February 2021

February 2021—Absorbing new biomarkers into lung cancer workups makes for a complicated diplomacy. How best to balance so many rivals? Does it make the most sense for laboratories to try to do everything at once, a full-court press involving next-generation sequencing panels? Or is it more practical to add a new marker only as a new targeted therapy receives approval? Where do RNA-based assays fit in? What about IHC? When do you make the switch? Or do you? And how best to handle cell-free DNA tests (which seem to be the rogue states in all this)? How do you weight external factors, such as reimbursement, existing equipment and capital expenditures, and physician expertise? Driving this all are medical breakthroughs. As with all forms of statecraft, the latest incident can change everything. For lung cancer, the most recent advance comes from the ADAURA trial, which showed a significant benefit of using osimertinib to treat stage IB to IIIA EGFR-mutation positive non-small-cell lung cancer.

February 2021—From the first, the COVID-19 pandemic has been marked by absence. Reagents and instruments, collection tubes and pipette tips; enough technologists to handle the overwhelming workloads; sleep—so much went missing or was in short supply, month after month.

February 2021—Eighteen months after introducing a next-generation sequencing assay to detect CMV antiviral resistance in the transplant population, Matthew Binnicker, PhD, D(ABMM), in an AMP presentation, shared a patient’s case and his laboratory’s broader experience.

February 2021—Cisgender male reference intervals can be used to interpret testosterone concentrations in transgender and nonbinary adults on masculinizing therapy, but reference intervals specific to the transmasculine population should be used to evaluate estradiol, say the authors of a recently published study.

February 2021—Variants and vaccines were in the news when Compass Group members spoke with CAP TODAY publisher Bob McGonnagle for the first time in the new year, on Jan. 5. “This is something we all need to stay close to,” Julie Hess, of AdventHealth, said of the variants. “We need to know if it’s going to impact our ability to detect.” With McGonnagle and Hess on the Jan. 5 call were Dwayne Breining, MD, and James Crawford, MD, PhD, Northwell; John Waugh, MS, MT(ASCP), Henry Ford; Stan Schofield, MaineHealth; Gregory Sossaman, MD, Ochsner; Peter Dysert, MD, Baylor Scott & White; Steven Carroll, MD, PhD, Medical University of South Carolina; Heather Dawson, Allina; Janet Durham, MD, ACL; Daniel Ingemansen, Sanford Health; Ericka Olgaard, DO, MBA, University of Arkansas for Medical Sciences; Sterling Bennett, MD, MS, Intermountain; and Judy Lyzak, MD, MBA, Alverno.

February 2021—Granulocyte morphology may contain clues to neutrophilia etiology, and that was the focus of a CAP20 virtual presentation by Olga Pozdnyakova, MD, PhD, associate professor of pathology at Harvard Medical School and medical director of the hematology laboratory at Brigham and Women’s Hospital. Reactive changes can mimic myeloproliferative neoplasm, but myeloproliferative neoplasm can have reactive morphology, she said. Pathologists can piece together clinical and morphological clues, “especially in concert with the clinical team, that may help them decide whether the changes are more reactive or more neoplastic in nature,” she told CAP TODAY in a follow-up interview. Neutrophilia is defined as greater than 7.7 × 10⁹/L or two standard deviations above the mean, and it is important to note whether it is present in the context of the left shift.

February 2021—What is the one most important thing to look for in an anatomic pathology computer system? That is one of several questions CAP TODAY publisher Bob McGonnagle put to five people in a Dec. 14 call on the AP LIS and more—surgical pathology volumes amid COVID-19, data integration, practice consolidation.

February 2021—New from CAP Publications is Surgical Pathology Review, by Daniel D. Mais, MD, associate professor of pathology, Department of Pathology, University of Texas Long School of Medicine, San Antonio. He and 14 other contributors wrote this book to ease the transition through board exams and into practice, Dr. Mais writes in the preface. Here is what he told CAP TODAY about the book.

February 2021—When I entered the practice of pathology the role was described as being a “doctor’s doctor.” That reflected the fact that physicians turn to the laboratory for so many tests that define diseases and determine the response to treatment, a reality true today. But my memories are of the more personal interactions with clinicians over the years as I pursued the practice of pathology beyond the microscope, and often beyond the laboratory.

February 2021—In late December, the U.S. Congress passed a COVID-19 relief bill that included two key items for pathologists—measures that the CAP pushed hard to achieve on our behalf. The document is more than 5,000 pages and addresses a large number of subjects, including thoroughbred horses. Here, I’d like to offer a brief analysis of the elements that affect our profession.

February 2020—SARS-CoV-2 is transmitted through respiratory droplets, close person-to-person contact, and infected surfaces. Those with COVID-19 often present with fever and respiratory symptoms, and diagnosis relies on detecting the virus through specimens from the upper and lower respiratory tract. However, an increasing number of patients are exhibiting such gastrointestinal symptoms as diarrhea, vomiting, and abdominal pain. A growing number of studies are reporting the presence of SARS-CoV-2 RNA in stool samples and anal swabs, generating interest in research focused on a fecal-oral route of transmission. The authors conducted a study to assess the clinical relevance of testing stool samples and anal swabs for SARS-CoV-2 and to provide a critical overview of literature addressing possible fecal-oral transmission.

February 2021—SARS-CoV-2 primarily causes pulmonary injury, but it has been implicated in hepatic injury through the use of serum markers and histologic evaluation. The histologic pattern of injury has not been completely described, and studies quantifying viral load in the liver are lacking. The authors conducted a study in which they reported the clinical and histologic findings related to the liver in 40 patients who died of complications of COVID-19. For the study, they subjected a subset of liver tissue blocks to polymerase chain reaction (PCR) for viral RNA. Peak levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated, with a median ALT peak of 68 U/L (normal up to 46 U/L) and median AST peak of 102 U/L (normal up to 37 U/L). Macrovesicular steatosis was the most common finding, involving 30 (75 percent) patients.

February 2021—Beta-thalassemia and sickle cell disease are common hereditary conditions that can have life-threatening complications. Both diseases are caused by genetic alterations affecting the beta subunit of hemoglobin. Mutations that reduce or prevent the synthesis of the beta-globin protein cause beta-thalassemia, a disease characterized by inadequate red blood cell production and, therefore, anemia. In contrast, sickle cell anemia results from a specific point mutation in the beta-globin gene that causes the resulting protein to polymerize. These protein polymers form rigid fibers that affect the stability of the red blood cell and cause its characteristic sickling deformity. Destruction of the aberrant red blood cells leads to anemia, and the sickled cells can also cause painful vaso-occlusive episodes and tissue damage.

Q. Can toxicology testing be performed on a person who has been deceased for two years? Read answer. Q. Is there a standardized procedure for performing platelet estimates that incorporates the dilution effect for low hemoglobin in anemic patients? The formula I found for platelet estimation works well with low hemoglobin levels but not with levels greater than 13 g/dL. Read answer.

Feburary 2021—Laboratories involved in requests for proposal for total lab automation systems may want to consider the words of wisdom of Francis of Assisi: “For it is in giving that we receive.”

February 2021—The FDA has issued an EUA for Siemens Healthineers’ IL-6 assay to measure the presence of interleukin-6 in human serum or plasma.