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Plenty of studies demonstrate that hospital-acquired anemia (HAA) can increase transfusion rates, mortality, morbidity and cause unnecessary patient burden, including additional length of hospital stay, sleep disruption and venipuncture harms resulting from blood samples unlikely to change clinical management. Beyond patient costs, community costs should also be considered, such as laboratory time and resources waste, environmental impact, increasing pressure on labs and fewer tests available on time for patients who can benefit from them most. Blood over-testing does not support the principles of non-maleficence, justice and respect for patient autonomy, at the expense dubious beneficence. Reducing the number and frequency of orders is possible, to a certain extent, by adopting nudge strategies and raising awareness among prescribing doctors. However, reducing the orders may appear unsafe to doctors and patients. Therefore, reducing blood volume from each order is a better alternative, which is worth implementing through technological, purchasing and organizational arrangements, possibly combined according to need (smaller tubes, adequate analytic platforms, blind dilution, blood conservative devices, aggregating tests and laboratory units). [ABSTRACT FROM AUTHOR]

The letter addresses concerns regarding the inaccurate definition of Bence Jones proteinuria (BJP) in the EFLM European Urinalysis Guideline 2023. The authors argue that the guideline's terminology does not accurately reflect the characteristics of BJP, which is defined as monoclonal free light chains of immunoglobulins. They caution against using total proteinuria as a screening method for BJP, as it may not be sensitive enough to detect clinically significant concentrations. The authors emphasize the importance of using strict and accurate definitions in guidelines and recommend urine immunofixation as the gold standard test for detecting BJP. [Extracted from the article]

C-reactive protein (CRP) is a cytokine-mediated acute phase reactant with a recognized role in inflammatory conditions and infectious disease. In coronavirus disease 2019 (COVID-19), elevated CRP concentrations in serum were frequently detected and significantly associated with poor outcome in terms of disease severity, need for intensive care, and in-hospital death. For these reasons, the marker was proposed as a powerful test for prognostic classification of COVID-19 patients. In most of available publications, there was however confounding information about how interpretative criteria for CRP in COVID-19 should be derived, including quality of employed assays and optimal cut-off definition. Assuring result harmonization and controlling measurement uncertainty in terms of performance specifications are fundamental to allow worldwide application of clinical information according to specific CRP thresholds and to avoid risk of patient misclassification. [ABSTRACT FROM AUTHOR]

Appropriateness in Laboratory Medicine has been the object of various types of interventions. From published experiences, it is now clear that to effectively manage the laboratory test demand it is recommended to activate evidence-based preventative strategies stopping inappropriate requests before they can reach the laboratory. To guarantee appropriate laboratory test utilization, healthcare institutions should implement and optimize a computerized provider order entry (CPOE), exploiting the potential of electronic requesting as "enabling factor" for reinforcing appropriateness and sustaining its effects over time. In our academic institution, over the last 15 years, our medical laboratory has enforced various interventions to improve test appropriateness, all directly or indirectly based on CPOE use. The following types of intervention were implemented: (1) applying specific recommendations supported by monitoring by CPOE as well as a continuous consultation with clinicians (tumour markers); (2) removing outdated tests and avoiding redundant duplications (cardiac markers, pancreatic enzymes); (3) order restraints to selected wards and gating policy (procalcitonin, B-type natriuretic peptide, homocysteine); (4) reflex testing (bilirubin fractions, free prostate-specific antigen, aminotransferases, magnesium in hypocalcemia); and (5) minimum retesting interval (D-Dimer, vitamin B12, C-reactive protein, γ-glutamyltranspeptidase). In this paper, we reviewed these interventions and summarized their outcomes primarily related to the changes in total test volumes and cost savings, without neglecting patient safety. Our experience confirmed that laboratory professionals have an irreplaceable role as "stewards" in designing, implementing, evaluating, and maintaining interventions focused to improving test appropriateness. [ABSTRACT FROM AUTHOR]

Results are automatically calculated by the system as follows: HbA SB 1c sb (mmol/mol)=[HbA SB 1c sb ( mol/L)/total haemoglobin (mol/L)] × 1,000. A bias >1 mmol/mol for Alinity became however evident only in samples with HbA SB 1c sb values >=69 mmol/mol. Keywords: clinical governance; diabetes; HbA1c; metrological traceability; total laboratory automation EN clinical governance diabetes HbA1c metrological traceability total laboratory automation 441 450 10 02/07/22 20220201 NES 220201 Introduction There are approximately 500 million people living with diabetes mellitus (DM) worldwide [[1]]. Alinity showed a mean positive absolute bias of 0.54 mmol/mol (range: -0.4 to 2.6 mmol/mol), corresponding to a mean percentage difference of 0.87% (range: -1.13 to 2.74%). [Extracted from the article]

Previous studies reported lipase elevations in serum of COVID-19 patients trying to establish a causal link between SARS-CoV-2 infection and pancreatic damage. However, the degree and prevalence of hyperlipasemia was not uniform across studies. We retrospectively evaluated 1,092 hospitalized patients with COVID-19 and at least one available lipase result. The number and frequency of patients with lipase above the upper reference limit (URL), >3 URL, and >6 URL were estimated. Correlations between lipase values and other biomarkers of organ or tissue damage were performed to identify possible extra-pancreatic sources of lipase release. The potential prognostic role of lipase to predict death and intensive care unit (ICU) admission during hospitalization was also evaluated. Lipase was >URL in 344 (31.5%) of COVID-19 patients. Among them, 65 (5.9%) and 25 (2.3%) had a peak lipase >3 URL and >6 URL, respectively. In the latter group, three patients had acute pancreatitis of gallstone or drug-induced etiology. In others, the etiology of lipase elevations appeared multifactorial and could not be directly related to SARS-CoV-2 infection. No correlation was found between lipase and other tested biomarkers of organ and tissue damage. Lipase concentrations were not different between survivors and non-survivors; however, lipase was significantly increased (p<0.001) in patients admitted to the ICU, even if the odds ratio for lipase as predictor of ICU admission was not significant. Lipase was elevated in ∼1/3 of COVID-19 patients, but the clinical significance of this finding is unclear and irrelevant to patient prognosis during hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: Procalcitonin (PCT) has been proposed for differentiating viral vs. bacterial infections. In COVID-19, some preliminary results have shown that PCT testing could act as a predictor of bacterial co-infection and be a useful marker for assessment of disease severity. Methods: We studied 83 COVID-19 hospitalized patients in whom PCT was specifically ordered by attending physicians. PCT results were evaluated according to the ability to accurately predict bacterial co-infections and death in comparison with other known biomarkers of infection and with major laboratory predictors of COVID-19 severity. Results: Thirty-three (39.8%) patients suffered an in-hospital bacterial co-infection and 44 (53.0%) patients died. In predicting bacterial co-infection, PCT showed a relatively low accuracy (area under receiver-operating characteristic [ROC] curve [AUC]: 0.757; 95% confidence interval [CI]: 0.651–0.845), with a strength for detecting the outcome not significantly different from that of white blood cell count and C-reactive protein (CRP). In predicting patient death, PCT showed an AUC of 0.815 (CI: 0.714–0.892), not better than those of other more common laboratory tests, such as blood lymphocyte percentage (AUC: 0.874, p=0.19), serum lactate dehydrogenase (AUC: 0.860, p=0.47), blood neutrophil count (AUC: 0.845, p=0.59), and serum albumin (AUC: 0.839, p=0.73). Conclusions: Procalcitonin (PCT) testing, even when appropriately ordered, did not provide a significant added value in COVID-19 patients when compared with more consolidated biomarkers of infection and poor clinical outcome. The major application of PCT in COVID-19 is its ability, associated with a negative predictive value >90%, to exclude a bacterial co-infection when a rule-out cut-off (<0.25 μg/L) is applied. [ABSTRACT FROM AUTHOR]

The immunohistochemistry was negative for human chorionic gonadotropin (hCG) subunit, even in the areas with intratubular neoplasia. At admission, serum AFP was undetectable, total hCG (Elecsys "hCG+ " assay, Roche Diagnostics) was 30 U/L (recommended cut-off for men <50 years, 0.3 U/L) and lactate dehydrogenase (LDH) 898 U/L (upper reference limit [URL], 220 U/L). We observed that the behavior of LDH and hCG+ paralleled, and the hCG+ peak at 1.1 U/L was anticipated of 1 week by a sudden increase in LDH (547 U/L). At admission of the patient, clinicians erroneously ordered the hCG Abbott, so laboratory professionals corrected the request and then recommended the ordering of hCG+ Roche for further evaluation. [Extracted from the article]

Background: Blood loss for laboratory testing may contribute to hospital-acquired anemia. When implementing the core laboratory (core-lab) section, we consolidated first-line tests decreasing the number of tubes previously dispatched to different sites. Here, hypothesized benefits of the amount of blood volume drawn were explored. Methods: We retrieved, using a laboratory information system (LIS), the number of tubes received by laboratories interested in the change from all clinical wards in a year-based period, i.e. 2013 for pre-core-lab and 2015 for core-lab system, respectively. Data were expressed as the overall number of tubes sent to laboratories, the corresponding blood volume, and the number of laboratory tests performed, normalized for the number of inpatients. Results: After consolidation, the average number of blood tubes per inpatient significantly decreased (12.6 vs. 10.7, p < 0.001). However, intensive care units (ICUs) did not reduce the number of tubes per patient, according to the needs of daily monitoring of their clinical status. The average blood volume sent to laboratories did not vary significantly because serum tubes for core-lab required higher volumes for testing up to 55 analytes in the same transaction. Finally, the number of requested tests per patient during the new osystem slightly decreased (−2.6%). Conclusions: Total laboratory automation does not automatically mean reducing iatrogenic blood loss. The new system affected the procedure of blood drawing in clinical wards by significantly reducing the number of handled tubes, producing a benefit in terms of costs, labor and time consumption. Except in ICUs, this also slightly promoted some blood saving. ICUs which engage in phlebotomizing patients daily, did not take advantage from the test consolidation. [ABSTRACT FROM AUTHOR]

This is vital in order to assure the correct differentiation, after a single hs-cTn measurement at ED admission, between patients with a negligible risk of cardiac adverse events who are potentially suitable for immediate discharge and those needing further evaluation in order to exclude/confirm AMI. Therefore, manufacturers of hs-cTn measuring systems should be encouraged to provide quality control materials that cover all the clinically relevant concentrations of the analyte, including those close to the LOD to monitor baseline drifts. [Extracted from the article]

Keywords: D-dimer; minimum retesting interval; testing appropriateness EN D-dimer minimum retesting interval testing appropriateness e175 e176 2 06/21/22 20220701 NES 220701 To the Editor, We read with great interest the review by Lang updating the experience about the application of the minimum retesting interval (MRI) concept [[1]]. For evaluating the efficacy and cost-effectiveness of this intervention, we collected data from laboratory information system about numbers of requested D-dimer tests through the same 9 month period (March-November 2017 vs. 2018), before and after the CPOE-based intervention. [Extracted from the article]

The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision. Firstly, the guideline drafters have to reconsider the available evidence that does not permit to assign the same class and level of evidence to the very well-validated 0-3 h algorithm and to the 0-1 h algorithm. In agreement with the validity of available data, the limitations of fast track protocols, in particular of the 0-1 h algorithm for NSTEMI rule-in, calls for caution. Secondly, as the current diagnostics guidance by the UK National Institute for Health and Care Excellence recommends, rapid diagnostic protocols should be performed only using well-validated hsTn; recommending the use of an assay before being commercially available is not fair and scientifically sound. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the efficacy of using a Sysmex XN-9000 hematology system based on white blood cells (WBC), red blood cells (RBC), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), men corpuscular hemoglobin concentration (MCHC) and platelets (PLT). The parameters used for the material include stabilized lysable human RBC, simulated PLT components, and whole-blood sample. The commutability results for the material are described.

A letter to the editor on plasma glucose determination is presented. Topics discussed include role of the measurement of fasting plasma glucose (FPG) in the diagnosis of diabetes, marketing of blood collection tubes as an effective antiglycolytic approach for glucose stabilization and clinical implications of the optimization of preanalytical steps with the consequent "shift-to-the-right" of FPG distribution

A large body of evidence attests that quality programs developed around the analytical phase of the total testing process would only produce limited improvements, since the large majority of errors encountered in clinical laboratories still prevails within extra-analytical areas of testing, especially in manually intensive preanalytical processes. Most preanalytical errors result from system flaws and insufficient audit of the operators involved in specimen collection and handling responsibilities, leading to an unacceptable number of unsuitable specimens due to misidentification, in vitro hemolysis, clotting, inappropriate volume, wrong container or contamination from infusive routes. Detection and management of unsuitable samples are necessary to overcome this variability. The present document, issued by the Italian Inter-society SIBioC-SIMeL-CISMEL (Society of Clinical Biochemistry and Clinical Molecular Biology-Italian Society of Laboratory Medicine-Italian Committee for Standardization of Hematological and Laboratory Methods) Study Group on Extra-analytical Variability, reviews the major causes of unsuitable specimens in clinical laboratories, providing consensus recommendations for detection and management. Clin Chem Lab Med 2007;45:728–36. [ABSTRACT FROM AUTHOR]

Background: Recent international recommendations for the diagnosis of gestational diabetes (GD) were implemented in a university hospital. The aim was to audit the appropriateness of use of the new diagnostic approach. Methods: The same 5-month period, one before [2009, traditional two-step oral glucose tolerance test (OGTT) approach, S1] and one after the implementation of new criteria (2010, S2) were compared. Results: In the two periods, 256 (S1) and 245 (S2) pregnant women were examined and 298 (50 g, n=195; 100 g, n=103) and 252 (75 g) OGTTs were, respectively, executed. In S1, 54 (27.7%) 50 g OGTTs resulted positive and 36 (66.7%) of those performed the 100 g OGTT. In addition, three (1.5% of total) 50 g OGTT negative women were submitted to 100 g OGTT. Sixty-three women did 100 g OGTT only. In total, 14 (13.6%) 100 g OGTTs were positive. In S2, 38 (15.1%) 75 g OGTTs were positive. In women who did the complete protocol in the hospital, 98.3% in S1 and 77.0% in S2 performed the correct protocol (p<0.0001). Conclusions: In this hospital new recommendations for GD diagnosis are not correctly applied in 23% of cases. The main issue seems to be the lack of consideration of the new threshold for fasting glycemia (5.1 mmol/L) as a main decisional driver for performing OGTT. [ABSTRACT FROM AUTHOR]

This letter to the editor addresses the issue of incomplete information provided by manufacturers regarding the metrological traceability of in vitro diagnostic calibrators, using plasma ethanol as an example. The authors argue that this lack of transparency can hinder accurate measurement in laboratories. They provide examples of manufacturers who do not disclose the traceability of their calibrators. The authors stress the importance of accurate information and measurement uncertainty estimation for identifying analytical limitations and improving standardization. The document includes references to scientific articles and resources related to analytical performance specifications and calibration of breath alcohol analyzers, which may be helpful for library patrons researching forensic science or alcohol analysis. [Extracted from the article]

No Abstract available [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about heat-shock proteins.