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Laboratory Medicine

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https://www.readbyqxmd.com/read/29165611/a-case-of-hodgkin-lymphoma-mimicking-lymphomatoid-granulomatosis-diagnosed-at-autopsy
#1
Sujal Shah, Megan Smith, Randall Butler
Hodgkin lymphoma and lymphomatoid granulomatosis (LYG) are entities that contain a small number of large, variably Epstein-Barr virus (EBV)-positive neoplastic cells scattered within background non-neoplastic mixed inflammatory infiltrate. The 2 entities can typically be distinguished histologically by the angiocentric and angiodestructive pattern of lymphomatoid granulomatosis (LYG); also, they differ in overall prognosis. Herein, we report a case of Hodgkin lymphoma in a 64-year-old Caucasian woman, diagnosed at autopsy with unusual histologic features and aggressive clinical course that mimicked LYG...
November 20, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29161406/evaluation-of-the-bacterioscan-216dx-for-standalone-preculture-screen-of-preserved-urine-specimens-in-a-clinical-setting
#2
Amity L Roberts, Upasana Joneja, Tatiana Villatoro, Eileen Andris, Judith A Boyle, James Bondi
Background: The BacterioScan 216Dx laser microbial growth monitoring system was evaluated as an option for preurine culture screening of preserved urine specimens at an acute care medical center. Methods: The BacterioScan 216Dx system performance characteristics and the economic impact (cost effectiveness) for the laboratory were assessed. Urinalysis performance compared to urine culture was assessed if urinalysis was ordered as part of the patient care set. Results: When compared to urine culture, the BacterioScan had an overall performance with corresponding 95% confidence intervals of 76% (68-83) sensitivity, 84% (80-87) specificity, 55% (48-63) positive predictive value, and 93% (90-95) negative predictive value for 610 randomly selected preserved urine specimens...
November 17, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29121246/the-reference-intervals-of-thyroid-hormones-for-pregnant-women-in-zhejiang-province
#3
Rulin Sun, Jun Xia
Gestation-specific reference intervals for thyroid hormones are used to estimate thyroid function in pregnant women. This study was to establish the reference intervals for pregnant women in Zhejiang province, China. A total of 9038 cases were recruited. The values of thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine, total thyroxine, and total triiodothyronine were determined by Beckman Coulter DxI-800 analyzers. Our results indicated that the level of TSH declined in the first trimester and then rose as pregnancy progressed...
November 7, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29069509/clinical-and-antibiotic-management-of-urinary-tract-infections-pre-and-postimplementation-of-the-clinitek-auwi-system-from-siemens-to-screen-out-negative-urine-samples-submitted-for-culture-a-retrospective-cohort-study
#4
Mario Gonzalez, Dana Razzano, Alaa Ebid, Finn D Schubert
Objective: To compare patterns of inpatient and outpatient antibiotic use between patients who awaited urine culture results and patients whose urine specimens had been submitted for culture and were screened using the CLINITEK AUWi System. Methods: This quasi-experimental retrospective cohort study included patient records with a urine specimen and hospital admission from 1 month before to 1 month after implementation of the system. We compared data from the pre- and postimplementation groups using the χ2 test or Fisher exact test...
October 23, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29069487/nf-%C3%AE%C2%BAb1-ikk%C3%AE%C2%B5-gene-expression-and-clinical-activity-in-patients-with-rheumatoid-arthritis
#5
Fabiola Lilí Sarmiento Salinas, Jonnathan Guadalupe Santillán Benítez, María Dolores Hernández Navarro, Hugo Mendieta Zerón
Objective: Rheumatoid arthritis (RA) is a systemic and autoimmune disorder whose primary characteristic is the chronic inflammation of joints. The objective of this study was to evaluate whether there was an association between nuclear factor kappa beta1/IKK epsilon (NF-κB1/IKKε) gene expression and clinical activity in RA. Methods: Sixty patients with RA were included in the study: 30 with clinical activity and 30 with clinical remission. NF-κB1/IKKε gene expression was performed by real-time quantitative polymerase chain reaction through relative quantification with Taqman probes...
October 23, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29069422/a-noninvasive-rhizopus-infection-with-a-bladder-fungal-ball-in-a-patient-with-poorly-controlled-diabetes-mellitus
#6
Aaron M T Barnes, Ruben J Crespo-Diaz, Justin Cohenour, Jonathan D Kirsch, Sophie Arbefeville, Patricia Ferrieri
Here we present the first reported case of a noninvasive Rhizopus fungal ball confined to the bladder of a patient with poorly controlled diabetes and right flank pain. The patient developed bilateral hydronephrosis after several hospital admissions for urinary tract infections with multiple failed courses of antibiotics. During cystoscopy to replace a ureteral stent, he was found to harbor a fungal ball in the bladder that was removed and grew Rhizopus in culture. Patient received treatment with amphotericin B and transitioned to long-term posaconazole therapy...
October 23, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29126302/the-clinical-utility-of-measuring-igg-subclass-immunoglobulins-during-immunological-investigation-for-suspected-primary-antibody-deficiencies
#7
Antony R Parker, Markus Skold, David B Ramsden, J Gonzalo Ocejo-Vinyals, Marcos López-Hoyos, Stephen Harding
Measurement of IgG subclass concentrations is a standard laboratory test run as part of a panel to investigate the suspicion of antibody deficiency. The assessment is clinically important when total IgG is within the normal age-specific reference range. The measurement is useful for diagnosis of IgG subclass deficiency, to aid the diagnosis of specific antibody deficiency, as a supporting test for the diagnosis of common variable immunodeficiency, as well as for risk stratification of patients with low IgA...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29126301/coagulation-testing-in-the-core-laboratory
#8
William E Winter, Sherri D Flax, Neil S Harris
Primary hemostasis begins with endothelial injury. VWF, produced by endothelial cells, binds to platelets and links them to subendothelial collagen. Platelet-derived ADP and thromboxane activate non-adhered platelets via their GPIIb/IIIa receptors, allowing these platelets to participate in platelet aggregation. Secondary hemostasis is initiated with the binding of factor VII to extravascular tissue factor (TF). Factors II, VII, IX and X are vitamin K-dependent factors. The role of vitamin K is to assist in the addition of gamma carboxylate groups to glutamic acids in the "GLA" domains of these factors...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29126300/deproteinization-is-necessary-for-the-accurate-determination-of-ammonia-levels-by-glutamate-dehydrogenase-assay-in-blood-plasma-from-subjects-with-liver-injury
#9
Melita Vodenicarovova, Hana Skalska, Milan Holecek
Objective: To determine the effect of presence of high concentrations of nicotinamide adenine dinucleotide (NADH)- and nicotinamide adenine dinucleotide phosphate (NADPH)-consuming enzymes on the accuracy of glutamate dehydrogenase (GLDH) assay for ammonia. Methods: We measured ammonia concentrations using GLDH and NADH or NADPH in blood-plasma specimens and specimens deproteinized by sulfosalicylic acid from CCl4-treated or control rats. The nonspecific oxidation of NADH and NADPH was measured in mixtures without GLDH...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29096030/tacrolimus-a-review-of-laboratory-detection-methods-and-indications-for-use
#10
Derick A Kalt
Tacrolimus (Tac) is an immunosuppressive drug that is used in preventing organ and tissue rejection in patients after transplantation. Tac administration requires frequent and diligent monitoring by physicians to ensure proper dosage and to limit the potential for harmful adverse effects, which can include renal damage, neurotoxicity, and other serious adverse events. Tac is a calcineurin inhibitor, which suppresses the function of T-cells. Its success as an immunosuppressive agent has been well documented in preventing graft-vs-host disease in several types of organ transplants...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29096016/opioid-use-disorders-medication-assisted-treatment-and-the-role-of-the-laboratory
#11
Roger L Bertholf, Gary M Reisfield
Urine drug testing is an essential component in the evaluation and management of individuals with opioid use disorders, including those on buprenorphine or methadone maintenance therapies. Notwithstanding its centrality in adherence monitoring, studies have shown that clinicians have important knowledge deficiencies regarding the ordering and interpretation of drug tests. In this review, we discuss the scope and frequency of testing, the advantages and disadvantages of immunoassay- (presumptive) and liquid chromatograph-mass spectrometry- (definitive) based techniques, indications for definitive testing, medical necessity, and other considerations...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29087481/employee-engagement-is-vital-for-the-successful-selection-of-a-total-laboratory-automation-system
#12
Hoi-Ying E Yu, Myra L Wilkerson
Objective: To concretely outline a process for selecting a total laboratory automation system that connects clinical chemistry, hematology, and coagulation analyzers and to serve as a reference for other laboratories. Methods: In Phase I, a committee including the laboratory's directors and technologists conducted a review of 5 systems based on formal request for information process, site visits, and vendor presentations. We developed evaluation criteria and selected the 2 highest performing systems...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29069512/acute-myeloid-leukemia-with-a-rare-t-7-14-q21-q32-and-trisomy-4-with-poor-clinical-outcome-a-case-report
#13
Seema B Jabbar, Sara Monaghan, Weina Chen, Prasad Koduru, Kirthi Kumar
Objectives: Recurrent cytogenetic abnormalities and/or molecular aberrations play an important role in the diagnosis and prognostification of acute myeloid leukemia (AML). We describe a case of a 40 year old woman diagnosed with de novo AML with a novel t(7;14)(q21,q32) and trisomy 4 with poor clinical outcome. Methods: Morphologic, flow cytometry and cytogenetic results of the patient's peripheral blood and bone marrow samples were analyzed. Results: The diagnostic bone marrow was hypercellular for age (>95%) with increased blasts (62%) that by flow cytometry exhibited myeloid differentiation with a few T/NK lineage markers...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29069468/leukocyte-dynamics-influence-reference-gene-stability-in-whole-blood-data-driven-qrt-pcr-normalization-is-a-robust-alternative-for-measurement-of-transcriptional-biomarkers
#14
Grant C O'Connell, Madison B Treadway, Ashley B Petrone, Connie S Tennant, Noelle Lucke-Wold, Paul D Chantler, Taura L Barr
Background: The use of reference genes for normalization of whole blood qRT-PCR data may be problematic in conditions such as stroke which induce alterations in white blood cell differential. In this study, we assessed the influence of stroke on the stability of commonly employed reference genes, and we evaluated data-driven normalization as an alternative. Methods: Peripheral whole blood was sampled from 33 stroke patients and 29 controls, and qRT-PCR was used to measure the expression levels of 10 target genes whose transcripts are known stroke biomarkers...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29053863/a-case-of-a-newborn-with-blocked-rhd-antigen-and-hdfn
#15
Haijuan Wang, Jian Chen, Yongmei Jiang
A group O RhD-negative pregnant patient with anti-D antibody at titer 1:2048 delivered a baby boy by cesarean section at 38 + 6 weeks gestational age. The neonate typed as group O, but D antigen was at first uncertain. DAT and antibody screen of newborn were both positive. Various assays were used for D antigen determination. Ultimately, D antigen blocked by high-titer maternal anti-D antibody was confirmed. Total bilirubin of the newborn was 52.7 umol/L, and hemoglobin was 1.46 mg/dL. O RhD-negative red cells were used for an exchange transfusion...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29036626/detection-of-an-underlying-22q11-2-duplication-in-a-female-neonate-with-trisomy-18
#16
Donald E Turbiville, Hai Wu, Jianli Dong
Current guidelines indicate that in patients with developmental disabilities or congenital anomalies, chromosomal microarray (CMA) is a first-tier diagnostic test. However, for patients with obvious chromosomal syndromes such as trisomy 13, 18, and 21, G-banded karyotyping is still recommended over CMA for establishing a diagnosis. In the case presented herein, a female neonate was suspected of having trisomy 18 based on pre- and postnatal evaluations. Karyotyping was requested but not performed due to insufficient cell growth; Interphase fluorescence in situ hybridization (i-FISH) found an extra copy of chromosome 18...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29036518/are-prothrombotic-mutations-a-time-to-event-risk-factor
#17
Branko V Tomic, Maja Z Gvozdenov, Iva B Pruner, Jelena M Simic, Mirjana K Kovac, Dragica P Radojkovic, Valentina J Djordjevic
Background: Deep vein thrombosis (DVT) represents a common disorder involving genetic and acquired risk factors. It has been proposed that acquired risk factors are more important with aging than genetic factors, indicating different prevalence of prothrombotic mutations throughout the lifespan. Objective: To determine the role of the most frequent prothrombotic genetic risk factors (Factor V [FV] Leiden and Factor II [FII] G20210A mutations) in first-time DVT etiology in patients of different ages...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29036487/prospective-and-retrospective-evaluation-of-the-performance-of-the-fda-approved-cepheid-xpert-flu-rsv-xc-assay
#18
Sophie Arbefeville, Elizabeth Thonen-Kerr, Patricia Ferrieri
Rapid and accurate detection of respiratory viruses is important in patient care and in guiding therapy and infection prevention policy. Rapid viral antigen assays are simple to perform and provide results within 15 to 30 minutes but are limited by their modest-to-moderate sensitivity. Molecular assays are more sensitive and specific but require more technical time and expertise and are more expensive. We verified the performance of the Xpert Flu/RSV XC assay prospectively, using patient respiratory samples from the 2014-2015 respiratory season, and, retrospectively, with frozen patient samples from the previous respiratory season...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29036415/transfusion-transmissible-infections-among-walk-in-blood-donors-at-kisumu-regional-blood-transfusion-centre-kisumu-county-kenya-2015
#19
Dominic Wamamba, Dickens Onyango, Elvis Oyugi, Evalyne Kanyina, Mark Obonyo, Jane Githuku, James Ransom
Background: Transfusion transmissible infections (TTIs) are threats to blood safety. This study investigated TTIs among volunteer blood donors at the Kisumu Regional Blood Transfusion Centre (KRBTC) in Kenya. Methods: We performed a retrospective record review of blood donor registers at KRBTC, 2015. Walk-in donors accepted for donation were analyzed to determine prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV), and syphilis...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29036315/probabilistic-modeling-approach-to-reducing-healthcare-costs-with-reflex-testing
#20
Sameer Prakash, Tyler Hamby, Van Leung-Pineda, Don P Wilson
Objective: Statistical methods can be utilized to optimize the order for reflex diagnostic testing to attenuate patient and hospital costs without affecting quality of care. Our objective is to demonstrate the method of developing an order for testing and to apply this method to an illustrative example. Methods: An algorithm was developed for minimizing costs for any given number of diagnostic tests, and it was retrospectively applied to a sample. Results: The actual scenario of using both tests on all patients was compared to 2 other hypothetical reflex testing approaches: all patients are given 1 test, and those patients who tested negative were then given the second test...
November 8, 2017: Laboratory Medicine
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