the association for clinical biochemistry | issue 550 | february 2009

In this issue

Nutrition andObesity in theMendips

HbA1c inOxford

What’s GoingOn . . .Joe O’MearaSpills the Beans

North ShoreHospital DoesDeacon’sChallenge

ACB Directors –Call forNominations2009

The Association for Clinical Biochemistry | Issue 550 | February 2009

ACBNews

About ACB NewsThe editor is responsible for the finalcontent. Views expressed are notnecessarily those of the ACB.

EditorDr Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07973-379050/0121-507-5353Fax: 0121-765-4224

Associate EditorsMrs Sophie BarnesDepartment of Chemical PathologySt Mary’s HospitalImperial College Healthcare NHS TrustPraed StreetLondon W2 1NYEmail: [email protected]

Mr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]

Mrs Louise TilbrookDepartment of Clinical BiochemistryBroomfield HospitalChelmsfordEssex CM1 5ETEmail: [email protected]

Situations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001Fax: 0207-403-8006Email: [email protected]

Display Advertising & InsertsPRC AssociatesThe Annexe, Fitznells ManorChessington RoadEwell VillageSurrey KT17 1TFTel: 0208-786-7376 Fax: 0208-786-7262Email: [email protected]

ACB Administrative OfficeAssociation for Clinical Biochemistry130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

ACB PresidentDr Ian WatsonDepartment of Clinical BiochemistryUniversity Hospital AintreeLongmoor LaneLiverpool L9 7ALTel: 0151-529-3575 Fax: 0151-529-3310Email: [email protected]

ACB Home Pagehttp://www.ACB.org.uk

Printed by Piggott Black Bear (Cambridge) LtdISSN 1461 0337© Association for Clinical Biochemistry 2009

ACBNews

The Association forClinical BiochemistryAnnual National MeetingThe Arena and Convention Centre, Liverpool18th – 21st May 2009

www.focus-acb.orgfocus on ideas: informatics,diagnostics,exercise,audit&science

General News page 4

Practice FRCPath Style Calculations page 12

Council Matters page 15

Meeting Reports page 17

Corporate News page 21

ACB News Crossword page 26

Council Nomination Form page 27

Situations Vacant page 28

Number 550 • February 2009

The monthly magazine for clinical science

Issue 550 | February 2009 | ACB News

Front cover: Pete Astley, Robyn Shea, Sara Neale and Keith Wakelin taketime out from the South West and Wessex meeting held recently in theMendips

Diplomate Statusafter FRCPathPart 1By Katy Cooper, Chair ACB TraineesCommittee and Sarah Hauxwell, ChairRCPath Trainees Advisory Committee

The Royal College of Pathologists recentlyreviewed the post-nominal awards aftersuccessful completion of its examinations.This review was undertaken to bring it linewith the other Medical colleges.As part of this review Membership was

abolished in favour of Fellowship and theDiplomate status was removed. TheDiplomate status has traditionally beenawarded to those who successfullycompleted a form of the FRCPath part 1which involved a written, oral and practicalexamination.The decision was taken after discussions

on the RCPath website and after publicationof an article in the Royal College ofPathologists Bulletin.The loss of the post-nominal award after

completing part 1 led to dissatisfactionamongst the Clinical Scientists in training,who felt the consultation process was sub-optimal. This dissatisfaction was conveyed tothe Clinical Biochemistry Specialist AdvisoryCommittee and thence to College Council,who reviewed its decision and the followingagreement was reached:

• College will not be re-instating theDiplomate status.

• College will extend the term for which thepost-nominal Diplomate is awarded toanyone successfully completing therequired examinations before the end of2009.

• Once awarded the term Diplomate maybe used in perpetuity.

Any Trainees with queries about their ownstatus are advised to contact Daniel Ross onemail at [email protected] �

4 | General News

ACB News | Issue 550 | February 2009

Maurice BellWe regret to record the death of MauriceBell MSc, FRSC at the age of 84. He was aBiochemist at the Manchester RoyalInfirmary, Chairman of the NW Region1964-5, and together with Harold Varley andAlan Gowenlock co-authored the 5th editionof Varley's classical book “Practical ClinicalBiochemistry” (1976).

We have also been informed by Mr AnthonyR Milner’s wife that her husband died on 8thJanuary 2009; and Angela Matthews fromSheffield Children’s Hospital passed away on31st December 2008. �

SudokuThis month’s puzzle

Lastmonth’ssolution

ACB National TrainingCourse No 622nd-27th March 2009Birmingham

Topics includeEndocrinology:

including Interactive Sessionwith Patient Groups

Paediatric Clinical BiochemistryEQA

Standardisation of AssaysProcurement Process

Point of CareDeveloping Networks

Registration:Residents £725 (ACB Members) -Full Board and Social ProgrammeNon-Residents £625 (ACB Members) Social Programme and LunchA Day rate is available on applicationA £100.00 levy will be applied to applications from individualswho are not members of the Association for Clinical Biochemistry.

Closing date for receipt offull payment: 6th March 2009

For further information and a full programme contact:ACB Office 130-132 Tooley Street, London SE1 [email protected]


6 | General News

Call forNominations 2009Election of Directors of the ACBNominations are called for the followingelected Directors: Director of Finance,Director of Publications and Communications(Company Secretary), Director of Education,Training and Workforce, Director of ScientificAffairs, Director of Clinical Practice andDirector of Regulatory Affairs.These posts are for a maximum term of five

years, commencing at the AGM in 2009.The following Directors are stepping down:

Director of Publications and Communications,Director of Scientific Affairs and Director ofClinical Practice, so we are eager toencourage nominations to these posts.The other Directors are willing to continue

for a further term of office.Nominations for these positions, duly

countersigned, should be made on thenomination form in this issue of ACB Newsand sent to: ACB Administrative Office,130-132 Tooley Street, London SE1 2TUbefore 10th March 2009. �

Association ofClinical Pathologists23rd ACP Management Course

2nd-4th September 2009Hardwick House Hotel, Sedgefield

This is a wide-ranging, residential, three-daycourse introducing management issues rele-vant to the running of a modern pathologyservice. It is intended for specialist registrars inpathology, clinical scientists and those whohave held their first consultant post for lessthan one year. The course includes practical,team-based exercises in business planning andfinancial management.Excellent quality en-suite accommodation

and all meals included. Hotel details atwww.hardwickhallhotel.co.ukAs the 2008 course was heavily oversub-

scribed early application is encouraged.Contact: Jacqui Rush on Tel: 01273 775700 or

email [email protected] and registration form:

www.pathologists.org.uk �

City General ReturnsAfter a difficult January, City General returns to discuss how on earth to control the increasingGP workload. A further workload increase in the New Year, on top of a 20% overall last year, ishard to sustain from the front reception to authorising the stuff. How does City General cope . .. how do you cope for that matter? All will be revealed in March! �

General News | 7

Glasgow Wins 2008 ScottishScience Award for Innovation

Part of the team led byProfessor Mike Wallacewho won the 2008Scottish HealthcareScience Award forrecognitionof achievement inhealthcare improvement.Their winning entry wasa simple automatedsolid phase extractionprocedure formeasurement ofVitamin D metabolitesby LC-MS/MS. �

From left to right John Harris,Susan Knox and Mike Wallace(not shown Lisa Calton andIsobel Ferguson)


8 | General News


Association for Clinical BiochemistryNI Region and Association forClinical Biochemistry in IrelandRadisson SAS HotelThe Gasworks, BelfastFriday 3rd April 2009Chair: Dr Tim Lang10.30 Newborn Bloodspot Screening

Mrs Hillary Leslie

11.00 Screening in Familial HypercholesterolaemiaDr Maurice O’Kane

11:40 Bowel Cancer Screening a GB PerspectiveDr Steve Smith

12.20 Screening Fail Safe ProceduresDr Rosemary Clarke

12:50 Lunch

Chair: Dr Michael Ryan

14.00 Biochemical Detection of Pheochromocytoma: Which Test, Which Patient?Dr Robert Peaston

14.40 Transcobalamin as a Marker of B12 DeficiencyProfessor John Scott

15.20 How We Can Influence Local Legislative AssembliesMr Joe O’Meara

16.00 Closing RemarksDr D McKillop, Meetings Secretary ACBNI

Registration

Please register before 20th March 2009 by contacting: Dr Derek McKillop, Clinical BiochemistryLaboratory, Craigavon Area Hospital. Email: [email protected] 0283 8613709 or Ms Ruth O'Kelly, Coombe Women's Hospital DublinEmail: [email protected]; Tel +3 5314 085663

General News | 9


West MidlandsClinical LaboratoryQuality ManagersAssociation SpringSymposiumFriday 27th March 2009Kingston Theatre,Austin CourtBirmingham10:30 Welcome & Introduction

Richard Daw, WMCLQMA Chair10:40 Implementing Uncertainty:

A Practical ApproachDietmar Stockl

11:20 The Electronic Care Record:Implications for QualityManagementRick Jones

12:00 Discussion period12:20 Lunch and networking13:20 Corrective and Preventative

Action: A Practical Guidespeaker to be announced

14:00 Laboratory Quality Managementafter Darzi and CarterIan Barnes

14:40 Discussion period15:00 Analytical and Process Quality:

A National InitiativeDavid Burnett/Jonathan Middle

15:30 Drinks reception, furthernetworking & close

Meeting registration is open to all,but will be of special interest toQuality Managers and Quality Leads.

Registration including lunch is £50.

Further information and onlineregistration is athttp://www.wmclqm.org.uk/2101.html

South WestWishes Wellto Astley

Peter Astley, Robyn Shea, Keith Wakelin andSara Neale

The Autumn meeting of the South West andWessex Region was held in the Mendips. Themeeting included a special thank you to PeterAstley who has recently retired fromSouthmead Hospital in Bristol. Sarah andRoybyn both presented for the regionalSiemens’ Award. See this issue for a fullreport on the meeting. �

Biochemists onthe River . . .This is an early notice for everyone whowould like to attend the ACB SouthernRegion Summer Social event. This will beheld on Saturday 25th July 5.30-10pm.This year you will be invited aboard a cruisealong the Thames which will start by theLondon Eye. Full details next monthbut if you can’t wait then Email:[email protected] �

10 | General News


Lab Tests Online (LTO) UK achieved twosignificant milestones in December 2008. Atthe end of the month, the site saw its sixmillionth visitor since launch in July 2004, andalso passed two million visitors in 2008 whichwas the highest annual figure ever, and 10%of the visitors to NHS Direct! Visitor numbersare still growing at 25% per year, as patientsand health professionals find authoritativeinformation about laboratory tests on the sitein language they can understand.There are now 200 tests and 102 conditions

listed, and the whole site contains over 2000web pages. Patient feedback remainsuniversally positive – recent comments fromusers include . . .

“Congratulations – this isa great resource”

“Really simple andinformative … wish ithad been here long ago”

“Helped with my peaceof mind”

LTO is not a static resource, and continues toexpand and develop with the aid of generoussupport from the Royal College ofPathologists and a grant from theDepartment of Health’s Pathology

Modernisation Programme. The developmentpriorities for 2009 include a new section ofthe site aimed at children, improved designand graphics, audit work to assess andenhance the site’s value to patients and carersand work to develop LTO as an electroniclearning resource for health professionalsalongside other NHS e-learning initiatives andexisting resources like Better Testing(www.bettertesting.org.uk), Pathopedia andMap of Medicine, The inter-relationshipsbetween these initiatives are complex, andneed careful analysis before proceeding.The UK site is part of a global family of sites

raising the profile of laboratory medicine (seeposter), and there are now versions availablein the USA, Australia, Spain, Italy, Germany,Poland, Hungary, Greece and the CzechRepublic. A French site will be coming on lineearly in 2009.LTO UK is managed by a Project Board

chaired by Mike Hallworth and is produced byan editorial team headed by StephenHalloran and supported by Nic Law andDragana Landup-Horgan in the ACB Office.Mike recently received the HealthcareScientist of the Year Award for 2008 inrecognition of his work in bringing the site tothe UK, and was delighted to accept it onbehalf of everyone involved. If you would liketo join the team in any capacity, volunteersare always welcome – contact Stephen orMike for further details! �

Lab Tests OnlineSuccess Continues!Mike Hallworth, LTO Project Board Chair

General News | 11


Separation Science: Applicationsin Clinical BiochemistryA joint meeting of Royal Society of Chemistry,Chromatography & Electrophoresis Group andACB Southern Regionto Mark the Official Retirement of Dr C K Lim

Friday 13th March 2009Robens Suite, Guy’s Hospital, London Bridge, London SE1 9RT

Session 1

Chair: Dennis Wright

10.20 Welcome and Introduction10.30 Porphyrins: 40 Years On

Chang Kee Lim, Birkbeck College11.00 Is the answer to Vitamin D analysis LC-MS?

Sandra Rainbow, Northwick Park Hospital11.30 Coffee/Tea12.00 Modern HPLC Packings: Use in Screening for Inborn Errors of Metabolism

Tony Marinaki, Guys & St Thomas’s Hospital12.30 Clinical Drugs of Abuse Screening: LC-MS vs Immunoassay

Richard Evers, King’s College Hospital

Session 2

Chair: Bob Flanagan14.00 Separation Science in Clinical Chemistry: from Tswett to Metabonomics

David Perrett, Queen Mary, University of London14.30 ICP-MS: Advantages and Pitfalls

Andrew Taylor, Royal Surrey County Hospital, Guildford15.00 Coffee/Tea15.30 Catecholamine Update

Eddie Carr, St Helier Hospital, Carshalton16.00 Volatile Profiling in Clinical Diagnostics: Will There Ever be a Role?

Paul Thomas, Dept of Chemistry, University of Loughborough16.30 Discussion/Round Table17.00 ACB Southern Region AGM and Awards Ceremony (Members Only)18.00 Reception*19.00 Dinner* (Close at 21:00pm)

RegistrationThe scientific meeting includes refreshments and lunch and has been accredited for 4 CPD points.Cost of scientific meeting: £25 members of ACB or RSC, £25 pre-registration Trainee ClinicalScientists, £50 non-members, £10 students or retired members.To register contact Dr Graham Mills, School of Pharmacy and Biomedical Sciences, University ofPortsmouth, St Michael’s Building, White Swan Road, Portsmouth PO1 2DT.E-mail: [email protected]

Serum AFP levels are being monitored following curative surgery for hepatoblastoma in a two-year old boy. Samples are normally being taken at weekly intervals but a repeat sample is takenin error two days after the routine week 4 sample. The requesting clinician is concerned that thissample appears to show evidence of disease recurrence. Assuming a biological variation of 12%and an analytical CV of 6% for this assay, determine whether this concern is justified.

Day AFP (kIU/L)7 1,613,00014 723,00021 329,00028 145,00030 149,000

FRCPath, Autumn 2008

If there had been no recurrence of the tumour then we would expect the AFP to continue to fallafter 28 days as it continues to be cleared from the circulation. However, the value at 30 dayshas risen slightly. So the problem is to decide whether this value is significantly different fromthe expected concentration taking into account both the biological and analytical imprecision.

The first step is to estimate the expected AFP concentration at 30 days. The clearance of atumour marker such as AFP normally follows first-order kinetics and the linear form of theequation is:

ln Cpt = ln Cp0 - kd.t

Where ln Cpt and ln Cp0 are the natural logarithms (to the base 2.718, usually denoted as logeor ln) of the plasma concentrations at times t and zero respectively. kd is the elimination rateconstant.

A useful first step is to calculate ln for each concentration and to plot the values against t:

Day AFP (kIU/L) ln AFP

7 1,613,000 14.29

14 723,000 13.49

21 329,000 12.70

28 145,000 11.88

30 149,000 11.91


12 | Practice FRCPath Style Calculations

Deacon’s ChallengeNo 94 - Answer


Practice FRCPath Style Calculations | 13

The data points for 7, 14, 21 and 28 days all fall on a straight line confirming that the clearanceof AFP follows first order kinetics. Furthermore the value at day 30 is above the line suggestingthat there may well be a recurrence of the tumour. By extrapolating the line beyond 28 days it ispossible to read off the expected ln AFP value at 30 days as 11.66. Taking the antilog then givesa concentration of 116,000 kIU/L (to 3 sig figs).

However, it would be much better to calculate this concentration directly from the data. Usingany two data points the value of the elimination rate constant (kd) can be calculated then usedto obtain the expected concentration at 30 days. Alternatively, if the day 7 result is taken as theinitial value (lnCp0), the mean of the results for days 14, 21 and 28 as lnCpt and the mean valueof t used, then equal weight is given to each pair of results:

ln Cp0 = 14.29

lnCpt = 13.49 + 12.70 + 11.88 = 12.693

t = (14 – 7) + (21 – 7) + (28 – 7) = 7 + 14 + 21 = 14 days3 3

Substitute these values and solve for kd:

12.69 = 14.29 - kd.14

kd = 14.29 - 12.69 = 0.114 days-1

14

Substitution of this value for kd, the lnCp0 result and t corresponding to 30 days (30 – 7 = 23days) into the rate equation allows calculation of the expected Cpt:

lnCpt = 14.29 - (0.114 x 23) = 14.29 - 2.62 = 11.67

Cpt = antilog 11.67 = 117,000 kIU/L

which is very close to the graphically determined concentration.

The next step is to calculate the total imprecision at this concentration. The combined CV(CVTotal) of this AFP result can be calculated from the expression:

CVTotal2 = CVBiological2 + CVAnalytical2

Substitute CVBiological = 12%, CVAnalytical = 6%

CVTotal2 = 122 + 62 = 144 + 36 = 180

CVTotal = √180 = 13.4%

Use this CV to calculate the standard deviation (SD) at the predicted concentration at 30 days(117,000 kIU/L):

CV (%) = SD x 100 so that SD = CV(%) x ConcentrationConcentration 100

Substitute CV = 13.4% and concentration = 117,000 kIU/L:

SD = 13.4 x 117,000 = 15,700 kIU/L (3 sig figs)100

Therefore the 95% confidence limits at the expected concentration of 117,000kIU/L (mean±1.96SD) are:

117,000 - (1.96 x 15,700) to 117,000 + (1.96 x 15,700)

= 117,000 - 30,800 to 117,000 + 30,800 (3 sig figs)

= 86,200 kIU/L to 147,800 kIU/L

The measured value at 30 days (149,000 kIU/L) is just outside of these limits indicating that theclinician’s fear of a possible recurrence is justified. The value obtained at the next sampling time(35 days) should clarify.

Question 95Reproduced below are peak area data from an HPLC analytical run set up to measureplasma phenylalanine. The assay is used to monitor adequacy of dietary control inpatients with phenylketonuria, good control being regarded as maintaining plasmaphenylalanine between 120 and 360 µmol/L.

N-methyl phenylalanine has been used as the internal standard. 200 µL of internalstandard has been added to 200 µL aliquots of samples and standards prior to analysis.

Standard concentration = 500 µmol/LN-methyl phenylalanine (NMP) concentration = 100 µmol/LQC target: 180 – 210 µmol/L

Sample Peak areaNMP Phenylalanine

Standard 20,000 81,000QC 22,000 35,000Patient 21,000 140,000

a) Is the assay in control?b) What is the patient’s plasma phenylalanine concentration?c) What comment would you make about the patient’s control from this result?

FRCPath, Autumn 2008


14 | Practice FRCPath Style Calculations

Dear ACB News readers,

I am a Clinical Biochemistry Registrar in Sydney, Australia. Earlier this year I was required to sit a paper ofcalculations and found the Deacon's Challenge series of problems invaluable in my preparation.However, I believe there is a simple and obvious flaw in the answers to challenge No 84 (March 2008) anda similar problem, No 47 (Feb 2005).

The problems pertain to the question of determining whether a particular concentration of protein in theCSF derives from CSF alone or contains contamination from blood. The solution uses the ratios:

Red cell count in CSF/ red cell count in blood =Protein concentration in CSF from blood/protein concentration in blood

So far, so good. Except that the figure used in the calculations for protein concentration in blood is in factprotein concentration in SERUM. Obviously these are different values, depending on the haematocrit.I spent hours agonising over this and finally got up the courage to admit to my boss I couldn't understandhow a serum concentration could be used instead of blood. I'm passing this on only because he agreeswith me and devoted Deacon’s Challenge readers might be interested!

Regards

Dr Amanda CaswellPacific Laboratory Medicine Services, Royal North Shore Hospital Sydney, Australia

Council Matters | 15


Labs are Vital™ (LRV)

From the feedback I’ve been getting there is afeeling that this hasn’t lived up to its promise!The good news is that the majority of thetechnical difficulties associated with separatingthe UK initiative from the US one have beenovercome and the programme is about to berevitalised! Some of the important points are:

� There is a clear, focused work plan for theWorking group (October 2008 to March2009).

� Tools (such as a “pack” explaining how toorganise an open day) were madeavailable on the website in time forNational Pathology Week (NPW).

� The campaign priorities will be (in order):

� Supporters – providing them with toolsand support and feed-back reports ofsuccessful activities.

� Commissioners and NHS management –a campaign to stimulate their interest inthe importance of laboratory medicine inpatient safety and care and as animportant factor in overall healthcarecosts. Tools for supporters will be gearedto enabling them to follow up locally onthe interests aroused.

� The public – raising the profile oflaboratory medicine in the public eye;NPW will be a significant element in this.

� Politicians and Decision Makers – thecampaign will extend into this arena oncethe groundwork in the other areas hasbeen established.

� Sponsoring bodies will work to consolidateLRV into their communications strategiesand their “business as usual”. Campaignswill be co-ordinated with more localactivities and members will be fully briefedon forthcoming campaigns as well as beingsupplied with materials that can support

their local efforts to follow up on thecampaigns.

� LRV will not “exhibit” at organisations’meetings but participate in theirprogrammes to reinforce being part of“business as usual” rather than a separate,stand alone, entity.

PR and Public Affairs Strategy

The Association’s Strategy for taking forwardGovernment Affairs and Public Relations hasbeen updated for 2008 to 2010 and wasadopted at the Executive meeting on 9thOctober 2008. A copy will be placed on theACB website. The important points are:� To concentrate on three main themes:

� The harmonisation of clinical biochemistryand laboratory medicine in the interestsof improved quality and patient safety.

� The development of knowledgemanagement as an educationalprogramme to achieve good practice inthe use of clinical biochemistry andlaboratory medicine services.

What’s Going On . . .Joe O’Meara, Government Affairs Officer

Joe O’Meara at the Corporate Members’ meetingalong with Peter Carpenter, ACB News Publisher andAndy Bufton of Abbott

16 | Council Matters


� Promoting work on future directions inclinical biochemistry and laboratorymedicine.

� To use LRV as a key delivery vehicle for theawareness campaign and to distributesupport materials to members for uselocally.

� To establish a communications infrastructurethrough the ACB Regions to ensure thatmembers are aware of the campaigns andequipped to follow them up locally withevents and/or background information. Thiswill also allow local issues to be identifiedand addressed and for successes to beshared with others.

� For the Government Affairs Officer toestablish links with DoH activities so that themembership can be kept informed of thecentrally sponsored projects that may affectthem, or in which they might be invited toparticipate. The information will bedistributed through ACB News (hopefullyquarterly) and through the Regionalcommunications infrastructure. This will beextended to Scotland, Wales and Irelandwhen the necessary links have beenestablished.

Parliamentary Launch ofNational Pathology Week

An opportunity has arisen to make apresentation in Parliament explaining whatPathology (and Laboratory Medicine) is aboutand to launch National Pathology Week toMembers of both Houses of Parliament. Weare working with the College on thisopportunity and it will be reported in a futureACB News.

Research Items Gaining Public Attention

Historically we have not done a great deal topublicise interesting research beingundertaken by our Members. Quite apart fromthe value of doing this for the authorsthemselves, there is much to be gained for ourpublications, in the context of increasing theirprofile and attracting good material.Additionally there are benefits for the

Association in establishing its credentials bothas a supporter of research and as anauthoritative body in its field.

Recent Successes

� Fist Clenching during Phlebotomy – VanessaThurlow’s paper attracted the attention ofthe BBC website and this was picked upquite widely, including “USA Today”,“Clinical Services Journal” (web-based),“Nursing Times”.

� HbA1c Standardisation – This picked up acouple of mentions in ScandinavianDiabetology periodicals.

Future Potential

I am working with the RSM publications groupto publicise material appearing in the Annalsand I will work with the ACB PublicationsCommittee to the same end. If you are aboutto publish something that might be of generalinterest, please let me know so that we canlook at promoting it.

Collaboration

This has been a cornerstone of my work fromthe outset. The most significant elements atpresent are:

� With the Royal Society of Medicine onpublicising research published in the Annals.

� With the College on National PathologyWeek and the Parliamentary presentation

� With the College and IBMS on participationin the Schools Science Conference.

� With the College, ACP, IBMS and BIVDA onLabs Are Vital™.

� With Diabetes UK on HbA1c standardisation.

Future Work

My main activities in the immediate future are:

� Parliamentary Presentation.

� Visiting ACB Regional Committees to set upour communications.

� Developing DoH links to identify relevantcentral projects and activities. �

Meeting Reports | 17


The autumn South West and Wessex regionalmeeting was a two-day event held in theWebbington Hotel, located in the beautifulSomerset countryside just outside ofWeston-super-Mare. The meeting, whichmarked the retirement of Dr Peter Astley,incorporated a variety of presentations onnutrition and obesity.

Aspects of Vitamin D

The meeting commenced with a series of talkson the topical subject of vitamin D. ProfessorWilliam Fraser (Liverpool) began with a conciseoverview, highlighting that the only realmarker of vitamin D deficiency is themeasurement of vitamin D itself, as othermarkers of deficiency, such as calcium and ALP,are often not abnormal in deficient subjects.Professor Fraser also illustrated the difficultiesin defining optimal vitamin D status and raisedthe question of whether assay specific

reference ranges would be more appropriate,due to the analytical variation between assays.Continuing the analytical theme, Mr Graham

Carter from DEQAS discussed the analyticalissues associated with vitamin D measurement.Vitamin D analysis is challenging for manyreasons, including; unequal recognition of D2and D3, problematic calibration and matrixeffects in automated immunoassays.Standardisation of both reference limits andcurrent methods are required to lowerimprecision. The need for a certified referencematerial is also paramount.The final talk on vitamin D was given by

Dr Adrian Martineau (London) who explainedthe less well-known aspects of the prohormone.Dr Martineau has been working on theimmunomodulatory actions of vitamin D,which has been found to reduce bothsusceptibility to infections and autoimmunedisorders.

Nutrition, Obesity and theBiochemistry LaboratoryRoanna George, North Bristol NHS Trust

Graham Carter looks at key issues concerned with vitamin D quality assurance

Siemens Award

Following lunch the Siemens Award wascontested, for which there were twocandidates, Miss Sarah Neale and Miss RobynShea. Both presented the findings from theirrecent MSc research projects.First, Sarah Neale (Plymouth) presented her

project on measurement of calprotectin andlactoferrin, faecal proteins that can bemeasured as surrogate markers ofgastrointestinal inflammation. ELISAtechniques are available to measure theseanalytes but results are often not availableimmediately. Rapid Tests for calprotectin andlactoferrin may reduce the need forinvestigation in new patients withgastroenterological symptoms. Sarahevaluated three new ‘rapid-tests’ andcompared them with the standard ELISAs.

She found that:

� Both analytes are good tests for excludingorganic bowel disease and could avoidendoscopy in many patients.

� ELISAs performed better than the rapid tests.

� All three rapid tests showed high specificityand negative predictive values withPhiCaRap being the most sensitive.

� Rapid tests allow samples to be brought tothe clinic where the result can be madeavailable quickly enough to inform theconsultation.

Validation of the Prenatal GeneticDiagnosis of Growth Disorders

Robyn Shea (Southampton) then presentedher project on the investigation of techniquesavailable for the diagnosis of imprinting

18 | Meeting Reports


Robyn Shea from Southampton is presented with the Regional Siemens’ Award by Mike Holden

disorders such as Beckwith-Wiedemannsyndrome. She investigated four methylation-specific PCR assays and four methylation-sensitive high resolution melting assays andadapted them for use with prenatal samples.She demonstrated that there is potential toutilise all of these tests in prenatal diagnosisbut further studies are required, using positivecontrol samples, before the tests can be usedin this setting.Both candidates were very strong but the

prize eventually went to Robyn Shea.

Pathology Harmonisation

A move away from nutrition saw pathologyharmonisation as the next topic on theagenda. This is an ongoing project designed tobring practices in UK laboratories more in-linewith one another. Roberta Goodall (NorthBristol) presented the results of a recent surveyconducted in the region, which demonstrateddifferences in practice between Trusts,including the use of different referenceranges, test names and units. Harmonisingthese aspects will improve the service weprovide and reduce confusion for service users.For further information please visit;www.pathologyharmony.co.uk

A Nutritional Medley

The afternoon continued with Dr Mike Colley(Swindon) who gave an excellent talk onre-feeding syndrome. Cases of overfeeding inseverely malnourished patients werepresented which highlighted that a patientcan show no physical signs of re-feedingsyndrome but their biochemistry can beextremely abnormal, therefore monitoring ofthe biochemistry is essential.Dr Robert Przemioslo (North Bristol) gave an

interesting presentation on fatty liver,explaining disease characteristics, progressionand association with the metabolic syndrome.New methods for disease staging werediscussed since morbidity is associated withdisease progression; therefore staging isimportant for prognosis. Management isdirected at treating the metabolic syndromeand it is important to remember that LFTs canbe normal in 80% of cases.

The evening saw a dinner held to mark theretirement of Dr Pete Astley, who has been agreat ambassador for the profession. He hashelped many of his colleagues, contributedgreatly to every department he has worked inand has been an excellent supervisor ofnumerous Trainees. I am sure that Pete will bemissed by many.

Day Two – Regional Audit Session

Day two began with a regional auditcompetition, aimed at sharing audit resultswith the other Trusts in the region. A total ofseven presentations were given, again, at avery high standard. The first and second prizeswere awarded to Tanya Hart (Poole andBournemouth), who outlined the problemsencountered in her laboratory with CSFspectrophotometry interpretation in thediagnosis of subarachnoid haemorrhage, andTim McDonald (Royal Devon and Exeter), whoaudited preoperative screening testrequesting. This proved a successful, highlyinformative, session, which would bebeneficial to incorporate in future meetings.

Obesity and Nutrition

After morning coffee, obesity was the topic onoffer, with Dr Pinkney (Truro) giving anendocrinologist’s view on the consequences ofobesity. The increased cancer risk associatedwith obesity was outlined, as was the link withinsulin resistance. It was interesting to notethat in an obese state TSH levels will rise,therefore distorting the TSH reference range,which raises the question of whether morethan one range is required.The final talk of the morning session was

given by Professor Byrne (Southampton), whogave a good overview of the metabolicsyndrome and the research he has beenundertaking in this field. The clinical criteriarequired to diagnose the metabolic syndromewere reviewed, as were the consequences ofthe disorder. Adiponectin is the mostpromising emerging biochemical marker forthe syndrome. The pitfalls of the Framinghamrisk score were also highlighted as itunderestimates cardiovascular disease risk indiabetics by a third and survival rate is

Meeting Reports | 19


worsened with increasing numbers of featuresof the metabolic syndrome.The final session gave an insight in the

practical use of nutrition. Sports dietitian MissHelen Brown (North Bristol) started with aninteresting insight into the life of a jockey,illustrating the conflict that the dietitianexperiences giving dietary advice to peoplewho are under-eating on purpose. Theremaining presentations offered a moreclinical slant, with Miss Joanna Clutterbuck(North Bristol) and Miss Alison Singer (NorthBristol) giving talks on nutrition in renal

disease and nutrition in patients with shortbowel syndrome respectively. Both talkshighlighted the difficulty in giving both sets ofpatients adequate nutrition and inmaintaining their fluid balance, as well asillustrating the many biochemical changes thatresult from these conditions.Thanks must go to all of the speakers who

kindly gave their time to deliver the highstandard of presentations and particularly toDr Julie Wassell who worked incredibly hard toorganise this very successful and informativemeeting. �

20 | Meeting Reports


Roberta Goodall presents her audit of regional reference ranges

Trace Elements in Clinical Practice17th June 2009Medical Education Centre, Royal Surrey County Hospital, Guildford

A full day meeting held in conjunction with Atomic Spectroscopy Group, Royal Societyof Chemistry.

For further details, please contact: Dr Andrew Taylor onEmail: [email protected] or see the full programme in ACB News soon.

Corporate News | 21


HbA1c andHaemoglobinopathiesin OxfordIan Barlow, Scunthorpe General Hospital

Professor David Lesley started by remindingus of the rapidly increasing incidences of bothType 1 and Type 2 diabetes, even though theyare quite distinctive diseases. He suggestedthat this is probably due to the origins andevolution of our species due to recentrelatively free availability of calories. As aconsequence, the human genetic profile hasnot adapted immunological and metabolicresponses quickly enough. There is increasingevidence to suggest that chronic inflammationplays a significant role in the development ofdiabetes. Modification of the inflammatoryprocess could provide future treatmentpotentials, such as the use of IL1 receptorantagonists to down regulate the immuneresponse in Type 2 diabetes and anti CD3monoclonal antibody in Type 1 diabetes.

The Genetics of Paediatric Diabetes

Dr Flanagan began by emphasising thatdiabetes is not simply a disease of children andadults, but can be diagnosed in the neonatalperiod and has an incidence of about 1 in100,000. All affected patients are islet cellantibody negative with about 50% of thecases being transient (although it may recur inthe second or third decades of life).Recent advances in genetics have identified

a number of mutations causing neonataldiabetes e.g. the KIR 6.2 mutation whichencodes the ATPase sensitive potassiumchannel. This affects intracellular calciuminflux and subsequent insulin secretion,leading to either permanent or transientdiabetes. The functional severity of themutation seems to correlate with the clinicalseverity and given the wide distribution ofATPase sensitive potassium channels, thismeans that other tissues can also be affected

e.g. some affected babies have severeneurological deficit due to the involvement ofnervous tissue.Similarly, mutations of the sulphonylurea

receptor gene (SUR1) can also manifest asneonatal diabetes. Mutation analysis is veryuseful, as this can be important with respect togenetic counselling.

The Menarini DiagnosticsSymposium on the17 & 18 September 2008was once again held inthe atmosphericKeble College Oxford

22 | Corporate News


Historically, affected babies have beentreated with insulin but recently it has beenshown that sulphonylureas and particularlyglibenclamide can lead to both animprovement in glycaemic control, and also animprovement in neurological symptoms(approx 25% of cases have neurologicalsymptoms). It has been postulated that ifsulphonylurea treatment is begun early it caneven inhibit the development of neurologicalsymptoms in mildly affected patients.Insulin gene mutations, of which 10 have

been identified so far, can also cause neonataldiabetes.She summarised by emphasising that

neonatal diabetes is becoming increasinglyrecognised and understood, and stressed theimportance of obtaining an accurate clinicaland genetic diagnosis as this will influenceprognosis, affect treatment and also helppredict the risk of inheritance.

Lipids and the Patient with Diabetes

Dr Judith Burrows started by highlighting theimportance of abdominal obesity, defined as awaist of >102 cm in men and >88 cm inwomen, in predicting the risk of the metabolicsyndrome and elevated lipids. She went on tohighlight that in the typical diabetic patienthypertriglyceridaemia was a common feature;as was a decrease in HDL.She also emphasised the increased risk of

cardiovascular disease in patients withtriglycerides of greater than 1.8 when smalldense LDL is elevated. This is because smalldense LDL is very susceptible to oxidation withan increased risk of an atherosclerotic plaquedeveloping. She went on to highlight thenumerous guidelines that have emerged withregard to the monitoring and treatment ofhyperlipidaemia in the diabetic patient withthe two most recent ones being the JointBritish Societies (JSB2) guideline and the NICE2008 guideline.The JBS2 guideline argues that no distinction

should be made between either primary orsecondary prevention as diabetic patients areat a higher risk of vascular disease (20% riskwithin a 10 year period) in any case, thereforethey should be treated accordingly. Moreover,

all patients over 40 years of age should begiven a statin, as should patients between 18and 39 if the HbA1c is 9% or higher and if thepatient has either hypertension or hyper-cholesterolaemia. She also highlighted thelower treatment targets for total cholesterolof <4.0 mmol/L and LDL of <2.0 mmol/L, butemphasised that it will prove very costly toachieve these targets if all patients aretreated.Five years ago the target cholesterol was 4.8

mmol/L but recent evidence has shown thatdecreasing LDL, irrespective of what thestarting cholesterol is, will realise benefits tothe patients. Lifestyle changes, together withimproved glycaemic control, are vital todecrease the risk of CHD events. Notably a lowfat diet rich in plant sterols, together withdecreased alcohol intake, stopping smokingand weight loss, particularly if associated withincreased exercise can all be beneficial. It hasbeen shown that exercise even withoutassociated weight loss has beneficial effects.Current therapy included in the NICE

guideline includes ezetimide (which stopscholesterol being absorbed in the gut), but theclinical benefit of this is still unclear. Moreover,there could also be an increased cancer risk.Fibrates are beneficial in both increasing

HDL and decreasing triglycerides but as yetthere is little clinical evidence to supportwidespread use. In contrast, nicotinic acid hasbeen shown to increase HDL, decrease bothLDL and VLDL and is probably clinicallyeffective but the side effects (notably flushing)often mitigate against its use. Anti-flushingagents could well be available in future whichare likely to increase the use of nicotinic acid.Recently CETP (cholesterol ester transfer

protein) inhibitors have been shown to beeffective in increasing HDL levels by up to 72%and also causing a modest decrease in LDL, butsurprisingly these patients appear to haveworse outcomes. The reason for this is obscurebut could be related to associatedhypertension in treated patients.Judith concluded by saying that the rates of

CHD deaths have decreased dramatically overthe last 25 years, partly due to reducedsmoking, better treatment of diabetes and

Corporate News | 23


hypertension and also by the increased use ofstatins. As an illustration of this, 4,000prescriptions for statins were written in 1994,whereas 40,000 such prescriptions werewritten in 2005. Clearly the cost to the NHS hasincreased dramatically, but the overall healthburden of CHD has decreased.Dr Norman Roberts began by reminding us

of the factors that affect glycation ofhaemoglobin and also emphasised thatalthough the N terminal of valine is the majorsite of glycation it is by no means the only site.Diglycation can also occur, but is rare. Normanhighlighted the importance of checking HPLCchromatograms routinely, to help identifyatypical separations and haemoglobinvariants. It is important to remember that thevariant itself can also be glycated andtherefore can co-elute either with the HbA orthe HbA1c peak. For example, the Raleighvariant can co elute with HbA1c and giveapparent values of 40%!He also discussed the difference between

mean plasma glucose levels and glycation ratesof red cells. Density of red cells, whichincreases with age, seems to be important;therefore ‘young’ cells have relatively lowdegrees of glycation due to their low density.Middle-age cells with medium density areincreasingly glycated, whereas old blood cells,which are high density, have the highestglycation. In other words, the glycation rate istime-dependant on the age of the cell.Therefore the HbA1c measured will beaffected by the red blood cell life, which canbe crucial in interpreting HbA1c in, forexample, patients with haemolytic anaemias.Ideally we should be considering correctingHbA1c for the age of the red blood cell, butuntil we have a simple method to assesserythrocyte age this will not be feasible.

Consensus on Reporting of HbA1c

Dr Garry John gave an overview of the IFCCHbA1c standardisation programme andhighlighted that European law stated that wemust have traceability to a higher referencevalue and this in essence has led to some ofthe current work within the IFCC.There was lively debate on the topic, but the

consensus statement at present proposes thatHbA1c is reported in IFCC units (mmol/mol ofhaemoglobin), the derived NGSP HbA1c i.e.DCCT aligned result and (subject to a verylively debate) the average derived glucoseresult, which is a calculated parameter basedon the IFCC HbA1c.

Estimated Average Glucose Result (eAG)

The difference between DCCT and IFCC HbA1clevels is in the region of 1.5 - 2.0%. It istherefore considered that utilisation of acommon currency (eAG) between patients anddoctors (i.e. patients already measure theirown glucose anyway) might be deemed to bea more suitable, and understandable, estimateof diabetic control, rather then the new IFCCHbA1c measurement.Whilst this has some theoretical advantages

Professor Eric Kilpatrick emphasised thatstudies have shown that when HbA1c iscompared to eAG there is a huge spread ofresults. For example, patients with the sameHbA1c result of 8% could have glucose resultsbetween 7 and 15 mmol/L!Therefore it would seem that eAG adds

nothing to HbA1c as an indicator of glycaemiccontrol. He also highlighted the potentialproblems that glucose meter reliability andtiming of glucose measurements might haveon the clinical utility of eAG. His feeling wasthat in the UK and Europe eAG was unlikely tobe adopted but he thought the USA might. Anentertaining and lively debate ensued!

Overview of Sickle Cell ScreeningProgramme

The screening programme first began inBirmingham 30 years ago where 20,000 gelelectrophoreses were done each year.Fortunately, automated HPLC systems nowmake life simpler! National screening has nowbeen in place for two years in England and isalso in the NHS plan. The incidence can be ashigh as 1 in 2000, with a high incidenceamongst African and Afro Caribbeanpopulations. Screening is done using the dryblood spot sample, alongside PKU, congenitalhypothyroidism and MCAD screening and isundertaken by 13 laboratories in England.

24 | Corporate News


Screening is starting to put pressure onhealth economics, as it costs approximately£20,000 per year to treat an affectedindividual. He highlighted that the disease isvariable with up to 80% of affected patientshaving relatively few problems whilst theremaining 20% can have severe organdamage; the reasons for which are not fullyunderstood. The triggers for “attacks” arenon-specific but infections are commonlyimplicated. Risk of stroke is high and this caneven occur in children - who may be left withsevere brain damage.However, 20-30% can have silent infarcts

where more subtle neurological problemsensue. Tools for assessment include annualtranscranial Doppler and measurement ofoxygen saturation, where a threshold of 96%is considered to be the level above whichfewer incidents occur.Other problems include endocrinopathies of

the pituitary and adrenals and delayedpuberty. The mainstay of treatment is bloodtransfusions, but iron chelators are needed iftransfusions are regular. Recently, oral ironchelators are becoming available thereforetransfusion is being offered more often.Hydroxyurea and stem cell transplants are alsopossible treatment options.

Spectrum of Haemoglobin Disordersin the UK

Professor John Porter introduced delegates tonew concepts in pathophysiology of sickle celldisease (SCD) and beta thalassaemia (Bthal)Approximately 12,500 SCD and 900 betathalassaemia sufferers are in the UK currently,together with 240,000 carriers of SCD and214,000 carriers of Bthal. Iron overload is amajor problem due to increased red cellturnover and transfusions, and thesequestration of sickle material in organs andcell debris in the blood stream can affectvirtually all organs and systems. When thishappens in the lungs it can be catastrophicand results in the sickle chest syndrome.A common feature of SCD is a depletion of

nitric oxide which promotes vascularvasoconstriction, the consequences of whichcan be pulmonary hypertension, priapism, leg

ulceration and non-haemorrhagic stroke.LDH levels can be used to subtype thephenotypes that have different haemolysisrates and iron chelation is vital to improveoutcome.He went on to highlight that low production

rate or high turnover rates of cells cancompromise the ability to detect normalhaemoglobins, emphasising the need to use acombination of laboratory techniques, notablyHPLC, isoelectric focusing and the “goldstandard”, mass spectrometry to elucidate rareabnormalities.Compound heterozygotes can be particularly

challenging and it can be sometimes useful togo back and test the parents of potentiallyaffected individuals to elucidate further.

Problems in Thalassaemia Diagnosis

Professor Bain rounded off the meeting byspeaking about Beta Thalassaemia andproblems in its diagnosis. Beta Thalassaemia isclassified as minor, intermediate or major andis an important diagnosis to make as it oftenmanifests with multiple fractures andhepatosplenomegaly in third world countries.She emphasised the importance of using thepercentage of HbA2 in such patients, which istypically measured using gel electrophoresis orcapillary electrophoresis. Haematology indices(MCV and MCH) are also useful but sheemphasised that these can be affected byconditions other than beta thalassaemia e.g.iron deficiency, renal failure, liver disease;thereby confounding diagnosis. Moreover,B12/folate deficiencies can also maskabnormalities by correcting what wouldotherwise be “abnormal” indices.DNA analysis in these situations can be

particularly useful. She also highlighted thatHbA2 methods should be more robust, asdifferences between instruments can be asmuch as 0.5% and large differences betweeninstruments from a common manufacturer canalso occur. She also emphasised the need toimprove imprecision and appealed to themanufacturers to get to grips with theseissues.She also emphasised the importance of

carefully inspecting HPLC traces to pick up rare

Corporate News | 25


defects such as Bthal “zero” or the alpha chainvariant G Philadelphia which can cause seriousinterpretational problems.She also highlighted the need to be aware

of potential carry-over on HPLC systems, whichcan cause serious interpretational pitfalls forthe unwary.Other interpretational difficulties can occur

in diabetes, secondary to HbA2 glycation,where the A2 retention time can be changed.Moreover, false increases in HbA2 can occur ifhaemoglobin is unstable e.g. in reticulocytosisor in patients with sickle cell traits or inanaemia.HIV infection and HIV treatment can cause

increases in A2 as can hypothyroidism andB12/Folate deficiency. Haematology indices canalso be similarly affected by other problemssuch as liver disease and again causeinterpretational problems. Paternity issues can

also arise e.g. in IVF programmes (or infidelity)where the origin of sperm and eggs can bedifficult to establish!Screening in the UK is done antenatally but

in other countries e.g. in Cyprus, where 1 in1000 Cypriots are affected, it is done when amarriage licence is being applied for. Suchprenatal screening is vital in Cyprus otherwisethe health system would be overwhelmed bynumbers of affected births. The incidence isalso high in the Middle East, thereforescreening programmes are widespread andeffective.This was an excellent meeting with scientific

content of the highest standard, and greatopportunities for networking. Many thanks toMenarini for the invitation and I look forwardto the possibility of attending the nextmeeting in two years time. �

26 | Crossword


ACB News CrosswordSet by RugosaKeep sane at coffee time with the ACB News Crossword. Always relating to the science and practice ofClinical Chemistry, you will never cease to be astounded by the convoluted mind of the ACB NewsCrossword compiler.

Prizes for your department: The first five correct solutions to appear on the ACB News fax machine (Fax:0121-765-4224) will receive a copy of the new educational Calcium Cases CD-ROM by Aubrey Blumsohn,Christina Gray, Neil McConnell, John O’Connor, Anne Pollock & Roy Sherwood and which retails at over£50. Please state clearly the name and address of the Department that is entering the competition.Remember that ACB News appears first as a PDF on www.ACB.org.uk around the 7th of each month.

Across1 Key citizens, men, organised

laboratory rates study (6,8)9 Fate of a mark change (5)10 Delivery of fluid for each

union (9)11 Voter upset re letter of credit

frittered away (7)13 Sneaky carnivorous mammal (6)15 Bottle opening after short

presentation for retirement fromservice (5)

18 Pointless deaf clinic treatment for‘Chalky’ (9)

20 NHS lawyer dealt with liquid gasrule (6,3)

21 Scheduling chart designer backshorse before race (5)

23 To wit, Scary Spice in denial (6)25 Add cover (7)29 Reason client let free (9)31 Traces scraps (5)32 Bank rule review confounded

rate plot (10-4)

Down2 Look after harbour (5)3 Pick out tipsy-cake mixture

leavening agent (5)4 Imply a relic was damaged by

experiment (11)5 Initial blood test assesses

intelligence in the US (3)6 Providing training with leading

text and new guidance (9)

7 Radical group that is outside,poorly lit up (5)

8 Drop basin (4)9 Inventor of a chemical method:

more a Jekyll and Hydecombination, losing readymoney (8)

12 Surprise at the dovecote? (3)13 Odd fellows with sound of

approval (4-7)14 Resisted change, like Sophie

Barnes or Louise Tilbrook forexample? (8)

16 Island staff (3)17 Gas rule lad left Wales upset (6,3)19 Charged one 31 of a pistachio

nut (3)22 Whole makes small holes,

we hear (3)24 Muscle biochemical performance

not good (5)26 Wax mount (5)27 Perfect mouth (5)28 Work on land for money (4)30 Period of first experimental

reaction-rate analyser (3)

Last month’s solution

Winners from Last Month:Hairmyres Hospital, East KilbrideHope Hospital, Salford

Council Nomination Form | 27


Association for Clinical BiochemistryCouncil Nomination Form 2009Election of Directors of theAssociation for Clinical Biochemistry

We, the undersigned, being Members* of the Association nominate

Name …………………………………………………………………………….

Address…………………………………………………………………………….

…………………………………………………………………………….

…………………………………………………………………………….

for election as ** Director of Finance /Director of Publications and Communications (CompanySecretary)/Director of Education, Training and Workforce/Director of Scientific Affairs/Director ofClinical Practice/Director of Regulatory Affairs according to Articles 11 and 14 as outlined inBye-Law 6, subsections 6.2 and 6.3 of the Articles of the Association.

Name 1. …………………………… ………………………………………….Capitals Signature



I am willing to undertake the duties and responsibilities of this office if elected.

………………………………………….Signature

………………………………………….Date

* Every Member other than a Corporate, Retired, Temporary Retired, Temporary, Federation,Affiliate or Student Member shall have one vote and is therefore entitled to support anomination. Federation Members can nominate and vote for the election of the Director ofRegulatory Affairs. Only Ordinary Members are eligible to hold office.

** Please make the appropriate deletions.

This form, duly countersigned, to be returned toThe Administrative Office, Association for Clinical Biochemistry,130-132 Tooley Street, London SE1 2TU, before 10th March 2009

28 | Situations Vacant


Situations Vacant | 29


To advertise your vacancy contact:ACB Administrative Office,

130-132 Tooley Street, London SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

Deadline: 26th of the month prior to themonth of publication

Training Posts:When applying for such posts you should ensurethat appropriate supervision and training support will be available

to enable you to proceed towards state registration and theMRCPath examinations. For advice, contact your Regional Tutor.The editor reserves the right to amend or reject advertisementsdeemed unacceptable to the Association. Advertising rates are

available on request

30 | Situations Vacant


Sheffield Children’sNHS Trust

Clinical Scientist£29,091 - £38,352 per annum – Band 7Clinical Chemistry & Molecular Genetics37.5 hours per week

This is a full-time permanent post shared betweenClinical Chemistry & Molecular Genetics but hosted byClinical Chemistry.

The Department of Clinical Chemistry offers a wide-ranging service for inherited metabolic disorders for thehealth region & beyond, an acute clinical chemistryservice for the hospital and a regional NewbornScreening Service. The Department of Molecular Geneticsoffers a wide range of molecular services for neurologicaldisorders, collagen disorders including Ehlers Danlossyndrome, inherited metabolic disease &oncology/leukaemia.

This post offers an opportunity for an enthusiasticcandidate to work within a small team in developing theClinical Chemistry/Molecular Genetics Service primarilyfor the NCS funded service for Ehlers-Danlos and othercollagen disorders. However, the post-holder would alsobe involved in supporting the metabolic bone diseaseservice & other areas within the laboratory through theprovision of biochemical & molecular assays, clinicaladvice, interpretation of analytical results, liaison withmedics and other laboratory services.

The post provides an excellent opportunity for a clinicalscientist with good communication and team workingskills to further develop their role within this expandingpaediatric diagnostic service.

A broad training in Clinical Chemistry with someexperience of paediatric biochemistry and/or an aptitudefor implementing/developing new assays would be anadvantage.

Study towards completion of FRCPath is encouragedwithin this fully integrated Pathology/GeneticsDirectorate.

Sheffield is a vibrant city offering easy access to theDerbyshire National Park. For further information or toarrange an informal visit please contact Dr Simon Olpin,Lead Clinical Scientist on 0114-271-7267 (MetabolicSection), or Dr Ann Dalton Head of Molecular Geneticson 0114-271-7004.

An application pack can be obtained via the NHS Jobswebsite www.jobs.nhs.uk or by contacting the HRDepartment on (0114) 2260634 (answer phone) quotingreference 425-434-09.

Closing Date: 12 March 2009

Sheffield Children’s NHS Foundation Trust in accordance with theEqual Opportunities policy is committed to treating all individuals

equally irrespective of age, race, social background, gender,sexual preference, colour, disability, nationality, ethnic origin,

marital status, religion or trade union membership.

Situations Vacant | 31


130-132 Tooley Street, London SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

Deadline: 26th of the month prior to themonth of publication

Training Posts:When applying for such posts you should ensurethat appropriate supervision and training support will be available

to enable you to proceed towards state registration and theMRCPath examinations. For advice, contact your Regional Tutor.The editor reserves the right to amend or reject advertisementsdeemed unacceptable to the Association. Advertising rates are

available on request



130-132 Tooley Street, London SE1 2TUTel: 0207 403 8001 Fax: 0207 403 8006Email: [email protected]

Deadline: 26th of the month prior to the month of publicationTraining Posts:When applying for such posts you should ensure that appropriate supervision

and training support will be available to enable you to proceed towards state registration and theFRCPath 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

the association for clinical biochemistry | issue 550 | february 2009

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