Garran, Australia
Garran, Australia

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PubMed | Centenary Hospital for Women and Children, ACT Pathology. and Gastroenterology and Hepatology Unit
Type: Case Reports | Journal: Internal medicine journal | Year: 2016

We report the first published case of aggressive diffuse large B-cell (non-Hodgkin) lymphoma in a 35-year-old pregnant woman who had Crohn disease and was taking long-term thiopurine therapy: the patient developed placental insufficiency, and there was intrauterine fetal death.


Simpson A.J.,ACT Pathology | Potter J.M.,ACT Pathology | Potter J.M.,Australian National University | Koerbin G.,ACT Pathology | And 10 more authors.
Clinical Chemistry | Year: 2014

BACKGROUND: Many patients presenting to the emergency department (ED) for assessment of possible acute coronary syndrome (ACS) have low cardiac troponin concentrations that change very little on repeat blood draw. It is unclear if a lack of change in cardiac troponin concentration can be used to identify acutely presenting patients at low risk of ACS. METHODS: We used the hs-cTnI assay from Abbott Diagnostics, which can detect cTnI in the blood of nearly all people. We identified a population of ED patients being assessed for ACS with repeat cTnI measurement who ultimately were proven to have no acute cardiac disease at the time of presentation. We used data from the repeat sampling to calculate total within-person CV (CVT) and, knowing the assay analytical CV (CV A), we could calculate within-person biological variation (CV i), reference change values (RCVs), and absolute RCV delta cTnI concentrations. RESULTS: We had data sets on 283 patients. Men and women had similar CVi values of approximately 14%, which was similar at all concentrations <40 ng/L. The biological variation was not dependent on the time interval between sample collections (t = 1.5-17 h). The absolute delta critical reference change value was similar no matter what the initial cTnI concentration was. More than 90% of subjects had a critical reference change value <5 ng/L, and 97% had values of <10 ng/L. CONCLUSIONS: With this hs-cTnI assay, delta cTnI seems to be a useful tool for rapidly identifying ED patients at low risk for possible ACS. © 2014 American Association for Clinical Chemistry.


Koerbin G.,ACT Pathology | Koerbin G.,University of Canberra | Sikaris K.A.,Sonic Healthcare | Jones G.R.D.,St Vincents Hospital | And 3 more authors.
Clinica Chimica Acta | Year: 2014

Although we are in the era of evidence-based medicine, there is still a substantial gap between theory and current practice with the application of reference intervals as decision making tools. Different laboratories may have different reference intervals for the same tests using the same analytical methods and platforms. These differences have the potential to confuse physicians making the assessment and monitoring of patients more difficult by providing discordant information. This paper attempts to demonstrate how to use evidence-based approach for harmonising reference intervals. In order to consider harmonisation we must first have an appreciation of the various factors that influence the determination of that reference interval such as the choice of individuals within the population studied, biological variability of the analyte studied, partitioning, sample collection, analytical aspects such as bias and statistical models.An a priori approach for determining reference intervals, whilst recommended, may be beyond the scope of most laboratories and consideration should be given to the use of a validated indirect a posteriori approach. Regardless of method used, the continuing application of an evidence-based approach in harmonised reference intervals to meet the quality expectations of physicians should be pursued. © 2013 Elsevier B.V.


PubMed | Monash Medical Center, ACT Pathology, Monash University and Sullivan Nicolaides Pathology
Type: Review | Journal: The Clinical biochemist. Reviews | Year: 2016

In clinical chemistry, harmonisation of the testing process is a global initiative with the purpose of improving patient safety, allowing better integration of research data and enabling the use of national electronic heath records. In Australia, as in other countries, the initial focus has been on the harmonisation of the more commonly measured analytes. There are also a number of calculated parameters, derived from these measured analytes, which could also be considered for harmonisation. Calculated parameters that are reported by laboratories and used for clinical decision-making should undergo the same robust process of harmonisation as is the case for the measured analytes. Aspects that should be considered for harmonisation are: terminology, the formulae used and where possible the use of common reference intervals. To investigate pathways towards the harmonisation of calculated parameters, three commonly reported parameters are considered. Calculated osmolality, the anion gap and albumin-adjusted calcium are all derived from common analytes which have individually been considered for harmonisation. They present different methodological, measurement uncertainty and terminological hurdles to harmonisation and are likely to require different pathways and solutions.


Koerbin G.,ACT Pathology | Koerbin G.,University of Canberra | Potter J.M.,ACT Pathology | Potter J.M.,Australian National University | And 8 more authors.
Clinical Chemistry | Year: 2012

BACKGROUND: There is little information available on cardiac troponin concentrations in healthy young children. METHODS: Using a precommercial high-sensitivity assay from Abbott Diagnostics, we measured cardiac troponin I (cTnI) in longitudinal blood samples collected at ages 8, 10, and 12 years from a cohort of healthy, community-dwelling children. The 99th percentile values were calculated and estimates of the long-term biological variation were made. RESULTS: cTnI concentrations were above the limit of detection in 87%, 90%, and 98%of the children at ages 8, 10, and 12 years. The 99th percentiles were lower compared to a healthy adult population in both male and female children at all ages studied. At the 3 periods of study assessment, different children had cTnI concentrations above the 99th percentile. The calculated 99th percentile varied markedly depending upon whether the lowest or highest cTnI measurement for an individual child was included in the calculation. Biological variation varied markedly between 0% and 136%, the index of individuality was low at 0.36, and the reference change value was an increase of 147% or a decrease of 59%. CONCLUSIONS: In this longitudinal study of cTnI concentrations in healthy children as determined by a high-sensitivity assay, different children had concentrations of cTnI above the 99th percentile at the 3 episodes of assessment. These results suggest that in children the 99th percentile may not be a reliable index of silent cardiac disease, but rather may be indicating low-grade intercurrent illness. © 2012 American Association for Clinical Chemistry.


PubMed | Australian National University, Griffith University, ACT Pathology, University of Canberra and Abbott Laboratories
Type: Review | Journal: The Clinical biochemist. Reviews | Year: 2016

For more than a decade there has been a global effort to harmonise all phases of the testing process, with particular emphasis on the most frequently utilised measurands. In addition, it is recognised that calculated parameters derived from these measurands should also be a target for harmonisation. Using data from the Aussie Normals study we report reference intervals for three calculated parameters: serum osmolality, serum anion gap and albumin-adjusted serum calcium. The Aussie Normals study was an


Using objective laboratory and clinical criteria to more accurately determine the 99th percentile values for cardiac troponin I and T. We measured cardiac troponin T and cardiac troponin I with high-sensitivity assays in a large cohort of apparently healthy community subjects and calculated 99th percentiles for different sexes and ages. Subjects with possible subclinical disease were eliminated based on objective laboratory criteria, eGFR and NT-proBNP, and clinical criteria, history and examination and echocardiogram. For men and women of all ages, separately, more than 50% of subjects were excluded using these criteria, with a lesser proportion of younger subjects being excluded. In men aged <75 years, the 99th percentile for cTnI decreased by more than 50% from 22.9 ng/L to 10.3 ng/L. In other age groups and for cTnT the decrease was smaller (%) but still considerable. For establishing cardiac troponin 99th percentiles, simply using self-reporting of health is insufficient. Objective laboratory measures and clinical and echocardiographic assessments are essential to define a healthy population, especially in older persons. © 2013. Published by Elsevier Inc. on behalf of The Canadian Society of Clinical Chemists. All rights reserved.


Crispin P.,Canberra Hospital | Sinclair F.,Australian National University | Andriolo K.,ACT Pathology
International Journal of Laboratory Hematology | Year: 2016

Introduction: Low haemoglobin density (LHD%) from Coulter counters has been suggested as a means to detect iron deficiency. Its performance in a broad population group, including pregnancy, has not been evaluated. Methods: A retrospective study of adult and paediatric (under 12 years old) patient samples referred for blood counts and iron studies between October 2013 and March 2015. Receiver operator characteristic (ROC) curves were constructed to evaluate the performance of LHD% adults, children, and in the antenatal subgroup. Results: Using a strict definition for iron deficiency, compared with a selected normal cohort, LHD% had a ROC area under the curve (AUC) of 0.90 (0.89–0.91), but in an unselected cohort, the AUC fell to 0.74 (0.73–0.75) with a sensitivity of 74% and specificity of 60% at a cut-off value of 5.9%. In the paediatric cohort, the AUC was 0.79(0.73–0.85), giving a sensitivity and specificity of 75% and 68%, respectively. LHD% did not effectively identify iron deficiency in pregnancy with an AUC of 0.60 (0.54–0.65) and was no better than MCV at detecting iron deficiency. Conclusion: LHD% detects iron deficiency in adult and paediatric populations, but not in the antenatal setting, and does not appear superior to MCV. © 2016 John Wiley & Sons Ltd


Potter J.M.,Australian National University | Koerbin G.,ACT Pathology | Abhayaratna W.P.,Australian National University | Abhayaratna W.P.,The Canberra Hospital | And 3 more authors.
Clinica Chimica Acta | Year: 2012

Aims: Whilst cardiac troponin is considered to be indicative of cardiac necrosis, the advent of new high sensitivity assays for troponin suggests that troponin may be present in the blood of healthy persons. We have examined a cohort of healthy children and measured TnT in their blood. Methods and results: In this community-based prospective study, we collected blood samples from a large cohort of healthy children at ages 8, 10 and 12. years and measured hs-TnT on these samples.727 children had at least one blood sample collected and of these 28.6% had at least one sample in which troponin was detected. The number of samples with a positive troponin at each period of blood collection varied between 14.0% and 20.3%. Statistical analysis showed that the prevalence of positive TnT varied between schools and the between school pattern was different in different years. Conclusions: Low concentrations of troponin may be seen transiently in healthy children with no evidence of cardiac injury. This between-school by year variation is highly significant and is suggestive of a transient infective agent. © 2011 Elsevier B.V.


PubMed | Australian National University, ACT Pathology and Canberra Hospital
Type: Journal Article | Journal: International journal of laboratory hematology | Year: 2016

Low haemoglobin density (LHD%) from Coulter counters has been suggested as a means to detect iron deficiency. Its performance in a broad population group, including pregnancy, has not been evaluated.A retrospective study of adult and paediatric (under 12 years old) patient samples referred for blood counts and iron studies between October 2013 and March 2015. Receiver operator characteristic (ROC) curves were constructed to evaluate the performance of LHD% adults, children, and in the antenatal subgroup.Using a strict definition for iron deficiency, compared with a selected normal cohort, LHD% had a ROC area under the curve (AUC) of 0.90 (0.89-0.91), but in an unselected cohort, the AUC fell to 0.74 (0.73-0.75) with a sensitivity of 74% and specificity of 60% at a cut-off value of 5.9%. In the paediatric cohort, the AUC was 0.79(0.73-0.85), giving a sensitivity and specificity of 75% and 68%, respectively. LHD% did not effectively identify iron deficiency in pregnancy with an AUC of 0.60 (0.54-0.65) and was no better than MCV at detecting iron deficiency.LHD% detects iron deficiency in adult and paediatric populations, but not in the antenatal setting, and does not appear superior to MCV.

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