Speakers
Greg Bulmer
Nuthar Jassam
Tejas Kelaria
Parallel session
This session will focus on the latest insights regarding the well-known analytes folate, albumin and PTH.
Chair: Greg Bulmer
11.30 The impact of accuracy of albumin measurement on clinical decision making - Nuthar Jassan
Albumin is the most abundant human serum protein and has various physiological functions and clinical applications. Albumin is the main determining factor of plasma oncotic pressure and it plays a significant role in modulating the distribution of fluids between compartments. Albumin also acts as a non-specific binding protein and transporter for several hormones and substances, e. g. certain drugs, toxins and cations like calcium. Albumin is measured in dialysis patients as a marker of therapy adequacy, in myeloma patients to support disease staging, in nutritional assessment as a core nutritional marker, in patients undergoing replacement therapy for human albumin, in liver disease and finally for the estimation of calcium status.
Serum albumin concentration is measured routinely by dye binding methods (BCG &BCP), with the immunochemical method accepted as the reference method. Clinical guidelines and professional bodies call for monitoring of serum albumin with a common reference range and specific target cut-offs that are independent of the assay used. While this practice is applicable for well standardised and accurate routine methods, it is not transferable to albumin measurements for a number of reasons. The accuracy of albumin measurement is compromised by the lack of specificity and the poor traceability transfer due to the large uncertainty at each step of the standardisation process. This is evident by the difference in albumin concentrations resulting from the use of dye binding methods. This session will discuss the impact of inaccuracy of albumins methods in practice before looking at strategies for improvement.
12.00 Should a single reference interval for parathyroid hormone (PTH) be used in adults, or are age-specific PTH reference intervals necessary? - Tejas Kalaria
Age-specific reference intervals for PTH are well recognized and adopted in paediatric populations. However, most laboratories use a single method-specific, but age and sex non-specific, PTH reference interval for adults. Recent data from independent groups show an increase in serum/plasma PTH with age, when controlled for 25-hydroxyvitamin D, renal function, and adjusted calcium. This lecture will present data on age-related PTH increase from studies within the UK and overseas, summarizing the available age-specific PTH reference intervals for commonly used methods. The impact of adopting method-specific, age-related PTH reference intervals, particularly on the diagnosis of normocalcaemic hyperparathyroidism, will be briefly discussed.
12.30 Folates and folic acid - Laboratory assessment and mandatory fortification - Nathan Timbrell
In 2021, the UK government announced the fortification of non-wholemeal wheat flour with folic acid across the UK with the aim of reducing the prevalence of neural tube defects. In February 2024, the UK’s Government notified the World Trade Organization and the European Commission, in accordance with international obligations, of this intention. The provisions on folic acid fortification of flour will become mandatory as of 1st October 2026.
Neural tube defects (NTD) have a significant impact on pregnancy outcome, life expectancy and quality of life of the baby, with approximately 1000 NTD-affected pregnancies each year in the UK. The Food Standards Scotland modelling indicated that mandatory fortification of non-wholemeal flour with folic acid would be expected to reduce prevalence of low folate intakes, resulting in a reduction in the number of NTD-affected pregnancies.
This session aims to improve current understanding of folates, folic acid, effects of deficiency and excess, the risks and benefits of folic acid fortification, and the laboratory assessment of folates.
I am currently a 3rd year Trainee Clinical Scientist in Biochemistry at University Hospitals Birmingham NHS Foundation Trust. A research background in carbohydrate and organic volatile chemistry led me to an interest in various hyphenated mass spectrometry techniques. My current interests include the clinical application of LC-MS/MS in the development of non-invasive tests for at-home or paediatric populations, such as salivary steroid quantification.
Pronouns: He/him
Nuthar is a Consultant Clinical Biochemist and Head of Biochemistry Department at Harrogate and District NHS Foundation Trust and a Clinical Director of Blood Sciences Departments for a network of three laboratories; Harrogate, Airedale and Bradford.
Nuthar takes pride in the fact that she enjoys research in any area of Clinical Biochemistry. She published over 45 papers and article reviews and over 22 abstract and conference papers. She is known for her interest in harmonisation of postgraduate training across Europe and standardisation of pathology practices within clinical networks. She brings experience in the field of quality of laboratory medicine by being member of a number of Experts on Laboratory Quality working groups and an invited speaker on national and international platforms in this field.
Nuthar has been a member/chair of a number of working groups and committees within the Association of Clinical Biochemistry and Laboratory Medicine in the UK. She currently chairs the European Federation of Laboratory Medicine (EFLM) Register. Nuthar previously chaired the EFLM working group for the post- graduate syllabus for European laboratory medicine specialists and was a board member of the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4).
Pronouns: She/her
Dr Tejas Kalaria is a Consultant in Chemical Pathology and Metabolic Medicine at Black Country Pathology Services, The Royal Wolverhampton NHS Trust, and Member Young Scientist on the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) post-analytical phase working group. Dr Kalaria’s areas of interest include endocrine biochemistry and post-analytics.
Pronouns: He/him/his
Nathan is a Senior Biomedical Scientist working within Synnovis, St Thomas' Hospital in London. He began his career on the Practitioner Training Programme (PTP) and trained at Royal Devon and Exeter Hospital. He later worked within Clinical Biochemistry at both Royal United Hospitals Bath and North Bristol NHS Trust, gaining experience in specialist sections such as Newborn Screening, Biochemical Genetics, and Clinical Toxicology. This gave Nathan exposure to several different chromatography and mass spectrometry methods. Now, he utilises this expertise within the Human Nutristasis Unit, a laboratory that specialises in the static and functional markers of vitamin status, along with testing related to warfarins and superwarfarins.
Nathan is currently undertaking equivalence training to register as a Clinical Scientist. As part of this, he has recently completed both an MSc in Biomedical Science and passed the IBMS Higher Specialist Diploma in Clinical Chemistry. These qualifications led Nathan to join the IBMS Specialist Advisory Panel in Clinical Biochemistry, where he is able to advise on science and policy. Nathan's interests also led him to become the deputy manager of the KEQAS external quality assurance scheme for Protein induced by vitamin K absence-II (PIVKA-II).
Pronouns: He/him/his