Annales de biologie clinique最新文献

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.

Large Language Models (LLMs), such as ChatGPT, Gemini, and Copilot, are generating growing interest for their ability to produce accessible medical responses. In hematology, a discipline focused on the interpretation of complex test results, these tools could potentially assist both patients and healthcare professionals. However, their performance, inherent biases, and impact on user perception remain poorly evaluated. A panel of 62 hematology-related questions, sourced from medical examinations or frequently asked by patients in clinical laboratories, was submitted to nine publicly available AI tools. The answers were independently assessed by two medical biologists using a 100-point scoring system (accuracy, clarity, relevance, tone). Additionally, a perception survey was conducted among 300 patients. The performance of the AI tools varied significantly, with scores ranging from 19 to 67 out of 100. OpenAI models showed clear improvement across versions, demonstrating a better ability to contextualize answers and to avoid extreme or inappropriate tones. However, clinical biases and hallucinations were still observed. Among patients familiar with LLM-based tools, two-thirds reported being willing to use them to interpret their biological test results. Despite their educational potential and accessibility, these AI tools exhibit notable limitations: lack of references, out-of-context responses, and optimism or alarmist biases. Autonomous use of these models carries risks, emphasizing the need for medical supervision and dedicated training for healthcare professionals. These tools should be considered as complementary aids, not substitutes, to medical biological reasoning.

Among the tools necessary for the diagnosis of primary hyperaldosteronism, catheterization of the adrenal veins represents the major examination to determine the presence of lateralized aldosterone secretion. To ensure that the catheter is well positioned at the level of the adrenal veins, a cortisol dosage is carried out in parallel with the aldosterone dosage. At the Hormonology and Tumor Markers laboratory of the Bordeaux University Hospital, this cortisol assay is carried out on an Abbott Architect i2000, making it possible to extend the calibration range up to > 3,300 nmol/L. Beyond that, the supplier recommends carrying out a manual dilution using calibrator A in which the cortisol concentration is equal to 0 nmol/L. The downside is that this calibrator cannot be supplied alone. It is only available in a common box with the 5 other calibrators necessary to carry out the cortisol calibration range. To overcome this expensive strategy, we studied the use of another diluent: 0.9% NaCl. Samples from 11 CVS were diluted with 0.9% NaCl and a comparison of cortisol results was performed (n = 128). Passing-Bablok regression of cortisol concentrations did not show significant deviation from linearity. The interpretation of CVS selectivity was not impacted by the change of diluent nor the interpretation of secretion lateralization. This change of diluent therefore did not modify the appropriate medical decision: medicinal treatment in the case of the identification of a bilateral secretion or proposal for surgical intervention in the case of the identification of a lateralized secretion.

Cyberattacks on healthcare organizations have escalated globally, resulting in serious risks to patient care and safety. Clinical laboratories, relying heavily on data-intensive systems, are particularly vulnerable to disruptions when hospital information systems are compromised. We conducted a single-center retrospective case study of a major cyberattack affecting the laboratory services at Notre Dame des Secours-UH in Lebanon. Operational data, incident reports, and recovery timelines were reviewed to characterize the attack's impact on laboratory operations and the resilience measures implemented. The cyberattack led to an immediate shutdown of laboratory information systems and automation, necessitating a shift to paper-based and manual processes. Key emergency protocols were activated within hours, including manual test ordering, handwritten result transcription with double verification, and specialized staff-controlled release of blood products. Critical services were maintained, but routine testing and volumes dropped sharply in the first week. A stepwise recovery ensued: by day 3 a limited laboratory information systems functionality was restored on a local network, by day 10 most laboratory services resumed albeit with workflow adjustments, and normal operations were largely re-established within two months. Our case points out to the operational resilience of a clinical laboratory during a prolonged cyber crisis. Effective crisis management, including timely incident response planning, staff adaptability, and emergency procedures, improved patient care in such a dreaded organizational situation and allowed for the return to normal workflow of the clinical laboratory.