Volume 54 Number 1 April 2000 ISSN 1171-0195

New Zealand Journal of Medical Laboratory Science

Official Publication of the New Zealand Institute of Medical Laboratory Science Incorporated

www. n z i m Is .o rg. n z A New Milestone in Blood Gas Instru~ntation

A Six Test Blood Gas/Oxygenation Panel

SQ2o/o nova Stat Profile® pH Ox Blood Gas/Oximeter biomedical Advanced Menu Automated Quality Control Using a unique combination of advanced optical and There is no operator involvement needed to run daily electrode technology, Stat Profile pHOx measures quality controls. A unique system combining on board hematocrit, hemoglobin, and oxygen saturation in controls and dedicated software allows QC to be run

addition to the standard pH, pC02, p02 blood gas either on a preprogrammed basis or on demand. panel. This new six test pHOx menu gives a much No Gas Tanks more complete diagnosis of patient oxygenation status at the same time, cost, and sample volume as Small Sample Volume the old three test menu. The full six test profile is run using 70 uL of sample. A

three test profile of pH, p02,and pC02 can be run using only 40 uL of blood.

New Zealand Distributor, DADE BEHRlNG DADE BEHRING DIAGNOSTICS LTD, P.O. Box 4079, Auckland Phone 09 366 4784 or Fax 09 379 8308 Freecall 0800 807 982 Email info@dadebehring .co.nz New Zealand Journal of Medical Laboratory Science Volume 54 Number 1 April 2000 ISSN 1171-0195

TH Pullar Memorial Address 1999 Fellowship Treatise

Deconstructin g the laboratory. Optimising the effectiveness of platelet transfusion therapy.

John Aitken ...... 3-6 Mark Bevan ...... 7-13

Editorial Regular Features

"Have To" or "Want To". Cha llenges for the 3rd Advertisers in this issue ...... 40

Millennium. Index to volume 53, 1999 ...... 19 Instructions to Authors ...... 2 Anne Paterson ...... 18 New Products and Services ...... 25-26 NZ Laboratory Science Trust ...... 37 Original Article Obituary- Karen Jane Hastie ...... 37 How accurate is data in abstracts of research articles? QTA Exam in ations ...... 28-30 Rob Siebers ...... 22-23 Special Interest Groups ...... 31-32, 38-40

NZ J Med Lab Science 2000 NEW ZEALAND JOURNAL OF MEDICAL LABORATORY SCIENCE

Editor: Rob Siebers. Wellington School of Medicine Information for Contributors: The Journal publishes original, review, leading & technica l articles, Editorial Board: short communications, case reports and letters in all disciplines of Biochemistry Medical Laboratory Science as well as related areas of interest to Trevor Walmsley Canterbury Health Laboratories, Chfistchurch Medical Laboratory Scientists (eg) epidemiology, public & community Cytology health, education, ethics, computer applications, management, etc. Carol Green Valley Diagnostic Laboratory, Lower Hutt All papers published will be in the form known as the "Vancouver Haematology Style" or Uniform Requirements for Manuscripts Submitted to Ross Anderson Diagnostic Laboratory, Auckland Biomedical Journals. Concise details are listed below while full details Health & Safety may be found in the NZ J Med Lab Science 1991; 45 (4): 108 -11 or Sue Duncan Blood Bank, Wellington Hospital from the Editor. Histology Papers submitted to the Journal are refereed and acceptance is at Ann Thornton Wellington School of Medicine the discretion of the Editor. Papers with substantive statistical analysis Immunology and data will be reviewed for appropriateness by the Statistical Adviser. Roger Linton Medlab South, Christchurch No undertaking is given that any article will be published in a particu­ Microbiology lar issue of the Journal. The copy deadline for each issue is the first of Sandie Newton Diagnostic Laboratory, Auckland the month prior to the month of publication. Jennie Dowling Diagnostic Laboratory, Auckland MNZIMLS Manuscripts: Fran van Til Rangiora Submitted papers (in duplicate) should be typewritten, in double Statistics spacing throughout on one side of A4 paper. Generally each Gordon Purdy Wellington School of Medicine component of the manuscript should begin on a new page in the Transfusion Science following sequence. Sue Baird Southland Hospital, lnvercargill * Title of paper, authors (including first name and Geoff Herd Northland Hospital, Whangarei qualifications), and institution(s) w here the work was carried out. Overseas Address for the corresponding author should also be given. John Sterling Editor, Australian journal of Medical Science * Abstract and keywords. Abstracts should be structured Tony Woods Editor, Australian Journal of Medical Science and contain concise and precise information regarding the study's Objective(s), Method(s), Result(s) and Conclusion(s). List up to 4 The New Zea land Journal of Medica l Laboratory Science is published keywords using Index Medicus medical subject headings. three t imes per year (April, August and November) on behalf of the * Text, in the order of Introduction, Materials and New Zealand Institute of Medical Laboratory Science (Inc) by Methods, Results, Discussion and Conclusion. Centurion Print Ltd, Auckland. * References should follow the style adopted by the US National Library of Medicine as used in Index Medicus. Refer to The Journal is indexed in the Cumulative Index to Nursing and Allied papers in recent issues of the Journal for guidance (or see NZ J Med Health Literature (CINAHL) and Excerpta Medica/EMBASE. Lab Science 1991; 45 (4): 108-11 ). Authors are responsible for accuracy of all references. Subscriptions: * Illustrations must be provided with a suitable legend typed Subscript ions to the Journal for non-members requiring delivery in on a separate sheet. Graphs should be 2-3 times larger than they New Zealand is $NZ33.00 for 1 year surface mail paid. Subscriptions would appear in the journal and contain a minimum of lettering. to the Journal for non-members requiring delivery overseas is Legends for these should also be typed on a separate sheet. $NZ39.60 for 1 year surface mail paid. All subscriptions except for Photographs should be original sharp, glossy black & white prints. single issues are due in February. Single issues are $NZ 12.00 Surface Authors wishing to submit colour photographs must contact the mail paid. Members of the NZIMLS should send their enquiries and Editor in the first instance. address changes directly to the Executive Officer of the NZIMLS, PO * Tables should be typed on a separate page complete with a Box 3270, Christchurch. title at the top and footnotes at the bottom. The tables should be numbered as they appear in the text and must not contain vertical lines. Advertising: * Acknowledgements should be made to people and/or Advertisement bookings and enquiries should be addressed to the organisations who have made substantial contributions to the study. Advertising Manager: Trish Rei lly, 48 Towai St., St Heliers, Auckland 5. Authors are responsible for obtaining consent from those Phone: (09) 575 5057. acknowledged. Financial contributions towards the study from granting bodies or commercial organisations must be stated. Editorial: Two copies of the manuscript are to be addressed to t he All editorial matter, including submitted papers, press releases and Ed itor NZ J Med Lab Science, d - Department of Medicine, Wellington books for review should be sent to the Editor: Rob Siebers, School of Medicine, PO Box 7343, Wellington South, together with a Department of Medicine, Wellington School of Medicine, PO Box 7343 letter from the corresponding author stating t hat the work is original, Wel lington South. Phone: (04) 385 5999 (Ext: 6838). Fax: (04) 389 is not under consideration for publication elsewhere, and in the case 5725, E-mail: [email protected]. of multi-authorship that all authors have contributed directly to the Contributors and advertisers are responsible for the scientific content planning, execution, analysis or to the writing of t he paper. and views. The opinions expressed in the Journal are not necessarily Additionally, author(s) are to state in writing that they have checked those of the Editor or Council of the NZIMLS. references cited in t heir article against the original or appropriate

NZ J Med Lab Science 2000 2 CDeconstructing the Laboratory

fohn Aitken Southern Community Laboratories, Princess Margaret Hospital, Christchurch

NZ J Med Lab Sc1ence 2000; 54(1).3·6

As someone more used to being used as a warnin g, rather than an • Capped laboratory budgets. example, I was somewhat surprised to be asked to give this address. I • Integrated care: Th is trend will channel money from traditional looked back over addresses given for the last 10 years, and was intim­ providers to a range of new options. idated by the quality and w isdom displayed in the presentations of my In the wider world we have seen the rise of aids, the development predecessors. I also noted that a high percentage of presenters subse­ of treatments for HIV, the co llapse of communism, the invention of the quently go through a career change, not necessarily to their advan­ PC, land in g on the Moon, the mu ltiplication of bureaucrats, the tage. I then mentioned to a few people whose opinions I respected remote exploration of Mars, and the emancipation of the descriptive that I was invited to deliver the Pu ll ar address, and the universa l analyti ca l word "bugger" by Saatchi and Saatchi response was, "well for God's sa ke, whatever you do, don't make it Dr Pullar has been quoted by another speaker as once stating that boring." Given the short attention span of most of my co ll eagues, this " if the job is well done, then it is noble." This is a fine sentiment, and is indeed a chall enge. I ag ree with the aphorism. Unfortunately, the reality of 1999 is better I chose as my title, " Deconstructin g the Laboratory" summed up as: "Bust your guts and do your best; go down the road Deconstruction is a term used to desc ribe a process of taking some­ with a II the rest." thing apart to understand it better. Reconstruction (restructuring) is What is wrong with us? First and foremost, we have an id entity cri­ the process of putting it back together aga in . If I decided to strip a ca r sis. We don't rea lly kn ow what we are. Here are so me co mmon term s down to see how it worked, that would be deconstruction. for our profession . Reconstruction wou ld be putting my car back together again, a M edica /laboratory technologist process I am not sure I cou ld carry out. If I wanted to remove one Medica/laboratory scientist provider from the market, and then introduce competition amongst Microbiologist, biochemist etc other providers, I might remove one wheel from the car and then set Grade Laboratory Officer the remaining three wheels to operate in opposing directions. This Lab technician would be see n as restructuring the car. So I'm just deconstructing Laboratory worker today -don't expect any so lutions. Pathology staff I never met Dr Pull ar, and have been unable to estab lish any li nk, however tenuous, between us. All ag ree however, and who am I to Ou r professional stand in g is uncertain, and our fortunes change argue, that Dr Thomas Pu ll ar, was an exceptional Pathologist, with rad­ accord in g to the whims of po liticians and our superiors. Right now, ical ideas about the elevated place that technologists should occupy in our stock is low; as evidenced by the fact that we are now cal led lab­ the sc ientific hierarchy, and the ab il ity and drive to push them into oratory workers by the media and some employers, which I consider a action to ach ieve it. Boy, do we need more people like him now. demeaning term. Other types of "workers" include sex workers and Dr Pu llar died in 1966, since his death we have seen major changes freezing workers. We don't refer to dentists as mouth workers. - God in laboratory services. knows what they'll be ca lling gastroenterolog ists. Our professional In the Public Sector, the laboratory can be seen either as a cost se lf-esteem is low, and progress off the bench and into management centre, part of the cost of treatment of a patient, or a profit centre, is mistakenly seen as a step upward by some medical laboratory scien­ earning external revenue for the hospital. The correct role in the cur­ tists. rent environment is stil l not clear. Technologists as a group of professionals rose to prominence dur­ The com munity laboratories face yet another round of close exam­ ing the Second World War. The origins of the technologist are li nked in ation, as well as the pressures of an in creas in gly co mpetitive mar­ to military developments. Military organisation was very lean, partly to ketplace. all ow for the direction of large bodies of troops on the battlefield. The Both groups have been affected by common pressures: Ca tholic Church has a similarly lean structure, for similar reason s. • Consolidation: Community providers are formin g alliances and Older members of the Institute will reca ll members of the NZIMLT who mergers. Public Hospitals are merging into larger facilities were trained in the UK by the British Armed Forces, usually conscript­ (Auckland , Wellington, and Christchurch) . ed as part of compulsory mi litary training (CMT) Looking back at pre­ • Downsizing: There is a national trend towards reduction of labo­ vious efforts to manage technologists is interesting, if only to see what ratory staffing levels, particularly at provincial level. not to do. Technologists do well in Wartime. • HFA re structuring : The purchaser wants value for money. • Fragmentation of technica l workforce : more staff are going part­ Britain time, or lack on-the-·job experience . Because of the highly technical nature of night bombing and the con ­ • Recruitment and retention problem s: Staff are more mobile, and tinual development of countermeasures by the German forces, there are attracted by higher wages in the community sector. was an extraordinary amount of technical equ ipment aboard a

NZ 1 Med l ab Sc1ence 2000 3 Lancaster bomber, as I have mentioned in a previous address to the plex challenges were found through the creation of self-managed Institute To use this technology, the crew had long and intensive tech­ teams of technical experts. nical t raining The average crew was older, and more likely than other In Postwar Japan, the US Occupation Forces began the process of branches of the armed forces to contain members with tertiary quali­ reconstruction of Japanese Industry. W.Edwards Deming was a statis­ fications The formation of a bomber squadron is instructive, given the tics expert sent by the USA to occupied Japan after the Second World investment and impact of RAF Bomber Command . Each bomber War. In a roundabout way, Deming built on the industrial complex squadron had a thin senior layer, often with a high percentage of staff experiences of the Second World War and instituted practices to revo­ w ho had flown previous tours before promotion to a leadership role. lutionise the Japanese economy, in a world no longer preoccupied This management layer was responsi ble for discipline and administra­ w ith destruction. On the basis of his theories and experiences, Deming tive functions. instituted 14 points for good management. Each of the 14 points pre­ An aircrew was self selected during operational training, and cisely addresses a specific aspect of Company cu lture. These are sim­ recognised as a single entity (what we now call a team.) The statisti­ ple ru les for efficient, sensible, and cooperative management. cal odds of surviving a tour with bomber command were 25%; hence Dr Deming was interested in data, and critically interested in what there was sufficient inducement to interact quickly and without fric­ people did w ith it. In his later work, built on the 14 points, he advo­ tion for the survival of the crew. Each bomber crew had it's own cated trying to understand and appreciate production as part of an ground crew. They were required to maintain the aircraft in top con­ overall system. Appreciation of the system requires some understand­ dition at all times, carry out servicing, refueling, bombing up, and ing of statistical variation, some understanding of psychology, and an instrument maintenance functions appreciation of the central position of the individual in generation of Although an essential component of any operation, they did not business. Each of these factors is inter-related and seen as a system. participate in operations as aircrew. They were auxiliary support staff. When the system is in harmony, quality improves. Disharmony cre­ There was a clear distinction between aircrew, groundcrew, and senior ates conflict. The harmonious integration of an individual into a bal­ command in the squadron hierarchy. anced system is a very Japanese concept, thus his ideas were readi ly Bomber command was data driven. Ra id damage was analysed, adapted in post war Japan, and the implementation of Deming's the­ and t he information used to modify tactics. The horror of area bomb­ ories was t he single most important factor in the spectacular growth ing and the toll on civilian populations has been well documented and of the Japanese automobile industry. descril:ied elsewhere. Armchair analysts may sit in judgment on t he Deming's ideas have particular application to high-tech specialties morality of area bombing, but nothing is simple. They w ere brave men, and ca n be discovered easily by a Net Sea rch (using Deming as key and no subsequent review can mar t he honour of t hat epitaph word). As examples, the following terse observations taken from his writings on management may ring some bells: USA "Fear invites wrong figures " The most obvious example of military use of technical expertise was "Bearers of bad news fare badly. To keep his job, anyone may pre­ the Manhattan Project. The aim was to produce t he Atomic Bomb. Top sent to his boss only good new s." scientists and technologists from all allied count ries and disciplines "Statistica l calculations based on warped figures may lead to con­ were recruited and tightly controlled by a central authority for a single fusion, frustration, and wrong decisions." purpose. The project was overseen by the military, but scientists were So, w hat can we, as Specialists in our various disciplines learn from given full rein on the building of the bomb, and few administrative the mistakes and successes of the past ? restrictions were placed on the development of the weapons. The suc­ cess of that project became clear to the world on the 6th of August Management of Technical Staff 1945. The downside of the Manhattan Project was the proliferation of Speer evenly divided technologists into two groups, "some needing nuclear weapons and the ongoing World threat of nuclear war. stability and security, and the others longing for responsibility, risk, and a chance to compete." The management challenge is to unite these Germany separate personalities and direct each individual according to their psy­ Albert Speer was appointed by Hitler to the position of Reichminister chological makeup. (I classify myself in the latter group, and it came as for Armaments at the age of 36, Originally an architect, Speer had an a bitter truth to me that I would have to accept that key individuals extensive background in construction. He was a charismatic individual might not willingly w ish to adapt themselves to the life of a pirate). w ith an intuitive understanding of the management of scientists. He Ba lance in the workplace is essential. Unless both groups are uni­ later commented that his early training as an architect had enabled fied for a common purpose, the organisation w ill be driving the car him to focus on detail and deal with fickle individuals. Speer's job in with one foot on the accelerator and one hand on the handbrake. 1942 was to restructure industry and integrate wartime developmen­ Central authority in the management of technical specialists does not, tal projects in order to increase efficiency. however, seem to be a high priority. Bomber Command and Speer freely adapted previous management theories and practices Manhattan project worked under central authority, whereas Speer had to suit his purposes. He created and led a system for technologists that remarkable success using an industrial self-responsibility model and guaranteed access and interaction w ith other levels of industry. limiting central interference. " Remember we have a powerful ally, the Scient ists were provided with an auxiliary management structure, enemy also has a General Staff". The common ingredient for success, which allowed free access. Small, independent teams of technical implicit during the War, and w ell recognised by successful organisa­ experts were formed to dea l w ith specific projects ranging from devel­ tions in peacetime is: Hire the best people, and let them get on with opment of small arms to rocketry. Speer directed technologists, and the Job. protected them from outside interference. During the most intense bombardments of Germany, total armaments production actually rose The Knowledge-Based Economy by 59%. After the War, Speer was tried by the Allies at Nuremburg We have heard much recently from the Government on the "knowl­ and sentenced to 20 years imprisonment for his use of slave labour. He edge-based economy" . Management of technical specialists should was implicated and involved in horrific war crimes. He was lucky to aim to ensure complete access to the knowledge produced by the esca pe the noose. In all of the above examples, the solutions to com- enterprise. The ski lls of scientists are not easily explained. Our knowl-

NZ J Med lab Soence 2000 4 edge quotient is high, but our abi lity to convey the knowledge is low. Additionally, we are discovering the commercia l necessity to continu­ The System ally explain what we do, to our customers, our superiors, and to the I assume you understand what a system is, so I won't attempt to general public. Knowledge should be easily accessible. Speer once define it. The appreciation of a system was seen by Deming as the key answered a critic of his open office door policy: "Where do you want to managing it. Knowing how the system works is essential before me to get all this information I need, except by opening myself to all implementing change. Managing change is difficult. Attempts to of it, from anybody?" restructure any system without extensive knowledge of the internal workings and functional relationships will at best be time-consuming What is Knowledge? and wasteful, and at worst be doomed. Knowledge = information + data + technica l skill s. Surprisingly, the value of knowledge within a business can be ca l­ Knowledge about variation culated. It is expressed as a ratio of intangible assets (market va lue) to Deming stressed the need to understand the impact of (statistica l) va ri ­ tangible assets (book va lu e) As an example Microsoft had a book ation on a system. Some understanding of variation, including the va lue of 22.4 Billion US dollars in July 1998, at the same period, the appreciation of a stable system and an understanding of causes and share market value stood at 260 Billion US doll ars: a ratio of 1 0:1 The consequences of variation are essential sk ills for management. ratio of market va lue to book value of other business sectors are listed Assessment of statistical significance w il l help decide the level of below response to a va riation. (so w ill intuition) Healthca re ratio = 2.8: 1 What are some variations that can impact on the medical labora­ Real estate = 0.8: 1 tory system? Tobacco/ beverages = 2.7: 1 • Ava ilabi lity of technical labour • Political will Anything above a ratio of 2:1 is regarded as a knowledge-based • Customer behaviour industry. Note that healthcare is rated at 2.8 :1 . (Medical Laboratories • Money (funding) were not assessed in the quoted article, and probably have a higher • The unsee n (Industrial action, co mpetitive behavior, development knowledge ratio than general healthcare). We work in a knowledge­ of new technologies, etc) based industry. Structure The knowledge resource What management structure is optimal for management of technica l Some business ana lysts estimate that only 20% of the knowledge experts? Currently the hierarch ica l management structure is the norm. avai lable to an enterprise from the employees is utilised. Thi s tacit From time to time, this structu re is varied, but radical change is rarely knowledge is restricted by a hierarchical structure, which tends to attempted. Most technologists will be familiar with the all too frequent resist exploitation of this data simply because the organisation w ill restructuring exercise. My experience is that they may provide justifi­ always resist the bypassing of formal management and hierarchical cation and meaning for the auxiliary staff, but they destabilise the structures. In other words, hierarchical structures do not encourage a technical sections and may also distort the information flow. com munication pathway that seeks the shortest path between the It is interesting to note the efforts of Barrie Edwards to introduce knowledge holder and the knowledge seeker. (If you think your a commonsense management structure in the early 1990s'. I was Organisation has lean flat stru ctu re, ask a Diagnostic Company how impressed by it at the time, but as Barri e would be the first to adm it, many different people they have to deal with in the marketing and there was no will or commitment from upper levels to implement the placement of an instrument. You might well be surprised.) structure. This type of structure is the one most li ke ly to optimise the access to knowledge held withi n the system. As a ru le, flat manage­ The mission ment structures are difficult to implement, particularly when rad ical All of the above examples of management of technical experts had a restructuring of management roles threatens the support staff. purpose, or a mission. What is the mission of a medical laboratory? Put Some labs unconsciously use the industrial self-responsibility simply, a laboratory helps the doctor to help the patient. (Other func­ model favoured by Albert Speer, particularly in satellite laboratories. tions are add-ons to this task.) In a knowledge-based system, this The few laboratories brave enough to al low and encourage consider­ translates to one crucial step: transfer of knowledge from a knowledge able technica l autonomy within and across departmental boundaries holder to a knowledge receiver. The fewer obstacles interrupting the see positive spin-offs that are evident both to the employees and the transaction, the more efficient the exchange becomes. customers.

Direction Psychology of technologists It always helps to tell people what the mi ss ion is. If technical experts Demi ng stresses the need to understand the psychology of the work­ don't know where they are supposed to be going how ca n you expect er. Given that technologists are not good at co mmunicating their them to get there? Deming describes this elegantly in point 1 of hi s 14 wants and needs, this can be difficult for the budding manager. In the points: "Create co nstancy of purpose." unlikely event that any non-technical management wannabe has read this far and still wishes to attempt to manage scientists, I congratulate Leadership them for their perseverance, and offer the following observations on Once a firm direction is decided, participatory leadership seems to be the psychology of technologists, if not to encourage persistence, then important. A film director is a good example of participatory leader­ at least to reduce the potential for damage. ship. Leaders of cl imbing expeditions are another. Self-managing teams may rotate leadershi p accord ing to the situation. Deming stress­ 1. Motivation es that a leader needs to learn the psychology of individuals, the psy­ The non-technical ma nager may use methods ranging from incentives chology of a group, the psychology of society, and the psychology of to horsewhipping in an effort to motivate staff. Motivation without change understanding the system is pointless. Speer, responsible for the man-

NZ J Med Lab Science 2000 5 ufacture of both the V.W. and the V2, when asked about the motiva­ tion of his technical experts, had this to say: "I don't know what their Over 25 years ofInnovations from incentive was, except perhaps satisfaction? Pleasure in something worked? In any case, the success was all due to them: I was only a lay­ man who knew how to smooth their path and protect them from -$- Labsystems interference." In other words, if you don't understand w hat they're Microplate Instrumentation with a focus on quality. doing, then leave them alone to get on with it. (At least that way, you won't be held res ponsible for screwing it up) *Lab systems Multiskan Ascent Photometric measurement performance for 2. Behavioural Characteristics • Critical of tradit ional hierarchies. 96- & 384-well plates. • Uncritical rece ivers of orders. • Use of jargon. • Reactionary. • Resourceful. • Adaptable.

3. Needs of technologists • Synerg istic leadershi p. • A clear task, and t he resources to carry it out. *Labsystems Well wash Ascent • Sense of purpose Twin-strip wash head system, orbital shaking, • Support 3 reagents. • Freedom from interference

4. Skills needed for a technologist • Tec hnica l know ledge to complete a task . • Appreciation of ethics • Appreciation (understanding) of a system. • Ability to network. • Abi lity to work unsupervised, and in team s

Ethi cs In the hea lth System of today, an ethi ca l perspective is esse ntial. We *Labsystems Multidrop 384 are accountable for our actions. Fam ilia ri se yourse lves w ith t he code of practice for our Profession . Remember, someday, somewhere, some­ High speed continuous dispensing into 384- & one may walk up to yo u and say: 96-well plates. • Did you know anythin g about what was going on? • What did you do about it? • Why not? (No further questions; you may step down)

Summary Our self-esteem as professionals is low. Most (but not all) current man­ agement structures deliberately undervalue the role of scientific staff. Remuneration rates, particularly in the public sector, further validate this perception. Hierarchical structures dominated by non-technical Also available from Labsystems Microplate Instrumentation managers seriously impede access to, use of, and interpretation of Range. Fluoroskan Ascent Fl for Fluomrnetric & data. The critica l factor in the success of any laboratory system is rapid Luminometric Technologies. Luminoskan Ascent, and unimpeded access to, and utilisation of the tacit knowledge held by the technologists, scientists, and cli nical staff of the laboratory. Nepheloskan Ascent, Ascent Software, iEMS Incubator/ Shaker, Wellmix, Wellwarm, Final thought: Assist Plate Handling Device (robotics) Finnpipettes & We tend not to lea rn f rom the past. FinnMicrotitre Plates & Strips.

"Most people live on a lonely island, 'For a complete catalogue, technical specifica tions, reference sites contact­ Lost in the middle of a foggy sea, Medica Pacifica Ltd PO Box 24-421 Royal Oak Most people long for another island, Auckland New Zealand. One where they know they'd like to be." Free Phone 0800 106 100 Free Fax 0800 688 883 -Bali Hai ("South Pacific") e-mail [email protected]

NZ 1 Med l ab SCience 2000 6 Optimising the Effectiveness of Platelet Transfusion Therapy

Mark Bevan Transfusion Medicine, Plamerston North Hospital

NZ 1 Med Lab Sc1ence 2000; 54(1):7·13

Abstract Preparation Platelet concentrates are the treatment of choice for the prevention of Febril e nonhaemolytic transfusion reactions (FNHTRs) are a common life threatening or debi litating bleeding in severely thrombocytopaenic adverse effect associated with the transfusion of platelet concen­ patients . Platelet concentrates can be prepared by either the buffy coat trates.(2) These reactions are thought to be caused by antigen-anti­ or platelet rich plasma methods, and issued in doses of four to six con­ body reactions involving contaminating white blood ce lls (WBCs) or centrates, or through col lection of an equivalent dose from a single from the transfusion of proinflammatory cytokines, such as lnterleukin donor by apheresis. The transfusion of platelets can lead to the devel­ (IL)- 1a, IL-6, IL-8, and tumor necrosis factor - a-(TN F-a),released into opment of febrile non-haemolytic transfu sion reactions in the patient. the plasma fraction of platelet concentrates during storage.(3-8) Th ese Th ese are most frequently caused by inflammatory cytokines which are contaminating WBC s have also been implicated in alia-immunisation re leased by contaminant w hite blood cel ls (WBC) and which accumu­ to Human Leukocyte Antigens (HLA), transmission of viral diseases late during storage. A more serious consequence of platelet transfu­ such as cytomegalovirus and human T-lymphotropic virus type I, sion is the development of refractoriness following alia-immunisation immunosuppressive effects and the occurrence of graft-versus-host to blood group, Human Leukocyte Antigens (HLA) and platelet specif­ disease.(4) It is desirable therefore to manufacture platelet concen­ ic ali a-a ntigens. Pre-storage leukodepletion has been proposed as a trates w ith as few w hite ce ll s as possible to reduce the number of mea ns of reducin g the risks of both these side effects. Thi s treatise will adverse transfu sion effects associated w ith platelet transfusions. discuss the advantages and disadva ntages of various platelet produc­ Platelet co ncentrates may be prepared from whole bl ood dona­ tion methods, the effects of storage on platelets, practices to aid in the tions by either the platelet -rich plasma or buffy-coat derived methods reduction of both transfusion reactions and the development of refrac­ or by apheresi s. (9) Of the whole blood derived platelet methods the toriness, and the provision of platelets for refractory patients. It will platelet rich plasma method is more popular in North America, while also discuss recent developments in platelet transfusion therapy pub­ the buffy coat derived method is more popular in Eu rope.(9) The lished in recent literature. platelet rich plas ma method ha s also been favoured in New Zea land, although the trend now appears to be towards buffy coat derived KeyWords platelet concentrates. Platelets, Buffy Coat, Platelet Rich Plasma, Apheresis, Cytokines, Leukodepletion, Refractoriness, Ali a-immunisation. Buffy Coat Derived Method In 1988 Hagman et al introduced the top-and-bottom bag system for Introduction blood component preparation, which in turn led to an alternative Platelet products are used in the treatment of thrombocytopaenic approach to platelet concentrate preparation.(1 O)This method involves patients with risks of bleeding and to treat patients with trauma or pooling buffy coats from four donors, and this pool serves as the start­ surgery related bleeding problems. ing material for the preparation of the buffy coat-derived platelets. More intense treatment schedu lin g and a w ideni ng indication for Although the platelet concentrates prepared by t hi s method contain the use of chemotherapy have seen the use of platelet concentrates WBCs from four donors, Kluter et al(1 1) and Flegel et al(1 2) have both increase dramatica lly during the last twenty years.(1) Platelet transfu­ reported that no cytokin es seem to be generated from in vitro activa­ sion therapy is expensive, the estimated cost of platelet support for tion of the WBCs during storage of the platelet concentrates. It should haematologic/oncologic disorders is greater than U.S.$2,000 per be noted however that the lack of cytokine generation is dependent patient and in platelet refractory allogeneic bone marrow transplant on the number of con taminating WB Cs being less than 1x 1o • per L in patients it is more than U. S.$15,000 per patient.(1) the buffy coat-derived platelet concentrates.(13) Preparing platelet Given the increasing use of platelet transfusion therapy, it is impor­ concentrates by the buffy coat method is a ve ry effective way of reduc­ tant to optimise the use of platelets without compromising patient ing the number of contaminating WBCs, buffy coat-derived platelet care, this is particu larly important for patients who are rece iving pro­ concentrates have been shown to contain as few WBCs as those fil­ phylactic platelet transfusions as these patients represent the largest tered prepared by the platelet-rich plasma method.(13) The study per­ number of patients receiving transfusions. There are several areas formed by Christensen et al showed that in unfiltered platelet con­ w hich ca n be looked at when trying to optimise the use of platelet centra tes obtain ed by the buffy coat deri ved method conta in ed, on concentrates, t hese in cl ude reducing the number of platelet associat­ Day one of storage, a med ian of 0.031 x 109 WBCs per L, which ed transfusion reactions, reducing the number of patients w ho equates to approximately 10-15 x 1o • WB Cs per buffy coat- derived become refractory or all oimmunised to platelets and re-eva lu at ing the platelet co ncentrate.( 11) ,(12) Th is low number of W BCs can be even platelet transfusion trigger. further reduced by f iltration of the buffy coat deri ved platelet co nce n­ trates, this study also revea led a tendency towards a lower WB C count in the pl atelet concentrates on Day 5 of storage. (13)

NZ J Med Lab Science 2000 7 A further factor which affects the amount of cytokines in the buffy of patients receiving sing le random apheresis platelets. Also the Tria l to ·coat derived platelets concentrates is the length of storage time before Reduce Alto-immunisation to Platelets (TRAP trial) did not show any the buffy coats are pooled and processed . Kluter et al found that benefit of single donor apheresis platelets compared to pool ed ran­ cytokine levels were barely detectable after the first twelve hours of dom-donor pl atelets .( 1) storage, and that after twenty four hours elevated levels of IL-8 were found in 25 perce nt of the buffy coats, however levels of IL-1 -a, IL-6 Le ukodepletion an d TN F-a were low. In conclusion of their study they stated that buffy Posttransfusion sid e effects to pl atelet transfusions include not only coats storage should not greatly excee d twelve hours, although they delayed side effects such as viral in fections and platelet refractorin ess, also conceded that the levels of IL-8 re leased after twenty four hour but also acute reactions that ra nge from feve r, urtica ri a and breathing storage were unli kely to cause severe transfusion problems.(8) difficul ties to anaphylaxis. As stated previously, the majority of these are thought to be caused by contaminating W8C in the platelet con­ Platelet-Rich Plasma Method centrate and have been reported to be preventable by remova l of the Preparation of platelets using the platelet-rich plasma method consists W8C before storage.(16),(17) of an initial centrifugation of the whole blood unit at low speed to sep­ In animal models, prestorage filtration reduces refractoriness and arate the platelet-rich plasma from sedimented W8Cs and red blood alto-immunisation as well as reducing cytokines which accumulate ce lls (R8Cs). Studies have shown that it is difficult to obtain complete during storage. Also, depending upon the type of fi lter, anaphylotox­ separation of platelets from W8Cs and R8Cs and that approximately ins such as C3a and C5a, which can be generated during storage, may 15 to 25 percent of the platelets get sedimented into the buffy coat. be adsorbed during passage through the filter.(17) A randomized Some studies have suggested that these larger and heavier platelets study by Chalandon et al comparing pre-storage filtration of platelets may be more haemostatically effective than the platelets suspended in with post-storage filtration found that pre-storage filtration had sever­ the platelet-rich plasma . A further disadvantage of this method is that al benefits. They found that pre-storage filtration not only reduced the 5 to 25 percent of the W8Cs will rema in in the supernatant platelet­ amount of cytokin es present in the platelet co ncentrate but also rich plas ma, with ce ntrifugation cond itions determining the specifi c mainta in ed the pH of the concentra te above 6.8 more regu larly than percentage.(14) post-storage filtration, w hich is importa nt in ma intaining pl atelet fu nc­ It is possible however to prepare a platelet concentrate that is W8C tion and in vivo recovery which are both adversely affected by low red uced before storage by filtration of the platelet rich plasma. This pH. (17) system invo lves the f iltration of the platelet-rich plasma du rin g expres­ Treatment of platelet concentrates with ultraviolet (UV) irrad iation sion from the centrifuged whole bl ood unit. In addition to removing has been investigated as a possible altern ative to pre-storage leukode­ the W8 Cs from the platelet co nce ntrates, this system also has the pl etion. UV irradiation has been shown to redu ce the proliferative potential to recover pl atelets that are just above the buffy coat layer responses of lymphocytes to alloantigens and mitogens and studies w hich are generally left w ith the R8 Cs. Thi s is possible beca use expres­ have shown that it is poss ible to irradiate platelet co nce ntrates so that sion of the platelet-rich pl asma co nti nu es after the buffy coat enters the proliferative responses of contam inating leukocytes were abol­ the filter, at w hi ch time the expression slows dramatica lly or stops ished whilst the platelets retain acceptable function. In one study, co mpletely.(14) A study by Sweeney et al using an in-line prototype fil­ Pa mphilon measured pH, lactate evolution and hypotonic stress ter in 1994 showed that platelet filtration resu lted in a 1 to 3 log 10 response (HSR) after irrad iating platelet concentrates with 3,000 reduction in W8C content. The variation in W8C reduction was Jou les/m' of UV-8 irrad iation during five days of storage. He found a thought to be due to breakthrough effects ( flow of the platelet-rich significant increase in lactate levels in the irradiated platelet concen­ plasma through he edges of the filter housing and failure to traverse trates when compared to the control, but the levels were not unac­ the filter fibres) or to the W8C load in the prefiltration platelet-rich ceptable, there were no differences in pH or HSR. However when high­ plasma. They concluded that the use of in-line platelet-rich plasma fil­ er doses of UV-8 irradiation 100,000 Jou/es/m') were used there was a ters should allow the production of prestorage W8C -reduced random­ marked deterioration in the HSR after 96 hours of storage and a drop donor platelet concentrates without deleterious effect upon the stored in pH. Increased irradiance also caused a drop in the platelet count due cells. Despite the fact that they also observed a 15 percent loss of to the formation of small aggregates in the presence of fibrinogen and platelets during filtration, they found that a pooled component of five collagen. This study showed that it is possible to prepare platelet con­ fi ltered platelet concentrates would have a platelet and W8C content centrates in UV permeable containers and irradiate them so that lym­ comparable to that generally available in low-W8C apheresis compo­ phocyte reactivity is abolished whil st acceptable platelet function is nents.(14) retained. Larger clinical studies have shown a reduction in both HLA alia-immunisation and platelet refractoriness that is statistically signifi­ Apheresis Platelets cant and equivalent to that achieved with leukodepletion.(18) A recent trend in platelet transfusion therapy has been a substantial Another study showed that irradiating platelet concentrates with increase in the use of sing le-donor apheresis platelets.(4- 15) This has UV-A irrad iation in conjunction with the use of psora /ens had a neg li­ been dri ven by the need for adequate platelet inventory to support gible effect on in vitro platelet function, as determ ined by a variety of card iac surgery and bone marrow transplantation programs, interest in assays inclu ding pH, p-se /ectin express ion , agg regation, shape minimizing allogeneic donor exposure for patients, and the desire for change, hypotonic shock response, ATP re lease and morphology. The leukodepleted platelet products.(15) resu lts also suggested that, in addition to inactivating viral and bacte­ Th ere have been three sma ll prospective randomized trials (involv­ rial co nta minants in platelet co nce ntrates, the use of pso ra/ens and ing sixteen to fifty-four patients per trial) to determine the relative ben­ UV-A irradi ation may reduce cytokine-associated FNHTRs by complete­ efits of providing single random- donor apheresis pl atelets compared ly eli minating cytokine synthesis by contaminating /eukocytes.( 19) with pooled random-donor platelet concentrates to prevent platelet alto-immunisation. Of these studies, only on e showed a significant Storage decrease in rates of platelet refractoriness and lymphocytotoxic anti­ Temperature body formation despite the fact that the number of donor exposures It was once a common pra ctice to store platelet concentrates at 4"C , for the patients who received pooled platelets was up to ten times that however it was noted that the recovery and surviva l of the platelets

NZ J Med Lab Sc1ence 2000 8 stored at this temperature were decreased relative to platelets that had pared to storag e on a flatbed to-and-fro agitator. Associated with the been stored at 22"C. It was found that the cold-induced storage loss of viabi lity is a loss of discoid shape and a decrease in HSR.(22) lesions include irreversible loss of discoid shape, caused by the depoly­ merisation of microtubules and the breakdown of pl atelet contractile Storage in a Synthetic Medium protein with loss of ATP. Howeve r, co ld stored platelet con centrates are The storage of platelets in a synthetic medium was first reported by haemostatica lly effective with the abil ity to rap idly correct bleeding Rock et al in the mid 1980's and subsequently proposed by others with time, whereas there is a lag period with platelets stored at 22"C, such some sli ght variation in composition, using a variety of different salt that they may not correct bl eeding ti me for up to 24 hours follow ing so lutions. In principle, the removal of the plasma from platelet co n­ transfusion.(20) The vast majority of platelet transfusions are for pro­ centrates resu lts in the remova l of pl as ma enzymes reduci ng their pro­ phylactic use in patients receiving chemotherapy and platelets stored teolytic effect on the platelet membrane, in particular glycoproteins at 4°C would clearly not be benefi cial to these patients. There is now lb/IXN and li b/lila co mplexes that are esse ntial for the ad hes ion of general agreement that platelet concentrates stored at 22"C combined platelets and for their participation in the aggregation respo nse. It has with continuous agitation to enable good gas exchange in an oxygen also been reported that the use of synthetic storage media with permeable bag is essential. A recent comparison of the loss of platelet inhibitors is associated with improved viability, reduction of bacterial viability during in vitro storage at 22T and 3TC indicated that the rate content, and better maintenance of other in vivo parameters.(20) of ag ing at 22"C is substantia lly reduced to that shown at 3TC. Thi s Holme et al studied storage of platelet concentrates in a synthetic may be re lated to the lower metabolic rate during storage at 22T.(20) mediu m composed of a physio log ic concentration of electrolytes, for­ It is important to maintain the storage temperature ra nge of 22 +I- tified with glucose as fuel for energy and bicarbonate for buffer. They 20C for platelet concentrates, platelets stored at temperatures below found improved in vivo viab il ity, when compared to storage in plasma, 20°C rapid ly lose their viability after infusion. In add ition to the change which was associated with improved maintenance of platelet discoid in shape from disc to sphere the platelets, upon rewarm ing, demon­ shape, improved HSR and a decrease in lactate production per platelet. strate a reduced respo nse to hypotonic stress, some loss of surface In addition, better ma intenance of oxygen consumption rate, GPib, GPib w hich may be re lated to microves iculation, expression of p­ and ATP levels were also found. se lectin, and mitochondrial damage as suggested by increased glyco l­ Storage in a glucose-free synthetic medium resulted in loss of vi a­ ys is, decreased oxygen co nsumption, and the loss of ability to synthe­ bility at 5 day storage as compared to storage in plas ma. Loss of vi a­ size ATP bility w as aga in found to be related to a reduction of discoid platelets and decreased HSR. In addition, decreased ATP levels were found, Storage Time while the oxyg en consumption rate was not affected.(22) In view of the relatively high frequency of transfusion-associated sep­ Cryoprese rvation of platelet concentrates is currently done using sis from bacterially contaminated platelet concentrates , stored for up 6% dimethylsulphoxide and is generally only performed on HLA or to 5 days at 22°C , the iss ue of the temperature of storage remain s a platelet matched platelets required for patients with HLA or platelet focus of interest. It appears that gram positive orga ni sms rea ch max i­ antibodies. The in vivo percentage recove ry of cryopreserved pl atelets mu m growth by day 3, which is somewhat quicker than gram nega­ is only about 50% of that seen in fresh pl atelets. Several pl atelet in tive orga ni sms. Th erefore, re ducin g the length of platelet storage vitro les ions have been found including reduced HSR , di sc to sp here before transfusion, with the hope of preventing bacteriologic co mpli ­ form ation, and p-selectin increase when co mpa red to plas ma stored cations and reducing the associated storage lesion, may prove benefi­ platelet co nce ntrates stored for five days under curre ntly optima l con­ cial (20) ditions. Owen et al also demonstrated red uced GPib and decreased Riccardi et al found a positive correlation between the age of buffy adhesive properties.(22) It would appear, therefore, that cryopreserved coat derived platelet concentrates and the risk of transfusion reactions, platelets have little place in platelet transfusion with the exception of with an important increase from the third to the fifth day of stor­ providing typed platelets for those patients undergoing long term age.(21) This finding is in agreement with other studies showing a pro­ platelet therapy. gressive increase of frequency of transfusion reactions during storage of platelet concentrates prepared by the platelet-rich plasma Transfusion method.(?) This increase in risk is probably due to the release of Transfusion Trigger cytokines by contaminating WBCs during storage and may be reduced To determine when platelet transfusions are needed, it is important to by pre-storage leukodepletion. In addition, it was found that buffy understand how platelets are involved in ma intaining normal coat storage for two days prior to platelet concentrate preparation was haemostasis. It has been postulated that platelets ma intain haemosta­ associated with a risk of transfusion reactions twice that of buffy coats sis by plugging gaps in the endothelium of blood vessels. Electron stored for one day, although this difference did not reach signifi­ microscopy studies have shown a thinning of the endothelium ce lls cance.(21) with gaps between the ce ll s in rabbits with severe thrombocytopae­ nia.(23) Others have proposed that that endotheli al ce ll s retract and pH expand intermittently leaving uncovered ga ps on the subendothelial It is well known that pH levels below 6.0 to 6. 1 during storage of basement membrane. Th us, there may be a conti nuous use of platelets platelet concentrates are associated with total loss of viability. A lesion to prevent extravasation of red cells thro ugh these gaps . Animal stud­ associated with a fall in pH is a disc-to-sphere transform ation which ies have show n a cl ea r co rrelation betwee n the amount of thrombo­ occurs at pH levels of 6. 7 and below, and which is irreversible at pH cytopaenia and the amount of spontaneous haemorrhage into the below 6.2, swellin g is also observed together with a reduced HSR . lymphatic system .(1) Recent studies have shown that p-selectin expression follows the Two mechanisms of platelet removal from the circu lation have reversible/irreversible morphological changes observed with fall in pH been identified, the majority are lost by sen escence after living out during storage. Th e use of gas permeable containers for platelet con ­ their normal lifespan (approximately 10.5 days), however, a small fixed centrates combined with continuous agitation aids in maintaining a fraction of about 7.1 x 1o • platelets/Ud are removed randomly, pre­ viable pH. However it has been found that storage of platelets on an sumably to provide for the endothelial supportive function.(23) There elliptical (ferris wheel) rotator results in a loss of viability when com- is a direct relationship between platelet counts and platelet survival in

NZ J Med Lab Scrence 2000 9 thrombocytopaenic patients with a platelet count below 100 x 10 9/L. transfusions, these transfusions were able to control bleeding, and As the platelet count decreases, an ever-increasing percentage of the there was no increase in haemorrhage, morbidity or mortality com­ available platelets are required to meet the need for haemostasis, pared to a prophylactic platelet transfusi on programme.(27) Which of rather than living out their norm al lifespan resulting in reduced platelet many possible platelet dosing strategi es will prove the most cost-effec­ survival in thrombocytopaenic patients. (1) tive in terms of the total cost of platelet therapy (e.g. the cost of the Th ere are two issues that are important to co nsider when planning pl atelet product, monitoring pl atelet co unts, transportation costs, prophylactic platelet transfusion therapy: one is the trigger level used nursing and laboratory technician time, order processin g, preparation, to initiate therapy; and the other is the dose of platelets used for each and distribution cha rges etc.) will requi re careful ana lys is. transfusion. Both of these factors may directly influence the number of platelets transfused during a thrombocytopaenic interva l, and thus, ABO Compatibility transfusion costs. A and B antigens are expressed on the surface of the platelets.(28) To Reductions in platelet therapy can be made through cha nges in determi ne the effect of ABO mismatching on platelet alia-immunisa­ indications (trigger or decision points) used to in itiate therapy. Most tion, forty leukaemic patients undergoing induction chemotherapy cl inicians use the patient's platelet count as an indicator for transfus­ were randomly assigned to rece ive two sets of pa ired transfusions of ing platelets rather than transfusing some fixed number of platelets ABO-compatible or ABO-incompatible pooled random- donor platelet per day. Although a 20 x 10 9/L platelet co unt has often been used as concentrates.(29) Although there were no differences in platelet an indication for prophylactic platelet transfusions in ch ronica lly respo nses to the first set of transfusions, the co rrected cou nt incre­ thrombocytopaenic patien ts with decreased platelet counts, there is ments for the second ABO-co mpatible transfusions averaged 14 x little direct evi dence to substantiate thi s practice. 10 9/L, compared with 9.5 x 10 9/L for the ABO- incompatible transfu­ Five rece nt studies (1). have evaluated prophylactic platelet tra ns­ sions. fusion therapy given at platelet counts of 10 x 10 9/L versus 20 x 10 9/L. In another study, twenty-six patients undergoing treatment for Th ree of these studies w ere randomized prospective trials and two acute leukaemia or autografting for relapsed Hod gkin's disease were were nonrandomized. Uniformly these studies showed no increase in randomly assigned to rece ive either ABO-compatible or ABO-inco m­ bleeding risk or red cel l transfusion requ irem ents using the lower patible platelet s. (30) Platelet refractoriness was sig nificantly lower in transfusion trigger with substantial decreases in the number of platelet the group rece iving ABO-compatible platelets. Only on e of thirteen transfusions req ui red and the associated costs. patients (8%) who received ABO-compatible platelets became platelet Another reason for co nsidering the use of a lower transfusion trig­ refractory compa red to nine of t hi rteen (69%) who rece ived ABO­ ger level is the effect of platelet transfusions on thrombopoietin lev­ inco mpatible platelets.(1) els.(24) The recent identification of thrombopoietin, the primary regu­ Patients who rece ived AB O-compatible pl atelets not only did not lator of pl atelet haemostasis, has allowed thrombopoietin levels to be increase their anti-A or anti-B titres , but they also developed lympho­ measured in a variety of settings and to also determine the loca lization cytotoxic and platelet-specific antibodies at a much lower rate than of its receptor on different cell. It has been determined that the throm­ the patients who received ABO-incompatible platelets. The repeated bopoietin rece ptor cMpl is located on both megakaryocytes and administration of ABO-mismatched platelets produced a significant platelets (25). It has been postulated that there is a relatively constant increase in anti-AlB titres in seven of thirteen patients (54%) that were amount of thrombopoietin produced; as long as the pl atelet coun t is generally correlated w ith poor platelet increments. In addition f ive of normal, only a small amount of thrombopoietin produced is not thirteen recipi ents (38%)of the ABO-mismatched platelets developed adsorbed by the circulating platelets an d remains ava il able to interact lymphocytotoxic antibodies and four of thirteen (3 1 %) developed with bone marrow megakaryocytes or earli er progenitor ce lls to stim­ platelet-specific antibodies compared with only one of thi rteen (8%) ulate new platelet production. However, at low platelet counts, more and one of th irteen (8%), respectively, of the recipients who rece ived thrombopoietin is ava il able to stimu late the production of greater ABO-compatible platelets. The close temporal association between the numbers of platelets to re-establish normal platelet counts. In a rabbit development of HLA and platelet specific all oantibodies and increases model, an imals were made thrombocytopaenic by the administration in anti-AlB titres suggests that in the process of respond ing to the of busulfan.(24) As the platelet count decreased after the busu lfan, ABO-incompatible antigens, recogn ition of other antigen incompati­ there was a reciprocal increase in the thrombopoietin level. However, bilities also occurred. The data from these two studies suggest that if the thrombocytopaenic anima ls were given a platelet transfusion, providing ABO-compatible platelets may be a simple method of there was an associated dramatic decrease in the thrombopoietin level decreasing the incidence of al loimmune platelet refractoriness. showing that the transfused platelets adsorbed thrombopoietin.(1) A further consideration in the use of ABO-incompatible platelet From t hi s, it could be hypothesized that the adm inistration of as few transfusions is the increased use of single-donor apheresis platelets. platelets as possible, consistent with the maintena nce of adequate Whilst a sin gle random-donor unit of platelets contains approximately haemostasis, would be associated with the ea rli est return of autolo­ 50 mls of plasma, a sing le-donor apheres is unit may contain up to 300 gous pl atelet production. mls. It is my opin ion that all group 0 single-donor apheres is platelet co ncentrates should be tested for hi gh titre anti-AlB haemolys in s and Transfusion Dose any that found to be positive should only be transfused to group 0 The circulating platelet count directly influences platelet survival(26), patients. I bel ieve that this is the safest practice since cases of acute therefore it is not surprising that the higher the post-transfusion haemolysis following the transfusion of plasma-incompatible platelets pl atelet count, the longer is the interva l between transfusions. Instead have been reported.(3 1) of givi ng large infrequent doses of platelets, an alternate, although untested, strategy might be to just provide t he mi nimum number of Selection of platelets for patients who are alloim­ platelets needed every day to meet the platelets' endothelial support­ munised or become refractory to random-donor ive function; e.g . two platelet concentrates per day. Thi s would require platelets. no pre-transfusion and post-transfu sion platelet counts and, if bl eed­ Thirty to seventy percent of multiply transfused thrombocytopaenic ing occurred, a further transfusion of platelets would be expected to patients become refractory to random-donor platelets , and patients control bleeding. In studies that provided only therapeutic platelet treated for malignant haematopoitic disorders are particularly likely to

NZ J Med lab Science 2000 10 become refractory to platelet transfusions.(32-35) HLA-matched and Alternative Therapies crossmatch-compatible platelets are two blood components typically Platelet transfusions are associated with several adverse effects, includ­ used to provide support for all oimmunised, thrombocytopaenic ing FNHTR, vira l transmission, alia-immunisation and platelet refrac­ patients w ho are refractory to randomly se lected platelets.(36) toriness, the platelet concentrates also have a very short shelf-life. This Th e use of HLA-matched and cross match-co mpatible platelets is ha s led to a sea rch for alternative therapies for thrombocytopaenic theoretica lly justified for patients in whom platelet alia-immunisation patients. is the ca use of refractoriness to randomly se lected platelets. Crossmatch-compatible platelets have the advantage of being more Thrombopoietin read ily ava ilable and less expensive than HLA-matched platelets(35), Thrombopoietin promotes megakaryocyte progenitor expansion and and platelet crossmatching by the solid-phase red cell adherence maturation and acts on both early and late progenitor ce lls. The addi­ method shou ld detect antibodies directed against ABO antigens and tion of thrombopoietin to enriched populations of murine platelet-specific antigens, in addition to antibodies directed against haematopoietic stem cells and progenitor cells in vitro results in the HLA antigens.(37) generation of megakaryocytes. It also supports the proliferation of There are several alternative solutions for the treatment of patients megakaryocyte colony forming units (CFU-Meg) in a dose-dependent who have become refractory to random-donor platelets, these include: manner. Thrombopoietin also stimulates megakaryocyte maturation, as evidenced by a large increase in ploidy of megakaryocytes exposed High-Dose Intravenous Immunoglobulin (IVIG) to this factor.(48) Recombinant thrombopoietin (PEG-rHuMGDF) is a High-dose IVIG increases platelet counts in patients with autoimmune form of thrombopoietin that has been modified by the removal of a thrombocytopaenia.(38) Several short reports have mentioned more or portion of the protein and addition of polyethylene glycol. less beneficial effects after using IVIG in alloantibody-induced platelet The biological activity and safety of PEG-rHuMGDF for transfusion refractoriness.(39) A randomized double-blind placebo­ haematopoietic support in patients undergoing cancer chemotherapy controll ed study in twelve alloimmunised patients showed significant has been exam ined in severa l trials.(49),(50) The results of these trials higher 1-hour post transfusion increments but there was no difference are promising, however the role of PEG-rHuMGDF in the prevention of in platelet survival after 24 hours. Improvement of platelet increments platelet transfusions rema ins to be determined. was only seen after very high dosages of IVIG ( > Sg/kg) and was less effective in severe alloimmunised patients.(40) Because of the high lnterleukin-11 costs and its transient effect, this approach is not su itable for routine lnterleukin -11 is a thrombopoietic growth factor whose major in vitro use but ca n be considered in case of life-threatening bleed in g. actions result from syn ergi stic interactions with other growth factors. IL-11 has a key ro le in the regu lation of haematopoiesis and is ca pable Immune Suppression of stimulating haematopoietic progenitors in the myeloid, erythroid, There is some evidence from studies in small numbers of all oimmu­ and megakaryocytic li neages(51 ). Except for mature platelets, all nised patients and animal models that immune suppressive therapy, stages of cells in the megakaryocyte lineage are stimulated by IL- such as cyclosporin A and anti-thymocyte globulin may reverse alia­ 11.(52) immunisation. However, as decrease of the antibodies requires at least Resu lts from studies recently reviewed by Du and Williams(53) ind i­ two to three weeks of drug administration, this approach is not appro­ cate that IL-11 acts on primitive stem ce lls as well as early and late priate for patients in need of immediate effective platelet support.(41) megakaryocyte progenitors. It has no independent effect on murine megakaryocyte colony formation, but it can stimulate the proliferation Antifibrinolytic Agents of human megakaryoblastic cell lines in a dose-dependent fashion. IL- In a double-blind study in twelve patients with acute promyelocytic 11 also synergises with IL-3 to enhance the growth of both murine and leukaemia, inhibition of fibrinolysis by the use of tranexamic acid was human megakaryocyte co lon ies as well as the size and ploidy of con­ shown to reduce the number of haemorrhagic periods without the stituent megakaryocytes. IL-11 also stimulates the maturation of occurrence of thromboembolic complications.(42) Another agent, megakaryocytes, ultimately increasing platelet production. Several tri­ aprotenin, acts as a potent plasma kallikrein inhibitor and can prevent als have been carried out to test the efficacy and safety of a recombi­ kallikrein induced fibrinolysis.(41) nant IL-11 (rhll-11) in patients at risk from thrombocytopae­ nia.(54),(55),(56) The results of all the trials have been good, with Removal of HLA Antigens from Platelets some of the most compelling evidence coming from the trials carried Elution techniques with chloroquine or citric acid have been used to out by Isaacs et al. They carried out a randomized, blinded, placebo­ remove HLA antigens from platelet membranes. Shanwell et al(43) controlled trial of rhll 11 in patients w ith high-risk primary or metasta­ reported the first successful HLA-eluted platelet transfusions in an tic breast cancer undergoing dose-intensive chemotherapy with HLA-all oimmunised patient. It was demonstrated that the degree of cyclophospham ide plus doxorubicin. Of the seve nty-seven patients HLA reduction varies, which raised doubts about the application of entered in the trial and included in the intent-to-treat ana lysis, forty HLA-e luted platelets for transfusion purposes.(44) Recently, develop­ were randomized to rhll-1 1 and thirty-seven to placebo. Sixty-eight ments have been made in the standardisation of HLA reduction after percent of the rhll- 11 group avoided platelet transfusions compared acid elution .(45) Acid-treated platelet transfusions were successfu lly with forty-one percent of the patients in the placebo group. Evaluable used on a sma ll sca le .(43),(46),(47) Although HLA reduction from the patients in the rhll- 11 group received an average of 0.8 platelet trans­ platelet membrane is feasible, platelet qua lity ca n become critica lly fusions as compared to 2.2 in the placebo group . The study showed affected. Further investigations are still needed to develop HLA-eluted that rhll-11 is effective in reducing treatment associated thrombocy­ platelet transfusions for routine transfusion purposes. topaenia and decreases the need for platelet transfusions in patients undergoing sequential cycles of dose-intensive chemotherapy.(55) Cryopreservation of Autologous Platelets If donor avai lab il ity is scarce, one can co nsider taking apheresis Platelet Substitutes platelets from the patient in a period of bone ma rrow recovery and Severa l substitutes for intact viable platelets have been investigated preserving these platelets for periods of thrombocytopaenia .

NZ J Med Lab Science 2000 11 and debated for their cli nical potentia l. Chao et al(57) reported the 6. Aye MT, Pa lmer DS, Giu livi A, Hashemi S. Effect of f iltration of successful use of platelet membrane microvesicles in rabbits and Galan platelet concentrates on the accumulation of cytokines and et al(58) have investigated the use of synthetic phospholipids as a platelet release factors during storage. Transfusion 1995; 35: 117- viable su bstitute for platelet co nce ntrates. Further study is still need ed 24. to define whether these substitutes will provide an acceptable alter­ 7. Muyll e L, Wouters E, Peeterm ans ME. Febri le reaction s to platelet native and are able to provide a long-lastin g hae mosta tic effect in transfusion : the effect of increased interleukin 6 levels in co nce n­ patients with aplastic thrombocytopaenia. trates prepared by the platelet-rich plasma method. Transfusion 1996; 36:886-90. Conclusion 8. Klu ter H, Sch lenke P, Mull er-Steinhardt M, Pau lse n M, Kirchner H. The requirement for platelet transfusions has increased markedly in the Impact of buffy coat storage on the generation of inflammatory past ten to twenty years and is likely to continue to do so, primarily cytokines and platelet activation. Transfusion 1997; 37:362-7. because of the requirement for platelet support in patients who 9. Rebulla P. In vitro and in vivo properties of various types of become thrombocytopaenic while undergoing dose-intensive platelets. Vox Sang 1998; 74(Suppl. 2): 217-22. chemotherapy. Platelet transfusions are associated with many adverse 10. Hog man CF, Eriksson L, Hedlund K, Wa llvik J. The bottom and top effects including FNHTRs, al loimmunisation, platelet refractoriness, the system: a new technique for blood component preparation and risk of transmission of bacterial, viral and perhaps other infectious dis­ storage. Vox Sang 1998; 55:211 -7. ease. The risk of many of these can be significantly reduced by 11. Kluter H, Muller-Steinhardt M, Danzer S, Wilhelm D, Kirchner H. leukodepletion, especia lly if it is carried out during the manufacture of Cytokin es in platelet co ncentrates prepared from pooled buffy the platelet concentrates, or by treatment of the platelet co ncentrates coats. Vox Sang 1995; 69: 38-43. with UV irradiation. 12. Flegel WA, Wiesneth M, StampeD, Koerner K. Low cytokine con­ Whilst many of these risks may be reduced by leukodepletion there tamination in buffy coat-derived platelet concentrates without fil­ are further means by which we can reduce some of the adverse risks tration. Transfusion 1995; 35:917-20 of platelet transfusions, transfusing ABO-compatible platelet concen­ 13. Christensen LL, Grunnet N, Rud iger N. Comparison of the level of trates has been shown to reduce the risk of platelet refractoriness, and cytokine mRNA in buffy coat-derived platelet concentrates pre­ transfusing platelets that are fresh may reduce the number of FNHTRs pared with or without white ce ll reduction by fi ltration. Transfusion in transfusion centres where pre-storage leukodepletion is not carri ed 1998; 38: 236-41. out. 14. Sweeney JD, Holme S, Heaton WAL, Nelson E. White ce ll -red uced In ad dition to the adverse effects li sted, platelet transfusion thera­ platelet concentrates prepared by in-line filtration of platelet-rich py is expensive and in add ition has the potential to interfere with deliv­ plasma. Transfusion 1995; 35: 131-6. ery of chemotherapy, both on time and at desired doses, thus poten­ 15. Goodnough LT, Ali S, Despotis G, Dynis M, DiPersio JF. Economic tially co mpromisin g the outcome of the treatment. It is these limita­ impact of donor platelet count and platelet yield in ap heres is prod­ tions, combin ed w ith the adverse effects mentioned, that has prompt­ ucts: re levance for emerging issues in platelet transfusion therapy. ed the development of agents with the potential to stimulate platelet Vox Sang 1999; 76: 43-9. production, thus reducing or eli minating the need for platelet transfu­ 16. Ogawa Y, Wakana M, Tanaka K, Oka K, Aso H, Hayashi M et al sion s. Both IL-11 and thrombopoietin have demonstrated potential Clinical eva luation of transfusion of prestorage-leukoreduced effectiveness in clinical trials, however further research is needed to apheresis platelets. Vox Sang 1998; 75: 103-9. firmly establish the clinical value of these thrombopoietic growth fac­ 17. Chalandon Y, Mermillod B, Beris P, Doucet A, Chapuis B, Raux­ tors, in the setting of myelosuppressive as well as myeloblative thera­ Lombard P et al Benefit of prestorage leukocyte depletion of sin­ py. The ultimate goa l of this research would be to develop agents that gle-donor platelet concentrates. Vox Sang 1999; 76: 27-37. would completely eli minate the need for platelet transfusions in 18. Pamphilon DH . The treatment of blood components with ultravio­ patients receiving chemotherapy. Until that time arrives we must con­ let-B irradiation. Vox Sang 1998; 74(Suppl. 2): 15-9. tinue to try and optimise the use of the platelet concentrates current­ 19. Hei DJ, Grass J, Lin L, Corash L, Cimino G. Elimination of cytokine ly ava ilable, by eva luating our manufacturing processes, particularly in production in stored platelet concentrate aliquots by photochemi­ regard to leukodepletion or leukoreduction, ensuring that the platelets ca l treatment with psoralen plus ultraviolet A light. Transfusion are stored under optimal conditions and continually evaluating our 1999; 39: 239-48. current practices. 20. Seghatchian J, Krailadsiri P. The platelet storage lesion. Transfus Med Rev 1997; 11: 130-44. References 21. Riccardi D, Raspollini E, Rebulla P, Pappalettera M, Marangoni F, 1. Sli chter SJ. Optimizing platelet transfusions in chronica lly throm­ Greppi N et al Relationship of the time of storage and transfusion bocytopenic patients. Semin Hematol1998; 35: 269-78. reactions to platelet concentrates from buffy coats. Transfusion 2. Fujihara M,Takahashi TA, Ogiso C. Hosoda M, lkebuchi K, 1997; 37 528-30. Sekiguchi S. Generation of interleukin 8 in stored apheresis 22. Holme S. Storage and quality assessment of platelets. Vox Sang platelet concentrates and the preventive effect of prestorage ultra­ 1998; 74(Suppl. 2): 207-16. violet B radiation. Transfusion 1997; 37: 468-75. 23. Kitchens CS, Weiss L. Ultrastructural changes of endothelium asso­ 3. Sarkodee-Adoo CB, Kenda ll JM, Sridhara R, Lee EJ , Sch iffer CA. ciated w ith thrombocytopenia. Blood 1975.; 46: 567-78. The re lationsh ip between the duration of platelet storage and the 24. Kuter DJ, Rosenberg RD. Th e reciprocal relationship of throm­ development of transfusion reactions. Transfusion 1998; 38: 229- bopoietin (c-Mpl ligand) to changes in the platelet mass during 35. bu su lfan-induced thrombocytopen ia in the rabbit. Blood 1995; 85: 4. Sweeney JD, Holme S, Stromberg RR, Heaton WAL. In vitro and 2720-30. in vivo effects of prestorage filtration of apheresis platelets. 25. Debili N, Wendling F, Cosman D, Titeux M, Florinda C, Dusanter­ Transfusion 1995; 35: 125 -30. Fourt I et al The Mpl receptor is expressed in the megakaryocytic 5. Ferrara, JL. The febril e platelet transfusion reaction: a cytokine lineage from late progenitors to plate lets. Blood 1995; 85: 391- shower. Transfusion 1995; 35:89-90. 401.

NZ J Med Lab Soence 2000 12 26. Hanson SR, Slichter SJ. Platelet kinetics in patients with bone mar­ 46. Castro E, Muncunill J, Barea L, Gonzalez R, Fernandez-Villalta MJ. row hypoplasia: evidence for a fixed platelet requirement. Blood Acid elution of platelets HLA-class I antigens in the treatment of a 1985; 66: 1105-9. refractory patient [letter]. Br J Haemato/1998; 100: 245-6. 27. Solomon J, Bofenkamp T, Fahey JL, Chillar RK, Beutel E. Platelet 47. Novotny VM, Huizinga TW, Van Doorn R, Briet E, Brand A. HLA prophylaxis in acute non-lymphoblastic leukaemia [letter]. Lancet class !-eluted platelets as an alternative to HLA-matched platelets. 1978; 1: 267. Transfusion 1996; 36: 388-91. 28. Dunstan RA, Simpson MB, Knowles RW, Rosse WF. The origin of 48. Broudy VC, Lin NL, Kaushansky K. Thrombopoietin (c-mpl ligand) ABH antigens on human platelets. Blood 1985; 65: 615-9. acts synergistically w ith erythropoietin, stem cell factor, and inter­ 29. Lee EJ, Schiffer CA. ABO compatibility can influence the results of leukin-11 to enhance murine megakaryocyte colony growth and platelet transfusion. Results of a randomized trial. Transfusion increases megakaryocyte ploidy in vitro. Blood 1995; 85: 1719-26. 1989; 29: 384-9. 49. Basser RL, Rasko JE, Clarke K, Cebon J, Green MD, Grigg AP et al 30. Carr R, Hutton JL, Jenkins JA, Lucas GF, Amphlett NW. Transfusion Randomized, blinded, placebo-controlled phase I trial of pegylated of ABO-mismatched platelets leads to early platelet refractoriness. recombinant human megakaryocyte growth and development fac­ Br J Haemato/1990; 75: 408-13. tor w ith f ilgrastim after dose-intensive chemotherapy in patients 31. Shanwell A, Ringden 0, Wiechel B, Rumin S, Akerblom 0. A study w ith advanced cancer. Blood 1997 ;90(6):2513. of the effect of ABO incompatible plasma in platelet concentrates 50. Fanucchi M, Glaspy J, Crawford J, Garst J, Figlin R, Sheridan Wet transfused to bone marrow transplant recipients. Vox Sang 1991; al Effects of polyethylene glycol-conjugated recombinant human 60: 23-7. megakaryocyte growth and development factor on platelet counts 32. Dutcher JP. Schiffer CA, Aisner J, Wiernik PH. Long-term follow­ after chemotherapy for lung cancer. N Eng/ J Med 1997; 336(6): up patients with leukemia receiving platelet transfusions: identifi­ 404-9. cation of a large group of patients who do not become alloimmu­ 51. Leonard JP, Quinto CM, Kozitza MK, Neben TY, Goldman SJ. nized. Blood 1981; 58: 1007-11. Recombinant human interl eukin-1 1 stimulates multilineage 33. Howard JE, Perkins HA. The natural history of alloimmunization to hematopoietic recovery in mice after a myelosuppressive regimen platelets. Transfusion 1978; 18: 496-503. of sublethal irradiation and carboplatin. Blood 1994; 83(6): 1499- 34. Klingemann HG, Self S, Banaji M, Deeg HJ, Doney K, Slichter SJ et 1506. al. Refractoriness to random donor platelet transfusions in patients 52. Webb IJ, Anderson KC. Risks, costs, and alternatives to platelet with aplastic anaemia: a multivariate analysis of data from 264 transfusions. Leuk. Lymphoma 1999; 34: 71-84. cases. Br J Haemato/1 987; 66: 11 5-2 1. 53. Du XX, Williams DA. lnterleukin-11: review of molecular cell biol­ 35. Freedman J, Gafni A, Garvey MB, Blanchette V. A cost-effective­ ogy, and clinical use. Blood 1997; 89: 3897-908. ness evaluation of platelet crossmatching and HLA matching in the 54. Gordon MS, McCaskiii-Stevens WJ, Battiato LA, Loewy J, Loesch D, management of alloimmunized thrombocytopenic patients. Breeden E et al A phase I trial of recombinant human interleukin- Transfusion 1989; 29:201 -7 . 11 (neumega rhiL-11 growth factor) in women with breast cancer 36. Welch HG, Larson EB, Sl ichter SJ. Providing platelets for refractory receiving chemotherapy. Blood 1996; 87: 3607-14. patients. Prudent strategies. Transfusion 1989; 29: 193-5. 55. Isaacs C, Robert NJ, Bailey FA, Schuster MW, Overmoyer B, 37. Shibata Y, Juji T, Nishizawa Y, Sa kamoto H, Ozawa N. Detection of Graham M et al Randomized placebo-cont rolled study of recom­ platelet antibodies by a newly developed mixed agglutination w ith binant human interleukin-11 to prevent chemotherapy-induced platelets. Vox Sang 1981; 41 : 2 5-3 1 . thrombocytopenia in patients with breast ca ncer receiving dose­ 38. Busse! JB, Pham LC, Aledort L, Nachman R. Maintenance treat­ intensive cyclophosphamide and doxorubicin. J Clin Oncol 1997; ment of adults with chronic refractory immune thrombocytopenic 15: 3368-77. purpura using repeated intravenous infusions of gammaglobulin. 56. Tepler I, Elias L, Smith JW 2nd, Hussein M, Rosen, Chang AY et al Blood 1988; 72: 121 -7. A randomized placebo-controlled trial of recombinant human 39. Schiffer CA, Hogge DE, Aisner J, Dutcher JP. Lee EJ, Papenberg D. interleukin-11 in cancer patients with severe thrombocytopenia High-dose intravenous gammaglobulin in alloimmunized platelet due to chemotherapy. Blood 1996; 87: 3607-14. transfusion recipients. Blood 1984; 64: 937-40. 57. Chao FC, Kim BK, Houranieh AM, Liang FH, Konrad MW, Swisher 40. Kickier T, Braine HG, Piantadosi S, Ness PM, Herman JH, Rothko K. et al Infusible platelet membrane microvesicles: a potential trans­ A randomized, placebo-controlled trial of intravenous gamma­ fusion substitute for platelets. Transfusion 1996; 36: 536-42. globulin in alloimmunized thrombocytopenic patients. Blood 58. Galan AM, Hernandez MR, Bozzo J, Reverter JC, Estel rich, Roy T et 1990; 75: 313-6. al Preparations of synthetic phospholipids promote procoagulant 41. Novotny VM. Prevention and management of platelet transfusion activity on damaged vessels: studies under flow conditions. refractoriness. Vox Sang 1999; 76: 1- 13. Transfusion 1998; 38: 1004-10. 42. Awisati G, ten Cate JW, Bu ller HR, Mandelli F. Tranexamic acid for control of haemorrhage in acute promyelocytic leukaemia. Lancet 1989; 2: 122-4. 43. Shanwell A, Sallander S, Olsson I, Gulliksson H, Pedajas I, Lerner R. An alloimmunized, thrombocytopenic patient successfully trans­ fused w ith acid-treated, random-donor platelets. Br J Haematol 1991; 79:462-5. 44. Bertolini F, Porretti L, Corsini C, Rebulla P, Sirchia G. Platelet qual­ ity and reduction of HLA expression in acid-treated platelet con­ centrates. Br J Haemato/1993; 83: 525-7. 45. Novotny VM, Doxiadis IN, Van Doorn R, Brand A. The kinetics of HLA class I elution and the relevance for the use of HLA-eluted platelet transfusions. Br J Haemato/1996; 95: 416-22.

NZ J Med l ab Science 2000 13 0 MODULAR ANALYTICS

• MODULAR ANALYTICS successfully combines Clinical Chemistry, Drug and Protein Analysis with Immunoassay on a single easy to use serum workarea.

• Seamless Integration improves your lab efficiency.

• Comprehensive, common proven reagent menu ensures result quality with 197 applications covering 95o/o of the serum workarea testing.

• Extendable and adaptable on site to meet the changing demand of lab services.

• Large installed base with over 200 systems installed world wide in 1999.

• Local experience, HAMILTON MEDLAB is the first MODULAR installation in NZ with the system operational within 3 days of installation

... tJ

ISE 900/1800 module

Windows NT Loading capacity Chloride, Potassium, Clinical Chemistry, based user of 300 samples in Sodium Homogeneous interface 2 trays Immunoassays 900 or 1800 tests/hour Touch screen and Continuous rack Up to 2400 tests/hour mouse operation loading 3 channels 16 assays Remote Diagnos- Dedicated STAT tic Access port Up to 3500 tests per bottle set •• arrives in Jfami[ton

I

~ P 800 module Core Unit

Clinical Chemistry, Heterogeneous Rerun buffer Homogeneous Immunoassays Immunoassays Un loading capacity of Up to 170 tests/hour 300 sa mples in 2 trays Up to 800 tests/hour Up to 25 assays Continuous rack Up to 44 assays unloadin g 100/200 test packs Up to 1200 tests per bottle set

A Wide Variety of Solutions · Editorial "Have To" or "Want To". Challenges for the 3rd Millennium

Anne Paterson, President NZIMLS Microbiology Department, Lakeland Health, Rotorua

NZ 1 Med Lab Soence 2000, 54( 1). 16, 18

Desiderata includes in its advice: " ... Keep interested in your own career persona l professional growth. however humble, it is a real possession in the changing fortunes of There are so many varied opportunities to be a driver within our time. Exercise caution in your business affairs, for the world is full of profession: trickery. But let this not blind you to what virtue there is; many persons • Testing a hypothesis, refin ing a protocol and presenting the devel­ strive for high ideals; and everywhere life is full of heroes ... " opment to professional co lleagues. The professionals stay interested in their profession, seek to posi­ • Writing up the interesting case history that struggled to diagnosis tively evo lve and mature the profession and their place in it. They pro­ to benefit the next patient with that illness. mote and practise the standards and va lues presented in their Code of • Supporting a Special Interest Group (S IG) of the NZIM LS by con­ Ethics in a world dominated by commerciali sm. tributing organisational, treasury or promotional sk ills that facili­ tate the dissemination of knowledge within our profess ion . The first challenge • Becom ing a part of the governance of the profession ad minister­ The first cha llenge for our profess ion in the 21st ce ntury and the in g the various operations and maintain in g communications with beginning of the 3rd millennium is for all of us to be first, profession­ other re leva nt groups, eg Ministry of Hea lth, Universities, al. Our training knowledge, skills and developments belong first to the Registration Board. profession . Businesses, whether private or public purcha se this exper­ • Most importantly, being a worthy rol e model to others. tise by employin g profess ionals. Although clashes may occur from time The opportunities offered to by the NZIMLS are many and varied, to time, ultimately it is loyalty to being profess ional first that strength­ however can be summarised as: ens the profession and the place of the profession within the work­ place, the hea lth sector and society. Ju st as a lawyer, accountant or NZIMLS teacher is expected to give the best professional performance, so are Opportunity to: we. And just as other professions must deal with poor practise, inad­ network equate standards and factory mentalities of " I'm here for the pay socialise onl y" so must we. Our cha ll enge is to ensure all mentors of our pro­ continue education fession promote and practise Medical Laboratory Science accord in g to develop persona lly our Code of Eth ics, for the very survival of our profession. Survival of develop professionally our, or any profession, requires clear, authoritative and progressive maturation. All practitioners in the field of medica l laboratory science So "network" with fell ow professiona ls - put aside commercial must participate in positive evo lution, advocating the standards, va lues barriers in the pursuit of sharing professional excellence with your col­ and ethics by which our profession and therefore we retain our repu ­ leagues. tation and standing in society. "Socialise" - enjoy fun and fellowship as you unwind from a sci ­ To stay interested in our careers what better vehicle to use than entific forum. our own professional body. The New Zealand Institute of Medical "Participate" in Continuing Education" -be a learner or leader as Laboratory Science (NZIMLS). What else unites or has the potential to appropriate. write professionals if not their own professiona l body to whom the "Develop persona lly and professionally" - be proud of who and first commitment is the welfare and benefits of its members. All must what you are. recognise that the NZIMLS functions and activities binds us and our A professional body, just like a golf club, can only offer opportuni­ unique disc iplines together, to affirm our co mmon foundation and ty. The ability to take up our professional opportunities is apparent via claim our right to repre sentation in the national arenas. the qualifications we hold . The third ingred ient with opportunity and ability is the motivation to make the most of what the NZIMLS offers The second challenge and must be triggered within each one of us. The second cha ll enge for our profession in this 3rd mi llennium is for The NZIMLS provides the infrastructure to ensure scientific meet­ all medica l laboratory scientists to belong to the NZIMLS and all to ings at regiona l, national and international levels. It financially under­ utilise the opportunities if offers to the full. The NZIMLS is li ke any vehi­ writes these meetings and through the executive office provides cle. It can sit in the sa leyards, you can buy it and it can sit in your adm inistrative support as appropriate and/or required. For example, garage but to get the fu ll benefits, one has to get in and drive it. laboratory co ntact li st s. In the current climate of takeovers, mergers, Sometimes being the passenger, perhaps attending the Annual joint ventures and alliances, just maintaining a list of current laborato­ Scientific meeting or reading the Journal (N Z J Med Lab Science), and ry titles, addresses and contact people requires sign ificant voluntary so metimes being the driver, presenting a paper or getting one pub­ effort and time commitment from colleagues in the workplace coordi­ lished . Driving a vehicle takes effort and concentration and so does nated by the work of the Executive Officer employed by the NZIMLS .

NZ J Med Lab Soence 2000 16 "One of the World's fastest growing Diagnostic Companies"

New Technology Biochip Array Quality Control Sera Control products Custom manufacture RIQAS External Quality Control Assurance Compare with 3,500 labs world-wide HDL & LDL New generation clearance method

Specific Proteins

Anti-oxidant Testing Clinical Chemistry Products Routine assays & specific tests Probably the most comprehensive range available

The Powerline Club Satellite communication technology Free customer service facility

Now exclusive to ~~ med·bio +Ph: 0800 MEDBIO +Fax: 0800101 441 +email: [email protected] The national laboratory list is utilised by SIG s, conference organise rs, We are professionals! graduates looking for employment etc. As professional, all of us are obliged to uphold our Code of Ethics. Th e Executive Officer and Exec utive Office of the NZIMLS is the We devalue ourse lves if we are not firstly profess ional. central mec hanism and constant point of reference in a voluntary and We need everyon e to be active in our professional body, NZIMLS. therefore changing succession of representatives w hether they be t he As the only ve hicle totally dedi cated to serve our interests. Each one of Presi dent, Reg ional Re prese ntative or a SIG Convenor, staffed durin g us shoul d seek to take up the opportunit ies for persona l and profes­ all busin ess hours, it is the administrative work horse and reference siona l growth. resource for all NZIMLS business, from examination timetables and syl­ Having achieved such a depth of specialist knowledge, we must labi to the various sc ientific events and their program mes. An alterna­ now be responsive to current trends of disease focussed ca re and tive so urce of communica t ion is the NZIMLS website adapt ourselves to fill these niches, w ithout losing our depth of exper­ www.nzimls.org.nz maintained through the efforts of vo lunteer col­ tise. leagues and our executive office. We are a complicated team of diverse sk ills and knowledge who All professionals and their societies must continually strive for must synchronise our efforts to fulfil our own NZIMLS mission state­ 100% of their potential members to ach ieve cha ll enges one and two. ment Our profession has many that do toil to achieve these, congratulations "The New Zealand Institute of Medical Laboratory Science is the to you. professional organisation that represents medica/laboratory scientists. It has an ongoing commitment to promote professional excellence The third challenge through communication, education and a code of ethics to achieve The third cha ll enge facing our profession is peculiar to medica l labo­ the best possible laboratory service for the ultimate benefit of the ratory science at this particular point in time is a here and now chal­ patient." lenge. Th is hurdle is that of the pure discip line specia list and a need to progress to the multi-expert or multi-expert tea m. We need to rethink and poss ibly repackage how we prese nt medica l laboratory science. Having spent the past 50 years proving just how different t he spe­ cia list discipli nes are, we need to take note of the emerging trends. Public drivers are dictating that care is more seamless and ill ness focussed . In se rving our clients, chiefly clin icians, we must become more flexible to respo nd to the demands of speciali st investigative work . We need to increase our co mmunica tion, co-operation and spec­ trum of expertise across our disciplines to offer a coordinated va lued laboratory science service. For example, w hile t he diagnosis of the leukemia, breast cancer or diabetes may be within one discipli ne, the management and monitoring of that patient does not. Specialist expertise w ill still be needed but our challenge is to respond to this ill­ ness oriented management trend and seek to co-ordinate our various expertise into packages that w ill pre-empt client demand or worse miss the opportunity to f ill the niche. So while SIGs have a deservedly recogn ised role within our professional body, the cha llenge for this century w ill be to find the balance between the specia list expert and the multi-expert team. A good starting place may be to maintain SIGs and devote the Annual Scientific meeting to multi-discipline fora on specific illness. This learning and sharing of expertise can be transplanted back into the workplace thus taking us a fu ll circle to the first cha ll enge of being a responsive proactive evolving professional. Discipli nes within medical laboratory science wax and wane through technological advances and economic drivers but although the boundaries and structures within our work may change, the pu rpose and need for the medical labora­ tory sc ient ist does not. All of us are in the business of the translation of so me form of organic material into words and/or numbers. The cl in­ ician needs and uses all of us in combinations that change with the dis­ ease and the patient. So lets not leave it just to the doctors and nurs­ es to run seminars on management of the patient w ith resp iratory ill­ ness, arthritis or the aged. We have the resources and ability to cohe­ sive ly prese nt t he medica l laboratory sc ientist(s) as a co nstructive co n­ tributor to any and all of these illnesses focussed tea ms. It w ill mean break in g down barri ers of ownershi p, such as the New Zea land Blood Service is esta bl is hing and recogn isi ng t he need for increased overl ap of knowledge between superficially sepa rate disci­ plines. It w ill mean expanding our expertise and co nstantly adjusting to accommodate our different clients. But the return will be an enhancement of our status within the health team .

NZ J Med Lab Science 2000 18 Index to Volume 53, 1999

Subject Index presence of Giardia antigen by enzyme immunoassay (EIA).

Biochemistry Amy H Chang, Jenny R Dowling, Arthur J Morris ...... 88-90

Laboratory and clinical aspects of measuring serum Letter to the Editor

eosinophil cationic protein (ECP) in asthma. A comparison of the DiaMed gel technique with conven-

S Holt, R Siebers ...... 3-4 tional tube technique in a transfusion medicine laboratory.

General Mark Bevan ...... 104 -105

1998 TH Pullar Memorial Address. Trends, technologies and Reports

medical laboratory scientists. Ross Hewett ...... 39-45 NZIMLS President's 1999 report. Shirley Gainsford ...... 112

Accuracy of references in the New Zealand Journal of Minutes of the 55th AGM of the NZIMLS ...... 113-114

Medical Laboratory Science. R Siebers ...... 46-48 Abstracts of papers presented at the South Pacific

Direct evolution of a full professor. Anon ...... 82 Congress. Christchurch, August 1999 ...... 128-153

New Zea land development assistance to the health labora- Book Reviews tory service in Bihn Dihn Province, Vietnam. Haematology laboratory management and practice. Eds:

Ron Mackenzie ...... 87 SM Lewis and JA Koepke. Butterworth Heinemann ...... 82

The inappropriate use of statistics. Obituary

TC Badrick, RJ Flatman ...... 95-1 03 Robert James Coleman ...... , ...... 56

Haematology Author Index Bad rick TC ...... 95-1 03 Thrombocytopenia-A review. Bevan M ...... 104-105 K Pot/uri, C Kendrick ...... 5-7 Castle JL ...... 49-56 Chiang AH ...... 88-90 Histopathology Delahunt B ...... 91-94 Proliferation markers in histopathology. Dowling JR ...... 88-90 Flatman RJ ...... 95-103 Brett Delahunt, Ann Thornton ...... 91-94 Gainsford S ...... 112 lmmunohaematology Hewett R ...... 39-45 HoltS ...... 3-4 Production of defined-haematocrit plasma-reduced blood Kendrick C ...... 5-7 for exchange transfusion. SR Khu/1 ...... 8-9 Khull SR ...... 8-9 Mackenzie R ...... 87 Microbiology Morris AJ ...... 88-90 Burkholderia cepacia: A review of an environmental sapro- Potluri K ...... , ...... 5-7 Siebers R...... 46-48 phyte as a human pathogen. JL Castle ...... 49-56 Siebers R...... 3-4 Feasibility of pooling faecal specimens for detecting the Thornton A ...... 91-94

NZ J Med lab Science 2000 19 Bayer

Diagnostics B A BAYER Bayer E R

Dear Customer, April 2000

Welcome to Bayer Diagnostics New Zealand!

The purpose of this letter is to inform you of the mutually agreed decision that Bayer will acquire the business of SCIANZ Corporation and integrate it with Bayer NZ Ltd to create Bayer Diagnostics as a direct organisation in New Zealand .

Bringing Bayer Diagnostics in New Zealand direct to you the customer will be under the leadership of Mr Paul Gibson, Customer Relations Manager who is based in Auckland. Mr Barry Jones, Managing Director of SCIANZ Corporation will continue in the New Zealand operations keeping close contact with you as well as ensuring a successful transition to the new structure. Barry is also responsible for the Australasian Region business development programs, sourcing new products for the portfolio of Bayer Diagnostics.

The prompt but careful completion of these changes ensures that you will experie nce no disruption to existing support levels, rather, we are now planning for improvements in our service to you.

Bayer Diagnostics is committed to providing the best support in our industry, as measured by you, our customers. You will find that the people in our new organisation are outstand ing in their skills and drive to satisfy your requirements. In most cases, the same dedicated people you've known before with SCIANZ Corporation will continue to address your needs as part of Bayer Diagnostics.

What does Bayer Diagnostics offer to you? With a portfolio covering cli nical chemistry, immunoassay, laboratory automation, haematology, urinalys is, haemostasis, critical care, histology and infectious disease serology, we provide one stop service for meeting the broadest range of needs. Especially exciting is the incred ible selection of new products just released, or coming soon in 2000. New stand alone and integrated platforms for biochemistry, haematology and immunoassay offer break-through solutions to all laboratories. We also will continue to combine this extensive range with our Lab Consulting services, to ensure you get the maximum benefit from workflow and productivity improvements.

In closing, we look forward to sharing a very exciting and successful 2000 with you . To make this happen we believe that proactive and ongoing communications is one of our highest priorities during the introduction of Bayer Diagnostics. If you have any questions, please contact us directly and we invite you to visit our website, www.bayerdiag.com , for continuous updates on Bayer Diagnostics.

I'd appreciate your feedback on concerns or issues you may have regarding the change from SCIANZ Corporation to Bayer Diagnostics.

Please contact our office directly on (09) 415-4240 or 0800 724 269

Yours Sincerely

George Nearchou

General Manager Diagnostics Business Group - Australia & New Zealand How Accurate is Data in Abstracts of Research Articles?

Rob Siebers MIBiol, FNZIMLS Department of Medicine, Wellington School of Medicine, Wellington

NZ J Med Lab Soence 2000, 54(1):22-23

Abstract were verified for accuracy against the source of the data and informa­ Objective. A previous study has identified errors in abstracts of pub­ tion in the body of the article (methods, results, figures, and tables). li shed scientific articles. The aim of this study was to determine the An abstract was deemed inaccurate if the data or information in the accuracy of abstracts of scientific articles published in the New Zea land abstract differed from that in the body of the article, or if data or infor­ Journal of Medical Laboratory Science . mation present in the abstract did not appear in the body of the arti­ Methods. All abstracts of scientific articles published in the New cle. Zea land Journal of Medical Laboratory Science from March 1995 to The number of articles with errors in the abstract was recorded November 1999, that had data, were checked for accuracy by the together with the number of errors per abstract, and the percentage author. abstract error rate was ca lculated . Results. Five out of 17 scientific articles contained one or more errors in the abstract, giving an abstract error rate of 29.4%. Results Conclusions. Some articles published in the New Zea land Journal During the five-yea r period chosen for the study (1995 to 1999), there of Medical Laboratory Scien ce have erroneous abstracts. Authors have were 17 scientific articles published in the New Zealand Journal of a responsibility to ensure accuracy of their abstracts. Medical Science that contained abstracts with data. Of these 17 arti­ cles, five contained errors in the abstract, givin g an abstract error rate Keywords. of 29.4%. Abstracts, accuracy Of the five articl es conta ining errors in the abstract, one articl e' abstract contained four errors, the other four articles contain ed only Introduction one error in the abstract. All but one error involved data in the abstract A published arti cle represents the final account of a scientific study. which differed from that in the body of the article. The reader can be expected to assume that the article is accurate in all aspects. Previous studies have shown that references in publi shed arti ­ Discussion cles frequently are erroneous (1-5). Also, references cited in the article The main finding of this study was that five out of 17 articles with are often misquoted (3-5). One major component of a scientific article abstracts containing data, had one or more errors in the abstract. The is the abstract. It is the most frequent and often the only part of the 29.4% abstract error rate compares to the only other published study articl e that is read. The abstract should provide a concise summary of on abstract accuracy, which found an abstract error rate of between the article. It comprises the rationale of the study, the methods used, 18% to 68% in six leading medical journals (6). A limitation of the pre­ the main results obtained, and the main conclusions or recommenda­ sent study may be the small number of articles studied, making a tions of the authors. direct comparison with Pitkin and co lleagues study (6) possibly not A recent study has shown that errors also occur in abstracts (6). valid . They studied 44 articles in each of the six journals. This was cal ­ Pitkin and co lleagues studied the abstracts of research articles in six culated from their previously publi shed prel iminary observations that leading medical journals (the Annals of Internal Medicine, the British to find between 25% to 50% of articles with abstract errors, a sam­ Medical Journal, the Journal of the American Medical Association, the ple size of 44 articles would have to be studied to detect a statistical­ Lancet, the New England Journal of Medicine, and the Canadian ly significant difference at the 80% power level (7). Despite the limita­ Medical Association Journa~. They found that between 18% to 68% tion of the present study in on ly studying 17 articles, a significant num­ of sc ientific articl es contained errors in the abstracts in these six jour­ ber of these articles contained errors in the abstract. nal s. Abstract deficiencies were defin ed as data in the abstract being The abstract of a sc ien tific article is frequently the on ly part of an inconsistent with that in the article's body, or data being included in article that is read. Because it is in reality a mini-a rticl e in itse lf, the the abstract that was not mentioned in the body of the article. resu lts and con clu sions contained therein are often quoted in subse­ The purpose of this study was to determine the accu racy of data quent articl es. This is especia lly so as it is nowadays easy to extract in abstracts of research articles published in the New Zea land Journal abstracts from electronic databases, eliminating the need to obtain the of Medical Laboratory Sc ience in the preceding five years. fu ll printed article . Thu s it is of utmost importance that data and other information in the abstract is accurate. Methods Although data in five of the abstracts in the present study was All articles published in the New Zealand Journal of Medical Laboratory erroneous, the errors in general were minor. For in stance, Siebers and Science from March 1995 to November 1999 were selected for the colleagues stated in the abstract that 60.5% of respondents had a study. Only scientific articles that had an abstract, and data in the lower overall knowledge of AIDS (8). In the results section the per­ abstract, were studied. For each articl e, the abstract was carefu lly scru­ centage of respondents was reported as 60.6%. Other errors were tinised by the author. Data, and other information, in the abstract more major. For in stance, Pottumarthy and co ll eagues stated in the

NZ J Med lab Science 2000 22 abstract that six isolates were susce ptible to aztreonam (9). In the 10. Winker MA. The need for concrete improvement in abstract qual­ results section only two iso lates were reported as being susceptible to ity. lAMA 1999; 281 : 1129-3 0. aztreona m. Correspondence: R. Siebers, Dept. of Medicine, Wellington School of What can be done to minimise abstract errors? Pitkin and Medicine, PO Box 7343, Wellington South. E-mail: [email protected] Branagan conducted a randomised controlled trial in which the inter­ vention arm was to provide authors of accepted manuscripts an instruction sheet stating three types of errors commonly found in abstracts (7). Th e co ntrol group was not given this instruction sheet. Th e authors in the intervention group were then urged to ca refully check their abstracts for any mistakes. Of the 250 manuscripts ran­ demised to either the intervention group or the control group, there was no difference in the rate of published abstracts containing errors (28% and 26% respectively). The authors concluded that many abstracts contained errors, that simple intervention was ineffective in reducing these errors, and that abstracts should be checked for accu­ racy by Editorial staff. Based on the findings of the studies by Pitkin and co ll eagues (6,7), the Journal of the American Medical Association has set quality crite­ ria to improve the accuracy of data in abstracts (reviewed and ed ited by Editorial staff), and to set the mini mum of what is expected of an abstract submitted to that journal (1 0). After implementation of their qua lity criteria, no discrepancies between the abstract and the body of the text of 27 articles published in their journa l in November 1998, were found. This co mpares to more than 50% of erroneous abstracts of 27 articles publi shed in November 1997, before quality criteri a were implemented. An Ed itor's job is already difficult and time consuming enough without adding additiona l tasks. A possible solution for journals with­ out extensive Ed itorial staff or resource s, would be for them to ask reviewers of submitted manuscripts to include a check of the abstract to en sure that data and other information contain ed therein, is con ­ sistent with what has been reported in the body of the text. · This will now be the author's intention as Editor of the New Zealand Journal of Medical Laboratory Science. Thi s, however, does not absolve authors from being pri marily responsible for accuracy of the su bmitted manu­ script, not only in the abstract, but also in the cited references, meth­ ods, resu lts, and conclu sions.

References 1. Siebers R. Accuracy of references in the New Zealand Journal of Medical Laboratory Science. NZ J Med Lab Science 1999; 53:46-8. 2. Siebers R. The accuracy of references of three all ergy journals. J Allergy Clin lmmunol 2000 (in press). 3. De Lacey G, Record C, Wade J. How accurate are the quotations and references in medical journals? Br Med J 1985; 291: 884-6. 4. Eichorn P, Yankauer A. Do authors check their references? A sur­ vey of accuracy of references in three public health journals. Am J Public Hea lth 1987; 77: 101 1-2. 5. Goldberg R, Newton E, Ca meron J, Jacobson R, Chan L, Bukata WR, et al. Reference accuracy in the emergency med ici ne litera­ ture. Ann Emerg Med 1993; 22: 1450-4. 6. Pitkin RM , Branagan MA, Burmeister LF. Accuracy of data in abstracts of publi shed research articles. lAMA 1999; 281: 111 0-1. 7. Pitkin RM, Bran agan MA. Ca n the accuracy of abstracts be improved by providing specific instructions? A randomized con­ trolled trial. lAMA 1998; 280: 267-9. 8. Siebers RWL, Lyn ch M, Singh KP. Relationship between AIDS/HIV knowledge, and attitudes, concerns and practices of medical lab­ oratory technologists in Fiji. NZ J Med Lab Science 1995; 49: 19- 21. 9. Pottumarthy S, Morris AJ, Shore KP, Bremmer DA. Potential for clinically mislea ding susce ptibility results due to extended spec­ trum beta-lactama ses. NZ J Med Lab Science 1997; 51: 8-11.

NZ 1 Med Lab Soence 2000 23 The Tl"ue Definition of Point-of-Cal"e Testing Fast. Simple. Reliable. Economical.

I·STAT fiATUII HOSPITAL IIMIPIT Comprehensive test menu e A wide range of analyte- 1n panel configurations Minimizes need for different analyzers- on one hand-held instrument • decreases costs e Minimal blood volume r qUtred-electrolytes, Reduces testing time 65 f..lW blood gases and electrolytes, 95 f..ll • • Sav~ nursing lime Mm1m1zes neonatal blood loss • due to testing needs Tru bedside testing ------­ • Simple 3-step procedure • Easy-to-use e Samples can be processed immediately- • Simplifies training no waiting • Allows nurses and medical staff to remain e Lab-quality results in 2 minutes with patient e No additional calibration procedures • Rapid res ults-for fast cli nical decisions or washing Prevents need for repeat samples due • to testing delay Economical ------e All testing contained in single cartridge • No hidden costs • Electronic OC Elimi nates additional, costly supplies such • as heparin syringes e Virtua lly maintenance-free • Simplifies O C - saves ti me • Minimizes maintenance costs Integrates with Precision Het data networking system ------e Multiple analyzers can tra nsmit data to e Allows POC coordinator to track cartridge Point-of-Care central workstati on usage-for more accurate inventory management A B B 0 T T New Products and Services

New from Socorex: Profiller 435 Any well fill ed outside the selected process limits automatica lly pro­ Profiller 435 is a pipette controller bu lb. Idea l for pipetting work w ith duces an aud ible alarm and provides an electrica l signal that ca n be glass or plast ic pipettes. Th e robust instrument is easy to operate, just used to stop the conveyor. squeeze the ru bber bu lb to produce aspi ra tion vac uum. Filling/dis­ A full database w ith sea rch features is maintained th roughout and, pensing lever button is thumb controlled with hi gh precision bu t no once a production batch is co mpleted, a f ull report ca n be printed on st rain. Has an air inlet w it h membrane f ilter. Autocl avable. any standard printer. Information available inclu des which plates were For more information please contact: incorrectly filled and w hat was done w ith that pl at e. The batch data­ Med-bio Limited base ca n be viewed at any time w ith the SPC graph viewer or plate Rose-Marie Daniel - North Island matrix vi ewer to assist in tracing production problems. Julie Vincent- South Island Modular Vision Ltd, Sunderland Business and Innovation Centre, 0800 MEDB/0 (633 246); Wearfie!d, Enterprise Pa rk, Sunderland, United Kingdom SR5 2TA. Fax: 0800 101 441; Company contact: Mr Brendan Ruff Te lephone: +44 191 516 6311; email: j vincent@medbio. co.n z Fax: +44 191 516 0688; E-ma il: [email protected]

MRSA DNA Probe for the Detection of MecA Gene The Alexon-Trend Velogene™ Ra pid M RSA Ident ification Assay is an New f rom Denka Se iken, a slide latex agg lutination assay for the innovative, use r-friendly DNA Probe for the detection of the MecA detection of PBP2 ' protein of Staph.aureus. The MRSA Screen test is a gene t hat codes for methicil lin resistance in Staphylococcus aureus. ra pid method for the detection of MR SA. Res ults are available in 15 Since results are avai lable w ithin 90 mi nutes post culture, the minutes. Th e latex part icl es are coated w ith a monoclional antibody Ve logene™ Rap id MRSA Identification Assay ha s potential cl inical util­ aga inst pen icill in bind ing protein 2', for high sensitivity and specificity. ity in preventing t he sp read of infections and reducing empiri cal van­ Suspect colonies can be taken from 18-2 4 hour cu lture on Blood comycin usage . Agar, Mann itol Sa lt Agar, etc. A simple extraction and latex agg lutina­ Th e assay co nsists of t hree stages - sa mple preparation, cycl ing t ion procedure follows. and detection. No special equi pment is requi red to perform this test MRSA Scree n ca n be used for diag nostic, surve illance, epidemio­ and res ults may be interpreted visuall y. log ica l and resea rch purposes. For further information on the Ve!ogene™ Rapid MRSA Identifica tion For more information, please contact: Assay please contact the New Zealand Distributors for Alexan-Trend· Med-bio Limited Ngaio Diagnostics Ltd Rose-Marie Daniel - North Island PO Box4015 Julie Vin cent - South Island Nelson South 0800 M EDB/0 (633 246); Email: [email protected] Fax: 0800 101 441; email: jvincent@medbio. co.n z New Latex Agglutination Test for Detection of Production Line Inspection System Gives Full Staph. aureus from Primary Cultures Quality Control of Blood Tests Alexon-Tren d now have ava ilable a new latex agg lutination test for detection of Staphylococcus aureus from primary cu lt ure. Reagent A Bri t ish-designed volume measuring microtitre plate dispensing sys­ detects both Protein A and Clu mping Factor. Features of this new tem using optical density can now be fi tted onto t he production li ne reagent are excell ent open-via l stability, long shelf life and exce ll ent for the f irst time, to ensure that the manufacture of blood test t rays spec ificity and se nsitivity. Blu e latex on a w hite ca rd en hances read­ can be inspected automatica lly 100% of the time. The test accuracy is ability and controls are included in each kit. Pricing is competitive. similar to that for offline readi ng system s - for every plate. The system For further information please contact the New Zealand Distributor: also detects foreign particles, such as a shard of cardboard, t hat may Ngaio Diagnostics Ltd have dropped into a well. PO Box 40 15 Nelson South Usin g digital camera technology, connected to a PC, t he IQIS fill vo l­ Ema il: [email protected] ume in li ne qua lity in spection system f rom Modular Vision meas ures the volume of reagents dispensed into ind ustry-standard 96-way Rapid Test Cards for Detection of Vaginosis microtitre plates . It is fitted onto the production line so every manu­ Ngaio Dia gnost ics are pleased to be appointed excl usive New Zea land factured plate is inspected automatically and the res ults stored in a Distributors for Lit mus Concepts Inc. Litm us Con cepts Inc. man ufac­ database . The ca meras 'look' at the product to located individual test ture rapid tests for improving the clinical eva luat ion of Infectious wells and measure how dark they are - the darker the well, the more Vag init is. liquid is presen t. These FemExam® Test Cards are rap id and easy to perform and OD measurement requires an appropri ate narrow-band optica l f ilter interpret. Th ey are stored at room temperature and have a long shelf for standard dye co lours. IQIS performs an adva nced ca li brat ion algo­ life. ri t hm that id entifies and co rrects mis-pipetted wells to all ow toleran ce Th e FemExam® pH and Amines Test Ca rd is performed in two for som e operator error at the cali bration stage . Correlation coeffi­ minutes or less. No reagents additions are involved and controls are cients are ca lculated and displayed with ind ividual well ca li bration bu il t in . Positive res ults are shown as two plus signs appea ri ng on the graphs and a graph ic of t he pipetting . credit card sized device . The system, w hich can be retrofitted to production lines, provides The other Test Ca rd is t he FemExam® Gardnere!la vagina/is PI P operators w ith a choice during production, of viewin g eit her a stat isti­ Activity Test Ca rd . Thi s Ca rd detects in 5 minutes or less elevated lev­ ca l process co ntrol (S PC) graph , showin g mea n fill and range together els of Gardnerella w hich are found in nea rl y all BV pos itive patients. w ith process li mits tramlines, or t he indivi dual pl ate matrix of fi ll vol­ For further information please contact the New Zealand Distributor: um es. Th e in kjet-marked plate number is rea d by an optica l ch aracter Ngaio Diagnostics Ltd recognition (OCR) camera and disp layed.

NZ J Med Lab Science 2000 25 PO Box 4015 Nelson South Rose-Marie Daniel - North Island Email: ngaio@xtra .co.nz Julie Vincent - South Island 0800 MEDBIO (633 246) Biolab Scientific Acquires Science & Technology Fax: 0800 101 441 (NZ) Ltd (SCI TECH) Email: Jvincent@medbio. co. nz Science & Technology (NZ) Ltd , a privately owned scientific instrument distributor, has been acq uired by Biolab Sc ientific. Finntip BioCon Mr Denholm Patterson, Managing Director of Sci Tech, said " Sci The new BioCon pipette tips are free from Endotoxin, DNA, DNase and Tech has a very strong technica l co mpetency particularl y in the devel­ RN ase. They are presterili sed with gamma irradiation . lnvividually opm ent of applications for hi gh tech in strumentation in industry. Our wrapped tips are available in boxes of 50 or 100 pi eces. staff and our supplier base are supportive of the move to join forces Contact M edica Pacifica Ltd 0800 106 100 or visit our web page w ith Biolab who have a broader market coverage both in New Zea land wwwmedica.co.nz and Australi a." Biolab wi ll be taking on the Sci Tech sales, marketing and techni­ Automated DNA and RNA purification with cal staff and w ill develop a business un it devoted to the higher tech­ Kingfisher from Labsystems nology products. The Sci Tech Dunedin office and technica l ce ntre will Contact Medica Pacifica Ltd for a demonstration on CD-ROM of the be retained as a support base for the strong relationships w ith cus­ Labsystem Kingfisher System. tomers in the lower So uth Island. Phone 0800 106 100 or visit our web site wwwmedica.co.nz. Catherine Ca larco, New Zea land Genera l Manager of Biolab Scientific co mments "for some time we have been ta rgeting to expand our product portfolio into the higher tech nology area. As new tech­ nology repl aces current in-lab methods we wa nt to be abl e to offer our customers the benefits the newer technologies offer. Over the last couple of years w e have developed a solid logistics , se rvice support and E-Commerce capabi lity which is the base for further expansion of the busin ess . Th e Sci Tech product range is a good fit with our current range and we look forward to the addition of their techn ica l capabili­ ties to enhance our offering to cu stomers." The acqu isition will be completed at the end of February. For Further information please contact: Catherine Calarco General Manager; NZ Biolab Scientific Ltd Ph: (09) 980 6741 Email: catherinec@biolabl. co. nz

Phadebact Products Med-Bio Ltd is very pleased to announce that we are the newly appointed distributors for Phadebact products, manufactured by Boule Diag nostics, Sweden. Med-Bio Ltd also provides techn ica l support for all their product range along w ith the exce ll ent service that we have become known for. Boule Diagnostics is a lead ing supplier of high quality microbiolo­ gy agglutination products, including Strep Grouping Kits, Monoclonal antibody for Neisseria gonorrhoeae, direct Mening itis Kit, direct tests for Strep. pneumoniae and Haemophil us influenzae. For more in formation please contact: Med-bio Limited Rose-Marie Daniel - North Island Julie Vin cent- South Island 0800 MEDBIO (633 246) Fax: 0800 101 44 1 Email: Jvincent@medbio. co. nz

Microgen New Product New from Microgen, Cryptosporidium IFA. FITC-conjugated mono­ clonal antibody for the detection of Cryptosporidium oocyts in clin ica l, veterinary and water samples . The Microgen Cryptosporidium IFA has bee n validated for both water and faeces testing. The results show exce ll ent fluorescence intensity and clean background, ensu rin g accurate results at all times. For more information please contact: Med-bio Limited

NZ J Med Lab SCience 2000 26 THE UK'S LEADING AGENCY FOR MEDICAL LABORATORY SCIENTISTS

'*' Friendly advice on: • UK entry CORINTH • Accommodation '*'Widest choice of posts '*' Top rates of pay MEDICAL '*' FREE Indemnity Insurance* For our FREE 'Working Holidays in Britain' can help! brochure, contact Kate Williams AIBMS MECI on 5 Theobald Court TOLL-FREE 0800-442933 (24 Hours) Theobald Street or Fax on 00 44 181 207 6894 or E-mail: [email protected] Borehamwood Herts, WD6 4RN, UK •subject to tiJe Terms of tile Policy

NZ J Med Lab Science 2000 THE NEW ZEALAND INSTITUTE OF MEDICAL LABORATORY SCIENCE [Inc]

CERTIFICATE OF QUALIFIED TECHNICAL ASSISTANT

EXAMINATION SUBJECTS EXAMINATION Clinical Biochemistry Transfusion Science Haematology Transfusion Science - Blood 1. The examination will be held annually in New Zea land Products in November. Histological TechniqueC/inical Microbiology Clinica l Cytology Clinica l Mortuary Hygiene and 2. Candidates must complete the application form and Techn ique forward this, complete with exam ination fees, to the lmmunologyVirology Executive Officer of the NZIMLS before the clos ing date. No late applications will be accepted. PREREQUISITES 1. Cand idates for the exam ination must be employed as 3. Candidates must be financial members of the NZIMLS medica l laboratory ass istants in an approved labora­ at the t ime of sitting the exam ination. tory in New Zea land and have worked continuously in the subject for 18 months prior to the examination or 4. The examination consists of one written paper of accumulated not less t han 18 months practical expe­ t hree hours duration. Candidates for the Clinica l rience in the exa mination subject. Cytology exa mination are also required to complete a Upon completion of two years continuous or accu­ practical examination. mulated practical experience in the subject, the cer­ tificate of Qualified Technical Assistant will be award­ 5. To pass the examination candidates must obtain an ed. overall mark of 50% . Clinical Cytology candidates must pass the practical and theory examinations. 2. Candidates who have passed a Qua lified Technical Assistant examination and who wish to sit a second 6. The results of the examinations will be announced by Qualified Technical Assistant examination must fulfil the NZIMLS. Successful candidates will be awarded the above criteria but need only to have worked con­ the NZIMLS QTA Certificate in the appropriate disci­ tinuously or accumulated experience of one year in pline. the examination subject. 7. The ca ndidate's script will be returned upon rece ipt of 3. Candidates must be financial members of the a written request by the ca ndidate. No copy will be NZIMLS at the time of sitting the examination retained and no correspondence relating to the mark­ and be a financial member or have submitted a ing of the script will be entered into. valid membership application form at the time of applying to sit the examination. 8. Candidates who have disabilit ies or injuries at the t ime of t he examination may request the SYLLABUS Exa minations Committee of the NZIMLS to all ow Copies of t he syll abus are avail able from t he Exec utive t hem a sc ribe. Details may be obtained f rom t he Officer of the NZIMLS, P 0 Box 3270, Christchurch . Executive Office r of the NZIMLS.

NZ J Med lab Science 2000 28 APPLICATION TO SIT THE EXAMINATION OF QUALIFIED TECHNICAL ASSISTANT

1st November 2000

SECTION 1 - TO BE COMPLETED BY THE CANDIDATE

Tit le:Mr, Mrs, Miss, Ms

Surname: ...... First Names: ......

Of, Laboratory:

Laboratory Address: ...... 0 ...... 0 •••• 0 ••••• 0 0 0 0 . 0 •••• 0 ••••• •••••••••••••• 0. 0 0 ••••••• 0 ••••••• 0 ...... 0 ...... 0

Subject (Haematology, Microbiology etc): o...... o... o......

EXAMINATION FEE: $125 (GST Inclusive) The full examination fee must be paid with the application.

SECTION B -TO BE COMPLETED BY THE PATHOLOGIST OR CHARGE SCIENTISTS

Date ca ndidate co mmenced w ork in exa mination subject:

"I certify that the above ca ndida te meets the requirements of the QTA Regulations"

Signed: ...... 0 ...... Designation: ...... 0 ......

Please state the name and address of the person respons ible for receiving the papers and supervising the Examination in your laboratory or centre.

Name: ···· ·· ····o ····· ·· o· ·· ·······································o.o...... o......

Laboratory Address: ...... o. 0 0 ...... o..... ··o··· ...... o·o···o ... ooo·oo ... oo .. o...... 0 ••• •••• ••••• •••••••• o..

APPLICATIONS CLOSE FRIDAY 26th MAY 2000 Please forward application forms accompanied by fees to: NZIMLS, P 0 Box 3270, Christchurch

NO LATE APPLICATIONS WILL BE ACCEPTED

Special Note to Applicants If no already members of the NZIMLS applicants to sit this examination must submit a va li d membership application along with t hi s examination app li cation.

For Office Use Only

Date received:...... Cheque number: ......

Bank: ...... Branch : ...... oo...... o......

Drawer: ...... 0 • • •• • • •• •• 0 . 0 0 ...... o •• • • •• • ••• ••• •••••• 0 0 •• 0 . Amount: ...... 0 •••• •••• 0 ...... 0 ••• •• • • •••

NZ J Med Lab Soence 2000 29 NZIMLS - membership application PO Box 3270, Christchurch, New Zealand Email: [email protected]

Please complete and return to PO Box 3270 Christchurch

Surname:

First Names:

Laboratory Address:

Employed as:

Specialty:

Address for correspondence: ......

Membership category: Fellow or Member $ 101.40 I annum Associate $ 48. 10 I annum Non-practising $ 44.20 I annum

Nominated by:

Guidelines for membership categories:

Member Any person who is registered with the NZ Medical Laboratory Technologists Board. Associate: Any person engaged in Medical Laboratory Science who is not eligible for any other class of membership eg. QTA Non-practising: 1. Any person who has been a Fellow, Member or Associate, but is no longer engaged in Medica l Laboratory Science and who w ishes to become a non-practising member. 2. Any person not engaged in Medica l Laboratory Science

Payment:

Charge to: VisaO Mastercard 0

Credit ca rd No.

Expiry Date:

Name of cardholder:

Date:

NZIMLS membership 1999-2000

NZ J Med Lab Sc•ence 2000 30 semtno,.,• BSIG (on behalf of the NZIMLS)

Not to be missed by Today's Medical Laboratory Inborn Errors of Metabolism - Scientists - exciting updates on Heart disease, Dr Richard MacKay, Paediatrician, Nelson Hospital, lead poisoning, and inborn errors. and Dr Chris Florkowski, Chemica l Pathologist, Canterbury Health Laboratories. Where Nelson When Saturday 29th April, 2000 Plus Proffered Papers ... Registration 9.30 - 1O .OOam . Best Proffered Paper Award Invited speakers:­ .. .sponsored by Abbott Diagnostics. Lead poisoning - We would recommend that each attending Dr Nick Baker, Paediatrician, Nelson Hospital, and laboratory present a 10 - 15 minute presentation. Mr. Trevor Walmsley, Canterbury Hea lth Laboratories. Costs: - A testing time for Heart Disease - Registration Members $40.00 Dr Andrew Hamer, Cardiologist, Nelson Hospita l, Non members $45.00 and Dr Peter George, Chem ica l Pathologist, Sem inar dinner $25.00 Canterbury Health Laboratories. Accommodation Sing le room $85.00 pp. per night

BSIG Seminar reply form

Attention: Nicola Thomas Fax number: 09 5731106

Name:

Laboratory:

Title of Paper:

Number of people wishing to attend: ......

Please indicate what you will be attending below ...

Yes No Seminar Dinner - Saturday night Accommodation Number of nights Cheaper accommodation required

If you would like transport arranged from the Airport, there is an airport transfer facility that costs $10.00.

NZ J Med Lab Sc1ence 1000 31 special interest in platelet disorders, clinical coagulation Karen Rogers problems and the therapeutic manipulation of adhesion Mycology Reference Laboratory, Starship Children's Hospital molecules. Karen has been working under the guidance of Dinah Parr since 1982. The Auckland Mycology Unit has performed the Andrew Butcher reference work for New Zealand since October 1997; offering a Institute of Medical and Veterinary Science, The Queen service for the identification and confirmation of: dermatophytes; Elizabeth Hospital, Microbiology and Infectious Diseases, saprophytic moulds; yeasts and aerobic actinomycetes. They South Australia also perform antifungal susceptibility testing.

Andrew has been working in medical laboratory science for the past 23 years having worked in Microbiology, general Craig Lehmann, PhD, CC(NRCC) Professor and Dean of the pathology and teaching laboratories in both Australia and School of Health, Technology and Management Canada. He has been employed in public, private and university laboratories specialising in microbiology and medical As a registered clinical chemist and while in the department parasitology. Over the past 10 years his focus has been of Clinical Laboratory Sciences, Craig established a national predominantly enteric microbiology and medical parasitology. and international reputation for his contributions in lipid He has been involved in teaching parasitology through research, clinical laboratory integration, diagnostic technology, continuing education programs and workshops as well as clinical laboratory economics, and clinical laboratory science lecturing for undergraduate students. education. Over these years, Andrew has been involved in a number of Craig's publication list is quite extensive and continues to parasitology research and development projects. From a add to the literature. In addition to his journal articles he has diagnostic view point he has attempted to improve fixation and contributed an educational video on clinical laboratory staining methods for protozoa, having modified the combination technology. He has co-edited and edited two clinical laboratory iron haematoxylin stain to provide a cost effective and efficient science textbooks. His latest text "Saunders Manual of Clinical screening method for routine laboratories. His other main Laboratory Science" has been rated by Doody's Rating Service: research area is the investigation of a new human fluke worm A Buyer's Guide to the 250 Best Health Science Books as one infection caused by Brachylaima sp .. This fluke worm infects of the top two hundred and fifty top health science texts. The humans via the ingestion of a small land snail which are infected two hundred and fifty texts were chosen from 3200 titles. with the metacerarial stage of this parasite. Brachylaima sp. has Because of these endeavours and others, he has made infected a number of children and adults in South Australia and .numerous presentations at national and international these infections represent the only known human cases. This professional meetings. research is concentrating on understanding the natural life Craig has had numerous honours bestowed upon him over cycle, reproducing the life cycle in the laboratory, investigating the years and his professional service endeavours have been the host-parasite relationship and improving diagnosis of further numerous as well as diverse. human cases both in Australia and overseas.

Mr Noel G Porter Professor Peter Molan B.Sc. Hons (Wales), Ph.D. (Liverpool) Plant & Food Composition Team, NZ Institute for Crop & Food Associate Professor of Biochemistry and Director of the Honey Research Limited, Lincoln Research Unit, University of Waikato Dr Porter is a senior scientist at Crop & Food Research's Prof Molan joined the staff of the University of Waikato in Lincoln campus, with 33 years research experience in the 1973 to establish the teaching of Biochemistry. He has been physiology of crop plants and the chemistry of their products. involved since 1973 in research on natural antibacterial Over the last 10 years, he has run a small multi-disciplinary substances and became interested in the antibacterial research group which has focussed on basic and applied properties of honey in 1981 . He discovered the unique research on new concepts, classes of information and antibacterial properties of manuka honey in 1982. measurement methods for the quality of crop products. Prof Molan has published 13 research papers and 4 review Recently, he has been involved in transferring R&D results and papers in international scientific and medical journals on the expertise on a wide range of natural products to commercial antibacterial properties and medical usage of honey, and has projects as a Tech link consultant for Technology New Zealand. been invited to speak at numerous conferences on the medical He has also served as technical consultant to FAO and UNIDO usage of honey. Awarded an MBE in the Queen's Birthday projects in Iran and North Korea. honours list 1995 in recognition for work on honey. His work over the last 20 years has covered all aspects of essential oil research and consultancy from market research and quality criteria through extraction technology to crop Dr Selwyn Lang management. He has been involved in commercial production Clinical Microbiologist and Infectious Disease Physician projects of 7 different essential oils in NZ. He has worked on Diagnostic Laboratory!Middlemore Hospital, Auckland manuka essential oils over the last 12 years, developing information on the chemistry and bioactivity of oils from different Dr Laing is a graduate of the University of Otago, he parts of the country, and working with commercial projects to attributes his interest in microbiology to his lasting association of develop production for export and domestic markets. One focus undergratudate laboratory time with the hospital squash court. has been to reduce oil production costs by improving extraction His interest in infections was furthered by two years at Sir technology and methods and selecting elite lines of plant Edmund Hi llary's hospital in Nepal. Post-graduate training was material for intensive cultivation. Most recently, his research at the University of Washington, Seattle and Duke University, interests have focussed on exploring the range of anti-bacterial North Carolina. He has produced the usual number of activity of the oil and obtaining some initial information on th e 'scientific' papers, mostly best forgotten, with an emphasis on mechanism of action of the active oil components. antibiotic treatment and he maintains an interest in this area. His expertise in veterinary microbiology is limited to caring for two cats and a dog (recently deceased).

NZ J Med lab Science 2000 34 NZIMLS Bay of Plenty Conference - Programmme Wednesday Workshops

Occupational Hea lth & Safety

Coagulation (Dry Workshop) - Haematology Special Interest Group

Thursday OPENING CEREMONY

PLENARY SESSION I

Paradigm Shift- The Motivation to Change The Health Reforms in Economic Terms - Pim Barren The Health Reforms : A Political View - Minister of Health or Funding Authority The Health Reforms : A Patients or Laypersons perspective - Sandra Coney The Social Changes/Aging Populations - Craig Lehmann, PhD, Dean, School of Health Technology & Management, Health Sciences Centre, State University of New York MICROBIOLOGY/ HAEMATOLOGY

Emerging Tropical Diseases - New Imports to New Zealand Dr Rod Ellis-Peglar, Infectious Disease Physician, Auckland Hospital HISTOLOGY & CYTOGENETICS

HAEMATOLOGY

" A Ce/libration of Haematology" Transplantation - Dr Robyn Rodwell, Mater Hospital, Brisbane Apoptosis - Graeme Findlay, Auckland School of Medicine Myelodysplastic Syndromes - Dr Elayne Knottenbelt, Haematologist, Medlab Central OCCUPATIONAL HEALTH & SAFETY

Clinical Incident Stress Debriefing (The La keland Health Model) - Ray Bloomfield, Chaplin OSH Management - Dr Max Robertson, Auckland NZIMLS AGM I Presentation of Examination and Journal Awards

Friday PLENARY SESSION II

The Paradigm Shirt - The Outcomes. The Changing Laboratories Re-engineering the Clinical Laboratory for the Millennium - Craig Lehmann, Dean, School of Health Technology & Management, Health Sciences Centre, State University of New York Automation .... Juggernaut or Opportunity - Helen Martin, Australia Hospital Outcomes - Dr Ross Boswell, Middlemore Hospital, Auckland LABORATORY INTEGRATION

Managing a Diagnostic Service in a Decentralised Community based System - Craig Lehmann, Dean, School of Health Technology & Management, Health Sciences Centre, State University of New York HAEMATOLOGY

Thrombophilia Factor V Leiden Platelet Function - Homocysteine MICROBIOLOGY

Identification of Common Pathogenic " Non-dermatophyte" Fungi - Karen Rogers, Mycology Reference Laboratory, LabPius Starship Children's Hospital, Auckland

Parasitology Protozoa Workshop - Andrew Butcher, Institute of Medical & Veterinary Science, The Queen Elizabeth Hospital, South Australia

NZ J Med Lab 5cient:e 2000 35 PCR IN INFECTIOUS DISEASES

. Tb . Chlamydia . HIV . HBV/ HCV . CMV . Toxo TRANSFUSION MEDICINE

New Blood Products OCCUPATIONAL HEALTH & SAFETY

Sleep/Wake Research - Dr Phillippa Gander, IMMUNOLOGYNIROLOGY

Cardiolipin Testing & Clinical Management - Dr Allan Sturgess, Royal North Shore Hospital, Sydney Use of ANA, ENA, RF in Clinical Management - Dr John Petrie, Rotorua EBV Serology BIOCHEMISTRY

PSA Total & Free. Role of Ratio's in Prostatic cancer . Diagnosis and treatment- Mr Peter Gil/ing, Urologist, Tauranga Diabetes and the role of the laboratory . Predeterminants Anti-GAD - Dr Steven Morris, Diabetologist, Tauranga Hospital

Saturday BIOCHEMISTRY

Drugs in the Workplace . Auckland Hospital - Dr Ron Couch, Toxicology, Auckland Hospital . Employer Perspective . Legal Aspects of Compulsory Drug Testing and Uses MICROBIOLOGY

Antibiotic Use/Abuse and Alternative Treatments . Agricultural Use- Dr Selwyn Lang, Diagnostic Medical Laboratory, Auckland . Manuka Oil - Dr Noel Porter, Christchurch . Honey- Prof Peter Malan, Associate Professor of Biochemistry, Director, Honey Research Unit, Department of Biological Sciences, University of Waikato . International resistance . National resistance - Dr Selwyn Lang, Diagnostic Medical Laboratory, Auckland TRANSFUSION MEDICINE

Triage Issues and the use of Blood Products -A Clinicians Perspective VETERINARY DIAGNOSTICS

HAEMATOLOGY

Aspects of Veterinary Haematology Dr Phillip Clark, Massey University

Paediatric Morphology IN FORMATION TECHNOLOGY

Proffered Papers and Posters

The Organising Committee extends an invitation to registrants to participate in the programme through presentation of an oral paper or a poster.

NZ J Mcd Lab Science 2000 36 N.Z. Medical Laboratory Science Trust Income and Expenditure Account for year ended 31 December 1999

INCOME: Interest Received: Cu rrent Account 44.83 Term Deposit 1 A 12.98 TOTAL INCOME $1.457.81

EXPENDITURE: Grants: J. Wypych 1,000.00 J Wypych 1,000 00 G. Herd 1,000.00 M. Bevan 1,000.00 A. Haywood 1'130.00 R. Siebers 1,000.00 K. Marson 632.00 6,762.00 Administration Expense 10.00 TOTAL EXPENDITURE $6,772.00 EXCESS EXPENDITURE $5,314.19

N.Z. Medical Laboratory Science Trust Obituary Balance Sheet as at 31 December 1999 Karen Jane Hastie 1974-1999 ACCUM ULATED FUND S Ba lance as at 1 January 1999 $16,003.12 Less Excess Expenditure 5,3 14.19 $10,688.93 It is with sympathy and deep sadness we note the pass in g of a popu­ lar and much loved fel low workmate. "Kazz", as she was affection­ Represented By: ately known was well respected by all as a conscientious and dedicat­ ANZ Banking Group ed co lleague. Her fun loving character and motivational drive was a Current Account $3,770.80 great asset to the workplace and ensured social events and activities Term Deposit 6,918.13 $10,688.93 were well organised. A keen surfer and competitive swimmer she loved the outdoors and salt air, often seen by many runn ing her dog along the sands of Ohope. Her stories and antics brightened and entertained many a day Auditors Report: on the workbenches of the Hospital Laboratory. I have examined the records and financial accounts of the N.Z. Medical Karen qualified with a Diploma of Medical Laboratory Science Laboratory Science Trust and report and confrim that the balances in through AIT in 1995, that year being the la st of the diploma qualifica­ the Trust's Bank accounts are as recorded in the above Balance Sheet tion and majored in Microbiology. After completing her training at as at 31 December 1999. Palmerston North Hospital she journeyed to the Bay of Plenty and in In my opinion the above Income & Expend iture account, for the early 1996 took up a Staff Technologist position in Whakatane year ended 31 December 1999 and the Balance Sheet as at 31 Hospital. December 1999, give a true and accu rate view of the Trust's affairs as As a Technologist, Karen was always eager to learn and enthusias­ at 31 December 1999. tic. Her unselfish attitude and hard work was easily recognisable and well appreciated. Always with a warm smile and friend ly manner, she David R Gordon won many friends from both staff and public. More recently, Ka ren Hon Auditor was in volved in the working committee for the forthco ming NZIMLT 14 January 2000 co nference in the Bay of Plenty. The "Lab Surfer Girl" will be well remembered for her specia l humour, wa rm character and professional dedication. Our hearts go out to her parents, Bil l and Helen , and her sister Rachel, w hose encour­ agement and support was overwhelmingly evident throughout her ca reer. Karen kept us youthful and filled our days with joy, she was a plea ­ su re to work with, taking great pride in her profession. It was a privi­ lege for all of us to have her as a friend and working co ll eag ue. Laboratory Staff Whakatane Hospital

NZ J Med Lab Science 2000 37 Haematology

Spec al Inter est Group

Journal Questionnaire desogestrel containing oral co ntraceptive is increased almost 50 fold. TRUE/FALSE Clinical Laboratory Haematology, 1999, Vol 21, 77-92 19. Lupus ant icoagu lant screen ing is recommended in Review: The Investigation and Management of Inherited patients w ith Activated Protein C res istance who Thrombophilia. proves to be negative. AM Cumming,CR Shiach 20. Hyperhomocysteinaemia is recognised as a risk factor for venous thrombosis, and arterial disease, including 1. Antithrombin (AT) inh ibits primarily thrombin and stroke, myocardial infarction and peripheral arterial also other activated serine proteases including disease. TRUE/FALSE factors Xa, IXa, Xla, Xlla and kall ikrein. TRUE/FALSE 21. Individuals with levels of Factor VIII greater than 2. Type I deficiency of AT is the production of a __ IU/dL have a re lative risk for t hrombosis of 4.8. variant protein . TRUE/FALSE What is the preva lence in the general population? 3. Type II deficiency of AT is characteri sed by low levels 22. In iso lation, the prothrombin gene 202 10 AG of functionally and immunologically determined AT TR UE/FALSE genotype appears to be a major risk factor for 4. Immunoassay alone w ill not permit the identification venous t hromboembolism . TR UE/FALSE of many type II AT variants. TR UE/FALSE 23. Venous thromboemboli sm is the most co mmon 5. The foll owing acqu ired states w ill give a reduced cause of maternal death in many western countries. TRUE/FALSE plas ma AT leve l; 24. Thrombophilia is less likely to be associated a) Heparin therapy. TRUE/FAL SE with or AT defi ciencies in b) Warfarin . TRUE/FALSE patients who present w ith a first thrombosis aged c) Li ver disease. TRUE/FAL SE over 40 years. But either __ or may 6. Activated Protein C together with Protein S, result in a first thrombosis at an older age. inactivates membrane-bound factor Va and VIll a. TRUE/FAL SE For t he answers tu rn to page 40. 7. Currently commercially ava il able functional assays have low specificity and the presence of Activated For copies of this article please contact Pip Sarcich, Protein C resista nce may give rise to spuriously Email: akspechaem@ahsl. co. nz high PS va lu es. TR UE/FALSE Phone: (09) 307 4949 ext 5591 8. Name three cond it ions associated w ith a reduction Fax.- (09) 375 4321 in functional (p lasma) Protein C levels. 9. Name one important factor that shou ld be co nsidered Report on Blood Film Morphology Workshop when determining a reference range for Protein S? I attended a very well run and organised third HSIG Morphology 10. Screening for Protein C and Protein S Workshop in Auckland at the end of November 1999. Having worked deficiencies shou ld be delayed until 14 days after in a sma ll rura l hospital laboratory for many years now, the opportu­ the completion of ora l anticoagu lant therapy. TRUE/FALSE nity to participate in such a course is invaluable. The course consisted 11. Activated Protein C res istance is shown (in 90% or of approximately 100 films covering a large number of disorders, more cases) to be associated with a gene mutation involving abnormalities in the white ce ll s, red cells and platelets. related to which factor? And what is it known as? Malaria and microfilaria were also covered . 12. Which risk factor for inherited thrombophilia is A hands on course like this enhances our ski ll s, brings us up to recognised to be the most common cause of venous date w ith any changes, helps to standardise our reporting of fil ms and t hromboembolism? stimulates us to improve our knowledge and to do more research. 13. contamination of plasma sa mples should be Another bonus is that it brings those of us who are more iso lated in avoided as this w ill reduce the Activated Protein C ratio. touch w ith others in the same position and we also learn what is hap­ 14. Phenotypic determination of Activated Protein C pening in the large cen tral laboratories. resistance is relatively inexpensive and easy to My personal thanks go to all those who org ani sed an exce ll ent perform. TRUE/FALSE cou rse. 15. Factor V Leiden mutation can be determined by Lesley Wiggins using t he modified APTI-based screening test, Te Kuiti Hospital w hich is very sensitive and specific. TRUE/FALSE 16. Genotyping of Factor V Leiden is the more definitive method and can be performed in any laboratory due to easy sa mple prepa ration and handling. TRUE/FALSE 17. Factor V Leiden mutation in iso lation is associated with a fold increased ri sk of venous thrombosis in heterozygous carriers, and an __ fold increased risk in homozygous carriers. 18. The risk of carriers of Factor V Leiden using a

NZ J Med Lab Sc1ence 2000 38 MICROBIOLOGISTS! SATURDAY 13 MAY 2000 Keep this date free for the ANNUAL S.I.G MEETING

To be held at the "Marion Davis Library" at Auckland Hosp ital Registration and morning tea from 9:30am Presentations starting at 1O:OOam • The programme this year will be similar to last year's w ith an opportunity to discuss and share any concerns or problems. • Dinner is included in the one-off registration at an undisclosed venue.

• For accommodation, contact Brendan at Auckland Vi sitors Ce ntre ph: 09 979 2337 ema il : [email protected] (for credit card bookings on ly)

Registration Form - MSIG Meeting - 13 May 2000

Registration Fee $70 institute member $90 non-member

Name Laboratory Ph/fax/email

I enclose a cheque made out to MSIG $ ------

I would like to contribute by presenting a paper on:

Topic: ------

Title:

Please send Registration Form and cheque to Sand ie Newton, Microbiology Department, Diagnostic Medical Laboratory, PO Box 14743, Panmure, Auckland .

NZ J Med lab Soence 2000 39 Answers of the Journal Article Advertisers in this issue Clinical Laboratory Haematology, 1999, Vol 21, 77-92 Review: The Investigation and Management of Inherited Abbott Diagnostics ...... 24 Thrombophilia. Bayer Diagnostics ...... 20-21 AM Cumming, CR Shiach Beckman Coulter ...... outside back cover Biolab Scientific ...... 27 1. Tru e BMG Associates ...... 40 2. Fa lse Corinth Medical ...... 27 3. Fa lse Dade Be hring ...... inside front cover 4. True GR Micro Ltd ...... 40 5. a)True b)false c)True Med-Bio Enterprises ...... 17 6. True Medica Pac ifica ...... 6 7. False Roche Diagnostics ...... 14-15, 32 8. Liver disease, Vitamin K deficiency, oral anticoagulant therapy and 9. Difference between the sexes (in healthy individuals), women on oral contraceptives, pregnancy, post-partum period or oral anticoagulants. 10. True MED-810 11. Factor V .... Factor V Lei den 12. Activated Protein C resistance/Factor V Le iden JOURNAL AWARD 13. Platelet 14. True 15. True Is an award to the value of $150 for 16. Fa lse each issue of the NZIMLS Journal. It is 17. Seven fold ... Eighty fold ... offered three times a year. 18. Tru e 19. Factor V Leid en 20. Tru e All fell ows, members and 21. 1 50 IU/dL.. 11 % associates of the NZIMLS Journal, 22. False w ill be automatically considered 23. Tru e 24. Protein C, Protein S... Factor V Lei den or Prothrombin G2 021O A for the award for that edition. va ri ant ..

...... The Doctors Laboratory, London W1, United Kingdom MEDICAL SCIENTISTS Medical Laboratory staff planning a working hol iday within COME AND WORK IN THE UK! t he UK are invited to contact us...... Our free service gives you: Short and long term positions are often avai lable and we pay excellent rates. o A superb choice of locum assignments throughout England For further details please visit our website o Top rates of pay, paid weekly www.tdlplc.co.uk o Free Professional Liability insurance o Meet and Greet ser.~ce on arrival at London airport o Accommodation arranged - from your first night on o Exclusive orientation program at our associate's offices in the centre of London o Access to our local experience in helping New We are regularly looking for Zealanders arrange UK \~sas, professional temporary laboratory scientists, with registration, ailfares . . F'i nd out whv so manv New Zealanders like vou have experience in medical microbiology, chosen us to help them find the right job overseas. for our central London laboratory.

Call Catherine Olsen If interested, please co nt act us: on 0800 803 854 - GR Micro Ltd Medical & Environmental Microbiological Services 61 Malvem Road, Mt. Albert, Auckland 1003 Tel: +44 20 7388 7320 Fax: +44 20 7388 7324 d.felmingham@ grmicro.co. uk www.grmicro.co.uk ~ ~

NZ J Med Lab Sc1ence 2000 40 NZIMLS degree programmes mission statement download NZIMLS QTA examination application activities of the download NZIMLS Fellowship application NZIMLS benefits of membership

rg.anizati. n that reprE!"aer1t5 Journal editor excellenc through journal issues ory servu::e or the ultrmate view journal article code of ethics titles NZIMLS membership categories membership fees in all dr5Clplines of medrcal laboratory sc1errce online & downloadable membership Scientific Meetrnq application online & downloadable annual membership payment International MLS professional organisations medical science pages self assessment exercises NZ and Australian Universities NZIMLS Council Council meetings SIG convenors NZIMLS annual scientific meeting downloadable SIG NZ and International Scientific meetings guidelines SIG seminars position responses application deadline dates for NZIMLS examinations for LA's and Near Fellowship and QTA examination dates Patient Testing.