TABLE OF CONTENT To edit
TITLE PAGE NO
WELCOME MESSAGES 3
4
TIMBALAN KETUA PENGARAH KESIHATAN (PERUBATAN) 5
KETUA PERKHIDMATAN PATOLOGI KEBANGSAAN 6
PENGERUSI PERSIDANGAN PATOLOGI KEBANGSAAN (NPC) 2019 7
FLOOR PLAN 8
GENERAL INFORMATION 9-10
ORGANIZING COMMITTEE 11-17
SCIENTIFIC PROGRAMME 18-20
SPEAKER'S PROFILE 21-28
LECTURE SUMMARY : PLENARY 30-52
LECTURE SUMMARY : BREAK UP SESSION 53
POSTER ABSTRACT
ACKNOWLEDGEMENT
2
KATA-KATA ALUAN TO EDIT
TIMBALAN KETUA PENGARAH KESIHATAN (PERUBATAN)
Syabas kepada pihak penganjur atas usaha gigih menjayakan NATIONAL PATHOLOGY CONFERENCE
2019 bertemakan “DEDICATED TO DISCOVERY, COMMITED TO CARE”. Sekalung tahniah juga
diucapkan kepada Perkhidmatan Patologi Negeri Johor yang bekerjasama rapat dengan Persatuan
Patologi Johor kerana telah berjaya melaksanakan mandat yang diberikan oleh Ketua Perkhidmatan
Patologi Kementerian Kesihatan Malaysia (KKM). Program ini berjaya mengumpulkan ahli-ahli
patologi dalam pelbagai disiplin dari seluruh negara bagi memberi pendedahan dan pendidikan
berterusan kepada warga kerja bidang kesihatan khususnya yang melibatkan perkhidmatan Patologi.
Perkhidmatan patologi ini adalah salah satu bidang pengkhususan yang penting dalam diagnosis dan
perawatan pesakit, termasuk juga dalam aspek pencegahan penyakit. Justeru itu, adalah diharapkan
konferens kali ini dan yang akan datang, sepatutnya menjadi wadah memperbaiki diri dan dapat
mempertingkatan kualiti perkhidmatan khususnya kepada pesakit dan seluruh rakyat amnya. Kepada
semua peserta, sila ambil peluang keemasan ini dalam menimba ilmu dan memotivasi diri dalam
memperbaiki kemajuan kerjaya. Ingatlah, mencari ilmu ini tidak akan berhenti sehingga ke akhir
hayat.
Adalah menjadi harapan agar program NATIONAL PATHOLOGY CONFERENCE 2019: DEDICATED TO
DISCOVERY, COMMITTED TO CARE, yang disokong oleh kementerian Kesihatan Malaysia dan
Perkhidmatan Patologi KKM dapat membantu meningkatkan lagi kualiti perkhidmatan Patologi ke
aras lebih tinggi dalam menyediakan kemudahan kesihatan kepada rakyat. Semoga usaha murni ini
akan terus berjaya pada masa akan datang.
Sekian terima kasih.
YBhg. Datuk Dr. Hj. Rohaizat Bin Hj. Yon 3
Timbalan Ketua Pengarah Kesihatan (Perubatan)
Kementerian Kesihatan Malaysia
KATA KATA ALUAN
KETUA PERKHIDMATAN PATOLOGI KEBANGSAAN
Persidangan Patologi Kebangsaan merupakan acara tahunan yang menjadi komitmen Perkhidmatan
Patologi Kebangsaan bagi memastikan warga Patologi sentiasa mengikuti perkembangan terkini dari
segi pengetahuan dan kemahiran diagnostik yang seiring dengan keperluan perkhidmatan perubatan
dan kesihatan.
Tahun ini Perkhidmatan Patologi Negeri Pulau Pinang telah diberi peluang untuk menjadi tuan rumah
bagi menganjurkan persidangan Patologi Kebangsaan. Saya ingin mengucapkan tahniah dan syabas
kepada Jawatankuasa Penganjur di bawah pimpinan Dr Ida Marhainis Binti Isahak atas kejayaan mere-
ka menganjurkan persidangan ini.
Tema yang telah dipilih untuk persidangan kali ini adalah “ Embracing Pathology Innovation In The
Digital Era” . Tema ini adalah bertepatan dengan aliran (trend) senario perubatan yang sangat yang
semakin beralih ke era teknologi yang canggih. Sekiranya aliran perkhidmatan Patologi yang ditawar-
kan tidak sejajar dengan aliran penjagaan kesihatan semasa, maka dikhuatiri perkhidmatan Patologi
tidak akan relevan lagi pada masa akan datang.
Saya berharap segala maklumat dan pengetahuan yang dibentangkan dalam persidangan ini dapat
membantu dalam mengembangkan potensi diri dan mencetuskan idea-idea baru yang bermanfaat bagi
menyumbangkan kepada perkembangan perkhidmatan Patologi yang sedia ada.
Semoga perkhidmatan Patologi yang diberikan nanti boleh mencapai tahap yang membanggakan. Akhir
kata, saya ingin merakamkan setinggi-tinggi penghargaan kepada semua pihak yang telah membantu
menganjurkan persidangan ini secara langsung atau tidak langsung.
Terima kasih.
Dr Arni Talib
Ketua Perkhidmatan Patologi Kebangsaan
Kementerian Kesihatan Malaysia
4
KATA KATA ALUAN
PENGERUSI PERSIDANGAN PATOLOGI KEBANGSAAN (NPC) 2021
Dengan Nama Allah Yang Maha Pemurah dan Maha Pengasih
Assalamualaikum dan selamat sejahtera
AlhamdulilLah, sekali lagi acara tahunan Persidangan Patologi Kebangsaan dapat diadakan. Kali per-
tama acara seumpama ini telah diadakan di Negeri Johor pada 10 tahun yang lepas. Kali ini giliran
Negeri Pulau Pinang mengendalikan buat kali pertama dengan kerjasama Jabatan Kesihatan Negeri
Pulau Pinang.
Persidangan seperti ini sentiasa memberi peluang kepada ahli pelbagai disiplin patologi untuk
berbincang dan mempertingkatkan pengetahuan yang berkaitan aspek perkhidmatan diagnostik dan
perkembangan teknologi terkini. Peluang juga dibuka bagi hasil kajian dibentang dan dikongsi untuk
kebaikan bersama Tema yang dipilih iaitu “Embracing Pathology Innovation In the Digital Era” diharap-
kan dapat memenuhi objektif dan matlamat perkhidmatan patologi kebangsaan yang selama ini
menekankan kualiti penjagaan pesakit melalui keputusan diagnostik yang tepat dan pantas serta khid-
mat konsultasi kepakaran secara berterusan.
Disini saya ingin merakam ucapan jutaan terima kasih kepada ahli jawatankuasa Persidangan Patologi
Kebangsaan 2021 atas sumbangan masa, idea dan tenaga untuk program ini.
Saya ingin juga mengambil peluang di sini mengucapkan setinggi penghargaan kepada pihak Kemen-
terian Kesihatan Malaysia dan Perkhidmatan Patologi Kebangsaan atas sokongan yang diberikan untuk
menjayakan persidangan ini.
Penghargaan saya juga kepada pihak yang menyumbang dalam bentuk yang berbagai termasuk
mengambil bahagian dalam pameran dan ceramah sepanjang persidangan ini.
Akhir sekali saya mendoakan kesejahteraan semua penceramah dan peserta yang telah sama-sama
datang untuk menjadikan persidangan ini satu realiti. Semoga mendapat manafaat bersama.
Sekian, terima kasih.
Dr. Ida Marhainis Binti Isahak
Pengerusi Persidangan Patologi Kebangsaan (NPC) 2021
5
ORGANIZING COMMITTEE 8
Chairman
Dr Ida Marhainis Isahak
Vice Chairman
Dr Hairuhasliza Harun
Secretary
Dr Tuan Hulwani Tuan Muhammad
Pn Nor Fasihah Yahaya
Treasurer
Dr Farisyah Syakirah Mohd Zain
Scientific Committee
Dr Nabeelah Abdul Khalid
Dr Nor Ayuni Khuzaimah
Dr Noor Shaidatul Akmal Ab Rahman
Dr Noor Bayani Che Muda
Dr Lim Chee Hoe
Dr Siti Hawa Hamzah
Dr Woo Yen Yen
Dr Siti Norsuhada Mua’ainue Deen
Pn Nurizal Md Zaid
Dr Ng Pui Foong
Dr Siti Atiqah Halim,
Cik Nurul Syuhada Ibrahim
Dr Nur Anisa Mohamed Haniffah
Corporate Committee
Dr Noria Abdul Mutalib
Dr Mohd Jamsani Mat Salleh
Dr Faridah Mohamad Taib
Hj Sairi Satari
Pn Rohayati Mohd Napiah
Pn Jacklin Anak Suloon
Poster
Dr Nurull Eddayu Hasbullah
Dr Teoh Pak Inn
Dr Mariani Hashim
IT/ Technical/ /Multimedia
Dr Justin Tan Tay Eng
Pn Siti Nordiyanah Zaharin
Dr Divagar Varatha Raju
Promotion
Dr Nazri Abdul Muthalib
En Kesavan Veeraswamy
Pn Saw Ai Kim
Registration
Dr Nurul Atiqah Ahmad Zaidi
Dr Malisalaora Mohamed
Dr Kaveta Balasubramaniam
SCIENTIFIC PROGRAMME
NATIONAL PATHOLOGY CONFERENCE “EMBRACING PATHOLOGY INNOVATION IN THE DIGITAL ERA” ,
VIRTUAL EVENT
17th-18th AUGUST 2021 (TUESDAY & WEDNESDAY)
Day 1 (17th August 2021, Tuesday)
TIME PROGRAMME
8.00 am – 8.30 am Registration
8.30 am – 8.35 am
Opening Remarks
8.35 am – 8.45 am Welcome Note by Dr Ida Marhainis Isahak (Organising Chairperson)
Head of Pathology Department, Hospital Pulau Pinang
8.45 am – 9.00 am Opening Ceremony
9.00 am – 9.15 am Launching Ceremony by Dr Arni Talib (Head of Pathology Service, Ministry of Health)
9.15 am – 10.00 am Keynote Address by Dr Arni Talib
10.00 am – 10.30 am The Medical Laboratory in Digital Health: Embracing Diagnostics 4.0
10.30 am – 11.15am
Break & Exhibition
PLENARY 1– Newborn Screening : The Challenges and Common Pitfalls
Dr. Yusof Abdul Rahman (Department of Genetic Medicine & ICPMR Chemical Pathology, Westmead Hospital)
11.15 am -11.30am Q& A
11.30 pm – 12.15 pm PLENARY 2 – How Artificial Intelligence Aid in Validation of Haematology Tests
Prof. Dr. N. Veera Sekaran A/L V. Nadarajan (Clinical Professor, University Tunku Abdul Rahman)
12.15 pm-12.30pm Q&A
12.30 pm – 2.30 pm Break/ Solat/ e-Poster & Exhibition Viewing
Breakout Sessions
Haematology Anatomic Pathology Microbiology Chemical Pathology
2.30 pm – 3.15 pm Lecture 1 Lecture 1 Lecture 1 Lecture 1
Roles of FISH in Detec- The Evolving Gleason New Updates on COVID- The Aldosterone Renin Ratio
tion of Haematological
Grading System 19 – Roles and Problems
Malignancies Dr Rosna Yunus Dr.Ang Peng Peng Dr Siti Sharina Anas
Dr Chin Loi Khim (Hospital Kuala Lumpur) (Hospital Seberang Jaya) (Hospital Putrajaya)
(Hospital Tunku Azizah)
3.15 pm –3.30pm Q&A Lecture 2 Lecture 2 Lecture 2
Updates on Peripheral Laboratory Diagnosis of Risk, Error and Uncertainty:
3.30 pm – 4.15 pm Lecture 2 Neuroblastic Tumour COVID-19, Current Issues & Lab Quality Management in
Management of Haema-
4.15 pm– 4.30 pm tology Laboratory dur- Dr Arni Talib Challenges the Age of Metrology
4.30 pm-5.30 pm (Hospital Kuala Lumpur) Dr Rozainanee Mohd Zain Puan Kala Devi A/P Nadarajan
ing Pandemic (Institute for Medical Re-
Dr Phandee (Hospital Sultanah Bahiyah)
Watanaboon- search)
yongcharoen
(Chulalongkorn Hospital)
Q&A 9
Exhibition & End of the day 1
TENTATIVE PROGRAMME
Day 2 (18th August 2021, Wednesday)
TIME PROGRAMME
8.00 am – 8.30 am
Registration
8.30 am – 9.15 am PLENARY 3 COVID 19 Vaccines : The Game Changer To End The Pandemic?
Professor Dr.Zamberi Sekawi , Department of Medical Microbiology , Faculty of Medicine and Health Sciences ,Universiti
Putra Malaysia
9.15 am– 9.30am Q&A
9.30 am – 10.15 am
INVITED SPEAKER 1 - Quality Aspects of Lab Management in Malaysia : A Historical Journey
Dr Jamilah Baharom (DSM Technical Assessor and former Head of Department, Department of Pathology, Hospital Pulau
Pinang)
10.15 am -10.30 am Q&A
10.30 am - 11.00 am
Break & Exhibition
11.00 am - 11.45 pm
INVITED SPEAKER 2 - Updates On Procurement Procedure (Tatacara Perolehan Terkini)
Pn Farmurhayati bt Jaafar (Bahagian Perolehan Dan Penswastaan KKM)
11.45am– 12.00pm Q & A
12.00 pm– 12.45pm PLENARY 4 – Current strategy for Cervical Cancer Screening in Malaysia
Dr Farveen Merican Abu Backer (Anatomic Pathologist, Hospital Sultan Abdul Halim)
12.45 pm –1.00pm Q & A
1.00 pm – 2.30 pm Lunch & Exhibition
Breakout session
Haematology Anatomic Pathology Microbiology Chemical Pathology
2.30 pm – 2.45 pm Lecture 3 Lecture 3 Lecture 3 Lecture 3
Diagnostic Dilemma: MMR Testing in Colorectal Improving Mycology Patient-based Real Time QC
Follow Up Trephine in Diagnosis in Malaysia
Cancer Dr Sahlawati Mustakim (Prof Tony Badrick)
Acute Leukaemia Datin Dr Nik Raihan Nik (Hospital Tengku Ampuan RCPA Australia
Dr Ho Chiak Vun, Ivy
(Loh Guan Lye Specialist Mustapha Rahimah)
(Hospital Sultanah Bahiyah)
Centre)
2.45 pm –3.00 pm Q&A Lecture 4 Lecture 4 Lecture 4
3.00 pm – 3.45 pm Diagnostic Approach to Bologna Workflow – Metabolic Syndrome – What
Lecture 4 Mediastinal Lymphoma When Every Hour Counts
Vaccine-induced Throm- Ms Miriam Cordovana to Look Out for?
botic Thrombocytopenia - Dr Shafinaz Sabudin Dr Shalini C Sree Dharan
Screening and Diagnosis (Hospital Raja Permaisuri (Bologna Italy) (Pantai Hospital Kuala Lum-
Prof Pantep Bainun) pur)
Angchaisuksiri
(Mahidol University
Bangkok)
3.45 pm- 4.00 pm Q&A
4.00 pm - 4.30 pm Prize Giving & Closing Ceremony
End of the Day 2
10
SPEAKER PROFILE
Dr. Yusof Abdul Rahman
Dr Yusof is currently a Staff Specialist / Consultant in the Department of Genetic
Medicine and ICPMR Chemical Pathology at Westmead Hospital, Sydney since
August 2019.
After graduating from University College Dublin Medical School in 1998, he com-
pleted his general medical training and obtained his membership for Royal College of Physicians of
Ireland. He spent a further three years in Dublin as an endocrine research fellow, and worked on his
doctoral thesis. In 2004, Yusof moved to London to join a Chemical Pathology & Metabolic Medicine
dual training programme at Imperial College Healthcare / Hammersmith Hospital rotation.
As part of his specialist training, he also spent two years at the Charles Dent Metabolic Unit, National
Hospital for Neurology and Neurosurgery focusing on Adults with Inherited Metabolic Disorders. He
obtained his Fellowship for the Royal College of Pathologists (FRCPath) in 2008, and the year after he
received dual-accreditation (CCT) for Chemical pathology and Metabolic Medicine. Yusof was appoint-
ed a Consultant Adult Inherited Metabolic Diseases at Guy's and St Thomas' NHS Foundation Trust and
Evelina London in 2019. He was there for 10 years before taking up the role at Westmead Hospital. He
gained his fellowship for the Royal College of Pathologists Australasia (RCPA) in August 2020.
Qualifications: MB BCh BAO (NUI), BMedSc (Hons), MRCP(Ire), FRCPath (UK), FRCPA
Prof Dr.N.Veera Sekaran A/L V.Nadarajan
Veera Nadarajan is a haematologist and transfusion medicine specialist based
in Kuala Lumpur, Malaysia. He currently serves as Clinical Professor at the
Department of Preclinical Sciences, University Tunku Abdul Rahman and as an
honorary consultant haematologist at the Department of Transfusion Medi-
cine, University Malaya Medical Centre.He obtained his MBBS and Master in Pathology from University
Malaya in Kuala Lumpur, Malaysia and received the DRCPath (Transfusion Medicine) from the Royal
College of Pathologists, UK. He has more than 20 years of experience as a haematologist and transfu-
sion medicine specialist, having served most of that time at the Faculty of Medicine in University Ma-
laya, Malaysia.Dr. Nadarajan has collaborated in several research projects as Principal Investigator.He
has over 30 publications in recognized peer-reviewed journals and has diverse research interests, which
include serological and molecular characterisation of blood groups, blood donor care and molecular
diagnosis of haematological disorders. Apart from clinical and research activities, he is actively involved
in teaching and training of haematologists and transfusion medicine specialists at the national level. He
sits on several national committees with regards to curriculum development, specialist accreditation
and quality standards.
11
SPEAKER PROFILE
Pn Famurhayati Binti Jaafar
Pn Famurhayati is Chief Assistant Secretary under Bahagian Perolehan dan
Penswastaan Kementerian Kesihatan Malaysia.She holds a Master in Land &
Resource Management .She have 11 years of experience working with Kementerian Perumahan dan
Kerajaan Tempatan and 4 years with Kementerian Kesihatan Malaysia.
Dr Jamilah
Dr Jamilah is a retired chemical pathologist since February 2014. She started
her career as Chemical Pathologist in 1995. She had contributed a lot to the
Chemical Pathology Service and also National Pathology Service as a whole.
She is former Head of Chemical pathology Unit, Hospital Kuala Lumpur from 1996 to 2002. She was also
the National Head Chemical Pathology for 6 years at the same time. Later in 2005, she went back to her
hometown and became the Head of Pathology Department, Hospital Pulau Pinang as well as the Head
of Pathology for the Penang state. She became a trained ISO 15189 assessor by DSM during the same
year and had vast experience in ISO Audit for almost 10 years. In 2010, she went for attachment in
Perth for few months before came back to continue her service until she retired in 2014.
12
11
SPEAKER PROFILE
Dr Chin Loi Khim
Dr Chin Loi Khim obtained her Masters of Pathology (Hematology) from Uni-
versity Malaya in 2007. She went on to do a Fellowship in Bone Marrow Cyto-
genetics at the St Vincent’s Hospital Melbourne, Australia in 2011. Subse-
quently she had training at the Prince Of Wales Hospital, Sydney in the field of prenatal testing of
thalassemia in 2016. She is now heading the Genetics Laboratory of Hospital Tunku Azizah Kuala
Lumpur
D r F a r v e e n M a r i c a n b i n ti A b u B a c k e r
Dr Farveen Marican binti Abu Backer is a Consultant Anatomic
Pathologist & Cytopathologist and Heads the Anatomic Pathology ser-
vices in Hospital Sultan Abdul Halim, Sungai Petani Kedah Darul Aman.
She graduated from Universiti Sains Malaysia in 2001. She received her
Pathology specialty training from University Sains Malaysia and obtained her Masters Degree in
Pathology (Anatomic Pathology) in 2010. Dr Farveen has a special interest in cytopathology and
did further training at St Vincent Hospital Sydney Australia in 2016. She is also a Fellow of Inter-
national Academy of Cytology and has been invited as Advisory Committee for RCPA QAP Cyto-
pathology since 2017.
SPEAKER PROFILE
Dr Ang Peng Peng
Dr Ang Peng Peng obtained her Medical degree for doctor of medicine from UKM in
2008. She is currently working as a ID physician in Hospital Seberang Jaya. She done
her subspecialty training in infectious disease in Hospital Pulau Pinang in 2018 and in Hospital Sungai
Buloh in 2019.Dr Ang Peng Peng is a member of Royal College of Physician (UK) . She actively involved
in publishing papers and journals .
Dr Rosna Yunus
Dr Rosna Yunus is a Pathologist in Kuala Lumpur Hospital ,Kuala Lumpur. She ob-
tainer her MBBS from Universiti Sains Malaysia in 1991. She hold her Master in
Pathology from Universiti Kebangsaan Malaysia in 2001. She involves actively in all
aspects of diagnostic histopathology,cytopathology and with special interest in urological pathology.She
did her subspecialty training in urological pathology in Tissupath Melbourne, Australia from Nov 2008-
March 2009 and Uropath,Perth,Western Australia from April 2009—May 2009.Dr Rosna Yunus actively
involved in research projects and publications throughout his service in Public Health.
Prof Dr Zamberi bin Sekawi
Prof Dr Zamberi bin Sekawi is a Professor of Medical Microbiology and a Con-
sultant Clinical Microbiologist. He was formerly the Technical Officer for Labora-
tory at the World Health Organization based in the South Pacific Office.
His research is mainly on respiratory viruses, hepatitis viruses and leptospirosis where he was recog-
nised internationally. He was the founding member of the Malaysian Influenza Working Group and the
Malaysia Leptospirosis Research Network. He is actively involved in the Malaysian Society of Infectious
Diseases and Chemotherapy and the International Society of Infectious Diseases
13
SPEAKER PROFILE
Dr Siti Sharina Anas
Dr Siti Sharina Anas obtained her medical degree and Master’s in Chemical Pathol-
ogy from USM. She was then posted to Hospital Kuala Lumpur, where she headed
the Chemical Pathology Unit. She continued the work of pioneers in providing
Urine Catecholamine testing for Government Hospitals from all over Malaysia. She had the opportuni-
ty to be attached to the Biochemistry Department in Royal Perth Hospital in 2009. The experienced
spent in Royal Perth Hospital had help her provide better service for the Endocrine Laboratory ser-
vices, particularly the Renin and Aldosterone testing. In 2010, she was transferred to Hospital Putraja-
ya, the centre for Breast and Endocrine Diseases till present time, and currently appointed as the Head
of Department of Pathology. Hospital Putrajaya provides specialized chemistry testing for government
Dr Phandee Watanaboonyongcharoen
Dr Phandee Watanaboonyongcharoen is currently working in Department of
Laboratory Medicine ,Faculty of Medicine, Chulalonkorn University and also in
Transfusion Medicine Unit,King Chulalongkorn Memorial Hospital. She is currently
Associate Professor of Laboratory Medicine and Director of Department of Laboratory Medi-
cine,Faculty of Medicine ,Chulalongkorn University . Dr Phandee Watanaboonyongcharoen is the mem-
ber of Thai Medical Council , Thai Society of Hematology ,Thai Society of Clinical Pathology dan Royal
College of Pathologist of Thailand.
Dr Arni Talib
Arni Talib is a Senior Consultant Pathologist and Head of Pathology Department in
Hospital Kuala Lumpur. She is also currently the National Head of Pathology Ser-
vices for Ministry of Health, Malaysia. She received her Medical Doctor degree
from Universiti Kebangsaan Malaysia in 1986 and graduated as Master of Patholo-
gy (Histopathology) from the same alma mater in 1994. She subsequently completed a one-year fellow-
ship training in Paediatric Pathology in the United Kingdom in 1998. Following the training, she has set
up Paediatric Pathology diagnostic and consultation service in the Department of Pathology, Hospital
Kuala Lumpur which serves as a National Referral Centre for the whole country. She holds a number of
posts and wears a few hats in the pathology field both in the MOH and outside. She had been an Hon-
ourary lecturer and examiner for the Master of Pathology candidates, member of the Conjoint Board
for Master of Pathology, council member of the College of Pathologists in the Academy of Medicine
Malaysia and also panel member of the National Specialist Registry. She is eagerly waiting to join the
senior citizen club in a few weeks’ time and hopes to pursue a more carefree career in her life in the
near future.
14
SPEAKER PROFILE
Dr Rozainanee Mohd Zain
Dr Rozainanee is currently the Consultant Clinical Virologist working at the Virology
Unit, Infectious Disease Research Centre. She supervises all specialised viral diagnostics
testing or activities that are carried out in the Unit to support the laboratory testing for
most government hospitals and primary health care facilities in the country. As a Clinical Virologist, she is actively
involved with the national reference laboratories activities and the designated reference laboratories; National
Poliovirus Laboratory, WHO National Influenza Centre, National Reference Laboratory for HIV/AIDS, National
Laboratory for Viral Hepatitis (recently designated) and National Laboratory for Japanese Encephalitis (until
2015).
In line with the Ministry of Health’s strategic priorities, Rozainanee had taken up the challenge to lead an im-
portant project in developing and implementing HIV drug resistance genotyping assay for the country. The test
was initially started as a two-year research project and thereafter, successfully expanded as a diagnostic test.
Currently, the test has been made available nationwide throughout all government and private hospitals across
the country. Information obtained from this test can be used to develop HIV drug resistance database for the
country as well as enhancing the national policy and practices in managing HIV patients in Malaysia.
She also responsible in carrying out National External Quality Assurance Scheme (NEQAS) to detect the presence
on HIV antibodies and to assess other government and private laboratories in the country in performing the tests
to detect the IV antibodies. NEQAS has substantially expanded to many hospitals and primary health care facili-
ties. Recently, a new scheme on Hepatitis Serology External Quality Assurance Scheme was introduced by IMR
and carried out and sample panels were sent to all major state hospitals in Malaysia. Furthermore, she involves
with all activities related to Polio Eradication programme and Severe Acute Respiratory infection surveillance. She
is an active member of ISO 15189 Implementation committee for IMR. Rozainanee has actively involved in con-
ducting research. She has been involving with research in many medically important viruses such as HIV, hepatitis
viruses, Middle East Respiratory Syndrome coronavirus (MERS-CoV), dengue, zika, rubella virus and SARS-CoV-2.
Puan Kala Devi Nadarajan
Pn Kala Devi Nadarajan, BSc (Hons) Biochemistry & Microbiology, Masters
(Business Administration). She’s a senior Biochemist in the Chemical Pathology
Laboratory in Sultanah Bahiyah Hospital, Alor Setar. She has 29 years of working
experience as Clinical Biochemist in chemical pathology laboratory and a special interest in imple-
menting Quality Control Strategy as well as the MS ISO 15189:2014. She has conducted many trainings
for prestigious organizations in Malaysia, namely the Malaysian Association of Clinical Biochemists, the
Dept. of Standards Malaysia and hospitals. She sits in the expert panel in developing National Occupa-
tion Skill Standards for the Human Resource Ministry. Pn Kala Devi is
also a qualified ISO 15189 assessor with Standards Malaysia.
15
SPEAKER PROFILE
Dr Ho Chiak Vun
Dr Ho Chiak Vun, Ivy - Consultant Histopathologist at Loh Guan Lye Specialists
Centre, Penang. She have sub-specialty in lymphoma and bone marrow patholo-
gy. Dr Ho graduated from International Medical University (IMU) with MBBS and
Master of Pathology from University Putra Malaysia (UPM). She obtained training in Hematopathology
at the Department of Pathology and Laboratory Medicine, Cuming School of Medicine, University of
Calgary, Canada. She is also member of International Academy of Cytology and also a member of Col-
lege of Pathologist, Academy of Medicine Malaysia. Dr Ho previously was Head of Department of Pa-
thology, Queen Elizabeth Hospital, Kota Kinabalu.
D a ti n D r N i k R a i h a n
Dr Nik Raihan Nik Mustapha is a Consultant Histopathologist at the Department
of Pathology Hospital Sultanah Bahiyah, Alor Setar. She graduated from Royal
College of Surgeons in Ireland in 1991. She received her Pathology specialty
training from University Sains Malaysia and obtained her Masters Degree in Pa-
thology in 1998. Dr Nik Raihan has a special interest in liver and GIT pathology and did further training
at National University Hospital, Singapore and Singapore General Hospital in 2005. For the past 15
years, she has been providing consult service in liver and GIT pathology for Ministry of Health hospitals
and more. Dr Nik Raihan had conducted courses and delivered multiple lectures in relation to inflamma-
tory bowel disease. She had also headed the pathology section for National Cancer Patient Registry -
Colorectal Cancer, which was a 10-year project that was concluded in 2019. Her research interest in-
cludes fatty liver disease. She is also involved in teaching trainees in histopathology specialty, as well as
liver and GIT pathology subspecialty/special interest. Dr Nik Raihan had presented a number of papers
16
SPEAKER PROFILE
Dr Sahlawati Mustakim
Dr Sahlawati graduated with an MB from the University College Cork of Ireland in 1997. She then ob-
tained her Masters in Pathology in 2004 from the National University of Malaysia. She pursues her sub-
speciality training in Mycology from the Mycology Reference Center of Manchester in 2009. She ob-
tained her microbiology training in Hospital Kuala Lumpur, Hospital Tuanku Canselor Tuanku Mukhriz
UKM, Hospital Sungai Buloh and currently practicing in Hospital Tengku Ampuan Rahimah Klang.
She has participated as an expert panel for national practice guidelines relating to antibiotic and infec-
tion control, as well as member in the technical working group for Malaysia Antimicrobial Resistance
Plan. Dr Sahlawati was the chairperson for Malaysian Mycology Interest Group as well as a member of
the Malaysian Society of Infectious Disease and Chemotherapy (MSIDC), European Society of Clinical
Microbiology and Infectious Disease (ESCMID) and International Society of Animal and Human Mycoses
Prof Pantep Angchaisuksiri
Pantep Angchaisuksiri is Professor of Medicine and Chief of the Haemo-
stasis and Thrombosis Unit in the Division of Haematology, Department of
Medicine, at Ramathibodi Hospital, Mahidol University in Bangkok, Thai-
land. He also holds posts of Adjunct Associate Professor of Medicine at the University of North Car-
olina at Chapel Hill, School of Medicine, North Carolina, and is co-director of the Bangkok Interna-
tional Haemophilia Training Centre of the World Federation of Haemophilia. Professor
Angchaisuksiri is a medical graduate of Chulalongkorn University in Bangkok, Thailand and was
trained in Internal Medicine at Prince of Songkla University and Haematology at Mahidol University.
He was also a clinical and postdoctoral fellow in Haematology/Oncology at the Medical College of
Virginia in Richmond, Virginia and the University of North Carolina at Chapel Hill, School of Medi-
cine, North Carolina, USA. An active clinician, Professor Angchaisuksiri works with patients with
thrombosis, haemophilia and other bleeding disorders, and has authored and co-authored papers
relating to haemostasis and thrombosis in several leading international scientific journals. He is a
council member of the International Society on Thrombosis and Haemostasis (ISTH) and the Asian-
Pacific Society on Thrombosis and Hemostasis (APSTH), an associate editor of the ISTH journal Re-
search and Practice in Thrombosis and Haemostasis (RPTH), an editorial board member of the jour-
nal Thrombosis Research, Journal Thrombosis, and Blood Research, and a member of several pro-
fessional societies, including the American Society of Haematology, and the World Federation of
Haemophilia. He is also a Chairman of the ISTH Education and Outreach Committee, and a member
of the ISTH Membership and Communications Committee.
17
SPEAKER PROFILE
Dr Shafinaz Sabudin
Dr Shafinaz Sabudin is an Anatomic Pathologist who has been working in Hospital
Taiping (2011- 2015) and Hospital Raja Permaisuri Bainun (2015- till current). She
graduated from University of Western Australia (MBBS) in 2000 and completed her
Master of Pathology (Anatomic Pathology) in 2011 under Universiti Malaya. Her
special interest is Lymphoreticular Pathology. She was a Lymphoreticular pathology trainee in Hospital
Queen Elizabeth, Sabah in 2018.
Ms Miriam Cordovana
Miriam Cordovana is a molecular biologist, and researcher in the R&D Depart-
ment of Bruker Daltonics in Bremen, working on methods and application devel-
opment. The focus of her work is development methods for diagnostics of sepsis,
antibiotic resistance and microbial typing, using MALDI-TOF MS and FTIRS. For-
merly she is a laboratory technicians for 13 years in the bacteriology and mycobacteriology laboratory
of the Operative Unit Microbiology – IRCSS Sant’Orsola di Bologna, Italy, performing routine diagnostic
and research studies about sepsis and antibiotic resistance. She is a member of ASM, ECCMID and
AMCLI (Italian Society of Clinical Microbiology), and actively involved in the ESGAI (ESCMID Study Group
for Anaerobic Infections).
Dr Shalini Sreedharan
Dr Shalini graduated from University Science Malaysia in 2005 and obtained her
MRCP in 2011. She completed her fellowship Endocrinology and Diabetes Fel-
lowship (Malaysia &UK in 2017). She is also a member of Malaysian Endocrine
and Metabolic Society (MEMS), USA Endocrine Society, Society for Endocrinolo-
gy UK and also European Endocrine Society. She was trained in Endocrinoogy sub speciality for 3 years
both locally and abroad including training at The Christie, NHS FoundationTrust, UK and also at Cam-
bridge University, UK. Later, she served as physician and endocrinologist at Hospital Sungai Petani and
also Hospital Ampang from 2018-2020.
She was previously an honorary lecturer for the Allianze University College for 2 years and also clinical
tutor and examiner for MBBS student for Allianze and Asian Institute of Medical Science and Technolo-
gy (AIMST) University.
She is currently a physician and Endocrinologist in Hospital Pantai Kuala Lumpur for past 1 year. She
had numerous presentations and also publications mainly on diabetes mellitus and also thyroid disor-
ders.
17
18
SPEAKER PROFILE
Prof Dr Tony Badrick
Tony Badrick B. App Sc, BSc, BA, M Lit St (Math), MBA, PhD(QUT), PhD(UQ), FAIMS, FAACB, FACB,
FAIM, Member Aust Maths Soc, FRCPA (Hon), FFSc(RCPA).
He was Associate Professor, Faculty of Health Sciences and Medicine at Bond University for 4 years
before becoming the CEO of the RCPAQAP in 2015. Adjunct Professor School of Pharmacy and Phar-
macology, Griffith University, Honorary Associate Professor, National Centre for Epidemiology and
Public Health ANU College of Health and Medicine and ANU College of Science, Honorary Associate
Professor, Faculty of Medicine, Bond University, Gold Coast, Visiting Fellow, Australian Institute for
Health Innovation, Macquarie University. He was President of the Australasian Association of Clinical
Biochemists (2003-2007) and Vice President of the Australian Institute of Medical Scientists (2011-
2018), is Chair of the Education and Laboratory Management Committee of the Asian Pacific Federa-
tion of Clinical Biochemistry, a member of two International Federation of Clinical Chemistry Working
Groups (Value of Pathology, Traceability), member of the Joint Committee on Traceability in Laborato-
ry Medicine, and currently the Chief Examiner of the Faculty of Science of the Royal College of
Pathologists of Australasia. Tony has also had published over 180 Papers and one book chapter (2 edi-
tions) in Health care management and chapters in Clinical Biochemistry texts (Tietz) and is Chair of the
Document Review and Liaison Committee of the National Pathology Accreditation Advisory Com-
mittee.
LECTURE SUMMARY
PLENARY 1
Newborn Screening – The Challenges and Common Pitfalls
Dr. Yusof Abdul Rahman,
Department of Genetic Medicine & ICPMR Chemical Pathology, Westmead Hospital
Newborn Screening Programs have been hailed as one of the most successful public health initiative in
modern time. The goal is to detect disorders that are threatening to life or long-term health before
they become symptomatic, and institute the treatment if indicated. It has been more than 50 years
since Robert Guthrie’s introduction of bacteria inhibition method to mass diagnosis of PKU. The num-
ber of conditions screened has expanded rapidly especially with the introduction of tandem mass spec-
trophotometry. Currently most NBS programs include inherited metabolism disorders such as PKU,
fatty acid oxidation defects and others, endocrine disorders, haemoglobinopathies, immunodeficiency,
cystic fibrosis, and critical congenital heart defects. This talk will discuss the governance around a na-
tional newborn screening program, the analytical aspects, and the management and follow-up process-
es required once a diagnosis has been made. It will highlight the analytical, logistical and legal challeng-
es, and also common diagnostic pitfalls.
PLENARY 2
How artificial intelligence aids in validation of haematological tests
Veera S Nadarajan, University Tunku Abdul Rahman
Artificial intelligence (AI) with incorporation of sophisticated machine learning (ML) algorithms has
become a mainstay of much of our daily activities, often without us even being aware of it.
Healthcare is its next frontier, and it is poised to disrupt the way we work especially in the areas of
diagnostics and imaging. The seamless integration of healthcare related information of an
individual from cradle to grave will drive much of this development. Access to personal healthcare
information through integration to clinical and hospital medical records, personalised genomics,
and self- monitoring though wearable and point-of-care or home-based testing will be important
elements of laboratory diagnostics in future. Real-time patient-based quality control is widely ap-
plicable now. ML algorithms facilitate checking of integrity of samples and detection of
mis-identified patient samples. AI technologies can now also be employed for early identification
of trends so that appropriate automatic notifications and interventions can be taken in a timely
manner. Validation of routine haematology and coagulation results with provision of appropriate
advice on further tests to be performed and possible diagnosis to be considered are also in
practise. In enomics, AI algorithms are crucial in identifying genetic abnormalities and to provide
relevant advice on risk stratification, prognosis, and targetable mutations. The standardisation of
communication protocols, consolidated cloud databases and integration of electronic medical
records with laboratory information systems will be important elements in moving the AI agenda
forward.
18
LECTURE SUMMARY
PLENARY 3
COVID-19 Vaccines: The game changer to end the pandemic?
Prof Dr Zamberi bin Sekawi
Universiti Putra Malaysia, UPM
The current coronavirus pandemic caused by SARS-CoV-2 had ravaged the global community for more
than a year. As of August 2021, it had infected more than 200 million people and killed more than 4 mil-
lion people. It seems to be unstoppable and still creating chaos and causing enormous pressure to the
already strained healthcare system in many countries worldwide. At the end of 2020, a few COVID-19
vaccines were approved for emergency use after they were found to be safe and effective in reducing
severe COVID-19 and deaths. Since then, vaccination programs have been ramped up all over the world.
Successes were reported in terms of reduction in the number of individuals with severe COVID-19 and
deaths. It was found to also reduce the onward transmission to a certain extent. The vaccines are current-
ly used as the key strategy to end the pandemic. Several issues remain unanswered at the moment. These
include the duration of protection and the role of booster doses; correlate of protection; severe or long
term vaccine adverse effects; vaccine effectiveness against the emerging variants and the role of heterol-
ogous prime-boost vaccination.
PLENARY 4
Current Strategy for Cervical Cancer Screening in Malaysia
Dr Farveen Merican Abu Backer
Hospital Sultan Abdul Halim
19
LECTURE SUMMARY
INVITED SPEAKER 1
Quality Aspects of Lab Management in Malaysia– A Historical Journey
Dr Jamilah Baharom, DSM Technical Assessor
Former Head of Department, Department of Pathology, Hospital Pulau Pinang
Quality aspect of laboratory management in Malaysia, can be divided into 3 phases that is before year
1990, period between 1990 to 2000 and after year 2000. Before 1990 quality practices was limited to
internal quality control in certain discipline only, the external QC was not a mandatory, documentation
was very poor, laboratories were working independently in each hospitals. In a period of 1990 to 2000,
the quality monitoring at national level was started through NIA indicator approach, limited to profi-
ciency testing and monitoring of turn around time. In year 2000 laboratory was hit by an incidences in
HIV testing, the impact of medico legal cases for blood transfusion and patient safety. This initiated the
move towards laboratory accreditation program in Malaysia. In year 2002 a contract was signed with
National Association of Testing Authority, Australia (NATA), since there was no local authority available
at that time. Seventy laboratories which includes state hospital laboratories, IMR and National Blood
Bank were schedule for accreditation process by NATA. Lessons learned from this activity will be dis-
cuss in the presentation. In 2003 Department of Standard Malaysia was appointed as accrediting body
in Malaysia, collaborated with Malaysia Society of Pathologist to develop Malaysian Standard for
ISO15189 and the supporting technical notes. Members of technical working team were trained to be
technical assessor and later as Lead assessor by the International Accreditation, New Zealand (IANZ).
Currently 11 lead assessors and 115 technical assessors are available through a series of training orga-
nized locally by DSM and 24 KKM laboratories has been accredited
INVITED SPEAKER 2
Updates On Procurement Procedure (Tatacara Perolehan Terkini)
Pn Farmurhayati bt Jaafar
Bahagian Perolehan Dan Penswastaan KKM
20
LECTURE SUMMARY : BREAK UP SESSION
The Evolving Gleason grading System
Dr. Rosna Yunus
Hospital Kuala Lumpur
Gleason grading system is the most widely used grading system used for prostate carcinoma, intro-
duced more than half a century ago by Dr. Donald F. Gleason in 1960s. It is one of the most important
prognostic indicators for prostate carcinoma patients, but it suffers from significant observer variabil-
ity. This system was established in the pre-Prostate Specific Antigen (PSA) era when the diagnosis and
management of prostate carcinoma were quite different from current practice.
For the grading system to remain relevant in modern practice, certain modification is required. Hence,
the evolution of grading of prostate carcinoma from the original Gleason system in the 1960-1970s to
a more patient-centric grading system proposed in 2013 from a group at John Hopkins Hospital. Vali-
dated in 2014 by a large multi-institutional study and subsequently accepted by the World Health
Organization (WHO), College of American Pathology (CAP), and the AJCC TNM system.
Dr. Gleason himself and in 2005, the International Society of Urological Pathology (ISUP), introduced
significant improvement through a consensus conference attended by International Urological Pathol-
ogy experts. Since the 2005 ISUP conference Gleason score 2-5 have effectively been abandoned for
needle biopsies and as a consequence the lowest score found on a needle biopsy is now 6. Modified
Gleason scoring system was established and widely used. The ISUP, through a further consensus con-
ference in 2014, introduced ISUP grading consisting of 5 grades: Grade 1 (GS 3+3), Grade 2 (GS 3+4),
Grade 3 (GS 4+3), Grade 4 (GS 4+4, 3+5, 5+3) and Grade 5 (GS 9-10). Given the significant new infor-
mation in the literature, primarily relating to the prognostic significance, it is likely that ISUP grading
will evolve further. Molecular testing in prostate carcinoma still require dedicated studies and active
surveillance population to substantiate the utility of these expensive test. Currently, there is active
research on Artificial Intelligence (AI) to assist in difficult areas of Gleason grading in an attempt to
standardize grading.
Update in Chronic Kidney Disease: Latest Laboratory Rule In Chronic Kidney Disease Management
Dr Siti Sharina binti Anas
Hospital Putrajaya
Chronic kidney disease (CKD) is a common clinical condition with significant adverse outcomes for the
patient and family members. CKD is classified based on the estimated glomerular filtration rate (eGFR).
eGFR and the level of proteinuria helps to risk stratify patients. Malaysian Association of Clinical
Biochemists has formed a task forced on Chronic Kidney disease (MACB CKD Task Force) and has come
up with recommendations for laboratory reporting of estimated glomerular filtration rate (eGFR).
21
LECTURE SUMMARY : BREAK UP SESSION
Role of FISH in Detection of Hematological Malignancy
By Dr Chin Loi Khim
Hospital Tunku Azizah Kuala Lumpur
FISH is advantageous as a rapid, sensitive test for the detection of cryptic or subtle chromoso-
mal changes. FISH technique has a tremendous impact on molecular cytogenetic diagnosis for
a better understanding of both numerical and structural aberrations in the detection of
known genes involved in chromosomal aberrations.
FISH is widely used in clinical practice to help in the diagnosis, prognosis, management and
selection of appropriate treatments for patients with haematological malignancies and solid
tumours. It is particularly crucial when karyotype analysis maybe difficult in low in-vitro cell
proliferation rate of certain hematologic malignancies such as the chronic lymphoid disorders.
In addition, FISH is also utilised for investigating the origin and progression of hematological
malignancies. The main goal of the cancer cytogenetic laboratory is to select appropriate FISH
Patient –based Real Time QC
By Prof Dr Tony Badrick
RCPA Australia
For many years the concept of patient-based quality control (QC) has been discussed and im-
plemented in hematology laboratories; however, the techniques have not been widely imple-
mented in clinical chemistry. This is mainly because of the complexity of this form of QC, as it
needs to be optimized for each population and often for each analyte. However, the clear
advantages of this form of QC, together with the ongoing realization of the shortcomings of
“conventional” QC, have driven a need to provide guidance to laboratories to assist in de-
ploying patient-based QC. Traditional IQC strategies can be at best only a point-in-time pro-
cess control and unable to provide real-time error monitoring. IQC in effect works only retro-
spectively, delaying error detection and allowing the potential for numerous erroneous pa-
tient results to be reported. The term patient-based real-time quality control covers many
activities that use data from patient samples to detect analytical errors. These activities in-
clude the monitoring of patient population parameters such as the mean or median analyte
value or using single within-patient changes such as the delta check. PBRTQC cannot totally
replace traditional IQC strategies based on stabilized control materials but is designed to aug-
ment and complement existing QC programs built on IQC strategies. In 1 implementation it
has been shown that PBRTQC has reduced the utilization of conventional QC material by ap-
proximately 75% to 85% (11). Patient safety is increased as the strengths of both approaches
complement each other, and a successful PBRTQC plan can markedly reduce the frequency
and cost of IQC, within the limitations of local regulations governing QC frequency .
28
24
LECTURE SUMMARY : BREAK UP SESSION
MMR Protein IHC Testing in Colorectal Cancer
By Datin Dr Nik Raihan Nik Mustapha
Hospital Sultanah Bahiyah
DNA mismatch repair (MMR) is a system for recognizing and repairing DNA mismatches (erroneous
insertion, deletion, and mis-incorporation of bases) that occur during cell replication. Execution of this
repair process is via MMR proteins, which are the products of MMR genes. Epigenetic inactivation of
MLH1 or germline mutation of MMR gene results in deficiency in MMR protein. This in turn causes ac-
cumulation of numerous DNA replication errors, resulting in microsatellite instability (MSI) and marked
increase in the rate of mutations.
Colorectal adenocarcinoma (CRC) is one of the commonest cancers worldwide. Twelve to 15% of CRC
result from deficiency in DNA mismatch repair, giving rise to a phenotype called MSI tumours. MSI tu-
mours develop either from germline mutation in MMR gene (namely MLH1, MSH2, MSH6 and PMS2,
i.e. Lynch syndrome) or more commonly, from epigenetic inactivation of MLH1 (i.e. sporadic MSI tu-
mours). In addition to possible detection of patients with Lynch Syndrome, these MSI tumours appear
to have more favourable prognosis than microsatellite stable tumours and they also respond differently
to chemotherapeutic agents. Thus identifying MSI tumours is of clinical significance.
MSI tumours can be detected by either MSI test, which is a PCR-based molecular analysis or MMR pro-
tein immunohistochemistry (IHC). The latter demonstrate loss of MMR protein expression in tumour
tissue. MMR protein IHC has high sensitivity and specificity, comparable to MSI molecular testing. Fur-
thermore, it is a simpler, cheaper and quicker method. Evaluation and interpretation of MMR protein
IHC will be discussed and some possible technical issues will also be addressed.
METABOLIC SYNDROME-WHAT TO LOOK OUT FOR?
By Shalini C Sree Dharan
Pantai Hospital Kuala Lumpur
Metabolic syndrome represents an increasingly common and lethal prelude to various diseases that
could be avoided if identified on time. Metabolic syndrome is not a disease, but rather a clustering of
metabolic risk factors that have been proven to make the incidence of cardiovascular disease (CVD) at
least twice as likely, and increase the possibility of suffering from type 2 diabetes (T2D) fivefold. Meta-
bolic syndrome is also related to various comorbidities, such as pro-inflammatory, prothrombotic
states. At its core, the origin of metabolic syndrome could be condensed to an energetic imbalance,
where the intake of energy far surpasses what is consumed in the human metabolism; a vicious cycle
associated with sedentary life and excessive food consumption. the proposed definitions bear the fol-
lowing comprising metabolic components in common: impaired glucose tolerance or T2D, obesity, high
blood pressure and/or dyslipidemia. The foundations of metabolic syndrome management are essen-
tially lifestyle modifications, like changes in dietary and exercise habit.
25
LECTURE SUMMARY : BREAK UP SESSION
Improving Mycology Diagnosis in Malaysia
Dr Sahlawati Mustakim
Hospital Tengku Ampuan Rahimah
The recognition of invasive fungal infection (IFI) and differentiation from other bacterial or
viral infections with similar clinical presentations can be challenging. The field of clinical my-
cology hasn't changed as much as clinical bacteriology, which is revolutionized by increasingly
sophisticated technology. The gold standard for the laboratory diagnosis of IFI is still largely
culture based, with a heavy dependence on phenotypic or genotypic identification tech-
niques. With advances in serological and fungal antigen detection assays as well as the intro-
duction of molecular techniques, nonculture diagnostics now serve as an essential component
to diagnosis because they are sensitive and offer rapid results. None of these tests, however,
have proven sufficient to replace the gold standard as standalone tests and should all be used
in combination with assessments of the host and radiographic features to optimally manage
at-risk patients. Conventional microbiological, histological and radiological techniques remain
the cornerstone of diagnosis.
“The Bologna Workflow – ID and resistance testing directly from posi-
tive blood cultures: when every hour counts”
Ms Miriam Cordovana
Bologna, Italy
Sepsis is still, nowadays, a major concern worldwide. It is burdened by high morbidity and mortality,
and the appropriate antibiotic therapy affect significantly the survival rate. The rapid identification of
the causative agent is crucial for the patient’s outcome, especially for those in critical wards (ICU, he-
matology, oncology, pneumatology, neonatology, etc.)
Since the introduction in routine practice of MALDI-TOF MS for microbial identification, it was applied
also to the direct identification from the positive blood culture bottle, in order to shorten the time-to-
report. Several methods have been developed, based on the short subculture approach or on the sepa-
ration of bacteria from the blood culture sample.
The Rapid Sepsityper is based on a lysis-centrifugation approach. It enables the microbial identification
directly from the positive blood culture bottle in 15-20 minutes. Starting from 1 ml of positive blood
culture, it includes a lysis step of the blood cells, followed by a washing step, in order to obtain a pure
bacterial pellet, which is a viable biomass directly suitable for MALDI-TOF MS identification and for fur-
ther downstream applications.
In this presentation, I will show the results of the evaluation and then the results of two years of rou-
tine practice with Rapid Sepsityper in the University Hospital IRCSS Sant’Orsola in Bologna, Italy. In ad-
dition, I will present the results of the application of STAR-Carba and STAR-Cepha to detect car-
bapenemase and ESBL/AmpC production starting from the Sepsityper pellet.
26
LECTURE SUMMARY : BREAK UP SESSION
Management of Hematology Laboratory during Pandemic
Phandee Watanaboonyongcharoen
Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University
The Coronavirus disease 2019 (COVID-19) pandemic originated in December 2019 at Wuhan city of
China. It has rapidly widespread across the world and has become a global public health crisis. Severe
acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was recognized as a new human infectious
virus causing COVID-19 pandemic. The COVID-19 pandemic also has an impact on the laboratory com-
munity. Our everyday routine has been changed. In order to address the general workflow safety con-
cerns of laboratory personnel, the guideline for general laboratory safety practices during the pan-
demic was established. We performed site- and activity-specific risk assessments to implement the
effective strategies for our laboratory. Laboratory personnel has been identified as a priority group for
COVID-19 vaccination program. COVID-19 represents a challenge for all medical specialties. In hema-
tology laboratory, SARS-CoV-2 has a significant effect on many laboratory parameters such as white
blood cells, platelets, prothrombin time and D-dimer. The hematological findings of COVID-19 patients
have prognostic implications and guide patient treatment. Also, most asymptomatic COVID-19 pa-
tients may present to the hospital with hematological abnormalities which could lead to proper COVID
-19 diagnosis and management. The role of a hematology laboratory expert is ensure accurate, relia-
ble and timely laboratory results with safe laboratory management.
Risk,Error And Uncertainty :Lab Quality Management in the Age of Metrology
Puan Kala Devi A/P Nadarajan
Hospital Sultanah Bahiyah
Laboratory quality management system is a systematic, integrated set of activities to establish
and control the work processes in pre-examination, examination and post-examination phase.
Each component in the QMS uses different tools to helps laboratory management to achieve
quality standards. In this session, an overview of different tools such as risk management, error
calculation and measurement uncertainty is provided specifically for chemical pathology tests as
well as for pathology services generally for better comprehension.
It is widely known that risk, error and uncertainty are three things that appear in a laboratorian’s
life that are intertwined and yet can appear separately; depending on who is looking at them and
in what context. Laboratory management could take a holistic approach to identify processes
that could significantly compromise quality of examination regardless of who and context. Effort
and measures taken to calculate or detect risk, error and uncertainty is not only to satisfy accredi-
tation requirement but also to ensure patient safety, which is the ultimate destination.
27
New Updates on COVID –19
Dr Ang Peng Peng
Hospital Seberang Jaya
Laboratory Diagnosis of COVID-19,Current Issues & Challenges
Dr Rozainanee Mohd Zain
Institute for Medical Research
28
Updates on Peripheral Neuroblastic Tumour
Dr Arni Talib
Hospital Kuala Lumpur
Diagnostic Dilemma : Follow Up Trephine in Acute Leukaemia
Dr Ho Chiak Vun,Ivy
Loh Guan Lye Specialist Centre
29
Diagnostic Approach to Mediastinal Lymphoma
Dr Shafinaz Sabudin
Hospital Raja Permaisuri Bainun
Vaccine-induced Thrombotic Thrombocytopenia –Screening and Diagnosis
Prof Pantep Angchaisuksiri
Mahidol University Bangkok
30 E-POSTER ABSTRACT
EP01
A case of primary bone marrow lymphoma with secondary CNS involvement
1Hari Priya Raghvan, 1Raja Zahratul Azma, 1Hafiza Alauddin, 1Reena Rahayu Md Zin, 2Sivakumar
Palaniappan, 2Nor Rafeah Tumian
Department of 1Pathology and 2Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras
Kuala Lumpur
Introduction: Primary bone marrow lymphomas (PBMLs) are a rare condition. Most primary bone
marrow lymphomas are B-cell non-Hodgkin lymphomas (NHLs), among which the diffuse large B-cell
lymphomas (DLBCLs) predominate. Non-Hodgkin’s Lymphoma (NHL) affects extranodal sites in one-
third of cases. Secondary central nervous system lymphoma (SCNSL) is a rare condition as well. It is
usually of a high grade B cell lymphoma with neurological deficit. We report a case of primary
bone marrow DLBCL with secondary involvement of the CNS. Case report: A 46-year-old man pre-
sented with right sided lower limb and upper limb weakness for one week associated with headache
and dizziness. GCS on arrival to UKMMC was three. Clinically, there was no any lymphadenopathy
or hepatosplenomegaly. MRI of the brain showed presence of mass at left posterior parietal area.
Intraoperatively there was large tumor arising from pericranium with extra and intracranial and
subdural components with parietal cortex invasion. Histopathology findings consistent with DLBCL -
Germinal Centre B-Cell subtype. Bone marrow aspiration and trephine was performed and findings
showed hypercellular marrow with evidence of DLBCL. Immunophenotyping findings confirmed that
majority of the nucleated marrow cells were mature lymphoid cells. Cytogenetics showed 46, XY
with no evidence of clonal abnormality. He was risk stratified with IPI score of four (high risk) with
Stage IV disease. He was initially commenced on intravenous dexamethasone and subsequently
started on Rituximab, methotrexate, vincristine and procarbazine (R-MPV). Conclusion: This case
exhibits a rare case of primary bone marrow lymphoma with secondary central nervous system in-
volvement. Presence of two extranodal sites with IPI score of four denotes an aggressive disease
with poor prognosis compared to other lymphomas. Prompt diagnosis and timely treatment is very
important to control the disease and autologous HSCT will be beneficial to maintain complete remis-
sion status.
EP02
A case of myeloid neoplasm associated with eosinophilia and FIP1L1-PDGFRA rearrangement:
An aggressive presentation
1Noor Hayati Sabtu, 1Fatin Akmal Baharom, 1Azlinda Abu Bakar, 2Hon Siong Leng
1Haematology unit, Pathology Department, 2Clinical Haematology Hospital Melaka
Introduction: The World Health Organization (WHO) in 2016 has updated a classification for re-
current, genetically defined eosinophilias driven by constitutively activated tyrosine kinase (TK) fu-
sion genes termed “Myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA,
PDGFRB, FGFR1 or PCM1-JAK2”. Several studies have showed that imatinib therapy results in high
rates of complete hematologic remission with PDGFRA and PDGFRB rearrangement. Case report:
We report a young patient presented as Acute Myeloid Leukaemia with eosinophilia and FIP1L1-
PDGFRA rearrangement. He has massive splenomegaly. Peripheral blood film and bone marrow
aspirate showed marked eosinophilia and 40% of myeloblasts which confirmed by flow cytometry.
FIP1L1-PDGFRA fusion gene was observed in both interphase FISH and real time polymerase chain
reaction (RT-PCR). Cytogenetic analysis showed abnormal male karyotype with derivative chromo-
some 3 and deletion of long arm of chromosome 6. Despite initiation of Imatinib and intensive chem-
otherapy, patient had an aggressive clinical course, and succumbed from the disease. Discussion:
We proposed that this patient has additional driver mutations involve genes encoding functional
categories of proteins including transcription factors (e.g., CEBPA, RUNX1, GATA2, and ETV6), sig-
naling molecules (FLT3, NRAS, PTPN11, KRAS, KIT, CBL, and NF1), splicing factors (SRSF2, SF3B1,
and U2AF1), and proteins with other functions (NPM1, SMC1A). FLT3, KIT and NPM1 mutations are
excluded from our limited panel. Studies have shown that few rare PDGFRA partners for instance
ETV6 at (12p13) leading to t(4;12)(q12;p13) and t(4;14)(q12;q24) are infrequent cytogenetic
abnormalities which confer poor clinical outcome. Nevertheless, Imatinib resistance may occur in pa-
tient with T674I and D842V mutations which may be treated with alternative TK inhibitors such as
sorafenib, or nilotinib.
31
EP04
Lung adenocarcinoma: When cancer strikes the bone marrow
Zainal Norsafina, Shafee Siti Fatimah, Md Shahid Siti Nur Azwa, Salleh Amizatul Aini,
Hospital Serdang
Introduction: We report a case of a 63-year-old gentleman newly diagnosed as advanced lung
adenocarcinoma with metastasis to the bone marrow and left adrenal gland. Case report: Patient
came presented with shortness of breath, paroxysmal nocturnal dyspnoea, orthopnoea and weight
loss. Chest examination revealed reduced air entry over the left side with radiographical findings
exhibit ill-defined dense consolidation at the periphery of left mid zone. CT Thorax demonstrate left
upper lobe lung mass suspicious of malignancy, with bilateral lung, left adrenal and bone metasta-
ses. Unfortunately, CT-guided lung biopsy was not performed due to unfavourable patient’s condi-
tion. Serial Full Blood Count (FBC) showed down going trend of haemoglobin (Hb) and platelet count
leading to bicytopenia with the lowest count being Hb of 7.8 g/dL and platelet of 41 x109/L. Pe-
ripheral blood smear and bone marrow aspirate examinations suggestive of bone marrow infiltra-
tion by non-haemopoietic malignant cells. Trephine biopsy revealed diffuse infiltration by malignant
cells as evidenced by CKA1/3, CK7 and Napsin A positivity, which consistent with metastatic adeno-
carcinoma, favour lung primary. Unfortunately, patient succumbed to death due to the progression
of the disease. Discussion: Bone marrow aspiration and trephine biopsy are useful diagnostic tools
to identify advanced lung carcinoma in cases whereby biopsy of the primary site cannot be per-
formed for various reasons.
Keywords: lung adenocarcinoma, bone metastasis, non-haemopoietic malignant cell.
EP05
Non-secretory multiple myeloma, a plasma cell myeloma variants – A case report
Munirah Ismail1, Fatin Amirah Suib1, Sharifah Mai Sarah Syed Azim1, Norlida Mohamad Tahir1,
Tengku Norita Tengku Yazid1
¹Department of Pathology, Hospital Selayang, Selangor, Malaysia
Introduction: Non-secretory myeloma is a type of plasma cell myeloma variants in which an M pro-
tein is absent in the serum and urine electrophoresis. Case report: We presented a case of 59
years old ladies who initially presented with presyncopal attack, epigastric pain, loss of weight and
multiple bony pain. On physical examination noted that she had localized left lower rib pain and
spinal tenderness. Routine blood examinations showed mild anaemia with normal white blood cell
count and platelet, high creatinine and hypercalcaemia. Peripheral blood picture showed hypo-
chromic microcytic red cells with unremarkable findings on other cell lineages. Radiological exami-
nations were done and showed multiple areas of lytic bone lesions. Bone marrow aspirate and tre-
phine biopsy was done and showed plasmacytosis which was supported by immunophenotyping
that showed the presence of 8% clonal plasma cells. However, protein electrophoresis showed no
paraprotein or immune paresis in the serum sample and no light chain or paraprotein detected in
the 24-urine protein that was usually present in multiple myeloma. Discussion: Based on clinical
presentation and investigations, this patient fits the diagnosis of non-secretory myeloma in which she
had biopsy proven plasmacytoma, evidence of end-organ damage which is bone lesions and lack
of serum and urinary monoclonal protein on electrophoresis. The presence of anaemia and bone
lesion in an elderly patient should alert the clinician to investigate along the lines of multiple myelo-
ma and the absence of paraprotein in the blood or urine does not exclude multiple myeloma.
Keywords: Multiple myeloma, non-secretory, plasma cell variants
32
EP06
Occult tuberculosis in systemic lupus erythematous patient with pyrexia of unknown origin
Dr Nornattasa binti Mohmad Sallih, Pathologist (Hematology), HSIJB
Dr Thaenujah Nair A/P Ramachandran, Medical Officer Pathology, HSIJB
Introduction: In Systemic Lupus erythematosus (SLE), extrapulmonary Tuberculosis (EPTB) is more
common than pulmonary TB (PTB). The diagnosis of ‘fever secondary to SLE’ is a diagnosis of exclu-
sion, tenable only after an evaluation for infection is unrevealing. Despite the modern diagnostic
tools and advanced therapeutics possibilities, we reported an EPTB from the Bone marrow aspirate
and trephine biopsy (BMAT) examination. Case report: This is a 28th years old staff nurse in Klinik
Kesihatan, first presented to us in 7th January 2020 and diagnosed with SLE (Eular SLE Criteria). She
denies exposure to any TB patient. The Chest X-Ray was normal. All septic workups were done and
she was treated for EPTB with 1+ positive Acid Fast Bacilli (AFB) from gastric lavage. Her second
admission was due to anti TB drugs transaminitis whereby repeat TB workup was negative. Due to
persistent high grade fever at home, without bicytopenia/pancytopenia, BMAT was carried out to in
her third admission to exclude any occult malignancy. Following the BMAT, her trephine biopsy
showing numerous granuloma with very scanty of AFB noted. Discussion: Our case study shows the
propensity of EPTB in a SLE patient without nephritis. BMAT is an accepted investigation in PUO to
uncover haematological malignancies, such as lymphoma, and sometimes infections. Many factors
may contribute to the delay in EPTB as early treatment is important in view high morbidity and mor-
tality of infections per se among SLE patient especially in the first two years of diagnosis.
EP07
Persistent polyclonal B-Cell lymphocytosis (PPBL) – A rare entity
Sri Rahayu S1, Siti Shahrum M.S.2, Norazlina A.2, Mimi Azura A.2
¹Jabatan Patologi, Hospital Pakar Sultanah Fatimah Muar
²Jabatan Patologi, Hospital Tunku Azizah Kuala Lumpur
Introduction: Persistent Polyclonal B-cell Lymphocytosis (PPBL) is a rare disorder of unknown aetiolo-
gy that usually presented among women with history of chronic smoker. It is characterized by a pol-
yclonal expansion of CD19+CD27+IgM+ memory B cells, presence of binucleated lymphocytes and
moderate elevation of serum IgM. We presented a case report of PBBL in a patient with history of
persistent lymphocytosis. Case presentation: A 59 years old gentleman, known case of Chronic Lung
Disease presented with intermittent fever for three weeks. Physical examination showed mild hepa-
tomegaly with no palpable lymph node. Blood investigation showed mild anaemia with absolute
lymphocytes count of 16.2 x 103/µL. LDH and CRP are normal. Peripheral blood film shows lym-
phocytosis with 25% lymphoid cells. Bone marrow aspirate is hypercellular with lymphocytosis. Tre-
phine biopsy shows nodular infiltration by B lymphoid cells at paratrabecular and interstitial areas.
Immunophenotyping done showed increased in B lymphocytes population (54.4%) expressing CD19,
CD20 and CD79b with no kappa or lambda light chain restriction. Similar findings seen on kappa
and lambda immunohistochemistry staining on trephine biopsy. Hence, no clonality established. Cor-
relating with clinical history and morphological findings, features are consistent with PPBL. Discus-
sion: PPBL is a rare condition defined by prolonged lymphocytosis with no clonality established. In
some cases, extra isochromosome for the long arm of chromosome 3+i (3q) or HLA-DR7-positive
detected on cytogenetic analysis. Although the disorder is usually benign, previous studies reported
few patients subsequently developed a mature B cells malignancy. Therefore, long term follow up is
needed in all PPBL patients.
Keywords: Lymphocytosis, Benign
33
EP08
Pseudo thrombotic microangiopathy: A diagnostic confusion.
Nurul Atiqah Abdul Ghani, Abdul Kadir bin Mat, Nor Nazuha binti Mohamad@Manas, Nur Fatin
Izati binti Ahmad Mustaffa, Sanada binti Abu Bakar.
Pathology Department Hospital Taiping
Introduction: Pseudo-thrombotic microangiopathy (TMA) in Vitamin B12 deficiency can cause diag-
nostic confusion with true TMA as both can present with similar picture of hemolysis. It is recognized
yet uncommon as only about 2.5% of Vitamin B12 deficiency patient present with pseudo
TMA. Here we share a case of severe Vitamin B12 deficiency with pseudo TMA. Case report: A 48
years old Chinese man with underlying Hepatitis B came in with constitutional symptoms for past 1
year. Clinically, patient looks pale and jaundice with presence of hepatomegaly. Laboratory inves-
tigations showed pancytopenia (hemoglobin (Hb): 7.5g/dL, platelet: 40 x109/L and white cell count
(WBC): 2.4x109/L) with reticulocyte count of 1.53%. Metabolic panel indicate hyperbilirubinemia
(total bilirubin: 39.3 umol/L with indirect bilirubin of 28.2umol/L) and markedly raised on lactate
dehydrogenase (LDH): 2069u/L. Peripheral blood smear showed presence of macrocytosis, schisto-
cytes and marked thrombocytopenia, similar to microangiopathic hemolysis. Anemia workup noted
severely low Vitamin B12 level: <61pmol/L. Patient was treated with Vitamin B12 supplement and
repeated investigations showed normalized Vitamin B12 level and normal RBC morphology in pe-
ripheral blood smear. These findings confirmed the diagnosis. Discussion: When treating patient
with pseudo thrombotic microangiopathy due to Vitamin B12 deficiency, laboratory studies are in-
dispensable. The lactate dehydrogenase, bilirubin level and reticulocyte count should be evaluated.
A more elevated LDH as well as relatively normal unconjugated bilirubin and low reticulocyte count
are suggestive of pseudo TMA.
Keywords: Pseudo TMA, Thrombotic Microangiopathy, Vitamin B12 deficiency.
EP09
A case report of clinically significant alloantibody anti-c and anti-s in a sickle cell disease pa-
tient
AizuddinMJ, MohamedR, TangLX, TorgiMF, WanAlKamarShahWNH, AbdulKarimF
Blood Transfusion Unit, Pathology Department, Hospital Ampang, Selangor
Introduction: We report a case of a newly detected anti-s in Sickle Cell Disease (SCD) patient who
presented with sickling crisis. It is usually immune globulin (IgG) antibody that is reactive at 37°C
and can be implicated in hemolytic transfusion reaction (HTR) and hemolytic disease of fetal and
newborn (HDFN). Case report: We report a case of Mrs. P, a 32-year-old Indian female diagnosed
as Sickle Cell Disease. Previous antibody identification reported as alloantibody anti-c. Her pheno-
type is R1R1, Jk(a+b+), Fy(a+b+), MM, SS and kk. She had been receiving phenotype specific
Packed Red Cells ie. Group O Rh(D) positive (R1R1), s antigen negative. Her genotyping reported
same as her phenotype. She presented with sickling crisis and symptomatic anemia with hemoglobin
level of 7.5 g/dL. Her antibody screening revealed panagglutination reaction (2+). Direct Antiglob-
ulin Test (DAT) was negative. Antibody identification detected alloantibody anti-c and unable to
exclude an anti-s. Further test of allogeneic adsorption with O Rh (D) negative; rr, SS phenotype
packed cells was unable to be proceeded due to unavailability of such typed cells. Phenotypic
crossmatch with selected cell panels (R1R1, ss), (R1wR1, ss) and (R1Rz, ss) revealed all 2+ reactions,
most likely due to anti-s. Subsequently, two units Packed Cells of O Rh (D) Positive units R1R1, SS
were transfused to her with no adverse transfusion reaction. Discussion: An allogeneic adsorption
test is useful to be performed when there is presence of multiple antibodies in order to separate the
specificities. Searching for suitable adsorbing cell(s) may be difficult in certain blood transfusion unit
with limited inventory stock. We couldn’t find a combination of blood group O Rh(D) negative rr, SS
adsorbing cell for this case. In order to prove the presence of anti-s in this patient’s sample without
the interference of anti-c, the rule out cells chosen are (R1R1, ss), (R1wR1, ss) and (R1R2, ss).
34
EP10
Genetic modifier changes clinical manifestation: Case report of siblings with HbE/Beta Thalas-
saemia
Mimi Azreen Abdullah, Anis Amira Jaafar, Wan Norhasanah Wan Yusof, Suryati Hussin
Haematology Unit, Pathology Department, Hospital Raja Perempuan Zainab II
Malaysian Thalassaemia Registry 2018 reported, there are 7984 Thalassaemia patients in Malay-
sia and about 56.7% of them are transfusion dependant. The majority of the cases are HbE Beta
Thalassaemia, followed by Beta Thalassaemia Major. Individual with severe type of HbE-Beta Tha-
lassaemia resembles Beta Thalassaemia major and needs regular blood transfusion. Here we re-
ported 2 siblings with HbE Beta Thalassaemia but with different clinical manifestation and disease
severity. The first sibling, a twelve-year-old girl was diagnosed with HbE Beta thalassaemia at the
age of 1 year 6 months when incidentally noted low hemoglobin during pre-operative assessment.
Whereas the ten-year-old brother was screened for thalassaemia at the age of 6 months old. Blood
transfusion was started at the age of 6 years and 4 years respectively. The brother needs monthly
blood transfusion in contrast with his sister who needs 3 monthly transfusions. Molecular testing re-
vealed additional heterozygous alpha gene mutation Hb Adana in the brother. This compound ge-
netic mutation explained the severity manifested by the brother. Understanding on genetic modifier
is important to describe these differences. It is important for molecular testing to be readily availa-
ble for proper counselling and management of the patient.
Keywords: HbE Beta Thalassaemia, Hb Adana
EP11
Myelodysplastic syndrome with pure red cell aplasia and del (20q).
Noor Adilah J , Nor Shazwani AA , Azizon O, Azrina A, Nur Shibrah MN
Hematology Unit, Department of Pathology, Hospital Sultan Abdul Halim
Introduction: Myelodysplastic syndrome (MDS) with erythroid aplasia is a very rare disorder that
has not been clearly defined. We report a patient without pre-existing medical illness and a fre-
quent admission for symptomatic anemia (lowest Hb was 2.7 g/dL) with a mean reticulocytes count
of 1.4%. WBC showed raised WBC count with neutrophil predominant and a normal platelet count.
Full blood picture showed features of dysplasia with no blast cells seen. Bone marrow examination
exhibits a trilineage dysplasia and a low percentage of erythroid precursors (~3%). A diagnosis of
Myelodysplastic syndrome with multilineage dysplasia (WHO 2018) with pure red cell aplasia was
made. Cytogenetic analysis of the bone marrow showed a male karyotype with presence of Del 20
(q). Other conditions known to be associated with erythroid aplasia were not elicited further. This
patient was opted for conservative management. Discussion and conclusion: This case illustrates a
rare case of Myelodysplasia with pure red cell aplasia and presence of Del (20q) by cytogenetic
analysis which has been reported to have favorable prognosis in MDS. In this case it is best if pa-
tient has been investigate for other known conditions to be associated with pure red cells aplasia
(e.g. serum erythropoietin & parvovirus B19 detection). Trial of certain therapy (e.g. serum erythro-
poietin or immunosuppressive therapy) if started, response can be monitored and provide added
value for future references.
Keywords: Myelodysplasia with Del (20q), pure red cell aplasia
35
EP12
A rare case of coexistence of CMML and melioidosis – Which one occurred first?
Azizon O1, Noor Adilah J1, Nor Shazwani AA, Nur Shibrah MN1, Noor Hasliza Z2, Kartina MN 2
¹Haematologi Unit, Department of Pathology, Hospital Sultan Abdul Halim, ²Microbiology Unit, De-
partment of Pathology, Hospital Sultan Abdul Halim
Introduction: Chronic Myelomonocytic Leukemia (CMML) is a rare disorder classified as MPN/MDS
and characterised by persistent monocytosis >1x109/L in the peripheral blood (PB). Melioidosis is
an infection caused by a gram negative bacteria, Burkholderia pseudomallei, and it is endemic in
Malaysia, Thailand, Singapore and Australia. We report a diabetic patient presenting with fever
and diarrhoea with infectious markers positive. She also has respiratory symptoms and pleural ef-
fusion but culture and sensitivity (C&S) of the sputum and blood as well as other markers of infec-
tions were negative. Subsequently she was diagnosed as CMML and her condition worsened, was
intubated and succumbed to her illness. The final blood C & S sample which grew B. pseudomallei
came back soon after. Discussion and conclusion: This case indicates the rare coexistence of
CMML with melioidosis. The presentation is atypical for CMML. And being a diabetic and living in
an area with high incidence of melioidosis, B. pseudomallei infection need to be ruled out especially
when other common infections have been excluded.
Keywords: CMML, melioidosis, Burkholderia pseudomallei, DM
EP13
Case report of chronic lymphocytic leukaemia presented with erythrocytosis
Norhayati F1, Kalaichelvi M2, Shalini P2, Norahninzu A3, Ahmad TS4
¹Pathology Department, Hospital Teluk Intan, ²Pathology Department, Hospital Raja Permasiuri Bainun,
³Pathology Department, Hospital Sri Manjung, 4Pathology Department, Hospital Queen Elizabeth
Introduction: Coexistence of erythrocytosis and Chronic Lymphocytic Leukaemia (CLL) is rare. It is
essential to investigate patient with apparent erythrocytosis for the presence of clonal lymphoprolif-
erative disorder to avoid misdiagnosis in patient who presented with increased RBC mass. Case
report: 51 year old gentleman, non-smoker presented with history of polycythaemia since 2016.
Venesection done twice in 2017. Examination revealed no hepatosplenomegaly or lymphadenopa-
thy. Her hematologic parameters revealed Hb 16 g/dL, RBC 6.8x106/µL, HCT 54.2%, MCV
79.9fL, MCH 23.6 pg, Platelet 338x103/µL, WBC 8x103/µL with Neutrophil 3.74x103/µL, Lym-
phocyte 3.04x103/µL, Monocyte 0.9x103/µL, Eosinophil 0.23x103/µL and Basophil 0.1x103/µL.
Peripheral blood film showed normochromic normocytic red cells with left shift. No abnormal lym-
phoid cell. Bone marrow aspirate showed haemodiluted marrow sample. Trephine biopsy revealed
a normocellular marrow with nodular pattern of infiltration by tumour cells which composed of small
lymphocytes. They express CD20+, CD79+, CD5+, CD23+, Cyclin D1- and CD3-. No obvious evi-
dence of erythroid hyperplasia. JAK-2 and Calreticulin mutation analysis are not detected. Discus-
sion: There is erythrocytosis without evidence of erythroid hyperplasia. Therefore, proper bone
marrow assessment is important to look for occurrence of CLL with co-existence of erythrocytosis to
avoid missed diagnosis of Lymphoproliferative disorder in patient who presented with erythrocyto-
sis.
Keywords: Erythrocytosis, Chronic Lymphocytic Leukaemia
36
EP14
Compound heterozygous Haemoglobin D-Punjab/ Beta Thalassaemia versus Homozygous Hb
D-Punjab: Diagnostic challenges in interpreting haemoglobin analysis.
Munirah AR1, Siti Aisyah AG2, Norhayati F2, Faidatul Syazlin AH3, Yuslina MY3
¹Haematology Unit, Department of Pathology, Hospital Kuala Lumpur, ²Pathology and Transfusion
Department, Hospital Kulim, ³Haematology Unit, Cancer Research Centre, Institute for Medical Re-
search
Introduction: Compound heterozygous Hb D-Punjab/ Beta thalassaemia and Homozygous D-Punjab
are rarely reported in our country, thus may lead to diagnostic challenge when interpreting the Hb
analysis. Nevertheless, when interpreting Hb analysis, attention must be given to differentiate these
mutations as compound heterozygous Hb D-Punjab/ Beta thalassaemia carry 25% risk of offspring
with beta major if the partner is beta thalassaemia trait, which is prevalent in our country. Case
report: We reported a case of a 16-year-old Malay student who was involved in the National Tha-
lassaemia screening program. She was asymptomatic, her Full Blood Count showed Hb of 11.9g/dL,
MCV: 61.2fL and MCH: 19.3pg. Her Hb analysis by Capillary Electrophoresis revealed very high
Hb D of 92.3% with HbA2 (5.9%) and HbF (1.8%). The additional method by High Performance
Liquid Chromatography showed abnormal peak of 83.9% at D window, HbA2 of 3.4% and HbF of
1.7%. From these findings, a presumptive diagnosis of homozygous Hb D was made. However, DNA
analysis performed later revealed compound heterozygosity for Codon 121 (G>C) Hb D-Punjab
and beta thalassaemia, IVS1-1 (G>T) mutations. Discussion: The purpose of this study is to high-
light the diagnostic challenge in interpretating haemoglobin analysis in differentiating compound
heterozygous Hb D-Punjab/ Beta Thalassaemia from Homozygous Hb D-Punjab.
Keywords: Compound heterozygous Haemoglobin D-Punjab/ Beta Thalassaemia, Homozygous Hb D-
Punjab,haemoglobin analysis
EP15
A delayed diagnosis of compound heterozygous 3.7 alpha globin gene deletion and Haemo-
globin Adana
Azly Sumanty AG, Wan Amal Hayati WH, Wan Zuhairah WE, Embong, Norhafizatul Aida AK ,
Noraesah M.
Hospital Sultanah Nur Zahirah, Hospital Kuala Lumpur
Introduction: Haemoglobin Adana is known as a rare non-deletional alpha chain mutation. Despite
rarity, this mutation and its coinheritance with other alpha thalassaemia has been well described.
Such interactions may lead to various clinical presentations. Molecular techniques are required to
confirm the diagnosis. Case Report: A 55-year-old Malay lady was referred to our centre for sus-
pected myelofibrosis when she presented with severe anaemia and splenomegaly. Bone marrow
examination was performed and showed erythroid hyperplasia. Molecular analysis for thalassae-
mia confirmed a diagnosis of compound heterozygous 3.7 alpha globin gene deletion and Haemo-
globin Adana. Discussion: Thalassaemia should be suspected in patients presenting with severe
anaemia, especially in populations with high incidence of thalassaemia. This may avoid missed or
delayed diagnosis.
Keywords: Haemoglobin Adana, thalassaemia
37
EP16
Hb Köln: A diagnostic challenge
Azly Sumanty AG, Wan Amal Hayati WH, Wan Zuhairah WE, Nazzlin Dizana D, Yuslina MY.
Hospital Sultanah Nur Zahirah, Institut Penyelidikan Perubatan
Introduction: Hemoglobin Köln is an unstable hemoglobin variant which has been reported in Eu-
rope and other Asian countries but infrequently reported in Malaysian population. It is commonly
inherited but rarely can occur de novo. Case Report: A 4-year-old Malay boy who presented with
chronic cyanosis was referred to our pediatric hematologist after extensively investigated by cardi-
ac and respiratory team. Hemoglobin analysis performed to exclude thalassemia/
hemoglobinopathy. Molecular analysis of the beta globin chain showed presence of Hemoglobin
Köln. Both parents did not have similar mutation. Discussion: The diagnosis of hemoglobin variants
poses a challenge to clinicians. Knowledge on the clinical symptoms and required tests to select is
crucial. Thus, laboratory medicine plays an extremely important role in aiding clinicians to confirm
the diagnosis.
Keywords: Hb Köln, hemoglobin variant
EP18
Disseminated tuberculosis with bone marrow involvement – A case report
Munirah Ismail1, Fadia Sharmin Fauzi1, Sharifah Mai Sarah Syed Azim1, Norlida Mohamad Tahir1,
Tengku Norita Tengku Yazid1, Anuradha Radhakrishan2
1Department of Pathology, Hospital Selayang, Selangor, Malaysia, 2Department of Infectious Disease,
Hospital Selayang, Selangor, Malaysia
Introduction: Disseminated tuberculosis is a disease caused by the hematogenous spread of Myco-
bacterium tuberculosis and bone marrow involvement is considered rare. Case report: We present-
ed a case of 41 years old gentleman with underlying advanced retroviral disease (RVD) and recent
admission for a left parotid abscess. This patient had presented with a history of fever and gener-
alised body weakness for two weeks. On physical examination, there is left parotid swelling possi-
ble due to the previous infection. He had an episode of septicaemic shock requiring fluid resuscita-
tion during initial admission. Routine laboratory investigations including infective markers and radio-
logical imaging which is CT brain and neck was done to look for possible sources of infections. The
peripheral blood picture showed pancytopenia with no other remarkable findings. Bone marrow
trephine biopsy was done and show the presence of tuberculous granuloma with acid-fast bacilli
(AFB) demonstrable by Ziehl Neelsen stain. His blood culture also turns out to be positive for Pseu-
domonas Aeruginosa. Other infective markers such blood culture for fungal, CSF work out for tuber-
culosis, bone marrow culture for fungal and tuberculosis, tissue culture from parotid and CMV viral
load are still pending. He was then started on treatment for disseminated tuberculosis and Pseudo-
monas bacteremia. Discussion: Since this patient is immunocompromised, he is vulnerable to many
opportunistic infections. The presentation of disseminated tuberculosis is non-specific and can be a
diagnostic challenge. The presence of signs and symptoms of infection with cytopenia on peripheral
blood examination especially in immunocompromised patients warrants a bone marrow histopatho-
logical examination and culture to exclude the possibility of disseminated tuberculosis.
Keywords: Disseminated tuberculosis, bone marrow
38
EP19
A rare case of non-deletional HbH disease in an Indonesian family
Ruzanaz Syafira Ruzman Azlee1, Syahzuwan Hassan1, Ermi Neiza Mohd Sahid1, Faidatul Syazlin
Abdul Hamid1,Norafiza Mohd Yasin1, Yuslina Mat Yusoff1, Ezalia Esa1
1Haematology Unit, Cancer Research Centre, Institute for Medical Research, Jalan Pahang, 50588
Kuala Lumpur, Malaysia
Introduction: Non-deletional HbH is more severe than deletional type and usually manifests as ane-
mia and hemolysis. It can be aggravated by pregnancy, infection or exposure to oxidant drugs. We
report a family with Hb Constant Spring (CS), whom the wife had a non-deletional HbH disease
caused by compound Hb Constant Spring (CS) and a rare uncharacterized large alpha gene dele-
tion. Case Report: A 29-year-old Indonesian lady, G3P1+1 was seen in O&G clinic at 20 weeks of
gestation for anemia. She had history of multiple blood transfusions in pregnancy. Currently, 9 pints
of blood had been transfused. Her pre-tranfusion Hb was 7.6g/d with MCV and MCH of 79.5fl and
21.7pg. The capillary electrophoresis (CE) was suggestive of HbH CS with HbCS (2.1%), HbH
(0.2%) and Hb Bart’s (4.6%). Her husband was asymptomatic. His blood count and CE findings were
clearly suggestive of Hb CS trait. Multiplex ARMS PCR analysis detected homozygous HbCS in the
patient and fetus; and heterozygous HbCS in the husband. As there was high suspicion of HbH dis-
ease in the patient, Multiplex Ligation-dependent Probe Amplification analysis was proceeded. It
revealed uncharacterized large deletion of 101.9 kb spanning from upstream HBM (184nt) until
LUC7L gene (277nt) involving the HBA1 and HBA2 genes in a heterozygous state. Discussion: The
patient is having non-deletional HbH disease resulting from compound heterozygous HbCS and dou-
ble alpha gene deletion. The deletion is uncharacterized and large. This finding needed to be ex-
cluded in their child as there is 25% risk of inheritance. Further molecular analysis is also required to
characterize the deletion.
Keywords: Non Deletional HbH Disease, Hb Constant Spring, double alpha gene deletion, MLPA
EP20
Hb Louisville, a rare hemoglobinopathy causing hemolytic anemia and low oxygen saturation
Ermi Neiza Mohd Sahid1, Noor Adilah Jaapar2,Faidatul Syazlin Abdul Hamid1, Syahzuwan Hassan1,
Norafiza Mohd Yasin1, Yuslina Mat Yusoff1, Ezalia Esa1
1Haematology Unit, Cancer Research Centre, Institute for Medical Research, Selangor, Malaysia, 2Hos-
pital Sultan Abdul Halim, Kedah, Malaysia
Introduction: Hemoglobin (Hb) Louisville, also known as Hb Bucureşti, is a rare hemoglobinopathy. It
was first described in a Caucasian family in Louisville, Kentucky in 1971. This is the first case report
involving Malay ethnicity. Case Report: The patient is a 28 years old Malay woman who presented
with hemolytic anemia at 12 weeks of pregnancy. She had history of blood transfusions at younger
age. Her SPO2 level was low (~80%) but her PaO2 was normal with no evidence of methemoglo-
binemia. She is asymptomatic with no underlying cardiac or respiratory illness. Blood investigations
showed low Hb (7.4 g/dL), low red cell count (2.63 x 106/uL), high reticulocytes count (13.15%),
and raised Lactic Acid Dehydrogenase level. The blood film exhibited polychromasia with no pres-
ence of spherocytes and the Coomb test was negative. Hb analysis showed HbA, HbA2 and HbF
levels of 95.5%, 3.4% and 1% respectively. Molecular studies for α-globin genes were negative
while DNA sequencing of β-globin gene revealed mutation at codon 42 [β42(CD1)Phe→Leu]. Dis-
cussion: Position 42 is a crucial point of contact between the β-hemoglobin chain and heme. Substitu-
tion of phenylalanine by leucine distorts the heme pocket, leading to instability of the Hb molecule.
This caused the shifts of oxygen dissociation curve to the right and subsequently reduces the produc-
tion of erythropoietin; leading to a lower steady-state level of Hb. Carriers has risk of hemolytic
crisis when exposed to oxidizing agents, drugs or infections. Therefore, awareness and identification
of this disease will enable proper patient care and genetic counseling.
Keywords: Hb Louiseville, Hb Bucuresti, DNA sequencing, Hemolytic Anaemia
39
EP21
A case series of pediatric chronic myeloid leukemia in Hospital Sultanah Nur Zahirah
Wan Zuhairah W. Embong, Muhammad Khairil Anuar Wahab, Azly Sumanty Abdul Ghani, Wan
Amal Hayati Wan Hassan, Nazzlin Dizana Din
Hematology Unit, Department of Pathology, Hospital Sultanah Nur Zahirah, Kuala Terengganu
Background: Chronic Myeloid Leukemia (CML) is a rare disease in children. It only constitutes 2-3%
of all pediatric leukemia. Case Report: We present six cases of pediatric CML diagnosed in Hospi-
tal Sultanah Nur Zahirah (HSNZ) between 2016 to 2021. Five of the children’s age ranging from
10 to 14 years old, with one was almost three years old upon diagnosis. At presentation, all the
patients have hepatosplenomegaly with four of them have massive splenomegaly. All patients have
normochromic normocytic anemia (median hemoglobin 8.6g/dL). The median of White Blood Cells
(WBC) and platelet are 308.5x109/L and 390x109/L respectively. Three of them had blast crisis
upon diagnosis while the other one transformed to acute leukemia a month after diagnosis. Major
BCR-ABL1 fusion transcript were detected in all patients. Four of them received Tyrosine Kinase In-
hibitor (TKI) with two patients already underwent allogeneic stem cell transplant. Discussion: Pedi-
atric CML is a rare disease, and even extremely rare in less than three year old. It has more ag-
gressive course of the disease than adult CML. Otherwise, the findings of histopathological, cytoge-
netic and immunophenotyping are comparable to adult.
Keywords: Paediatric, Chronic Myeloid Leukemia, BCR-ABL1, Tyrosine Kinase Inhibitor
EP22
A case report of therapy related acute myeloid leukaemia following chemotherapy for ad-
vanced breast cancer
Amal Hayati WH1, Noor Hafidah H1, Azly Sumanty AG1, Wan Zuhairah WE1, Norhafizatul Aida
AK2, Faezahtul Arbaeyah H3, Shenaz Banu SK4, Siti Shahrum MS4, Aziati Azwari A5
¹Haematology Unit, Department of Pathology, Hospital Sultanah Nur Zahirah, ²Medical Department,
Hospital Sultanah Nur Zahirah, ³Pathology Department, Universiti Sains Malaysia, ⁴Haematology Unit,
Department of Pathology, Hospital Tengku Azizah, ⁵Human Genome Centre, Universiti Sains Malaysia.
Introduction: Therapy-related acute myeloid leukemia (t-AML) is included in the clinicopathologic
syndrome of therapy-related myeloid neoplasms (t-MNs) which form a distinct entity within the
World Health Organization (WHO) classification. Case Report: A 45 year old lady with advanced
right breast cancer and was treated with surgery, chemotherapy and radiotherapy. She had re-
ceived a combination of chemotherapy, Fluoracil, Epirubicin and Cyclophosphamide. After 5 years,
she presented with lethargy and fever. Physical examination revealed no hepatosplenomegaly or
lymphadenopathy. Her blood count showed WCC 20.1 x 109/L, Hb 6.9 g/dl , PLT 21 x 109/L,
Neutrophils: 0.82 x 109/L, Lymphocytes: 5.38 x 109/L, Monocytes: 13.82 x 109/L. Initial FBP
showed monocytosis with occasional blast cells. Bone marrow aspiration was haemodiluted and
presence of 8-12% blast cells in the haemodiluted sample. Trephine biopsy showed increase in im-
mature cells. Subsequent FBP showed presence of 55% blast cells with occasional Auer rods seen.
Peripheral blood immunophenotyping showed presence of 24% myeloblast and 32% promono-
cytes. Cytogenetic analysis showed 46, XX, del ( 11)(q23) [7]/ 46, idem, dup (2) (q22q33). Discus-
sion: Therapy related AML (t-AML) is a late complication of chemotherapy. Alkylating agents are
well-known factors associated with an increased risk of developing t-AML. 11q23 rearrangement
were found in t-AML patient following a treatment with alkylating agent, anti- topoisomerase II or
radiotherapy. t-AML should be considered in any AML patients with a prior history of exposure to
cytotoxic chemotherapy. Identifying these cases is very important as t- AML conveys an independent
risk factor for poor survival.
Keywords: therapy related acute myeloid leuakemia, alkylating agent, breast cancer
40
EP23
c-KIT D816V mutation in core-binding factor acute myeloid leukaemia
Zahidah Abu Seman, Nor Rizan Kamaluddin, Ezalia Esa, Ermi Neiza Binti Mohd Sahid, Norafiza Binti
Mohd Yasin, Julia Abdullah, Yuslina Mat Yusoff
Institute for Medical Research
Introduction: Core-binding factor acute myeloid leukaemia (CBF-AML) is defined by the presence
of a t(8;21)(q22;q22) and the associated RUNX1–RUNX1T1 fusion gene, or an inv(16)(p13.1q22)/
t(16;16)(p13.1;q22) with the resulting CBFB–MYH11 fusion gene. CBF-AML has been considered an
AML group with favourable prognosis. However, concurrent c-KIT mutation is associated with ad-
verse prognosis. c-KIT D816V activating mutation is frequently found in CBF-AML and have been
reported in 30-45% of cases. This study aims to explore c-KIT D816V mutations in CBF-AML pa-
tients. In this study, we retrospectively analysed the frequency of c-KIT D816V mutation in CBF-AML
patients. Materials and Methods: A total of 156 samples CBF-AML patients were selected between
January 2016 and December 2020. The bone marrow and peripheral blood samples were extract-
ed using QIAamp DNA MiniPrep Kit. Mutation detection was performed using Human c-KIT Gene
D816V Mutation Detection Kit and run via Applied Biosystems 7500 Real-time PCR. Results: Out of
156 patients, 26 (16.7%) were found to have c-KIT D816V mutation with median age of 19.5
(range, 1 – 64). Male to female ratio was 1.6:1 with an ethnic composition of Malays 50%, Chinese
19%, Indian 4% and others 27%. Discussions: This study highlights the frequency and distribution
pattern of c-KIT D816V mutation in Malaysian cohort. c-KIT D816V mutation in our CBF-AML pa-
tients are lower compared to other study, which may suggest a unique genetic finding in our AML
patients. Identification of this mutation are important for prognostication and optimization of patient
care.
Keywords: core binding factor; acute myeloid leukaemia; c-KIT D816V mutation
EP24
Case series of Heterozygous Hb E with alpha thalassaemia
S.Y. Koh
Department of Pathology, Hospital Tuanku Ja’afar
Introduction: Haemoglobin E (Hb E) is a β-haemoglobin variant caused by point mutation, results in
G>A substitution in codon 26. When Hb E and two gene deletion alpha thalassaemia trait coexist,
marked reduction in Hb E level observed. In practice, Hb E level <25% is used based on high per-
formance liquid chromatography (HPLC) as initial discrimination. This study aim to determine the
mean level of Hb E in capillary electrophoresis (CE) for such condition. Materials and methods: Cas-
es with ‘Hb E with suspected alpha thalassaemia’ (n=110) were retrieved from laboratory infor-
mation system for year 2018-2020. Hb analysis results and DNA analysis result for alpha thalas-
saemia were reviewed. Cases with anaemia without serum ferritin to exclude iron deficiency or
without DNA confirmation of alpha thalassaemia are excluded from this study. Results: Seven cases
of heterozygous α0-thalassaemia SEA deletion/Hb E, 2 cases of homozygous α+-thalassaemia 3.7
deletion/Hb E, one case of heterozygous α+-thalassaemia 3.7 and 4.2 deletion and 6 cases of Hb
Constant Spring (Hb CS)/Hb E identified. Hb E level in CE range 15.8-18.2% (mean=16.4); while
Hb E/A2 in HPLC range 18.9-22.5% (mean=20.1) for Hb E/two gene deletion alpha thalassae-
mia. For Hb CS/Hb E, Hb E level in CE range 22.6-24.3% (mean=23.2) and Hb CS in CE range
0.2-0.4%; while Hb E/A2 in HPLC range 25.3-30.1% (mean=27.3). Discussion: A cut off Hb E
<20% in CE could be a useful marker to identify heterozygous Hb E with two gene deletion alpha
thalassaemia. Though Hb CS could be missed, CE is sensitive to detect this variant.
Key words: Hb E, alpha thalassaemia
41
EP25
A study on clinical impact of hematology sample rejection in district major specialist hospital
Sri Rahayu S, Jefri A, Nur Aisyah SA, Yong LM
Jabatan Patologi, Hospital Pakar Sultanah Fatimah Muar
Introduction: Sample rejection is one of quality procedures in total testing process. The objective of
this study is to identify clinical impact of hematology sample rejection in HPSF Muar. Materials and
Methods: This retrospective study accumulated rejection sample data from 1 January 2020 to 31
December 2020 through LIS. Rejection causes, sources and clinical impact in term of timeliness of
recollected samples, abandoned samples and recollected samples with critical result were evaluat-
ed using the SPSS version 24. Results: Total number of rejection samples in Hematology Unit were
4,284 from 151,488 samples received in 2020. Rejection rate was 2.82%. Majority of rejection
samples were in-house test samples (98.5%). Commonest cause of rejection is clotted sample
(44.8%) followed by hemolysis (26.7%). About 3136 samples were recollected (73.2%) and medi-
an time of recollected sample received was 85 minutes. Study showed 21.7% rejected samples
were not recollected, categorised as abandoned sample (p=0.12). Most of abandoned samples
come from Emergency department. About 5.0% (157) of the recollected samples showed results
within critical limit of notification for FBC, Coagulation profile and FBP (p=0.2). Discussion: Our
study shows rejection causes are mainly contributed by improper blood taking technique. Hence,
phlebotomy training shall be mandatory to all new staff. Major consequences of sample rejection
are a significant delay in availability of test report particularly critical results and increased num-
ber of abandoned samples. Effective communication between laboratory and clinical department
should be emphasized to prevent this issue.
Keywords: Sample rejection, Clinical impact, Hematology
EP26
Establishment of reference range for CD3+, CD4+ and CD8+ T-lymphocyte among healthy
adults in Penang, Malaysia
Shaira M. N., Nabeelah A. K., Siti Salwani R., Norfazlina S.
Haematology Unit, Department of Pathology, Hospital Pulau Pinang
Introduction: Measurement of T-lymphocyte cells population percentage and absolute count are
useful in the diagnosis of patients with human immunodeficiency virus (HIV) infection and monitoring
these immunological markers in the initiation of antiretroviral therapy and prophylactic drugs for
opportunistic infections1. These ranges tend to vary across populations and have not been compre-
hensive established in the Malaysian population. Therefore, this study aimed to establish reference
ranges for T lymphocytes subset count and CD4+/CD8+ ratio. Material and Methods: A cross sec-
tional study was conducted on apparently healthy individuals from December 2019 to February
2020. The sample was collected in EDTA Vacutainer tube and screened for biohazard after collec-
tion. Samples were analysed using Beckman Coulter AQUIOS CL Flow Cytometer and stained with
AQUIOS Tetra-1 Panel monoclonal antibody reagents to enumerate the T-cell subpopulations. Ref-
erence ranges values are expressed as percentage (%) of the total lymphocyte count and as abso-
lute counts (cells/uL). Geometric mean and 95% confidence were used to calculate the reference
intervals. Results: Reference intervals for CD3+, CD3+/CD4+, CD3+/CD8+, CD45+ Low SS,
CD45+ and CD4+/CD8+ ratio were established by assaying 120 healthy donor samples on
AQUIOS CL. The normal reference intervals were 831-2240 cells/uL, 358-1279 cells/uL, 268-925
cells/uL, 1291-3227 cells/uL, 4361-9597 cells/uL, and 0.490-2.405 for CD3+, CD3+/CD4+,
CD3+/CD8+, CD45+ Low SS, CD45+and CD4+/CD8+ ratio respectively. Discussion: The refer-
ence range for a laboratory test can be defined as a range in which at least, 95% of the test re-
sults from apparently healthy individuals would fall within the confidence interval. Population data
from this study have shown the characteristics of normal distribution based on Anderson-Darling A2
test (p>0.05).
42 EP27
Factors affecting cord blood glucose-6-phosphate dehydrogenase levels
Sarah Abdul Halim1,3, Shafini Mohamed Yusoff1,3, Rosnah Bahar1,3, Wan Zaidah Abdullah1,3, Erinna
Mohamad Zon2,3
1Department of Haematology, School of Medical Sciences, USM, 16150 Kubang Kerian, Kelantan,
2Department of Obstetric and Gynaecology, School of Medical Sciences, Health Campus, Universiti
Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia, 3Hospital Universiti Sains Malaysia,
16150 Kubang Kerian, Kelantan, Malaysia
Introduction: Glucose-6-Phosphate Dehydrogenase (G6PD) is an enzyme that provides the only
source of NADPH in red blood cell. There is mixed evidence for mean G6PD levels in term and
premature neonates. The objectives of this study are to compare the mean cord blood G6PD level
of term and preterm neonates and to assess other factors affecting G6PD level. Methods: This was
a cross sectional study done in Hospital USM. Quantitative assay (Biosensor1) was performed on
455 cord blood samples taken at birth. Birth parameters were collected from labour room records.
Results: 93.4% (371) of the samples were term neonates, whilst 6.6% (84) were preterm neonates.
The mean G6PD level for term neonates was 6.84 U/gHb whilst for preterm neonates was 6.63 U/
gHb. Using independent T-Test, there was no significant difference in the mean G6PD levels be-
tween term and preterm neonates (p= 0.22). There was no significant association between gesta-
tional age groups and mean G6PD level when tested using one way ANOVA test, stratified across
gestational age groups. One way ANOVA test was also used to assess the association between
maternal blood group and birthweight with cord blood G6PD level. For maternal blood group and
birthweight, the p values were more than 0.05. Discussion: There is no significant difference be-
tween mean G6PD level for term and premature neonates. Overall, there is no significant associa-
tion between maternal blood group and birthweight with G6PD level. Larger study with hetero-
genous population of premature neonates is needed to evaluate mean G6PD level of preterm neo-
nates.
Keywords: Glucose-6-Phosphate Dehydrogenase, term, premature, birthweight, maternal blood group.
EP28
Intraoperative blood loss and blood transfusion requirement among liver transplant recipients.
A national single center experience 2020.
Mohd Faeiz Yusop¹, Norlida Mohamad Tahir1, Sharifah Mai Sarah Syed Azim1, Ameera Ashyila
Kamaruzaman1, Arvend Kugaan1, Mohd Fairuz Osman1, Nur Raihan Hatta1, Tengku Norita Tengku
Yazid1, Suryati Mokhtar2, Haniza Omar3, Ahmad Suhaimi Amir4
¹Department of Pathology, Hospital Selayang, Selangor, Ministry of Health, Malaysia, ²Department of
Hepatobiliary, Hospital Selayang, Selangor, Ministry of Health, Malaysia, ³Department of Hepatology,
Hospital Selayang, Selangor, Ministry of Health, Malaysia, ⁴Department of Anaesthesiology and Inten-
sive Care Unit, Hospital Selayang, Selangor, Ministry of Health, Malaysia
Background: Liver Transplantation (LT) is a complicated surgical procedure with high risk for massive
intraoperative blood loss due to pre-existing coagulopathy, portosystemic shunts with collateral cir-
culations and splenomegaly. The transfusion service will direct most of their resources towards LT
programmes with great impact on cost. The purpose of this study was to evaluate single center
transfusion strategies and to identify the risk factors associated with the intraoperative blood loss
and blood transfusion. Methods: The study includes 18 patients who underwent LT at Hospital Sela-
yang between January 2020 and December 2020. Retrospective analysis of data included pre-
operative assessment of coagulopathy, intraoperative blood loss, blood component transfusion. Re-
sults: The mean age in the study group was 36.4 ± 12.68 years. The mean intraoperative blood
loss was 4450 ± 1646 ml requiring 4.17 ± 3.3 Packed Red Blood Cell (PRBC) Units, 7.56 ± 5.5
platelet units, and 9.50 ± 6.0 fresh frozen plasma (FFP) units. The independent risk factor for High
Blood Loss (HBL) group was lower pre-operative platelet count and it is statistically significant (p =
0.024). The HBL group is associated with higher usage of PRBC (p = 0.024) and Platelet Units (p =
0.031) and it is statistically significant. The length of stay (LOS) in ICU averaging 8.6 ± 4.95 days
and there is no significant differences comparing the HBL and LBL group (p = 0.552). The mortality
< 90 days for all recipients was 22.2%. Conclusion: The pre-operative platelet count for is the
most important factor associated with HBL in LT procedure. Usage of PRBC and Platelet units were
statistically higher in the HBL group. Comparing HBL and LBL patients, there is no difference in terms
of the LOS in ICU post-operatively. A larger sample size would be needed in view of relatively
small sample size.
43
EP29
Detection of thalassemia intermedia among Form 4 Students in Penang State
Ewe Lean Theng, Muhaashini A/P Kandasamy, Kaveta A/P Balasubramaniam, Ida Marhainis Isahak
Haematology Unit, Department of Pathology, Hospital Pulau Pinang.
Background: Thalassemia is the commonest inherited blood disorder in Malaysia. National Thalasse-
mia Screening Programme enables to identify carriers and assess the risk of an individual having an
affected child and to provide information on the option available to facilitate the people to take
positive action in the control and prevention of Thalassemia. Materials and methods: Data was
collected retrospectively in Haematology laboratory, Hospital Pulau Pinang from 2016 to 2020.
The diagnostic workups included full blood count, blood film morphology and haemoglobin analysis.
Cases with positive findings were suggested to send for DNA analysis for confirmation. Results: A
total of 16 patients were identified however only 5 of them had complete and diagnostic workup
data. There were four patients who are Malay ethnicity and one who is Chinese Malaysian with four
being female. The hematological indices revealed hypochromic microcytic anemia in all 5 cases with
Hb ranging from 8.6 to 11.2 g/dL, RBC indices ranging from 4.1 to 6.4 and MCH were between
17.1 to 20.9. In all 5 cases, target cells were observed on the peripheral blood smear. Patient who
had moderate level of haemoglobin were clinically symptomatic. The cases identified from Hb anal-
ysis were HbH disease (1 case), HbH-Hb Constant Spring (1 case), HbE/ β thalassemia (1 case) and
HbE/ β variant (2 cases) with HbE/ β thalassemia showed the lowest Hb level (8.6 g/dL). Unfortu-
nately, none of these cases was sent for DNA analysis for confirmation. Conclusion: Significant la-
boratory detection of thalassemia carrier was identified in Form 4 screening programme. This popu-
lation of carrier can receive counselling and cascade screening before marriage, hence prevent or
reduce the birth of new cases.
EP30
Verification study on Cepheid GeneXpert Systems for major BCR-ABL1 quantitation at Hospital
Tunku Azizah (HTA), Hospital Pulau Pinang (HPP) and Hospital Sultanah Aminah (HSA) - 3
centers experience
Siti Shahrum M. S.1, Mahiran M.1, Siti Aisyah A.1, Mimi Azura A.1, Ida Marhainis I.2, Nor Ayuni
K.2, Wee S.Y.3, Indhira S.3
¹Hospital Tunku Azizah, Kuala Lumpur, ²Hospital Pulau Pinang, ³Hospital Sultanah Aminah, Johor
Bharu
Introduction: BCR-ABL1 quantitation is the standard-of-care protocol in Chronic Myeloid Leukaemia
(CML) molecular monitoring.1 We offered Major BCR-ABL1 Quantitation test since December 2020
using Xpert BCR-ABL Ultra on GeneXpert System. This automated cartridge-based assay performs
RNA extraction, cDNA production, real-time qPCR, and signal detection directly from a whole blood
sample. It is aligned to the WHO International Scale (IS) with sensitivity reaching MR4.5. Material
and Methods: We assessed the performance of Xpert BCR-ABL Ultra using Xpert BCR-ABL IS Panel
C130, an external Quality Control. Two samples from CML patients at HPP and HSA were ana-
lyzed at each hospital and re-tested at HTA. External Quality Assurance (EQA) samples were also
analyzed to assess the accuracy of the GeneXpert System. Results: Linear regression analysis on
Xpert BCR-ABL IS Panel C130 showed high degree of correlation with the coefficient determinant,
R2 ≥ 0.9923. The results were well within the acceptable 2-3-fold variability for each level. There
was a good concordance between results of all samples performed at the three centers. External
Quality Assurance (EQA) samples results were satisfactory. Discussion: IS% value obtained from
Xpert BCR/ABL Ultra is reproducible and comparable among GeneXpert Systems at HTA, HPP and
HSA. Xpert BCR-ABL Ultra assay captures adequate ABL copies (>32,000) to support a sensitivity
claim of MR4.5. The benefits of this test include less laborious procedure with simpler workflow with-
out requirement of highly trained personnel. Results are available within 2.5 hours. The limits of de-
tection, sensitivity, specificity, and precision are comparable to the standard qPCR.
Keywords: BCR ABL1 Quantitation, Chronic Myeloid Leukaemia, GeneXpert System, International
Scale, qPCR
44
EP31
Blood requisition and transfusion practice for elective surgical procedures in Hospital Port Dick-
son, Negeri Sembilan.
K. F. Lee1, Nur Juliana Idris1
1Pathology Unit, Hospital Port Dickson, Negeri Sembilan, Malaysia
Introduction: The preoperative blood requests for elective surgeries frequently exceeds the actual
requirement resulting in unnecessary crossmatching. The objective of this study is to evaluate the
efficacy of blood utilization as the first step to developing a maximum surgical blood-order sched-
ule (MSBOS) at local setting. Material and methods: We collected data retrospectively by manual
extraction of each form requesting for crossmatched pack cells (PCs) from 1 January 2020 to 31
December 2020. The data included department requesting the crossmatched PCs, types of elective
surgical procedure, number of units requested, number of units crossmatched and number of units
transfused. Indices used for data analysis were crossmatch to transfusion ratio (CT ratio), transfusion
probability (TP) and transfusion index (TI). Results: A total of 127 patients from three different
departments (obstetrics & gynaecology, general surgery and orthopaedics) were included in this
study. Out of 227 units of PCs crossmatched, only 33 units were transfused for 26 patients. The
overall ratios of CT, TP, and TI were 6.9, 21%, and 0.3 respectively. Better blood utilisation was
seen in orthopaedic surgeries with CT ratio of 2.3 and transfusion probability of 50%. Meanwhile
we noticed the highest CT ratio in obstetric surgeries particularly in patients undergoing elective
lower segment caesarean section (LSCS). Discussions: This study indicated an ineffective blood
utilization in majority of the elective surgical procedures performed in this hospital. Thus, a locally
accepted MSBOS is recommended and introduction of type and screen (GSH) can be safely imple-
mented according to patient’s risk factors.
Keywords: Blood transfusion, crossmatch to transfusion ratio, maximum surgical blood ordering sched-
ule, transfusion index, transfusion probability.
EP32
Clinico-pathologic features of newly diagnosed early T-cell precursor lymphoblastic leukemia:
Hospital Tunku Azizah Kuala Lumpur experience
Nurimatussolehah S., Siti Shahrum M. S., Norazlina A., Shenaz Banu S. K., Suzana Z., Mimi Azura A.
Hospital Tunku Azizah, Kuala Lumpur
Introduction: Early T-cell Precursor Acute Lymphoblastic Leukemia (ETP-ALL), a subtype of T-ALL,
express unique immunophenotypic markers which retain multi-lineage differentiation potential, sug-
gesting their direct derivation from hematopoietic stem cells. The prevalence of ETP-ALL in various
age groups has been reported to be around 5-17% cases of T-ALL. We present 3 ETP-ALL cases
diagnosed at Hospital Tunku Azizah Kuala Lumpur (HTAKL). Material and Methods: Diagnosis of
ETP-ALL established by flow cytometry analysis whereby it detects a T-Lymphoblast lacking expres-
sion of CD5, CD8 and CD1a and is positive for ≥1 of the myeloid/stem cell markers namely CD34,
CD117, CD13 or CD33 with negative cyMPO. Clinicopathologic, molecular and cytogenetic findings
were also reviewed. Results: The ETP-ALL comprises of 21.4% of total childhood T-ALL in HTAKL. All
present with anemia, leukocytosis and thrombocytopenia with hepatomegaly ± splenomegaly, one
has mediastinal mass. More than 70% blasts observed in bone marrow examination. Flow cytometry
analysis shows a T-Lymphoblast lacking expression of CD5, CD8 and CD1a and is positive for ≥1
myeloid/stem cell markers and negative cyMPO. 1 case has brighter expression of CD5, hence
diagnosed as Near-ETP-ALL. Del1(p32)(STIL-TAL1) detected in Near-ETP-ALL case. Discussion: ETP-
ALL is a subgroup of T-ALL characterized by early arrest in T-cell differentiation and positivity for
at least one marker of stem cell or myeloid lineage. Our incidence of ETP-ALL among childhood T-
ALL is higher than other studies.4,5 The flow cytometry of T-Lymphoblast with weak CD5 (<75% of
blasts), CD8 and CD1a negativity as well as a myeloid/stem cell antigen positivity in T-ALL almost
always indicates ETP-ALL.1,4,6 However, the brighter expression (≥75% of blasts) of CD5 may sug-
gest Near-ETP-ALL. Its early recognition, using immunophenotypic criteria, is essential for the devel-
opment of an effective clinical management strategies for this high risk leukemia.
Keywords: Early T-Cell Precursor, Acute lymphoblastic leukemia
45
EP33
Proposed criteria for FBP request in a Covid-19 pandemic era.
1Rafika Zainal Zahari 1 Wan Aswani Wan Yusof, 1Raudhawati Osman, 1Azlinda Abu Bakar , 1Hanis
Syazwani Akmal
1Haematology Unit, Pathology Department, Hospital Melaka, Jalan Mufti Haji Khalil, 75400,
Introduction: A full blood picture (FBP) is an interpretative morphological description of smeared
blood cells which guide the clinician to a diagnosis. FBP is processed by either a manual or automat-
ed method and the cost of test varies. Drying blood smear might risk aerosol contamination, thus sam-
ple processing needs to be performed in appropriately equipped laboratories with Class II BSC by
competent personnel with safety precaution. This study aims to look for significant correlation be-
tween FBP request and positive smear findings (PSF); to propose utilization of selected ISLH guideline
criteria for requesting FBP. Materials and method: A retrospective study was conducted on 656 FBP
samples from 9th March 2020 until 6th April 2020. The FBP was processed using Sysmex FBC XN
1000 analyzer and SP10 automation slide marker. 7 FBC parameters from ISLH criteria for blood
smear review used are: Hemoglobin (Hb), Mean Corpuscular Volume (MCV), Total White Cell Count
(TWC), Absolute Lymphocyte Count (ALC), Absolute Neutrophil Count (ANC), Absolute Monocyte
Count (AMC) and Platelet Count. Statistical analysis was performed using SPSS version 19.0. Results:
There were 111/656 (17%) urgent and 545/656 (83%) routine FBP requests. A significant correla-
tion is seen between selected ISLH criteria and PSF (p<0.01). Using the appropriate ISLH laboratory
parameters for Hemoglobin, 23/40 (57.5%) routine FBP and 39/52 (75%) urgent requests dis-
played PSF. For the TWC, 7/11 (63.6%) routine FBP and 34/51 urgent requests (66.7%) showed
PSF. Based on the ANC, all routine (n=14) and 25/31 (80.6%) urgent requests had PSF. For AMC,
11/14 (78.6%) routine and 16/19 (84.2%) urgent requests showed PSF. For the platelet count pa-
rameter, 35/49 (71.4%) routine and 34/41 (82.9%) urgent requests displayed PSF. Conclusion:
This study supports the adaptation of selected ISLH guideline criteria as the indicator for FBP request
to minimize the laboratory staff exposure and budget control.
Keywords: Full blood picture, positive smear finding, Covid19, ISLH criteria
EP34
Comparison of the phenotype and haematological parameters between HbH-Pakse and HbH-
Constant Spring: The IMR experience
Nur Izzati Tukiman1, Norafiza Mohd Yasin1, Faidatul Syazlin Abdul Hamid1, Yuslina Mat Yusoff1, Ermi
Neiza Mohd Sahid1, Ezalia Esa1
Haematology Unit, Cancer Research Center, Institute for Medical Research, National Institute of Health,
Selangor, Malaysia.
Introduction: Haemoglobin H (HbH) disease is a type of α-thalassaemia characterized by inactiva-
tion of three α-globin genes either due to deletion or non-deletional mutation. Haemoglobin Constant
Spring (Hb CS) (TAA→CAA) and hemoglobin Pakse (Hb Pakse) (TAA→TAT) are both the example of
non-deletional mutation caused by a single nucleotide substitution in the termination codon which
leads to elongation of the α2 globin chain. Materials and methods: We carried out a retrospective
analysis of eighteen cases which were referred to our laboratory in IMR during the period of 2017
to March 2021 for confirmatory of HbH-CS. The haematological parameters including RBC, Hb,
MCV, MCH and RDW were analysed. Hb A2 and Hb F level were quantified by HPLC and/or CE.
Common alpha globin gene deletions and point mutations were ruled out using the Multiplex Gap
and ARMS PCR methods. Further investigation was done using direct DNA sequencing method. Data
were analyzed using IBM SPSS Statistic version 23. Results: Thirteen cases were confirmed as HbH-
CS while five cases as HbH-Pakse. Majority of the patients in HbH-CS group were Malays (61.5%),
followed by Chinese (23.1%), Kadazan (7.7%) and Orang Asli (7.7%). All of the patients in HbH-
Pakse group were Malays. Based on our analysis, there were no significant differences on the hae-
matological parameters among both groups. Interestingly, two out of five cases of HbH-Pakse pre-
sented as transfusion dependent thalassaemia. The other three cases presented as mild to moderate
thalassaemia intermedia. Discussions: From our observation, we found that HbH-Pakse can appear
to have more severe phenotype compare to HbH-CS. Other type of genetic modifier not being test-
ed by our current methods should be further explored. This finding illustrates that definitive diagnosis
by DNA analysis is crucial in patient’s management and also to facilitate genetic counselling.
Keywords: HbH, Hb Pakse, non-deletional HbH, alpha thalassaemia
46
EP35
Discrepancy of hemoglobin level between laboratory and POCT analyzer: How to trouble-
shoot? Hospital Sungai Buloh experience
Sharifah Khairul Atikah Syed Kamaruddin1, Lee Chew Kiok2, Norjana Jais1, Firdaus Mashuri1, Nor
Khairina Mohamed Kamarudin1, Raja Muhammad Zul Hatta1, Lau Hui Bing1
¹Pathology Department Hospital Sungai Buloh, ²Anesthesiology and Critical Care Department Hospital
Sungai Buloh
Introduction: A discrepancy was noted for hemoglobin level measured by blood gas analyzer GEM
PREMIER 3500 in intensive care unit compared to the laboratory automated hematology analyzer
Beckman Coulter Unicel DxH800.Unicel DxH800 measures hemoglobin level directly via photometric
method, whereas GEM PREMIER 3500 indirectly measures hemoglobin level from hematocrit(Hct)
using internal algorithm. We conducted a correlation study to compared Hb level between these two
analyzers and to obtain a new Hct ratio to overcome the discrepancy. Method: Forty-two paired
samples acquired from the intensive care units and were analyzed with DxH800 and GEM PREMIER
3500. Hemoglobin and hematocrit levels were recorded and divided into hematocrit 20-29%, 30-
39% and 40-49%. Data obtained were analyzed using SPSS Statistics. Result: The mean difference
(GEM-DxH) of hemoglobin level for hematocrit 20-29% is -1.40g/dL (95% CI, -1.71 to -1.09).
Whereas the mean difference for hematocrit 30-39% and 40-49% are-0.46g/dL (95% CI, -0.94
to 0.03) and 0.80g/dL (95% CI, -2.09 to 0.49) respectively. There is higher negative bias in the
lower hematocrit group (9.1% vs 1.1% vs 0.9%). Regression analysis show R square value of 0.81.
Conclusion: We concluded that GEM PREMIER 3500 has a significant negative bias for lower hem-
atocrit which may affect decision for prompt treatment in the intensive care units. A new hematocrit
conversion factor of 0.33 for GEM PREMIER 3500 was calculated and applied.
Keywords: Hemoglobin , blood gas analyzer, laboratory automated hematology analyzer
EP36
Molecular profiling of Haemophilia B patients in Malaysia: Identification of 5 Novel mutations
Yuslina Mat Yusoff1, Nursaedah Abdullah Aziz1, Lam Kah Yuen1, Faridah Md Afandi2, Tun Maizura
Mohd Fathullah2, Faraizah Abd Karim3, Ezalia Esa1, Nik Nor Imam Nik Mat Zain1, Zulaiha Muda4,
Suzana Zainol4, Jameela Satar5, Zubaidah Zakaria1, Hishamshah Ibrahim6.
1Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Institute of
Health, Kuala Lumpur, 2Haemostasis Unit, National Blood Bank, Kuala Lumpur, 3Pathology Department,
Hospital Ampang, Kuala Lumpur, 4Paediatric Department, Hospital Tunku Azizah, Kuala Lumpur, 5Hae-
matology Department, Ampang Hospital, Kuala Lumpur, 6Deputy Director General of Health (Research
and Technical Support) Office, Ministry of Health, Putrajaya
Introduction: Haemophilia B is an X-linked recessive bleeding disorder caused by functional defi-
ciency of coagulation factor IX. The gene encoding factor IX compose of 33.5 kb DNA with 8 exons
located on the long arm of the X chromosome (Xq27). A wide range of mutations showing large mo-
lecular heterogeneity has been described. Our objective is to characterise the mutational spectrum
of Factor 9 gene in our local multi-ethnic Haemophilia B (HB) patients. Materials and Methods: A
total of 32 HB patients from 28 families were recruited from 2014 until July 2021. They consist of
18 Malays, 8 Chinese, 4 Indians and 2 indigenous Malaysian Borneo. Genomic DNA was extracted
and subjected for PCR amplification, followed by Sanger sequencing and analysed using CLC Main
workbench version 6.6.1 software (CLC bio, Qiagen). The identified mutations were assessed using
European Association for Haemophilia and Allied Disorders (EAHAD) Factor IX Variant Database.
Results: Overall, 20 missenses, 5 nonsenses, 4 frameshifts, 2 inframes and 1 silent mutation were
identified. We discovered 5 novel mutations; a missense variant (c.230 T>G, p.Val77Gly), a non-
sense variant (c.874 C>T, p.Gln292*), 2 frameshift variants (c.40delC, p.Leu14Serfs*7;
c.523_539delinsGAA, p.Pro175_Arg180delinsGlu) and an inframe variant (c.318_319insGGC,
p.Gly106_Ser107insGly), where all those novel mutations were associated with severe HB pheno-
types. Discussion: Mutational spectrum of HB in Malaysian population showed a remarkable heter-
ogeneity. Identification of causative mutation would enable precision carrier detection, genotype-
phenotype correlation and inhibitor risk prediction. The findings will be used to develop a Malaysian
mutation database which would facilitate HB diagnosis and carrier screening.
Keywords: Haemophilia B, Factor IX, Factor 9 gene, novel mutation.
47
EP37
Genomic landscape of HbE/Beta thalassaemia in Malaysian population
Norafiza Mohd Yasin1, Haifa Hanani Mohamad Zaki, Faidatul Syazlin Abdul Hamid1, Syahzuwan
Hassan, Raja Zahratul Azma Raja Sabudin2, Hafiza Alauddin2,Norunaluwar Jalil2, Ezalia Esa1
1Haematology Unit, Cancer Research Center, Institute for Medical Research, National Institutes of
Health, Selangor, Malaysia, 2Department of Pathology, UKM Medical Centre, Kuala Lumpur
Introduction: Haemoglobin E trait may be co-inherited with either β° or β+ thalassaemia. Compound
Hb E/ Beta thalassemia is characterized by marked clinical variability, ranging from a mild and
asymptomatic anaemia to a life-threatening disorder requiring transfusions from infancy. Materials
and Methods: Retrospective analysis of 523 samples send to Institute for Medical Research (IMR)
and UKM Medical Centre since 2011 to 2020 were analysed. DNA was extracted using QIAsym-
phony DSP DNA Kit. Molecular analysis were performed using β-multiplex Ligation-dependent
Probe Amplification Refractory Mutation System (ARMS) for Hb E and for five common beta muta-
tions. HBB gene sequencing and β-Multiplex Ligation-dependent Probe Amplification (MLPA) were
done if required. Results: From total of 523 individuals, most of the patients were Malay, followed
by indigenous people including Bajau, Sungai and Chinese with n= 471, 90%, n=44, 8.4% and
Chinese n=8, 1.5% respectively. No Indian ethnicity found. HbE/Beta thalassaemia are commonly
found in patient aged 0-10 years old with mean age of 3.7 years old. HbE/ β+ is commonest geno-
type account for (n=254, 50.48%) followed by HbE/β° (n-227, 43.4%), HbE/HPFH/DeltaBeta
(n=21, 4.02%) and HbE/Beta variant (n=11, 2.1%). Three most common mutations identified in
HbE/β+ group were IVS1-5, Codon19 and Poly A mutations with 45.4%, 35.6% and 9.1% respec-
tively. For HbE/β° group, three most common mutations identified were FIL deletion, IVS1-1 and
CD41/42 with 32.5%, 28.1%, 27.6% respectively. Several rare cases were identified which includ-
ed L’Aquilla and Asian Indian. Conclusion: Identification of mutations in thalassemia patients are
important for molecular genotyping in order to confirm the clinical diagnosis and initiate family
screening for early diagnosis and treatment. Large part of this phenotypically variability can be
explained by the severity of β-thalassaemia alleles.
Keywords: HbE/β-thalassemia, Genotype spectrum, Phenotype diversity
EP38
Next-generation sequencing analysis for diagnosis of thalassaemia and haemoglobinopathies
Ezalia Esa, Faidatul Syazlin Abdul Hamid, Raihan Sabirin, Yuslina Mat Yusoff, Ermi Neiza Mohd
Sahid, Norafiza Mohd Yasin
Haematology Unit, Cancer Research Centre, Institute for Medical Research
Introduction: The diagnosis of thalassaemia/haemoglobinopathies require a combination of screen-
ing and molecular test. The screening tests enable us to make a presumptive diagnosis and it can
only be confirmed by molecular analyses. ARMS-PCR, Gap-PCR, MLPA and direct DNA sequencing
are the common molecular methods used in our laboratory. In this study we explore the feasibility of
a next-generation sequencing (NGS) for diagnosis of thalassemia. Materials and Methods: We
performed targeted NGS analysis on 182 pre-genotyped DNA samples using Devyser Thalassae-
mia kit. This assay can detect specific thalassaemia mutations and deletions involving HBA1, HBA2
and HBB gene in a single run. The results were then compared to their routine molecular tests results.
Any additional variants found by NGS assay were validated using the routine techniques. Results:
The NGS assay had successfully identified all variants detected by the routine tests. No discordance
results between the two. Ten additional variants were found among 17 cases by NGS assay. Vali-
dation of these variants had confirmed the NGS findings. In total, there were 69 mutations and 24
deletions detected by this assay. Five types of alpha globin gene amplification were discov-
ered. Discussions: This study demonstrated the superiority of NGS in both sensitivity and specificity
to the conventional method. The conventional method is unable to detect the specific variants pre-
cisely as the indication of molecular analysis is guided by the presumptive diagnosis made from the
screening test. The NGS assay has been proven as being a comprehensive and an efficient tech-
nique for diagnosis of thalassemia/haemoglobinopathies.
Keywords: NGS assay, additional variants, routine molecular tests
48
EP39
A deadly Talaromycosis, one of the world’s “most feared fungi” infection – A case report
Abdul Aziz Safura, Mohamad Siti A’ini Syazrah, Abdul Hamid Azura
Department of Pathology, Hospital Kajang, Selangor, Malaysia
Introduction: We report a case of a 38-year-old newly diagnosed HIV patient caused by oppor-
tunistic Talaromycosis infection. Case report: Patient first came presented with dysphagia, hoarse-
ness of voice and weight loss. Physical examination revealed multiple cervical lymphadenopathy,
hepatosplenomegaly, generalized ulcerative skin rash, fever and tachycardia. FBC showed pro-
gressive bicytopenia with Hb 4.9 g/dL and platelet 34 x103/uL. OGDS showed multiple mucosal
ulcers from tonsilopharynx to stomach. CECT of neck was suggestive for lymphoma. Peripheral
blood smears were studied but no evidence of lymphoma. HIV was tested positive. Finally Talaromy-
ces marneffei (formerly called Penicillium marneffei) was identified in blood culture and the diagnosis
of Talaromycosis was made. Unfortunately, patient succumbed to death after first dose of Ampho-
tericin B due to septic shock secondary to fungemia. Discussion: Diagnosis is made by identification
of the fungus from clinical specimens. Biopsy of lymph nodes and bone marrow demonstrated foamy
histiocytes containing yeast-form organisms. Conclusion: Once considered rare, Talaromycosis is
now regarded as one of the world’s most feared fungi1 due to increased incidence of HIV and
AIDS. With its prevalence in South East Asia, an early diagnosis in an immunocompromised patient
and prompt initiation of antifungal therapy are the principal goals for a favorable clinical outcome.
EP40
An uncommon instance of polymicrobial cutaneous diphtheria caused by punctured fish bones
Amirul Ashraf Ismail1, Haziratul Hananie Usman1, Hor Jie Ning1, Nurul Hafizah Mohd Yusoff1
1Department of Pathology, Hospital Duchess of Kent, Sandakan,Malaysia
Abstract: A rare case of cutaneous diphtheria caused by perforated fish bones in a patient re-
ferred from a Sandakan’s Hospital. Corynebacterium diphtheriae was isolated from a shin ulcer,
along with Streptococcus pyogenes, to corroborate the diagnosis of cutaneous diphtheria. After the
discovery of S.pyogenes, the patient was isolated and treated with Ciprofloxacin and Clindamycin.
After 3 days, culture sent again and C.diphtheriae was isolated, the patient was started on Penicillin.
Elek's test was submitted and it came back positive. Elek's test, sometimes referred to as the Elek
plate test, is an in vitro pathogenicity assay conducted on specimens of Corynebacterium diphtheri-
ae. It is used to determine if C. diphtheriae strains are toxigenic. The patient was discharged after
obtaining negative cultures on following occasions. Corynebacterium diphtheriae is an infectious
disease caused by an infectious bacterium, yet it is highly curable with antibiotics. Non-toxigenic
strains typically induce cutaneous infections while toxigenic strains are most frequently associated
with pharyngeal diphtheria. For strongly suspected case, specific treatment with antitoxin & antibi-
otics should be initiated while studies are pending. In untreated persons, the bacteria may persist 2-
6 weeks after infection treated with appropriate antimicrobial agent are usually communicable for
less than 4 days. Asymptomatic carriers may shed organisms for 6 months or longer. Cases or carri-
ers who are not hospitalized should be advised to restrict contact with others until completion of
course of antibiotics. Organism is eliminated by proven two consecutive negative cultures after ther-
apy is completed.
Keywords: Polymicrobial, Coryney diphtheriae, Elek’s test, Penicillin, Toxin
49
EP42
Cryptococcus gattii: Cryptococcus meningitis in an immunocompetent person in a tertiary hospi-
tal Selangor.
Siti Noraisyah OTHMAN1,2, Ahneez Abdul HAMEED2, Norazlah BAHARI2, Anuradha RADHAKRISH-
NAN3, Syahrul Hafiz MOHD SHAH3
1Center for Diagnostic & Reasearch Laboratories, Faculty of Medicine, Universiti Teknologi MARA,
Selangor, Malaysia, 2Department of Pathology, Hospital Selayang, Selangor, Malaysia, 3Department
of Medical, Hospital Selayang, Selangor, Malaysia.
Introduction: Cryptococcosis caused by Cryptococcus gattii, is a life-threatening fungal infection with
recently increasing prevalence. C. gattii is a species complex comprising multiple independent spe-
cies. Here we described a case of Cryptococccus gattii infection in an immunocompetent patient.
Case Description: A 46-year-old gentleman with known case of hypertension on medication was
referred to a tertiary care hospital facility with a month history of headache and bilateral lower
limb weakness. Prior to that he had visited a private hospital but conditioned remained the
same. On examination he was afebrile, haemodynamically stable with reduce power of both lower
limb. Initial cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis with high protein and
low glucose content. CSF opening pressure was 29mmHg. Gram stain of CSF showed capsulated
yeast cells and latex agglutination test for Cryptococcus was positive while CSF cryptococcalantigen
(CrAg) titer was > 1:512. After 16-18 h incubation at 37 °C, Cryptococcus grew in the CSF culture.
Cryptococcus gattii was identified by matrix-assisted laser desorption/ionization time of flight
massspectrometry (MALDI-TOF Bruker MS Biomerieux, database IVD). The fungal isolate was sent to
the Medical Mycology Laboratory at National Institute of Health (NIH) for antibiotic susceptibility
testing. He was diagnosed to have cryptococcal meningitis. Serial CT brain was done on day 3 and
day 17 and showed worsening of communicating hydrocephalus. He was started on IV Amphotericin
B and oral Flucytosine. Discussion: Crptococcus gattii is easily mistaken with Cyptococcus neofor-
mans due to their phenotypic characteristic similarities. Recognition of disease in immunocompetent
patients can be difficult as presentation is often more indolent and subtle than the classic presenta-
tion of meningitis. This can lead to a delay in diagnosis and initiation of treatment, which can lead to
complications and development of more severe disease.
EP43
Disseminated CMV infection with CNS involvement presenting as sudden unexpected death in
an infant.
Emira Ab Rahim1, Mohd Fairuz Osman1, Nur Syahrina Rahim1,2
1Department of Pathology, Hospital Selayang, 2Faculty of Medicine & Health Science, Universiti Sains
Islam Malaysia
Background: CMV infections emerge in the first year of life may been perinatally or postnatally
acquired. They have a silent clinical progress in most infants while some may be noted to have non-
specific lower respiratory tract symptoms or infectious mononucleosis-like disease. We would like to
share a case of disseminated CMV infection in an infant revealed at autopsy. Case presentation: A
2.5-month-old female infant was found unresponsive on bed by the babysitter. She was rushed to
and resuscitated at the nearby clinic, however was pronounced dead by the paramedic. The exter-
nal examination showed a well-nourished infant with no suspicious external injury. Autopsy examina-
tion revealed bilaterally enlarged submandibular glands with evidence of CMV infection with viral
inclusions in the glands, adrenals and kidneys. Lungs showed associated diffuse interstitial pneumon-
itis. There were evidences of CNS involvement with turbid CSF and presence of dural T-cells infil-
trates and microglial nodules in brain tissues. Discussion and Conclusions: CMV infections may
have non-specific signs and can remain undetected until death. The interstitial pneumonia may be
severe in premature infants, leading to fibrosis and bronchopulmonary dysplasia. The partially ob-
structed airway due to CMV sialadenitis and brain stem involvement increases the vulnerability to
unexpected death. CMV also suppresses the immune system, and may predispose to other bacteri-
al / viral infections.
Keywords: Disseminated CMV infection, infant, autopsy, pneumonitis, sialadenitis, brain stem involve-
ment, unexpected death
50
EP44
Enteric fever mimicking as acute appendicitis
Aishah binti Nazir Deen
Microbiology Unit, Department of Pathology, Hospital Sultanah Aminah Johor Bahru
Although typhoid fever is a common infectious disease in Asian countries, it is still uncommon among
children in Malaysia. The overlapping features shared by typhoid fever and acute appendicitis may
confuse clinicians and could lead to delay in the diagnosis of typhoid. This report presents a case of
a 5 years old girl who presented with high grade fever for six days’ duration associated with ab-
dominal pain, vomiting and diarrhea for three days.She was febrile with temperature of 380C. Her
abdomen was distended, non-specific tenderness and mild hepatomegaly. On the second day, there
was localised right iliac fossa tenderness and persistent vomiting. Ultrasound abdomen showed free
fluid was detected at the pouch of Douglas. She was initially diagnosed as acute appendicitis and
was due for an appendicectomy. However, her blood culture result was reported as positive and
showed growth of Salmonella Typhi. Antibiotic therapy of ceftriaxone was initiated and patient
recovered uneventfully after 7 days of antibiotics without the need for operation. The report not
only highlights that Salmonella Typhi infection could masquerade as acute appendicitis but also em-
phasizes the vital role of laboratory investigation such as blood culture in helping to guide clinician
towards the right diagnosis and treatment.
Keywords: Typhoid fever, Salmonella Typhi, children, acute abdomen, acute appendicitis
EP45
Hypervirulent Klebsiella pneumoniae (hvKP) necrotizing fascitis; an uncommon but potentially
fatal infection
Nurul Azreen Ishak, Nurul Huda Umur
Department of Pathology, Hospital Shah Alam
Introduction: Klebsiella Pneumoniae is a common pathogen isolated in laboratory. Hypervirulent
Klebsiella Pneumoniae (hvKP) has ability to cause severe infection in young and immunocompetent
patient. Case Report: A 50 years old Malay gentleman with uncontrolled diabetis mellitus
(hemoglobin A1c 14%) and hypertension presented with left axillary abscess with sized of 8x5cm.
There was no history of recent trauma or intravenous drug user. Incision and drainage of left axil-
lary abscess was done with 10cc pus aspirated. Blood investigation showed leucocytosis (22.1
x10^3/uL) and elevated C-Reactive Protein (CRP) (86mg/L). He was started on antibiotic. There
were few sets of tissue, pus and blood culture and sensitivity were obtained grew Klebsiella Pneu-
monia sensitive strain which were sensitive to second, third and fourth generation cephalosporin, B-
lactam/B-lactamase inhibitor, aminoglycosides and carbapenem. However his symptoms deteriorat-
ed despite on Piperacillin/tazobactam and infective marker also increased. Contrast-enhanced
computed tomography (CECT) demonstrated extensive necrotizing fasciitis of left axilla complicated
with multiloculated subcutaneous and intramuscular collections extending to posterolateral chest wall
and left upper arm and also associated with extensive abdominal wall cellulitis. Klebsiella Pneu-
moniae isolated showed positive ‘string test’ (hypermucoviscous). The specimen was sent to Institute
for Medical Research (IMR) for Polymerase Chain Reaction (PCR) and came back as Hypervirulent
Klebsiella Pneumoniae. 2 weeks later the patient succumbed to death. Discussion: Diabetes mellitus
(DM) has been recognized as a predisposing factor to bacterial infections. Treating infection be-
come extremely challenging with infection of Hypervirulent Klebsiella Pneumoniae with high rate of
morbidity and mortality even though it is a sensitive strain.
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