The latest news in hematology

Multiple myeloma is a cancer of the bone marrow with approximately 20,000 new cases diagnosed each year in the U.S. For many years, the diagnosis of myeloma was based on determining the presence of an M-spike in the densitometric trace of a serum protein electrophoresis (SPE) gel. Unfortunately, SPE is very insensitive for light chain myeloma resulting in up to 15% to 20% of myeloma patients being missed by electrophoretic methods. With the introduction of free light chain assays, light chain levels can now be fully quantitated down to their normal range, greatly improving diagnostic sensitivity. In fact, both the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology and the International Myeloma Working Group Guidelines now recommend that serum free light chain assays be included in the initial diagnostic workup of suspected myeloma and related plasma cell disorders. [Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Multiple Myeloma V.1.2011. © 2010 National Comprehensive Cancer Network Inc. All rights reserved.]

Dick Rowland
Chief Executive Officer
The Binding Site
Provider of Freelite serum free light chain assays

Automation and IT to help manage workloads

The world of hematology continues to automate — body-fluid analysis, for example, is now routinely available as an automated method on most high-volume hematology systems. Increasing volumes of work due to our aging population and the consolidation of testing will continue to drive this trend. Increasingly, sophisticated IT solutions will also have an impact. Automatic review and validation of tests is becoming a prerequisite to managing workloads in the face of laboratory personnel shortages. As a company with significant IT experience, Siemens recognizes that the creation and management of data in the medical laboratory — and the medical industry overall — will continue to create a demand for stronger partnerships between the laboratory and healthcare professionals.

Fred Stelling
Director
Global Hematology Marketing
Siemens Healthcare Diagnostics
Maker of ADVIA 2120i hematology system

QC: keeping up with the new technology

The clinical laboratory role in the care pathway has become increasingly important as hospitals nationwide brace for tougher regulatory oversight aimed at quality and cost transparency. The restructuring of DRGs to MS-DRGs used in the inpatient prospective payment system and the new POA requirements will impact how hospitals code patients and, consequently, the way in which hospitals are reimbursed. As such, best-in-class automated hematology systems with advanced, clinically relevant parameters that can potentially impact treatment guidelines, care pathways, patient flow, and ROI are essential. Additionally, clinical labs will want to ensure that these advanced clinical parameters can be automatically measured in the course of a routine CBC and require no additional capital, training, or reagents. By thoroughly considering quality, instrument reliability and the ability to provide advanced clinically relevant results, lab managers can impact overall healthcare efficiencies operationally, clinically, and financially.

Ralph Taylor
Vice President, Marketing and Medical Affairs
Sysmex America
Maker of Sysmex XE-5000 automated hematology system

The LEANer, the better

The vast majority of labs are facing competing pressures, beginning with increased workloads — something which is likely to worsen over time as the graying population continues to grow and, with it, the need for healthcare services and less availability of laboratorians. (It is estimated that as many as 60% of experienced technologists will be at retirement age within the next few years.) In fact, the trend has been for labs to use generalists more and more for specialized testing like hematology, requiring analyzers to be easy to use as well as efficient and accurate. Turnaround time, especially for labs that support an ED, will also continue to be a challenge. Finally, pressure from hospital administrators to reduce costs will worsen as payers evaluate and revise reimbursement policies. Many labs are turning to LEAN, the identification of “non-value-added” activities, to reconcile many of these challenges. Similarly, analyzers that are automated and true to LEAN principles will be in demand as pathologists and lab directors seek to manage competing demands.

Cindy Collins
Group Vice President
Beckman Coulter Cellular Analysis Business Center
Maker of UniCel DxH 800 Coulter Cellular Analysis System

Detect schizophrenia via blood test
My Health News Daily reported on Oct. 13, 2010, that a new blood-based diagnostic test may help assist psychiatrists in confirming recent onset of schizophrenia. To make a diagnosis, the biomarker profile of a suspected schizophrenia patient is compared with that of a patient with the disease. Scientists have found 51 biomarkers associated with the disease; and in a study led by Spain, blood samples from 577 patients in various stages of schizophrenia were measured against 229 people without the disorder. The test was accurate in diagnosing 83% of patients. The 51 biomarkers were still identifiable after some patients underwent four to six weeks of medication. The test was particularly effective in difficult cases with patients who had experienced multiple psychotic episodes.
The findings, reported in the May 2010 issue of Biomarker Insights, were not widely reported. The test called VeriPsych is not, say its researchers, meant to provide a definitive diagnosis of schizophrenia. Meanwhile, they are developing a test that would distinguish between schizophrenia and other mental illnesses like bipolar and major depressive disorders. Currently, patients with schizophrenia are diagnosed through interviews with a doctor and have to be suffering from two or more common symptoms for a month or less. Diagnosis can be tricky since schizophrenia can also mimic other conditions like depression, anxiety, or bipolar disorders. An estimated 2.4 million American adults (1.1% of people 18 or older) suffer from schizophrenia, according to the National Institute of Mental Health; fewer than half receive appropriate antipsychotic medication or psychosocial interventions, according to a July 2004 report by the Agency for Healthcare Research and Quality.

Watermelon reduces blood pressure
According to TopNews U.S. on Oct. 14, 2010, a new study conducted by food scientists at the Florida State University suggests that watermelon is beneficial in acting against pre-hypertension that gives birth to many heart diseases. The researchers in the study, which appears in the American Journal of Hypertension, claim that they are the first to conclude that by taking doses of watermelon, health middle-aged men and women could find improvement in their aortic hemodynamics in pre-hypertension. The researchers used four men and five post-menopausal women, ages 51-57, with pre-hypertension who, for six weeks, were regularly given six grams of the amino acid L-citrulline/L-arginine from watermelon extract. In all nine patients, the study found, there was improvement in artery functioning and reduction in aortic blood pressure. The scientists hope to conduct the same study on a large scale based on the reported results from this preliminary study.

Test being refined for earlier detection of Parkinson's

According to Postmedia News on Oct. 14, 2010, an international team led by a Canadian neuroscientist believes it has identified signature proteins in the blood and spinal fluid that show the progression of Parkinson's disease in the brain. Currently, no single test exists to predict who will develop Parkinson's, the second leading brain-wasting disorder behind Alzheimer's. The 10-year effort started at Harvard University and continued at the Ottawa Hospital Research Institute, yielding, to date, a method that, in principle, could identify people at risk of developing the disease. The team's findings were presented in September at the World Parkinson's Congress in Scotland and require further testing; but, if proven, the protein markers could form the basis of a test to screen people for early signs of the disease. It might also allow scientists to study how the disease progresses and, perhaps, find drugs to slow or halt the process. At present, patients are assessed according to the severity of physical symptoms — rigidity, poor balance, and uncontrollable shaking — and the method is so imprecise that it can lead to diagnosis only when the disease is already well advanced. The Michael J. Fox Foundation has given $40 million for a five-year study of a spinal-fluid test to detect the disease. But spinal taps have drawbacks, so the team is also in the early stages of developing a blood test, a much-less invasive procedure; this test has been tried so far in nearly 600 American and Canadian patients. Both the blood test and the spinal-fluid test aim to measure a Parkinson's protein, alpha-synuclein, found at very low levels in the spinal fluid in seven out of 10 patients with the disease. Researchers believe that once that protein is in a person's nervous system, it collects in the brain in deposits that damage neurons and lead to the debilitating symptoms of Parkinson's. Twenty years ago at Harvard, the lead neuroscientist of the team identified a protein called beta-amyloid as a physical hallmark of Alzheimer's, a discovery became the cornerstone of what is today a leading theory about how to treat the disease.

Weatherall studies tropical genetic blood diseases
Sir David Weatherall, now 77, Oxford researcher-physician, was among the first to use molecular biology tools to understand thalassemia. In a recent New York Times interview, Weatherall told Reporter Claudia Dreifus the high points of his biomedical career when he was in New York to receive the Lasker-Koshland Special Achievement Award for 50 years of international statesmanship in the field. His first experience came shortly after his medical training when he had to serve a compulsory military stint in Malaya. The Commonwealth army put him in charge of a pediatric ward there in a hospital for families of Commonwealth soldiers. In his spare time, he went to the biochemistry department at Singapore University Hospital where he worked with others for six months to solve the puzzle of a 2-year-old patient with profound anemia — the daughter of a Gurkha from Nepal. The diagnosis was thalassemia, a genetic disease thought to occur only in the Mediterranean. Thalassemia meant she did not live to adulthood, which happened to most sufferers in the 1950s.
Weatherall continued his research on thalassemia, becoming “hooked on genetic blood diseases.” He studied at Johns Hopkins University in Baltimore and found with his colleagues there that two main types of the disease existed due to defects in the alpha or beta chains. By 1974, he and others used that information to develop a prenatal test which showed the imbalance of chain production, and then identified a form of thalassemia with no alpha strand present at all, causing babies to be stillborn. He says the impact on families with children suffering from the disease hit him hard after he established a research institute in Sri Lanka. He wants to look into a form of Asian thalessemia where, he claims, there is a strong hint a high proportion of children might be able to go through life with low hemoglobin and without transfusions. He wants to find out if this form is genetic or perhaps these children are affected by their environment. His Lasker-Koshland prize, he says, will probably finance that research.