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2014 Issues

Anemia: classification challenge and clinical questions

December 2014—Anemia is in the eye of the classifier. While that’s not as elegant as the “beauty-beholder” saying, it’s much more important. To be able to effectively treat and diagnose anemia, “You have to know what is causing the decrease in red cells,” said Sherrie Perkins, MD, PhD, speaking at an AACC workshop this year. There are plenty of definitions to choose from, said Dr. Perkins, of the University of Utah/ARUP Laboratories, Salt Lake City. At the most basic level, she noted, anemia is a pathologic condition marked by a reduced capacity of blood to transport and deliver adequate oxygen to tissues. In short, anemia is a manifestation of disease, not a disease itself.

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Study: elevated vancomycin MICs no cause for concern

December 2014—Elevated vancomycin minimum inhibitory concentrations do not increase the risk of death in patients with Staphylococcus aureus bacteremia, according to the findings of a comprehensive meta-analysis published in the Oct. 9 issue of JAMA. Despite widespread speculation about rising vancomycin resistance, or “MIC creep,” the authors find little evidence to challenge the current CLSI susceptibility breakpoint of ≤ 2 µg/mL for vancomycin.

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From the President’s Desk: Are we there yet?, 12/14

December 2014—At this time of year, when we are inclined to reminisce, I often recall holiday travel with small children. I mention this to explain my headline—an existential question also relevant to our work at the CAP. When those around the table begin to debate a point (say, for example, during a CAP Board of Governors meeting), I sometimes recall voices. I suspect that’s true for many of us.

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Amid Ebola preparation, an EV-D68 outbreak

December 2014—In addition to preparing for Ebola patients, many clinical laboratories and hospitals in recent months faced outbreaks of respiratory illness caused by enterovirus D68 among children. “EV-D68 infections may be associated with severe acute respiratory illness, viral pneumonia, and severe reactive airway disease,” says Susan Novak, PhD, D(ABMM), director of microbiology at Kaiser Permanente Regional Reference Laboratories in Southern California. Focal limb weakness has also been reported as possibly related to EV-D68, she adds.

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From tumor board, an integrated diagnostic report

December 2014—The handling of molecular information bears a certain resemblance to Wall Street’s bundling of mortgages in recent years. You can slice ’em, dice ’em, and repackage them in all sorts of ways. In medicine, however, this is being done—one would hope—without the ensuing meltdown. The goal is to shape personalized medicine, using the results of next-generation sequencing and other technologies to evaluate genetic information ranging from single gene to whole exome or whole genome, with proteomics possibly not too far behind.

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Molecular Pathology Selected Abstracts, 12/14

December 2014—Overcoming limitations in the sequencing of whole viral genomes: The identification and analysis of pathogenic viruses, especially the Ebola virus, has recently received significant attention. The sequencing of newly identified viral genomes has presented historical challenges as existing technology fails to capture the 3’ and 5’ terminal ends of the viral genome.

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Q&A column, 12/14

December 2014—What are the legal ramifications for medical technologists or medical laboratory technicians if they release results on suboptimal specimens on the insistence of physicians? What are the consensus recommendations for the diagnosis of eosinophilic esophagitis, eosinophilic gastroenteritis, and eosinophilic colitis? What is the clinical significance of increased lymphocytes in esophageal biopsy? Has there been a significant increase in diagnosed eosinophilic disorders over the past 10 or so years?

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