LabMedUK24 conference Brighton – editorial

LabMedUK24, hosted by the Association for Laboratory Medicine (LabMed), was held at the Brighton Metropole, Brighton, between the 10th and 12th June 2024.

The meeting was opened by Kath Hayden, President, celebrating this as the first conference as the rebranded Association for Laboratory Medicine and highlighting the future plans for the Association and its continued work on expanding the Learning Academy, training and support for members with bursaries and scientific scholarships, and expanding our publishing and editorial content.

The conference attracted 303 delegates over the 2 days, with 92 trainees attending the Biochemistry training day and 15 attending the Microbiology day.

This year plenary lectures offered a breadth of nationally and internationally recognized scientific and clinical research. The programme commenced with the International Award Lecture with Dr Octavia Peck-Palmer, President of the ADLM and Associate Professor of Pathology, Critical Care Medicine and Translational science at the University of Pittsburgh, speaking about how laboratory medicine can lead the way in translating data analytics to identify and eliminate health disparities. A really thought-provoking session that highlighted the many weaknesses in the evidence used to develop our current guidelines, and the work we need to do to reach under-represented groups in our local populations.

The morning parallel sessions included an excellent session on faecal testing, which featured the work undertaken by the Southern Bowel Screening Hub to test qualitative lateral flow point of care kits for faecal immunochemistry testing (FIT) with interesting findings particularly for sensitivity of these tests that will be important to consider for routine use. This was followed by talks from other laboratories on their experiences with implementing calprotectin and FIT into clinical pathways, including the Nottingham experience of how implementing FIT plus anaemia into the symptomatic pathway can be used for risk stratification of patients and referral for colonoscopy.

The alternative parallel focused on Paediatric Biochemistry, which was both insightful and fascinating. It began with an educational session on the biochemistry of sterols, bile acids and oxysterols. The LC-MS method presented, sterolomics, is an extremely powerful and valuable tool in the measurement of cholesterol pre-cursors and metabolites. Especially vital in patients who were clinically suspected, but have not been genetically confirmed, to have disorders of cholesterol biosynthesis. This was followed by a talk on the role of GC-MS-based metabolomics, focusing on principles of the method, development of libraries and dealing with unknown compounds. The role of the Clinical Biochemist in the Syndrome Without a Name (SWAN) clinic was highlighted in this session, as well as the diagnostic odyssey that a patient may go through and demonstrated the aims of the SWAN team and the specialists involved in patient care. Particularly, this session conveyed that clinical biochemists play a vital role in the application of data from academia to the clinical laboratory and of metabolomics in cases of variants of unknown significance (VUS).

Our second plenary of the day was our Impact Award Lecture, where this year Catherine Dibden, Consultant Clinical Scientist in Biochemistry at Barnsley and Rotherham Hospitals, was recognized for the initiative to implement a new chest pain pathway in the Emergency Department (ED) during the COVID-19 pandemic. A higher hs-cTnI cut-off and different risk scoring algorithm were developed enabling an additional 20% of patients to be discharged home after a single troponin result, with an audit undertaken post-implementation demonstrating comparable patient outcomes to the old pathway whilst producing a saving of over 800 h of patient stay in the ED annually.

The afternoon sessions covered laboratory management and myeloma alongside an excellent Medal Award session and a debate session on the new NICE guidelines on Vitamin B12 deficiency.

The benefit of using emotionally intelligent, compassionate leadership to drive change was evidenced using real-life examples during the Laboratory Management symposium. Creating safe spaces to cultivate engagement and listening with fascination were encouraged, whilst it was acknowledged that avoidance of over-promising and personal overwhelm is important when responding with empathy. This was followed by a presentation of a collaborative project performed to develop pathology network care sets for syndromic requesting in line with evidence, whilst assessing clinical impact to avoid healthcare inequalities.

It was fabulous to have a parallel session on Myeloma, which was organized and Chaired by Immunology colleagues. Myeloma UK presented data that has established that earlier detection of myeloma is crucial to improve patient outcomes and experience. An MGUS monitoring algorithm was evaluated which explored how the laboratory can support this process within a pressured healthcare system. The potential role of mass spectrometry for sensitive serum testing in myeloma to reduce bone marrow sampling and facilitate earlier detection of relapse, also highlighted the benefits to laboratory efficiency and reduction of subjectivity in reporting.

The Medal Award provides an exciting opportunity for trainees within the profession to show case projects that they have completed.

A variety of projects were presented including an investigation of the preanalytical affects on ammonia levels, which concluded that ice is not required and samples are stable for longer that we have previously been led to believe, a study of the impact of using ALT and AST methods without pyridoxal-5-phosphate and the need to follow the IFCC recommendations, an audit of xanthochromia analysis, implementation of steps to reduce turnaround times for emergency departments and the use of serum free light chains for the diagnosis of MS.

The worthy winner was Ryan Cooper for presenting his abstract on ‘Clinical performance of the Binding Site free light chain assay in cerebrospinal fluid and serum for diagnosis of multiple sclerosis’. The runner up was Gavin Mercer Smith with his excellent presentation on ‘Plasma ammonia analysis: is transport of samples on ice required? An investigation in samples from patients with hyperammonaemia’.

A lively session was held to end the day, organized by the Association’s Scientific Affairs and Clinical Practice Committee, it was well received amongst delegates and was highlighted of one of the best sessions of the conference. Participants were made up of representatives from the NICE guideline committee for the ‘Vitamin B12 deficiency in over 16’s: diagnosis and management’ who discussed the overview and implementation of guidelines, this was followed by an interactive discussion with the audience. Excellent presentations were given explaining B12 as a biomarker and the limitations of 1st and 2nd line testing. The presentation highlighted poor method harmonization that results in large variations across manufacturers. It highlighted the challenges around funding of more expensive tests such as MMA along with its limitations. Also noted, was the current lack of B12 standardization between assay manufacturers and the various diagnostic challenges faced by clinicians. From the show of hands in the audience when asked if the guidelines would be implemented, there was a hesitancy in committing to the recommendations. Many laboratory professionals feel that the NICE guidance has been a positive step to re-ignite awareness on this long-overlooked topic, but they acknowledge that the diagnosis and management of B12 deficiency is still far from where it needs to be. A thought-provoking debate that generated further questions to answer.

Wednesday’s programme headlined with the Laboratory Medicine Foundation Award, presented each year to recognize an outstanding contribution to Laboratory Medicine. This year we recognized Professor Brian Keevil, Consultant Clinical Scientist in Biochemistry at Wythenshawe Hospital, Manchester University NHS Foundation Trust and Honorary Professor at the University of Manchester for his pioneering work in developing novel mass spectrometry methods for the measurement of steroids and therapeutic drug monitoring. The session focused on the how assays for salivary steroids have been developed to aid in the investigation of endocrine disorders, and in particular the major role salivary cortisone can play in the investigation of adrenal dysfunction.

Wednesday’s symposia opened with parallel sessions on mass spectrometry and home self-testing. The Mass Spectrometry symposia, raised the question, is metabolomics the next big thing? The process from discovery through to validation of metabolic markers using metabolomics was explained using examples from current studies including identifying markers that increase the risk of development of type 2 diabetes. A fascinating talk on the biomarkers of dying followed, where significant metabolites identified in the urine of lung cancer patients in their last week of life have been found, opening up the possibility of developing a point of care test using a panel of metabolites to create a risk of dying. The final talk covered urine steroid metabolomics for the different diagnosis of adrenal tumours where current biochemical tests suffer from a high false positive rate. Poor outcomes for adrenal carcinomas have led to the project to develop a 15 steroid panel to identify a high/low risk score.

An important area of growth in laboratory medicine is home self-testing, it is particularly important to improve access to laboratory diagnostic tests. This session discussed the pros and cons of this way of testing, provided examples of implementation into routine laboratory practice and shared experiences of gaining accreditation for these tests.

Improvement opportunities for diagnosis and monitoring of specialist endocrinology conditions were presented on Wednesday afternoon, serving also as constructive educational sessions. Firstly, the practical use of co-peptin to improve diagnosis of Diabetes Insipidus (DI) and the diagnostic performance alongside various dynamic function testing were considered in patients with polyuria/polydipsia. Secondly, current issues with thyroglobulin immunoassays and the potential improvements with mass-spectrometry measurement of thyroglobulin were highlighted. A validation of thyroglobulin measurement by LC-MS/MS and a reflex strategy was presented. Thirdly, clinical utility for 21-deoxycortisol (21DO) over 17-hydroxyprogesterone (17-OHP) measurement in CAH was demonstrated via findings in a service that provides serum 21DO. Encouragements were made to consider inclusion of 21DO in LC-MS/MS methods for 17OHP to aid in the interpretation of raised 17-OHP.

A look at the future implications of AI and machine learning session started with the complex pathway to AI implementation in the NHS including ethical and regulatory considerations. This was followed by a study investigating whether AI using current available tools can replace clinical biochemists reporting of thyroid function tests. The audience was pleased to hear that they are unable to, although improved medical AI tools are now available. An excellent presentation from the team from Angers in France provided data from their serum protein electrophoresis computer-assisted trace recognition (SPECTR) tool for the detection of monoclonal gammopathy, where data has been used to train the system to provide results comparable to experts.

For our final plenary, on behalf of the Royal College of Pathologists, we were delighted to welcome Dr Graeme Eisenhofer to deliver the Flynn Award Lecture where he presented his work with the laboratory and clinical research groups at University Hospital Dresden on integrating mass-spectrometry data with AI to build clinical support systems for the investigation of adrenal disorders. The aim of the system now developed is to use LC-MSMS steroidomics and AI to allow a route from a patient presenting with endocrine hypertension to operation without the need for additional testing or adrenal vein sampling.

The interactive Clinical Case session was, as always, a popular session to end on. Some excellent presentations were given of really interesting cases and unusual presentations. The audience vote for their favourite presentation in this session and this year’s winner was Mariana Abdel-Malek for her case; a curable fate of chronic hypophosphataemia and runner up was Katie Hadfield, for her presentation; When history repeats itself: a case of unusual thyroid function tests.

A total of 99 posters were presented throughout the conference and the following awards were given:

Audit Poster Award:

Winner: Laura Cook, LDL-cholesterol: time for a change?

Runner up: Emma Dewar, A regional audit of cryoglobulin analysis in Scotland

Cases Poster Award:

Winner: Laura Parry, Sex cord-stromal tumour – a rare cause of precocious puberty

Runner up: Danielle Bell, An uncommon cause of neonatal hyponatraemia and hyperkalaemia

The President’s Shield was presented to Dr Emma Lewis, posthumously, to recognize the amazing contribution that she made to both the FCS and the Association over the many years that she was involved. As her husband was unable to travel to Brighton, the Shield was presented to him at the Countess of Chester hospital, where Emma worked, and was attended by colleagues.

There were also a number of Industry Sponsored workshops hosted by our sponsors, all of which were well attended and thoroughly enjoyed.

In addition to our scientific content and to support the sustainability values of the association, a beach clean was organized for Tuesday evening. This was really well attended and was a great way for delegates to network whilst getting out in the sea air, blowing away the cobwebs and giving back to the local community. Expect more initiatives such as this at future conferences.

LabMedUK25 will be held in Manchester at the Bridgwater Hall 10–12 June.

Supplemental Material

Supplemental Material - LabMedUK24 conference Brighton – editorial

Supplemental Material for LabMedUK24 conference Brighton – editorial by Kath Hayden and Sarah Robinson in Journal of Annals of Clinical Biochemistry.