Annales de biologie clinique最新文献

A 14-year-old patient underwent liver transplant. Three months after transplantation, EBV associated lymphoma was suspected. EBV serologies before and after transplantation were particularly discrepant. Eighteen months before transplantation, the serological profile suggested a recent EBV primary-infection, four months before transplantation, we had isolated anti-EBNA IgG and five days after transplantation, the serological profile suggested a past infection. All EBV PCR performed on whole blood were negative. Retrospectively, immunoblots anti-EBV IgG were performed. Blots showed no anti-EBV IgG before and until the day of liver transplantation. Five days after transplantation, slight bands of both IgG anti-p18 (VCA) and anti-EBNA-1 were found, without any other serological marker. These were probably due to passive transfers of IgG during surgery. There was therefore no argument for an immunization against EBV before or after liver transplant for this patient.

Acromegaly is a rare endocrine disorder leading to an acquired physical disfigurement and multisystem damage. It is caused in over 95% of cases by a secreting pituitary adenoma. Latency period between disease onset and diagnosis is mainly 10 years due to progressive chronic evolution and exposure to high levels of GH and IGF-1. Here we present a case of acromegaly with over 25 years of diagnostic delay in 69-years-old male with typical features and recurrent urolithiasis. Biochemical diagnosis was confirmed by high levels of IGF-1and lack of suppression of GH during an oral glucose load. Imaging and histological study revealed a co-secreting GH/ prolactine macroadenoma. After three months of complete transphenoidal surgical resection, biochemical remission was not obtained and the patient was treated by a somatostatin receptor ligand. Based on this severe case with atypical manifestations, the diagnosis of acromegaly should be always considered.

This study aims to determine the concordance of results between D-10® and Minicap Flex Piercing® and the impact of the presence of hemoglobin variants in the glycated hemoglobin assay. All the samples were assayed in parallel. The agreement between these methods was assessed using the Bland and Altman plot. We collected a total of 166 samples. In the entire study population and in patients with a hemoglobin variant, the Bland and Altman graph showed good agreement between the values (for respective biases of 0.21% and 0.29%) as well as a significant correlation (p < 0.001). Our results differ from those found by Kesso Barry et al. This difference can be explained by the high prevalence of patients with abnormal hemoglobins S and C (39.2 %) in our study population. Despite a good agreement between the methods, the results do not allow us to confirm a transferability between the two systems in diabetics and carriers of hemoglobin variants.

Alanine (ALT) and aspartate aminotransferases (AST) are intracellular enzymes involved in the metabolism of amino acids. The measurements of their activities are two of the most ordered tests in clinical laboratories, used to screen, diagnose and follow diseases affecting the liver. Recent works highlighted that reference values for ALT and AST vary according to the analytical method and the individual’s characteristics, like with many other biomarkers. Reference values for ALT show clinically significant differences according to the analytical method (higher when supplementing samples with phosphate pyridoxal), gender (higher in males than in females), body mass index (positive correlation), and age (higher in infants and the elderly), but not according to ethnicity or employed analyzer. According to the analytical method and age, reported reference values for AST show clinically significant differences, similar to ALT. These observations prove clinical laboratories’ interest in updating their reference values according to sex, body mass index, age (especially when providing testing to pediatric or elderly populations), and the analytical method employed. If possible, a standardized method should be used, including sample supplementation with pyridoxal phosphate, to ensure the comparability of results between laboratories.

A 16-year-old child with no medical history was admitted to the hospital emergency for abdominal pain associated with polyuria-polydipsia and weight loss (baseline BMI: 25,4 kg/m2). Diagnosis of severe ketoacidosis was quickly raised regarding major metabolic acidosis, high ketonemia and glycemia. Acute pancreatitis was then diagnosed according to a plasmatic lipase more than tenfold normal values associated with a severe hypertriglyceridemia superior to 100 mmol/L. The triad composed of diabetic ketoacidosis-acute pancreatitis-hypertriglyceridemia is rarely found in childhood and can have deleterious consequences. The etiology of this disease is still enigmatic, as one can be both, cause and consequence of the other. Genetic investigation of familial chylomicronemia legitimated to invalidate the dyslipidemia etiology of this event. On the other hand, the association of a genetic variant of lipoprotein lipase leading to a decrease in its activity, with the insulinopenia of type 1 diabetes most certainly triggered this episode of hypertriglyceridemia.

The influence of hemolysis was evaluated for 26 clinical chemistry parameters on DxC 700AU (Beckman Coulter®). Ten sample pools were prepared and separated into six aliquots. These aliquots were overloaded with hemolysis in increasing amounts to reach levels equivalent to the maximum hemolysis thresholds H1 (+), H2 (++), H3 (+++) and H4 (++++). Each aliquot is compared to its reference aliquot (not hemolyzed) and a ratio is calculated for each parameter. We proposed that there was a significant difference if, for a given analyte and threshold, more than 20% of the ratios are above the total acceptable limit variability. A significant difference was found for TGP, TGO, cholesterol, creatine kinase (CPK), lactate deshydrogenase (LDH), phosphorus and potassium at H1 (+), chlorine, iron, γ-glutamyltransferase (GGT), and magnesium at H2 (++), amylase and alkaline phosphatase (PAL) at H3 (++++), and prealbumin at H4 (++++). No interference was found until H4 included for uric acid, calcium, creatinine, lipase, glucose, HDL-cholesterol, triglycerides, urea, sodium and immunoglobulins A, G and M. The overestimation of kalemia was calculated as a function of hemolysis, ranging from 0.28 mM +/–0.047 (upper H1 threshold) to 1.37 mM +/–0.126 (upper H4 threshold). Its estimation makes it possible to propose a result rendering algorithm of kalemia according to the hemolysis index. Evaluation of the automates hemolysis indexes is highly recommended for each laboratory. It can allow for some critical parameters the establishment of a decision tree facilitating the result rendering, after clinicobiological consultation.