Clinical laboratory最新文献

Background: Angioimmunoblastic T-cell lymphoma (AITL) is a distinct subtype of peripheral T-cell lymphoma (PTCL) and accounts for 2% of all non-Hodgkin lymphomas. Its typical characteristics include an aggressive course, progressive lymphadenopathy, hepatosplenomegaly, systemic symptoms, anemia, hypergammaglobulinemia, and generally poor prognosis.

Methods: We describe a rare case in which the left inguinal lymph node was completely excised and biopsied one year ago. Based on histomorphology and immunohistochemistry, B-cell small lymphocytic lymphoma (CLL/SLL) was diagnosed. Routine bone marrow examination indicated the presence of immature lymphocytes; however, immunophenotyping showed no significant abnormal lymphocytes. One month ago, the patient developed swelling in the left lower limb, which gradually worsened. A fine-needle aspiration biopsy of the left inguinal lymph node revealed angioimmunoblastic T-cell lymphoma.

Results: The final diagnosis for this patient is a transformation from B-cell small lymphocytic lymphoma to angioimmunoblastic T-cell lymphoma (AITL) one year after the initial diagnosis.

Conclusions: In this report, we present a rare case of AITL. The aim is to enhance awareness among readers regarding the clinical, immunological, and phenotypic characteristics of various forms of AITL.

Backround: Patients with hemophilia A can develop inhibitors to factor concentrates. Emicizumab, a nonfactor-based therapy, has efficacy despite inhibitors. FVIII activity assessment on emicizumab treatment requires a bovine chromogenic reagent such as TriniCHROM FVIII:C.

Methods: FVIII levels were measured in 15 patients with and 35 without hemophilia and 10 patients on emicizumab therapy with a time-to-clot and the TriniCHROM FVIII:C reagents. FVIII inhibitor levels were also determined with both reagents.

Results: Acceptable agreement of FVIII and FVIII inhibitor levels were obtained with the 2 reagents (R² = 0.92 and 0.96, respectively) in patients not exposed to emicizumab. The time-to-clot FVIII assay overestimated FVIII levels in patients on emicizumab therapy. The chromogenic FVIII assay delivered accurate endogenous FVIII levels in patients on emicizumab therapy.

Conclusions: The TriniCHROM FVIII:C assay is compatible with routine automated coagulation analysers and delivers accurate FVIII and FVIII inhibitor levels.

Background: Sigma methodology is a statistical calculation and quality management tool that provides information about process performance. If clinical laboratories start using sigma metrics to monitor their performance, they can more easily identify gaps in their performance, thereby improve their performance and patient safety. This study aimed to calculate sigma metrics and quality target index values by using internal quality control data from coagulation tests, thus evaluating the analytical performance.

Methods: Sigma levels were calculated using the formula: [total allowable error (TEa) - bias]/coefficient of variation (CV). Sigma values ≥ 6, between 3 and 6, and < 3 were classified as "world-class", "good" or "unacceptable", respectively. A biological variation database (BVD) was used for TEa. The quality goal index (QGI) is the reason behind a low sigma value, that is, lower precision, lower accuracy, or both due to the combination. QGI was calcu-lated using the formula QGI = bias/1.5 x % CV. With a QGI value of < 0.8, the measurement indicates that the accuracy of the procedure needs to be improved; QGI values > 1.2 indicate accuracy needs to be improved and values 0.8 ≤ QGI ≤ 1.2 indicate both precision and accuracy need to be improved.

Results: Sigma and QGI of three-monthly two-level internal quality control values were calculated by using the laboratory automation system. In the prothrombin time (PT) and activated partial thromboplastin time (APTT) tests of the coagulation parameters studied, sigma values were found to be < 3 in both levels. When the QGI value was calculated, it was PT 0.45 and APTT 0.90 for level 1 and PT 0.16 and APTT 0.6 for level 2, respectively.

Conclusions: It was decided that sigma values of coagulation parameters at "low quality" levels and improvement studies should be carried out for coagulation parameters in our laboratory. By evaluating sigma levels, it is possible to identify tests with a high probability of failure, and these tests should undergo strict quality control inspections. In clinical biochemistry laboratories, appropriate quality control planning should be performed for each test by using the Six Sigma methodology and by calculating the quality target index.

Background: Entamoeba histolytica, a protozoan parasite, is responsible for intestinal amebiasis and can cause severe complications. It is prevalent in tropical and subtropical regions and is a significant health concern in developing countries. Traditional diagnostic methods often delay the diagnosis, leading to prolonged patient suffering and increased risk of complications.

Methods: We report the case of a 59-year-old HIV-positive man on Odefsey, who presented with a week-long history of abdominal pain and diarrhea. Initial stool analysis suggested bacterial colitis, and empirical treatment with levofloxacin was initiated. However, the patient's condition worsened, resulting in hospitalization. Laboratory findings included elevated white blood cell count and high-sensitivity C-reactive protein, with low plasma sodium and potassium levels. Stool bacterial cultures were negative for common pathogens.

Results: Rapid diagnosis was achieved using the FilmArray GI Panel, which detected E. histolytica within an hour. Subsequent stool microscopy suggested the presence of E. histolytica/E. dispar cysts. Prompt antiamoebic therapy with metronidazole and paromomycin resulted in significant clinical improvement. The case was reported to the Centers for Disease Control (CDC) as a Category II notifiable disease.

Conclusions: This case underscores the critical role of the FilmArray GI Panel in the rapid detection of E. his-tolytica, facilitating timely and effective treatment. Early diagnosis using advanced molecular diagnostics significantly improves patient outcomes and should be incorporated into routine clinical practice for managing gastrointestinal infections.

Background: The human adrenal gland is composed of the cortex and the medulla, which contain different function cells. The aim of this study was to build a 3D culture system for human adrenal glands.

Methods: Human fetal adrenal tissues were digested into a cell suspension culture and processed in three-phase 3D cultures.

Results: Apparent spheroids could be seen from the 4th day on. After 21 days of 3D culture, steroid synthesis cells were evident via CYP17A1+ immunohistochemical staining and flow cytometry analysis. Electron microscopy analysis showed that these cells were present in lipid droplets in the cytoplasm. Meanwhile, TH+ cells represented catecholamine-producing cells, and these cells exhibited electron density particle gathering in the cytoplasm. Dehydroepiandrosterone and epinephrine syntheses were further confirmed via enzyme-linked immunosorbent assay.

Conclusions: We established a 3D culture system for human adrenal glands by using a sequential processing medium to facilitate cortical-medullary cell development.

Background: We analyzed the clinical distribution and the antibiotic susceptibility of pathogens for catheter-related blood stream infection (CRBSI) in the hospital retrospectively.

Methods: The clinical information and pathogens associated with CRBSI were collected from the Microbiology Laboratory of the hospital retrospectively from January 2017 to December 2021. Identification and the antibiotic susceptibility test (AST) were carried out with VITEK-2 Compact. The data were analyzed by WHONET 5.6.

Results: A total of 138 isolates (6.4%) associated with CRBSI were found during the 5-year period. Among the pathogens of CRBSI, 89 (64.5%) isolates were coagulase-negative Staphylococcus, 6 (4.3%) were strains of Enterococcus, and 4 (2.9%) were strains of Staphylococcus aureus. Staphylococci and Streptococci were all sensitive to Linezolid, Vancomycin, Quinuprine/Dafuprine, and Tigecycline. There were 39 (28.3%) Gram-negative bacilli isolates, including 17 strains of Klebsiella pneumoniae (12.3%), 6 (4.3%) strains of Acinetobacter baumannii, and 6 (4.3%) strains of Burkholderia cepacia. The drug resistance rates of Gram-negative bacilli to most drugs were higher than 50%. The main departments where CRBSI pathogens were isolated were Peritoneal Tumor Surgery (86, 62.3%), ICU (20, 14.5%), Emergency Department (6, 4.3%), and Respiratory Department (6, 4.3%).

Conclusions: With the emergence of multidrug-resistant (MDR) bacteria, more attention should be paid to the prevention and control of nosocomial infections. At the same time, the use and management of antibiotics should be standardized, and monitoring of multidrug-resistant bacteria should be strengthened in hospitals.

Background: COQ8B nephropathy is a hereditary mitochondrial kidney disease. Most cases present with steroidresistant nephrotic syndrome and focal segmental glomerulosclerosis, whereas this patient exhibited asymptomatic isolated proteinuria and mild renal histopathology.

Methods: Appropriate laboratory tests, abdominal ultrasonography, renal biopsy, and whole exome sequencing were performed to explore the cause of the disease.

Results: Laboratory results revealed that the patient was asymptomatic. Abdominal ultrasonography confirmed left renal vein nutcracker. Renal histopathology showed mild mesangial proliferation. An unreported splice mutation in the COQ8B (c.893+2T>A) gene was identified by whole exome sequencing.

Conclusions: COQ8B nephropathy is an emerging cause of isolated proteinuria, particularly prevalent among adolescents. For nephritis of unknown etiology following renal biopsy, prompt consideration of gene sequencing is advisable.

Background: Neonatal birth/perinatal asphyxia is a critical condition that can adversely affect many different bodily tissues, particularly the brain; depending on duration and severity of asphyxia, leading to difficulties and lifelong disabilities. These can be avoided by early detection of the biochemical derangements and prompt intervention. Serum alpha-ketoglutarate (α-KG) and cord blood lactate have been found to be associated with birth asphyxia and may have potential to act as biomarkers for birth asphyxia.

Methods: Serum levels of α-KG and cord blood lactate were estimated in 34 birth asphyxiated neonates with clinical evidence of asphyxia. The levels were also analyzed in 46 apparently healthy controls, and data was compared among different groups by using appropriate statistical analysis. Serum α-KG was estimated by enzyme-linked immunosorbent assay (ELISA) and cord blood lactate by blood gas autoanalyzer (BGA) in the serum samples.

Results: Serum α-KG levels were found to be increased in birth asphyxiated neonates as compared to healthy controls (p-value = 0.06). Correlation of serum α-ketoglutarate (ng/mL) levels with outcome (discharged/expired) in birth asphyxiated neonates was not found to be statistically significant (r value = 0.156, p-value = 0.384). A statisti-cally significant correlation was not found between severity of birth asphyxia and levels of serum α-ketoglutarate (ng/mL) (r value = 0.029, p-value = 0.86). Also, correlation of cord blood lactate levels (mmol/L) with severity in birth asphyxiated neonates was not found to be statistically significant (r value = 0.326, p-value = 0.10). Correlation between cord blood lactate levels (mmol/L) and outcome in birth asphyxiated neonates (discharged/ expired) was not found to be statistically significant (r value = 0.03, p-value = 0.87), while correlation of cord pH levels and severity of birth asphyxia in cases was found to be highly statistically significant (r value = -0.60, p-value < 0.01) Conclusions: Serum α-KG and cord blood lactate bear the potential to act as biomarkers in neonates with birth asphyxia.

Background: Acute necrotizing encephalopathy is a rare acute, explosive, and severe form of encephalopathy that predominantly occurs in children; however, it is infrequent in adults. The patient is typically caused by viral infection, with rapid onset of fever, convulsion, disturbance of consciousness, and other symptoms. It presents symmetrical, multifocal, involving bilateral thalamic damage and other typical imaging features. This disease has a poor prognosis and can lead to severe neurological symptom sequelae such as epilepsy, coma and even necrotic encephalopathy [1], and its fatality rate can be as high as 52% [2]. Early identification and timely treatment are the key to reducing the fatality rate.

Methods: Laboratory routine examinations, encompassing blood routine, biochemistry, influenza PCR, cytokines, and blood gas, were carried out for the patient. Moreover, imaging examinations such as skull CT were also conducted. Based on the combination of clinical symptoms, the patient was diagnosed and treated.

Results: Auxiliary examination: The white blood cell count was 2.33 x 109/L, the lymphocyte percentage was 62.3%, the platelet count was 83.0 x 109/L, the CRP was 7.4 mg/L, the PCR was positive, the partial pressure of oxygen was 59.3 mmHg, the partial pressure of carbon dioxide was 26.6 mmHg, the lactic acid was 6.98 mmol/L, the ALT was 1,892 U/L, the AST was 6,804 U/L, the IL6 was > 1,1836 pg/mL, the plasma D-dimer determination was > 35.20 mg/L, the 3P test was positive, the PT was > 180 sec, and the fibrinogen was 0.1 g/L. Skull CT revealed a small number of low-density changes in the bilateral thalamus.

Treatment: Oral tube intubation, ventilator-assisted ventilation, cranial pressure reduction, pressure enhancement, methylprednisolone injection for anti-inflammation, plasma and platelet transfusion, and oseltamivir capsule for antiviral purposes. After MDT consultation, acute necrotic encephalopathy was considered, and intravenous shock therapy with immunoglobulin and methylprednisolone needle was added. Forty-eight hours after admission, the patient's condition deteriorated, multiple organ failure occurred, and the family gave up treatment.

Conclusions: Acute necrotizing encephalopathy is infrequent in adults, prone to being overlooked and misdiagnos-ed, and the disease progresses rapidly with a high fatality rate. Clinicians should enhance the early recognition ability of the disease and actively administer glucocorticoid treatment combined with immunoglobulin, which is conducive to a better prognosis for patients.