2021 Poster Awards

First Place Poster Award Presentation (Survey category)

A Survey Of Perceptions About Formalin Safety And Specimen Quality In The Workplace

Larisa Golinowski1,2, Nancy G. Chan1,2, Jonathan Keow1,2

1department Of Pathology And Laboratory Medicine, Schulich School Of Medicine & Dentistry, Western University, London, Ontario, Canada
2department Of Pathology And Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada

Introduction: Neutral buffered formalin is the gold standard fixative agent to preserve cellular structures for microscopic examination. It has also been associated with both short-term and long-term occupational health risks, which are often balanced with impact on specimen quality. Due to ongoing concerns about occupational exposure, we sought to probe the depth of understanding amongst laboratory staff with a targeted survey.

Methods: An incentivized online survey was issued to 104 technical and medical staff. The survey consisted of 17 multiple choice and free-text questions addressing various aspects of formalin handling. These questions were structured to identify safety concerns, desired improvements to the work environment and specimen types most often received with inadequate formalin.

Results: A total of 58 participants responded. Participants reported perceived short-term risks of ocular and respiratory irritation, breathing difficulties, skin irritation and headaches; and longterm risks of developing cancer, worsening existing medical conditions, and concerns about reproductive complications. Participants feel that occupational risks can be mitigated with proper PPE, improved ventilation, and a formal training module. For specimen quality and handling, respondents are aware of the recommended ratio for optimal tissue fixation, and feel that many specimens are received with unsatisfactory amounts of formalin.

Conclusions: These data highlight the main areas of occupational concern and provide direction for future endeavours. The lab may therefore benefit from the implementation of a formalin handling training module, improved ventilation systems and further education about the perceived and actual risks associated with formalin exposure.

Keywords: Formalin, Safety, Health Risks, Ventilation, Specimen

First Place Poster Award Presentation (General category)

Cloxacillin-induced acute vanishing bile duct syndrome: a case study and literature review.

Kyrillos Faragalla1, Helena Lau2, Hanlin L Wang3, Jimin Liu4

1faculty Of Health Sciences, Mcmaster University, Hamilton, On, Canada
2gastroenterology, Halton Healthcare, Oakville, On, Canada
3pathology And Laboratory Medicine, David Geffen School Of Medicine, La, United States
4laboratory Medicine, Halton Healthcare, Oakville, On, Canada

Objective: Ductopenia is a chronic process where ?50% of portal tracts lack bile ducts. One etiology is drug-induced liver injury. Cloxacillin, an anti-staphylococcal penicillin, typically causes “bland” cholestasis. We present the first case of cloxacillin-induced acute ductopenia and a review of published cloxacillin-induced liver injuries.

Method: Clinical information was obtained from hospital records and two authors examined liver biopsy slides. Google Scholar was used for the literature review.

Data: A 66-year-old woman with no prior liver disease, but known penicillin allergy, was treated for a post-carotid angioplasty staphylococcal infection with 6 weeks of cloxacillin. She presented with a two-week history of weakness and jaundice. Bloodwork showed AST 822, ALT 877, ALP 4275, bilirubin 752, and eosinophilia. She required ICU transfer for hypotension and was started empirically on prednisone. Liver biopsy revealed severe centrilobular cholestasis, mild portal necroinflammation, and ductopenia with epithelial injury, but no ductular reaction. Two-months later, she was discharged on hydrocortisone and ursodiol with persistently elevated ALP 1807 and total-bilirubin 304. She was considered for liver transplantation but died of liver failure four months later.

Four additional articles were found with histopathologic descriptions of cloxacillin-related liver injury. These included portal inflammation, cholestasis and mild necroinflammation. Clinical features were reported in two cases; both had mild symptoms with cholestatic liver enzymes and hyperbilirubinemia. Both patients recovered completely within 10-60 days.

Conclusion: Cloxacillin-induced cholestasis can be secondary to acute ductopenia, which can result in worse clinical outcomes than previously described “bland” cholestasis. Liver biopsy is recommended to identify cases with acute ductopenia.