Annales de biologie clinique最新文献

The obstetrical follow-up of patients with a severe hypofibrinogenemia requires a multidisciplinary collaboration because of potential maternal-fetal complications (recurrent miscarriages, intrauterine fetal demise, post-partum hemorrhage, thrombosis). We report the obstetrical management of a multiparous patient with a severe congenital hypofibrinogenemia associated with a platelet disorder (abnormal phospholipid externalization). A therapeutic strategy based on a biweekly administration of fibrinogen concentrates associated with enoxaparin and aspirin allowed the maintenance of pregnancy. But this last one got complicated by a placenta percreta requiring a salvage hysterectomy with an appropriate hemorrhage prophylaxis.

Anti-Jo1 antibodies are usually known markers of myositis. However, they can be associated with different pathologies. We aimed to determine the immuno-clinical characteristics of patients with positive anti-Jo1. We enrolled 31 anti-Jo1 positive patients, selected from 10429 cases tested for antinuclear antibodies (ANA) by indirect immunofluorescence. The anti-Jo1 identification was motivated by the ANA pattern or the clinical data of patients. The average age of patients was 36.9 ± 10 years (F/M sex ratio: 3.4). The overall prevalence of anti-Jo1 was 0.3% among all ANA-tested cases. The ANA pattern associated with the presence of anti-Jo1 was heterogeneous with ANA negative in 38.7 % of cases. They were associated with different autoantibody specificities in 64.5 % of cases and were alone in 35.5% of cases. When confronted with clinical data, anti-Jo1 positivity was associated with autoimmune (77,4%) and non-autoimmune (22,6%) clinical conditions. Our study shows a low overall prevalence of anti-Jo1. These antibodies must be systematically tested for in the context of myositis even if ANA is negative. Nevertheless, their positivity in other systemic or even non-autoimmune diseases requires further studies to better understand their clinical significance.

The diagnosis of subarachnoid hemorrhage (SAH) is extremely important for appropriate management. Cerebral computed tomography (CT), used as the first-line investigation to detect bleeding, has excellent sensitivity if performed promptly, but its sensitivity falls sharply with the time elapsed since the onset of SAH. Oxyhemoglobin and bilirubin, the breakdown products of heme, are detectable in cerebrospinal fluid (CSF) by spectrophotometric absorption, which defines the search for xanthochromia pigment in CSF. Both parameters can be sought when imaging is negative or doubtful with a strong suspicion of SAH based on clinical signs. In this context, our working group at the Société Française de Biologie Clinique (SFBC) is proposing recommendations to provide medical biologists with support for the implementation and validation of "oxyhemoglobin and bilirubin in CSF" test and enabling them to play their part in the diagnostic process. From the pre-analytical stages through to the delivery of results, we will summarize the pitfalls to be avoided, the main decision values and different physiological and pathological profiles.

The relevant and correct prescribing of medical biology is a major public health issue. Correct prescribing is a legal obligation under article L6211-8 of the French Public Health Code and is an integral part of the biologist's daily work, already specified in the 2012 (section 4.7) and 2022 (section 5.3.3) versions of the NF EN ISO 15189 standard. COFRAC document SH REF 02 v08 specifies the requirements for consultancy services. The adaptation of the prescriptions is a revision of the contract with the prescriber, which makes it possible to optimize patient care and ensure the satisfaction of the laboratory users. Although essential, accurate prescribing is time consuming. "Chronophage" is the term that has been used for almost a decade. At present, the work of biologists in this area is not valued. In fact, there is no evaluation system to highlight this regulation control activity. To date, no work has been published to estimate this time, this chronophagy, and to evaluate its impact. Cost measurement using Time-Driven Activity-Based Costing (TDABC), a variant of Activity-Based Costing (ABC), is based on a process approach. The main contribution of TDABC is that it uses a single cost driver: time. Serum immunofixation is a test used to confirm and monitor plasma cell dyscrasias, the archetype of which is multiple myeloma. The learned societies and the IMWG provide explicit diagnostic criteria, but the guidelines do not address the frequency of follow-up. In particular, the frequency of repeat and follow-up serum immunofixation remains unaddressed from an evidence-based medicine perspective. This work has made it possible to highlight the savings made between 1st January and 31th August 2023 thanks to the involvement of the biologist and to highlight his essential role in the process of controlling the overall expenditure (reagents, human resources, time and money) in the specialized biochemistry sector (bench: proteins) and to strengthen the role of the biologist within the institution. The various players in the healthcare sector - prescribing physicians, biologists, hospital administrators and, last but not least, patients - all have an essential role to play in maximizing value for patients and in the healthcare economy.