International journal of laboratory hematology最新文献

Introduction: We investigated the stability and accuracy of platelets with MgSO₄ and compared the results of blood counts between MgSO₄ and K2EDTA.

Methods: Platelet stability as a function of time was assessed on the XN Sysmex analyzer by comparing the percentage deviation to the desirable bias of the EFLM. Accuracy was determined by calculating the LoQ of platelets corresponding to a CV of 10%. Results from 250 patients were compared between K2EDTA and MgSO₄.

Results: At 20°C, platelets were stable for 24 h in impedance, 10 h in fluorescence and at 4°C for 4 h in impedance, 2 h in fluorescence. This decrease is related to the formation of platelet aggregates. For platelets in fluorescence, LoQ is 4 × 10⁹/L using MgSO₄. The results of the complete blood count did not differ between K2EDTA and MgSO₄ except for the MCV, for which the median relative bias (MRB) with respect to K2EDTA was -5.6%. For MgSO₄ platelets, the MRB is 2.9% in fluorescence and 11.9% in impedance.

Conclusion: The use of MgSO₄ with the XN produces results comparable to those obtained with K2EDTA, except for those related to MCV and for impedance platelets.

Introduction: D-dimers are produced by lysis of cross-linked fibrin. In children, D-dimer testing is used to evaluate disseminated intravascular coagulation (DIC) and some inflammatory states, but its use is not validated for screening or ruling out suspected venous thromboembolic events (VTE). In adults, D-dimers are used to evaluate DIC, and a low D-dimer level is used to exclude VTE in patients when combined with a low or moderate probability of VTE.

Methods: To assess D-dimer utilization and opportunities for improvement, we conducted a retrospective, consecutive-case cohort study (with ethics approval) of patients who had D-dimer tests at Hamilton hospitals, from 06/2022 to 05/2023.

Results: D-dimer levels were evaluated for 175 children and 200 adults (respective results, children/adults: median ages: 12/63, ranges 0-17/18-94 years), and an overlapping cohort of 99 consecutive persons with ≥ 5 D-dimer determinations. Most patients had D-dimer tests in emergency departments (60%/62%) and elevated D-dimer levels (55%/61%). Reasons for D-dimer assessment included: suspected VTE (50%/70%), DIC (17%/3.5%), childhood inflammatory conditions (23%/0%), and "off-label" uses (e.g., arterial thrombosis assessment; 5%/22%). VTE likelihood and DIC scores were rarely documented. Patients with multiple tests accounted for 15% of D-dimer workload. Among patients with multiple tests for DIC, most had overt DIC on initial assessment, with declining D-dimer levels over 10-14 days, including patients who died.

Conclusion: VTE and DIC assessment was the most common reason for D-dimer assessments for children and adults. Quality improvement initiatives are needed to improve relevant clinical VTE and DIC score documentation and D-dimer test utilization.

Introduction: Thrombosis is a leading cause of mortality in polycythemia vera (PV), yet little is known about early predictors of thrombosis progression. Emerging evidence links systemic inflammation to thrombosis risk. This study assessed hematological inflammatory parameters, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI), for their utility in predicting thrombosis progression in PV.

Methods: This retrospective study analyzed 102 PV patients (2008-2024) and 115 healthy controls. Clinical and laboratory data, including thrombotic events, were examined. Patients were stratified into low-and high-risk groups, further categorized by thrombosis progression. Inflammatory biomarkers were derived from baseline blood counts.

Results: Median follow-up was 51 months, the 10-year thrombotic events-free survival rate was 84.30%, and 21 patients (20.59%) showed thrombosis progression. PV patients had higher NLR, MLR, PLR, SII, SIRI, and AISI than controls. NLR, MLR, SIRI, and AISI were associated with an increased risk of thrombosis compared to the low-risk group. In the progression group, high monocytes, NLR, MLR, SIRI, AISI, and previous thrombosis were notably correlated. ROC analysis showed that MLR (AUC = 0.739), SIRI (AUC = 0.714), AISI (AUC = 0.670), and NLR (AUC = 0.649) had the highest predictive ability for thrombosis progression. Multivariate analysis identified MLR (HR = 6.979) and previous thrombosis (HR = 4.494) as independent risk factors.

Conclusion: These findings support recent reports linking systemic inflammation to thrombosis risk in PV patients and highlight for the first time that MLR may serve as a valuable prognostic biomarker for thrombotic events.

Introduction: Numerous algorithms based on recent developments of additional parameters on last generation haematology analysers have opened new perspectives for hereditary spherocytosis (HS) screening. Although some studies have demonstrated significant age-related variation for reticulocyte-derived parameters, these algorithms did not consider patients' age. Moreover, the apparent lack of short-term stability of some parameters could represent an obstacle to their use if not performed as first-line testing. This study aimed to identify robust and discriminating parameters that could be used for HS screening at any patients' age.

Methods: After an evaluation of the reference values and stability of the additional parameters offered by the Sysmex XN-9000, we retrospectively collected and analysed the haematological parameters of 103 confirmed HS patients and 124 controls. The HS group was also compared to 116 samples from patients affected with other red blood cell or iron disorders.

Results: Our findings confirm that the reticulocyte count (Ret) and its ratio to the immature reticulocyte fraction (Ret/IRF) are the most effective and robust parameters for HS screening, with stability up to 48 and 96 h at room temperature (RT) and 4°C, respectively. The Ret/IRF ratio was mostly affected by patients' age rather than haemoglobin levels. We therefore proposed different algorithms that can be adapted to the laboratory's needs and that incorporate age-specific thresholds for Ret/IRF. The combination of Ret and Ret/IRF allowed a sensitivity between 91.3% and 100% and a specificity between 77.1% and 94.2%.

Conclusions: This new age-dependent algorithm using Sysmex's most stable parameters offers an easy-to-use tool for HS screening, even in cases of delayed or residual blood analysis.

Chronic lymphocytic leukemia (CLL) is the most common low-grade B-cell neoplasm worldwide. While diagnostic criteria are well established, prognostication and management of this disease are an evolving field, owing to the biological and clinical heterogeneity of CLL. Molecular, cytogenetic, and immunogenetic workup are key in the management of CLL, and include evaluation for specific gene variants, copy number variants (CNVs), and detailed analysis of the immunoglobulin heavy chain variable region (IGHV) with respect to somatic hypermutation (SHM) status and the presence of recurrent stereotyped IGHV subsets. IGHV status has significant prognostic, predictive, and therapeutic implications in CLL and has been incorporated into multiple risk stratification systems. The advent of both next-generation sequencing (NGS) and novel targeted therapies has added further complexity to immunogenetic analysis in CLL. Owing to the necessity and growing complexity of IGHV analysis, the European Research Initiative on CLL (ERIC) developed guidelines to standardize methods for immunogenetic analysis and provide recommendations for interpretation of challenging cases (including multiple productive IGHV clones and discordant SHM status) and has published multiple updates, revising recommendations and raising new questions. This review discusses the biology and clinical significance of IGHV status in CLL as well as laboratory methodology in immunogenetic analysis, the evolution of the ERIC recommendations leading into the era of NGS, and recent advances and emerging strategies in this field.

Introduction: Coagulation tests are crucial for diagnosing hemostatic disorders. However, preanalytical errors, particularly sample clotting, may compromise test accuracy and lead to clinical misinterpretation. As not all clots are detectable by visual inspection, this study characterized clotted citrated samples to establish objective criteria for clot identification.

Methods: Routine coagulation assays-including PT, APTT, fibrinogen, D-dimer, FDP, fibrin monomer complex (FMC), plasmin-α2 plasmin inhibitor complex (PIC), and thrombin-antithrombin complex (TAT)-were performed, and 101 paired specimens from 101 patients who required blood recollection were analyzed. Among the 77 specimens with visible clots, coagulation profiles were analyzed to identify cut-off values and develop logistic regression models. The models were subsequently validated using an additional 24 abnormal but clot-free specimens.

Results: Clotted samples showed significantly shortened APTT and elevated FDP, FMC, PIC, and TAT levels. Shortening of APTT by ≥ 3.1 s relative to the reference was a reliable indicator of clotting. Combining APTT with TAT or FMC provided high diagnostic accuracy (AUC: 0.969 and 1.000, respectively). We established a "Clotting Score" to assess sample viability even without visible clots. FDP and PIC increased progressively with time in clotted samples.

Conclusion: Sample clotting substantially affects the accuracy of coagulation tests. Shortened APTT and elevated FMC and TAT serve as reliable indicators, with FDP and PIC offering time-sensitive supplementary clues. This multimodal approach could help standardize criteria for sample rejection and recollection, thereby improving test reliability and supporting clinical decisions.

With the advent of effective multikinase and selective tyrosine kinase inhibitors in systemic mastocytosis, diagnosing this rare disease has been critical to improving patient morbidity and mortality. This state-of-the-art review interprets the international diagnostic criteria, including differences between the WHO 5th edition classification and the International Consensus Classification. Subclassification of systemic mastocytosis is critical for correct therapeutic strategies, and diagnostic difficulties are described for the practicing pathologist. Morphologic mimics, which require alternative treatment, are discussed.

Hematopathology workflows are complex, since they include numerous data points necessary for guiding further testing, diagnosis, and patient management. The workflows start with complete blood cell counts, with subsequent morphologic evaluation of peripheral blood (PB) and bone marrow (BM). Digital pathology has the potential to revolutionize PB and BM assessment through the implementation of artificial intelligence for assisted and automated evaluation, but there remain major hurdles toward this ultimate goal, such as lack of regulatory oversight, data standardization, insufficient knowledge and training, and resistance to change, among others. This article reviews the current state of digitalization in the hematopathology practice, recent research using machine learning models for automated specimen analysis, outlines the advantages and barriers facing clinical implementation of artificial intelligence, and offers prospective artificial intelligence-driven clinical workflows for efficient and comprehensive clinical workup.

Digital pathology (DP) has evolved alongside other technical advances, transforming our daily lives and diagnostic medicine. It is likely that, as in other areas of life, science, and medicine, the overall level of digitization will continue to rise, along with an increasing number of groups implementing DP. This review explores the clinical DP ecosystem with a focus on hematology and hematopathology, addressing the benefits of DP, such as improved workflow efficiency, remote practice, enhanced collaboration, and integration of artificial intelligence tools. Several challenges and pitfalls are also highlighted, such as technical scanner challenges, image management system issues, IT infrastructure, regulations, and the critical (and expensive) topic of data storage, and retrieval for DP. We also propose a roadmap for the successful implementation of DP, designed to support institutions of all sizes to make the transition to DP. This roadmap emphasizes well-thought-out, strategic planning and aims to ensure that organizations and individuals considering a switch to DP are able to deliver meaningful benefits to pathologists, health systems, providers, and most importantly, patients.

Hematologic emergencies are urgent health conditions which result in significant mortality and morbidity unless timely therapeutic measures are taken. Therapeutic success depends on their timely and accurate recognition by hematology laboratory services. This review highlights the laboratory's role in identifying conditions associated with increased schistocytes (thrombotic microangiopathies) and acute promyelocytic leukemia. Their detection based on the routine laboratory and morphology methods should trigger appropriate additional laboratory workup including molecular tests, flow cytometry, etc. Hematology laboratory professionals should be skilled to recognize these emergencies and recommend additional workup, playing a critical role in the timely diagnosis and management of life-threatening conditions.