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Zhou C, Xie Q, Wang H, Wu F, He D, Huang Y, He Y, Dai S, Chen J, Kong L, Zhang Y. Biological variation in the estimated glomerular filtration rate of healthy individuals within 24 h calculated using 2021CKD-EPI equations. Ir J Med Sci 2024; 193:1613-1620. [PMID: 38308766 DOI: 10.1007/s11845-024-03621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND AND AIMS Use the MDRD (Modification of Diet in Renal Disease) and 2021 CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation void of race coefficients (CKD-EPICrea, CKD-EPICys-C, and CKD-EPICrea+Cys-C) to estimate the BV (Biological variation) of eGFR (estimated glomerular filtration rate) within 24 h in a healthy population to help explain future studies using eGFR in the context of a known BV. METHODS Blood samples were collected from 30 healthy subjects at six time points within 24 h. Serum creatinine (S-Crea) and serum cystatin C (S-Cys-C) were measured, and the BV of eGFR was calculated. Outlier and variance homogeneity analyses were performed, followed by CV-ANOVA on trend-corrected data. RESULTS The eGFR CVI for the four equations (MDRD, CKD-EPICrea, CKD-EPICys-C, and CKD-EPICrea+Cys-C) were 8.39% (7.50-9.51%), 3.90% (3.49-4.42%), 6.58% (5.88-7.46%), and 5.03% (4.50-5.71%), respectively. The corresponding II and RCVpos/neg values were 0.69, 0.48, 0.51, and 0.31, and (29.30%, - 22.66%), (12.69%, - 11.2 6%), (20.97%, - 17.33%), and (15.88%, - 13.70%), respectively; RCVpos /neg of eGFR was highest in the MDRD equation and lowest in the CKD-EPI Crea equation. Additionally, the RCVpos/neg values of the individual was highest in the MDRD equation and lowest in the CKD-EPICrea+Cys-C equation; they are (56.51%, - 36.11%) and (5.01%, - 4.77%), respectively. CONCLUSIONS We present data on the 24 h BV eGFR of the 2021 CKD-EPI equations. The presence of BV has impact on the interpretation of GFR results, affecting CKD disease grading. The RCVpos/neg differences were large among the individuals. When using eGFRs based on the MDRD and CKD-EPI equations, it is necessary to combine RCVpos/neg values before interpreting the results.
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Affiliation(s)
- ChaoQiong Zhou
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - QianRong Xie
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
- Department of Clinical Laboratory, The Third People's Hospital of Chengdu, Chengdu, Sichuan, 610000, China
| | - HuaLi Wang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - Feng Wu
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - DaHai He
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - Ying Huang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - Ying He
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - ShiRong Dai
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - Jie Chen
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China
| | - LiRui Kong
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China.
| | - Yan Zhang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, No. 342, South Street, Pidu District, Chengdu, Sichuan, 611730, China.
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Kurka H, Dilba P, Perez CC, Findeisen P, Gironés IG, Katayev A, Alonso LR, Valcour A, Rehberg T, Weber B, Donner H, Thorenz A. Feasibility of using real-world free thyroxine data from the US and Europe to enable fast and efficient transfer of reference intervals from one population to another. Pract Lab Med 2024; 39:e00382. [PMID: 38463194 PMCID: PMC10924049 DOI: 10.1016/j.plabm.2024.e00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Objectives The direct approach for determining reference intervals (RIs) is not always practical. This study aimed to generate evidence that a real-world data (RWD) approach could be applied to transfer free thyroxine RIs determined in one population to a second population, presenting an alternative to performing multiple RI determinations. Design and methods Two datasets (US, n = 10,000; Europe, n = 10,000) were created from existing RWD. Descriptive statistics, density plots and cumulative distributions were produced for each data set and comparisons made. Cumulative probabilities at the lower and upper limits of the RIs were identified using an empirical cumulative distribution function. According to these probabilities, estimated percentiles for each dataset and estimated differences between the two sets of percentiles were obtained by case resampling bootstrapping. The estimated differences were then evaluated against a pre-determined acceptance criterion of ≤7.8% (inter-individual biological variability). The direct approach was used to validate the RWD approach. Results The RWD approach provided similar descriptive statistics for both populations (mean: US = 16.1 pmol/L, Europe = 16.4 pmol/L; median: US = 15.4 pmol/L, Europe = 15.8 pmol/L). Differences between the estimated percentiles at the upper and lower limits of the RIs fulfilled the pre-determined acceptance criterion and the density plots and cumulative distributions demonstrated population homogeneity. Similar RI distributions were observed using the direct approach. Conclusions This study provides evidence that a RWD approach can be used to transfer RIs determined in one population to another.
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Affiliation(s)
| | | | | | | | | | - Alex Katayev
- Department of Science and Technology, Labcorp, Elon, NC, United States
| | | | - André Valcour
- Center for Esoteric Testing, Labcorp, Burlington, NC, United States
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Trapé J, Bérgamo S, González-Fernández C, Rives J, González-García L. Variations in tumor growth, intra-individual biological variability, and the interpretation of changes. Clin Chem Lab Med 2024; 0:cclm-2023-0780. [PMID: 38369758 DOI: 10.1515/cclm-2023-0780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES The identification of changes in tumor markers (TMs) in cancer patients that indicate response to treatment, stabilization or disease progression is a challenge for laboratory medicine. Several approaches have been proposed: assessing percentage increases, applying discriminant values, and estimating half-life (t1/2) or doubling time (DT). In all of them it is assumed that the TM is a surrogate of the variation in tumor size. In general this variation is time-dependent, but this is not the case of intraindividual biological variability (CVi), which can range from 6 % in CA15-3 to 22 % in CA125. When decisions are made on the basis of DT or t1/2, these values can be affected by the CVi; if it is very large, the growth rate very slow and the period of time between determinations very short, the result obtained for DT may be due mainly to the CVi. The aim of this study is to establish the relationship between the CVi and temporal variables. METHODS We related equations for calculating DT and t1/2 to the reference change values in tumor markers. RESULTS The application of the formula obtained allows the calculation of the optimal time between measurements to ensure that the influence of the CVi is minimal in different types of tumors and different scenarios. CONCLUSIONS Intraindividual variation affects the calculation of DT and t1/2. It is necessary to establish the minimum time between two measurements to ensure that the CVi does not affect their calculation or lead to misinterpretation.
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Affiliation(s)
- Jaume Trapé
- Laboratory Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
| | - Silvia Bérgamo
- Laboratory Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Spain
- Doctoral School, University of Vic - Central University of Catalonia, Vic, Spain
| | - Carolina González-Fernández
- Laboratory Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Gastrointestinal Oncology, Endoscopy and Surgery research group (GOES), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Spain
| | - José Rives
- Laboratory Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Laura González-García
- Laboratory Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Spain
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Doyle K, Bunch DR. Reference intervals: past, present, and future. Crit Rev Clin Lab Sci 2023; 60:466-482. [PMID: 37036018 DOI: 10.1080/10408363.2023.2196746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
Clinical laboratory test results alone are of little value in diagnosing, treating, and monitoring health conditions; as such, a clinically actionable cutoff or reference interval is required to provide context for result interpretation. Healthcare practitioners base their diagnoses, follow-up treatments, and subsequent testing on these reference points. However, they may not be aware of inherent limitations related to the definition and derivation of reference intervals. Laboratorians are responsible for providing the reference intervals they report with results. Yet, the establishment and verification of reference intervals using conventional direct methods are complicated by resource constraints or unique patient demographics. To facilitate standardized reference interval best practices, multiple global scientific societies are actively drafting guidelines and seeking funding to promote these initiatives. Numerous national and international multicenter collaborations demonstrate the ability to leverage combined resources to conduct large reference interval studies by direct methods. However, not all demographics are equally accessible. Novel indirect methods are attractive solutions that utilize computational methods to define reference distributions and reference intervals from mixed data sets of pathologic and non-pathologic patient test results. In an effort to make reference intervals more accurate and personalized, individual-based reference intervals are shown to be more useful than population-based reference intervals in detecting clinically significant analyte changes in a patient that might otherwise go unrecognized when using wider, population-based reference intervals. Additionally, continuous reference intervals can provide more accurate ranges as compared to age-based partitions for individuals that are near the ends of the age partition. The advantages and disadvantages of different reference interval approaches as well as the advancement of non-conventional reference interval studies are discussed in this review.
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Affiliation(s)
- Kelly Doyle
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dustin R Bunch
- Nationwide Children's Hospital & College of Medicine, The Ohio State University, Columbus, OH, USA
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Benozzi SF, Unger G, Campion A, Milano PG, Pennacchiotti GL. Coffee intake one hour prior to phlebotomy produces no clinically significant changes in routine biochemical test results. Biochem Med (Zagreb) 2023; 33:020705. [PMID: 37324115 PMCID: PMC10231766 DOI: 10.11613/bm.2023.020705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/25/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Although current guidelines recommend not drinking coffee prior to phlebotomy, our hypothesis is that drinking coffee does not affect the clinical interpretation of biochemical and haematological test results. Materials and methods Twenty-seven volunteers were studied in basal state (T0) and 1h after (T1) drinking coffee. Routine haematological (Sysmex-XN1000 analyser) and biochemistry parameters (Vitros 4600 analyser) were studied. Results were compared using the Wilcoxon test (P < 0.05). A clinical change was considered when mean percent difference (MD%) was higher than the reference change value (RCV). Results Coffee intake produced statistically, but not clinically, significant: i) increases in haemoglobin (P = 0.009), mean cell haemoglobin concentration (P = 0.044), neutrophils (P = 0.001), albumin (P = 0.001), total protein (P = 0.000), cholesterol (P = 0.025), high density lipoprotein cholesterol (P = 0.007), uric acid (P = 0.011), calcium (P = 0.001), potassium (P = 0.010), aspartate aminotransferase (P = 0.001), amylase (P = 0.026), and lactate dehydrogenase (P = 0.001), and ii) decreases in mean cell volume (P = 0.002), red cell distribution width (P = 0.001), eosinophils (P = 0.002), and lymphocytes (P = 0.001), creatinine (P = 0.001), total bilirubin (P = 0.012), phosphorus (P = 0.001), magnesium (P = 0.007), and chloride (P = 0.001). Conclusion Drinking a cup of coffee 1 hour prior to phlebotomy produces no clinically significant changes in routine biochemical and haematological test results.
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Affiliation(s)
- Silvia F Benozzi
- Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS), Bahía Blanca, Argentina
| | - Gisela Unger
- Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS), Bahía Blanca, Argentina
| | - Amparo Campion
- Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS), Bahía Blanca, Argentina
- Hospital Municipal de Agudos "Dr. Leónidas Lucero", Bahía Blanca, Argentina
| | - Pablo G Milano
- Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS), Bahía Blanca, Argentina
- Instituto de Investigaciones Bioquímicas de Bahía Blanca (INIBIBB), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional del Sur (UNS), Bahía Blanca, Argentina
| | - Graciela L Pennacchiotti
- Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur (UNS), Bahía Blanca, Argentina
- Hospital Municipal de Agudos "Dr. Leónidas Lucero", Bahía Blanca, Argentina
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Application of the Hoffmann, Bhattacharya, nonparametric test, and Q-Q plot methods for establishing reference intervals from laboratory databases. Clin Biochem 2023; 113:9-16. [PMID: 36587756 DOI: 10.1016/j.clinbiochem.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/05/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Reference intervals (RIs) are vital for interpreting laboratory biomarkers and enabling clinical decision-making. Among various RI-estimation methods, we explored the application value of Hoffmann, Bhattacharya, nonparametric test, and Q-Q plot methods for estimating the RI of urea, creatinine, and uric acid (UA). METHOD This cross-sectional study collected patient data recorded between January 2020 and April 2022 at the Chongqing University Central Hospital Laboratory Information System. The RIs of urea, creatinine, and UA levels were established using the Hoffmann, Bhattacharya, nonparametric, and Q-Q plot methods, and RI differences with different computational methods were verified using the reference change value (RCV%) of biological variability. RESULTS We included 16,474 and 123,570 patients in the physical examination and clinical groups, respectively. In the clinical group, differences in the RI upper limit of analytes with the four methods (excluding the Q-Q plot method) were within the permissible RCV% range; only the nonparametric test produced an RI of urea with the lower limit within the permissible RCV% range. In the physical examination group, the relative RI differences among the four methods (excluding the lower limit of RI obtained using the Q-Q plot) were all within the acceptable RCV% range; the relative deviation of the RI of UA with the four methods was within the acceptable RCV% range (excluding the lower RI limit obtained using the Q-Q plot and nonparametric test). CONCLUSION The Hoffmann and Bhattacharya methods may provide reliable RIs for indirect estimations of urea, creatinine, and UA based on laboratory datasets.
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Abdollahian N, Ghazizadeh H, Mohammadi‐Bajgiran M, Pashirzad M, Yaghooti Khorasani M, Bohn MK, Steele S, Roudi F, Kamel Khodabandeh A, Ghazi Zadeh S, Alami‐Arani I, Badakhshan SN, Esmaily H, Ferns GA, Assaran‐Darban R, Adeli K, Ghayour‐Mobarhan M. Age-specific reference intervals for routine biochemical parameters in healthy neonates, infants, and young children in Iran. J Cell Mol Med 2022; 27:158-162. [PMID: 36524863 PMCID: PMC9806292 DOI: 10.1111/jcmm.17646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022] Open
Abstract
Age and sex need to be considered in the establishment of reference intervals (RIs), especially in early life when there are dynamic physiological changes. Since data for important biomarkers in healthy neonates and infants are limited, particularly in Iranian populations, we have determined age-specific RIs for 7 laboratory biochemical parameters. This cross-sectional study comprised a total of 344 paediatric participants (males: 158, females: 186) between the ages of 3 days and 30 months (mean age: 12.91 ± 7.15 months). Serum levels of creatinine, urea, uric acid, calcium, phosphate, vitamin D and high-sensitivity C-reactive protein (hs-CRP) were measured using an Alpha classic-AT plus auto-analyser. We determined age-specific RIs using CLSI Ep28-A3 and C28-A3 guidelines. No sex partitioning was required for any of the biomarkers. Age partitioning was required for kidney function tests and phosphate. The serum concentration of urea and creatinine increased with age, while phosphate and uric acid decreased with age. Age partitioning was not required for serum calcium, vitamin D, and hs-CRP, which remained relatively constant throughout the age range. Age-specific RIs for 7 routine biochemical markers were determined to address critical gaps in RIs in early life to help improve clinical interpretation of blood test results in young children, including neonates. Established age partitions demonstrate the biochemical changes that take place during child growth and development. These novel data will ultimately better disease management in the Iranian paediatric population and can be of value to clinical and hospital laboratories with similar populations.
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Affiliation(s)
| | - Hamideh Ghazizadeh
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada,International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Maryam Mohammadi‐Bajgiran
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Mehran Pashirzad
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Mahdiyeh Yaghooti Khorasani
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Mary Kathryn Bohn
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Shannon Steele
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Fatemeh Roudi
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Atieh Kamel Khodabandeh
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
| | - Sara Ghazi Zadeh
- Department of BiologyMashhad Branch, Islamic Azad UniversityMashhadIran
| | - Iman Alami‐Arani
- Department of BiologyMashhad Branch, Islamic Azad UniversityMashhadIran
| | | | - Habibollah Esmaily
- Social Determinants of Health Research CenterMashhad University of Medical SciencesMashhadIran
| | - Gordon A. Ferns
- Brighton & Sussex Medical SchoolDivision of Medical EducationSussexUK
| | | | - Khosrow Adeli
- CALIPER Program, Division of Clinical Biochemistry, Pediatric Laboratory MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Majid Ghayour‐Mobarhan
- International UNESCO Center for Health‐Related Basic Sciences and Human NutritionMashhad University of Medical SciencesMashhadIran
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ÖNER E, BELGE KURUTAS E. BIOLOGICAL VARIATIONS OF URINARY MELATONIN LEVELS IN PATIENTS WITH CHRONIC HEPATITIS B. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1102203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Objective: Biological variation-(BV) data of analytes have been used to evaluate the significant changes in serial results of healthy individuals in clinical laboratories. The aim of this study was to calculate within-(CVw)-(within-individual BV) and between-individual (CVg)-BV, index of individuality,and RCV of urine Melatonin analyte in patients with Chronic Hepatitis B(CHB).
Material and Methods: 20-CHB patients and 20 healthy individuals as control were involved in this study. Index of individuality and reference change value were calculated from within-subject and between-subject variations. Melatonin levels in human urines was measured with commercial a kit by-ELISA.ANOVA test was used to calculate the variations.
Results: Melatonin were significantly higher in patients with CHB compared to healthy subjects. Also,RCV of Melatonin analyte in CHB patients was relatively higher, because of high within-subject variation,resulting in a higher RCV.
Conclusion: RCV concept for predicting the clinical status in CHB patients represents an optimization of laboratory reporting and could be a valuable tool for clinical decision.
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Sajid IM, Frost K, Paul AK. 'Diagnostic downshift': clinical and system consequences of extrapolating secondary care testing tactics to primary care. BMJ Evid Based Med 2022; 27:141-148. [PMID: 34099498 DOI: 10.1136/bmjebm-2020-111629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 12/21/2022]
Abstract
Numerous drivers push specialist diagnostic approaches down to primary care ('diagnostic downshift'), intuitively welcomed by clinicians and patients. However, primary care's different population and processes result in under-recognised, unintended consequences. Testing performs poorer in primary care, with indication creep due to earlier, more undifferentiated presentation and reduced accuracy due to spectrum bias and the 'false-positive paradox'. In low-prevalence settings, tests without near-100% specificity have their useful yield eclipsed by greater incidental or false-positive findings. Ensuing cascades and multiplier effects can generate clinician workload, patient anxiety, further low-value tests, referrals, treatments and a potentially nocebic population 'disease' burden of unclear benefit. Increased diagnostics earlier in pathways can burden patients and stretch general practice (GP) workloads, inducing downstream service utilisation and unintended 'market failure' effects. Evidence is tenuous for reducing secondary care referrals, providing patient reassurance or meaningfully improving clinical outcomes. Subsequently, inflated investment in per capita testing, at a lower level in a healthcare system, may deliver diminishing or even negative economic returns. Test cost poorly represents 'value', neglecting under-recognised downstream consequences, which must be balanced against therapeutic yield. With lower positive predictive values, more tests are required per true diagnosis and cost-effectiveness is rarely robust. With fixed secondary care capacity, novel primary care testing is an added cost pressure, rarely reducing hospital activity. GP testing strategies require real-world evaluation, in primary care populations, of all downstream consequences. Test formularies should be scrutinised in view of the setting of care, with interventions to focus rational testing towards those with higher pretest probabilities, while improving interpretation and communication of results.
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Affiliation(s)
- Imran Mohammed Sajid
- NHS West London Clinical Commissioning Group, London, UK
- University of Global Health Equity, Kigali, Rwanda
| | - Kathleen Frost
- NHS Central London Clinical Commissioning Group, London, UK
| | - Ash K Paul
- NHS South West London Health and Care Partnership STP, London, UK
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10
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Cembrowski GS, Lyon AW, McCudden C, Qiu Y, Xu Q, Mei J, Tran DV, Sadrzadeh SMH, Cervinski MA. Transformation of Sequential Hospital and Outpatient Laboratory Data into Between-Day Reference Change Values. Clin Chem 2022; 68:595-603. [PMID: 35137000 DOI: 10.1093/clinchem/hvab271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/15/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Serial differences between intrapatient consecutive measurements can be transformed into Taylor series of variation vs time with the intersection at time = 0 (y0) equal to the total variation (analytical + biological + preanalytical). With small preanalytical variation, y0, expressed as a percentage of the mean, is equal to the variable component of the reference change value (RCV) calculation: (CVA2 + CVI2)1/2. METHODS We determined the between-day RCV of patient data for 17 analytes and compared them to healthy participants' RCVs. We analyzed 653 consecutive days of Dartmouth-Hitchcock Roche Modular general chemistry data (4.2 million results: 60% inpatient, 40% outpatient). The serial patient values of 17 analytes were transformed into 95% 2-sided RCV (RCVAlternate), and 3 sets of RCVhealthy were calculated from 3 Roche Modular analyzers' quality control summaries and CVI derived from biological variation (BV) studies using healthy participants. RESULTS The RCVAlternate values are similar to RCVhealthy derived from known components of variation. For sodium, chloride, bicarbonate calcium, magnesium, phosphate, alanine aminotransferase, albumin, and total protein, the RCVs are equivalent. As expected, increased variation was found for glucose, aspartate aminotransferase, creatinine, and potassium. Direct bilirubin and urea demonstrated lower variation. CONCLUSIONS Our RCVAlternate values integrate known and unknown components of analytic, biologic, and preanalytic variation, and depict the variations observed by clinical teams that make medical decisions based on the test values. The RCVAlternate values are similar to the RCVhealthy values derived from known components of variation and suggest further studies to better understand the results being generated on actual patients tested in typical laboratory environments.
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Affiliation(s)
- George S Cembrowski
- Faculty of Medicine & Dentistry, Laboratory Medicine and Pathology, University of Alberta, Alberta, Canada
| | - Andrew W Lyon
- Saskatoon Health Region, Pathology and Laboratory Medicine, Saskatoon, Canada
| | - Christopher McCudden
- Department of Pathology & Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Yuelin Qiu
- Medical Student, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Qian Xu
- Family Practice, Vancouver, British Columbia
| | - Junyi Mei
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - S M Hossein Sadrzadeh
- Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark A Cervinski
- Laboratory Medicine, Geisel School of Medicine, Dartmouth, NH, USA
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Zhang Y, He DH, Jiang SN, Wang HL, Xu XH, Kong LR. Biological variation of thyroid function biomarkers over 24 hours. Clin Chim Acta 2021; 523:519-524. [PMID: 34762936 DOI: 10.1016/j.cca.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free T3 (FT3), and free T4 (FT4) are used to diagnose thyroid diseases and monitor treatment effects. Reliable biological variation (BV) data is required to ensure accurate clinical decisions. METHODS Blood samples were collected from 31 healthy subjects at 00:00, 04:00, 08:00, 12:00, 16:00, and 20:00; each sample was analyzed twice for TSH, T3, T4, FT3, and FT4. After outlier exclusion, normality assessment, and variance homogeneity, sex-stratified BV, including within-subject (CVI) and between-subject (CVG), was defined using nested ANOVA. RESULTS Concentrations of five biomarkers were significantly different between sexes. The CVI and CVG estimates were 34.54% and 34.43% for TSH, 5.89% and 14.18% for T3, 4.48% and 14.96% for T4, 5.37% and 11.23% for FT3, and 3.57% and 8.03% for FT4, respectively. The individual indexes (IIs) of all the biomarkers (except TSH) were ≤ 0.63. Males had lower CVIs and IIs than females. CONCLUSION CVI estimates of all hormones, except TSH, were lower than those reported on the BV website, showing low IIs and differences between sexes. We provide updated data on the short-term BV of thyroid function biomarkers according to sex and complement BV data of thyroid function biomarkers.
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Affiliation(s)
- Yan Zhang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, China
| | - Da-Hai He
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, China
| | - Shun-Ning Jiang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, China
| | - Hua-Li Wang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, China
| | - Xiao-Hua Xu
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, China
| | - Li-Rui Kong
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, China.
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Fuchs M, Kirchhoff F, Reichel H, Perka C, Faschingbauer M, Gwinner C. Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty. Bone Jt Open 2021; 2:566-572. [PMID: 34337971 PMCID: PMC8384436 DOI: 10.1302/2633-1462.28.bjo-2021-0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS Current guidelines consider analyses of joint aspirates, including leucocyte cell count (LC) and polymorphonuclear percentage (PMN%) as a diagnostic mainstay of periprosthetic joint infection (PJI). It is unclear if these parameters are subject to a certain degree of variability over time. Therefore, the aim of this study was to evaluate the variation of LC and PMN% in patients with aseptic revision total knee arthroplasty (TKA). METHODS We conducted a prospective, double-centre study of 40 patients with 40 knee joints. Patients underwent joint aspiration at two different time points with a maximum period of 120 days in between these interventions and without any events such as other joint aspirations or surgeries. The main indications for TKA revision surgery were aseptic implant loosening (n = 24) and joint instability (n = 11). RESULTS Overall, 80 synovial fluid samples of 40 patients were analyzed. The average time period between the joint aspirations was 50 days (SD 32). There was a significantly higher percentage change in LC when compared to PMN% (44.1% (SD 28.6%) vs 27.3% (SD 23.7%); p = 0.003). When applying standard definition criteria, LC counts were found to skip back and forth between the two time points with exceeding the thresholds in up to 20% of cases, which was significantly more compared to PMN% for the European Bone and Joint Infection Society (EBJIS) criteria (p = 0.001), as well as for Musculoskeletal Infection Society (MSIS) (p = 0.029). CONCLUSION LC and PMN% are subject to considerable variation. According to its higher interindividual variance, LC evaluation might contribute to false-positive or false-negative results in PJI assessment. Single LC testing prior to TKA revision surgery seems to be insufficient to exclude PJI. On the basis of the obtained results, PMN% analyses overrule LC measurements with regard to a conclusive diagnostic algorithm. Cite this article: Bone Jt Open 2021;2(8):566-572.
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Affiliation(s)
- Michael Fuchs
- RKU Department of Orthopaedic Surgery, University Ulm Medical Centre, Ulm, Baden-Württemberg, Germany
| | - Felix Kirchhoff
- RKU Department of Orthopaedic Surgery, University Ulm Medical Centre, Ulm, Baden-Württemberg, Germany
| | - Heiko Reichel
- RKU Department of Orthopaedic Surgery, University Ulm Medical Centre, Ulm, Baden-Württemberg, Germany
| | - Carsten Perka
- Department of Orthopaedic Surgery, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
| | - Martin Faschingbauer
- RKU Department of Orthopaedic Surgery, University Ulm Medical Centre, Ulm, Baden-Württemberg, Germany
| | - Clemens Gwinner
- Department of Orthopaedic Surgery, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
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Tahmasebi H, Asgari S, Hall A, Higgins V, Chowdhury A, Thompson R, Bohn MK, Macri J, Adeli K. Influence of ethnicity on biochemical markers of health and disease in the CALIPER cohort of healthy children and adolescents. Clin Chem Lab Med 2021; 58:605-617. [PMID: 31874092 DOI: 10.1515/cclm-2019-0876] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022]
Abstract
Background Accurate pediatric reference intervals (RIs) for laboratory tests determined in a healthy pediatric population are essential for correct laboratory test interpretation and clinical decision-making. In pediatrics, RIs require partitioning by age and/or sex; however, the need for partitioning based on ethnicity is unclear. Here, we assessed the influence of ethnicity on biomarker concentrations in the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort of healthy children and adolescents and compared the results with the National Health and Nutrition Examination Survey (NHANES). Methods A total of 52 biomarkers were measured in a multiethnic population of 846-1179 healthy children (aged 5 to <19 years) upon informed consent. Biomarker concentrations were retrospectively compared between four major ethnic groups (i.e. Black, Caucasian, East Asian, and South Asian, determined by parental ethnicity). Retrospective results were verified prospectively using an additional 500 healthy pediatric samples with equal sample size across ethnicities. Ethnic-specific differences were assessed based on statistical significance and biological and analytical variations. Appropriate age-, sex-, and ethnic-specific RIs were calculated. Results Ethnic-specific differences were not observed for 34 biomarkers examined in the retrospective analysis, while 18 demonstrated statistically significant ethnic differences. Among these, seven analytes demonstrated ethnic-specific differences in the prospective analysis: vitamin D, amylase, ferritin, follicle-stimulating hormone (FSH), immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM). Analysis of select NHANES data confirmed CALIPER findings. Conclusions This is the first comprehensive Canadian pediatric study examining ethnic-specific differences in common biomarkers. While the majority of biomarkers did not require ethnic partitioning, ethnic-specific RIs were established for seven biomarkers showing marked differences. Further studies in other populations are needed to confirm our findings.
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Affiliation(s)
- Houman Tahmasebi
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shervin Asgari
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Alexandra Hall
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Victoria Higgins
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ashfia Chowdhury
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Rebecca Thompson
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Mary Kathryn Bohn
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Macri
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Khosrow Adeli
- CALIPER Program, Clinical Biochemistry, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada, Phone: +(416)-813-8682
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Jungert A, Frank J. Intra-Individual Variation and Reliability of Biomarkers of the Antioxidant Defense System by Considering Dietary and Lifestyle Factors in Premenopausal Women. Antioxidants (Basel) 2021; 10:448. [PMID: 33805781 PMCID: PMC7998493 DOI: 10.3390/antiox10030448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/11/2023] Open
Abstract
Epidemiological studies frequently rely on a single biomarker measurement to assess the relationship between antioxidant status and diseases. This bears an inherent risk for misclassification, if the respective biomarker has a high intra-individual variability. The present study investigates the intra-individual variation and reliability of enzymatic and non-enzymatic biomarkers of the antioxidant system in premenopausal women. Forty-four apparently healthy females provided three consecutive fasting blood samples in a four-week rhythm. Analyzed blood biomarkers included Trolox equivalent antioxidant capacity (TEAC), catalase, glutathione peroxidase, glutathione, vitamin C, bilirubin, uric acid, coenzyme Q10, tocopherols, carotenoids and retinol. Intra- and inter-individual variances for each biomarker were estimated before and after adjusting for relevant influencing factors, such as diet, lifestyle and use of contraceptives. Intraclass correlation coefficient (ICC), index of individuality, reference change value and number of measurements needed to confine attenuation in regression coefficients were calculated. Except for glutathione and TEAC, all biomarkers showed a crude ICC ≥ 0.50 and a high degree of individuality indicating that the reference change value is more appropriate than population-based reference values to scrutinize and classify intra-individual changes. Apart from glutathione and TEAC, between 1 and 9 measurements were necessary to reduce attenuation in regression coefficients to 10%. The results indicate that the majority of the assessed biomarkers have a fair to very good reliability in healthy premenopausal women, except for glutathione and TEAC. To assess the status of the antioxidant system, the use of multiple measurements and biomarkers is recommended.
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Affiliation(s)
- Alexandra Jungert
- Institute of Nutritional Science, Justus Liebig University, Goethestrasse 55, D-35390 Giessen, Germany
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Garbenstrasse 28, D-70599 Stuttgart, Germany;
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15
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Zhao H, Lin Q, Huang L, Zhai Y, Liu Y, Deng Y, Su E, He N. Ultrasensitive chemiluminescence immunoassay with enhanced precision for the detection of cTnI amplified by acridinium ester-loaded microspheres and internally calibrated by magnetic fluorescent nanoparticles. NANOSCALE 2021; 13:3275-3284. [PMID: 33533772 DOI: 10.1039/d0nr08008j] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A novel enhanced chemiluminescent immunoassay (CLIA) for ultrasensitive and excellent precisive determination of cardiac troponin I (cTnI) was reported. The method made full use of poly[(N-isopropyl acrylamide)-co-(methacrylic acid)] (P(NIPAM-co-MAA)) microspheres as new potential signal enhancers and magnetic fluorescent nanoparticles as internal standards for better precision. This protocol involved a sandwich format, in which the antigen in the sample was captured by the immobilized antibodies on the surface of magnetic fluorescent beads and recognized by the other antibodies labeled with acridinium ester (AE)-loaded P(NIPAM-co-MAA) microspheres. The combination of the remarkable sensitivity of the enhanced CLIA method and the use of P(NIPAM-co-MAA) microspheres as anti-cTnI carriers for acridinium ester signal amplification provided an extremely sensitive limit of blank (LoB) at 0.097 pg mL-1, a limit of detection (LoD) at 0.116 pg mL-1, and a limit of quantitation (LoQ) at 0.606 pg mL-1, much greater than those achieved by the classical chemiluminescence immunoassay (CLIA, Getein). Moreover, the intra-day variable coefficient can be improved to 1.21-2.12%, and inter-day variability was 2.01-3.49% under the application of magnetic fluorescent beads as an internal standard. The sensitivity and precision have reached a high level, comparable with the current commercial detection kits. The results showed a good correlation with a commercial chemiluminescence assay (CLIA, Abbott), with a correlation coefficient of 0.9883. This proposed method has been successfully applied to the clinical determination of cTnI in the human serum.
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Affiliation(s)
- Huan Zhao
- State Key Laboratory of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China.
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16
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Jeffery U, Jeffery ND, Creevy KE, Page R, Simpson MJ. Variation in biochemistry test results between annual wellness visits in apparently healthy Golden Retrievers. J Vet Intern Med 2021; 35:912-924. [PMID: 33528843 PMCID: PMC7995418 DOI: 10.1111/jvim.16021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Annual wellness testing is widely recommended for apparently healthy dogs, but there is little data to assist with distinguishing normal variation from clinically important changes. Objectives To define variability in biochemistry analytes between annual wellness tests in healthy Golden Retrievers. Animals Four hundred thirty‐four Golden Retrievers undergoing annual health assessments by their primary care veterinarians as part of a prospective cohort study. Methods Changes in 23 biochemistry analytes were calculated between year 1 and year 2 health checks for 196 dogs classified as healthy for ≥3 consecutive years. Using a direct nonparametric method, annual change intervals were constructed to define normal variability. A validation cohort of 238 dogs without a diagnosis of systemic disease for ≥3 consecutive years were compared with the reference and annual change intervals, and the proportions of dogs outside annual change intervals and a population‐based reference interval were compared by using a McNemar test. Results Annual change intervals were calculated based on 190 dogs after outlier removal. For all 23 analytes, >90% of dogs in the validation cohort were within the annual change interval. There were no significant differences in the classification by reference versus annual change intervals. Conclusions and Clinical Importance The annual change intervals met performance requirements for classification of dogs that did not develop systemic disease in the year following wellness testing as normal.
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Affiliation(s)
- Unity Jeffery
- Department of Veterinary Pathobiology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Nick D Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Kate E Creevy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Rod Page
- Flint animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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17
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Imbert-Bismut F, Payet PE, Alfaisal J, Munteanu M, Rudler M, Sultanik P, Alkouri R, Sakka M, Djavoudine S, Dever S, Mestari F, Bonnefont-Rousselot D, Poynard T, Thabut D. Transportation and handling of blood samples prior to ammonia measurement in the real life of a large university hospital. Clin Chim Acta 2020; 510:522-530. [DOI: 10.1016/j.cca.2020.07.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 01/28/2023]
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18
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Gupta AK, Kunnumbrath A, Tayal SG, Mehan A, Sahay R, Kumar U, Jeladharan R, Anthony ML, Singh N, Chandra H, Chowdhury N. Short-term biological variation of differential count in healthy subjects in a South Asian population. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:654-658. [PMID: 33016776 DOI: 10.1080/00365513.2020.1827290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Estimates of Within-Subject and between subject biological variation for the white blood cell differential count (DC) have not been reported in South Asia. Therefore, we attempted to measure the short-term biological variation estimates for DC. The study was conducted on 28 healthy volunteers (15 males and 13 females). Blood from the volunteers was collected in the morning in K3-EDTA vials and analyzed in triplicate on the Sysmex XN-1000 analyzer, for six consecutive days. The Within subject, between subject and analytical coefficient of variation of the DC was calculated from the results by nested repeated measures ANOVA after outlier exclusion. The Reference change values (RCV) were also calculated. The within-subject variation for eosinophil Count and between subject variation for basophils in our study from South Asia was greater than the published European and American studies. Males and females showed similar biological variation for DC. The within-subject variation of other parameters (Neutrophils, Lymphocytes, Monocytes and Basophils) were similar or showed only mild differences to the published studies. The markedly different within-subject variation for Eosinophil counts suggest that the RCV for DC in South Asians need to be different from the published data in order to have clinical relevance. The Within-subject variation values of the other parameters seem transportable from the published European and American studies, but the small differences found mean that further regional estimates need to be reported for robust evidence of the same.
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Affiliation(s)
- Arvind Kumar Gupta
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Arathi Kunnumbrath
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Sakshi Garg Tayal
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Anoushika Mehan
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Rishabh Sahay
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Utpal Kumar
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Reshma Jeladharan
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Michael Leonard Anthony
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Neha Singh
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Harish Chandra
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Nilotpal Chowdhury
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
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An Analysis of Variability in "CatWalk" Locomotor Measurements to Aid Experimental Design and Interpretation. eNeuro 2020; 7:ENEURO.0092-20.2020. [PMID: 32647037 PMCID: PMC7458803 DOI: 10.1523/eneuro.0092-20.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/02/2022] Open
Abstract
Preclinical studies in models of neurologic injury and disease rely on behavioral outcomes to measure intervention efficacy. For spinal cord injury, the CatWalk system provides unbiased quantitative assessment of subtle aspects of locomotor function in rodents and so can powerfully detect significant differences between experimental and control groups. Although clearly of key importance, summary group-level data can obscure the variability within and between individual subjects and therefore make it difficult to understand the magnitude of effect in individual animals and the proportion of a group that may show benefit. Here, we calculate reference change intervals (RCIs) that define boundaries of normal variability for measures of rat locomotion on the CatWalk. Our results indicate that many commonly-used outcome measures are highly variable, such that differences of up to 70% from baseline value must be considered normal variation. Many CatWalk outcome variables are also highly correlated and dependent on run speed. Application of calculated RCIs to open access data (https://scicrunch.org/odc-sci) on hindlimb stride length in spinal cord-injured rats illustrates the complementarity between group-level (16 mm change; p = 0.0009) and individual-level (5/32 animals show change outside RCI boundaries) analysis between week 3 and week 6 after injury. We also conclude that interdependence among CatWalk variables implies that test “batteries” require careful composition to ensure that different aspects of defective gait are analyzed. Calculation of RCIs aids in experimental design by quantifying variability and enriches overall data analysis by providing details of change at an individual level that complement group-level analysis.
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Effects of Time-Interval since Blood Draw and of Anticoagulation on Platelet Testing (Count, Indices and Impedance Aggregometry): A Systematic Study with Blood from Healthy Volunteers. J Clin Med 2020; 9:jcm9082515. [PMID: 32759828 PMCID: PMC7465339 DOI: 10.3390/jcm9082515] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
Platelet count, indices (mean volume, young-immature platelet fraction) and aggregation are widely used laboratory parameters to investigate primary hemostasis. We performed a systematic, thorough evaluation of the influence of the time-interval since blood draw from 20 healthy individuals and of the anticoagulation of collected blood on such parameters. Blood was anticoagulated with citrate, K2-ethylenediaminetetraacetic acid (EDTA) and hirudin and analyzed 5, 30, 60, 120 and 180 min after blood draw. Multiple electrode aggregometry (MEA) was performed with either hirudin (half-diluted with NaCl) or citrate samples (half-diluted with NaCl or CaCl2 3 mM). Platelet count and indices (Sysmex XN-20) were rather stable over time with EDTA blood. MEA results were lower with citrate blood than with hirudin blood; supplementation with calcium was partially compensatory. MEA results were also lower when performed less than 30 or more than 120 min after blood draw. Platelet clumping, quantitatively estimated with microscope examination of blood smears, was more important in hirudin blood than citrate or EDTA blood and could explain some of the differences observed between preanalytical variables. The results stress once more the importance of preanalytical variables in hemostasis laboratory testing. Decision thresholds based on those tests are only applicable within specific preanalytical conditions.
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Arnold JE, Camus MS, Freeman KP, Giori L, Hooijberg EH, Jeffery U, Korchia J, Meindel MJ, Moore AR, Sisson SC, Vap LM, Cook JR. ASVCP Guidelines: Principles of Quality Assurance and Standards for Veterinary Clinical Pathology (version 3.0): Developed by the American Society for Veterinary Clinical Pathology's (ASVCP) Quality Assurance and Laboratory Standards (QALS) Committee. Vet Clin Pathol 2020; 48:542-618. [PMID: 31889337 DOI: 10.1111/vcp.12810] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Melinda S Camus
- Department of Pathology, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | | | - Luca Giori
- Department of Biomedical and Diagnostic Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Emma H Hooijberg
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Unity Jeffery
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jérémie Korchia
- Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, TX, USA
| | | | - A Russell Moore
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sandra C Sisson
- Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Linda M Vap
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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Arbiol-Roca A, Imperiali CE, Dot-Bach D, Valero-Politi J, Dastis-Arias M. Stability of pH, Blood Gas Partial Pressure, Hemoglobin Oxygen Saturation Fraction, and Lactate Concentration. Ann Lab Med 2020; 40:448-456. [PMID: 32539300 PMCID: PMC7295962 DOI: 10.3343/alm.2020.40.6.448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/24/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
Background The storage temperature and time of blood gas samples collected in syringes constitute preanalytical variables that could affect blood gas or lactate concentration measurement results. We analyzed the effect of storage temperature and time delay on arterial or venous blood gas stability related to pH, partial pressure of carbon dioxide (pCO2) and oxygen (pO2), hemoglobin oxygen saturation (sO2), and lactate concentration. Methods In total, 1,200 arterial and venous blood sample syringes were analyzed within 10 minutes of collection. The samples were divided into different groups to determine parameter stability at 25, 4–8, and 0–3.9°C and at different storage times, 60, 45, 30, and 15 minutes. Independent sample groups were used for each analysis. Percentage deviations were calculated and compared with acceptance stability limits (1.65× coefficient of variation). Additionally, sample group sub analysis was performed to determine whether stability was concentration-dependent for each parameter. Results The pH was stable over all storage times at 4–8 and 0–3.9°C and up to 30 minutes at 25°C. pCO2 was stable at ≤60 minutes at all temperatures. pO2 was stable for 45 minutes at 0–3.9°C, and sO2 was stable for 15 minutes at 25°C and for ≤60 minutes at 0–3.9°C. Lactate concentration was stable for 45 minutes at 0–3.9°C. Subanalysis showed that stability was concentration-dependent. Conclusions The strictest storage temperature and time criteria (0–3.9°C, 45 minutes) should be adopted for measuring pH, pCO2, pO2, sO2, and lactate concentration in blood gas syringes.
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Affiliation(s)
- Ariadna Arbiol-Roca
- Laboratori Clínic Territorial Metropolitana Sud-Hospital Universitari de Bellvitge. Hospitalet de Llobregat, Barcelona, Spain
| | - Claudia Elizabeth Imperiali
- Laboratori Clínic Territorial Metropolitana Sud-Hospital Universitari de Bellvitge. Hospitalet de Llobregat, Barcelona, Spain
| | - Dolors Dot-Bach
- Laboratori Clínic Territorial Metropolitana Sud-Hospital Universitari de Bellvitge. Hospitalet de Llobregat, Barcelona, Spain
| | - José Valero-Politi
- Laboratori Clínic Territorial Metropolitana Sud-Hospital Universitari de Bellvitge. Hospitalet de Llobregat, Barcelona, Spain
| | - Macarena Dastis-Arias
- Laboratori Clínic Territorial Metropolitana Sud-Hospital Universitari de Bellvitge. Hospitalet de Llobregat, Barcelona, Spain
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Dupuy AM, Bargnoux AS, Kuster N, Cristol JP, Badiou S. Determination of hemolysis cut-offs for biochemical and immunochemical analytes according to their value. ACTA ACUST UNITED AC 2020; 58:1232-1241. [DOI: 10.1515/cclm-2019-1228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/18/2020] [Indexed: 11/15/2022]
Abstract
Abstract
Background
All general biochemistry instruments allow the measure of hemolysis index (HI), and suppliers provide an acceptable HI for each assay without consideration of the analyte value or its clinical application. Our first objective was to measure the impact of hemolysis degree on plasma biochemical and immunochemical analytes to determine the maximum allowable HI for each of them using four calculation methods as significant bias in comparison to manufacturer’s data. The second objective was to assess whether the maximum allowable HI varied according to the analyte values.
Methods
Twenty analytes were measured in hemolyzate-treated plasma to determine the HI leading to a significant change compared to baseline value. Analytes were assessed at one (3 analytes), two (5 analytes) and three (12 analytes) values according to their sensitivity to hemolysis and their clinical impact. We used four calculation methods as significant limit from baseline value: the total change limit (TCL), the 10% change (10%Δ), the analytical change limit and the reference change value.
Results
Allowable HI was significantly different according to the threshold chosen for most analytes and was also dependent on the analyte value for alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, creatine kinase, iron, haptoglobin and high sensitivity troponin T. No hemolysis interference was observed for albumin, creatinine, C-reactive protein, and procalcitonin even at an HI value of 11 g/L.
Conclusions
This study highlights that TCL is the most appropriate calculation method to determine allowable HI in practice for biochemical and immunochemical parameters using Cobas 8000© from Roche Diagnostics. In addition, different allowable HI were found according to analyte value leading to optimization of resampling to save time in patient care.
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Affiliation(s)
- Anne Marie Dupuy
- Department of Biochemistry , Lapeyronie University Hospital , Montpellier , France
| | - Anne Sophie Bargnoux
- Department of Biochemistry , Lapeyronie University Hospital , Montpellier , France
- PhyMedExp, INSERM, CNRS , University of Montpellier , Montpellier , France
| | - Nils Kuster
- Department of Biochemistry , Lapeyronie University Hospital , Montpellier , France
- PhyMedExp, INSERM, CNRS , University of Montpellier , Montpellier , France
| | - Jean Paul Cristol
- Department of Biochemistry , Lapeyronie University Hospital , 191 Avenue du Doyen Gaston Giraud , 34295 Montpellier Cedex 5 , France
- PhyMedExp, INSERM, CNRS , University of Montpellier , Montpellier , France , Fax: +33 4 67 33 83 93
| | - Stéphanie Badiou
- Department of Biochemistry , Lapeyronie University Hospital , Montpellier , France
- PhyMedExp, INSERM, CNRS , University of Montpellier , Montpellier , France
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Robinson JL, Seiden-Long I, de Koning L. Identification and implementation of hemolysis interference thresholds in serum ionized calcium measurement. Clin Biochem 2020; 78:66-67. [PMID: 31972149 DOI: 10.1016/j.clinbiochem.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Jason L Robinson
- Alberta Precision Laboratories, Diagnostic and Scientific Research Centre, #9 3535 Research Way NW, Calgary, AB T2L 2K8, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, 3030 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Isolde Seiden-Long
- Alberta Precision Laboratories, Foothills Medical Centre, McCaig Tower, 3134 Hospital Drive NW, Rm 7507, 7th Floor, Calgary, AB T2N 5A1, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, 3030 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Lawrence de Koning
- Alberta Precision Laboratories, Alberta Children's Hospital, Room B3-724, Calgary, AB T3B 6A8, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, 3030 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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25
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Arredondo ME, Aranda E, Astorga R, Brennan-Bourdon LM, Campelo MD, Flores S, Medel C, Manríquez I, Ochoa P, Varela B, Salinas CV, Lima-Oliveira G. Breakfast can Affect Routine Hematology and Coagulation Laboratory Testing: An Evaluation on Behalf of COLABIOCLI WG-PRE-LATAM. TH OPEN 2019; 3:e367-e376. [PMID: 31853513 PMCID: PMC6917510 DOI: 10.1055/s-0039-3401002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/25/2019] [Indexed: 10/26/2022] Open
Abstract
Laboratories worldwide perform both hematological and coagulation testing on patients avoiding fasting time. In 2017, the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) commissioned the Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) to study preanalytical variability and establish guidelines for preanalytical procedures to be applied by clinical laboratories and health care professionals. This study, on behalf of COLABIOCLI WG-PRE-LATAM, aims to evaluate the effect of the breakfast on routine hematology and coagulation laboratory testing. We studied 20 healthy volunteers who consumed a breakfast containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood specimens for routine hematology and coagulation laboratory testing before breakfast and 1, 2, and 4 hours thereafter. Significant differences between samples were assessed by the Wilcoxon ranked-pairs test. Statistically significant differences ( p < 0.05) between basal and 4 hours after the breakfast were observed for red blood cells, hemoglobin, hematocrit, mean corpuscular volume, white blood cells, neutrophils, lymphocytes, monocytes, mean platelet volume, and activated partial thromboplastin time. In conclusion, the significant variations observed in several hematological parameters, and activated partial thromboplastin time due to breakfast feeding demonstrate that the fasting time needs to be carefully considered prior to performing routine hematological and coagulation testing to avoid interpretive mistakes of test results, and to guarantee patient safety. Therefore, COLABIOCLI WG-PRE-LATAM encourages laboratory quality managers to standardize the fasting requirements in their laboratory, i.e., 12 hours.
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Affiliation(s)
| | - Eduardo Aranda
- Laboratory of Thrombosis and Hemostasis, Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Lorena Michele Brennan-Bourdon
- Clinical Laboratory Network from the State of Jalisco, Public Health State Laboratory (LESP), Comisión Para la Protección Contra Riesgos Sanitarios del Estado de Jalisco (COPRISJAL), Guadalajara, Mexico
| | | | | | | | | | - Patricia Ochoa
- Facultad de Medicina, Universidad Católica de Cuenca, Cuenca, Ecuador
| | | | | | - Gabriel Lima-Oliveira
- Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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26
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Gupta AK, Kunnumbrath A, Tayal SG, Kumar U, Bharati V, Anthony ML, Singh N, Chandra H, Chowdhury N. Short term biological variation of common hematological parameters in healthy subjects in a South Asian population. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 80:93-98. [DOI: 10.1080/00365513.2019.1700424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Arvind Kumar Gupta
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Arathi Kunnumbrath
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Sakshi Garg Tayal
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Utpal Kumar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Vandna Bharati
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Michael Leonard Anthony
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Neha Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Harish Chandra
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Nilotpal Chowdhury
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
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27
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Abstract
Abstract
A number of improvement proposals and corrections of the German Rili-BAEK (Guideline of the German Medical Association on Quality Assurance in Medical Laboratory Examinations) are discussed with special focus on the internal and external quality assurance (IQA/EQA) as well as reference intervals for quantitative results. Particular attention is paid to reconsider the retrospective analysis of control measurements. Such an analysis can be very useful to monitor establishing errors of measurement even before they become critical. The present method “Quadratischer Mittelwert der Messabweichung (QMMA)” has proved to be ineffective. Furthermore, the current idea of a common limit for single control measures and the retrospective statistics must be revised. As a more sophisticated concept, the novel Adaptive Retrospective Monitoring (ARM) has been developed. ARM is recommended as the new minimum requirement for the entire internal quality assurance. Further proposals to enhance clarity are given concerning the release decisions of medical devices and the EQA. Individualized medicine begins with a patient-specific interpretation of analytic results. This requires standardized subgroup-specific reference intervals with smooth age-related adaptations. Only large laboratories are able to ensure the desired specificity and a sufficient statistical significance of self-developed in-laboratory reference intervals. Hence, the need of a central database for harmonized reference intervals is discussed and recommended. Suitable and consistent reference intervals are also an essential prerequisite for unitless laboratory values like the zlog value.
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28
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Wenping S, Ying L, Yuzhong L, Hui L. Variations in laboratory parameters in prechronic disease to determine disease occurrence at the molecular level. Biomark Med 2019; 13:1227-1234. [PMID: 31580165 DOI: 10.2217/bmm-2018-0291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aim: Change at a molecular level should occur before histopathological impairments. We refer to these changes as 'prechronic disease state.' Methods: Two blood samples were taken 1 day apart, 1 month apart and 2 years apart to determine the contribution of genetic and biological variations. Results: The 95% CI calculated quantitatively by the variability of genetic variation was very similar to the reference interval provided by the laboratory for most indicators, indicating that pathological variability had occurred without consideration of biological variation if an indicator's value lies outside of the reference interval. Conclusion: The physiological or predisease state can be distinguished directly using the laboratory reference interval.
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Affiliation(s)
- Sun Wenping
- College of Medical Laboratory, Dalian Medical University, Dalian, PR China
| | - Liu Ying
- Second Affiliated Hospital of Dalian Medical University, PR China
| | - Li Yuzhong
- College of Medical Laboratory, Dalian Medical University, Dalian, PR China.,Second Affiliated Hospital of Dalian Medical University, PR China
| | - Liu Hui
- College of Medical Laboratory, Dalian Medical University, Dalian, PR China
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29
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Lenicek Krleza J, Honovic L, Vlasic Tanaskovic J, Podolar S, Rimac V, Jokic A. Post-analytical laboratory work: national recommendations from the Working Group for Post-analytics on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2019; 29:020502. [PMID: 31223256 PMCID: PMC6559616 DOI: 10.11613/bm.2019.020502] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/14/2019] [Indexed: 12/20/2022] Open
Abstract
The post-analytical phase is the final phase of the total testing process and involves evaluation of laboratory test results; release of test results in a timely manner to appropriate individuals, particularly critical results; and modification, annotation or revocation of results as necessary to support clinical decision-making. Here we present a series of recommendations for post-analytical best practices, tailored to medical biochemistry laboratories in Croatia, which are intended to ensure alignment with national and international norms and guidelines. Implementation of the national recommendations is illustrated through several examples.
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Affiliation(s)
- Jasna Lenicek Krleza
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
| | - Lorena Honovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Jelena Vlasic Tanaskovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Sonja Podolar
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Vladimira Rimac
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Anja Jokic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Biochemistry, Haematology and Coagulation, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
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30
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Ercan M, Akbulut ED, Avcı E, Yücel Ç, Oğuz EF, Turhan T, Serdar M. Determining biological variation of serum parathyroid hormone in healthy adults. Biochem Med (Zagreb) 2019; 29:030702. [PMID: 31379460 PMCID: PMC6610671 DOI: 10.11613/bm.2019.030702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/24/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Measurement of parathyroid hormone (PTH) is essential in the investigation and management of calcium metabolism disorders. To assess the significance of any assay result when clinical decision making biological variation (BV) of the measurand must be taken into consideration. The aim of the present study is determining the BV parameters for serum PTH. Materials and methods Blood samples were taken at weekly intervals from 20 healthy subjects for ten weeks in this prospective BV study. Serum “intact PTH” concentrations were measured with electrochemiluminescence method. Biological variation parameters were estimated using the approach proposed by Fraser. Results The values of within-subject biological variation (CVI), between-subject biological variation (CVG), analytical variation (CVA), reference change value (RCV) and individuality index (II) for serum PTH were 21.1%, 24.9%, 3.8%, 59.4% and 0.8%, respectively. Within-subject biological variation and CVG were also determined according to gender separately; 18.5% and 24.0%; 26.2% and 18.6% for male and female, respectively. Calculated desirable precision and bias goals were < 10.6% and < 6.3%, respectively. Conclusion This study may contribute to BV data on serum PTH as it includes a sufficient number of volunteers from both genders over an acceptable period of time. We do not recommend the usage of population-based reference intervals for serum PTH concentrations. Reference change value may be helpful for the evaluation of serial serum PTH results. Nonetheless, evaluation of data according to gender is necessary when setting analytical performance specifications.
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Affiliation(s)
- Müjgan Ercan
- Faculty of Medicine, Department of Biochemistry, Harran University, Şanlıurfa, Turkey
| | - Emiş Deniz Akbulut
- Biochemistry Laboratory, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Esin Avcı
- Faculty of Medicine, Department of Biochemistry, Pamukkale University, Denizli, Turkey
| | - Çiğdem Yücel
- Biochemistry Laboratory, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Esra Fırat Oğuz
- Biochemistry Laboratory, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Turan Turhan
- Biochemistry Laboratory, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Muhittin Serdar
- Faculty of Medicine, Department of Biochemistry, Acıbadem University, İstanbul, Turkey
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31
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Pinto RVL, Rodrigues G, Simões RL, Porto LC. Analysis of Post-Sample Collection EDTA Effects on Mean Platelet Volume Values in Relation to Overweight and Obese Patient Status. Acta Haematol 2019; 142:149-153. [PMID: 31189163 DOI: 10.1159/000499101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mean platelet volume (MPV) may be a useful biomarker for platelet activation in obese patients. However, storage duration and use of anticoagulant K3-ethylenediaminetetraacetic acid (EDTA) may interfere with these measurements. OBJECTIVES The aim of this study was to measure the variability of MPV in obese patients following exposure to EDTA. METHOD A total of 160 patients were divided into 3 groups according to body mass index (BMI; normal: <25 kg/m2; overweight: 25-30 kg/m2; obese: >30 kg/m2). Blood was collected in sterile tubes containing K3-EDTA. Blood cell counts were obtained using the CELL-DYN Ruby system immediately and 1, 2, and 3 h after collection. RESULTS MPV was found to be directly proportional to BMI. With the addition of EDTA, MPV was increased in the first hour after collection; MPV then decreased to levels that were lower than initial baseline measurements. CONCLUSIONS K3-EDTA use alters platelet volume. The time from collection to measurement should be standardized to reduce MPV value variance. MPV should be determined within 1 h of collection to avoid anticoagulant use-related interference.
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Affiliation(s)
- Renata V L Pinto
- Laboratório Central, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Genilson Rodrigues
- Laboratório de Farmacologia Celular e Molecular, Departamento de Biologia Celular, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael L Simões
- Laboratório de Farmacologia Celular e Molecular, Departamento de Biologia Celular, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luís Cristóvão Porto
- Serviço de Patologia Clínica, Piquet Carneiro Policlínica, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil,
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Abstract
Inflammatory bowel disease (IBD) denotes a group of chronic incurable disorders characterized by relapsing-remitting inflammation of the gastrointestinal tract. IBD represents a growing global burden with a prevalence exceeding 0.3% in the Western world and an accelerating incidence in newly industrialized countries. The target for treating IBD has shifted in recent years from symptom control to mucosal healing (MH), which has been shown to be associated with favorable long-term outcomes. The gold standard for ascertaining MH is endoscopic assessment, but endoscopy is limited by its invasive nature, high cost, and finite availability. Surrogate biomarkers are therefore of great utility. Calprotectin, a cytosolic protein derived predominantly from neutrophils, is now widely used in this capacity. Calprotectin is found in various bodily fluids at concentrations proportional to the degree of inflammation, including in feces at levels roughly six times higher than in the blood. Fecal calprotectin (FCP) therefore reflects intestinal inflammation. Various assays, including point-of-care and home-based tests, are now available for measuring FCP. FCP is used for screening purposes, to aid in distinguishing inflammatory from non-inflammatory gastrointestinal conditions like irritable bowel syndrome (IBS), as well as in the monitoring of known IBD. The aims of this review are to provide an overview of the methods used to measure FCP and to review the evidence supporting the use of FCP in IBD, particularly as it pertains to screening, monitoring and predicting disease relapse.
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Affiliation(s)
- Amanda Ricciuto
- a Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children , University of Toronto , Toronto , Canada
| | - Anne M Griffiths
- a Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children , University of Toronto , Toronto , Canada
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33
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Agirbasli M, Aksoy A. Letter by Agirbasli and Aksoy Regarding Article, "Associations of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Mass Index With Mortality and Cardiovascular Outcomes in the General Population". Circulation 2019; 139:e911-e912. [PMID: 31059319 DOI: 10.1161/circulationaha.118.038950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mehmet Agirbasli
- Departments of Cardiology (M.A.), Medeniyet University School of Medicine, Goztepe Kadikoy, Istanbul, Turkey
| | - Alperen Aksoy
- Clinical Biochemistry (A.A.), Medeniyet University School of Medicine, Goztepe Kadikoy, Istanbul, Turkey
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Performance of plasma free metanephrines in diagnosis of pheochromocytomas and paragangliomas in the population of Asturias. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2019. [DOI: 10.1016/j.endien.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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35
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Martínez-Morillo E, Valdés Gallego N, Eguia Ángeles E, Fernández Fernández JC, Prieto García B, Álvarez FV. Rendimiento de las metanefrinas libres plasmáticas en el diagnóstico de los feocromocitomas y paragangliomas en la población asturiana. ENDOCRINOL DIAB NUTR 2019; 66:312-319. [DOI: 10.1016/j.endinu.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/14/2018] [Accepted: 08/18/2018] [Indexed: 11/30/2022]
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36
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Monneret D, Gellerstedt M, Bonnefont-Rousselot D. Determination of age- and sex-specific 99th percentiles for high-sensitive troponin T from patients: an analytical imprecision- and partitioning-based approach. Clin Chem Lab Med 2019; 56:818-829. [PMID: 29176015 DOI: 10.1515/cclm-2017-0256] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/10/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Detection of acute myocardial infarction (AMI) is mainly based on a rise of cardiac troponin with at least one value above the 99th percentile upper reference limit (99th URL). However, circulating high-sensitive cardiac troponin T (hs-cTnT) concentrations depend on age, sex and renal function. Using an analytical imprecision-based approach, we aimed to determine age- and sex-specific hs-cTnT 99th URLs for patients without chronic kidney disease (CKD). METHODS A 3.8-year retrospective analysis of a hospital laboratory database allowed the selection of adult patients with concomitant plasma hs-cTnT (<300 ng/L) and creatinine concentrations, both assayed twice within 72 h with at least 3 h between measurements. Absence of AMI was assumed when the variation between serial hs-cTnT values was below the adjusted-analytical change limit calculated according to the inverse polynomial regression of analytical imprecision. Specific URLs were determined using Clinical and Laboratory Standards Institute (CLSI) methods, and partitioning was tested using the proportion method, after adjustment for unequal prevalences. RESULTS After outlier removal (men: 8.7%; women: 6.6%), 1414 men and 1082 women with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 were assumed as non-AMI. Partitioning into age groups of 18-50, 51-70 and 71-98 years, the hs-cTnT 99th URLs adjusted on French prevalence were 18, 33, 66 and 16, 30, 84 ng/L for men and women, respectively. Age-partitioning was clearly required. However, sex-partitioning was not justified for subjects aged 18-50 and 51-70 years for whom a common hs-cTnT 99th URLs of about 17 and 31 ng/L could be used. CONCLUSIONS Based on a laboratory approach, this study supports the need for age-specific hs-cTnT 99th URLs.
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Affiliation(s)
- Denis Monneret
- Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP), Paris, France
| | - Martin Gellerstedt
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG-Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,School of Business, Economics and IT, University West, Göteborg, Sweden
| | - Dominique Bonnefont-Rousselot
- Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP), Paris, France.,Faculty of Pharmacy, Department of Biochemistry, Paris Descartes University, Paris, France.,CNRS UMR8258 - INSERM U1022, Faculty of Pharmacy, Paris Descartes University, Paris, France
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Rimac V, Lapic I, Kules K, Rogic D, Miler M. Implementation of the Autovalidation Algorithm for Clinical Chemistry Testing in the Laboratory Information System. Lab Med 2018; 49:284-291. [PMID: 29432621 DOI: 10.1093/labmed/lmx089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective Autovalidation algorithm should be properly designed with clearly defined criteria and any data that do not meet the criteria, must be reviewed and manually validated. The aim was to define the rules for autovalidation in our laboratory information system (LIS), and validate the algorithm prior to its implementation in routine laboratory work. Methods Autovalidation was implemented for all routine serum biochemistry tests. The algorithm included analytical measurement ranges (AMR), delta check, critical values, serum indices and all preanalytical and analytical flags from the analyzer. Results In the validation process 9805 samples were included, and 78.3% (7677) of all samples were autovalidated. The highest percentage of non-validated samples (54.9%) refers to those with at least one result outside the method linearity ranges (AMR criteria) while critical values were observed to be the least frequent criterion for stopping autovalidation (1.8%). Also, 38 samples were manually validated as they failed to meet the autovalidation criteria. Conclusion Implementation of algorithm for autovalidation in our institution resulted in the redesign of the existing LIS. This model of the autovalidation algorithm significantly decreased the number of manually validated test results and can be used as a model for introducing autovalidation in other laboratory settings.
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Affiliation(s)
- Vladimira Rimac
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ivana Lapic
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Dunja Rogic
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marijana Miler
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
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Falay M, Senes M, Korkmaz S, Turhan T, Okay M, Öztürk BA, Yücel D, Ozet G. Biological variation estimates of prothrombin time, activated partial thromboplastin time, and fibrinogen in 28 healthy individuals. Int J Lab Hematol 2018; 40:721-725. [DOI: 10.1111/ijlh.12910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Mesude Falay
- Hematology; Ankara Numune Training and Research Hospital; Ankara Turkey
| | - Mehmet Senes
- Biochemistry; Saglik Bakanligi Ankara Egitim ve Arastirma Hastanesi; Ankara Turkey
| | - Selcuk Korkmaz
- Biostatistics; Trakya Universitesi Tip Fakultesi; Edirne Turkey
| | - Turan Turhan
- Biochemistry; TC Saglik Bakanligi Ankara Numune Egitim ve Arastirma Hastanesi; Ankara Turkey
| | - Murat Okay
- Biochemistry; Ordu Devlet Hastanesi; Ordu Turkey
| | - Berna Afacan Öztürk
- Hematology; Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi; Ankara Turkey
| | - Doğan Yücel
- Biochemistry; Saglik Bakanligi Ankara Egitim ve Arastirma Hastanesi; Ankara Turkey
| | - Gulsum Ozet
- Hematology; Ankara Numune Training and Research Hospital; Ankara Turkey
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39
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Unger G, Benozzi S, Campion A, Pennacchiotti G. Preanalytical phase: Effects of water ingestion during fasting on routine hematological parameters in a small cohort of young women. Clin Chim Acta 2018; 483:126-129. [DOI: 10.1016/j.cca.2018.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022]
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40
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Johnson PR, Gwilt SC, Neville CG. Estimates of Within-Person Biological Variation and Reference Change Values of Serum S100B and NSE Proteins. Clin Chem 2018; 64:866-868. [PMID: 29483103 DOI: 10.1373/clinchem.2017.285973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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41
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Molina A, Guiñon L, Perez A, Segurana A, Bedini JL, Reverter JC, Merino A. State of the art vs biological variability: Comparison on hematology parameters using Spanish EQAS data. Int J Lab Hematol 2018; 40:284-291. [DOI: 10.1111/ijlh.12783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A. Molina
- Hematology External Quality Assessment Laboratory; Biomedical Diagnostic Center; Hospital Clínic of Barcelona; Barcelona Spain
- CORE Laboratory; Biomedical Diagnostic Center; Hospital Clínic of Barcelona; Barcelona Spain
| | - L. Guiñon
- Quality Department; Biomedical Diagnostic Center; Hospital Clínic of Barcelona; Barcelona Spain
| | - A. Perez
- Hematology External Quality Assessment Laboratory; Biomedical Diagnostic Center; Hospital Clínic of Barcelona; Barcelona Spain
| | - A. Segurana
- Hematology External Quality Assessment Laboratory; Biomedical Diagnostic Center; Hospital Clínic of Barcelona; Barcelona Spain
| | - J. L. Bedini
- CORE Laboratory; Biomedical Diagnostic Center; Hospital Clínic of Barcelona; Barcelona Spain
| | - J. C. Reverter
- Hematology External Quality Assessment Laboratory; Biomedical Diagnostic Center; Hospital Clínic of Barcelona; Barcelona Spain
| | - A. Merino
- CORE Laboratory; Biomedical Diagnostic Center; Hospital Clínic of Barcelona; Barcelona Spain
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Lobo R, Jaffe AS, Cahill C, Blake O, Abbas S, Meany TB, Hennessy T, Kiernan TJ. Significance of High-Sensitivity Troponin T After Elective External Direct Current Cardioversion for Atrial Fibrillation or Atrial Flutter. Am J Cardiol 2018; 121:188-192. [PMID: 29221605 DOI: 10.1016/j.amjcard.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/21/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022]
Abstract
External transthoracic direct current (DC) cardioversion is a commonly used method of terminating cardiac arrhythmias. Previous research has shown that DC cardioversion resulted in myocardial injury as evidenced by increased levels of cardiac troponin, even though only minimally. Many of these studies were based on the outdated monophasic defibrillators and older, less sensitive troponin assays. This study aimed to assess the effect of external transthoracic DC cardioversion on myocardial injury as measured by the change in the new high-sensitivity cardiac troponin T (hs-cTnT) using the more modern biphasic defibrillators. Patients who were admitted for elective DC cardioversion for atrial fibrillation or atrial flutter were recruited. Hs-cTnT levels were taken before cardioversion and at 6 hours after cardioversion. A total of 120 cardioversions were performed. Median (twenty-fifth to seventy-fifth interquartile range) cumulative energy was 161 J (155 to 532 J). A total of 49 (41%) patients received a cumulative energy of 300 J or higher. The median hs-cTnT level before cardioversion was 7 ng/L (4 to 11 ng/L) and that after cardioversion was 7 ng/L (4 to 10 ng/L). A Wilcoxon signed-rank test showed no significant difference between pre- and post-cardioversion hs-cTnT levels (Z = -0.940, p = 0.347). In conclusion, external DC cardioversion did not result in myocardial injury within the first 6 hours as measured by high-sensitivity troponin T. Patients who are cardioverted and are found to have a significant increase in cardiac troponin after cardioversion should be assessed for causes of myocardial injury and not assumed to have myocardial injury due to the cardioversion itself.
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Affiliation(s)
- Ronstan Lobo
- Department of Cardiology, University Hospital Limerick, Ireland.
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Mayo Clinic Foundation, Rochester, Minnesota
| | - Ciara Cahill
- Department of Cardiology, University Hospital Limerick, Ireland
| | - Ophelia Blake
- Department of Cardiology, University Hospital Limerick, Ireland
| | - Syed Abbas
- Department of Cardiology, University Hospital Limerick, Ireland
| | - Thomas B Meany
- Department of Cardiology, University Hospital Limerick, Ireland
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43
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Buoro S, Carobene A, Seghezzi M, Manenti B, Dominoni P, Pacioni A, Ceriotti F, Ottomano C, Lippi G. Short- and medium-term biological variation estimates of red blood cell and reticulocyte parameters in healthy subjects. ACTA ACUST UNITED AC 2018; 56:954-963. [DOI: 10.1515/cclm-2017-0902] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/22/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
The integrated evaluation of traditional and innovative red blood cell (RBC) and reticulocyte parameters is a rapid, inexpensive and non-invasive diagnostic tools for differential diagnosis and follow-up of anemia and other pathological conditions needing bone marrow erythropoiesis assessment. Therefore, estimating the biological variation (BV) of these parameters is essential for evaluating the analytical performance of hematological analyzers, and for enabling accurate data interpretation and appropriate clinical management. This study aims to define short- and medium-term BV estimates and reference change value (RCV) of RBC and reticulocyte parameters.
Methods:
Twenty-one healthy volunteers participated in the assessment of medium-term BV (blood sampling once/week, five consecutive weeks) and 22 volunteers in the assessment of short-term BV (blood sampling once/day, five consecutive days) using Sysmex XN. Outlier analysis was performed before CV-ANOVA, to determine BV estimates with confidence intervals (CI).
Results:
Medium- and short-term within-subject BV were between 0.3% and 16.4% and 0.2%–10.4% (MCH and IRF), respectively, whereas medium and short-term between-subjects BV ranged between 0.9% and 66.6% (MCHC and Micro-R) and 1.4%–43.6% (MCHC and IRF), respectively. The RCVs were similar for all parameters in both arms of the study, except for hemoglobin, RDW-CV and MCV.
Conclusions:
This study allowed for estimating the BV of many RBC and reticulocyte parameters, some of which have not been currently explored. For RBC, hemoglobin, RDW-CV and MCV it seems advisable to use RCV calculated according to monitoring time and/or differentiated by sex. As regards analytical goals, we suggest using the most stringent targets found in the short-term arm of this study.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory , Papa Giovanni XXIII Hospital , Piazza OMS , 1 – 24127 Bergamo , Italy , Phone: (+039) 0352674550, Fax: (+039) 0352674939
| | - Anna Carobene
- Medical Laboratory Service, San Raffaele Hospital , Milan , Italy
| | - Michela Seghezzi
- Clinical Chemistry Laboratory , Papa Giovanni XXIII Hospital , Bergamo , Italy
| | - Barbara Manenti
- Clinical Chemistry Laboratory , Papa Giovanni XXIII Hospital , Bergamo , Italy
| | - Paola Dominoni
- Clinical Chemistry Laboratory , Papa Giovanni XXIII Hospital , Bergamo , Italy
| | | | - Ferruccio Ceriotti
- Central Laboratory , Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry , University of Verona , Verona , Italy
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Alquézar-Arbé A, Sionis A, Ordoñez-Llanos J. Cardiac troponins: 25 years on the stage and still improving their clinical value. Crit Rev Clin Lab Sci 2017; 54:551-571. [PMID: 29226754 DOI: 10.1080/10408363.2017.1410777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Twenty-five years ago, non-isotopic immunoassays for measuring the cardiac specific isoforms of troponin I (cTnI) and T (cTnT) were developed. Both biomarkers radically changed the diagnosis, prognosis, and therapy indication of acute coronary syndromes (ACS) and, particularly, of myocardial infarction (MI). However, cardiac troponins (cTn) rapidly demonstrated their usefulness in other cardiac and non-cardiac conditions, a part of the ischemic coronary diseases. Consequently, the number of patients to be tested for cTn and the number of tests requested to clinical laboratories sharply increased. Though the manufacturers continuously improved the analytical characteristics of the first cTn assays and produced different cTn assay "generations", the universal definition of myocardial infarction required less-than-available analytical imprecision at the cTn concentration used to assess MI (i.e. the 99th reference percentile). To address the clinical requirements, manufacturers developed the high-sensitivity cTn (hs-cTn) assays that allow to measure the 99th reference percentile with adequate precision, to detect cTn in many healthy subjects and, hence, to calculate the hs-cTn biological variation and especially to observe in very short time intervals serial differences in hs-cTn attributable to cardiac ischemia. Since the number of patients attending the emergency departments (ED) for a suspected ACS or MI is increasing, the improved properties of hs-cTn assays, allowing faster and safer patient assessment, will help to alleviate the sometimes overcrowded EDs. However, there are many biological, analytical, and clinical factors that can influence the true hs-cTn values of a patient. Clinicians and laboratory professionals should know about them for the best interpretation of the otherwise largely useful hs-cTn measurements. In conclusion, 25 years after their introduction for clinical use, "cTn are still on the stage and improving their clinical value".
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Affiliation(s)
| | - Alessandro Sionis
- b Cardiology Department, Acute and Intensive Cardiac Care Unit, IIB-Sant Pau, CIBER-CV , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.,c Faculty of Medicine , Universitat de Barcelona , Barcelona , Spain
| | - Jorge Ordoñez-Llanos
- d Clinical Biochemistry Department , Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau , Barcelona , Spain.,e Biochemistry and Molecular Biology Department , Universitat Autònoma , Barcelona , Spain.,f Task Force on Clinical Application of Cardiac Biomarkers , International Federation of Clinical Chemistry , Milan , Italy
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45
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Benozzi SF, Unger G, Campion A, Pennacchiotti GL. Fasting conditions: Influence of water intake on clinical chemistry analytes. Biochem Med (Zagreb) 2017; 28:010702. [PMID: 29187795 PMCID: PMC5701773 DOI: 10.11613/bm.2018.010702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 10/08/2017] [Indexed: 11/01/2022] Open
Abstract
Introduction Currently available recommendations regarding fasting requirements before phlebotomy do not specify any maximum water intake volume permitted during the fasting period. The aim was to study the effects of 300 mL water intake 1 h before phlebotomy on specific analytes. Materials and methods Blood was collected from 20 women (median age (min-max): 24 (22 - 50) years) in basal state (T0) and 1 h after 300 mL water intake (T1). Glucose, total proteins (TP), urea, creatinine, cystatin C, total bilirubin (BT), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides (Tg), uric acid (UA), high-sensitivity C-reactive protein, gamma-glutamyl transferase (GGT), aspartate-aminotransferase (AST), alanine-aminotransferase and lactate-dehydrogenase (LD) were studied. Results were analyzed using Wilcoxon test. Mean difference (%) was calculated for each analyte and was further compared with reference change value (RCV). Only mean differences (%) higher than RCV were considered clinically significant. Results Significant differences (median T0vs median T1, P) were observed for TP (73 vs 74 g/L, 0.001); urea (4.08 vs 4.16 mmol/L, 0.010); BT (12 vs 13 µmol/L, 0.021); total cholesterol (4.9 vs 4.9 mmol/L, 0.042); Tg (1.05 vs 1.06 mmol/L, 0.002); UA (260 vs 270 µmol/L, 0.006); GGT (12 vs 12 U/L, 0.046); AST (22 vs 24 U/L, 0.001); and LD (364 vs 386 U/L, 0.001). Although the differences observed were statistically significant, they were not indicative of clinically significant changes. Conclusions A water intake of 300 mL 1 h prior to phlebotomy does not interfere with the analytes studied in the present work.
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Affiliation(s)
- Silvia F Benozzi
- Bioquímica Clínica I, Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur, Bahía Blanca, Argentina
| | - Gisela Unger
- Bioquímica Clínica I, Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur, Bahía Blanca, Argentina
| | - Amparo Campion
- Bioquímica Clínica I, Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur, Bahía Blanca, Argentina.,Hospital Municipal de Agudos ''Dr. Leónidas Lucero'', Bahía Blanca, Argentina
| | - Graciela L Pennacchiotti
- Bioquímica Clínica I, Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur, Bahía Blanca, Argentina.,Hospital Municipal de Agudos ''Dr. Leónidas Lucero'', Bahía Blanca, Argentina
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Buoro S, Carobene A, Seghezzi M, Manenti B, Pacioni A, Ceriotti F, Ottomano C, Lippi G. Short- and medium-term biological variation estimates of leukocytes extended to differential count and morphology-structural parameters (cell population data) in blood samples obtained from healthy people. Clin Chim Acta 2017; 473:147-156. [DOI: 10.1016/j.cca.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/08/2017] [Indexed: 10/19/2022]
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Lippi G, Adcock D, Simundic AM, Tripodi A, Favaloro EJ. Critical laboratory values in hemostasis: toward consensus. Ann Med 2017; 49:455-461. [PMID: 28042729 DOI: 10.1080/07853890.2016.1278303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The term "critical values" can be defined to entail laboratory test results that significantly lie outside the normal (reference) range and necessitate immediate reporting to safeguard patient health, as well as those displaying a highly and clinically significant variation compared to previous data. The identification and effective communication of "highly pathological" values has engaged the minds of many clinicians, health care and laboratory professionals for decades, since these activities are vital to good laboratory practice. This is especially true in hemostasis, where a timely and efficient communication of critical values strongly impacts patient management. Due to the heterogeneity of available data, this paper is hence aimed to analyze the state of the art and provide an expert opinion about the parameters, measurement units and alert limits pertaining to critical values in hemostasis, thus providing a basic document for future consultation that assists laboratory professionals and clinicians alike. KEY MESSAGES Critical values are laboratory test results significantly lying outside the normal (reference) range and necessitating immediate reporting to safeguard patient health. A broad heterogeneity exists about critical values in hemostasis worldwide. We provide here an expert opinion about the parameters, measurement units and alert limits pertaining to critical values in hemostasis.
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Affiliation(s)
- Giuseppe Lippi
- a Section of Clinical Biochemistry, University of Verona , Verona , Italy
| | - Dorothy Adcock
- b Colorado Coagulation, Laboratory Corporation of America® Holdings , Englewood , CO , USA
| | - Ana-Maria Simundic
- c Department of Medical Laboratory Diagnostics , University Hospital Sveti Duh , Zagreb , Croatia
| | - Armando Tripodi
- d Angelo Bianchi Bonomi, Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health , Università degli Studi di Milano and IRCCS Cà Granda Maggiore Hospital Foundation , Milano , Italy
| | - Emmanuel J Favaloro
- e Department of Haematology, Sydney Centres for Thrombosis and Haemostasis , Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital , Westmead , New South Wales , Australia
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48
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Delanaye P, Glassock RJ, De Broe ME. Epidemiology of chronic kidney disease: think (at least) twice! Clin Kidney J 2017; 10:370-374. [PMID: 28617483 PMCID: PMC5466090 DOI: 10.1093/ckj/sfw154] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/27/2016] [Indexed: 12/11/2022] Open
Abstract
The introduction of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines has substantially contributed to the early detection of different stages of chronic kidney disease (CKD). Several recent studies from different parts of the world mention a CKD prevalence of between 8 and 13%. There are several reasons the CKD prevalence found in a study of a particular population is clearly overestimated. The structure of the population pyramid (young or older age) of the study sample may result in high or low CKD prevalence. The absence of using an isotope dilution mass spectrometry creatinine assay can be the source of high bias in CKD prevalence. In addition, using an arbitrary single threshold of estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2) for classifying CKD leads to a substantial 'overdiagnosis' (false positives) in the elderly (>65 years of age), particularly in those without albuminuria (or proteinuria), haematuria or hypertension. It also results in a significant 'underdiagnosis' (false negatives) in younger individuals with an eGFR >60 mL/min/1.73 m2 and below the third percentile for their age/gender category. The use of third percentile eGFR rates as a cut-off based on age/gender-specific reference values of eGFR allows the detection of these false positives and negatives. In the present article, we focus on an important and frequently omitted criterion in epidemiological studies: chronicity. Indeed, the two most important factors introducing a high number (up to 50%) of false positives are lack of confirming proteinuria and the absence of proof of chronicity of the eGFR found at first screening. There is an urgent need for quality studies of the prevalence of CKD using representative randomized samples of the population, applying the KDIGO guidelines correctly.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology Dialysis Transplantation, CHU Sart Tilman, University of Liège, Liège, Belgium
| | - Richard J. Glassock
- Department of Medicine, David Geffen School of Medicine at UCLA, Laguna Niguel, CA, USA
| | - Marc E. De Broe
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
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49
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Buoro S, Seghezzi M, Manenti B, Pacioni A, Carobene A, Ceriotti F, Ottomano C, Lippi G. Biological variation of platelet parameters determined by the Sysmex XN hematology analyzer. Clin Chim Acta 2017; 470:125-132. [PMID: 28479317 DOI: 10.1016/j.cca.2017.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/27/2017] [Accepted: 05/04/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND This study was aimed to define the short- and medium-term biological variation (BV) estimates, the index of individuality and the reference change value (RCV) of platelet count, platelet distribution width, mean platelet volume, platelet larger cell ratio, plateletcrit and immature platelet fraction. METHODS The study population consisted of 43 health subjects, who participated to the assessment of medium-term (21 subjects; blood sampling once a week for 5 consecutive weeks) and short-term (22 subjects; blood sampling once a day for 5 consecutive days) BV study, using Sysmex XN-module. Eight subjects were also scheduled to participate to both phases. The data were subject to outlier analysis prior to CV-ANOVA, to determine the BV estimates with the relative confidence intervals. RESULTS The medium-term and short-term within-subject BV (CVI) was comprised between 2.3 and 7.0% and 1.1-8.6%, whereas the medium-term and short-term between-subjects BV (CVG) was comprised between 7.1 and 20.7% and 6.8-48.6%. The index of individuality and index of heterogeneity were always respectively <0.6 and >0.63 for all the parameters, in both arms of the study. The RCVs were similar for all parameters, in both arms of the study. CONCLUSION This study allowed to define the BV estimates of many platelet parameters, some of them unavailable in literature. The kinetics of platelet turnover suggests the use of short-term BV data for calculating analytical goals and RCV. The correct clinical interpretation of platelet parameters also necessitates that each laboratory estimates local RCV values.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Michela Seghezzi
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Barbara Manenti
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Anna Carobene
- Clinical Laboratory Service, San Raffaele Hospital, Milano, Italy
| | | | | | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Guy J, Wagner-Ballon O, Pages O, Bailly F, Borgeot J, Béné MC, Maynadié M. A 5-color flow cytometric method for extended 8-part leukocyte differential. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 92:498-507. [DOI: 10.1002/cyto.b.21524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/11/2017] [Accepted: 03/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Julien Guy
- Service d'Hématologie Biologique, CHU de Dijon; Dijon France
| | - Orianne Wagner-Ballon
- Département d'Hématologie et d'Immunologie Biologiques; Hôpital Henri Mondor, APHP, UPEC, INSERM U955 IMRB; Créteil France
| | - Olivier Pages
- Service d'Hématologie Biologique, CHU de Dijon; Dijon France
| | - François Bailly
- Service d'Hématologie Biologique, CHU de Dijon; Dijon France
| | - Jessica Borgeot
- Service d'Hématologie Biologique, CHU de Dijon; Dijon France
| | - Marie-C Béné
- Service d'Hématologie Biologique, CHU de Nantes; Nantes France
| | - Marc Maynadié
- Service d'Hématologie Biologique, CHU de Dijon; Dijon France
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