Annales de biologie clinique最新文献

Bone marrow metastasis of solid tumours is a sign of advanced disease, with their frequency depending on the primary cancer site. Bone marrow metastasis of bladder cancer is an unusual presentation of the disease. We present a case of a patient with non-muscle-invasive bladder cancer, presenting with recurrent macroscopic haematuria after urinary catheterisation leading to discovery of bi-cytopenia on complete blood count. Myelogram realized after sternal bone marrow aspiration showed presence of metastatic cells immunostained for urothelial nature. The clinical course was rapidly unfavorable leading to patient's death shortly after diagnosis. metastasis of bladder cancer to the bone marrow is a highly unusual situation associated with a poor prognosis.

CDT (Carbohydrate-Deficient Transferrin) has been the reference blood biological marker for screening and monitoring alcohol consumption for many years due to its high specificity. However, its generalization has been slowed by the lack of standardization of the methods used for its measurement. Thus, the limit of reference values could vary from one to three times depending on the procedure. A working group of the IFCC (International Federation of Clinical Chemistry) described a reference method validated by the IFCC and the JCTLM (Joint Committee for Traceability in Clinical Medicine). This made it possible to produce standards used by manufacturers to align their methods with the IFCC reference method. This study compared the results obtained with the «classic» procedure of a commercial capillary electrophoresis method with those obtained using the standardized IFCC procedure of the same method. The data were obtained from an external quality control from 2019 to 2024. The results show 1) a 40% decrease in the inter-laboratory dispersion of results, 2) an excellent correlation between the "Standard" procedure and the IFCC procedure and an alignment with the reference HPLC method measured in parallel. These results demonstrate the benefit of using a standardized IFCC procedure for the homogenization of CDT assay results.

Hyperkalemia, characterized by an elevated serum potassium level, is a common and serious complication in patients with Chronic Kidney Disease (CKD). It can lead to major cardiovascular disorders, making rigorous management essential. Objective: To study the determinants of hyperkalemia in patients with renal failure undergoing conservative treatment followed at the CNHU-HKM in Cotonou (Bénin) in 2024. This was a cross-sectional study conducted from October 1 to December 31, 2024, involving patients monitored in the teaching nephrology and hemodialysis clinic for end-stage chronic kidney disease. Eligible patients were at least 18 years old, on conservative treatment, and had provided informed consent. The dependent variable was a serum potassium level above 5.0 mmol/L associated with a cardiac disorder. Determinants were identified using a significance threshold of p < 0.05. A total of 110 patients were included. The mean age was 57 ± 1.3 years, with a sex ratio of 1.8. Among them, 30 patients developed hyperkalemia, representing a prevalence of 27.3 %. The identified determinants were male gender (aOR = 5.3; p = 0.024) and the use of ACE inhibitors (aOR = 5.1; p = 0.022). Hyperkalemia remains a frequent issue in nephrology, requiring increased vigilance and appropriate management, particularly for at-risk patients.

In the face of climate emergency, medical biology laboratories (MBLs) must reconcile diagnostic performance, innovation, and environmental sustainability. Playing a crucial role in patient diagnosis and follow-up, MBLs have a significant ecological footprint due to their high energy consumption, extensive use of plastics, and substantial waste production, including hazardous materials classified as carcinogenic, mutagenic, reprotoxic, or radioactive. Still with the goal of continuing to contribute to patient care activities and improving the quality of care, this article provides an overview of concrete strategies and perspectives for reducing the ecological footprint of medical biology MBLs. Through practical examples and evidence-based recommendations, we aim to raise awareness among medical biologists and equip them with the necessary tools to integrate ecological transition into their daily practices.

Metabolomics is an approach to systems biology which studies the metabolic profiles of biological fluids, cells, tissues or organisms as a function of pathophysiological conditions or in response to different stimuli or treatments. Despite its development in research, its use in laboratory medicine remains limited and the contours of clinical metabolomics are not clearly defined. In June 2024, the French Society of Clinical Biology (SFBC)'s 'Clinical Metabolomics in Laboratory Medicine' working group conducted an online survey to establish the current status of clinical metabolomics players in France and to better define the issues and expectations involved. Of the 37 specialists who responded, 75% were affiliated to laboratory medicine, while the others were only affiliated to a research unit. The results revealed a wide range of analytical approaches, with mass spectrometry being the most widespread, with targeted and untargeted approaches depending on the objectives of the laboratories. The most frequently mentioned clinical areas of application were hereditary metabolic diseases (45%), metabolic diseases (45%), nutrition (35%), oncology (32%) and neurology (26%). The definitions of clinical metabolomics varied widely depending on the context in which the participants practiced. In this publication, the SFBC Working Group aims to define the scope and objectives of clinical metabolomics in laboratory medicine, relying in particular on a glossary designed to harmonize dedicated terminology.

To assess the validity of the hemolysis index (HI) as a method for plasma hemoglobin measurement and its relevance in the clinical-biological monitoring of patients on extracorporeal membrane oxygenation (ECMO). HI results from a Roche Cobas® analyzer (HIc) were compared with those obtained using the reference Drabkin and Sysmex methods. A full method validation was performed in accordance with SH GTA 04 (scope B). A retrospective study was then conducted in patients on ECMO to evaluate whether the HI could predict hemolysis events within 24 hours of ECMO initiation, according to ECMO type, and its potential association with mortality. HIc values were strongly correlated with reference measurements (p < 0.0001), and validation criteria were fully met. The study included 106 patients on ECMO (mortality rate: 55.7%). Survival was higher in patients with HIc < 10 mg/dL compared to those with HIc > 50 mg/dL (severe hemolysis). Early hemolysis was not associated with increased mortality. Severe hemolysis occurred significantly more frequently with veno-arterial ECMO circuits than with veno-venous circuits (p = 0.003). HIc offers analytical advantages (speed, automation, low cost) and appears to be a reliable surrogate for plasma hemoglobin measurement. IHc could be used to predict hemolysis events in patients on ECMO. Further studies, in particular kinetic studies, are needed to confirm the relevance of HI in routine hemolysis monitoring and to help differentiate in-vivo hemolysis from pre-analytical artifacts.

Insufficient standardization and comparability of total bilirubin assays in neonates pose a problem for the interpretation of results, in application of national and international recommendations for the management of neonatal ejaundice. We present the results of a study carried out in the AP-HP Sorbonne Université group. Intra-laboratory and inter-technique variations were assessed on switchable control samples prepared by the Centre National de Référence en Hémobiologie Périnatale. Results were compared with those obtained using the connected validation technique. The results of the accuracy studies showed performance in line with clinical needs in neonatology for all the methods tested. Accuracy studies were used to check whether the clinical interpretation of results was relevant to consensus criteria. The results confirmed the trends observed in a national multicenter SFBC (Société Française de Biologie Clinique) - CNBH (Collège National de Biochimie des Hôpitaux) - CNRHP (Centre National de Référence en Hémobiologie Périnatale) study and in the CNRHP recommendations on the subject. In conclusion, a good knowledge by the medical biologist of the recommended criteria for interpretation and therapeutic decisions, of the limits and performance of the techniques used, and a close clinicobiological partnership are essential for optimum efficiency in the management of neonatal jaundice.