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Toxicological screening is a specific approach to analytical toxicology that uses analytical tools such as GC-MS, LC-UV (diode array) or LC-MS. Toxicological screening allows the detection and simultaneous identification of a large number of compounds. The results may be based on the use of one or more techniques. As part of the accreditation process for medical biology examinations according to standard NF EN ISO 15189, the group from SFTA and SFBC recommends an approach to accredit toxicological screening. Indeed, the complexity of the accreditation of this analysis comes in particular from the high number of compounds that can be detected. Validation parameters are discussed in the specific context of toxicological screening by considering two distinct approaches: the simple identification of compounds, or the identification and estimation of a range of concentration related to clinical outcomes.

Resume Le criblage toxicologique est une approche specifique de la toxicologie analytique qui fait appel a des outils analytiques tels que la CG-SM, la CL-UV (barrette de diodes) ou la CL-SM. Le criblage toxicologique permet la detection et l’identification simultanees d’un grand nombre de composes. Les resultats peuvent etre bases sur l’emploi d’une ou de plusieurs techniques. Dans le cadre du processus d’accreditation des examens de biologie medicale selon la norme NF EN ISO 15189, le groupe issu des societes savantes SFTA et SFBC recommande une demarche pour accrediter le criblage toxicologique. En effet, la complexite de l’accreditation de cette analyse provient en particulier du nombre eleve de composes susceptibles d’etre detectes. Les parametres de validation sont discutes dans le cadre specifique du criblage toxicologique en considerant deux approches distinctes : l’identification des composes ou l’identification et l’estimation d’une zone de concentration.

Amyloidosis results from extra-cellular deposition of proteins which interfere with tissue function. We report the case of a patient with pathological heart involvement which is caused by immunoglobulin D amyloidosis, and review current data on the amyloidois diagnosis and management.

La carence en fer (CF) chez les donneurs de sang (DDS) est un probleme sous-estime et peut entrainer des symptomes, meme en l’absence d’anemie. La prevention de la CF repose principalement sur la prevention de l’anemie chez les donneurs de sang total (ST), en ajournant lorsque le taux d’hemoglobine (Hb) est inferieur a un seuil (120 g/L femmes, 130 g/L hommes en France). L’objectif est d’estimer la prevalence de la CF chez les donneurs de ST en France et d’identifier les facteurs de risque (FdR) associes a cette CF. Une etude transversale, multicentrique a ete effectuee chez les donneurs de l’EFS et du CTSA. Tous les candidats au don de ST repondant aux criteres de selection etaient potentiellement inclus a l’exclusion des dons-saignees et des refus de participation a l’etude. La ferritine a ete dosee sur des tubes reorientes d’echantillons tires au sort, issus de collectes mobiles et en sites fixes du 11 au 28 mars 2019. La CF a ete definie par une ferritinemie

We present here a description of the experience in whole-blood transfusion of a health service team deployed to a medical treatment facility in Afghanistan from June 2011 to October 2011. The aim of our work was to show how a "walking blood bank" could provide a sufficient supply.We gathered the blood-group types of military personnel deployed to the theater of operations to evaluate our "potential walking blood bank," and we compared these data with our needs.Blood type frequencies among our "potential walking blood bank" were similar to those observed in European or American countries. Our resources could have been limited because of a low frequency of B blood type and negative rhesus in our "potential walking blood bank." Because of the large number of potential donors in the theater of operations, the risk of blood shortage was quite low and we did not face blood shortage despite significant transfusion requirements. Actually, 93 blood bags were collected, including rare blood types like AB and B blood types.In our experience, this international "walking blood bank" provided a quick, safe, and sufficient blood supply. More research in this area is needed, and our results should be confirmed by further prospective trials.Therapeutic study, level V.

Within the framework of routine fitness examinations, French Air Force military crew underwent urine testing for 3,4 methylenedioxymetamphetamine (MDMA [ecstasy]). The cross-reactivity of a dyslipidemic drug, fenofibrate, with an MDMA immunoassay was studied and confirmed on a large population sample.A 3-year retrospective study was performed on the MDMA DRI Ecstasy Assay on the Unicel DXC 600. In the event of positive test result, a confirmatory testing was carried out by gas chromatography/mass spectrometry (GC/MS) to establish the presence of MDMA. When analysis by GC/MS did not confirm the presence of MDMA, a false-positive result was suspected and the samples were analyzed by high-performance liquid chromatography-mass spectrometry to identify a potential interfering substance.A total of 15,169 urine samples, from 7,803 patients, were tested for 3 years. Of the tested samples, 22 (0.15%) were positive by DRI Ecstasy Assay. None of them were positive by GC/MS. A cross-reactivity of fenofibrate's metabolite with MDMA using this assay was systematically found.Fenofibrate's interference with MDMA immunoassay was confirmed. Fenofibrate being widely prescribed, physicians had to be alerted that this treatment could lead to false-positive results.

Laboratories working towards accreditation by the International Standards Organization (ISO) 15189 standard are required to demonstrate the validity of their analytical methods. The different guidelines set by various accreditation organizations make it difficult to provide objective evidence that an in-house method is fit for the intended purpose. Besides, the required performance characteristics tests and acceptance criteria are not always detailed. The laboratory must choose the most suitable validation protocol and set the acceptance criteria. Therefore, we propose a validation protocol to evaluate the performance of an in-house method. As an example, we validated the process for the detection and quantification of lead in whole blood by electrothermal absorption spectrometry. The fundamental parameters tested were, selectivity, calibration model, precision, accuracy (and uncertainty of measurement), contamination, stability of the sample, reference interval, and analytical interference. We have developed a protocol that has been applied successfully to quantify lead in whole blood by electrothermal atomic absorption spectrometry (ETAAS). In particular, our method is selective, linear, accurate, and precise, making it suitable for use in routine diagnostics.

Disseminated intravascular coagulation (DIC) is a complex abnormality of hemostasis with dramatic consequences and long described as associated with tumors. Yet the diagnosis and management of paraneoplastic DIC are poorly defined. The purpose of this paper is to review DIC associated with solid tumors, at the pathophysiological and therapeutic levels in particular. We also report data from a recent retrospective series of patients with DIC in the context of a solid tumor, to illustrate the epidemiological, clinical and prognostic.

To prepare the French Accreditation Committee (COFRAC) visit for initial certification of our medical laboratory, our direction evaluated its quality management system (QMS) and all its technical activities. This evaluation was performed owing an internal audit. This audit was outsourced. Auditors had an expertise in audit, a whole knowledge of biological standards and were independent. Several nonconformities were identified at that time, including a lack of control of several steps of the internal audit process. Hence, necessary corrective actions were taken in order to meet the requirements of standards, in particular, the formalization of all stages, from the audit program, to the implementation, review and follow-up of the corrective actions taken, and also the implementation of the resources needed to carry out audits in a pre-established timing. To ensure an optimum control of each step, the main concepts of risk management were applied: process approach, root cause analysis, effects and criticality analysis (FMECA). After a critical analysis of our practices, this methodology allowed us to define our "internal audit" process, then to formalize it and to follow it up, with a whole documentary system.

Objectif : Un desequilibre du metabolisme du cuivre est a l'origine de maladies genetiques graves ; la maladie de Menkes lors de deficits en cuivre et la maladie de Wilson caracterisee par une surcharge en cet oligo-element. Le diagnostic des ces pathologies implique le dosage du cuivre serique et urinaire par spectrometrie d'absorption atomique electrothermique (SAAE). Nous decrivons ici le protocole de validation de notre technique de dosage du cuivre serique par SAA. Methode : Nous avons applique un protocole recommande par la Societe Francaise des Sciences Techniques et Pharmaceutiques (SFSTP). Resultats : Ce protocole nous a permis de tester la linearite, la fidelite et l'exactitude de notre methode et de definir le domaine de linearite ainsi que les limites de detection et de quantification. Conclusion : L'etude realisee a permis de valider la methode de dosage utilisee au laboratoire.

A 41-year-old white male patient presented to the pulmonary clinic complaining of chronic exertional dyspnea. He had a 15-year history of smoking, but no prior diagnosis of lung disease. A comprehensive battery of laboratory tests was performed. Results for complete blood count, serum chemistry panel, hepatic function tests, and inflammatory markers were within reference intervals. …

Disseminated intravascular coagulation (DIC) is a complex abnormality of hemostasis with dramatic consequences and long described as associated with tumors. Yet the diagnosis and management of paraneoplastic DIC are poorly defined. The purpose of this paper is to review DIC associated with solid tumors, at the pathophysiological and therapeutic levels in particular. We also report data from a recent retrospective series of patients with DIC in the context of a solid tumor, to illustrate the epidemiological, clinical and prognostic.

LDL cholesterol (LDL-C) is commonly measured for evaluation and management of hypercholesterolemia. The Friedewald formula [LDL-C = (total cholesterol)—(HDL cholesterol)—triglycerides/2.2 for mmol/L] is commonly used to determine LDL-C, but this method has some well-established shortcomings and may not meet the National Cholesterol Education Program criteria of total error

The aim of the study was to investigate the residual blood level of O before each cycle of various oxaliplatin (O) based protocols, and to explore its predictive value for potential occurrence of a severe neurotoxicity. Methods: Between 11/2005 and 06/2008, 220 Pts were included in a prospective cohort, in 7 French centers. Patients received a minimum of 7 cycles of O. Blood samples were taken before each cycle with a maximum of 12 cycles. In parallel neurotoxicity was assessed by the modified Levi score (grade 0 to 3) and by the Von Frey filament exam. Saliva was collected before the first cycle for genomics analysis. The O concentration was obtained by Atomic Absorption Spectrometry assay after nitric digestion of total blood. Polymorphism of different targets were investigated (carrier proteins: MRP2, OCT1, OCT2, GSTP1, adducts repair system: ERCC1, ERCC2). Time to first severe neurotoxicity occurrence (TTSN Events: Grade 2 or3) was estimated using Kaplan-Meier. Predictive value of severe neurotoxicity was explored using univariate and multivariate logistic or Cox regressions. Harrel C index was produced. Results: 206 pts with gastro-intestinal cancer had, at the time of analysis, completed follow-up and 201 pts (91.3%) were eligible for pharmacokinetics. (85%) received FOLFOX regimen (85mg/m2every 2 weeks), the others GEMOX or XELOX (100mg/m2 every 3 weeks). The mean total dose of O received for all pts was 1.18 ± 0.4 g. After cycle 1, 2 and 10, median residual level of O was respectively 0.31 mg/L, 0.43 mg/L and 0.60 mg/L. The maximal concentration was obtained between cycle 5 and cycle 9. Respectively 89 Pts (44%) and 15 pts (7%) had a Gr2 and a Gr3 neurotoxicity. Median time TTSN was 141 days (95% CI: 132 – 161). O concentration before 2nd cure (HR = 1.39, p < 0.0001) is associated with TTSN (cure N°2 for Gr0 and Gr1, cure N° 7 for Gr2 and Gr3) but not with the frequency. Multivariate logistic and Cox analyses confirmed these results. Conclusions: 1. The mean residual blood level of O before the second cure is correlated with the occurrence of Gr2 or Gr3 neurotoxicity (p Mann-Whitney = 0.0007) 2. The residual blood level of O before the second O cure is correlated with the delay of occurrence of a Gr2 or Gr3 neurotoxicity in patients receiving an O based-regimen (Harrel C=0.54, p=0.021). Further statistical analyses will be done to analyse the data from the Von Frey filaments and the gene polymorphism and will be presented at the meeting. An O posology adaptation or infusion duration modification based on Platinum residual level of cure 1 have to be considered in future clinical trial in order to avoid severe Gr2 or Gr3 neurotoxicity. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):C129.