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van der Molen AJ, Krabbe JG, Dekkers IA, Geenen RWF, Bellin MF, Bertolotto M, Brismar TB, Cadamuro J, Correas JM, Heinz-Peer G, Langlois MR, Mahnken AH, Ozben T, Quattrocchi CC, Radbruch A, Reimer P, Roditi G, Romanini L, Sebastià C, Simundic AM, Stacul F, Clement O. Analytical interference of intravascular contrast agents with clinical laboratory tests: a joint guideline by the ESUR Contrast Media Safety Committee and the Preanalytical Phase Working Group of the EFLM Science Committee. Clin Chem Lab Med 2024; 62:608-614. [PMID: 38050439 DOI: 10.1515/cclm-2023-1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023]
Abstract
The Contrast Media Safety Committee of the European Society of Urogenital Radiology has, together with the Preanalytical Phase Working Group of the EFLM Science Committee, reviewed the literature and updated its recommendations to increase awareness and provide insight into these interferences.
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Affiliation(s)
- Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes G Krabbe
- Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Marie-France Bellin
- University Paris-Saclay, AP-HP, University Hospital Bicêtre, Service de Radiologie, BioMaps, Le Kremlin-Bicêtre, France
| | | | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology, Unit of Radiology, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Jean-Michel Correas
- Université de Paris, AP-HP, Groupe Hospitalier Necker, DMU Imagina, Service de Radiologie, Paris, France
| | | | - Michel R Langlois
- Department of Laboratory Medicine, AZ St.-Jan Hospital, Bruges, Belgium
| | - Andreas H Mahnken
- Department of Radiology, Marburg University Hospital, Marburg, Germany
| | - Tomris Ozben
- Department of Clinical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | | | - Alexander Radbruch
- Clinic for Diagnostic and Interventional Neuroradiology, University Clinic Bonn, and German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - Peter Reimer
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Carmen Sebastià
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital Sveti Duh, Zagreb University, Zagreb, Croatia
| | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Trieste, Italy
| | - Olivier Clement
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, Paris, France
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van der Molen AJ, Krabbe JG, Dekkers IA, Geenen RWF, Bellin MF, Bertolotto M, Brismar TB, Cadamuro J, Correas JM, Heinz-Peer G, Langlois MR, Mahnken AH, Ozben T, Quattrocchi CC, Radbruch A, Reimer P, Roditi G, Romanini L, Sebastià C, Simundic AM, Stacul F, Clement O. Analytical interference of intravascular contrast agents with clinical laboratory tests: a joint guideline by the ESUR Contrast Media Safety Committee and the Preanalytical Phase Working Group of the EFLM Science Committee. Eur Radiol 2023:10.1007/s00330-023-10411-x. [PMID: 38060004 DOI: 10.1007/s00330-023-10411-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 12/08/2023]
Abstract
The Contrast Media Safety Committee of the European Society of Urogenital Radiology has, together with the Preanalytical Phase Working Group of the EFLM Science Committee, reviewed the literature and updated its recommendations to increase awareness and provide insight into these interferences. CLINICAL RELEVANCE STATEMENT: Contrast Media may interfere with clinical laboratory tests. Awareness of potential interference may prevent unwanted misdiagnosis. KEY POINTS: • Contrast Media may interfere with clinical laboratory tests; therefore awareness of potential interference may prevent unwanted misdiagnosis. • Clinical Laboratory tests should be performed prior to radiological imaging with contrast media or alternatively, blood or urine collection should be delayed, depending on kidney function.
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Affiliation(s)
- Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes G Krabbe
- Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Marie-France Bellin
- University Paris-Saclay, AP-HP, University Hospital Bicêtre, Service de Radiologie, BioMaps, Le Kremlin-Bicêtre, France
| | | | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology, Unit of Radiology, Karolinska Institutet and Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Jean-Michel Correas
- Université de Paris, AP-HP, Groupe Hospitalier Necker, DMU Imagina, Service de Radiologie, Paris, France
| | | | - Michel R Langlois
- Department of Laboratory Medicine, AZ St.-Jan Hospital, Brugge, Belgium
| | - Andreas H Mahnken
- Department of Radiology, Marburg University Hospital, Marburg, Germany
| | - Tomris Ozben
- Department of Clinical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Alexander Radbruch
- Clinic for Diagnostic and Interventional Neuroradiology, University Clinic Bonn, and German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - Peter Reimer
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Carmen Sebastià
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital Sveti Duh, Zagreb University, Zagreb, Croatia
| | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Trieste, Italy
| | - Olivier Clement
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, 20 Rue LeBlanc, F-75015, Paris, France.
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Gomez-Rioja R, Von Meyer A, Cornes M, Costelloe S, Vermeersch P, Simundic AM, Nybo M, Baird GS, Kristensen GBB, Cadamuro J. Recommendation for the design of stability studies on clinical specimens. Clin Chem Lab Med 2023; 61:1708-1718. [PMID: 37021544 DOI: 10.1515/cclm-2023-0221] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES Knowledge of the stability of analytes in clinical specimens is a prerequisite for proper transport and preservation of samples to avoid laboratory errors. The new version of ISO 15189:2022 and the European directive 2017/746 increase the requirements on this topic for manufacturers and laboratories. Within the project to generate a stability database of European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group Preanalytical Phase (WG-PRE), the need to standardise and improve the quality of published stability studies has been detected, being a manifest deficit the absence of international guidelines for the performance of stability studies on clinical specimens. METHODS These recommendations have been developed and summarised by consensus of the WG-PRE and are intended primarily to improve the quality of sample stability claims included in information for users provided by assay supplier companies, according to the requirements of the new European regulations and standards for accreditation. RESULTS This document provides general recommendations for the performance of stability studies, oriented to the estimation of instability equations in the usual working conditions, allowing flexible adaptation of the maximum permissible error specifications to obtain stability limits adapted to the intended use. CONCLUSIONS We present this recommendation based on the opinions of the EFLM WG-PRE group for the standardisation and improvement of stability studies, with the intention to improve the quality of the studies and the transferability of their results to laboratories.
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Affiliation(s)
- Rubén Gomez-Rioja
- Department of Laboratory Medicine, La Paz-Carlos III-Cantoblanco University Hospital, Madrid, Spain
| | - Alexander Von Meyer
- Institute for Laboratory Medicine and Microbiology Munich Municipal Clinic Group, Munich, Germany
| | - Michael Cornes
- Biochemistry Department, Worcestershire Acute Hospitals NHS Trust, Worcester Royal Hospital, Worcester, UK
| | - Sean Costelloe
- Department of Clinical Biochemistry, Cork University Hospital Group, Cork, England
| | - Pieter Vermeersch
- Department of Laboratory Medicine, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense Universitetshospital, Odense, Denmark
| | | | - Gunn B B Kristensen
- Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
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Cadamuro J, Simundic AM, von Meyer A, Haschke-Becher E, Keppel MH, Oberkofler H, Felder TK, Mrazek C. Diagnostic Workup of Microcytic Anemia: An Evaluation of Underuse or Misuse of Laboratory Testing in a Hospital Setting Using the AlinIQ System. Arch Pathol Lab Med 2023; 147:117-124. [PMID: 35472855 DOI: 10.5858/arpa.2021-0283-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT.— Underuse of laboratory testing has been previously investigated in preselected populations, such as documented malpractice claims. However, these numbers might not reflect real-life situations. OBJECTIVE.— To evaluate the underuse and misuse of laboratory follow-up testing in a real-life hospital patient population with microcytic anemia, using laboratory results ordered during routine patient care. DESIGN.— From all patients in whom a microcytic anemia was detected during routine diagnostics in 2018, all available laboratory data were collected and screened for appropriateness of diagnostic workup of iron deficiency and thalassemia. Subgroup analysis was performed for patient groups with mean corpuscular volume values 75 to 79 μm3 (group 1), 65 to 74 μm3 (group 2), and <65 μm3 (group 3). RESULTS.— A total of 2244 patients with microcytic anemia were identified. Follow-up testing for iron deficiency was not performed in 761 cases (34%). For inconclusive ferritin levels due to elevated C-reactive protein results (n = 336), reticulocyte hemoglobin content or soluble transferrin receptor levels were missing in 86 cases (26%). In patients with suspected thalassemia (n = 127), follow-up testing for hemoglobin variants was not performed in 70 cases (55%). Subgroup analysis showed that the frequency of underuse of iron status as well as thalassemia/hemoglobinopathy testing decreased from group 1 to group 3. When considering relevant preexisting anemia diagnoses, laboratory tests were underused in 904 cases (40.3%). CONCLUSIONS.— Because 40% (n = 904) of the patients with microcytic anemia were potentially not followed up correctly, laboratory specialists are advised to act by implementing demand management strategies in collaboration with clinicians to overcome underuse of laboratory tests and to improve patient safety.
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Affiliation(s)
- Janne Cadamuro
- From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek)
| | - Ana-Maria Simundic
- The Department of Medical Laboratory Diagnostics, Faculty of Pharmacy and Biochemistry, University Hospital Sveti Duh, University of Zagreb, Zagreb, Croatia (Simundic)
| | - Alexander von Meyer
- The Institute for Laboratory Medicine and Medical Microbiology, München Clinic, Munich, Germany (von Meyer)
| | - Elisabeth Haschke-Becher
- From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek)
| | - Martin H Keppel
- From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek)
| | - Hannes Oberkofler
- From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek)
| | - Thomas K Felder
- From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek)
| | - Cornelia Mrazek
- From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek)
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Cadamuro J, Simundic AM. The preanalytical phase – from an instrument-centred to a patient-centred laboratory medicine. Clin Chem Lab Med 2022; 61:732-740. [PMID: 36330758 DOI: 10.1515/cclm-2022-1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Abstract
In order to guarantee patient safety, medical laboratories around the world strive to provide highest quality in the shortest amount of time. A major leap in quality improvement was achieved by aiming to avoid preanalytical errors within the total testing process. Although these errors were first described in the 1970s, it took additional years/decades for large-scale efforts, aiming to improve preanalytical quality by standardisation and/or harmonisation. Initially these initiatives were mostly on the local or national level. Aiming to fill this void, in 2011 the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group “Preanalytical Phase” (WG-PRE) was founded. In the 11 years of its existence this group was able to provide several recommendations on various preanalytical topics. One major achievement of the WG-PRE was the development of an European consensus guideline on venous blood collection. In recent years the definition of the preanalytical phase has been extended, including laboratory test selection, thereby opening a huge field for improvement, by implementing strategies to overcome misuse of laboratory testing, ideally with the support of artificial intelligence models. In this narrative review, we discuss important aspects and milestones in the endeavour of preanalytical process improvement, which would not have been possible without the support of the Clinical Chemistry and Laboratory Medicine (CCLM) journal, which was one of the first scientific journals recognising the importance of the preanalytical phase and its impact on laboratory testing quality and ultimately patient safety.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh”, University of Zagreb, Faculty of Pharmacy and Biochemistry , Zagreb , Croatia
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Nikolac Gabaj N, Miler M, Vrtaric A, Celap I, Bocan M, Filipi P, Radisic Biljak V, Simundic AM, Supak Smolcic V, Kocijancic M. Comparison of three different protocols for obtaining hemolysis. Clin Chem Lab Med 2022; 60:714-725. [PMID: 35212494 DOI: 10.1515/cclm-2021-1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hemolysis is associated with erroneous or delayed results. Objectives of the study were to compare four different methods for obtaining hemolysis in vitro on three different analyzers. METHODS Hemolysis was prepared with addition of pure hemoglobin into serum pool, osmotic shock, aspiration through blood collection needle, freezing/thawing of whole blood. Biochemistry parameters were measured in duplicate at Architect c8000 (Abbott, Abbott Park, USA), Beckman Coulter AU680 (Beckman Coulter, Brea, USA) and Cobas 6000 c501 (Roche, Mannheim, Germany), according to manufacturers' declarations. Cut-off value was defined as the highest value of H index with corresponding bias lower than acceptance criteria. RESULTS We were not able to obtain results with freezing protocol. On all three platforms, lowest number of analytes were sensitive to hemolysis at H=0.5 using method of adding free hemoglobin. When osmotic shock was used, cut-off values for the most analytes were generally met at lower values. Hemolysis significantly interfered with measurement of potassium and lactate dehydrogenase (LD) at H=0.5 on all platforms. The most of the tested analytes had the lowest acceptable H index when aspiration method was used. At the low level of hemolysis (H=0.8) glucose, sodium, potassium, chloride, phosphate, and LD were affected on all analyzers, with some additional analytes depending on the manufacturer. CONCLUSIONS Hemolysis interference differs on different analyzers and according to protocol for obtaining hemolysis. Aspiration method was generally the most sensitive to hemolysis interference, while addition of free Hb was the most resistant.
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Affiliation(s)
- Nora Nikolac Gabaj
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Marijana Miler
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Alen Vrtaric
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivana Celap
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marina Bocan
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Medical Biochemistry Laboratory, Polyclinic Salzer, Zagreb, Croatia
| | - Petra Filipi
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Department of Medical Laboratory Diagnostics, University Hospital Centre Split, Split, Croatia
| | - Vanja Radisic Biljak
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ana-Maria Simundic
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Vesna Supak Smolcic
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Clinical Department of Laboratory Diagnostics, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Medical Informatics, Rijeka University School of Medicine, Rijeka, Croatia
| | - Marija Kocijancic
- Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
- Department of Laboratory Medicine, Central Laboratory, University Clinic Halle, Halle, Germany
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Cadamuro J, Baird G, Baumann G, Bolenius K, Cornes M, Ibarz M, Lewis T, Oliveira GL, Lippi G, Plebani M, Simundic AM, von Meyer A. Preanalytical quality improvement - an interdisciplinary journey, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE). Clin Chem Lab Med 2022; 60:cclm-2022-0117. [PMID: 35258235 DOI: 10.1515/cclm-2022-0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
Abstract
Since the beginning of laboratory medicine, the main focus was to provide high quality analytics. Over time the importance of the extra-analytical phases and their contribution to the overall quality became evident. However, as the initial preanalytical processes take place outside of the laboratory and mostly without its supervision, all professions participating in these process steps, from test selection to sample collection and transport, need to engage accordingly. Focusing solely on intra-laboratory processes will not be sufficient to achieve the best possible preanalytical quality. The Working Group for the Preanalytical Phase (WG-PRE) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has provided several recommendations, opinion papers and scientific evidence over the past years, aiming to standardize the preanalytical phase across Europe. One of its strategies to reach this goal are educational efforts. As such, the WG-PRE has organized five conferences in the past decade with the sole focus on preanalytical quality. This year's conference mainly aims to depict the views of different professions on preanalytical processes in order to acquire common ground as basis for further improvements. This article summarizes the content of this 6th preanalytical conference.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Geoffrey Baird
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Gabriele Baumann
- Department of Laboratory Medicine, Pyhrn-Eisenwurzen Klinikum, General Hospital Steyr, Steyr, Austria
| | - Karin Bolenius
- Department of Nursing, Umeå University, The Unit of Research and Education, The County Council of Västerbotten, Umeå, Sweden
| | - Michael Cornes
- Clinical Chemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | - Mercedes Ibarz
- Laboratory Medicine Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Tom Lewis
- North Devon District Hospital, Devon, UK
| | - Gabriel Lima Oliveira
- Clinical Laboratory, Carlo Poma Hospital, Mantua, Italy
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Mario Plebani
- Honorary Professor of Clinical Biochemistry and Clinical Molecular Biology, School of Medicine, University of Padova, Padova, Italy
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Alexander von Meyer
- Institute for Laboratory Medicine and Medical Microbiology, Munich Clinics, Munich, Germany
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Poloni JAT, de Oliveira Vieira A, Dos Santos CRM, Simundic AM, Rotta LN. Survey on reporting of epithelial cells in urine sediment as part of external quality assessment programs in Brazilian laboratories. Biochem Med (Zagreb) 2021; 31:020711. [PMID: 34140834 PMCID: PMC8183119 DOI: 10.11613/bm.2021.020711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Epithelial cells (ECs) are structures regularly observed during urine microscopy analysis. The correct identification of EC subtypes can be useful since renal tubular epithelial cells (RTECs) are clinically relevant. We investigate the urinary ECs report and the judgement of its clinical importance by Brazilian laboratories. Materials and methods A survey with four questions was made available to participants of the Urinalysis External Quality Assessment Program (EQAP) from Controllab. Laboratories composed 3 groups: (1) differentiating ECs subtypes: “squamous”, “transitional” and “RTECs”; (2) differentiating ECs subtypes: “squamous” or “non-squamous” cells; (3) without ECs subtype identification. Participants did not necessarily answer to all questions and the answers were evaluated both within the same laboratory’s category and within different categories of laboratories. Results A total of 1336 (94%) laboratories answered the survey; Group 1, 119/140 (85%) reported that ECs differentiation is important to the physician and 62% want to be evaluated by EQAP, while in Group 3, 455/1110 (41%) reported it is useful to them, however only 25% want be evaluated by EQAP. Group 2 laboratories 37/51 (73%) reported that the information is important, but only 13/52 (25%) are interested in an EQAP with differentiation of the 3 ECs subtypes. Conclusion Most of the laboratories do not differentiate ECs in the three subtypes, despite the clinical importance of RTECs. Education of laboratory staff about the clinical significance of urinary particles should be considered a key priority.
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Affiliation(s)
- José A T Poloni
- Health School, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.,Controllab, Rio de Janeiro, Brazil
| | | | | | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Liane N Rotta
- Department of Diagnostic Methods and Post Graduation Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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von Meyer A, Lippi G, Simundic AM, Cadamuro J. Exact time of venous blood sample collection - an unresolved issue, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE). Clin Chem Lab Med 2021; 58:1655-1662. [PMID: 32549131 DOI: 10.1515/cclm-2020-0273] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
Abstract
Objectives An accurate knowledge of blood collection times is crucial for verifying the stability of laboratory analytes. We therefore aimed to (i) assess if and how this information is collected throughout Europe and (ii) provide a list of potentially available solutions. Methods A survey was issued by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group on Preanalytical Phase (WG-PRE) in 2017, aiming to collect data on preanalytical process management, including sampling time documentation, in European laboratories. A preceding pilot survey was disseminated in Austria in 2016. Additionally, preanalytical experts were surveyed on their local setting on this topic. Finally, the current scientific literature was reviewed on established possibilities of sampling time collection. Results A total number of 85 responses was collected from the pilot survey, whilst 1347 responses from 37 European countries were obtained from the final survey. A minority (i.e. ~13%) of responders to the latter declared they are unaware of the exact sampling time. The corresponding rate in Austria was ~70% in the pilot and ~30% in the final survey, respectively. Answers from 17 preanalytical experts from 16 countries revealed that sampling time collection seems to be better documented for out- than for in-patients. Eight different solutions for sample time documentation are presented. Conclusions The sample collection time seems to be documented very heterogeneously across Europe, or not at all. Here we provide some solutions to this issue and believe that laboratories should urgently aim to implement one of these.
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Affiliation(s)
- Alexander von Meyer
- Institute for Laboratory Medicine and Microbiology, Munich Municipal Clinic Group, Munich, Germany, Phone: +49-179-2940459
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Ana-Maria Simundic
- Department for Medical Laboratory Diagnostics, Clinical Hospital "Sveti Duh", Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
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10
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Simundic AM. La EFLM Academy - ventajas y oportunidades. Adv Lab Med 2021; 2:141-148. [PMID: 37363325 PMCID: PMC10197303 DOI: 10.1515/almed-2021-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 06/28/2023]
Affiliation(s)
- Ana-Maria Simundic
- Departamento de Diagnóstico de Laboratorio Médico, Hospital Universitario “Sveti Duh”, Sveti Duh 64, 10 000Zagreb, Croacia
- Facultad de Farmacia y Bioquímica, Universidad de Zagreb, Zagreb, Croacia
- Presidenta de la EFLM, Milan, Italy
- Directora del Grupo de trabajo del Curso Syllabus sobre el Programa Formativo de la EFLM, Milan, Italy
- Miembro de la Junta Directiva de la IFCC (International Federation of Clinical Chemistry and Laboratory Medicine), Milan, Italy
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11
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Simundic AM. The Academy of the European Federation of Clinical Chemistry and Laboratory Medicine - benefits and opportunities. Adv Lab Med 2021; 2:141-148. [PMID: 37363328 PMCID: PMC10197670 DOI: 10.1515/almed-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
- European Federation of Clinical Chemistry and Laboratory Medicine (EFLM), Milan, Italy
- Task group EFLM Syllabus Course (TG-ESC), Milan, Italy
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12
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Bauçà JM, Imperiali CE, Robles J, Díaz-Garzón J, Vuljanic D, Begovic E, Tikhonov A, Alic L, Nikler A, Simundic AM. Thoughts and expectations of young professionals about the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Clin Chem Lab Med 2021; 59:71-77. [DOI: 10.1515/cclm-2020-0717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/07/2020] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Young laboratory medicine professionals (YLMPs) are the future of clinical laboratories. Although everyday practice shows significant differences among countries, especially during residency training, most of them face the same challenges. Besides promoting scientific, professional and clinical aspects of laboratory medicine in Europe, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) should take into consideration YLMPs’ concerns and interests to help them achieve excellence. The aim of this survey was to assess the opinion and expectations of YLMPs about their involvement in the activities of EFLM.
Methods
An online survey was distributed to YLMPs in Europe through different channels. The questionnaire consisted of 21 items grouped into five sections: demographic questions, opinion about the current status of YLMPs within EFLM, YLMPs network, suggestions and opportunities, and scientific training and exchange. Where appropriate, responses from residents and specialists were compared.
Results
A total of 329 valid responses were obtained from 53 different countries. Countries with the highest number of participants were Spain, Turkey, Croatia and Romania. A significant percentage would like to know more about EFLM and their activities (86%) and wish EFLM promoted networking and scientific exchanges (95%), for instance by means of a European YLMPs network (93%). EFLMLabX project was widely unknown (75%).
Conclusions
YLMPs demand better connection to share concerns about daily healthcare duties, to keep updated and to advance professionally. EFLM needs to improve their advertising through national societies to increase YLMPs’ participation. In addition to international meetings and congresses, respondents have emphasized that workshops and other small group activities would significantly help promote laboratory medicine practice in Europe.
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Affiliation(s)
- Josep Miquel Bauçà
- Department of Laboratory Medicine , Hospital Universitari Son Espases , Palma , Spain
| | | | - Juan Robles
- Department of Laboratory Medicine , Hospital Universitari Son Espases , Palma , Spain
| | - Jorge Díaz-Garzón
- Department of Laboratory Medicine , Hospital Universitario La Paz , Madrid , Spain
| | - Dora Vuljanic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Zagreb , Croatia
| | - Ermin Begovic
- Department of Medical Biochemistry and Immunology , Clinical Center University of Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Aleksei Tikhonov
- Laboratory of Biological Microchips , Engelhardt Institute of Molecular Biology, Russian Academy of Sciences , Moscow , Russia
| | - Lejla Alic
- Department of Medical Biochemistry, Faculty of Medicine , University of Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Ana Nikler
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Zagreb , Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Zagreb , Croatia
- Faculty of Pharmacy and Biochemistry , University of Zagreb , Zagreb , Croatia
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13
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Vermeersch P, Frans G, von Meyer A, Costelloe S, Lippi G, Simundic AM. How to meet ISO15189:2012 pre-analytical requirements in clinical laboratories? A consensus document by the EFLM WG-PRE. Clin Chem Lab Med 2021; 59:1047-1061. [PMID: 33554545 DOI: 10.1515/cclm-2020-1859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022]
Abstract
The International Organization for Standardization (ISO) 15189:2012 standard aims to improve quality in medical laboratories through standardization of all key elements in the total testing process, including the pre-analytical phase. It is hence essential that accreditation bodies, assessing laboratories against ISO15189:2012, pay sufficient attention to auditing pre-analytical activities. However, there are significant differences in how technical auditors interpret the pre-analytical requirements described in ISO15189:2012. In this consensus document, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Pre-analytical Phase (WG-PRE) sets out to review pre-analytical requirements contained in ISO15189:2012 and provide guidance for laboratories on how to meet these requirements. The target audience for this consensus document is laboratory professionals who wish to improve the quality of the pre-analytical phase in their laboratory. For each of the ISO requirements described in ISO15189:2012, members of EFLM WG-PRE agreed by consensus on minimal recommendations and best-in-class solutions. The minimal consensus recommendation was defined as the minimal specification which laboratories should implement in their quality management system to adequately address the pre-analytical requirement described in ISO15189:2012. The best-in-class solution describes the current state-of-the-art in fulfilling a particular pre-analytical requirement in ISO15189:2012. We fully acknowledge that not every laboratory has the means to implement these best-in-class solutions, but we hope to challenge laboratories in critically evaluating and improving their current procedures by providing this expanded guidance.
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Affiliation(s)
- Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven Belgium
| | - Glynis Frans
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Alexander von Meyer
- Institute of Laboratory Medicine and Microbiology, Munich Municipal Hospital Group, Munich, Germany
| | - Seán Costelloe
- Department of Clinical Biochemistry, Cork University Hospital, Cork, Republic of Ireland
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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14
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Radišić Biljak V, Vidranski V, Ružić L, Simundic AM, Vidranski T. Women in sports: the applicability of common national reference intervals for inflammatory and coagulation biomarkers (HemSter Study). Biochem Med (Zagreb) 2020; 31:010702. [PMID: 33380889 PMCID: PMC7745160 DOI: 10.11613/bm.2021.010702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Intensive physical activity causes functional and metabolic changes in the athlete’s organism. The study aimed to verify the common national available reference intervals (RIs) for common inflammatory and screening coagulation tests in a population of healthy young female athletes. Materials and methods One hundred and twenty-one female athletes (age range: 16–34), from various sports disciplines (water polo, handball, volleyball, football, basketball), were included in the study. All participants completed the international physical activity short-form questionnaire. Blood samples were collected between 8–10 am, after an overnight fast, before any physical activity. Reference intervals were determined according to Clinical & Laboratory Standards Institute EP28-A3C Guidelines. Results Calculated RIs for white blood cell count (WBC), prothrombin time (PT), and activated partial thromboplastin time (APTT) ratio were in accordance with the common national RIs. Calculated RI for C-reactive protein (CRP) was lower (< 2.9 mg/L) than the proposed cut-off for a healthy population (< 5.0 mg/L). Reference interval for fibrinogen was higher (1.9–4.4 g/L), than the available RIs (1.8–3.5 g/L). D-dimer cut-off value was set at 852 µg/L fibrinogen equivalent units (FEU), higher than the proposed 500 µg/L FEU for venous thromboembolism (VTE) exclusion. Conclusions The applicability of the available RIs for WBC count, PT, and APTT-ratio was confirmed. However, RIs for CRP and fibrinogen differed significantly than the available common national RIs for the healthy non-athletes’ population. A higher cut-off for D-dimers should be extensively verified before implementation for VTE diagnosis exclusion in a group of healthy young female athletes.
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Affiliation(s)
- Vanja Radišić Biljak
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Valentina Vidranski
- Department on Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Lana Ružić
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Tihomir Vidranski
- Department of Kinesiology, Faculty of Education, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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15
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Wieringa G, Queraltó J, Homšak E, Jassam N, Cavalier E, Svinarov D, Krleža JL, Christou S, Pikner R, Larsen TR, Tomberg K, Linko-Parvinen A, Sapin V, Baum H, Kroupis C, Bagoly Z, Costelloe S, Sciacovelli L, Stasulans J, Vitkus D, Meunier D, Solnica B, Reguengo H, Mambet C, Kovac G, Krhin B, Ohlson M, Buhagiar G, Simundic AM. A proposed Common Training Framework for Specialists in Laboratory Medicine under EU Directive 2013/55/EC (The Recognition of Professional Qualifications). Clin Chem Lab Med 2020; 59:505-512. [PMID: 33554548 DOI: 10.1515/cclm-2020-1504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022]
Abstract
European Union (EU) Directive 2013/55/EC (The Recognition of Professional Qualifications) allows Member States to decide on a common set of minimum knowledge, skills and competences that are needed to pursue a given profession through a Common Training Framework. To be adopted the framework must combine the knowledge, skills and competences of at least one third of the Member States. Professionals who have gained their qualifications under a Common Training Framework will be able to have these recognised automatically within the Union. The backbone of the European Federation of Clinical Chemistry and Laboratory Medicine's (EFLM) proposed Common Training Framework for non-medical Specialists in Laboratory Medicine is outlined here. It is based on an Equivalence of Standards in education, training, qualifications, knowledge, skills, competences and the professional conduct associated with specialist practice. In proposing the recognition of specialist practice EFLM has identified 15 EU Member States able to meet Equivalence and in whom the profession and/or its training is regulated (an additional EU Commission requirement). The framework supports and contributes to the Directive's enabling goals for increasing professional mobility, safeguarding consumers and ensuring a more equitable distribution of skills and expertise across the Member States. It represents EFLM's position statement and provides a template for professional societies and/or competent authorities to engage with the EU Commission.
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Affiliation(s)
- Gijsbert Wieringa
- European Federation of Clinical Chemistry and Laboratory Medicine, Brussels/Milan, Belgium/Italy
| | - Josep Queraltó
- Spanish Society for Clinical Biochemistry and Molecular Pathology, Madrid, Spain
| | - Evgenija Homšak
- European Federation of Clinical Chemistry and Laboratory Medicine, Brussels/Milan, Belgium/Italy
| | - Nuthar Jassam
- European Federation of Clinical Chemistry and Laboratory Medicine, Brussels/Milan, Belgium/Italy
| | | | | | - Jasna L Krleža
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Spyroula Christou
- Greek Society of Clinical Chemistry and Clinical Biochemistry, Athens, Greece
| | - Richard Pikner
- Czech Society of Clinical Biochemistry, Prague, Czech Republic
| | | | - Karel Tomberg
- Estonian Society of Laboratory Medicine, Tartu, Estonia
| | | | | | - Hannsjorg Baum
- German Society of Clinical Chemistry and Laboratory Medicine, Bonn/Berlin, Germany
| | - Christos Kroupis
- Greek Society of Clinical Chemistry and Clinical Biochemistry, Athens, Greece
| | - Zsuzsa Bagoly
- Hungarian Society of Laboratory Medicine, Debrecen, Hungary
| | - Sean Costelloe
- Association of Clinical Biochemists in Ireland, Dublin, Ireland
| | - Laura Sciacovelli
- The Italian Society of Clinical Biochemistry and Clinical Molecular Biology, Milan, Italy
| | | | - Dalius Vitkus
- Lithuanian Society of Laboratory Medicine, Vilnius, Lithuania
| | | | - Bogdan Solnica
- Polish Society for Laboratory Diagnostics, Warsaw, Poland
| | - Henrique Reguengo
- Portuguese Society of Clinical Chemistry, Genetics and Laboratory Medicine, Porto, Portugal
| | - Cristina Mambet
- Romanian Association of Laboratory Medicine, Bucharest, Romania
| | - Gustav Kovac
- Slovak Society of Clinical Biochemistry, Bratislava, Slovakia
| | - Blaž Krhin
- Slovenian Association for Clinical Chemistry and Laboratory Medicine, Ljublijana, Slovenia
| | - Mats Ohlson
- Swedish Society for Clinical Chemistry, Stockholm, Sweden
| | | | - Ana-Maria Simundic
- European Federation of Clinical Chemistry and Laboratory Medicine, Brussels/Milan, Belgium/Italy
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16
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Radišić Biljak V, Simundic AM. Counting and reporting band count is unreliable practice due to the high inter-observer variability. Clin Chem Lab Med 2020; 58:e134-e137. [PMID: 32126009 DOI: 10.1515/cclm-2019-1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/10/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Vanja Radišić Biljak
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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17
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Radišić Biljak V, Čičak H, Šegulja D, Simundic AM. An Unusually High Plasma Cobalamin in a Male Patient. Clin Chem 2020; 66:858-859. [DOI: 10.1093/clinchem/hvaa033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/18/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Vanja Radišić Biljak
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Helena Čičak
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Dragana Šegulja
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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18
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Saracevic A, Medved I, Hrabric Vlah S, Kozmar A, Bilic-Zulle L, Simundic AM. The association of systemic inflammatory markers with indicators of stress and cardiac necrosis in patients undergoing aortic valve replacement and revascularization surgeries. Physiol Res 2020; 69:261-274. [PMID: 32199011 DOI: 10.33549/physiolres.934243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim was to investigate: changes of inflammatory, stress and cardiac response in patients undergoing open heart surgeries up to five days after the procedure; the association between inflammatory, stress and cardiac response and whether changes in a certain marker can predict short-term patient outcome. Ninety patients were divided into three groups, 30 participants each (on-pump,off-pump revascularization and valve replacement group). The following markers were measured:complete blood count, CRP, IL-6, IL-10, leptin, resistin, monocyte chemoattractant protein-1 (MCP-1), cortisol, CK and hsTnT in 5 points. Resistin increased in all three groups. Lower IL-10 levels were found after the surgery and higher levels of leptin and MCP-1 in the off-pump than in the on-pump group. Off-pump group had higher values of IL-6, IL-10, leptin, resistin and MCP-1 and lower levels of CK and hsTnT 24 after surgery than the on-pump group. We found significant correlation between MCP-1 and resistin. The difference between resistin at time points 2 and 3 significantly predicted transfusion needs; while the difference between CRP and resistin before and at the end of the surgery together with the difference between leukocytes at the end and 24 hours after the surgery predicted the use of inotropic agents/vasopressors. Cardiac surgeries cause an increase of inflammatory, stress and cardiac markers. Only resistin correlated with MCP-1 which confirms the link between resistin secreted form infiltrated macrophages and enhanced release of MCP-1.
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Affiliation(s)
- A Saracevic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.
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Abstract
This case report describes occurrence of unusual, dark brown coloration of citrate plasma and serum samples in a female 68 years old patient admitted into Emergency department (ED). Patient complained of nausea and vomiting, fever up to 38.9°C, colicky pain in abdomen, diminished urinary output and yellowish skin tone. Her medical history included arterial hypertension, hypothyroidism and facial squamous cell carcinoma. For previous two years, she was treated with tuberculostatic therapy for Mycobacterium avium positive interstitial lung disease. Regular follow-up showed no signs of active disease. Upon admission to ED, complete blood count (CBC) analysis showed low red blood count (RBC) (3.76 x1012/L (reference interval (RI) 3.86 – 5.08 x1012/L)), low haemoglobin (Hb) concentration (111 g/L (RI 119 - 157 g/L)) and low haematocrit (Hct) (0.310 L/L (RI 0.360 – 0.470 L/L)). Biochemistry analytes were high, with foremost lactate dehydrogenase (LD) activity (2900 U/L, RI < 240 U/L). After communication with the clinician, methaemoglobin measured in arterial blood gas sample was reported. Patient was admitted to the Intensive care unit and upon reflex testing of haptoglobin, intravascular haemolysis was confirmed. This case indicates that every case of brown coloration of the serum must be promptly communicated to the clinician. Reflex testing assured timely diagnosis and favourable patient outcome.
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Affiliation(s)
- Lora Dukic
- Department of medical laboratory diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Nikolina Maric
- Department of emergency and intensive medicine, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of medical laboratory diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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20
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Lippi G, Simundic AM, Plebani M. Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). ACTA ACUST UNITED AC 2020; 58:1070-1076. [DOI: 10.1515/cclm-2020-0285] [Citation(s) in RCA: 411] [Impact Index Per Article: 102.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/22/2022]
Abstract
Abstract
A novel zoonotic coronavirus outbreak is spreading all over the world. This pandemic disease has now been defined as novel coronavirus disease 2019 (COVID-19), and is sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As the current gold standard for the etiological diagnosis of SARS-CoV-2 infection is (real time) reverse transcription polymerase chain reaction (rRT-PCR) on respiratory tract specimens, the diagnostic accuracy of this technique shall be considered a foremost prerequisite. Overall, potential RT-PCR vulnerabilities include general preanalytical issues such as identification problems, inadequate procedures for collection, handling, transport and storage of the swabs, collection of inappropriate or inadequate material (for quality or volume), presence of interfering substances, manual errors, as well as specific aspects such as sample contamination and testing patients receiving antiretroviral therapy. Some analytical problems may also contribute to jeopardize the diagnostic accuracy, including testing outside the diagnostic window, active viral recombination, use of inadequately validated assays, insufficient harmonization, instrument malfunctioning, along with other specific technical issues. Some practical indications can hence be identified for minimizing the risk of diagnostic errors, encompassing the improvement of diagnostic accuracy by combining clinical evidence with results of chest computed tomography (CT) and RT-PCR, interpretation of RT-PCR results according to epidemiologic, clinical and radiological factors, recollection and testing of upper (or lower) respiratory specimens in patients with negative RT-PCR test results and high suspicion or probability of infection, dissemination of clear instructions for specimen (especially swab) collection, management and storage, together with refinement of molecular target(s) and thorough compliance with analytical procedures, including quality assurance.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement , University of Verona , Piazzale LA Scuro , 37134 Verona , Italy
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital Sveti Duh , Zagreb , Croatia
| | - Mario Plebani
- Department of Laboratory Medicine , University Hospital of Padova , Padova , Italy
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21
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Mrazek C, Simundic AM, Salinas M, von Meyer A, Cornes M, Bauçà JM, Nybo M, Lippi G, Haschke-Becher E, Keppel MH, Oberkofler H, Felder TK, Cadamuro J. Inappropriate use of laboratory tests: How availability triggers demand - Examples across Europe. Clin Chim Acta 2020; 505:100-107. [PMID: 32084382 DOI: 10.1016/j.cca.2020.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The appropriate use of laboratory diagnostics is increasingly at stake. The aim of this study was to depict some paradigmatic examples of under- and overutilization, as well as possible solutions across Europe. METHODS We collected six examples from five European countries where a rise or decline of orders for specific laboratory parameters was observed after organizational changes but without evidence of changes in patient collective characteristics as source of this variation. RESULTS The collected examples were the following: 1-Germany) Switch from a Brain-Natriuretic-Peptide assay to NT-pro Brain-Natriuretic-Peptide assay, resulting in a 374% increase in these analytics; 2-Spain) Implementation of a gatekeeping strategy in tumor marker diagnostics, resulting in a 15-61% reduction of these diagnostics; 3-Croatia) Stepwise elimination of creatine-kinase-MB assay from the laboratory portfolio; 4-UK) Removal of γ-glutamyl transferase from a "liver function" profile, resulting in 82% reduction of orders; 5-Austria) Implementation of a new device for rapid Influenza-RNA detection, resulting in a 450% increase of Influenza testing; 6-Spain) Insourcing of 1,25-(OH)2-Vitamin D measurements, leading to a 378% increase of these analyses. CONCLUSION The six paradigmatic examples described in this manuscript show that availability of laboratory resources may considerably catalyze the demand, thus underscoring that inappropriate use of laboratory resources may be commonplace in routine laboratories all across Europe and most probably beyond. They also demonstrate that the application of simple strategies may assist in overcoming this issue. We believe that laboratory specialists need to refocus on the extra-analytical parts of the testing process and engage more in interdisciplinary patient-care.
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Affiliation(s)
- Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia; Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia
| | - Maria Salinas
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Michael Cornes
- Biochemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | - Josep Miquel Bauçà
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - Mads Nybo
- Dept. of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | | | - Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
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22
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Ibarz M, Cadamuro J, Sumarac Z, Guimaraes JT, Kovalevskaya S, Nybo M, Cornes MP, Vermeersch P, Simundic AM, Lippi G. Clinicians' and laboratory medicine specialists' views on laboratory demand management: a survey in nine European countries. ACTA ACUST UNITED AC 2020; 8:111-119. [PMID: 31990661 DOI: 10.1515/dx-2019-0081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/05/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laboratory tests are an essential aspect of current medical practice and their use has grown exponentially. Several studies however have demonstrated inappropriate use of laboratory testing. This inappropriateness can lead to delayed or wrong diagnosis, negatively impacting patient safety and an increase in health care expenditure. The aim of the present small-scale survey was to obtain information on the current status of demand management in European laboratories, as well as the opinions of laboratory and clinical professionals in this regard. METHODS Two surveys were developed, one for laboratory specialists and one for clinicians, covering information on current use, knowledge and opinions on the possible impact of different demand management strategies on patient outcome and health care costs. Additionally, we asked for the current state and willingness on collaboration of laboratory specialists and clinicians. RESULTS One hundred and fifty responses, 72 laboratory specialists and 78 clinicians, from nine countries were received. Developing local ordering protocols/profiles in collaboration with clinicians was the most used strategy (80.3% of laboratories). Of clinicians, 85.6% considered measures to ensure appropriate use of tests necessary and 100% were interested in advice/information about their indication. Of the laboratory specialists 97.2% were either already participating or willing to participate in multidisciplinary groups on the appropriateness of test demand as were 60.3% of clinicians, and 85.9% of clinicians were interested in attending activities about laboratory test demand management. CONCLUSIONS The results of our survey show that tools to improve the appropriate use of laboratory tests are already regularly used today. Laboratory medicine specialists as well as clinicians are willing to undertake additional shared activities aimed at improving patient-centered laboratory diagnostic workup.
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Affiliation(s)
- Mercedes Ibarz
- Department of Clinical Laboratory, University Hospital Arnau de Vilanova, IRBLleida, Rovira Roure 80, 25198 Lleida, Spain
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Zorica Sumarac
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Pharmacy, Novi Sad, Serbia
| | - Joao Tiago Guimaraes
- Department of Clinical Pathology, Sao Joao Hospital Center, University of Porto, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Svetlana Kovalevskaya
- Clinical Laboratory Diagnostic Department with Course of Molecular Medicine, 1st Pavlov State Medical University, St-Petersburg, Russia
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Michael P Cornes
- Department of Clinical Biochemistry, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Pieter Vermeersch
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Nikler A, Radišić Biljak V, Čičak H, Marić N, Bejuk D, Poloni JAT, Simundic AM. Escherichia coli spheroplasts in a Croatian patient misclassified by two urine sediment analysers as erythrocytes: case report. Biochem Med (Zagreb) 2019; 29:030801. [PMID: 31624465 PMCID: PMC6784421 DOI: 10.11613/bm.2019.030801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/08/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction It has already been reported that subinhibitory concentrations of β-lactam antibiotics can cause abnormal changes of bacterial forms, such as spheroplasts. Herein we report a case of Croatian male patient with Escherichia coli spheroplasts present in urine after treatment with tazobactam, on the tenth day of hospitalization. The aim of this report is to emphasize the inability of imaging based automated urine analysers to recognize some relatively uncommon forms of bacterial presentation in urine sediment. Materials and methods During routine urine analysis, unusual particles were observed in patient urine. Urine sediment was examined by two urine analysers: Atellica 1500 (Siemens, Germany) and Iris iQ200 (Beckman Coulter, USA). Additionally, urine was sent for culture testing to Microbiology department. Results Both urine analysers didn’t indicate presence of bacteria in urine sediment. Unusual particles observed on the tenth day were classified as erythrocytes by both instruments. Dipstick test showed blood trace and microscopic analysis revealed bacteria in urine. Urine culture was positive for Escherichia coli. Careful examination of urine sediment has confirmed that shapes present in urine were abnormal bacterial forms called spheroplasts. Conclusions Imaging based automated urine analysers are not able to recognize bacterial spheroplasts in urine sediment misclassifying it as erythrocytes. Microscopic examination remains the gold standard for urines with blood trace or negative blood, in which erythrocytes are reported by urine analyser in urine sediment. Failure to identify and follow up such cases may lead to inaccurate treatment decisions and puts patient safety at risk.
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Affiliation(s)
- Ana Nikler
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Vanja Radišić Biljak
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Helena Čičak
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Nikolina Marić
- Department of Emergency and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Danijela Bejuk
- Department of Clinical Microbiology and Hospital Infections, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Jose Antonio Tesser Poloni
- Carlos Franco Voegeli Clinical Analysis Laboratory, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.,Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.,Controllab, Rio de Janeiro, Brazil
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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24
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Simundic AM, Filipi P, Vrtaric A, Miler M, Nikolac Gabaj N, Kocsis A, Avram S, Gligorovic Barhanovic N, Bulo A, Cadamuro J, van Dongen-Lases E, Eker P, Vital-E-Silva A, Homsak E, Ibarz M, Labudovic D, Nybo M, Pivovarníková H, Shmidt I, Siodmiak J, Sumarac Z, Vitkus D. Patient's knowledge and awareness about the effect of the over-the-counter (OTC) drugs and dietary supplements on laboratory test results: a survey in 18 European countries. Clin Chem Lab Med 2019; 57:183-194. [PMID: 30055099 DOI: 10.1515/cclm-2018-0579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/24/2018] [Indexed: 12/19/2022]
Abstract
Background Nowadays over-the-counter (OTC) drugs and dietary supplements are widely used. Their use can have a significant impact on the validity of laboratory results. The aim of this multicenter European study was to determine the frequency of consumption of various dietary products and OTC drugs among patients and explore their level of knowledge and awareness about the potential impact of various products on laboratory test results. Methods Eighteen European countries participated in this study. The survey was carried out anonymously on a subsequent series of outpatients (n=200) in each participating country. Included were patients who were referred to the laboratory for blood sampling and who voluntarily agreed to participate in the study. The survey included questions about the frequency of consumption of various products, awareness of the importance of informing physicians and laboratory staff about it and information about influence of preanalytical factors in general on laboratory test results. Results In total, 68% of patients were regularly taking at least one OTC drug or dietary supplement. The frequency of patients consuming at least one OTC drug or dietary supplement differed between countries (p=0.001). Vitamins (38%), minerals (34%), cranberry juice (20%), acetylsalicylic acid (ASA) (17%) and omega fatty acids (17%) were the most commonly used in our study. Conclusions The use of various OTC drugs and dietary supplements is highly prevalent in Europe and patients are often not willing to disclose this information to the laboratory staff and ordering physician. The education of both patients and healthcare staff is needed.
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Affiliation(s)
- Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital Sveti Duh, Zagreb, Croatia, E-mail:
| | - Petra Filipi
- Department of Medical Laboratory Diagnostics, University Hospital Centre Split, Split, Croatia
| | - Alen Vrtaric
- Department of Clinical Chemistry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Marijana Miler
- Department of Clinical Chemistry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- Department of Clinical Chemistry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Andrea Kocsis
- Department of Laboratory Diagnostics, Jósa University Hospital, Mátészalka, Fehérgyarmat, Nyírbátor, Hungary
| | - Sanja Avram
- Department for Laboratory Diagnostics, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | | | - Anyla Bulo
- Laboratory Department, Clinical Biochemistry Laboratory, University Hospital Center "Mother Teresa", University of Medicine, Tirana, Albania
| | - Janne Cadamuro
- Department of Laboratory Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | | | - Pinar Eker
- Umraniye Research and Training Hospital, Istanbul, Turkey
| | | | - Evgenija Homsak
- Department for Laboratory Diagnostics, University Clinical Centre Maribor, Maribor, Slovenia
| | - Mercedes Ibarz
- Laboratory Medicine Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Danica Labudovic
- Department of ME Biochemistry, School of Medicine, SsCyril and Methodius University in Skopje, Skopje, Macedonia
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Hedviga Pivovarníková
- synlab slovakia s.r.o. Prešov, Private Diagnostic Laboratory, Hospital Jan Adam Reiman, Prešov, Slovakia
| | - Inna Shmidt
- Clinical Diagnostic Laboratory, Clinical Hospital Saint Luke, Saint Petersburg, Russia
| | - Joanna Siodmiak
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Zorica Sumarac
- Policlinic Laboratory Diagnostics Department, Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Dalius Vitkus
- Institute of Biomedical Sciences, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Abstract
Hemolysis is conventionally defined as membrane disruption of red blood cells and other blood cells that is accompanied by subsequent release of intracellular components into the serum or plasma. It accounts for over 60% of blood sample rejections in the laboratory and is the most common preanalytical error in laboratory medicine. Hemolysis can occur both in vivo and in vitro. Intravascular hemolysis (in vivo) is always associated with an underlying pathological condition or disease, and thus careful steps should always be taken by the laboratory to exclude in vivo hemolysis with confidence. In vitro hemolysis, on the other hand, is highly preventable. It may occur at all stages of the preanalytical phase (i.e. sample collection, transport, handling and storage), and may lead to clinically relevant, yet spurious, changes in patient results by interfering with laboratory measurements. Hemolysis interference is exerted through several mechanisms: (1) spectrophotometric interference, (2) release of intracellular components, (3) sample dilution and (4) chemical interference. The degree of interference observed depends on the level of hemolysis and also on the assay methodology. Recent evidence shows that preanalytical practices related to detection and management of hemolyzed samples are highly heterogeneous and need to be standardized. The Working Group for Preanalytical Phase (WG-PRE) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has published many recommendations for facilitating standardization and improvement of this important preanalytical issue. Some key EFLM WG-PRE publications related to hemolysis involve: (i) a call for more transparency and some practical recommendations for improving the harmonization of the automatic assessment of serum indices and their clinical usefulness, specifically the hemolysis index (H-index), (ii) recommendations on how to manage local quality assurance of serum or plasma hemolysis/icterus/lipemia-indices (HIL-indices) and (iii) recommendations on how to detect and manage hemolyzed samples in clinical chemistry testing. In this review we provide a comprehensive overview of hemolysis, including its causes and effects on clinical laboratory assays. Furthermore, we list and discuss the most recent recommendations aimed at managing hemolyzed samples in everyday practice. Given the high prevalence of hemolyzed blood samples, the associated costs, the great heterogeneity in how hemolysis is handled across healthcare settings, countries and continents, and increasing patient cross-border mobility, standardization and quality improvement processes aimed at combatting this important preanalytical problem are clearly warranted.
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Affiliation(s)
- Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", University of Zagreb, Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Geoffrey Baird
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Seán J Costelloe
- Department of Clinical Biochemistry, Cork University Hospital, Cork, Republic of Ireland
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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26
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Simundic AM, Bölenius K, Cadamuro J, Church S, Cornes MP, van Dongen-Lases EC, Eker P, Erdeljanovic T, Grankvist K, Guimaraes JT, Hoke R, Ibarz M, Ivanov H, Kovalevskaya S, Kristensen GBB, Lima-Oliveira G, Lippi G, von Meyer A, Nybo M, De la Salle B, Seipelt C, Sumarac Z, Vermeersch P. Joint EFLM-COLABIOCLI Recommendation for venous blood sampling. Clin Chem Lab Med 2019; 56:2015-2038. [PMID: 30004902 DOI: 10.1515/cclm-2018-0602] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/10/2018] [Indexed: 11/15/2022]
Abstract
This document provides a joint recommendation for venous blood sampling of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) and Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI). It offers guidance on the requirements for ensuring that blood collection is a safe and patient-centered procedure and provides practical guidance on how to successfully overcome potential barriers and obstacles to its widespread implementation. The target audience for this recommendation are healthcare staff members directly involved in blood collection. This recommendation applies to the use of a closed blood collection system and does not provide guidance for the blood collection with an open needle and syringe and catheter collections. Moreover, this document neither addresses patient consent, test ordering, sample handling and transport nor collection from children and unconscious patients. The recommended procedure is based on the best available evidence. Each step was graded using a system that scores the quality of the evidence and the strength of the recommendation. The process of grading was done at several face-to-face meetings involving the same mixture of stakeholders stated previously. The main parts of this recommendation are: 1) Pre-sampling procedures, 2) Sampling procedure, 3) Post-sampling procedures and 4) Implementation. A first draft of the recommendation was circulated to EFLM members for public consultation. WG-PRE-LATAM was also invited to comment the document. A revised version has been sent for voting on to all EFLM and COLABIOCLI members and has been officially endorsed by 33/40 EFLM and 21/21 COLABIOCLI members. We encourage professionals throughout Europe and Latin America to adopt and implement this recommendation to improve the quality of blood collection practices and increase patient and workers safety.
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Affiliation(s)
- Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital "Sveti Duh", Zagreb, Croatia, E-mail:
| | | | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Michael P Cornes
- Department of Clinical Biochemistry, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | | | - Pinar Eker
- Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Tanja Erdeljanovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Joao Tiago Guimaraes
- Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, Porto, Portugal; and EPI Unit,Institute of Public Health, University of Porto, Porto, Portugal
| | - Roger Hoke
- National Association of Phlebotomists, London, UK
| | - Mercedes Ibarz
- Department of Clinical Laboratory, University Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Svetlana Kovalevskaya
- Clinical Laboratory Diagnostic and Pathomorphology Department, Autonomous non-profit organization of additional professional education "Institute of Laboratory Medicine", Moscow, Russia
| | | | - Gabriel Lima-Oliveira
- Section of Clinical Biochemistry, University of Verona, Verona, Italy; andLatin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Barbara De la Salle
- West Hertfordshire Hospitals NHS Trust, Operating UK NEQAS for Haematology and Transfusion, Watford, UK
| | | | - Zorica Sumarac
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Pieter Vermeersch
- Department of Laboratory Medicine, University of Leuven, Leuven, Belgium
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Lippi G, Salvagno GL, Lampus S, Danese E, Gelati M, Bovo C, Montagnana M, Simundic AM. Impact of blood cell counts and volumes on glucose concentration in uncentrifuged serum and lithium-heparin blood tubes. Clin Chem Lab Med 2019; 56:2125-2131. [PMID: 29935113 DOI: 10.1515/cclm-2018-0523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/30/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although it is known that glucose concentration exhibits a time-dependent decay in uncentrifuged serum and lithium-heparin blood tubes, no evidence exists on how this variation may depend on blood cell counts (CBC) and volumes. METHODS Venous blood was drawn from 30 non fasting healthy volunteers into three serum and three lithium-heparin tubes. One serum and lithium-heparin tubes were centrifuged within 15 min after collection and glucose was measured with a hexokinase assay. The second and third serum and lithium-heparin tubes were maintained at room temperature for 1 and 2 h after the first tubes were centrifuged. These other tubes were then centrifuged and glucose was measured. CBC was performed in the first lithium-heparin tube, before centrifugation. RESULTS The mean decrease of glucose was higher in lithium-heparin plasma than in serum (0.33 vs. 0.24 mmol/L/h; p<0.001). Glucose concentration decreased by 7% and 5% per hour in lithium-heparin plasma and serum, respectively. In univariate analysis, the absolute decrease of glucose concentration was associated with sex (higher in men than in women), red blood cell (RBC) count, hematocrit, white blood cell (WBC) count, neutrophils and monocytes in both lithium-heparin plasma and serum. In multivariate analysis, the decrease of glucose concentration remained independently associated with RBC, WBC, neutrophils and monocytes in both sample matrices. No significant association was found with platelet number and erythrocyte or platelet volume. CONCLUSIONS Glucose concentration decrease in uncentrifuged lithium-heparin and serum tubes depends on the baseline number of RBC, WBC, neutrophils and monocytes within the tubes.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Simona Lampus
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Elisa Danese
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Matteo Gelati
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Chiara Bovo
- Medical Direction, University Hospital of Verona, Verona, Italy
| | - Martina Montagnana
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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28
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Cadamuro J, Lippi G, von Meyer A, Ibarz M, van Dongen E, Cornes M, Nybo M, Vermeersch P, Grankvist K, Guimaraes JT, Kristensen GBB, de la Salle B, Simundic AM. European survey on preanalytical sample handling - Part 2: Practices of European laboratories on monitoring and processing haemolytic, icteric and lipemic samples. On behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE). Biochem Med (Zagreb) 2019; 29:020705. [PMID: 31223259 PMCID: PMC6559623 DOI: 10.11613/bm.2019.020705] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/12/2019] [Indexed: 12/31/2022] Open
Abstract
Introduction No guideline currently exists on how to detect or document haemolysis, icterus or lipemia (HIL) in blood samples, nor on subsequent use of this information. The EFLM WG-PRE has performed a survey for assessing current practices of European laboratories in HIL monitoring. This second part of two coherent articles is focused on HIL. Materials and methods An online survey, containing 39 questions on preanalytical issues, was disseminated among EFLM member countries. Seventeen questions exclusively focused on assessment, management and follow-up actions of HIL in routine blood samples. Results Overall, 1405 valid responses from 37 countries were received. A total of 1160 (86%) of all responders stating to analyse blood samples - monitored HIL. HIL was mostly checked in clinical chemistry samples and less frequently in those received for coagulation, therapeutic drug monitoring and serology/infectious disease testing. HIL detection by automatic HIL indices or visual inspection, along with haemolysis cut-offs definition, varied widely among responders. A quarter of responders performing automated HIL checks used internal quality controls. In haemolytic/icteric/lipemic samples, most responders (70%) only rejected HIL-sensitive parameters, whilst about 20% released all test results with general comments. Other responders did not analysed but rejected the entire sample, while some released all tests, without comments. Overall, 26% responders who monitored HIL were using this information for monitoring phlebotomy or sample transport quality. Conclusion Strategies for monitoring and treating haemolytic, icteric or lipemic samples are quite heterogeneous in Europe. The WG-PRE will use these insights for developing and providing recommendations aimed at harmonizing strategies across Europe.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Mercedes Ibarz
- Department of Laboratory Medicine, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Edmee van Dongen
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.,Section of Clinical Chemistry, University of Verona, Verona, Italy.,Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany.,Department of Laboratory Medicine, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain.,Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Clinical Chemistry Department, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Medical Biosciences, Clinical Chemistry, Umea University, Umea, Sweden.,Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, and EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal.,Norwegian Quality Improvement of laboratory examinations (Noklus), Bergen, Norway.,UK NEQAS Haematology, West Hertfordshire Hospitals NHS Trust, operating UK NEQAS for Haematology and Transfusion, Watford, UK.,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | | | - Michael Cornes
- Clinical Chemistry Department, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umea University, Umea, Sweden
| | - Joao Tiago Guimaraes
- Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, and EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Gunn B B Kristensen
- Norwegian Quality Improvement of laboratory examinations (Noklus), Bergen, Norway
| | - Barbara de la Salle
- UK NEQAS Haematology, West Hertfordshire Hospitals NHS Trust, operating UK NEQAS for Haematology and Transfusion, Watford, UK
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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29
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Cadamuro J, Lippi G, von Meyer A, Ibarz M, van Dongen E, Cornes M, Nybo M, Vermeersch P, Grankvist K, Guimaraes JT, Kristensen GBB, de la Salle B, Simundic AM. European survey on preanalytical sample handling - Part 1: How do European laboratories monitor the preanalytical phase? On behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE). Biochem Med (Zagreb) 2019; 29:020704. [PMID: 31223258 PMCID: PMC6559617 DOI: 10.11613/bm.2019.020704] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/12/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Compared to other activities of the testing process, the preanalytical phase is plagued by a lower degree of standardization, which makes it more vulnerable to errors. With the aim of providing guidelines and recommendations, the EFLM WG-PRE issued a survey across European medical laboratories, to gather information on local preanalytical practices. This is part one of two coherent articles, which covers all practices on monitoring preanalytical quality except haemolysis, icterus and lipemia (HIL). Materials and methods An online survey, containing 39 questions dealing with a broad spectrum of preanalytical issues, was disseminated to EFLM member countries. The survey included questions on willingness of laboratories to engage in preanalytical issues. Results Overall, 1405 valid responses were received from 37 countries. 1265 (94%) responders declared to monitor preanalytical errors. Assessment, documentation and further use of this information varied widely among respondents and partially among countries. Many responders were interested in a preanalytical online platform, holding information on various aspects of the preanalytical phase (N = 1177; 87%), in a guideline for measurement and evaluation of preanalytical variables (N = 1235; 92%), and in preanalytical e-learning programs or webinars (N = 1125; 84%). Fewer responders were interested in, or already participating in, preanalytical EQA programs (N = 951; 71%). Conclusion Although substantial heterogeneity was found across European laboratories on preanalytical phase monitoring, the interest in preanalytical issues was high. A large majority of participants indicated an interest in new guidelines regarding preanalytical variables and learning activities. This important data will be used by the WG-PRE for providing recommendations on the most critical issues.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Mercedes Ibarz
- Department of Laboratory Medicine, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Edmee van Dongen
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.,Section of Clinical Chemistry, University of Verona, Verona, Italy.,Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany.,Department of Laboratory Medicine, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain.,Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Clinical Chemistry Department, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Medical Biosciences, Clinical Chemistry, Umea University, Umea, Sweden.,Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, and EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal.,Norwegian Quality Improvement of laboratory examinations (Noklus), Bergen, Norway.,UK NEQAS Haematology, West Hertfordshire Hospitals NHS Trust, operating UK NEQAS for Haematology and Transfusion, Watford, UK.,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | | | - Michael Cornes
- Clinical Chemistry Department, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umea University, Umea, Sweden
| | - Joao Tiago Guimaraes
- Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, and EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Gunn B B Kristensen
- Norwegian Quality Improvement of laboratory examinations (Noklus), Bergen, Norway
| | - Barbara de la Salle
- UK NEQAS Haematology, West Hertfordshire Hospitals NHS Trust, operating UK NEQAS for Haematology and Transfusion, Watford, UK
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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Celap I, Nikolac Gabaj N, Demarin V, Basic Kes V, Simundic AM. Genetic and lifestyle predictors of ischemic stroke severity and outcome. Neurol Sci 2019; 40:2565-2572. [PMID: 31327072 DOI: 10.1007/s10072-019-04006-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Different models that include clinical variables and blood markers have been investigated to predict acute ischemic stroke treatment course and recovery. AIM The aim of the study was to investigate associations between lipid levels, lifestyle factors, hemostatic (F5, F2, SERPINE1, F13A1, and FGB), and atherogenic (APOA5 and ACE) gene variants and acute ischemic stroke (AIS) severity. MATERIALS AND METHODS This study included 250 patients with AIS in which F5, F2, SERPINE1, F13A1, FGB, APOA5, and ACE genotypes were determined. Total cholesterol (TC), high-density cholesterol, low-density cholesterol, and triglycerides concentrations were measured within 24 h of the AIS onset. Examination of the neurological deficit was done using National Institutes of Health Stroke Scale/Score (NIHSS). RESULTS APOA5 genotype [TC + CC] was more frequent (P = 0.026) in patients with the NIHSS score ≥ 21. Univariate regression analysis has shown that triglycerides (OR 0.55, 95% CI 0.34-0.91; P = 0.019), obesity (0.28, 95% CI 0.10-0.73; P = 0.010), age (OR 1.08, 95% CI 1.04-1.13; P < 0.001), and APOA5 genotype (TC + CC) (OR 2.40, 95% CI 1.10-5.25; P = 0.034) are significantly associated with a severe stroke. When all variables were included in model age (OR 1.06, 95% CI 1.01-1.11; P = 0.018), obesity (OR 0.25, 95% CI 0.08-0.77; P = 0.016) and APOA5 genotype (TC + CC) (OR 3.26, 95% CI 1.29-8.23; P = 0.012) remained significant for the risk of severe AIS. CONCLUSION APOA5 genotype (TC + CC), age, and obesity could be used as prognostic risk factors for a very severe stroke (NIHSS ≥ 21).
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Affiliation(s)
- Ivana Celap
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
| | - Nora Nikolac Gabaj
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vida Demarin
- Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vanja Basic Kes
- Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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Cadamuro J, Ibarz M, Cornes M, Nybo M, Haschke-Becher E, von Meyer A, Lippi G, Simundic AM. Managing inappropriate utilization of laboratory resources. ACTA ACUST UNITED AC 2019; 6:5-13. [PMID: 30096052 DOI: 10.1515/dx-2018-0029] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/27/2018] [Indexed: 12/29/2022]
Abstract
Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria, Phone: +43-57255-57263, Fax: +43-57255-23199
| | - Mercedes Ibarz
- Laboratory Medicine Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Michael Cornes
- Clinical Chemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | | | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
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Abstract
Several lines of evidence now confirm that the vast majority of errors in laboratory medicine occur in the extra-analytical phases of the total testing processing, especially in the preanalytical phase. Most importantly, the collection of unsuitable specimens for testing (either due to inappropriate volume or quality) is by far the most frequent source of all laboratory errors, thus calling for urgent strategies for improving blood sample quality and managing data potentially generated measuring unsuitable specimens. A comprehensive overview of scientific literature leads us to conclude that hemolyzed samples are the most frequent cause of specimen non-conformity in clinical laboratories (40-70%), followed by insufficient or inappropriate sample volume (10-20%), biological samples collected in the wrong container (5-15%) and undue clotting (5-10%). Less frequent causes of impaired sample quality include contamination by infusion fluids (i.e. most often saline or glucose solutions), cross-contamination of blood tubes additives, inappropriate sample storage conditions or repeated freezing-thawing cycles. Therefore, this article is aimed to summarize the current evidence about the most frequent types of unsuitable blood samples, along with tentative recommendations on how to prevent or manage these preanalytical non-conformities.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37100 - Verona, Italy
| | - Alexander von Meyer
- Institute for Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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33
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Saracevic A, Dukic L, Simundic AM. Haemolysis and lipemia interfere with resistin and myeloperoxidase BioVendor ELISA assays. Biochem Med (Zagreb) 2019; 29:020703. [PMID: 31015785 PMCID: PMC6457919 DOI: 10.11613/bm.2019.020703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 02/23/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction The aim of our study was to investigate the influence of haemolysis and lipemia on resistin (RES) and myeloperoxidase (MPO) measurement by BioVendor enzyme-linked immunosorbent assays (ELISA). Materials and methods Blood was taken from healthy volunteers into lithium heparin tubes. Plasma samples were spiked with Lipofundin® emulsion (B. Braun Melsungen AG, Germany) for lipemia interference testing. Haemolysed samples were obtained by drawing aliquots of heparinized blood through a 26 gauge needle. Index of haemolysis (H), lipemia (L) and triglyceride concentration were measured on Abbott Architect c8000. Haemoglobin concentration was measured on Sysmex XN-1000. Concentrations of RES and MPO in all samples were determined with RES and MPO ELISA kits (BioVendor, Czech Republic). All measurements were performed in triplicate. Biases from the native samples were calculated for both analytes and compared with an arbitrary value (e.g. ± 10%). Results Triglyceride concentration in the investigated samples ranged from 0.57 to 38.23 mmol/L, which corresponds to L index from - 0.01 to 13.77. Haemoglobin concentration in all samples ranged from 0 to 8 g/L which correspond to H index from 0.05 to 8.77. Both MPO and RES showed significant biases at 1 g/L haemoglobin (58.7% and 66.7%, respectively). Also, both MPO and RES showed significant biases at 4.66 mmol/L triglycerides (33.8% and - 12.2%, respectively). Conclusions Resistin BioVendor assays are affected by haemolysis and lipemia already at low degree of interferent. Haemolysis was found to interfere at 1 g/L haemoglobin for both assays, while lipemia interferes at 4.66 mmol/L of triglycerides.
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Affiliation(s)
- Andrea Saracevic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Lora Dukic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
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Soldo I, Radisic Biljak V, Bakula B, Bakula M, Simundic AM. The diagnostic accuracy of clinical and laboratory parameters in the diagnosis of acute appendicitis in the adult emergency department population - a case control pilot study. Biochem Med (Zagreb) 2019; 28:030712. [PMID: 30429680 PMCID: PMC6214693 DOI: 10.11613/bm.2018.030712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/04/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction The evaluation of patients with suspected appendicitis strives to identify all patients with presenting symptoms while minimizing negative appendectomy rate. The aim of the study was to identify the optimal combination of clinical and laboratory parameters that should facilitate the emergency department surgeon’s definite decision. Materials and methods The study group comprised 120 patients with suspicion of acute appendicitis (AA). In 60 patients the AA diagnosis was confirmed intraoperatively and by histological analysis. Clinical parameters included: appetite, vomiting, diarrhea, dysuria, signs of localized peritonitis and pain migration. Measured laboratory parameters were: C-reactive protein (CRP), complete blood count (CBC) and the urine test strip. Results The control group of patients were more likely to present following symptoms: no changes in appetite (P < 0.001), diarrhea (P = 0.009) and dysuria (P = 0.047). CRP and white blood cell count (WBC) were significantly higher in the group with confirmed AA compared to the control group (44.7 vs. 6.6, and 13.6 ± 3.9 vs. 9.0 ± 3.4, respectively; P < 0.001). The multivariate logistic regression analysis identified lack of appetite (P = 0.013), absence of diarrhea (P = 0.004), and positive finding of signs of localized peritonitis (P = 0.013), as well as WBCs (P < 0.001) and negative urine test strip results (P = 0.009) as statistically significant predictors of AA. The highest percentage of correctly classified cases (82%) was achieved by combination of common clinical exam and basic inexpensive laboratory parameters (WBCs and urine test strip). Conclusions Acute appendicitis in the emergency setting may be successfully ruled in based on elevated WBCs and negative urine test strip in combination with signs of localized peritonitis, lack of appetite and absence of diarrhea. Since CRP did not contribute to the overall diagnostic accuracy, its use in AA diagnostic protocols is of no value.
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Affiliation(s)
- Ivo Soldo
- Surgery Clinic, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Vanja Radisic Biljak
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Branko Bakula
- Surgery Clinic, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Maja Bakula
- Department of Ophthalmology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
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35
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Lippi G, Cadamuro J, von Meyer A, Simundic AM. Practical recommendations for managing hemolyzed samples in clinical chemistry testing. Clin Chem Lab Med 2019; 56:718-727. [PMID: 29373316 DOI: 10.1515/cclm-2017-1104] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/15/2017] [Indexed: 01/04/2023]
Abstract
We suggest here a pragmatic approach for managing results of clinical chemistry testing in hemolyzed samples collected from adults/older children, attempting to balance the need to produce quality laboratory data with clinical urgency of releasing test results. Automatic measurement of the hemolysis index (H-index) in serum or plasma is highly advisable, whilst low-quality assessment of this test remains less good than a visual inspection. Regarding its practical use, when the H-index value does not generate an analytically significant bias, results can be released, whilst when the value is associated with analyte variation in a range between analytically and clinically significant bias (i.e. variation does not exceed the reference change value [RCV]), results of hemolysis-sensitive tests can be released in association with a comment describing the direction in which data are potentially altered, suggesting the need to collect another sample. When the H-index is associated with analyte variation exceeding clinically significant bias (i.e. variation exceeds the RCV), results of hemolysis-sensitive tests should be suppressed and replaced with a comment that biased results cannot be released because the sample is preanalytically compromised and advising the recollection of another sample. If H-index values reach an even higher critical cut-off (i.e. H-index corresponding to a cell-free hemoglobin concentration ≥10 g/L), all laboratory data may be unreliable and should hence be suppressed and replaced with a comment that all data cannot be released because the sample is grossly hemolyzed, also suggesting the recollection of another sample. Due to inaccuracy and imprecision, the use of corrective formulas for adjusting data of hemolysis-sensitive tests is discouraged.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37100 - Verona, Italy
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Alexander von Meyer
- Institute for Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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Luksic AH, Nikolac Gabaj N, Miler M, Dukic L, Bakliza A, Simundic AM. Visual assessment of hemolysis affects patient safety. Clin Chem Lab Med 2018; 56:574-581. [PMID: 29095694 DOI: 10.1515/cclm-2017-0532] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/19/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Manual handling of hemolyzed samples is not standardized and is vulnerable to errors. This study aimed to evaluate laboratory errors due to manual handling of hemolyzed samples and to assess the risk they might have for patient safety. METHODS Data were retrospectively obtained from a laboratory information system for 25 emergency tests from hemolyzed samples. Hemolysis (concentration of free hemoglobin >0.5 g/L) was visually assessed by comparison with a color chart. The reference person reestimated the routinely assessed degree of hemolysis to all samples (n=3185) received in the laboratory in a 1-week period. For each test, the correct and incorrect way of handling results was determined. Risk assessment was performed according to ISO 14971 standard with five categories of risk (S1-S5) and error occurrence (O1-O5). RESULTS In the studied period, the emergency laboratory received 495 hemolyzed samples (15.5%) with a total of 2518 laboratory test requests (15.5%): 102 (20.6%) of the reports from hemolyzed samples had a comment on hemolysis; 31% of the test results were handled incorrectly (20.7% due to the incorrect release of the test result despite hemolysis interference and 10.3% due to unnecessary suppression), accounting for 4.8% of the total test volume. Tests with the highest combination of risk and occurrence rate were troponin T, potassium and total bilirubin. CONCLUSIONS Manual handling of hemolyzed samples may lead to risk of errors in reporting results for troponin T, potassium and total bilirubin, which may have an effect on clinical decision. In addition, unnecessary suppression of the sample results unaffected by hemolysis could affect patient outcome.
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Affiliation(s)
- Ana Helena Luksic
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, Zagreb, Croatia, Phone: +385996913474
| | - Nora Nikolac Gabaj
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marijana Miler
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Lora Dukic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ana Bakliza
- Department of Laboratory Diagnostics, Psychiatric Hospital "Sv. Ivan", Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
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von Meyer A, Cadamuro J, Lippi G, Simundic AM. Call for more transparency in manufacturers declarations on serum indices: On behalf of the Working Group for Preanalytical Phase (WG-PRE), European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Clin Chim Acta 2018; 484:328-332. [DOI: 10.1016/j.cca.2018.03.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
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38
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Culjak M, Gveric Grginic A, Simundic AM. Bacterial contamination of reusable venipuncture tourniquets in tertiary-care hospital. ACTA ACUST UNITED AC 2018; 56:e201-e203. [DOI: 10.1515/cclm-2017-0994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/15/2018] [Indexed: 11/15/2022]
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Lippi G, Cadamuro J, Danese E, Gelati M, Montagnana M, von Meyer A, Salvagno GL, Simundic AM. Internal quality assurance of HIL indices on Roche Cobas c702. PLoS One 2018; 13:e0200088. [PMID: 29979722 PMCID: PMC6034854 DOI: 10.1371/journal.pone.0200088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022] Open
Abstract
Automatic assessment of hemoglobin (H), lipaemia (L) and icterus (I) in serum or plasma (HIL indices) is the mainstay for evaluating sample quality. We planned this study to verify whether in-house prepared internal quality control (IQC) materials may be suitable for quality assurance of HIL indices. Pools containing different values of each of the three HIL indices were prepared from routine plasma samples, divided in aliquots and frozen at -20°C. Stability of frozen materials was assessed by thawing one aliquot of each pool after different days of freezing (1, 4, 8, 15, 22 and 29), and by measuring HIL indices on baseline fresh samples and frozen-thawed aliquots with Roche Cobas c702. Five fresh liquid IQCs materials were also measured at the same time points. Intra-assay and inter-assay imprecision of HIL indices calculated with commercial IQC materials ranged between 1.1-2.0% and 1.6-3.3%, respectively. When target values of HIL indices were calculated using frozen-thawed aliquots, the inter-assay imprecision of in-house prepared materials was optimal, even better than that of commercial liquid IQCs (H-index, 0.8% versus 1.6%; L-index, 2.2% versus 2.5%; I-index, 0.8% versus 3.3%). In conclusion, in-house prepared IQC materials are cost-effective alternatives to commercial liquid IQCs for HIL quality assurance.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Elisa Danese
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Matteo Gelati
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | | | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG, Weiden, Germany
- Institute of Laboratory Medicine, Klinikum St. Marien, Amberg, Germany
| | | | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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40
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Tesija Kuna A, Dukic K, Nikolac Gabaj N, Miler M, Vukasovic I, Langer S, Simundic AM, Vrkic N. Comparison of Enzymatic Assay for HBA1C Measurement (Abbott Architect) With Capillary Electrophoresis (Sebia Minicap Flex Piercing Analyser). Lab Med 2018. [PMID: 29528429 DOI: 10.1093/labmed/lmx090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective To compare the analytical performances of the enzymatic method (EM) and capillary electrophoresis (CE) for hemoglobin A1c (HbA1c) measurement. Methods Imprecision, carryover, stability, linearity, method comparison, and interferences were evaluated for HbA1c via EM (Abbott Laboratories, Inc) and CE (Sebia). Results Both methods have shown overall within-laboratory imprecision of less than 3% for International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) units (<2% National Glycohemoglobin Standardization Program [NGSP] units). Carryover effects were within acceptable criteria. The linearity of both methods has proven to be excellent (R2 = 0.999). Significant proportional and constant difference were found for EM, compared with CE, but were not clinically relevant (<5 mmol/mol; NGSP <0.5%). At the clinically relevant HbA1c concentration, stability observed with both methods was acceptable (bias, <3%). Triglyceride levels of 8.11 mmol per L or greater showed to interfere with EM and fetal hemoglobin (HbF) of 10.6% or greater with CE. Conclusion The enzymatic method proved to be comparable to the CE method in analytical performances; however, certain interferences can influence the measurements of each method.
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Affiliation(s)
- Andrea Tesija Kuna
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Kristina Dukic
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marijana Miler
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ines Vukasovic
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Sanja Langer
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ana-Maria Simundic
- Department for Medical Laboratory Diagnostic, University Hospital Sveti Duh, Zagreb, Croatia
| | - Nada Vrkic
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
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41
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona, Piazzale LA Scuro , 37100 Verona , Italy
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital Sveti Duh , Zagreb , Croatia
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42
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Begcevic I, Brinc D, Dukic L, Simundic AM, Zavoreo I, Basic Kes V, Martinez-Morillo E, Batruch I, Drabovich AP, Diamandis EP. Targeted Mass Spectrometry-Based Assays for Relative Quantification of 30 Brain-Related Proteins and Their Clinical Applications. J Proteome Res 2018; 17:2282-2292. [PMID: 29708756 DOI: 10.1021/acs.jproteome.7b00768] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cerebrospinal fluid (CSF) is a promising clinical sample for identification of novel biomarkers for various neurological disorders. Considering its direct contact with brain tissue, CSF represents a valuable source of brain-related and brain-specific proteins. Multiple sclerosis is an inflammatory, demyelinating neurological disease affecting the central nervous system, and so far there are no diagnostic or prognostic disease specific biomarkers available in the clinic. The primary aim of the present study was to develop a targeted mass spectrometry assay for simultaneous quantification of 30 brain-related proteins in CSF and subsequently to demonstrate assay feasibility in neurological samples derived from multiple sclerosis patients. Our multiplex selected reaction monitoring assay had wide dynamic range (median fold range across peptides = 8.16 × 103) and high assay reproducibility (median across peptides CV = 4%). Candidate biomarkers were quantified in CSF samples from neurologically healthy individuals (n = 9) and patients diagnosed with clinically isolated syndrome (n = 29) or early multiple sclerosis (n = 15).
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Affiliation(s)
- Ilijana Begcevic
- Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario M5S 1A8 , Canada.,Department of Pathology & Laboratory Medicine , Mount Sinai Hospital , Toronto , Ontario M5T 3L9 , Canada
| | - Davor Brinc
- Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario M5S 1A8 , Canada.,Department of Pathology & Laboratory Medicine , Mount Sinai Hospital , Toronto , Ontario M5T 3L9 , Canada.,Department of Clinical Biochemistry , University Health Network , Toronto , Ontario M5G 2C4 , Canada
| | - Lora Dukic
- Department of Medical Laboratory Diagnostics , University Hospital "Sveti Duh" , 10000 Zagreb , Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital "Sveti Duh" , 10000 Zagreb , Croatia
| | - Iris Zavoreo
- University Department of Neurology , Medical School University Hospital "Sestre milosrdnice" , 10000 Zagreb , Croatia
| | - Vanja Basic Kes
- University Department of Neurology , Medical School University Hospital "Sestre milosrdnice" , 10000 Zagreb , Croatia
| | - Eduardo Martinez-Morillo
- Laboratory of Medicine, Department of Clinical Biochemistry , Hospital Universitario Central de Asturias , 33011 Oviedo , Spain
| | - Ihor Batruch
- Department of Pathology & Laboratory Medicine , Mount Sinai Hospital , Toronto , Ontario M5T 3L9 , Canada
| | - Andrei P Drabovich
- Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario M5S 1A8 , Canada.,Department of Clinical Biochemistry , University Health Network , Toronto , Ontario M5G 2C4 , Canada
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario M5S 1A8 , Canada.,Department of Pathology & Laboratory Medicine , Mount Sinai Hospital , Toronto , Ontario M5T 3L9 , Canada.,Department of Clinical Biochemistry , University Health Network , Toronto , Ontario M5G 2C4 , Canada
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Lippi G, Cadamuro J, von Meyer A, Simundic AM. Local quality assurance of serum or plasma (HIL) indices. Clin Biochem 2018; 54:112-118. [DOI: 10.1016/j.clinbiochem.2018.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/08/2018] [Accepted: 02/24/2018] [Indexed: 01/06/2023]
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Abstract
The measurement of fasting plasma glucose may be biased by a time-dependent decrease of glucose in blood tubes, mainly attributable to blood cell metabolism when glycolysis is not rapidly inhibited or blood cells cannot be rapidly separated from plasma. Although glycolysis inhibitors such as sodium fluoride (NaF) in combination with potassium oxalate (KOx) are currently used for overcoming this drawback, their efficacy for stabilizing blood glucose is seemingly limited, and probably lower than that of newer additives such as the citrate buffer. Therefore, we performed a critical analysis of the current scientific literature aimed to generate evidence-based information about the advantages of using citrate buffer in blood tubes compared to the more conventional NaF additive. The results of our systematic overview of the literature show that citrate blood tubes represent a considerable step forward in achieving more accurate and reliable plasma glucose measurements, thereby limiting the risk of underdiagnosing diabetes due to spurious decrease of glucose concentration in uncentrifuged blood specimens, ensuring higher stability of glucose levels over time, while simultaneously producing less hemolysis compared to NaF blood tubes. Therefore, we suggest that the use of this new mixture should be encouraged for achieving a higher degree of accuracy and standardization of plasma glucose measurements.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy.
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | | | - Joao T Guimaraes
- São João Hospital Center, University of Porto, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
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Abstract
BACKGROUND Temporal pattern of lipids changes in stroke patients and its prognostic significance has not yet been fully understood. Our aim was to assess the early temporal changes of lipids in acute ischemic stroke patients and its prognostic significance in predicting stroke outcome. METHODS Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were measured at admission, 24 hours, 48 hours, 72 hours, and at discharge. Stroke outcome was assessed by infarct volume, neurological deficit at discharge and 90 days stroke mortality. We have included only patients for whom blood and all clinical data were available at all time points during the follow-up period. RESULTS In our stroke cohort (n = 52) there was a mean decrease of HDL-cholesterol from admission to discharge (0.32 mmol/L, 23%), accompanied with an increase in triglyceride concentration of 0.3 mmol/L (8%). LDL-cholesterol and total cholesterol had an initial rise at 24 hours, followed by the subsequent fall at 48 hours, 72 hours, and at discharge. Decreased HDL-cholesterol at 48 hours after stroke onset and at discharge is associated with poor patient functional outcome. Patients with large infarct volume had significantly higher concentrations of total cholesterol and LDL-cholesterol at 24 hours, 48 hours, and at discharge than patients with small and medium infarct volume. CONCLUSIONS Early after the onset of acute ischemic stroke there is a marked change in the concentration of serum lipids. Reliable assessment of lipid status cannot be done during the early period after the stroke onset.
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De la Salle B, Meijer P, Thomas A, Simundic AM. Special issue on External Quality Assessment in Laboratory Medicine - current challenges and future trends. Biochem Med (Zagreb) 2017; 27:19-22. [PMID: 28392722 PMCID: PMC5382846 DOI: 10.11613/bm.2017.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Piet Meijer
- ECAT Foundation, Voorschoten, The Netherlands
| | - Annette Thomas
- WEQAS Quality Laboratory, Cardiff and Vale University Health Board, Llanishen, Cardiff, UK
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia; Editor-in-Chief, Biochemia Medica, Zagreb, Croatia
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Simundic AM, Cadamuro J, Cornes M. Biochemia Medica introduces new section: Pre-analytical mysteries. Biochem Med (Zagreb) 2017; 27:418-420. [PMID: 28694732 PMCID: PMC5493178 DOI: 10.11613/bm.2017.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/16/2017] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ana-Maria Simundic
- Editor-in-chief, Biochemia Medica, Zagreb, Croatia.,Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Janne Cadamuro
- Case report Editor, Pre-analytical mysteries, Biochemia Medica, Zagreb, Croatia.,Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Michael Cornes
- Case report Editor, Pre-analytical mysteries, Biochemia Medica, Zagreb, Croatia.,Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
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Lippi G, Simundic AM, Musile G, Danese E, Salvagno G, Tagliaro F. The alcohol used for cleansing the venipuncture site does not jeopardize blood and plasma alcohol measurement with head-space gas chromatography and an enzymatic assay. Biochem Med (Zagreb) 2017; 27:398-403. [PMID: 28694729 PMCID: PMC5493181 DOI: 10.11613/bm.2017.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction This study aimed to establish whether an alcoholic antiseptic, wiped or not before venipuncture, may jeopardize alcohol testing with a commercial enzymatic assay and a reference head-space gas chromatography (GC) technique. Materials and methods Venous blood was collected from 23 healthy volunteers, with two sequential procedures. In the first blood collection, 2 mL of alcoholic antiseptic (0.5% chlorhexidine, 70% ethanol) were place on a gauge pad, the venipuncture site of right arm was cleaned but the antiseptic was not let to dry before phlebotomy. In the second blood collection, 2 mL of the same alcoholic antiseptic were placed on another gauge pad, the venipuncture site of left harm was cleaned and the antiseptic was accurately cleansed before phlebotomy. Ethanol was measured with a reference GC technique in whole blood and EDTA plasma, and a commercial enzymatic assay in EDTA plasma. Results No subject complained about feeling a particular itchy sensation when the alcohol was not wiped before puncturing the vein. The concentration of alcohol in all EDTA plasma samples was always lower than the limit of detection of the enzymatic assay (i.e., 2.2 mmol/L; 0.1 g/L). Similarly, alcohol concentration was also undetectable using a reference GC technique (i.e., < 0.22 mmol/L; 0.01 g/L) in EDTA plasma and whole blood. Conclusion It seems reasonable to conclude that using ethanol-containing antiseptics before venipuncture may not be causes of spurious or false positive results of alcohol measurement at least when ideal venipunctures can be performed.
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Affiliation(s)
- Giuseppe Lippi
- Working Group for Preanalytical Phase (WG-PRE), European Federation for Clinical Chemistry and Laboratory Medicine (EFLM).,Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Ana-Maria Simundic
- Working Group for Preanalytical Phase (WG-PRE), European Federation for Clinical Chemistry and Laboratory Medicine (EFLM).,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | - Giacomo Musile
- Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Elisa Danese
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Gianluca Salvagno
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Franco Tagliaro
- Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
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Habibzadeh F, Simundic AM. Predatory journals and their effects on scientific research community. Biochem Med (Zagreb) 2017; 27:270-272. [PMID: 28694717 PMCID: PMC5493176 DOI: 10.11613/bm.2017.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.,Editor-in-chief, Biochemia Medica, Zagreb, Croatia
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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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