Leading Edge 2021 Issue 2

2 2021 ISSUE 2 The latest NHS England performance figures show that nearly 3,000 people have been waiting almost two years for a procedure, whilst 400,000 have been waiting over a year. These numbers are a stark reminder that as we learn to live with COVID-19, the pressure faced by the NHS in tackling the enormous backlog, is unprecedented. However, the NHS has demonstrated a willingness to innovate during the pandemic, making use of new technologies to facilitate new pathways and new ways of working, to develop extra capacity and aid recovery. Alpha Laboratories has been working continuously with various Trusts to help support improved efficiencies. This issue of Leading Edge highlights several solutions that can improve work flows and enhance capacity. The new fPELA assay now enables pancreatic testing from the same patient sample as that used for calprotectin, on high throughput clinical chemistry analysers. In addition the new BioSystems BA200 offers a stand-alone platform for faecal testing if you need to free up your main analysers. We have reported during the pandemic how many Trusts have adopted the use of calprotectin home testing for monitoring IBD patients. On pages 4-5 you can read how some continue to find this complementary to laboratory testing. Diagnostic technologies such as faecal immunochemical testing (FIT) can triage patients and fast track the most in need. See pages 8-9. Alongside this, tailored patient sample collection and return logistics have been enhancing compliance and increasing test uptake. For some light relief read about Jock the gorilla on page 6! Launched in summer 2020, the new BÜHLMANN fPELA turbidimetric immunoassay for faecal pancreatic elastase, complements the popular calprotectin fCAL turbo assay, that is widely used across the UK. Using the same CALEX faecal extraction device as the calprotectin assays and running on main-stream clinical chemistry analysers, the fPELA is set to improve workflow and turnaround times, in a similar manner to the fCAL turbo. Rachel Navin and Sarah Rogers are both Senior Biomedical Scientists at York hospital, the largest hospital within the York and Scarborough Teaching Hospitals NHS Trust. Here they report on their experience of introducing the BÜHLMANN fPELA into their routine testing. “We currently test around 2,000 faecal elastase samples a year, which works out to about 40 per week. These samples are primarily from York, but we do also test for some other local hospitals. Primarily requests for pancreatic elastase come from gastroenterology and Cystic Fibrosis patients, for whom it is used for both diagnosis and monitoring of pancreatic insufficiency. Previously we were running the Schebo ELISA assay, initially manually, but in recent years it has been run on the Dynex DS2 ELISA processor provided by Alpha laboratories to run the BÜHLMANN fCAL ELISA. With the Schebo method we were freezing the samples on receipt, due to stability concerns, and then running the assay once a week. We are looking to switch the BÜHLMANN fCAL ELISA assay to the fCAL turbo on our existing Roche platforms. This means the DS2 will be decommissioned, so we needed to look for an alternative option for the elastase assay as we didn’t want to go back to manual testing. In the past we have had a few issues with the Schebo assay and had already investigated switching to alternative ELISA assays. These assays also required the use of the DS2 so were not considered this time. A New Era in Pancreatic Elastase Testing by Rachel Navin and Sarah Rogers, Senior Biomedical Scientists at York Hospital Sarah Rogers (left), Rachel Navin (right) with their colleague Hannah Eccles (centre) in their laboratory at York Hospital.