APFCB 3rd Place - Global MedLab Week 2025

Summary

This video highlights the critical role laboratory tests and medical professionals play in diagnosing and managing complex medical conditions. The story follows Mr. Lanta's case of hypoglycemia, where blood samples and various tests, including a selective arterial calcium stimulation test, are used to identify the cause of his condition. Despite initial negative imaging results, the medical team works collaboratively to pinpoint an insulin-secreting lesion in the pancreas, leading to a successful diagnosis and treatment. The video emphasizes the importance of laboratory support in saving lives.

Takeaways

• 😀 Every second counts in saving lives, and every medical decision has a significant impact on patients.
• 😀 Hypoglycemia diagnosis in Mr. Lanta was confirmed by measuring plasma glucose and taking blood samples for insulin and c-peptide.
• 😀 Intravenous dextrose was administered, improving symptoms and fulfilling the vapor's trial for hypoglycemia treatment.
• 😀 The journey of a blood sample begins with careful collection by a nurse, followed by immediate preservation in ice to maintain sample stability.
• 😀 In the laboratory, medical laboratory technicians ensure accurate results by checking sample information and following strict quality steps.
• 😀 Unusual test results are reviewed by chemical pathology registrars who evaluate the patient's medical history for accuracy.
• 😀 Chemical pathology plays a key role in validating the accuracy of glucometers used in clinical settings through method comparison.
• 😀 Mr. Lanta’s results showed elevated insulin and c-peptide levels, suggesting endogenous hyperinsulinism, which led to further tests to exclude insulin autoimmune syndrome.
• 😀 Imaging tests, including CT and endoscopic ultrasound, were performed but did not identify the insulin-secreting lesion.
• 😀 The final diagnostic step was a selective arterial calcium stimulation test, which successfully localized the insulin-secreting lesion to the pancreas.
• 😀 A multidisciplinary team, including clinicians and laboratory professionals, collaboratively decided to proceed with distal pancreatectomy for treatment.

Q & A

What is the importance of measuring plasma glucose and other blood samples in hypoglycemia diagnosis?

Measuring plasma glucose helps confirm hypoglycemia. Blood samples for insulin and C-peptide are also taken to differentiate between endogenous (produced by the body) and exogenous (from an external source) causes of hypoglycemia.

What is the significance of intravenous dextrose administration in this case?

Intravenous dextrose administration helps improve symptoms of hypoglycemia, and its effectiveness fulfills the Vapor's trial, which is used to assess the response to glucose treatment in such conditions.

Why are plasma glucose and insulin considered unstable analytes?

Plasma glucose and insulin are unstable because they can degrade or change over time. This is why blood samples need to be quickly processed and kept on ice to maintain their accuracy before testing.

What role does the medical laboratory technician play in the diagnostic process?

The medical laboratory technician ensures the correct handling and testing of blood samples. They verify that the sample information matches the request form and follow strict protocols to ensure the accuracy of test results.

How does the chemical pathology team contribute to the accuracy of glucometers?

The chemical pathology team compares glucometer readings with those from a central laboratory's automated glucose assay to ensure the glucometers' readings are accurate and reliable in the clinical setting.

What does an elevated insulin and C-peptide level in the presence of hypoglycemia indicate?

An elevated insulin and C-peptide level suggests endogenous hyperinsulinism, meaning the body is producing too much insulin, which could be due to conditions like an insulinoma (a tumor in the pancreas that secretes insulin).

What is the purpose of testing for anti-insulin antibodies in this case?

Testing for anti-insulin antibodies helps rule out insulin autoimmune syndrome, a condition where the body produces antibodies against its own insulin, causing hypoglycemia.

Why were pancreatic imaging tests like CT and endoscopic ultrasound performed?

Pancreatic imaging, including CT and endoscopic ultrasound, was performed to locate any insulinoma (a tumor) in the pancreas. These tests were done to rule out any visible lesions that could be causing hyperinsulinism.

What is the selective arterial calcium stimulation test (SACST), and why is it important?

The SACST is a procedure where calcium is injected into different pancreatic arteries to localize insulin-secreting lesions, such as insulinomas. It is crucial for pinpointing the exact location of the tumor to plan for treatment.

How did the multidisciplinary team contribute to the management of Mr. Lanta's case?

The multidisciplinary team, including clinicians and laboratory professionals, collaborated to analyze test results, decide on further tests, and determine the best management strategy. This collaboration led to the decision to proceed with distal pancreatectomy, a surgical treatment for the insulin-secreting tumor.