Biochemia medica最新文献

This case report investigates the occurrence of green discoloration in serum and citrate plasma samples collected from a male adult patient following a multivisceral organ transplant. In collected samples, it was necessary to investigate the influence of sample discoloration on the results of laboratory tests and to determine the appropriate approach to sample management. Hematology, coagulation and blood gas analysis showed no flags, but the biochemical lipemia index was susceptible to positive interference, necessitating dilution of the native sample. Despite the green discoloration, both native and diluted samples exhibited minimal interference on routine clinical chemistry analyses, demonstrating the reliability of the laboratory test results. This case report underscores the influence of preanalytical factors on the results of laboratory tests, the need for a thorough assessment of the sample adequacy for laboratory testing and the strict application of appropriate guidelines in the sample management in order to make an accurate diagnosis and ensure optimal patient care.

Introduction: Subclinical hypothyroidism (SCH) is an independent risk factor for cardiovascular diseases due to endothelial dysfunction and atherosclerosis development. The aim of this study was to determine whether the levothyroxine therapy could impact the concentrations of endothelial dysfunction blood markers, namely endothelin-1 (ET-1), asymmetric dimethylarginine (ADMA) and endocan, in patients with a mild form of SCH (thyroid-stimulating hormone (TSH) ≤ 10 mIU/L).

Materials and methods: In this case-control prospective study, SCH patients and healthy controls were recruited during their regular health examinations. Medical specialists prescribed levothyroxine to SCH patients if necessary. The endothelial dysfunction markers, as well as other biochemical markers, were measured in all subjects at baseline, and after 6 months of levothyroxine treatment following the euthyroidism.

Results: Our study showed higher ADMA (248.00 (168.78-540.20) vs. 166.30 (140.60-243.40) μg/L, P = 0.002), endocan (114.30 (63.45-194.65) vs. 67.26 (50.80-126.10) ng/L, P = 0.004), low-density lipoprotein cholesterol (LDL) (3.3 ± 0.6 vs. 3.7 ± 0.9 mmol/L, P = 0.043) and non-high-density lipoprotein cholesterol (non-HDL) (3.8 ± 0.7 vs. 4.2 ± 1.0 mmol/L, P = 0.020) concentrations in patients with a mild form of SCH in comparison with healthy subjects. In SCH patients, after 6 months of levothyroxine treatment following the euthyroidism, we observed a significant decrease in endocan (91.47 (61.88-200.03) vs. 97.90 (55.18-154.88) ng/L, P = 0.004), and total cholesterol concentrations (CHOL) (6.2 ± 1.0 vs. 5.8 ± 1.0 mmol/L, P = 0.039).

Conclusions: A mild form of SCH is associated with higher concentrations of endocan, ADMA, LDL and non-HDL. The potential benefits of levothyroxine therapy were shown through the significant decrease of endocan and CHOL concentrations in SCH patients, thus contributing the atherosclerosis prevention.

Introduction: Knowledge and systematic evaluation of analytical errors is the task of internal analytical quality control management. The aim of this study was to assess whether the Westgard rules proposed by Bio-Rad's Westgard Advisor software are more efficient in the monitoring of analytical performance than those previously in use.

Materials and methods: The study was carried out on the nephelometer Atellica NEPH630 (Siemens Healthineers, Erlangen, Germany). Five parameters were chosen: serum immunoglobulin A (IgA), alpha 1 - antitrypsin (AAT), prealbumin, lipoprotein (a) (Lp(a)) and ceruloplasmin. The study was divided into 4 phases (A, B, C, D): phase A - old rules used (1_3s, R_4s and 2_2s); phase B - first introduction of new rules (30 days), (1_3s/2_2s for IgA; 1_3s/2_2s/R_4s/4_1s/10_x for the remaining parameters); Phase C - second intervention (after 60 days) 1_3s/2_2s/R_4s/4_1s for IgA and Lp(a), 1_3s/2_2s/R_4s/4_1s/8_x for prealbumin and ceruloplasmin and 1_3s/2_2s/R_4s/4_1s/10_x for AAT; and Phase D - values at the end of the study (1_3s for IgA, 1_3s/2_2s/3_2s/R_4s/3_1s/12_x for AAT and ceruloplasmin, 1_3s/2_2s/R_4s/4_1s/8_x for prealbumin and 1_3s/2_2s/R_4s/4_1s/10_x for Lp(a).

Results: At the end of the study the coefficient of variation (CV%), bias (%) and sigma for IgA were 2.55%, - 1.09% and 5.33, respectively; for AAT 3.88, - 2.21 and 3.25; for prealbumin 3.99, - 0.14 and 2.95; for Lp(a) 8.02, - 0.34 and 3.81; for ceruloplasmin 2.48, - 3.65 and 3.49.

Conclusions: By using newly suggested rejection rules, we did not observe an improvement in monitoring of analytical performance.

Introduction: Higher concentrations of the small-cell lung cancer (SCLC) serum marker, pro-gastrin-releasing peptide (proGRP), in lung inflammations has been indicated in literature. The objective of this study was to compare serum proGRP concentration in pneumonia, chronic obstructive pulmonary disease (COPD) and early-stage primary lung cancers.

Materials and methods: An observational study was performed to assess serum proGRP against other lung cancer markers in pneumonia, COPD and in stage 1/2 carcinomas. A total of 91 cases of pneumonia or chronic obstructive pulmonary disease (COPD), with 107 cases of early-stage lung adenocarcinoma (ADC), squamous cell carcinoma (SQCC) and 14 cases of neuroendocrine tumors (NET), including SCLC, were analyzed. Serum proGRP (Roche Diagnostics, Basel, Switzerland), cytokeratin 19 fragment 21-1, carcinoembryonic antigen, neuron-specific enolase and C-reactive protein were measured and compared. For the statistical analysis, Mann-Whitney U test, Kruskal-Wallis ANOVA, multiple linear and multinomial logistic regression modeling were used.

Results: Compared to the early-stage ADC and SQCC, proGRP in pneumonia, COPD and in NET was higher (P ≤ 0.011 in all comparisons). In 11 cases of pneumonia and COPD, proGRP reached cut-off for SCLC of 100 ng/L. No clinically relevant differences between pneumonia or COPD and early-stage cancer were observed for other markers. Concentration of proGRP was associated with CRP (model coefficient was 0.20; P < 0.019) and both parameters contributed to classification of cases to pneumonia/COPD, ADC/SQCC, and NET categories (P < 0.004, in all cases).

Conclusions: Concentrations of proGRP in pneumonia and COPD patients were higher than in patients in the ADC and SQCC early stages and could exceed the SCLC cut-off.

Ceftriaxone, a widely used antibiotic, is one of the most common drugs to cause drug-induced immune hemolytic anemia. In this report, we describe the effect of ceftriaxone on red blood cell parameters (low red blood cell count, low hematocrit, and high erythrocyte index values) in two pediatric patients without clinical symptoms of hemolytic anemia. Although automated hematology analyzers have helped to detect incorrect results, a peripheral blood smear examination was necessary for recognizing the erythrocyte agglutinins caused by ceftriaxone. Serological testing was not possible, but the resulting drug-induced antibodies mimicked cold agglutinins in the first patient and warm agglutinins in the second patient. Timely reactions and corresponding laboratory procedures prevented potential complications due to drug administration. This report aims to present laboratory findings and preanalytical challenges in these cases and share our experiences in solving them.

The application of advanced artificial intelligence (AI) models and algorithms in clinical laboratories is a new inevitable stage of development of laboratory medicine, since in the future, diagnostic and prognostic panels specific to certain diseases will be created from a large amount of laboratory data. Thanks to machine learning (ML), it is possible to analyze a large amount of structured numerical data as well as unstructured digitized images in the field of hematology, cytology and histopathology. Numerous researches refer to the testing of ML models for the purpose of screening various diseases, detecting damage to organ systems, diagnosing malignant diseases, longitudinal monitoring of various biomarkers that would enable predicting the outcome of each patient's treatment. The main advantages of advanced AI in the clinical laboratory are: faster diagnosis using diagnostic and prognostic algorithms, individualization of treatment plans, personalized medicine, better patient treatment outcomes, easier and more precise longitudinal monitoring of biomarkers, etc. Disadvantages relate to the lack of standardization, questionable quality of the entered data and their interpretability, potential over-reliance on technology, new financial investments, privacy concerns, ethical and legal aspects. Further integration of advanced AI will gradually take place on the basis of the knowledge of specialists in laboratory and clinical medicine, experts in information technology and biostatistics, as well as on the basis of evidence-based laboratory medicine. Clinical laboratories will be ready for the full and successful integration of advanced AI once a balance has been established between its potential and the resolution of existing obstacles.

Introduction: Reliable and accurate measurement of blood glucose concentration is of crucial importance for making clinical decisions in diagnosis diabetes, gestational diabetes and impaired fasting glucose tolerance.

Materials and methods: Survey was performed in form of questionnaire. Questionnaire was sent to all Croatian laboratories (N = 204) in electronic form using SurveyMonkey cloud-based software (SurveyMonkey, Inc., San Mateo, USA) as an extra-analytical module of the Croatian EQA (External Quality Assessment) provider Croatian center for external quality assessment (CROQALM) in June 2023.

Results: In total 148 (73%) of laboratories responded to the survey. Large proportion of laboratories never use glucose inhibitor tubes for random glucose measurement (more than half) or for glucose function tests (one quarter). Only three laboratories use recommended glycolysis inhibitor citrate. Many other inhibitors are also used, even if some of them are not recommended for plasma glucose measurement. Glucose is almost never (93%) sampled on ice when glucose inhibitor tube is not available.

Conclusions: Laboratories in Croatia do not follow the recommended procedures regarding glycolysis inhibitors for glucose determination.

Introduction: Ferroportin (Fpn) is the only known iron exporter and plays an essential role in iron homeostasis. Serum concentrations of Fpn in health and/or diseased states are still mostly unknown. Therefore, the aim of this study was to determine the concentration of Fpn in the serum of women of reproductive age (WRA) for the first time, and to establish whether there is a difference in the concentration of Fpn according to ferritin status.

Materials and methods: This research included 100 WRA (18-45 years, C-reactive protein (CRP) < 5 mg/L, hemoglobin > 120 g/L). Serum Fpn was measured using Enzyme Linked Immunosorbent Assay (ELISA) method on the analyzer EZ Read 800 Plus (Biochrom, Cambridge, UK). Reference interval was calculated using the robust method.

Results: The median concentration of Fpn in the whole study group was 9.74 (5.84-15.69) µg/L. The subgroup with ferritin concentration > 15 µg/L had a median Fpn concentration 15.21 (10.34-21.93) µg/L, which significantly differed from Fpn concentration in the subgroup with ferritin concentration ≤ 15 µg/L (5.93 (4.84-8.36) µg/L, P < 0.001). The reference limits for the Fpn were 2.26-29.81 µg/L with 90% confidence intervals (CI) of 1.78 to 2.83 and 25.37 to 34.33, respectively.

Conclusions: The proposed reference interval could help in the future research on iron homeostasis both in physiological conditions and in various disorders, because this is the first study that measured Fpn concentration in a certain gender and age group of a healthy population.

This case report describes interference from heterophilic antibodies in D-dimer assay. The interference was suspected due to discrepancies between D-dimer concentrations in the original sample and diluted samples, as well as inconsistent clinical findings. The patient's medical history, laboratory results, and imaging studies were considered in the investigation. Heterophilic antibodies, likely developed during the SARS-CoV-2 infection, were identified as the probable cause of interference. The interference was confirmed through various methods, including dilution studies, blocking heterophilic antibodies, and comparing results with an alternative D-dimer method. This case highlights the importance of recognizing and addressing interference in D-dimer testing, emphasizing the need for collaboration between clinicians and laboratory specialists.

Ovarian cancer is the 8th most common malignancy in women and the deadliest gynecological cancer. Due to the non-specific symptoms and the lack of effective diagnostic methods, late diagnosis remains the main barrier for improving the poor prognosis. Human epididymis protein 4 (HE4) is a protein overexpressed in ovarian cancer, but not in healthy individuals or benign conditions. The aim of this review article is to evaluate the laboratory aspect and potential clinical application of urine HE4. The methodology is presented, together with discussion on preanalytical, analytical and postanalytical phase of HE4 detection using urine. Moreover, we present the diagnostic role of urine HE4 in differential diagnosis, chemotherapy response, detection of recurrence and detection of low-malignant potential tumors. It has been found that urine HE4 presents as a promising, non-invasive tumor marker for detection and monitoring of ovarian cancer. However, standardization of the HE4 detection process is needed prior to implementation in clinical diagnostics.