Laboratory medicine and clinical medicine are co-dependent components of medicine. Laboratory medicine functions most effectively when focused through a clinical lens. Me dical practice as a whole undergoes change. New drugs, treatments and changes in management strategies are introduced. New techniques, new technologies and new tests are developed. These changes may be either clinically or laboratory initiated, and so their introduction requires dialogue and interaction between clinical and laboratory medicine specialists. Treatment monitoring is integral to laboratory medicine, varying from direct drug measurement to monitoring cholesterol levels in response to treatment. The current trend to »personalised medicine« is an extension of this process with the development of companion diagnostics. Technological innovation forms part of modern laboratory practice. Introduction of new technology both facilitates standard laboratory approaches and permits introduction of new tests and testing strategies previously confined to the research laboratory only. The revolution in cardiac biomarker testing has been largely a laboratory led change. Flexibility in service provision in response to changing clinical practice or evolving technology provides a significant laboratory management challenge in the light of increasing expectations, shifts in population demographics and constraint in resource availability. Laboratory medicine practitioners are adept at meeting these challenges. One thing remains constant, that there will be a constant need laboratory medicine to meet the challenges of novel clinical challenges from infectious diseases to medical conditions developing from lifestyle and longevity.
1. Braga F, Infusino I, Panteghini M. Role and responsibilities of laboratory medicine specialist in the verification of metrological traceability of in vitro medical diagnostics. J Med Biochem 2015; 34: 282–7.
2. Theodorsson E. Quality assurance in clinical chemistry: A touch of statistics and a lot of common sense. J Med Biochem 2016; 35: 103–12.
3. Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. »Zombie« Outbreak Caused by the Synthetic Cannabinoid AMB-FUBINACA in New York. N Engl J Med 2017; 376: 235–42.
4. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Sim-vastatin Survival Study (4S). Lancet 1994; 344: 1383–9.
5. West of Scotland Coronary Prevention Study: identification of high-risk groups and comparison with other cardiovascular intervention trials. Lancet 1996; 348: 1339–42.
6. Oliver M, Poole-Wilson P, Shepherd J, Tikkanen MJ. Lower patients’ cholesterol now. BMJ 1995; 310: 1280–1.
7. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315–81.
8. Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA et al. Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med 2017; 45: 781–9.
9. Schuetz P, Briel M, Christ-Crain M, Stolz D, Bouadma L, Wolff M et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis 2012; 55: 651–62.
11. Corte CD, Ferrari F, Villani A, Nobili V1. Epidemiology and Natural History of NAFLD. J Med Biochem 2015; 34: 13-7.
12. Sattar N, Forrest E, Preiss D. Non-alcoholic fatty liver disease. BMJ 2014; 349: g4596.
13. Talmud PJ, Shah S, Whittall R, Futema M, Howard P, Cooper JA et al. Use of low-density lipoprotein cholesterol gene score to distinguish patients with polygenic and monogenic familial hypercholesterolaemia: a casecontrol study. Lancet 2013; 381: 1293–301.
14. Annesley TM, McKeown DA, Holt DW, Mussell C, Champarnaud E, Harter L et al. Standardization of LCMS for therapeutic drug monitoring of tacrolimus. Clin Chem 2013; 59: 1630–7.
15. Karmen A. A note on the spectrometric assay of glutamic-oxalacetic transaminase in human blood serum. J Clin Invest 1955; 34: 131–3.
16. Karmen A, Wroblewski F, Ladue JS. Transaminase activity in human blood. J Clin Invest 1955; 34: 126–31.
17. Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R, Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem 1999; 45: 1104–21.
18. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD et al. Third universal definition of myocardial infarction. Eur Heart J 2012; 33: 2551–67.
19. Collinson P, Hammerer-Lercher A, Suvisaari J, Apple FS, Christenson RH, Pulkki K et al. How Well Do Laboratories Adhere to Recommended Clinical Guidelines for the Management of Myocardial Infarction: The CARdiac MArker Guidelines Uptake in Europe Study (CARMAGUE). Clin Chem 2016; 62: 1264–71.
20. Collinson P, Pulkki K, Suvisaari J, Ravkilde J, Stavljenic-Rukavina A, Hammerer-Lercher A et al. How well do laboratories follow guidelines on cardiac markers? The cardiac marker guideline uptake in Europe study. Clin Chem 2008; 54: 448–9.
21. Collinson PO, Dieijen-Visser MP, Pulkki K, Hammerer-Lercher A, Suvisaari J, Ravkilde J et al. Evidence-based laboratory medicine: how well do laboratories follow recommendations and guidelines? The Cardiac Marker Guideline Uptake in Europe (CARMAGUE) study. Clin Chem 2012; 58: 305–6.
22. Myocardial infarction redefined–a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 2000; 21: 1502–13.
23. Collinson PO, Rosalki SB, Flather M, Wolman R, Evans T. Early diagnosis of myocardial infarction by timed sequential enzyme measurements. Ann Clin Biochem 1988; 25: 376–82.
24. Gibler WB, Lewis LM, Erb RE, Makens PK, Kaplan BC, Vaughn RH et al. Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: serial CK-MB sampling in the emergency department [published erratum appears in Ann Emerg Med 1991 Apr; 20(4): 420]. Ann Emerg Med 1990; 19: 1359–66.
25. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37: 267–315.
26. Apple FS, Jaffe AS, Collinson P, Mockel M, Ordonez-Llanos J, Lindahl B et al. IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin Biochem 2015; 48: 201–3.
27. Kavsak PA, Don-Wauchope AC, Hill SA, Worster A. Acceptable Analytical Variation May Exceed High-Sensitivity Cardiac Troponin I Cutoffs in Early Rule-Out and Rule-In Acute Myocardial Infarction Algorithms. Clin Chem 2016; 62: 887–9.