergencies/diseases/
There has been a rapid response of the IVD novel-coronavirus-2019
industry to develop assays for SARS-CoV-2. ◆ New England Journal of Medicine:
Luckily these have migrated into the UK www.nejm.org/coronavirus
laboratories at a much faster rate (50,442 ◆ CDC: www.cdc.gov/coronavirus/2019-
tests on 18/3/20) than in the US due to nCoV/index.html
stringent Food and Drug Administration
regulations. Real-time RT-PCR is used for
References
SARS-CoV-2 RNA viral detection in upper 1. Kristian G. Andersen, Andrew Rambaut,
W. Ian Lipkin, Edward C. Holmes, Robert F.
and lower respiratory specimens and Garry. The proximal origin of SARS-CoV-2.
serological analysis of anti-COVID-19 Nature Medicine, 2020; DOI: 10.1038/s41591-
antibodies by automated immunoassays 020-0820-9.
can be used for disease surveillance. 2. Li Q, Guan X, Wu P, et al. Early Transmission
The preferred testing is by molecular Dynamics in Wuhan, China, of Novel
Coronavirus–Infected Pneumonia. N Engl J
diagnosis of COVID-19 by real-time RT-PCR, Med 2020; Jan 29. doi:10.1056/NEJMoa2001316.
such as RdRp gene assay, which amplifies a 3. Van Doremalen N, Bushmaker T, Morris DH,
conserved region of the RNA dependent et al. Aerosol and Surface Stability of SARS-
RNA polymerase gene that is specific to CoV-2 as Compared with SARS-CoV-1. N Engl J
SARS-CoV-2, which has been used for Med. 2020 Mar 17. doi: 10.1056/NEJMc2004973.
4. Guan WJ, Hu Y, Liang WH, et al. Clinical
confirmation of this disease by PHE Characteristics of Coronavirus Disease 2019 in
laboratories. In addition, oligonucleotide China. N Engl J Med. 2020 Feb 28. doi: 10.1056/
primers and probes selected from regions NEJMoa2002032.
of the virus nucleocapsid (N) gene are also 5. Lippi G, Plebani M. Laboratory abnormalities
included in the panel. In confirmed in patients with COVID-2019 infection. Clin
Chem Lab Med 2020 March; DOI: 10.1515/
COVID-19 cases, the laboratory testing cclm-2020-0198.
should be repeated to demonstrate viral 6. Hu H, Ma, F, Wei X, Fang Y. Coronavirus
clearance prior to healthcare discharge. fulminant myocarditis saved with gluco-
You will appreciate this is a dynamic corticoid and human immunoglobulin. Eur
situation changing both globally and Heart J, ehaa190, March 20;
doi:10.1093/eurheartj/ ehaa190 ■
nationally. As more information becomes
Issue 664 | April 2020 | ACB News
10 | Coronavirus/COVID-19
New COVID-19 test to
differentiate between lethal
and non-lethal infections
therefore developed an extended Viral
This is a copy of a Press Respiratory Infection Array that tests
Release from Randox simultaneously for COVID-19 and nine
other viruses. This will eliminate the
Laboratories which need for multiple back-and-forth tests
Members may find before the root cause of symptoms is
found, and empower clinicians to make
interesting. Please see fast and informed decisions.”
www.randox.com for the The test is available on the Randox
current situation. Evidence Investigator with a turnaround
time of 5 hours.
A ground-breaking test for the Benefits of the new Randox
potentially fatal COVID-19 strain of
coronavirus is available at global health COVID-19 test
diagnostics company Randox Laboratories. ◆ Quick Turnaround Times (5 hours
The test, developed on Randox’s on Evidence Investigator)
patented Biochip Technology, is as an ◆ Multiplex array differentiates
enhanced multiplex array which includes between mild and serious infection
tests for COVID-19 and nine other ◆ Automated and semi-automated
respiratory viruses which can display the options available
same symptoms.
◆ Medium to high throughput
The new enhanced Biochip therefore
(54 samples in 5 hours)
allows clinicians to quickly and efficiently
differentiate between potentially lethal The Biochip tests simultaneously,
and non-lethal infections. from one patient sample, for the
Dr Peter FitzGerald, Managing Director viruses below:
of Randox Laboratories, commented: ◆ COVID-19 (previously named
“Current technologies for the diagnosis 2019-nCoV)
of coronavirus are designed simply to ◆ Coronavirus 229E/NL63
detect the presence or lack of COVID-19,
and therefore neglect to differentiate For more information email:
between this strain and other marketing@randox.com or visit:
respiratory infections. We have www.randox.com ■
Issue 664 | April 2020 | ACB NewsGeneral News | 11
Reduction in planned HCPC registration
fee increase
The ACB are pleased to inform the ways of working as well as continuing
membership that the Health & Care to manage our costs to minimise the
Professions Council (HCPC) has decided to burden on our registrants.
reduce the planned increase in registration This rise will still allow us to invest in
fees (https://www.hcpc-uk.org/news-and- smarter technology to help us support
events/news/2020/update-on-our-new- registrants and the public we protect.
fee-proposals/). It will also allow us to prepare for the
The ACB sent HCPC a letter of Government reform of regulation,
opinion advising against the increase resulting in an improved approach to
(http:acb.org.uk/docs/default-source/ fitness to practise and greater work
uk-organisations/acb-response-to- with stakeholders on how to prevent
hcpc-consultation-on-fees-dec-2018). harm before it takes place.” –
The planned increase was £16 but has statement from HCPC announcement
now been reduced to £8.12 and HCPC
HCPC works to protect the public by
will be retaining the 50% discount for
regulating 15 health and care professions,
graduate applications received for the
including those in the healthcare
first two professional years of registration.
laboratory profession. Healthcare
“…many professionals’ salaries have laboratory professionals must be
not increased substantially for some registered with HCPC to practice under
time, so as a result we are finding new their professional title. ■
Sudoku
This month’s puzzle
Solution for February
Issue 664 | April 2020 | ACB News12 | General News
Women in Science celebrated with ACB
Members interviewed by Science Council
Alexandra Yates, ACB Member and scientists and other academics should
ACB Director of Scientific Affairs, just be the professional face and then
and Dr Elaine Cloutman-Green, ACB we don’t get people bringing their
Member and ACB Microbiology whole selves to the role and until
Professional Committee member, took part that happens we won’t make the
in a podcast series by Science Council in most of what they’re capable of.” –
celebration of International Day of Elaine Cloutman-Green
Women and Girls in Science on 11th
Both Alexandra and Elaine saw the call for
February 2020 and International Women’s
interviewees by the Science Council on
Day on 8th March 2020.
Twitter and cite it as a great place to link
Their interviews cover a range of topics
up with like-minded people and stay on
from what they love about their work,
top of updates to help with Continuing
the importance of diversity, advice for girls
Professional Development.
wanting to become scientists and the
challenges of not having role models early ◆ Listen to Alexandra’s interview:
on in their career. soundcloud.com/user-
801113867/alexandra-yates
“I love science because you’re always
Follow Alexandra Yates on Twitter:
learning…I am lucky that in my career
twitter.com/alex79yates
it is healthcare related so you feel like
you’re making a direct difference to ◆ Listen to Elaine’s interview:
patients.” – Alexandra Yates soundcloud.com/user-801113867/dr-
elaine-cloutman-green
“I don’t want to be ‘the scientist’,
Follow Elaine Cloutman-Green on
I want to be Elaine and Elaine comes
Twitter: twitter.com/girlymicro
with passion and expertise and joy
with what she is doing…I feel ◆ Listen to the full podcast series:
sometimes in STEM we think that soundcloud.com/user-801113867 ■
ACB Retired Meeting Postponed
We regret to inform you that due to the available through the ACB Office. We ask
COVID-19 outbreak we have taken the for all those with travel expenses already
decision to postpone the ACB Meeting for booked to make every effort to seek
Retired Members. This was due to take refunds or ticket deferments from their
place on 27th April 2020. We will be travel company before contacting the ACB.
sending further details in due course We apologise for any inconvenience this
regarding alternative arrangements. has caused and hope that you agree that
For those who have registered, this is the most sensible course of action in
reimbursement of delegate fees is the current circumstances. ■
Issue 664 | April 2020 | ACB News14 | General News
Lab Tests Online-UK Editors needed
Lab Tests Online-UK invites interested as a trusted website.
Healthcare Scientists, doctors and recently Editing pages is interesting and plays
retired Fellows to join the voluntary team an important role in helping patients
of editors for www.labtestsonline.org.uk understand the tests we perform.
Lab Tests Online-UK (LTO-UK) is CPD points can be claimed as
written by practising laboratory self-accredited points under the RCPath
professionals to help the public CPD scheme.
understand the many clinical laboratory Your role as an editor would involve the
tests that are used in diagnosis, review of new and existing pages on the
monitoring and treatment of disease. website about specific tests and conditions
It is supported by the Association for and the contribution to the articles for
Clinical Biochemistry and Laboratory news feed. All specialties are welcomed
Medicine (ACB), the Institute of Biomedical to apply and we have a particular shortage
Science (IBMS) and The Royal College of of editors with haematology, genetics
Pathologists, and is entirely dependent and microbiology/virology expertise.
on the efforts of unpaid volunteers. It is Please contact:
non-commercial and is consistently rated labtestsonlineuk@acb.org.uk for more
highly by patient associations and GPs information. ■
Condolences
It is with regret that we must inform you of the sad news of the death of Retired ACB
Member Graham Rex Shuttleworth who died just before Christmas. ■
Publication Deadlines
To guarantee publication, please submit your article by the 1st of the preceding
month (i.e. 1st May for June 2020 issue) to:
editor.acbnews@acb.org.uk
We try to be as flexible as possible and will accept articles up to the 20th
to be published if space allows. Otherwise they will be held over to the next issue.
If we are aware that articles are imminent, this gives us more flexibility
and we can reserve space in anticipation.
If in doubt, please contact Ian Hanning, Lead Editor,
via the above e-mail. ■
Issue 664 | April 2020 | ACB NewsGeneral News | 15
UNIVANTS of Healthcare Excellence
Ian Young, Queen’s University, Belfast
In 2019, the ACB was delighted to support pre-eclampsia to help improve outcomes
the inaugural UNIVANTS of Healthcare and reduce readmissions, leading to
Excellence Awards hosted by leading increased patient satisfaction and lower
professional healthcare societies, costs. A team from the University of
institutions and associations. This is Dundee and Ninewells Hospital developed
intended to be an annual award which a novel approach to improve the diagnosis
will recognise interdisciplinary care teams and management of liver disease using an
around the world who have achieved intelligent algorithm, called iLFT
measurable, innovative impact within the (intelligent liver function test). The iLFT
healthcare system. It is hoped that the system offers real-time decisions about
award winners – and participants – will testing results, generating a follow up
provide models to inspire continued plan that is sent to the primary care
solutions within healthcare that will physician in as little as four hours. A pilot
positively affect patients, clinicians and of the test at the University of Dundee
health systems globally. found that iLFT helped increase diagnoses
It was particularly pleasing that two of from 41 to 93%, and use of the algorithm
the three winners in the first year of the could provide improvements in the
awards – which were open to global patient’s quality of life while reducing the
participants – were from the UK, reflecting number of follow-up visits.
the strength of laboratory medicine in the Representatives of both teams were
UK and the strong collaborations which due to be presented at Focus 2020 in
exist between laboratory professionals and Belfast in May to discuss their innovative
clinicians. The awards were presented approaches.
during the AACC Meeting in Anaheim in The UNIVANTS 2020 Awards are now
2019 and subsequently celebrated at open for entry with a deadline of
events in Oxford and Dundee. 31st August. Further details can be found
A multidisciplinary team from Oxford at: https://www.univantshce.com/
University NHS Foundation Trust evaluated It would be great to see more ACB success
the use of new diagnostic tests for this year! ■
Dundee Team from left to right: Elizabeth Furrie, Oxford Team from left to right: Guy Checketts,
Ian Kennedy, Jennifer Nobes, Michael Hugh Tim James, Julia Eades, Manu Vatish, Matthew
Miller, John Dillon, and Ellie Dow Covill (missing from this photo is: Sofia Cerdeira)
Photos courtesy of Lisa Harrison, Abbott
Issue 664 | April 2020 | ACB News16 | General News
Analyte Monographs – Past, Present and
Future
Gina Frederick, AMALCs Editor-in-Chief
Past Dr William Marshall was appointed as
Analyte monographs alongside the the original Editor-in-Chief of the
laboratory medicine catalogue (AMALCs) AMALCs over 10 years ago, his role being
were originally conceived as an extension to edit and supervise the process and to
of the laboratory medicine catalogue write several of the early monographs to
(LMC). The plan was to write and publish give prospective contributors an idea of
a series of monographs that included all what was required. William stepped
the information required for both down from this role in May 2019.
providers and users of laboratory tests in Present
all disciplines, essentially to act as an
◆ AMALCs are a fantastic resource.
encyclopaedia to something that was
They provide a detailed summary
called ‘The Laboratory Medicine
of the nature and use of individual
Catalogue’. The LMC was a project
assays, and provide clinical and
initiated by the DoH and funded by them.
analytical information for laboratory
The LMC fell by the wayside,
staff and users, including a description
but the ACB thought that the idea was
of the analyte, details of analytical
still good and AMALCs were continued.
methods, uses, causes, follow-up of
A long-term ambition was to extend the
abnormal results, and any guidelines
content beyond clinical biochemistry to
and systematic reviews.
immunology, haematology and
microbiology.
Issue 664 | April 2020 | ACB NewsGeneral News | 17
◆ More importantly, they are ◆ Initiating a review process for existing
peer-reviewed and can therefore be AMALCs.
included in publication lists on CVs. ◆ Giving them a more ‘corporate’ look
◆ They are an educational activity and such as including the ACB logo.
attract five CPD points. ◆ Updating the ‘Writer’s Pack’.
◆ Trainees may write them under the ◆ Updating the web-page.
supervision of a more senior colleague. ◆ Publicising!
The Analyte Monographs can be found We would encourage members of all
under the publications section of the ACB grades to contribute to this project.
website: http://acb.org.uk/whatwedo/ It is an excellent activity for Trainees to
science/AMALC.aspx get involved in, and a great revision
There is also a link to some of the analyte exercise. And good for your CV! And you
monographs from Lab Tests Online-UK. may even get a mention in the new
edition of Tietz as we have been
Future
approached about the possibility of
Although there is an extensive selection of including a link to the AMALCs!
analyte monographs available, there are As well as the analyte monographs
many gaps, including some of the more listed on the website, the following
routine tests e.g. LH/FSH. Currently there are in progress: Caeruloplasmin, LDH,
are no entries for Immunology and Troponins, NSE, Prolactin, Bicarbonate,
Haematology tests. Microbiology has its Vitamin B12, and TSH.
own version of the monographs. If you wish to write an analyte
They are an excellent resource but are monograph, and require a ‘Writer’s Pack’,
under-utilised and under-publicised. or for any further information, please do
Plans for the future include: get in touch, via email at:
◆ Commissioning of new AMALCs. AMALCs@acb.org.uk
◆ Extending the content beyond clinical Finally, we would like to thank
biochemistry to immunology and William Marshall for creating and
haematology, starting with some of maintaining the AMALCs over the last
the cross-specialty tests such as decade. ■
immunoglobulins and complement.
Issue 664 | April 2020 | ACB News18 | Microbiology News
Summary of Results from the
ACB Microbiologists’ Survey
Issue 664 | April 2020 | ACB News20 | Deacon's Challenge Revisited
Deacon’s Challenge
Revisited
No 7 - Answer
The absorbances of a solution containing NAD and NADH in a 1 cm light path cuvette
were 0.337 at 340 nm and 1.23 at 260 nm. The molar extinction coefficients are:
NAD: 1.8 x 104 at 260 nm, 1.0 x 10-3 at 340 nm
NADH: 1.5 x 104 at 260 nm, 6.3 x 103 at 340 nm
Calculate the concentrations of NAD and NADH in the solution.
MRCPath November 1995
Both NAD and NADH absorb at the two wavelengths used (260 nm and 340 nm).
Absorbances are additive, therefore at either wavelength:
Total absorbance = Absorbance of NAD + Absorbance of NADH
At any wavelength the absorbance of NAD or NADH is given by:
Absorbance = Molar extinction coefficient x Molar concentration x Cell path
Therefore for each wavelength equations can be set up relating measured total
absorbance to the sums of the individual absorbances of NAD and NADH:
Measured absorbance = (NADConc x NADCoeff) + (NADHConc x NADHCoeff)
At 340 nm: 0.337 = 1.0 x 10-3 [NAD] + 6.3 x 103 [NADH] ....................(i)
At 260 nm: 1.23 = 1.8 x 104 [NAD] + 1.5 x 104 [NADH] ...................(ii)
(The cell path is 1 cm and can be ignored)
These form a pair of simultaneous equations that can be solved for [NAD] and [NADH] in
the usual manner. However, solving a set of simultaneous equations can be a lengthy
process and it is worth remembering that these calculations are designed to be simple!
Therefore we should look for approximations and short cuts. In this particular example it
is possible to considerably simplify the calculation. The molar extinction coefficient of
NAD at 340 nm is much lower than that of NADH (by a factor of approx. 10-6) so that the
contribution of NAD to absorbance at this wavelength can be ignored. Equation (i) can
then be simplified to:
Issue 664 | April 2020 | ACB NewsDeacon's Challenge Revisited | 21
0.337 = 6.3 x 103 [NADH]
[NADH] = 0.337 = 5.35 x 10-5 M = 53.5 µmol/L
6.3 x 103
[NAD] can be calculated by substituting [NADH] = 5.35 x 10-5 into equation (ii):
1.23 = 1.8 x 104 [NAD] + (1.5 x 104 x 5.35 x 10-5)
1.23 = 1.8 x 104 [NAD] + (8.03 x 10-1)
1.8 x 104 [NAD] = 1.23 - (8.03 x 10-1) = 0.427
[NAD] = 0.427 = 2.37 x 10-5 M = 23.7 µmol/L
1.8 x 104
Question 8
A patient receiving total parenteral nutrition is receiving 11.8 g nitrogen/24 h as amino
acids. Urinary urea excretion is 580 mmol/24 h.
Indicating what assumptions you make, calculate whether she is in positive or negative
nitrogen balance.
MRCPath November 1999
Issue 664 | April 2020 | ACB News22 | Meeting Reports
Frontiers in Laboratory
Medicine Report: Day 1
Niamh Horton, Trainee Clinical Biochemist, Mid Cheshire NHS
Foundation Trust
The changing role of Clinical Scientists,
and the pathology workforce as a whole,
was a running theme throughout the day.
It was fascinating to hear from Dr Bill
Morice, who gave his personal view from
the Mayo Clinic and Pathology in the USA.
Bill discussed how several innovation
projects have been implemented in the
Mayo Clinic, and whilst much of it was on
a large scale, the procedures enabling
innovation at the Mayo Clinic are still very
relevant to Pathology within the UK.
Bill summarised the drivers of innovation
and stated it was always important to
identify the barriers of entry and the rate
of change which often become the major
determinants of the success of innovation.
Following this, Andy Howlett
discussed the NHS Improvement project.
Andy discussed how NHSI aims to improve
the care and efficiency within the NHS,
and showed some preliminary data
highlighting how the large-scale project
This years FiLM conference was again held has improved productivity within
at Austin Court in Birmingham and Pathology. Andy also discussed the role
brought together Scientists and Clinicians we all play within the project and
from several Pathology specialisms. This
year I was lucky enough to attend as part
of the Emerging Leaders Programme,
with innovation in Pathology the focus of
the first day.
The conference was opened by the ACB
President, Neil Anderson, who emphasised
that Pathology has already made many
advances and improvements in recent
years. Neil reiterated that we all have the
ability to be innovators, with laboratories
becoming more automated providing an
opportunity for staff to become involved
in taking Pathology directly to the user. Dr Bill Morice
Issue 664 | April 2020 | ACB NewsMeeting Reports | 23
promoted the potential for the
development of new roles for current
NHS staff as a result of NHSI.
The second session of the day focused
upon innovating technology and was
opened by Sheryl Warttig who gave a
really informative overview of the role
NICE play in the innovation pathway.
Sheryl explained how NICE are actively
involved with supporting the development
and adoption of new health technologies.
Sheryl discussed HealthTech Connect,
a new tool developed by NICE aimed
Dr Marion Wood, GIRFT Pathology
specifically for innovation. Sheryl discussed
how it was becoming more difficult to
identify non-drug technology, and innovation and quality and gave a very
therefore HealthTech Connect aims to act refreshing view of audits! Jo highlighted
as a repository and it can assess evidence that quality is never an accident and
and provide support for innovators. should not be taken for granted, and
To put this innovation into context, reiterated that we spend a lot of time
a team from Nottingham, Consultant undertaking compliance audits rather
Haematopathologist David Clark and than risk based audits. Jo challenged us all
Consultant Breast Pathologist Dr Gurprit to think about audits and identify the
Atwal, presented their experience of opportunities for shared learning from
implementing digital pathology. They each audit. Jo specifically commented on
discussed how this was implemented and the number of audits on water that she
how digital pathology has innovated the sees and questioned us to think about
cellular pathology reporting practices in what we want to achieve when we
Nottingham, improving patient care. It will undertake an audit.
be really interesting to see how widely this The afternoon started with a session on
technology is adapted, especially in other GIRFT showing the progress made by the
areas of Pathology. This technology was GIRFT Pathology team, comprised of
also found to help with the recruitment Dr Martin Myers, Dr Tom Lewis and
issues, which whilst focused upon a specific Dr Marion Wood. Some of the initial data
area, are a widely reported national issue. was fascinating, and this is being used to
The team has highlighted how digital compare departments nationally but also
pathology enabled real time collaboration within Pathology networks. I found the
with colleagues. During the panel variation in Primary Care particularly
discussion, some audience members interesting, for example, initial data shows
questioned if digital pathology altered the a large inter-seasonal variability in the
relationship between colleagues. However, number of hyperkalaemic results. Whilst
the team confirmed that they saw this this data may not be overly surprising,
technology as having huge benefits and the team highlighted how the data allows
helping to alleviate the current unmet quantifiable measures of issues commonly
need with regards to the limited number discussed in Pathology. The data also
of Histopathologists. enables such issues to be addressed as a
Jo Martin, President of the RCPath, whole Pathology Network, enabling
focused upon the relationship between corrective actions to be implemented,
Issue 664 | April 2020 | ACB News24 | Meeting Reports for example focusing upon pre-analytical With Scientists leading the project, issues with sample transport. This issue this large workload could be realigned to may be commonly identified in make it more predictable for the Biochemistry, but corrective action requires laboratory. This project not only maximises involvement from several departments. the potential of laboratory staff by The data from GIRFT was shown to enable extending their roles, but also aims to such conversations to take place. improve patient outcomes by improving During the panel discussion, profile chronic disease monitoring. Current data based testing was also discussed at length. suggests that only 50% of HbA1c requests It was suggested that symptom based are performed at the recommenced requesting may be an alternative to frequency. Differing repeat testing reduce some of the unnecessary test intervals was also highlighted by the requesting identified using the GIRFT data. GIRFT Pathology team as an area which I think this would be a really interesting requires harmonisation. option to discuss with local Primary Care Kerry Roulston finished the session by clinicians, and to involve them in some of discussing her evaluation of a new system the innovations that arise from the GIRFT for rapid identification of antimicrobial Pathology projects. susceptibility testing. Kerry highlighted The first day finished with examples of that despite the large initial work innovation projects from the NHS in required, this innovation reduced the time England. Clare Ford discussed the taken for an accurate susceptibility result implementation of High-sensitive Troponin to be reported. Implementing the new and the role of the Biochemistry system had several positive downstream Department in the development of a effects and significantly reduced the time chest pain pathway, linking the front line required for a patient to be started on the clinicians directly to the laboratory. optimum therapy. Kerry highlighted that The project involved a large during this project it was important to implementation team involving both have an auditable clinical outcome which clinical and laboratory staff. Implementing was successfully achieved. the new method enabled patients to be Day 1 highlighted that innovation does discharged earlier, and reduced the mean take time and effort and can cause length of stay from 23 to 9.6 hours, disruption. However, this is proportional resulting in an estimated annual saving of to the gain from such innovation, not just £788,000. financially, but for other clinical staff and Professor Tony Fryer gave an overview of most importantly, for patients. Lab4i, a project currently being developed FiLM was fascinating and very in collaboration with UHNM and external informative, and I returned to my partners. Tony highlighted the shared department with several new project purpose aspect of the NHSE change model ideas! I would recommend FiLM to early and emphasised the importance of using career scientists who can gain an invaluable the expertise of Scientists. The extended insight into many of the changes occurring roles of Scientists has previously been in Pathology in the UK. ■ highlighted by the AHCS, and Lab4i showed a novel aspect of a possible ◆ The second day of FiLM will be extended role. Lab4i aims to improve reported in the next issue of ACB News scheduled testing of patients with chronic by Gemma Reidy, Senior Clinical conditions, which currently forms a huge Biochemist, UHCW NHS Trust part of the laboratory workload. Issue 664 | April 2020 | ACB News
Meeting Reports | 25
Mick’s Festschrift
Divya Patel and Roger Bramley, Leeds Teaching Hospitals NHS Trust
Dr Mick Henderson, Consultant Clinical
Scientist in Biochemistry, retired in January
2020. Mick was Head of the Biochemical
Genetics and Newborn Screening
Laboratory at Leeds Teaching Hospitals,
where he had worked for 36 years. From
2014 to 2019 Mick was also Head of the
Biochemical Genetics Laboratory at the
Willink Laboratory in Manchester. Many of
us have received invaluable expert advice
from Mick in the investigation of Inborn
Errors of Metabolism (IEM). Mick has
always had a passion for teaching and he Mick Henderson and Carys Lippiatt
has provided specialist training in this field
to local, regional and national Trainee
Inborn Errors of Metabolism by bringing
Scientists and Clinicians, many of whom
focus to the phenylalanine oxidation
have spent time in the Leeds and Willink
pathway. We were reminded of the work
labs under Mick’s leadership. It is largely
of the pioneer in the field,
due to Mick’s determination that the
Dr Archibald Garrod, whose investigation
National School for Healthcare Scientists
of infants with brownish-black stained
agreed in 2004 to fund ten Higher
nappies led to the discovery in 1902 of
Specialist Trainee posts in Biochemical
the first condition determined to be an
Genetics, thus creating the next generation
inherited metabolic disorder, alkaptonuria.
of experts in the field. To celebrate Mick’s
Another disorder within the same
career, a Festschrift was held in his honour
pathway was identified in 1934 by
on the 23rd January 2020 at the Thackray
Dr Asbjørn Følling. Using a classical
Museum in Leeds.
organic chemistry approach, Følling
The meeting was chaired by two of
showed that children with severe mental
Mick’s close colleagues at Leeds Teaching
retardation excreted high amounts of
Hospitals – Mr Robert Barski and Dr Carys
phenylpyruvic acid in their urine;
Lippiatt.
he named the disorder phenylketonuria
Science, medicine, serendipity, (PKU). This became the first form of
the Australian bottle-brush plant mental retardation to have an identifiable
and the importance of stuff chemical abnormality. In the 1960s,
Dr Robert Guthrie realised that prompt
Professor John Walter, recently retired
diagnosis of PKU could facilitate
Consultant in Inherited Metabolic Disease
treatment early enough to prevent
at the Royal Manchester Children’s
irreversible neurological damage.
Hospital, presented the first talk of the
PKU was the first disorder to be screened
meeting. He met Mick in Bristol, where
for in newborn infants, using Guthrie’s
Mick worked as a Trainee Clinical Scientist
bacterial inhibition assay.
and later worked with Mick again at the
In keeping with the theme of ‘firsts’,
Willink Laboratory. Professor Walter’s talk
Professor Walter then spoke of the
highlighted the ‘firsts’ in the field of
Issue 664 | April 2020 | ACB News26 | Meeting Reports discovery of the herbicide nitisinone, a chemical derived from a natural phytotoxin obtained from the Australian bottlebrush plant. It is used to treat a third disorder of the pathway, tyrosinaemia type I, and is the first treatment to be based on a weed killer. The talk concluded with a reflection on the role of serendipity in each of the above scientific discoveries and a video of Dr Følling talking about his discovery of “stuff” (phenylketones). Professor Walter thanked Mick for all his years of measuring various “stuff” for of developing severe side effects following clinicians! vaccination. In addition, there is a need to Newborn screening for severe establish a suitable cut-off and screening combined immunodeficiency in the protocol. UK: Clinical cases and conundrums ERNDIM: the ultimate in Dr Leslie Tetlow, Consultant Clinical networking Scientist and Lead of the Newborn Professor Brian Fowler, a long-standing Screening Laboratory in Manchester, colleague of Mick’s through ERNDIM, has collaborated with Mick over many travelled from Switzerland to speak. years. Dr Tetlow spoke about the highly Professor Fowler described the humble anticipated newborn screening pilot for beginnings of ERNDIM in 1991 and its severe combined immunodeficiency development from a European initiative to disorder (SCID), which comprises a group a Worldwide EQA provider, offering 16 of rare inherited disorders that affect the EQA schemes for laboratories investigating development of functional T cells and B Inborn Errors of Metabolism for 408 cells in infants. SCID screening will be participating laboratories spanning 63 based on PCR amplification of T-cell countries. Mick succeeded in introducing receptor excision circle (TREC) DNA, which an EQA scheme for white cell cysteine, serves as a marker for the number of what was initially felt to be ‘an impossible mature T cells. Low TRECs are expected in task’. He also organised and continues to infants with SCID but may also be seen in deliver scientific training for the study of other immunodeficiency disorders or due IEMs through the SSIEM’s (Society for the to an underdeveloped immune system Study of Inborn Errors of Metabolism) seen in prematurity. Academy. Dr Tetlow highlighted various obstacles Professor Fowler ended the talk by to screening, including the identification presenting Mick with a certificate to grant of T-cell lymphopaenias due to other him membership of the highly selective primary and secondary disorders. senior SSIEM (aka SSSIEM who lunch)! For instance, there is the potential to miss infants with delayed onset SCID who may Primary hyperoxaluria have detectable (or even elevated) T cell Dr Eric Finlay, a Consultant Paediatric numbers due to a partial defect. This has Nephrologist at Leeds, has worked implications for the BCG vaccination since alongside Mick for 15 years. He high- babies with severe immunological lighted how the paediatric lab under deficiencies are at considerably higher risk Mick’s leadership had facilitated the Issue 664 | April 2020 | ACB News
Meeting Reports | 27
in the amount of data available, and the
interface between clinicians, geneticists
and biochemists is more important than
ever to ensure that a patient’s genetic
information is appropriately interpreted in
parallel with the biochemical information
about their phenotype. Finally, Dr Dobbie
considered recent interesting progress in
genomics and how free foetal DNA allows
prenatal whole genome sequencing.
Unravelling metabolism with Mick
diagnosis of primary hyperoxaluria in Professor Simon Heales, Head of the GOSH
children, due to close collaboration with Biochemistry Laboratory and Director of
the Paediatricians and scientific vigilance the Neurometabolic Laboratory at UCL,
in the interpretation of urine organic acid presented the last talk of the day
chromatograms. The Leeds renal team is discussing his 25 year history of working
responsible for the management of the with Mick. Professor Heales framed his talk
third largest cohort of primary around an acrostic from Mick’s name:
hyperoxaluria patients in the UK. “Metabolism” highlighting the many areas
Dr Finlay described emerging novel where Mick has expert knowledge;
treatments for hyperoxaluria and some of “Imparting” listing the many educational
the clinical trials that Leeds patients have bodies Mick has worked with and helped
been recruited into. to develop over the years; “Collaborative”
demonstrating links between labs and
The revolution in gene testing – individuals that Mick has helped to build.
will it make Biochemistry Emphasised through a case of Aromatic
unnecessary? Acid Decarboxylase (AADC) deficiency
Dr Angus Dobbie is a Clinical Geneticist at diagnosed in record time through joint
LTHT who trained as a Biochemist work by the Leeds and UCL labs. Finally,
alongside Mick at Southmead Hospital in he postulated that not a single member of
Bristol about 40 years ago. He switched to the audience could disagree that Mick
a medical career in Clinical Genetics and wasn’t “Kool!”
later followed Mick up north to Leeds. Mick thanked everyone for coming
As with many stories about Mick, this talk and highlighted the importance of
began with a conversation in the pub collaboration not just between
with Mick and Angus discussing how laboratories and clinicians but also
developments in the field of Clinical and collaboration between labs. It was a
Laboratory Genetics may or may not put testament to Mick’s countless successful
Biochemists out of a job. Dr Dobbie collaborations that so many scientists and
discussed how genetics has changed over clinicians from all over the UK and beyond
the course of their careers, highlighting attended this excellent meeting to
the human genome project which took celebrate his career.
20,000 staff 19 years at a cost of All of us here at Leeds and I’m certain all
$3,000,000,000 and how, less than 20 years of those who know him will wish Mick a
later, a genome can be sequenced by one very happy and well deserved retirement,
staff member in a matter of days costing with five grandchildren it certainly won’t
around $1,000. This has led to an explosion be a quiet one! ■
Issue 664 | April 2020 | ACB News28 | Meeting Reports
The End of an Era –
Farewell Dr Julian Barth
Stephen Gibbons, Divya Patel & Carys Lippiatt, Leeds Teaching
Hospitals NHS Trust
It truly is the end of an era. The man, laboratory methodology and novel
the legend, Dr Julian Barth, Consultant biomarkers. He also has a great interest in
Chemical Pathologist, has retired from the pathophysiology and management of
Leeds Teaching Hospitals Trust after over obesity and collaborated with the British
30 years’ service. Obesity and Metabolic Surgery Society to
Julian entered the world of Pathology establish nutritional guidelines for patients
many moons ago, after starting his following bariatric surgery. His clinical
medical career in the world of practice included lipid clinics, porphyria
dermatology; particularly that of the clinics and obesity clinics.
follicularly challenged. His early research During his career, Julian held several
focused on the pathophysiology of hair. eminent positions including President of
His decision to embark on a career change the Association for Clinical Biochemistry,
was made after ‘recognising the golden Editor-in-Chief for the Annals of Clinical
future of Chemical Pathology’; as this Biochemistry and Honorary Reader in
excerpt from the 1990 Leeds Pathology Chemical Pathology and Metabolic
Newsletter shows. Medicine at the University of Leeds.
As his colleagues and friends alike will
testify, he is a true ambassador for our
profession.
To celebrate Julian’s career, a Meeting
of the Trent, Northern and Yorkshire
Region was held at The Old Medical School
in Leeds on the 21st November 2019,
chaired by Dr Carys Lippiatt.
Lipid management in high risk
patients
Dr Hannah Delaney, Consultant Chemical
Pathologist and Clinical Lead at Sheffield
Julian’s publication record is nothing Teaching Hospitals, gave a talk on lipid
short of remarkable and includes more management in high risk patients.
than 200 peer reviewed journal articles Dr Delaney presented a series of clinical
(and still rising!) as well as the cases that demonstrated challenges in lipid
indispensable ‘red book’ (Biochemical management, including statin intolerance,
Investigations in Laboratory Medicine). which results in some patients suffering
His interests are wide ranging and include from statin induced musculoskeletal
endocrinology of hair loss and hirsuitism, symptoms that resolve after stopping the
adrenal and pituitary diseases and their medication. For patients with primary
investigation, porphyria, statistics and hypercholesterolaemia or mixed
dyslipidaemia, with a high risk of
Issue 664 | April 2020 | ACB NewsMeeting Reports | 29
A career bookended
Dr Steve Orme, Consultant Endocrinologist
at LTHT, provided us with an insight into
how our understanding of the
pathophysiology of acromegaly has
improved since this disease was discovered
in 1886. He discussed a common
manifestation of acromegaly; bitemporal
hemianopia, which is caused by pressure
on the mid-optic chiasm, and showed how
surgical resolution of this can be
demonstrated with the Goldman’s visual
field test. An interesting yet unresolved
theory for increased cancer incidence in
patients with acromegaly was discussed;
Dr Orme’s view is that this is likely to be
directly related to the effects of excess
circulating growth hormone. Published
Dr Hannah Delaney
data (Orme et al, 1998) revealed
correlations between post treatment
cardiovascular disease, and in whom GH levels and all cause/cardiac/cancer
cholesterol levels cannot be managed mortality. He concluded his talk with a
through diet and statin treatment, NICE note that research (and life) is becoming
recommends the use of proprotein more complex but does help to refine
convertase subtilisin kexin type 9 inhibitors treatment goals, in the case of acromegaly
(PCSK9i) such as Alirocumab and ensuring post treatment GH levels are not
Evolocumab. These monoclonal antibodies raised.
block PCSK9 binding to low density
lipoprotein (LDL) receptors, decreasing
their hepatic degradation and increasing
their availability to clear LDL from the
blood. Despite the benefits conveyed by
PCSK9 inhibitors, Dr Delaney highlighted
that uptake is low, largely due to
inadequate referral of eligible patients to
specialist centres. However, access to these
medications should improve thanks to the
work of the NHS Accelerated Access
Collaborative to establish centralised
PCSK9i services.
Dr Delaney also described the under
diagnosis of familial hypercholesterol-
aemia (FH), a common and treatable
disease, and the commitment of the NHS
long term plan to reduce cardiovascular
events by expanding access to genetic
testing for FH to identify at risk patients. Dr Steve Orme
Issue 664 | April 2020 | ACB News30 | Meeting Reports
Litigation in bariatric surgery faced when surgery is carried out in the
Professor Stephen Pollard, Consultant private sector, for example lack of MDT to
Surgeon at LTHT, gave a fascinating support decisions and lack of critical
overview of litigation in bariatric surgery. care/imaging facilities.
To introduce this unfamiliar theme From thyroid to cardiometabolic
Prof Pollard provided an overview of the research: fibrin, glucose, life and
medico-legal framework, including some death
key legal judgements. The story of the
Professor Ramzi Ajjan, Consultant in
Paisley snail from 1928, where a lady
Diabetes and Endocrinology at Leeds
contracted gastroenteritis from drinking
Teaching Hospitals Trust, gave a talk which
contaminated ginger beer (Google it…!),
began with Dr Ajjan recalling his own
marked a legal precedent and the start of
career journey and how this led to him
negligence lawsuits. He went on to discuss
meeting Julian. He started with his
the landmark case in 2015 (Montgomery
exploration of correlation in research
v Lanarkshire) which changed the historic
whilst studying at university, describing
position of consent. Prior to this, doctors
the correlation that he observed on
only needed to discuss the common risks
campus between fashion and coolness/
of a procedure; following the
attractiveness in the general student
Montgomery verdict, it was ruled that
population! To gain further research
doctors should provide patients with a
experience he set out on a brief visit to the
comprehensive list of possible risks
UK, which resulted in him completing a
regardless of rarity. As we might expect,
4 year PhD at the University of Sheffield,
there has been an almost exponential rise
after which he completed his clinical
in bariatric surgery, which alongside
training in Diabetes and Endocrinology at
cosmetic surgery has the highest insurance
Leeds. Here, his path crossed with Julian’s
premiums amongst surgical specialities.
and together they have collaborated on
Indeed, he stated his last annual premium
several exciting research studies and
was in excess of £30k! Prof Pollard ended
publications.
the talk by discussing some of the issues
Dr Ajjan’s initial research direction
started with the thyroid, where he
established a Chinese hamster ovary cell
line to express the human Na+/I– symporter,
which transports iodine into the thyroid.
However, due to concerns regarding
funding for thyroid research, he shifted his
focus into diabetes and cardiovascular
disease research. Following the publication
of 3 papers, he applied and was
successfully awarded a Clinician Scientist
Award from the National Institute for
Health Research UK in 2005 to further his
research interests in glycaemia and
thrombosis. Notably, he found that both
hyperglycaemia and hypoglycaemia have
prothrombotic effects, delaying fibrin clot
lysis which is an independent predictor of
Professor Stephen Pollard cardiovascular mortality. With an aim to
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