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Advances in Clinical Laboratory Hematology. The twenty-third Arnold O. Beckman Conference in Clinical Chemistry.

The Beckman Conference began in 1977 with the purpose of educating both clinical chemists and clinicians. The 23rd annual Arnold O. Beckman Conference was held on February 6 and 7, 2000, in Miami, Florida. As in the past, the goal of this year's conference was to strengthen attendees' knowledge in an area of clinical medicine.

Acknowledgment and Opening of the A. 0. Beckman Coherence

Frank A. Sedor, PhD, AACC president, opened the Conference. He stated, "We are here because Dr. Arnold O. Beckman had the foresight and exercised it in his generosity to provide for a meeting to target improvement in healthcare and in professional growth of clinical chemistry. It is a tribute to his foresight that this year's Conference addresses 'Advances in Clinical Laboratory Hematology'. The melding of the roles of once disparate laboratory specialists into Clinical Laboratory Scientists is reflected in the topics to be addressed over the next 2 days. As we build on the twin strengths of our profession, science and technology, we see the artificial walls that once separated laboratory areas crumble. They crumble to the benefit of healthcare and as a paean to the advances in scientific discoveries of the last 20 years". As condition of the gift from the Arnold and Mabel Beckman Foundation, AACC disseminates the conference proceedings by publishing them in Clinical Chemistry.

After Dr. Sedor's introduction, I briefly reviewed both Dr. Beckman s history and the conference history. Additional information is available on the Web (1) and in this Journal (2, 3).

2000 Conference Summary

The conference committee chose clinical hematology because many clinical chemists have expanded roles in the modern clinical laboratory. Often the management of "wet" hematology is included in these new roles. The conference was divided into four sessions: clinical hematology, white cell hematology, coagulation and transfusion medicine, and red cell hematology. In addition to the formal presentations, the participants attended two case study sessions.

The clinical hematology session started with a presentation by Dr. Patrick C. J. Ward (University of Minnesota at Duluth, Duluth, MN) on the complete blood count and evaluation of the peripheral smear. He reviewed the spectrum of cell counters available in 2000 and the morphology of blood cells, and predicted the direction of instrumentation. Carl T. Wittwer, MD, PhD (University of Utah, Salt Lake City, UT) next discussed the principles and new technology of flow cytometry. In addition to reviewing the physics of these instruments and some common techniques, such as CD4 counts and leukemia/ lymphoma phenotyping, Dr. Wittwer discussed two novel applications in testing for paroxysmal nocturnal hemoglobinuria and feto-maternal hemorrhage. Dr. D. Brian Dawson (University of Texas Southwestern Medical Center, Dallas, TX) reported on the molecular pathology of clinical hematology. He reviewed three topics: (a) the application and limitation of Southern blotting and PCR for detecting monoclonality in leukemias/lymphomas; (b) methods for detecting minimal residual disease; and (c) association of viral infections with specific hematologic disorders.

White cell hematology was the subject of the second scientific session. Dr. Stanley S. Levinson (University of Louisville, Louisville, K1') reviewed paraproteins, the monoclonally derived immunoglobulins seen in some hematologic malignancies. He began by reviewing the structure and production of immunoglobulins and progressed to the classification and identification of monoclonal gammopathies. The second presentation was by Dr. Roy D. Baynes (Karmanos Cancer Institute and Wayne State University, Detroit, MI), who covered bone marrow and stem cell transplantation. The review was divided into topics by the relatedness of the donor: autologous, syngeneic, related allogeneic, unrelated allogeneic, and xenogeneic. The last talk of this session was on the classification of leukemia/lymphoma by Dr. Robert W. McKenna (University of Texas Southwestern Medical Center, Dallas, TX). Whereas past classifications were based on morphologic criteria, the use of immunophenotyping, cytogenetics, and molecular analysis has led to a more detailed and organized classification scheme.

The third session reviewed coagulation and transfusion medicine. The bleeding disorders were covered by Dr. Douglas A. Triplett (Indiana University School of Medicine, Indianapolis, IN). Dr. Triplett reviewed the process of vessel wall injury, platelet adhesion, and formation of fibrin to produce hemostasis. His presentation also covered the coagulopathies and common laboratory tests for monitoring hemostasis. Speaking next, Dr. George (Bo) H. Goldsmith (University of Louisville, Louisville, KY) reviewed the laboratory evaluation of hypercoagulable states. His talk included newly identified diseases, such as activated protein C resistance, hyperhomocysteinemia, and prothrombin G20210A. Finally, Dr. Paul M. Ness (Johns Hopkins University, Baltimore, MD) updated the conference attendees on transfusion medicine. In addition to basic transfusion medicine, Dr. Ness predicted advances in four areas: automated blood screening and patient testing, chemical inactivation of infectious agents, cleaving ABO antigens from red cells, and chemicals that can substitute for hemoglobin.

The last scientific session was composed of three presentations on red cell hematology. Dr. George G. Klee (Mayo Clinic, Rochester, MN) reviewed vitamin [B.sub.12], folate, and homocysteine, including a laboratory cascade for diagnosing pernicious anemia. Next, Dr. Judith Andersen (Wayne State University, Detroit, MI) gave a clinician-scientist's perspective on anemas. Her presentation covered the erythron, anemia classification, diagnosis, and nonhematologic consequences of anemia. Lastly, a physician-clinical chemist team, Dr. Gwen Clarke and Trefor Higgins (Dynacare Kasper Medical Laboratories and University of Alberta, Edmonton, Alberta, Canada) reviewed hemoglobinopathies. This presentation exemplified the importance of clinical hematology for clinical chemists and other clinical laboratory scientists. The use of HPLC has streamlined the diagnostic strategy of these inherited disorders.

The conference attendees and speakers participated in two case study sessions, one each day. Speakers Ward, Triplett, Clarke, and Higgins provided and discussed hematology cases. Additional cases were provided by Beckman committee members Martin H. Kroll, MD, and Ronald J. Elin, MD, PhD.

I could not have chaired the 2000 conference without the generous contribution of time and able knowledge of my fellow committee members: Ronald J. Elin, Joseph H. Keffer, Michael Kleerekoper, and Martin H. Kroll. Their pleasant cooperation, dedication to recruiting superb speakers, and broad knowledge of clinical laboratory medicine were essential for the successful planning of this conference. A special thanks goes to Lisa Dunay from the AACC office.

References

(1.) Beckman Coulter. The Arnold 0. Beckman story. http://www. beckman.com/beckman/gen-info/foundr.asp.

(2.) Anonymous. Arnold 0. Beckman to receive 1999 Public Welfare Medal. Clin Chem 1999;45:445-8.

(3.) Ashwood ER. Acute coronary syndromes: from bench to bedside. The twenty-first Arnold 0. Beckman Conference in Clinical Chemistry. Clin Chem 1998;44:1795-7.

Edward R. Ashwood

Department of Pathology, University of Utah School of Medicine, ARUP Laboratories, Inc., 500 Chipeta Way, Salt Lake City, UT 84108. E-mail ashwood@med.utah.edu.

Received May 22, 2000; accepted May 22, 2000.
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Title Annotation:Beckman Conference
Author:Ashwood, Edward R.
Publication:Clinical Chemistry
Article Type:Conference notes
Date:Aug 1, 2000
Words:1104
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