webinar recordings

Courses tagged with "webinar recordings"

Speaker: Johannes (Hans) Hoffmann (DE)
Moderator: Giuseppe Lippi (IT)

Date: 12th Fbruary 2019 at 18:00 CET


Modern hematology analyzers do much more than just counting blood cells. Practically all instruments currently available also perform a white blood cell (WBC) differential and they produce flags or alerts for possible morphological abnormalities. Hematology analyzers have completely replaced traditional methods of cell counting and microscopic blood smear examination for the vast majority of blood samples.

In addition to these capabilities, hematology analyzers generate an ever-increasing amount of raw data, which can be transformed into cell parameters, for which no historical equivalent exist. This trend already started in the early days when measuring and reporting mean red cell volume (MCV) became possible. MCV has evidently established its clinical significance, due to the crucial role in classifying anemia. After MCV, many other parameters have been developed, not only for red blood cells, but also for platelets and white blood cells. However, in contrast to MCV, the clinical relevance of many of the new parameters is still unclear. Hematology analyzer manufacturers are generally launching these new parameters as research tools, without the slightest clue whether they can be of clinical value. This then opens possibilities for laboratory professionals examining the potential clinical significance of such parameters. Unfortunately, this type of research is plagued by serious challenges: most of the new parameters are not internationally standardized, limiting their widespread use in clinical practice. Sometimes the parameters depend on a certain technology, meaning that only laboratories using a specific make of hematology analyzer can use the parameter. And last but not least, some parameters are even specific for one individual hematology analyzer; other analyzers of the same model may produce different results and thus require separate clinical validation. An example of the latter are the so-called cell population data that have attracted a lot of interest in recent years; some interesting and promising applications were described, but one should also be aware of the limitations of this type of parameters.

The primary aim of this presentation is to discuss the technological principles used by the major hematology analyzers and to demonstrate how these technologies generate new cellular parameters. The second part will focus on understanding the potential use and limitations of new parameters, which are essential for researchers who are interested in investigating their clinical application. 

Category: Recorded
Speaker: Giuseppe Lippi
Moderator: Dirk Roggenbuck
Recorded on 22nd January

Abstract: Sepsis is a severe, often life-threatening, condition developing when the organism’s response to an infection triggers a paramount biological effect, which finally generate injuries to its own tissues and organs, up to septic shock, multi-organ failure (MOF) and death. Evidence has been provided that the measurement of some biomarkers in serum or plasma may have clinical values for diagnosing and monitoring sepsis. Consensus has now been reached that procalcitonin is the biomarker for which the most solid evidence has been garnered, that whatever sepsis biomarkers shall always be available on prescription, that test results should always be interpreted according to clinical data, and that test ordering should follow specific biomarker’s kinetics. Sepsis biomarkers assessment may be sometimes combined for diagnosing sepsis. In such case, the combination of procalcitonin with C reactive protein (CRP) or presepsin is the most widely suggested. Sepsis biomarkers should be integrated into diagnostic threshold, prioritizing the high negative predictive value and based on analytically sensitive techniques. Evidence is also strongly emerging that some of these biomarkers, especially procalcitonin and presepsin, may retain clinical usefulness for antibiotic stewardship, and that serial testing shall be set according to biomarker’s kinetics. The assessment of biomarkers other than procalcitonin, presepsin and CRP is now discouraged, at least until stronger evidence will be published. Molecular biology techniques are also emerging as potential alternatives for rapid etiological diagnosis of infections. Further refinements of molecular assays would probably help overcoming the current limitations of their diagnostic performance.
Category: Recorded

Speaker: Michael Cornes (UK)
Moderator: João Tiago Guimarães (PT)

Recorded on 15th May 2018


National and international (WHO, CLSI) guidelines recommended that order of draw of blood during phlebotomy should be blood culture/sterile tubes, then plain tubes/gel tubes, then tubes containing additives. This prevents contamination of sample tubes with additives from previous tubes for example sodium citrate or more commonly potassium EDTA (K3EDTA).

These recommendations are based on a case report by and a follow up study by Calam and Cooper in 1982 which reported that incorrect order of draw caused hyperkalaemia and hypocalcaemia. By measuring EDTA, it has been demonstrated that reverse order of draw of blood samples using closed loop venesection systems does not cause EDTA contamination. It is difficult to reconcile the directly conflicting results of these studies but it may be that reversed order of draw using poor technique and/or difficult venepuncture may result in sample tube cross-contamination.

It has been shown that contamination is still relatively common and may be difficult to identify. As this is not due to reversed order of draw of blood samples in a closed loop system other mechanisms must be in operation. Here I will present the evidence for and against the need to follow an order of draw.

Category: Recorded

Presenter: Federica Braga (IT)
Moderator: Anne Stavelin (NO)

Recorded on 17th April 2018

The participation to EQA schemes that meet specific metrological criteria is mandatory for the evaluation of performance of participating laboratories in terms of standardization and clinical suitability of their measurements. The requirements for this type of EQA are as follows: in addition to the use of commutable control materials, it is necessary to assign values (and uncertainty) to them with reference measurement procedures (RMP) performed by an accredited laboratory and to define and apply clinically allowable performance specifications to verify the suitability of laboratory measurements in a clinical setting. Unfortunately, there are few permanent EQA programs covering these requirements because some practical constraints including technical, psychological and economic aspects, which limit their introduction. It is, however, clear that these aspects should be immediately solved. Indeed, EQA schemes are in a unique position to add substantial value to the practice of Laboratory Medicine, by identifying analytes that need improved harmonization and by stimulating and sustaining standardization initiatives that are needed to support clinical practice guidelines. This will definitively help those manufacturers that produce superior products to demonstrate the superiority of those products and oblige users (and consequently industry) to abandon assays with demonstrated insufficient quality.

Category: Recorded

Recorded on: 3rd April 2018 at 18:00 CET

Speaker: Tiago Guimaraes
Moderator: Giuseppe Lippi


Every laboratory has to be aware of the need to validate the tubes it is using.

The importance of the pre-analytical activities is well known but sometimes not valued.

For tube validation each place has to set its own objectives according to its particular needs.

The EFLM Working Group on pre-analytics tries to help in setting some consensus on these aspects.

A EFLM Recommendation on this is being prepared.

Category: Recorded

Speaker: J.F.M. (Hans) Jacobs (NL)

Moderator: Christopher McCudden (CA)

Recorded on  27th March 2018 at 14:00 CET

Treatment of multiple myeloma (MM) has substantially changed with the recent introduction of therapeutic monoclonal antibodies (mAb) which have further improved the rates and depth of clinical response. mAb therapy in MM patients has introduced new challenges in how therapy responses can be defined. On the one hand, recently approved mAb interfere with routine M-protein diagnostics. On the other hand, given the high rates of complete responses, new response categories need to be defined to measure minimal residual disease. As a reaction to these challenges research has focused on adaptations of conventional M-protein diagnostics to mitigate interference and on the introduction of novel methods that enable the identification of minimal residual disease. The aim of this e-seminar is to discuss how mAb therapy has changed both the therapeutic as well as the diagnostic landscape of MM. 

Category: Recorded

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

Recorded: 06-03-2018 at h. 18.00 CET

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.

Category: Recorded

Speaker: Callum G. Fraser (UK)
Moderator: Sally C Benton (UK)

Date: 23rd January 2018 at h. 18.00 CET

Registration is open (enter the course to register).

How to enter the course?

Abstract: Colorectal cancer (CRC) is still a very important health problem world-wide.  It is the third most common cancer and the fourth leading cause of cancer-related death. Fortunately, many screening programmes have now been set up to detect neoplasia in those who do not have any symptoms of bowel disease. These programmes lead to early detection of CRC and its precursors, which significantly improves outcomes.  There are a number of strategies available for CRC screening, but faecal immunochemical test for haemoglobin (FIT) are now considered as the best currently available non-invasive investigation and are being widely established.  FIT are available in two formats, qualitative FIT and quantitative FIT: the former are often used in opportunistic screening, whereas the latter are widely used in population-based programmatic screening. Quantitative FIT have many advantages, a major benefit being that the faecal haemoglobin concentration (f-Hb) can be estimated. This Webinar will explore the diagnostic accuracy of FIT, and factors affecting f-Hb, including age, sex and socioeconomic status.  The difficulties in selecting the f-Hb cut-off to be used for CRC screening will be addressed in detail.  

However, most CRC are not detected through screening programmes, but when a person with symptoms seeks medical advice. The symptoms of serious bowel disease are very common presentations in primary care, but most with these do not have serious disease. Generally, people with symptoms are referred to secondary care for colonoscopy, which is inadequate in many countries. A particular problem is that the number of patients with symptoms being referred from primary care is increasing rapidly, in large part due to local, regional and national campaigns raising awareness of the need to get symptoms investigated. This Webinar will discuss the significant evidence now available that demonstrates that triage using FIT at a low cut-off around 10 μg Hb/g faeces has the potential to correctly rule-out CRC and avoid colonoscopy in many symptomatic patients. Importantly, secondary care referral following a positive FIT allows the identification of other significant bowel pathology in patients who are found not to have CRC, mainly inflammatory bowel disease. This very recent use of FIT is an excellent example of translation of research into clinical practice: the first study investigating the use of quantitative FIT using numerical data on f-Hb was published on-line in 2012 and, only five years later, a national guideline has recommended its use in routine clinical practice.

Category: Recorded

Speaker: Giuseppe Lippi (IT)

Recorded on 19th December 2017 at h. 18.00 CET

Hemostasis is a complicated mechanism finalized to preventing unjustified bleeding during vascular injury, or unwarranted thrombosis when the vessels are substantially intact. Hemostasis is typically classified in two essential steps. The first event is an endothelial injury, which activates primary hemostasis and is then followed by activation of secondary hemostasis. Specifically, primary hemostasis develops with recruitment of a many platelets being at site of vascular injury. Platelets are subjected to a sequential process of activation, adhesion and aggregation. This initial hemostatic plug is however unstable, since it is vulnerable to fast dissolution within in the local blood, especially in arteries. To prevent dissolution, additional fundamental mechanisms of secondary hemostasis (also known as blood coagulation) are activated, with the aim to stabilize the initial plot by large fibrin deposition.

The diagnostics of bleeding disorders of primary and secondary hemostasis remains a challenge for laboratory professionals, especially those lacking experience background, experience and skill on this topic. Bleeding is essentially due to many acquired or congenital conditions, impairing either primary or secondary hemostasis. A universal consensus on the diagnostics of bleeding diseases remains an unmet target, so that the aim of this Webinar is providing practical guidance for laboratory professionals who are less familiar with this important area of in vitro diagnostic testing. A practical strategy for diagnosing bleeding disorders of primary and secondary hemostasis is necessarily based on a multifaceted and multistep strategy, entailing accurate personal and family history collection, interpretation results of the so-called first-line hemostasis tests, then followed by interpretation (when necessary) of second- and third-line test to identify the both nature and severity of bleeding disease.

The observation of profound hemorrhages rather than muco-cutaneous bleeding suggests a disorder of secondary hemostasis. Although positive family history can be frequently seen in patients with congenital disorders, the absence of clinically significant symptoms in relatives cannot be considered always suggestive of acquired disorders. The next phase is based on performance of the so-called first-line coagulation tests, mainly represented by activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen, especially when the family history is not indicative of specific factor deficiencies. The observation of abnormal results of these tests and the combination of results can help driving performance of the so-called second-line tests, which especially entail clotting factor assays. The so-called third-line tests (especially entailing immunologic tests of coagulation factors and molecular biology) are then useful to make a final diagnosis and/or for detecting the specific nature of the protein deficiency.

Category: Recorded

Speaker: Ana-Maria Simundic (HR)
Moderator: João Tiago Guimarães (PT)

Recorded on 21st November 2017 at 18:00 CET

European National Societies, members of EFLM, have agreed in Porto, during the 3rd EFLM-BD European Preanalytical Phase Conference that harmonization of preanalytical practices and policies is necessary and possible in each and every country in Europe as well as internationally, at the European level. The Working group for Preanalytical phase (WG-PRE) of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM), has taken the leading role in this process. The aim of this e-seminar is to present past, ongoing and future WG-PRE activities and various projects which aim is to improve the quality of preanalytical phase in Europe as well as to promote wide harmonization of preanalytical practices, patient safety improvement and reduction of unnecessary waste and healthcare expenses.

Category: Recorded

Speaker: Anna Merino (ES)
Moderator: Ciriaco Carru (IT)

Recorded at  7th November 2017 18:00 CET

With the advance of the technology of hematology analyzers, the indications for peripheral blood film (PBF) review by an expert have declined, but still remain essential. PBF review contributes to the following: 1) Complements/validates the findings of automated hematology analyzers, 2) Provides information on hematologic abnormalities that cannot be assessed by the current hematology analyzers, 3) Abnormal red cell morphology detection, 4) Identification of blasts, lymphoma or other abnormal cells, 4) Platelet clumping or abnormal platelet morphology inspection and 5) Dyshematopoiesis detection. Some examples are provided in the presentation. It also discusses on some issues related to who performs the PBF review.

 The PBF review by laboratory technologists validates hematology analyzer flags and identifies specific cells or qualitative abnormalities that cannot be identified by hematology analyzers. In addition, technologists triage blood films that require expert morphology review. The contribution of the pathologists is relevant since they are able to make a specific diagnosis, provide differential diagnosis, and/or recommend further testing based on all hematologic quantitative and qualitative values. In addition, they can summarize the findings in a narrative interpretation that becomes part of patient’s medical chart.

 The International Council of Standardization in Hematology (ICSH) is developing standards, guidelines and recommendations in peripheral blood film review internationally, which can provide the following benefits for pathologists: 1) Define the role and standardize the expectations of laboratory physicians, 2) Narrow the indications for PBF review by pathologists to those that contribute to patient care, 3) Provide a framework for reporting and 4) Opportunity for national and international collaboration & advancement of the field. Some of the ICSH recommendations are discussed in the presentation.

Category: Recorded

Webinar recording + quiz.

Speaker: Ralf Lichtinghagen (GER)

Moderator: Merve Sibel Gungoren (TR)

Recorded at 18th October 2017

The stage of fibrosis is the most important single predictor of significant morbidity and mortality in chronic liver disease. The mechanisms leading to fibrosis and eventually cirrhosis are thought to be similar, irrespective of the underlying etiology. At cellular level, hepatic stellate cells (HSC) undergo a phenotypic switch usually addressed as transactivation. Activated HSC are regarded as the main source of extracellular matrix (ECM) in the fibrotic liver. Additional cell types namely fibroblasts and myofibroblasts may also contribute to ECM deposition. Despite the similarities in pathophysiology at cellular level, morphogenesis and histologic appearance of the fibrotic liver may differ according to the etiology.

Liver biopsy remains the gold standard to evaluate liver fibrosis. Not least, one has to keep in mind that liver biopsy provides additional information like histological grading and etiology that may be overlooked when surrogate markers are used. Ideally, those tests should answer two questions. 1) What is the stage of fibrotic organ damage (i.e. the amount of deposited ECM and the disturbed balance of hepatic microarchitecture)? 2) What is the net balance between ECM deposition and degradation (i.e. the dynamics of ECM turnover)? The former serves to evaluate the prognosis and indicate therapy, while the latter might be used to control the efficacy of treatment with regard to disease progression.

Many different parameters including standard clinical chemistry and parameters of matrix metabolism have been evaluated. In the last decade, markers were assembled to multiparametric scores. Here, we can distinguish scores assembled of standard clinical chemistry markers (e.g. aspartate aminotransferase-to-platelet ratio index, FibroTest, Forns’ index) from scores using circulating markers of hepatic matrix metabolism like hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1), matrix metalloproteinase-2, propeptide of type III procollagen (PIIINP).

In the webinar we will learn further details about the relevant complex scores, the clinical evaluation and current practical guidelines.

Category: Recorded

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.

Category: Recorded

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.

Category: Recorded

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.

Category: Recorded

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.

Category: Recorded

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.

Category: Recorded

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

Category: Recorded

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.

Category: Recorded