Author and Module Information

All individuals involved in planning and developing the contents of this program were required to disclose whether or not they (or an immediate family member) have any financial relationships relevant to the contents of this educational activity. If any potential or real conflicts of interests were identified by the organizing committee, they were resolved prior to the program. The committee members’ disclosure information is provided below:

Co-Editors in Chief

Nader Rifai, PhD
Professor of Pathology, Harvard Medical School
Louis Joseph Gay-Lussac Chair in Laboratory Medicine
Director of Clinical Chemistry, Boston Children's Hospital

Christina Ellervik, MD, PhD
Assistant Professor of Pathology, Harvard Medical School
Associate Director of Clinical Chemistry, Boston Children's Hospital

Drs. Ellervik and Rifai both disclosed no relevant financial relationships

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Topics


Body Fluid

Author Information:
Darci R. Block, PhD, DABCC
Consultant
Mayo Clinic
Dr. Block disclosed honorarium/expenses from AACC for a webinar on body fluid testing

Learning Objectives
  • Differentiate between standard and non-standard body fluids
  • Describe collection and handling of various body fluids
  • Describe anatomy, production, and composition of various body fluids in physiological and disease states
  • Describe clinical utility of various analytes in various body fluids
  • Interpret results from measurements of analytes in various body fluids
  • The fluids covered in the course are: serous, pleural, peritoneal, pericardial, synovial, amniotic, cerebrospinal

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Cell-free DNA in Prenatal Screening

Author information:
Christina Lockwood, PhD, DABCC, DABMGG
Associate Professor, Department of Laboratory Medicine
Director, Genetics and Solid Tumor Diagnostics Laboratory

Learning Objectives
  • Understand the biological sources of cell-free DNA
  • Recognize the technologies available for cell-free DNA prenatal aneuploidy screening
  • Describe the clinical utility of cell-free DNA prenatal aneuploidy screening
  • Know the general performance characteristics for cell-free DNA prenatal aneuploidy tests (sensitivity, positive predictive value, etc)
  • Identify challenges associated with cell-free DNA prenatal aneuploidy screening
  • Compare cell-free DNA prenatal aneuploidy screening with traditional prenatal screening
  • Understand that incidental findings may arise from cell-free DNA prenatal aneuploidy screening
  • List future applications of cell-free DNA in prenatal tests

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Clinical Toxicology: Drugs of Abuse

Author Information:
Shannon Haymond, PhD
Director
Clinical and Mass Spectrometry Laboratories
Northwestern University
Dr. Haymond had no relevant financial relationships to disclose

Learning Objectives

 

  • Differentiate between forensic and therapeutic screening
  • Recall general legal regulations of drug screening
  • Describe and compare specimen types
  • Describe general principles for analytical methods of drug screening
  • Describe and interpret analytical methods for the following drugs of abuse:
    • acetaminophenbenzodiazepine
    • PCP
    • Marijuana
    • Opiates
    • Cocaine
    • Barbiturates

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Concepts of Mendelian Inherited Disorders

Author Information:
Ann Moyer, MD, PhD
Assistant Professor of Laboratory Medicine and Pathology
Co-Director, Personalized Genomics Laboratory
Mayo Clinic

Learning Objectives
  • Recall definitions of basic terms used in genetics
  • Recognize inheritance patterns of common Mendelian disorders
  • Compare and contrast inheritance patterns
  • Determine which inheritance pattern is most likely based on a pedigree
  • Review clinical and genetic characteristics of common Mendelian disorders
  • Describe the process of X-inactivation and its implications
  • Demonstrate knowledge of Hardy-Weinberg equilibrium and Bayes Theorem

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Hemolytic Disease of the Fetus and Newborn

Author Information:
Kerry O'Brien, MD
Medical Director Blood Bank and Clinical Pathology Residency Program Director
Beth Israel Deaconess Medical Center
Assistant Professor of Pathology
Harvard Medical School
Dr. O’Brien disclosed salary/consultant fees from DynaMed

Learning Objectives
  • Discuss the pathophysiology of HDFN and which patients are most at risk for HDFN
  • Describe the usual ABO groups involved in HDFN due to ABO antibodies and the difference between ABO HDFN and HDFN from other IgG antibodies
  • Describe the critical titer of anti-D as it pertains to HDFN
  • Detail the history of Rh immune globulin, its clinical utility, its mechanism of action, how it is dose and when it should be given to women at risk of HDFN due to anti-D
  • Discuss the methodology and indications for the rosette test, the Kleihauer-Betke test and flow cytometry in assessing for fetomaternal hemorrhage
  • Discuss whether women with weak D and partial D mutations are candidates for Rh immune globulin
  • Explain why anti-K HDFN differs from all other types of HDFN and how one would monitor the at-risk patient
  • Discuss when and how an antibody titration procedure is performed in a pregnant woman
  • Describe the clinical presentation of HDFN
  • Detail the antenatal management of pregnancies at risk for HDFN including the use of middle cerebral artery Doppler ultrasonography, fetal blood sampling, and intrauterine transfusion
  • Describe the post-delivery management of neonates afflicted with HDFN including the use of neonatal intravenous immunoglobulin, phototherapy, and red cell exchange transfusion

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Liver Disease

Author Information:
Paul Johnson, PhD, MBA, MT(ASCP)
Assistant Professor, Clinical Laboratory Science
Upstate Medical University

Learning Objectives

  • Describe micro- and macroscopic anatomical findings of the liver
  • Describe biochemical functions of the liver
  • Describe clinical features of various liver diseases
  • Describe pre-analytical and biological variation of liver biomarkers
  • Describe analytical principles for measurement of liver biomarkers
  • Describe inherited conditions of liver disease
  • Describe hepatobiliary disease
  • Describe hepatocellular disease

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Mass Spectrometry

Author Information:
Erin Kaleta, PhD, DABCC
Clinical Director
Sonora Quest Laboratories
Dr. Kaleta had no relevant financial relationships to disclose

Learning Objectives

  • Describe basic concepts of mass spectrometry
  • Differentiate between hard and soft ionization
  • Differentiate between electron impact, electrospray, chemical, and desorption ionization techniques
  • Contrast the configurations of quadrupole, ion trap, and time of flight mass analyzers
  • Describe the practical use of various types of mass analyzers
  • Diagram a tandem mass spectrometer
  • Describe the function of each component of a tandem mass spectrometer
  • Contrast fixed and scanning mode configurations for ion selection
  • Describe sample preparation and introduction methods for mass analysis

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Metals: Trace and Toxic

Author Information:
Paul J. Jannetto, PhD, DABCC, FAACC, MT (ASCP)
Director, Metals Laboratory
Director, Clinical and Forensic Toxicology Laboratory
Director, Clinical Mass Spectrometry Laboratory
Mayo Clinic
Dr. Janetto had no relevant financial relationships to disclose

Learning Objectives

  • Recognize the common clinical signs and symptoms of deficiency or toxicity to essential, non- essential, and heavy elements
  • Identify the appropriate laboratory test/specimen matrix which should be ordered/collected to assess for elemental exposure or toxicity
  • Correctly interpret the elemental laboratory test results and suggest appropriate follow-up testing or care
  • Identify common sources of exposure to various elements

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Nuclei Acid Isolation

Author Information:
Linnea Baudhuin, PhD
Associate professor
Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
Dr. Baudhuin had no relevant financial relationships to disclose

Learning Objectives

  • Recall the major steps involved in nucleic acid isolation
  • Discuss overcoming issues with difficult sample types during nucleic acid isolation
  • Detail different reagents and approaches involved with cell lysis and nucleic acid separation
  • Compare similarities and differences between DNA and RNA extraction
  • Describe different types of liquid phase nucleic acid extraction
  • Recall details about the different methods for solid phase nucleic acid extraction
  • Discuss measurement and optimization of nucleic acid quantity and quality

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Pharmacogenetics

Author Information:
Hoi-Ying (Elsie) Yu, PhD, DABCC, FAACC
System Director
Chemistry, Toxicology and Point-of-Care Testing
Geisinger Health System
Department of Lab Medicine

Learning Objectives

  • Identify different types of pharmacogenetic targets and understand how medications can be affected by genes
  • Recall the specific role of pharmacogenetics in certain cancer treatments
  • Define the specific roles of pharmacogenetics in pain management
  • Recall details about cardiovascular-related pharmacogenetics
  • Describe examples for psychiatry-related pharmacogenetics
  • Describe HLA genes that impact drug hypersensitivity
  • Recall clinical benefits and limitations of pharmacogenetic testing

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Protein Electrophoresis

Author Information:
Danyel Tacker, PhD
Associate Professor (Clinical)
Director
Clinical Chemistry at WVU Health Science Center
Dr. Tacker had no relevant financial relationships to disclose

Learning Objectives

  • Understand basic principles in electrophoretic separation
  • Discuss indicated uses for protein electrophoresis tests
  • Interpret protein electrophoretic patterns in health and disease states
  • Describing major pitfalls in electrophoretic separation

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Serum Enzymes

Authors Information:
Christopher McCudden, PhD, DABCC, FAACC, FCACB
Associate Professor
Department of Pathology and Laboratory Medicine
University of Ottawa
Clinical Biochemist, Division of Biochemistry
The Ottawa Hospital
Dr. McCudden had no relevant financial relationships to disclose

Danyel Tacker, PhD
Associate Professor (Clinical)
Director
Clinical Chemistry at WVU Health Science Center
Dr. Tacker had no relevant financial relationships to disclose

Learning Objectives

  • Describe the basic structure and function of enzymes
  • Recognize different enzymes naming conventions and nomenclature
  • Discuss the methods to measure clinically relevant enzymes
  • Identify clinically relevant serum enzymes
  • Discuss how serum enzymes are used to diagnose and manage disease

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The Exocrine Pancreas

Author Information:
Mark Marzinke, PhD, DABCC
Associate Professor
Departments of Pathology and Medicine
John Hopkins University School of Medicine
Dr. Marzinke had no relevant financial relationships to disclose

Learning Objectives

  • Describe the cytoarchitecture of the pancreas
  • Recall the digestive enzymes synthesized, stored, and secreted by the pancreas
  • Identify the components of pancreatic fluid, and its role in downstream digestion
  • Recognize the importance of pH in pancreatic enzyme activity
  • Describe how amylase and lipase are measured in the clinical laboratory setting
  • Stratify invasive and noninvasive tests to assess pancreatic function
  • Detail how laboratory tests can be used in the differential diagnosis of pancreatitis
  • Compare and contrast clinical presentation and laboratory findings associated with acute and chronic pancreatitis

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Therapeutic Drug Management I

Author Information:
Christine Snozek, PhD, DABCC, FAACC
Department of Laboratory Medicine and Pathology
Mayo Clinic
Dr. Snozek had no relevant financial relationships to disclose

Learning Objectives

  • Understand the rational for therapeutic drug monitoring
  • Describe the principles of pharmacokinetics
  • Describe the preanalytical and analytical factors affecting drug measurement

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Thyroid

Author Information:
Robert Nerenz, PhD
Assistant Professor
Department of Pathology and Laboratory Medicine
Dartmouth Hitchcock Medical Center
Dr. Nerenz had no relevant financial relationships to disclose

Learning Objectives

  • Understand basic pathophysiology of the thyroid gland
  • Describe basic biochemistry of the thyroid
  • Describe major sources of preanalytical and analytical error in thyroid testing
  • Understand analytical principles used for thyroid function testing
  • Interpret thyroid function testing results

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Vitamins

Authors Information:
Rav Sodi, PhD, CSci, EuSpLM, FRCPath
Consultant Clinical Biochemist and Head of Department
Royal Lancaster Infirmary and Furness
General Hospital, UHMBT, Lancaster
Honorary Lecturer, Lancaster Medical School
University of Lancaster, UK

Lynn A. Brunelle, PhD, DABCC
Operations Director
ALPCO
Dr. Brunelle disclosed grant/research funds and consultant fees from Sciex

Nicole V. Tolan, PhD, DABCC
Assistant Adjunct Professor in Pathology and Laboratory Medicine
Tufts University School of Medicine
Director of Scientific and Medical Affairs
SCIEX Diagnostics
Dr. Tolan disclosed grant/research funds and consultant fees from Sciex

Learning Objectives

  • Classify vitamins based on solubility in water or fat
  • Recall common and chemical names and structure of all major vitamins
  • List common food sources of the vitamins
  • Describe the absorption, metabolism and functions of vitamins in the body
  • Describe classic diseases related to vitamin deficiency and their biochemical investigations
  • Describe vitamin toxicity and how to investigate this
  • List analytical principles for vitamins

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Vitamin D

Author Information:
Nicole Tolan, PhD
Instructor in Pathology
Beth Israel Deaconess Medical Center
Dr. Tolan disclosed grant/research funds and consultant fees from Sciex

Learning Objectives

  • Describe the biochemistry of vitamin D
  • Describe major sources of preanalytical and analytical error in vitamin D testing
  • Understand methodologies used for vitamin D testing and their limitations
  • Interpret vitamin D results

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