The Newsletter of the Asia-Pacific Federation for Clinical Biochemistry andLaboratory Medicine for circulation among APFCB and IFCC members only

APFCB News 2024 Issue 1
Publication Team, 2024 Issue 1
Chief Editor

Prof. Pradeep Kumar Dabla,
INDIA

Past Chief Editors

Dr. Raja Elina Raja Aziddin,
MALAYSIAAPFCB Executive Board and Chairmenof Committees, Elected 2024

Executive Board
PresidentCEO, RCPAQAP

Prof. Praveen Sharma,
INDIA
Dr. Joseph B Lopez,
MALAYSIA

Editorial Members

Dr. Leslie Lai, Kuala lumpur,
MALAYSIA

Dr. Tony Badrick
Faculty of Health Sciences andMedicine, Bond University, Australia

Immediate Past

Dr. Endang Hoyaranda

President

Prodia Group, Jakarta, Indonesia

Vice-President

Dr. Samuel Vasikaran

Prof. Ryunosuke Ohkawa,
JAPAN

Consultant Chemical Pathologist,

Prof. Deepak Parchwani,
INDIA

Western Australia

PathWest-Laboratory Medicine,
Secretary

Prof. Praveen Sharma
Former Professor and Head, Dean

Dr. Vivek Pant, NEPAL

Research Biochemistry at AIIMS,
Jodhpur, India

APFCB Membership

Editor-in-chief, Indian Journal ofCouncil Members

Clinical Biochemistry

Australasian Association of Clinical Biochemists (AACB)
Association of Clinical Biochemists of India (ACBI)
Association for Clinical Biochemistry, Sri Lanka (ACBSL)
Chinese Society of Laboratory Medicine (CSLM)
Chinese Association for Clinical Biochemistry, Taiwan (CACB)
Hong Kong Society of Clinical Chemistry (HKSCC)
Indonesian Association for Clinical Chemistry (IACC)
Iranian Association of Clinical Laboratory Doctors (IACLD)
Japan Society of Clinical Chemistry (JSCC)
Korean Society of Clinical Chemistry (KSCC)
Malaysian Association of Clinical Biochemistry (MACB)
Mongolian Association of Health Laboratories (MAHL)
Nepal Association for Medical Laboratory Sciences (NAMLS)
Pakistan Society of Chemical Pathologists (PSCP)
Philippine Association of Medical Technologists (PAMET)
Singapore Association of Clinical Biochemistry (SACB)
Thailand Association of Clinical Biochemists (TACB)
Vietnamese Association of Clinical Biochemistry (VACB)

Treasurer

Senior Biochemist and Head of the
Drug and Research Laboratory,
Kuala Lumpur, Malaysia
Corporate Representative

Dr. Douglas W. Chung
Area Marketing Manager Asia
Pacific, Core Diagnostics at Abbott
Laboratories

Chairman of Committees
Communications andPublications
Education

Prof. Pradeep Kumar Dabla,
INDIA
Dr. Cui Wei,
CHINA

Affiliate Members
Chinese Association of Clinical Laboratory Management (CACLM)
Association of Medical Biochemists of India (AMBI)
Macao Laboratory Medicine Association (MLMA)
Nepalese Association for Clinical Chemistry (NACC)
College of Chemical Pathologists of Sri Lanka (CCPSL)
Philippine Council for Quality Assurance in Clinical Laboratories(PCQACL)

Dr. Raja Elina Raja Aziddin

Laboratory Management

Dr. Tjan Sian Hwa,
INDONESIA

Scientific

SINGAPORE
Congress and Conference

Corporate Members
Abbott Laboratories (Singapore) Pte Ltd.
Beckman Coulter Hong Kong Ltd.
Becton Dickinson Holdings Pte. Ltd.
Bio-Rad Laboratories (Singapore) Pte Ltd.
DiaSys Diagnostic Systems GmbH
Roche Diagnostics Asia Pacific Pte Ltd.
Siemens Healthcare Pte Ltd.
Snibe Diagnostics Pte Ltd.
Roche Diagnostics Pte Ltd.
Waters Pacific Pte Ltd.
Sukraa Software Solution Pvt Ltd
sysmex Pte Ltd. Singapore
RCPA QAP Pvt Ltd Sydney, Australia
Thermo Fisher Scientific
Greiner Bio-One Singapore Pte. Ltd.
QuidelOrtho Pvt Ltd

Dr. Tze Ping Loh,

Dr. Woei-horng Fang,
TAIWAN

Submissions
The APFCB News welcomes suitable contributions for
publication. These should be sent electronically to the Chief
Editor. Statements of opinions are those of the contributors
and are not to be construed as official statements, evaluations
or endorsements by the APFCB or its official bodies.
Contact email: c-cp@apfcb.org
Cover page: Three Friends of Winter in a Chinese Garden
by Dr. Tan It Koo,
Founding and Past President APFCB

Address
The registered address of APFCB is as follows:
APFCB, c/o Solid Track Management Pte Ltd. 150 Cecil Street,#10-06, Singapore 069543

APFCB
News
2024
Issue
11
APFCB
News
2024
Issue

Contents
From the desk of Chief Editor - Prof. Pradeep Kumar Dabla

01

Message from APFCB President - Dr. Tony Badrick

03

Greetings from IFCC President- Dr. Tomris Ozben

04

APFCB Activities 2024
Report APFCB Communication & Publications Committee (C-CP)

07

Report APFCB Education Committee (C-E)-APFCB Laboratory Medicine Contest

13

Member Societies - Annual Activities Reports
National Society Report- JSCC Japan

16

National Society Report- CACB Taiwan

19

National Society Report- ACBI India

21

National Society Report- KSCC Korea KSCC Spring Meeting, May 2023

32

National Society Report- KSCC Korea KSCC Fall Meeting, Nov 2023

37

National Society Report- IACC Indonesia

43

National Society Report- MACB Malaysia

48

Young Scientists Column
The IFCC Task Force - Young Scientists (IFCC TF-YS): Perspective for Young Scientist in 2024

55

Young Scientist Interview Dr. Chao Lien Liu, Japan

57

Young Scientist Interview Dr. Vivek Pant, Nepal

61

Industry Voice Section
Symphony of Science and Sustainability - A Green Revolution in Laboratories

65

Expert Opinion Paper
Cardiovascular Disease Epidemic in India and Triglyceride - Associated Residual

69

Atherosclerotic Cardiovascular Disease Risk
Navigating Lp(a) Measurement Challenges: From Guidelines to Laboratory Perspectives

79

Understanding and Addressing Healthcare Workforce Shortages

89

Special Report
APFCB - APAC CVD Alliance (Asia-Pacific Cardiovascular Disease Alliance)92APFCB
News
2024
Issue
11
APFCB
News
2024
Issue
APFCB Auspices
APFCB Auspices Events Calendar, Activities 2023

94

Clinical Case
(APFCB Laboratory Medicine Case Contest)
Case 1 – Dr. Ni Kadek Mulyantari, Indonesia

96

Case 2 – Dr. Sumita Sharma, India

98

Case 3 - Dr Hani Ajrina Zulkeflee, Malaysia

102

Painting Story
Three Friends of Winter in a Chinese Garden

108

APFCBNews
News2024
2024Issue
Issue11APFCB
From the desk of Chief Editor,
APFCB eNews
Dear Friends,
With the rise of the New Year 2024, the Team APFCB Committee of Communication andProf. Pradeep Kumar Dabla

Publications (C-CP) presents you with the 1st issue of APFCB News, 2024. The New Year came withChief Editor, APFCB eNews

new hopes while facing different challenges to deliver the responsibility of development,
overseeing, reviewing, and addressing system-wide policies as well as issues pertaining to theorganization's website and its online operations along with APFCB news publications. After
assuming the role by current C-CP, the APFCB is not only officially available but is actively
disseminating the relevant information under the purview of APFCB on official Facebook, Twitter,
LinkedIn, Instagram and YouTube.
In this issue, we bring you information and news from various APFCB member countries, with awide spectrum ranging from annual reports of the year 2023 to the academic activities performed
at both National and International levels. With the letter of “Chief Editor & APFCB President”, we
also welcome the address by “IFCC President, Prof. Tomris Ozben” for the APFCB community
while beginning her term of office on January 1st, 2024.
Expert’s opinion in this issue is focused into the field of cardiovascular science, highlighting thetriglyceride associated residual atherosclerotic cardiovascular disease risk to the challenges
involved while measuring Lp(a) levels. Special report from APFCB - APAC CVD Alliance to mention
the ongoing collaborative work to elevate the public and policy awareness about CVD at theregional and domestic forums in Asia. Industry partners have shown great enthusiasm with thereport on Green Revolution in Laboratories.
Since the C-CP resumed the office, Young Scientist column has become the integral part of APFCB
news showcasing excellent report of activities by IFCC-TFYS extending to the interesting
conversation with young scientist from Japan and Nepal. Future Leaders!

11APFCB News 2024 Issue 1

APFCB auspices events and activities calendar presented indicating commitment to promotescientific events under APFCB umbrella. One of important reader’s attractions is “Case Series”
from APFCB lab medicine case contest contributed by APFCB Education committee.
Don’t forget to login to APFCB social media for receiving constant updating news about the
APFCB Congress 2024, Sydney Australia. Join us at the Congress!
This time, Dr. Tan It Koon is taking us to visit “Three Friends of Winter in a Chinese Garden”
through his lively painting strokes and its mesmerizing description.

As members of the Committee on communication and publication, we continue to take pride in
APFCB system and its continuing improvement. C-CP Team is keen to extend the invitation to
the member societies for corresponding members and young scientists positions open incommittee. Join us!
Happy New Year 2024!
Happy Reading!!
Best Wishes
Team APFCB C-CP

02

APFCB News 2024 Issue 1

From the desk of APFCB
President

Greetings
Dr. Tony Badrick
At this time of the year, we often reflect on the year that has been and consider what we havelearnt from the experience to carry into next year. At the beginning of 2023, many countries
were still coming out of lockdown. The impact of COVID-19 on the world cannot be
understated, yet strangely, we have moved on. It was a tragic time for many. We learned theimportance of so many people in keeping our societies functioning: healthcare professionals,
shops, manufacturers, logistics, and those involved with waste disposal. Laboratories wererecognized for the key role they play in a pandemic, in fact without laboratories, the pandemic
would have been far worse. The scientific response to the pandemic was incredible.
But we realized how fragile our systems, and sometimes people, were. Sustaining the pressureof providing critical results in the face of a workforce that was susceptible to the infection overthose covid years was an enormous challenge. The risk has not disappeared, but we have more
tools now to deal with another emerging pandemic.
We need not forget the important lessons of well-trained and competent staff and internal
processes. Our quality systems and quality people held the worst impacts of the virus at bay.
The ability of laboratories to develop and/or implement new tests and procedures rapidly
provided the health system with the ability to identify the risks accurately and respond
appropriately.
Organizations such as the APFCB allow us to learn from others who faced the same challenges.
The professional networks that we form and maintain are a critical, if not always recognized,
part of the sustainability and resilience of our healthcare systems.
I wish you all a prosperous 2024 filled with new opportunities professionally and personally.
Best Wishes
President, APFCB
Dr. Tony Badrick

3

President, APFCBAPFCB News 2024 Issue 1

Greetings from IFCC President

Prof. Dr. Tomris Ozben
IFCC President
It is both an honor and a privilege for me to commence my role as the President of the IFCC
Executive Board, beginning my term of office on January 1st, 2024. I extend my heartfelt
gratitude to the IFCC member societies within the 6 IFCC Regional Federations for theirkind support and trust. I sincerely appreciate their confidence and assure them that I will exert
my utmost effort to merit their trust. My commitment involves dedicating my time and energy
to enhance the functions and activities of IFCC.
Taking on a leadership position, with other dedicated members of the IFCC Executive Board,
IFCC officers, Regional Federations, National Societies, and Corporate members, our primaryobjective is to fortify the robust foundations on which the Federation stands. Our efforts will becentered on identifying new opportunities and devising new strategies that empower Laboratory
Medicine to play a pivotal role in patient care. Our goal is to ensure that theIFCC continues
to stand as the foremost global organization representing Laboratory Medicine worldwide.
IFCC demands a dedicated and proficient management team. The President, along with themembers of the new IFCC Executive Board and officers of the IFCC Functional Units, will devote
both commitment and time. Our aim is not just to sustain, but to enhance IFCC functionsand
activities, making significant contributions to the advancement of Laboratory Medicine andthe
growth of its professionals. We are set to carry the IFCC flag even higher, maintaining past
initiatives and developing new projects. The expertise, knowledge, and fresh ideas from the
Executive Board members and IFCC officers, working with enthusiasm across different
functional units, will drive this progress. We emphasize close collaboration with IFCC Regional
Federations, IFCC Member Societies, and Corporate Members, encouraging their active
participation in all IFCC activities.

4

APFCB
APFCB News
News 2024
2024 Issue
Issue 1
1
We extend our heartfelt gratitude to the former IFCC Presidents, outgoing members of the IFCC
Executive Boards, and officers of the Functional Units for their exceptional contributions,
voluntary services, knowledge, and enthusiasm throughout the years.

Their dedication has played a crucial role in building a robust and continually advancing
Federation, establishing it as a leading organization in laboratory medicine worldwide,
providing high-quality healthcare services to its members. We will always remember and deeply
appreciate their significant contributions. While they may no longer hold active roles, we areconfident that their interests and contributions to the IFCC will persist. We look forward toworking closely with them, drawing upon their extensive experience and knowledge for the
benefit of IFCC.
In recent years, IFCC's activities have experienced steady growth. The substantial services
and contributions of IFCC to the enhancement of Laboratory Medicine are widely acknowledged.
This remarkable success is attributed to the voluntary service, dedication, and time invested
by over 300 laboratory scientists from Member Societies and Corporate Members, serving
across various IFCC Functional Units. Our gratitude extends to the IFCC officers representing
Member Societies and Corporate Members for their unwavering support over the years. Their
ongoing commitment and loyalty have played a pivotal role in the successful execution ofnumerous IFCC tasks and projects.
I firmly believe that advancing healthcare through Laboratory Medicine hinges on the active
engagement and dedicated involvement of IFCC Member Societies, Corporate Members, and
IFCC officers of the Functional Units. Their collective efforts play a pivotal role in guiding our
profession toward the objectives and direction which will be outlined in the new IFCC Strategic
Action Plans, set to be implemented in the coming years. These plans will be crafted incollaboration with the IFCC Executive Board, IFCC Functional Units, IFCC National Societies, andCorporate Members, incorporating their suggestions, ideas, and comments in formulating the
EFLM Strategic Action Plans.
Success in this evolving landscape requires collaborations between industry, public, private,
and academic drivers of innovation. The IFCC Executive Board welcomes the input of ideas,
comments, suggestions, and sharing of challenges and concerns from National Societies and
IVD Industry Partners. We invite them to actively participate in IFCC's endeavors, encouraging
collaboration to fortify IFCC's leadership role in advancing laboratory medicine and enhancing
the quality of healthcare and medical laboratories worldwide. Their engagement andcontributions are vital as we work together towards
these shared goals. Their feedback, participation, and engagement will be integral to steeringlaboratory medicine forward and shaping the future of our profession.

5

APFCB News 2024 Issue 1
Achieving our shared objectives requires collaborative action and effort. To facilitate this, aninteractive global platform will be established for IFCC members in laboratory medicine,colleagues from the in vitro diagnostic industry, digital health, and medical devices.

This platform will provide opportunities to interact, share, and learn through networking
discussions on trends, opportunities, and challenges. It aims to deliver the latest innovations
and cutting-edge technologies in laboratory medicine, establish partnership models for
efficient integration and adoption of emerging technologies, prepare for new in vitro diagnostic
regulations in Europe and beyond, transition to green and sustainable medical laboratories,
harmonize and standardize laboratory tests, and enhance collaborations in education andresearch.
I am looking forward to fostering productive collaborations and establishing efficient bridges
with the IFCC Member Societies and Corporate Members in the ongoing and future activities of
IFCC.
With my best regards.
Prof. Dr TomrisOzben, EuSpLM, Ph.D., D.Sci.
Specialist in Clinical Biochemistry
IFCC President
Full Professor of Biochemistry and Clinical Chemistry
Akdeniz University, Medical Faculty, Dept. of Clinical Biochemistry, Antalya Turkiye
University of Modena and Reggio Emilia, Medical Faculty, Clinical and Experimental Medicine,
Ph.D. Program, Modena, Italy

6

APFCB News
News 2024
2024 Issue
Issue 11APFCB

APFCB Activities

Report APFCB - Communication andPublication Committee (C-CP)Prof (Dr.) Pradeep Kumar Dabla
Chair, APFCB C-CP
The APFCB Committee of Communication and Publications (C-CP) has the responsibility ofdeveloping, overseeing, reviewing, and addressing system-wide policies as well as issues
pertaining to the organization's website and its online operations.
The committee is also responsible for the online publication of APFCB news and collaborates
with member associations and corporate members to promote participation and wider
dissemination of relevant online activities, educational material and resources for laboratory
medicine personals. Through this mode C-CP directly supports novel ideas, encouragement andpromotes member associations to develop policy and strategy that assist with broad goalsfor
patient care. The new Chair of the Communication and Publications Committee for the term
2023-2025 was appointed in March 2023 by the APFCB-EB.
Members of the APFCB C-CP for this term were:

Dr. Pradeep Kumar Dabla (Chair), INDIA

Dr. Deepak Parchwani (Web Editor), INDIADr. Ryunosuke Ohkawa, JAPANDr. Mingma Lhamu Sherpa, INDIA

Dr. Alireza Lotfi Kian , IRAN



Dr. Tze Wei Poh (Corporate - Beckman Coulter) (member till Dec2023)

Dr. Mayank Upadhyay, Corporate MemberDr. Vivek Pant, Young Scientist Member

Following their appointment, through the APFCB e-newsletter, social media, and official
website, the newly C-CP team has strengthened the organization's online presence. Over thecourse of the previous year, the C-CP maintained active communication and used electronic
methods to promote the APFCB's operations to both its member societies in the Asia Pacificarea and to nations under the umbrella of IFCC.
In summary, the following heads outline the committee's operation in the preceding year:
1. APFCB Website - Maintenance & Management:

The C-CP is in charge of creation, upkeep, and administration of the APFCB website. Since thepresent committee began its term, a new and dynamic APFCB website has been developed. The
most recent details about webinars, online courses, and virtual conferences hosted by the7

APFCB
2024 Issue
1
APFCB
News News
2024 Issue
1

APFCB Activities

APFCB, its member societies, and international professional bodies are regularly updated on thefederation's website. Scientific publications, guidelines, and webinars (live & recorded) on avariety
of interesting topics are also made available.
A substantial transformation has occurred since the previous version, including improved webinar
exposure with ongoing updates; the creation of a quick link tab emphasizing APFCB Auspices on
the home page, social media, and news; upgrading of the announcement section, social media,
visitors’ stats and a designated space has been created for corporate partners.
APFCB auspices calendar organized:

As APFCB is committed to maintain and promote an exchange of information in the field for patientcare by creating the links of communication between the involved parties. APFCB auspices granted
for scientific conferences and meetings symbolize that the scientific conference or meeting is of ahigh scientific and/or educational level. Granting of APFCB auspices has been methodically set up
and organized since the federation views it as a crucialarea for its outreach.
2. Stewardship of APFCB Social Media Platform

Social media has become an indispensable part of our lives. In fact, it is a great online teachinglearning and publicizing platform for the federation. Everyone has at least one account in any oneof the social media sites. This allows the federation to meet the target population who browse andconnect with friends and colleagues via these social media platforms on a daily basis. This createsan opportunity for our federation to be even more user-centric information across the world.
The current C-CP set up newer social media profiles and revived the passive handles for the APFCB
in an attempt to effectively communicate and distribute news, publications, nominations, awards,
congress and updates on the federation's activities with national societies and clinical laboratory
experts.
Under the current C-CP, the APFCB is not only officially readily available, but is actively
disseminating the relevant information under the purview of APFCB on Facebook, Twitter, LinkedIn,
Instagram and YouTube.

8

APFCB
News
2024
Issue
APFCB
News
2024
Issue
1 1

APFCB Activities

Links to the APFCB social media pages are as follows:(https://www.apfcb.org/networking)Facebook Page: https://www.facebook.com/APFCB/Twitter: https://twitter.com/APFCB_LM
Instagram: https://www.instagram.com/apfcb_lm/
LinkedIn https://www.linkedin.com/company/apfcb/
YouTube: https://www.youtube.com/channel/UCoiicTsnVX-COjklgZHQ54Q
3. Publication of online activities, educational material and resources
In the era of digital connectivity, the publication of online activities, educational materials, andresources plays a pivotal role in fostering accessible learning environments. Through diverse
platforms, educators can share engaging content, interactive exercises, and valuable resources,
transcending geographical boundaries. This dissemination facilitates the democratization of
education, empowering learners globally.
Amidst the ongoing surge in digital connectivity demand, the publication of online activities,
educational materials, and resources is significantly enhanced through the continuous efforts of
C-CP. We have provided diverse platforms to share dynamic content, interactive exercises, andvaluable resources, creating a vibrant and accessible learning ecosystem.

(visit: https://www.apfcb.org/continuing_education).
4.

Practices to promote education and relevant activities of the federation
The homepage of the APFCB website and social media platforms are used to publicize all
forthcoming events. The C-CP also notifies members of impending events and extends blast
email invitations to them. The C-CP is relentlessly working to meticulously update and expand
the list of members in its database.

9

APFCB
APFCB News
News 2024
2024 Issue
Issue 1
1

APFCB Activities

5. Publication of APFCB eNews
C-CP takes charge of the online publication of APFCB eNews(https://www.apfcb.org/#enewsletter). The chair of the C-CP who was appointed in March
2023has been given the responsibility of being the Chief Editor of the APFCB eNews.
The newsletter is published twice a year and can be found on the APFCB website as an e-book.
It can also be accessed as a PDF version. As per convention of the newsletter's biannual
publication schedule, two editions were released in the year 2023:

In keeping with convention, paintings of Dr. Tan It Koon, the organization's founder and former
president, was used as the front cover of both issues (Issue 1: A Bunch of Ripening Bananas with
Flower Bud Still Attached and Issue 2: A Beautiful View of the Three Gorges in China).
The published APFCB News (Volume 1 and 2) includes myriads of information, ranging fromdelineating annual reports from member’s societies showcasing their efforts in adding scientificknowledge to laboratory medicine, expert opinion in laboratory quality management & artificial
intelligence, special reports from IFCC Global Medical Lab Week celebrations 2023 & sustainablegreen labs.
A feature piece on Tony Badrick (APFCB President), authored by Dr. Pradeep Kumar Dabla (Chief
editor of APFCB eNews), was published in APFCB eNews 2023 Issue 2 in recognition of the honor
he received by his appointment as “Member of the Order of Australia” for his services andimmense contribution towards the community and science.
Industry partners have shown great enthusiasm while sharing reports for industry voice whether
triage testing or non-invasive prenatal testing (NIPT). Their active engagement underscores acommitment to advancing cutting-edge technologies and practices, fostering innovation, andcollectively shaping the future landscape of diagnostic and prenatal healthcare.

10

APFCB
APFCB News
News 2024
2024 Issue
Issue 1
1

APFCB Activities

An additional fascinating feature of the APFCB eNews 2023 is the increased visibility of young
scientists and it is always thrilling to share efforts by young scientists. The full report on the
2nd IFCC Young Scientists’ Forum organized in conjunction with IFCC World Lab Euro Med
Lab2023 in Rome was made available in the second issue.
To standardize article submissions to the APFCB news, the C-CP team drew up a guideline
for the submission of reports, articles and corporate advertisements. These guidelines areaccessible on the APFCB website homepage via this link:
https://www.apfcb.org/Submission%20Guidelines%20APFCB%20News%20050721.pdf.
A key new feature added to APFCB eNews is the clinical case discussion due to its inevitable
importance in clinical medicine and practice as an instructive example to people who might
encounter similar problems.
The APFCB eNews features compelling quiz and expert papers, offering a rich source ofknowledge in the field of clinical chemistry and laboratory medicine. The quiz engages
readersin testing their understanding of crucial topics, while expert papers delve into thelatest advancements and insights. This combination ensures a comprehensive learning
experience, keeping professionals abreast of developments in laboratory medicine andpromoting continuous education within the APFCB community. It serves as a valuable
platform for sharingexpertise and fostering collaborative growth.
Recommendations for the upcoming year:

The committee will further explore under the following headings in 2023-2024 to expand
the APFCB network:• APFCB Webinar platform
Marshall McLuhan in 1964 quoted that through digital communication the world is becoming
aglobal village. It is a concept that says that communication has become instantaneous due
to technological evolution. The same notion has now come into existence as learning/relearningalso shifted to the digital arena. With this concept and considering the increased
activities/requirements and best marketing techniques, we propose to organize a series ofwebinars to reach our target audience.
XA webinar permits many virtual functionalities in a sense that a fully-managed webinar
platformprovides the organizers with numerous sets of interactive features that not only
make learning easy, but also networking. Another characteristic that makes webinars an
exceptional choice is that they can reach a wider audience without any limitations. Some of11

APFCB
APFCB News
News 2024
2024 Issue
Issue 1
1

APFCB Activities

the most eminentadvantages of webinars include simpler way to gather wider audience, aasy
availability of high-profile guests, cost-effective learning method, encourages interaction,
great flexibility & convenience for all, excellent way to grow network and not to exclude
branding & customization.
Social media expansion
By connecting on social media handles that the target population uses on a daily/regular basis,
it enables us to meet them where they are and gives our federation the chance to disseminate
the information worldwide. Major benefits of social media for our system includes, but notlimited to, a communication channel for networking, for creative demonstration, connectingwith experts, as a marketing tool, access to information and to publish news and update.
Because of this, it is necessary to use these social media channels aggressively for outreach.
E-Mail Marketing
E-mail marketing is a type of direct digital marketing method that uses emails to engage witha target audience. It involves sending promotional or informational content. APFCB can use email marketing typically to create brand awareness and generate leads and presence at aninternational forum cost effectively.
To utilize the Apace News as a platform for APFCB activities:
In the forthcoming issues of APFCB News 2024, C-CP intends and purposes to publish the
APFCB Clinical Cases in batches of 2 to 4, considering that case studies are one of thecornerstones of medical progress and may provide novel ideas in the field.
As members of the Committee on communication and publications, we continue to takepride in APFCB and its strive for continuing
Report by:
improvements.
Team APFCB C-CP
Chair: Prof (Dr.) Pradeep Kumar Dabla

12

APFCB
APFCB News
News 2024
2024 Issue
Issue 1
1

APFCB Activities

Report APFCB Education Committee (C-E)– APFCB Laboratory Medicine Contest
Dr. Wei Cui
Chair, APFCB Committee-Education (C-E)
To show the clinical significance of laboratory medicine and encourage all the laboratory
professionals in the Asia-Pacific region to pay more attention to special cases in routine work,
APFCB, in collaboration with Shenzhen Mindray Bio-Medical Electronics company, organized the
APFCB Laboratory Medicine Case Contest. This event was themed ‘Value of Laboratory Medicine:
Resolve Clinical Challenges’ and all the laboratory professionals in the AP region were welcome
to participate.
The overall process of the contest was composed of three rounds. In the first round, theparticipant was required to submit an unpublished clinical case report that described an
atypical, misdiagnosed, special or rare case that received a definitive diagnosis or successfultreatment. For these cases, the participant had to explain and analyze in detail how thelaboratory played an important role in various facets of patient management. The participant
could share the experience he/she had obtained during daily work which could be helpful toimprove the work efficiency of laboratory professionals and to improve the total laboratory
quality. The winners of the first round then continued to the second round. The second round
was a video case presentation. The top 10 winners were then entered into the third and final
round. The third round was an online presentation followed by Q&A.
10 winners were awarded first prize, second prize or third prize based on the quality of theircase reports and presentations
The contest was launched on August 28. In the first round, a total of 68 case reports fromIndonesia, Sri Lanka, India, Pakistan, Malaysia, and Japan were received. 50 reports wereenrolled in the second round. 47 qualified video presentations were admitted. After assessmentof their topic, content, academic value, and originality, 10 winners were selected who
participated in the finals on December 15. We invited six distinguished professors to be thejudges of the finals. They were Dr. Tony Badrick, Dr. Leslie Lai, Dr. Tjan Sian Hwa, Dr. Helen
Martin, and Dr. Goce Dimeski and Drv Wei Cui According to the total of the six scores awarded
by each of the six judges for each participant, the 10 contestants were awarded first prizes,
second prizes or third prizes. Here are the winners’ names and their topics.
First Prizes
1. Dr. Kadek, Indonesia, A Very Rare Case A Change in The Rhesus Blood Type in A Patient With

Colorectal Cancer.

13

APFCB
APFCB News
News 2024
2024 Issue
Issue 11

2.

Member Society

Dr. Sumita Sharma, India, Coexistence of Haemoglobin D Punjab with Beta Thalassaemia

Traitand Gilbert Syndrome A Complex Case Analysis
Second Prizes
1.

Dr. Yoji Uejma, Japan, A case of Ureaplasma meningitis in which rapid identification

andquantitative bacterial count testing were effective
2.

Dr. Siddiq Ozaal, Sri Lanka, A Diagnostic dilemma in a female who presented

withhypercalcemia with a parathyroid and pancreatic tumor
3.

Dr. Ayu Mardewi, Indonesia, Hypokalemic Periodic Paralysis and Type 1 Renal

TubularAcidosis in a Young Woman
Second Prizes
1.

Dr. Yoji Uejma, Japan, A case of Ureaplasma meningitis in which rapid identification

andquantitative bacterial count testing were effective
2.

Dr. Siddiq Ozaal, Sri Lanka, A Diagnostic dilemma in a female who presented

withhypercalcemia with a parathyroid and pancreatic tumor
3.

Dr. Ayu Mardewi, Indonesia, Hypokalemic Periodic Paralysis and Type 1 Renal

TubularAcidosis in a Young Woman

14

APFCB
APFCB News
News 2024
2024 Issue
Issue 11

Member Society

Screenshot of APFCB Laboratory Medicine Case Contest Finals

15
15

APFCB
APFCB News
News 2024
2024 Issue
Issue 11

Member Society

National Society Report- JSCC Japan
Japan Society of Clinical Chemistry (JSCC)
The 63rd Annual Meeting of the Japan Society of Clinical Chemistry (JSCC), chaired by Professor
Hiroshi Yoshida (Director of Jikei University Kashiwa Hospital), was held at the Ochanomizu Sola
City Conference Center in Tokyo from October 27 to 29, 2023. Although epidemics of infectious
diseases, including COVID-19 and influenza, had not been completely stamped out in Japan,
more than 800 paid participants joined the meeting on site. The theme of the meeting was“Development of clinical chemistry that contributes to sustainable and high-quality healthcare”.
We realized that the translation of basic science research from the bench to clinicalimplementation at the bedside has been steadily progressing in clinical chemistry and relatedareas. In addition to the Chairperson’s lecture (Dr. Hiroshi Yoshida), there were 3 educational
lectures by experts, 13 symposia, 11 co-sponsored seminars, and 106 general and student
presentations, which were followed by active question-and-answer sessions. Special lectures
were given by Dr. Yutaka Yatomi (Professor Emeritus, University of Tokyo and Dean, Graduate
School of International University of Health and Welfare) on “Development and social
implementation of clinical chemistry to ensure high-quality medical care” and by Dr. Masashi
Yanagisawa (Professor, University of Tsukuba and Director, International Institute for Integrative
Sleep Medicine) on “Trying to solve the mystery of sleep: Understanding the essence ofsleepiness”. Their fascinating lectures were also extremely informative, which covered a wide
range of topics related to basic and clinical sciences. In the JSCC international session, Professor
Nader Rifai of Harvard Medical School gave a presentation (pre-recorded) entitled “The use of
the adaptive learning concept in laboratory medicine”. He presented “Learning Lab for
Laboratory Medicine”, the AI-driven online program for adaptive e-learning, and its usefulness
in education and training. In the evening of the second day, a reception was held for theparticipants, the first part of which featured a reading performance by Ms. Haruka Miyagishimaof the Shizuoka Performing Arts Center. The participants enjoyed traditional Japanese culture
and friendly interations with one another.
Finally, we would like to express our sincere gratitude to all the participants who came to theconference venue, to the sponsors, to the secretariat of the Japan Society of Clinical Chemistry,
to the staff members of the Department of Laboratory Medicine, The Jikei University School of
Medicine, and to the members of the clinical Laboratory departments at the four Jikei University
Hospitals.
The next 64th meeting will be held by Dr. Toshiyuki Yamada (Professor, Jichi Medical University)
in Utsunomiya, Tochigi, from August 30 to September 1, 2024.
Photo 1: Poster for the 63rd annual Meeting of the Japan Society of Clinical Chemistry
Photo 2: Dr. Hiroshi Yoshida (Professor, The Jikei University School of Medicine and the Directorof Jikei University Kashiwa Hospital) gave a special lecture (Chairperson’s Lecture) entitled“Challenges for the promotion and clinical application of problem-oriented research that
contributes to the development of clinical chemistry” on the first day of the meeting.

16

APFCB
Issue21
APFCB News
News 2024
202 Issue

Member Societies

Photo 3: Dr. Yutaka Yatomi (Professor Emeritus, University of Tokyo and Dean, Graduate
School of International University of Health and Welfare) gave a special lecture on the firstdayof the meeting.
Photo 4: Dr. Masashi Yanagisawa (Professor, University of Tsukuba and Director,
InternationalInstitute for Integrative Sleep Medicine) gave a special lecture on the second
day of the meeting.
Dr. Masashi Yanagisawa (speaker, left) and Dr. Hiroshi Yoshida (session chair, right)

17

APFCB News
News 2024
2024 Issue
Issue 21
APFCB

Member Societies

18
18

APFCB News
News 2024
2024 Issue
Issue 21
APFCB

Member Societies

National Society Report- CACB Taiwan
NAME OF SOCIETY

Chinese Association for Clinical Biochemistry(CACB-Taiwan)

OFFICIAL SOCIETY EMAIL ADDRES

office@cacb.org.tw

NAME OF PRESIDENT &SandyHuey-Jen Hsu

EMAIL ADDRESS

sandyhsu@ntu.edu.tw

NAME OF NATIONAL REPRESENTATIVE TO

Woei-horng Fang

APFCB & EMAIL ADDRESS

whfang@ntu.edu.tw

In a momentous convergence of expertise and innovation, CACB orchestrated the Symposiumof Adaptive Learning and AACC Learning Lab at the 2023 Annual Meeting of the Taiwan Societyof Laboratory Medicine at Chung Shan Medical University, Taichung on November 18th, 2023.
CACB was honored to invite Dr. Nader Rifai, a distinguished figure in the field of laboratory
medicine, to record a video presentation addressing the pivotal topic of "The Use of Adaptive
Learning in Laboratory Medicine: Introduction of AACC Learning Lab." As an expert in clinicalchemistry and a key contributor to the field, Dr. Rifai delved into the significance of adaptive
learning methodologies within the context of laboratory medicine. His presentation exploredthe transformative impact of adaptive learning on medical education, emphasizing the AACC
Learning Lab as an innovative platform. CACB Executive Director, Dr. Woei-Horng Fang,
described his experience on leading the initiative of translating clinical biochemistry courses
into Traditional Chinese as well as Simplified Chinese. CACB President, Dr. Sandy Huey-Jen Hsu
shared her valuable experience of using both English and Chinese versions of Learning Lab. The
audience provided positive feedback and expressed appreciation for this initiative. CACB
encouraged the participants to spread the word and to join us for translating more courses inthe Learning Lab. Our goal is to enhance the learning interest of students and medical laboratory
professionals, fostering the sharing of new knowledge and innovative interactive learning
experiences."s(Photo 1) Dr. Nader Rifai delivered a pre-recorded speech at the Symposium of Adaptive
Learning and AACC Learning Lab in Taichung, Taiwan on November 18th, 2023.

19

APFCB
APFCB News
News 2024
2024 Issue
Issue 12

Member Societies(Photo 2) CACB Executive Director, Dr. Woei-Horng Fang leads the AACC Learning Lab Chineseversion initiative.

(Photo 3) CACB President, Dr. Sandy Huey-Jen Hsu shared her experience of using AACC
Learning Lab.

(Photo 4) CACB Board Members and the distinguished guests at the Symposium of Adaptive
Learning and AACC Learning Lab.
Upcoming events for 2024:
CACB annual conference and scientific symposium will be held in conjunction with the
38thJoint Annual Conference of Biomedical Science (JACBS). The main theme for JACBS
2024 is“Biomedicine and Life”. Dr. Man-Ho Choi, Principal Scientist at Korea Institute of Science andTechnology, will deliver a keynote speech regarding steroidogenesis in adrenal diseases. A
symposium of three speakers, Professor Cheng-Hsun Chiu, Dr. Wei-Kai Wu and Professor
Hsinchu Lai are invited to share their expertise of microbiome in health and disease.

20

APFCB
APFCB News
News 2024
2024 Issue
Issue 12

Member Societies

National Society Report- ACBI India
49th ACBICON 2023 KERALA 13th September 2023 to 16th September 2023
“Laboratory Medicine Path Ahead-Amalgamating Technology and Humanity”
CONFERENCE REPORTThe 49th ACBICON 2023 was organized in Kerala by the Association of Clinical Biochemists ofIndia (ACBI) and the Believers Church Medical College. Themed “Laboratory Medicine Path Ahead-Amalgamating Technology and Humanity”, it attracted around 1,000 biochemists and medical
lab professionals nationwide. The conference, which offered sessions like keynotes, symposia,
and workshops, aimed to provide an enriching platform for experts to share knowledge andadvancements in clinical biochemistry. For the first time, ACBI opened its exhibition to the
public. 49th ACBI also collaborated with global entities like the IFCC and APFCB to ensureinternational standards were maintained. The inaugural ceremony on 14 September 2023 wasmarked by addresses from key personalities. The ceremony commenced with a warm welcome
address by the Organizing Secretary, 49th ACBICON 2023, Dr. Kannan Vaidyanathan. He
extended gratitude to all the attendees and highlighted the importance of the event, followed
by Dr. Seema Bhargava, the President of the Association of Clinical Biochemistry of India, whostressed the gathering's significance. The General Secretary, Association of Clinical
Biochemistry of India, Dr. Rajiv Ranjan Sinha provided an annual report for the year 2022,
detailing the association's accomplishments. The CEO and Director of Believers Church Medical
College, Dr. George Chandy Matteethra, highlighted the growing collaboration between theinstitutions. The ceremony was further honored by the presence of the former Hon. Health
Minister, Smt. K.K. Shailaja Teacher, as the Chief Guest. Her inspiring words underscored theimportance of healthcare advancements and appreciated the efforts of the organizers. Dr. Riju
Mathew, Associate Professor, Department of Biochemistry, closed the event by thanking
everyone involved.

21

APFCB
APFCB News
News 2024
2023 Issue
Issue 12

Member Society

22

APFCB News 2024 Issue 1

Member Societies

The conference featured seven prominent orations aimed at advancing clinical biochemistry
inIndia. The K.L. Gupta Memorial Oration was delivered by Dr. Alpana Sharma, Professor AIIMS,
New Delhi, who discussed innovative strategies in cancer research, emphasizing the
progression from diagnostics to therapeutics. The Dr. K.P Sinha Oration was delivered by Dr
Tony Badrick, Chief Executive Officer, Royal College of Pathologists of Australasia Quality
Assurance Programs, who highlighted the importance of patient-centered care, emphasizing
the need to treat every patient as an individual in clinical decision-making. The Taranath Shetty
Memorial Oration was delivered by Dr Chandrabhas Narayana from RGCB, Thiruvananthapuram.
The Awadhesh Saran Memorial Oration was delivered by Dr. Shyam S Chauhan, Professor & Head
Department of Biochemistry AIIMS New Delhi, who explored the role of Heterogeneous Nuclear
Ribonucleoprotein D in oral cancer, emphasizing its significance in diagnosis and treatment.
The Dr. T.N. Patabhiraman Oration was delivered by Dr. Seema Bhargava, President, ACBI,
Chairperson and Senior Consultant, Department of Biochemistry & Professor, GRIPMER, who
discussed the contributions of Nobel Laureates in Biochemistry and contrasted them with otherimpactful figures in the field who haven’t received a Nobel Prize. The Dr. Praveen Sharma Oration
was delivered by Dr. Poornima Manjrekar who highlighted the evolving landscape of type 2
diabetes, discussing contemporary trends and emerging challenges. The Mrs. & Dr. G.P.Talwar
Oration was delivered by Dr. Medha Rajappa, Additional Professor of Biochemistry Departmentof Biochemistry Jawaharlal Institute of Postgraduate Medical Education & Research(JIPMER),
Dhanvantari Nagar, Puducherry, who delved into biomarker signatures of inflammatory skindiseases, emphasizing their importance in refining treatment approaches.

23

APFCB News 2024 Issue 1

Member Societies

24
24

APFCB
APFCB News
News 2024
2023 Issue
Issue 1
2

Member Societies

Sessions
The 49th ACBICON 2023 Kerala meticulously organized 19 sessions, spread over three days,
into four parallel segments in distinct halls. Day one comprised 11 parallel sessions, while day
two had 5, and day three had 3 parallel sessions, each catering to specific themes. Renowned
personalities chaired the sessions, enhancing the discussions with their expertise. Speakers,
experts in their fields, presented on various topics, ensuring comprehensive learning forattendees regardless of their familiarity with the subject. Each talk was followed by a Q&A
segment, promoting active engagement and in-depth understanding. A highlight was the
symposium by the IFCC Committee on Clinical Laboratory Management (C-CLM). Prof. Sedef
Yenice (VLP), Executive Member of IFCC Education and Management Division (EMD) spoke on
the role of data analytics in clinical labs, and Prof. Praveen Sharma, Secretary, Asia- PacificFederation for Clinical Biochemistry & Laboratory Medicine (APFCB), highlighted the importanceof Emotional Intelligence in leadership. Additionally, embracing the digital age, ProfDr. Tomris
Ozben, President of the European Federation of Clinical Chemistry and Laboratory Medicine(EFLM) and President Elect of the International Federation of Clinical Chemistry and Laboratory
Medicine (IFCC) presented virtually on the advancements in oncology diagnostics, emphasizing
the shift from traditional tumor markers to liquid biopsies. Several parallel sessions highlighted
international speakers. Dr Khosrow Adeli, President, International Federation of Clinical
Chemistry and Laboratory Medicine (IFCC), whose discourse on "emphasizing the cardiovascularrisks associated with postprandial dyslipidemia in obesity and diabetes" was a standout
contribution to the discussions. His deep dive into the complex interrelations between dietary
patterns, metabolic responses, and cardiovascular health provided attendees with valuable
insights. Dr Adeli's ability to elucidate the intricacies of this topic showcased not only hisexpertise but also highlighted the critical need for increased awareness and understanding ofthese cardiovascular risks in the context of modern health challenges. All through Parallel
Session 5 at the 49th ACBICON 2023 Kerala, the focus was on the integration of cutting-edge
AI into medical diagnostics, especially its role in promoting health equity. Led by Dr. Pradeep K
Dabla (Chair, Communication and Publications Committee, Asia-Pacific Federation for Clinical
Biochemistry & Laboratory Medicine (APFCB) ) and Dr. Bernard Gouget, Chair IFCC C-MHBLM;
Committee on Mobile Health and Bioengineering in Laboratory Medicine, President of the
National Committee for the Selection of Reference Laboratories, Ministry of Health andPrevention, and Ex-President of the Healthcare Division Committee, painted a future where AI
reshapes healthcare and laboratory diagnostics for more equitable outcomes. A standout talkwas delivered by Dr. Bernard Gouget on "Unlocking the Potential of Chat GPT: Can it be our
Virtual Assistant in Lab Medicine for Better Care?" where he emphasized AI's transformative
potential in enhancing lab operations and patient care. He envisioned AI as a pivotal tool in Lab
Medicine, enhancing accuracy and accessibility. Parallel Session 6 at the 49th ACBICON 2023
Kerala delved into "Advances in Cancer Diagnostics: Current Indian Scenario" under the expert
guidance of Chairperson Dr. Arnab Pal (Professor, Post Graduate Institute of Medical Education
and Research, Chandigarh). The session highlighted the importance of cancer diagnostics,
especially in India's diverse context. Dr. Maritha Kotze (Division of Chemical Pathology, NHLS
and Stellenbosch University, Tygerberg Hospital, Bellville,Cape Town, S Africa) further enriched
the discussions by detailing the progression of genetic testing in pathology. During the 49th
ACBICON 2023 Kerala, Parallel Session 7, chaired by Dr. Dharamveer Yadav, Professor, All India
Institute of Medical Sciences Jodhpur, delved into Molecular Diagnostics. The session
spotlighted Dr Maritha Kotze's insights on integrating25

APFCB News 2024 Issue 1

Member Societies

point-of-care DNA screening with comprehensive genome sequencing, highlighting its potential
to revolutionize pathology and patient care. Following Dr Kotze, the focus shifted to Dr
Manogari Chetty’s (Professor and HOD: Craniofacial Biology, Pathology & Radiology) discussion
on dental and cranio-facial genetics in Africa. Dr. Helen Martin, (Past Secretary, Asia-PacificFederation for Clinical Biochemistry & Laboratory Medicine (APFCB) an APFCB Traveling Lecturer,delved deep into Vitamin D's pivotal role in health. Her comprehensive overview touched upon
its significance in bone health, immunity, and mood regulation. In a shift to a digital format,
Parallel Session 12, under the AACC India Section and chaired by Dr. Jayashree Bhattacharjee,
showcased Dr. Octavia M. Peck Palmer's (Division Director, Clinical Chemistry Medical Director,
UPMC Presbyterian and Shadyside Automated Testing Laboratories) deep dive into theintersection of laboratory and emergency medicine. Her talk, "The Total Testing Process:Collaboration between Laboratory Medicine and Emergency Medicine to Ensure Quality Testing,"
highlighted the vital role of collaboration in ensuring accuracy and efficiency in emergency
medical testing. Parallel Session 13 of the 49th ACBICON 2023 Kerala delved deep into a topic
of pressing relevance, especially given the global surge in cases of diabetes mellitus. Titled "TheValue and Evidence of Laboratory Tests Used in the Management of Diabetes Mellitus," thissession, held under the auspices of IFCC/EBLM Evidence-based Laboratory Medicine, promised
to impart essential insights into the role of lab tests in diabetes management. Presiding overthe session as the Chairperson, Dr. Seema Bhargava (President, ACBI, Chairperson and Senior
Consultant, Department of Biochemistry & Professor, Ganga Ram Institute for Postgraduate
Medical Education & Research (GRIPMER) navigated attendees through a series of presentations
and discussions that merged foundational knowledge with the latest advances in diabetes
diagnostics and management. Dr. Emma English delivered an insightful analysis on "examining
the pros and cons of HbA1c testing." Her balanced presentation highlighted both the strengths
and limitations of the test, offering attendees a comprehensive understanding. Dr. Emma
English’s skill in presenting intricate details in a clear manner was especially commendable,enriching the audience's knowledge on HbA1c testing nuances. Parallel Session 16, chaired by
Dr. Tony Badrick, (CEO, Royal College of Pathologists of Australasia Quality Assurance
Programs) focused on "The Clinical Laboratory in Health & Disease." The session explored thevital role of laboratories in patient care, highlighting the latest advancements and challenges.
Under Dr. Badrick's expert leadership, attendees were treated to a series of enlightening
presentations and discussions. During this session, Dr. Tomris Ozben's online presentation on"transitioning labs to greener practices" was a standout. Addressing an increasingly important
topic, Dr. Ozben highlighted the urgency and methods for making laboratories moreenvironmentally friendly. The talk was not only timely but also forward-thinking, reflecting theneed for sustainable practices in modern medical science. Dr. Ozben's approach to the subject,delivered with clarity and expertise, resonated with attendees and emphasized the imperativefor eco-friendly transitions in lab operations. Meanwhile, Session 19, at the 49th ACBICON 2023
Kerala, titled "Miscellaneous - 2," ventured into innovative topics in clinical chemistry andlaboratory medicine. Led by Chairpersons Dr. D Dash and Dr. SB Sharma, the session spotlighted
unique areas of research. A highlight was Dr. John Anetor's (Head of Department, Chemical
Pathology, University of Ibadan, Ibadan, Nigeria) presentation on the "Exposome-Nutriome
Pathway," exploring the intricate relationship between lifetime exposures, nutrition, and theirimplications on health. Dr. Anetor emphasized the role of laboratory medicine in understanding
these interactions and their health impacts.

26

APFCB
2024 Issue
Issue 2
1
APFCB News
News 2023

Member Societies

Prelude to the 49th ACBICON 2023 Kerala: Insightful PreConference
Workshops: Before diving into the deep waters of the 49th ACBICON 2023 Kerala, attendees
were treated to a series of enlightening pre-conference workshops. Designed to provide indepth understanding on specialized topics, these sessions were helmed by distinguishedfacultyand hosted across eminent venues in Thiruvananthapuram. At the renowned Rajiv
Gandhi Centre for Biotechnology (RGCB), a session on ‘Proteomics and Medical Applications’
was conducted, shedding light on the dynamic world of proteins and their implications inmedicine.The insightful discourse was further enhanced by Dr. Abdul Jaleel’s workshop on“Genomics in Infectious Diseases,” where attendees delved into the genomic intricacies
underlying infectious pathogens and their interactions with the host. Not too far, at the
RGCB's Kinfra Campus, another enlightening session was in progress. Dr. Radhakrishnan
Nair, a prominent figure in the domain, presided over two critical workshops. The first covered
the intricate topic of “Inborn Metabolic Disorders and Amino Acid Analysis,” providing an
understanding of genetic metabolicdefects and the methods to diagnose them. The second
was an essential session for budding and seasoned researchers alike, titled “From Conceivinga Research Topic to its Publication.” Dr.Sucheta Dandekar, Professor of Biochemistry Era's
Lucknow Medical College, Lucknow Member of the Quality Assurance Committee and Global
Consultant by FAIMER, Philadelphia and Dr. Thomas Chacko, Dean Medical Education &Professor Community Medicine, Believers Church Medical College, Thiruvalla, elucidated theresearch process's nuances, from ideation to the pivotal moment of publication, providing
attendees with a roadmap to academic success. Further, the Al Saj Convention Center inKazhakkoottam was buzzing with activity. A timely workshop on the “Transition from
ISO15189 2012 to 2022 - Learning Opportunities” was hostedhere, guiding laboratories on
the transition journey between these standards. Dr. Pradeep Kumar Dabla, Chair,Communication

andPublications

Committee,

Asia-PacificFederationforClinical

Biochemistry & Laboratory Medicine (APFCB), with his vast expertise, illuminated the updates,
the implications, and the strategies to ensure compliance and quality.

27

APFCB
2024 Issue
Issue 2
1
APFCB News
News 2023

Member Societies

28

APFCB
2024 Issue
Issue 2
1
APFCB News
News 2023

Member Societies

Poster and Oral Presentation: The national conference featured competitions in poster andoral presentations, allowing scholars to showcase their research. Participants displayed
their findings in posters, promoting individual interactions, while the oral presentations
allowed adeeper exploration of their topics. Both formats were assessed by expert panels
for clarity, depth, and relevance. Winners received cash prizes and achievement
certificates, acknowledging their valuable contributions and efforts in the field.
Quiz competition Organized by Department of Biochemistry AFMC (Armed Forces Medical
College, Pune): The quiz competition added a dynamic and engaging facet to theconference, allowing attendees to actively participate, challenge themselves, and interact
with the contentin a fun and competitive manner.

29

APFCB
2024 Issue
Issue 2
1
APFCB News
News 2023

Member Societies

Corporate Innovation & R&D Highlights: The 49th ACBICON 2023 in Kerala served as bothan academic and corporate hub, highlighting advancements in clinical biochemistry andlaboratory medicine. Industry leaders showcased innovations, emphasizing the synergy
between academic research and industry application to produce tangible healthcare
solutions. The event fostered interactions between corporate entities and the academic
community, ensuring R&D efforts met practical healthcare needs. Attendees gained
insights into the latest industry technologies and trends, underlining the industry's
commitment to advancing the field.

A Banquet to Remember: The 49th ACBICON 2023, Kerala featured a memorable evening
at Uday Samudra Leisure Beach Hotel, Kovalam, Thiruvananthapuram, where guests weretreated to an elegant banquet dinner set to the soothing tones of water music. The serene
ambiance was enlivened by a DJ, making attendees of all ages dance and enjoy. The
highlight for many was the diverse culinary spread, ranging from traditional Kerala dishes
to international cuisines, all accentuated by expertly crafted cocktails. Beyond just a
dinner, the banquet was a blend of fine dining, lively music, and spirited camaraderie,
underscoring the conference's balance of intellectual and social enjoyment.

30
30

APFCB
APFCB News
News 2024
2023 Issue
Issue 1
2

Member Societies

Showcasing Kerala's Cultural Heritage at the Conference: One of the most memorable
aspects of the conference was the vibrant showcase of Kerala's rich cultural heritage
through its iconic art forms. For those unfamiliar with these traditional dances, brief
introductions were provided, ensuring participants understood the significance andstories behind each performance. The inclusion of these cultural events was met withoverwhelming positivity. Attendees expressed their joy and appreciation for theopportunity to witness such authentic performances, with many considering it a highlightof their visit.

31

APFCB
APFCB News
News 2024
2023 Issue
Issue 1
2

Member Societies

National Society Report- KSCC Korea
KSCC Spring Meeting, May 11, 2023
Korean Society of Clinical Chemistry (KSCC) held its spring meeting in Seoul on May 11, 2023.
A total of 363 people attended the event, including 148 clinical pathologists, 51 resident
doctors, and 57 certified laboratory technologies. The number of attendees increased comparedto the previous fall meeting in 2022 (which had 310 attendees), possibly due to reduced
concerns about COVID-19. During the meeting, we provided information on the latest laboratory
tests and instruments in the field of clinical chemistry, covering analytical performance
specifications, tumor markers, urine analysis, etc. The meeting comprised five symposium
sessions and two review courses. The review courses were available online for a month.
Here are the details of the program and the event photos:◎ Symposium (Part 1)

32

APFCB News 2024 Issue 1

33

Member Societies

APFCB News 2024 Issue 1

Member Societies

34

APFCB
APFCB News
News 2024
2023 Issue
Issue 1
2

Member Societies

Professor Yong Wha Lee (President of KSCC) delivering the opening address

Executive board members and advisors of KSCC

35

APFCB News 2024 Issue 1

Member Societies

The organizing committee of the 2023 KSCC spring meeting
KSCC Fall Meeting Plan
KSCC will hold the fall meeting in Seoul on November 1–2, 2023.

36

APFCB
APFCB News
News 2024
2023 Issue
Issue 12

Member Societies

National Society Report- KSCC Korea
KSCC Fall Meeting, November 1–2, 2023
Korean Society of Clinical Chemistry (KSCC) held its fall meeting in Seoul on November1–
2, 2023. A total of 366 people attended the event, including 144 clinical pathologists, 34
resident doctors, 43 certified laboratory technologies, etc. The number of attendees
increased comparedto the previous fall meeting in 2022 (which had 310 attendees). The
meeting comprised five symposium sessions, two workshops, and review course as video
on demand format.
During the symposium, we provided information on the latest laboratory tests andinstrumentsin the field of clinical chemistry, covering pre-analytical phase management,
medical informatics, heart failure diagnosis, genetic testing, etc. Furthermore, this fallmeeting also placed emphasis on educational programs. Among them, two workshops
focused on data analysis using the R programming language and assay performance
evaluation. Additionally, an online education program (Review Course) was delivered
through Video On Demand (VOD) format.
Here are the details of the programs and the event photos:

37

APFCB News 2024 Issue 1

Member Societies

38

APFCB News 2024 Issue 1

39

Member Societies

APFCB News 2024 Issue 1

Member Societies

40

APFCB News 2024 Issue 1
APFCB News 2024 Issue 1

Member Societies

Professor Yong Wha Lee (President of KSCC) delivering the opening address

Executive board members and advisors of KSCC

41
40
41

APFCB News 2024 Issue 1
APFCB News 2024 Issue 1

Member Societies

The organizing committee of the 2023 KSCC fall meeting
KSCC 2024 Spring Meeting Plan
KSCC will hold the spring meeting in Seoul on April 11–12, 2024.

42

APFCB News 2024 Issue 1
APFCB News 2024 Issue 1

Member Societies

National Society Report- IACC Indonesia

Indonesian Association of Clinical Chemistry Report
ArwinPrasasto, DarmastantiWidi–secretariat@iacc.web.id
Green Laboratory Webinar: Make Your Effort Be Measured
Sustainability development is the development that meets the needs of the present
without compromising the ability of future generations to meet their own needs. The
Indonesia Sustainable Development Goals Summit 2023 committed to successfully
implementing the development agenda to achieve 17 goals before 2030.
Hospitals, health practitioners & laboratory medicine community face a great challenge
because of the useof more energy & water than offices and generate huge amounts ofhazardous & non- hazardous waste. At the same time, it is a great opportunity tocontribute to improving the sustainability performance of laboratories & healthcare
systems.
All laboratories, including laboratories, should do their part to reduce the harm they doto theenvironment and also to improve patients' comfort and safety. At this stage theawareness of the environmental impact of clinical laboratories is limited. Therefore, there
is a need to sensitize labs about the importance of adopting good environmental
practices.
One of the ways to achieve this, IACC in cooperation with APFCB presents an online
seminar that aims to engage laboratories in Indonesia and other countries to contributeto developing sustainable laboratories and having a culture behavior to support green
environment laboratories. The goals of this webinar are for the participants to understandthe sustainability and the impact of doing sustainable activities, understand howlaboratories can participate in sustainability efforts, and understand how to measure theimpact of our green activity.
There were 649 registered participants and during the webinar, there were 266
participants from Indonesia and abroad (Malaysia, India, Singapore, South Korea, etc.).
The webinar ran well. The speakers of the webinar were Dr. Lia Partakusuma, MM, SpPK(K),Dr. Tony Badrick (APFCB), and Jay Nam. The participants were enthusiastic and asked
questions tothe speakers during the 30-minute discussion session.

43

APFCB News 2024 Issue 1
APFCB News 2024 Issue 1

Member Societies

Instagram Reels Competition for Green Laboratory
29 participants from Indonesia joined the Green Award Instagram reels competition. The
content and quality of the video, engagement, and creativity were the criteria of thewinner. All of the participants of this competition were being awarded and also one
participant who wrotean article on the past seminar in early 2023 was being awarded inthis event.
The list of the participants:@apfcb.july@vymayka@kristinafnynt@ritani.manurung@ppdspatologiklinikfkuns@patklinudayana@wendy_dalimunthe@patklin.ua@katrintimorensa@labrskb@rspertaminatarakan@avirigas@laboratorium_rspb@awyusufs@krist_ryrin@yulistianingsihwiwik@auliasofiarahma@ikeindriyani@susipurwanti@rsudbumiayu_brebes@arwin.prasasto@dr.diane.sppk@tamidantoni@allam.medica@alknbl@ilhksiam@henimokasari94

44

APFCB News 2024 Issue 1
APFCB News 2024 Issue 1

Member Societies

Social Services for Anak Dalam Tribes
The Anak Dalam tribe or Orang Rimba is one of the minority ethnic groups living in Jambi
Province. This tribe is still categorized as an "isolated community" because of theirnomadic lifein the forest. They live in groups with a tribal leader and live by hunting.
IACC conducted this event from the 4th to the 6th of August 2023. The main agenda is
to givemass treatment to the tribe and also give a blood test for them.

45

APFCB News 2024 Issue 1
APFCB News 2024 Issue 1

Member Societies

May I Help You Campaign (Pre-analytical Survey)
Preanalytical errors occur most frequently (70% of the total testing process) and can haveseriousimpacts on patients. Therefore, correct preanalytical activities are needed to beable to providegood laboratory results. Improvements in pre-analytical quality need tobe carried out continuously. Since 2012, IACC has carried out the May I Help You
Campaign pre-analytical survey activities to improve pre-analytical quality in Indonesia.
In 2023, collaboration was carried out with the Jakarta Health Service to conduct a surveyof 10laboratories, including 6 Type A and B Regional Hospitals in Jakarta. Surveys wereconducted for these six hospitals in January – June 2023 and an evaluation/follow-up
survey was carried out in July – December 2023, namely Pasar Minggu Hospital, Koja
Regional Hospital, Cengkareng Regional Hospital, Pasar Rebo Regional Hospital, Budi Asih
Hospital, Adhyaksa Hospital. Several materials were found that needed attention forimprovement in each hospital.
Meet the Expert
Ethics are the principles that guide us to make a positive impact through our decisions
and actions. In the laboratory we often face technical, medical and ethical problems. When
problemsoccur, laboratory managers must be able to resolve the problem properly. This
is where leadership is really needed, especially ethical leadership.
This hybrid seminar was conducted (offline and online) on 18th December 2023. The
speaker was Prof. Rajiv Erasmus from South Africa. Prof Rajiv Erasmus also represented the
APFCB. Therewere 142 participants in total offline and online.

IACC Instagram Live!
IACC conducted Instagram Live several times during the second semester of 2023. The
topics were on in vitro fertilization, hepatitis, upper respiratory tract infection, childhood
cancer awareness, thrombosis, and Pediatric Reference Value & IFCC Program forDeveloping Countries. The target audience were the public and laboratory workers. The
notable speakers were Prof. Koshrow Adeli, PhD., Prof. Dr. Rahajuningsih
D. Setiabudi, Sp.PK(K), Dr. ThyrzaDarmadi, Sp.PK, Dr. Dr. Nuri DyahIndrasari, Sp.PK(K),Dr. Dennis Jacobus, Sp.PK, and many more.

46

APFCB News 2024 Issue 1

Member Societies

IACC Website Refresh!
The IACC website has been around since 2015 and has helped many of its members.
Member registration, activity news and seminar materials can be obtained on the website.
Since 2019, the name IACC has been used to replace HKKI. However, the website andemail address still use the HKKI name. In 2024, we will use the name IACC as the name of
our website and become iacc.web.id. The secretariat's email address has also beenchanged to secretariat@iacc.web.id. In the future, the new IACC website will use newfeatures to make it easier to register and pay membership fees, make it easier to register
for IACC activities, makeit easier to get seminar materials and certificates, and monitor
IACC activities through the activity calendar. We

47

APFCB News 2024 Issue 1

Member Societies

National Society Report- MACB Malaysia
MALAYSIAN ASSOCIATION OF CLINICAL BIOCHEMISTS (MACB)
1. HbA1C User Meeting
Everlife-Chemopharm Group organized a hybrid HbA1c User Meeting at Vida Bukit Ceylon, Level 22,
KLon 19th September 2023 under the MACB auspices. The meeting featured lectures from threeesteemed speakers: Dr. Marco Flamini, Bio-Rad Global Product Manager; Dr. Adlin Zafrulan Bin
Zakaria, Senior Chemical Pathologist at Hospital Raja Perempuan Zainab II; and Associate Professor
Dr. Busadee, ClinicalPathologist at Mahidol University in Thailand.
In the meeting, Dr Marco Flamini shared on “Diabetes and Hemoglobinopathy Testing, A Synergic
Strategy for A Common Goal: A Healthier Community.”; Dr Adlin on “Streamlining Laboratory
Reporting: Overcoming Challenges with Bio-Rad HPLC Method”; and Dr BusadeeProtumvinit on“Update on Diabetes Situation in Thailand & Potential Effect of Analytic and Clinical Factors of
HbA1c”. The meeting ended after Dr Hanisah Abdul Hamid’s topic on “Correlation of HbA1c value
between Variant II Turbo HbA1c Analyzer and D100 HbA1c Analyzer among patients with P3 > 5%”

Pic 1: Event flyer

Pic2: Opening remarks by MACB President

48

APFCB News 2024 Issue 1

Member Societies

Overall, it was a fruitful meeting with 33 physical attendees and 134 virtual attendees
who joined on Microsoft Teams.

Pic 3: Lecture and Q&A session with Dr

Pic4: Participants at HbA1C User Meeting

Marco Flemini

2.0 THE 7th CONGRESS OF ASIA ASSOCIATION OF MEDICAL LABORATORYSCIENTISTS(AAMLS 2023)
The Malaysian Association of Clinical Biochemists (MACB) signed a Memorandum ofUnderstanding withMalaysian Institute of Medical Laboratory Sciences (MIMLS) to support
the Asia Association of Medical Laboratory Scientists (AAMLS) Congress which was hosted
by MIMLS at World Trade Centre Kuala Lumpurfrom 9th to 12th October 2023. The aim of
this collaboration between MIMLS and MACB was to showcasethe best of Malaysia medicallaboratory industry to delegates from across Asia, fostering a sense of hope andappreciation for the advancements in medical laboratory sciences in the country. The
MACB supported the congress in 2 programmers:
Pre-Congress Workshops (Day 1):
MACB conducted pre-congress workshop on 9th October from 1.30pm to 5.30pm on“Impact of Iso 15189:2022 On Laboratory Quality Management”. A lecture on‘Introduction to ISO 15189:2002: Requirements for Quality and Competence’ was given
by Ms Fariza Wan Abdullah Department of Standards Malaysia, Ministry of International
Trade and Industry Malaysia, ‘Risk Based Approach in ISO 15189:2022’ by Dr Raja Elina
Raja Aziddin, President of MACB and ‘Managing Quality in the Context of ISO 15189:2022’
by Ms Rozita Abdullah, Clinical Biochemist, Hospital Sungai Buloh.
Symposium 12 – Immunology and Clinical Chemistry (Day 2)
MACB assisted MIMLS in inviting 2 speakers for this symposium. The lecture on ‘Vitamin
D & EndocrineDisorders’ was delivered by Dr Sharifah Faradila Wan Muhammad Hatta,
Consultant Internal Medicine Physician and Endocrinologist, KPJ Damansara Specialist
Hospital 2 and ‘Interference in Immunoassays’ by Ms Joanne Lee Mee Yin, Senior Manager,
Quality Assurance and Technical Excellence, Parkway Laboratories, IHH Singapore.

3.0 MALAYSIA BUSINESS EVENTS WEEK (MBEW)
The MACB participated in the MBEW which was organized by Malaysia Convention &Exhibition Bureau (MyCEB) on 22nd-23rd August, 2023 at Kuala Lumpur Convention
Centre.

49

APFCB News 2024 Issue 1

Member Societies

Pic 5: MACB President at MBEW
The program, themed “Riding the Waves” aims to create a series of ripples and impact
towards financialand socio-economy for the country through Business Events. The event
showcased knowledge sharing and case studies with a focus on sustainability andresilience. This event was attended by more than
300 local and international delegates consisting of business event industry players,
association executives and students. The MACB was represented by the President.

4.0 Hosting of APFCB Webinar
On 4th October 2023, the MACB hosted the APFCB Webinar on “All you ever wanted to know
about Patient Based Real Time Quality Control”. The purpose of this webinar is toregistrants the opportunity to ask any questions they may have about this form of QC.

Pic 6: Webinar flyer

5.0 MACB SYMPOSIUM ON POINT OF CARE TESTING
A MACB Symposia on Point of Care Testing (POCT) was held in conjunction with the 33 rd
MACB AGM 2023. The symposium discussed the impact of the recently adopted ISO
15189:2022 on POCT requirements and the process of preparing POCT facilities in
Malaysia for accreditation.

50

APFCB News 2024 Issue 1

Member Societies

Pic 7: Flyer for MACB Symposium on POCT
Lectures for the symposium were delivered by speakers from Malaysia, Thailand andSingapore.

6.0 MACB ANNUAL GENERAL MEETINGThe hybrid 33rd MACB Annual General Meeting (AGM) was held on Saturday, 25th
November 2023 at Triune Centre, Bangsar, KL Eco City.

Pic 8: MACB AGM Announcement

51

APFCB News 2024 Issue 1

Member Societies

Pic 9: MACB members at the AGM 2023

7.0 PARTICIPATION IN INTERNATIONAL MEETINGS IN 2023
a) IFCC WORLDLAB - EUROMEDLAB CONGRESS 2023 IN ROME, ITALYFROM 21st-25th MAY 2023
The MACB sent 9 of its members to attend the IFCC WorldLab-EuroMedLab Congress
2023. This was made possible with the support from MACB-SNIBE Travel Grant. The
Congress was well run and receiveda record attendance. Members who attended foundthis event as an exceptional platform for learning, exchanging knowledge and fosteringsocial networking. Overall, members who attended gained a valuable experience to betterhelp them in providing a better service and plan the future direction of the laboratory
services in their respective organizations.

52

APFCB News 2024 Issue 1

Member Societies

Pic 10: MACB members with APFCB President at the IFCC WorldLab
EuroMedLab Congress2023

Pic 11: MACB member’s t at the
IFCC WorldLab EuroMedLab
Congress 2023

Pic 12: MACB member’s t at the IFCCWorldLab EuroMedLab Congress
2023tradeexhibition

The Malaysian team was headed by the MACB president who attended the Congress inher capacity as amember of the IFCC Clinical Lab Management Committee, and was
supported by the IFCC.

53

APFCB News 2024 Issue 1

Member Societiesb) SNIBE INTERNATIONAL SYMPOSIUM ON IMMUNOASSAY
The International Immunoassay Symposium which was jointly organized by SNIBE, IFCC,APFCB, EFLM and Colabiocli was held in Shenzhen China from 24th-28th August 2023. The
symposium was attended by 9 MACB members who received the MACB-SNIBE travel
grants. The symposium highlighted issues which include biomarkers in cancer and liver
fibrosis, value-based medicine, sustainability as well as Environmental, Social andGovernance (ESG) for medical laboratories. Lectures were delivered by international
experts.

Pic 13: MACB members at the International Immunoassay Symposium in
Shenzhen China
MACB members who attended found that the symposium provided a platform for sharing
knowledge, insights and advancements in the field of immunoassay. The symposium wasvery well received with representatives from 55 countries.

54

MemberSocieties
APFCB News
2024
IssueNews
1 2024 Young
APFCB
Issue 1Scientists Column
The IFCC Task Force – Young Scientists(IFCC TF-YS): Perspectives for Young
Scientists in 2024
Santiago Fares Taie, Argentina YS (CUBRA), IFCC-TF-YS chair
Marie Lenski, French YS (Société Française de BiologieCliniques SFBC), IFCC-TF-YS
member
The aim of the IFCC task Force – Young Scientists (IFCC TF-YS) is to ensure that young
scientists(< 40 years old) make a significant and growing contribution to the activities of IFCC
and to the promotion of laboratory medicine at the Centre of healthcare. 2023has been abusy year for young scientists participating in IFCC TF-YS (young scientist) activities, andnew opportunities will be proposed for 2024.
IFCC TF-YS led two live webinars in 2023, moderated by YS members. The duration ofeach webinar was 90 minutes to include presentations from three YS speakers, a panel
discussion, and final take-away messages. All these free eLearning programs provided acertificate of attendance.The webinars presented until now had close to 800 attendees
each from countries around the world. In 2024, new webinars will be leaded by YS, andseveral others will include YS as renownedspeakers.
During 2023 IFCC TF-YS developed a clinical case study project where YS from IFCC
communitycould present their experience with interesting real life case studies. A firstsession was done in November 2023 with 3 Young scientists’ presentations of thestructured case reports followed by a panel discussion. This project will continue in 2024with the presentations of newselected clinical cases from various topics as endocrinology,
hematology, clinical chemistry, etc. New abstract call will arrive soon. The TF-YS is
structured with 6 core members, and 44 corresponding members nominated by IFCC Full
Members and Corporate Members. Corresponding members have a central role in 1) the
dissemination and promotion of TF-YS activities, 2) the dynamic of the TF-YS and thesuccess of future or launched programs 3) the identification of young scientists that could
have a growing contribution to the activities of the TF-YS. The capillary program launchedin 2020 by the TF-YS intended to map National YS- WGs and to increase the participationof TF-YS corresponding members during national meetings. Major progresses were donein 2023, mostly by using zoom meetings. In 2024, the IFCC TF-YS will continue assisting
its corresponding members to motivate them to create YS groups in their country andregion. Moreover, we are permanently trying to get more committedwith our activities by
doing surveys and seeking other points of view for our programs.
In a continuing evolving Laboratory Medicine profession with new technologies andmethods every year, YS find exchange programs and communication essential to widen
their horizonsand sharpen the laboratory skills. Lab-surfing (www.lab- surfing.com) is aLaboratory professional social media designed and created to fulfil these objectives. Morethan 800 YS registered from all around the world and could easily communicate.

55

Young Scientists Column

APFCB News 2024 Issue 1

The mentorship program interviews is intended to educate Young Scientist members on
anycurrent mentorship program in the laboratory research area. The program focuses on“how, when, what and why” about the existing mentor and mentee relationship and tips on
how others can learn from their relationship. In 2024, new inspiring feedbacks on
mentorships will be available.
In 2023 Live My Lab project was launched, which consists in a virtual/remoted visit of areal lab, driven by young scientists. Thanks to this program, it is possible to visit otherlaboratories and how they treat the samples (pre-analytics, analytics and post-analytics)
from the seat of your office. During 2023, IFCC TF-YS worked together with the CPD to callforvideos anddevelopmaterial

usedduringthe

Global

Med

Lab

Week

(globalmedlabweek.org). In 2024, the IFCC TF-YS will continue to encourage young
scientists to participate in the IFCC Global MedLab Week, to increase the visibility the workof Medical Laboratory Professionals worldwide.
Young Scientists are future leaders, and need to be trained and encouraged to succeedin theirrole, ideally with the support of experienced/senior leaders. In this objective, thethird edition of the IFCCYS FORUM will take place during the IFCC World Lab Dubai 2024.
The participationto the forum is supported by +50 IFCC-ROCHE scholarships, offering aunique possibility of training and improve communication and networking.
In 2024, young scientists will be able to participate in many other activities proposed by
IFCC TF-YS. Information on all mentioned activities, objectives and projects of the TF-YS
are available on IFCC website https://ifcc.org/task-force-young-scientists-tf-ys/, orfollow us on Instagram(/ifcc_tfys), Facebook (/ifccYOUNG), LinkedIn (/groups/3049837/)
For more info, visit us at: https://ifcc.org/task-force-young-scientists-tf-ys

56

APFCB News 2024 Issue 1

Young Scientists Column

Young Scientist Interview

Dr. Chao Lien Liu, Ph.D.
Faculty Positions:

Associate professor at the School of Medical Laboratory Science and Biotechnology,
College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan



Associate professor at Ph.D. Program in Medical Biotechnology, College of Medical
Science and Technology, Taipei Medical University, Taipei, Taiwan

Special Local Responsibilities:


Member of the Taiwan Society of Laboratory Medicine

Member of the Taiwan Society on Thrombosis & Hemostasis (TSTH)

Special National Responsibilities:


Member of the International Society of Transgenic Technology (ISTT)Member of the American Society of Gene & Cell Therapy (ASGCT)

Member of the International Society on Thrombosis & Hemostasis (ISTH)



Member of the European Association for Cancer Research (EACR)Member of the American Association for Cancer Research (AACR)Member of the American Association of Immunologists (AAI)

Editor Board member for Frontiers in Bioscience-Scholar

Guest Editor for Frontiers in Cell and Developmental Biology

1. Please introduce yourself
My name is Chao Lien Liu. I came from a stable, comfortable, middle-class family. My
parents held a small garment factory and raised six children, making them almost
overwhelmed. As the middle child in the family, I was naturally trained in independent
thinking and learning, which directed me to education/research in medical science andbiotechnology according to my interests.

57

APFCB News 2024 Issue 1

Young Scientists Column

I received my bachelor’s degree in medical technology as the Valedictorian from the
Department of Medical Laboratory Science and Biotechnology, China Medical University(CMU), Taiwan, andobtained a master’s degree and a Ph.D. degree in Pathology from the
Department of Pathology,College of Medicine, National Taiwan University (NTU), Taiwan.
After finishing my Ph.D.program, I worked with Dr. Miao as a post-doctoral fellow at the
Department of Immunology &Immunotherapies at Seattle Children’s Research Institute(SCRI), Seattle, WA, USA, and then came back to Taiwan to join the School of Medical
Laboratory Science and Biotechnology at Taipei Medical University, as a full-time facultyin 2013.
I am now an Associate Professor in the School of Medical Laboratory Science andBiotechnology (SMLSB) at Taipei Medical University (TMU), Taiwan. I am also serving as an
Associate Professor in the Ph.D. Program in Medical Biotechnology (PPMB) at Taipei
Medical University (TMU), Taiwan. To develop precision medicine, I also attended the
OXCEP Academic Medicine Course at St Edmund Hall, University of Oxford, UK, in 2022
to promote the medical technology profession and life-long learning in biomedical
science.

2. What is your main focus?
I have been an independent faculty since 2013 and am responsible for teaching(Immunology- related courses), academic research, and administrative services at the
SMLSB/PPMB, TMU. Currently, my research areas are focused on two different parts of
Immunology-related studies,including (i) Immunotherapy strategies by using CAR-T cells,
CAR-NK cells, -T cells, and the irderived exosomes to attack solid tumors, including
ovarian cancer (OC), pancreatic cancer (PaC), and prostate cancer (PC); and (ii)
Immunosenescence and Senotherapeutics in aging and age-associated diseases. Bothhave great potential for clinical application and are among the most actively studied
topics in translational medicine. Our research team involves different expertise with our
national/international collaborative networks, including National Taiwan University,
Chang Gung Memory Hospital, Taoyuan General Hospital, Ministry of Health and Welfare,and Seattle Children’s Researcsh Institute.

58

APFCB News 2024 Issue 1

Young Scientists Column

3. What else is important to you?
In addition to academic research, I have been actively engaged and responsible fordeveloping English-medium instruction (EMI) teaching in medical technology andpromotinginternational collaboration

and activities forfaculties and students,

respectively, in both SMLSB and PPMB programs at TMU. To bring our students in line withinternational practice, especially the School of Medical Laboratory Science andBiotechnology (SMLSB) and the Ph.D. Program in Medical Biotechnology (PPMB) programs
at Taipei Medical University recruit students from all over the world, and most of thesubjects need to be organized as EMI courses. Therefore, I have been trained as an EMI
lecturer by the Oxford Emi training courses, and I am also promoting the quality of
medical technology education by utilizing EMI teaching.
Furthermore, international collaborations are needed for the sustained development ofinnovative research, education, and an international vision for faculties, students, andmedical technologists/laboratory scientists in Taiwan. I have worked with manycolleagues worldwide to create international exchange activities for students and faculty
members. Specifically, I am actively involved in two international student exchange
activities, including (i) the Tokyo Medical and Dental University-Taipei Medical University
exchange program and (ii) the Hokkaido University-Taipei Medical University exchange
program for students and faculty members, which have been organized annually for many
years. Recently, we also aimed to create a similar student exchange program and amemorandum of understanding (MOU) contract between Chulalongkorn University(Thailand) and Taipei Medical University.

4. What are your interests in biomedical laboratory medicine?
Biomedical laboratory medicine is an interdisciplinary field that brings together
knowledge in medicine, science, statistics, and technology, which plays a vital role indetecting, diagnosing, and treating disease and are rapidly progressing in the healthcareera. As mentioned above, my teaching and research correlate to the Immunology field. Inline with the global megatrends, I am actively focused on immunotherapy (e.g., Abs or
immune cells therapy), personalized medicine with a new perspective on healthcare,targeting diseases, such as cancers, autoimmune diseases, aging, and age-relateddiseases as the emerging therapeutics for clinical immune knowledge, high-throughput
technologies, health informatics, and bioinformatics. The immunotherapy field is a good
opportunity to train competitive medical technologists or biomedical laboratory scientists
in this personalized healthcare era, and they will need to have life-long learning andinvestigating.

59

APFCB News 2024 Issue 1

Young Scientists Column

5. What are your future goals?
As a faculty member in biomedical laboratory medicine at the university, I dedicated mylife to promoting education in medical biotechnology and laboratory science (e.g., EMIteaching and course optimization) and accelerated international collaborations that gear
students to international conventions. Moreover, I also devoted myself to advancing the
Taiwan Society of Laboratory Medicine (TSLM) to improve the environment and provide
benefits for clinical staff in Taiwan, such as promoting a bill amended for medical
technologists.
To develop the best clinically feasible therapeutic strategy, I am devoted to developing
immunotherapy for immediate clinical translation. I assembled a research team at the
beginningof 2013 at SMLSB, TMU, and am focused on cellular therapy (both engineered
and non- engineered) targeting solid tumors, aging, and age-related dysfunction andassessing their fundamental immunotherapeutic mechanisms. Given my background in
Medical Biotechnology/Immunotherapy, my ultimate goals in research are (i) to train
graduate students and post-doctoral fellows to become scientists with essential
competencies for afterwardacademic research, (ii) to facilitate our immunotherapeuticstrategies used in the clinic for precision medicine, as well as for future manufacturing.
Interviewer:
Dr. Ryunosuke Ohkawa, Ph.D.
Professor of Analytical Laboratory Chemistry,
Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University.
Member, APFCB Committee-Communication & Publications (C-CP)

60

APFCB News 2024 Issue 1

Young Scientists Column

Young Scientist Interview

Dr. Vivek Pant, MD
Current Position:
Consultant Biochemist, Samyak Diagnostic Pvt. Ltd, Kathmandu, Nepal

Special Responsibilities:

Corresponding member, Task Force Young Scientist, IFCC

Corresponding member, Task Force on Outcome Studies in Laboratory Medicine, IFCC Corresponding
member, Task Group Young Scientist, EFLM

Young Scientist member, Communication and Publication division, APFCB

1.

Please introduce yourself

I am Dr. Vivek Pant. I got my medical degree (MBBS) from Kathmandu University in 2012.
Then, I worked as a medical officer in the Emergency department of the Institute ofMedicine, Tribhuvan University Teaching Hospital. While working as a medical officer, I
was more interested in the biomarkers rather than the subjective symptoms of diseases.
What fascinated me more was that the symptoms of the same disease would vary between
patients, but the impact of the disease on the body's functional equilibrium was almost
the same. I was more inclined towards understanding the objective versus subjective
realm of the diseases. Pursuing this dream of working with biomarkers, I studied MD
Clinical Chemistry at the Institute of Medicine, Tribhuvan University, under a Nepal
Government Scholarship.

s

61

Young Scientists Column

APFCB News 2024 Issue 1

Currently, I am working as a consultant biochemist at Samyak Diagnostic, a referrallaboratoryin Kathmandu. My responsibility in the clinical laboratory includes verifying
laboratory results,evaluating them on the grounds of the patient’s clinical history, andproviding interpretative comments to the clinicians. I also work as a research director at
the same institution.
Apart from this, I am a member of working groups such as Task Force Young Scientist andTaskForce on Outcome Studies in Laboratory Medicine for the International Federation
for Clinical Chemistry and Laboratory Medicine (IFCC). I also work as a corresponding
member of Task Group Young Scientist for the European Federation for Clinical Chemistry
and Laboratory Medicine (EFLM) and a corresponding member in the Communication andPublication division of the Asia Pacific Federation for Clinical Biochemistry and Laboratory
Medicine (APFCB).

2.

What is your main focus?
More often than not, physicians are reluctant to collaborate with laboratory professionals
whilefacing a diagnostic challenge. I think a good physician identifies opportunities forlaboratory professionals to become a more integral part of the clinical care team. To that
end, I have beenwriting original articles and case reports that highlight the indispensablerole of laboratory physicians in the effective management of diseases. For example, Ipublished a case where an artifact of measurement led to false reporting of triglyceridein the case of glycerol kinase deficiency. As a consequence, the patient was not diagnosed
accurately, and doctors kept increasing his drugs for hypertriglyceridemia. Eventually,
after 13 years of being in treatment, the patient came to consult a laboratory physician
by himself. Clinicians did not bother to communicate with laboratory physicians during
the entire course of treatment. Therefore, I circulated my published case report among
clinicians to champion the need to integrate laboratory professionals into the clinical care
team.
Diabetes being omnipresent mainly in the South Asian context, I also strive to work on
biomarkers related to it. Multiple studies have reported discordance between HbA1c andglucoselevels.

The

discrepancy

isattributed

to

the

high

prevalenceofhemoglobinopathies, chronic kidney disease, iron deficiency anemia, and the use of drugs
such as dapsone. I advocated the use of alternate marker such as fructosamine, andpublished article on false HbA1c results in various conditions. I also published reports ontroubleshooting false Hba1c result and recommended to provide interpretative comments
in such cases. I disseminated these reports in various laboratories and among clinicalsocieties.

62

APFCB News 2024 Issue 1

Young Scientists Column

Now, I am happy that I have managed to have professional relationships with many clinicians
throughout the country. I have championed that Laboratory physicians could be valuable
resources whenever clinicians need assistance in selecting appropriate tests, interpreting
test results, disentangling complicated diagnoses, and being acquainted with laboratory
updates. This has been partly achieved through scientific writing and its dissemination as a
research paper in journals and international conferences.
I have disseminated my research findings at the annual conference of IFCC, APFCB,
Association for Diagnostics and Laboratory Medicine (ADLM), Australian Association ofClinical Biochemists(AACB), European Society of Endocrinology (ESE), American Association
for ClinicalEndocrinology (AACE), Japan Association of Clinical Laboratory Science (JCLS) and
Nepalese Association for Clinical Chemistry (NACC).

3.

What else is important to you?

Especially in a resource-limited setting like ours, a laboratory quality management system
is very important to me. Being a consultant biochemist in the first accredited (ISO15189:2012) clinical laboratory in Nepal, I have to keep myself updated. I am a certified
internal auditor andrecently completed an International Lead Assessor course as per therequirements of the ISO 15189:2022 conducted and organized by the Foundation for
Quality (India) and the Accreditation Education Research & Scientific Services Center(AERSSC), Nepal. I train other laboratory professionals in my country on how to implement
a quality management system for improving patient safety and meeting accreditation
requirements. The training program is accredited by the Nepal Medical Council. I am also
involved in various lectures, audio conferences, and workshops on topics about laboratory
quality and laboratory statistics.

4.

What are your interests in biomedical lab medicine?

I am interested in the clinical and laboratory aspects of hormones. As is known that theendocrine system is dynamic whereby one hormone influences the production of anotherhormone with a cascade effect. Pitfalls hormonal assays are commonly seen in clinicalpracticeand may lead to erroneous clinical impressions and treatments. I am interested in
knowing themechanisms of such laboratory pitfalls, reviewing clinical scenarios in which
they might occur,and exploring the ways to resolve these phenomena.
I have a strong interest in medical writing as well.

63

APFCB News 2024 Issue 1

5.

Young Scientists Column

What are your future goals?

The scientific and technological advances occurring in medical research laboratories are notbeing translated into care for patients in our country. I have a great interest in advanced
diagnostic techniques such as Mass Spectrometry and its use in clinical practice. Being
involvedin IFCC is one of my best experiences so far. I am happy that I got the opportunity
to learn newmethodologies and acquire new skills in a new environment. I was awarded a
Professional Scientific Exchange program scholarship by the IFCC to visit the hormone
laboratory at Oslo University Hospital in 2022 and learn the basics of the liquid
chromatography-mass spectrometry technique. I am looking forward to performing
collaborative studies and transferring the technology to Nepal.
Interviewer
Dr. Kohki Okada
Junior Associate Professor
Department of Medical Technology and Sciences, Faculty of Health Sciences, Kyoto
Tachibana University, Kyoto, Japan

64

APFCB News 2024 Issue 1

Industry Voice Section

Symphony of Science and Sustainability: A
Green Revolution in Laboratories
Author:Dr. Shailaja Alapaty
Vydehi Institute of Medical Sciences
HOD, Prof Dept. of Biochemistry, Head of PurchaseEmail - headpurchase@vimsmail.com

The fluorescent hum of laboratories, once a triumphant melody of scientific progress, now
facesa counterpoint: the rising crescendo of a green revolution. A transformative movement
is brewing, envisioning laboratories bathed in the golden glow of solar panels, where water
is revered, not recklessly squandered, and robots glide among sleek, energy-efficientequipment,minimizing waste and errors. In this digital symphony, data swirls seamlessly inthe cloud, replacing mountains of paper and plastic with elegant efficiency.
Ignoring the environmental impact of laboratories is no longer an option. They guzzle water,
generate mountains of hazardous waste, and rely heavily on fossil fuels, casting a longshadow on the planet's health. But amidst this disharmony, a new melody rises – thesymphony of greenlabs. This vision is not a futuristic fantasy, but a clarion call to action,
demanding immediate attention.
The challenges are stark, yet solutions bloom within reach. Dry chemistry, with its cleveralchemy, replaces water-intensive processes. Automated systems minimize human error
and waste, while green chemistry envisions a future where reagents dance with eco-friendly
elegance. Digitalization orchestrates a paperless waltz, saving trees and streamlining
workflows. But for this symphony to play, an orchestra must form. Leadership sets the
tempo, allocating resources and crafting clear goals. The staff becomes the virtuosos,
trained and empowered to perform the green movements with skill and dedication.
Collaboration, acting as the conductor, brings together technology providers, green
champions, and policymakers to harmonize efforts and amplify the impact.
The transition to green labs is not merely a trend; it is a moral imperative. It is aboutsafeguarding the environment while propelling scientific progress forward. It is about leaving
alegacy not just of groundbreaking discoveries, but of a world where scientific advancement
andenvironmental responsibility coexist in harmonious co-existence.
Imagine a global network of green labs, where reduced water consumption could rejuvenate
parched rivers, minimized waste could transform landfills into verdant gardens, and the loweredenergy footprint could dim the ominous glow of climate change. This vision is not a pipe dream,
but a symphony waiting to be played.

65

APFCB News 2024 Issue 1

Industry Voice Section

Leading the Green Revolution: VITROS® Systems and Technologies
Amidst this paradigm shift, exploring alternatives to traditional wet chemistry becomes
imperative. Dry technology, exemplified by VITROS® Systems and VITROS® Technologies,
presents a sustainable solution. These instruments eliminate the need for external water,
treatment plants, plumbing, and drainage, contributing significantly to environmental
sustainability.
One notable advantage of dry chemistry is the dramatic reduction in water consumption.
Laboratories performing 15,000-18,000 tests daily can save an estimated 2500 liters ofwater,aligning with global conservation efforts. This translates into not only cost savings but
also improved operational efficiency. Eliminating water-related maintenance time and costs
enhances overall lab productivity, allowing for more streamlined diagnostic processes.
But the green symphony extends beyond water conservation. Dry chemistry addresses
challenges associated with variable water quality, ensuring more reliable and consistentdiagnostic outcomes. Laboratories embracing dry chemistry report improved accuracy inresults, reducing the margin of error in diagnostic assays. This shift towards greener
practicesis not a dismissal of wet chemistry, but rather a recognition of the strengths eachmethodologybrings to the table.

Balancing the Scales: Financial Considerations
However, in the pursuit of greener labs, acknowledging the additional expenses laboratories
incur in maintaining water quality fit for analysis is crucial. Traditional wet chemistry auto
analyzers necessitate extensive measures such as water softening, reverse osmosis, and deionization. Costs associated with water quality management, including the maintenance oftreatment systems, validation, and quality control tests, and collaborations with water
treatment experts, contribute to the overall financial burden.
As laboratories grapple with these financial challenges, the green lab movement becomeseven more vital. It advocates for a holistic approach where leadership sets the tempo,
allocating resources and crafting clear goals. The staff becomes the virtuosos, trained andempowered toperform the green movements with skill and dedication. Collaboration, acting
as the conductor,brings together technology providers, green champions, and policymakers
to harmonize effortsand amplify the impact.

From Green Labs to a Greener Future
Implementing green labs is not just a trend; it's a moral imperative. It's about safeguarding theenvironment while propelling scientific progress forward. It's about leaving a legacy not only ofgroundbreaking discoveries but of a world where scientific advancement and environmental
responsibility coexist harmoniously.

66

APFCB News 2024 Issue 1

Industry Voice Section

Envisioning a global network of green labs holds immense potential. The reduced water
consumption could rejuvenate parched rivers, minimized waste could transform landfills into
verdant gardens, and the lowered energy footprint could contribute to dimming the ominous
glow of climate change. This vision is not a pipe dream, but a symphony waiting to be played,with laboratories at the forefront of this transformative movement.

A Hopeful Overture in Arid Lands: Dry Chemistry for Water-Scarce Regions
Amidst the global symphony of green labs, a poignant melody takes center stage: theapplication of dry chemistry in regions struggling with water scarcity. For laboratories inparched lands, where every drop is precious, the traditional reliance on wet chemistry poses anuntenable challenge. Here, dry technology rises as a conductor of hope, orchestrating a future
where vital medical testing can thrive despite the constraints of a desert landscape.
Imagine a small clinic nestled in the heart of a sunbaked village. Imagine the despair if a lifesaving blood test cannot be conducted because water, the very essence of life, is simply too
scarce. This is the harsh reality for millions across the globe. But with dry chemistry, this melody
of despair shifts to a hopeful serenade.
Gone are the days of bulky water treatment systems and miles of plumbing snaking througharid landscapes. Dry chemistry instruments, like those offered by VITROS® Technologies,
require no external water. Their tests rely on pre-measured, sealed reagents, eliminating theneed for water purification and disposal. This not only conserves precious resources but also
reduces logistical burdens, making diagnostic testing accessible even in the remotest regions.
The benefits extend beyond water conservation. Dry chemistry offers greater stability and shelf
life for reagents, making them ideal for areas with limited infrastructure and unreliabletransportation. Additionally, their compact size and minimal maintenance requirements makethem perfect for resource-constrained settings.
The melody of hope extends beyond immediate medical benefits. By reducing water
consumption and waste generation, dry chemistry labs contribute to environmental
sustainability in water-scarce regions. This creates a ripple effect, improving public health,promoting economic development, and fostering a sense of environmental stewardship.

Harmonizing the Global Stage: Collaboration and Innovation
The green lab movement transcends national borders, demanding a global orchestra to amplify
its impact. Organizations like My Green Lab champion sustainable practices across continents,
inspiring laboratories worldwide to join the eco-conscious chorus. Countries like Sweden andAustria lead the charge with ambitious policies and innovative initiatives, showcasing diverse
pathways to green lab implementation. Sharing best practices and fostering international
collaboration becomes crucial in amplifying the symphony's impact.

Z67

APFCB News 2024 Issue 1

Industry Voice Section

The Ethical Imperative: Beyond Technology, Responsibility
The green lab movement transcends mere environmental benefits, weaving itself into thetapestry of ethical responsibility. By minimizing their environmental footprint, laboratories
contribute to safeguarding human health, animal welfare, and social justice. Reduced water
consumption benefits communities facing water scarcity, while responsible waste disposal
protects ecosystems and human health. By embracing green practices, laboratories become
stewards of a sustainable future, ensuring long-term prosperity for generations to come.
The Future Beckons: A Tapestry of Possibilities As the green lab movement gains
momentum, the future holds a tapestry of exciting possibilities. Artificial intelligencepromises to revolutionize diagnostics, minimizing waste and energy consumption throughtargeted testing and optimized workflows. Bioprinting could lead to sustainable lab
consumables, replacing plastic with biocompatible materials grown from living cells.
Renewable energy sources like solar and wind power offer laboratories independence fromfossil fuels, further reducing their environmental footprint.
However, challenges remain. Ensuring equitable access to green technologies forlaboratoriesin developing countries requires dedicated efforts and international
collaboration. Addressingpotential job displacement associated with automation demands
proactive reskilling and workforce development programs. The future symphony of greenlabs requires both technological innovation and social responsibility to ensure aharmonious crescendo for all.

From Harmony to Action: The Final Crescendo
The orchestra of green labs stands poised, instruments tuned, ready to play their part in atransformative environmental revolution. Leaders must set the tempo, staff must practicetheirparts with dedication, and collaborative efforts must harmonize to amplify the impact.
The choice is clear: continue the discordant hum of unsustainable practices, or join thesymphony of science and sustainability, composing a future where laboratory advancements
and environmental responsibility resonate in perfect harmony.
As the final notes of the green lab symphony fade, a powerful echo resonates with thepromiseof a future where scientific progress and environmental responsibility dance in perfectharmony. This is not merely a vision, but a call to action for every laboratory across theglobe. By embracing the orchestra of green technologies, nurturing the dedication of thescientific virtuosos, and amplifying the melody of collaboration, we can transform thedisharmony of unsustainable practices into a symphony of hope. Let us begin, then, not withhesitant whispers, but with a resounding crescendo, rewriting the narrative of science withevery green innovation,every drop of water saved, and every laboratory transformed into abeacon of environmental consciousness. Together, we can orchestrate a world wherescientific breakthroughs heal the planet, and the chorus of a sustainable future sings forgenerations to come. Let the green revolution in laboratories begin. Now, it's time to raise
the curtain and play the music.

68

APFCB News 2024 Issue 1

Expert Opinion Paper

Cardiovascular Disease Epidemic in India andTriglyceride-Associated Residual
Atherosclerotic Cardiovascular Disease Risk
Pratishtha Mehra1, Vimal Mehta1, Jamal Yusuf1, Safal1, Pradeep Kumar Dabla2
1Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education andResearch, New Delhi, India
2Department of Biochemistry, G. B. Pant Institute of Postgraduate Medical Education andResearch, New Delhi, India
Corresponding Author:
Dr. Vimal Mehta, Director-Professor, Department of Cardiology
G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER),
New Delhi, INDIA
E-mail ID: drvimalmehta@yahoo.co.in

ABSTRACT
Cardiovascular disease (CVD) is the leading global cause of mortality, with a significant rise inlow- and middle-income countries. India faces a substantial burden of CVD, with alarming
prevalence rates and an increase in associated deaths over the years. Despite a comparable
cardiovascular death rate to Western populations, Indians developed atherosclerotic
cardiovascular disease (ASCVD) a decade earlier. Lifestyle factors, genetic predisposition, andvarious risk factors contribute to this high prevalence. The management of ASCVD risk in India
lifestyle measures, addressing risk factors such as sedentary lifestyle, unhealthy diet, obesity,
metabolic syndrome, smoking, dyslipidemia, prediabetes, diabetes, and hypertension.
Specifically, focusing on lipid management guidelines, low-density lipoprotein cholesterol(LDL-C) lowering is considered a crucial global need for additional interventions.

This expert paper highlights the role of hypertriglyceridemia, its association with ASCVD, andthe importance of managing triglyceride levels. Non-high-density lipoprotein cholesterol (nonHDL-C) and apolipoprotein B (Apo B) are highlighted as valuable indicators for assessing
residual risk beyond LDL-C levels. The Lipid Association of India proposes non-HDL-C as a coprimary target, emphasizing the need for a comprehensive lipid management strategy,
particularly in high-risk populations.

69

Expert Opinion Paper

APFCB News 2024 Issue 1
EPIDEMIOLOGY

Cardiovascular (CV) disease is the leading cause of death in the world causing nearly one-thirdof all deaths. It has reached epidemic proportions in low- and middle-income countries withover three-quarters of total CV deaths occurring in these countries.1 India has one of thehighest burdens of cardiovascular disease (CVD) with coronary heart disease prevalence rates
in India ranging from 2% to 7% in rural populations and from 7% to 13% in urban
populations.2,3CV disease was responsible for 26.6% of total deaths in India in 2017, comparedwith 15.2% in 1990. The Global Burden of Disease (GBD) study group reported a 2.3-foldincrease in the prevalence of both ischemic heart disease (IHD) and stroke in the country
between 1990 and 2016. Also, there was a two-fold increase in the number of prevalent casesof CV disease, from 25.7 million in 1990 to 54.5 million in 2016.4,5
Although the cardiovascular death rate in India is similar to Western populations, alarmingly
Indians develop atherosclerotic cardiovascular disease (ASCVD) about a decade earlier than theWestern populations, despite having lower levels of low-density lipoprotein cholesterol (LDLC).6 It has been reported that more than 50% of coronary artery disease (CAD)-associated deaths
in India occur before the age of 50 years and 25% of myocardial infarctions (MI) occur before
the age of 40 years.7In the INTERHEART study, the median age of MI among Indians was 53.0
years compared to 58.1 years in other countries.8
The high prevalence of CV disease can be attributed to the increased frequency of risk factors
in the Indian population like sedentary lifestyle, unhealthy diet, obesity, metabolic syndrome,smoking,dyslipidemia,

prediabetes,

diabetes,

andhypertension.

Further,

genetic

predisposition, low-grade inflammation, and other known and unknown risk factors contributeto the increased prevalence.
According to International Diabetes Federation Atlas estimates, age-adjusted comparative
prevalence of diabetes in India was 9.6% as of 2021.9The prevalence of hypertension was 25.3%
in the fourth District-Level Household Survey conducted in India from the year 2012-2014, withhypertension being common even among younger age groups (18-25 years).10Dyslipidemia isalso highly prevalent in India with the ICMR–INDIAB study reporting that 79% of Indian subjects
have at least one lipid abnormality. The decreased high-density lipoprotein-cholesterol (HDLC) levels were found in 72.3% of subjects, hypertriglyceridemia in 29.5% and elevated LDL-C
levels were identified in 11.8% of subjects.11

70Expert Opinion Paper

APFCB News 2024 Issue 1

MANAGEMENT OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK
The institution of lifestyle measures is key to decreasing the risk of ASCVD including avoiding
smoking and alcohol, regular exercise, preventing obesity, heart a healthy diet, and optimal
management of hypertension and diabetes. Since the incidence of diabetes is increasing andthe incidence of prediabetes is 2-3 times that of diabetes, patients with prediabetes must be
managed appropriately to circumvent the onset of diabetes and ultimately reduce the risk ofdeveloping ASCVD.

Low-density lipoprotein cholesterol (LDL-C) lowering to reduce CV risk
LDL-C has both a causal and a cumulative effect on the risk of atherosclerotic cardiovasculardisease. In all the major guidelines across the globe for dyslipidemia management, LDL-C isthe primary target for ASCVD risk reduction. The LDL-C goals have been a moving target withthe recent American College of Cardiology (ACC) and European guidelines recommending LDLC goals of <55 mg/dL in very high-risk patients.12,13
The Lipid Association of India was the first organization in the world to recommend the LDL-C
goal of <50 mg/dL in very high-risk patients in the year 2016 considering the increased riskof ASCVD in South Asian individuals. The statin therapy is the first-line therapy for managementof dyslipidemia. The LDL-C levels are lowered by 30% with moderate-intensity statin therapy;
high-intensity statins (HIS) reduce LDL-C by 50%. The combination therapy with HIS + ezetimibe
reduces LDL-C levels by about 65%. The addition of bile acid sequestrants or bempedoic acidresults in an additional LDL-C reduction of 20%.The proprotein convertase subtilisin/kexin type
9 (PCSK9) inhibitors reduce LDL-C by about 55%-60%.14

Residual risk
Multiple randomized trials with statins have shown that statins reduce adverse CV events bothin primary and secondary prevention. However, there is a huge residual risk despite the use ofstatinsasapproximately

75%

of

CV

eventscannotbeprevented

despitestatintherapy.15Although newer non-statin therapies like ezetimibe, bempedoic acid, and PCSK9
inhibitors have been shown to reduce LDL-C levels beyond the 50-60% reduction seen withstatins with additional CV benefit, still there remains a significant residual risk.
Although part of this residual risk may be attributable to many conventional, non-conventional,
and genetic risk factors as listed above, the lipid-associated risk is of extreme importancebecause it is the lipids that accumulate in the arterial wall to initiate atherogenesis. The lipidrelated risk is ascribed to several factors including non-attainment of LDL-C goals,
hypertriglyceridemia, atherogenic dyslipidemia, small, dense LDL particles, remnant cholesterol(cholesterol in triglyceride-rich lipoproteins) and lipoprotein (a).

71

APFCB News 2024 Issue 1

Expert Opinion Paper

Triglycerides and cardiovascular disease
The triglycerides (TG) are transported in the blood by TG-rich lipoproteins. The TG-richlipoproteins are chylomicrons (CMs) (90% TG), very-low-density lipoproteins (VLDL) (70% TG),
intermediate-density lipoproteins (IDL) (30% TG), chylomicron remnants and VLDL remnants(Figure 1). The remnants are derived from CMs secreted from the intestine and VLDL particles
secreted from the liver as TGs are partially degraded by lipoprotein lipase (LPL) in the
bloodstream. TGs are also present in small amounts (<10%) in low-density lipoprotein (LDL)and high-density lipoprotein (HDL) particles.

Figure 1. Triglyceride-rich apo B containing plasma lipoproteins
The normal plasma triglyceride levels are <150 mg/dL with optimal levels being ≤100 mg/dL,levels beyond 150 mg/dL are associated with ASCVD risk. This CV risk is typically present when
triglycerides are moderately elevated (up to 500 mg/dL). The TG elevations ≥500 mg/dL are
more of a concern about the risk of pancreatitis than ASCVD risk. The increased TG levels areoften due to factors like increased fat intake, sedentary lifestyle, obesity, metabolic syndrome,insulin resistance, diabetes (especially uncontrolled), alcohol consumption, etc.; likewise, theyalso show a marked decrease in response to control of the above, making lifestyle interventions
key to management of hypertriglyceridemia.16
Hypertriglyceridemia is a risk factor for atherosclerotic cardiovascular disease either directly or
indirectly. It can be a manifestation of underlying atherogenic risk factors and diseases listed
above or may be directly responsible as cholesterol in triglyceride-rich lipoproteins can get
deposited in the arterial wall. As lipoprotein particles ≤70 nm in size can72

APFCB News 2024 Issue 1

Expert Opinion Paper

enter the arterial wall, VLDL, VLDL remnants, intermediate-density lipoproteins, andchylomicron remnants can infiltrate the arterial wall. Chylomicrons being very large and having
a very short half-life are not atherogenic.
The triglyceride content of triglyceride-rich lipoproteins (TGLPs) gets hydrolyzed by the actionof lipoprotein lipase, an enzyme present on the vascular endothelial surface to provide free fatty
acids to peripheral tissues like muscle, adipose tissue, etc. for energy and storage. The
cholesterol component of TGLPs is directly atherogenic. Moreover, the TG-rich lipoproteins can
indirectly potentiate atherogenesis by potentiating inflammatory response by upregulating proinflammatory cytokine production and promoting thrombin generation. The pooled data fromsecondary prevention trials: the Cholesterol and Recurrent Events trial (CARE) and the Longterm Intervention with Pravastatin in Ischemic Disease study (LIPID) showed that TG levels
remain a CV disease risk factor in patients treated with statins, with patients in the statin arms
having increased event rates if TG levels were high.17 This suggests that control of both LDL-C
and TGs may be important to achieve CV risk reduction. Since TG levels directly correlate withthe remnant cholesterol (cholesterol content of TGLPs) levels, TG levels must be lowered
therapeutically to reduce the CV risk.
Although statins lower TG levels by up to 35% based on baseline TG levels, certain drugs likefibrates, niacin, and omega-3 fatty acids decrease TG levels more significantly. However, earlier
trials with fenofibrate, niacin, and a relatively low dose of omega-3 fatty acids (up to 1 gm/day)
failed to show the significant benefit of these drugs in reducing the primary outcome in large
randomized trials. However, in the REDUCE-IT (Reduction of Cardiovascular Events With
Icosapent Ethyl- Intervention Trial) trial, 8179 high-risk patients (70% secondary prevention)with plasma triglyceride concentrations of 135-499 mg/dL were randomized to treatment with
4 g icosapent ethyl (a purified derivative of eicosapentaenoic acid (EPA)) daily or a mineral oil
control and followed up for a median of 4.9 years. The high dose icosapent ethyl lowered theplasma triglyceride concentration by a median of 19.7% and reduced the risk of ASCVD events
by 25% compared with the placebo, however, the reduction in ASCVD risk was unrelated to thechange in plasma triglycerides.18In The EVAPORATE trial icosapent ethyl 4 gm daily
demonstrated significant regression of low attenuation plaque volume on coronary computed
tomographic angiography compared with placebo over 18 months. 19
Omega-3 carboxylic acid (omega 3 CA) formulation of omega-3 fatty acids (EPA anddocosahexaenoic acid (DHA)) does not require hydrolysis by pancreatic lipase during intestinal
absorption, eliminating the need for consumption with a high-fat meal, resulting in greater
bioavailability compared with standard omega 3 ethyl ester formulations. The administration of
4 gm/day of omega 3 CA produces similar increases in plasma EPA levels as doses of purified
EPA approved for clinical use, and also increases DHA concentrations. In the STRENGTH trial,

73

APFCB News 2024 Issue 1

Expert Opinion Paper

13,078 statin-treated patients with high CV risk, hypertriglyceridemia, and low HDL-C wererandomized to omega-3 CA in a dose of 4 gm per day. The median baseline triglyceride levelwas 240 mg/dL and 70% of participants had diabetes. Triglyceride levels were reduced by 18%
which was similar to REDUCE IT trial. CRP levels significantly decreased with omega-3 CA use
vs. corn oil (–20% vs –6.3%; P <0.001). However, no significant difference in the composite
outcome of major adverse CV events was seen.20
Although both REDUCE-IT and STRENGTH trials randomized subjects with hypertriglyceridemia
with approximately the same baseline triglyceride levels, the STRENGTH trial did not show thebenefit of omega-3 CA. STRENGTH trial used a combination of EPA and DHA, whereas the
REDUCE-IT trial used only purified EPA.21
The EPA and DHA decrease the production of triglyceride-rich VLDL particles from the liver
resulting in a reduction of apoB100-containing VLDL particles and their remnants in thecirculation and increase clearance of chylomicrons from the circulation. An increase in the EPA
to arachidonic acid ratio generates anti-inflammatory mediators such as resolvins and they may
have beneficial effects on endothelial dysfunction, and inflammation seen in the arterial wall. In
the REDUCE-IT trial, there was a drop in the CRP levels with EPA, however, there was nointeraction between baseline CRP and relative risk reduction, which could be expected if it wasa strong anti-inflammatory action that drove the benefit. Therefore, other mechanisms
responsible for the salutary CV benefits of purified EPA need to be explored. Omega-3 fatty
acids are associated with increased bleeding times and reduced thrombogenic potential.
Further, EPA stabilizes cholesterol within cell membranes, in a way that DHA does not becauseof their different physical structures.
In the PROMINENT trial, the treatment with fenofibrate, a selective peroxisome proliferator–
activated receptor α modulator was studied in 10,497 patients with diabetes with triglycerides
levels 200-499 mg/dL and HDL-C <40 mg/dL. Pemafibrate significantly reduced triglycerides
by −26.2%, very low-density lipoprotein (VLDL) cholesterol by −25.8%, remnant cholesterol by−25.6%, and apolipoprotein C-III by −27.6%. Despite this, there was no reduction in the primary
endpoint with pemafibrate compared with placebo at a mean follow-up of 3.4 years likely
because apolipoprotein B levels did not decrease but rather increased by 4.8% in thepemafibrate group.22

Non-high-density lipoprotein cholesterol (non-HDL-C)
Non-high-density lipoprotein cholesterol (non-HDL-C) represents the total cholesterol carriedby apoB-containing lipoprotein particles. It is calculated from the standard lipid profile as nonHDL-C =total cholesterol −HDL-C. Since non-HDL-C measures all the apo B-containing
lipoproteins, it also correlates with the circulating levels of apo B. Although, non-HDL-C and74

APFCB News 2024 Issue 1

Expert Opinion Paper

apo B correlate significantly, yet are only moderately concordant because the cholesterol
content per apo B particle is variable. Non-HDL-C gives an estimate of total atherogeniccholesterol mass, whereas apo B is a better predictor of total atherogenic lipoprotein particles.
Nevertheless, the ability of non-HDL-C compared with apo B to predict ASCVD events continues
to be a point of ongoing discussion.23 Non-HDL-C measurement is more practical due to easeof calculation with no added cost. A meta-analysis of 25 trials including 1,31,134 participantson lipid-lowering therapy inferred that non-HDL-C outperforms apo B for the prediction of
CVD.24

Apolipoprotein B (Apo B)
Each apo B-containing particle has a single apo B molecule, thus the levels of apo B in plasma
are a measure of the number of apo B-containing lipoprotein particles in plasma. The
standardized assays for apo B are available, while some measure only apo B 100, othersmeasure both apo B100 and apo B48. Since apo B48 is present in small quantities even in nonfasting samples, both may be acceptable in routine practice.
In certain circumstances like subjects with elevated triglycerides, diabetes, obesity, or very low
achieved LDL-C levels, the calculated LDL-C level may underestimate both the total
concentration of cholesterol carried by LDL and the total concentration of apo B containing
lipoproteins, thus underestimating the risk of ASCVD. About 20% of patients may havediscordance between measured LDL-C and apo B levels.

Lipid goals to reduce CV risk
LDL-particle numbers, non-HDL-C, and apo B provide a better assessment of on-treatment
residual risk than achieved LDL-C levels. Although statins which lower LDL-C also lower nonHDL-C and apoB, the statin therapy reduces LDL-C to a greater extent than LDL particle
numbers, non-HDL-C, and apo B. While LDL-C lowering remains the primary focus of therapy,
the Lipid Association of India guidelines propose non-HDL-C as a co-primary target (Table1).14Besides LDL-C goals, the treatment goals for both non-HDL-C and apoB should be achieved
especially in patients with diabetes, obesity, metabolic syndrome, and high triglycerides, inwhom measurement of LDL-C levels alone tend to underestimate the risk.

75

APFCB News 2024 Issue 1

Expert Opinion Paper

Whether the relative importance of apoB (particle numbers) and non-HDL-C (cholesterol carriedby apoB lipoproteins) in atherogenesis differs especially over time and during different stagesof plaque development needs further study. Till we have more answers, it is important toachieve LDL-C, non-HDL-C, and apo B goals for optimal reduction of lipid-associated CV risk
(Figure 2).

Figure 2. Algorithm for management of dyslipidemia

76

Expert Opinion Paper

APFCB News 2024 Issue 1
CONCLUSIONSThe higher the baseline LDL-C levels, the higher the CV risk. Patients with ASCVD and multiple
risk factors and comorbidities have a higher risk of future adverse CV events. Hence, they need
to be treated aggressively to achieve LDL-C goals. The risk stratification must be done in eachpatient and the LDL-C goal should be determined. High-intensity statins followed by ezetimibe
and bempedoic acid are the way to go in most patients. Lifestyle measures including smoking
cessation, alcohol restriction, low-fat diet, regular exercise, weight control in appropriate
patients, and adequate control of blood sugar and blood pressure, are important for their
desirable effect on lipid profile and reduction of CV risk. Elevated non-fasting plasma
triglycerides are a marker of elevated remnant cholesterol. Non-high-density lipoproteincholesterol (non-HDL-C) represents the total of cholesterol carried by apo B-containing
lipoprotein particles. Apo B levels reflect the number of all atherogenic particles. Statin therapy
reduces the LDL-C more than apo B by about 15%. On-treatment apo B is a more reliable index
of the residual risk. In patients who have achieved LDL goals, non-HDL and apo B goals may be
pursued to further reduce the CV risk.

References1.

Amini M, Zayeri F, Salehi M. Trend analysis of cardiovascular disease mortality,
incidence, and mortality-to-incidence ratio: results from global burden of disease
study 2017. BMC Public Health 2021;21:401.

2.

Krishnan MN. Coronary heart disease and risk factors in India- on the brink of an
epidemic? Indian Heart J 2012;64(4):364-7.

3.

Huffman MD, Prabhakaran D, Osmond C, et al. Incidence of cardiovascular risk factors
in an Indian urban cohort results from the New Delhi birth cohort. J Am Coll
Cardiol2011;57:1765-74.

4.

The changing patterns of cardiovascular diseases and their risk factors in the states ofIndia: the global burden of disease study 1990–2016. Lancet Glob Health
2018;6:e1339-e1351.

5.

Kalra A, Jose AP, Prabhakaran P. The burgeoning cardiovascular disease epidemic in
Indians- perspectives on contextual factors and potential solutions. Lancet Reg HealthSoutheast Asia 2023:12:100156.

6.

Mehta V, Iyengar SS, Yusuf J, Mukhopadhyay S, Sattur GB, Puri R. Fighting theatherosclerotic cardiovascular disease epidemic: Declaring war on lipids by Lipid
Association of India. J Assoc Physicians India 2020;68(11[Special]):6-7.

7.

Ardeshna DR, Bob-Manuel T, Nanda A, Sharma A, Skelton WP 4th, Skelton M, Khouzam
RN. Asian-Indians: a review of coronary artery disease in this understudied cohort in
the United States. Ann Transl Med 2018;6(1):12.

8.

Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors
associated with myocardial infarction in 52 countries (the INTERHEART study): casecontrol study. Lancet 2004;364:937-52.

9.

IDF

Diabetes

Atlas.

10th

edition,2021.

https://diabetesatlas.org/data/en/country/93/in.html

77

APFCB News 2024 Issue 1

Expert Opinion Paper

10. Geldsetzer P, Manne-Goehler J, Theilmann M, et al. Diabetes and hypertension in India:
a nationally representative study of 1.3 million adults. JAMA Intern Med 2018;178:36372.
11. Joshi SR, Anjana RM, Deepa M, et al. Prevalence of dyslipidemia in urban and rural India:
the ICMR–INDIAB Study. PLoS One 2014;9(5):e96808.
12. Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2022 ACC Expert Consensus Decision
Pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the
management of atherosclerotic cardiovascular disease risk: A report of the American
College of Cardiology solution set oversight committee. J Am Coll Cardiol
2022;80(14):1366-1418.
13. Mach F, Baigent C, Catapano AL, Koskinas KC, et al; ESC Scientific Document Group.
2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to
reduce cardiovascular risk. Eur Heart J 2020;41(1):111-188.
14. Puri R, Mehta V, Duell PB, et al. Proposed low-density lipoprotein cholesterol goals forsecondary prevention and familial hypercholesterolemia in India with focus on PCSK9
inhibitor monoclonal antibodies: Expert consensus statement from Lipid Association ofIndia. J Clin Lipidol 2020;14(2):e1-e13.
15. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study ofcholesterol-lowering with simvastatin in 20,536 high-risk individuals: a randomized
placebo-controlled trial. Lancet 2002;360(9326):7-22.
16. Puri R, Mehta V, Iyengar SS, et al. Triglycerides and atherosclerotic cardiovasculardisease. J Assoc Physicians India. 2020 Nov;68(11[Special]):35-41.
17. Sacks FM, Tonkin AM, Shepherd J, et al. Effect of pravastatin on coronary disease eventsin subgroups defined by coronary risk factors: the Prospective Pravastatin Pooling
Project. Circulation 2000;102(16):1893-900.
18. Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for
hypertriglyceridemia. N Engl J Med 2019;380:11-22.
19. Budoff MJ, Bhatt DL, Kinninger A, et al. Effect of icosapent ethyl on the progression ofcoronary atherosclerosis in patients with elevated triglycerides on statin therapy: final
results of the EVAPORATE trial. Eur Heart J 2020;41(40):3925-32.
20. Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of high-dose omega-3 fatty acids vs corn
oil on major adverse cardiovascular events in patients at high cardiovascular risk: The
STRENGTH randomized clinical trial. JAMA 2020;324(22):2268-80.
21. Oscarsson J, Hurt-Camejo E. Omega-3 fatty acids eicosapentaenoic acid anddocosahexaenoic acid and their mechanisms of action on apolipoprotein B-containing
lipoproteins in humans: a review. Lipids Health Dis 2017;16:149.
22. Das Pradhan A, Glynn RJ, Fruchart JC, et al. Triglyceride lowering with fenofibrate to
reduce cardiovascular risk. N Engl J Med 2022;387:1923-34.
23. Puri R, Mehta V, Iyengar SS, et al. Non-HDL cholesterol and atherosclerotic
cardiovascular disease. J Assoc Physicians India 2020;68(11[Special]):54-58.
24. Robinson JG, Wang S, Jacobson TA. Meta-analysis of comparison of the effectivenessof lowering apolipoprotein B versus low-density lipoprotein cholesterol and non-highdensity lipoprotein cholesterol for cardiovascular risk reduction in randomized trials.
Am J Cardiol2012;110:1468-76.

78

APFCB News 2024 Issue 1

Expert Opinion Paper

Navigating Lp(a) Measurement Challenges:
From Guidelines to Laboratory Perspectives
Dr. Deepak N Parchwani1, Dr. Ragini D. Singh1, Prof Dr (Col) CDS Katoch2
1Department of Biochemistry; All India Institute of Medical Sciences Rajkot, Gujarat, India
2Executive Director; All India Institute of Medical Sciences Rajkot, Gujarat, India

Corresponding Author:
Dr. Deepak N Parchwani
Additional Professor
Department of Biochemistry
All India Institute of Medical Sciences Rajkot, Gujarat, INDIA
E-mail: drdeepakparchwani@yahoo.com

Abstract:
This comprehensive review delves into the evolving landscape of Lp(a) measurement
standardsand examines the discordance and challenges in cardiovascular risk assessmentin the contextof Lp(a). Acknowledging the shifting trends towards universal screening for
Lp(a) endorsed by international societies working on risk assessment, management, andpreventionofcardiovascular diseases, this review highlights the divergence inrecommendations and the lack of consensus on Lp(a) risk thresholds. Ethnic variations in
Lp(a) levels and ongoing clinical trial stargeting Lp(a) underscore the urgency of a unified
and standardized approach to Lp(a) measurement. This article explores the intricacies ofLp(a) isoform size heterogeneity, availablemeasurement approaches, and the reporting unit
challenge for the molecule. Emphasis is placed on collaborative efforts, transparent
calibration, and the pivotal role of laboratories in ensuring the precision and reliability ofLp(a) measurements. The discussion encompasses the call for unified calibration standards,
highlighting the need for continuous external quality assessment and transparent reportingin clinical laboratories until a standardized Lp(a) measurement system is established.

79

Expert Opinion Paper

APFCB News 2024 Issue 1

Harmonizing Lp(a) Measurement Standards: Bridging Guidelines and Clinical Realities
Updated clinical guidelines and consensus statements/recommendations from various
notable international societies working for the prevention, management, and risk
assessment of atherosclerotic cardiovascular diseases (ASCVD) have emphasized thesignificance of evaluating Lp(a) levels in both primary and secondary prevention groups.
The European Atherosclerotic Society (EAS)/ European Society of Cardiology (ESC) (2019)
and Canadian Cardiovascular Society (CCS) (2021) have advocated universal screening for
adults [1]. The landscape of Lp(a) testing has seen a shift towards universal screening,with ongoing debates regarding its benefits and potential implications for cardiovasculardisease (CVD) risk assessment and management. The rationale for this approach is based
upon, the high epidemiology burden of elevated Lp(a) and accumulating “evidencebased” data from randomized control trials linking Lp(a) to ASCVD. Universal screening isbelieved to enhance ASCVD risk assessment. Divergent views on universal screening havebeen reported by the National Lipid Association (NLA) scientific statement. They caution
against testing in the general population because of the lack of currently targeted Lp(a)-lowering therapies. Intriguingly, apart from the discordance related to screening of thegeneral population, the professional societal guidelines also lack a generalized consensus
on Lp(a) risk thresholds [1].
Given the evidence-based role of Lp(a) as a causal independent CVD risk factor [2], theobserved ethnic

variations

in

Lp(a)

levelscombined

with

the

divergenceinrecommendations by international societies for screening the population for Lp(a) levels,
there is an urgent need for a unified approach to Lp(a) measurement standardization andestablishing universally applicable standards for Lp(a) measurement and subsequent
generation of Lp(a) risk thresholdsacross geographies.
With multiple ongoing clinical trials exploring Lp(a)-targeting therapies with a ray of hope[3], defining Lp(a) risk thresholds based on a unified standardized approach for Lp(a)measurementwill be of paramount importance for effective risk and clinical management.
In this direction, the concerted efforts by the International Federation of Clinical
Chemistry (IFCC) and laboratories shall play a crucial role in standardizing andharmonizing Lp(a) measurements,

thereby ensuring consistency acrossdiversepopulations. Addressing Lp(a) measurementissues, transparent calibration, and adopting
reliable methodologies are imperative for an accurate risk assessment. Furthermore,collaborative efforts among laboratories, clinicians, and researchers are essential forestablishing comprehensive guidelines that account for ethnic variations, advancing
precision in Lp(a) risk evaluation, and therapeutic interventions.

80

APFCB News 2024 Issue 1

Expert Opinion Paper

The following discussion aims to provide insights into the challenges, advancements, andCollaborative strategies that can contribute to the harmonization of Lp(a) measurement
standards, enhance clinical interpretation, and facilitate comprehensive insights into itsrole incardiovascular health.

Navigating challenges in Lp(a) measurement
As the landscape of cardiovascular risk assessment evolves, the identification of Lp(a) as a
distinct contributor to cardiovascular health and its incorporation into the risk prediction
framework highlights the critical role of accurate measurements in assessing and guiding
therapeutic interventions, signifying a paradigm shift in the nuanced comprehension andmanagement of CVD risk [2].

Peculiarities of Lp(a) structure: Implications for Isoform Heterogeneity and Challenges
in Measurement"
While navigating the challenges associated with Lp(a) measurement, it was observed that thisenigmatic molecule has inherent structural peculiarities that cause ‘isoform heterogeneity’ andthat leads to a major analytical challenge. Lp(a) has a unique apolipoprotein structure consistingof 11 types of Kringle sequences (Kringle IV type 1 to type 10; Kringle V) and a protease domain.
Kringle IV type 2 shows sequence polymorphism with a variable number of repeated copies(ranging from 3 to >40) [4], which creates diverse apo(a) isoform landscapes and leads tomolecular weights ranging from approximately 250 to 800 kDa [5]. Notably, there is an inverse
relationship between the isoform size of Lp(a) and its plasma concentration. The repetitive
Kringle IV2 (KIV2) structure and the high homology between these repetitive units pose asubstantial hurdle for the precise measurement of the encoded protein. This isoform
heterogeneity introduces ‘measurement bias’ that complicates the precise quantification [6,7]
and this potential ‘measurement bias’ further influences the measurement outcomes.

Precise Quantification of Lp(a): What are the available approaches to measuring
Lp(a)?
We have different analytical assays available to measure Lp(a) concentration in serum: isoformsensitive, isoform-insensitive, and newer assays based on mass spectrometry. The widely
available, commercially utilized, immunoturbidometric or immunonephelometric assays use
antibodies raised in animals that are polyclonal in nature and cross-react with variable epitopesof apo(a). This polyclonality raises concerns about potential “measurement bias” withconsequences.

81

APFCB News 2024 Issue 1

Expert Opinion Paper

The bias manifests as smaller isoforms that are linked to elevated levels being underestimated,
whereas large isoforms with numerous KIV repeats associated with lower levelsare overestimated[8]. Furthermore, this bias affects theassociation between Lp(a) and ASCVD risk [9] and themisclassification of patients with Lp(a) levels close to predefined cut-off points [9].
An alternative approach for Lp(a) measurement available is ELISA, using a monoclonal antibody
directed against the apoB of Lp(a). This assay is insensitive to the apo(a) isoform size
heterogeneity [6]. The limited adoption of this method may be attributed to overlooking the
LDL-unbound-‘free’ apo(a) (approx. 5%) [10,11], with uncertain implications for apo(a)atherogenicity [10].
A newer approach that is well-suited for high-throughput applications, marking a significant
stride in precision and efficiency in Lp(a) analysis, is a mass spectrometry-based approach [12].
Unlike traditional immunochemical assays, this method identified unique peptide fragments of
apo(a) that were absent in the KIV2 domain, mitigating issues of isoform size bias. However,cost concerns currently limit its application in routine clinical practice.

Prevalence of assays reporting Lp(a) values as mass concentration (mg/dl) vs.
particle concentration (nmol/L): The reporting unit challenge
Recently, the discontinuation of the use of mg/dl units for Lp(a) reporting has been
recommended [13], and it has been observed that the measurement of Lp(a) in particle
concentration units (nmol/L) is being increasingly adopted. Numerous high-throughput
platforms employing methods such as immunoturbidimetry or immunonephelometry now
report Lp(a) measurements in nmol/L.
The primary question here is why we need Lp(a) concentration to be reported as nmol/L, andsecondly, can mg/dl be converted to nmol/l and vice versa for Lp(a)?
Expressing Lp(a) as a mass concentration (mg/dL) introduces inherent bias because a given
mass represents fewer particles for large isoforms and more particles for small isoforms.
Furthermore, because Lp(a) isoforms have different molecular weights, direct conversion is notpossible, unlike that of other lipids and lipoproteins [9]. Furthermore, commercial assays thatincorporate five isoform sizes as calibrators are standardized against the WHO/IFCC referencematerial, which is reported in nmol/L units to effectively minimize isoform size bias [7].

82APFCB News 2024 Issue 1

Expert Opinion Paper

From a technical standpoint, most assays in clinical practice utilize polyclonal antibodies
against Lp(a) and are inherently isoform-sensitive [7,14,15]. However, some assay
manufacturers have claimed that their assays demonstrate isoform insensitivity by making
direct comparisons with isoform-insensitive assays [12]. This approach is good, but its
limitations include inadequate representation of certain apo(a) isoform groups (smallerones) owing to the limited sample pool. Additionally, some assay manufacturers areclaiming a conversion factor between 2.0 and 2.5 from mg/dl to nmol/l without providing
reasons behind [16]. This conversion with a fixed factor of 2.5 leads to overestimation forlarger isoforms and underestimation for smaller isoforms. Furthermore, some assay
manufacturers offer both mass and molar assays for Lp(a), despite using similar types ofpolyclonal antibodies, the same calibrator, and the same measurement system. Given the
structural heterogeneity of Lp(a), thisis highly unlikely.

EnhancingLp(a)Measurement

Accuracy:

Multipoint

Calibrators,

Transparencyin Calibration, and Certification Processes
Overcoming the above-mentioned challenges is pivotal for refining Lp(a) measurement
methodologies and ensuring alignment with their true physiological significance.
Researchers and laboratories are actively pursuing strategies to address this complexity,
ultimately helpingto enhance the reliability and clinical relevance of Lp(a) measurements
in cardiovascular health assessments.
To optimally minimize the major obstacle for Lp(a) measurement i.e., isoform size bias, theuseof multipoint calibrators (5- 5-point calibrator) is suggested. The multipoint calibrator
should cover the measured concentration range and each calibrator should be independentand containa suitable distribution of apo(a) isoforms traceable to the WHO/IFCC referencematerial [7]. Additionally, the assay manufacturers must transparently disclose crucial
information regardingthe apo(a) isoform size associated with each calibration and specify
that the multipoint calibrator is a dilution of a single calibrator or consists of various
calibrators with different apo(a) isoform sizes. A clear and comprehensive disclosure ofthese aspects will ensure the integrity and reliability of the Lp(a) measurements acrossdiverse calibration points [16]. Furthermore, the Northwest Lipid Metabolism and Diabetes
Research Laboratory (NLMDRL) at the University of Washington, Seattle, offers acertification process for assessing the performance of various assays. This involved
comparing the Lp(a) values obtained through the certification process with those derived
from the monoclonal antibody-based ELISA method [7].

83APFCB News 2024 Issue 1

Expert Opinion Paper

Laboratory Perspectives on Lp(a): Investigating the Enigma and Advancing
Clinical Understanding
Given the role of Lp(a) as an independent causal risk factor for CVD, Lp (a) measurements
needto be standardized. This involves addressing the technical challenges, implementing
unified calibration standards, and ensuring continuous External Quality Assessment
Schemes (EQAS). Concerted efforts by laboratories and researchers should aim to enhancemeasurement accuracy, resolve technical intricacies, and promote uniform reporting
practices. Such initiativeswill strengthen the reliability of Lp(a) assessments, offering afoundation for precise clinical interpretation and facilitating comprehensive insights into
their role in cardiovascular health.

Call for Unified Calibration Standards
The demand for Lp(a) measurement is expected to surge, particularly if ongoing trials ofLp(a)-lowering drugs yield positive results. High-throughput methods, often based on
immunoturbidimetric and immunonephelometric techniques, are essential to meet thisdemand. A recent study compared the performance of six widely utilized commerciallyavailable assays that use five-point calibrators provided by manufacturers on a sample sizeof 144 serumsamples to an assay that claims to be isoform-insensitive (Denka Reagents).
The overall bias between the assays ranged from -5 to +15 mg/dl. This suggests that all
assay manufacturers should use a particular set of calibrators [17].
Furthermore, along with other scientific contributors [12], the IFCC Working Group forStandardization of Apo lipoproteins by Mass Spectrometry [18] is diligently involved incrafting advanced reference materials using contemporary methodologies. These materials
are universally available and can serve as calibration standards for assay manufacturers.
Leveragingthe inherent robustness of mass spectrometry technology facilitates the precise
and reproducible quantification of proteins at the molecular level. This positions mass
spectrometry as the benchmark reference method for clinical assay comparisons,particularly in molar units. The anticipated accessibility of these newly calibrated referencematerials will present an opportunity for assay manufacturers to enhance the calibration
precision of their methods.

84

APFCB News 2024 Issue 1

Expert Opinion Paper

The Crucial Role of Continuous External Quality Assessment in Lp(a)measurement
Clinical laboratories must systematically undergo external quality assessment to promptly
identify and address disruptions introduced throughout the chain, from assay production
to clinical application.

This ongoing evaluation is indispensable for upholding the integrity and reliability oflaboratory processes, facilitating the early detection and effective mitigation of potential
disturbances. Continuous participation in external quality assessment programs serves asa robust mechanism to ensure the precision and consistency of laboratory procedures,thus
contributing significantly to the overall reliability of clinical practice. External quality
assurance programs should distribute samples with known apo(a) isoform compositionsand Lp(a) values assigned by a validated method independent of apo(a) size polymorphism
and withcalibration traceable to the WHO/IFCC SRM-2B reference material [7].
Furthermore, external quality assurance samples should encompass a clinically relevant
range, particularly within the management threshold range of 90-200 nmol/L. This
comprehensive approach ensures thorough assessment and validation of laboratory
performance across key parameters [7,16].

Transparent Reporting in Clinical Laboratories
Until a unified standardized system for Lp(a) measurements has been generated, clinicallaboratories must transparently report not only the measured Lp(a) concentration but also
specify the assay and calibrators employed. This is crucial for accurate clinical interpretation,
particularly for serial measurements conducted across different laboratories in some cases.
The laboratory must indicate the reported unit, as confusion often arises from unit
discrepancies, impacting daily clinical counseling. This straightforward disclosure ensuresconsistency, eliminates ambiguity, and enhances the reliability of the Lp(a) concentration
data in clinical settings [16].

85Expert Opinion Paper

APFCB News 2024 Issue 1

Conclusion
The complex landscape of Lp(a) measurement requires a concerted effort to standardize
andharmonizepracticesforpreciseclinicalinterpretation.

The

divergenceinrecommendations from international societies underscores the critical need for a unified
approach to Lp(a) measurement standardization. As clinical guidelines advocate universal
screening and ongoing trials exploring Lp(a)-targeting therapies, establishing universally
applicable standards and defining risk thresholds are paramount.
Laboratories play a pivotal role in this endeavor by addressing challenges, such as isoform
heterogeneity and reporting units. Multipoint calibrators, transparent calibration, andcertification processes are crucial for accurate quantifications. Collaboration amonglaboratories, clinicians, and researchers is essential for comprehensive guidelines thatconsider ethnic variations and advance precision in Lp(a) risk evaluation. Continuous
external quality assessment further ensured the reliability of laboratory procedures.
As we navigate the complexities of Lp(a) measurement, transparent reporting practices havebecome a temporary solution, enhancing consistency across diverse laboratories. Until aunifiedstandard is established, these initiatives collectively contribute to bridging guidelines
with clinical realities, ultimately advancing our understanding of Lp(a) in cardiovascular
health.

References
1.

Alebna P L, Mehta A. An Update on Lipoprotein(a): The Latest on Testing, Treatment, andGuideline Recommendations. Expert Analysis, Sep 19, 2023

2.

Virani SS, Koschinsky ML, Maher L, et al. Global think tank on the clinical considerationsand
management of lipoprotein(a): The top questions and answers regarding what clinicians needto know. Prog Cardiovasc Dis. 2022;73:32-40. doi:10.1016/j.pcad.2022.01.002

3.

Wei, Trent; Cho, Leslie. Recent lipoprotein(a) trials. Current Opinion in Lipidology 33(6):p301-308, December 2022. | DOI: 10.1097/MOL.0000000000000856

4.

Kronenberg F, Utermann G. Lipoprotein(a): resurrected by genetics. J Intern Med
2013;273(1):6-30. https://doi.org/10.1111/j.1365-2796.2012.02592.x.

86Expert Opinion Paper

APFCB News 2024 Issue 1
5.

Utermann G, Menzel HJ, Kraft HG, Duba HC, Kemmler HG, Seitz C. Lp(a) glycoprotein
phenotypes. Inheritance and relation to Lp(a)-lipoprotein concentrations in plasma. J Clin
Invest. 1987;80(2):458-465. doi:10.1172/JCI113093

6.

Marcovina SM, Albers JJ, Gabel B, Koschinsky ML, Gaur VP. Effect of the number ofapolipoprotein(a) kringle 4 domains on immunochemical measurements of lipoprotein(a).
Clin Chem. 1995;41(2):246-255.

7.

Cegla J, France M, Marcovina SM, Neely RDG. Lp(a): When and how to measure it. Ann Clin
Biochem. 2021;58(1):16-21. doi:10.1177/0004563220968473

8.

Kronenberg F, Tsimikas S. The challenges of measuring Lp(a): A fight against Hydra?.
Atherosclerosis. 2019;289:181-183. doi:10.1016/j.atherosclerosis.2019.08.019

9.

Wilson DP, Jacobson TA, Jones PH, et al. Use of Lipoprotein(a) in clinical practice: A biomarker
whose time has come. A scientific statement from the National Lipid Association [publishedcorrection appears in J Clin Lipidol. 2022 Sep-Oct;16(5):e77- e95]. J Clin Lipidol.
2019;13(3):374-392. doi:10.1016/j.jacl.2019.04.010

10. Mooser V, Marcovina SM, White AL, Hobbs HH. Kringle-containing fragments ofapolipoprotein(a) circulate in human plasma and are excreted into the urine. J Clin Invest.
1996;98(10):2414-2424. doi:10.1172/JCI119055.
11. Kostner KM, Maurer G, Huber K, et al. Urinary excretion of apo(a) fragments. Role in apo(a)catabolism.

Arterioscler

Thromb

Vasc

Biol.

1996;16(8):905-911.

doi:10.1161/01.atv.16.8.905
12. Marcovina SM, Clouet-Foraison N, Koschinsky ML, et al. Development of an LC-MS/ MS
proposed candidate reference method for the standardization of analytical methods to measure
lipoprotein(a). Clin Chem 2021;67(3):490-499. https://doi. org/10.1093/clinchem/hvaa324
13. Benn

M,

Nordestgaard

BG.

From

genome-wide

association

studiestoMendelianrandomization: novel opportunities for understanding cardiovascular disease causality,
pathogenesis,

prevention,

doi:10.1093/cvr/cvy045

87

and

treatment.

CardiovascRes.

2018;114(9):1192-1208.

APFCB News 2024 Issue 1

Expert Opinion Paper

14. Marcovina SM, Albers JJ. Lipoprotein (a) measurements for clinical application. J Lipid Res.
2016;57(4):526-537. doi:10.1194/jlr.R061648
15. Tsimikas S, Fazio S, Viney NJ, Xia S, Witztum JL, Marcovina SM. Relationship of lipoprotein(a)molar concentrations and mass according to lipoprotein(a) thresholds and apolipoprotein(a)isoform size. J Clin Lipidol. 2018;12(5):1313-1323. doi:10.1016/j.jacl.2018.07.003
16. Kronenberg F. Lipoprotein(a) measurement issues: Are we making a mountain out of amolehill? Atherosclerosis. 2022;349:123-135. doi:10.1016/j.atherosclerosis.2022.04.008
17. Scharnagl H, Stojakovic T, Dieplinger B, et al. Comparison of lipoprotein (a) serum
concentrations measured by six commercially available immunoassays. Atherosclerosis.
2019;289:206-213. doi:10.1016/j.atherosclerosis.2019.08.015
18. Cobbaert CM, Althaus H, Begcevic Brkovic I, et al. Towards an SI-Traceable Reference
Measurement System for Seven Serum Apolipoproteins Using Bottom-Up Quantitative
Proteomics: Conceptual Approach Enabled by Cross-Disciplinary/Cross-Sector Collaboration.
Clin Chem. 2021;67(3):478-489. doi:10.1093/clinchem/hvaa239

88

APFCB News 2024 Issue 1

Expert Opinion Paper

Understanding and Addressing Healthcare
Workforce Shortages
Damien Gruson1,2,3
1Departmentof Laboratory Medicine, Cliniques Universities’ St-Luc and Université

Catholique deLouvain, Brussels, Belgium.
2Pôle

de recherche en Endocrinologie, Diabète et Nutrition, Institute de Recherche

Experimental et Clinique, Cliniques Universities’ St-Luc and Université Catholique deLouvain, Brussels,Belgium.
3IFCC Division on Emerging Technologies

Email: Damien.gruson@saintluc.uclouvain.be
Like many laboratory and health managers, I am concerned about the shortage affecting
our health forces and I therefore wanted to write this short article to guide reflection on thissubject.
Health systems worldwide rely fundamentally on the presence and performance of healthworkers. They are the pillars upon which the structure of health services is built, and theiravailability, accessibility, acceptability, and quality directly influence the attainment of thehighest standards of healthcare. However, a looming crisis threatens this foundational
aspect of healthcare systems: a shortage of healthcare workers.
Projections from the World Health Organization (WHO) indicate an estimated deficit of 10
million health workers by 2030, predominantly affecting low- and lower-middle-income
nations. But this scarcity is not confined to specific economic tiers; it extends across various
nations, each grappling with distinct challenges in the education, employment, deployment,
retention, and efficacy of their healthcare workforce.
The genesis of this enduring scarcity can be traced to chronic underinvestment in healthworker education and training, resulting in a mismatch between educational strategies andpopulation needs. Moreover, the intricate issue is compounded by the inability to deploy
healthcare workersto rural, personnel might seem like a straightforward solution. However,healthcare, being a complex system, demands a nuanced approach.

APFCB News 2024 Issue 1

Expert Opinion Paper

healthcare workforce shortages, it's imperative to pivot from a problem-centered approach
The COVID-19 pandemic has underscored the significance of robust human resources
towards a solution-oriented perspective that accounts for multifaceted dimensions.
management in healthcare. Nevertheless, the predominant focus remains fixated on the
The dilemma of healthcare workforce scarcity is not limited to its impact on the healthshortageitself, potentially hindering a comprehensive solution. To effectively address
system alone; it also intertwines with societal disparities. A myopic focus on managing
workforce shortages might inadvertently exacerbate inequalities and create further
challenges for certain segments of society.
Furthermore, as healthcare organizations strive for enhanced efficiency and effectiveness,they often overlook the needs and well-being of healthcare professionals. Issues such as
burnout, stress, and work-life balance are frequently sidelined, potentially impeding longterm workforceplanning and management.
The solution demands a holistic approach. Prioritizing quality primary care and ensuring
equitable access to healthcare should be central to workforce policies. It necessitates areevaluation of working conditions, rights, opportunities for advancement, and the creationof asustainable equilibrium between personal and professional life for healthcare workers.
Despite the recognition of these priorities in global policies, the execution of interventions
still lacks the promise of substantial and enduring change. The persistent question
prevails: Are we attempting to solve these problems with the same mindset that
contributed to their creation?
We might have several options to prevent the shortage of such precious resources and thefollowing figure highlights five of them:

89

90

APFCB News 2024 Issue 1

Expert Opinion Paper

In conclusion, the shortage of healthcare workers in laboratory medicine necessitates aparadigmshift in approach—one that transcends mere problem identification and delves
into comprehensive, sustainable solutions that prioritize the needs of both citizens andhealthcare professionals. Only by reshaping perspectives, policies, and practices canhealthcare systems globally navigate this pressing challenge and secure a robust, resilient
workforce for the future.

References1.

https://www.who.int/health-topics/health-workforce#tab=tab_1

2.

https://www.myadlm.org/cln/articles/2023/june/laboratory-organizations-urgecongress-to-address-workforce-shortages

3.

Džakula A, Relić D. Health workforce shortage - doing the right things or doing things right?
Croat Med J. 2022 Apr 30;63(2):107-109. doi: 10.3325/cmj.2022.63.107. PMID: 35505643;
PMCID: PMC9086817.

4.

Kagonya VA, Onyango OO, Maina M, Gathara D, English M, Imam A. Characterising support
and care assistants in formal hospital settings: a scoping review. Hum Resour Health. 2023
Nov

27;21(1):90.

doi:

10.1186/s12960-023-00877-7.

PMID:

38012737;

PMCID:

PMC10680191.
5.

https://www.ft.com/partnercontent/j-and-j/what-is-the-cure-for-the-globalhealthcare-worker-shortage.html

6.

https://www.pwc.com/gx/en/issues/c-suite-insights/the-leadership-agenda/talentrequired-for-healthcare-shortages.html

91

APFCB News 2024 Issue 1

Special Report

APFCB - APAC CVD Alliance(Asia-Pacific Cardiovascular Disease Alliance)
CVD is the leading cause of death in the Asia-Pacific, with the largest increase in premature
deaths occurring in East Asia, South Asia, and Southeast Asia over the last 20 years. In 2019
alone, over 10 million people died of heart disease in Asia, making up 35% of all deaths intheregion.
The APAC CVD Alliance is a multisectoral, multistakeholder coalition dedicated to improving
heart health for patients, societies, and economies by elevating public and policy awarenessabout CVD at regional and domestic forums in Asia.

Objectives:

Patients, allied health professionals, academia, corporate partners, and a global healththink-tank launch the Asia-Pacific Cardiovascular Disease Alliance (APAC CVDAlliance) tobattle CVD across Asian health systems.



The APAC CVD Alliance will engage policymakers, patients, professionals, academia,nonprofits, and implementation partners to champion increased attention and innovations for
CVD.



The Alliance is keen to work with more patients in Asia – reach out at apaccvd.org/partnerwith-us
The APAC CVD Alliance aims to: increase public and policy awareness of the importance of
tackling CVD at regional and domestic forums in Asia; encourage the implementation ofscalable and sustainable CVD innovations across all health systems, and emphasize thatfighting CVD is a much-needed investment for healthy societies and productive economies.

The four strategic partners are,


the Asia-Pacific Federation for Clinical Biochemistry and Laboratory Medicine (APFCB),

Global Alliance for Patient Access (GAfPA),

Global Heart Hub (GHH),



Universiti Teknologi MARA (UiTM) Faculty of Medicine – and corporate partners Amgen,
Novartis, and Roche Diagnostics

92

APFCB News 2024 Issue 1

Special Report

Dr Tony Badrick, President, APFCB said “Accurate and rapid diagnoses for people with CVD
is fundamental to all health systems. As the largest clinical biochemistry and laboratoryfederation in Asia, we have seen that investing in capacity building and education oflaboratory professionals is essential for the early detection and treatment of CVD and othernon- communicable diseases. The APAC CVD Alliance’s mandate to elevate policy
awareness dovetails with the APFCB’s goal of encouraging continual improvements tolaboratory practicesin the region.”

ACCESS Health International (Asia) President Dr Krishna Reddy said, “TheAllianceaims to harness the existing good work in tackling CVD in the Asia-Pacific. ACCESS
Health is proud to be the secretariat for this regional initiative and we look forward to
improving investment in CVD innovations in policies, care models, products, or services
across all health systems.” Based in Singapore as its regional hub for Southeast Asia, global
health think-tank ACCESS Health International is the secretariat for the APAC CVD Alliance.

Timothy Fang, APAC CVD Alliance Program Lead at ACCESS Health International
Source: apac.cvd.org/partner-with-us
Contact: timothy.fang@accessh.org
Report compiled by:Prof. Pradeep K. Dabla
Chair APFCB C-Communication & Publication

93

APFCB Auspices

APFCB News 2024 Issue 1

APFCB Auspices Events Calendar Activity 2023

Dr. Woei-horng Fang, PhD
Chair, APFCB C-CC
APFCB Auspices
One of the functions of the APFCB C-CC is the award of auspices of the APFCB for various
scientific events like conferences, congresses, and events organized by regional society
members and corporate members. The provision of auspices is mutually beneficial: the
APFCBlends its prestige to a meeting which should help it attract greater participation andin return the APFCB benefits from greater name recognition among the participating
laboratory scientists. All applications for APFCB auspices are evaluated by the C-CC andtreated on a case-by-case basis in an efficient and timely manner. The C-CC is careful toaward auspices only toscientific meetings that are organized by learned bodies and vendors
such as APFCB corporatemembers where the content is of scientific and educational value.
In 2023, the committee members evaluated and granted APFCB auspices to the following
scientific events.
Conferences and Events:

Dates

Organizer

City andCountry

1

IFCC Visiting Lecture23-25 Mar

Jakarta,Indonesian Association

2023 : Prof. Khosrow

2023

Indonesia

for Clinical Chemistry

1 Apr 2023

Indore, India

Snibe Co., Ltd.

19 Apr 2023

Hong Kong

Snibe

Adeli (IFCC President)
2

Snibe Academic
Conference on
Immunology

3

Maglumi X Series: The
Global IVD Pioneer

Co.,
Ltd.

4

New Progress in Researchand Application of

22 Apr 2023

Shenzhen,

Snibe Co., Ltd.

China

International Laboratory
Medicine

94

APFCB Auspices

APFCB News 2024 Issue 1
5

14th International & 20th

16-19 May

National Congress on2023

Tehran, Iran

Iranian Association
ClinicalQuality Improvement inofLaboratory

Doctors

Clinical Laboratories
6

24 Jun 2023

Delhi, India

Snibe Co., Ltd.

9 Jul 2023

Dubai

Snibe Co., Ltd.

Annual Academic sessions

14-15 Jul

Kandy, Sri

College of Chemical

CCPSL 2023

2023

Lanka

Pathologists of Sri

Snibe Academic
Conference on
Immunoassay

7

International Conference
on Immunology

8

Lanka
9

10

International Symposium

26-27Aug

Shenzhen,

Snibe Co., Ltd.

on Laboratory Medicine

2023

China

49th Annual Conference

14-16 Sep

Thiruvalla,

Association of Clinicalof Association of Clinical

2023

Kerala, India

Biochemists of India

16 Sep 2023

Negombo, SriSnibe Co., Ltd.

Biochemists of India
11International Symposiumon Laboratory Medicine

12

Re-imagining Mass

Lanka
5 Oct 2023

Spectrometry – A

Yokohama,

Roche Diagnostics Asia

Japan

Pacific

Shenzhen,

Snibe Co., Ltd.

Convergence of ideation,
innovation andintegration
13

International Symposium

29 Oct 2023

on Laboratory Medicine
14

15

China

Roche Experience Days

8-9 Nov

Seoul, South

Roche Diagnostics Asia

(RED) 2023 with virtual

2023

Korea

Pacific

International Symposium

25 Nov 2023

Kathmandu,

Snibe Co., Ltd.

on Immunoassay
16

International Symposium

Nepal
9 Dec 2023

on Immunoassay
17

95

AMBICON 2023

Colombo, SriSnibe Co., Ltd.

Lanka
13-16 Dec

Navi Mumbai,

Association of Medical

2023

India

Biochemists of India

APFCB News 2024 Issue 1

Clinical Case

CASE-1: Ni Kadek Mulyantari, Tania
Wangunhardjo, I Made Mahayasa, Ngakan
Putu Daksa Ganapati
Faculty of Medicine, Udayana University / Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar
Bali-Indonesia

E-mail: kadek_mulyantari@unud.ac.id

Case History
The patient is a 51-year-old woman diagnosed with Wound dehiscence following a colontransverse colostomy and Adenocarcinoma of the Rectosigmoid. The Clinical Chemistry
resultswere:AnalyteResults

Biological Reference interval

Creatinine

0.62 mg/dL

0. 57-1.1

Bun

9.2 mg/dL

6.0-23.0

e-GFR

104.4

>90

AST

28 U/L

11.0-27.0

ALT

22 U/L

11.0-34.0

Albumin2.60 g/dL

3.40-4.80

Blood glucose

120 mg/dL

70-140Sodium

132 mmol/L

136-145

Potassium

3.71 mmol/L

3.50-5.10

Chloride

94.8 mmol/L

96-108

Questions:
1.

What is the indication to check the analyte?

2.

What is the interpretation of the clinical chemistry result?

3.

Are there any other tests you might suggest to the patient?

96

APFCB News 2024 Issue 1

Clinical Case

Discussion
Question 1
The patient suffers from colorectal cancer and received chemotherapy drugs. Thoughchemotherapy is an effective way to treat cancer, it also carries a risk of side effects. The
purpose of clinical chemistry tests in this patient is to predict the presence of side effects ofchemotherapy and tumor metastases.
The patient plans to continue Folfox VI chemotherapy 3 series and radiotherapy. Other
indications of laboratory examination in this patient are routine pre-chemotherapy blood tests
and routine pre-operation procedures. The patient also plans to do wound debridement on thecolostomy site. Routine pre-chemotherapy blood tests can be undertaken within 2–3 days oftreatment.

Question 2
The interpretation of clinical chemistry results were normal liver function test, normal kidney
function test, and normal electrolyte parameters. The patient suffers from hypoalbuminemia.
Hypoalbuminemia in this patient can be caused by a hypermetabolism state and decreased
nutritional intake.

Question 3
Complete blood count is one of the most important tests before and after chemotherapy.
Chemotherapy-induced alterations in complete blood count may cause many significant
problems in clinical practice. Anemia, neutropenia, and thrombocytopenia induced bychemotherapy regimens may cause life-threatening complications such as severe infections
and hemorrhagic complications. Moreover, these side effects may also necessitate dose
reduction and/or delay in schedules of chemotherapy treatment.

References
1.

Chambers P, Weil L, Forster MD, Kipps E, Wong ICK, Jani Y. Evidence to guide the optimal
timing for pre-chemotherapy blood tests for early breast, colorectal cancer and diffuse
large B-cell lymphoma. Cancer Medicine. 2021;10:7996–8004.

2.

Sökmen FC, Kasapoğlu B, Yozgat A, Engin H. Assessment of Hematological Parameters
Before and After Adjuvant Chemotherapy in Patıents with Colorectal Cancer. 2019;52(3):405-409.

97

APFCB News 2024 Issue 1

Clinical Case

CASE-2: Dr. Sumita Sharma, Dr. Kapil Sharma,
Dr. Onjal K. Taywade, Dr Manish Kumarand
Dr. Anurag Sankhyan
1Departmentof Biochemistry, All India Institute of Medical Sciences, Bilaspur, Himachal

Pradesh,India
2Department of General Medicine, All India Institute of Medical Sciences, Bilaspur, Himachal

Pradesh, India

Email:drsumita17@gmail.com

Case History
An 18-year-old female presented to General Medicine OPD for evaluation of jaundice. The
patient had a history of intermittent jaundice for the last one year. At the time ofpresentation,there was no history of fever, anorexia, weight loss, dark urine, clay-coloured
stool, pruritus, pain abdomen, abdominal distension or pedal swelling. She did not have ahistory of any chronicdisease or blood transfusion and her family history was not significant
for any chronic disease.On physical examination, mild pallor and mild icterus were noticed.
There was neither any lymphadenopathy nor hepatosplenomegaly. Cardiovascular andcentral nervous system examination was normal.
The results of the investigations conducted are summarized in Table 1.

Investigation

ResultReference Interval

Haemoglobin

11.5

12.0-15.0 g/dl

Total Leucocyte Count

7,210

4,000-10,000/l

3,76,000

1,50,0004,00,000/l

Red blood cell count

5.5

4.5-5.5 million/l

Packed cell volume

37

38-48 %

Mean cell volume

68

83-101 fl

Mean cell haemoglobin

2127-32 pg

Mean corpuscular haemoglobin

3130-35 g/dl

concentration
Red cell distribution width

20.3

10.0-16.0 %Reticulocyte count

2.6

1.0-2.7 %Total Bilirubin

4.7

0.3-1.2 mg/dL

Direct Bilirubin

0.1

0.0-0.3 mg/dL

Indirect Bilirubin

4.6

0.3-0.9 mg/dL

Aspartate transaminase15

0-35 U/L

Alanine transaminase

140-45 U/L

Platelet count98Clinical Case

APFCB News 2024 Issue 1
Alkaline phosphatase73

45-117 U/LTotal protein

6.8

6.0-8.0 g/dL

Albumin

4.9

3.2-4.5 g/dL

Globulin

1.9

2.5-3.5 g/dL

Albumin/Globulin ratio

2.6

1.5-2.5

Lactate dehydrogenase154<247 U/L

Iron

89

60-180 g/dL

Total iron binding
capacity282

244-450 g/dL

Ferritin38

10-291ng/ml

Transferrin saturation

32

12.8-36.4 %HBsAg

Non-reactive--

Anti-HCV

Non-reactive--

HAV-IgM Ab

Non-reactive--

Anti-HEV-IgM

Non-reactive--

G6PD screening

Normal--4436-195 mg/dl

Negative--

Haptoglobin
Direct Coombs’ test
Peripheral blood smear

Predominantly

microcytic

examination

hypochromic RBCs,anisocytosis,--

poikilocytosis, few pencil
cells and target cells werenoted

The laboratory investigations of this patient showed that the patient had mild microcytic
hypochromic anaemia. However, since the iron studies were found to be normal, the physician
decided to order an Hb HPLC study. The biochemist discussed the Hb HPLC findings (Figure
1)with the treating physician and screening of both parents was considered for confirmationof the findings. The patient’s father turned out to be a carrier of thalassaemia and the motherof Hb D-Punjab.Assessment of liver function showed mild unconjugated hyperbilirubinaemia
withnormal serum proteins and liver enzymes. The workup for haemolysis was negative. Thus,a genetic analysis of the UGT1A1 polymorphism was conducted, revealing the patient's
UGT1A1*28/*28 genotype, which is linked to a significant decrease in UGT enzyme activity.

Questions
1.

What are the abnormal findings in Hb HPLC results in this patient?

2.

What is the cause of hyperbilirubinemia in this patient?

3.

What guidance ought to be provided to this patient?

Discussion
Question 1
Hb HPLC study revealed the presence of HbD, high HbF and normal HbA2 in thispatient. HPLC findings are suggestive of compound heterozygous HbD-Punjab andbeta thalassemia trait with a false normal HbA2. The screening of parents forthalassemia substantiates these findings.

99

APFCB News 2024 Issue 1

Clinical Case

Question 2
The absence of evident hemolysis and underlying hepatic pathology indicates the possible
presence of Gilbert syndrome. Genetic assessment of the UGT1A1 polymorphism confirms
thatthe patient has the UGT1A1*28/*28 genotype that is associated with severely reduced
UGT enzyme activity. This genetic profile strongly suggests that the primary factor
contributing to unconjugated hyperbilirubinemia is most likely the reduced conjugation ofbilirubin resulting from diminished activity of the UGT enzyme in this patient. Notably, ahomozygous HbD state typically only results in sub-clinical jaundice, making Gilbert
syndrome a major contributor to the observed hyperbilirubinemia.

Question 3
The patient needs to be counseled and reassured regarding the benign course of thedisease. She should be sensitized about various precipitating factors like fever, physicalexertion, prolonged fasting, etc. that may increase her bilirubin levels. The patient should
receive guidance to refrain from undergoing unnecessary laboratory investigations to avoid
thepotential discomfort or inconvenience associated with repeated blood draws.

References
1. Torres L de S, Okumura JV, Silva DGH da, Bonini-Domingos CR. Hemoglobin D-Punjab:
Origin, distribution and laboratory diagnosis. Rev Bras HematolHemoter.
2015;37(2):120–6.
2. Basmanj MT, Karimipoor M, Amirian A, Jafarinejad M, Katouzian L, Valaei A, et al.
Co-inheritance of hemoglobin D and β-thalassemia traits in three Iranian families:
Clinical relevance. Arch Iran Med. 2011;14(1):61–3.
3. Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010;5(1):1–15.
4. Vítek L, Tiribelli C. Gilbert´s syndrome revisited. J Hepatol. 2023;79(4):1049–55.
5. Petrenko AA, Pivnik A V, Kim PP, Demidova EY, Surin VL, Abdullaev AO, et al.
Coinheritanceof HbD-Punjab/β+-thalassemia (IVSI+5 G-C) in a patient with Gilbert’s
syndrome. Ter Arkh. 2018;90(7):105–9.

100

APFCB News 2024 Issue 1

101

Clinical CaseClinical Case

APFCB News 2024 Issue 1

CASE-3: Dr. Hani Ajrina Zulkeflee, Dr Wan Nur
Aimi Wan Mohd Zamri, Dr Siti Nadirah Ab
Rahim, Dr Wan Nor Fazila Hafizan Wan Nik and
Dr Razan Hayati Zulkeflee
1.

Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru

Nilai, 71800 Nilai, Negeri Sembilan, Malaysia.
2.

Pathology Department, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah, 68000

Ampang,Selangor, Malaysia.
3.

Pathology Department, Hospital Selayang, Lebuhraya Selayang – Kepong, 69100 Batu

Caves,Selangor, Malaysia.
4.

Pathology Unit, Faculty of Medicine and Defence Health, National Defence University of

Malaysia, Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia.
5.

Department of Chemical Pathology, School of Medical Sciences, Universiti Sains

Malaysia, 16150 Kota Bharu, Kelantan, Malaysia. 6Department of Haematology, School of
MedicalSciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.
E-mail: haniajrina@usim.edu.myCase History
A 31-year-old lady presented with infected burn injuries. Her past medical history was
unremarkable.

Duringtheadmission,herlaboratory

results

showedpersistent

hyperkalaemia while the patient remained asymptomatic. The serial laboratory results were:102

Clinical Case

APFCB News 2024 Issue 1
Mode ofsampletransport

DateType ofsampleation

Haemolysis
index

Hospital A (reference range)

Pneumatic tube14/1/20
23

system15/1/20

Plasma23
17/1/2023
17/1/20
23

Serum

11/4/20
23

Plasma19/6/2023mmol/Lase< 247 U/L

Total whitecell count

4.0 – 10.00
X 109/L

-

1262

NIL

7.5

1709

-

1+

19.3

2430

-

NIL

6.6

-

-

3.4 – 4.5

120 – 246

4.078 –

mmol/L

U/L

11.37 K/uL

NIL

8.6

1291

483.7

NIL

4.2

319

18.5

NIL

3.8

255

3.4

by hand23

3.4 – 4.5

dehydrogen

13.6

Hospital B (reference range)

20/1/20concentration

LactateNIL

Manualtransport

Potassium

Questions
1. What possibilities could you offer to explain the potassium results?
2. How to investigate the results?
3. What further tests to confirm the patient’s diagnosis and what is the underlying mechanism
related to hyperkalaemia?
4. What is the best advice to clinicians when dealing with hyperkalaemia in this case?

Discussion
Question 1
Serial potassium results showed hyperkalaemia, which is diagnosed when the potassium
concentration is above 5.0 mmol/L. It is particularly concerning when the level rises above
6.5mmol/L due to its potential cardiotoxicity risks.1

103

APFCB News 2024 Issue 1

Clinical Case

The patient showed no symptoms of hyperkalaemia such as palpitation, chest pain and muscle
weakness. Her electrocardiography results showed no tall and tented T wave, shortened QTinterval, widened QRS complex or absent T wave. Thus, pseudo-hyperkalaemia is suspected.
Pseudo-hyperkalaemia refers to an erroneous hyperkalaemia and it poses a significant
challenge in the accurate determination of potassium concentration.2 Upon receiving
hyperkalaemic results, the attending physicians are warranted to decide promptly, and this may
result in injudicious administration of potassium-lowering therapies.
The possible causes of pseudo-hyperkalaemia include:Haemolysis of red blood cells (e.g. difficult venepuncture, improper specimen handling)

In vitro leakage from other blood cells (e.g. thrombocytosis, leucocytosis)

Potassium contamination (e.g. EDTA tube sampling, sampling at the same side of
intravenous fluid).1

Question 2
Timely identification of pseudo-hyperkalaemia is crucial to prevent the administration of
inappropriate treatments. A combination of severely elevated potassium concentrations
reaching levels incompatible with life and asymptomatic presentation raises the suspicion ofpseudohyperkalaemia.2 This shall be confirmed with a repeat sampling. Alternatively, utilizing
a direct ion-selective electrode method through a blood gas analyser for the measurement ofwhole blood potassium offers a swift method to identify true hyperkalaemia, as it bypasses thetechnical processing of a patient’s sample.3
Red blood cell haemolysis is the predominant preanalytical factor leading to pseudohyperkalaemia. Any reported potassium concentration surpassing the reference range
necessitates an accompanying assessment of the haemolysis index (H-index).4 Most of her
results exhibited a negative haemolysis index, effectively ruling out haemolysis as thecontributing factor.
Reflex testing with serum calcium, magnesium, and alkaline phosphatase (ALP) helps mitigate
the risk of K2-EDTA contamination. EDTA selectively chelates divalent cations, such as calcium
and magnesium, leading to hypocalcaemia and hypomagnesaemia, respectively. Indirectly,
depletion of these ions renders them inaccessible for various enzymatic reactions. For instance,
ALP requires magnesium and zinc as the enzyme cofactors. Thus, this elucidates the observed
low concentrations of ALP in samples contaminated with EDTA.5

104

APFCB News 2024 Issue 1

Clinical Case

Simultaneous measurement of serum and plasma potassium is beneficial for further
investigation of its underlying cause. Reverse pseudo-hyperkalaemia refers to an elevatedplasma potassium concentration compared to the serum levels observed in the presence ofsignificant leucocytosis.6 Conversely, thrombocytosis leads to an increased measured serum
potassium due to the release of potassium by platelets during the clotting process.7
Figure 1 depicts the proposed stepwise laboratory approach to hyperkalaemia, aiming forthe early detection of erroneous results.

Figure 1: Diagnostic algorithm on approach to pseudohyperkalaemia

Question 3
Urgent blood film and bone marrow biopsy confirmed a diagnosis of Chronic Lymphocytic
Leukaemia (CLL).
Dysplastic leukocytes in leukaemia are easily ruptured during sample centrifugation due toan increased in the membrane fragility. CLL for example, has cytoskeletal defects on its
lymphocytes and this is manifested as smudge cells on peripheral blood film. In the presenceof hyperleukocytosis, in vitro lysis of CLL lymphocytes can lead to the spurious
hyperkalaemia. 2, 4

105

Clinical Case

APFCB News 2024 Issue 1

Serum potassium measurement yields a lower result as the fibrin clot in the serum capturesand stabilizes delicate tumour cells during sample centrifugation, consequently minimizing
therelease of potassium from the cells.7
The pneumatic tube system is not an appropriate method for sample transport in this casedueto the additional mechanical force exerted on the fragile leukemic cells. This is evident
in the higher reported potassium concentration compared to the specimens transported
manually byhand.
Chemotherapy was commenced, and serial laboratory results showed reduction of whitebloodcell count along with plasma potassium levels. This showed that the magnitude ofpotassium elevation is proportional to the white cell counts as we can see the normalizationof plasma potassium is achieved when the white cell counts reduced.
19/1/2023
WBC count

15/2/2023

9/3/2023

11/4/2023

12/5/2023

476.1

414.3

18.5

2.8

5.7

4.9

4.2

3.9

494.3
(4.078 – 11.37 K/uL)
Plasma potassium
7.7(3.4 – 4.5 mmol/L)

Question 4This case highlights the importance of recognizing pseudo-hyperkalaemia in patients withextreme hyperleukocytosis. This awareness is essential to prevent iatrogenic hypokalaemia
and ensure prudent patient management. The significance of identifying pseudohyperkalaemia isparticularly emphasized in this patient, as accurate electrolyte monitoringis crucial to assess the risk of tumour lysis syndrome during her chemotherapy treatment.
2,4

The most suitable method for monitoring the patient's potassium levels is through whole
bloodpotassium analysis using a direct ion-selective electrode method through the blood
gas analyser.3,8 This approach aids in distinguishing between true and erroneous
hyperkalaemia Additionally, it is imperative for clinicians to correlate blood test results withclinical findings. Effective communication between clinicians and laboratory personnel
becomes essential whenreported results show discrepancies.

106

APFCB News 2024 Issue 1

Clinical Case

References
1. Lindner G, Burdmann EA, Clase CM, Hemmelgarn BR, Herzog CA, Małyszko J, Nagahama
M, et al. Acute hyperkalemia in the emergency department: a summaryfrom a Kidney
Disease: Improving Global Outcomes conference. Eur J Emerg Med 2020; 27(5):329337.
2. Dewey J, Mastenbrook J, Bauler LD. Differentiating Pseudohyperkalemia From True
Hyperkalemia in a Patient With Chronic Lymphocytic Leukemia and Diverticulitis. Cureus
2020 17;12(8):e9800.
3. Shrestha B, Rijal SS, Pokhrel A, Paudel A, Baral K, Poudel B, et al. Pseudohyperkalemia
Associated With Leukemia. Cureus 2022; 14(4):e23978.
4. Haque MZ, Nasir A, Judge R. Pseudohyperkalemia in chronic lymphocytic leukemiaand
diabetic ketoacidosis. Clin Case Rep. 2023 Aug 22;11(8):e7821.
5. Van Elslande J, Dominicus T, Toelen J, Frans G, Vermeersch P. A case of severe
pseudohyperkalaemia due to muscle contraction. Biochem Med (Zagreb) 2020;30(2):021004.
6. El Shamy O, Rein JL, Kattamanchi S, Uribarri J, Vassalotti JA. Reverse pseudohyperkalemia
is more than leukocytosis: a retrospective study. Clin Kidney J2020; 14(5):1443-1449.
7. Merritt M, Kline H, Garimella S, Seigler R. Pseudohyperkalemia in a patient with T-cellacutelymphoblastic leukemia and hyperleukocytosis. J Pediatr Intensive Care 2018;7:166–168.
8. Massicotte-Azarniouch D, Canney M, Sood MM, Hundemer GL. Managing
Hyperkalemia in the Modern Era: A Case-Based Approach. Kidney Int Rep 2023;
24;8(7):1290-1300.

107

APFCB News 2024 Issue 1

Painting Story“Three Friends of Winter in a Chinese Garden”
By
Dr Tan It Koon
In China's Suzhou city, about 200 private traditional-style gardens were created by top
imperial government officials, scholars, and wealthy merchants as part of their family
homes. The concept underlying the planning of such gardens was the creation of scenes ofnatural beauty surrounding the residence one lives in to give the impression of living in themountains with scenic views of nature. Views at every nook and corner of the garden would
appear like beautiful idyllic Chinese traditional landscape paintings by great masters inminiature 3-dimensional forms. Stones from the bottom of the Tai Lake were selected andassembled to appear like the well-known mountains and waterfalls and ponds were created
to enhance the beauty of the gardens. Growing plants that bloom at different times of theyear and whose foliage changes their colors depending on the seasons helps to provide
changing views of the garden with change of season.
My large scrolled painting is an example of such a garden in winter when snow covers
everything under the dark sky. This 《Three Friends of Winter in a Chinese Garden 》
painting features plum trees in full bloom, snow-covered pine trees and bamboo plants,
and unique beautiful rocks from Tai Lake in varied sizes, shapes, and states of watererosion. A couple of visitors are seen walking on a zig-zag walkway built over the manmade
lake while 3 other visitors are admiring the snowy scene from the snow-capped pavilions
in the distance.
When snow covers everything and the cold causes most plants to lose their foliage andwildlife go into hibernation, plum trees show their pride and nature of unyielding strength
by beginning to bloom with pink and white blossoms. At the same time, pine trees andbamboo remain green and thrive with vigor in such harsh and adverse environments. It is
not surprising that they have been regarded by learned scholars of ancient China as the《 Three Friends of Winter. They represent the most desirable virtues of righteous
gentlemen and great scholars: righteousness, strength, and humility.98777⁹nmklm
With Best Wishes

Dr Tan It Koon
SACB Founding President
APFCB Founding President
IFCC Executive Committee Member
WHO Expert Committee Member

108