2026 Roundtables

Roundtable Discussions – Tuesday, May 5, 1330 – 1430

 

R0501: Implementing Point of Care Glucose Monitoring in Critical Care Settings

Yun Huang, Kingston Health Sciences Centre

Learning Objectives – at the end of this presentation participants will be able to:

1. Discuss the clinical needs and impact of POC glucose monitoring on patient care in ICUs.
2. Interpret the accuracy of glucose measurements obtained using glucose meters, blood gas analyzers, and continuous glucose monitors in ICUs.
3. Identify key factors involved in implementing, using, and managing POC glucose testing in ICUs.

Patients in critical care frequently exhibit hyperglycemia due to stress-induced physiological responses, insulin resistance, medications, or parenteral nutrition. They are also prone to hypoglycemia as a result of intensive insulin therapy, severe organ failure, or sepsis. Hyperglycemia, hypoglycemia, and glycemic variability in critically ill patients are all associated with increased morbidity, mortality and prolonged intensive care unit (ICU) stays. Frequent glucose monitoring is required for critically ill patients, and the measurements must be sufficiently accurate to support immediate medical intervention. The glucose testing method should require only a very small blood sample, or ideally be non-invasive, and should not be affected by common interferences, such as medications frequently administered in the ICUs. Methods for glucose monitoring in ICUs include point of care (POC) glucose meters, POC blood gas analyzers, and core lab chemistry analyzers. More recently, continuous glucose monitors (CGMs) have been introduced into ICUs, offering advantages such as minimal invasiveness, reduced blood draws, and the generation of large amount of continuous data for analysis. However, implementing these glucose monitoring devices in ICUs, using them effectively, and maintaining their quality remain significant challenges.

 

R0502: The Evolving Stream of Biological Diagnosis in Neurodegenerative Diseases: What’s Coming Next

Pankaj Kumar, BC Neuroimmunology Laboratory

Learning Objectives – at the end of this presentation participants will be able to:

1. Describe the evolving role of plasma biomarkers in the biological diagnosis of neurodegenerative diseases, with emphasis on AD.
2. Identify key biomarkers including p-tau217, NfL, GFAP, BD-tau, and novel detection platforms.
3. Recognize how diagnostic laboratories can prepare for implementation of next-generation plasma biomarker testing and result interpretation.

The landscape of neurodegenerative disease (NDD) diagnostics is rapidly evolving, shifting toward biologically precise approaches. This transformation is most evident in Alzheimer’s disease (AD), where the focus has shifted toward enabling therapeutic intervention at preclinical stages in Canada, following Health Canada’s recent approval of lecanemab. Currently, plasma phosphorylated tau 217 (p-tau217), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) demonstrate comparable diagnostic accuracy while being minimally invasive. Future directions emphasize the development of more specific blood biomarkers, such as plasma BD-tau217. Additionally, emerging detection technologies, including next-generation sequencing and nucleic acid–linked immuno-sandwich assay (NULISA) platforms, offer both ultra-high sensitivity and scalable multiplexing capabilities. Looking forward, biological diagnostics will increasingly unify the detection and management of other NDDs, such as frontotemporal dementia, Lewy body disease, amyotrophic lateral sclerosis, and vascular dementia. This discussion will highlight how advances in plasma biomarkers are redefining the diagnosis and management of NDDs, and how clinical laboratories should prepare for these developments.

 

R0503: Optimizing Test Utilization Across Healthcare Settings: Practical Strategies from Academic Laboratories

Jieli Shirley Li, The Ohio State University

Learning Objectives – at the end of this presentation participants will be able to:

1. Identify common patterns of test overutilization and underutilization.
2. Apply practical strategies to implement diagnostic stewardship initiatives using real-world case studies.
3. Develop collaborative approaches to engage clinicians and reduce unnecessary test utilization while maintaining high-quality patient care.

Inappropriate laboratory test utilization impacts patient care, increases cost, and strains laboratory resources. Both overuse and underuse can delay appropriate diagnosis and treatment, yet utilization challenges vary significantly across healthcare settings. This session will provide a practical and case-based framework for improving test utilization using real-world examples, including procalcitonin and protein electrophoresis (SPEP/UPEP), which are frequently misordered or misinterpreted. The speaker representing large academic medical centers, will share lessons learned, operational strategies, and collaborative approaches for engaging clinicians and improving ordering practices. The session will include interactive discussion to help participants implement evidence-based utilization strategies in their own institutions. Attendees will learn approaches for developing institutional guidelines, applying decision support, and balancing stewardship with clinical effectiveness.

 

R0504: ISO 5649: A New International Standard for Laboratory Developed Tests

Isolde Seiden Long, Alberta Precision Laboratories

Learning Objectives – at the end of this presentation participants will be able to:

1. Describe how ISO 5649 can help their laboratory meet regulatory requirements.
2. Apply principles of laboratory developed test lifecyle management.
3. Be aware of risk management and performance evaluation concepts and how they apply to laboratory developed tests.

The session will provide an overview of ISO 5649 Medical laboratories — Concepts and specifications for the design, development, implementation and use of laboratory-developed tests. The new ISO 5649 document is beneficial not only for medical laboratories, but also for related stakeholders such as regulatory authorities and/or accreditation bodies monitoring the quality and performance of these laboratories. During the session we will discuss the document scope, structure and how the concept of the LDT lifecycle may be applied. The document sets requirements representing a state-of-the-art approach for ensuring quality, safety and performance of LDTs. It outlines the general principles and criteria by which Laboratory Developed Tests shall be designed, developed, validated, implemented, monitored for use and retired by medical laboratories.​ While ISO 5649 is a stand-alone document, it supports the application of ISO 15189:2022 “Medical laboratories – Requirements for quality and competence” and provides a practical interpretation of these requirements.

 

R0505: Configuring and Validating Open-Channel Tests on Automated Analyzers

Chien-Yi Lu, University of Toronto

Learning Objectives – at the end of this presentation participants will be able to:

1. Describe key parameters to consider when configuring open-channel assays on a core analyzer.
2. Explain how to troubleshoot open-channel assays using real case examples.
3. Identify validation studies needed before implementing an open-channel assay on a core analyzer.

Open-channel or third-party assays allow core laboratories to add niche or locally required tests on high-throughput platforms. However, when the assay IFU does not provide platform-specific applications, the laboratory may need to configure the method from the ground up. This roundtable will walk through a practical, higher-level approach to bringing an open-channel assay into service, including setting of assay parameters and validation. Using real cases from the Roche cobas pro, participants will learn key factors to consider and how to troubleshoot issues before implementation. Attendees will also be invited to share their experience so we can compare requirements and solutions across platforms and institutions.

 

R0506: Updated 2025 International Myeloma Working Group / International Myeloma Society Response Criteria Guidelines and Impact to Laboratory Practice

Tracy Morrison, Trillium Health Partners

Learning Objectives – at the end of this presentation participants will be able to:

1. Discuss Response Criteria for Myeloma and its related spectrum of disease.
2. List changes to updated Response Criteria guidelines released in 2025.
3. Evaluate the impact of changes to laboratory practice in Clinical Chemistry.

The International Myeloma Working Group / International Myeloma Society (IMWG/IMS) is a leading collaborative group of Clinical Scientists that set guidelines for Diagnosis, Response and Treatment of Multiple Myeloma and its related disorders. The guidelines on Response Criteria were recently updated and shared at the 2025 IMS meeting. The update includes changes relevant to laboratory practice in Clinical Chemistry. The most prominent update is that the use of urine testing for measurable disease is minimized. Instead, sFLC testing is prioritized over urine as a marker for measurable disease, second to serum protein electrophoresis (SPEP). Another update is that immunoglobulin quantitation is preferred to SPEP for IgA and IgD Myeloma assessment. Also, confirmation of protein measurement no longer requires ‘sequential’ laboratory testing of the same marker. Rather ‘simultaneous’ confirmation from two laboratory markers is supported. Finally, there is a recommendation to disclose the method when mass spectrometry is used in result reporting. In this roundtable, these changes will be reviewed, as well as their overall impact to laboratory medicine practice.

 

R0507: What is the Future of Patient-Based Real-Time Quality Control?

Jan Palaty, LifeLabs Medical Laboratories

Paul Yip, Sunnybrook Health Sciences Centre

Learning Objectives – at the end of this presentation participants will be able to:

1. Describe the benefits and applications of PBRTQC and related methods through real-life examples.
2. Discuss concepts and calculations behind moving average QC methods, especially exclusion rules.
3. Implementation: List options in commercial and custom software and explain how to promote stakeholder buy-in.

This session will review the 2019 IFCC recommendations and highlight practical implementation for process control, inter-instrument, and inter-site comparisons. Also, middleware solutions integrated with chemistry analyzers are making implementation more feasible. The discussion will review experiences with patient moving averages in both hospital and community lab settings. Participants will be encouraged to share their own experiences with this technique.

 

R0508: Shrinking the Draw: Strategies and Advances in Reducing Sample Volume

Junyan Shi, Vancouver General Hospital, Vancouver Coastal Health

Learning Objectives – at the end of this presentation participants will be able to:

1. Identify key clinical and operational drivers for reducing blood sample volumes across different patient populations.
2. Describe current strategies, emerging technologies, and validation approaches that enable small-volume testing in clinical laboratories.
3. Evaluate quality indicators and sustainability outcomes associated with reduced-volume sample collection and testing practices.

While the value of blood testing for disease diagnosis and monitoring is undisputed, frequent blood sampling can lead to iatrogenic anemia, a modifiable cause of significant blood loss in critically ill patients, often increasing the need for transfusion. Minimizing blood draw volumes is also important in vulnerable populations such as pediatric and geriatric patients, where smaller sample collections can improve patient outcomes and comfort. Beyond clinical benefits, reducing blood collection volumes aligns with planetary health initiatives by decreasing medical waste, lessening environmental impact, and reducing energy consumption associated with sample production and disposal. This roundtable will engage participants in discussing strategies and technological advances aimed at minimizing sample volumes in clinical laboratories. Participants will explore evaluation and validation approaches, technical and regulatory challenges to clinical implementation, and share insights from published studies or real-world experiences. Finally, we will review quality indicators that can be used to assess the downstream impacts of reduced-volume testing.

 

R0509: Strategies for Providing Customized Interpretive Comments for Hemoglobin A1C Results Outside the Analytical Measuring Range on Automated Immunoassay Platforms

Hana Klassen Vakili, Shared Health

Learning Objectives – at the end of this presentation participants will be able to:

1. Recognize clinical conditions leading to inaccurate HbA1c determination.
2. Explain the value of patient medical review to identify causes of abnormal results and tailor interpretive comments.
3. Compare possible tools for proper result interpretation and providing appropriate guidance for clinical follow-up.

Hemoglobin A1c (HbA1c) is a key marker for diagnosing dysglycemia and managing diabetes. The HbA1c determination is often assessed on automated platforms with direct interface with the Laboratory Information System (LIS) or Middleware. Management of reporting numerical results below and beyond analytical measuring range (AMR) is usually handled by LIS or middleware rules defined by < lower limit or > upper limit. Conditional comments can also be implemented for each result in either middleware or LIS. Accurate interpretation of HbA1c results is extremely complex and multifactorial. Inconsistent reporting across laboratories can lead to misinterpretation and inappropriate clinical decisions.

 

 

R0510: Levelling Up Point of Care Testing in Acute Care Settings: Building Awareness of the Choosing Wisely Canada Recommendations from the Canadian Society of Clinical Chemists

Allison Venner, Alberta Precision Laboratories

Learning Objectives – at the end of this presentation participants will be able to:

1. Explain the process that led to the development POCT Choosing Wisely Canada recommendations for the acute care setting.
2. Summarize the seven POCT recommendations and identify the value of having them available in the acute care setting.
3. Describe how some of the POCT recommendations could be implemented at hospitals within Canada.

Point of care testing (POCT) provides many advantages and testing options to support patient care. Conversely, challenges are common and appropriate utilization remains a cornerstone for high quality POCT success. With an aim to fill this gap, the Canadian Society of Clinical Chemists (CSCC) POCT Special Interest Group (SIG) and Utilization Management SIG developed Choosing Wisely Canada recommendations for POCT in the acute care setting. This roundtable aims to review the effective and collaborative process, including a two-round Delphi survey, that was used to reach the final seven recommendations, and highlight opportunities for successful adoption through open discussion and implementation experiences.