Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine最新文献

Background: Non-secretory multiple myeloma (NSMM) is defined as clonal bone marrow plasma cells ≥10% or biopsy proven plasmacytoma, evidence of end-organ damage due to underlying plasma cell dyscrasia, namely hypercalcemia, renal insufficiency, anaemia, bone lesions and lack of serum and urinary monoclonal protein on electrophoresis and immunofixation. They represent 3-5% of multiple myeloma (MM). With the advent of serum free light chain (s FLC) measurement, most of NSMMs have been classified as Light chain Multiple myeloma (LCMM). Thus, the proportion of true NSMM, meaning MM that secretes no monoclonal protein (complete immunoglobulin, heavy or light chain) is close to 1-2% of all myelomas. There is a need to distinguish between the true non-secretory from the other forms of oligo-secretory (OSMM) and secretory form of myeloma like LCMM with use of advanced diagnostic tools such as s FLC assay as the former has a good prognosis.

Case presentation: We discuss a case of a 65-years-old female who presented with chronic chest pain since one year. Cardiac and musculoskeletal involvement were ruled out. Monoclonal gammopathy was suspected in view of imaging abnormalities. Surprisingly, SPE and IFE reported absence of M band. A provisional diagnosis of NSMM was made based on biopsy features. However, diagnosis of NSMM was later changed to LCMM in view of a positive sFLC ratio.

Conclusions: It is well-known that the sequence of diagnostic investigations plays a crucial role in the timely diagnosis and management of patients. However, in this case it was a faulty sequence of ordering investigations which prolonged the hospital stay and delayed therapeutic intervention for the patient concerned. Serum Protein Electrophoresis (SPE), Immunofixation electrophoresis (IFE) and sFLC are simple blood-based tests which can help diagnose a majority of cases of monoclonal gammopathies. They need to be included as first line tests in our approach to evaluating a suspected case of monoclonal gammopathy.

Effective communication is pivotal in maximizing the impact and value of laboratory medicine (LM) within healthcare. This review explores diverse strategies to enhance communication among healthcare providers, patients, laboratory personnel, and the general public. Key strategies include improving interdisciplinary collaboration through clear reporting, regular multidisciplinary meetings, and consultative services. Enhancing patient communication involves providing accessible test results via patient portals, developing educational materials, and fostering direct patient-provider communication. Implementing efficient information systems by integrating laboratory information systems with electronic health records and using automated alerts ensures timely data sharing and critical value notifications. Continuous education and training for healthcare providers and laboratory staff will keep them updated on advancements and improve communication skills. Fostering a culture of open communication encourages feedback and transparency, while leveraging technology such as telemedicine, mobile health applications, and artificial intelligence--(AI)-driven tools enhances real-time consultations and personalized insights. AI can be used to assist communication through providing advanced data analysis, personalized patient insights, enhanced communication, streamlined workflows, and demonstrable impact through research and analytics. These strategies collectively ensure accurate conveyance of critical information, improving patient and public insight and leading to better patient outcomes and more informed clinical decisions.

Objectives: Considering The pivotal role of biochemical testing for the management of diabetes mellitus, we studied the current status of diabetes testing and reporting in three countries of the Asia-Pacific region.

Methods: A survey of 254 practicing pathology laboratories comprising of 40, 11 and 203 laboratories from Sri Lanka, Singapore and the Philippines was conducted under the auspices of the Asia-Pacific Federation for Clinical Biochemistry and Laboratory Medicine (APFCB) Working Group for Diabetes Testing Harmonization using Survey Monkey and Google Forms.

Results: The country response rate varied from 40% to 88%. A diagnostic threshold of 6.5% (48 mmol/mol) for HbA1c is reported by 51%, 22% and 90% of the participant laboratories in Sri Lanka, Singapore and the Philippines, respectively. All participants in Singapore and 86% of the laboratories in Philippines use NGSP-certified methods for HbA1c. Traceability to Certified Reference Materials for both glucose and HbA1c results was confirmed by 74% of Sri Lankan laboratories. For albuminuria testing, early morning spot urine albumin to creatinine ratio is recommended by 56%, 75% and 69% of the laboratories in Sri Lanka, Singapore and the Philippines, respectively, while 16%, 50% and 26% of the laboratories recommended 24-hour urine collection.

Conclusion: There is a lack of harmonization in diabetes testing and reporting practices both across and even within the three countries surveyed. Scientific bodies or professional associations have an important role in harmonization of laboratory testing and reporting of results for the diagnosis and management of diabetes mellitus.

Introduction: Patient-based quality control (PBQC) is an alternate quality control technique to conventional (internal) quality control. It uses patient results generated for clinical care to monitor the analytical performance through statistical analysis. The use of PBQC in routine laboratory is impeded by lack of familiarity and appropriate informatics tool.

Method: A Spreadsheet for PBQC Analysis and Evaluation (SPAE, based on Microsoft Excel) is developed. It incorporates IFCC recommended features for PBQC informatics tool that has been automated, including data visualization, data (Box-Cox) transformation, extreme value treatment (winsorization) and user parameter selection (block size, acceptable false positive rate, desirable bias for detection).

Results: Following parameter selection and data input, the spreadsheet automatically calculates the winsorization limits, transformed values, performance verification metrics such as false positive rates and number of results affected before error detection (NPed) - a performance metric for how sensitive the PBQC model detects the predefined error (bias). The verified PBQC model can be used for routine monitoring. The performance of the spreadsheet tool was verified against an independent model based on Python. Laboratory users can download the tool at https://github.com/HuiQi96/PBQC/blob/main/PBQC_model_v2.2.zip.

Discussion: The SPAE is a simple-to-use desktop tool that lowers the barrier for laboratory users to adopt PBQC in their quality control system. In addition, the spreadsheet can be used as an educational tool, such as when conducting a workshop, to help laboratory users better familiarize themselves with the PBQC concepts and used for independent verification of the output of another informatics tool.

This case report describes a 41-year-old woman with no significant medical history and a normal body mass index (BMI), who presented with ureterohydronephrosis due to a 5.5mm x 9mm calculus composed primarily of calcite (CaCO₃) at the ureterovesical junction. The kidney stone, associated with cystitis and perirenal fat infiltration, was spontaneously expelled and subsequently analyzed. Optical microscopy revealed a grey homogeneous stone with a rough surface and white crystals upon examination. Fourier-transform infrared spectroscopy (FTIR-ATR) confirmed the stone's composition as pure calcite, displaying characteristic absorption bands indicative of its crystalline structure. The patient reported long-term use of multiple vitamins and plant-based supplements, possibly contributing to stone formation. The discussion includes insights on calcite urolithiasis, highlighting factors such as alkaline urine pH and calcium metabolism that can influence stone formation, underscoring the complexity of managing kidney stone risk in supplement users.

Background: ICAP describes ANA patterns from AC- 0 to AC-29. They are further marked for competent or expertise reporting depending on ease of identification. There are some debatable patterns in ICAP which share similar features with a few others yet have a distinct identity and few others which are not addressed by ICAP but are described by BCA like Quasihomogenous. This study analysed four nuclear patterns with overlapping features, namely Homogenous, speckled, Dense Fine Speckled70(DFS70) and quasi-homogenous to identify challenges posed in their identification due to overlapping features.

Methods: All samples which were reported as positive for the above four nuclear patterns (n=388) by IIF using HEp-2 cell were included in the study. LIA was performed on 103 such samples to look for association between the ANA patterns and specific antibody detected by LIA.

Results: DFS70 pattern is a rare pattern and existed in combination with other autoantibodies thus making its identification difficult on IIF. Homogenous pattern corresponded to AC- 29 (anti-topoisomerase, anti-Scl 70) which was probably due to wrong identification. Mixed pattern i.e speckled and homogenous was associated with Sm and U1sn RNP antibodies.

Conclusions: DFS 70 is a pattern with overlapping features of both homogenous and speckled and calls for expertise reporting. More awareness is required about AC 29 pattern as it is an overlap of five different components. Its identification poses significant challenges and is rightly placed in the expert reporting by ICAP. Mixed pattern (speckled and homogenous) referred to as Quasihomogenous by BCA needs to be addressed by ICAP.

Background: Clinical testing for drugs of abuse typically involves initial screening followed by confirmatory testing. Due to limited evidence-based guidelines, the healthcare provider makes the decision to confirm abnormal screens based on the clinical context. This two-step approach proved to be inadequate in scenarios like maternal substance abuse and subsequent fetal/ newborn exposure. The goal of this study is to assess and improve the confirmatory testing rate of abnormal screens among pregnant patients at our women's center.

Methods: A retrospective chart review was conducted to assess the confirmation rates among positively screened pregnant patients, and a lab stewardship initiative was implemented to remind ordering physicians about the importance of confirmatory drug tests. Abnormal screens were classified as expected positives based on the medication-related interference, social history and self-reported substance use from the provider notes.

Results: Only 28% of pregnant patients with unexpected positive drug screens underwent confirmatory testing during the pre- intervention period, which rose significantly to 67% during the post-intervention period. Furthermore, outcome analysis revealed that 50% of patients with concordant confirmatory test results were referred to social work and psychiatry in the post-intervention period.

Conclusions: This study highlights the value of laboratory stewardship in optimizing drug testing practices for pregnant patients.