A 2018/2019 Summer Studentship research project
This survey will show if urgent testing avalability has an impact on clinical management of patients who may have ANCA vasculitis. The information may guide the design of an information sheet on urgent ANCA testing that could be placed on health and laboratory pathways.
Student: Isla Revell
Supervisor: Dr Ignatius Chua
ANCA vasculitis is a form of progressive small vessel vasculitis usually affecting airways, lung and kidney that requires rapid treatment with immunosuppression. Even through the diagnosis of ANCA vasculitis is primarily based on clinical presentation and laboratory testing is not required for diagnosis, there has been increasing demand on the ANCA testing by various hospital specialties. Currently the rapid ANCA test is available daily and could be performed out-of-hours by the Immunology laboratory but is both labour intensive and expensive.
Survey the rapid ANCA vasculitis test to determine if test is requirested for the correct context and if the rsults contribute to disease management and outcome.
Retrospective urgent ANCA testing worksheets performed in 2013–18 are identified by laboratory systems. Test request details are reviewed on scanned lab form on LATTE and clinical data reviewed when available on HCS. Outcome of testing and final diagnosis is reviewed by the reviewing clinical letters or discharge summaries. Prospective requests are followed up in the laboratory from pre-testing though to post-testing stages.
Survey ANCA testing for frequency, timing and origins both prospectively and retrospectively. Determine proportion of high vs low pretest predictive value of requests using a preset criteria for ANCA vasculities. Determine concordance of rapid ANCA testing with routine ANCA testing on the same urgent request. Study cases of negative test results that become subsequently positive. Determine if urgent testing has an influence on management and outcome by looking at instigation of treatment such as cylophosphamide, rituximab and plasmapheresis.
Student researcher’s component of the study
All aspects described in the method section above.