Annales de biologie clinique最新文献

The latest international recommendations advocate for the measurement of cardiac troponin (cTn) in the context of acute coronary syndrome (ACS) with a result turnaround time of less than 1 or 2 hours. To establish a national overview of organizational practices and turnaround times for these measurements. Two surveys targeting emergency physicians and biologists described the qualitative and quantitative organizational data of cTn measurement. 27 hospitals with an annual number of visits totaling 35,000 [28,700-55,500], with 8.5% of patients presenting with chest pain and 0.9% with ACS. The satisfaction rate of emergency physicians regarding the turnaround time is 27%, and 50% wish to see it reduced. Quantitatively, 74,112 troponin requests were analyzed, 33% of which were performed during on-call periods. Cardiac cTnT represents 70% of the measurements, and 98 % of the methods are highly sensitive. The median pre-registration time is 19 minutes [10-35], laboratory-processing time is 55 minutes [42-82], and overall turnaround time is 81 minutes [60-121]. The turnaround time is shorter when there is a connected prescription or an expert system for biological validation (p < 0.0001). The turnaround times for troponin results are on average >1 hour. For most laboratories (83 %), the turnaround time is in line with European recommendations allowing the application of an H0-H2 algorithm.

An 86-year-old woman is monitored for IgA λ-associated multiple myeloma, treated in second intention with dexamethasone, revlimid and daratumumab after a relapse. A control serum protein electrophoresis detects the presence of a new monoclonal spike, later confirmed by immunofixation as an IgG κ. Suspecting an interference due to the immunotherapy, a daratumumab specific immunofixation reflex assay (DIRA) is performed, with the addition of anti-daratumumab antibodies, confirming the interference. A second multiple myeloma case is presented, describing interference with daratumumab co-migrating with the original monoclonal immunoglobulin. Based on these cases, we propose an algorithm of action to confirm the interference and provide an accurate biological result consistent with the therapeutic and clinical context.

Thrombin is one of the key components of the hemostatic system. The thrombin generation assay (TGA) assesses the activation, propagation and inhibition of coagulation. This global coagulation test is of interest for assessing the risk of bleeding and thrombosis. Numerous studies have been performed in the "thrombophilia". We performed a systematic review of studies on thrombinography in thrombophilia. The included studies, published in English, were original investigations using TGT during venous thromboembolic disease, arterial occlusive pathology, pregnancy, anti-phospholipid syndrome, constitutional thrombophilias, or oncology. Eighty studies were selected between January 2003 and June 2022. Most had fewer than 100 patients. The only two studies that included more than 1000 patients showed an increased risk of thrombotic recurrence or increased mortality from cardiovascular disease associated with increased thrombin generation. All "thrombophilia" have been studied, but lack of standardization between conditions has limited the development of clinical research with this assessment technique. Harmonization of practices may provide more relevant systems for predicting the occurrence of arterial or venous thrombotic events.

To explore the relationship between early coagulation changes, cerebral hemodynamics, and neurological prognosis in acute ischemic stroke (AIS) patients with rheumatoid arthritis (RA). Seventy-two AIS patients with RA were included. Coagulation markers (PT, APTT, FIB) and transcranial Doppler ultrasound (TCD) assessments of middle cerebral artery (MCA) mean velocity (Vm) and pulsatility index (PI) were measured at baseline and after 14 days of treatment. Prognosis was evaluated using the modified Rankin Scale (mRS) at 3 months, dividing patients into good (mRS ≤ 2) and poor prognosis (mRS > 3) groups. Multivariate logistic regression and ROC analysis assessed the predictive value of coagulation and hemodynamic changes for adverse outcomes. After 14 days, APTT and MCA (PI) increased, while FIB decreased in both groups (P < 0.05). The good prognosis group had higher MCA Vm and lower FIB at baseline (P < 0.05). Independent risk factors for poor prognosis included diabetes, NIHSS score ≥ 8, FIB, and MCA (Vm, PI) (P < 0.05). ROC analysis showed combined FIB, Vm, and PI had better predictive value for poor outcomes. Early hypercoagulable state and suboptimal cerebral hemodynamics are associated with poor neurological outcomes in AIS with RA.

A woman pregnant with her first child, blood group B+, showed pan-agglutination on antibody identification panels during her pregnancy follow-up. The absence of agglutination between the patient's plasma and a panel of B-phenotype red blood cells led to the conclusion of the presence of an anti-H1I1. This antibody is not thought to be responsible for fetal anemia or neonatal hemolytic disease, thus follow-up of fetal anemia is not necessary. However, in the event of transfusion, prior compatibility with blood of the same ABO group is necessary. In emergencies, group O depot blood should not be used whenever possible.

Early diagnosis of liver fibrosis remains a challenge. The aim of this study was to compare the performance of the GPR, APRI and FIB-4 scores in the diagnosis of significant fibrosis in chronic hepatitis B. This was a 6-month cross-sectional study. Patients were aged 18 and over, had a FibroScan® and had venous blood samples taken. 133 patients were included. The mean FibroScan® value was 5.33 ± 0.47 kPa, with 26.32% showing significant fibrosis (>7.2 kPa). The GPR score had a sensitivity of 80% compared with 48.57% and 51.42% respectively for the APRI and FIB-4 scores. However, its specificity was lower (51.02%) compared with the APRI (77.55%) and FIB-4 (81.63%) scores. The area the ROC curve of the GPR score (0.760) was higher than that of the APRI (0.712) and FIB-4 (0.724) scores in predicting significant fibrosis (p < 0.05). The GPR score is more accurate for assessing liver fibrosis in chronic hepatitis B in sub-Saharan Africa.

Medical biology is a medical specialty shared by medical doctor (MD) and pharmacists (PharmD), and Hemostasis is one of its disciplines. Since 2007, physicians have lost interest in medical biology. In haemostasis, the regulatory heterogeneity of status between medical biologists/MDs and medical biologists/PharmDs in a strained health system raises two major issues: (i) with demographic change, optimal patient care may no longer be guaranteed, (ii) medical biologists/PharmDs are sometimes forced to go beyond the scope of their regulatory field of practice. We conducted a survey in 2022 to examine hemostasis advice and consultation practices: 152 professionals responded, including 99 pharmacist-biologists (65.1%), 42 physician-biologists (27.6%) and 11 clinicians (7.2%). Of the practitioners questioned, 91.9% gave diagnostic advice and 75.0% therapeutic advice. 41% of respondents carried out haemostasis consultations, including 24.2% of pharmacists. Our survey reveals a little-known role for medical biologists specialized in haemostasis, particularly pharmacists, and calls for a global reflection on a possible regulated and supervised evolution of their field of practice, to enable them to pursue their mission in complete safety.

Clinical biology plays a crucial role in healthcare. However, this specialty is facing a loss in attractiveness in medical studies. What is driving this decline in interest? Based on insights from the "Livre Blanc de la Formation en Biologie Médicale", written and validated by two unions representing laboratory medicine residents in France, and the insight of young clinical biologists, this article delves into young biologists' perspectives on their profession, through the eyes of the "New Generation in Clinical Biology" task force of the French Clinical Biology Society (SFBC). We explore key challenges our field will have to overcome for the new generation. At the same time, we shed light on their aspirations: modernizing missions, promoting research, and expanding career opportunities. Finally, we propose concrete solutions to revitalize the field and ensure a stronger integration of young professionals into the healthcare system.

Coronary artery disease (CAD) is a worldwide leading cause of death. Considering that 20%-40% of patients with CAD have a long asymptomatic period of atherosclerosis, it has become urgent to explore the feasibility of diagnosing CAD at an early stage. This is an observational, case-control study, a total of 489 consecutive CAD patients and 75 non-CAD controls were recruited. The levels of low-density lipoprotein subfractions (LDLC1-7) in serum were measured by the Quantimetrix Lipoprint LDL system. The levels of 18 trace elements (vanadium, chromium, manganese, cobalt, nickel, copper, zinc, gallium, arsenic, selenium, strontium, cadmium, tin, antimony, barium, mercury, thallium, and lead) were tested using inductively coupled plasma mass spectrometry. Six machine learning algorithms (Logistic Regression, K Neighbors, GaussianNB, Random Forest, Decision Tree and XGBoost) were used to construct CAD diagnostic models. The levels of LDLC-3, LDLC-4, LDLC-5, and lead were significantly higher in CAD patients, while the levels of LDLC-1, chromium, manganese, cobalt, and strontium were lower (p < 0.05 for all). Univariate logistic regression analysis indicates that LDLC-3, LDLC-4, and lead were the risk factors for CAD development (odds ratio >1 and p < 0.05 for all), while LDLC-1, chromium, manganese, cobalt, and strontium were the protective factors for CAD (odds ratio < 1 and p < 0.05 for all). XGBoost had the best overall diagnostic performance among the six algorithms. There are significant differences in the levels of several LDL subfractions and trace elements between non-CAD controls and CAD patients. These biomarkers may help the diagnostic of CAD while applying machine learning algorithms.