Readers Respond

Dec. 1, 2009

Letters to the Editor

Readers Respond

Clarification on data

As the product manager of Sebia Electrophoresis, specifically our hemoglobinopathy/thalassemia testing methods, I read with great interest the lead article in the [August 2009. pp. 8-16] issue of MLO — “Hemoglobinopathies and clinical laboratory testing.”

Within the article, there is data taken from the 2009 CAP
HG-A survey. The article states and pictures (Figure 4) the following:
“according to the 2009 CAP HB-A proficiency surveys, ion-exchange HPLC,
in which Hb species are separated based on charge differences, account for
the majority (93%) of the methods used for the measurement of Hb and
detection of hemoglobinopathies.”

In my position, I am quite familiar with the
Hemoglobinopathy (HG) CAP surveys. There are subcategories such as “Hb A2
Quantitation” and “Hemoglobin Electrophoresis Alkaline and Acid
Hemoglobin or IEF or HPLC
.” Please take a look at the data I pulled
[that] presents peer-groups for each of these two categories:

Hemoglobin A2 Quantitation: (combined methods for easier viewing)

  • Helena Quick Column Methods — 44 reporting labs, or
  • HPLC Methods (Bio-Rad, Primus, Tosoh) — 192
    reporting labs, or 75.6%; and
  • Sebia CE Method — 18 reporting labs, or 7.1%.

Hemoglobin Electrophoresis Alkaline and Acid
Hemoglobin or IEF or HPLC
(Hb A fraction data):

  • Beckman Coulter (gel) — 23 reporting labs, or 6.6%;
  • Helena (gel) — 73 reporting labs, or 21.0%;
  • HPLC— 135 reporting labs, or 38.9%;
  • IEF — eight reporting labs, or 2.3%;
  • Sebia Hydrasys (gel) — 90 reporting labs, or 25.9%;
  • Sebia Capillarys — 18 reporting labs, or 5.2%.

When I looked at the above data from the HG-A 2009 survey
carefully, regarding HPLC specifically, I determined 75.6% reporting labs
for Hb quantitation and 38.9% reporting labs for qualitative results (Hb
variant detection)
. I am confused [as to] how the authors determined
that 93% of reporting labs are utilizing HPLC “for the measurement of Hb and
detection of hemoglobinopathies.”

From reading this article, MLO readers without a
great deal of knowledge of the hemoglobinopathy market may not realize that
other traditional (gel electrophoresis, IEF, manual columns) and novel (CE)
methodologies are currently being utilized in clinical labs both
for Hb quantitation and Hb separation and variant detection.
certainly a useful method utilized in many labs; however, as seen above,
38.9% of labs utilize HPLC for the detection of Hb variants/hemoglobinopathies
not 93%.

Also, Continuing Education question 19 (p. 21) reads
as follows “According to 2009 CAP proficiency surveys, HPLC accounted for
75% of the methods used for detection of hemoglobinopathies.” (True/False)
What would be the correct answer then?

I would like to see further clarification from the
authors. I must say that, personally, I found the article to be quite
comprehensive and educational — providing very useful information concerning
various Hb testing methodologies for the clinical lab, as well as the
newborn screening lab.

—Bonny Champagne, MT(ASCP)

Senior Product Manager

Sebia Electrophoresis

Norcross, GA

Dr. Ross Molinaro's response:
The authors would like to thank Ms. Champagne for this letter. Data from
Figure 4 is in reference to the 2009 CAP Hb A2 Quantitation Hemoglobinopathy
survey. In this article text and Figure 4 legend, the authors would like to
note that ion-exchange HPLC, when taken together with quick column HPLC,
account for 93% of the methods, in the CAP Hb A2 survey. The reader is
correct that other CAP surveys do exist for analyzing hemoglobinopathies,
however, the authors are speaking only of the subcategory Hb A2 survey in
this case.

—Ross J. Molinaro

Assistant Professor
Pathology and Lab Medicine;
Medical Director, Core Laboratories
Emory University Hospital Midtown
Atlanta, GA

Editor's note:
Dr. Molinaro has also assured us that CE question 19 is valid as it
currently stands.

Being boss

Your “bottom line” answer to “Wanted: Happy applicants” in the September 2009 MLO (p. 53) really hit the mark. The “supervisor” asking the question needs to consider what is making his lab an unhappy place to work and should probably look inward, either at himself or in his lab, for answers first. Clues may identify insufficient personnel with a greater than average workload; an insufficient or non-existent continuing education (seminars, teleconferences) program for the staff; lack of any kind of recognition program (which does not always have to be about money!) or a power-mongering boss who likes to be in control of most of what goes on, leaving very little for his techs to take care of by themselves without his/her oversight (poor delegator), who appears to favor some staff over others, who does not recognize and, hence, underutilizes or does not properly utilize the strengths and skills of his personnel to the best interest of the lab.

I know because I have been associated with this
industry — both clinical and industrial — for 25 years. I also have been
a supervisor and have eaten a lot of “humble pie” by being open with my
staff and taking feedback (which was not easy) as well as giving it. I
believe feedback should go two ways. It is amazing how many “techs” get
promoted to a management-level position with little or no formal
training, simply because they were great techs and/or have been in their
position for a long time. However, a good technologist does not imply
that person will excel in management. There are skills that need to be
learned, just as there were educational hurdles to clear and
certification(s) to possess to determine one's worthiness as a tech; not
everyone, though, is cut out to be in a management-level position simply
because it appears to be the logical next move.

—Name withheld by request

Some days, we got it …

I am currently a med tech. I had a major genetics research project due on cystic fibrosis, and I just wanted to let you know how USEFUL your July 2008 cover story [“Cystic fibrosis: newborn screening in America,” pp. 16-27] regarding newborn screening for CF was. It was an excellent reference source for me — the most extensive current reference article that I found with both background and current information. I just wanted to say thank you. So many peer-reviewed journals have such limited access unless you are logged into your library database. I originally accessed the article through our database; but it is the weekend, and I am at home and having trouble logging in remotely. I decided to give your website a shot with a somewhat negative attitude. I was pleasantly surprised to see that I was able to access the article and get what I needed online from your website without any hassle. THANK YOU again. I look forward to using your journal again for future references.

—Name withheld by request

Editor's note:
We are always happy to hear that someone could use MLO resources
in order to succeed at a project. We get many requests from faculty and
students regarding past issues. Our online CLR directory is an
excellent source for our readers and vendors, too. The MLO
website has been undergoing “growing pains” for many months, but the end
is in sight! We hope to have all phases of our website — including our
frequently sought-after archived articles — operating in synch by
January 2010. Please come back from time to time to see how our
“construction” is coming along.