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

APFCB News 2023 Issue 2
Publication Team, 2023 Issue 2
Chief Editor

Prof. Pradeep Kumar Dabla,
INDIA

Past Chief Editors

Dr. Raja Elina Raja Aziddin,
MALAYSIAAPFCB Executive Board and Chairmenof Committees, Elected 2023
Executive Board
PresidentCEO, RCPAQAP

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

Editorial Members

Dr. Leslie Lai, Kuala lumpur,
MALAYSIA

Faculty of Health Sciences andMedicine, Bond University, Australia
Immediate Past

Dr. Endang Hoyaranda

President

Prodia Group, Jakarta, Indonesia

Vice-President

Dr. Samuel Vasikaran
Consultant Chemical Pathologist,

Prof. Damien Gruson,
BELGIUM
Prof. Ryunosuke Ohkawa,JAPAN

Dr. Tony Badrick

PathWest-Laboratory Medicine,
Western Australia
Secretary

Prof. Praveen Sharma
Former Professor and Head, Dean

Prof. Deepak Parchwani,
INDIA

Research Biochemistry at AIIMS,
Jodhpur, India
Editor-in-chief, Indian Journal of

APFCB MembershipCouncil Members
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)

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)

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
Sukraa Software Solution Pvt Ltd.
Sysmex Corporation
RCPA QAP
Thermo Fisher Scientific

Waters Pacific
Greiner Bio-One Singapore Pte. Ltd.
Quidel Ortho

Clinical Biochemistry
Treasurer

Dr. Raja Elina Raja Aziddin
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

Laboratory Management

Dr. Tjan Sian Hwa,
INDONESIA

ScientificDr. Tze Ping Loh,
SINGAPORE

Congress and Conference

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: afpcbofficial@apfcb.org
Cover page: A Beautiful View of the Three Gorges in China
Contributed 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 2023 Issue 2

Contents
From the desk of Chief Editor – APFCB eNews

01

From the desk of APFCB President

02

APFCB Activities 2023
Order of Australia Award to Dr. Tony Badrick, APFCB President

03

APFCB 16th Congress 2024 in conjunction with the AACB 61st Annual Scientific Conference

04

APFCB Supports Young Scientists to show their abilities in IFCC Congress

05

Member Societies - Annual Activities Reports
National Society Report– CACB Taiwan

10

National Society Report– SACB, Singapore

13

National Society Report– IACC, Indonesia

20

National Society Report– PSCP Pakistan

28

National Society Report– ACBI India

30

National Society Report– JSCC, Japan

35

National Society Report– MACB, Malaysia

36

National Society Report– IACLD, Iran43

Young Scientists Column
The Second IFCC Young Scientists’ Forum – IFCC World Lab EuroMed Lab 2023 – Rome

45

Young Scientist Interview

50

Industry Voice Section
Heart Attack diagnoses at the bedside can now take as little as 20 minutes

55

New ACMG guidelines shape NIPT uptake in Asia Pacific58

Roche Experience Days (RED) 2022 Post-event summary report61

APFCB News 2023 Issue 2

Expert Opinion Paper
Quality Control Systems

63

A New Horizon of Biochemistry and Laboratory Medicine with Chat GPT

67

Laboratories Need To Apply Green Principles

69

Special Report
Global Medlab Week 2023

72

IFCC Podcast

75

Sickle cell Disease: Prevalence, Challenges and road map for its
Control in India by 2047

77

APFCB Auspices
APFCB Auspices Events Calendar 2023

83

Clinical case84

Painting Story

89

A Beautiful View of the Three Gorges in China

APFCB News 2023 Issue 2
From the desk of Chief Editor,
APFCB eNews

My Dear Colleagues & Friends,
I am glad to present you with the 2nd issue of APFCB eNews, 2023.The APFCB executive board
and council members with its conviction of promoting science and education in the region were

Prof. Pradeep Kumar Dabla
Chief Editor, APFCB eNews

always standing tall while promoting various programmers under different committees acrossall regions.
During the time, APFCB Committee-Communication & Publication (CP) has worked committedly
to raise the communication standards and networking with the member societies & partners
while updating addresses, office bearers, so that important information could reach to allmembers within time. Though not limited, we plan to extend communication via social media
platforms, automated e-mailing and providing archived electronic information viz, webinars,
educational videos and other modern tools.
In this issue we bring myriads of information, ranging from delineating reports from themembers societies showcasing their efforts in adding scientific knowledge to the laboratory
medicine, expert’s opinion in laboratory quality management &artificial intelligence, special
reports from IFCC Global Medical Lab Week celebrations 2023 & sustainable green labs. Industry
partners have shown great enthusiasm while sharing reports for industry voice whether triage
testing or non-invasive prenatal testing (NIPT).
It is always thrilling to share efforts by young scientists, the full report on 2 nd IFCC Young
Scientists’ Forum organised in conjunction with IFCC World Lab Euro Med Lab 2023, and Romeis made available. APFCB Young Scientists Award Competition 2023 provided financial assistanceto Young Scientists to show their abilities in IFCC congress. Lots of appreciations for the future
leaders! APFCB auspices events calendar is also presented in this issue to promote scientificevents under APFCB umbrella. Further, APFCB and the AACB are proud to host the APFCBCongress 2024 at Sydney Australia, so don’t forget to visit the report.
However, APFCB eNews cannot be completed without the contributions of Dr. Tan It Koon, in theform of beautiful painting titled “A Beautiful View of the Three Gorges in China” and its
mesmerising description.
Team APFCB C-CP thanks to APFCB family and invite contributions for the next issue, year 2024.

Happy Reading!!
Best Wishes
Team APFCB C-CP

1

APFCB News 2023 Issue 2

From the desk of APFCB
President

Welcome to the second edition of the APFCB News letter for 2023.
Dr. Tony Badrick
The new Executive Board and Chairs of Committees have been working this year to provide
more resources for the Federation to progress. The work of the APFCB is undertaken entirely
voluntarily by the EB and Chairs. This includes all the secretarial services, the organisation of
educational activities such as scholarships, and communications. This has been a labour oflove by the officers for over thirty years. However, there have been problems, mainly relating
to the transition when one officer takes over from another. The emails change and somedocuments are lost as they are held, often unknowingly, by the ex-office holder. To provide a
better service to the APFCB and the officers, the EB has entered into an agreement with the
AACB to supply a secretariat to the APFCB. This service will allow the EB to develop theorganisation further. If you wish to contact the APFCB, please use the following
Email: secretariat@apfcb.org
APFCB Secretariat now available!
The Secretariat will provide a repository for essential APFCB documents and records.
The Secretariat will be developed to keep a database of Member Organisations and their key
contacts and Office holders.
Member Organisations are invited to contact the APFCB Secretariat for enquiries related to
APFCB activities, and to contact the APFCB Executive Board and Committees.
The APFCB Secretariat is run by AACB Services Pty Ltd on behalf of the APFCB.
The APFCB Newsletter showcases the activities of the member organisations, so please taketime to read these.
In 2024, the APFCB Congress will take place in Sydney. This is the major activity of the APFCB.
Please watch the progress of the developing program and see if you may be able to attend.
Best Wishes
President, APFCB

Dr. Tony Badrick

2

President, APFCBAPFCB News 2023 Issue 2

APFCB Activities“Order of Australia” Award to Dr. Tony Badrick,
APFCB President

Dr. Tony Badrick
APFCB President

The Asia Pacific Federation of Clinical Chemistry (APFCB) proudto announce that APFCB
President, Dr. Tony Badrick has been awarded the “Member of the Order of Australia”
Award, the year 2023 for his distinguished services in the field of laboratory medicine, lab
quality management, and education.
Currently, he is working as CEO of the RCPAQAP and the deputy Chief Examiner and Chair of
the Faculty of Science of the Royal College of Pathologists of Australasia. He completed his
services as President of the Australasian Association of Clinical Biochemists (2003- 2007), Chairof the Education and Laboratory Management Committee of the Asian Pacific Federation ofClinical Biochemistry, and Vice President of the Australian Institute of Medical Scientists.
The Order of Australia award is instituted by Her Majesty the Queen on 14 February 1975, wasestablished as “an Australian society of honour for the purpose of according recognition toAustralian citizens and other persons for achievement or for meritorious service”. It is the preeminent way Australians recognise achievements that benefit or bring honour to the Australiancommunity. In the Australian honours system, appointments to and awards in the Order ofAustralia confer recognition for outstanding achievement and service.

Dr Tony Badrick truly deserves the honor of “Member of the Order of Australia” for his services
and immense contribution towards the community and science.

Report by:

Prof. Pradeep Kumar Dabla
Chief Editor, APFCB eNews

3

APFCB Activities

APFCB News 2023 Issue 2

APFCB 16th Congress 2024 in conjunction with
the AACB 61st Annual Scientific Conference
The Asia-Pacific Federation for Clinical Biochemistry and Laboratory Medicine (APFCB) and theAustralasian Association for Clinical Biochemistry and Laboratory Medicine (AACB) are proud tohost the APFCB Congress 2024.
The scientific program will deliver the most recent scientific research related to laboratory
medicine by world renowned experts. The scientific program enables those providing a clinicalbiochemistry testing service and users of biochemical analyses to update knowledge on recent
developments and advances, share expertise and experience, as well as discuss problems intheir field of practice.
Sydney is one of the world’s most picturesque cities that is surrounded by a majestic harborand scattered with beaches, national parks and iconic buildings. It is a city that is inviting you
to explore before, during and after the Congress. Catch a ferry across the harbor to take in a
panoramic view of the iconic Sydney Harbour Bridge and Sydney Opera House, cuddle up to acute Koala at Taronga Zoo Sydney or discover the city from above at the Sydney Eye Tower.
On our beautiful Sydney spring evenings we will deliver the unique experience of Australia;
enjoy indigenous traditional dance; our superbly fresh food and extraordinary wine and a nightlife of excitement with opportunities to socialise with old friends and to make new ones.
An exciting range of opportunities have been developed, each containing benefits that will
ensure your Organisation receives maximum exposure. Sponsorship packages have been
designed to suit a range of budgets. Early confirmation of your Conference sponsorship will
ensure an even higher level of exposure.

For sponsorship opportunities visit our website.

Key Dates
Call for Abstracts Open
October 2023
Early Bird Registration Open
October 2023
Call for Abstracts Close
January 2024
Notifications to Authors
May 2024
Standard Registration Open
July 2024

Contact Us

4

Are you interested to hear more? Chat with us!
APFCB 2024 Conference Secretariat
ICMS Australasia
GPO Box 3270
+61 (02) 9254 5000
info@apfcbcongress2024.org

APFCB News 2023 Issue 2

APFCB Activities

APFCB Supports Young Scientists to show
their Abilities in IFCC Congress
IFCC-EFLM WORLDLAB-EUROMEDLAB 2023 in Roma, Italy
Dr. Wei Cui
Chair, APFCB-Education Committee

APFCB Young Scientists Award Competition 2023 report:“It was my first international conference and was a great pleasure for me to attend such an
extraordinary event. All the sessions were well organized and very beneficial, I thoroughly
enjoyed.” - Dr. Monica Irungbam, senior resident, Govind Ballabh Pant Institute of Postgraduate
Medical Education and Research, New Delhi, India“My Dream come true, with award from APFCB I can to take part in this event to gain scientificexperience both personally and professionally from the experts and young scientists.”- Siska
Darmayanti, product lead, PT. Prodia Widyahusada Tbk, Jakarta, Indonesia“Attending the prestigious IFCC-Euro Med Lab 2023 in the enchanting city of Rome was an
exhilarating experience that I will cherish for a lifetime”-Chandra Agung Purnama, faculty ofpharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.
“It was an amazing, memorable experience to be at the congress. All the scientific sessions
were enriched with knowledge and provided me with a future vision for my academic work. “Dr.
Taru Goyal, senior demonstrator, Department of Pediatrics, Postgraduate Institute of Medical
Education & Research, Chandigarh, India.
As a scientific organization committed to promote a variety of scientific and educational
programs for clinical biochemists in Asia-Pacific region, APFCB keeps up efforts on fostering
the scientific potential of young scientists. In April, APFCB Education Committee organized aYoung Scientists Award Competition, which could provide financial support for young scientists
to attend IFCC-EFLM WorldLab/EuroMedLab in Rome, Italy, from May 21-25, 2023.
After a thorough assessment of applicants’ abstracts which have been accepted by the
congress, ten winners were selected. They were invited to the congress and IFCC Young
Scientists FORUM in Rome. The Competition Award could cover the winners’ expenses,
including travel and hotel expenses. Eight of them finally attended the congress. They are Rina

5

APFCB News 2023 Issue 2

APFCB Activities

Scientific journey. The congress, coupled with the warmth of international connections and the
grandeur of Rome, left an indelible impression on my professional and personal growth. The
knowledge gained, the insights shared, and the bonds formed have enriched my understandingof the scientific landscape and ignited a renewed passion for pushing the boundaries ofknowledge. I am profoundly grateful for the opportunity to participate in this remarkable eventand eagerly look forward to future endeavors that will continue to shape my path as a young
scientist.” - Chandra Agung Purnama, faculty of pharmacy, Universitas Padjadjaran, Jatinangor,
Indonesia.
“The conference also gave me the opportunity to meet colleague from other countries and it
was a delightful experience discussing our research work. I have created some contacts which
will help me to improve my research work. Thank you for this opportunity and looking forward
to actively participate in any events or activities that will come.” - Dr. Monica Irungbam, seniorresident, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New
Delhi, India“The opportunity to be a part of the young scientist forum was especially wonderful, as it issuch a great platform to have one-to-one interaction of your scientific ideas with the young
scientists. The young scientist award is a great recognition for young scientists who want toparticipate in such grand conferences but are hindered due to lack of financial support and it
surely is a motivation for the entire young scientist fraternity.” - Dr. Taru Goyal, seniordemonstrator, Department of Pediatrics, Postgraduate Institute of Medical Education &Research, Chandigarh, India.
“My experience at the Euromedlab Rome Congress 2023 was transformative, invigorating mypassion for laboratory medicine and inspiring me to reach new heights. I also thankfull I had anice time site seeing Rome City. By sharing my journey, I hope to empower young scientists toseize opportunities, push boundaries, and make a lasting impact in their respective fields. Let
us embark on this collective journey towards scientific excellence.” - Rina Triana, Research
Support Head, PT. Prodia Widyahusada Tbk, Jakarta, Indonesia.
“From the topics, those insights will help me better understand the important breakthroughsof Clinical Chemistry in Medical Laboratory applications, thus allowing me to share this with mycolleagues and initiate applicable ideas for innovations in health-care. Furthermore, I aspire to
use the new knowledge to contribute to my work and the society by implementing (digital)technology aspects for a more personal and precise health-care that aligns with my company's
vision” - Siska Darmayanti, product lead, PT. Prodia Widyahusada Tbk, Jakarta, Indonesia.

6

Scientific journey. The congress, coupled with the warmth of international connections and the
grandeur of Rome, left an indelible impression on my professional and personal growth. The

APFCB News 2023 Issue 2

APFCB Activities

Kawaguchi (Japan), Siska Darmayanti (Indonesia), Taru Goyal (India), Monica Irungbam (India),
Rina Triana (Indonesia), Chandra Agung Purnama (Indonesia), Juliyatin Putri Utami(Indonesia), Aktaruddin Arief Santoso (Indonesia)
For all the winners, the meeting was impressive and fruitful. Most important, this experienceis critically helpful for their scientific and career success in the future.

Photo courtesy: Dr. Taru Goyal

Photo courtesy: Chandra Agung Purnama

7

APFCB News 2023 Issue 2

Photo courtesy: Siska Darmayanti

Photo courtesy: Rina Triana

8

APFCB Activities

APFCB News 2023 Issue 2

APFCB Activities

Photo courtesy: Dr. Monica Irungbam

Photo courtesy: Chandra Agung Purnama

9APFCB News 2023 Issue 2

Member Societies

National Society Report – CACB Taiwan
Prepared by Dr. Ching-Ying Kuo, Secretary General, CACB-Taiwan
NAME OF SOCIETY

Chinese Association for Clinical Biochemistry (CACBTaiwan)

OFFICIAL SOCIETY EMAIL

office@cacb.org.tw

ADDRESSNAME OF PRESIDENT &Sandy Huey-Jen Hsu

EMAIL ADDRESS

sandyhsu@ntu.edu.tw

NAME OF NATIONAL

Woei-horng Fang

REPRESENTATIVE TO APFCB &whfang@ntu.edu.tw

EMAIL ADDRESSREPORT ON SOCIETY ACTIVITIIESCACB held its annual conference and scientific symposium in conjunction with the 37th Joint
Annual Conference of Biomedical Science (JACBS) at the National Defense Medical University
Campus, Taipei on March 18th and 19th, 2023. The main theme for JACBS this year was“Metabolism in Human Health”. Four speakers were invited to present the progress on
metabolomics and its clinical applications. Professor Andrew Hoofnagle, Director of Division ofChemistry, Department of Laboratory Medicine and Pathology University of Washington,delivered a keynote speech on “Clinical Metabolomics: Current state and future directions”.
Professor Ming-Shi Shiao, Consultant and CRO, Geneon Link, and adjunct Professor, Graduate
Institute of Traditional Medicine, National Yang Ming Chau Ton University, presented“Metabolomics Enables Precision Medicine”. Professor Jentaie Shiea from National Sun Yat-sen
University talked about “Rapid Characterization and Imaging of Drugs and Potential Metabolic
Disease Biomarkers on Human Skin with Ambient Ionization Tandem Mass Spectrometry”.
Professor Tjin-Shing Jap, Physician, Division of Endocrinology and Metabolism, Taipei-Veterans
General Hospital shared” The laboratory evaluation of glucose and lipid metabolism fromBiochemical perspectives”. Following the symposium, student’s research oral presentationcompetition and poster contest were also held. Overall, the two-day conference was very
successful and truly an enjoyable academic gathering for the attending members of CACB.

10APFCB News 2023 Issue 2

Member Societies

CACB also invited Professor Hoofnagle to give a lecture entitled "Clinical Mass Spectrometry" at
the College of Medicine, National Taiwan University. In this lecture, Professor Hoofnagle
introduced the application of mass spectrometry in clinical settings and compared it withimmunoassays. Professor Hoofnagle's presentation provided

important insights into thedevelopment of clinical mass spectrometry.

(Photo 1) Dr. Andrew Hoofnagle delivered a keynote speech at the Annual General Meeting
2023.

(Photo 2) CACB board members and the symposium speakers Drs. Tjin-Shing Jap (back, 2ndfrom the left), Ming-Shi Shiao (back, 3rd from the left), Jentaie Shiea (back, 3rd from the right)
in Annual General Meeting 2023.

11

APFCB News 2023 Issue 2

Member Societies(Photo 3) Dr. Hoofnagle and the audience at National Taiwan University College of Medicine.

Upcoming events for 2023:
CACB is planning to hold an educational session to promote AACC Learning Lab. The session
will be held in conjunction with the annual meeting of Taiwan Society of Laboratory Medicine
in Taichung on November 18th, 2023.

12

APFCB News 2023 Issue 2

Member Societies

National Society Report- SACB, Singapore
PRESIDENT(APFCb rep)

Dr Leslie Lamleslie.lam@parkwaylabs.com.sg

Secretary

Dr Tan Jun Guan

treasurer

Mr Johnson Setoh

Asst Secretary

Ms Siti Ramah

Council Members

Dr Kho Shu Hui
Ms Joanne Lee
Ms Chong Ai Teng

Co-opted Members

Ms Ummi Kulsum
Ms Foo En Xin

WWW.SACB.ORG.SG | ADMIN@SACB.ORG.SG

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APFCB News 2023 Issue 2

Member Societies

ANNUAL SCIENTIFIC MEETING 2023
The Singapore Association of Clinical Biochemists (SACB) held its Annual Scientific Meeting(ASM) on 11th March 2023 at M Hotel Singapore. This marked a remarkable milestone as not
only was this the association’s first in-person gathering since the onset of the COVID-19
pandemic, it was also the first scientific meeting led by a new President of SACB. Amidst an airof anticipation and camaraderie, over 200 delegates graced the event, with 11 industry partners
lending their unwavering support. Presiding over the event was none other than the 4th
President of SACB, Dr. Leslie Lam. He eloquently expressed the collective sentiments of thedelegates who had looked forward to reconnect face-to-face after enduring a three-year hiatus.
A pivotal highlight of the event was the unveiling of the new SACB logo and the new SACB
website [https://sacb.org.sg/]. In commemoration of this momentous occasion, we introduced
our first Polo T-shirt featuring our new logo. With this new refreshed identity, it represents a
fresh chapter and renewed commitment to advancing laboratory medicine in Singapore.

Previous SACB Logo

New SACB Logo

SACB Polo T-Shirt

14

APFCB News 2023 Issue 2

Member Societies

ANNUAL SCIENTIFIC MEETING 2023
The heart of the Annual Scientific Meeting lay in its diverse array of expert speakers, totaling
six accomplished individuals who delivered captivating presentations on a range of topics.
Among them were esteemed College of American Pathologist (CAP) Inspectors, Dr. C. Robert
Biased and Dr. Kailash B Sharma, who provided valuable insights on “Ensuring High Quality
Laboratory Practices”. Additionally, Dr. Peh Bee Keow, Region Medical & Scientific Affairs
Manager at Roche Diagnostics Asia Pacific, delved into the pressing subject of “Alzheimer’s
Disease Now and in Future”, enlightening the audiences with studies and projections. Further
enriching the scientific discourse, Dr. Poh Tze Wei, Scientific Marketing and Digital Marketing
Leader at Beckman Coulter, offered a comprehensive overview of diabetes and its test panel.
Meanwhile, Dr. Peter Deman, International Scientific and Professional Affairs Manager at BioRad Quality Control Division, shared an insightful talk on “New Quality Control Trend in theClinical Laboratory”. To complete this meeting, Mr. Norizhar Bin Mohamed Zakaria, Lab
Consulting Manager at Siemens Healthcare shared the latest advancements in their programmein his presentation, “Solutions and Tools to Support Quality Management in the Laboratory.
Digitalisation to Drive Quality”. Overall, the event can be deemed a resounding success, given
the rekindling of valuable connections and the unmistakable sense of contentment expressedby the attendees.

15

APFCB News 2023 Issue 2

Member Societies

SACB President, Dr Leslie Lam presenting tokens of appreciation to our guest speakers.
ANNUAL GENERAL MEETING 2023
The Singapore Association of Clinical Biochemists (SACB) also held its Annual General Meeting(AGM) concurrently with its Annual Scientific Meeting on 11th March 2023 at M Hotel Singapore.
During our AGM 2023, Mr. Johnson Setoh, SACB treasurer, presented the association’s summaryof activities and financial statement of FY21. The council also had the opportunity to propose
various constitution amendments and our Ordinary members were able to exercise their voting
rights in favour of the proposed changes.

Our council members registering our Ordinary members to to ensure sufficient quorum
is met for proposed changes to the the Constitution.

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APFCB News 2023 Issue 2

Member Societies

SACB Treasurer, Mr. Johnson Setoh presenting the financial statements for FY21 to ourmembers.
SACB EDUCATION PROGRAMME 2022
The Singapore Association of Clinical Biochemists (SACB) successfully concluded its annual tenweek education programme series, which took place every Wednesday, 7th September 2022 to
9th November 2022. The programme was conducted via a hybrid mode, utilising both Zoom
and physical attendance. Notably, the education programme garnered significant interest,
attracting 213 participants from various institutions across Singapore.
Focusing on the crucial domain of laboratory medicine, the comprehensive series delved into adiverse array of topics, skillfully curated to enhance participants’ knowledge and proficiency inthe field. Esteemed experts and practitioners were invited to share their insights and expertise,
ensuring a high standard of educational content. The educational sessions featured
distinguished speakers who led thought-proving discussions, shedding light on criticalsubjects.
With a comprehensive and diverse range of topics Discussed in the annual education
programme series. The participants were able to gain valuable insights into various aspects oflaboratory medicine.

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APFCB News 2023 Issue 2

Member Societies

Physical attendees for our education programme18

APFCB News 2023 Issue 2

Member Societies

CELEBRATING IFCC 70TH ANNIVERSARY
In commemoration of IFCC’s remarkable 70-years journey in advancing excellence in laboratory
medicine, SACB proudly extends its felicitations. The 4th President of SACB, Dr. Leslie Lam, andthe dedicated team show their appreciation by offering a photo to honour the IFCC’s significant
global leadership in this pivotal field of medical science.

SACB congratulates IFCC for 70 years of global leadership in laboratory medicine.

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APFCB News 2023 Issue 2

Member Societies

National Society Report- IACC, Indonesia

Indonesian Association of Clinical Chemistry Report
Arwin Prasasto–hkki.secretariat@gmail.com
IFCC VISITING LECTURE
The President of the IFCC (International Federation of Clinical Chemistry and Laboratory
Medicine), Prof. Khosrow Adeli Ph.D., FACB, DABCC, FAACC, visited Indonesia from March 23–
25,2023. The IACC (Indonesian Association of Clinical Chemistry) hosted a number of events
during the course of the three-day visit.
On March 23, the IACC invited Perhimpunan Dokter SpesialisPatologiKlinik Indonesia- PDS
PATKLIN (Indonesian Association for Clinical Pathologists and Laboratory Medicine) and
Persatuan Ahli TeknologiLaboratorium Medic Indonesia-PATELKI (Indonesian Association of
Medical Laboratory Technologists) to hear Prof. Khosrow discuss his experience on the
launching of the Caliper Project, a study on laboratory reference range for children. The IACC
intends to conduct a PIPER STUDY—research on the pediatric laboratory reference ranges inIndonesiain the future. The discussion which took place on the ninth floor of Prodia Tower wasattended by 2 representatives from PDS PATKLIN, and 2 representatives from PATELKI.

Day 2 of Prof Khosrow Adeli’svisit on March 24, 2023 morning, started with a visit to the RSCM
(CiptoMangunkusumo Hospital), accompanied by the IACC team, Dra. Endang W Horayanda, Dr.
Thyrza L Darmadi, SpPK and Mr. Krist Haksa together with 2 young staff from the RSCM Clinical
Pathology Department, namely Dr. ReivaSpPK and Dr. Sanny, SpPK. We saw the flow of thenewborn screening program at RSCM. RSCM is a national referral hospital and a teaching
hospital of the University of Indonesia. Prof. Khosrow Adeli visited Building A which is an
inpatient ward building, and he saw how the 48 hour old baby’s dried blood sample on filteredpaper was taken by the RSCM Laboratory Technologist. After leaving Building A, Prof. Khosrow
went to the RSCM Clinical Pathology Laboratory to see how dried blood samples of neonates
which were sent to RSCM from various locations outside of Jakarta were handled by thelaboratory. Following that, Prof. Khosrow Adeli gave a lecture to the Clinical Pathology Specialist
Residents on newborn screening exams and his working experiences at Sick Kids Hospital in
Ontario, Canada. Over 50 residency students, 5 consultants, and members of the RSCM Clinical
Pathology team attended the event. The participants were quite engaged and directly posedseveral questions to Prof. Khosrow. In the afternoon at the Grand Mansion Hotel, Menteng, IACC
held a Round Table Discussion on the topic POCT in the Emergency Setting,20

APFCB News 2023 Issue 2
which was presented by 3 speakers, namely, Prof. Khosrow Adeli, Dr. July Kumalawati, SpPK (K),DMM and Dr. Antonius Pudjiadi, SpA (K). Prof. Khosrow Adeli spoke about POCT Managementin Healthcare Setting: Experience Sharing from Canada, Dr. July Kumalawati presented POCTManagement in Hospital: Experience Sharing and Perspective from Indonesia National
Reference.
Hospital, and Dr. Antonius Pudjiadi presented the benefits of POCT from a Clinician Perspective.
This RTD was guided by Prof. Dr. Marzuki Suryaatmadja, SpPK (K). The RTD event was held in a
hybrid manner, with 60 offline participants and 37 online participants.

On the 3rd day, March 25, 2023, a symposium and panel discussion on newborn screening washeld at the Grand Mansion Hotel, Menteng. The newborn screening symposium was opened
with remarks and a plenary lecture by the representative of the Minister of Health, Dr. Lovely
Daisy, MKM as Acting Director of Nutrition and Mother and Child Health. Dr Lovely Daisy
presented the Indonesian Ministry of Health Policy on Newborn Screening Program forCongenital Hypothyroidism and Other Congenital Diseases. After that, Prof. Khosrow Adeli
presented the IFCC Initiatives on Newborn Screening. The event continued with a presentation

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APFCB News 2023 Issue 2

Member Societies

by Prof. Dr.dr. Aman B PulunganSpA (K), FAAP, FRCPI (Hon) about the Opportunity of CAH
screening in the Newborn in Indonesia. The next speaker was Prof. Aw Tar Choon, MBBS, MMed,
MRCP, FRCPA, FRCP, FAMS, MPP who presented Neonatal Blood Screening Singapore
Experiences: Using Cord Blood Specimen. The symposium session was guided by Dr. Lia G
Partakusuma, SpPK (K), MM, MARS. After the industrial symposium and break, the event
continued with a panel discussion consisting of 2 speakers, namely Dr.dr. Merci Monica
Pasaribu, SpPK (K) and Prof. Khosrow Adeli. This panel discussion was hosted by Dr. Thyrza L
Darmadi, SpPK. Dr Merci presented challenges in Newborn Screening from Laboratory
Perspective, Prof Khosrow Adeli presented Experiences in Overcoming Laboratory Challengesof Newborn Screening. The symposium and newborn screening panel discussions were held ina hybrid manner, with 70 participants attending physically at the hotel and 51 online
participants attending the zoom platform.

EXTERNAL QUALITY ASSURANCE PROGRAM FROM IFCC
This external quality assurance program from IFCC has been going on since 2022. This year,
IACC added 5 more labs to this program. A total of 10 labs (3 private labs, 2 public labs, 2
private hospitals and 3 public hospitals) have joined this program. IFCC sends a sample in eachquarter. The results are excellent, with 10 labs averaging 94 from 100 between January andJune 2023.

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APFCB News 2023 Issue 2

Member Societies

RE-ANALYTICAL QUALITY IMPROVEMENT PROGRAM
One of the programs conducted by IACC is May I Help You Campaign MIHYC). This campaign
has been going on since 2011. This campaign intended to improve the pre-analytical quality inIndonesian laboratories. From January to July 2023, MIHYC assessors have assessed 6
laboratories (1 private lab and 5 public hospitals). There are 4 more hospitals to be assessed
this year.
A Pre-analytical Workshop was also held by IACC and ARSADA (Asosiasi Rumah Sakit Daerah –Indonesian Regional Public Hospital Association) on July 21-22, 2023. Speakers were IACC
members. This workshop was attended by around 40 participants from Greater Jakarta, North
Sumatera, and Lampung. Attendees are clinical pathologists and laboratory technicians.

NEWBORN SCREENING WEEK:IACC held The Newborn Screening Week from June 23 to July 1, 2023. This campaign containedseries of events, including social activities (free lab tests), seminars for congenital hypothyroid
screening, workshops on pre-analytics and analytics for congenital hypothyroid screening, also
Instagram Live to promote awareness for congenital hypothyroidism.
Workshop, Public seminar and social activities were held in Pasar Minggu Public Hospital on
June 23-24, 2023 at 8 AM to 12 PM. There were 29 attendees, 2 speakers, 5 instructors, and 9committees for workshops.

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APFCB News 2023 Issue 2

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There were 48 attendees, 16 volunteers for social activities, 2 speakers (Dr. Stephanie Adelia,
Sp.A and Dr. Nurbani, Sp.A) and 8 committees for public seminar and social activities.

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APFCB News 2023 Issue 2

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Instagram Live was held on June 28, 2023. It was viewed by 650-690 people. The speakers
were Dr. Yosanti Elsa, Sp.PK (K) and Dr. Frida Soesanti, Sp.A (K) with Dr. Reisa Brotoasmoro as
the host.

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APFCB News 2023 Issue 2

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The Newborn Screening Week activities were also carried out in various cities in Indonesia (Solo,Surabaya, Lampung, etc.). Activities carried out were seminars, social services and workshops.

In Lampung, IACC Lampung collaborated with Indonesian TV Station to do an educational
program on hypothyroid screening awareness.

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APFCB News 2023 Issue 2

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The final event was the Newborn Screening Webinar. This webinar was attended by 238
people (pediatricians, clinical pathologists, lab techs, medical doctors, etc.). There were 6
speakers for this webinar.

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APFCB News 2023 Issue 2

Member Societies

National Society Report- PSCP Pakistan
Chemilumnescence : The Queen of Immunoassays Series of Seminars Jointly Organized
by Pakistan Society of Chemical Pathologists (PSCP) and SNIBE (China)
A series of seminars were jointly organized by PSCP and SNIBE (China) at various places inPakistan on the topic “Chemiluminescence: The Queen of Immunoassay”In these seminars
speakers highlighted the high analytical sensitivity of chemiluminescence technology andcreated awareness about the availability of a state-of-the-art chemiluminescence-based
autoanalysers

Seminar at Quaide Azam Medical
College Bahawalpur

Prof. Aamir Ijaz Delivering Lecture

Dr. Sidra Ghazzanffar moderating a seminar in Sialkot

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APFCB News 2023 Issue 2

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Two webinars and 26 Seminars were held during from 2021 to 2023 at Lahore, Peshawar,
Rawalpindi, Karachi, Gujranwala, Multan, Faisalabad, Quetta, Hyderabad, Sukkur, Bahawalpur,
Sialkot, Abbottabad and Sargodha (conducted even twice in some cities).
Some Posters of the seminars conducted are as below:

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National Society Report- ACBI India
FORTHCOMING EVENT FOR 2023:
1. This year the Annual National Conference will be held in Thiruvananthapuram (Trivandrum)
Kerala from 13th to 16th September 2023.

God's Own Country, Kerala, as it is known has figured this year in "New York Times Top 52
Destinations" in the world. Kerala offers a breathtaking backdrop for this conference. With its
lush green landscapes, serene backwaters, and rich cultural heritage, it is the perfectdestination to inspire creativity and foster scientific exchange. In addition to the scientificprogram, we have organized social events and excursions that will allow you to experience thevibrant culture, warm hospitality, and natural beauty of Kerala.
Welcome Message from Organizing Secretary, Dr. Kannan Vaidyanathan

It gives me great pleasure to invite you all for the 49th Annual Conference of the Associationof Clinical Biochemists of India (ACBI) "49th ACBICON 2023 Kerala" organized jointly under the
auspices of Believers Church Medical College Hospital (BCMCH), Thiruvalla and the ACBI in thecapital city of Kerala, Thiruvananthapuram. The dates of the conference are 14th - 16th
September 2023 with a number of exciting pre-conference workshops on 13th September 2023.
The theme of ACBICON 2023 Kerala is "Laboratory Medicine Path Ahead -Amalgamating
Technology and Humanity." Our goal is to provide an engaging and intellectually stimulating
environment where experts from various subfields of clinical biochemistry can discuss the latest

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APFCB News 2023 Issue 2
developments, cutting-edge research, and innovative technologies. Through keynote lectures,plenary sessions, symposia, workshops, and poster presentations, we aim to create a vibrantplatform for knowledge dissemination and networking. For the first time in the history of ACBI,
this year we are opening the exhibition to the public.
The

venue

for

the

main

conferenceis Al Saj

Convention

Thiruvananthapuram,

which

is

20

drive

only

minutesfromCenter, Kazhakoottam,
International

AirportThiruvananthapuram.
I encourage you to actively participate in the conference, present your research findings, andengage in fruitful discussions with fellow delegates. ACBICON 2023, Kerala will not only provide
you with a valuable learning experience but also offer ample opportunities to forge new
professional connections and collaborations.
I would like to express my sincere gratitude to our esteemed speakers, sponsors, and theorganizing committee members for their valuable contributions and support in making
ACBICON 2023, Kerala a reality. Without their dedication, this conference would not have beenpossible.
Once again, I extend a warm welcome to all participants, both national and international, to
ACBICON 2023 in Kerala. Let us come together, learn from each other, and create lasting
memories.
See you in Kerala!
Dr. Kannan Vaidyanathan
Organizing Secretary, ACBICON 2023, Kerala
2. Scientific activities held in different parts of the country under ACBI banner:a. ACBI WB Chapter had organized an outreach conference on “Translational Research andDiagnostics” at Gorumara Nest, Gorumara, Jalpaiguri District, West Bengal on June 16 and 17,
2023.

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APFCB News 2023 Issue 2

ACBICON ODISHA 2023

32

Member Societies

APFCB News 2023 Issue 2

Member Societies

ACBICON ODISHA 2023

Winners, Post-graduate Immunology quiz

Runners-up, Post-graduate Immunology quizGroup Photo with all delegates

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APFCB News 2023 Issue 2

Member Societiesc. The 3rd workshop on Basic Molecular Techniques was held in AIIMS Jodhpur from 14th to18th March 2023. The workshop was organized by the Department of Biochemistry, All India
Institute of Medical Sciences, Jodhpur under the aegis of the Rajasthan Association of Clinical
Biochemists India. It was helmed by Dr. Mithu Banerjee, HOD Biochemistry, AIIMS, Jodhpur and
Dr. Dharmveer Yadav, organizing secretary.

Report compiled by Dr. Rajiv R Sinha, General Secretary, ACBI.

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APFCB News 2023 Issue 2

Member Societies

National Society Report- JSCC, Japan
Hideo Sakamoto, Ph.D. International Exchange Committee of JSCC
The Japan Society of Clinical Chemistry (JSCC) has recently launched a new program called theStudent Award from 2023 to acknowledge exceptional accomplishments by students in clinicalchemistry.
The JSCC Student Award is a prestigious recognition bestowed upon student members of the
JSCC who have demonstrated remarkable research skills in the field of clinical chemistry. Thisaward highlights the outstanding contributions made by students toward the advancement ofclinical chemistry and acknowledges their potential to make a significant impact in the field.
The JSCC recognizes the importance of fostering and encouraging excellence in researchamongst its student members and believes that this award will inspire future generations ofclinical chemists to aim for excellence.
To be eligible for the JSCC Student Award, applicants must meet the following criteria: 1) They
must be a "Student Member" of the JSCC. 2) They must be enrolled in a vocational school, juniorcollege, university, or graduate school (including working graduate students). 3) Those whohave received the JSCC Young Investigator Award (YIA) are not eligible. 4) Previous recipients of
the JSCC Student Award cannot apply again. To apply, student members should indicate theirinterest in the award when submitting an abstract for the Annual Meeting.
The process of selecting the most deserving candidates involves several steps. Firstly, the Chairof the Annual Meeting will meticulously scrutinize the pool of applicants and identify amaximum of 10 potential awardees. The selected candidates will then proceed to the judging
stage, which will take place during a dedicated session at the Annual Meeting. Finally, based on
the scores garnered by each candidate, around 5-6 winners will be chosen.
The fortunate recipients of the esteemed awards will be granted a commendation certificate
and a valuable prize presented by the President of JSCC, during the Annual Meeting.
Furthermore, the distinguished recipients will also be extended an invitation to attend a special
gathering held in their honor during the Annual Meeting's reception.
A total of 25 students applied for the esteemed Student Award in 2023, with only 10 being
chosen as symposiasts. The highly anticipated Student Symposium will be held on October 28th,
2023 at the Ochanomizu Sola City Conference Center, Tokyo, Japan. The winner of the Student
Award will be selected from this talented group of participants.

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APFCB News 2023 Issue 2

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National Society Report- MACB, Malaysia
1. SNIBE-MACB Immunoassay Conference
The International Conference on Immunoassay that was held on 2nd March 2023 at the Aloft
Hotel, Kuala Lumpur Sentral was jointly organized by the Malaysian Association of Clinical
Biochemists (MACB), the International Federation of Clinical Chemistry and Laboratory Medicine(IFCC), and SNIBE. The conference was attended by more than 300 delegates from Malaysia andother Southeast Asian countries, including Indonesia, Philippines, Thailand, Myanmar andVietnam.

Picture 1: International Immunoassay Conference organised by the MACB, IFCC
and SNIBE at the Aloft Hotel, Kuala Lumpur Sentral on 2nd March 2023.

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APFCB News 2023 Issue 2

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The conference covered a wide range of topics related to immunoassay. Among the topics
discussed were “Free Testosterone: A Laboratory Test with Several Clinical Implications” thatwas delivered by renowned international speaker Prof. Maurizio Ferrari, “The Use of ANA/dsDNA
in Clinical Practice” by Prof. Aw Tar Choon, “Clinical Application of PCT, hs-CRP and IL-6 in
Inflammation Monitoring” by Prof. Anderson Amirthanathan, and “Autoantibodies for Type 1
Diabetes” by Dr.SaraswathyApparow.
The conference was a resounding success, with participants expressing satisfaction with thequality of the lectures and the organization of the event. The venue, the Aloft Hotel, Kuala
Lumpur Sentral, provided an ideal setting for the conference, with spacious halls and modern
amenities. The conference also received support from Biomed Global.
In conjunction with the conference, MACB signed a Memorandum of Understanding (MOU) with
SNIBE. This MOU sets the terms and understanding between MACB and SNIBE to enhance mutual
cooperation in promoting learning and research in clinical biochemistry in Malaysia.
2. Workshop on calibration & checking of measuring equipment
The Malaysian Association of Clinical Biochemists organized a workshop on “CALIBRATION &CHECKING OF MEASURING EQUIPMENT” on 21st-22ndMarch 2023. The event was a collaboration
with the National University of Malaysia and was held at the Faculty of Health Sciences, UKM,
Kuala Lumpur.

Picture 2: MACB Workshop on Calibration & Checking of Measuring Equipment in UKM,
Kuala Lumpur on 21st -22nd March 2023.

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The workshop provided training on the calibration and checking of measuring equipment,
including thermometer, timer, balance, pipette and pH meter, according to MS ISO 15189:2014
Technical Requirement on Calibration & Checking of Measurement Equipment. Around 80
participants attended the workshop.
The training was conducted by experienced speakers who were well-versed in the subject
matter. The participants received hands-on training in the calibration and checking of themeasuring equipment. The speakers also provided guidance on troubleshooting equipmentrelated problems that can occur in clinical biochemistry laboratories. Overall, the workshop
received a positive-feedback.
3) IFCC President Visiting Lecture Program
The Malaysian Association of Clinical Biochemists hosted the IFCC President, Prof Khosrow
Adeli’svisiting lecturer program to Kuala Lumpur Malaysia from 26th -28th March 2023. In
conjunction with Professor Dr. Khosrow Adeli’s visit, the MACB held a series of scientificprogrammes which included the Paediatric Pathology Symposium, a laboratory visit and 2
roundtable discussions.
a) Paediatric Pathology Symposium
The Malaysian Association of Clinical Biochemists (MACB) and the Pathology Department of
Hospital TunkuAzizah jointly organized the Paediatric Pathology Symposium with the theme“Metabolic Syndrome in Children: Current Scenario & Challenges” at the Auditorium Perdana,
Hospital TunkuAzizah on 27th March 2023.

Picture 3: The MACB Paediatric Pathology Symposium on 27th March 2023 in Conjunction
with the IFCC President’s Visit to Malaysia

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APFCB News 2023 Issue 2

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The symposium provided the latest updates on metabolic syndrome in children and covered a
range of topics. Prof. Dr. Khosrow Adelipresented 2 lectures:1) Pathophysiology of PaediatricObesity and Metabolic Syndrome and 2) Clinical Application of Cardiac Markers in Paediatrics.
Other topics included Obesity in Children – Malaysian Scenario, The Changing Face of PaediatricDiabetes and Testing in Malaysia -Laboratory Perspective and Experience which were presented
by local expects Prof. Dr. Muhammad Yazid Bin Jalaludin, a Senior Consultant Paediatrician andConsultant Paediatric Endocrinologist at the University Malaya Medical Centre (UMMC), Dr.
Nalini M Selveindran, a paediatric endocrinologist from Hospital Putrajaya (HPJ) and
Dr.SaraswathyApparow, a Chemical Pathologist from Institute of Medical Research (IMR).
The event was attended by approximately 200 healthcare professionals which include doctors,
medical lab scientists, pathologists, paediatricians, and nurses..
b) Laboratory Visit
After the symposium ended, Prof. Dr. Khosrow Adeli visited the Pathology Laboratory at the
Hospital TunkuAzizah to have further discussions with the paediatricians, pathologists andmedical lab scientists there. The discussions involved topics related to the laboratory
techniques used in diagnosing and monitoring metabolic syndrome and its associatedconditions, such as diabetes and cardiovascular disorders.

Picture 4: Discussions during the IFCC President’s laboratory visit to Paediatrics Hospital(Hospital Tunku Azizah), Kuala Lumpur on 27th March 2023
The hospital presented the newborn screening programme in Malaysia to Prof. Adeli who inturnshared his expertise on the latest research and developments in the field of metabolic
syndrome and discussed potential collaborations between the hospital and his institution.
These discussions were valuable for the hospital staff in improving their understanding andmanagement of metabolic syndrome in children.

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APFCB News 2023 Issue 2

Member Societiesc) Roundtable Discussions
In conjunction with the visit by IFCC President to Malaysia, the MACB organised a roundtablediscussion on “Training needs and research opportunities for Medical Lab Scientists” at theFaculty of Health Sciences, UniversitiKebangsaan Malaysia Jln Raja Laut, Kuala Lumpur on 28th
Mac 2023. The roundtable discussion was attended by 30 participants which included lecturers,
researchers, medical lab scientists, graduate and postgraduate students.

Picture 5: Roundtable discussion with Prof. Khosrow Adeli on the topic of “Training needs
and research opportunities for Medical Lab Scientists” at the Faculty of Health Sciences,
National University of Malaysia (UKM) on 28th March, 2023.
The focus of the discussion was on the current and future training needs for Medical Laboratory
Scientists in Malaysia. The feedback obtained from Prof Adeli will be useful in developing
learning modules for the biomedical science graduate and postgraduate students in line withthe recent technological advancements in laboratory medicine. Potential research opportunities
and international expert collaborations were also discussed.
Later in the afternoon on the same day, the MACB held another roundtable discussion on“Reference interval and the CALIPER Initiative” at Melati Room, Hotel Impiana, Kuala Lumpur.

Picture 6: A roundtable discussion with Prof. Khosrow Adeli on “Reference interval andthe CALIPER Initiative” at Melati Room, Hotel Impiana, Kuala Lumpur on 28th March, 2023

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APFCB News 2023 Issue 2

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This discussion was attended by thirty participants which included clinicians, paediatricians,
researchers and medical lab scientists. The interactive session included the discussion on theinitiative to conduct a study on paediatric reference interval in Malaysian children. It was afruitful discussion with opportunities for collaboration in the near future.
4.

NATIONAL ABG SYMPOSIUM: Updates on Latest ISO 15189 and iQM

The National ABG Symposium: Updates on Latest ISO 15189 and iQM was held at Royale Chulan
Hotel, Kuala Lumpur on 12th July 2023. The symposium under the auspices of the Malaysian
Association of Clinical Biochemists (MACB) was jointly organized by the Straits Scientific andWerfen. Over 70 people attended the Symposium which consisted of a virtual session, lecturesand interactive discussions with Blood Gas users.

Picture 7: Participants at the National ABG Symposium at Hotel Royale Chulan, Kuala
Lumpur on 12th July, 2023.

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The main objectives of this symposium were to provide a continuous learning platform for ABG
users in line with the requirements of the new edition of ISO 15189:2022, as well as to provide
updates on blood gas technology and its intelligent Quality Management (iQM). Speakers
included Professor Emeritus Sharon S. Ehrmeyer from University Wisconsin-Madison and Davide
Columbo, the Global Acute Care expert with 35 years’ experience in Blood Gas.

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APFCB News 2023 Issue 2

Member Societies

National Society Report- IACLD, IranActivities information


Executing the External Quality Assurance Program for laboratories across Iran

Publication of a Three-monthly printed Journal in persian called Laboratory &Diagnosis



Executing the eduction courses & education webinars medicine laboratoryHolding meetings of the national assembly of laboratory science associations
with the presence of representatives of associations in laboratory science,
pathology and DCLS


Holding meeting with the following different organizations:

National Medical Device DirectorateMinistry of Health and Medical Education



Health Reference LaboratoryMedical Council of the Islamic Republic of Iran etc …

International relations:International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)

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

Asia-Pacific Accreditation Cooperation (APAC)

Holding National meetings
The 14th International & 20th National Congress on Quality Improvement in ClinicalLaboratories, 16-19 May 2023, Tehran-Iran.
Holding a tour of Dubai, especially for the exhibition of laboratory equipment (ARABLAB EXPO),
19- 21 September 2023
Holding Education Course
Free educational webinar on the interaction of laboratories with the General Directorate ofMedical Equipment: how to report quality problems, declare shortages and high prices oflaboratory products and equipment, July 2023.
Training seminar on intelligent quality assurance in medical laboratory, July 2023. Course
Medical community tax information.
Practical theoretical and practical course of sampling in clinical laboratory, 2-3, 9-10 July 2023.
Educational Webinar on Quality Management in the Department of Biochemistry (with emphasison the checklist of health reference laboratory requirements, paragraphs 68 to 84), February
and March 2023.
Educational webinar on laboratory diagnosis of superficial skin fungal infections, February
2023.
Scientific conference on principles of customer orientation, February 2023. Educational webinar
on quality control in microbiology department, January 2023.
Educational webinar on basic instrument quality control in microbiology department, January
2023.

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APFCB News 2023 Issue 2

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Educational webinar on the principles of interpretation and laboratory challenges of viral
hepatitis, January 2023.
Educational webinar on immunopathology of viral and autoimmune hepatitis, January 2023.
Educational webinar on review and interpretation of EQAP results in the hematology
department, January 2023.
Educational webinar on the review and interpretation of EQAP43 results in the biochemistry
department, January 2023.
Educational webinar on quality control in antimicrobial susceptibility testing (antiprogram),
January 2023.
Scientific conference of thyroid ology and management of laboratory challenges of thyroid tests,
January 2023.
Publications:
Journal of Laboratory and Diagnosis No. 59, spring 2023. Journal of Laboratory and Diagnosis
No. 58, winter 2023.

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APFCB News 2023 Issue 2

Young Scientists Column

The Second IFCC Young Scientists’ Forum –IFCC Worldlab Euromed Lab 2023 – Rome
Author: IFCC Task Force –Young Scientists (TFYS)
21 May 2023 in Rome, Italy:Following the successful inaugural “Young Scientists’ Forum” inSeoul, the second forum was conducted with more young scientist participation as a satellite
meeting at the IFCC ROMA 2023 WORLDLAB EUROMEDLAB, on 21 May 2023 in Rome, Italy.
There were 85 in-person and online participants at the forum representing 36countries
worldwide, especially with the help of many travel scholarships awarded to young scientists
worldwide.

The opening of the second Young Scientists’ Forum got off to a great start with distinguishedguestsnamelyProf.KhosrowAdeli,Prof.TomrisOzben,

Dr.

Santiago

Fares

Taie,

Dr.TommasoTrenti, and Prof. Rajiv Erasmus delivering motivational speeches to the young
scientists commending them on their activities and supporting them to continue young
scientists’ activities for they are the future of the laboratory medicine. Prof. Adeli alsomentioned that the number of scholarships for young scientists for this meeting has increased.
Dr Santiago Fares Taie, the current Chair of the TF-YS, addressed the young scientists reiterating
the activities and objectives of the Young Scientist’s Task Force urging young scientists tocontinue their activities across the world.
The forum commenced with the session on "Digital technologies", moderated by Aleksei
Tikhonov (Gustave Roussy, France) and Marie Lenski (Lille University Hospital, France), featuring
four presentations related to digital technologies in laboratory medicine. “Evaluating A Patientfor A Monoclonal Gammopathy: The MG-Testing Shiny App” by John Gabriel Bautista Abcede(Australia)introduced a web-based application that can help clinicians and laboratory
professionals to interpret and report serum protein electrophoresis and immunofixation resultsfor patients with suspected monoclonal gammopathiesproviding recommendations for further
testing and referral based on the International Myeloma Working Group guidelines. The next
presentation was by Arnel Christian King Dy (Philippines) on “Enzymatic Correction of Jaffe
Derived Serum Creatinine Interferences: A Machine Learning Approach”, which described anovel method to correct the interference of non-creatinine chromogens observed in the Jaffe
method for serum creatinine measurement using a machine learning approach.

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Young Scientists Column

APFCB News 2023 Issue 2

He demonstrated that by using these validated models, labs can easily correct Jaffe methodinterferences and approximate enzymatic method values online further stating that his method
could befurther improved for its accuracy and precision and is freely available online. Ronald
Khunga (Malawi) presented a “Social Network Strategy: An Innovative Way of Identifying andTesting High-Risk Men” demonstrating how a social network strategy, a peer-driven recruitment
approach, can be used to recruit peers of HIV-positive and high-risk HIV-negative men andincrease the uptake of HIV testing and linkage to care among high-risk men in Malawi. The lastpresentation of the session was on “Digital Competence In Laboratory Medicine: Results Of A
Survey Among Young Scientists” by Marie Lenski (France), reporting the results of a survey
conducted by Young Scientists to assess the level of digital competence among younglaboratory professionals worldwide. The survey revealed that there is a need for more training.
and education on digital skills and tools in laboratory medicine. Based on results from thissurvey, an international working group on digital competence for Young Scientists will beestablished, to build a learning environment and propose common international resources. The
goal is to help the next generation of specialists to be ready to tackle the upcoming professional
challenges. This session was a great opportunity to showcase the innovative work of young
scientists in laboratory medicine and to foster networking and collaboration among them.

The second session of the forum was on interesting presentations about “Chronic Diseases”
coordinated by Dr. Sean Campbell, (United States) and Dr. Tamar Ramishvili (Georgia). Thissession commenced with a great presentation by Mohammed YassineKaabar, (Tunisia) on“Evaluation of GPR score for non-invasive assessment of Liver Fibrosis in Chronic Hepatitis B
Tunisianpatients”.

He

and

his

team

retrospectively

studiedthegamma-glutamyltranspeptidase-to-platelet ratio (GPR) as a novel biomarker in patients diagnosed with liver
fibrosisinhepatitis

B

virus

(HBV)

mono-infection.

The

next

speakerwasDon

MakwakiweMatshaz, (South Africa), who discussedan excellent study on “HHEX And MTR1B
Gene Polymorphisms Associated with The Risk of Type 2 Diabetes Mellitus in A Mixed Ancestry
South African Urban Population”. This cross-sectional study, conducted with a total of 1650
participants from South Africa and revealed SNPsthat may increase the risk of developing Type
2 Diabetes Mellitus (T2DM).
Furthermore, Matshaz and his team have concluded that the mentioned SNPs may be used as
screening targets to identify individuals in whom interventions may be useful to reduce thedevelopment of T2DM. Also, these SNPs may be alternative therapeutic targets once their rolein the pathophysiology of T2DM is fully elucidated. A young scientist from Nepal,
SushantPokhrel shared with us a study on the “Associated Non-Invasive Biomarkers for Risk of46

APFCB News 2023 Issue 2

Young Scientists Column

Liver Disease in Type 2 Diabetes Mellitus Patients”. According to this study routine screening of
Aspartate to platelet ratio index (APRI), gamma-glutamyl transpeptidase to platelet ratio (GPR),
fibrosis-4index (FIB-4), and triglyceride and glucose index (TyG) may be helpful in preventing
progression of liver disease in T2DM patients. The last speech of this session was carried out
by a young scientist from India, Shruti Gupta. She presented her study about the “Association
Of Interleukin-22 Transmembrane Receptor and Binding Protein with its Levels in Tuberculosis”.
According to her presentation, the upregulation of IL-22R1 and downregulation of IL-22R2 may
be a host mechanism to combat the infection. It should be noted that this is the first study tocheck for the diagnostic efficiency of IL-22. The presentations of these studies generated greatinterest from the audience and the interaction between the speakers and YS from the audiencefacilitated sharing experiences and opinions about the research processes with each other.

The third session in the forum was on “Laboratory Management and Quality Control” chaired by
Claudia Imperiali (Spain) and UdaraSenarathne (Sri Lanka). SerafeimKarathanos (Greece)
discussed “Education and Training of Young Scientists in EQA Schemes Operation andManagement” and stressed the importance of continuous professional development activities
for young scientists to improve their understanding of quality assurance. The next talk was byJosep Miquel Bauça (Spain) on the “Past present and future of the reference intervals in
medicine” providing a broader overview of reference values followed by a talk on the“Establishment of Age-Specific Reference Interval for Amino Acids in Dried Blood Spot byTandem Mass Spectrometry” by BabuVinodh Kumar (India). The last talk in the session was by
HamidehGhazizadeh (Iran), who discussed about the Comparison of Biochemical andhematological markers Reference Intervals Derived by Direct and Indirect Procedures Based on
The Isfahan Cohort Study. The session was interactive with many questions arising from theaudience, allowing a better understanding of the concepts of reference interval establishment
and laboratory quality management among young scientists.

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Young Scientists Column

The forum continued with the 4th session: Biomarkers of cardiovascular risk. The session wasmoderated by Dr. Marco Alfonso Perrone (corresponding member IFCC-YS for Italy) and Dr.
Giulia Sancesario (Head of Italian YS and past member IFCC-YS). The first speaker was Dr. Marco
Alfonso Perrone from Italy with the lecture entitled: "Cardiac Biomarkers during Exercise: fromPatient to Professional Athlete". During the presentation, Dr. Perrone showed the use of cardiac
biomarkers in response to exercise and the possible interactions between cardiac patients andprofessional athletes. of particular importance is the use of clinical biochemistry in the early
diagnosis of myocardial injury compared to other imaging methods and the pathophysiology
of cardiac troponin release during exercise. The second speaker was Dr.JuditGonda from
Hungary with the title of the lecture: “The Increase of Soluble Urokinase Plasminogen Activator
Receptor in Heart Failure is Related To Disease Severity and To Cardiac Mortality”. During thepresentations, Dr.Gonda showed data from the study on the use of Soluble Urokinase
Plasminogen Activator Receptor in patients with heart failure, showing how increased levels of
the biomarker were correlated with heart disease severity and increased mortality. The third
speaker was followed by Dr.DharmsheelShrivastav from India with the title of the reading: "Riskfactors influencing left ventricular ejection fraction in patients with coronary artery disease: atertiary care center experience in North India". In the presentation, Dr.Shrivastav showed how
risk factors and biochemical markers correlated with left ventricular function in case series
collected at his research center in Northern India. In particular, the study
showed that cholesterol levels were more correlated with left ventricle function. At theconclusion, the 4th speaker was Dr. Marlena AginieszkaOlejnik from Poland with the title of thelecture: “Klotho And Fgf23 as Potential Biomarkers for Myocardial Infarction In Patients With
Acute Coronary Syndrome”. In the presentation Dr. Olejnik showed data from the study where
they evaluated the levels of Klotho and FGF23 and demonstrated their possible use as
biomarkers of acute myocardial infarction in patients with coronary artery disease.
The session aroused great attention from the audience with subsequent questions and a richdiscussion. Cardiovascular diseases (CVD) remain the leading cause of death in the world, but,thanks to clinical and biochemical innovations, today CVD also represent one of the fields inwhich there are major innovations available to the health of cardiac patients. Thanks to the IFCC
and the YS for this beautiful session!

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The closing remarks were delivered by Dr.AshlinRampul(South Afrika), who commended thehighly scientific program at the second young scientist forum. He urged the young scientists tocontinue activities and become part of the IFCC TF-YS activities. The forum participation has
improved every year and the number of young participants in Dubai isexpected to grow further.
Prof. Damian Gruson also a former member of the Young Scientist Task Force at its inception
also delivered concluding remarks stating“You will have good times in your career and not sogood times but the most importantfact is as a young scientist you shouldcontinue to work hard
without letting failures hinder the progress in your career”. The young scientists were all
thanked for their contribution to the forum and special thanks were noted to the ItalianSociety,especiallyGiulia Sancessaro and Marco Perroni who were excellent hosts and invited the
young scientists to a spectacular get-together.

For more info, visit us at: https://ifcc.org/task-force-young-scientists-tf-ys/

49Young Scientists Column

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Young Scientist Interview

TewaritSarachana, M.T., Ph.D.
Positions in the Faculty of Allied Health Sciences, Chulalongkorn University- Deputy Dean
- Head of Chulalongkorn Autism Research and Innovation Center of Excellence (Chula ACE)
- Associate Chairperson of Medical Technology Program and Head of Medical Technology
Education Subcommittee, the B.Sc. Program in Medical Technology- Assistant Professor, Department of Clinical Chemistry
Positions in Thailand’s significantorganizations associated with Biomedical Laboratory
Science- Executive board member and Head of International Relations, the Association of Medical
Technologists ofThailand under thepatronage of

Her Royal Highness

Princess

SoamsawaliKromMuenSuddhanarinatha- Executive board member and Head of the Molecular Biology and Human Genetics
Subcommittee, the Royal College of Medical Technology- Secretary of Dean Consortium of Medical Technology Schools of Thailand- Secretary of Academic Affairs Subcommittee, Medical Technology Council- Technical Assessor for ISO15189, ISO15190, ISO22870, ISO20387 Accreditations, Departmentof Medical Sciences, Ministry of Public Health50

APFCB News 2023 Issue 2

Young Scientists Column

1. Please introduce yourself
My name is TewaritSarachana. I was born into a low-income family. My parents were divorced
when I was very young, and my sisters and I were raised by a single mother who worked as aseamstress and made additional money by selling food on the street. I would not have comethis far without the incredible support from many people, including my family and teachers. I
am forever grateful for their kindness and can firmly say that education and research in medical
technology have entirely changed my life.
I received my bachelor’s degree in medical technology with First-Class Honors, Gold Medal,
from the Faculty of Allied Health Sciences, Chulalongkorn University, Thailand, and attained amaster’s degree in Genomics, Proteomics, and Bioinformatics, and a Ph.D. in Molecular Medicine
majoring Neuroscience from the George Washington University, Washington, D.C., and USA.
After finishing Ph.D., I worked for Food and Drug Administration (FDA), USA, as a post-doctoral
researcher, and then came back to Thailand to join the Department of Clinical Chemistry,
Faculty of Allied Health Sciences, and Chulalongkorn University, as a full-time lecturer in 2013.
I am now an Assistant Professor in the Department of Clinical Chemistry and Deputy Dean of
the Faculty of Allied Health Sciences at Chulalongkorn University. I am also serving as Head of
the Chulalongkorn Autism Research and Innovation Center of Excellence (Chula ACE), which isformerly known as the Chulalongkorn Systems Neuroscience of Autism and Psychiatricdisorders (SYNAPS) Research Unit.
In addition to the university, I am very fortunate to have an excellent opportunity to work for
multiple major medical technology organizations in Thailand, including the Association of
Medical Technologists of Thailand, the Royal College of Medical Technology, the Dean
Consortium of Medical Technology Schools of Thailand, Medical Technology Council, andMinistry of Public Health. In these organizations, I am engaged in developing national policies
and guidelines and creating activities that help enhance the professional competencies of
medical technology graduates and staff, assessing clinical laboratory quality according tointernational standards, and promoting the medical technology profession and life-longlearning in medical technology in Thailand.
2. What is your main focus?
My research focus areas include) the development of innovative artificial intelligence and multiomics approaches for screening and classifying people with autism to identify bimolecularmarkers and therapeutic targets for autism and each subtype of autism, ii) the investigation ofenvironmental factors and molecular mechanisms related to the cause or the risk of autism andother psychiatric disorders, and iii)the development of innovative clinical biochemistry
analytical techniques for biomolecules and chemicals that are environmental factors associatedwith the risk of psychiatric disorders. Our work involves expertise in systems biology, integrated
multi-omics, neuroscience, clinical biochemistry, health informatics, and artificial intelligencein our team together with our national/international collaborative networks, including
Genomics Thailand, the George Washington University, Karolina Instituted, KTH Royal Instituteof Technology, and Tohoku University.

51Young Scientists Column

APFCB News 2023 Issue 2
3. What else is important to you?

In addition to research, I play multiple roles in student development and education, academic
services, and management. I have been actively engaged in the promotion of outcome-based
education in medical technology and the development of the new version of Chulalongkorn
University’s medical technology curriculum, which includes three specialized tracks which are
Precision Health, Organization and Clinical Laboratory Management, and Data Science andArtificial Intelligence for undergraduate students in the medical technology program. I am also
promoting the quality of medical technology education by utilizing the ASEAN University
Network-Quality Assurance (AUN-QA) Standards in our undergraduate and graduate programs.
Moreover, international collaborations are much needed for the sustainable development of oursociety. I have worked with many colleagues worldwide to create international exchange
activities for students, faculty members, and medical technologists/biomedical laboratory
scientists. An example of international exchange activities I am actively involved in is the Tokyo
Medical and Dental University-Chulalongkorn University Exchange Program for medical
technology/biomedical laboratory science students and faculty members, which has beenorganized annually for several years. These international collaboration activities promote
education and research for sustainable development and allow students to learn to work in a
multicultural society, essential for becoming competent global citizens in the 21st Century.
Besides international exchange activities at the university level, I am strongly motivated topromoteinternational

collaborations

formedicaltechnologists/biomedicallaboratory

scientists. As an executive board member and the Head of International Relations of the
Association of Medical Technologists of Thailand, I am engaged in creating a memorandum of
understanding (MOU) between the Korean Association of Medical Technologists and the
Association of Medical Technologists of Thailand to support exchange activities of medical
technologists between the two countries. We also aim to create similar MOUs with othercountries, including Japan and Taiwan. I am now an Assistant Professor in the Department ofClinical Chemistry and Deputy Dean of the Faculty of Allied Health Sciences at Chulalongkorn
University. I am also serving as Head of the Chulalongkorn Autism Research and Innovation
Center of Excellence (Chula ACE), which is formerly known as the Chulalongkorn systems
Neuroscience of Autism and Psychiatric disorders (SYNAPS) Research Unit. In addition to theuniversity, I am very fortunate to have an excellent opportunity to work for multiple major
medical technology organizations in Thailand, including the Association of Medical
Technologists of Thailand, the Royal College of Medical Technology, the Dean Consortium of
Medical Technology Schools of Thailand, Medical Technology Council, and Ministry of Public
Health. In these organizations, I am engaged in developing national policies and guidelines andcreating activities that help enhance the professional competencies of medical technology
graduates and staff, assessing clinical laboratory quality according to international standards,
and promoting the medical technology profession and life-long learning in medical technology
in Thailand.

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4. What are your interests in biomedical laboratory medicine?
Biomedical laboratory medicine has progressed continuously and rapidly in recent years.
Advanced, high-throughput technologies, including next-generation sequencing and mass
spectrometry, have now been utilized in many clinical laboratories throughout the world, andthe costs of molecular tests using these techniques, such as whole genome/exome sequencing,are now much lower, making them more and more accessible to many people. These highthroughput technologies have generated an enormous amount of data requiring experts inbioinformatics, health informatics, and data science to manage such big data and expand theuse of data in the healthcare system. These global megatrends have brought a new perspective
to healthcare, making

emergingfieldsrelated topersonalized

medicine, suchaspharmacogenetics and cancer genetics, possible and practical in many real-life situations.
Artificial intelligence, robotics, and the Internet of Things (IoTs) are increasingly applied inclinical laboratories. I think this is a wonderful opportunity and, simultaneously, a threat to
medical technologists or biomedical laboratory scientists. New competencies in many areas,
including advanced molecular biology, bioinformatics, health informatics, and data science,
have become more critical for medical technologists or biomedical laboratory scientists in thispersonalized healthcare era. They need to have life-long learning skills and agility fortechnology. In addition, they also need to have humanity in healthcare as it cannot be replacedby artificial intelligence.
5. What are your future goals?
I have established the Chulalongkorn Autism Research and Innovation Center of Excellence(Chula ACE), formerly known as the Systems Neuroscience of Autism and Psychiatric disorders(SYNAPS) Research Unit. Chula ACE aims to solve significant public mental health problems in
Thailand and worldwide by creating knowledge and innovations in personalized medicine thatwill lead to an understanding of genetic and environmental factors underlying the etiology orsusceptibility of autism spectrum disorder and other psychiatric disorders. The ultimate goal is
to design and develop innovative approaches for screening, diagnosis, classification, prognosis,
treatment, and prevention of psychiatric conditions, which are the most effective and beneficial
to the health care of patients in each particular group. Besides creating research and innovation,
we also train undergraduate and graduate students and post-doctoral researchers to become
medical technologists and scientists with the required competencies for the personalized
medicine era.

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Education in medical technology has changed my life. As an educator, I strongly hope to createan academic and research network between my university and national/international
collaborators. We will join together to continue to change students’ lives by providing quality
education and innovation in medical technology/biomedical laboratory science, supporting
each other in training medical technologists/biomedical laboratory scientists and teachers forthe 21st Century, all of which will eventually improve the quality of life for all people aroundthe world and lead to the sustainable development of our world.
Interviewer:
Dr. RyunosukeOhkawa, Ph.D.
Professor of Analytical Laboratory Chemistry,
Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University.
Member APFCB Committee-Communication & Publications (CP)54

APFCB News 2023 Issue 2

Industry Voice Section

Heart Attack Diagnosis at The Bedside
Can Now Take as Little as 20 Minutes
Curtis Marsh, Director of Global Product Management for Quidel Ortho,
headquartered in San Diego, California

Several conditions, such as chest pain, have similar symptoms to a heart attack.
Doctors need to be able to distinguish between them quickly and confidently.
When a person is experiencing a heart attack, every minute counts. Faster diagnosis
means faster treatment and less tissue death. But the symptoms of heart attacks are
similar to other conditions, such as panic attacks and gastroesophageal reflux disease.
All these conditions may lead patients to the emergency department (ED) where theypotentially wait hours for critical test results, while still unsure if they’re having a heart
attack. Quidel Ortho’ s latest cardiac test, Quidel®TriageTrue® High Sensitivity
Troponin I Test (TriageTrue), can be used at the patient’s bedside as an aid to diagnosea heart attack within 20 minutes. Curtis Marsh explains how this test benefits thepatients, doctors, and healthcare system.
What does QuidelOrtho’sTriageTrue test measure?
Triage True measures a protein called Troponin I, found in heart muscle, which isnormally present in the blood at extremely low levels. A damaged heart releases
troponin, so elevated levels can mean the patient is having a heart attack.
Since some small amount of troponin is always present in the blood, it’s important thata test be sensitive enough to discern normal levels from those that indicate cardiac
damage. Given that a heart attack is defined as a change in troponin over time with atleast one measurement above the cutoff, multiple readings are required, reinforcing
the need for a high-sensitivity test to detect true changes.

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Industry Voice Section

What makesTriageTruea high-sensitivity troponin test?
Clinical organizations, such as the International Federation of Clinical Chemistry andEuropean Society of Cardiology (ESC), have defined the requirements for a highsensitivity troponin assay. These requirements include metrics to ensure that the assay
performs at a high level of sensitivity, accuracy, and precision. TriageTrue was able toachieve the designation of high sensitivity by fulfilling such analytical requirements.
How is this test used at the patient’s bedside?
TriageTrue runs on Quidel’snear-patient instrument called the Triage MeterPro®, which
can also analyze a full complement of cardiometabolic biomarkers and toxicology
drugs. It’s a compact, easy-to-use fluorimeter that provides quantitative biomarker
concentrations
The test cartridge runs a whole blood or plasma sample and works as a lateral flow
immunoassay. When the patient sample is added, it flows through the cartridge by firstmixing with the fluorescently labeled antibodies which bind to the biomarker (e.g.,
troponin). These biomarker-antibody conjugates are then captured on the diagnostic
lane, where the meter’s laser and photodiode determine the fluorescent signal, applyanalgorithm, and ultimately the biomarker concentration. This process takes less than 20
minutes.

The high sensitivity comes from a redesigned cartridge, which includes a ‘passive
mixing well’ (1) to homogenize the sample, a 'microfluidic pinch' (2) to physically slow
the flow and increase the binding of troponin to the fluorescently labeled antibodies,and an improved normalization algorithm which takes place in the diagnostic lane (3)How does Triage True achieve high sensitivity?
We redesigned several features of our cartridge. The improved filter pocket isextremely efficient separating red blood cells and conditioning the sample. We also
added a ‘passive mixing well’ to make the sample treatment more homogenous.

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The major contributors to the sensitivity and precision of the assay are the ‘microfluidic
pinch’ and the normalization process. The pinch slows the flow of the sample,
increasing the mixing and binding between troponin and the antibodies. This allows
for significant signal, even with low levels of troponin.
Normalization works by comparing assay and control signals generated in the
diagnostic lane. When these immunofluorescence signals are compared and thenconverted to a concentration, the result is normalized. Normalization is used in many
immunoassays to adjust for any signal variation attributed to deviations in total
available fluorescence, binding, interferences, etc.
Why does high-sensitivity testing at the point-of-care matter?
The benefit is the quick time to result for every patient, especially given the tightening
guidelines. It used to be that two high-sensitivity troponin tests given three hours apartwere adequate for diagnosing a heart attack; now the guidelines recommend two highsensitivity tests, one hour apart. However, current troponin testing is often done in a
hospital’s central lab, which isn’t close to the ED. Therefore, the time to get thetroponin result can be an hour or more, hindering the doctor’s ability to rapidly
diagnose the patient.
Triage True replaces this time-consuming process, allowing doctors to quickly andreliably get high-sensitivity troponin results within 20 minutes and thereby accelerate
the diagnosis. The earlier the diagnosis, the earlier doctors can give the correct
treatment, leading to better outcomes.
The healthcare system also ultimately benefits from this advancement. Of all thepatients in the ED with chest pain, most of them aren’t having a heart attack. But untilthat diagnosis is made, these patients are taking up a bed in the ED, nervously waiting
for a diagnosis. TriageTrue can improve ED workflow by quickly identifying low-risk or
non-cardiac patients, who can then be triaged faster and more confidently.
What’s the status of TriageTrue in Europe and the US?
TriageTrue was launched in Europe in 2019. In March 2020, TriageTrue performancein the APACE study cohort was published in the Journal of the American College of
Cardiology by Dr. Jasper Boeddinghaus, who is part of Professor Christian Mueller’s
team at the Cardiovascular Research Institute Basel. The publication independently
demonstrated that TriageTrue had very high diagnostic accuracy and clinicalperformance that’s comparable to central lab assays. Also, the study validated a 0/1hour algorithm for TriageTrue which was independently published in the guidelines of
the ESC.
TriageTrue is not yet available in the U.S. The U.S. clinical trial to support an FDA
submission is underway.
Report by:
Curtis Marsh is Sir Director, Global Product Management at
Quidel Ortho Email Id – Curtis.Marsh@quidelortho.com

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APFCB News 2023 Issue 2

Industry Voice Section

New ACMG guidelines shape NIPT uptake in
Asia PacificDr. Patrick Danoy,
APAC Business Manager, NGS Sample Prep & NIPT, Roche Diagnostics Asia Pacific,
Singapore
This article originally appeared on labinsights.com.
The rise of non-invasive prenatal testing (NIPT) has been one of the biggest success stories inlaboratory medicine in recent decades. For many pregnant patients, a simple blood test targetingcell-free placental DNA can significantly reduce the need for invasive alternatives such as
amniocentesis or chorionic villus sampling (CVS) that introduce a small but real risk of
miscarriage.
If pregnant women are part of the patient population served by your clinical laboratory, NIPT is
an important capability to add to your test menu if it has not yet been implemented. Recent
updates to guidelines for prenatal screening from the American College of Medical Genetics andGenomics (ACMG) are likely to increase demand for NIPT around the world, including in Asia
Pacific.
According to those guidelines, published late last year, ACMG makes a “strong recommendation”
that all pregnant women carrying single babies or twins should be tested with NIPT instead of
traditional prenatal screening methods. Specifically, ACMG recommends NIPT as the preferred
method to screen for:

Trisomy 21 (Down syndrome)Trisomy 18 (Edwards syndrome)Trisomy 13 (Patau syndrome)Sex chromosome abnormalities / aneuploidy

For each of these conditions, ACMG relied on evidence showing that detection rates are excellent
better than 98% for trisomies 18 and 21 and sex chromosome abnormalities, with the detection
rate for trisomy 13 around 93%.
While the guidelines indicate that additional screening targets, such as microdeletions and rareautosomal trisomies, are future areas of interest, the ACMG has not issued arecommendation forusing NIPT for this purpose across all pregnant women.

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APFCB News 2023 Issue 2

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NIPT uptake in South Korea and Singapore
In laboratories offering targeted NIPT products for prenatal screening, these tests havebeen welcomed by physicians and patients. At Seoul Clinical Laboratories in Korea, forexample, Dr. Mikyeong Lee and Dr. Bryan Lee saw so much demand for NIPT results thatin 2021 they shifted to a system that allows them to perform screening in their own lab
without the need for extensive informatics support or expensive sequencing instruments
In Korea, the average age of pregnant women has been steadily rising; today, at least athird of all expecting mothers are considered high-risk. That makes NIPT a criticalalternative to invasive tests that could add to the risk.
“Literally every baby is precious,” says Dr Mikyeong Lee. “While NIPT is not a diagnostic
test, it screens out low-risk pregnancies, so physicians can provide a rationale when
performing invasive testing for chromosomal abnormalities. Having a low-risk result at
screening will greatly reduce any stress a pregnant woman will have about her baby’s
health.”Dr Bryan Lee notes the value of selecting a test limited to the targets recommended by
ACMG or other professional guidelines. “When only abnormalities included in practicalguidelines such as the recent ACMG guidelines are tested, there is no need for lengthy
consideration on whether the test is appropriate,” he says. “On the other hand, NIPT tests
that utilize other less proven technologies or are not as widely used will inevitably incur
higher costs and require more effort.”
Meanwhile, in Singapore, physicians at Singapore General Hospital have offered NIPT
capabilities since 2017 and their patients have responded well. A local study publishedin 2022 showed that patients appreciated the higher detection rates and lower false positive rates of this kind of testing. Physicians have also been happy, especially because
NIPT has fewer timing restrictions compared to conventional tests that have to be done
at very specific points in gestation.
“NIPT is a test with increasing demand and laboratories should consider if they can help
with fulfilling this demand,” says Dr Tan Lay Kok at Singapore General Hospital. “Keyfactors to consider would be laboratory expertise, commercial viability, and clinical needin the patient pool.”
Addressing concerns from patients and clinicians
Even in the early years of NIPT availability, the technique rapidly replaced traditional
invasive tests that had been used for decades. But NIPT is still based on a relatively young
technology, and as such, it has encountered growing pains among clinical audiences andthe general public.
Concerns about the use of NIPT are often based on a misunderstanding about the
purpose of this kind of testing. NIPT is intended as a screening tool rather than as adiagnostic test; any positive findings should be followed up with traditional methods
such as amniocentesis or CVS for confirmation.

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While this is common knowledge within the clinical lab community, many obstetricians
and general practitioners are not fully aware of this or may fail to explain it adequately
to patients prior to testing. Without that valuable context, false positives can be seen as
catastrophic by patients.
Those false positives tend to come from areas of testing that go beyond ACMG
guidelines, such as microdeletions. Even though NIPT products that promise to test amuch larger number of targets may be enticing to patients and physicians alike, choosing
a test that only screens for the current ACMG targets — trisomies 21, 18, and 13 alongwith sex chromosome abnormalities — allows clinical laboratory teams to report themost relevant and reliable results without getting into problematic areas of lower
accuracy and the possible onslaught of follow-up testing that ensues.
References:[1]

Sim, W.S. et al. (2022) ‘Preferences for a non‐invasive prenatal test as first‐

line screening for Down syndrome: A discrete choice experiment’, Prenatal Diagnosis,
42(11), pp. 1368–1376. doi:10.1002/pd.6239.
[2]

Baldus, M. (2023) ‘overestimated technology – underestimated consequences’ –reflections on risks, ethical conflicts, and social disparities in the handling of noninvasive prenatal tests (nipts) - medicine, health care and philosophy, Springer Link.
Available at: https://link.springer.com/article/10.1007/s11019-023-10143-1.
[3]

Matloff, E. (2022) What the NYTimes got wrong on prenatal screening, Forbes.

Availableat:https://www.forbes.com/sites/ellenmatloff/2022/01/06/what-the-nytimes-got-wrong-on-prenatal-screening/? sh=418f1e8537a7.

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APFCB News 2023 Issue 2

Industry Voice Section

Roche Experience Days (Red) 2022 Post-Event
Summary Report
WesleyWong,

Consulting

Team

Manager,

Application&

Consulting,Roche

Diagnostics Asia Pacific, Singapore

At last year’s edition of Roche Experience Days (RED), an annual thought leadershipconference hosted by Roche Diagnostics Asia Pacific, healthcare experts from across Asiaand around the world came together to discuss key trends that will impact laboratory
medicine. The event attracted thousands of attendees globally, making RED 2022 one of
the largest and most impactful laboratory thought leadership events in the Asia Pacificregion—and the world.
The theme of the event, which was held on 15-16 November 2022, was “Shaping the
Future of Healthcare Excellence,” and the programme offered a glimpse of both thecurrent and future needs of a rapidly changing healthcare landscape. This includes ourongoing transition to a post-COVID world, in which many healthcare organizations are
shifting focus from pandemic management back to more routine operations, and looking
to drive greater innovation and superior patient experience.
The Programme
Clinical labs are also transforming in order to cope with this new direction. To help theaudience to get more insights on these topics, the programme included the following(click on the links to watch the full sessions):
Partnering Patients: Strengthening the Patient Voice within Health Systems in Asia PacificSpeakers: Genevieve Woo (Presenter, Channel News Asia (CNA Singapore)), Lance Little(Managing Director, Asia Pacific Region, Roche Diagnostics Asia Pacific)
Labs Of The Future: Enablers for Patient-Centred Care
Speakers:Genvieve Woo (Presenter, Channel News Asia (CNA Singapore)), Dr. Robert
Grenfell (Public Health Physician, Chief Strategy and Regions Officer, Grampians Health
Australia), Dr. Kuldeep Singh (KS) Sachdeva (Regional Director, The Union South-East
Asia, International Union against Tuberculosis and Lung Disease, India), Dr. DewiMuliaty(President Doctor, PT ProdiaWidyahusadaTbk, Indonesia)

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Industry Voice Section

Reduction, a new educational topic for medical technologists
Speaker: Dr. Raja Elina (President, Malaysian Association of Clinical Biochemists (MACB),
Malaysia)
President of FET, a telecommunication company to talk about 5G and telemedicine
Speaker: Dr. Chee Ching (President, FarEasTone Telecommunications Co, Taiwan) New
Technologies for diagnostic laboratories in logistics, instrumentation, and precision
medicine
Speakers: Dheeraj Jain (Founder & Managing Director, Redcliffe Labs, India), Dr. Imran
Nazir Ahmad (Chief of Pathology and Director of Laboratory, Shifa International Hospital,
Pakistan), Prof Markus R. Wenk (Professor, Precision Medicine Translational Research
Programme, Yong Loo Lin School of Medicine, National University of Singapore,
Singapore)
APACMed shared their plans on how to shape healthcare ecosystems, including
whitepapers published
Speakers: Chris Hardesty (Strategic Advisor, Asia Pacific Medical Technology Association,
Singapore), Dr. Roberta Sarno (Director of Digital health, Asia Pacific Medical Technology
Association, Qatar)
A4HPV and Singapore Heart Foundation - 2 non-profit organizations that had patientadvocates come to share their stories
Speaker: Summer Ng (Patient Advocate, A4HPV, Singapore), Yvonne Ng (Founder, A4HPV,Singapore), Sandy Yzelman (Patient Advocate, Singapore Heart Foundation, Singapore)
Rare genetic disease and the diagnostic odyssey: a caregiver’s journey
Speaker: Will Greene (Healthcare Engagement Lead, Roche Diagnostics Asia Pacific,
Singapore)
Virtual reference site visit: Changi General Hospital Singapore
Speaker: Clinical Assistant Prof Jansen Koh (Chief, Department of Respiratory & ClinicalCare, Changi General Hospital, Singapore)Intellect - Start-up Company that discussed Mental Wellbeing and Resilience in theworkplace2022 was the third year in a row that RED was run as an almost exclusively virtual event. To help
reach a multilingual audience from across Asia Pacific, we offered real-time language
interpretation in Chinese, Korean, Thai, and Vietnamese. We also partnered with Channel News
Asia (CNA), a Singaporean multinational news channel,
To co-create the ‘Diagnostics Media Forum’, which will be broadcast on TV in Q1 2023.
Since Roche believes strongly in social responsibility and environmental stewardship, the event
also included interactive polling that allowed the audience to choose the location of where toplant 1000 trees by Eco Matcher, a social enterprise. Polling results chose the location of the‘Roche Forest’ in KoSiboya, Thailand.
The Outcome
2022 was the biggest year yet in our annual RED event series. The sessions drew more than
21,000 registrants and over 5,000 viewers for our live event. The feedback also showed thesuccess of the event with an average 64.9 net promoter score.

62

APFCB News 2023 Issue 2

Expert Opinion Paper

Quality Control Systems

Dr. Tony BadrickCEO, RCPAQAP Australia
Laboratory results are a key enabler of disease diagnosis and the management of effective
treatment. Therefore, clinical laboratories have a responsibility, often mandated, to provide
results that are fit for those purposes. This means the assays must have stable characteristics
and produce consistent results from day to day. Quality systems such as ISO 15189 have been
produced by the international laboratory medicine community to provide a management andtechnical structure to assist laboratories in achieving these goals [1]. The Quality system includes
governance processes, document control, equipment maintenance, staff training, andcompetence requirements to provide the essential supporting framework to build the capability
needed to create and produce consistent results. However, the essential process that must be
understood and utilised every day by most technical staff to produce patient results is theprinciples of quality control (QC).
When we think of internal quality control, we usually consider putting the quality control samples
onto the analyzer, reviewing the sample results using certain rules, and not much more. But there
is more than this to a quality control system [2]. It consists of the following concepts; anunderstanding of error, a sample to use to determine of the analytical system is in control, a setof rules and acceptable ranges for the QC result, a process to follow if the QC sample is not incontrol including troubleshooting possible causes and subsequent rectification of the problem
including verification that the problem is fixed, identification of any patient results which may
need to be rerun, and a process to escalate these patient risk results.
Let us consider each of these components of the QC system.
Firstly, an understanding of error. We design a QC system to detect errors, but only the errors we
expect to find. In analytical systems, we identify two types of error, a shift in the mean of the QC
sample (bias) and an increase in the standard deviation (SD) of the distribution of QC results(imprecision). These two errors are related to the two components of the Gaussian distribution of
the QC results, that is the mean and SD of repeated assays of the QC sample. This is a criticalpoint to understand, as the success of the rules we will use ultimately depends on the accuracyof this mean and SD. There are guidelines that provide advice on how many QC samples areneeded to determine these two parameters.

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Expert Opinion Paper

To assess if the assay is in control, we will run a sample, a QC sample that we expect will behave
the same way that a patient sample behaves in the assay so that a change in the assay that affects
patient results will be reflected in this QC sample [3, 4]. The QC sample is usually prepared frompooled human serum samples but has been modified by spiking to produce higher values,
filtering, adding preservatives, and lyophilization [5]. These steps are necessary to make thematerial stable and useful, but they may impact the way the sample behaves in the assay
compared to a patient sample.
Next, we select rules that will identify when a QC sample result is outside the expected statistically
acceptable variation. We recall that the Gaussian (normal) distribution predicts that 95% of theresults should lie within the mean plus or minus two SDs, and 99% will lie within the mean plus
or minus 3 SDs. Using the properties of the Gaussian distribution, we can derive the probabilityof two or more QC sample results occurring in certain patterns, for example, two results occurring
within the mean plus or minus two SD. These rules are the Westgard rules, and they rely on QC
sample results following the Gaussian distribution [6–8]. Note that these rules are determined to
identify statistically significant differences from the QC sample distribution when the assay is incontrol. For instance, these rules will not reduce patient harm from incorrect results if thestatistically significant difference is greater than a clinically significant change! [9]When a control rule alarms, meaning that the QC sample result is outside the statistically expectedvariation range, then, patient results may have an error that could affect their interpretation. Notethat we are assuming that a shift in bias or SD that is statistically significant may not be clinicallysignificant. There are common and uncommon causes of a change in the QC value. The mostcommon cause is a problem with the QC material itself [10]. It may have been incorrectly prepared(reconstitution or thawing), maintained (evaporation or deterioration), or handled (wrong QC
sample used. Other causes include reagent lot changes, calibrator lot, instrument malfunction, or
inappropriate operator intervention. To determine which of these has occurred and if there has
been an impact on patient results, there needs to be a documented and understood process oftroubleshooting, rectification, and verification that the assay is back in control [11].
If there has been a problem with the assay that has been detected by the QC sample, then it isessential that any patient samples affected are identified. Again, there should be a documented
process that may involve sample every fifth or tenth patient sample looking for a significant
difference in the two results from the patient. Then these patient results should be amended, andthe clinicians notified where this is deemed necessary in terms of patient risk.
The system above relies on several basic issues. The QC sample behaves the same way as a patient
sample, there is a relationship between a statistically significant difference detected by the QC
rule and a clinically significant result, and the frequency of QC samples used will detect an error
in a timely manner. Sohow can we incorporate these concerns into our QC strategy?
The first problem relates to the commutability of the QC sample, dose it Bhave as a patient sample
does in the assay? This is difficult as many QC materials do not, and it is not an easy task to provethat the QC material is commutable. There are other approaches to QC [12], but conventional QC
will be with us for some time, so we need to be aware of this issue. When changing reagent lots,
it is worth using previous patient samples to ensure that these changes do not lead to drift inpatient results that May not be detected by conventional QC.

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The next problem is the frequency of QC samples [13]. Originally when the Westgard rules weredeveloped, patient samples were bracketed by QC samples, and a ‘batch’ of patient results was
not released until the QC sample at the end of the batch passed assessment. Now patient results
are usually released as soon as they are analysed, so a QC failure will be detected after results
have been sent to the referring clinician. This has occurred because modern instrumentation isextremely reliable and stable. There are a few times when there is an analytical failure. However,this can breed complacency in operators [14]. There are few QC failures and most of those occur
because of the QC material itself. Operators will see few real failures due to the reagents or
instrument. The infrequent failures lead to the risk that when a real failure occurs, it will not be
detected or responded to.
There are some steps we can put into place to ensure laboratories build processes that can
mitigate against these potential errors [15].
Try to make the time between QC evaluations no longer than the time needed to correct
results before they’re acted on.

Always end patient testing with a QC evaluation.

Know the number of patient results between QC evaluations.



If you’re using a 1:2s QC rule and you get a rule failure, repeat it - but just once!

Estimate your measurement procedure’s reliability.



Devote more QC to analytes with a high probability that erroneous results lead to patient
harm.



Devote more QC to analytes with high expected severity of patient harm from anerroneous result.

These can be useful to apply every day. But QC is poorly understood and practiced today [16]. We
all need to think about what we do and why do it!
References:
1. ISO 15189:2022 Medical laboratories — Requirements for quality and competence, ISO. (2022).
2. T. Badrick, The quality control system, Clin Biochem Rev. 29 Suppl 1 (2008) S67- 70.
3.

W.G. Miller, G.L. Myers, Commutability still matters, Clin Chem. 59 (2013) 1291– 1293.

https://doi.org/10.1373/clinchem.2013.208785.
4. W.G. Miller, G.L. Myers, R. Rej, Why commutability matters, Clin Chem. 52 (2006) 553–554.
https://doi.org/10.1373/clinchem.2005.063511.
5. P.M.S. Clark, L.J. Kricka, T.P. Whitehead, Matrix effects in clinical analysis: commutability ofcontrol materials between the Ketchum, Beckman and SMA 1260

glucoseandurea

methods,

Clinica

Chimica

Acta.

113

(1981)

293–303.

https://doi.org/10.1016/0009-8981(81)90282-5.
6. J.O. Westgard, S.A. Westgard, Establishing evidence-based statistical quality control practices,
Am J ClinPathol. 151 (2019) 364–370. https://doi.org/10.1093/AJCP/AQY158

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7. J.O. Westgard, Statistical Quality Control Procedures, Clin Lab Med. 33 (2013) 111–124.
https://doi.org/10.1016/j.cll.2012.10.004.
8. A. Katayev, J.K. Fleming, Past, present, and future of laboratory quality control: patient- based
real-time quality control or when getting more quality at less cost is not wishful thinking, J Lab
Precis Med. 5 (2020) 28–28. https://doi.org/10.21037/jlpm-2019-qc-03.
9. M. Panteghini, F. Ceriotti, G. Jones, W. Oosterhuis, M. Plebani, S. Sandberg, Strategies to define
performance specifications in laboratory medicine: 3 years on from the Milan Strategic
Conference, Clin Chem Lab Med. 55 (2017) 1849– 1856. https://doi.org/10.1515/cclm-20170772.
10. P.J. Howanitz, G.A. Tetrault, S.J. Steindel, Clinical laboratory quality control: A costly process
now out of control, Clinica Chimica Acta. 260 (1997) 163–174. https://doi.org/10.1016/S00098981(96)06494-7.
11. G. Jones, J. Calleja, D. Chesher, C. Parvin, J. Yundt-Pacheco, M. Mackay, T. Badrick, Collective
Opinion Paper on a 2013 AACB Workshop of Experts seeking Harmonisation of Approaches to
Setting a Laboratory Quality Control Policy, Clin Biochem Rev. 36 (2015) 87–95.
12. H.H. van Rossum, A. Bietenbeck, M.A. Cervinski, A. Katayev, T.P. Loh, T.C. Badrick, Benefits,
limitations and controversies on patient-based real-time quality control (PBRTQC) and theevidencebehindthepractice,

Clin

Chem

Lab

Med.

59

(2021)

1213–1220.

https://doi.org/10.1515/cclm-2021-0072.
13. C.A. Parvin, A.M. Gronowski, Effect of analytical run length on quality-control (QC)
performance and the QC planning process, Clin Chem. 43 (1997) 2149–2154.
14. T. Badrick, A.S. Brown, Identifying human factors as a source of error in laboratory quality
control, J Lab Precis Med. (2023).
15. C. Parvin, J. Jones, QC design: It’s easier than you think. MLO. 2013; 45(12):18- 22. Medical
Laboratory Observer. 45 (2013) 18–22.
16. C. Parvin, J. Jones, QC design: It’s easier than you think. MLO. 2013; 45(12):18- 22. Medical
Laboratory Observer. 45 (2013) 18–22.

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A New Horizon of Biochemistry and Laboratory
Medicine with Chat GPT
Kazuhiko Kotani1, 2, 4, Pradeep Kumar Dabla3, 4
1. Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
2. Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
3. Department of Biochemistry, G.B. Pant Institute of Postgraduate Medical Education andResearch (GIPMER), New Delhi, India
4. MHBLM Committee, International Federation Clinical Chemistry and Laboratory Medicine (IFCC),
Milan, Italy

Corresponding Author
Prof. Kazuhiko Kotani, kazukotani@jichi.ac.jp
Artificial intelligence (AI) is capable to simulate human intelligent behavior and critical thinking
using computer and machine technology. At present, AI is transforming many fields of societies,
including the medical field. One of the most recent topics in AI- based medicine is the Chat
Generative Pre-trained Transformer, “ChatGPT” in brief, for generating human like text, which
gives answers to queries in natural language processing. It led the world to the transformative
potential of artificial intelligence (AI) with rare unexpected creativity. This is such a generative AI,
and would be so helpful for building up knowledge and providing interpretations. It is part of thefamily of generative pre-training transformer (GPT) models that can engage with people to answer
questions and uses natural language processing models. It is the largest publicly available
language models in current state.
It is also expected to revolutionize the fields of biochemistry and laboratory medicine. On theother hand, the studies in the field have just begun. A study has been recently reported from thebiochemical specialists of Indian institute (Ghosh A, 2023). That study examined the responses
to biochemistry questions that require higher-order
Thinking. In total, 200 questions, which were selected from the question bank for the competency
modules of a valid curriculum, were used for that study. When the specialists evaluated the
responses on a 5-point scale, the score was mostly 4 out of 5 points. It implicates that ChatGPT
has the potential to resolve questions on biochemistry.
Another study has been recently performed by the European Federation of Clinical Chemistry andLaboratory Medicine Working Group on Artificial Intelligence (Cadamuro J, 2023). That study
examined the ChatGPT-v4.0’s interpretations of laboratory reports based on the popular test items.
The specialists evaluated the ChatGPT’s interpretations of 10 cases the reference intervals andpractical units of test items,as67

APFCB News 2023 Issue 2

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well as the patient’s age and gender attributes. The evaluation of interpretations was relatively
high in terms of relevance, correctness, and safety, but not helpfulness. In some cases, there wereincomplete interpretations of test items. Interpretation in considering therapy (e.g., drug dosing)appeared to be difficult. The authors have concluded that presently, ChatGPT may interpretlaboratory reports on a test-by-test basis, but not the full picture. In research purposes, it has
shown the importance of analyzing huge amounts of available literature beyond the scope of asingle individual's expertise which helped to reduce the time, energy, and resources spent on
experiments that may have a higher probability to obtain futile results (Cahan P, 2023).
Given the small number of studies, the value of ChatGPT is yet to be determined in the fields ofbiochemistry and laboratory medicine. However, the development of AI-related medicine
continues and its apparent potential advantages cannot be denied including expediting research
workflows by aiding in data management, candidate selection in trials, and supporting overall
research activities. Thus, it can prove helpful in enhancing the productivity of research work.
Extending further, the ChatGPT can potentiate the efficiency of academic publishing while helping
to review the manuscripts and their editing. Inpatient care, its potential cannot be denied forpatient education and assistance in clinical decision-making.
Further, ethical considerations are soon necessary. It cannot be neglected that the speed oftechnology evolution and adoption requires paying close attention to any medical, ethical, legal,
and reputational risks. Human specialists-ChatGPT collaboration will become even more
important for the future of biochemistry and laboratory medicine. In its current state, it lacks thecapability to offer comprehensive diagnosis while giving critical thinking and originality which isimportantly required in healthcare while removing potential biases involved. Thus, it still seems
a distant approach while replacing the inherent human qualities and reasoning that are important
to medical practice. Thus, instead of implementing the technology hastily; it should be inclined
towards its careful introduction and to open a debate about its risks and benefits.
References:
1. The Lancet Digital Health. ChatGPT: Friend or foe? Lancet Digit Health. 2023; 5: E102.
2. Ghosh A, Bir A. Evaluating ChatGPT’s stability to solve higher-order questions on thecompetency-based medical education curriculum in medical biochemistry. Cureus. 2023; 15:e37023.
3. Cadamuro J, Cabitza F, Debeljak Z, De Bruyne S, Frans G, Perez SM, Ozdemir H, Tolios A,
Carobene A, Padoan A. Potentials and pitfalls of ChatGPT and natural-language artificial
intelligence models for the understanding of laboratory medicine test results. An assessment by
the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group on
Artificial Intelligence (WG-AI). Clin Chem Lab Med. 2023; 61: 1158-1166.
4. Gruson D, Dabla PK. Artificial intelligence and laboratory medicine: at the crossroads of value
ethics and liability. APFCB News. 2023; 1: 69-70.
5 . Cahan P, Treutlen B. A conversation with ChatGPT on the role of computational systems biology
in stem cell research. Stem Cell Reports. 2023 Jan 10; 18(1):1

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Laboratories Need To Apply Green Principles

Dr. Endang Hoyaranda
Indonesian Association for Clinical Chemistry

We do not inherit the earth from our ancestors; we borrow it from our children
The world has been struggling for decades to preserve the earth. Despite the efforts of various
governments, foundations, groups to lead greener movements, the earth is still suffering fromincreased global warming, pollution, North pole and Antarctic melting, and of course diseases
in humans and animals.
We want to inherit a better world to our next generations. We need to ask ourselves, what we do
NOW is going to improve the sustainability of the earth or will worsen the current situation of
global warming. Mr. Barack Obama mentioned in his quote: “We are the first generation to feelthe impact of climate change and the last generation who can do something about it”.
The awareness of mankind to contribute to the preservation needs to be increased. All industry
leaders shall be leaders in environmental preservation movements. In particular, industries
utilising large amounts of natural resources or producing waste which contributes to theincreased worsening of the environment, should contribute the most to the efforts of giving backto nature.
Where does the medical laboratory stand?
Medical laboratories are one of the main sources of energy consumers and waste generators.
Clinical laboratories are said to consume 10 times as much energy compared to offices. It also
consumes 4 times as much water than offices. Scientific laboratories in general produce 5.5
million tonnes of plastic waste alone every year, which is 1.8% of the plastic waste produced
worldwide. Hardly any other place uses as much plastic as hospitals for hygienic reasons. Medicallaboratories consume a lot of disposable plastics especially for use on patients, and with the same
reasons: Hygiene which remains uncompromisable. Nothing may come as a higher priority thanpatient safety, which forces the laboratory to use disposables. And then comes safety in theworkplace, which is also an important reason to use disposables. Considering those reasons, it
seems not to be close to the horizon that plastics disposables will see a reduced utilization in thenear future. Although said as not necessarily a utopia, the road to reducing the use of disposable
plastics is still long. So what can we do as medical laboratory practitioners, to help the earth fromgetting worse?

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The following, although not a Pandora’s Box, may serve as ways for us to contribute.
There are at least four ways the medical lab practitioner can contribute to. Firstly: design a green
building, if you have the liberty and access to it; secondly: create and implement policies on
resource utilization and waste management; thirdly: implement environment best practices andhabits in the workplace, and fourthly: imply policies on utilization of eco-friendly products.
1.

Design of a green building

Not every lab can be designed according to green building principles, as many laboratories occupy
already existing buildings, but if one has the luxury of starting a lab from anew, the following aresome important features of a green laboratory building: Orientation of building towards sunrise, so that individuals working in the building will haveaccess to morning sun.
 Easy to accessed be by public transport so workers and service users can reach the lab withminimal use of time and energy.
 Recycling facilities within premises Unused land and rooftops turned into gardens Utilisation of recycled materials for construction
 Maximum use of natural light, with low emissivity glass, high windows Water conservation by storing rainwater, and using water from sewage for toilets flushing andlandscape irrigation
2.

Creating and implementing policies on resource utilization and waste management

Lab management needs to understand more about what policies on resource utilization and waste
management can be implemented?


The most effective approach to green resource utilisation is to use eco-friendly equipment
for air conditioning, lights, toilets. Motion sensor lights, which are switched on and off whenpeople enter or leave, green air conditioning system using ‘variable refrigerant volume’ which
can increase air conditioning efficiency by 30% or more, toilets which flush with 4.5 literinstead of 6 liter water, waterless urinoirs, motion sensor faucets, just to mention some.



To minimise utilisation of clean water, use stored rainwater and waste water instead for toilet
flushers and watering the gardens.

Standard laboratory waste management shall be practiced, with as much recycled products
used as possible.

3.

Implementing environment best practices and habits in the workplaceIt has been a worldwide recommendation for all citizens of the earth since the last decadethat people shall not use disposable plastic cups. A personal tumbler usage policy shall be astandard policy for all medical laboratories.
For all plastic use, it is mostly common to urge on usage of reusable plastic or other materials.
However, although recycled materials are already a step forward, the recycling process itself

xin practice is not as easy and simple. That is why as long as reusable materials are available,
this must be the choice before recycled materials.
Each laboratory shall have a policy on paper consumption. Which documents are allowed forprinting, how much paper in the kitchen or toilets are to be used, shall be policies
implemented with enforcement.

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Whenever possible, laboratories shall implement the R5 policy and audit it periodically. R5stands for: Reduce, Reuse, Recycle, Replace, Replant. Reduce everything possible to increase
efficiency: waste, electricity, water, paper. Reuse waste like plastic bottles as plant pots, etc.
Recycle whatever is recyclable. Replace as much eco-unfriendly materials with eco-friendly
materials like fabric towels instead of paper towels. Replant, or reforestation as much plants
in gardens and lands to serve as buffer.

Implement a freezer usage policy: periodic defrosting, cleaning out of unneeded materials,

4.

Implementing policies on utilization of eco-friendly products

What are categorized as eco-friendly products? In principle, eco-friendly products are products
which cause minimal harm to people and the environment.
Some characteristics of eco-friendly products are:

Products which are not produced using a lot of resources (electricity, water, pesticides, etc)Renewable energy from wind, solar, rain, waves, geothermal sources, plants, are good
resources alternatives whenever available

Products made of recycled material – yard waste, recycled glass-paper-plastic, rather thanaluminum cans which needs 500 years to decompose.



Products which are produced in a manner producing minimal harmful waste.

Some features are: not containing chlorofluorocarbons, or hydro-chlorofluorocarbons, orother ozone-depleting substances; low embodied energy (energy required to produce andtransport the materials and products)

Some eco-friendly PPE: organic cotton or recycled material laboratory coats; nitrile gloves;reusable and biodegradable goggles, polyethylene shoe covers.

All the above are opportunities of individual labs. Apart from that, group of medical laboratory
practitioners may start movements, perhaps in collaboration with the IVD industry in raisingawareness of practitioners by conducting surveys, or creating self-assessments for laboratories.
Self-assessments may serve as awareness tools and if followed with site visits may also serve ascompetition programs. Even a simple freezer usage competition may work as an effective toolin raising awareness. Greenlab leaders in the country/region may conduct webinars continuously
as to keep the awareness at a high level.
The road to a green earth is still very long, and some may think is impossible, as mankind
nowadays live with the comfortability of today’s technology and convenience, but there is noother choice than striving for embitterment. Because we want the coming generations to live ina livable world, eating healthy food and breathing healthy air. To quote a saying from theAboriginals: “Look after the land and the land will look after you, destroy the land and it will
destroy you”.
Jakarta, 29 July 2023

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Global Medlab Week 2023

Prof. Rajiv Erasmus
Dr. Maria Schroeder-Castagno
Dra. BQF. María del C. Pasquel
The Global Medical Lab Week celebrations is now in its second year. Its role is to highlight thevital role of the clinical laboratory professionals in health care, public health and the diagnosis of
disease. The recent COVID19 epidemic highlighted the critical role laboratory professionals’
played in the diagnosis and monitoring of patients with COVID19. This year the GMLW took placefrom 23rd to 29th April and was principally organized by the Committee on Public Relations (CPR), a subcommittee of the Communications and Publications Division (C-PD Committee).
Like last year this was highly successful thanks to the collaboration of professionals from the 96
member countries that are part of the IFCC and that are within the 6 large federations that makeit up: African Federation of Clinical Chemistry (AFCC), Arab Federation of Clinical Biology (AFCB ),Asia Pacific Federation of Clinical Biochemistry and Laboratory Medicine (APFCB), Latin American
Confederation of Clinical Biochemistry (COLABIOCLI), North American Federation of Clinical
Chemistry and Laboratory Medicine (NAFCC).
The successful global Campaign was also possible because C-PR additionally received thefundamental support and tight cooperation from different IFCC Committees, Groups and Task
Forces, to organize the GMLW 2023. For example, the Task Force of IFCC Young Scientists (TFYS)

proposedtheinitial

ideas

and

greatlypromotedthemaking

of

the

video

“LiveMyLab”considering it a very valuable tool of easy communication of our role as lab
professionals in patient welfare with public and health system-professionals. Furthermore, theIbero-American Working Group on Nomenclature and Translation (WG-IANT), its Chair Dr. Raúl
Girardi, from Argentina, held WhatsApp groups between the member responsible for the C-PR,
Dr. Maria Pasquel.The National Representatives and the champions of each country also played acritical role introducing dozens of videos and podcasts that were made in which activities carriedout by the clinical laboratory professionals were made known for the benefit of the general public
and other non-laboratory healthcare professional groups.
The Internet and Digital Communications Committee (C-IDC) was very helpful and collaborativein this digital communication, while COLABIOCLI presented 24 videos and 2 podcasts, being thefederation that contributed the most.

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Several worldwide countries developed press releases, scientific activities, activities between
scientific societies and the families of their members to publicize the profession of the clinicallaboratory professional and such activities were also promoted on social networks in whichphotos, logos of the week and videos made by different professionals in their laboratories wereshared.
In recognition of their time, effort, and co-operation those who collaborated in this year’s GMLW
2023 activity received a certificate of participation.
IFCC is very appreciative of all the cooperation given to GMLW 2023, which has led to theincreased activity on IFCC's social media on Facebook, Instagram, LinkedIn, and podcasts on
Spotify. The immense support from the IFCC office through the efforts of Ms. Silvia Colli-Lanziis
acknowledged and indeed this week would not have been a success had it not been for her daily
input and support.
For next year’s GMLW the theme of “LABS SAVES LIVES” has been proposed by the C-PR Committee.
It is possible to continue sharing this important GMLW information from the following link.

https://ifcc.org/ifcc-communications-publications-division-cpd/cpd-committees/publicrelations-c-pr/happy-laboratory-professionals-week-2023/
Attached are some clips announcing the GMLW for 2023? Also attached are the video clips andpodcasts for GMLW 23

IFCC President, Prof. Khosrow Adeli, institutes the Global Medlab Week in Munich, April 11,2022, during the Euromedlab.

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Link GMLW 2023
Welcome – Global Med Lab Week 2023 – IFCC – Let´s Celebrate Med Lab Professionals around theWorld

7 Winner Videos -LiveMyLab during GMLW 2023 selected from roughly 50 videos sent by
worldwide colleagues. Welcome – Global Med Lab Week 2023 – IFCC – Let´s Celebrate Med Lab
Professionals around the World
Links to visualize “LiveMyLab” videos and Spotify PodCasts:
https://ifcc.org/ifcc-communications-publications-division-cpd/cpd-committees/publicrelations-c-pr/happy-laboratory-professionals-week-2023/

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IFCC Podcast Welcome – Global Med Lab Week 2023 – IFCC – Let´s Celebrate Med Lab
Professionals around the World
GMLW Organizers: Committee on Public Relations (C-PR), IFCC President Prof. Khosrow

IFCC Public Relations Committee during the meeting on May 22 held in Rome during theEuromedlab- World lab 2023: from left to right are:75

APFCB News 2023 Issue 2

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Dr. Endang Hoyaranda (APFCB; C-PR Advisor), Dr. BQF. María PasquelMoxley (Ec, C-PR member),Dr. Enrique Rodríguez Borja (Es, Corr. Member),Prof. Rajiv Erasmus (C-PR Chair),Prof. Khosrow
Adeli (IFCC President), Dr. Peter Vervaat (AuC-PR member), Dr. Maria Schroeder-Castagno (C-PR
member).
Committee on Public Relations (C-PR):
Dr Maria Pasquel Moxley (member)
Dr Maria Schroeder- Castagno (member)
Dr Peter Vervaaat (member)Prof Rajiv Erasmus (chair)

IFCC Public Relations Committee (C-PR) and Task Force Young Scientists (TF-YS) during themeeting on May 22 held in Rome during the Euromedlab- World lab 2023: from left to right andline below and above are:
C.B. Jessica Peña (Roche scholarship recipient Guest), Dr. BQF. María Pasquel Moxley (C-PR
member), Dr. Maria Schroeder-Castagno (C-PR member& TF-YS Corr. member), Dr. Udara
Senarathne (TF-YS member);Dr. Claudia Imperiali (TF-YS member); Dr. Francisco Josue Carrillo (TFYS Guest); Dr. Enrique Rodríguez Borja (C-PR Corr. Member); Prof. Rajiv Erasmus (C-PR Chair,);
Prof. Okesina (C-PRadvisor); Dr. Marie Lenski (TF-YS member), Dr. Peter Vervaat (C-PR member),Dr. Ashlin Rampul, (TF-YS member).

IFCC and IFCC Roche Scholarships recipients, with the IFCC President Prof. Khosrow Adeliand
other C-PR and TF-YS IFCC Officers (Dr. Maria Schroeder-Castagno (C-PR member& TF-YSCorr.
member), Dr. Claudia Imperiali (TF-YSmember), Dr. Marie Lenski (TF-YSmember), Dr. Elodie
Lebredonchel (TF-NBS member&TF-YSCorr. member), Prof. Pillay (C-PDChair) Supporting GMLW
2023 during the meeting on May 22 held in Rome during the Euromedlab- World lab 2023.

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Sickle Cell Disease: Prevalence, Challenges
And Road Map For Its Control In India By 2047

Prof. Hariom Sharma
Laboratory Director
Govt. Medical College & Sir T. Hospital
Bhavnagar – Gujarat – India
Hon. Scientific Coordinator of SCDIO – France
Introduction
Sickle cell disease (SCD) is first molecular disease known to mankind, and at the same time it ismost neglected disease world over. Red blood cells become sickle shape as result of missense
mutation in the HBB gene encoding the β-globin subunit of haemoglobin. An individual will havesickle cell trait due to one sickle mutation (usually sickle haemoglobin [HbS]), whereas sickle celldisease will arise due to mutation on both HBB genes (at least one of which is HbS). Sickle cell
trait is largely a benign condition but on the other hand confers protection against severe malaria.
Sickle cell disease patients will have a lifelong, severely-disabling disease with lower quality oflife, high use of medical resources, increased economic burden, and nearly guaranteed early
death. Sickle cell disease (SCD) is very complex in nature as it causes multiple complication like
malformed, sickle-shaped red blood cells that occlude capillaries and prevent tissue oxygen
delivery, leading to acute and chronic pain, severe anaemia, kidney dysfunction, acute chest
syndrome, stroke and other cardiovascular diseases, increased susceptibility to infectious
diseases (including malaria), pregnancy complications, and maternal mortality
The number of people living with sickle cell disease globally increased by 41·4% (38·3–44·9), from
5·46 million (4·62–6·45) in 2000 to 7·74 million (6·51–9·2) in 2021. According to one report causespecific all-age deaths globally in 2021 was 34,400 (25000–45200), but total sickle cell diseasemortality burden was nearly 11-times higher at 3,76,000 (3,03 000–4,67 000). In children
younger than 5 years, there were 81,100 (58 800–108000) deaths, ranking total sickle cell diseasemortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across allcauses estimated by the GBD in 2021.
Different forms of Sickle Cell Disease (SCD) and its worldwide distribution
In Africa, Caribbean, North & South America, and Europe:77

Sickle Cell occurrence known as Haplotype

Sickle hemoglobin (HbS)Sickle hemoglobin C (HbC)



Beta thalassemia Sickle cell

Homozygous Sickle cell (SS)APFCB News 2023 Issue 2

Special Report

In Asia & Middle East:An additional Sickle Cell occurrence known as Asian Haplotype

Shared by people in Asia, the eastern province of Saudi Arabia and throughout central
India



Asian Haplotype associated with high levels of fetal hemoglobin and frequent deletional
alpha thalassaemia

Prevalence

155 countries concerned in 5 continents

The most widespread worldwide
100 Millions Sickle Cell traits carriers
500 000 newborn with sickle cell traits
yearlyEvidence of life improvement for sickpeople in northern hemisphere
United States
The exact number of people living with SCD in the U.S. is unknown, but it is estimated thatapproximately 100,000 Americans are affected by the disease. One out of every 365 Black or
African-American is born with SCD. Whereas one out of every 16,300 Hispanic-American are bornwith the disease.It is reported that 1 in every 13 Black or African-American babies carries sickle
cell trait (SCT)
Africa and Asia
Half of the world’s SCD population lives in three countries: Nigeria, India, and the Democratic
Republic of Congo. The disease affects up to 2 percent of the population, and the carrier
prevalence rate (sickle cell trait) is as high as 10 to 30 percent.

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APFCB News 2023 Issue 2

Special Report

Nigeria alone has been estimated to have at least 150,000 newborns with SCD annually. Estimates
are challenging because of the lack of federal newborn screening programs; however,approximately 700,000 births occur per year and the prevalence of SCD in newborns was 3
percent in a regional newborn screening program report.
India
India has the largest tribal population which is 8.6% /67 million of the total population. The
prevalence of sickle cell carriers among different tribal groups varies from 1 to 40 per cent.
Distribution of Hb Variants in India

In spite of the fact that sickled red blood cells were detected in Assam as early as in the year
1952, the sickle cell hemoglobinopathy has remained a neglected field of research in India.
Challenges to control SCD
SCD is Illness of ignorance, poverty & pain, it is necessary to destroy the myths that are sourcesof indifference and passivity. The comparison of the therapeutic possibilities between developed
and developing countries is an example of more than unbearable inequality; troubling evidenceemphasizes the tragic disparity among humans facing disease and death. In the developing
countries, financial burden on the parents of the children suffering from SCD limits the quality ofthe daily medical care and sometimes results in their death for lack of available but expensive
cares such as transfusion or antibiotics prophylaxis.
Role of clinical laboratories and healthcare system in the management of SCD
Laboratories can play a vital role in screening of the population for the disease diagnosis, whereas
Primary Healthcare/Tertiary care hospital shall have facilities for immunization, necessary
medicine and infrastructure for daycare to be affordable. Transfusion facilities can help primarily
in management of the SCD patients and also in bringing down the burden of the disease.

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APFCB News 2023 Issue 2

Special Report

Prenatal diagnosis
Although there are significant advances in the management of sickle cell disease, yet increased
morbidity and early death are not infrequent. Thus, prenatal diagnosis remains an important
option for couples at risk of having a child with homozygous sickle cell anemia, sickle βthalassemia or HbSD disease despite the fact that it is impossible to predict the severity of thedisease and many individuals may have a milder clinical presentation. With increasing awarenessin the community more couples are opting for prenatal diagnosis. It is reported that around 400
prenatal diagnosis for sickle cell disorders about 20 per cent were tribal couples mainly fromSouth Gujarat, Maharashtra, Madhya Pradesh and Odisha. Chorionic villus sampling at 10 to 12
weeks of gestation and DNA analysis by reverse dot blot hybridization or allele specific priming
were the methods of choice for prenatal diagnosis. This makes prenatal diagnosis simpler andmore cost-effective in tribal populations. For couples who came late, the cordocentesis and foetal
blood analysis by HPLC were done. These technologies have now been established at regional
centers.
Role of laboratory in monitoring and management of SCD patient
There are numerous methods available to diagnose hemoglobinopathies. The first is hemoglobin
fractionation and consists of separating hemoglobin species based on charge and/or size.
Hemoglobin fractionation can be performed by high-performance liquid chromatography (HPLC)
methods, capillary electrophoresis (CZE) methods, and gel electrophoresis methods (alkaline andacid gels and isoelectric focusing, IEF gels).
HPLC separates hemoglobin fractions based on charge, whereas with CZE and gel methods,
separation is based on both size and charge. HPLC and CZE are high resolution quantitativetechniques. Gel methods, on the other hand, are low resolution compared to HPLC and CZE,
although they can be semi quantitative.
Mass spectrometry and molecular methods (sequencing and deletion/duplication) are extremely
powerful techniques for diagnosing hemoglobinopathies and thalassemia, particularly those thatare challenging to diagnose with HPLC, CZE, and gel methods. However, these methods are for
qualitative identification and do not quantify hemoglobin species.
Patients with SCD have historically been managed by RBC transfusions and/or hydroxyurea.
Managing and monitoring patients on these treatments requires discrimination and accuratequantitation of the various hemoglobin species; therefore, HPLC or CZE are the preferred methods
for following:80

APFCB News 2023 Issue 2

Special Report

Table 1: Technologies for SCD diagnosis and monitoring:Technique
Peripheral

Sensitivit

Specificityy35.0%.

96.7%

Accuracy

Advantages

Disadvantage

Result90.5%

SimpleDependence

Detecton thesicklecells

blood smear

preparation,(PBF)

inexpensive,

pathologist's

Turnaround timeskills, does not(TAT) is 44 min.

differentiate
betweendifferent typesof SCD.

Solubility

Sickling:

Sickling:

Sickling:

Easy,

Testing

Detect theand Sickling

65.0%

95.6%

92.5%

inexpensive,

newborns

sickling

fast, affordable,shows false-

event.

Solubility

Solubility

Solubility

TAT 38 min for

negative: 45.0%.

: 90.0%.

: 85.5%.

sickling, TAT for

result, does

solubility 70
min.

not
differentiate
between SCD
types.

Capillary

Not

Not

electrophore

reportedreported

Not

Reliable, ability

Expensive,

Identify

reported

to distinguishrequiresandmost types ofskilledquantify

technicians.

Hb F, Hbsissickle celldiseaseA, Hb A2,

including

Hb S, Hbheterozygous.

C, Hb
Barts andother.

Isoelectric

Not

Not

focusing

reportedreported

Not1) Detect Hb S

Expensive,

Hb A, Hb

reportedand HbA easilyrequires highly

F, Hb C,in a hightrained staff to

Hb S, Hb E

concentration ofinterpret theand Hb O

(IEF)

Hb F,

results.

Arab.

2) Hb D-Punjab
easily separated
from Hb S,
3) need small
volume of thesample,4) able to use
dried bloodspot,5) TAT is 45 min
High-

Not

Not

performance

reportedreportedliquidNot

Reliable, ability

Misdiagnoses

Detect Hbreported

to distinguish

the new

F, Hb A2,

most types ofvariants that

Hb S, Hb

chromatogra

sickle cell

mimic Hb S,

C, Hb

phy

diseaseExpensive andBarts, and(HPLC)

includingneeds trained

other Hbheterozygous,

personnel,

variants.

fully automated.

not practical inlimitedresources81

APFCB News 2023 Issue 2

Special Report

It is evident that there is availability of broad spectrum laboratory tools and techniques available
for the mass screening of the population followed by confirmatory diagnosis and prognosis of
the disease. A network of laboratories need to be created for the screening of population which
is pre-disposed to SCD followed by strategic sickle cell control program planning andimplementation will certainly will meet the nations goal to eradicate the disease.
Road Map
The National Sickle Cell Anemia Elimination Program, introduced in the Union Budget 2023,
focuses on addressing the significant health challenges posed by sickle cell disease, particularly
among tribal populations of the country. Sickle cell disease (SCD) is a chronic single gene disordercausing a debilitating systemic syndrome characterized by chronic anemia, acute painful
episodes, organ infarction and chronic organ damage and by a significant reduction in life
expectancy. Implemented in 17 high-focus states
Across the country, this program aims to improve the care and prospects of all sickle cell disease
patients while reducing the prevalence of the disease. The 17 states are- Gujarat, Maharashtra,
Rajasthan, Madhya Pradesh, Jharkhand, Chhattisgarh, West Bengal, Odisha, Tamil Nadu,
Telangana, Andhra Pradesh, Karnataka, Assam, Uttar Pradesh, Kerala, Bihar, and Uttarakhand.
The program is executed in a mission mode as part of the National Health Mission (NHM), aims
to eliminate sickle cell genetic transmission by the year 2047, showing a long-term commitment
to eradicating the disease. Over a period of three years, spanning from the fiscal year 2023-24 to
2025-26, the program targets screening approximately 7.0 crore people. This ambitious goal
highlights the program's dedication to reaching a large portion of the population, promoting early
diagnosis and intervention. All these exaggerated efforts will certainly eradicate the sickle celldisease in the population.
References:
1. Nicholas J Kassebaum, Institute for Health Metrics and Evaluation, Hans Rosling Center for
Population Health, Seattle Lancet Haematol 2023; 10: e585–99:Global, regional, and national
prevalence and mortality burden of sickle cell disease, 2000–2021: a systematic analysis from the
Global Burden of Disease Study 2021.
2. R. S. Balgir: Epidemiology, Population Health Genetics and Phenotypic Diversity of Sickle Cell
Disease in India. The Internet Journal of Biological Anthropology. 2007; 1(2).
3. Roshan B. Colah, Malay B. Mukherjee, Snehal Martin, PMC Disclaimer Sickle cell disease intribal populations in India. Indian J Med Research 2015; 141(5):509-15.
4. Okwi A.L., Byarugaba W., Parkes A.T.R. of S. and S.T. and P.; Ocaido, M. The Reliability of
Sickling and Solubility Tests and Peripheral Blood Film Method for Sickle Cell Disease Screeningat District Health Centers in Uganda A. Clin. Mother Child Heal. 2010; 7:1–5.
5. Frömmel C. Newborn Screening for Sickle Cell Disease and Other Hemoglobinopathies: A Short
Review

on

Classical

Laboratory

Methods-Isoelectric

Focusing,

HPLC,

and

Capillary

Electrophoresis. Int. J. neonatal Screen. 2018; 4: 39.
6. Nair S. Potential Pithfalls in Using HPLC and its Interpretation in Diagnosing HbS. J. Rare Dis.
Res. Treat. 2018; 3: 9–12.
7. Wjdan A. Arishi, 1 Hani A. Alhadrami,1,2,* and Mohammed Zourob3,*Techniques for the
Detection of Sickle Cell DiseaseMicromachines (Basel). 2021; 12(5): 519.

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APFCB News 2023 Issue 2

APFCB Auspices

APFCB AUSPICES EVENTS CALENDAR 2023

Dr. Woei-horng Fang, PhD
Chair, APFCB C-CC

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APFCB News 2023 Issue 2

Clinical Case

CLINICAL CASE
Case History & Examination
A 45-year-old female presented to the Department of Medicine clinic at a tertiary care referral
hospital, Delhi, India with the chief complaints of fever, right loin pain associated with nausea
and dysuria since last 5 days. She gave the history of visiting a private clinic 3 weeks earlier withsimilar complaints and received parenteral antibiotics for the same, to which she responded
initially but again developed fever and right flank pain and visited our hospital. She is a known
case of Diabetes mellitus and is on regular oral hypoglycemic agents for the last 2 years. She also
has a history of recurrent urinary tract infections in the past.
On physical examination, the patient was found to be febrile with oral temperature 39.5°C, heart
rate 93 bpm, and blood pressure 100/60 mm Hg. No signs of pallor, icterus or lymphadenopathy
were seen. Chest and cardiac auscultation did not reveal any abnormality. On palpation, theabdomen was found to be soft and lax but there was right renal angle tenderness. The patient
was admitted to medicine ward in view of persistent fever and recurrent urinary tract infections
for further evaluation and laboratory investigations. The results as shown below (Table 1):
Laboratory Investigations
Blood investigation

Test result

Biological reference
interval

Complete blood countHemoglobin

12.5 gm/dL

12-15.5gm/dL

WBC-TLC

12 x 10³/µl

5-10 x10³/µl

Neutrophils

82%

60-75%

Lymphocytes

20.0%

20-40%

Platelets

160 × 10^3/µL

150-400 x 10^3/µL

Urea

30 mg/dl

18-55mg/dl

Creatinine

2.7 mg/dl

0.5-1.1mg/dl

Sodium

139 mEq/L

135-145 mEq/L

Potassium

4.8 mEq/L

3.5-5.3 mEq/L

HbA1c Value

7.5%

4.2%- 5.7%

C-reactive protein (CRP)

90 mg/L< 5 mg/L

Renal function tests

Serum electrolytes

Routine investigations revealed high HbA1c value (7.5%) with normal serum sodium levels,
normal levels of urea and haemoglobin. Serum creatinine was raised. TLC was also raised alongwith CRP depicting infection. Further blood culture test was ordered for which two sets of blood
samples were collected in aerobic and anaerobic bottles; only one of the aerobic bottles was
flagged positive in the after >48 hrs of incubation. The gram-stained smear of the sample fromthe positive blood culture bottle showed presence of gram-negative bacilli in clumps, andculture on blood agar plates also grew the same organism.

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APFCB News 2023 Issue 2

Clinical case

The isolate was positive for indole and catalase, whereas oxidase, citrate and urease were
negative (Figure: 1).

Figure 1: Isolate positive for indole (marked)
Urine Examination
Urine routine and microscopic examination

Test result

Reference

Physical Examination
Volume

20 mL

Color

Pale yellow

Straw coloredTransparency

Clear

Clear

DepositAbsentAbsentUrine glucose

Positive

Negative

Urine protein

0.25 g/l(normal <0.1 g/l)- Dipstick

NitritePositive

Negative

Leukocytes

70-80/hpf

Normal <0-4/hpf

Erythrocytes

55/ hpf

Normal <0-4/hpf

Bacteria

2+

AbsentChemical Examination

Microscopic Examination

Urine Routine/Microscopy revealedurine protein 0.25 g/l (normal <0.1 g/l) by Dipstick, while
glucose and nitrites were positive. Microscopy-revealed leukocytes 70-80/hpf (normal <04/hpf), erythrocytes 55/hpf (normal <0–4/hpf) and bacteria 2+ (Table 2). Urine ketone bodies,bilirubin, urobilinogen, and leukocyte esterase were negative.
Urine sample was also collected for culture (clean catch mid-stream urine), which showed yield
growth of E. coli on CLED agar plates after18 hrs of incubation (Figure: 2).

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APFCB News 2023 Issue 2

Clinical case

Figure 2: Colonies of lactose fermenting bacteria on
CLED agar plates after 18 hrs of incubation

Antibiotic susceptibility testing (AST)
It was done by Kirby Bauer disk diffusion susceptibility test method on Mueller Hinton agar plates
which showed the bacteria resistant to ciprofloxacin and sensitive to 1st generation
cephalosporin’s (Figure 3).

Figure 3: Mueller Hinton agar plates which showed thebacteria resistant to ciprofloxacin and sensitive to 1st
generation cephalosporins

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APFCB News 2023 Issue 2

Clinical caseRadiological examination:
Ultrasound findings revealed enlargement of kidney in size with surrounding perinephric fat
stranding along with ptheresence of calculi in the right kidney (Figure 4).

Figure 4: USG findings: Hypoechoic kidney with renal sinus
fat lost.

Interpretation & Analysis

Major hospital admissions due to lower urinary tract infections have a high chance of progressing
to upper urinary tract and cause pyelonephritis. Inflammation of the renal parenchyma broughton by bacteriuria that travels from the bladder via the ureters and up to the kidneys is the hallmarkof acute pyelonephritis.
In this case study, urinary analysis, radiological results, together with the recognized presenting
symptom triad of nausea, fever, and flank pain allowed the practitioner to make the diagnosis ofacute pyelonephritis. The diagnosis for Pyelonephritis was mainly done on the basis of clinicalhistory, urine microscopy and culture and blood culture. Radiological findings of ultrasoundhelped rule out other possibilities such as a renal abscess and emphysematous kidney.
Complications were ruled out by other biochemical blood investigations.
Being a female, known diabetic patient with history of recurrent episodes of UTI made the patient
more prone to develop pyelonephritis. Urine culture which showed yield growth of E. coli on CLED
agar plates, also led the way closer to the diagnosis, as E. coli is the most common bacteria tocause pyelonephritis. Furthermore, antibiotic sensitivity testing helped us know that the patient
was resistant to ciprofloxacin treatment.
So correct line of treatment was started during her inpatient stay: IV ampicillin +1 aminoglycoside
until afebrile till 24 hours, then oral antibiotics for 3 weeks. These antibiotics were adjusted
accordingly after monitoring of AST results. Patient’s condition improved as reported in the follow
up visits to the OPD.
Diagnosis:
ACUTE PYELONEPHRITIS

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References:1.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, seventh edition.

2.

Song HK, Shin DH, Na JU, Han SK, Choi PC, Lee JH. Clinical investigation on acutepyelonephritis without pyuria: a retrospective observational study. J Yeungnam Med Sci. 2022;
39(1):39-45.

3.

Hudson, C and Gerri Mortimore. The diagnosis and management of a patient with acutepyelonephritis. British journal of nursing. 2020; 29(3): 144-150.

4.

Venkatesh L, Hanumegowda RK. Acute Pyelonephritis - Correlation of Clinical Parameter with
Radiological Imaging Abnormalities. J Clin Diagn Res. 2017; 11(6):TC15-TC18.
Georgi Abraham and others, Diagnosis of acute pyelonephritis with recent trends

5.

Georgi Abraham and others, Diagnosis of acute pyelonephritis with recent trends inmanagement, Nephrology Dialysis Transplantation. 2012; 27(9):3391–3394
Contributed by:
Dr. Marilyn Masih
Senior Resident
Department of Biochemistry
G.B.Pant Institute of Postgraduate Medical Education & Research (GIPMER)
Delhi, India

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APFCB News 2023 Issue 2

Painting Story

A Beautiful View of the Three Gorges in China
By Dr Tan It Koon
I am so glad I had the opportunity to visit the Three Gorges three times before building of thedam by the Chinese Government. I also visited the Small Gorge which is narrower and accessible
only by smaller boats. The narrow waterway required skillful boatman to navigate the rapids andshallow waters at parts of the journey. However, the views are much more spectacular than thoseon the main route.
At about 6300 km, Chang Jiang or Long River (长江) is the longest river in Asia and third longest
in the world. It is the longest in the world to flow entirely within one country and plays a largerole in the history, culture, and economy of China. For thousands of years, the river has beenused for water, irrigation, industry, sanitation, transportation, boundary marking, and war.
Passing through 10 provinces, it commences its flow from the Tanggula Mountains (唐古拉山) in
ethnic Tibetan Qinghai (青海) Province in northwest China and ends at the East China Sea inShanghai (上海). Along the middle reaches of the river, between the western upstream Baidi City
(白帝城 ) of Chongqing (重 庆 ) Municipality and Yichang (宜昌 ) city of Hubei ( 湖北 ) Province
downstream, the river passes through 3 adjacent gorges, known as the Three Gorges (三峡):Qutang, Wuxia, and Xiling gorge (瞿塘, 巫峡, 西陵峡) cutting through the Wu Mountains (巫山).
Spanning a distance of about 120 km, these gorges are noted for their natural beauty: unusual
looking mountain peaks ranging from 800 m to 2000 m, precipitous valleys, dense forest, andspectacular landscape. Many ancient government officials, scholars, poets, and painters visited
the Three Gorges and left their impressions and praises in writings. Archaeological discoveries inrecent years have shown for the first time that the Three Gorges area should be recognized as
the birthplace of Chinese civilization.
As the source of the river was not ascertained until modern times, different names were given to
the lower and upstream sections of the river. “Yangtze River 扬子江” was actually the name of
Chang Jiang only for the lower part from Nanjing (南京) to the river mouth at Shanghai. Yangtze
is the local name for the Lower Yangtze in the region of Yangzhou (扬州). The name likely comesfrom an ancient ferry crossing called Yangzi or Yangzi Jin (扬子津). Europeans who arrived in theregion applied this local name to the river. Due to the fact that Christian missionaries carried out
their activities mainly in this area and were only familiar with the name of this part of the river,“Yangtze River” was consequently used to refer to the entire river in the English language by
foreigners.
Prior to the building of a dam, rapids, strong currents and narrower passage ways with protruding
rocks at some sections of the river used to pose difficulty of movement and risk of capsizing toboats and rafts sailing through. Men from the rural villages nearby used to work as trackers to
help boats and barges manoeuvre safely through such dangerous passages. Working with little
or no clothing, the nearly naked men used ropes to pull boats safely through the rough and rocky
patches. Having to get in and out of water frequently caused clothing to be wet and heavy, andvery uncomfortable
To wear. Wet clothing predisposed the men to become ill with a cold, resulting in loss of income
due to illness. Furthermore, wearing clothes was impractical as the friction of ropes around the
body invariably shred them to pieces.

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APFCB News 2023 Issue 2

Painting Story

In 1992 the development of a Three Gorges Dam was approved by the Chinese Government, andwork began in late 1994. The reservoir dam was constructed at Sandouping (三斗坪), Yichang (宜昌) of Hubei (湖北) Province, in the middle of Xiling Gorge. The project was completed by the endof 2008. Several years later, a ship-lift was added. The dam became the largest hydroelectric
power station in the world. The dam and reservoir have had a massive impact on the region’s
ecology and people, requiring the mass relocation of villages, towns, and industries. The higher
water level has changed the scenery of the Three Gorges. As the river is wider, the mountains
now appear lower. Nevertheless, the gorges continue to offer beautiful views of the surrounding
cliffs. The increased width and depth of the river permits larger ships through the gorges, andthere has been a significant increase in river traffic of all kinds, including bulk cargo and container
barges. As the dangerous passage ways have disappeared with the building of the dam and risingwater level, there is no longer a need for the trackers.
This painting is inspired by my experience of the 3 cruises I had through the Three Gorges andthe Small Gorge prior to the building of the dam and reservoir.
With Best Wishes
Dr Tan It Koon
Founding President, SACBFounding President, APFCBFormer IFCC, Executive Board Member
Former WHO Member of Expert Committees

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