ONE-TO-ONE IBMS GRANTS COVID-19

LONG COVID BIOMEDICAL RESEARCH LOCKDOWN QUIZ

Dr David Strain Four grant recipients Thirty questions
explains what we know explain their IBMS- about the pandemic
about long COVID: p.16 supported projects: p.28 and the past year: p.34
THE BIOMEDICAL SCIENTIST
DECEMBER 2020

THEBIOMEDICALSCIENTIST.NET DECEMBER 2020

THE YEAR THAT BEAT THE PANDEM C?

P01 Cover_December 2020_Biomedical Scientist.indd 1 19/11/2020 09:22

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p02_BIO.Dec20.indd 2 18/11/2020 14:25

 DECEMBER 2020
Contents
THE BIOMEDICAL
SCIENTIST 3

CONTENTS
EDITORIAL
5 Sarah May on the return
of the “Christmas gene”

NEWS
7 News in numbers IBMS.ORG DECEMBER 2020
8 Research, funding, developments
and clinical updates
13 Product advances and launches

OPINION ADVICE
14 The big question: Which 36 Training in the pandemic:
important medical issues do Four reflections on a biomedical
you think have been side-lined science training programme
due to the pandemic?
39 Verification: The introduction
16 One-to-one: Dr David Strain of a new in-house mass
explains what we know so far spectrometry assay
about long COVID
42 How to... spot medical

18
misinformation in the pandemic

SCIENCE
18 2021: the year that MY IBMS
beat the pandemic? COVER 44 Institute news: The latest
With the end of the FEATURE from the IBMS, including
year approaching, we
an update on the Certificate
ask six experts what
of Expert Practice courses
they expect to happen with
coronovirus next year 47 CPD update: Training courses,

16
events and activities
24 Guido Fanconi: The second
instalment of our historical look 48 Here to help: Looking back
at the work of Guido Fanconi at a year of virtual support

28 Supporting biomedical
research 2020: IBMS grant
recipients explain their projects MY LAB
34 The great big biomedical

28 42
50 John McNulty gives a tour of
lockdown quiz: The COVID-19 the laboratories at St Helens and
pandemic and the past year Knowsley Hospital NHS Trust

EDITOR RECRUITMENT ADVERTISING Neither the publisher nor the IBMS is able to
Rob Dabrowski +44 (0)20 7880 7665 take responsibility for any views or opinions
SENIOR DESIGNER biomedicaljobs@redactive.co.uk expressed in this publication. Readers are
Gary Hill advised that while the contents are believed
ISSN 1352-7673 to be accurate, correct and complete, no
PICTURE EDITOR PUBLISHED BY © 2020 Institute of reliance should be placed upon its contents
Akin Falope Redactive Publishing Ltd Biomedical Science being applicable to any particular
PUBLISHING DIRECTOR Level 5, 78 Chamber Street, London E1 8BL
PRINTED BY circumstances. Any advice or information
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Warners Midlands plc published is done so without the Institute,
PRODUCTION its servants or agents and any contributors
Rachel Young Bourne, Lincolnshire PE10 9PH
having liability in respect of its content.
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+44 (0)20 7880 7556 plastic wrap – check your local Subscriptions are available by
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P03 Contents_December 2020_Biomedical Scientist.indd 3 19/11/2020 12:57

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18/11/2020 14:26
 EDITORIAL
Sarah May
THE BIOMEDICAL
SCIENTIST 5

I THE CHRISTMAS
am so relieved that the human
genome has been mapped because I
know it is now only a matter of time
before the C-gene is discovered, its
effect on behaviour better understood

and, in very severe cases, treatments
developed. I am of course referring to
the Christmas gene, whose influence
is once again reaching its annual peak.
This elusive gene is probably autosomal
dominant, as its expression is widespread
and men and women appear to be
roughly equally affected. However, the
mode of expression varies slightly in that
women suddenly have an overwhelming
urge to wear sequins, while normally
conservative male dressers find the allure
of a primary coloured jumper or tie, with
images of snowmen, reindeer or Father
Christmas, to be totally irresistible. Both
sexes exhibit a matching enthusiasm to
decorate their homes with anything that
sparkles or twinkles.
Another peculiarity of its expression
is that it appears to trigger a highly
competitive trait in certain individuals,
creating the suburban equivalent of Star
Wars – Light Wars. Gene-influenced
neighbours vie to see who can cram the
most lights around the eves, windows and
trees in their front gardens. If this level
of competitiveness could be harnessed by
our Olympic athletes we would be awash
with medals. However, it’s a fine balance
and one twinkle too many can condemn
a household to the purgatory of bad light
taste ridicule. Then there is the hot
chestnut debate of white versus coloured
GENE
lights and flashing versus static, not to
mention the potential social suicide of
“putting the lights up too early”. Just
remember, these individuals are at the
mercy of their genes.
Some people try to mitigate the
expression of their gene by attempting to
be tasteful; they drag their eyes away from
the plethora of bright red and gold and
head for the cool blues and silver. But we’re
not fooled, they too have the C-gene. And
there’s no help for those who are straying
into the pale pink and beige displays!
Those who carry this C-gene can be
found in all walks of life; I remember the
unnerving site of a senior mortician
sitting in his office wearing a Santa hat;
he carried the C-gene. Then there was the
sheer excitement in a certain cytology
laboratory when someone found a cluster
of cells in a smear that looked exactly
Sarah May, Deputy
Chief Executive of the
IBMS, on the arrival
of the festive season.
like a reindeer (pre-HPV testing days);
they all carried the C-gene.
Now for confession time: I too carry
that dominant C-gene. It’s the only
explanation for why I simply had to
buy that multi-function string of 2000
warm white lights. It’s a genetic thing
and way beyond my control. So, let’s
embrace that gene, we’ll all be back to
normal again in January.
Sarah May
Deputy Chief Executive

Institute of Biomedical Science is the PRESIDENT HEAD OF COMMUNICATIONS FOLLOW THE INSTITUTE
professional body for the biomedical Allan Wilson CSci FIBMS Dan Nimmo
science profession.
CHIEF EXECUTIVE EDUCATION AND TRAINING Join us on
Jill Rodney education@ibms.org
INSTITUTE OF BIOMEDICAL SCIENCE facebook.com/
12 Coldbath Square DEPUTY CHIEF EXECUTIVE EXAMINATIONS biomedicalscience
London, EC1R 5HL Sarah May CSci FIBMS examinations@ibms.org
United Kingdom Follow us on Twitter
+44 (0)20 7713 0214 EXECUTIVE HEAD OF EDUCATION MEMBERSHIP
Alan Wainwright CSci FIBMS mc@ibms.org @IBMScience
+44 (0)20 7837 9658
Email: mail@ibms.org EXECUTIVE HEAD OF MARKETING CHARTERED SCIENTIST
Web: www.ibms.org AND MEMBERSHIP Find us on
chartered@ibms.org
Lynda Rigby LinkedIn

P05 ED Leader_December 2020_Biomedical Scientist.indd 5 19/11/2020 09:23

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p06_BIO.Dec20.indd 6 18/11/2020 14:27

 NEWS
In numbers
THE BIOMEDICAL
SCIENTIST 7

IN NUMBERS 2x
SCIENCE NEWS

ETHNIC MINORITIES HIGHER COVID RISK

Black people are
twice as likely as

50,000
white people to catch
the coronavirus.

In November the UK reached 50,000

COVID-19 deaths, according to official
government statistics. The worst affected
areas (death toll per 100,000) were:
115.2: North West
104.7: North East The claim comes from a
study of 18 million people.
89.3: West Midlands The research also
85.4: Yorks and Humber indicates Asian people
74.3: East Midlands are 1.5 times more likely
than white people to
be infected – and may
ACCESS FOR DISABLED PEOPLE be more likely to need
intensive care.
Disabled people have been struggling to A total of 14% of key
access care and treatment since the start workers, who cannot
of the pandemic, according to new figures work from home, are
from the Office for National Statistics.
92% effective?

from ethnic minorities.

29% said they are only receiving care While 34% of critically ill
for some of their condition COVID-19 patients are
from ethnic minorities.

27% said their treatment had started

or continued as normal
Early results from
22% said their treatment had been
cancelled or did not start trials of a COVID
vaccine developed
15% said their treatment had started
or continued, but was reduced. in Russia suggest it
could be 92% effective.
The data is based on 16,000
volunteers given the Sputnik V
vaccine or a dummy injection.
Russian researchers claim there
were “no unexpected adverse
The annual report by the Health events” 21 days after volunteers
received their first of two injections.
and Safety Executive shows: The researchers say there have
38.8 million working days were been requests for more than 1.2
lost due to work-related illness billion doses of the Sputnik vaccine.
and workplace injury in 2019/20, They claim it’s possible to
costing the UK £16.2bn. produce 500 million doses every
More than 50% of this figure is year for the global market.
attributed to mental ill health. Many scientists say the results
have been rushed out too quickly.

P07 News In Numbers_December 2020_Biomedical Scientist.indd 7 19/11/2020 12:58

 8 THE BIOMEDICAL
SCIENTIST
NEWS
Science

SCIENCE

GASTROENTEROLOGY
NEWS
HAEMATOLOGY

Genetic risk NEW BIOMARKER FOR

for IBD patients
In a retrospective study, investigators found that a combination of
rare and common genetic variants in some inflammatory bowel
disease (IBD) patients significantly increased their risk of developing
clot-causing thromboembolic diseases.
Senior author Dermot P McGovern said: “The genetic signature
we identified more than doubled the risk of developing potentially
fatal blood clots in approximately one in seven IBD patients.
“While the risk for blood clots in IBD patients could be attributed
to episodes of severe inflammation in the gastrointestinal tract that
led to surgery, or to a side-effect of some medications, very little was
known about the impact of genetics on that risk.”
Researchers used whole-genome sequencing and genotyping to
assess 792 IBD patients and then identify patterns associated with
the development of venous or arterial thromboembolisms.
bit.ly/2Il3Zrj
STROKE SEVERITY
A biomarker in the blood may determine the extent of
brain injury from different types of strokes and predict
prognosis in these patients.
New US research reports that the blood biomarker
is a protein known as neurofilament light (NFL),
which is abundant in neurons found in the brain.
When neurons are injured following a stroke, or
from other neurological diseases, NFL is released
into cerebrospinal fluid that bathes the brain and
then into the blood. The amount of NFL released is
indicative of the level of neuron injury in the brain,
according to the research team.
Tania Gendron, study lead author, said:
“Reliably predicting a patient’s prognosis
is important to their care, as it informs
treatment and rehabilitation decisions.”
bit.ly/2IkDvGr

COVID-19

RAPID FINGER-PRICK ANTIBODY COVID TEST ACCURACY

The accuracy of a rapid
finger-prick antibody test
for SARS-CoV-2 may be
considerably lower than
previously suggested, finds a
study published by The BMJ.
The results suggest that if
10% of people given the test
had previously been infected,
around one in five positive test
results would be incorrect
(false-positive results).
degree of accuracy for
surveillance studies, but
laboratory confirmation of
positive results is likely to be
needed if these tests are to be
used to provide evidence of
protection from the virus.
The AbC-19 Rapid Test uses
a drop of blood from a
finger-prick to see if it’s likely
that someone has previously
been infected with SARS-
The latest research
was commissioned by
the Department of Health
and Social Care and
conducted by scientists from
Public Health England and the
universities of Bristol,
Cambridge and Warwick.
Scientists tested blood Based on a series of
samples in a laboratory from analyses, the researchers
2847 key workers. Of these, estimated the specificity of
268 had a previous PCR the AbC-19 test (ability to
IMAGES: ISTOCK/SHUTTERSTOCK

These conclusions contrast
with an earlier (not yet
peer-reviewed) study
suggesting the test gives
no false-positive results.
The findings suggest the
test can deliver a sufficient
CoV-2. It gives results
in 20 minutes, without
the need to go to a
laboratory, and is
approved for use by
health professionals in
the UK and EU.
(polymerase-chain reaction)
positive result, so were “known
positives”, while the remaining
2579 had unknown previous
infection status.
A further 1995 pre-pandemic
blood samples were also tested.
correctly identify a true
negative sample) to be 97.9%,
meaning that 2.1% of people
who did not have a previous
SARS-CoV-2 infection
incorrectly tested positive.
bit.ly/3kjT7qs

P08-11 News-Science_December 2020_Biomedical Scientist.indd 8 19/11/2020 09:24

 NEWS
Science
THE BIOMEDICAL
SCIENTIST 9

WHAT’S HOT AND WHAT’S NOT

HOT
EARWAX
A study of 37 participants
has shown a build-up
of the stress hormone
cortisol can be measured
from the oily secretions
around the ear canal.

HOT
RATTAN
Rattan can be used to
build a scaffold to
support damaged bones,
claim Italian researchers,
as it has similar strength,
flexibility and porosity.

HOT
3D PRINTING
Australian technology
allows the 3D printing
MICROBIOLOGY
of multiple mini tumours
simultaneously, which
can then be tested
Protein that protects with different drugs.

against Lyme NOT

Yale scientists have discovered a protein that

NIGHTCLUBS
Nightclubs may be left
helps protect hosts from infection with the without smoke machines
tick-borne spirochaete that causes Lyme Disease. when they reopen because
so much dry ice will be
The finding may help diagnose and treat the infection, they report.
needed to transport
Lyme Disease is endemic in many parts of the UK – particularly coronavirus vaccines, a
in woodland or heath-land areas – and is transmitted by ticks scientist has suggested.
infected with the spirochaete Borrelia burgdorferi.
The course of the disease varies among individuals, with the
NOT
majority experiencing mild symptoms easily treated by antibiotics.
However, in some cases of untreated Lyme the infection can FRIDGES
Researchers from
spread to the heart, joints, nervous system, and other organs. Michigan Technological
For the study, the Yale team expressed more than 1000 human University claim they
have a way to stabilise
genes in yeast and analysed their interactions with 36 samples of
the viruses in vaccines
B. burgdorferi. They found that one protein, Peptidoglycan Recognition using proteins, rather
Protein 1 (PGLYRP1), acts like an early warning signal to the than temperature.
immune system when exposed to the bacteria. When exposed
to the Lyme spirochaete, mice lacking PGLYRP1 had much higher
NOT
levels of B. burgdorferi than mice with the protein and showed
signs of immune system dysfunction, the researchers report. AGE GATES
Yes/no questions and
bit.ly/38xM2QV

1000
THE YALE TEAM EXPRESSED
MORE THAN 1000 HUMAN GENES
IN YEAST AND ANALYSED
THEIR INTERACTIONS WITH 36
SAMPLES OF B. BURGDORFERI
indefinite attempts to enter a
legal date of birth are
“inconsequential barriers” to
underage users accessing
websites selling alcohol,
according to a new paper.

P08-11 News-Science_December 2020_Biomedical Scientist.indd 9 19/11/2020 09:25

 10 THE BIOMEDICAL
SCIENTIST
NEWS
Science

IMMUNOLOGY

URGENT NEED FOR

EARLY COVID-19
TREATMENTS
COVID-19 treatments for people with
early infection are needed urgently, NEUROBIOLOGY
according to Anthony S Fauci, Director
of the US National Institute of Allergy
and Infectious Diseases. DETECTING
Treating people early in the course of
infection with SARS-CoV-2 would speed ALZHEIMER’S
their recovery, reduce the likelihood that
they develop severe outcomes and
BEFORE
reduce demand on the healthcare system,
Fauci and colleagues wrote in JAMA.
SYMPTOMS
Despite experiencing only mild
symptoms early in infection, many
COVID-19 patients progress to severe
Procedures have been developed to help and depression, Kiselica found that those
disease that leads to hospitalisation.
Some also will experience lengthy identify early signs of cognitive decline with the amyloid plaque in their brain
recoveries and develop long-lasting and detect Alzheimer’s disease before were more likely to show Alzheimer’s-
fatigue, mental impairment and problems symptoms arise. related symptoms compared with those
with heart and lung function. Andrew Kiselica, an Assistant Professor without the amyloid plaque, as expected.
While several treatments, such as
of Health Psychology in the US, is behind More significantly, Kiselica found that
remdesivir and dexamethasone,
are available, or are in the research that looks at datasets from the 42% of those with the amyloid plaque
development, that National Alzheimer’s Coordinating Centre. showed no signs of cognitive decline at all.
can be administered He examined more than 400 individuals “We have developed clear procedures
early during the who had been declared “cognitively for classifying individuals who are
course of
normal,” and particularly focused on 101 asymptomatic or symptomatic in the
infection to
prevent disease of these individuals who had a buildup preclinical stages of Alzheimer’s disease,”

IMAGES: ISTOCK/SHUTTERSTOCK/ACS
progression of amyloid plaque in the brain, which is Kiselica said. “This is important because
and longer- associated with Alzheimer’s disease. if a drug to treat Alzheimer’s is approved by
term After analysing test results that the FDA down the road, the drug will likely
complications,
provided data on their memory and be most effective on those with Alzheimer’s-
more are
urgently needed, attention, caregiver observations related changes in the brain but no
they write. of signs of cognitive decline, and outward signs of cognitive decline yet.”
bit.ly/2Ird9lE neurobehavioural symptoms, like anxiety bit.ly/35r8Yzr

UNDER THE zoologist, best known for his

pioneering research in immunology,
MICROSCOPE Ilya Ilyich Mechnikov, in 1903. It
comes from the Greek γέρων, geron,
This month:
“old man” and -λογία, -logia, “study”.
Gerontology
What is Gerontology? I assume there’s been some new
It is the study of the social, cultural, research in this area.
psychological, cognitive, and Yes, indeed. A new US study
biological aspects of ageing. examined how age affected
the practice of preventive and
Any etymological insights risky behaviours in response
on the term? to COVID-19 and how
Yes, as it happens – the these behaviours changed
word was coined by over the first three months
Nobel-winning Russian of the pandemic.
What did they find?
At the beginning of the
lockdown period, older people
were no more likely than younger
people to practise preventive
behaviours in response to the
pandemic. In fact, in March, older
people were no different from
younger people in their engagement
in wearing a facemask, washing
hands frequently, cancelling personal
and social activities, and avoiding
high-risk people, public places and
eating at restaurants. However, by
May, older people were more likely
to implement such behaviours.
And what about
risky behaviours?
Older people were less likely
than younger people to have close
contact with non-household people
and less likely to go to other people’s
homes a month after the pandemic
started. However, both younger and
older people tended to resume these
potentially risky social behaviours
as the pandemic progressed.
Where can I read more about this?
The team published their findings
in PLOS ONE. Here’s the link to read
their paper – bit.ly/2IwKWtw

P08-11 News-Science_December 2020_Biomedical Scientist.indd 10 19/11/2020 09:25

 NEWS
Science
THE BIOMEDICAL
SCIENTIST 11

BIOTECHNOLOGY

CLOTH FACEMASK THAT CAN

BE DISINFECTED BY THE SUN
Scientists have developed
a special type of cotton
facemask that kills up to
99.9999% of bacteria and
viruses within 60 minutes
of daylight exposure.
Facemasks made of various
cloth materials can filter
nanoscale aerosol particles,
potentially helping to
reduce the spread of
diseases, including
COVID-19.
But live bacteria
and viruses on the
surface of the mask
can still be contagious.
Now a team has developed a
new cotton fabric that releases
reactive oxygen species (ROS)
when exposed to daylight,
killing microbes attached to
the fabric’s surfaces while
being washable, reusable and
safe for the wearer.
The researchers made their
antimicrobial fabrics by
attaching positively solution of a negatively charged disinfected by spending
charged chains of photosensitizer (a compound an hour outside in sunshine,
2-diethylaminoethyl that releases ROS upon or a longer period of time
chloride (DEAE-Cl) exposure to light), which under office or building lights,
to ordinary cotton. attached to the DEAE chains by which are much less intense
Then, they dyed the strong electrostatic interactions. than sunlight.
modified cotton in a The cloth masks can be bit.ly/36nbsxK

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p12_BIO.Dec20.indd 12 18/11/2020 14:33
 NEWS
Technology
THE BIOMEDICAL
SCIENTIST 13

TECH

NEWS
IKA BC PLATFORMS ATIK CAMERAS

DESIGN AWARD COVID AND SEROLOGY CAMERA

The newly launched Matrix Orbital
Delta Plus has received a
prestigious design award.
It is one of two new
thermoshakers, which complete
the IKA Matrix product portfolio.
These compact devices improve
optimal mixing of small and very
small volumes.
The Matrix Orbital Delta Plus has
been awarded the 2021 German
Design Award thanks to the
diecast housing, clear
shape, smooth
surface and
inventive layout.
ika.com
BC Platforms has been appointed
as data platform partner in a
cross-UK project to enable research
by connecting COVID-19 data
derived from patients’ serology
samples, and improve the UK’s
resilience to the novel coronavirus.
The project aims to make the
most of this valuable resource
for research and innovation, and
ensure it is findable, accessible,
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P13 News-Technology_December 2020_Biomedical Scientist.indd 13 19/11/2020 12:58

 14 THE BIOMEDICAL
SCIENTIST
OPINION
Big question

THIS MONTH WE ASK

“Which
important
medical issues
do you think
have been
side-lined due
to the pandemic?”

THE BIG
QUESTION
P14-15 Big Question_December 2020_Biomedical Scientist.indd 14 19/11/2020 09:26

David Ricketts
Head of Laboratory Process Improvement
Health Services Laboratories LLP
T T
he pandemic has caused massive
disruption to the country and
healthcare in particular. The impact
on cancer screening is well
documented, but my interest is focused
more on the impact on the routine health
surveillance of long-term treatable
conditions such as diabetes.
The access to phlebotomy and GPs has
been an issue that is not the whole story.
Given the mixed reaction of the public to
basic health messages – such as mask
wearing and social distancing, coupled
with the risk of complications of
contracting COVID-19 if you have a
pre-existing condition – do you want to
go out and queue for a blood test, if you
can actually get an appointment?
POCT is a solution, but this involves
purchasing equipment and connectivity,
which is fine for those who require
monitoring, but we need to look
differently at provision of pathology from
the community.
There is no reason, for many tests, why
we cannot get patients to self-collect
capillary samples and send them into the
labs by post, or drop-off points, then have a
clinical follow-up by video conference with
their healthcare provider to discuss results.
This will lead to fewer GP and OPD
appointments in person and will allow
efficient access to pathology testing.
The downside is that this does not fit
well with our current model of service
delivery and large automated systems,
but, for public health provision, this is
IMAGE: IKON
something that we need to look at, as
COVID-19 is going nowhere soon.
P14-15 Big Question_December 2020_Biomedical Scientist.indd 15
OPINION
Big question
THE BIOMEDICAL
SCIENTIST 15
Cherie Beckett Simon Bowen
Biomedical Scientist, Microbiology Haematology Biomedical Scientist
The Princess Alexandra Hospital NHS Trust Hampshire Hospitals NHS Foundation Trust
T
he pandemic has had a significant he medical area that causes me
impact on healthcare in so many the biggest concern has been
ways, largely through the necessary the reduction of cancer diagnosis
funnelling of resources to attempt and monitoring capacity. It is
to control the virus. Difficult decisions also natural to think about the cervical
have been made in terms of prioritising screening programme, but the pandemic
care and ensuring infection prevention has also significantly reduced capacity
and control. in medical imaging and endoscopic
To reduce hospital attendances (and programmes. Furthermore, the routine
potential exposure and additional follow-up surveillance procedures for
demands on the system), some elective known cancer patients have been delayed,
surgeries have been cancelled, but this which adds to the anxiety that these
of course has undoubtedly affected patients experience.
disease progression, for example, in cancer
patients. Routine cervical screening and
mammography have also been affected,
which will have consequences to come.
Fewer face-to-face consultations has led
The NHS will
to an increase in empirical therapies and
patients critically ill with COVID-19 have
catch up with the
required antibiotics due to the acquisition
of opportunistic bacterial infections,
backlog, but, until
with many stepped up to last-line drugs.
The necessary prioritising and adapting
then, patients will
of care during the pandemic has led to
many unfortunate and unexpected
be diagnosed later
side-effects. We are already seeing such into their disease
effects, but many more will surely
emerge. The focus now is how we move
forward as we play “catch-up” with
missed surgeries, referrals to speciality
care, diagnosing patients presenting late
due to inaccessibility of – or perhaps fear
of accessing – healthcare during the
pandemic and how we tackle the levels
of antimicrobial resistance that pre-
pandemic were already significantly high.
All will be a huge challenge that we must
face with the utmost urgency.
19/11/2020 09:26
 16 THE BIOMEDICAL
SCIENTIST
OPINION
One-to-one

Dr David Strain, a
Senior Clinical Lecturer,
is heading up the
British Medical
Association’s work on
the long-term impact
of COVID-19. Here he
explains what we know
so far about long COVID. WHAT
O IS LONG
ne of the more puzzling
phenomena to emerge from
the coronavirus pandemic has
been that of long COVID. The
condition is characterised
by chronic, often debilitating,
symptoms that a small

number of people who have
had the virus continue to experience weeks
and even months after the main phase of
the disease has passed – they can suffer
from persistent coughing and shortness
of breath, muscle fatigue, lethargy and
headaches, gastrointestinal problems, and
damage to the liver and heart. Some people
also report depression and PTSD. 
The COVID Symptom Study at King’s
College London found that while most
people who become unwell with the virus
recover fully after 11 days, an estimated
one in seven will remain ill for at least four
weeks, one in 20 for eight weeks and one
in 45 for 12 weeks or more. It also found
that older people are more likely to get
long COVID – 22% of over 70s, compared
with 10% of 18-49 year olds. Those with
a slightly higher than average BMI are
more susceptible, as are people with
asthma. Women are also slightly more
likely to experience long COVID than men.
Looking at cul-de-sacs
What’s going on? One of the people who
has been looking more closely at long
COVID is Dr David Strain, Senior Clinical
COVID?
Lecturer at the University of Exeter
Medical School and Co-Chair of the BMA’s
Medical Academic Staff Committee. He
has also been working on the COVID ward
for older adults at the Royal Devon &
Exeter NHS Foundation Trust since the
start of the pandemic.
“In the world before COVID I was part
of a multidisciplinary team that was
looking at chronic fatigue syndrome.
That’s a post-viral myalgia that
causes all sorts of problems for
a small proportion of the
population,” he says. “We very
quickly realised that there is
something very similar going
on with COVID and so tried
to keep that work going. I was
already looking at doing some research
into chronic fatigue syndrome,
particularly at the associated muscle
wasting, which is much like the muscle
wasting we see in older people.”
Strain’s pre-COVID research interest
focused on the microcirculation in the
human body’s tiniest blood vessels, which
are responsible for delivering all the
necessary oxygen and nutrients to
the muscles. Since the onset of
the pandemic, he has
continued to look closely
at the microcirculation.
“When we think about the
blood supply, we tend to think
about the bigger vessels,” he
says. “They’re effectively the

P16-17 Opinion DS-OTO_December 2020_Biomedical Scientist.indd 16 19/11/2020 09:27


motorways of the body. But my focus has
always been on the cul-de-sacs – the bits
that get you from the motorway to your
house. That’s the bit of the body I have
always been interested in and we were
working on this hypothesis that chronic
fatigue syndrome was caused by a lack of
perfusion in those vessels to the muscles
and other tissues, which resulted in the
muscle weakness and general tiredness
IMAGES: ISTOCK PHOTO/SHUTTERSTOCK
and lethargy that we see.
“It has also been very well characterised
that our patients with COVID got lots
of damage to their small blood vessels.
We saw a lot of very small blood clots
alongside the more evident problems
of kidney failure, the pulmonary strokes
and so on. So we rapidly realised that a
P16-17 Opinion DS-OTO_December 2020_Biomedical Scientist.indd 17
number of patients were being racked by
some sort of chronic fatigue syndrome.”
Genetic make-up
Strain is now working with a group of
geneticists in a bid to determine what
genetic make-up might predispose
somebody to suffer from long COVID. He’s
also looking to set up studies that will
investigate the potential physiological
factors that are involved in the long-term
symptoms. While these pieces of research
are still at the development stage, people
suffering from long COVID can do little
more than sit it out.
“In this situation, time is the healer,”
says Strain, “and there are large numbers
of people who are getting better.” He
bases this statement partly on the
evidence gleaned from his work with the
BMA Academic Staff Committee, which
sent out a COVID survey to doctors during
the first wave of the pandemic and has
just started again as the second wave has
begun to hit.
“One of the questions we ask is, ‘Have
you had COVID and have you been left
with long-term COVID-type symptoms?’
We’ve seen that around 20% of doctors
who have had COVID were left with long
symptoms beyond the month. But we’ve
also found that those numbers then
decline rapidly, with about only 3% going
on for longer than a month.”
OPINION
One-to-one
THE BIOMEDICAL
SCIENTIST 17
DAVID STRAIN
Senior Clinical
Lecturer,
University of
Exeter; Honorary
Consultant, Royal
Devon & Exeter
NHS Foundation Trust
MB ChB, Liverpool
BSc(Hons), FRCP, MD (London)
Multidisciplinary approach
For most patients on the COVID ward at
the Royal Devon & Exeter who are older
adults, the concerns are more immediate,
though they are in the hands of a team
that looks to address every aspect of the
complex issues that older people can face.
“We closely evaluate them because COVID
is often just one of many conditions they
can have, such as heart disease, previous
strokes and mental health needs. The
nurses, physiotherapists, occupational
therapists, discharge coordinators and
geriatrics team meet daily to discuss
patients and to decide out who needs
what. We think this multidisciplinary
approach has made a big difference. It has
been unusual for our patients to get to
the cytokine storm stage. I saw it seven or
eight times at most during the first wave.”
They are now starting to see the second
wave, which seems to have hit the south
west suddenly. “It has taken us a bit by
surprise,” says Strain, though he also feels
they are better prepared for dealing with
the effects of the virus. “Doing the ward
rounds today, I saw 20 patients who are
acutely unwell with COVID, but it’s now
easier to say who is over the worst of it or
who is having a second dip. In those cases,
we know what to expect and how to
support them. We are part of several
ongoing studies, and convalescent plasma
appears to make a big difference, as does
simple dexamethasone.”
19/11/2020 09:27
 18 THE BIOMEDICAL
SCIENTIST
SCIENCE
Cover feature

THE YEAR THAT BEAT THE PANDEM C?

P18-23 CF-Covid 2021_December 2020_Biomedical Scientist.indd 18 19/11/2020 09:27


With the end of 2020 approaching, we
asked six experts what they expect
to happen with coronovirus next year.
B
ack in March, the cover
of the Biomedical
Scientist magazine
featured a science
fiction-inspired image
of coronovirus particles
hurtling through space
towards the earth,
alongside the words
“Global catastrophe?”
At the time of writing, there had
only been two recorded deaths
outside China due to COVID-19
– one in Hong Kong and one in the
Philippines. Coronovirus was still
an epidemic in its infancy.
We asked a group of experts if they
believed a virus could cause global
catastrophe. The broad consensus
was it is certainly possible, but
medical and social advances meant
it was by no means inevitable.
Nine months on and the number
of recorded global cases has topped
50 million, with more than 1.2
million deaths from COVID-19 (and
the actual number of cases expected
to be far, far higher).
As we near the end of the year,
coronovirus is still raging around
the world, with no sign of death and
infection rates abating, but
promising news of vaccine
developments offers a faint glimmer
of hope on the distant horizon.
It is against the backdrop of
this bleak year, in which
science fiction has become
science fact, that we asked
six immunology and
virology experts what
the next 12 months hold.
P18-23 CF-Covid 2021_December 2020_Biomedical Scientist.indd 19
DAVID WELLS
Head of Pathology
NHS England and NHS Improvement
T
his year has been one like no other;
the pandemic has changed the very
way the world operates and has
changed everyone’s lives in ways
that would previously have been
unthinkable in this country. To think that
2021 will be much different is perhaps
being too optimistic currently, despite
the news around the current performance
of possible vaccines. The hard work
that laboratory teams have experienced
throughout 2020 will continue, as will the
need for our teams to demonstrate their
skills in innovating and adopting new
techniques to ensure that we provide the
scale of testing needed by our patients,
staff and the wider community to tackle
the virus. Different to 2020 is the
optimism we will see as 2021 passes, as
Professor Chris Whitty says, the number
of shots on goal will take us forward in
the fight. More and better public health
approaches will see lockdowns far more
nuanced allowing us to live more familiar
lives, treatments will be more effective,
and finally vaccines will begin the major
shift in the global fight against the virus.
Next year will teach us resilience, as
although we should be optimistic,
January and February are going
to be tough as we go through
winter and the second wave.
Spring will give us respite
and time to regroup in our
laboratory teams, it will also
give us time to reflect on the
SCIENCE
Cover feature
THE BIOMEDICAL
SCIENTIST 19
past 12 months, recognising our
personal contributions, our teams’
efforts and also mourning those
we have lost on the journey. The
rest of the year will see our
profession demonstrate how we
create a sustainable future, starting to put
into place an infrastructure that allows us
to scale a response to future pandemics.
Next year will end feeling closer to the
end of 2019, but different as we move
into a new future forever changed by our
exposure to COVID-19.
SALLY CUTLER
Professor of Medical Microbiology
University of East London
A
s the notable and somewhat bizarre
year of 2020 draws to a close, our
thoughts might wander towards
the forthcoming year and how
the current COVID-19 pandemic will
influence our year ahead. For me, this
falls into several categories:
1) Control of community viral spread
where restrictions and compliance have
been largely instrumental.
2) Addressing knowledge gaps in
protective immunity that are key for the
success of vaccination strategies and our
on-going future of living with COVID-19.
3) Elucidating the pathogenesis of
COVID-19 to understand the scientific
basis for risks and bias according to
human race, gender, age and vertebrate
susceptibility factors for other species.
4) Living with the legacy of COVID-19
and defining “the new normal”.
The differential compliance to guidelines
19/11/2020 09:27
 20 THE BIOMEDICAL
SCIENTIST
SCIENCE
Cover feature
made to reduce community transmission
has been an eye-opener, and I am sure we
are set to see more examples of flaunting
rules in the year to come. Introducing
behavioural change is challenging at the
best of times, but many do not appear
to comprehend the gravity or reasoning
underpinning many of the efforts to
reduce transmission. This has not been
helped by differential rules in different
places and the changes almost week by
week. I strongly suspect that this will be
an on-going concern as we enter 2021.
We have much still to learn from
SARS-CoV-2, particularly regarding
“immunity”, if this is indeed achievable.
During 2021 we are likely to see the
unveiling of various new vaccines that
have been produced at an unprecedented
speed, but the efficacy of these will
probably not be realised until the new
year. It is becoming increasingly apparent
that natural infection does not necessarily
generate a lasting immunity, with
growing reports of re-infection.
Furthermore, we are beginning to
realise that detection of antibodies does
not equate to neutralising antibodies, and
that antibody responses post-infection
are highly variable and appear to wane
rapidly. What is the cross-protection
between the diversifying evolutionary
P18-23 CF-Covid 2021_December 2020_Biomedical Scientist.indd 20
viral genotypes? Is sterile
immunity an achievable goal?
Will all vaccine recipients
respond in a standard way
when the response to natural
infection is so highly varied?
Indeed, if there are adverse
consequences to vaccination, what
will be the impact of this on vaccination
not just against COVID-19, but other
infectious diseases? At this point in time,
we have the questions, but not the
answers, with these likely to become
more apparent in the forthcoming year.
Observational studies have revealed a
huge disparity amongst those developing
more severe infection consequences.
The underpinning reasons for these
findings require considerable research to
further elucidate the pathogenesis of this
virus and understand why immune
dysregulation is seen in some cases but
not others. Immense research funding
is being ring-fenced for COVID-19-based
research, with 2021 and beyond likely
to unveil deeper understanding of these
pathological mechanisms.
Lastly, 2021 is unlikely to see us put
the lid back onto the “Pandora’s box”, but
will need to see us adapt to a co-existence
to our life living with SARS-CoV-2. I hope
that with continuing community
transmission and the roll-out
of vaccines the huge waves
of infection we currently are
enduring will be reduced to
ripples, but suspect that this
infection will be a lasting legacy
that will co-exist with the
human race throughout our time.
PHILLIPA BURNS
Higher Scientific Specialist Trainee
in Microbiology
Hull University Teaching Hospitals
J
ust as I was putting pen to paper,
the news broke that the Pfizer
COVID-19 vaccine has proven
efficacy and will be imminently
presented to the FDA for approval,
changing the entire content of my answer.
My optimism is cautious, a vaccine
will not be a panacea, and is still some
way off, but it is clearly a leap forward
from our current position and a great
day for science and humankind.
A vaccine offers us hope for the future,
a chance to reconnect with families and
friends, an end to lockdowns and
restrictions and an end to unrelenting
work pressures. And, at this point, many
19/11/2020 09:28

of us need to know that there is a finish
line, even if it is some way into the future.
In the year ahead, we will see some
major studies report their findings and
we will finally start to understand our new
foe. I am looking forward to the results
of SIREN, one of the few studies solely
recruiting healthcare workers to establish
if we, the frontline, develop immunity,
even when we have mild or asymptomatic
infection, and if immunity prevents
re-infection. These are crucial questions
for the safety of all healthcare workers.
So many COVID-19 treatment myths
have been debunked this year,
notably hydroxychloroquine.
I hope we continue to
challenge hypotheses through
multicentre studies to ensure
patient safety and to restore the
public faith in experts.
We have made real progress in
vaccine and drug development,
IMAGES: GETTY IMAGES/ISTOCK/SHUTTERSTOCK
necessity remaining the mother
of invention, with the rising
specialism of vaccinology,
now firmly planted between
infection and immunity,
pushing us to re-write the rules
of vaccine creation. I expect the
advances made in the creation
of the COVID-19 vaccine to
P18-23 CF-Covid 2021_December 2020_Biomedical Scientist.indd 21
prompt research into other infectious
agents that we believed were unbeatable.
We have learned to work in different
ways, sharing early data and assay
verifications, pushing the boundaries
of our local networks to support services
in need and bring testing parity for
patients. I hope the rapid adoption of
new technology and the sharing of
resources continues in the year ahead, as
I don’t think we have the reserves in the
tank to cope with a difficult flu season.
2021: A vaccine offers us
hope for the future, a
chance to reconnect with
families and friends and
an end to lockdowns
SCIENCE
Cover feature
THE BIOMEDICAL
SCIENTIST 21
I am sure in the year ahead there will
be many commentaries and lessons to
be learnt, reflection being the first step
in planning for the future, but we
need to remain proud of the leaps our
profession has made in this short time
frame. I hope that we will build on the
professional momentum brought by the
pandemic and that we inspire the future
generations of aspiring scientists to
pursue careers in biomedical science.
BAMIDELE FARINRE
Senior Biomedical Scientist and
STEM Ambassador
London
W
ithout an iota of doubt,
the current pandemic
has affected the whole
world in a manner
that means our lives will never
be the same again. It has
impacted our social behaviour
– in our daily interactions, how
we work, and learn.
Furthermore, social distancing
and lockdown measures have
led to a more cautious existence,
professionally and personally.
19/11/2020 09:28
 22 THE BIOMEDICAL
SCIENTIST
SCIENCE
Cover feature
There’s a surge in mental health issues
as a result of COVID-19 affecting all age
groups. The uncertainty surrounding
how and when we can see our loved ones,
when we can go on holidays and the
inability to plan ahead is overwhelming.
Looking ahead into 2021, infection
control measures and mitigating efforts
will need to continue to avert a possible
second major outbreak, especially in the
winter months, which have been noted
as a high transmission period. This is
because people are more likely to stay
indoors, where virus transmission
through droplets is a bigger risk.
There’s no clear-cut criterion that
determines when the pandemic will be over
and normalcy regained. With intermittent
lockdowns, the future is full of unknowns;
questions remain about how long we
continue to wear masks and practise social
distancing and whether rapid COVID-19
tests become widely available and properly
deployed. Additionally, it depends on the
arrival of a vaccine, and on how long the
immune system stays protective after
vaccination or recovery from infection.
In spite of all the advances in our
healthcare system – including ambulance
services, intensive care units, antiviral
drugs, supportive care, epidemiology,
global surveillance systems and the
number of developments we’ve seen in
the twentieth century – surprisingly
we’ve still had to fall back on the sorts
of measures that were proven to be
effective in 1918 during the flu pandemic;
these include good clinical care for
victims, quarantine, social isolation
and basic measures, such as masks and
hand hygiene.
Importantly,
some questions
remain unanswered
– whether people
will develop lasting
immunity to the virus
and whether seasonality
affects its spread. Ultimately,
evidence from past historic
P18-23 CF-Covid 2021_December 2020_Biomedical Scientist.indd 22
pandemics suggests that COVID-19
may have permanent cultural, economic
and political effects. In conclusion,
it is highly possible that personal
behavioural changes – such as hand-
washing and wearing masks – continue
beyond strict lockdown, helping to
curtail the tide of infections.
ELAINE CLOUTMAN-GREEN
Principal Clinical Scientist, Infection
Prevention and Control
Great Ormond Street Hospital
“T
he Magic 8 Ball Says the Future
= Outlook Not So Good.”
This may have been as it was
happening as Boris Johnson
announced a further lockdown and so the
realities of this virus were very real again
for everyone. Despite that, I believe there
will be some positives that come out of
the pandemic in 2021, so I thought I’d
break it down so we can see some of the
progress as well as continued issues.
The Good: Healthcare for a long time
has been designed with the doctor or
healthcare professional in mind, mostly
because of the historical legacy of the
NHS. This has often presented barriers
to patients and also led to very set ways
of working across the system, which often
hasn’t considered laboratory services.
The pandemic has caused a rapid shift
in delivery of services, both within and
external to the laboratories. This has
led to a breaking down of professional
boundaries and silos. It has also led to
the rapid implementation of technologies
that would have
taken decades to
introduce otherwise.
This will be a new
legacy, which, if
harnessed, will benefit
not only healthcare
scientists but also the
system as a whole.
The Bad: 2021 will not be a return to
normal. I said to friends at the start of the
pandemic that I thought we were in this
for at least 18 months and now I think
that was conservative. The vaccine, if and
when it comes, will only be for sub-groups
of the wider population. That means the
virus will continue to circulate and
the winter of 2021 is still likely to be
challenging, if not as challenging as what
we are currently facing in 2020. This
means that there will continue to be high
levels of workload and pressure upon
laboratory staff and so it will be really
important to find ways to support staff
during this time.
The Ugly: The issues with testing that are
undertaken by pillar 2 are still in the media
being linked (mistakenly) with hospital
testing. As the frustration with testing
provision increases within the general
population, it’s going to be really crucial
that we try to get the message out there
about the wonderful work being done by
our workforce. I hope that the knowledge
and experience of the registered workforce
will be harnessed to address some of the
issues, but I worry that they won’t.
19/11/2020 12:58

SARAH PITT
Principal Lecturer, School of Pharmacy and Biomolecular Sciences, University of Brighton
I
n the 21st century there have been a
number of zoonotic viral infections
leading to epidemics and pandemics.
Examples include SARS-CoV, Influenza
A H1 N1 (Swine ‘flu) and Ebola, as well
as SARS-CoV-2. The experience so far
suggests that it takes humans 18 months
to two years to catch up with the emerging
virus and bring the infection under
control. SARS-CoV was first identified
towards the end of 2002 and the last cases
of the infection were diagnosed in May
2004. There are big differences in the
epidemiology of SARS-CoV-2, notably
the role of asymptomatic patients in
transmission, which has allowed the virus
to spread globally. However, it is still likely
that we will experience more infrequent
and localised outbreaks of COVID-19
P18-23 CF-Covid 2021_December 2020_Biomedical Scientist.indd 23
during 2021, rather than the large “waves”
we have experienced during 2020.
Kit-manufacturing companies
responded quickly to bring out a variety
of tests for SARS-CoV-2. Prospective
evaluation of assays is effectively going
on in “real time” as they are being used
for diagnosis. Over the next few months,
we should develop a better understanding
of which tests perform best in particular
contexts. Also, how the tests for viral
RNA, antigen and antibody each fit in
to diagnostic algorithms will become
clearer. It will also be important to
evaluate which biochemical and
haematological markers are useful in
assessing and managing patients with
serious COVID-19 infection.
The prospects for safe, effective vaccines
SCIENCE
Cover feature
THE BIOMEDICAL
SCIENTIST 23
are looking promising. This will be one
tool in the suite of measures to control
SARS-CoV-2 and it will be important for
IBMS members to explain the benefits
of vaccination whenever the opportunity
arises. Uptake for other vaccinations, such
as MMR, might have been reduced during
the middle of 2020, so there might be
outbreaks of other infections for
laboratories to diagnose. Since screening
for cancers and other conditions was
scaled back during the first lockdown,
the volume of laboratory work related to
those programmes might increase into
2021. People who have delayed seeking
medical advice or treatment may need
more intensive interventions, which will
again involve clinical laboratories’ various
inputs in diagnosis and monitoring of
their condition.
So biomedical and clinical scientists
and their work will probably stay in the
news for a while yet. We will probably
have to continue with public health
measures, such as social distancing and
wearing masks in enclosed public spaces,
for some months to come. However, let’s
hope that SARS-CoV-2 follows the same
pattern of the other 21st century epidemic
viruses and is more or less under control
by mid-2021. It will be nice to get to a
point where a small outbreak of COVID-19
in one town is in the news, but it is no
longer the main headline.
19/11/2020 09:28
 24 THE BIOMEDICAL
SCIENTIST
SCIENCE
Guido Fanconi
MEDICAL EPONYMS: PART 3(2)
GUIDO
FANCONIThis is the second instalment on Guido
Fanconi in a series of short biographies
of persons whose names are directly used for
diseases, conditions, syndromes or tests familiar
to those working in clinical pathology labs.
I
n 1931, Fanconi reported a child with
glycosuria and albuminuria, in
addition to rickets and dwarfism.
Two years later, a similar case of a
five-year-old child with short
stature, glycosuria, “abundant”
urine, low serum phosphate and
rickets was reported by the Italian
paediatrician Giovanni de Toni. In 1934
the French paediatrician Robert Debre
reported an 11-year-old girl with rickets,
glycosuria and increased organic acid
excretion. In 1936 Fanconi suggested that
the organic acids were amino acids and
recognised the similarities in these
reports and added two more cases and
elaborated on the biochemistry of this
collection of symptoms. In 1943 McCune
and colleagues produced a comprehensive
description of the clinical and chemical
features of renal Fanconi syndrome (RFS)
with a literature review of cases to that
P24-26 GuidoFanconi-Pt3.2_December 2020_Biomedical Scientist.indd 24
date and designated the condition as
the Fanconi syndrome. A study in 1946
by Charles Dent at University College
Hospital, London used paper partition
two-way chromatography to identify
the amino acids, as a generalised renal
aminoaciduria in a 34-year-old man
with RFS. In 1949 Fanconi, working with
German physician Horst Bickel in Zurich,
reported a combination of findings in a
child including urine aminoaciduria,
glycosuria and rickets, but significantly
glycogen deposition, and was designated
as glycogen storage disease type XI.
However, it is now regarded as a defect
of carbohydrate transport and cited as
Fanconi Bickel syndrome.
During the following two decades,
a number of inherited diseases and
deposition conditions associated with
renal tubular dysfunction displayed the
biochemical hallmarks of RFS.
The nature
of the defect
Pioneering research
studies by Alfred Newton
Richards and colleagues
at the University of
Pennsylvania were
performed during the 1920s
on kidney physiology. Using a
specialised micromanipulator
and micropipette system,
glomerular filtrate was extracted
for quantitative chemical analysis,
confirming the principles of
filtration and tubule reabsorption
of selected solutes. The proximal
convoluted tubule is now established
as the site of selective reabsorption
into the peritubular capillaries. Around
66% of salts and water are reabsorbed
by a combination of passive and active
19/11/2020 09:29
 SCIENCE
Guido Fanconi
THE BIOMEDICAL
SCIENTIST 25

Left. Rickets. Coloured X-ray of

the weakened bones and bowed
legs of a child suffering from
rickets. The skeleton of the legs
appears deformed, with the long
bones of the limbs severely curved.

resorption via the Na/K ATPase

“Failure to pump. Normally, 100% of

thrive and valuable solutes, such as

glucose, amino acids,

recurrent episodes phosphate and

bicarbonate, are
of dehydration reabsorbed by secondary
active transport through
and signs of co-transporters driven by
the sodium gradient out of the
rickets are most nephron. In RFS with multiple
solutes affected, it is likely this may be
commonly found” due to defects in energy generation, Na/K
ATPase activity or dysfunction of cellular
organelles involved in membrane protein
recycling. However, the exact mechanism
is not absolutely established. Disturbances
in cellular energy metabolism have been
shown in animal models and may be
involved in cystinosis, one of the most
common causes of RFS in children.
Genetic studies in a five-generation black
family with isolated autosomal dominant
RFS tend to indicate mitochondria
enzyme systems play a significant role
in proximal tubular function.
Urine retinol binding protein 4 has
been found to be a sensitive biomarker
for the reduced function of proximal renal
tubule and is elevated in RFS.

Types of RFS
There are many causes of RFS, but

IMAGES: SCIENCE PHOTO LIBRARY/SHUTTERSTOCK/US NATIONAL LIBRARY OF MEDICINE

generally these are all rare. Morbidity is
related to secondary metabolic effects,
such as bone formation, growth and
mobility, and in cystinosis may lead to
serious renal failure and require dialysis or
transplantation. Most inherited conditions
are autosomal recessive, however, in Lowe
syndrome (oculocerebrorenal syndrome) it
is inherited as X-linked recessive and
mainly occurs in male individuals. The
age of onset varies in Lowe syndrome.
Infantile cystinosis is often evident in
the first year of life, while others, such
as Wilson disease and glycogen storage
disease, usually appear in childhood. The
acquired forms vary, related to the time
and nature of exposure.

P24-26 GuidoFanconi-Pt3.2_December 2020_Biomedical Scientist.indd 25 19/11/2020 09:30

 26 THE BIOMEDICAL
SCIENTIST
SCIENCE
Guido Fanconi
Causes of RFS
These may be empirically classified
as idiopathic, primary inherited or
secondary acquired.
Idiopathic RFS
There is often no obvious cause and most
are sporadic, genetic inheritance may be
autosomal recessive, X-linked or autosomal
dominant. Failure to thrive and recurrent
episodes of dehydration and signs of
rickets are most commonly found.
Primary inherited
Cystinosis may be responsible for about
20% of RFS, but has a low incidence of
1:200,000. Mutations of the CTNS gene
have been identified. A defect in the
lysosomal cystine transporter, cystinosin,
leads to cystine accumulation in all organs.
Young children with infantile
cystinosis may present with failure to
thrive, polyuria, polydipsia and later
nephrocalcinosis may be detected and,
without effective treatment, chronic renal
failure occurs by the end of the first decade.
Dialysis and transplantation are usually
successful, but many serious complications
may occur following transplant.
Laboratory investigations include the
measurement of cystine in white blood cells
or skin fibroblasts. For the interested reader
cystinosis has been well reviewed by Gahl
(2002) and Cherqui & Courtoy (2016).
Tyrosinaemia type 1
This is caused by a deficiency of
fumarylacetoacetate hydrolase due to a
mutation on chromosome 15. There is
significant liver dysfunction, which may
be apparent in the first few months and
develop into cirrhosis. There are urine
losses of phosphate that can cause
severe rickets. Plasma tyrosine
and methionine are raised,
but contained with a low
tyrosine and phenylalanine
diet, drug enzyme-blocking
agents improve hepatic and
renal function.
P24-26 GuidoFanconi-Pt3.2_December 2020_Biomedical Scientist.indd 26
Fanconi Bickel syndrome
This is an autosomal recessive condition
due to a mutation of the glucose
transporter 2 gene, resulting in impaired
galactose metabolism and deposition of
glycogen in the liver and proximal tubule.
There is failure to thrive, enlarged liver
and spleen and rickets in infancy.
Molecular genetic sequence analysis of
selected exons or the whole coding region
is required for diagnosis. Treatment
entails a galactose-restricted diet and
symptomatic treatment of renal tubular
dysfunction, and rickets with vitamin D
and phosphate supplements.
Wilson disease
There is a reduced capacity to transport
hepatic copper to its carrier protein
caeruloplasmin and, consequently, copper
accumulates in the liver and other tissues.
It is an autosomal recessive condition due
to a mutation in the Wilson disease
protein ATP7B and leads to hepatic
dysfunction in older children, who may
exhibit neurological symptoms affecting
behaviour and muscle coordination.
Further complications may include
haemolytic anaemia, cardiomyopathy
and hypoparathyroidism.
Laboratory findings include an
increased urine copper excretion and a
low plasma caeruloplasmin. A liver biopsy
and genetic studies may be required for
reliable diagnosis. A diet low
in copper-containing foods,
such as mushrooms, nuts and
shellfish, is recommended.
Prompt treatment is required
with oral binding agents,
notably D penicillamine or
trientine hydrochloride.
Left. Cystine in bone marrow. Light
micrograph of crystals of cystine among
blood cells in a sample of bone marrow.
Secondary acquired
A wide range of drugs, heavy metals
or immunological proteins may cause
RFS by damage to the proximal tubule.
Such drugs include valproic acid,
chemotherapy agents, such as
cisplatin, tenofovir used in HIV
treatment, and those used in the
treatment of hepatitis B patients. It has
been proposed that measurement of urine
β2 microglobulin can be used to assess
and monitor renal tubular function on
these therapies, which may need to be
withdrawn or changed.
Heavy metal exposure to cadmium,
mercury or lead may cause RFS and a
number of mechanisms have been
proposed, including effects of ATP energy
generation for tubular reabsorption,
membrane and mitochondrial changes.
Urine or blood analysis of the suspected
metal can be used in diagnosis, notably
blood lead monitoring in children.
Dysproteinaemias, such as multiple
myeloma, amyloidosis and Waldenstrom’s
macroglobulinaemia, are causes of RFS in
adults. Deposition of crystallised free light
chains in proximal tubule cells causes
inflammation and atrophy.
In AL amyloidosis (ALA) abnormal
plasma cells can lead to deposition of fibril
amyloid in the heart, liver and kidney.
Immunofixation electrophoresis of urine
or serum is positive in 90% of ALA patients
with renal biopsy confirmation.
Concluding comments
Fanconi recognised the significance
of the cardinal urinary features of RFS and
their association with a growing number
of clinical conditions in the following
decade, some of which are rare and
inherited but are clinically significant in
paediatric medicine. More recently, a wide
range of newer drugs have been shown
to be associated with acquired RFS.
Stephen Clarke is a retired IBMS fellow.
To read this article with full references, visit
thebiomedicalscientist.net
19/11/2020 09:40
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 28 THE BIOMEDICAL
SCIENTIST
SCIENCE
Research grants

P28-32 Research Grants_December 2020_Biomedical Scientist.indd 28 19/11/2020 09:30

 SCIENCE
Research grants
THE BIOMEDICAL
SCIENTIST 29

Below. Light micrograph of Prussian

blue stain on a liver biopsy showing
haemosiderin deposition within
hepatocytes in a case of hereditary
haemochromatosis, type 1.

SUPPORTING
BIOMEDICAL
RESEARCH 2020
The four recipients of IBMS research grants
in 2020 explain their projects and the
impact they hope their work will have.

I
n 2020, the IBMS awarded research
grants totalling almost £18,000.
From identifying novel strategies
to treat osteoarthritis, to
investigating whether human
papillomaviruses cause urinary
cancer, the IBMS has supported four
cutting-edge biomedical research
projects this year. Here the recipients
outline their work.

PAUL WALLER
Associate Professor in Biomedical
Science, Kingston University London
Mechanisms of hepatic iron overload in
dysmetabolic iron overload syndrome
Recent evidence indicates that one-third
of patients with non-alcoholic fatty liver
disease (NAFLD) will also have a condition
known as dysmetabolic iron overload
syndrome (DIOS). This condition is
characterised by mild increases in total
body and liver iron stores, with the
presence of fatty liver and/or metabolic
abnormalities, after exclusion of any
known cause of iron excess, such as
alcoholism. It is not yet confirmed why
iron overload occurs in these individuals,
however, clinical observational studies
highlight an independent role of iron
in developing metabolic disease, such
as type 2 diabetes.
Due to the increasing prevalence of
metabolic syndrome, DIOS is believed
to be the most common iron overload
condition, with more than 10 cases for

P28-32 Research Grants_December 2020_Biomedical Scientist.indd 29 19/11/2020 09:30

p30_BIO.Dec20.indd 30 18/11/2020 14:37

each case of hereditary haemochromatosis.
The development of DIOS appears to
be related to altered regulation of iron
transport associated with hepatic
steatosis, insulin resistance and
inflammation, as well as macrophage iron
retention. It also appears to be linked
to a state of hepcidin resistance. There
are currently limited studies on molecular
mechanisms of iron excess in DIOS.
The grant awarded by the IBMS
will allow the purchase of ELISA kits for
the measurement of ferroportin, ZIP14
and DMT1. Results from these analyses,
together with those from routine
investigations, will provide insight
into altered iron homeostasis in patients
with DIOS.
DR HOSSEIN ASHRAFI
Associate Professor,
Kingston University London
IMAGES: SCIENCE PHOTO LIBRARY/SHUTTERSTOCK/GETTY
Association of high-risk human
papillomavirus (HPV) types and urinary
cancers (prostate and bladder)
Infection by high-risk human
papillomaviruses (HPVs) have been
implicated as causative agents in a variety
of cancers. HPVs have been found to cause
close to half of vaginal, penile, anal, and
oral cancers. These findings suggest that
HPV DNA might be transported from the
original infection site to other organs and
P28-32 Research Grants_December 2020_Biomedical Scientist.indd 31
“The knowledge
acquired will
lead to a better
understanding
of risk factors”
may be responsible for the development
of cancer in various organs. Indeed, our
published findings, partially supported by
the IBMS, have shown the evidence for the
presence of HPV types in breast cancer.
Studies on HPV role in urinary
carcinogenesis have generated
controversy and it is still not clear
whether HPV is present in prostate and
bladder tumours. Despite the medical
importance and the high incidence rate
of urinary cancers among the global
population, there are no studies in the
UK, to our knowledge, that investigate
the implication of HPV infection in
prostate and bladder cancer development.
However, my research team in Kingston
University and Kingston Hospital
have now reported the first
documented identification of
12 other high-risk HPV types
in freshly obtained prostate
and bladder cancer tissues
obtained from the hospital.
This provides a solid basis to
SCIENCE
Research grants
THE BIOMEDICAL
SCIENTIST 31
Left. Human
papillomaviruses,
illustration.
advance research in a crucial health
priority affecting people with these
cancers. The knowledge acquired will lead
to a better understanding of risk factors
other than those established to date.
Cancer prevention, viral carcinogenesis
and urinary cancers are rapidly
developing sectors of the field of
biomedical science and the prospect
of investigating the use of vaccines
to prevent cancer is very appealing.
DR IAN LOCKE
Director of Learning, Teaching and
Quality in Biomedical Science,
University of Westminster
Effect of urocortin I on osteoclast
differentiation and activity: a new
prospect for the prevention of loss
of bone density in OA
Osteoarthritis (OA) is one of the most
widespread skeletal diseases, reducing the
quality of life for more than 8 million
people in the UK. OA can develop in any
joint, but is common in those bearing the
heaviest weight (e.g. hips and knees) and
is characterised by cartilage degradation
and deterioration of the underlying
subchondral bone. Although chondrocytes
are the only cells present in the cartilage
matrix, the picture becomes more
complex at the cartilage-bone interface.
The development of a pro-inflammatory,
pro-apoptotic environment in the
cartilage can influence the balanced
activity of osteoclasts, osteoblasts and
osteocytes – the cells responsible for
turnover and maintenance of the bone.
The aim of this project is to further
investigate the role of the
endogenous peptide, urocortin I,
which we have shown to not
only preserve the chondrocytes
that maintain and repair
cartilage, but also to have
significant effects on osteoclast
differentiation and activity.
19/11/2020 12:59
 32 THE BIOMEDICAL
SCIENTIST
SCIENCE
Research grants

Right. Coloured X-ray of a side view

of the right knee of a 73-year-old
female patient with osteoarthritis,
with osteophytes (bony outgrowths)
present on the patella (kneecap, left).

Osteoclasts are the cells responsible for

bone resorption and healthy bone
structure is dependent on a dynamic
equilibrium between the activity of
osteoclasts and that of osteoblasts,
which are the cells responsible for bone
formation. An imbalance between bone
resorption and formation may occur under
certain conditions and can contribute to
various rheumatic diseases, including OA,
rheumatoid arthritis and osteoporosis,
amongst others. This project aims to
further our understanding of how
urocortin I modulates osteoclast
differentiation and activity and the
signalling pathways involved in that
modulation. Understanding the role of the
urocortin system in controlling osteoclast
reabsorption could identify a possible
route for dual pharmacological
intervention in OA, where the prevention
of chondrocyte death and excessive
osteoclast reabsorption is critical. “An imbalance between bone resorption
and formation may occur and can
KAVINDIYA MODARAGE contribute to various rheumatic diseases”
PhD Researcher - University of
Wolverhampton
such as autosomal recessive polycystic the role of Rnd3 in the kidneys, and,
The role of Rnd3 in kidney kidney disease, nephronophthisis and from this knowledge, find the connection
morphogenesis and function Meckel–Gruber syndrome. My between abnormalities in Rnd3
My research project aims to investigate investigation is based on a novel mouse expression and the rise of phenotypic
the expression of Rho family GTPase 3 model created by the International Mouse similar autosomal dominant polycystic
gene (Rnd3) and its influence in the Phenotyping Consortium. Tissues kidney disease (ADPKD). As investigations
manifestation of diseases in the kidneys retrieved from mouse models will be reveal further insight into the molecular
and potentially secondary effects in the utilised to fulfil the agendas of the mechanisms of Rnd3, this may also reveal
cardiovascular system. Identifying the objectives. The first objective is to why and how specific symptoms develop.
exact role of Rnd3 and its effect characterise the kidney phenotype of This information could then be
concerning co-morbidities that focus on postnatal and adult Rnd3 mutant mice, utilised to provide valuable insight into
the heart and kidneys during next to study cell behaviour by using novel pharmacological drugs that could
development and adulthood will be a precision-cut kidney slices obtained from be commissioned in clinical trials
fundamental aspect of the mouse kidneys at P3 and P14 to focusing on improving the prognosis
investigation. Another crucial generate real-time 3D video. The of ADPKD patients.
component of the final objective is to investigate
investigation will be the
relationship between
defective Rnd3 expression and
the involvement of Rnd3
in cellular signalling and
disease mechanisms.
ℹ Further information about IBMS
research grants, along with
application forms, can be found on the
its potential association with The theory behind the IBMS website. The deadline for applications
rare, recessive genetic conditions, investigation is to demonstrate is 31 March in the year of application.

P28-32 Research Grants_December 2020_Biomedical Scientist.indd 32 19/11/2020 09:31

p33_BIO.Dec20.indd 33 18/11/2020 14:38
 34 THE BIOMEDICAL
SCIENTIST
SCIENCE
Lockdown quiz

THE
GREAT BIG BIOMEDICAL
The final instalment of our biomedical science
quiz for 2020. This time, we have three rounds
testing members’ knowledge of the pandemic.

I
n the first couple of months of 2020,
it seemed that Brexit and the
environment were going to dominate
the news agenda for the year. Then the
coronovirus outbreak in Wuhan changed
everything. Believed to be from a wet
market in the city, the outbreak became
an epidemic, then a pandemic and the
globe was the thrust into lockdowns, social
distancing and daily headlines reporting
death rates, transmission rates and potential
hopes for a return to normal life through
medical innovation or unique social
solutions. It has been a year like no other.
Looking back at the year
As 2020 draws to a close, and
newspaper headlines focus on whether PANDEM
families and friends will be reunited at
SPECIA IC
Christmas and what hopes there are for
immunity in the new year, we look back
L!
over the last 12 months with 30 questions.

ROUND ONE: INTERNATIONAL

A consumer rights group is taking legal
1 action against which government over
COVID-19 outbreaks at ski resorts in March?
In April, Donald Trump suggested
2 that injecting what substance into the
body could be used to help treat COVID-19?
The President of which country said:
3 “The virus is here, we’re going to have
to confront it. Confront it like a man, not
a boy... We're all going to die one day”?
As of November, which Scandinavian
4country had the cumulative highest
number of coronavirus cases?
Which country has the highest
5 number of deaths per 100 confirmed
cases (observed case-fatality ratio)
according to the Johns Hopkins University?
In November, the UK imposed
6 a ban on non-UK citizens coming
from Denmark amid concerns over a
new coronavirus strain that had spread
to humans from which animals?
In August, which president said a
7 vaccine developed is his country had
passed all the required checks and it had
been given to one of his own daughters?
In June, telecoms masts were pulled
8 down and destroyed in a country for
fears that 5G technology could transmit
coronavirus (despite the fact the country had
no 5G network). Which country was this?
From April to June, which Central
9 American country tried to curb the
pandemic by requiring women and men
to remain at home on alternate days?
Which country, neighbouring Iran,
10 had not, as of November, confirmed
a single case of coronovirus (there are
claims that this is because the government
banned the word)?

P34-35 Lockdown Quiz_December 2020_Biomedical Scientist.indd 34 19/11/2020 12:59


LOCKDOWN QUIZ
ROUND TWO: THE UK
In which month were the first two cases
1 of coronavirus confirmed in the UK?
Where was the first British citizen
2 confirmed to have died of COVID-19
at the time of death?
In March it was announced weekly
3 episodes of which soap would be
reduced from four to two to keep it on
the air for as long as possible?
Which was the first UK city to enter
4 a local lockdown?
ROUND THREE: CORONOVIRUS GENERAL KNOWLEDGE
In 1931, Arthur Frederick Schalk and
1 Merle C Fawn at the North Dakota
Agricultural College were the first to report
what was later identified as coronavirus
disease. In which animals was it found?
In which decade were coronaviruses
2 first discovered in humans?
There are four main sub-groupings
3 of coronaviruses, what are these?
What does the acronym “SARS” stand
4 for in SARS-CoV-2?
A To see the answers, scroll to the bottom of the online version
of the article, which can be found at thebiomedicalscientist.net
P34-35 Lockdown Quiz_December 2020_Biomedical Scientist.indd 35
Where did Boris Johnson’s former
5 Chief Advisor Dominic Cummings
drive to on his wife’s 45th birthday – while
recovering from suspected coronavirus
– to “check his eyesight”?
In which month did the UK surpass
6 Italy to become the country with
the highest declared death toll in Europe,
with more than 32,000 fatalities?
Which member of the royal family
7 cancelled their wedding reception at
Buckingham palace due to coronavirus?
What does the “19” stand for in
5 COVID-19?
SARS was first discovered in February
6 2003, in an outbreak that lasted
approximately six months and which the
WHO says reached 29 countries. What was
its country of origin?
MERS-CoV was first identified in
7 Saudi Arabia in 2012 and an estimated
35% of reported patients died. Which
animal is believed to have transmitted the
virus to humans?
SCIENCE
Lockdown quiz
THE BIOMEDICAL
SCIENTIST 35
On 18 May what did the government
8 announce was being added to the
official list of coronovirus symptoms?
Who was the first Member of
9 Parliament to test positive
for coronavirus?
Who was due to headline the
10 Sunday night of this year’s cancelled
Glastonbury festival (it would have been
their debut at the event)?
On average how many spikes
8 does a coronavirus particle have
(answers within a range of 10 accepted)?
Infection begins when which
9 element of the particle attaches to
its complementary host cell receptor?
In July, a cat from Weybridge was
10 confirmed as the first animal in the
UK to test positive for COVID-19. What
was its name?
19/11/2020 09:32
 36 THE BIOMEDICAL
SCIENTIST
ADVICE
Training
REFLECTIONS
ON TRAINING
We present four reflections on
one biomedical science training
programme in the south east
of England and how it has coped
during the COVID-19 pandemic.
Simonne Weeks – Senior
Lecturer for Biomedical
Scientist Placements
at University of Brighton
Throughout my biomedical science career
I have held positions as a training officer
and quality manager and am acutely
aware of the pressures training officers
and trainees encounter. From a quality
perspective, the right training is
paramount for patient safety. In my
current role as a Senior Lecturer, I
redesigned the University of Brighton’s
training programme to effectively support
training officers and trainees to create
original and innovative pieces of evidence
for the IBMS Certificate of Competency
portfolio. I ran monthly seminars that
covered the key concepts for each module
and through interactive sessions trainees
could apply this knowledge into practice,
thereby demonstrating their competency.
My secret ingredient was supporting and
allowing trainees to practise their critical
reflective writing.
When trainees engaged with this new
format, they produced outstanding pieces
of evidence that demonstrated their
competency, capacity and confidence to
join the bank rota as verified biomedical
scientists because it showed their
commitment to continually seek to
P36-37 Advice-Training_December 2020_Biomedical Scientist.indd 36
improve their practice. This was the
preferred outcome for all parties;
the trainees gained verification,
training officers could focus on
the competency in practice now
the knowledge, skills and critical
reflective practice was being supported
by the university, and the pathology
management could be reassured the new
generation of trainees were fit for practice.
Maimoona Naz – University
of Brighton student and trainee
at East Surrey Hospital
My placement year was life changing. It
was my first full-time job and I found the
work environment a completely different
lifestyle. I did my placement as a part of
University of Brighton’s Clinical Placement
for Biomedical Scientist module where I
attended monthly seminars. My university
tutor covered the key concepts of
professional conduct and practice in order
to become an HCPC-registered biomedical
scientist. Every month we discussed
lab-based tasks that would meet the HCPC
standards. These tasks became evidence
for my registration portfolio. My tutor
was very keen for us to produce reflective
statements for each piece of evidence,
because it allowed us to think about
our roles and responsibilities as future
biomedical scientists and the
impact of our job in the delivery
of patient care. At the beginning
it was quite difficult to produce
good reflective statements but
over time and continual practice
it became natural to reflect upon daily
tasks in the lab.
I faced many other challenges in my
training, including working during a
global pandemic. In the lab we were
constantly adapting to new government
guidelines. Social distancing made it
harder to meet with my training officer
in small rooms. We had to reduce the
number of meetings and tried to link up
via email as much as possible.
I used all the resources that were
available to me, for instance attending
seminars on MS teams, asking how to
improve my evidence with my academic
tutor and discussing issues with my
training officer, who also helped me finish
my portfolio on time. I cannot thank my
tutor and training officer enough for their
support and willingness to help me achieve
my goal in such a challenging time.
I believe strong willpower and a team
that supports you as a trainee are vital
for success. What I have learnt through
this experience is that being able to adapt
quickly, develop problem-solving skills
19/11/2020 09:32

and being resilient are key skills for
a biomedical scientist.
Lesley Stewart – Senior
Biomedical Scientist
at East Surrey Hospital
I have been a haematology training officer
for approximately 15 years. This role can
be very rewarding, particularly seeing how
a trainee’s knowledge, skills, competence
and confidence develop and blossom into
a state-registered biomedical scientist.
However, it can be challenging to find
enough time to perform the training
officer role with the additional demands
and responsibilities of the senior
biomedical scientist role.
Under COVID-19 pressures, the
University of Brighton switched to a
virtual format to continue with its
programme of monthly seminars and the
students were able to submit evidence
electronically for guidance and feedback
from their university tutor. As training
officer, I felt that the university
maintained its level of support, despite
the COVID-related difficulties. It worked
IMAGES: SHUTTERSTOCK
well because the university continued
coordinating all the evidence, which made
it easier for the students to keep on track.
I consider a portfolio to be exceptional
when the trainee demonstrates real
P36-37 Advice-Training_December 2020_Biomedical Scientist.indd 37
insight into the requirements of the
portfolio by relating the standards to
their day-to-day practice in the lab and
to the bigger picture of the trust and
service users. They also need to be able
to express themselves clearly and present
information in a concise manner and use
an appropriate format. I really liked how
the university offered a more structured
approach to complete the portfolio work
for the students. The evidence became
more directly linked to their actual lab
experience. Both the lab competency and
knowledge components of the portfolio
worked very well together, rather than
feeling separate as they have done in the
past. I also liked the reflective statements
and the embedding of reflective practice
within the training programme.
“Over time,
it became
natural to
reflect upon
daily tasks
in the lab”
ADVICE
Training
THE BIOMEDICAL
SCIENTIST 37
Paul Laurance-Young –
IBMS Verifier and Lecturer
in Biomedical Science
at University of Plymouth
I simply love teaching students – giving
them the basic tools to set them on the
path toward a career that can be at
times both frustrating and incredibly
rewarding. As a former biomedical
scientist, it is a chance to provide the next
generation of students with real-world
experience, coupled with text-book
knowledge. The challenges are different,
but certainly nothing that working for the
NHS in my role as training officer has not
amply prepared me for.
The IBMS portfolio is incredibly
personal. The trainee decides what format
of evidence to include under the guidance
of their training officer or university
tutor. The average portfolio includes
30 pieces of evidence that demonstrate
meeting the HCPC standards of
proficiency. I have been an IBMS verifier
for two years and am well versed in
what constitutes good and bad evidence.
So, when I had a comprehensive viva
with a trainee at East Surrey Hospital,
I was particularly impressed with how
both the trainee and training officer
made particular reference to the quality
and skill with which University of
Brighton conducted itself in helping to
deliver an effective training programme.
An exceptional portfolio documents
both reflective practice and personal
development throughout the training
programme. There must be examples
of their own practice and vivid
engagement with their
training officers and
colleagues. This type
of portfolio tracks the
transitional development
from trainee to
biomedical scientist
and it is this reflection,
as well as practical
competency, that creates
an outstanding candidate.
19/11/2020 09:32
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 ADVICE
Validation
THE BIOMEDICAL
SCIENTIST 39

INTRODUCTION OF A NEW IN-HOUSE

MASS SPECTROMETRY ASSAY
Working in a laboratory often involves
implementing a new method to improve the
or drop (ion
service, writes Specialist Biochemistry Team suppression) in
Manager Madihah Abbas. signal intensity
that would affect

I
SO 15189 standards require a
comprehensive analytical validation
to be carried out for all new methods
introduced into the clinical
laboratory repertoire. Description
of acceptable performance criteria
is essential before method
development and validation, in
order to minimise analyst/reviewer bias.
In this article I will discuss the commonly
cited acceptance criteria required for
validation, based on my MSc project of
introducing a new method for liquid
chromatography-high-resolution accurate
mass/mass spectrometry (LC-HRAM/MS).
Background
Congenital adrenal hyperplasia (CAH)
is a childhood adrenal disorder with an
estimated annual incidence worldwide of
1 in 10,000 to 20,000 live births. Affected
children have symptoms of salt-wasting,
more commonly in males, and females
usually present with ambiguous genitalia.
Routine practice uses serum samples for
diagnosis, with blood spot samples for
treatment monitoring. The advantages of
using blood spot samples for 17-OHP is that
they are stable for weeks and sampling can
be performed at home from a finger prick.
The results obtained are used to adjust
the dosage of hydrocortisone, which is
the main treatment for CAH. The goal
IMAGES: SHUTTERSTOCK
frequently used technique for 17-OHP
measurement. However, IA has issues
with cross-reactivity with other steroids,
and non-specific binding causing higher
values, whereas mass spectrometry is a
more sensitive detection method used to
detect the separated compounds as they
are eluted from the column.
Method validation involved
reviewing:
1) Ion suppression happens in the initial
stages of ionisation in the LC–MS
interface, when a component eluted from
the high-performance liquid
chromatography (HPLC) column impacts
the ionisation of a co-eluted analyte. If
competing compounds are present this
can result in a surge (ion enhancement)
TABLE 1: SPECIFICITY OF THE 17-OHP LC-HRAM/MS ASSAY
Peak area detected
17-OHP
Cortisol
Prednisolone
Corticosterone
Dexamethasone
Cortisone
the accuracy of
patient results.
2) Specificity is essential to investigate
interference from other commonly
prescribed or structurally similar drugs,
as well as other steroids produced by the
adrenal glands. For MS this is performed
by direct injection of supraphysiological
concentrations of specific drugs using the
liquid chromatography method. Then the
chromatogram produced is monitored for
interference at the retention time.
Specificity experiments demonstrated
that only progesterone gave an interfering
peak at the retention time of 17-OHP in
the table below, but this is not thought
to be clinically significant, as at 1 μmol/L
the peak area was only 83,559, which is
Retention time
329,196,991 2.42
(300nM)
none -
none -
29,038,141 2.16
none -
none -

of therapy is to replace missing 17-OHP none -

glucocorticoids, which will suppress 11-Deoxycorticosterone 2,223,629,093 2.04
ACTH production and normalise
Progesterone 83,559 2.42
adrenal androgens.
21-Deoxycortisol >800,000 1.20
Immunoassay (IA) has been the most

P39-40 Advice-Verifying_December 2020_Biomedical Scientist.indd 39 19/11/2020 09:33

 40 THE BIOMEDICAL
SCIENTIST
ADVICE
Validation

significantly less than the peak area
generated by spiking expired red cells
with 2.5 nm certified 17-OHP (382,197).
In particular the 11-deoxycorticosterone
was analysed to ensure that the peak
for this isobaric compound did not elute
at the same point as 17-OHP, as this has
the identical exact mass but different
molecular formulae.
Table 1 shows that adequate baseline
separation has been achieved, so they will
not interfere in the quantification of 17-OHP.
3) Precision characterises the closeness
of agreement between the measured
values obtained by replicate
measurements under specific conditions,
which quantitatively is stated as standard
deviation (SD) or % coefficient of variation
(%CV) carried out at clinically important
values/cut-offs/action limits. Typically,
large SD and %CV values indicate an assay
has poor precision.
To assess within-batch imprecision the
Immunoassay QC was used at three
different levels, due to limited availability
of the CDC QC. To assess between-batch
imprecision, QCs were run 12 times in a
single analytical batch.
Both inter- and intra-batch
precision was acceptable with
%CV <15%. However, due to
limited availability of QC material
only 12 results could be obtained
from a required 20 according to
validation guidelines.
4) Accuracy of the assay was determined by
spiking seven plasma samples, each with
various concentrations of 17-OHP. Each
sample was assayed in duplicate, and %
recovery calculated from the measured
compared with the expected concentration.
According to validation guidelines, the
mean value should be within 15% of the
nominal spiked concentration.
5) Carryover experiments demonstrated
no significant detectable 17-OHP in zero
calibrator samples that had been injected
into the mass spectrometer immediately
following a succession of three high-
concentration samples.
6) Lower limit of quantitation (LLOQ)
is defined as the lowest concentration
with both %CV and mean value from
the theoretical target of <20% where the
analyte can be determined
with an acceptable repeatability
and trueness.
7) Trueness may be evaluated in a
number of ways:
Repeat investigation of numerous levels
of certified reference materials with the
results compared with the allocated value
Comparison of results with those
attained using a reference method
Recovery experiments by means of
spiked samples
Comparison with the results from
“fresh” EQA material using the peer
group mean as the right value.
8) Lower limit of detection (LLOD) is
linked to the smallest amount or
concentration of analyte in the sample
that can be reliably distinguished
from zero.
9) Linearity of the assay was assessed
by repeat analysis of calibration curves
analysed in separate batches (n=6), and
weighted linear regression of the
correlation coefficient r2 value of the
calibration curves was ≥0.990.

Conclusion
An LC-HRAM/MS method has been

TABLES 2-4: RESULTS TABLES developed for the quantification of

17-OHP in blood spots. This assay will
enable improved specificity and better
17-OHP intra-batch immunoassay 17-OHP inter-batch CDC (n=12)
(n=12) EQA performance, compared with the
immunoassay method.
QC 1 QC 2 QC 3 QC A QC B QC C
Laboratories should regularly review
Mean (nmol/L) 22.06 55.38 126.30 34.31 64.57 123.49 their policies and procedures for
SD 1.95 2.50 5.52 3.13 6.19 11.41 method validation to ensure all
%CV 8.84 4.51 4.37 9.13 9.59 9.24 aspects have been assessed and covered
before implementation.
Table 2: Within- and between-batch imprecision of the 17-OHP LC-HRAM/MS assay

Madihah is a Specialist Biochemistry

Spiked concentration (nmol/L) Mean recovery (%) Mean 2.119
Team Manager at The Christie Pathology
10 97.7 SD 0.30 Partnership. She would like to thank Edward
50 101.5 %CV 14.37 Hinchliffe and Claire Manfredonia for their
200 106.1 Table 4: Precision of 17-OHP at
support and guidance, and her colleagues
Mean 101.7 concentration 2.5 nmol/L in specialist biochemistry and newborn
screening at Manchester University NHS
Table 3: Accuracy of the 17-OHP assay determined by calculating
% recovery values having spiked whole blood plasma samples
Foundation Trust for giving her time to
(n=7) each with three different concentrations of 17-OHP carry out the experiments described above.

P39-40 Advice-Verifying_December 2020_Biomedical Scientist.indd 40 19/11/2020 09:33

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 42 THE BIOMEDICAL
SCIENTIST
ADVICE
How to...

HOW TO…
SPOT MEDICAL
MISINFORMATION
IN THE PANDEMIC

Brian Eggo and

colleagues from
Skeptics in the Pub
give some practical
guidance on how to
ensure you aren’t misled by
unfounded claims in the media.

T
he internet has revolutionised society
in ways that could scarcely have been
imagined just a few decades ago. There’s
a vast ocean of information to dive into
and explore – and it’s only a click away.
Unfortunately, that ocean is badly polluted.
It puts us in a difficult position when it
comes to figuring out what we should
believe, and how that informs our actions,
particularly when it comes to matters of health.
The good news is that the warning signs can be
relatively easily spotted in most cases. The bad news is
that we’re in the middle of a global pandemic, so we’re
scared, we’re grieving and we’re desperate.
Add to that some information-overload and we have
a perfect cocktail of confusion to lead you to making

P42-43 Advice-Missinformation_December 2020_Biomedical Scientist.indd 42 19/11/2020 09:34


bad decisions.
As a remedy, here we
prescribe a healthy dose
of scientific scepticism
and critical thinking
skills. To help you
on your way, here
are our top tips for
spotting questionable
health claims.
Give panaceas
a pass
In simplest possible terms, cure-alls cure
nothing. The longer the list of conditions
that something claims to treat, the less
likely it is to do anything. It should set off
your sceptical spider senses even more if
an alternative health treatment that has
been around for some time is proclaimed
as a cure for a new disease.
Beware of biases
The human brain is amazing, but flawed.
All of our cognitive shortcomings are
further fuelled by social media
algorithms, which are considerably more
likely to push content in your direction
that fits your worldview. With this in
mind, some self-reflection and humility
IMAGES: ISTOCK
about your own shortcomings will serve
you well. Be extra cautious of claims
that fit comfortably with your worldview.
P42-43 Advice-Missinformation_December 2020_Biomedical Scientist.indd 43
Prudence with proclamations
Many countries across the world have
varied their approach to tackling
COVID-19. Some are due to factors such
as population density, cultural norms, or
infrastructure. It’s no surprise, however,
that some of the worst-hit countries are
those where the leaders don’t pay
appropriate attention to the advice of
the scientific community. Whatever
your politics, it never hurts to question
your Government’s wisdom.
Peruse problematic press
Science communication is difficult, and
there’s a conflict of interest between
accurately reflecting findings, and
garnering public interest. In addition,
accuracy is diluted as the conclusions of a
study become a press release, then a news
story, (with attention-grabbing headline).
This is exacerbated by the unprecedented
thirst we have for new data in the middle
of a pandemic. As such, you should be
extra cautious about what you read. It’s
prudent to delve behind the headlines and
go to the source, and to wait and see what
the rest of the scientific community has
to say about it before making a judgment.
Critique claims carefully
A claim to cure anything (particularly a
virus like COVID-19) should always set off
ABOUT SKEPTICS
IN THE PUB
Skeptics in the Pub is an
informal community which
promotes scientific scepticism,
reason, and critical thinking. There
are many groups across the UK, and
across the globe that run regular lectures
and social events, usually in some form
of drinking establishment. During lockdown
restrictions we are collaborating to host
online talks every Thursday at 7pm GMT.
To find out more about us, visit
https://sitp.online
ADVICE
How to...
THE BIOMEDICAL
SCIENTIST 43
alarm bells, as it’s highly unlikely. If you
hear [miracle cure x] kills [disease y] in a
petri dish it sounds impressive, but is
almost entirely meaningless (napalm will
kill cancer cells, but we wouldn’t advise it
for a tumour). Claims to treat or mitigate
the effects of a disease are more common.
We’re learning more about severe cases
of COVID-19, but still have a long way to
go. Anything that claims to be able to
treat it right now should be met with the
utmost scepticism.
Be pharma-logical
There’s a constant campaign by
proponents of alternative medicine to
try and discredit mainstream medical
practices. Any time you see the term “big
pharma” being used, it’s usually paired
with an attempt to sell some snake oil, or
perhaps talk you out of vaccinating your
children. Let’s be very clear though, while
pharmaceutical companies are not driven
by altruism, that shouldn’t fool you into
thinking that everything they do is bad,
or that the alternative medicine on offer
would be of any use. Be reasonable and
balanced in your approach.
Separate pseudoscience
from science
Pseudoscience has the look and feel of
legitimate science – it can even appear
in studies published in peer-reviewed
journals. In the case of medical
interventions, there are legitimate
health professionals who genuinely
believe and actively promote
pseudoscience. Fortunately, there
are almost always some red flags
that can be spotted with a little
investigation, and the above points
will help you along the way with that.
In conclusion
The waters are murky, but a little bit
of critical thinking will provide some
much-needed illumination. Be careful
what you believe, and look out for your
family and friends, too.
19/11/2020 09:40
 44 THE BIOMEDICAL
SCIENTIST
MY IBMS
News
MY IBMS
QUALIFICATIONS
Certificate of Expert Practice – apply now
A
pplications are open
for the Certificate
of Expert Practice
(CEP) online courses
in leadership and
management, quality
management,
molecular pathology,
point-of-care testing (POCT), and
training, which will commence
in January 2021. These distance-
learning courses are delivered
online, using the Blackboard
Virtual Learning Environment
(VLE), which offers flexibility to
participants on where and when
they access the course.
The deadline for applications
for these qualifications has been
extended to 18 December and we
limit the numbers on each course to
60. The quality management course is
now full and cannot take any further
applications, but there are a limited
number of places still available for the
CEPs in leadership and management and
training, but these are filling up quickly.
We still have places for the molecular
pathology and POCT courses.
The CEP in leadership and
management has been designed
specifically for managers in the pathology
environment. This CEP addresses the key
elements of the laboratory manager’s role
by exploring it in the context of both the
organisation and the local team and it
also emphasises the importance of the
people in the team and working together
to achieve successful outcomes.
The CEP in molecular pathology
P44-45 MY IBMS-News_December 2020_Biomedical Scientist.indd 44
NEWS
provides a theoretical introduction to the
subject and its application. It is intended
to support those already trained and
experienced in this discipline but who
wish, or need, to extend their knowledge
and understanding as new molecular
techniques are integrated into their work.
The CEP in POCT is essential for anyone
preparing to manage a POCT service and
also existing POCT managers who feel
they would benefit from some supported
learning to help them manage an
expanding workload and a workforce of
largely non-laboratory staff.
The IBMS document Clinical laboratory
standards for IBMS qualifications and guidance
for training laboratory management and approval
strongly recommends that training
managers/coordinators within a
laboratory undertake the CEP
in training. This CEP will also
benefit anyone who is interested
in understanding about the roles
and responsibilities of individuals
of laboratory staff, IBMS
qualifications, planning laboratory
training and different learning and
assessment styles.
Each course consists of a common
introductory module and then six
modules that each last two weeks
(with a one-week break in the middle
of the course). The modules are
delivered in a student-focused format
with tasks that help participants to
understand the content of the
module. A tutor-led forum for each
module enables participants to post
their responses to these tasks and
explore different aspects of the
module between the module tutor and
the other participants on the course. These
forums enable participants to share
knowledge, thoughts and experiences,
which, from feedback that has been
received in the past, we know individuals
find valuable for their own workplaces.
The qualifications are assessed through
the submission of two assessment pieces
(one at the mid-point and the other at the
end of the course) and an end-of-course
online examination.
ℹ Each qualification costs £685.
Only one qualification can be
undertaken at a time. Applicants must
have Member or Fellow status of the
IBMS. More details and application forms
can be found on the IBMS website.
19/11/2020 12:59

SUPPORTING THE PROFESSION
RENEW YOUR IBMS MEMBERSHIP
Thank you for supporting the IBMS during
2020. It has been a challenging year for
the profession and we are extremely
proud of all of our members’ efforts.
The IBMS has been working hard to
provide the services that you want and
need during these difficult times and we
hope that you will continue to support us.
Membership fees for next year
are now available online at
ibms.org/join/membership-fees.
You can also renew your membership
online at the IBMS website.
The IBMS offers a £5 discount on the
THE BIOMEDICAL SCIENTIST LIVE
Access new CPD content now
IBMS members can still access content
from the four-day virtual event The
Biomedical Scientist Live.
The new virtual event, brought to you
by the IBMS, took place in November,
but members are still able to view
recordings of all the sessions.
The Biomedical Scientist Live
featured a packed line-up of
knowledge-sharing sessions,
including seminars, presentations,
P44-45 MY IBMS-News_December 2020_Biomedical Scientist.indd 45
annual subscription if you pay by
annual Direct Debit, or alternatively
you can opt to pay your subscription
in 10 equal instalments from January
to October.
UK taxpayers can claim tax relief
on their subscription.
Additionally, by taking advantage
of the savings on offer with IBMS
Additions, you could recover the cost
of your IBMS membership fee.
For more information visit the IBMS
website and if you have any queries
contact subs@ibms.org
discussions and demonstrations.
It also presented in-depth learnings
from the pandemic, the latest research
across a range of specialisms and
showcased cutting-edge technologies.
The Biomedical Scientist Live is
free to access for IBMS members.
For more information and
to register to see the sessions
featured in the event, visit
live.thebiomedicalscientist.net
MY IBMS
News
THE BIOMEDICAL
SCIENTIST 45
CONFERENCE
NEW DATES FROM
IBMS CONGRESS
The IBMS has announced new dates for
Congress 2021 to ensure the safety of
delegates while uncertainty continues
over social distancing regulations.
In light of the ongoing pandemic,
and the uncertainty over when social
distancing indoors will be significantly
reduced, it has been decided that
IBMS Congress will be moved from
September 2021 to March 2022.
Although Congress is still a
considerable way off, it is not clear
when we may be able to see a
significant reduction of COVID-19 risk
in respect of large gatherings.
Consideration must be given to
delivering a safe and successful event
for delegates, speakers and exhibitors.
The IBMS will keep members
updated on plans and the full
programme will be announced in
early 2021 to allow plenty of time
for planning budgets.
Save the new Congress date:
14-17 March 2022, at the International
Conference Centre in Birmingham.
CPD AWARDS
SCIENCE COUNCIL
HONOURS IBMS
MEMBERS
Two IBMS members have received
commendations at this year’s Science
Council CPD Awards.
The annual awards celebrate the
continuing professional development
(CPD) achievements of registrants
across the Science Council registers.
The IBMS members are registered
science technician Katy Johnson and
chartered scientist Janice Harland.
Christian Burt, IBMS Professional
Support Services Manager, said: “Katy
and Janice should be really proud to
receive commendations from the
Science Council for their CPD.”
He added: “Once again, it is IBMS
members who have shone bright and
been commended for their clear
commitment to lifelong learning
and self and service improvements.”
19/11/2020 09:34
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p46_BIO.Dec20.indd 46 18/11/2020 14:43

 MY IBMS
Continuing professional development
THE BIOMEDICAL
SCIENTIST 47

EVENTS AND
TRAINING COURSES
More training courses, CPD and local events and activities are available on the IBMS website.

DATE TITLE VENUE CONTACT

December
2 Dec UK Standards for Microbiology Investigations Joint Bacteriology London I Public Health England
and Virology Working Group Meeting
2-7 Dec Introduction to Immunocytochemistry Webinar Online I UK NEQAS CPT
10 Dec Fresh Muscle Biopsies Webinar Online I UK NEQAS CPT
14-15 Dec Advanced Agilent HPLC Equipment Servicing Course Rochester I stuart@laserchrom.com
2021
January
11-13 Jan ICC Technical Issues and Quality Assurance Webinar Online I UK NEQAS CPT
18-20 Jan ICC Applications in Laboratory Practice Webinar Online I UK NEQAS CPT
June
16-17 Jun Beginners Immunohistochemistry Sheffield I l.baxter@sheffield.ac.uk
July
14-15 Jul Advanced Immunohistochemistry Sheffield I l.baxter@sheffield.ac.uk

P47 My IBMS-CPD_December 2020_Biomedical Scientist.indd 47 19/11/2020 09:35

 48 THE BIOMEDICAL
SCIENTIST
MY IBMS
Here to help

HERE TO HELP

OVERCOMING THE CHALLENGES

OF THIS YEAR WITH YOUR SUPPORT
IBMS Education Officer Deborah Vuong
looks back over the past year and the
achievements made while going virtual.

T
his year has brought with it
many changes, and much
uncertainty affecting the way
many of us live and work.
Here at the IBMS we continue
to offer support and guidance
during this unsettling time
to ensure that we maintain
a level of “normality” for our service users
allowing them to continue progressing
in their careers. However, this has not
been without its challenges.
In addition to the high volumes of
emails, calls and enquiries received from
those seeking our advice and assistance
during this time, we have maintained In September, the IBMS added to our over 1000 assessments, allowing new
our continued effort to deliver a high offering of specialist portfolios and biomedical scientists and specialists to
level of service, as well as identifying introduced two new cytopathology take the next steps in their career. You
new ways of supporting our members. portfolios to reflect the expansion of have embraced our new processes with
The pandemic has allowed us to knowledge required across the discipline. enthusiasm and welcomed new resources
transform the way we work with a We recognise how crucial the that we have introduced during this
number of our processes going “virtual”. continuation in your journey is for the period. Your valued feedback has allowed
In March we introduced a whole new way field of biomedical science, and it is now us to evaluate and improve our processes
forward for completing our qualifications more important than ever to have more as we continue to meet your needs.
electronically, to prevent any delays in registered biomedical scientists In 2021, we look forward to hosting
career progression. We have also hosted practising. The continued growth in both further training days, introducing a
virtual training days to bring new portfolio applications and requests to programme of Support Hub events, and
portfolio assessors on board, as well as arrange assessments as soon as possible offering more resources for our members.
new non-accredited degree assessment reflects this and, as such, we will We want to assure you that, whatever the
assessors to augment our current continue to implement changes coming year brings, your development
IMAGES: ISTOCK/SHUTTERSTOCK

pool of external assessors. which facilitate this. and progression continues to be at the
We have launched the “IBMS As 2020 draws to a close, forefront of our work.
Support Hub”, in order to we would like to thank our On behalf of the education team here
provide further training members and service users for at the IBMS we would like to thank you
and support to aid in the their continued support. With for your support during 2020 and wish
development of our members. your help we have carried out well you a happy and safe 2021.

P48 My IBMS-HTH_December 2020_Biomedical Scientist.indd 48 19/11/2020 09:35

 RECRUITMENT
For recruitment advertising contact our Sales Team +44 (0)20 7880 7665
THE BIOMEDICAL
SCIENTIST 49

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Senior Biomedical Scientist
£40,000 to £45,000
The Senior Biomedical Scientist will play a crucial role managing a team of BMSs and MLAs within the Pathognomics laboratory.
The SBMS will perform routine and specialist analytical testing on a range of biological samples, including urgent analytical
testing as required. The role holder will be expected to prioritise their own workload and manage the workload of their team.
These are full-time positions with a standard 37.5 hour working week. They are based at the Pathognomics laboratory in
Huntingdon.
For full details of both posts and to apply online please visit cyted.ai/careers
The closing date for applications is 4 January 2021.
If you have any questions please contact hr@cyted.ai

ONE-TO-ONE SAMPLE RECEPTION IBMS GRANTS

CANCER DIAGNOSTICS REDEFINING ROLES SUPPORTING RESEARCH

New cancer tests could Making changes for a Seven award recipients
lead to a breakthrough more stable workforce outline their grant-
in understanding: p.16 and fewer errors: p.24 supported projects: p.28

THE

THEBIOMEDICALSCIENTIST.NET DECEMBER 2019

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BIO Recr Dec20.indd 49 18/11/2020 14:46

 50 THE BIOMEDICAL
SCIENTIST
MY LAB
John McNulty

MY LAB

HAEMATOLOGY AND BLOOD TRANSFUSION

John McNulty, Senior Biomedical Scientist, gives a guided tour of the
pathology department St Helens and Knowsley Hospital NHS Trust.

T
he pathology Kingdom Accreditation
department Service (UKAS) assessments,
at St Helens allowing for continued
and Knowsley accreditation to ISO 15189. This
Teaching is thanks to the continued
Hospitals NHS hard work and organisation
Trust (STHK) is of our medical laboratory
responsible for assistants and biomedical
providing pathology services scientists who provide a
to STHK and the GP practices high-quality diagnostic
within the St Helens, service over multiple sites.
Knowsley and Halton Clinical Staff progression is
Commissioning Groups (CCGs). bolstered by the completion
After a successful merger of registration and specialist
with the pathology services at portfolios, with the majority
Southport and Ormskirk of staff also completing BBTS
Hospitals NHS Trust (SOHT) in Specialist Certificates and
October 2014, the department significant numbers studying
provides support for the trust to Master’s level.
as well as Southport and Formby, and morphology, erythrocyte sedimentation We also have an education programme
West Lancashire GP practices, primarily, rates, routine coagulation testing, ABO of lunchtime presentations.
performing over 1.6 million tests in and Rh grouping, antibody screening, Our quality management system
haematology and transfusion yearly. patient crossmatching and antenatal involves the processing of internal quality
The STHK pathology departments screening. Specialist testing is performed controls, including inter-hospital
consist of a main hub at Whiston at Whiston, including coagulation factor comparison testing, as well as
Hospital, where all disciplines are based, assays, thrombophilia testing, Hb participating in external quality control
and a blood sciences essential services electrophoresis and antibody identification. schemes across haematology and blood
laboratory (ESL) is based at Southport Our Ormskirk laboratory offers limited transfusion, such as NEQAS and WASPS.
Hospital, with smaller laboratories of on-site testing, including some The completion of training logs and
limited repertoire at Ormskirk Hospital haematology and urgent transfusion annual competency assessments has
and St Helens Hospital. Our laboratories provision, while the lab at St Helens given us the flexibility to provide a high
are equipped with Sysmex haematology provides a basic haematology and level of performance during the COVID-19
and coagulation analysers and Grifols coagulation service for real-time results pandemic. The ability to react to the
transfusion analysers. to support the haematology and changing aspects of healthcare during the
The sites at Whiston and Southport anticoagulation clinics. pandemic has been essential, and the
provide a 24/7 haematology and The haematology and blood transfusion positive attitude of both teams at the
transfusion service, using a range of departments at STHK and SOHT have had STHK and SOHT sites has allowed for
automated and manual techniques to great success in recent years with continuous quality improvements during
perform full blood counts, blood cell excellent results in successful United this time.

P50 My Lab-John McNulty_December 2020_Biomedical Scientist.indd 50 19/11/2020 09:36

p51_BIO.Dec20.indd 51 18/11/2020 14:44
 Roche Diagnostics gives you
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p52_BIO.Dec20.indd 52 18/11/2020 14:45