Video Lectures

In the era of precision therapy, and with the increasing use of neoadjuvant chemotherapy, accurate diagnosis and classification of breast tumors on core needle biopsy is ever more critical at the malignant end of the spectrum. Similarly, with the emphasis on de-escalation of therapy, and the move toward fewer surgical excisions for benign, high-risk lesions, the opportunity for a “second-look” to confirm diagnostic impression on core needle biopsy has been removed. The consequences of diagnostic error, it could be argued, carry the potential for more significant morbidity in contemporary practice.

This lecture will cover a broad spectrum of interesting breast pathology including both benign and malignant entities from ten real cases encountered at the University of Utah Department of Pathology and ARUP Laboratories. The focus is loosely on spindled lesions of the breast, infectious lesions of the breast, and other cases with interesting or surprising results resulting from pathologic examination. Topics covered include cystic neutrophilic granulomatous mastitis, pseudo angiomatous stromal hyperplasia, mammary myofibroblastoma, and demodex folliculitis, among others. The goal is a broad overview of lesions that a general pathologist may encounter in day-to-day practice with suggestions about work-up, comments, or clinical significance discussed.

This presentation will cover pediatric follicular lymphoma, HGBCL with 11q aberration and HGBCL with MYC, BCL2, BCL6 rearrangements and TdT expression. Clinical cases will include abundant hematoxylin and eosin pictures, accompanied by pertinent immunohistochemical stains. Each case discusses clinicopathologic findings, differential diagnosis and appropriate ancillary testing.

What do you picture in your head when you hear the term "diagnosis" or "diagnostic testing”? Most people imagine a test revealing, for the first time, the answer to a confusing set of symptoms. But diagnosis is better thought of not as a one-time event, but as an iterative, continuous process by which information is gathered and incorporated into medical decisions. In other words, it's less about individual test results and more about how we process and integrate those results. This becomes even more critical as we enter the artificial intelligence (AI) era, where software algorithms play a growing role in diagnosis. This presentation will take a critical look at the relationship between medical science and diagnostic testing, and how we can preserve that linkage in the setting of complex diagnostic algorithms.

This presentation will provide a general overview of common plasma cell dyscrasias and their clinical presentations. It will also provide an explanation of various diagnostic methodologies for detecting, characterizing, and monitoring monoclonal gammopathies. In addition, results interpretation and the clinical significance of laboratory findings will be addressed.

Rapidly expanding demand for neural autoantibody testing has come with increased recognition that these antibodies may be associated with immunotherapy-responsive forms of psychiatric disease, dementia, epilepsy, and others. However, the rapid growth of this field as well as the rarity of these disorders has resulted in significant confusion among patient-facing physicians about how to order and interpret these diagnostic tests. In this video lecture, Dr. Smith discusses many of the common challenges with neural autoantibody test utilization, interpretation, and application in clinical care. Clarifying these challenges highlights important opportunities for laboratory professionals to improve the value of this diagnostic testing for patients.

For many years, immunohistochemistry (IHC) has played an essential role in diagnostic pathology. Advancements in our understanding of many diseases and increasing availability of targeted therapy have given the IHC technology a boost to evolve. This presentation is based on a series of diagnostically challenging cases referred to our hematopathology team by surgical pathologists. The diagnostic workup for these cases highlights newer applications of widely available IHC stains and also introduces recently developed markers.

Premalignant clonal hematopoiesis refers to a heterogeneous group of conditions, including clonal hematopoiesis of indeterminate potential (CHIP) and clonal cytopenia of undetermined significance (CCUS). CCUS is defined by expansion of a population of hematopoietic cells derived from a single clone, as demonstrated by the detection of myeloid neoplasm-associated somatic mutation or cytogenetic aberration (i.e., clonal hematopoiesis) in association with sustained cytopenia otherwise clinically unexplained and absence of dysplasia. CHIP is a closely related entity defined by the presence of clonal hematopoiesis in the absence of cytopenia. In both conditions, diagnostic criteria of myelodysplastic or other hematologic neoplasm are unmet. The natural history and risk of progression from clonal hematopoiesis to overt malignancy is augmented by mutational dynamics. Substantial data links CHIP to increased all-cause mortality primarily attributable to cardiovascular disease such as myocardial infarction, ischemic stroke, and venous thrombosis. The principal feature underlying these nonhematologic disease associations is a proinflammatory state. Clinical management of patients with clonal hematopoiesis is an area of active investigation.

While in most instances prostate pathology is fairly straightforward, there are several instances of challenging cases. The reporting practices of prostate carcinoma has also undergone several changes in the recent years with certain histopathological features being relevant from the clinical management of patients. In this presentation, some common, interesting, and rare cases encountered in prostate pathology will be discussed. The presentation will provide information on differential diagnosis, ancillary tests that are useful in making the diagnosis and the clinical relevance of the cases.

The advent of digital pathology and whole slide imaging (WSI) solutions has continued to gain momentum in laboratory medicine. As the scope and needs of pathology practices and institutions they support vary significantly, selection of digital solutions for pathology practice requires institutional collaboration of executive, physician, information technology, and laboratory operations leadership.

Three challenging cases in hematopathology where integration of all clinical, morphological, immunophenotypic, and ancillary molecular or cytogenetic testing is needed to reach the best diagnosis will be presented.

HER2-positive metastatic breast cancer survival has improved significantly with many novel directed therapies under investigation. HER2-low expression can respond to directed therapy; however, more accurate testing is still needed.

As the use of artificial intelligence (AI) moves from being a curiosity to a necessity, it is clear that the benefit obtained from using AI models to prioritize care interventions is an interplay of the model’s performance, the capacity to intervene, and the benefit/harm profile of the intervention. We will begin the conversation reviewing the necessary data strategy to enable organization wide AI adoption and leading into a discussion of the core intuition behind foundation models. After a brief review of the kinds of use-cases that AI can serve across multiple medical specialties, we will discuss Stanford Healthcare’s efforts to shape the adoption of health AI tools to be useful, reliable, and fair so that they lead to cost-effective solutions that meet health care's needs. The conversation will draw on examples from multiple specialities including pathology, cardiology, internal medicine, surgery, psychiatry and oncology.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder with varying patient presentation. The pathophysiology is attributed to a mutation in the PIGA gene, causing deficiency in glycosylphosphatidylinositol (GPI)-anchored proteins on blood cells, increasing susceptibility to complement-mediated destruction. Diagnosis involves thorough clinical evaluation and laboratory testing including flow cytometry. Treatment options are varied, evolving, and dependent on disease severity. Patient response to therapy and disease monitoring requires regular lab assessments.

Pharmacogenomics (PGx) delves into how genetic factors, whether inherited or acquired, influence individuals' responses to drugs. As a swiftly evolving branch of laboratory medicine, clinical PGx testing holds the potential to significantly impact the well-being of patients taking medications. In this webinar, Dr. Yuan Ji, section chief of Molecular Genomics and Genomics, will provide insights into the latest advancements in technologies, professional guidelines, and regulatory frameworks driving the field of clinical PGx testing. The presentation will underscore the vital clinical significance of such testing while also addressing the hurdles and prospects associated with its widespread clinical adoption.

In this presentation, Dr. Pantrangi will discuss the importance of the distinction between hydatidiform moles (a.k.a. molar pregnancy) and nonmolar conceptions, their accurate diagnosis, precise assessment of the risk of persistent gestational trophoblastic disease, including choriocarcinoma associated with different subtypes of hydatidiform moles, and the appropriate guidance of clinical management. Dr. Pantrangi will elaborate on the genetic origins of hydatidiform moles and nonmolar pregnancies and diagnostic techniques. Also, a few cases will be discussed to demonstrate the potential pitfalls encountered with the use of a single technique or solely based on morphology, which can lead to misinterpretation of the results. For instance, donor egg conceptions and lack of clinical history led to the misinterpretation as complete hydatidiform mole (CHM) based on short tandem repeat genotyping data alone. Dr. Pantrangi will illustrate how the integration of ancillary techniques, particularly p57 immunohistochemistry and DNA genotyping, would help in providing refined diagnosis. She will also briefly talk about genomic imprinting role on the malignant potential of hydatidiform moles.

Follicular helper T-cell (TFH) lymphomas comprise a unique group of T-cell lymphomas that represent neoplastic proliferations of follicular helper T-cells and share genetic, immunophenotypic, morphologic, and clinical features. Angioimmunoblastic T-cell lymphoma (AITL) is the prototypical TFH lymphoma; in addition, the 5th World Health Organization (WHO) and the International Consensus Classification (ICC) recognizes two other unique subtypes: follicular type and not otherwise specified (NOS). TFH lymphomagenesis is largely driven by the stepwise acquisition of somatic mutations with TET2 and DNMT3A mutations occurring early in hematopoietic stem cells. Subsequently, other characteristic mutations such as RHOA and IDH2 (in AITL) are observed. This presentation discusses the morphologic spectrum, immunophenotype, diagnostic mimics/pitfalls, and unique genetic attributes of this category of T-cell lymphomas.

This talk will cover the advances in clinical flow cytometry for hematopathology diagnosis.

Burnout is a significant problem in healthcare, including among pathologists and the laboratory workforce. There are many resources available on the topic, video lectures included, but this presentation is particularly relevant to pathology and laboratory medicine. The primary focus is on well-being while also discussing the flip side, burnout, but whichever side of the coin you look at, ultimately, wellness is the goal.

This presentation will distinguish the difference between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Explain how fecal calprotectin or fecal lactoferrin can be used to differentiate IBS and IBD along with ways to monitor inflammatory disease course. In addition, we will explore the testing used to screen and diagnose colorectal cancer.

This is a case-based presentation focusing on diagnosis of common kidney tumors using cytology and small biopsy specimens. Before reviewing individual cases, common indications for kidney biopsy, accuracy of diagnosis, and adequacy including rapid on-site-evaluation (ROSE) will be briefly discussed. Additionally, cytology of normal renal elements is included, as there can be significant cytomorphologic overlap with certain neoplastic lesions.

This comprehensive presentation and panel discussion will delve into the cutting-edge innovations that are reshaping the fields of hematopathology and hematology. The role of applied artificial intelligence (AI) in enhancing diagnostic precision and streamlining workflows will be covered. The panel will explore the impact of digital pathology and the latest advances in genetics and immunophenotyping, which have significantly improved our understanding of hematologic diseases.

The immune system and microbes are known to affect various aspects of energy metabolism in organisms. In this seminar, I will discuss our recent findings that have revealed unexpected ways by which the immune system and the microbial environment can affect systemic lipid metabolism. In an acute manner, T cells can control systemic lipid metabolism by inducing lipid secretion from the skin. In addition, T cells and the microbiome affect gametes (sperm and eggs) in a nongenetic manner to induce metabolic and other phenotypic changes in succeeding generations of progeny. Thus, T cells and their response to microbes can affect not only the lipid metabolism of the individual but also of future generations. T cells and microbes could play an important role in organisms for sensing environmental changes, which nongenetically create phenotypic diversity in offspring to hasten natural selection processes for adaptation.

Over the last decade, large-scale genomic studies have estimated the incidence of presumably pathogenic germline mutations in children and adults with cancer to be 8%. Many of the patients with these germline mutations lack a family history consistent with cancer predisposition syndromes. These findings highlight not only the importance of comprehensive sequencing to screen for germline variants but also that familial cancer syndromes are much more common than previously recognized. In this talk, we address recently described predisposition genes in familial leukemias and myelodysplastic syndromes in both pediatric and adult patients. We use three examples to describe the common clinical and pathologic characteristics of familial myeloid neoplasms, the clinical utility of NGS testing in familial cancers, and current recommendations on diagnostic and management guidelines. This talk is not designed to serve as a comprehensive list of all described predisposition genes in hematologic malignancies.

Prolonged clotting times (e.g., PT, aPTT) may be identified as unexpected laboratory findings or in the context of an evaluation for a bleeding disorder. Hemostasis/thrombosis laboratories are increasingly employing algorithmic strategies to evaluate prolonged PT and aPTT. This presentation will review basic principles of prolonged clotting time evaluation, discuss the benefits and challenges of pathologist contributions to a prolonged clotting time reflexive panel, and identify result patterns observed in prolonged clotting time panels performed and interpreted at ARUP Laboratories in recent years.

Inherited predisposition to hematopoietic malignancies due to deleterious germline variants is being recognized in an increasing number of genes due to the increasing availability of next generation sequencing (NGS). With greater numbers of genes and mutation types identified, the complexity of clinical testing also increases, challenging busy practitioners to diagnose patients accurately. Recognition of germline cancer predisposition has important health implications for the management of the index patient and his/her family members and complicates planning for allogeneic stem cell transplantation in which relatives are often the preferred donors. Challenges to diagnosis of these conditions include: (i) the idea that these syndromes are rare; (ii) the idea that germline variants only pertain to people presenting at young ages; (iii) busy clinics that make it difficult to take comprehensive personal and family histories from patients and carefully review available molecular profiling data; (iv) complicated syndromes in which presentations are more varied than classic descriptions; (v) obtaining comprehensive testing that includes assessment of single nucleotide and copy number variants in all of the genes that can confer risk; (vi) obtaining true germline tissue in quantities that allow comprehensive testing; and (vi) a lack of data regarding the natural history of these disorders. Key features of the initial clinical presentation that signal a likelihood of having germline predisposition include: personal history of two or more cancers; personal history of a hematopoietic malignancy along with a family history of another hematopoietic malignancy/prolonged cytopenia/or other hematologic abnormality such as macrocytosis or onset of a nonhematopoietic tumor at an age < 50 years old within two generations of the proband; and/or molecular testing of hematopoietic cells showing a deleterious variant in a gene known to confer a hereditary hematopoietic malignancy, especially one that persists despite change in disease status (i.e., persists from diagnosis through remission). I will discuss how to prioritize patients for germline testing; how to perform rigorous and comprehensive germline testing, and how positive results impact treatment plans for the index patient and cancer surveillance strategies for the individual and their family members who share the deleterious variant.

In line with all areas of molecular oncology, molecular testing has also expanded into the area of prostate carcinoma, providing insight into pathobiology of these tumors as well as significantly aiding in identifying diagnostic, prognostic and predictive biomarkers. Most recent guidelines from professional societies now include recommendations for relevant molecular testing in prostate carcinomas to complement the clinical practice. In this presentation, we will discuss relevant established and emerging standard of care molecular biomarkers in prostate carcinoma and the role pathologists can play in identifying clinically relevant molecular biomarkers.

Thyroid carcinomas encompass a diverse group of malignancies with varying patient presentations, often featuring thyroid nodules. Diagnostic workup involves thyroid lab tests, imaging studies, and fine-needle aspiration. Treatment depends on carcinoma type, commonly involving surgical excision, radioactive iodine, or other modalities. Prognosis is generally favorable with high survival, necessitating long-term surveillance. Lab tests are crucial for monitoring treatment and possible disease recurrence. Thyroglobulin interpretation faces interferences; therefore, testing methods and optimal laboratory utilization are vital.

Myeloproliferative neoplasms (MPNs) are a group of myeloid disorders that usually presents with elevated peripheral blood counts, hepatosplenomegaly and genetic alterations of tyrosine kinase genes. Due to a significant overlap in clinical, morphologic and laboratory findings, diagnostic workup of these patients is complicated and requires integration of numerous diagnostic modalities. Although certain genetic alterations are preferentially enriched in specific MPN types lacking the Philadelphia chromosome, none of them are disease defining; therefore, a thorough workup should always include a bone marrow biopsy for morphologic evaluation and diagnosis. This lecture will focus on specific bone marrow morphologic findings associated with MPNs, as well as on the importance of a comprehensive approach for accurate diagnosis and prognosis.

Urothelial neoplasia, including urothelial carcinoma and urothelial carcinoma with divergent differentiation, dominate the urinary tract. Recognition and diagnosis of less common tumors, whether primary or secondary, is of utmost importance as surgical and oncologic management varies considerably and appropriate classification is essential.

This presentation will provide a great overview of structure, functions, and clinical relevance of human leukocyte antigen (HLA). It will also provide insights on the common methodologies and address the current challenges with HLA testing and interpretation.

The work up of pancreatic and biliary lesions usually starts with a fine needle aspirate (FNA) or small biopsy specimen. Many times, either due to the paucity of findings or the non-definitive nature of findings, classifying these lesions is difficult. Understanding and implementing molecular testing in this setting can help resolve differential diagnostic dilemmas and can help define management for patients. Moreover, molecular testing may be useful in determining the presence of malignancy or malignancy potential of a neoplastic process. Understanding of the molecular mechanisms at the base of these different entities and knowledge of the testing available can help define diagnostic strategies that can contribute to a prompt and accurate diagnosis.

This lecture reviews the epidemiology as well as the pathophysiological progression of HIV infection. It further explores the evolution of clinical assays for HIV diagnosis, tracing their development from the early stages of the HIV epidemic to current testing approaches and diagnostic algorithms. Light is also shed on testing and diagnosis of HIV infection in special populations such as neonates. The lecture concludes by examining HIV therapy and management strategies, encompassing aspects such as pre- and postexposure prophylaxis.

Through the use of clinical cases the presenter will describe weird and extraordinary microorganisms (so-called “Weirdobacters” or “Extraordinaribacters”) that are not often encountered in the clinical microbiology laboratory, and as such they can be overlooked despite their clinical importance. Their clinical presentation, key microbiologic characteristics, and treatment will be discussed. Ultimately, the presenter hopes attendees will be even more enthused about all things clinical microbiology at the completion of the talk.

Blood transfusion is cited as one of the most overused healthcare interventions, making patient blood management (PBM) a prime target for informatics-based approaches and artificial intelligence (AI) solutions. During this presentation, we’ll probe PBM strategies, AI use cases, and the current state of the field of transfusion medicine, including AI limitations. An analysis of a novel data visualization tool that can provide unique insights into PBM practice performance will be presented.

Hiring top-level lab salespeople and coaching them in the field is a demanding assignment—and far different than managing laboratory technical staff. This presentation reviews a number of important components a sales manager should consider when interviewing and managing their sales representatives to be prepared, professional, and productive.

We are learning more and more about how changes in our DNA affect health and disease every day—however, use of DNA screening as part of clinical care is still lagging behind. A simple blood test can now help to identify changes in our genes that might increase the chances of developing certain conditions, such as cancer, heart disease, or even brain disorders, like autism. DNA screening tests can catch potential health issues before symptoms occur or give a genetic explanation for a disease that already exists. Learning this information is not only important for an individual’s health, but also for their family’s health since these gene changes can be inherited. In this presentation, we’ll explore how we’re implementing DNA screening at Geisinger as part of everyday healthcare to prevent disease or detect it earlier, and what the impact is on patients and their families.

This lecture will review genitourinary (GU) syndromic associations using real cases as examples. The topics included are von Hippel Lindau, hereditary papillary renal cell carcinoma, fumarate hydratase deficiency/hereditary leiomyomatosis and renal cell carcinoma, and succinate dehydrogenase deficiency. The lecture reviews some of the GU-associated tumors for each syndrome with a particular focus on the guidelines for referral to genetic counseling and further genetic testing. Also included are discussions of challenging immunohistochemistry interpretations and other ancillary tests that may help make these diagnoses or suggest referral for molecular genetic confirmation. At least two nonclassical presentations are also discussed with discussion about the implication of these findings and suggestions for increased rate of detection.

The parasites that infect humans are broad and diverse. Though many teaching and review content focuses on the common gastrointestinal parasites, this presentation will focus instead on the other body sites in the human that can be infected by parasites. Common diagnostic tests and recommended methods of detection are reviewed in addition to clinical syndromes associated with different stages of these diseases.

Blood parasites represent a global burden of disease, particularly due to malaria being a leading cause of morbidity and mortality. Blood parasites are critical to detect and treat and require different techniques for not only lab testing but also specimen collection. The most common blood parasites are reviewed in this presentation with a strong focus on best practice for microscopy as well as adjunct methods of diagnosis for unique clinical presentations.

In 2022, a new version of the WHO's Urinary and Male Genital Tumours was published. In this new edition, a contemporary classification for renal tumors included 1) a new subgrouping of tumors (i.e., “molecularly defined,” “oncocytic,” and “other” categories), 2) the official inclusion of three new renel cell carcinoma (RCC) subtypes, 3) downgrading of one tumor type from carcinoma to benign, 4) the elimination of so-called type I and type I papillary RCCs, and 5) a new list of emerging entities that require additional evidence prior to inclusion as distinct subtypes. These new WHO changes, as well as corresponding diagnostic criteria, differential diagnoses, ancillary studies, molecular alterations, and potential diagnostic pitfalls will be discussed.

This lecture will provide a case-based illustration of challenges in the diagnosis of lymphoproliferative disorders in needle core biopsy specimens.

Infectious agents cross state and country boundaries in many ways and can appear at our facility unexpectedly. Pathologists have an important role in the diagnosis of these infections, including: a) identifying the organism, but not necessarily defining the specific genus and species; b) providing guidance for alternative specimens and methods that can be helpful for diagnosis; c) contributing to the knowledge of the pathogenesis of different infectious diseases. I will use three cases to exemplify the role of pathology in the diagnosis of infectious diseases.

This presentation will cover recent advances in uterine sarcoma classification with emphasis on genotype-phenotype correlation and possible therapeutic implications. Discussion will include recognition of novel uterine sarcoma subtypes, application of molecular techniques in uterine sarcoma diagnosis, and therapeutic biomarkers.

In the current era, a diagnosis of acute leukemia is faced with many challenges associated with rapidly evolving scientific and technological discoveries leading to new ancillary testing and reporting guidelines, as well as classification systems. To meet these challenges, hematopathologists in all practice settings need to be aware of the most important developments, especially those associated with changes in patients' clinical management. This lecture will present a comprehensive workup of three clinical cases presenting with increased blasts with a specific emphasis on critical and actionable phenotypic and genetic information that can help guide clinicians’ use of novel therapies and thereby improve patient outcome.

The year 2020 will go down as one of the most difficult, trying, and socially polarizing years in modern history because of the global pandemic of COVID-19. Nearly every facet of life on earth faced disruptive and dynamic challenges that pushed operational processes to the brink of collapse in different ways. Laboratory medicine is no exception to this disruption and learned a great deal from these experiences. Though COVID-19 was exceptional, should the laboratory community, especially the clinical microbiology lab, have been more nimble and able to respond to such an emerging challenge? Were 2016 Zika, 2014 Ebola, 2012 MERS CoV, and 2009 nH1N1 not enough of a practice schedule for the big game? In 2022, human monkeypox virus further exposed the fact that clinical laboratories, including public health and federal agencies, had made improvements but were still unable to adequately respond. The clinical lab is at a turning point of being reactive versus proactive. This presentation will focus on strategies and approaches to consider for making your laboratory proactive to respond to the next emerging pathogen or reemerging infectious disease.

This lecture is designed to provide a broad overview and a brief update on testing and diagnosis of common sexually transmitted infections (STIs). It will cover the current CDC 2021 screening, testing, and treatment recommendations for common STI pathogens namely, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. The lecture will compare the benefits and limitations of the different testing modalities for the common STI pathogens. Emergence of drug resistance for specific STI pathogens will be discussed. Lastly, an overview of molecular diagnostics and their advantages will be presented.

The diagnosis of B-cell lymphomas is complex and even more so with the latest WHO and ICC classification systems. In this talk, we will review an architectural framework for how to approach and diagnose mature B-cell lymphomas. New entities and important updates that all pathologists and clinicians should be familiar with will also be covered.

This lecture will review infectious and inflammatory lesions in the genitourinary tract. Topics covered include Schistosoma-associated squamous cell carcinoma, ketamine associated cystitis, syphilis and its increasing frequency, inflammatory myofibroblastic tumor, and angiomyolipoma masquerading as expansile histiocytic inflammation. The implications and prognosis of Schistosoma-associated squamous cell carcinoma is compared to urothelial carcinoma. Ketamine cystitis is a rapidly growing problem with limited clinical recognition and profound impact on bladder health. The continued spread of syphilis across the U.S. has resulted in presentations in non-classical sites and the review covers diagnostic clues. Novel immunohistochemical methods and best practices are suggested for the diagnosis of ALK-positive inflammatory myofibroblastic tumor. Finally, we review a challenging clinical case with histiocytic inflammation nearly completely obscuring a clinically relevant neoplasm, angiomyolipoma.

Urine drug testing is commonly used for investigation of unknown ingestions and compliance monitoring. This presentation discusses the rationale for using urine as a specimen type, the common analytical techniques used for testing, and important considerations for interpretation of results.

Dr. George will discuss the evolution of hematopathology diagnosis with microscopic analysis (blood, bone marrow, and solid tissue) providing the initial framework of hematopathology. Subtypes were further defined initially based on phenotypic attributes, which were assessed by immunohistochemistry and subsequently by flow cytometry. The field gradually moved away from a pure cell of origin classification to a more integrated approach, and molecular subtypes were described. This revolutionized the field through better prognostication and personalized therapy, as novel therapeutics began to be considered in lieu of or in combination with standard chemotherapy. The advent of high-throughput sequencing/next generation sequencing (NGS) led to major advances with the discovery of mutations. NGS was quickly integrated into the clinical testing environment and is now routinely used in the world of myeloid neoplasms; several institutions also offer NGS for lymphomas. This webinar will also cover current and future uses of digital pathology and artificial intelligence in the world of hematopathology. Finally, Dr. George will conclude with a brief assessment of the International Consensus Classification and the World Health Organization classifications and discuss practical approaches to a more integrated hematopathology diagnostic process.

Complete blood count is one of the most common tests ordered by healthcare providers. Careful morphologic review of blood smears can reveal important diagnostic clues and help with the patient’s management. This lecture, presented as a series of vignettes, will focus on specific morphologic findings in peripheral blood samples with neutrophilia, monocytosis and lymphocytosis. In addition, the lecture will point out the important morphologic features associated with neoplastic, rather than reactive, conditions.

In this presentation, Dr. Trish Simner will discuss the various applications of next generation sequencing (NGS) for infectious disease diagnostics. She will discuss the Johns Hopkins experience with targeted and metagenomic NGS assays and the value for patient care. Logistics of performing such testing in clinical practice will be covered. Furthermore, the development of NGS assays to further evaluate host response, the microbiome and antimicrobial resistance will be reviewed.

While this presentation is focused on academia, and pathology in particular, and has a focus on faculty, especially those in leadership positions or aspiring to such, it is also has broader value. In brief, this talk outlines attributes that may be useful for people working within academic health centers, or other complex organizations.

In recent years, we have witnessed major shifts in our understanding of several entities known as “benign lymphadenopathies.” Recognition of new pathogenetic aspects and their influence on the prognosis has changed our diagnostic and treatment approaches. This presentation focuses on important entities including Castleman disease, IgG4-related disease, and benign T- and B-cell proliferations. The discussion will emphasize the most recent recommendations that encompass the changes in the diagnostic work-up and the clinical significance of the rendered pathologic diagnosis.

Interference in laboratory assays is a concern since it can positively or negatively influence test results with potential impact on patient care. Interferents could be endogenous or exogenous compounds. Dietary supplements such as biotin and vitamin C are examples of exogenous interferents in common laboratory assays. During this presentation, the mechanisms underlying such interference will be discussed, along with ways of detecting it and possible solutions.

The importance of molecular alterations in gliomas has long been recognized. Accordingly, the new WHO Classification of CNS Tumors has incorporated many molecular alterations into the diagnostic algorithms used for primary gliomas. This lecture will describe these alterations, their diagnostic and/or prognostic significance, and the molecular testing modalities that detect them.

This presentation will provide an understanding of the fundamental components of a laboratory quality management plan based on the Plan-Do-Study-Act model. The description and roles of key stake holders in the planning, implementation, maintenance, and improvement stages of total quality management plan is discussed. Lastly, the presentation touches on the implementation of these concepts and reliable tools to monitor elements of the plan, key performance indicators, and improvement initiatives. The principal goal is to provide learners with a framework for improving or establishing and implementing a quality management plan.

Using a case-based approach, this talk focuses on the molecular and immunohistochemical features that can be helpful in diagnosing and understanding well-differentiated hepatocellular lesions: focal nodular hyperplasia, hepatocellular adenoma, and hepatocellular carcinoma.

Automated methods for urinalysis promise greater efficiency, increased throughput, and improved accuracy and precision over conventional methods. This presentation provides a brief overview of urinalysis methods and describes an approach to method validation of automated urinalysis instrumentation.

There has been rapid evolution in genetic testing from simple single gene markers to now a whole “omic” approach fueled largely by rapid technological advancements, followed by the completion of Human Genome Project. This talk will explore some of the advances in genetic/genomic testing and efforts to evaluate evidence and to standardize testing as well as exploring the future of genomic testing.

Biological therapies can be highly effective in treating malignancies but can cause interference with blood bank testing. Two monoclonal therapies directed at cluster designation antigens that cause red blood cell agglutination are highlighted: CD38 and CD47. This lecture will review the serologic reactivity and methods to abrogate blood bank interference.

Acute liver injury has a wide variety of causes with a complex laboratory workup involving many different areas in the clinical laboratory including chemistry, immunology, and microbiology, as illustrated in this case presentation of acute Q fever hepatitis. The goal of this lecture is to review basic liver function and laboratory testing for acute liver injury, with an emphasis on testing for autoimmune hepatitis, Epstein-Barr virus, and Coxiella burnetii.

Liquid biopsy is one of the newer methods of sampling cancer genome using a blood sample. Commercial offerings in that arena are rapidly expanding and staying informed regarding available assays can be challenging. Potential applications of liquid biopsy are broad, and many are currently being studied in clinical trials. The anticipated results have the potential to change cancer patients’ management and improve outcomes in the near future. However, is there a benefit of using liquid biopsy in standard clinical care today? In what clinical scenarios can this approach be beneficial? This session will discuss the basics of liquid biopsy and present clinical scenarios where this approach can be useful in today’s workup of oncological patients.

Learners will become familiar with current standards of a work-up and helpful molecular tests to aid in diagnosis, prognostication, and choosing the appropriate therapy for several types of lymphoma. B-cell and T-cell clonality testing will be discussed, including how the assays work, when to use them, and what the pitfalls are in ordering and interpreting these assays. Learners will leave with a better understanding of how these ancillary tests can be used in the work-up of lymphomas.

Practical molecular pathology of colon cancer is the focus of this presentation. Topics include MSI testing by PCR, IHC and germline testing and how to distinguish sporadic MSI-high colon cancer from inherited Lynch syndrome MSI-high cancers. The therapeutic, familial, syndromic, and prognostic reasons for why this MSI-high differential is critical are fully explored. KRAS and BRAF testing and their significance to EGFR pathway chemotherapy are reviewed. Helpful information on microdissection in molecular testing is provided.

Pharmacogenomics has been at the forefront of precision medicine during the last few decades. In this presentation, a historical overview will be presented. Then some basic principles relevant to pharmacogenomics together with a review of the relevant molecular methodologies with a comparison of their advantages and disadvantages will be discussed. Finally, some of the implementation challenges will be reviewed, some inherent to pharmacogenomics, while others are relevant to precision medicine initiatives in general.

The Introduction to Molecular Diagnostics lecture is designed to provide a broad background in the study of human genome structure and function, and how this knowledge is applied to clinical testing. This lecture will cover basic molecular biology concepts as well as genomic alterations that serve as molecular biomarkers in cancer. The foundations of major molecular techniques commonly performed in clinical laboratories, including karyotype testing, fluorescent in situ hybridization (FISH), chromosomal microarray, and polymerase chain reaction (PCR)-based assays will be presented, and specimen requirements, advantages, and limitations of each technique will be discussed.

Immunohistochemistry is an indispensable complement to diagnosis and predicting response to therapy and has applications across basic, translational, and clinical research. Everybody benefits from smart, technically sound immunohistochemistry. This lecture will describe the concept of next-generation immunohistochemistry and will present several novel diagnostic markers “discovered” through this approach. It will also emphasize the importance of careful antibody selection, optimization, and validation.

Autoimmune neurology is a rapidly growing field, with new antibodies, syndromes, and treatment strategies developing every year. While individual antibody-mediated neurologic diseases are rare, autoimmune causes of encephalitis are as common as infectious causes. This presentation provides a brief overview of autoimmune neurology, discusses strategies for testing for these rare diseases, and reviews some of the common pitfalls that can lead to misdiagnosis.

This presentation describes the classification and structure of herpes simplex viruses 1 and 2 (HSV-1 and HSV-2) along with the symptoms, transmission, management, and prevention of infection. Additionally, it compares the indications, benefits, and limitations of the testing modalities used to identify HSV infections.

Gastroesophageal cancers are commonly diagnosed at advanced stages, which portend poor prognoses and have limited available therapeutic options. Numerous clinical trials have recently begun to evaluate the prognostic implications of new biomarkers in this clinical setting, including PD-L1, HER2, and microsatellite instability-high (deficient mismatch repair). This lecture will touch on the clinical indications of these biomarkers, how to interpret the associated immunohistochemical tests, and how the respective treatments impact the prognosis of these cancers.

The emergence of artificial intelligence (AI) and computational pathology provides new tools to bring automation to the practice of anatomic pathology. With the recent FDA approval of the first algorithm to determine the presence of prostate cancer in prostate needle biopsies, computational pathology has come a step closer for actual utilization by pathologists. To deploy algorithms in clinical practice requires a large infrastructure in digital pathology and a change in operational workflows. I will discuss the key elements that are needed for digital sign-out and present data on clinical implementation of a commercial algorithm for evaluation of H&E slides and calibration of a commercial algorithm for PD-L1. I will also briefly discuss regulatory considerations of digital pathology. Altogether, examples will be used to illustrate the state of the art of digital and computational pathology and the challenges that exist for clinical implementation of this new technology.

Comprehensive genomic testing with next-generation sequencing (NGS) can inform clinicians with valuable insights into available genomic-based targeted treatments and immunotherapies for cancer patients. However, implementing an effective and well-organized clinical precision oncology program can be challenging due to ever-growing and ever-changing molecular testing and treatment standards. This presentation will describe key components of precision cancer medicine: NGS testing, Molecular-Tumor-Board, and a review of 2021 FDA-approved new oncologic drugs. The presentation will conclude with a case study in precision oncology with a lung cancer patient with brain metastasis.

Recently, a student at Texas State University handled a “downed/sick” bat and was not aware of the risk surrounding contact with a bat. The case will be discussed in terms of (1) the scenario that took place with the student; (2) rabies public health education and epidemiology; (3) specimen collection requirements; and (4) laboratory diagnostics of specimens submitted for rabies testing. Dr. Rohde has worked in the field of zoonotic diseases for over 30 years and has extensive public health and medical laboratory experience with the rabies virus.

Annually, millions of patients seek medical advice due to chronic gastrointestinal issues. One challenge for gastroenterologists is differentiating between highly prevalent functional disorders, such as irritable bowel syndrome (IBS), and immune-mediated conditions such as Celiac disease that require more aggressive management. Advancements in noninvasive serology-based diagnostic tests have reduced the need for invasive procedures. These developments simultaneously have created challenges with test utilization due to varying diagnostic accuracies and lack of guidance. Recently, there has been new recommendations for the laboratory testing and clinical diagnosis of celiac disease, including recommendations for biopsy-free diagnosis. During this presentation, current updates on analytical and clinical recommendations, developments in testing methodologies and strategies, including reflex algorithms, and gaps in the laboratory diagnosis and management of patients with celiac disease will be discussed. Laboratorians and healthcare providers may find the session informative to help mitigate inappropriate testing and optimize patient outcomes in suspected celiac disease patients.

For the last decade, molecular classification of cutaneous melanoma has guided systemic therapy for unresectable and metastatic disease. During this period, we have also learned where somatic mutation testing can be strategically used to help resolve diagnostic uncertainty. While standard-of-care mutation testing in melanoma has remained stable, therapeutic breakthroughs and the evolution of medical oncology has outpaced laboratory biomarker development. Now, more than ever, there is significant clinical need for assays that improve risk stratification for this deadly disease. Recent data from clinical trial specimens hint at potential utility for circulating tumor DNA testing in improving risk stratification for stage II-IV melanoma. Nevertheless, more clinical validation studies are needed. In contrast, genomic signatures derived from melanoma and other tumors, such as global mutation burden and inflammatory gene expression, are purely investigational but suggest a biomarker framework for future clinical trials in immuno-oncology.

This presentation provides an overview of newborn drug testing, with emphasis on testing meconium and/or umbilical cord tissue, which are neonatal specimens that can be used to detect in utero drug exposures. Guidance for interpretation of results and investigation of unexpected results is discussed as well.

Hereditary breast cancer is characterized by onset at a young age, bilateral breast cancer, multiple primary breast cancers, and a history of first- or second-degree family members with similar diagnoses. Approximately 15–20% of the patients from families with a history of an inherited form of breast cancer are negative for BRCA1 and BRCA2 mutations. Additional, non-BRCA genes have been identified as predisposing for breast cancer. Multigene testing is routine in hereditary cancer syndromes. Next generation sequencing now permits multigene panel testing, which provides clinicians with more information in a single test with improved efficiency and speed and lower cost. Also in this presentation, two diseases related to renal cancer will be discussed: Birt-Hogg-Dubé syndrome and Von-Hippel-Lindau syndrome. Genetic mechanisms, genetic counseling issues, and a testing strategy for retinoblastoma are discussed.

In May 2022, the Word Health Organization declared monkeypox virus (MPXV) a “public health emergency of international concern.” Prior to the 2022 global outbreak, monkeypox (MPX) was a relatively unknown viral illness associated with sporadic clusters in endemic countries and occasional travel-associated cases. In response to this emerging pathogen, clinical laboratories quickly responded by developing molecular assays for MPXV detection. However, any clinical assay is not without its limitations, and these must be taken into account to ensure appropriate reporting of results. In this lecture, we will start by exploring the basic virology of MPXV and exactly how it emerged on the global stage. The second half of this presentation is focused on the development and implementation of MPX assays. Focus is placed on studies examining how the testing process, including pre- and postanalytic factors, influence assay performance. The intended audience includes clinical laboratorians, technologists, and anyone with an interest of the role laboratories play in the diagnosis of infectious diseases.

In 2020, the differential diagnoses for “small round blue cell tumors” expanded to include new official entities described by the World Health Organization (WHO). Specifically, the WHO editorial board now recognizes novel subtypes of undifferentiated small round cell sarcomas, defined by specific molecular alterations. These undifferentiated round cell sarcomas were previously referred to as “Ewing-like sarcomas.” We now know this group includes tumors with distinct diagnostic and clinical features. Namely, round cell sarcomas with EWSR1–non-ETS fusions show unexpected and unusual morphologic and immunophenotypic patterns. CIC-rearranged sarcomas are critically important to recognize because they can occur at any age, arise in any location and are uniquely, extremely aggressive. Sarcomas with BCOR genetic alterations are the rarest of the undifferentiated round cell sarcomas and can present with deceptively low-grade appearances. Although this field continues to evolve, there are now molecular/genomic tools available in clinical laboratories to accurately diagnose these entities. Importantly for providers, the National Comprehensive Cancer Network (NCCN) clinical guidelines for bone and soft tissue tumors include recommendations for comprehensive genomic profiling of suspected Ewing sarcomas if conventional assays such as FISH, PCR, and/or cytogenetics is negative. This is a logical recommendation given the diversity of genetic alterations, the limitations of conventional assays and the distinct, as well as emerging, types of round cell sarcomas.

During this lecture, the practice of molecular diagnostics for lung cancer patients will be discussed. Iin the first part of the presentation, an historical approach will be taken, starting with the discoveries of treatable mutations in EGFR and ALK, followed by initial and revised professional guidelines that were published to standardize practice around the world. The majority of the presentation will address recent applications and indications of molecular pathology testing for lung cancer, including new genetic alterations and new applications of testing for the earlier genetic alterations, with an emphasis on clinical utility in patient care. These new indications will form the basis for a newly launched project to revise the international practice guidelines again, in 2021.

In line with all areas of molecular oncology, molecular testing has also expanded into the area of genitourinary tumors, providing insight into pathobiology of these tumors as well as significantly aiding in identifying diagnostic, prognostic and predictive biomarkers. Most recent guidelines from professional societies now include recommendations for relevant molecular testing in genitourinary tumors to complement the clinical practice. In this presentation, a case-based format is used to exemplify relevant established and emerging standard of care molecular biomarkers in genitourinary tumors and how pathologists can use available data from molecular pathology reports to help in their practice. The presentation will also provide guidance in selecting appropriate testing methodologies for the required assays.

During this video lecture, you will hear from legal experts regarding the Anti-Kickback Statute (AKS) and the Eliminating Kickbacks in Recovery Act (EKRA) along with recent relevant court cases.

Errors in specimen collection result in inaccurate results. This presentation focuses on identifying specimen collection issues and strategies for preventing them. We will discuss common errors in patient identification, phlebotomy techniques, and specimen labeling. We will also discuss identifying collection issues via pre-analytical processes, training for accuracy in collection, and monitoring improvement.

This presentation covers Lean value and the nine DOWNTIMES wastes of Lean. A variety of laboratory scenarios will be discussed to assist in distinguishing between value-adding and nonvalue-adding activities as well as demonstrating how to identify and measure waste in any process.

Clinicians make thousands of decisions every day. Deciding how to use and interpret diagnostic tests is just one small part of those myriad decisions. Come learn how to influence those decisions through thoughtful design and understanding of the common biases that influence human choice.

Long before the pandemic, clinical laboratories were understaffed and tasked with an ever-increasing amount of demands as the industry shifted to a value-based care model. Now faced with the uncertainty of COVID-19 surges demanding more of an already strained system, recruiting and retaining staff has become harder than ever. These staffing challenges are due to a complex mix of burnouts, retirements, career changes, lack of qualified personnel, and other economic factors, but one issue remains clear—the clinical laboratory labor shortage has reached critical levels, and labs need to find better strategies to build and retain a stronger workforce. In this webinar, ARUP’s human resources and recruiting experts will discuss industry trends, successful strategies for recruiting the necessary staff to meet increased workloads, and creative tactics to retain and motivate current staff. Our experts will also answer questions from the webinar registrants to provide additional solutions on recruiting and retention.

Choosing the right laboratory test for any clinical situation can be difficult. One particularly complex situation is choosing appropriate testing for transgender and nonbinary patients. Gender and sex are words that many use interchangeably, however, understanding their differences is key to creating systems that accurately represent transgender patients. Correct identification and representation of all people and clinical scenarios allows laboratories to provide an accurate result for the right test.

Artificial intelligence (AI) is a recent tool for clinical pathology and clinical microbiology specifically for integration with diagnostic care. What can AI and computer vision do for microbiology? In the world of parasitology, we have developed and integrated the world’s first AI model which augments the technologist’s workflow to aid in detection of intestinal protozoa. AI model and computer vision integration makes the work of detecting protozoa from stool faster, more sensitive, and more enjoyable. This presentation will explore the current technology deployed in our laboratory as well as provide a sneak peek at the next generation AI model for additional detection of less common protozoa.

Problem solving has traditionally focused on constraining human behaviors to optimize system performance, but inhibiting behavior has the unwanted side effect of inhibiting creativity and innovation as well. In today’s complex and ever-changing environment, stifling creativity and innovation are dangerous strategies. Creative Problem Solving will explore methods for solving problems with creativity while accounting for human limitations and explore reasons that innovation can be challenging. Methods for stimulating new ideas while maintaining order and stability in the laboratory setting will be presented. Cycles of innovation and stabilization will be key to surviving in the current healthcare environment.

Introduction to gating in flow cytometry with an emphasis on gating strategies in clinical flow cytometry used to identify neoplastic populations of interest. Also covers major artifacts that can lead to spurious results that should be recognized. This lecture serves as the foundation for practical immunophenotyping skills needed to succeed in your early clinical flow cytometry rotation

This lecture covers the technology behind flow cytometry including a very high level overview of how a modern flow cytometer works, how fluorophores work along with their technical limitations such as tandem breakdown, and compensation issues. Also covered an explanation for modern displays of bivariate data, fit for purpose panel design, and more examples compensation artifacts.

This lecture covers B and T cell lymphomas, their phenotypes and properties, and differential diagnoses of key phenotypes. This lecture is not only useful for those entering clinical practice in hematopathology but serves as a useful review for those taking AP/CP boards.

This lecture covers acute leukemias and myeloid neoplasm, particularly phenotypes that help with lineage assignation as well as phenotypic properties seen in translocation defined AMLs. Of particular interest is knowledge of maturation sequences of myeloid and lymphoid progenitors – a topic that needs to be well understood for both MRD and MDS analysis.

This lecture provides a broad overview to minimal residual disease testing by flow cytometry including rare event analysis, clinical and therapeutic implications, pitfalls to avoid, and general approaches taken by major centers for MRD analysis.

Diabetes Mellitus is a major public health problem worldwide and its incidence is projected to continue rising at an alarming rate. It is a chronic condition of hyperglycemia that overtime leads to serious damage to many of the body’s systems, including the heart, kidneys, blood vessels, and nerves if poorly controlled. Therefore, testing for the diagnosis and monitoring of diabetes is critical so treatment can be initiated and adjusted before extensive damage occurs. This presentation will describe the clinical presentation, diagnosis, and treatment of type 1 and type 2 diabetes with an emphasis on analytical methods used in diagnostic testing.

Hereditary hemolytic anemia (HHA) is a group of heterogeneous disorders with diverse genetic etiologies. The clinical presentation ranges from mild hemolytic anemia to severe, transfusion-dependent hemolytic anemia with varied complications. In neonates, one of these complications is unconjugated hyperbilirubinemia, which may lead to neurotoxicity. Next generation sequencing (NGS) studies facilitate the identification of these complex multigene disorders.

Acute pancreatitis presents with abdominal pain, nausea, and vomiting, while chronic pancreatitis presents with abdominal pain, diarrhea, and weight loss. Unfortunately, these clinical symptoms are not specific for pancreatic diseases, so laboratory testing and imaging are essential in making a diagnosis. An approach to laboratory testing for diagnosis, prognosis, and guidance of management of these diseases will be discussed, as well as important clinical features, pathophysiology, and risk factors.

This presentation will cover fun, bizarre cases in Parasitology. We will discuss the route of infection for various foodborne parasites and the clinical presentation of zoonotic parasites.

Downward reimbursement pressure and a need for cash is leading to the sale of hospital outreach programs. This is a short-term solution that provides the health system with an infusion of cash but takes away the long-term benefits and revenue potential that comes from investing in the laboratory. With proper planning, it is possible to reclaim outreach business that has been sold, as demonstrated by Tucson Medical Center.

The Introduction to Clinical Cytogenetics course is designed to provide a broad background in the study of chromosome structure, function, and variation, and how this knowledge is applied to clinical testing. This lecture will cover basic biology concepts, including cell division, gametogenesis, and genomic imprinting, as well as common cytogenetic terms such as mosaicism, chimerism, among others. The foundations of karyotype testing will be presented, as well as the nomenclature used to describe chromosomes and their abnormalities.

The Introduction to Clinical Cytogenetics lecture 2 will explore the many forms of chromosome structural rearrangements observed in cytogenetic studies, their nomenclature notation, and their relationship with health and disease in both the constitutional and cancer settings. Advanced concepts in oncology karyotype nomenclature will be presented to facilitate the recognition of tumor clonal diversity and complex karyotype interpretation.

The Introduction to Clinical Cytogenetics lecture 3 will expand on the list of chromosome tests used in the clinic. An in-depth description of fluorescence in situ hybridization (FISH) will be presented, including the major FISH probe strategies, nomenclature, and applications. Chromosome microarray will be presented, together with a description of technical processing, analysis, and applications in constitutional and cancer studies.

Ethanol is one of the most widely used drugs in the world and excessive ethanol use can lead to abuse and alcohol dependence. Alcoholism is the leading cause of morbidity and mortality in the U.S and the 3rd leading cause of preventable death. Testing for alcohol exposure is important to manage the health of patients with alcohol use disorders, to detect individuals driving under the influence, assess patient adherence in drug and alcohol abstinence programs, evaluate fetal risk for neonatal alcohol exposure during pregnancy, and for prequalification screening for organ transplantation surgery.

This presentation will provide an understanding of the fundamental concepts of method/assay verification and validation. Which studies are required by CLIA regulations based on waved versus nonwaived test categorization will be defined, as well as best laboratory practices for meeting each of the requirements. Practical application of these concepts will be demonstrated using a recent example of an assay that was implemented at University Hospital laboratory.

The healthcare industry continues to face the challenges presented by the COVID-19 pandemic. These challenges include falling margins, flattened revenues, and rising expenses. Given the low Diagnosis Related Group (DRG) based reimbursement under the Centers for Medicare & Medicaid Services (CMS) prospective payment system, it is more important than ever for hospitals to focus on quality measures to provide timely and effective care, prevent complications and deaths, reduce readmissions, and minimize the overall cost of care. While Case Management is typically tasked with addressing these issues, partnership with the clinical laboratory can provide valuable and unique insight and strategies.

Until recently, Case Management and clinical laboratories were thought to be an unlikely partnership, however, this webinar will explore real world examples of how collaboration with the laboratory can improve quality metrics within a hospital and demonstrate the value of the clinical laboratory. Dr. Fletcher will outline laboratory strategies for driving improvement in length of stay, transitions of care, denials in payment, readmissions, and hospital-acquired conditions. Each of these strategies has potential to save millions of dollars or drive additional revenue while simultaneously improving patient care.

Clinical laboratories face immense challenges with the COVID-19 pandemic. While support for COVID-19 testing has been an essential focus of the coordinated clinical laboratory response, the pandemic influences laboratory operations in numerous ways that challenge the traditional concepts of laboratory management. In this webinar, ARUP Chief Operations Officer Jonathan Genzen, MD, PhD, details the challenges, setbacks, successes, and opportunities for development throughout the COVID-19 pandemic to consider as laboratories move forward.

As healthcare costs continue to climb in the United States, drug costs are responsible for a disproportionate percentage of the overall healthcare spend. Pharmacogenetic testing has been scientifically validated as an option to help lower drug costs, yet little data exists on the testing's potential to improve patient care while also lowering health plans' costs. This presentation will provide the premise of pharmacogenetic testing then share how one self-insured company implemented pharmacogenetic screening of its high-risk populations as part of a collaborative laboratory/pharmacy stewardship program. Lessons learned and an examination of the financial and quality impacts of pharmacogentic panel testing will also be discussed.

This presentation will provide an overview of the factors that affect blood pressure and how the endocrine system plays an important role. Endocrine disorders that may present with high blood pressure will be reviewed. A focused discussion on primary hyperaldosteronism will explain how this disorder results in hypertension, and how laboratory testing is critical for its diagnosis. Finally, the problem of low blood pressure will be discussed, and laboratory testing for diabetes insipidus (which may present with low blood pressure) will be outlined.

This presentation will provide a brief overview of blood pressure control by the renin-aldosterone system. Additionally, it will describe how primary hyperaldosteronism occurs when this pathway malfunctions, and how laboratory testing, especially adrenal venous sampling, is critical for diagnosis of primary hyperaldosteronism. Finally, interpretation of adrenal venous sampling results will be reviewed.

Because of the ongoing influences of reimbursement declines, budgetary pressures, staffing shortages, regulatory challenges, and more, hospital laboratories are at increased risk for becoming a "commodity" in the eyes of C-Suite members. Some hospital executives even question whether the laboratory is part of the hospital's core business, and have sold or are considering selling its hospital laboratory operation to an outside commercial entity. This presentation will examine these influences, debunk the myths, and provide attendees with strong supporting evidence for maintaining and expanding the role of the hospital laboratory in the local delivery of healthcare.

Laboratory stewardship, which has evolved from its predecessor of utilization management, is rapidly becoming an essential tool in the clinical laboratory’s arsenal for improving quality patient care. This presentation looks at broad laboratory stewardship topics using the format first popularized by the game show Jeopardy!™. Using this format provides a fun, engaging, and entertaining experience for learners. Our “show” is hosted by Dr. Mike Astion, a widely known and published expert on laboratory stewardship, co-founder of PLUGS (Patient-centered Laboratory Utilization Guidance Services), and Medical Director of Seattle Children’s Hospital Department of Laboratories. Timely and relevant commentary is provided by Dr. Jane Dickerson who is a co-founder of PLUGS and Director of Clinical Services at Seattle Children’s Hospital and Dr. Andrew Fletcher who is the Medical Director of Consultative Services at ARUP Laboratories and also widely known and published expert in laboratory stewardship.

This two-part series provides an introduction to the science of cytogenetics. Cytogenetics is the study of chromosomes, genomic structure, function and variation, and the role of these aspects in human disease and heredity. Explanations will include the basics of technologies of chromosome analysis and karyotyping.

This two-part series provides an introduction to the science of cytogenetics. Cytogenetics is the study of chromosomes, genomic structure, function and variation, and the role of these aspects in human disease and heredity. Explanations will include the basics of technologies of chromosome analysis and karyotyping.

Marketing in the reference laboratory industry has evolved over the past 50 years. In the early days, sales reps and upper management had to develop new and effective strategies and tactics that centered on selling a healthcare service as opposed to a product, such as equipment or pharmaceuticals. As such, lab sales reps have learned significant lessons over the years from those nascent times. The listener—either experienced or not—should find some nuggets of wisdom in this presentation that will help him/her grow their business as well as prevent the loss of an account to a competitor.

Clinical laboratories are increasingly called upon to share genetic testing data, as well as reevaluate results from previously performed tests for hereditary conditions. These efforts create unique opportunities and challenges during the diagnostic workup for new and previously tested patients. This presentation will provide an overview of current practices and policies surrounding genetic data sharing and variant reanalysis, with shared stories on successes and hurdles overcome to help patients with rare genetic disorders end their diagnostic odyssey.

In this lecture Dr. Tracy George focuses on the microscopy of cerebrospinal fluid, pleural fluid, peritoneal fluid, and pericardial fluid. Both normal and abnormal cell types will be shown and features that help distinguish benign from malignant cytology will be discussed. Recommendations for additional ancillary studies will also be explored.

This presentation will provide an overview of the Clinical Laboratory Improvement Amendments (CLIA) regulations described in Title 42, Part 493 of the Code of Federal Regulations along with basic CLIA standards and requirements for laboratory certification and/or accreditation.

Opioid medication abuse and misuse is a major cause of morbidity and mortality in the United States. The clinical laboratory plays a vital role as the healthcare system in the United States deals with the current opioid epidemic. This lecture is intended to help medical laboratory scientists gain a basic understanding of clinical uses of opioid medications, the short- and long-term effects of opioid use, and the different scenarios for performance of opioid testing for patients. In addition, this lecture covers laboratory testing methods for opioids and includes clinical cases to illustrate how test results can be combined with clinical information to determine individual drug use patterns in order to help build physician-patient relationships.

During this presentation, we will discuss how order sets impact the laboratory and examine specific issues regarding test ordering. Next, we will explore an example of an efficient order set development/maintenance process and highlight how the laboratory can contribute. Physician preference items (“favorites”) will also be discussed as well as possible solutions for optimization. We will offer specific examples of laboratory order set initiatives and optimization so that laboratorians can begin driving quality and cost reduction in their healthcare systems.

Extreme molecular diagnostics takes only seconds. With very short turn-around times, pre-analytical and post-analytical challenges are minimized, point-of-care testing makes sense, and high-throughput is not necessary. Extreme PCR in <15 seconds, high speed melting analysis in 4 seconds, and rapid sample preparation enable sample-to-answer diagnostics in <1 minute.

This presentation describes a pathway for health care technology companies to incorporate medical ethics into their business strategy. It provides counterexamples of health technology companies who failed to prioritize patient interests, and ultimately failed financially as a result. The medical ethical principles of respect for persons, beneficence and justice are briefly described, along with illustrations from the information technology sector.

Big data and artificial intelligence are revolutionizing most areas of society, and are poised to make a similar impact on health care and medicine. Like all new powerful technologies, AI has risks as well as benefits. If not carefully managed, AI can contribute to serious harm to patients in areas including privacy and nosocomial injury. This presentation will describe the nature of these risks along with potential approaches to reduce harm.

The Doctor of Clinical Laboratory Science (DCLS) is an advanced practice healthcare practitioner dedicated to increasing the value of diagnostics through consultation as members of interprofessional healthcare teams and conducting research focused on evidence of the impact of diagnostics on healthcare outcomes. As a member of interprofessional healthcare teams, the DCLS contributes by providing consultation to assure quality & value improvement in utilization and delivery of laboratory services. Consultation occurs in a variety of setting as described in the Diagnostics Consultation Model^©. Case examples will demonstrate the value of the DCLS consult to quality patient care, safety, laboratory utilization and cost outcomes.

Lab and pharmacy interact on a daily basis, whether intentionally or incidentally. Identifying these areas is a starting point for a more collaborative partnership in patient care activities. There are also many benefits to each department and the hospital overall. In addition, emerging, high profile initiatives depend heavily upon teamwork and leadership from both lab and pharmacy for success.

It is crucial to correctly identify ABO discrepancies. All ABO discrepancies must be investigated and the underlying cause identified before a patient or donor’s correct blood type can be resulted.

This panel discussion will cover some different outsourcing arrangements offered by commercial laboratories, focusing specifically on the impacts to laboratory personnel, clinician satisfaction, and patient care.

This video lecture is part three of a three-part series entitled "Don't Sell Your Lab Short."

Does your lab currently obtain tests or other services from an outside vendor that could potentially be insourced? Or has your lab or hospital considered outsourcing some or all lab services to an outside company? These types of decisions are extremely common throughout healthcare, and they’re often driven by top-down financial analyses, which, in some cases, leads to disastrous outcomes. This presentation will provide examples from healthcare and other industries to show how a more holistic approach to cost analysis can lead to better insourcing and outsourcing decisions.

This video lecture is part one of a three-part series entitled "Don't Sell Your Lab Short."

Names for lab tests have traditionally been chosen by clinical pathologists and scientists. While these test names make perfect sense to anyone in the clinical laboratories, that is not always the case with clinicians. Clinicians often order the wrong test or a sub-optimal test, or more tests than necessary, because the relevant test names are unclear or obscure. Often the wrong orders lead to safety and quality issues. Many hospital Utilization Management (UM) or Lab Stewardship efforts focus on correcting such test names, which is typically a slow and non-trivial process, as no standardized lab names exist.

This talk will discuss solutions to non-standard lab names, namely, TRUU-Lab, a collaborative effort among pathologists, clinicians, professional organizations, accreditation agencies, large reference labs and terminology groups to create a consensus guideline for giving laboratory test more rational and consistent names. The ultimate goal is to bring this consistency and ease of use into electronic health records (EHR) and laboratory information systems (LIS).

This session will discuss many of the interventions undertaken by the speaker at his institution to improve care delivery through laboratory stewardship interventions. Emphasis will be placed on laboratory leadership, collaboration with clinical colleagues, the importance of communication and professionalism, and a systems-based approach to problem solving. Evidence will be presented that these interventions, in addition to promoting healthcare affordability, directly improve the quality of healthcare delivered, as outlined by the Institute of Medicine.

This lecture provides an introduction to familial genetic testing, meant for non-genetics providers and other healthcare professionals. Standard genetics methodologies are reviewed, and considerations for streamlining test selection and ordering are discussed.

Having a strong ergonomics program can help decrease workers compensation claims and improve employee’s performance. This workshop will focus on what ergonomics is and why it is an important element of a comprehensive occupational health and safety program.

We will review proper workstation setup, as well as laboratory ergonomic work practices and principals with a focus on repetitive tasks such as microscope use, pipetting, and miscellaneous hand tool and computer use. Additionally, we will identify what to include in an ergonomics program—from effective training to ergonomic assessments and everything in between.

Additionally, we will discuss specific laboratory case studies and work through problem-solving exercises to identify risk factors in a laboratory setting and how to mitigate the identified risk.

This session will provide an understanding of three fundamental concepts of quality control: stability, capability and controllability. The theory of each of these concepts will be described and will be followed with practical advice on how to apply these concepts in the real world. A top level approach to quality improvement will be presented along with practical tools to implement each phase of the quality improvement process. The goal is to provide participants with a practical approach to QC analysis and a roadmap for QC improvement.

How should laboratories treat their clinician customers? On one hand, laboratories want to provide excellent customer service by accommodating their clinical customers’ preferences. On the other hand, laboratories need to enforce standardized processes such as proper specimen submission. This pre-recorded webinar will provide examples from other industries to illustrate how a “tough love” approach can produce high levels of process quality and clinician loyalty at the same time.

Clinical laboratories often receive orders for tests that are outside the mainstream of clinical testing. Some of these are new/emerging tests for which there simply isn’t a lot of clinical experience. Some are research biomarkers that are primarily of interest to bench scientists. Some are panels or algorithms designed largely in response to marketing considerations. What these all have in common is a lack of clinical evidence demonstrating clinical utility, i.e. therapeutic benefit for patients as a consequence of the tests. How should clinical labs evaluate requests for such tests? Historically many laboratories have approached these requests from a financial and/or logistical perspective, approving the tests as long as they don’t overly burden the local laboratory (and provided that they are performed in a CLIA-licensed setting). This presentation will present an additional framework for consideration, namely bioethics. What is the ethical impact of such testing on the individual patient as well as on society as a whole? And how can potentially useful – but still unproven – laboratory tests be introduced into clinical settings in an ethically consistent manner?

Originally presented on July 10, 2018 as a live Seattle Children's Hospital Webinar Series

This presentation will delve into the concept of lab stewardship and its critical role for the future of laboratory medicine. Dr. Fletcher will also outline several strategies for implementing successful interventions to drive downstream savings in healthcare systems.

The ABO blood group system is the most important in transfusion medicine. This presentation covers basic ABO inheritance, antigen production and expression, and weak subgroups.

No short description

This lecture will describe the roles of a mentor and protégé. It will evaluate the responsibilities of each member of the partnership to ensure cross functional development within the organizations. It will describe strategies to use when setting up a successful mentoring program.

This lecture will examine how bullying in the workplace might be defined and specific examples of how these behaviors might be displayed. In addition, methods for addressing and dealing with bullying, as well as current legislative and organizational strategies, will be covered.

This course describes the Enzyme Linked Immunosorbant Assay (ELISA) testing method used in many analytical tests. Included are descriptions of the testing process and what is being tested. Animations are used to help illustrate what is happening at the molecular level.

Several effective approaches to antibody identification in the routine blood bank exist. This presentation explains a conservative approach to antibody identification and several demonstrations of ruling out, choosing appropriate selected cells, and completing antibody workups are given.

Laboratories are under intense pressure to increase value. Cost-effectiveness analysis (CEA) can help labs increase value by identifying optimum testing scenarios. This webinar explains important concepts such as cost-perspectives, methods for estimating costs, estimating outcomes, evaluating outcomes, and evaluating uncertainty in model outputs. At the end of this lecture, viewers will understand the different types of frameworks and analyses that are used in cost-effectiveness analysis.

The Lewis system is unique among blood group systems in that the antigens are not manufactured within the erythrocyte, nor do they form an integral part of the cytoskeletal membrane. Rather, they are synthesized by tissues, secreted into blood and body fluids, and adsorb onto the red blood cell. While antibodies against antigens in this system are fairly commonly encountered, they are generally not considered to be clinically significant in transfusion. In vitro and in vivo hemolysis are rare but have been reported. Because Lewis phenotype expression is based upon the interaction of several genes, and because the phenotype expression can be transient, the Lewis system is a fascinating system to learn about.

The understanding of anemias is very important as clinicians attempt to provide high quality medical care to their patients. The medical laboratory scientist must also understand anemias to provide the needed information to physicians. This lecture will address the basics of the classification of anemias and tools used in the medical laboratory to assess a patient’s blood health or presence of anemia.

Hematology instrumentation has advanced to now routinely include at least a five-part differential and, in some laboratories, automated cell image analysis. Yet, a manual examination of the blood smear is still an essential procedure that provides valuable diagnostic information. This session will use case studies to define important morphologic variations and physiologic processes in selected disease conditions.

Laboratory formularies are an emerging tool for promoting effective use of the clinical laboratory. This presentation covers the key considerations for developing, applying, and managing a lab formulary: governance, process, evidence base, and analytics. In the end, a formulary is not so much a product as it is an interconnected system for managing and influencing diagnostic practices.

In this lecture, Dr. Schmidt covers performance evaluation of diagnostic tests. Traditional performance measures such as sensitivity, specificity and ROC curves are reviewed. Reasons for differences in diagnostic studies are examined including real differences, threshold effects, sources of bias, and random variation. Shortcomings of the traditional approaches to test evaluation are also discussed and alternative approaches such as diagnostic research (vs test research), clinical trial evaluation, and cost-effectiveness evaluation are presented.

Discrepant results are often identified by delta check alerts. Delta checks compare current laboratory results to previous results; if the difference between the two values exceeds predetermined biological limits (within a predetermined length of time), a technologist is alerted and the discrepancy can be investigated further. Causes of discrepant laboratory results include both preanalytical and analytical issues, as well as true biological changes occurring within the patient.

Many preanalytical issues cannot be detected by traditional QC methods, leading to the possible reporting of erroneous laboratory results. The wrong result compromises patient care by leading to inappropriate diagnoses or treatment. Delta check alerts provide an additional means to identify these types of problems, in addition to alerting health care providers to true changes in their patient’s condition.

Clinical Laboratory Scientists are trained to perform laboratory tests and to troubleshoot and validate the results of those tests which contribute to a patient’s medical diagnosis. During this presentation, we will compare the steps involved in pre-analytical, analytical, and post-analytical laboratory testing to the steps involved in pre-analytical, analytical, and post-analytical phases of developing leaders in the clinical laboratory.

Tired of fighting with the finance department to get the resources you need to carry out your mission? Ever feel that your CFO is from a different planet and that you just can’t communicate? Do financial concerns kill creativity and stifle progress in your organization? Where is the peace? Where is the love?

This lecture will give you practical tips and tools to help your organization balance operational and financial considerations. First, this course unlocks the mysterious world of accounting . . . revealing the core principles, objectives, and concepts of this centuries-old art. Next, we tackle the sometimes thorny subject of “Margin” verses “Mission” providing some useful prospective on this important topic. Next, we shatter the language barrier, giving you simple terms and lingo to facilitate financial communications. Soon you’ll be fluent in the latest accounting jargon. Finally, we conclude with some take-home financial analysis tools that will have your finance people saying: “Wow! – How’d you get so darn smart?!!!”

This shouldn’t be shocking news to most healthcare professionals, but customer service IS a critical function of quality patient care. However, when we as laboratorians think about customer service activities and how that translates into patient care, we tend to think it’s just about what occurs in the literal presence of patients. So, here’s what may be news to some, the patient experience isn’t just about what we do when we’re in their physical presence, but also what we do as we interact with everyone who is in any way associated with their care. Therefore, we must make every effort to be engaged in skilled customer service activities with everyone, at all times. Now, the question may arise, what ARE the necessary skills and activities for providing great customer service (i.e., quality patient care) and how well do YOU execute them? This session will provide an opportunity for self-assessment utilizing a customer service skills preferred profile and an interactive discussion regarding the do’s and don’ts for outstanding customer service.

Our traditional response to complex problems is to find and eliminate the human behaviors that we think are responsible for errors, and are perplexed when the error we thought we eradicated occurs again and again. We ignore the fact that 95% of process performance is attributable to the design of the work and the system in which the work resides and only 5% to the human component. The importance of creative design in the laboratory is often overlooked and its potential is underutilized. In this session we will discover how to design a work environment where error is, if not impossible, at least very difficult. Using innovative problem solving principles and techniques, we will open the door to organizational excellence by design.

This is a basic overview of the disease malaria and the causative agents, Plasmodium species. The life cycles of the parasites and their differentiating characteristics in the human host are discussed, for Plasmodium falciparum. P. ovale, P. vivax, P. malariae. Case studies demonstrate the disease states caused by each species.

Phlebotomists routinely encounter dangerous conditions, problem patients, and other issues during blood collection. This session will suggest techniques that can help you avoid or safely manage these difficulties. Areas to be discussed include:

• risks associated with venous blood collection, such as improper vein selection and needlestick exposure
• unusual patient situations that impact phlebotomy practice, including the cancer and bariatric patient
• communication barriers and methods to improve patient interactions, like developing good listening skills and effective communication approaches with the elderly

Designed for phlebotomists and phlebotomy students who have comprehension of the basics of the venipuncture technique, this session will enhance your skills, build your knowledge base, and help you deliver the highest quality in patient care.

Employees being able to report laboratory errors without fear is a key component of an effective error management system. This presentation will focus on the necessity for making the system useful and easy to use. Case studies are used to discuss a variety of errors and to illustrate how identification of errors can lead to practical solutions in error prevention. A just culture vs. punitive culture will be addressed along with ideas for getting employee “buy-in”. Additionally, strategies for mentoring and coaching employees with high error rates will be provided.

When we bring up the topic of change, we often think of it as a negative. But why? We’re not opposed to changing a hairstyle, the color of our hair, changing cars, or even changing jobs. Now cell phone contracts are starting to lighten up so we can have a new cell phone almost every six months. There has been a lot of information written about the logical steps to change, but what about the human side of change? Cheryl Vincent will discuss the steps to change but also add a human dimension to the concept of Change Management.

Ms. Manning will give a comparison of the differences in learning in the laboratory and nursing professions. She will share personal examples of the struggles each profession has in understanding each other. She will also discuss practical ways to bridge the gaps in understanding between the two professions. Ms. Manning encourages the audience to be interactive and to share problems as well as best practices and successes in bridging the gap between these two professions.

Eradicating error in healthcare may seem like a Sisyphean task, yet legislators, regulators and the public in general expect error-free work from medical professionals. How to work without error is the subject of countless lectures, papers and studies, encompassing every discipline from manufacturing to service. The Toyota Production System of quality manufacturing uses the term "poke-yoke" (mistake-proofing) to describe the process of eliminating production defects. "Error-Proofing in Healthcare" will distill and discuss the essential elements of "poke-yoke", starting with defining and exploring the types of error most often encountered in the provision of medical care. Proven improvement tools and techniques for ensuring quality outputs will be presented with practical applications to place the error-proofing strategy in the context of the laboratory.