Annales de biologie clinique最新文献

This observation reports the case of an occupational allergic asthma in a laboratory technician, caused by exposure to formaldehyde. She experienced feelings of discomfort during low exposure, below the regulatory exposure thresholds. Sent to occupational medicine, signs of an asthma attack were noted by the doctor. Respiratory function tests showed bronchial hyperactivity. The diagnosis of formaldehyde asthma was made due to the recurrence of signs during exposure and the absence of other allergies. This type of occupational asthma is rare nowly and this case is an opportunity to recall what the different occupational asthmas are and which are the most common among laboratory technicians.

The Working Group Preanalytical Phase of the European Federation of Clinical Chemistry and Laboratory Medicine advises suppressing haemolysis-sensitive tests when haemolysis is clinically significant, as improper specimen handling can rupture red blood cells, increasing potassium levels. Thus, a correctly repeated blood sample should show lower potassium levels than a haemolysed one. This study aimed to determine the prevalence of haemolysed samples with potassium levels below the reference range and whether this predicts hypokalemia in repeated collections. From March 2022 to March 2024, 396,640 non-haemolysed samples (H-index < 2 UA) were analyzed. Samples with an H-index ≥ 2 AU were classified as haemolysed, and potassium values were suppressed. Warnings were issued for haemolysed samples with potassium below the reference range (3.4-4.5 mmol/L), advising new sample collection. Twenty-five (0.01%) repeat samples were taken within 24 hours of a previously haemolysed sample with low potassium. Severe and moderate hypokalemia were more common in these repeats, with severe hypokalemia (≤2.5 mmol/L) found in 48% of repeat tests, compared to 0.3% in all samples. Though rare, a decrease in potassium in haemolysed samples often precedes hypokalemia diagnosis. Implementing a simple and cost-effective LIS algorithm to alert clinicians could potentially reduce diagnosis and treatment time.

Clostridioides difficile is a Gram-positive, spore-forming anaerobic enteropathogen responsible for a wide spectrum of clinical diseases ranging from mild diarrhoea to pseudomembranous colitis. It is the first cause of healthcare-associated diarrhoeas, but community-associated Clostridioides difficile infections (CDI) are increasingly reported in patients without the common risk factors (age > 65 years, previous antibiotic treatment). The main C. difficile virulence factors are toxins A (TcdA) and B (TcdB), and in some cases the binary toxin. The CDI incidence has increased in Europe since the early 2000s, then decreased to reach approximately 4 cases/10,000 patients/days. C. difficile should be tested only in diarrheal stools. Children less than 3 years old are frequently colonized, therefore CDI diagnosis should be carried out only in specific cases (outbreak, Hirschsprung disease). No stand-alone method can be used for the CDI diagnosis. The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) recommends a two-step algorithm with a sensitive screening test (molecular assay or glutamate dehydrogenase immunochromatographic assay). If the screening test is negative, the CDI diagnosis can be ruled out. If the screening test is positive, a second highly specific test should be used, such as toxin A/B immunochromatographic assay.

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.