May 19, 2022: Early detection of a macrotroponin complex during a hospital admissionB & Is harmonization of ANCA testing achievable with reporting result-specific likelihood ratios?

Speaker #1:

Annie Ren. Clinical Chemistry Fellow. University of Toronto.

Annie Ren is a first year Clinical Chemistry Fellow at the University of Toronto. Annie completed her PhD degree in Laboratory Medicine and Pathobiology at the University of Toronto. Her PhD thesis focused on using multiplexed immunoassay-based platforms for identifying personalized tumor markers for ovarian cancer.

Overview:

My interest in this topic was precipitated by the 2021 release of a position paper in CCLM, by experts from the EFLM Task and Finish Group on Autoimmunity Testing. The paper suggests an innovative idea of reporting test result-specific likelihood ratios to harmonize the largely method-dependent results from current ANCA tests. To appreciate the novelty and timeliness of this proposal, my talk aims to bring the audience through 1) how ANCA testing evolved in its utility in AAV management, 2) the obstacles that dampened the efforts in ANCA test standardization, and 3) a renewed hope for the harmonization of ANCA test reports by leveraging the statistical concept of likelihood ratios. If likelihood ratio reporting is implemented in the future, this new harmonization strategy may be applicable to other autoantibody tests that also see substantial challenges in standardization.

Objectives:

At the end of this activity, participants will be able to:

1. Understand the importance of anti-neutrophil cytoplasmic antibody (ANCA) testing for the clinical management of ANCA-associated vasculitis (AAV)
2. Appreciate the considerable efforts and difficulties associated with the standardization of ANCA testing
3. Familiarize with the new idea of reporting result-specific likelihood ratios for ANCA tests
4. Consider the feasibility and challenges of likelihood ratios reporting from the perspectives of clinical laboratorians and clinicians.

Speaker #2:

Matthew Lafreniere. Clinical Biochemistry Fellow. McMaster University.

Matthew Lafreniere is currently a Clinical Biochemistry Fellow at McMaster University. He received a doctorate degree in chemistry from the University of Ottawa and a business diploma in scientific management and leadership from Telfer School of Management as part of an NSERC CREATE scholarship in medicinal and biopharmaceutical development. Dr. Lafreniere will be starting as a staff Clinical Biochemist at Sunnybrook Health Sciences Center in July 2022.

Overview:

Macrotroponins are often complexes that form between antibodies and cardiac troponin in the circulation. The prevalence of macrotroponins is not well known, with some reports indicating up to 5% of patients with elevated hsTnI might be affected. Elevated troponin results may lead to misdiagnosis and poor management of patients. Herein, we present a case of detecting a macrotroponin early in a patient’s transition from the emergency department to a hospital ward. The patient was discharged the next day limiting further hospital investigations and hospital stay

Objectives:

At the end of this activity, participants will be able to:

1. Describe the role of high-sensitivity troponins in the diagnosis and management of myocardial infarction
2. Describe an approach taken to investigating a suspected case of macrotroponin
3. Describe the role of matrix effects in analysis of macrotroponins