Grassroots explosion of VOICE, VALUE, VISION Official publication of the American Society for Clinical Laboratory Science ~ South Dakota

TOPIC QUICK L INKS:

2013 Renew/Recruit - 1

ASCLS-SD Leadership Info - 2

Outgoing President Message -2 Incoming President Article-2-3 ASCLS-SD & ASCLS Premier Websites - 3 Region V Director Message -3-5 ASCLS-SD Industry Sponsors - 4

Recruit! Be a Star - 5

Events Calendar - 6

Membership Corner - 5-7 "No Excuses & ASCLS 3R's" ASCLS-SD New Members– 7 Legislative Symposium - 7-8 ASCLS Reg V Student Rep: Student Challenge - 8-9 Rising Cost of Biofilms - 8-9 Government/Payment Hot Topics (side bar) - 8-10 Newborn Screening SCID -10-11 Peripheral Smear Findings - 11-12 2013 Science Fairs - 11-12 Granulocyte Transfusion - 12-13 2013 Annual Meeting Report - 13 2013 ASCLS-SD Awards & Scholarships (side bar) - 12-14 ASCLS-SD Strategic Initiatives & Activities Update - 13 ASCLS-SD Spotlight: Stacie Lansink & Amanda Graves - 14

Fall Meetings Save the Date -15

Renew & Recruit in 2013! You Are Important!

It's that time of year... ASCLS membership renewal & recruitment time! Your membership is important! With each SD member that renews, our profession and organization is stronger.. more visible...and our professional voice is louder! Why is this important? We are embarking on the rocky road of healthcare reform, so our voice needs to be heard within our facilities, within the state, region and at the national level. Your continued membership in ASCLS allows that to happen. Renew right away!

Be a winner! Renew before July 30 and you will be entered into a prize drawing!

VOLUSION….ASCLS-SD is published quarterly and is made available to all ASCLS SD members in electronic format. The current issue and past issues will also be available for on-line viewing on the Society’s web page: www.ascls-sd.org The co-editors reserve the right to edit content and length of material to meet publication specifications.

All ASCLS SD members are invited to submit articles of interest to the co-editors for publication in future issues.

ASCLS Members are the HEART of ASCLS national, regional and state!

There is a continuous flow of goals, ideas, strategic actions and communication between our grassroots members, our state, our region and national ASCLS

Sharing of time and talents at all levels of our society moves our profession and our professional organization forward

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ASCLS SD 2013-14 Leadership &

Contact Information:

President: Shirley Heber (P) 605-201-6087 sheber@sio.midco.net 1st Vice President: Pat Tille (P) 605-688-6016 patille@live.com 2nd Vice President: Bernie Reddy (P) 605-225-1773 bernie.reddy@avera.org Secretary/Treasurer: Pam Kieffer mpkieffer@gmail.com Past-President: Robert Jenson bob.jenson@prairielakes.com Board-Members-At-Large:

Kay Rasmussen krasmussen99@yahoo.com

Stacie Lansink medstacie@hotmail.com

Tanya Crockett crockett@hcinet.net New Professional Member-at-Large: Katie Pieschke kapieschke@gmail.com Student Forum Rep: Amanda Graves akgraves@jacks.sdstate.edu Membership Chair: Mona Gleysteen GLEYSTEM@lakeareatech.edu Publications Chair: Lezlee Koch lezleek@sio.midco.net

Outgoing President's Message: It's Spring & The Grass is Growing! By: Robert Jenson, ASCLS-SD President 2012-13

Wow another year has flown by. The winter cold and snow have finally melted away and the grass is starting to green. The grass roots of ASCLS-SD are strong and growing as well this spring! Shirley Heber was elected President at our spring annual business meeting and her term will begin this August. As I reflect on the past year it is truly amazing of this grass roots organization all that goes on in the roots of this organization. I want to thank the dedicated board of directors of ASCLS-SD which are listed in the VOLUSION in each publication. We have ten members on the board and we have met monthly over this past year. These meeting keep us focused on the local, regional and national issues. A word of thanks to the 11 Scientific Assembly Chairs for this past year. They have been available for questions from members as well as provide educational articles for our quarterly newsletter the VOLUSION. These chairs were: Vikki Laurence (Chemistry/UA), Melissa Saxlund (Microbiology), Warren Erickson (Lab Admin), Alison Albertson (Immunology), Rebecca Aman (Immunohematology), Sheila Schneider (Hemat/Hemostasis), Patrick Bezenek (Industry), Vicki Geiser (Education), Shelia Rezac (POC/Phlebotomy), Patricia Tille (Molecular Diag/Genetics), Lori Murray (Reg Affair/QM/Pt Safety) and Michelle Friesen (Consultants). Additional thanks and recognition to all the planning committee members for the Fall 2012 Collaborative meeting in Aberdeen, the ASCLS-SD members on the Fall Region V 2012 conference committee, planning committee for the Spring 2013 meeting. We also have committees meeting already working on the Fall 2013 Collaborative meeting in Rapid City, The Fall Region V meeting in Alexandra and for the Spring 2014 meeting in Sioux Falls. We have also had some awesome work done by the four Task Forces for Membership, Leadership, Promotion of the Profession, and New Professionals/Students which includes another 10 -15 active ASCLS-SD members on these committees. Where am I going with this? Well if we throw in the annual award recipients I will guess that we would then have had approximately 50 different individuals in the past year that were involved in some aspect of ASCLS-SD on a state, regional or national level. With 139 members that is 35% involvement by our members. What other organization can boast that kind of percentage! It goes to show that our grass roots are strong and growing. There are many opportunities for everyone to get involved in ASCLS in varied areas of interest. Thank you to all those that have been involved in the past year, you make ASCLS-SD the strong organization that is today.

Incoming President's Message: "Get Involved!" By: Shirley Heber, ASCLS-SD Incoming President 2013-14

The page has turned, and it’s time for an introduction. First of all, I want to say thank you to the SD membership for putting your trust in me and electing me as your society President for the coming year. A little about myself:

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Your ASCLS Premiere Websites!

Visit Them Often!

ASCLS-SD www.ascls-sd.org

ASCLS Region V www.ascls-

sd.org/asclsregionv

ASCLS Region V Fall Symposium

www.ascls-sd.org/region-v-

meeting

ASCLS www.ascls.org

ASCLS Region V Tri-State

Leadership Academy

www.ascls-sd.org/tri-state-leadership-

academy

I am South Dakota born and raised – Lake Preston was my home for the first 18 years of my life, followed by three years of study in Medical Technology at South Dakota State University in Brookings, marriage, a honeymoon spent touring clinical internship sites in Colorado (we lab folks are pretty focused), and a year of study at St. Joseph’s Hospital laboratory in Denver, Colorado. This completed my Bachelor’s Degree from SDSU. At this point, my husband and I continued on our sixteen year journey of work assignments around the nation, finally returning to South Dakota in 1992 where I literally started over on the night shift at Avera McKennan Hospital laboratory. I later earned a master’s degree at the University of South Dakota and moved back into laboratory management, followed by a transition into laboratory outreach consulting. Throughout the moves and various positions, I have remained committed to the field of laboratory science and have never regretted my career choice. One bonus of moving so often was the ability to work in many different laboratories and disciplines – I studied for my boards in Oklahoma, moved to north Texas where I commuted and worked as a generalist, on to a position as a Blood Banker in Alabama, next to the Red Cross in Montana, back to south Texas where I specialized in Chemistry and later laboratory management, then to north Texas again where I moved to a part-time generalist position while raising my three small children. I met wonderful people along the way, observed and learned the right AND wrong ways to perform laboratory tests, and gleaned knowledge about personnel, human resources, the field of laboratory medicine, compliance, billing, and more. The door truly is wide open for so many exciting careers and positions associated with laboratory science. My #1 ASCLS goal for 2013 is to encourage involvement from ALL members. You have each taken the first important step – joining ASCLS. A primary bonus of membership is the opportunity to meet other professionals and learn from them! Choose an area that motivates you and GET INVOLVED! Serve on a committee, write an article (or if writing isn’t your passion, agree to proof articles for the newsletter), attend a meeting, offer ideas for speakers, or BE a speaker, work with students, run for a board position, recruit other members, the list is endless……..and we have room for YOU. Don’t wait to be asked – volunteer! Move out of your comfort zone – it truly can be fun! I hope to meet many of you at upcoming functions this year. Again, don’t wait for an invitation – get involved – ASCLS-SD needs you!

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Region V Director's Message: ASCLS & Region V Updates! By: Deb Rodahl, ASCLS Region V Director

It’s hard to believe that the State meetings have come and gone despite the lingering winter that challenged some of the events! Much work is happening Nationally, Regionally, as well as locally! The National Meeting will be held in Houston July 30th – August 3rd. The program information and registration is available on line. I hope to see many of you there! Delegates to the

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ASCLS-SD Proudly Salutes It's

Premier Industry Sponsors!

www.mayomedicallaborato

ries.com

www.usd.edu/medlab

www.sdstate.edu/cee/degr

ees/mls.cfm

www.alere.com

national meeting have an opportunity to see how ASCLS functions as a “grass-roots” organization first hand. National Elections – Slate of Candidates (to be voted on at the National Meeting): President Elect - Susanne Zanto (MT) Secretary / Treasurer - Cindy Johnson (MN) and John Koenig (MO) Judicial Committee (1) - Holly Weinberg Nominations Committee:

Sally Pestana Bill Hunt Vicki Freeman

Director Region I - Maddie Josephs Director Region VII - Karen Chandler Region VIII - Joni Gilstrap and Stephanie Mihane

The ASCLS Interim Board of Director’s meeting was held in March. There were many “Requests for Actions” presented, discussed, debated, and voted on. Motions that were approved at the March BOD meeting include: Establish a task-force to review the New Professional committee related to Structure,

Status, and Charges. It was noted that the New Professional’s represent an important voice for ASCLS and we need to ensure that the national committee is set-up for success.

Establish a Task Force to evaluate the Minority Forum to ensure it is able to reach out to our diverse members and help grow the diversity in our profession

Establish a Task Force to create a checklist process for the Awards Committee Approve the creation of a “Lifetime Achievement Award” Approve the recognition of all State “Member of the Year” awardees at the national

meeting Approved the creation of an “Advanced Management Institute” for 2014. This

institute would be held just prior to the National Meeting. A Task-Force has developed the goals and framework for the institute and is now working to have in place for 2014. Many Region V members are part of this task force! (Rick Panning, Lezlee Koch, Cindy Johnson, and Deb Rodahl)

Referred DCLS Position Paper to the House of Delegates for review. This will be presented at the House of Delegates for discussion and approval.

A task force was established in 2012 to review the current ASCLS Committee structure to evaluate opportunities to combine and/or eliminate some committees. A number of recommendations were presented to the board and the following were those that were approved: Consolidation of CEAC with Abstract Proposal and Review committee (This committee

historically has set the program for national meeting and will now be conducted as part of the Abstract Proposal and Review Committee)

Dissolve the DCLS Oversight Committee and incorporate with Education Scientific Assembly

Dissolve Professional Standards Committee. (This work will be assigned to the appropriate committee or task-force as items come up for review)

Revision of Scientific Assemblies as follows: Chemistry / Urinalysis Education Hematology / Hemostasis Immunology / Immunohematology Laboratory Administration / Consultant Microbiology / Public Health

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Recruit A New Member!

Be An ASCLS Star! Every clinical laboratorian deserves the professional benefits of ASCLS! Award winning

publications Members-only

discounts for continuing education, resources, references and tools

Professional & Regulatory Advocacy

Grassroots benefits at the local, state, and regional levels

An instant professional family of thousands

Cutting edge resources and updates

Leadership development

Discounted services - credit cards, hotels, insurance programs and more

Share ASCLS's VOICE, VALUE & VISION with your professional friends and colleagues! We all benefit when ASCLS grows! The more members we have in South Dakota, the stronger our professional voice is here at home. Recruitment tips & tools can be found at: http://www.ascls.org http://www.ascls-sd.org/

Join Online at: www.ascls.org/join-ascls/join

Point of Care Phlebotomy

ASCLS Region V Updates: The Region V Tri-State Leadership Academy planning committee is busy putting the program schedule together for the kick-off this fall. This project stemmed from a desire of individual states to bring the ASCLS National Leadership Academy to the local level. This would allow more of our members to participate and at a reduced overall cost. Minnesota, North Dakota, and South Dakota have agreed to a 3-year pilot of this program. Planning Committee members include: JoAnn Nickles (Chair – MN), Jean Bauer (MN), Char Romain (MN), Dawn Michelson (ND), Alice Hawley (ND), Susan Lopez (SD), and Lezlee Koch (SD – Web and Design). The Region V Tri-State Symposium has been joined by the Minnesota chapter of CLMA to help coordinate this meeting. Since both groups were holding a fall meeting, it made sense to join forces! CLMA members across the region will be invited to attend at our reduced “member” rate. Put September 30th – October 1st on your calendars to head to the Arrowwood Resort in Alexandria, Minnesota. The Arrowwood is a very scenic and relaxing location for this Fall meeting so come early for a chance to golf, fish, and hike or take advantage of the horse-back riding, spa, or great indoor water park. There is fun for everyone! It is truly an honor to represent Region V in ASCLS. I enjoy hearing from our members (or non-members). I can be reached at drodahl@earthlink.net (651)779.8906

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ASCLS-SD MEMBERSHIP

CORNER

ASCLS Membership: Every excuse in the book! By: Mona Gleysteen, ASCLS-SD Membership Chair 2012-13

I have a book that has the title, “Every Excuse in the Book.” Yes, it really exists but every year, I’m provided with an excuse or more that aren’t even in the book! I thought I’d give a list of some of my favorites and relate them to reasons people decide not to become a member or renew membership in ASCLS. Here are some favorites from the book for problems in school:

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ABC

ASCLS

July 30- Aug 3, 2013 Houston TX

www.ascls.org/index.php/ascls-meetings/annual-meeting

ASCLS Region V Fall Symposium Sept 30-Oct 1, 2013

www.ascls-sd.org/region-v-meeting

ASCLS-SD & CLMA

2013 Fall Conference

November 7-8, 2013 Rapid City SD

www.ascls-sd.org/id71.html

My computer crashed. I went to public school. I have low self-esteem. I have an evil twin. You should have been more specific. There’s no evidence of wrongdoing on my part. You should be more accepting. Genetics. I was testing you. It was a cry for attention. In my homeland, this is acceptable behavior. The teacher hates me. I’ll never need this in the real world. There are no jobs out there anyway. I have problems at home. I need a miracle to pass and you won’t let me pray. I forgot my cheat sheet. I drank a slushy too fast and it froze my brain. I’m tired from playing midnight basketball. I’m Gen X. I didn’t want to seem too perfect. You’re thinking in black and white. Think in shades of gray.

How about some reasons for either not joining or renewing membership in ASCLS? No one appreciates me or the job I do. Money—I don’t have any. My work won’t pay for me to join. I just don’t see the value. I’m just a student. I don’t want to be involved. I plan to—just not right now. I don’t like politics.

Those are just a few. Here is my comeback: ASCLS and ASCLS-SD appreciates you and the job you do. In fact, your ASCLS

professional family may be the few people who really understand what it is that you do and how important it is.

Very few people have loads of money which I why you need to prioritize your spending. This is something that you can do for you. Think of it as a spa day

Once upon a time work used to pay some peoples due but I think that the people who remember those days are retired or nearly retired. Work rarely pays for anything extra any more—just get used to it.

Value is what you make it. There are plenty of networking, educational opportunities, perks, and leadership opportunities if you take advantage of them.

Transitioning from being a student to a first year professional is important to maintain your connectivity to other laboratory professionals.

You can be as involved as you wish. Some people are members for years without being on the board of directors or becoming more involved. Some people become members and get totally involved immediately. It is up to you.

I’m working on my procrastination issues—just you wait and see! (One of my new favorite sayings)

I don’t like politics either but they impact me every day. I think people shouldn’t complain unless they vote—very similar to involvement in Political Action Committees (PACs) with ASCLS. If you don’t like what the government is doing with

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ASCLS-SD Proudly

Recognizes It's New

Members!

Michael Weisenburg

Palmyra NY

Stefan Stinnett Brookings SD

Alison Slepikas Huron SD

Julie Nelson Plattsmouth NE

Donald Richards

Brookings SD

"Wishing You A Wondrous

& Professional Journey In

ASCLS!"

regard to reimbursement, you definitely need to either join or renew your membership in ASCLS and make you voice heard.

These are just a few reasons to either become a member or renew your membership . Please help me spread the word.

ASCLS Membership: Renew, Recruit, Rejuvenate! By: Shirley Heber, ASCLS-SD Incoming President

The Three “R’s – traditionally, this has been “Readin’, (w)Ritin’, (a)Rithmetic. But it’s 2013, and it’s time for three new ASCLS “R’s”……..

First, RENEWAL. Every year when you make the decision to renew your ASCLS membership, you are making a professional statement about who you are and what you believe. Belief in yourself as a laboratory professional, and belief in the importance of supporting this valuable career.

Secondly, RECRUITMENT. The most successful professions are those who continually push forward, advocating for themselves, their peers, and their future. In order to continue these efforts, increased membership in a laboratory professional organization is vital. Increased numbers assure increased voices – which can move our profession forward from whispered requests to clearly voiced opinions, resulting in successful action and activity.

Lastly, REJUVENATE! Membership in a professional society guarantees action, activity, and a network of friends. It is not only a desire, it is a necessity to share our opinions, experiences, laughter and fun with other laboratory professionals who can relate to our daily lives.

Take this opportunity to renew your ASCLS membership. Go to www.ascls.org and click on Membership Info and renew today. And while you are renewing, invite a professional friend to join!

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Legislative Symposium 2013 - A report from your delegation By: Richard Kipena, ASCLS-SD Student Forum Rep 2012-13 & Legislative Symposium attendee This year’s Legislative Symposium was another successful venture to Capitol Hill to present the key issues facing clinical laboratorians to our congressional representatives. The ASCLS-SD members representing our PROFESSIONAL VOICE at this year's event were: Tanya Crockett, Tami Svatos, Stephanie Bonnertz, and myself. We met with each congressional representative’s legislative aides, and even got a surprise visits from Rep. Thune and Rep. Noem during our meetings with their offices! The main concerns that were brought to the tables of the legislators concerning our profession included clinical laboratory payment cuts (and revision of the fee schedule), the ever-present workforce shortage, and expressing the importance of our profession to the public.

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Government

Affairs & Reimbursement

Hot Topics! The potential impact for our laboratories

from these hot topics could be devastating!

OIG Special Report 6/10/13: COMPARING LAB TEST PAYMENT RATES - MEDICARE COULD ACHIEVE SUBSTANTIAL SAVINGS

Summary: State Medicaid plans and federal employee health plans paid between 18% and 30% less than the Medicare Clinical Laboratory Fee Schedule paid for the top 20 clinical laboratory tests in 2011.

This special report estimates that Medicare could have saved $910 million by paying health care providers at the lowest of the surveyed rates. The report recommends that the Centers for Medicare & Medicaid

The workforce shortage is perhaps the topic that made the greatest impact during our visits. We asked our representatives to re-authorize the Workforce Reinvestment Act, which would allow for the allocation of roughly $2.6 billion to the maintenance and development of health related workforce programs, such as clinical laboratory training programs, as one example. The importance of the shortage lies in the statistics; approximately 40% of the current laboratory practitioners will retire within the next ten years. We must train at least 11,000 new professionals every year, but are only educating less than half to meet the need! These numbers helped emphasize the importance of our services to the health care system, and opened a door for representatives to advocate for the profession on our behalf.

Another hot issue this year was the implications that the laboratory reimbursement cuts have on our profession. Health care reform has led to a 1.75% cut each year to the Part B Clinical Lab Fee schedule, in addition to productivity adjustments. This totals to almost 20% in reductions to the clinical laboratory in the next few years! Tangential to the reimbursement topic, we also requested that Congress look at modernizing the clinical laboratory fee schedule that was established back in 1984 – this is to reflect routine testing done today and to alleviate the increasing costs in molecular diagnostic testing currently.

The 2013 Legislative Symposium provided a greater insight to the current issues we are facing as a profession. Despite our attendance and voicing our concern, we should still expect to see these issues in future symposiums, and until then we will continue to storm Capitol Hill every year to remind them!

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ASCLS Region V Student Forum: A Challenge for Students! By: Karen Larson, Region V Student Forum Rep

Many of you have just graduated. Some of you will be heading into your last year and getting ready to start your clinical internships. No matter where you are in your laboratory education, it’s an exciting time to be a student! This is also the very best time to start getting more involved in ASCLS. Why not become more involved now while you’re just beginning your career? If you find it to be a rewarding experience like I do, you’ll have that many more years left to make a difference and get involved. The reason ASCLS is such a successful society is entirely because of its members. That includes you! By working on one of the many committees, serving in one of the numerous leadership roles, or volunteering your time at one of the countless events, you’ll be benefiting not only ASCLS, but yourself as well. You’ll have the chance to meet other professionals who can advise you as mentors, it will give you experiences to talk about during job interviews, and it will lead to many long-lasting professional friendships.

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Services seek legislation that would allow it to set lower payment rates for tests under the fee schedule, and consider legislation to allow copayments and deductibles for the tests. In the report, CMS said it is exploring whether it has authority under the current statute to revise payments for laboratory tests. To access the complete report and identify which tests were included in the study visit: http://oig.hhs.gov/oei/reports/oei-07-11-00010.asp

AETNA National Contract Default Fee Schedule Effective 7/1/13: SLASHES REIMBURSEMENT FOR 39 CLINICAL LABORATORY TESTS & 8 ANATOMIC PATHOLOGY TESTS Aetna’s default fee schedules will lower reimbursement amounts dramatically for 47 targeted lab tests. The new reimbursement rates are set at approximately 45-50% of the current Medicare National Limit on the 2013 Clinical Laboratory Fee Schedule. It has been

When I first accepted the Region V Student Representative position and the Minnesota Student Forum Chair position, I didn’t really know what I was getting into. I knew that I would enjoy representing other students, but I didn’t know what my responsibilities would be or if I would be good at the job. What I’ve found is that as long as you step up and show a desire to volunteer your time and skills, you’ll be successful! There have been many other active members who have helped guide the way for me this past year. They’ve taught me what has worked in the past and encouraged me to pursue the new ideas I’ve brought with me. My challenge to you as students is to work towards becoming more active ASCLS members! With the new ASCLS year starting at the end of July, there are many opportunities for you to get involved. Contact your leaders now to see how you can help support your society. It’s sure to be a rewarding experience! Don't forget! If you've graduated, renew your ASCLS membership as a First Year Professional... an exciting professional journey in ASCLS awaits you! ASCLS-SD President Elect, Shirley Heber: sheber@sio.midco.net ASCLS Region V Director, Deb Rodahl: drodahl@earthlink.net ASCLS President Elect, J.R. Constance: jrc@rodricon.com

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Microbiology Scientific Assembly: The Rising Cost of Biofilms By: Melissa Saxlund, ASCLS-SD Microbiology SA Chair 2012-2013

First of all, what is a biofilm? A biofilm is a formation of cells that are irreversibly linked and enclosed in a polysaccharide matrix made up of gram positive, gram negative, yeast or fungal species. Biofilms can be found throughout

nature, our homes, and our bodies. Biofilms cannot be removed by gentle rinsing which makes them difficult to eradicate.

Biofilms can build up on a number of implanted medical devices, including venous and urinary catheters, mechanical heart valves, pacemakers, contact lenses, endotracheal tubes, and intrauterine devices. Biofilms are able to more readily attach to hydrophobic, nonporous surfaces such as Teflon and plastics. Our bodies produce a number of conditioning films to add attachment of bacteria, yeast, and fungi to biomaterials. These include blood, tears, urine, saliva, intravascular fluid, and respiratory secretions. The most common biofilm found is the one that develops on your teeth. Oral biofilms can be the causative agents in ventilator-associated pneumonia and bacterial endocarditis. There are several characteristics of biofilms that are important in the infectious disease process. First, the detachment of biofilm cells or aggregates may produce a bloodstream or urinary tract infection and can also result in emboli. Second, the biofilm may also share plasmids resulting in increased antimicrobial resistance. Third, gram negative biofilms are also capable of producing endotoxins. These endotoxins are capable of crossing dialysis membranes and forming biofilms on hemodialysis tubing. Fourth, biofilms which develop on indwelling devices can also overcome the host immune system to cause localized or bloodstream infections. Finally, biofilms can become resistant to host immune system clearance. The structure of the biofilm can prevent antibodies from reaching the cells to destroy them, allowing an infection to develop.

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reported that some of the tests included in the 'slashed fee schedule' include: PAP smears, metabolic, liver, lipid, general health panels, PSA, thyroid tests, Urinalysis, iron studies, protime, etc. (if it's one of your top volume routine tests... you can bet it's on the list!) If you do not know whether this will impact your laboratory... be sure to ask your facility leaders.

TO QUOTE SOME OF OUR LABORATORY

INDUSTRY LEADERS...

Laboratory medicine is under siege!

We cannot afford to hide our heads in the

sand!

We must UNITE in our professional

organizations, within our institutions and

within our health systems!

We must be willing to

speak out and be advocates for our profession & our

services!

Ultimately laboratories have the potential to close and our patients may not

have access to the quality services they

deserve!

The cost of biofilms to hospitals and nursing homes can be staggering. One of the top five leading causes of death in the United States is hospital-acquired infections. Biofilm infections account for approximately 80% of hospital-acquired infections and cost upward of $11 billion dollars each year. Also contributing to the rise in healthcare costs are the drug-resistant bacteria which include biofilms. It is estimated that the drug-resistant bacteria cost an estimated $20 billion a year in healthcare costs and account for an additional 8 million days spent in the hospital.

References:

http://science.howstuffworks.com/life/cellular-microscopic/biofilm4.htm , May 1, 2013

http://www.infectioncontroltoday.com/topics/biofilms.aspx , May 2, 2013

Donlan, RM. Biofilms: Microbial Life on Surfaces. CDC 2002: Vol 8, No 9.

http://www-03.ibm.com/press/us/en/pressrelease/40188.wss, May 9, 2013

http://long-term-care.advanceweb.com/Editorial/Content/PrintFriendly.aspx?CC=198987

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Immunology Scientific Assembly: Newborn Screening for Severe Combined Immunodeficiency (SCID) By: Alison Albertson, Immunology Scientific Assembly Chair 2012-13 Similar stories have been shared, state by state, by parents recommending the adoption of newborn screening for SCID. Heather, a mother from Florida, shared the story of her son Brandon (http://primaryimmune.org/idf-advocacy-channel) who seemed healthy and normal at birth. At 6 months of age a cold was followed by admission to the hospital. Brandon was placed on oxygen and later a ventilator. Eventually through a skin biopsy they determined Brandon had SCID. Unfortunately, at the time of diagnosis he was too ill for a bone marrow transplant and did not survive. A second pregnancy for this family was much different. Heather, knowing she was a carrier of this gene and the possibility of a second child with SCID (it was x-linked) was prepared. At 10 weeks gestation, CVS (chorionic villus sampling) testing was done with the discovery that their second child, a boy, also had SCID. Their doctor offered them the option of bone marrow transplant in utero with a successful outcome. Their son Taylor showed no signs of SCID, and as a teenager continues to do well.

According to the Immune Deficiency Foundation, there are 17 known genetic causes of SCID, the most common being x-linked. The incidence of SCID is thought to be 1 in 50,000 – 100,000. SCID is caused by the lack of T cells which will affect the function of B cells (SCID can also be due to lack of T and B cells). Due to a compromised immune system, the child will suffer life-threatening bacterial, fungal and viral infections. Treatment options include bone marrow or hematopoietic stem cell transplant, enzyme replacement therapy (in ADA SCID) and gene therapy. Bone marrow or stem cell transplants are most effective if given in the first 3 months of life, before infections develop.

TREC (T cell Receptor Excision Circles) is the newborn screening test used. DNA is extracted from the dried blood spots and Real Time PCR is used to detect T cell receptor gene excision circles. In SCID, the TRECs will be absent or severely reduced. This test has been found to be very sensitive and has a false positive rate of less than 1%.

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ASCLS-SD Supports 2013

Regional Science Fairs

Budding scientists across the region prepare projects each spring for judging at a number of regional Science Fairs. ASCLS-SD is proud to sponsor annual awards in recognition of projects that best represent the field of clinical laboratory science.

Congratulations to the following

2013 award winners:

High Plains Science and Engineering Fair

(SDSMT) Daniel Hollibaugh -“Toilet Cleanliness”

South Central Science and Engineering Fair

(DWU): Aspen Bechen and

Miranda Goldammer - “Antimicrobial

Properties of Allium Sativum and Zingiber

Officinal”

Eastern SD Science and Engineering Fair

(SDSU): Emma McInerney and Samantha McInerney -

“Achoo!”

In May 2010, Kathleen Sibelius, Secretary of Health and Human Services recommended all states adopt newborn screening for SCID. According to the Severe Combined Immunodeficiency website (http://www.scid.net/index.htm) the states currently performing newborn screening include WI, MA, NY, CA, CT, MI, CO, MS, DE, Puerto Rico, FL, TX & MN. South Dakota Department of Health is making efforts to move forward toward statewide SCID screening. Many thanks go to the families who have been instrumental in the push for the adoption of this screening test. Hopefully through their hard work more children will receive treatment before it is too late.

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Hematology Scientific Assembly: Peripheral Smear Findings - Infectious Mono vs. Acute Myeloid Leukemia By: Sheila Schneider, ASCLS-SD Hematology Scientific Assembly Chair 2012-13 Infectious mononucleosis (IM) also known as Epstein-Barr Virus (EBV) or as the “kissing disease” is characterized by fever, sore throat, and fatigue. The most common used diagnostic criteria is a moderately increased White Blood Cell count (WBC) of 16,000-20,000 and rarely goes above 35,000 with the presence of 50% lymphocytes with at least 10% atypical or reactive lymphocytes. The atypical lymphocytes commonly resemble monocytes, thus the term “mononucleosis” was coined. There are three types of reactive lymphocytes commonly seen in IM: The Downey I cell (small lymphocyte with lobed nucleus and scant cytoplasm). The Downey II cell (a large lymphocyte with copious cytoplasm that reaches out and abuts adjacent cells), and the Downey III cell (a large lymphocyte with finely reticular chromatin and abundant cytoplasm.) Acute myeloid leukemia (AML), also known as acute myelogenous leukemia, acute myeloblastic leukemia, and acute nonlymphocytic leukemia, is characterized by similar symptoms as IM, flu or other common diseases with the addition of bone pain, bruising and unusual bleeding. It is common for AML to present with an increased WBC count but the count can also be within the low to normal range. Decreased red cell and platelet counts are common. When completing the WBC differential it is common to see atypical white cells that may be myeloid blasts. Myeloblasts are the earliest precursors in the myeloid series. These are large cells with a high nuclear/cytoplasmic ratio and very fine chromatin, nucleoli are able to be seen and they sometimes contain unique structures called Auer Rods. Auer Rods are clumps of azurophilic granular material that form elongated needles that may be seen in the cytoplasm of blast cells.

If you have a blood smear with an elevated WBC and big, atypical cells with fine chromatin, it could be difficult to tell the two disease states apart. It is important when making the decision on how to classify cells that we take the following things into consideration.

1. WBC count: Infectious Mono: moderately elevated 16,000-20,000; rarely goes above 35,000 AML: may be markedly elevated 50,000-100,000; but remember the count may also be considerably lower

2. Cellular morphology:

Summer 2013 - Pg 11

Northern SD Science and Mathematics Fair

(NSU): Mikinze Jones -

“Which Acne Medication(s) actually

“zap” those zits?

Eastern SD Winners: Emma and Samantha

South Central SD Winners:

Aspen and Miranda

(Pictures not submitted for High Plains or Northern Regions)

2013 ASCLS-SD Award Winners!

'Member of the Year'

Renee Rydell

'New Professional of the Year'

Katharine Pieschke

(continued next page)

Infectious Mono: lymphocytes are generally pretty heterogeneous. There are usually a lot of Downey II cells, with smaller numbers of Downey I and Downey III cells. AML: Blast-like cells will be seen (at least 20% of the nucleated cells in the blood or bone marrow must be blasts in order to call it AML). There are different types of AML. AML-M1 is composed almost completely of myeloblasts where as AML-M3 is primarily promyelocytes and AML-M5A is monoblasts. Homogeneous appearing blasts as opposed to the heterogeneous appearing lymphocytes in IM.

3. Auer Rods: Auer Rods are only found in malignant myeloid cells (almost always in myeloblasts.) So if you see an Auer Rod you know that you are usually dealing with an acute myeloid leukemia.

Note: In AML, additional diagnostic testing such as bone marrow aspiration/analysis, flow cytometry etc., will be required. In IM, additional diagnostic testing such as Epstein Barr Virus testing will be required.

Remember, as a medical laboratory professional, your 'hematologic eye, result assessment and attention to detail' can make a difference in the rapid diagnosis and treatment of both IM or AML!

References: Wikipedia pathologystudent.com mayoclinic.com

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Immunohematology Scientific Assembly: Granulocyte Transfusion By: Becky Aman, ASCLS-SD Immunohematology Scientific Assembly Chair 2012-13 Patients with extreme neutropenia may be candidates for granulocyte transfusion. Neutropenia can be caused by aggressive chemotherapy, stem cell transplantation, bacterial or fungal infections. Adults should be considered for granulocyte transfusion if they are profoundly neutropenic (<500/uL), the neutropenia is expected to persist for >/= 1 week, their infection is unresponsive to anti-microbial therapy and the patient has the possibility of their own recovery of granulocyte production. Septic neonates with neutrophil counts of <3000/uL and a diminished PMN storage pool should also be considered.

Granulocytes are collected using apheresis after the donor has been stimulated using granulocyte colony stimulating factor (G-CSF) and/or prednisone or dexamethasone. Optimum collection is achieved 8 hours after stimulation. Donors are given hydroxyethyl starch(HES) to aid in the separation of residual red blood cells from the granulocyte product. The final product is stable for 24 hours at room temperature without agitation. The product contains approximately 30 mL of red blood cells and 6 unit equivalents of platelets. AABB standards require that 75% of granulocytes components collected contain a minimum of 1.0 of 1010 granulocytes.

Donors must fulfill all the requirements of whole blood donors. In addition, since platelets are removed during collection, a platelet count of > 150,000 uL is recommended. Since the product contains >2 mL of red blood cells, standards require that the product be crossmatch compatible. If the recipient is CMV negative, the donor should be screened for CMV. Alloimmunized donors must receive HLA compatible product.

Adverse effect can be seen in both donor and recipient. Adverse events in recipients include transfusion reaction, hypoxia and pulmonary reactions, alloimmunization, CMV infections or

Summer 2013 - Pg 12

'Student of the Year'

Matthew Aas

'Keys to the Future' Brendon Sato

Jody Thompson

'Omicron Sigma National'

Pam Kieffer Pat Tille

Lezlee Koch

'Omicron Sigma Region V'

Tanya Crockett Katie Pieschke

Michelle Friesen Robert Jenson Susan Lopez

'Omicron Sigma State' Renee Rydell

Mona Gleysteen Stephanie Bonertz

Heather Hall Doris Heilman Deb Pravecek Bernie Reddy Tami Svatos

2013 Professional

Recognition Awards

65 Years!!! Marjorie Schrag

graft vs. host disease. Donors may experience hematoma, citrate toxicity or vasovagal symptoms as a result of apheresis. Donors may also experience changes in coagulation or anaphylactic reactions due to HES administration. Administration of G-CSF may result in side effects ranging from mild (bone pain, headache, myalgia, fever etc) to severe (splenic rupture, retinal hemorrhage, gouty arthritis or thrombotic events).

References: Henry JB (ed.) Clinical Diagnosis and Management by Laboratory Methods, 20th edition. New York: WB Sanders Company. 2001 pp776-805. Winters, Jeffrey L, Consultant: Division of Transfusion Medicine Mayo Clinic and Mayo Foundation, Rochester MN

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2013 ASCLS-SD Annual Meeting Summary Report By: Pam Kieffer, ASCLS-SD Secretary/Treasurer 2012-13

The ASCLS-SD Annual Spring Business Meeting was held in Yankton on April 9th. Robert Jenson, President of ASCLS-SD presided. The 2012-2013 Board of Directors were introduced and recognized. 2012 Annual Meeting minutes/2012-2013 Treasurer’s report presented and approved. President Jenson presented national, regional, and state annual highlights including:

ASCLS Strategic Initiatives and Actions for 2012-2013; Membership update which included concern over decreasing number of members; It was noted that in Region V, SD was the only state having an increase in membership of 7.3%. Way to go ASCLS-SD!

ASCLS-SD Elections: The 2012-2013 candidates were presented by Deb Pravecek: President Shirley Heber; 1st Vice President Pat Tille; 2nd Vice President Bernie Reddy; Board Members-at-Large: Tanya Crockett & Stacie Lansink; New Professional-at-Large Katherine Pieschke; Nominations Committee: Deb Pravecek, Lezlee Koch. No additional nominations from floor; motion was made to approve candidate slate by acclamation

2013 Scholarship Recipients: Amanda Graves, Stefan Stinnett, and Heather Halsey 2013-14 ASCLS-SD Student Forum Rep was announced: Amanda Graves 2013 Awards were presented (see side bar of this issue)

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ASCLS-SD Strategic Initiatives & Collaboration Activities

Student & New Professional Task Force: Successful scholarship fundraising event held at the spring meeting in Yankton; thank you to all the donations and participants!

Leadership Development Task Force: ASCLS Region V Tri-State Leadership Academy will kick off with the first class beginning at the fall 2013 ASCLS Region V Tri-State meeting! Student selection is in process.

2013 Fall Collaborative Conference: ASCLS-SD and CLMA Siouxland continue to work on the production of this falls meeting which will be held November 7-8 in Rapid City

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Summer 2013 - Pg 13

35 Years Mona Gleysteen

25 Years Sheri Allen Mary Parr

20 Years Alison Albertson Warren Erickson

10 Years Glenna Clement

5 Years Deniz Blankenfeld

Melissa Haag Nichole Holroyd

Janice Maag Kelly Odens

LeAnn Richardson Lynne Smith

Cheryl Wildermuth

2 Years Matthew Aas

Stephanie Allison Jennie Barents

Melissa Blackburn Ashley Bush

Bill Grefe Taylor Hausmann Amanda Howard Richard Kipena

Amanda Kronberg Lacey Lane

Alexandra Mammenga Glen San Juan

Kassandra Sheridan Sara Smith

Mike Whisler

2013 MLS

Scholarship Winners

Amanda Graves Stefan Stinnett Heather Halsey

ASCLS-SD Proudly Introduces: Stacie Lansink

2013-15 New ASCLS-SD Board Member-at-Large

Amanda Graves 2013-14 New ASCLS-SD Student Forum Rep

Stacie Lansink MT(ASCP) Stacie is proud to be one of the MLS program instructors at SDSU, Brookings SD. She obtained her MLS degree at Univ. of Nebraska Medical Center, Omaha NE, completed her internship at Nebraska Methodist Hospital in Omaha and is now working to complete her masters in MLS from UND, Grand Forks ND. She started her professional career at Sioux Valley Memorial Hospital in Cherokee IA, moved to Sioux Falls and worked at Avera McKennan Hospital and University for 10 years where she served as the Clinical Education Coordinator for 6 years.

When asked what some of her professional beliefs were, Stacie shared, " I feel that because we are behind the scenes, that we sometimes are not given due credit. As a healthcare professional, it is our responsibility to provide the most reliable results for the patient to be correctly diagnosed and treated properly. We are the heroes behind the scenes and when people ask what I do, I ask if they have ever had their blood drawn and I tell them that we are the ones that provide your physician with the results they need. Then the questions begin about laboratory tests and they realize there is someone just as knowledgeable about medicine as their physician."

Amandalynn Graves “I feel I am living proof that you can go back and achieve your dreams at any age.” This profound statement was made by Amandalynn Kacy Graves, recently appointed as Student Forum Representative for ASCLS-SD. Amandalynn is a non-traditional student, and recently completed her junior year at South Dakota State University, majoring in Medical Laboratory Science. She plans to complete her internship in the spring of 2014 at Rapid City Regional Hospital. Amandalynn shared “As a Clinical Laboratory Professional you are the backbone of the healthcare system; you are assisting a doctor in learning what is wrong with a patient. The healthcare world would not survive without Medical Laboratory Scientists. “ Amandalynn traveled to an ASCLS national meeting several years ago, where she presented research for Staphylococcus and the formation of Biofilm. This trip piqued her interest in the field of laboratory science, as well as ASCLS. Amandalynn stated “I decided to join ASCLS to meet people from around the United States that enjoy and love science as much as I do. I decided to apply for Student Forum Representative to help students within the state realize how important our field is and how important it is that they become an active member of our community. I want them to realize that even as students they still have a voice within the community of Medical Laboratory Science. It is important to get involved with the groups that support the profession; not only does this help to ensure that you keep current on all the new and exciting things happening in the medical field but it also allows you to connect with such a vast group of people that love the same things you love.” In her spare time, Amandalynn enjoys spending time with her husband and their dogs as well as performing research under Dr. Pat Tille’s direction.

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Summer 2013 - Pg 14

MEETINGS YOU WON'T WANT TO MISS! MARK YOUR CALENDAR NOW

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Summer 2013 - Pg 15