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

Introduction: One of the most essential components of a clinical laboratory's overall quality management system is quality control (QC) validation. We typically tend to use more reagents and resources than necessary in an attempt to preserve quality. Achieving higher results while using fewer resources is time imperative. We have attempted to address this issue by providing cost-benefit analysis by implementing effective QC procedures using six sigma methodology and their financial benefits.

Material and methods: Six sigma calculation of 23 routine chemistry parameters was performed over a period of one-year using bias% and cv%. New Westgard sigma rules were applied using Biorad Unity 2.0 software. A comparison was made before and after new sigma rules application including false rejection rate, probability of error detection rate, cost of all reruns, repeats, etc. Relative and absolute annual savings were computed and compared.

Results: Compared to the current rule, there was absolute savings of Indian Rupees (INR) 750105.27 when both internal failure and external failure costs were combined after the candidate rule was employed. The reduction in expenses varied with the quantity of samples examined and the quantity of QC operations carried out each day leading to an internal failure costs cut down by 50% (INR 501808.08) and external failure costs by 47% (INR 187102.8).

Conclusion: The study highlighted how quality control techniques in clinical laboratories need to be carefully planned in order to achieve significant cost reductions by lowering internal or external failure costs and effective prevention and appraisal cost planning activities prior.

Metabolomics involves the study of unique chemical fingerprints left behind by specific cellular processes. Metabolomics encompasses the analysis of both "endogenous" compounds, such as amino acids, lipids, cofactors, nucleotides, carbohydrates, hormones, etc., and "exogenous" metabolites including drugs, toxins, environmental contaminants, pesticides, herbicides, etc. Initially, metabolic analyses heavily relied on nuclear magnetic resonance (NMR), but recent advancements in mass spectrometry (MS) and Tandem MS have expanded the horizons of research, service, and education in this field. In this overview, we delve into the domain of mass spectrometry from the perspective of Chemical Pathologists. To establish a baseline, we conducted a search using the PakMediNet search engine. Our literature review yielded a total of 1167 articles, of which 1155 were excluded, and 12 were included. Our findings indicated that while MS is utilized for method development and biomarker evaluation in the fields of basic biological sciences and the pharmaceutical industry, there are limited collaborative efforts with Chemical Pathologists for clinical applications. It is imperative to harness the advancements in MS for research and development, as this technology is a driving force behind progress in service and education. Looking ahead, areas such as newborn screening, diagnostics for inherited metabolic disorders, heavy metals analysis, and toxicology hold great potential for research in collaboration with Chemical Pathologists. To achieve these goals, the formation of working groups, establishing partnerships with institutes possessing relevant expertise, and providing funding opportunities are essential steps forward.

Background-aim: Several factors, including ethnicity, age, iodine status, and assay method, can influence thyroid test results. This study aimed to establish reference intervals (RIs) for thyroid parameters in adults and older individuals, considering their iodine statuses.

Methods: A cross-sectional study at a single tertiary center was conducted. Participants underwent interviews, physical examinations, thyroid ultrasounds, thyroid autoantibody testing, and a spot urine iodine concentration analysis. The included participants were grouped into adult (age 18 - 59) and older (age ≥60) groups. The studies for 2.5th-97.5th values of thyroid parameters were committed to establishing RIs.

Results: A total of 357 individuals were screened, with 216 (112 adults, 54% women, 104 older, 50% women) were included in the analysis. The RIs for thyroid stimulating hormone (TSH) were as follows: 0.39 - 4.17 mIU/L for the overall group, 0.35 - 3.98 mIU/L in the adult group, and 0.42 - 4.83 mIU/L in the older group. The prevalence of adequate iodine intake (urine iodine level ≥ 200 μg/L) was 62.2% (186/299). Though RIs for TSH, Free T4, and Free T3 were slightly higher in the adequate iodine intake group, no statistically significant differences were noted. Positive anti-thyroglobulin antibodies were more prevalent in older participants (27.3% VS. 21.2%), as were anti-thyroid peroxidase antibodies (24.2% VS. 13.9%).

Conclusion: Older individuals exhibited significantly higher TSH levels and lower FT3/Total T3 levels, while FT4/Total T4 remained comparable to adults. All thyroid parameters and thyroid autoantibody levels showed no statistically significant differences between those with adequate iodine intake and those with iodine deficiency.

Objectives: To identify the variation of reference intervals, reporting units used for key blood chemistry parameters in laboratories across Pakistan and to understand the factors contributing to these discrepancies.

Methodology: A comprehensive e-questionnaire developed using google forms covering key blood chemistry parameters (Electrolytes, fasting glucose, glucose random urea, creatinine and lipid profile), reference intervals, reporting units, and laboratory practices was administered via email to the Pathologists. Frequency and percentages were calculated for each response and descriptive results were also evaluated.

Result: A total of 38 responses were received five responses were excluded due to incomplete forms. The responses from 33 laboratories revealed substantial variability in reference intervals (RIs) for routine blood chemistry parameters, underscoring a significant lack of standardization. 66.66% laboratories had not developed specific RIs, relying instead on manufacturer-provided RIs, with infrequent reviews or updates. Challenges were prevalent due to non-harmonized RIs, leading to patient and physician counseling issues. Primary obstacles included funding deficiencies and limited access to healthy samples.

Conclusion: These findings emphasize the critical need for national regulatory guidelines to standardize RIs, thereby enhancing the reliability and accuracy of laboratory diagnostics in Pakistan.

Introduction: Laboratory medicine is an evolving clinical specialty that is driven by technological advancements, availability of new evidence and new clinical workflows to cater to changing demographic and socioeconomic landscape. This report summarises the educational and practice needs based on the responses provided to a survey.

Method: The IFCC TF-GEL conducts regular educational webinars. At the end of the webinar, a participant survey is administered anonymously, which included an open-ended question for suggesting topics and areas in laboratory medicine for which future webinars can be organised for. This question was designed to take pulse of the educational and practice needs of the laboratory practitioners. All survey responses for this question between February 13 and September 23, 2024 were extracted from the online survey platform and objectively summarised using ChatGPT 4.o.

Results: Overall, 3902 comments were received from 12 webinars' global survey participants in 2024. Comments were qualitatively summarised into broad headings in laboratory medicine, including quality management and compliance, clinical chemistry and laboratory medicine, emerging trends and technologies, specialized testing and techniques, healthcare management and leadership, case studies and practical applications, public health and emerging health topics, innovation and future directions.

Discussion: Many of the topics highlighted by the laboratory practitioners have matching IFCC functional units. They can be engaged to developed freely accessible educational and practice guidelines resources to maintain the standards of profession of the laboratory practitioner globally. Additionally, the topics summarised here can also be used to develop local resource and curriculum.

Background: Gray Platelet Syndrome (GPS) is a very rare bleeding disorder. It is characterised by mild to moderate bleeding with macro thrombocytopenia and impaired alpha granules in megakaryocytes and platelets.

Case details: A 8-year-old boy, presented with ecchymotic patches all over the body since early childhood. On examination, he had ecchymotic patches over the thigh and back. There were no dysmorphic features, lymphadenopathy or hepatosplenomegaly. Hemogram showed borderline low platelet (1.1*10^9) and normal hemoglobin and leucocytes. Prothrombin and Partial thromboplastin time were normal. Peripheral smear showed large platelets that lacked granules and looked pale, prompting us to think of Gray Platelets Syndrome. Mean platelet volume was 12.8fL. Genetic sequencing revealed homozygous mutation in the exon35 of NBEAL2-(c.5597del) gene, confirming the gray platelet syndrome (GPS).

Conclusion: High index of suspicion and coordinated care between clinician and pathologists are important for timely diagnosis of such rare disorders.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an antibody-mediated neurological disease which is acute, severe and with a complicated differential diagnosis. In 38% of cases, it arises as a paraneoplastic neurological syndrome (PNS) associated with cancer. Ovarian teratomas are the most frequently associated tumors, especially in young women. However, teratomas are usually mature and benign and psychiatric and neurological symptoms improve after resection. Clinical laboratories play a key role in the diagnosis and prognosis of these diseases, highlighting the importance of laboratory test results to prompt the search for the associated tumor. In addition, communication between laboratory medicine specialists and clinicians, as well as a multidisciplinary approach, are essential for early disease identification and treatment.

Dyslipidemia, characterized by imbalances in lipid profiles, has emerged as a multifaceted health challenge in the population. Factors such as urbanization, dietary shifts, and genetic variations contribute to the rising prevalence of abnormal lipid levels. This condition significantly amplifies the risk of cardiovascular diseases, a leading cause of mortality. This study focused on dyslipidemia, risk factors, prevalence, evaluating the ratio of cholesterol to HDL (High density lipoproteins), triglyceride to HDL, LDL (Low density lipoproteins) to HDL, Cholesterol to LDL, triglyceride to LDL,HDL to LDL along with their comparative analysis and age-related patterns of dyslipidemia. A total of 100 were collected, comprising 64 males and 36 females. The findings revealed a significant prevalence of dyslipidemia, reaching 86%. Breakdown of lipid profiles showed specific prevalence rates for cholesterol (29%), triglycerides (50%), HDL (48%), and LDL (31%). Alarmingly, out of the 100, only 14 individuals had a normal lipid profile, indicating a high incidence of dyslipidemia in the region. Additionally, the study highlighted an age-dependent increase in the likelihood of developing dyslipidemia. The high prevalence of dyslipidemia is an important public health problem. Enhanced public health preventive measures should be implemented to better diagnose and comprehensively treat dyslipidemia.