European Federation of Laboratory Medicine e-learning platform offers:

  • webinars (the schedule of forthcoming webinars)
  • recordings of presentations (from webinars and congresses) packed with didactic quizzes into an e-learning courses
  • e-learning courses (educational activities of EFLM WG´s, postgradual education of trainees  - Specialists in Laboratory Medicine ...)

Available courses

Speaker: Aasne Karine Aarsand (NO)
Moderator: Bill Bartlett (UK)

Date: 26-09-2017 at h. 18.00 CET

Registration is open.

Biological variation (BV) data has many appliances in the daily laboratory life, being used both when evaluating the diagnosis and monitoring of disease and for setting analytical performance specifications. Thus, the quality of our work directly depends on the reliability of the BV estimates used as basis for these processes. Widely varying BV estimates are available for different measurands, and it is likely that this may be caused by differences in study design and statistical handling. Addressing this issue, the EFLM established in 2014 an EFLM Task and Finish Group (TFG) for the Biological Variation Database. The TFG is made up by members from the EFLM Working Group on Biological Variation, the Analytical Quality Commission of the Spanish Society of Clinical Chemistry and experts in the area. The TFG has developed a critical appraisal list for evaluation of studies on BV and this will be used as basis for the setup of a database with measures of BV, the derived performance specifications and the evidence behind it.

A 66-year-old woman was admitted to our hospital with shock and multiorgan failure. She was resident in the United States, in a rural area of New Jersey. She had been on vacation in Europe for 3 weeks and had suffered fever and chills for 1 week, and nausea, vomiting and abdominal pain for 2 days.On admission she showed respiratory, hepatic and renal failure, anemia, lymphopenia, thrombocytopenia, high lactate dehydrogenase (3500 IU/L; normal: 250–450) and negative direct and indirect Coombs test.The peripheral blood (PB) film revealed the diagnosis of the patient. Some interesting images of the morphological findings in blood cells will be discussed during the presentation. It will be useful for the participants to learn about the differential diagnosis in this special case, since the abnormalities that we found in blood cells can be easily confused with those of other more frequent disease. Diagnosis can be challenging and therefore knowledge of the distinguishing clinical features and epidemiology of these diseases is important. In addition to morphology, an adequate clinical history is important for speedy and accurate diagnosis.

Biomarkers that are surrogates for cardiac pathophysiology may help us understand the "state of the heart" in heart failure and may be indications for certain treatments. A good biomarker will also be able to be monitored and a change in the level will reflect a change in the condition. I will speak of three biomarkers that do exactly this (natriuretic peptides, high sensitivity troponins and sST2). Natriuretic peptides (NPs) (BNP and NTproBNP) are guideline standards to confirm the diagnosis of heart failure. They are good for monitoring volume as we diurese the patient. Their weaknesses include wide variability in levels in a given patient as well as elevations not secondary to an increase in left sided filling pressures. Additionally, their value is questionable in patients receiving Entresto (a drug that inhibits breakdown of NPs). High sensitivity troponin in the setting of acute heart failure (and maybe chronic) represents subendocardial necrosis and has a bad prognosis. It is possible that drugs like nitrates will be used in heart failure treatment more commonly when levels of high sensitivity troponin are high. Finally, sST2 is a marker of fibrosis and is elevated in virtually all patients with heart failure. In the acute setting, it defines a "sicker" patient who needs advanced treatment to avoid re-hospitalization. In the chronic setting, titrating medication to a sST2 level below 35 ng/ml appears to mitigate risk, even in the setting of a continued high NP level. Data with Entresto suggest sST2 levels are going to be useful in both selection of patients for Entresto as well as monitoring treatment and maybe regulating the dose.

Fasting blood samples have been the standard for measurement of triglycerides and cholesterol, despite the fact that we spend the vast majority of our time in non-fasting conditions. However, when recent studies suggest that postprandial effects do not substantially alter lipid concentrations and do not weaken, and even may strengthen, their association with cardiovascular risk, then a non-fasting blood draw has many practical advantages. Non-fasting cholesterol measurements include the ‘remnant cholesterol’ fraction, a strong risk factor for developing atherosclerosis independent of LDL cholesterol. Remnant cholesterol reflects the cholesterol in chylomicron- and VLDL-remnant particles and it is included in the ‘non-HDL cholesterol’ calculation.
Until recently, most guidelines focused on targeting primarily LDL cholesterol for the prevention of cardiovascular disease, but they now recognize that non-HDL cholesterol (or apolipoprotein B, the molecule carried by all non-HDL particles) is a more accurate and comprehensive predictor of atherogenic lipoprotein-related risk.
In 2016, the European Atherosclerosis Society (EAS) and EFLM Joint Consensus Panel recommended using non-fasting lipid testing for routine clinical practice and provided specific cutpoints for desirable fasting and non-fasting lipid concentrations to be reported by the laboratories uniformly.

The estimate of measurement uncertainty is important in Laboratory Medicine because it is required for reference measurement laboratories to obtain/maintain the accreditation according to ISO 17025:2003 and ISO 15195:2005 and for clinical laboratories to obtain the accreditation according to ISO 15189:2012. There are two approaches to estimate measurement uncertainty, the so-called ‘bottom-up’ and ‘top-down’ approaches.

At the beginning of 2015 the monograph “Rational Ordering of Laboratory Parameters” in Slovak language has been issued. The monograph with 185 pages from 4 editors and 18 authors represents an attempt to create a common denominator contributing to the consensus between clinicians, laboratory specialists and healthcare providers. This webinar discusses common problems in rational ordering of laboratory test.

E-learning offers a broad variety of tools that can bridge information gap between these worlds. In this interactive webinar, we will cover following objectives:

  • overview of basic tools used in e-learning
  • familiarize attendants with 5 commonly used ways of delivering content by e-learning (webinar, voice-over presentation, quiz, user generated content + social media, e-book)
  • give examples and practical hints for creating attractive educational materials

The preanalytical phase is the main contributor to diagnostic errors. Modifying staff behaviour to conform to venous specimen collection practice guidelines and other recommended practices has proved to be a difficult task.