Clinical laboratory最新文献

Background: The aim of this study was to investigate the clinical and laboratory features of primary IgG-κ with κ free light chain plasma cell leukemia.

Method: We retrospectively analyzed the clinical and laboratory features of a case of primary plasma cell leukemia of the IgG-κ with κ free light chain type and reviewed the literature on patients with primary plasma cell leukemia.

Result: The patient's white blood cell count was 36.95 x 109/L, hemoglobin was 43 g/L, platelet count was 64 x 109/L. Push film review: the number of white blood cells was significantly increased, and a type of cell was seen, with medium cytosol, polarized nucleus, abundant cytoplasm, stained areas, and rounded inclusions, which accounted for 90% of the total number of white blood cells. IgG 89.8 g/L, IgA < 0.26 g/L, IgM < 0.26 g/L, complement C3 0.33 g/L, complement C4 0.09 g/L; blood β2 microglobulin > 24.4 mg/L, ferritin 429.72 ng/mL. Serum protein electrophoresis: M protein bands were found, and the M protein content was 71.84 g/L. Serum immunofixation electrophoresis: precipitating bands were found in the IgG lane, two precipitating bands were found in the κ lane, and the monoclonal immunoglobulin type was IgG-κ with κ free light chain type. Flow cytometry: plasma cells accounted for 69.61% of the total, and their immunophenotypes were CD28+, CD38+, CD138+, CD27+ partially, CD269+ in small amount, CD19-, CD20-, and intracellular immunoglobulin Kappa light chain restriction expression, suggesting primary plasma cell leukemia.

Conclusions: For primary plasma cell leukemia, we should pay attention to the changes in the abnormal morphology and number of plasma cells. With the help of bone marrow smear, flow cytometry and other tests, we can make a clear diagnosis as early as possible and actively carry out treatment at an early stage.

Background: Our study aimed to analyze the molecular and clinical characteristics of angioimmunoblastic T-cell lymphoma (AITL), identify prognostic factors, and evaluate their implications for patient outcomes.

Methods: This retrospective study analyzed 33 patients diagnosed with AITL between 2012 and 2022 at our center. Clinical data, laboratory parameters, pathological findings, and treatment outcomes were evaluated. Survival analyses were performed using the Kaplan-Meier method, and prognostic factors were identified through univariate Cox regression analysis.

Results: The median age was 64.1 ± 7.2 years, with male predominance (63.6%). Most patients presented with advanced disease (69.7% stage IV). Immunophenotypic analysis confirmed high expression of follicular helper T-cell markers, including PD-1 (96.9%), CXCL13 (83.3%), and BCL-6 (96.6%). EBV was detected in 72.7% of specimens by EBER-ISH and 90% by EBV-DNA PCR. Univariate analysis identified lower hemoglobin, decreased platelet counts, low albumin levels, and elevated β2-microglobulin as significant negative prognostic factors for progression-free survival (PFS). For overall survival (OS), low albumin levels (HR 0.8, 95% CI 0.69 - 0.92, p = 0.002) and elevated β2-microglobulin (HR 1.32, 95% CI 1.03 - 1.69, p = 0.029) were significant predictors of inferior outcomes. Interestingly, PD-1 positivity was associated with significantly better PFS (HR 0.03, 95% CI 0 - 0.52, p = 0.016).

Conclusions: This study highlights the aggressive nature of AITL and identifies several readily accessible laboratory parameters as important prognostic factors. The protective effect of PD-1 positivity on survival outcomes warrants further investigation. While CHOP/CHOPE remains the standard treatment, the addition of novel targeted therapies shows promise for improving patient outcomes in this challenging lymphoma subtype.

Background: This study aimed to investigate the clinical features, coagulation, and risk factors of deep vein thrombosis (DVT) in patients with pelvic tumor and to construct a prediction model for postoperative DVT events.

Methods: Clinical data of 161 patients with pelvic tumors (preoperative DVT group n = 22, non-DVT group n = 139; postoperative DVT group n = 35, NDVT group n = 125; and one case of postoperative pulmonary thrombosis was excluded) were retrospectively analyzed. Age, BMI, disease type, FIGO stage, and coagulation parameters (prothrombin time, PT; activated partial thromboplastin time, APTT; fibrinogen, FIB; D-dimer, D-D; plasminogen activator inhibitor-1, PAI-1) were compared. The key variables were screened using principal component analysis. The prediction model for postoperative DVT was built through logistic regression, and its efficacy was tested using a ROC curve.

Results: PT, D-D, and PAI-1 were significantly higher in the preoperative DVT group than in the non-DVT group (p < 0.001), and APTT was significantly shorter (p = 0.002). The postoperative DVT group was characterized by advanced age (p = 0.032), a higher proportion of ovarian and endometrial cancers, a greater percentage of advanced FIGO stages (p = 0.002), longer postoperative bedtime of more than 72 hours (p = 0.028), and higher levels of PT, FIB, D-D, and PAI-1 (p < 0.001). Principal component analysis showed age and D-D as the main contributing factors. The logistic regression model showed that age (OR = 1.02, p = 0.05), elevated D-D (OR = 1.02, p = 0.001), FIGO stages III and IV (OR = 3.60, p = 0.048), absence of thrombolytic prophylaxis in the postoperative period (OR = 2.85, p = 0.049), and the presence of adjuvant therapy in the postoperative period (OR = 1.02, p = 0.038) were independent risk factors for postoperative DVT, and the AUC of the model reached 0.865 (p < 0.001).

Conclusions: Age, preoperative DVT, D-D level, and tumor stage are independent predictors of postoperative DVT in pelvic tumors. The constructed prediction model has high clinical value.

Background: This study investigates the changes in serum miRNA-210 expression at different stages of spontaneous intracerebral hemorrhage (sICH) and their clinical significance.

Methods: Twenty patients with sICH and admitted to the Neurosurgery Department of the Affiliated Hospital of Beihua University between August 2022 and January 2023 were selected for this study. Venous blood samples were collected on Day 1 (within 12 hours) and Day 7 after disease onset. Serum miRNA-210 expression was quantified using quantitative reverse transcription polymerase chain reaction (qRT-PCR).

Results: Serum miRNA-210 levels on Day 7 (31.5775 ± 0.13242) were significantly lower than on Day 1 (31.6865 ± 0.1654) in patients with sICH. Results of a paired t-test analysis showed a t value of 2.268, p = 0.035 (p < 0.05).

Conclusions: In this study, differences in serum miRNA-210 expression at different stages of sICH were found to be significant. Changes in miRNA-210 levels may serve as potential biomarkers for disease progression, providing insights for clinical management.

Background: This study aimed to improve circulating free DNA (cfDNA) purification methods by using quantitative analysis of housekeeping genes as a quality indicator to minimize leukocyte DNA contamination and ensure accurate plasma DNA assessment for cancer biomarker research.

Methods: Two genes were selected: LINE-1 (L1) and TOP1. Two primer pairs were designed to amplify both cfDNA and the contaminating genomic DNA, resulting in short- and long-stranded amplicons. Real-time quantitative PCR (qPCR) was used to determine the copy number of the small and large amplicons of the two target genes. The copy number values and the ratio between small and large amplicons (S/L) in DNA artificially fragmented by sonication were compared. To evaluate the effects of storage time and temperature on cfDNA extraction, cfDNA was extracted from K2EDTA tubes under different temperature conditions (4°C vs. 25°C) and storage periods (1, 3, 7, and 14 days), with cfDNA collected in Streck tubes as the standard for comparison.

Results: The S/L value of L1 and TOP1 increased proportionally with the degree of fragmentation (up to 174 bp), with TOP1 being more sensitive to fragmentation. When plasma DNA was extracted using three different commercial kits, the mean S/L of L1 and TOP1 mostly decreased on the third day of storage compared to the first day. The changes in the S/L ratio of the different assays at 25°C were in the order of Bioneer > ABI > Qiagen. The Qiagen kit consistently produced the highest S/L ratio among the three kits and was most similar to the results from the Streck tube.

Conclusions: qPCR assays using single- and multi-copy reference genes to quantify and evaluate the degree of plasma DNA fragmentation were developed and assessed. The copy number ratio of small and large amplicons effectively represents the fragmentation status of the sheared DNA. This assay provides a valuable tool for assessing plasma DNA quality and fragmentation status.

Background: Recent studies show sCD40L as a potential biomarker for thrombotic risk and cancer progression. Accurate measurement of sCD40L level is critical for research and clinical applications. However, variations in preanalytic conditions, sample types and discrepancies in reference range across ELISA kits pose challenges to standardization in biobanking and research reproducibility.

Methods: sCD40L levels were measured using two ELISA kits. Bayesian statistical methods defined reference ranges, and paired t-tests and Pearson's correlation assessed differences and correlation between kits.

Results: The reference range for sCD40L using the R&D kit was 1,095.48 - 6,603.00 pg/mL, and for the Invitrogen kit, 1,620.00 - 10,405.00 pg/mL. There was a statistically significant difference between kits (p = 0.0019), and a strong correlation (r = 0.88) in serum samples.

Conclusions: sCD40L reference values differ by ELISA kit, underscoring the need for institution-specific reference ranges. Serum, not plasma, is preferable for sCD40L measurement. Establishing standardized reference ranges will improve the reliability of sCD40L as a biomarker in research fields.

Background: Extremely low levels of high-density lipoprotein cholesterol (HDL-C), defined as < 10 mg/dL, are rarely observed in clinical laboratories and may result from severe metabolic disorders, genetic conditions, or analytical and preanalytical interferences. Understanding the prevalence and associated findings of such results is critical for accurate interpretation.

Methods: We retrospectively analyzed 1,022,234 HDL-C test results from specimens submitted to GC Labs, a large referral laboratory in South Korea, between January and December 2023. For specimens with HDL-C < 10 mg/dL, concurrent laboratory findings were evaluated. Additional comparisons of the prevalence of HDL-C < 10 mg/dL and its associated laboratory findings were made using public datasets from KNHANES (2011 - 2023), NHIS (2023), and US NHANES (2015 - 2020).

Results: Among all specimens, 147 (0.015%) showed HDL-C < 10 mg/dL. Out of these, 125 specimens had available concurrent test results. Common findings included abnormal liver chemistries (56.8%), decreased kidney function (31.2%), elevated CRP (20.0%), anemia, and very high triglyceride levels (≥ 500 mg/dL in 33.6%). Several patterns suggested preanalytical issues, including delayed serum separation, dilutional effects, or lipemic interference observed on gross examination (12.0%). One case showed no apparent abnormalities, raising suspicion of rare genetic or medical conditions or analytical error. Public datasets showed similarly low prevalence (0.004 - 0.009%) and comparable findings.

Conclusions: Extremely low HDL-C values are rare but often linked to identifiable biochemical abnormalities or preanalytical/analytical interferences. Reviewing concurrent test results and specimen handling helps distinguish true pathology from spurious results and improve diagnostic accuracy in clinical laboratories.

Background: The non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) has emerged as a novel lipid biomarker with potential relevance to nonalcoholic fatty liver disease (NAFLD), yet its role remains underexplored.

Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2017 through 2023, we investigated the relationship between NHHR and NAFLD. NHHR values were log-transformed (LnNHHR) to achieve normal distribution. Multivariate logistic regression and restricted cubic spline (RCS) models were applied to examine the association between NHHR and both NAFLD and hepatic fibrosis. Robustness was evaluated through subgroup and sensitivity analyses.

Results: NHHR levels were significantly elevated in individuals with NAFLD and hepatic fibrosis compared to those without (p < 0.001). Multivariate logistic regression indicated a positive correlation between increased LnNHHR and NAFLD risk [odds ratio (OR): 2.94, p < 0.001], whereas no significant association was found with hepatic fibrosis (OR: 1.02, p = 0.870). Participants in the highest LnNHHR quartile (Q4) had a 3.09-fold higher likelihood of NAFLD compared to those in the lowest quartile (Q1) [95% confidence interval (CI): 2.60 - 3.67, p < 0.001]. However, no significant trend was observed for hepatic fibrosis across quartiles (p > 0.05). RCS analysis revealed a J-shaped relationship between LnNHHR and both NAFLD (pinteraction < 0.001) and hepatic fibrosis (pinteraction = 0.006). Stratified analyses further demonstrated that NHHR's impact on NAFLD varied across age groups (pinteraction = 0.024), while its effect on hepatic fibrosis differed by education level (pinteraction = 0.048).

Conclusions: NHHR is strongly linked to an increased risk of NAFLD, suggesting that improving NHHR levels may help mitigate hepatic steatosis.

Background: An icteric coloration or lipemic appearance of serum is frequently observed in clinical practice. These changes in appearance can be detected either visually after centrifugation or during the analytical phase by spectrophotometric determination of the HIL indices (hemolysis, icterus, lipemia). These endogenous interferences can be the cause of analytical interferences affecting the accuracy of the results of the analyses carried out.

Methods and results: Our observation describes an atypical brown 'coffee-like' coloration of the plasma, causing a discrepancy between the total bilirubin dosed and the icterus index measured on our analytical system.

Conclusions: It is essential to preserve the crucial information gathered during the pre-analytical and analytical phases, in order to avoid improperly cancelling the results or giving incorrect results as a result of analytical interference.

Background: Mycobacterium tuberculosis may persist latently within the host, often presenting with atypical clinical features. In the context of immunosuppression, latent infection can reactivate, and the increased susceptibility to opportunistic infections further complicates the diagnosis and management of tuberculosis.

Methods: We report the case of a patient with connective tissue disease and a history of pulmonary nodule resection, who developed respiratory symptoms following two months of methylprednisolone therapy. The initial diagnosis was community-acquired pneumonia. Targeted next-generation sequencing of sputum identified pathogens.

Results: tNGS identified multiple pathogens, including Mycobacterium tuberculosis, Cryptococcus, and rhinovirus. Retrospective analysis suggested that tuberculosis likely resulted from the reactivation of latent Mycobacterium tuberculosis bacilli at the site of a previously resected pulmonary lesion.

Conclusions: In immunosuppressed patients, latent tuberculosis reactivation and rare infections should be considered. When symptoms are atypical, tNGS provides an effective tool for rapid and accurate pathogen detection to guide treatment.