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

APFCB News 2015
APFCB News 2016
Publication Team, 2016 Issue- 1
Chief Editor

Praveen Sharma
Jodhpur, India
praveensharma55@gmail.com

Immediate past
Chief Editor

Joseph B Lopez
Kualalumpur, Malaysia
jblopez2611@gmail.com

General andCase Studies Editors

Leslie Lai
Kuala lumpur, Malaysia
lesliecharleslai@gmail.com
Tester Ashavaid
Mumbai, India
dr_tashavaid@hindujahospital.com
Aysha Habib
Karachi, Pakistan
aysha.habib@aku.edu

APFCB Membership

Members
Australasian Association of Clinical Biochemists (AACB)
Chinese Society of Laboratory Medicine (CSLM)
Hong Kong Society of Clinical Chemistry (HKSCC)
Association of Clinical Biochemists of India (ACBI)
Indonesian Association for Clinical Chemistry (IACC)
Japan Society of Clinical Chemistry (JSCC)
Korean Society of Clinical Chemistry (KSCC)
Malaysian Association of Clinical Biochemistry (MACB)
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)
Association for Clinical Biochemistry, Sri Lanka (ACBSL)
Chinese Association for Clinical Biochemistry, Taiwan (CACB)
Thailand Association of Clinical Biochemists (TACB)
Vietnamese Association of Clinical Biochemistry (VACB)
Mongolian Association of Health Laboratorians (MAHL)
Iranian Association of Clinical Laboratory Doctors (IACLD)
Affiliate Members
Chinese Association of Clinical Laboratory Management CACLM)
Association of Medical Biochemists of India (AMBI)
Macao Laboratory Medicine Association (MLMA)
Nepalese association of Clinical Chemistry (NACC)
Philippine Council for Quality Assurance in Clinical Laboratories(PCQACL)
College of Community Physicians of Sri Lanka (CCPSL)Corporate Members
Abbott Diagnostics
Beckman Coulter
Becton Dickinson
Bio-RadDiasorin Ltd
DiaSys Diagnostic Systems, GmbH
Kopran Laboratories Ltd
Mindray
Ortho-Clinical Diagnostics
RandoxRoche Diagnostics
Sekisui Medical Co Ltd
Siemens Healthineers
Sukraa Software Solution Pvt Ltd
SysmexSnibe Diagnostics
Technidata Medical Software
Wondfo Biotech

APFCB Executive Board and Chairmenof Committees, Elected October, 2016
Executive Board
President

Leslie C Lai
Consultant Chemical Pathologist,
Kuala Lumpur, Malaysia
lesliecharleslai@gmail.com

Immediate Past
President

Joseph B Lopez
MAHSA University College,
Kuala Lumpur, Malaysia
jblopez2611@gmail.com

Vice-President

Sunil K Sethi
National University Hospital, Singapore
patsks@nus.edu.sg

Secretary

Endang Hoyaranda
Prodia, Jakarta, Indonesia
ehoya@prodia.co.id

Treasurer

Elizabeth Frank
BioChem Diagnostic Laboratory,
Mysore, India
anet21frank@gmail.com

Corporate Representative

Alexender Wong
Siemens Healthcare Diagnostics Holding
GmbH, Germany
alexender.wong@seimens.com

Chairman of Committees
Communications

Praveen Sharma
All India institute of Medical Sciences Jodhpur,
India
praveensharma55@gmail.com

Education &Laboratory
Management

Tony Badrick
Brisbane, Australia
tony_badrick@snp.com.au

Scientific

Kiyoshi Ichihara
Yamaguchi University, Japanichihara@yamaguchi-u.ac.jp

Conference

Joseph B Lopez
MAHSA University College
Kuala Lumpur, Malaysia
jblopez2611@gmail.com

Hon. Auditors

Woei-horng Fang.
President Chinese Association for Clinical
Biochemistry, Taipei, Taiwan
whfang@ntu.edu.tw
Romeo Joseph Ignacio
Vice President & General Manager
Sysmex Philippines Inc.
Ignacio.RomeoJoseph@sysmex.com.ph

Submissions
The APFCB News welcomes suitable contributions for publication.
These should be sent electronically to the Chief Editor. Statements ofopinions are those of the contributors and are not to be construed as
Official statements, evaluations or endorsements by the APFCB or its
Official bodies.
Cover page: “Squirrels enjoying Hawthorn Berries "Contributed by Tan It Koon
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
Tel: 6223 9118 Fax: 6223 9131

APFCB News 2016

Contents
From the desk of Chief Editor - Praveen Sharma
Message from APFCB President - Leslie Charles Lai
APFCB Activities
AACC approached APFCB for symposia – Tony Badrick
Report from the EFLM-UEMS conference 2016 – Ronda Greaves
Member Societies
Australasian Association of Clinical Biochemists (AACB)
Indonesian association of clinical chemistry (IACC)
Hon Kong Society of Clinical Chemistry (HKSCC)
Singapore Association of Clinical Biochemists (SACB)
Features
Scientific article: Vitamin B12 Deficiency: Active B12 Assay – M Saleem

Chief Editor's Desk

APFCB News 2016

From the desk of Chief Editor…
Dear Colleagues,
Greetings!
I extend my warm gratitude for your continuous support to me and the communicationcommittee that has helped us in successful publishing of APFCB news all through these years. I
am pleased to inform you that from this year – on APFCB news shall be published twice in ayear as issue –I and issue –II. This issue comes right before we meet at the 14th APFCBCongress, Taipei and so is all the more significant. We have tried to gather as muchinformation as possible from the first half of this year.
We present to you issue –I of the APFCB news 2016. Although a small issue it is highlights thevarious events occurring in the first half of the year. I take this opportunity to thank thosemember societies and national representatives who have contributed by sending the activities
report form their societies.
We have been extremely fortunate to have consistently got support and encouragement form
Tan It Koon, the founding and the past president of APFCB. He has been an active contributor
to the progress and development of APFCB. I'm thankful to him for providing beautiful
paintings from his art treasure for the fourth consecutive issue of APFCB news. The cover
page of the APFCB news 2016 volume-I has been graciously provided by him. It shows“Squirrels enjoying Hawthorn Berries”.
Looking forward to meet you all at Taipei!

Praveen Sharma
Editor in Chief

1

APFCB News 2016 President’s Message

Message from APFCB President…
My greetings to one and all.
This is the last time I will be contributing an article to the APFCB eNews as President of the
Asia-Pacific Federation for Clinical Biochemistry (APFCB). Elections for the new Executive
Board (EB) will be held on 26 November in Taipei prior to the commencement of the
APFCB Congress. The term of office for the new EB will begin on 1 January 2017 and I willcontinue as the Immediate Past President on the new EB.
I look back on my 18 years‟ involvement with the APFCB with great fondness, first as Chairof the Education Committee from 1998 till 2004, then as Vice President from 2004 till 2010
and as President from 2010 till the end of 2016. I have had the great fortune to haveworked closely with people who have been committed to the growth and development of
the APFCB and I would like to thank them all. It will not be possible for me to name them
all and I shall not attempt to do so.I would, however, like to thank the current Executive
Board members who have worked tirelessly for the APFCB and their dedication should be
acknowledged and appreciated:
Mr Joseph Lopez, Immediate Past President
Associate Prof Sunil Sethi, Vice President
Dra EndangHoyaranda, Secretary
Dr Elizabeth Frank, Treasurer
Dr Alexander Wong, Corporate Representative
There has been an increase in the number of educational and scientific activities conductedby the APFCB. The APFCB Travelling Lectureship has been a permanent fixture since 1998.
We have a Vietnam Chemical Pathology course and a Point of Care Testing (POCT)
workshop held annually in Vietnam sponsored by Roche and organised by Dr Ronda
Greaves, APFCB-Beckman Coulter Scientific Symposia in the region, APFCB-Siemens
workshops, APFCB-IFCC-Abbott Turning Science in Caring Scientific Symposium, APFCBRoche Lean/Six Sigma workshops, BD May I Help You campaigns, APFCB-BD Speciality
Regional meeting, APFCB Chemical Pathology regional course modelled on the AACB
curriculum, Interpretative Commenting EQAP as well as IFCC Visiting Lectureships to ourregion. The person responsible for many of our educational activities is Dr Tony Badrick,
Chair of the Education and Laboratory Management Committee. The number of scientificactivities has also increased, with expansion of our Asia-Pacific regional reference interval
study to an IFCC global reference interval study under the chairmanship of Prof Kiyoshi
Ichihara, and several harmonisation projects and paediatric research projects chaired andcoordinated by Dr Ronda Greaves.I am very grateful to our Corporate members, ourknowledge partners, for the many joint workshops which have benefited our members
greatly. The Chair of the Congress and Conferences Committee, Mr Joseph Lopez who isalso the Immediate Past President of APFCB, has been responsible for the granting of
APFCB auspices to scientific workshops, meetings and conferences, and for the APFCB
congress guidelines, as well as overseeing the APFCB congresses and in establishing theregional Chemical Pathology course. The Chair of the Communications Committee,
Professor Praveen Sharma, has been responsible for getting the APFCB website up andrunning as well as updating the contents of the website. Professor Sharma is also the Chief
Editor for the APFCB eNews which will now be published twice a year.

2President’s Message APFCB News 2016
We have Memoranda of Understanding (MoUs) with the World Association of Societies of
Pathology and Laboratory Medicine (WASPaLM) and the American Association for Clinical
Chemistry (AACC). Two joint projects between WASPaLM and APFCB are planned: Joint
accreditation workshops for our region and a joint Chronic Kidney Disease (CKD) regional
project. The CKD project is under the Chairmanship of Dr Graham Jones who is also the
APFCB Travelling Lecturer for 2015/2016 and the topic of his travelling lectureship is CKD.
AACC has commenced a quality initiative programme focused on our region similar to thatwith South America and the first such programme will be conducted this September with
the Chinese Society of Laboratory Medicine (CSLM).
I would like to take this opportunity to welcome our newest Ordinary member, Iranian
Association of Clinical Laboratory Doctors (IACLD) and our new Affiliate members,
College of Chemical Pathologists of Sri Lanka (CCPSL) and Philippine Council for Quality
Assurance in Clinical Laboratories (PCQACL) who joined us in 2016. The APFCB now has
18 Ordinary members, 6 Affiliate members and 18 Corporate members.
I look forward to seeing many of you at the 14th APFCB Congress, 26th till 29th
November 2016 in Taipei.

Best wishes

Dr Leslie Charles Lai
President, APFCB

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APFCB News 2016

APFCB Activities

AACC approached APFCB for symposia
Tony Badrick
The APFCB were approached by the AACC to propose a Symposium for the 2016
Philadelphia Meeting. The concept was that the Symposium showcase some of the activities
sponsored by the APFCB that may be of broad interest and relevance to a general audience.

The proposal was for the following topics and speakers:
Moderator: Tony Badrick
1.
2.
3.

Driving change in the pre-analytical phase of testing – Endang Hoyaranda
Ethnic and Regional Differences in Common Laboratory Tests and their
Implications for the Globalization of Medical Practice – Kiyoshi Ichihara
Improving Clinical Commenting by an EQA program - Tony Badrick

The proposal was accepted by the oversight committee and was run as a Symposium on
Wednesday 3 August.
There were approximately 60 participants in the audience at the beginning of the two and ahalf hour session, though the number did drop as the afternoon progressed. This is not
unusual for afternoon Symposia and we were competing against seven other sessions. There
were a broad range of questions at the end of each paper and I believed the audience wereinterested in the topics. I also presented a brief overview of the APFCB and its activities. The
talks were well presented and of a high scientific value.
This was an AACC sponsored session with the AACC waiving Registration fees, paying forairfares and some accommodation. This sponsorship allowed more of the EB to attend themeeting and the AACC Leadership forum which was a bonus for the APFCB. The value tothe APFCB was high with greater visibility to a wide audience and some insight into therange and depth of scientific and educational activities we are engaged in in our Region.

4

APFCB News 2016

APFCB Activities

Report from the EFLM-UEMS conference
2016
Ronda Greaves
Prepared by the person who was arrowed when he left the breakfast table for a glass ofjuice...

The speakers at the APFCB Symposium, Pediatric Endocrine. From left to right: Dr Ronda
Greaves, Dr Tze Ping Loh, Dr Chung Shun Ho and Prof Stefan Wudy.
The Asia Pacific Federation for Clinical Biochemistry sponsored a symposium entitled"Pediatric Endocrine" at the 4th Joint EFLM-UEMS Congress, which was held over 21-24
September 2016 in Warsaw, Poland. The congress hosted more than 700 delegates withover 200 proffered abstracts presented as posters and orals over the four days. Importantly,
the structure of this congress brought together clinical and laboratory professionals as part ofthe important clinical interface. The four speakers representing the Federation, were Dr
Tze Ping Loh (Chemical Pathologist, Singapore), Dr Chung Shun Ho (Scientist, Hong Kong),
Prof Wudy Stefan (Paediatric Endocrinologist, Germany) and Dr Ronda Greaves (Paediatric
Clinical Biochemist, Australia) together complemented this clinical interface theme.
The preparation for the symposium began many months before the congress with the
speakers discussing their topics to ensure a coherent theme. It was decided that the lectures
would be presented as "Clinical Utility of Steroid Analysis", followed by "Mass Spectrometry
Analysis of Serum Steroids", "Interpreting of Mass Spectrometry Data for the Diagnosis of
Disorders of Sexual Development" and "Mass Spectrometry Reference Intervals for Serum
Steroids". With the unique clinician-laboratorian audience mix in this joint congress, equalconsideration was given to both parties.
In the opening lecture, Dr Loh provided an overview of the steroidogenesis pathway, thefunction of steroid hormones, and went on to discuss clinical scenarios, with particularreference to the paediatric population, where steroid analysis would be important.

5

APFCB Activities

APFCB News 2016

The challenges of both clinical and laboratory assessment of patients with steroid hormone
disorders were discussed. Finally, a clinical case of isolated, gross elevation ofandrostenedione was used to illustrate these challenges.
In the second lecture, Dr Ho gave the audience a quick 101 on liquid chromatography
tandem mass spectrometry using illustrative animations. Following this, through a mix ofdata presentation and clinical cases, the unique advantages and operational challenges werediscussed. Bringing balance to his pitch, Dr Ho also provided evidence that liquid
chromatography tandem mass spectrometry may not be the silver bullet laboratorians andclinicians have hoped to believe. Finally, digging into his deep experience, Dr Ho provided
practical tips on pitfalls to avoid during the set-up of a tandem mass spectrometry facility/
assay.
Prof Wudy picked up from Dr Ho and switched the focus to gas chromatography mass
spectrometry. The advantages and disadvantages between liquid and gas chromatography
were elegantly articulated with a strong message that both methods are complementary,
not competing. The clinical utility of gas chromatography mass spectrometry was further
illustrated through cases and data published by Prof Wudy on disorders of sex
development. Finally, some fresh off the press data on the novel use of gas chromatography
mass spectrometry in the field of steroidomics was also shared.
Shouldering the heavy duty of keeping everyone awake and in the lecture hall, instead ofrushing for the coffee break was Dr Ronda Greaves. She shared the five pillars ofharmonisation, with an emphasis on reference interval harmonisation. The concept ofreference intervals was quickly visited. Data on the paediatric reference intervals for selectsteroid hormones for preterm babies, which is the fruit of a labour of love spanning four
years, were also shared as an example of the challenges. Thereafter, the findings of a
hardworking PhD student, who systematically reviewed all published data related topaediatric steroid hormone reference intervals were presented using a traffic light system
to gauge the quality of the data, as well as the presence of analytical pre-requisite forreference intervals harmonisation. Overall, the clinical need for harmonised reference
intervals is recognised, although, more scientific work needs to be done to achieve that.
Beyond the lectures, the Congress also provided opportunities for old friendships to be
renewed and new friendships forged. Internally, the group took the opportunity to discussmany projects and collaborations over countless glasses of orange juices. The paediatricendocrine group also interacted with members of the IFCCTask Force for PaediatricLaboratory Medicine, who were also presenting at the Congress. All work and no playmakes a scientist dull. Some of the additional highlights of the congress included theopening lecture presented by Prof Dennis Lo with the cultural interlude from the string
quartet performance and the social event comprising of a guided tour around the Old
Town of Warsaw, which is a UNESCO World Heritage site. Finally the wonderful andwarm hospitality of the organising committee lead by Professors Grazyna OdrowqzSypniewska and Eberhard Wieland made this an extraordinarily successful and rewarding
meeting for all. We are very grateful and wish to thank both the APFCB and the EFLMUEMS for supporting our symposium.

6

APFCB News 201634

Member Societies

Australasian Association of Clinical
Biochemists (AACB)
Activity report for January – June 2016 by Helen Martin
Current Council Members
President: Ms Helen Martin
Vice President – Finance, Planning and Branches: Mr Bruno Sonza
Vice President – Education and Training: Dr Ken Sikaris
Vice President – Scientific and Regulatory Affairs: Ms Maxine Reed
Vice President – Media and Communications: Ms Sandra Klingberg
Chair, Board of Examiners: Mr Greg Ward
Branch Representatives to Council
New South Wales & Australian Capital Territory (NSW&ACT): Mr Peter Ward
New Zealand(NZ): Dr Samarina Musaad
Queensland (QLD): Ms Kate Waller
South Australia and Northern Territory (SA&NT): Mr Bruno Sonza
Tasmania (TAS): Mr Robert White
Victoria (VIC): Dr Ronda Greaves
Western Australia (WA): Ms Liz Byrnes
Chief Executive officer: Mr Chris Harnett
Council Meeting
Council met at the national office in Sydney on the weekend of 16th and 17th April.
Strategic objectives were reviewed on the 16th and general business was conducted on the
17th.
Branch Activities
The large state branches usually provide a monthly scientific meeting for the membership atlarge and also monthly tutorials for those sitting examinations (although all are welcome).
Smaller branches find it more suitable for their membership to hold full day or weekend
meetings as this format allows more of their local membership to attend. Amongst othermeetings, most branches have held a movie night to screen “That Sugar Film”, a documentarystyle film that tells a startling story about the metabolic effects of a mere two month period of
dietary change from unprocessed food to processed foods that are either specifically labelled,
or at least perceived by the consumer as “healthy”, has on a lean, young, healthy Aussie
male.Our own Professor Ken Sikaris has a role in the film as an expert in the interpretation ofpathology tests; in the film Ken (Professor Blood) states he is amazed at the level of changes inliver function tests that has occurred during the experimental period. I highly recommend thisfilm to anyone interested in health.

38

7

NSW&ACT
February: Illicit drugs in society – clinical, social and analytical issues. Dr Alex Wodak, Dr
Santiago Vazquez, Todd Mcbriar
March: Movie night “That Sugar Film”
April: Cases – back to basics. Dr Jason Chung, Dr MacmurphyAlbeos, Peter WardMember Societies APFCB News 2016
June: NSW Posters from 2015 AACB Annual Scientific Meeting. Various presenters.
NZ
Full day meeting held 1 June 2016 “The eclectic world of clinical chemistry”
Program: morning
Troponin session
Appropriate use of cTNs-don‟t forget pre-test probability: Chris Florkowski
Troponin assays revisited in 2016 – including a snapshot of NZ practice: Jill Tate
Troponin as a risk management marker in cardiac disease: Andrew St John (Abbott)Special chemistry session
Mass Spectrometry: Opening Up Pandora's Box: Ronda Greaves
High Performance Liquid Chromatography:Gerald Woollard. Mass Spectrometry: Models for on-going education: Ronda Greaves
Program: afternoon
Young scientists session
Kavain interference in urine Amphetamine and Ethanol drug screening:Tejal Patel
Quality matters from a quality officer: Matthew Slater
Hypopituitarism :Mijoo Kim
Miscellaneous session
POCTandharmonisation: Lyn Clarke; Mind the Gap: Geoff Herd
Scientific and Regulatory Committee matters (AACB): Maxine Reed
The Cost of Quality :NicoVandepoele (Bio-Rad)
Neonatal Screening: Mark De Hora
Best Practice Advocacy Centre (BPAC): Tony Fraser on NZ Ministry of Health PSA guidelines
QLD
March: Queensland member posters from the Annual Scientific Meeting
April: Back to basics. HbA1c
May: Translation of diagnostic pathology to research
June: Ordinary general meeting
SA&NT
February: Clinical cases – Focus on liver function tests. Helen Martin
March: Drowning in honey – cases in diabetes. Dr Wayne Rankin
April: Cases from the Northern Territory. Robert McFarlane
May: Young scientist‟s presentations. Ashley Chandler, Alan Vrbanac, Cory Markus, Dennis
PenglisJune: MARS – liver disease and the ICU. Dr Alpesh Patel
TAS
Weekend meeting to be held 21st and 22nd August 2016 in the beautiful Tamar Valley. Hobart
will host the Chemical Pathology Course in 2017.
VIC
February: Cases in clinical biochemistry. Drs Kartika Henry, GeethaRathnayake, Christina
Trambas, Kay Wen Choy, MiretteSaad, Abdul Wahab.
March: Ricketts and osteomalacia. Dr Tina Yen
April: Allergy and specific IgE. Dr David Tran
May: Challenges in HbA1c analysis. Dr Trefor Higgins

8

APFCB News 2016 Member Societies
June: Extreme cases in clinical biochemistry. Drs Julie Ryan, G Liu, Jim Doery, Kay Weng
Choy, Ray Czajko
WAMarch: Movie night “That Sugar Film”
April: Industry developments presentation – Beckman Coulter, Bio-Rad and Thermo Fisher
May: Bone Health – Dr Paul Chubb and Dr Sam Vasikaran
National Meetings
Chemical Pathology Course – 8th-12th February 2016
The AACB-RCPA Chemical Pathology Course is the educational highlight of the first half ofour calendar year. This year, 144 delegates from 6 countries attended the course held in
Melbourne at the beautiful and historic State Library right in the centre of the city.
Scholarships to support attendance were awarded to: Nicole James, Dr MiretteSaad, Sabrina
Koetsier, Robin Williams and Aida Mulabecirovic.
ProgramMonday 8thMorning sessions
Immunoassay sensitivity and specificity: Dr Fernando San Gil
Osmometry: Mr Steven Weier
Acid-Base Measurement - what‟s going on in the black box?:Mr Joe D‟Agostino
Organising for a quality laboratory: Mr Ray Czajko
How to troubleshoot failing QC: Dr Douglas Chesher
Laboratory Accreditation; ISO, NATA: Dr Ronda Greaves
Monday 8th Afternoon sessions
Massively parallel sequencing: Dr Susan Matthews
Molecular Markers for Tumours: Dr MiretteSaad
DNA - inherited disorders: Dr GeethaRathnayake
Measurement and estimation of GFR. Why do we do it and what problems arise: Ms Christine
Mandelt
What is the best way to measure protein in urine and what does it mean?:Ms Helen Martin
Biochemical testing in acute and chronic kidney failure: Dr Kay Weng Choy
Tuesday 9th Morning sessions
How well do labs measure thyroid hormones? Standardisation versus harmonization: Prof
Howard MorrisInterpretive comments for TFTs. If you put anything, what should it be?:Dr Penny Coates
Thyroid diseases in pregnancy. Prevalence, significance and diagnosis: Dr David Deam
Pre-analytical factors in glucose testing: Ms Daniella Atanasovski
Diabetic emergencies: Dr Wayne Rankin
Glucose measurements in pregnancy. Why are these important and what has changed: Dr
Nilika Wijeratne
Tuesday 9th afternoon sessions
Breakout Sessions: Cases and calculations
Endocrine cases: Dr Wayne Rankin
pH/blood gas cases: Alan Riglar
Miscellaneous cases: Dr Que Lam
Electrolyte cases: Dr David Deam
Calculations: Dr Andrew Wootton
Clearance creatinine/drugs: ValenaBraniff

9Member Societies APFCB News 2016
Statistics/uncertainty of measurement: Dr Ian Farrance.
Wednesday 10th morning sessions
Drugs of abuse - GC and LCMSMS compared: Mr Amir Naimi
Why are therapeutic drugs ineffective in some people and toxic in others?:Prof Hans Schneider
The 5 most common phone questions in a toxicology laboratory: Ms Helen Martin
What are cryo-proteins and how do you test for them?:Mr Geoff Raines
Should serum light chains replace urine Bence Jones protein?:Dr Christina Trambas
Plasma Protein Electrophoresis: measurement and interpretation: Ms Catherine Lynch
Wednesday 10th afternoon – free timeThursday 11thmorning sessions
1st Trimester Screening: Mr Greg Ward
The metabolic autopsy: Dr James Doery
Neonatal Biochemical Emergencie: Dr Tina Yen
Investigation of Iron Overload: Dr Paul Chubb
Investigation of Iron deficiency: Mr Robert White
Investigating B12 deficiency: Dr Zhong Lu
Thursday 11th afternoon sessions
Biochemical Investigation of Malabsorption: Dr Alan McNeil
Pancreatitis: Ms Janine Grant
Faecal Occult Blood Testing: Mr Steven Weier
Lipoprotein metabolism: Dr Douglas Chesher
Lipoprotein disorders: Dr Ken Sikaris
Friday 12th morning sessions
Insulin-like Growth factors: Dr Penny Coates
Menopause: diagnosis and management: Dr Ken Sikaris
Adrenal Cortical Function Testing: Dr Cherie Chiang
Quiz: Dr Andrew Wootton
The Examiners: “a blues band”: Mr Greg Ward
Webinars
AACB provides webinars most months, 2016 webinars have been as follows:
March: An introduction to porphyrins and porphyria. John Zoanetti
April: Biochemical testing in acute and chronic renal failure. Dr Kay Weng Choy
June: Biliary atresia: Dr Stephen Mouat
Publications
Clinical Biochemist Newsletter: is published quarterly and as the name implies, is principallyintended to keep the membership informed about AACB activities; issues this year werereleased in March and June.
The Clinical Biochemist Reviews is a peer reviewed journal of review style articles also
published quarterly; two editions have been produced so far this year.

10Member Societies APFCB News 2016
Hong Kong Society of Clinical Chemistry(HKSCC)The year started with the newly elected office bearers elected at the Annual General Meeting(AGM) of the Hong Kong Society of Clinical Chemistry held on 23 January 2016, taking up theiroffice. The office bearers elected were:
President
Vice President
Immediate Past President
Secretary
Treasurer
Council Members

Dr Doris CK CHING
Mr Yun Chuen LO
Ms Judy PS LAI
Dr Iris HS CHAN
Ms Cybil TY WONG
Prof YM Dennis LO
Prof Allen CK CHAN
Prof Joseph LEE
Dr Liz YP YUEN
Dr Lydia CW LIT
Dr Eric LK LAW
Dr Jeffery SS KWOK
Mr Michael HK LEE
Ms Karen KT LAW
Mr Eric WK WONG

National Representative to IFCC
National Representative to APFCB
Representative to FMSHKProf Allen CK CHAN
Dr Doris CK CHINGProf Joseph LEE

Dr Graham Jones of St Vincent‟s Hospital, Sydney, Australiawas the APFCB Travelling
Lecturer. He was invited to deliver two APFCB lectures entitled: “Chronic Kidney Disease –the Role of the Routine Laboratory” and “HbA1c –Measurement and Interpretation” in the2016 Annual Scientific Meeting (ASM).There were also 5 presentations from the industries(Roche, Abbott, Thermo-Fisher, Beckman-Coulter and AB Sciex).The 14 industrial booth
exhibitions and lectures were well attended by over 190 members and guests.
Education activities for the year carried on with presentations by distinguished academia andscientists. Two scientific meetings were organized in the first half year of 2016:
1.

Professor Mitchell G. Scott, External Examiner for Chemical Pathology, Chinese
University of Hong Kong delivered a dinner lecture at the Cordis Hong Kong Hotel on
12 April 2016. The title of his talk was „Laboratory Testing for Growth Hormone Abusein Sports Perspective‟. The event was attended by 110 members and guests.

2.

A joint afternoon seminar with Hong Kong College of Pathology (HKCPath) was held at
Queen Elizabeth Hospital on 7June. Dr John Christopher Coakley, Specialist in
paediatric/ neonatal chemical pathology, has been appointed the RCPA Visiting Lecturer
2016 and he delivered two lectures on “Investigation of Jaundice in Infants andChildren” and “Lipid Problems in Children”. To keep abreast of the recent advancesand service developments of Clinical Chemistry in Hong Kong locality, presentations
were followed and delivered by two distinguished members: Dr Chloe Mak and Dr
Felix Wong. Dr Mak introduced “Pilot Study of Newborn Screening for Inborn Errors ofMetabolism in collaboration with Department of Health and Hospital Authority” and Dr
Wong highlighted “Inborn Errors of Carbohydrate Metabolism: two recent cases inHong Kong”. The event was attended by about 100 members and guests.

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APFCB News 2016

Member Societies

Council 2016 – 2017

Dinner lecture (12 April 2016): Professor Mitchell G. Scott

Dinner lecture (12 April 2016): Professor Mitchell G. Scott

12

Member Societies

APFCB News 2016

Joint seminar (07 June 2016): Dr John Christopher Coakley

47

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APFCB News 201614

Member Societies

Member Societies APFCB News 2016

Indonesian Association for Clinical Chemistry(IACC)
1.

14thNational Congress of Indonesian Association for Clinical Chemistry
Indonesian Association for Clinical Chemistry (IACC) held a National Congress in Hotel
Bumi Surabaya, 21 April 2016. Dr. July Kumalawati, DMM.,SpPK (K) elected by all
congress delegation to continue her success to lead IACC for second period 2016-2019.

Dr. July Kumalawati, DMM, SpPK(K) elected president of IACC 2016-2019

2.

Workshop and Seminar
IACC held Workshops and Seminar during 14th National Congress for Clinical Chemistryin Hotel Bumi Surabaya, 22-24 April 2016. Seminar topic is IVD Innovation for theenhancement of Clinical Laboratory Quality. Around 600 participants were attended thisSeminar.

Elected President IACC, dr. July Kumalawati, DMM.,SpPK(K) and Congress
Chairman dr. RobiulFuadi, SpPK opened the 14th National Congress of IACC
Seminar and Workshops.

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APFCB News 2016 Member Societies
IACC delightedly give the appreciation and honorary award for the founders of IACC
during the 14th National Congress of IACC. IACC was founded in January 1980 by someIndonesia scientist as follow:
1.
2.
3.
4.
5.

Prof. dr. Marsetio Donoseputro, SpPKProf. dr. Tedjo Baskoro, SpPKDr. Yohanes Widyaharsana
Drs. Andi Wijaya
Dr. Ing. Bina Suhendra

Past IACC President DewiMuliaty, PhD (right) and Elected President dr. July Kumalawati,
DMM., SpPK (K) of IACC give the honorary award for Founder of IACC. Left-Right: Mrs.
Widyaharsana, Prof. dr. Marsetio D, SpPK family, Andi Wijaya, PhD

Prof. dr. Jusak NugrahaSpPK(K) talked with exhibitor staff during IVD Exhibition in
14th National Congress of IACC.

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Member Societies

APFCB News 2016The Organizing Committee of 14th National Congress of IACC
3.

APFCB Travelling Lecture
Supported by APFCB, Dr. Graham Jones, PhD from New South Wales University
Australia kindly visited Indonesia and spoke about Laboratory Management and Chronic
Kidney Disease during 14th National Congress of IACC.

Prof. JusakNugraha, SpPK the head of IACC Surabaya Branch as the host of 14th National
Congress IACC give the appreciation for Dr. Graham Jones, PhD as the speaker from APFCB
Travelling Lecture.

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APFCB News 201618

Member Societies

4.

MIHY Program
IACC and BD has extend the agreement to continue May I Help You Program to increase
the quality of Pre-analytical in Laboratory Medicine in Indonesia. This program hasreached 58 hospitals/laboratories and many more in the waiting list.

5.

PROJECT OF INDONESIA PEDIATRIC REFERENCE INTERVAL (PIPER Study)
IACC and new Board of Indonesian Association of Pediatrics (IDAI) has preliminary
understanding to held the study for set up the reference range for Indonesian childpopulation.

6.

RESULT INTERPRETATION AND COMMENTING PROGRAM
IACC launched the online training on result interpretation and commenting through IACC
website namely www.hkki.org . We called this program by Interactive Case Study. Every
three month we update the case study and result.

Member Societies

APFCB News 2016

Singapore Association of Clinical Biochemists(SACB)
The first half of this year was filled with a multitude of activities for the Singapore Association ofClinical Biochemists (SACB).
On 5th March 2016, our annual scientific meeting (ASM) was held at the Carlton Hotel,
Singapore. Speakers came from Australia, China, Malaysia, Singapore, UK and USA. This year,
172 participants attended the ASM and were rewarded with a range of talks in the scientificprogramme, covering topical issues including patient safety, laboratory automation, point-ofcare testing, management of quality controls, troponins, HIV testing, clinical and analyticalaspects of vitamin D and Graves disease. After the scientific programme, members of the
SACB conducted our annual general meeting and elected new council members for a term of
two years. We thanked the council members who had contributed their time and effort in thelast two years, and welcomed new council members. Welcomed new council members.
The SACB, in conjunction with the Mayo Clinic (USA) and the Endocrine and Metabolic Societyof Singapore, co-organised a Laboratory Endocrinology course at the Pan Pacific Hotel,
Singapore. The two-day course in February 2016 covered the principles, methodology, utility
and potential pitfalls of various laboratory assays of relevance to clinical endocrinologists.
International and local experts spoke on a number of topics ranging from mass spectrometry,
assay performance, lipids, adrenal disorders, thyroid hormones, reproductive endocrinology to
the growth hormone axis. Multiple members of the SACB participated in this course. Clinicalcase discussion sessions during the course also provided a platform for constructive dialogues
between clinicians and laboratory professionals.
The SACB, in conjunction with the Mayo Clinic (USA) and the Endocrine and Metabolic Societyof Singapore, co-organised a Laboratory Endocrinology course at the Pan Pacific Hotel,
Singapore. The two-day course in February 2016 covered the principles, methodology, utility
and potential pitfalls of various laboratory assays of relevance to clinical endocrinologists.
International and local experts spoke on a number of topics ranging from mass spectrometry,
assay performance, lipids, adrenal disorders, thyroid hormones, reproductive endocrinology to
the growth hormone axis. Multiple members of the SACB participated in this course. Clinicalcase discussion sessions during the course also provided a platform for constructive dialogues
between clinicians and laboratory professionals.
Looking ahead, the SACB will be conducting its annual series of educational lectures scheduled
for the second half of the calendar year. As the only professional body dedicated to clinicalbiochemistry in Singapore, the SACB will continue to take the lead in education and skills
improvement for the profession.

19MemberFeatures
Societies APFCB News 2016
Vitamin B12 Deficiency: Active B12 Assay
Dr M. Saleem
Consultant Chemical Pathologist: MBBS, MAACB, FRCPA
South Australia Pathology
Adelaide
Australia

Introduction
Vitamin B12 also called cobalamin, is a water soluble vitamin utilised as a cofactor for enzymes thatcatalysemethyl group transfer. This includes DNA methylation, myelin formation and theconversion of homocysteine to methionineand therefore plays a fundamental role in the normal
functioning of the brain and nervous system, and for the formation of blood.
Estimates of the prevalence of B12 deficiency vary depending on the population tested and the
diagnostic test cut-offs used. The incidence appears to increase with age (>65 years) and withthe ubiquitous use of gastric acid–blocking agents.

Consequences of Vitamin B12deficiency

VitaminB12 deficiency can interrupt key biochemical pathways which may disrupt DNA synthesis
resulting in megaloblastic anaemia and other adverse effects on the nervous system and otherorgans.
A full blood count which shows anaemia and macrocytosis has traditionally prompted
practitioners to look for Vitamin B12 deficiency. The presence of hypersegmented neutrophils(Figure 2) has been considered to be of high diagnostic accuracy although there are other nonspecific causes for this finding (eg iron deficiency anaemia). Untreated, deficiency of Vitamin B 12
may lead to severe anaemia.
Importantly, Vitamin B12 deficiency may present without any haematological abnormalities at all.
There is a broad range of neurological symptoms associated with Vitamin B 12deficiency which
may include peripheral neuropathy, irritability, tiredness and mild deterioration of memory andcognitive ability. Severe deficiency causes subacute combined degeneration of the spinal cord. In
pregnancy, maternal Vitamin B12 deficiency is associated neural tube defects in infantsand
deficiency in childhood is associated with developmental delay and failure to thrive.
Impaired DNA synthesis may also affect other rapidly dividing cells causing glossitis,
gastrointestinal symptoms and infertility.

Causes of Vitamin B12 deficiency
Vitamin B12 deficiency due to poor nutrition is rare, given the small daily requirement of Vitamin
B12(1-5 mg/day) and its presence in abundant quantities in animal products. Populations at risk fornutritional deficiency include elderly population at risk of poor intake of meats and dairy
products, chronic alcoholics and strict vegans. Vitamin B 12 deficiency may also occur at times ofincreased requirement such as in pregnancy and during lactation.

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APFCB News 2016 Features
Absorption of Vitamin B12 requires adequate gastric acid and intrinsic factor as well as a functionalterminal ileum. Pernicious anaemia is caused by the autoimmune destruction of the gastric parietal
cells and loss of intrinsic factor. Total or subtotal gastrectomy and gastric bypass procedures may
result in Vitamin B12 deficiency. Exocrine pancreatic failure and loss or disease of the terminal ileum
may also impede absorption. Intestinal bacterial overgrowth may consume Vitamin B12 causing
deficiency.

Who should be tested for Vitamin B12 deficiency?
Several guidelines recommend that patients with symptoms or signs of Vitamin B 12deficiency
includinganaemia(macrocytic
anaemiaormacrocytosis)
andpatients
withsuspectedneuropsychiatric abnormalities should be tested for Vitamin B 12 deficiency.
Otherpopulations where testing could be considered include the elderly, long-term vegans,patients who abuse alcohol, peopleon drugs that interfere with vitamin B 12 absorption (long-term
H2 receptor antagonists,protonpump inhibitors or met formin) and patients with inflammatory
bowel disease, gastric or smallintestine resection.

Forms of Vitamin B12 in the blood
Serum Vitamin B12 is bound to two major carrier proteins;(Figure 1)
1) Haptocorrin (HC, also calledTranscobalamin 1) binds the major portion of plasma Vitamin B 12
which is not active in Vitamin B12 delivery to cells.
2) Transcobalamin II: binds Vitamin B12 to form a complex called holotranscobalamin (holoTC).
Transcobalamin II binds only 20–30% of vitamin B12 circulating in the blood, but is responsible fordelivery of Vitamin B12 to cells, hence its name active-B12.

Biochemical tests used in the diagnosis of Vitamin B12 deficiency
Total Vitamin B12 in Serum
This is the most common test of Vitamin B 12 statusand measures the sum of inactive (haptocorrin
bound) and active Vitamin B12 (HoloTc). In clinical situations where there is a significant change in
the inactive Vitamin B12 fraction (haptocorrin bound), total serum Vitamin B12 may not reflect tissue
status. Inactive Vitamin B12 is decreased in pregnancy/oestrogen therapy but may be increased inrenal failure and haematological malignancies. Therefore tissue deficiency of Vitamin B 12 may occur
despite apparently normal serum total Vitamin B12 levels and vice versa. Up to 30% of patientswith Vitamin B12 deficiency may show serum total Vitamin B12 levels in the lower normal range.
HoloTCin Serum
HoloTC (active B12) levels give a better indication of biologically active B12 available for the tissue.
Levels ≤35pmol/L are considered to be deficient; in a minority of patients levels above this cutpointmay still be associated with tissue deficiency and patients in whom there is clinical suspicion of
deficiency may benefit from homocysteine or methylmalonic acid analysis.
Intrinsic Factor Antibodies /Parietal Cell Antibodies
Intrinsic factor antibodies and Parietal cell antibodies may be helpful in supporting a diagnosis ofpernicious anaemia.The presence of IFA is virtually diagnostic of pernicious anaemia, but they aredetected in only about 50% of cases. B12 treatment can cause false negatives. In the past, thediagnosis of pernicious anaemiawas usually established by assessing B 12 absorption with the Schilling
test, but this test is no longer available.
Homocysteine
The poor conversion of homocysteine to methionine in Vitamin B 12 deficiency may cause anelevated fasting plasma homocysteine level. While a normal plasma homocysteine makes Vitamin
B12 deficiency unlikely,

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Features

APFCB News 2016it has limited specificity because elevations occur in inherited and acquired disorders, including
folate and pyridoxine(B6) deficiency and particularly in patients with chronic kidney disease.
Methylmalonic acid (MMA)
Poor conversion of methylmalonyl Coenzyme A to succinyl Coenzyme Ain Vitamin B12 deficiency may
cause an elevated serum level of MMA. Like homocysteine, MMA also has poor specificity as elevations
may occur in rare inherited disorders and in chronic kidney disease. In the absence of these conditions
a significantly elevated MMA strongly supports Vitamin B12 deficiency.
Summary
1.
2.
3.
4.
5.

Vitamin B12 deficiency is common
Symptoms may be ill-defined and a high index of suspicion is necessary
Vitamin B12 exists as an active and an inactive form in the blood
Total serum Vitamin B12 assays measure active and inactive forms and are thus prone to false
positives & negatives.
“Active B12” assay measures only the active form and is thus superior for detecting deficiency.

References
1.
2.
3.
4.
5.

Green R et al., Baillieres Clin Haematol., 1995; 8: 533-6
Lindenbaum J et al., New Eng J Med., 1988; 318: 1720-8
Snow CF Arch Intern Med., 1999 ;159 :1289-98.
Hvas AM et al., UgeskrLaeger., 2003; 165: 1971-6.
Hermmann W et al Curr. Drug Metab. 2005; 6: 47-53

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