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February 2013

Steep climb to suitable reference standards

February 2013—It’s a long way from ancient Greek philosophers to modern-day clinical laboratory directors. Yet both types of scholars have one thing in common: the pursuit of truth. Socrates and his disciples thought of truth as correspondence to an objective universal ideal in the mind. Today’s clinical laboratory scientists need a more concrete standard against which to measure their results, leading to the continuing search for suitable reference materials to be used in method development, test validation, internal QC, assay calibration, and proficiency testing.

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Twilight zone for CVD risk markers?

February 2013—Times are tough all over. For the middle class, for newspapers, for François Hollande and his fellow French Socialists. Consider adding cardiac risk markers to that list. Despite decades of research and clinical experience, the marker conversation—what to measure, how, in whom—has become more an endless loop than a solid lineup. Old standbys still turn up in studies of novel markers, and tests that have arguably outlasted their usefulness still adhere, like barnacles, to laboratory menus. Some observers are even questioning the tenets of risk assessment.

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Latest anticoagulants—nuts and bolts for labs

February 2013—The list of anticoagulants has grown in recent years, which means there’s more to know about whether, when, and how to monitor. Last month in CAP TODAY, Michael Laposata, MD, PhD, spoke briefly about the newer drugs and explained how the older ones—warfarin, heparin, and low-molecular-weight heparin—work, and what that means for labs. This month, he returns to the newest of the major anticoagulants.

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From the President’s Desk: Transformational practice—2 in spotlight

February 2013—A National Football League playoff game was on the ceiling monitor in the airport lounge where I was trying to work on this column, and the announcer was talking about how well they were moving the ball. My first reaction was that he sounded awfully excited for a guy with only one ball to move. Maybe he should come to work at the CAP and see what real excitement is.

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AMP case report: Multilocus sequencing for rapid identification of molds

February 2013—CAP TODAY and the Association for Molecular Pathology have teamed up to bring molecular case reports to CAP TODAY readers, starting this month. AMP members will write the reports using clinical cases from their own practices that show molecular testing’s important role in diagnosis, prognosis, treatment, and more. We aim to publish a few a year. The first such report comes from the University of Washington Medical Center, Seattle. (If you would like to submit a case report, please e-mail the AMP at amp@amp.org. For more information about the AMP, visit www.amp.org.)

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Hemolysis—can better processes add up to millions?

February 2013—If anybody is a believer in programs to reduce hemolysis rates in the hospital, it’s Dennis Ernst, MT(ASCP), director of the Center for Phlebotomy Education. Ever since he left the bench 15 years ago, Ernst has been traveling the country with a mission: to show clinical laboratories, nursing departments, hospital administrators, and clinicians that the payoff from high-quality phlebotomy is much greater than they might realize. Despite hemolysis being the No. 1 reason the laboratory rejects blood specimens, hemolysis does not strike randomly, and it’s not inevitable, Ernst emphasizes. “Typically the causes of hemolysis are all behavioral,” he says.

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AP tracking: an eagle eye on blocks and slides

February 2013—A high-tech blend of hall monitor, bloodhound, and lost and found, tracking systems to manage tissue specimens, blocks, and slides have gradually been taking root as part of an automated workflow in some anatomic pathology laboratories. As manual labeling, logging, and data capture give way to bar coding and even radio frequency identification, it’s a revolution of sorts, but a quiet one.

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Anatomic pathology systems product guide

February 2013—In the market for an anatomic pathology system? Check out the 27 AP offerings from 24 vendors. The systems profiled in this annual product guide are commercially available in the United States. In this year’s lineup for the first time is information pertaining to whether vendors provide a list of client sites to potential customers on request.

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Clinical Pathology Selected Abstracts, 2/13

February 2013—Outcome of patients who refuse transfusion after cardiac surgery: Jehovah’s Witness patients may refuse blood transfusion, due to religious beliefs, following cardiac surgery. Strategies to conserve blood for such patients may include the preoperative use of erythropoietin, iron, and B-complex vitamins, as well as hemoconcentration; intraoperative use of antifibrinolytics and cell-saver and smaller cardiopulmonary bypass circuits; and tolerance of low hematocrit levels postoperatively.

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Anatomic Pathology Selected Abstracts, 2/13

February 2013—BRCA1 and BRCA2 mutations, TP53 abnormalities, and immune cell infiltrates in ovarian carcinoma; Significance of loss of ARID1A/BAF250a expression in endometriosis; Relationship between pathologic complete response and prognosis after chemotherapy in breast cancer subtypes; Determining HER2 status on breast core-needle biopsies; Use of MiTF in differentiating cellular neurothekeoma from plexiform fibrohistiocytic tumor; A study of genetic heterogeneity in HER2/neu testing by FISH

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Newsbytes, 2/13

February 2013—Subspecialty no more—integrating informatics; PathCentral sells diagnostic laboratory business; ONC asks labs about health information exchange; EMR module from Psyche addresses meaningful use; NetLims to release new version of lab system; Online database addresses meaningful use measures

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Put It on the Board, 2/13

February 2013—An estimate of specimen identification error; Cepheid CT/NG test classified as moderate complexity; ARUP to offer Oncimmune early-stage lung cancer test; Hologic test cleared for detecting GI pathogens; IntelligentMDx to develop tests for Qiagen platform; Latest lab vacancy data in

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Q & A Column, 2/13

February 2013—What are the limitations of using myoepithelial markers in diagnostic breast pathology? Immunohistochemical studies using antibodies to highlight myoepithelial cells (MEC) can be useful adjuncts to traditional morphologic diagnosis in the practice of breast pathology. Antibodies commonly used to detect MEC include smooth muscle actin, calponin, smooth muscle myosin heavy chain, p63, CD10, cytokeratin 5/6, and p75, and each shows varying sensitivity and specificity.

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