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President's Message
Jenica Harrison, PhD, MT(ASCP)
President, ASCLS-VA

 
Welcome to our first ASCLS-VA newsletter in quite some time.  I admit, I struggled for weeks trying to think of a message that seemed “presidential”.  My struggle ended when I remembered what I encourage others to do which is to be yourself, be the best at it, and everything else will fall into place.  As I was sitting in my office thinking of what to write, I thought of the “good” and the “bad” related to our profession.  We can all think of reasons why we love the medical laboratory science profession (I hope) and we can all see “areas of improvement” (using performance evaluation terminology).  For example, we positively impact many lives daily is an example of a good aspect.  We are not as widely recognized as some other medical professions is an example of a bad aspect.  In order to keep the “good” flowing and improve the “bad”, I encourage all of us to keep the passion, shine our light, be the change, and participate.  Let us start with keeping the passion.

“It’s a beautiful thing when a career and a passion come together”- Author Unknown.  Do you remember why you wanted to be a medical laboratory professional?  For some of you I imagine that you identified your love for science as a child, then later honed your love to the direction of medical laboratory sciences.  Some of you may have discovered your passion for science in high school or college and discovered the field of medical laboratory science along the way. Some of you may have had an experience that exposed you to a healthcare environment as a child or young adult and you thought “where did that blood that saved grandma come from?” or “how does the doctor know that my dad’s cell count is normal?”  Whatever your reason for joining the medical laboratory profession, it likely started with a curiosity that morphed into a passion. I charge you to remain conscientious of your passion for our profession and to let your passion guide and inspire you through good and bad days.  Moreover, be mindful that passion sparks devotion and as we devote ourselves to improve the health of others, we are shining our light.

“Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”- Martin Luther King, Jr. Our nation has been plagued with mass shootings for way too long now. After the recent mass shooting at a synagogue in Pennsylvania, I thought of Martin Luther King’s quote above and how I was thankful to be a part of a profession that helps to drive out darkness every day.  As a medical laboratory science professional, although we play different roles, we need to remember that we are acting as a “light” within our communities. Every time you send results that are used to diagnose and treat a patient you are acting as a light.  Every time you educate a developing professional (i.e., student) or ascending professional (i.e., new professional), you are acting as a light. Every time you train a person on a new instrument or new assay, you are acting as a light.  Every time you help the lab acquire and validate new technologies, you are acting as a light.  Through our hard work, parents learn that their child is free of leukemia, another child makes it through a sickle cell crisis due to the blood they received, and someone’s uncle gains the satisfaction of knowing that his diet and exercise regimen is improving his HDL and cholesterol. And, I could have listed many more ways we impact society.  Colleagues, please continue to let your light shine! My next charge to you is to “be the change”.

“Be the change you wish to see in the world” -Mahatma Gandhi.  I once worked in an environment where the majority of the people I worked around seemed to be in a bad mood most of the time.  I would walk down the hall and people would consistently walk past me, day in and day out, and not say “hello” and/or may keep their head down.  This perceived negativity began to make me feel icky every day at work.  As a new employee, I first just behaved like everyone else. But, I was not being myself in doing so. Thus, one day I decided “enough of this, I am going to say ‘hello’ regardless of the outcome.” Over time, more and more people started to consistently smile and/or say “hello”.  Thus, in a small way, I felt that I made a positive work environment change. Many of you may have stories of how you provoked change in a different way. Maybe you noticed an error in an SOP and you volunteered to update it, maybe you came up with a solution that helped to improve a process, or maybe you volunteered to organize a laboratory party because of the joy it brings to your colleagues.   Always remember, you have the power to elicit small and big changes that can make things better for not only you but for others.  Lastly, I charge you to participate.

Each and every one of us is vital to the success, promotion, and recognition of our profession. Complaining about the “areas of improvement” linked to our profession will get us nowhere, but action will. Furthermore, a loud and unified voice has the greatest probability to evoke change. But, how can we become unified if we do not know each other?  This is where ASCLS and ASCLS-VA come in. Participating in these societies allow us to come out of our little bubbles and meet likeminded people from not only our state but from across the country. At the least, you can gain a new friend or two and, at the most, we come together not only have fun but to strategize on how to “be the change” for our profession and in doing so strengthen our loud united voice.

Now you are wondering “how can I participate in ASCLS and ASCLS-VA?” First, if you are not already a member, please go to ascls.org or ascls-va.org to become a member of both societies.  We are planning to have our annual ASCLS-VA meeting in April 2019.   Please stay tuned for more information.   If you would like to participate on the annual ASCLS-VA meeting planning committee, please email ascls.virginia@gmail.com. The national ASCLS meeting will be held June 23-27, 2019 in Charlotte, NC. Please go to ascls.org for more information.  Be well and remember to keep the passion, shine our light, be the change, and participate.

Publish your work in Clinical Laboratory Science!
Teresa S. Nadder, PhD, MLS(ASCP)CM
Clinical Practice Editor, Clinical Laboratory Science 

“The amount of writings of a profession is a measure of its vitality and activity, whilst their quality is a rough indication of its intellectual state.”  -  Sir Robert Hutchison (1871-1960) Lancet 1939;2:1059

Our Commonwealth of Virginia offers top-rated healthcare facilities and academic programs with high standards of excellence, filled with a multitude of talented laboratory professionals ranging from those working at the bench to administrators and those in academe.  As our ASCLS-VA president Dr. Jenica Harrison states in this newsletter, “remember to keep the passion, shine our light, be the change, and participate.”  As ASCLS members, it is our duty to society and our colleagues to light the pathway to improvements in healthcare.  Sharing your expertise through publications is one means of satisfying our duty.


For greater access with the scientific and medical community, Jim Flanigan, ASCLS Executive Vice President, announced that the ASCLS Board of Directors made the decision to change publishers for its Clinical Laboratory Science journal.  The new publishing platform, HighWire, was developed at Stanford University and hosts many scientific and medical publications, including those from AACC and ASM.

The Clinical Laboratory Science journal accepts electronic submissions through an integrated author/reviewer portal for manuscript processing through HighWire’s BenchPress system.  This easy to use system allows first-time users to create an account so that authors may track their submissions in real time.  One important advantage of using this system, as noted by Mr. Flanigan, is the dramatic decrease in time from submission of the manuscript to a decision rendered to the author(s).   A second important advantage for authors is that the Clinical Laboratory Science journal publishes all submissions that have been accepted, edited and approved immediately online, ahead of print, speeding the process for authors to disseminate their research findings.  The ability to “publish ahead of print” as soon as submissions are approved coupled with the digital object identifier (DOI) that is assigned by the publisher for each manuscript published electronically allows global access of the manuscript to the scientific community.  The DOI assigned to the manuscript provides a persistent link to its location on the internet.  Indeed, DOIs are being assigned to the Clinical Laboratory Science journal content from 2009 to the present.  The content is now indexed in Google Scholar and is in the process of preparing this content for PubMed.
Efforts are underway toward the second phase of the transition in publishers, which includes managing subscriptions and assembling the “publish ahead of print” manuscripts into new issues for the journal.   

Though important to the overall success of the journal, ASCLS will need to purchase a companion system to carry out these “back-end” functions.  For more information regarding the Clinical Laboratory Science journal, please visit http://clsjournal.ascls.org/.
Publishing our work can be one of the most rewarding experiences in our careers. As the Clinical Practice editor, I would like to encourage you to consider submitting a manuscript to the Clinical Laboratory Science journal.  Other sections of the journal include Research and Reports, Education, and Focus (a series of articles on related topics).  The focus on scholarly productivity as an outcome measure for performance evaluations is observed in both academic and clinical settings.   We can use this medium for educating health professionals on topics such as quality improvements, best practices, method evaluations, educational techniques, innovative technologies, management, and research findings and its implications on diagnostic processes and management of therapy.  A productive history of publications provides not only self-satisfaction and attainment of career goals, but also affords status to the institution and to our profession.

Publishing a manuscript requires patience until completion of the process. I recommend seeking at least one co-author to assist with producing the manuscript.  Most manuscripts are not accepted as originally submitted and require revisions and/or clarifications.  By reading and following the "Guidelines for Authors" and the use of the Author Checklist to verify that all required items have been addressed from the onset helps to save time (http://clsjournal.ascls.org/).   Upon submission of the manuscript, a minimum of two reviewers will be asked to critique the manuscript.  A decision to accept, accept with minor revisions, accept with major revisions, or reject is rendered to the author(s) from the section editor.  If revisions are needed, the author(s) will determine if the comments are justified and address each comment succinctly and completely. The revised manuscript should be sent with an accompanying letter listing and addressing the reviewers' comments.  The Clinical Laboratory Science journal also has available a group of consulting editors that can assist those in the process of developing a topic, writing the manuscript, or addressing reviewers’ concerns.  Questions may also be sent to the Editor-in-Chief, Dr. Perry Scanlan.

Our Commonwealth of Virginia offers top-rated healthcare facilities and academic programs with high standards of excellence, filled with a multitude of talented laboratory professionals ranging from those working at the bench to administrators and those in academe.  As our ASCLS-VA president, Dr. Jenica Harrison states in this newsletter, “remember to keep the passion, shine our light, be the change, and participate.”  As ASCLS members, it is our duty to society and our colleagues to light the pathway to improvements in healthcare.  Sharing your expertise through publications is one means of satisfying our duty.

References:
Delost, M, Nadder, TS.  Selecting a research topic and getting it published:  topic selection and evidence of impact.  Clinical Laboratory Science, 27(4):231-236, 2014.
Delost, M, Nadder, TS.  Selecting a research topic and getting it published: research design and dissemination of results.  Clinical Laboratory Science, 27(4): 237-244, 2014.
(L-R) Bill Veilleux, Jenica Harrison, and Julie Bayer-Vile, representing ASCLS-VA at the national meeting in Chicago.
ASCLS-VA in Chicago
Bill Veilleux, MLS (ASCP)CM

Ascending Professional Respresentative, ASCLS-VA
Bill shares his experience at his first ASCLS Annual Meeting this summer!


I was very excited to attend my first ASCLS national meeting in Chicago this year.  Having just graduated, I was eager to meet more laboratory professionals and see what the field is all about.  The week started with a mixer for new professionals, hosted by the New Professional New Member Forum, now the Ascending Professionals Forum, which was a great way to meet new graduates and people who have been in the profession a couple of years.  There were more opportunities to network and socialize at the President’s reception and LABapalooza afterparty, which was a fun time and I made many new friends.  I was particularly interested in learning what the many CLS career options are, so getting a chance to meet people from a variety of backgrounds was something didn’t want to miss. Another highlight of the meeting for me was the Lab Expo, which had hundreds of vendors from around the world.  It was exciting to see the latest technology and innovation; even after going to the expo every day I still didn’t see everything. I recommend to anyone who hasn’t been to attend a national meeting.  There is much more to see and do, such as attending the scientific talks, or getting involved with ASCLS committee meetings and region caucuses.  I am glad I went to the national meeting; it was worth it to meet other laboratory professionals and see the opportunities the CLS field has to offer.  Next year it will be in Charlotte, NC. Hope to see you there!

 

What's New in ASCLS Membership

ASCLS has rolled out new membership categories for the 2018-2019 year. Which category is right for you?


At the 2018 ASCLS Annual Meeting in August, the House of Delegates voted to approve a new structure for membership categories.

Professional: Anyone that is a practicing and/or certified medical laboratory professional, regardless of the stage of their career, is welcome to join as a Professional member. 

Community: Community membership is open to anyone who would like to join ASCLS, but community members do not have voting rights and cannot hold an office in ASCLS.

Ascending Professional: This category is for medical laboratory professionals who are new to the field, having graduated from a clinical laboratory science program in the last five years. 

Developing Professional: A Developing Professional membership is for anyone who is currently enrolled in a clinical laboratory science degree program.

Emeritus: Emeritus members are those who have previously been Professional members of ASCLS and whose combined age and years of service to the profession are equal to or greater than 90. Thank you for your years of service!

More information can be found on the ASCLS Membership Page. Along with streamlined categories, there is also an updated dues structure, so please take the time to make sure you're registered in the best membership category.

A Case Study in Acute Promyelocytic Leukemia

Briana MacRae, MLS (ASCP)CM
President-Elect, ASCLS-VA

The case of a 40-year old female with a fall, bruising, and unexpected neurological changes.


Patient Presentation:
40 year old female presented as a transfer from a community hospital.  The patient had been feeling unwell over the past two to three weeks and reported symptoms including fevers, sinus congestion, and easy bruising.  She had sought medical attention and had been managed symptomatically.  The patient fell in the shower on the day of presentation to the hospital; her finance noticed her fall immediately and she was taken to an urgent care clinic. 

Upon presentation at the urgent care clinic, her easy bruising was noted as well as jaundice, she was transferred to the community hospital.  During transport to the community hospital, her neurological status declined; she became confused and lost the ability to speak.  At the community hospital, a head CT was obtained demonstrating a large intraparenchymal hemorrhage.  She was transferred to UVA Medical Center for further management.
Upon arrival at UVA, it was noted that she had flexor posturing in the upper and lower extremities, fixed pupils and no corneal reflexes.
The patient’s complete blood count with differential was “significantly deranged” and the patient was reported to have acute leukemia, morphologically consistent with Acute Promyelocytic Leukemia.

Laboratory Results of Clinical Significance:
CBC with Differential
WBC – 11.21 k/uL (4.0-11.0)
RBC – 1.94 M/uL (4.20-5.20)
HGB – 6.7 g/dL (12.0-16.0)
HCT – 19.5 % (35.0-47.0)
MCV – 100.5 fL (83.0-95.0)
MCH – 34.5 pg (28.0-32.0)
MCHC – 34.4 g/dL (32.0-36.0)
RDW – 16.2 % (11.0-14.0)
PLT – 12 k/uL (150-450)
Neutrophil% - 2.0
Lymphocyte% - 17.0
Atypical Lymphocyte% – 3.0
Myelocyte% - 5.0
Promyelocyte% - 64.0
Blast% - 9.0
Nucleated RBC% – 1.0
Pathologist Review – Leukemia with features consistent with Acute Promyelocytic Leukemia. Thrombocytopenia. Macrocytic anemia.
 
Comprehensive Metabolic Profile
Soduim – 132 mmol/L (136-145)
Potassium – 3.3 mmol/L (3.4-4.8)
Chloride – 101 mmol/L (98-107)
CO2 – 16 mmol/L (22-29)
BUN – 23 mg/dL (7.0-18.7)
Creatinine – 1.3 mg/dL (0.6-1.1)
Glucose – 211 mg/dL (74-99)
Calcium – 8.2 mg/dL (8.5-10.5)
Total Protein – 6.6 g/dL (6.0-8.3)
Albumin – 3.1 g/dL (3.2-5.2)
Total Bilirubin – 0.7 mg/dL (0.3-1.2)
ALKP – 62 U/L (40-150)
AST – 15 U/L (<35)
ALT – 36 U/L (<55)
Anion Gap – 15 mmol/L (5-15)

Other Labs
Haptoglobin – 254 mg/dL (30-200)
LDH – 341 U/L (125-250)
Fibrinogen – 210 mg/dL (151-402)
PT – 16.4 seconds (9.8-12.6), INR 1.5 (0.9-1.2)





Patient Outcome:
The patient had a left intraparenchymal hemorrhage when she was admitted to the Neuro ICU. She has had several weeks of bruising, several days of a febrile illness with a fall in the shower this AM. Her neurologic status deteriorated rapidly over the next few hours, resulting in a coma and respiratory failure. The CBC with differential demonstrated marked anemia, thrombocytopenia, and the peripheral smear revealed blasts and promyelocytes, consistent with acute promyelocytic leukemia (APL). The intraparenchymal hemorrhage was thought to be due to a coagulopathy in association with the diagnosis of APL. No treatment options were available for treatment of the intraparenchymal hemorrhage. The family decided to withdraw care due to the poor prognosis and the patient passed peacefully.
 
Discussion of Acute Promyelocytic Leukemia:
Acute Promyelocytic Leukemia (APL) accounts for approximately 10% of the adult cases of AML and is characterized by abnormal promyelocytes in greater numbers than 30% of non-erythroid cells.  These abnormal promyelocytes have morphologic features that include heavy granulation, abundant cytoplasm, and a nucleus that is often reniform or bilobed.  Auer rods are frequently seen and may be in bundles or stacks; these cells are called “faggot cells”.  Acute Promyelocytic Leukemia has a characteristic cytogenetic translocation, t(15;17), that leads to a fusion gene and the oncogenesis of APL. Immunophenotypically, APL shows positive expression for CD13 and CD33, with the lack of CD34 and HLA-DR expression.  The abnormal promyelocytes stain strongly positive for Myeloperoxidase (MPO) and Sudan black B (SBB).
Clinically, APL is associated with a high incidence of disseminated intravascular coagulation (DIC).  The abnormal promyelocytes seen in APL are rich in thrombotic substances that can initiate DIC when released.  DIC can be associated with hemorrhagic manifestations, as noted in the case study presented. 
The patient presented in this case study had a rapid manifestation of hemorrhagic complications due to the abnormal promyelocytes, with a rapid decline and very short survival.  Due to the rapid nature of this patients decline, no special stains, flow cytometric analysis, or cytogenetic tests were performed.  The diagnosis was made morphologically and from the clinical manifestations.   

Do you have an artistic talent? Do you have an interesting case study or new research that you're working on? Do you have something you'd like to share with the ASCLS-VA community? Let us know, we'd love to highlight your accomplishments in our next newsletter! Email us at ascls.virginia@gmail.com to share!
Recipe: Sweet Potato Pound Cake


Sweet Potato Pound Cake

Serves: 24
1 (8oz) package cream cheese softened
½ cup butter softened
2 cups sugar
4 large eggs
2 ½ cups cooked, mashed sweet potatoes
3 cups all-purpose flour
2 tsp. baking powder
1 tsp. baking soda
¼ tsp. table salt
1 tsp. ground cinnamon or nutmeg (optional)
1 tsp. vanilla extract
Preheat oven to 350°. Beat cream cheese and butter at medium speed until creamy. Gradually add sugar, beating until light and fluffy. Add eggs one at a time, until yellow disappears. Add sweet potatoes and beat well.
In a separate bowl mix together, flour, baking powder, baking soda, salt, and cinnamon or nutmeg (optional). Gradually add these ingredients to the sweet potato mixture, beating at low speed until blended and stir in vanilla.
Spoon batter into a greased and floured 10-inch tube pan. Bake at 350° for 1 hour and 5-10 minutes or until a wooden pick comes out clean when inserted in the center. Cool cake for 10 minutes, then remove from pan to a wire rack to cool completely (approximately 1 hour).
Nutrition:
Calories: 269
Total Fat: 11.5g
Total Carbohydrates: 37.4g
Protein: 3.8g

Recipe courtesy of Jenica Harrison
Photo courtesy of Julie Bayer-Vile

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