Laboratory medicine最新文献

Introduction: Medical laboratory science professionals face obstacles related to social media use. We aimed to identify social media trends among the medical laboratory science workforce and barriers to professional use.

Methods: A 23-item qualitative survey was administered to American Society for Clinical Pathology members, with data collected and managed using Research Electronic Data Capture (REDCap) tools. Statistical analysis was completed using Microsoft Excel and REDCap native functions. Entries that were not complete were excluded; pathologists and students were also excluded due to low response rates.

Results: Of the 238 participants who met inclusion criteria, 217 (91.2%) had at least 1 social media account. The most frequently cited uses were entertainment (60.8%) and socializing (50.2%), and the most common barriers to professional social media use were privacy concerns (48.9%) and limited time to dedicate to social media activities (48.5%). Among the 21 participants who did not participate in social media, 17 cited privacy concerns, 11 never considering joining, and 9 cited time concerns as barriers to creating social media accounts.

Discussion: Most medical laboratory scientists use social media for personal reasons, with major barriers to professional use being privacy concerns and limited time. Targeted initiatives may be useful for increasing professional social media use.

Introduction: The diagnosis of primary biliary cholangitis (PBC) relies on the detection of specific antibodies, yet there is variability in the diagnostic accuracy and efficiency among the different diagnostic methods. We aimed to assess the individual diagnostic performance of these markers using different detection methods.

Methods: A total of 112 participant-54 with PBC and 58 acting as disease controls-were enrolled. The levels of anti-M2-3E, anti-gp210, and anti-sp100 antibodies were measured using immunoblot tests from Euroimmun, flow cytometry-based multiplex bead immunoarray (MBIA [Tellgen]), and multiplex magnetic barcode encoding (MMBCE [Livzon]) assay. The 6 antigens used in the MBIA assay included recombinant E2 subunits of the pyruvate dehydrogenase complex, branched-chain 2-oxo acid dehydrogenase complex, and 2-oxoglutarate dehydrogenase complex, which together represent the M2-3E epitope group. In addition, recombinant gp210, sp100, and centromere protein B were included for the detection of antinuclear antibodies. Each antigen was covalently bound to a uniquely fluorescence-coded microsphere to allow multiplexed antibody detection in a single sample.

Results: Anti-M2-3E and anti-gp210 antibodies showed much higher positivity rates in the PBC group than among control individuals. Quantitative levels of the antibodies were markedly elevated in patients with PBC. The area under the curve for the combined markers was consistently high (0.825-0.837) across platforms, indicating robust diagnostic accuracy. The logistic regression analysis revealed a substantial advantage in combining multiple markers, with anti-sp100 showing the highest odds ratio for PBC diagnosis.

Discussion: The study demonstrated consistent diagnostic performance across the immunoblot, MBIA, and MMBCE detection methods for PBC markers. These findings underscore the potential of a multimarker approach to enhance PBC assessments in clinical settings.

Trial registration: This study received retrospective approval from the Ethical Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (institutional review board No. TJ-IRB202308129, dated August 12, 2023).

Introduction: A 29-year-old man with multiple co-morbidities, including alcoholic cirrhosis, was admitted for severe alcohol-related hepatitis, epistaxis, and fever of unknown cause. With no history of transfusions, the patient's hemoglobin level had dropped from 100 g/L to 81 g/L, with a platelet count of 46 × 109/L. Pretransfusion testing was ordered for potential transfusion.

Methods: Automated group and antibody screen performed on the Quidel Ortho Clinical Diagnostics Vision platform and all complex investigation performed by the conventional manual tube method.

Results: Pretransfusion tests showed that the patient was A RhD positive on forward grouping, while the reverse grouping showed an unexpected agglutination in A1 and A2 cells. Stronger agglutination reactions were noted at room temperature. The routine 3-cell antibody screen was negative but showed panreactivity on the saline room-temperature 11-cell panel and nonreactive at 37°C and on the indirect antiglobulin test (IAT). A stronger reaction was observed when the patient's plasma was tested against cord (i) cells than with adult (I) cells. It was concluded that a compound cold antibody anti-IH was present. A compatible O RhD positive red blood cell (RBC) unit was transfused to the patient which was noted to be M positive in addition to 2 A RhD positive platelet units. In the subsequent episode, viral serology returned a positive high avidity index with Epstein-Barr virus and cytomegalovirus mononucleosis assays implying a reinfection or reactivation of both infectious mononucleosis and cytomegalovirus mononucleosis. Therefore, transient anti-i was not ruled out. A new group and screen sample was obtained that demonstrated the same discrepancy in the reverse grouping, but the antibody screen revealed an anti-M alloantibody. An additional 3 crossmatch compatible group O RhD positive, M negative RBC units was transfused, but no clinically significant increment in hemoglobin was observed. A further 3 crossmatch compatible group A RhD positive, M negative RBC units were transfused, finally producing an increment increase in hemoglobin level.

Discussion: This report highlights that benign cold antibodies can often be a nuisance in the investigation of RBC alloantibodies. Prewarming techniques must be used to eliminate these interferences and discrepancies, while titration of these cold agglutinins at different temperatures can help differentiate them.

Introduction: Platelet parameters are inexpensive and readily available biomarkers for platelet activation. This study investigated the differences and usefulness of platelet parameters in myeloproliferative neoplasms (MPNs), immune-mediated thrombocytopenia, and myelodysplastic syndrome (MDS), which are major hematologic disorders associated with platelet activation or dysfunction.

Methods: We enrolled 418 patients: 186 with MPN, 109 with immune-mediated thrombocytopenia, and 123 with MDS. Platelet count and platelet parameters, including mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit, and mean platelet component (MPC), were measured using an automated hematology analyzer.

Results: Platelet parameters, particularly MPV and MPC, showed statistically significant differences in MPN compared with healthy control individuals, indicating the most significant platelet activation in primary myelofibrosis. We noted that MPV, plateletcrit, and MPC differed substantially between immune thrombocytopenic purpura and aplastic anemia compared with healthy control individuals, with statistically significant differences in MPV, PDW, and MPC between immune thrombocytopenic purpura and aplastic anemia. All parameters revealed statistically significant differences between MDS and healthy controls.

Discussion: Platelet parameters demonstrated significant differences among patients with MPN, immune-mediated thrombocytopenia, and MDS compared with healthy control individuals, suggesting platelet activation in these disorders. They may also be useful markers for differentiating the causative disease in patients with thrombocytosis or thrombocytopenia.

Introduction: This retrospective cross-sectional study aimed to evaluate the differences between the restriction fragment length polymorphism (RFLP) patterns of the dormancy survival regulator (DosR) regulon in latent tuberculosis vs active disease.

Methods: Sputum samples from 90 patients with active Mycobacterium tuberculosis infection were collected. The presence of the devR, devS, and dosT genes in active and induced dormant M tuberculosis infection was evaluated using polymerase chain reaction (PCR). In addition, the differences between the restriction enzyme digestion of these genes were determined using the RFLP method.

Results: The devR gene was much more prevalent in dormant than in active samples, with statistical significance set at P = .033. The PCR-RFLP patterns obtained from the effect of the AciI endonuclease on devR, the EaeI and HincII endonucleases on devS, and the HaeIII and AciI endonucleases on dosT showed a statistically significant difference between the active and dormant groups (P = .001, P = .01, P = .008, P = .001, and P = .001, respectively), and this difference was associated with more diverse patterns in the active group.

Discussion: Results suggested that the DosR regulon may have more nucleotide variations at the active stage. This study is the first to investigate the devR, devS, and dosT genes using PCR-RFLP as a cost-effective and straightforward method.

Introduction: Hemoglobin (Hb) variants are genetic disorders that lead to structural impairment of Hb. Most of these disorders lack clinical symptoms and are typically detected through prenatal, newborn, or routine health screenings. Hemoglobinopathy evaluation typically starts with screening tests performed by electrophoresis or liquid chromatography. In some cases, on top of the conventional test results, racial or geographic information is incorporated to assess high-risk populations for certain mutations, but this addition can also at times be misleading.

Methods: This report presents 2 rare cases of Hb variants in the San Francisco Bay area that were diagnosed using the capillary electrophoresis-high-resolution mass spectrometry (CE-HR-MS) method: Hb New York trait in case 1 and Hb Al-Ain Abu Dhabi trait in case 2.

Results: Overall, these results demonstrate the utility of CE-HR-MS as an updated approach to definitively diagnose hemoglobin variants.

Discussion: CE-HR-MS has the potential to be implemented into clinical practice as an alternative diagnostic method to gene sequencing.

Background: Anti-M antibodies are a group of frequently detected, naturally occurring antibodies, most of which are immunoglobulin M (IgM) antibodies, inactive at 37 °C, and clinically insignificant in blood transfusion experiments, except for their effect on blood groups. Anti-M antibodies may be clinically significant in some exceptional cases, however, such as cardiac surgery, when the core body temperature drops, resulting in hemolytic transfusion reactions. The present study was conducted to explore the interference caused by the presence of anti-M antibodies on blood group identification, analyze the necessity of detecting such antibodies in advance for transfusion compatibility testing and clinical transfusion, and explore the importance of O-antigen erythrocytes in routine blood typing, especially in screening for IgM-class antibodies.

Methods: This study was initiated by collecting blood typing specimens from January 2021 to December 2023 in the Blood Transfusion Department, where the O cell control tubes showed agglutination in the blood group reverse serotyping, which were ultimately determined to be influenced by the anti-M antibodies. This study further analyzed the absorption of plasma using M antigen-positive type O erythrocytes, followed by repeat ABO typing with either the absorbed plasma or standard reverse grouping erythrocytes without M antigen. Our subsequent steps included a cross-matching test with manual tube testing, the Polybrene method, and antiglobulin test, monitoring of the hemoglobin value after transfusion.

Results: A total of 11 patients had anti-M antibodies detected in their serum. Among these 11 patients, 9 had blood type discrepancies identified during blood typing, and the other 2 cases were identified as type O. We saw 4 cases of IgM-type antibodies, 1 case of IgG-type antibodies, and 7 cases of IgM-type and IgG-type antibodies. The forward and reverse typing of 9 samples showed consistent results after serum reverse typing was rechecked by O cell absorption. Cross-matching was compatible with blood donors without M antigen, and 7 of these patients were treated with transfusion, all of whom had elevated hemoglobin levels after transfusion, with no adverse transfusion reactions.

Discussion: In specimens with irregular anti-M antibodies, serum absorption can be used to eliminate the interference caused by the irregular antibodies and obtain the correct experimental results. Moreover, the addition of type O red blood cells in the experiment can improve the detection rate of partial antibodies. For specific patients, such as individuals undergoing surgery, regardless of whether the antibody reacts at 37 °C, we recommend choosing M antigen-negative donors for blood transfusion to ensure the safety of blood transfusion for patients in clinical settings.

Introduction: Salmonella is one of the main pathogenic bacteria causing foodborne diseases. This microorganism mainly infects food, especially meat and poultry products that have not been fully heated or cooked, and enters the human body, causing infection, or infects through the handling of contaminated food. Salmonella infection occurs worldwide, highlighting the importance of preventing such diseases. Salmonella disease poses a serious threat to public health security in low- and middle-income countries and even globally. Therefore, it is important to quickly and accurately detect Salmonella. Currently, the detection methods for Salmonella mainly include traditional detection methods as well as immunologic and molecular-based technologies. Traditional methods are cumbersome, time-consuming, and inefficient, and methods based on immunology and molecular biology require advanced equipment and technical know-how.

Methods: Loop-mediated isothermal amplification (LAMP) has advantage of rapidity, accuracy, and economy, but it is necessary to contact the carcinogen ethidium bromide when observing the results of agarose gel electrophoresis.

Results: In this experiment, a LAMP combined with lateral-flow device (LAMP-LFD) method was established that identified different serotypes of Salmonella.

Discussion: This method is convenient, fast, nontoxic, and harmless. It can detect Salmonella specifically and launch preliminary evaluation and application.

Introduction: Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are novel therapeutic agents for managing anemia in patients with chronic kidney disease (CKD); however, no clinically viable markers for the anemia-improving effect of HIF-PHI have been reported. Therefore, we evaluated changes in iron metabolism markers and identified predictors of anemia amelioration during HIF-PHi treatment.

Methods: We included 48 patients with CKD not undergoing dialysis: 29 patients receiving epoetin β-pegol, an erythropoiesis-stimulating agent (ESA) and 19 patients receiving roxadustat, an HIF-PHi. Markers of iron metabolism, including hepcidin, were measured during treatments using a widely available automated analyzer.

Results: The hemoglobin levels did not differ substantially between the HIF-PHi and ESA groups. Patients treated with HIF-PHI exhibited lower serum iron, ferritin, transferrin saturation, and hepcidin values and higher unsaturated iron-binding capacity at 1 month than did patients receiving the ESA. Reduced hepcidin levels at 1 month were strongly associated with increased hemoglobin levels at 3 months.

Discussion: Our findings suggest that the hepcidin level, as an initial response, can help predict the responsiveness of the HIF-PHi to anemia in patients with CKD. Measuring hepcidin, an integral indicator of iron metabolism, using standard equipment in general hospital laboratories would be beneficial in routine clinical practice.

Introduction: Naegleria fowleri is a pathogenic free-living amoeba that causes primary amoebic meningoencephalitis, a rare and difficult-to-diagnose form of meningitis. By testing patient cerebrospinal fluid (CSF) for ergosterol, a membrane component unique to fungi and amoeba, cases of primary amoebic meningoencephalitis may be distinguished from cases of bacterial and viral meningitis.

Methods: Pooled CSF was fortified with ergosterol, extracted, filtered, and measured by liquid chromatography-tandem mass spectrometry. Measurement method precision, sensitivity, recovery, and stability were evaluated. In vitro cell cultures of N fowleri and a sample (n = 200) of deidentified residual patient CSF specimens were also tested for ergosterol.

Results: Ergosterol remained stable in CSF at 4 °C and -80 °C. The mean variation and total error of the method were 7.4% and 15.8%, respectively. The method limit of quantification (LOQ) was 1.0 ng/mL, which translated to an in vitro LOQ of 2650 cells/mL or higher. A trace of ergosterol, below the LOQ, was detected in a patient specimen positive for cryptococcal meningitis but not in any other CSF specimens.

Discussion: Ergosterol can be reliably detected in spiked human CSF samples and in the supernatant of N fowleri CSF cultures at concentrations of 1.0 to 500 ng/mL. The clinical utility of this method, however, requires further exploration.