2015 2 s newsletter World Pathology Day 3 Sjogren’s syndrome 4 SA antibiogram 6 InSIDe Pathology at your fingertips 8 Donating bone tissue 10 Genetic testing 10 Respiratory virus update 12 For our patients and our population www.sapathology.sa.gov.au From the Respiratory serology changes SA Pathology is decommissioning two antibody test services, the inside Chlamydophila pneumoniae and Respiratory Viruses by Complement This is a time of massive change for the Fixation Tests (CFT). From the Executive Director health system, including for SA Pathology, with the impacts of a burgeoning older Alternatives population and increased demand for You are encouraged to request timely access to affordable and quality PCR tests for faster, more sensitive pathology services, coupled with budget diagnosis of respiratory viruses, pressures on the health system and the M. pneumoniae and B. pertussis. implementation of new computer systems Serological tests for other pathogens and improved pathology automation. including Legionella, M. pneumonia and B. pertussis are not affected. In line with the Transforming Health initiative’s need to provide ‘the best care, Respiratory virus and Chlamydophila first time, every time’, our services will serology is now only available on continuously evolve and improve to focus paired samples and if required, CFT on achieving better outcomes for our testing can be arranged. patient population in partnership with all our Local Health networks and clinicians. Why the change? Whilst antibody testing can provide With the delivery of new e-Health systems a diagnosis of infection a definitive we are pleased to bring you this and analysers designed to handle millions result requires evidence of rising issue of the SA Pathology Newsletter, of tests every year, it is imperative our antibody levels in specimens collected the first for 2015, and trust you will organisation is ready when the new Royal two weeks apart. Paired samples are find it filled with relevant and useful Adelaide Hospital opens its doors in infrequently received and patients information. 2016. have usually recovered from illness, As you will be aware from reports in the You can be assured we will continue hence follow-up testing is rarely media, the efficiency and effectiveness of to deliver accurate, timely results to sought, resulting in low test volumes. SA Pathology was externally reviewed last support you in the care of your patients, year by SA Health. As South Australia’s maintaining our critical support of During 2013-14, SA Pathology public and most comprehensive medical staff in both the private and received over 4,500 samples for pathology provider it is appropriate that public sectors, and our reputation for Chlamydophila pneumoniae and our performance is reviewed regularly, scientific and clinical excellence. over 3,000 samples for respiratory particularly in the face of rapidly changing virus testing, from which only one technology and demographics. Mr Ken Barr patient showed evidence of infection based on paired specimens. New Patient Centres With the introduction of the molecular For your patients’ convenience SA Pathology has opened two new assay, a test for respiratory pathogens patient centres. is now available for reliable diagnosis of acute viral infection on a range of Campbelltown Port Augusta samples. Located within the Health Centre Located within the Ghan Medical 58 newton Road, Campbelltown Centre, 16 Young Street, Port Augusta More Information Monday – Friday 8.30am to12.30pm Mondays, Tuesdays and Thursdays If you wish to speak to a pathologist, from 8.30am to 11.30am call SA Pathology on 8222 3000 and ask for the on-call microbiologist. ¥ For a complete list of our Patient Centres visit www.sapathology.gov.au SA Pathology Newsletter Contact Design Published by SA Pathology [email protected] Sue Dyer Design Editorial Committee Photography Cover Our new Pathology Guide, Mark Fitz-Gerald, Ming Qiao, SA Pathology Photo and Imaging all our tests and mobile friendly too Dianne Zurcher, Kieran Weir Printing ISSn 2203 – 2339 Print and David Johnston Fivestar Print ISSn 2203 – 2347 Online SA Pathology Newsletter > 2 – 2015 PAGE 2 WORLD PATHOLOGY DAY Across the nation and around the world, the inaugural World Pathology Day was held on 5th of November 2014. Commencing the week with ‘Open On World Pathology Day, the ABC Many people passing through the Lab’ on november 3rd, SA Pathology 891Mornings radio program featured area took the opportunity to talk to our invited clinicians and medical students Professor Howard Morris and Doctor scientists and look through microscopes to see its main Frome Road Adelaide Penny Coates, who explained at images of cells and tissue, and to laboratories and automated pathology pathology’s critical role in patient discuss pathology’s role in health care. systems in operation. diagnosis and treatment. We enjoyed providing the South Feedback from attendees was Offering the public a unique insight Australian public a unique insight into extremely positive and SA Pathology into pathology’s role in medical the critical service pathology offers and plans to hold similar Open Lab events diagnosis, SA Pathology mounted a thank our partner organisations RAH later this year. display of anatomical specimens in and RCPA for their support. ¥ the Royal Adelaide Hospital foyer. Parasite testing Medicare rebate changes SA Pathology has introduced a new In December 2014 Medicare n taking medication known to molecular testing regime for faecal announced that Folate, Vitamin D, decrease 25OH-D levels such as parasites. B12 and Haemoglobin A1c (HbA1c) anticonvulsants tests would only be covered by rebates n having chronic renal failure or renal For routine initial testing Polymerase for patients with specified clinical transplant recipients. Chain Reaction (PCR) molecular conditions. tests have now replaced traditional Haemoglobin A1c microscopy. PCR detects significantly For patients who meet these changed For diagnosis of diabetes mellitus in more parasite infections for most conditions, please include appropriate asymptomatic at-risk patients, HbA1c common pathogens including G clinical notes. is rebated once every 12 months only. intestinalis, E histolytica, D fragilis In patients known to have diabetes, and Cryptosporidium spp. It can Folates the HbA1c is still rebated up to four distinguish between pathogenic and Red Cell Folate and Serum Folate are times per year for the management non-pathogenic Entamoeba and offers covered by Medicare if the patient is of their condition. faster turnaround times. deemed at risk of folate deficiency due to anaemia, pregnancy, malabsorption B12 What to collect or malnutrition. Up to 30% of patients with B12 Collect unpreserved faecal specimens; deficiency may show serum B12 levels there is no requirement for a special Vitamin D in the lower normal range. For better faecal parasite collection kit. Where A suite of conditions apply; all are diagnosis of this patient group, indicated by a patient’s clinical history, covered in the Path Brief currently SA Pathology will automatically add such as recent overseas travel, or if available on the SA Pathology website. a Holotranscobalamin in all pathology the patient is a migrant or refugee, Some examples of patients’ clinical tests with low or borderline B12 levels. microscopy tests will be performed in conditions include those; This will provide a more accurate addition to PCR. n suffering from malabsorption estimate of tissue B12 availability for (e.g. due to cystic fibrosis, short these patients. For further information about PCR bowel syndrome, inflammatory testing contact SA Pathology on bowel disease or untreated coeliac You do not need to change your 8222 3000 and ask for the on-call disease etc.) current ordering practice. ¥ clinical microbiologist. ¥ n having deeply pigmented skin, or chronic and severe lack of sun exposure SA Pathology Newsletter > 2 – 2015 PAGE 3 www.sapathology.sa.gov.au Sjogren’s John Bahnisch syndrome Sjogren’s syndrome (SS) is a slowly progressive and currently incurable autoimmune disorder characterised by the presence of autoantibodies and immune cells that target epithelial exocrine glands, specifically the salivary and lacrimal glands. Whilst lifespan is not generally reduced quality of life may diminish. Presentation The secondary form involves gland decreased tear production, ulcers inflammation associated with and cornea abrasion. The principle features, known as the another autoimmune disorder such sicca complex, are: − xerostomia (failure of salivary as rheumatoid arthritis, SLE and glands) may cause mouth and n dry mouth scleroderma. throat dryness, speaking and n dry eyes swallowing difficulties, dental SS is characterised by two n lymphocytic infiltration of the decay, candidal mouth infections. phenomena. exocrine glands. − failure of other exocrine glands, 1 Lymphocyte infiltration of the including skin, respiratory tract, After systemic lupus erythmitosis exocrine glands with predominantly digestive system and genital (SLE), SS is the second most T cells, and progressive destruction tract. common autoimmune disorder, of the glands. Inflammatory n Systemic systems affecting 1% – 2% of the population. changes may block smaller gland Middle-aged women are most ducts. − Arthritic joint and muscular pain commonly affected with a female:male 2 B cell hyperactivity with − Lymphadenopathy ratio of 9:1. It also affects about circulating auto-antibodies − Renal disease 50%