Clinical laboratory最新文献

Background: After the patient had a long course of disease and symptoms of bilateral breast milk secretion, the doctor first considered that the patient had breast cancer. After screening and excluding the breast, he found that the patient had high prolactin, and suspected that the patient had a pituitary tumor. After breast cancer and pituitary adenoma were excluded, the doctor suspected that there might be interference of macroprolactin. After PEG treatment, we also excluded the interference of macroprolactin. After repeated communication with doctors and patients, we found that the patient had gone to a psychiatric hospital for treatment and taken the antidepressant drug Deanxit (Flupentixol and Melitracen tablets).

Methods: Flupentixol acts by antagonizing hypothalamic prolactin releasing inhibitory factors, reducing dopamine release, leading to hyperprolactinemia.

Results: The patient's examination found that prolactin was 3,172.9 mIU/L (normal range 108.80 - 557.10 mIU/L), and after PEG treatment, it was 2,692.86 mIU/L. Patient stopped using Deanxit for one month, and prolactin levels were 302.8 mIU/L.

Conclusions: Only effective communication between laboratory and clinical departments can make laboratory results more accurate and provide strong guarantees for clinical diagnosis and treatment.

Background: Fusarium species is a facultative pathogen capable of causing invasive infections in patients with hematological malignancies after allogeneic hematopoietic stem cell transplantation (HSCT).

Methods: We retrospectively analyzed a case of T-lymphoblastic lymphoma combined with disseminated fusariosis after HSCT in our hospital. Case reports of Fusarium fungemia in patients with hematological disorders over the past 20 years in Asia were reviewed.

Results: Despite undergoing treatment with a combination of amphotericin B and voriconazole, the patient ultimately succumbed to multiple organ failure.

Conclusions: Fusarium fungemia poses a fatal outcome. The adequate courses of antifungal medications are crucial.

Background: Acute myeloid leukemia (AML) with the t(8;21)(q22;q22) mutation, which produces the AML1/ETO fusion gene on chromosome 8q22, is a specific subtype of AML categorized as AML t(8;21) in the WHO classification and AML-M2 in the FAB classification. This subtype is typically linked to a positive prognosis, although variant additional chromosomal abnormalities are often observed.

Methods: We report a rare case of this category with unusual karyotype and morphologic characteristic mimick-ing APL.

Results: A diagnosis of acute myeloid leukemia (AML-M2) was made through comprehensive diagnostics.

Conclusions: Recognition of the morphological variation is helpful in diagnosis. In addition, further research is needed to better understand the molecular mechanisms underlying unusual rearrangements and their clinical significance.

Background: The goal was to investigate the clinical characteristics of acute T-lymphoblastic leukemia (T-ALL) transforming into acute myeloid leukemia (AML) and to provide a basis for improved clinical diagnosis and treatment of this condition.

Methods: A retrospective analysis was performed on the clinical data and treatment process of a patient with T-ALL who transitioned to AML after undergoing allogeneic hematopoietic stem cell transplantation. Relevant literature was also reviewed.

Results: The patient, a 24-year-old female, initially presented with fatigue. A comprehensive examination confirmed the diagnosis of T-ALL. Following induction chemotherapy, the patient achieved complete remission (CR) as determined by hematologic and cytogenetic assessments. The patient subsequently underwent allogeneic hema-topoietic stem cell transplantation from a sibling donor. Six months post-transplantation, bone marrow cytology indicated a relapse, with morphology and immunophenotype consistent with AML. The patient is currently in the terminal stage of a malignant tumor, with a very poor prognosis.

Conclusions: Lineage switching following acute leukemia relapse is associated with a poor prognosis, necessitating treatment adjustments based on the post-relapse phenotype. Clinically, for recurrent leukemia, comprehensive evaluations-including leukemia immunophenotyping, gene mutation analysis, and cytogenetic and molecular biological examinations-are essential to better guide treatment and assess prognosis.

Background: This study retrospectively analyzed the prognostic impact of transfusion burden in patients with lower-risk myelodysplastic syndrome (LR-MDS) and the outcomes of each treatment option.

Methods: Data on 168 patients with LR-MDS between July 2011 and April 2020 were retrospectively reviewed. Non-transfusion dependent (NTD) was defined as no transfusion history in a period of 16 weeks, low transfusion burden (LTB) as receiving 3 - 7 red blood cell (RBC) units in a period of 16 weeks, and high transfusion burden (HTB) as receiving ≥ 8 RBC units in a period of 16 weeks.

Results: The treatment response was observed over 4 - 6 months after treatment. Among the 168 patients, 105 were treated with anabolic steroids (n = 65), erythroid stimulating agents (n = 12), or hypomethylating agents (n = 28). The overall response rate was 53.3% (56/105), with 53 patients showing hematologic improvement (50.5%). The clinical benefit rate was 78.1% (82/105). The 5-year overall survival (OS) rates were 75.5%, 45.8%, and 33.3% for NTD, LTB, and HTB, respectively (p = 0.001). The 5-year incidences of acute myeloid leukemia were 0%, 9.9%, and 32.5% in NTD, LTB, and HTB, respectively (p < 0.001). In the multivariate analysis, age (hazard ratio [HR] 1.04, p = 0.009), LTB (HR 3.77, p = 0.002), HTB (HR 4.59, p < 0.001), and hemoglobin response (HR 0.45, p = 0.036) were significant factors for OS.

Conclusions: Our findings show transfusion dependency is an adverse prognostic factor in LR-MDS. HTB presented a higher risk of leukemic transformation.

Background: We aimed to evaluate the value of lipoprotein-associated phospholipase A2 (Lp-PLA2) in the serum plus leukocyte-derived markers such as platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) for predicting heart failure (HF) after acute myocardial infarction (AMI).

Methods: A total of 80 AMI patients (case group) hospitalized between June 2019 and July 2022 and 80 healthy subjects (healthy group) were selected. An HF group and a non-HF group were established for the case group. The general data, serum Lp-PLA2 concentration, PLR, and NLR were compared between the two subgroups. Analysis of the risk factors for HF in AMI patients was performed.

Results: The case group, compared with the healthy group, had higher serum Lp-PLA2 concentration, PLR, and NLR (p < 0.05). HF occurred in 10 cases (12.50%) in the case group. In comparison to the non-HF group, increases of serum Lp-PLA2 concentration, PLR, and NLR were detected in the HF group (p < 0.05). Elevated se-rum Lp-PLA2 concentration, PLR, and NLR served as risk factors for HF in AMI patients (OR > 1, p < 0.05). NLR, PLR, serum Lp-PLA2, and combination of the three had the areas under the curves of 0.734, 0.731, 0.719, and 0.910, respectively, in predicting HF in AMI patients.

Conclusions: NLR, PLR, and serum Lp-PLA2 concentration were elevated in AMI patients, that were associated with HF. Combined determination of NLR, PLR, and serum Lp-PLA2 can effectively predict the risk of HF in AMI patients.

Background: Procalcitonin (PCT) is a useful biomarker for infection and especially useful for sepsis management. Multiple platforms, including the chemiluminescence immunoassay (CLIA), have been used for serum PCT analysis. However, the results from different analytical platforms should be evaluated to determine if they can be mutually substituted in the same laboratory.

Methods: The serum PCT were analyzed on the Mindray CL-6000i chemiluminescent immunoassay (candidate method), the Roche Elecsys, and the VIDAS PCT chemiluminescence immunoassay platforms (comparative measurements), and the results were evaluated and compared, following the CLSI EP09-A3 guidelines, by using patient samples with different PCT concentrations.

Results: The median of difference was 0.04 (95% CI: 0.038 - 0.045) between the candidate method and the comparative measurements for the concentration interval of < 0.5 ng/mL. The median of percentage difference was 6.6% (95% CI: 5.5% - 8.7%) for the concentration interval of 0.5 - 2.0 ng/mL, the median of difference was 0.11 (95% CI: 0.06 - 0.17) for the concentration interval of 2.0 - 10.0 ng/mL, and the median of percentage difference was -4.7% (95% CI: -6.1% - 2.4%) for the concentration interval of 10.0 - 100.0 ng/mL. The acceptable bias was ± 0.055 (± 10.4%) at 0.53 ng/mL (low value), and the acceptable bias was ± 0.83 (± 9.0%) at 9.34 ng/mL (high value). The bias between the candidate method and comparative measurements was acceptable for the full concentration ranges.

Conclusions: The bias between the PCT results from Mindray, Roche, and VIDAS was acceptable. Therefore, the results of the three analytical platforms were comparable, and they may be mixed-used in the same institution.

Background: This study aimed to analyze the correlation of urine protein/creatinine ratio (UPCR) in late pregnancy with pregnancy outcomes in patients with preeclampsia (PE) combined with hyponatremia.

Methods: The data of 288 PE patients were collected and compiled for retrospective analysis. The patients were divided into two groups: observation group (52 cases, complicated with hyponatremia) and control group (236 cases, not complicated with hyponatremia). The general conditions, clinical data, and the adverse maternal and infant outcomes were statistically analyzed in both groups. Risk factors were analyzed using logistic regression, and the predictive efficacy was assessed using the ROC curves.

Results: Comparing the general data of the two groups, the differences were not statistically significant (all p > 0.05). Multifactorial analysis showed that uric acid (OR = 0.001, p = 0.010) and 24-hour urinary protein (OR = 2.654, p = 0.001) were the independent risk factors for hyponatremia in PE. In the observation group, placental abruption (9.6%, p = 0.015), hepatic and renal impairment (38.6%, p < 0.001), pleural effusion (30.7%, p = 0.001), fetal growth restriction (50.0%, p = 0.001), fundus lesions (7.6%, p = 0.012), HELLP syndrome (7.7%, p = 0.017), mild neonatal asphyxia (17.3%, p = 0.025), severe asphyxia (3.8%, p = 0.046), metabolic acidosis (9.6%, p = 0.001), intrauterine infection (5.7%, p = 0.004), and neonatal hospitalization exceeding 20 days (30.7%, p < 0.001) occurred in a higher percentage than in the control group. There was no significant difference in postpartum hemorrhage, eclampsia, respiratory distress syndrome, abortion, or neonatal death (all p > 0.05).

Conclusions: The UPCR in late pregnancy is an independent risk factor for hyponatremia in PE. Patients with PE combined with hyponatremia are at high risk of adverse maternal and infant outcomes.

Background: Primary hyperparathyroidism (PHPT) is a disease caused by excessive secretion of parathyroid hormone (PTH) due to parathyroid gland lesions, resulting in high serum calcium and low phosphorus, leading to symptoms such as digestive ulcers and urinary tract stones.

Methods: We report a case of multiple urinary tract stones with high serum calcium and low serum phosphorus. Upon investigation, it was found that the cause was primary hyperparathyroidism.

Results: The serum PTH level of the patient was detected to be significantly elevated. At the same time, neck ultra-sound showed the presence of a parathyroid adenoma. Therefore, it is believed that the patient has PHPT causing high serum calcium and low serum phosphorus, leading to multiple urinary tract stones.

Conclusions: When patients with urinary tract stones have high serum calcium levels and low serum phosphorus levels, laboratory personnel should consider the possibility of PHPT. Simultaneously measuring PTH levels and promptly reminding clinical doctors to perform parathyroid ultrasound and other examinations on patients to reduce the possibility of a missed PHPT diagnosis.

Background: Thrombin is a protein involved in the clotting process and binds to free fibrinogen turning it into insoluble fibrin, causing blood to clot. Thrombin time (TT) is a test for the conversion of fibrinogen to fibrin on a common pathway and a screening test for the ability of a subject's plasma to convert fibrinogen to fibrin.

Methods: We reported two cases of abnormal extension of TT due to different reasons. We used magnetic bead method to detect thrombin time and used time unit sec to represent TT detection data.

Results: In the two cases, we found the TT results of patients taking dabigatran are abnormally high, and normal plasma contaminated with heparin can also cause abnormally high TT results.

Conclusions: The influence of heparin on TT was the greatest, followed by activated prothrombin time (APTT), but the influence on prothrombin time (PT) and fibrinogen (FIB) was not obvious. TT is highly sensitive to dabigatran in blood, so TT is not suitable for monitoring dabigatran. The normal value of TT can be used to confirm whether dabigatran has drug residues. In addition, idarucizumab can be used to reverse the anticoagulant activity of dabigatran when dabigatran causes life-threatening bleeding or other high-risk bleeding surgeries.