[Doping and sports]

Doping is widely known as the use of banned substances and practices by athletes in an attempt to improve sporting performances. The term doping likely derives from "dope", an ancient expression referred to a primitive alcoholic drink that was used as a stimulant in South African ceremonial dances; gradually, the term was extended and finally adopted his current significance. There are at least two essential reasons to support the fight against doping: the potential harmful effects on athletes and the depth corruption of the fair competition. An exhaustive list of banned substances and methods has been drawn by the International Olympic Committee and further accepted by other International Sport Authorities and Federations. This list, regularly updated, is basically divided into doping substances (stimulants, narcotic analgesics, anabolic agents, diuretics, peptide and glycoprotein hormones and analogues), doping methods (blood doping, pharmacological, chemical and physical manipulation) and drugs subjected to certain restrictions (alcohol, marijuana, local anesthetics, corticosteroids and beta-blockers). Although there might be some medical conditions, which could legitimate the need of these substances or methods, there is no place for their use in sport. Thus, an athlete's consume of any of these substances or methods will result in disqualification. Aim of the present review is to provide a synthetic description of both the desirable effects and the potentially harmful consequences of the use of some of the major doping substances and methods.

Lipoprotein(a) concentration is not associated with venous thromboembolism in a case control study

BACKGROUND AND OBJECTIVE

Lipoprotein(a) is an LDL-like particle displaying strong athero-thrombotic properties. Although Lp(a) plays a pivotal role in the genesis and progression of thrombosis in the arterial district, its role in promoting thrombosis in the venous district is still unclear.

DESIGN AND METHODS

To give further insight into the thrombotic potential of Lp(a), 100 potentially eligible consecutive outpatients who had suffered from previous episodes of venous thrombosis (deep vein thrombosis with or without pulmonary embolism) were enrolled into the study. Thirty-six of these patients who did not fulfil the entry criteria were then excluded from the study. The concentration of Lp(a) was thus measured in 64 patients, and compared to that of 64 control subjects, matched for sex (p=0.46), age (p=0.25) and pharmacological treatment; no subject belonging to the control group had a familial or personal history of venous thromboembolism. Exclusion criteria for both groups included: diabetes mellitus, liver or kidney diseases and malignancy, as established by both laboratory analysis and physical examination. To rule out false elevations of Lp(a) due to the presence of a concurrent acute phase response, C reactive protein (CRP) was measured in both groups using a commercial immunonephelometric assay.

RESULTS

No statistically significant differences were observed in the median Lp(a) concentration between patients and controls (median: 69 vs 83 mg/L, respectively; p=0.34). Neither were any significant differences found between patients who had suffered from deep venous thrombosis with (n=18) or without (n=46) pulmonary embolism (median: 73 vs 69 mg/L, respectively; p=0. 83). The concentration of CRP did not differ significantly between cases and controls (median: 1.8 vs 2.3 g/L, respectively; p=0.37).

INTERPRETATION AND CONCLUSIONS

Although there are several plausible biological mechanisms to explain the strong thrombogenicity of Lp(a) in vitro, we failed to demonstrate a convincing association between Lp(a) and thrombosis in the venous district. Besides the proven prothrombotic role of Lp(a) in some selected clinical settings, it is thus conceivable that the contribution of Lp(a) to genesis and progression of the venous thrombosis might be marginal or efficiently counterbalanced in vivo. The clinical usefulness of including the measurement of Lp(a) among the screening tests for thrombophilic patients, therefore, remains questionable.

Detection of vascular haemodynamics through a high-speed velocity profiler

OBJECTIVE

This paper aims at demonstrating that ultrasound Doppler multigate spectral analysis performed with advanced equipment may provide detailed and significant haemodynamic information.

METHODS

A novel multigate system was recently introduced and shown capable of performing real-time spectral analysis of Doppler data from 64 resolution cells located at different depths from the transducer. The system extends the typical capabilities of conventional Pulsed Wave (PW) equipment by displaying the full spectral content of Doppler signals over an ultrasound scan line rather than in a single resolution cell. In cases where it is appropriate to display the available information in a simpler form, parameters such as the maximum frequency can be extracted from each spectrum, by using conventional or advanced image processing methods.

RESULTS

In-vitro experiments show that the multigate system can perform velocity measurements with good accuracy and precision. Examples of in vivo profiles detected from carotid, femoral and radial arteries are presented. In particular, the first results obtained from the aorta are shown.

CONCLUSIONS

Blood flow behavior can be accurately investigated using a real-time multigate system which extends Doppler spectral analysis to a whole scan line.

Biochemical risk factors and patient's outcome: the case of lipoprotein(a)

Lipoprotein(a) (Lp(a)) is a genetic variant of low density lipoproteins and consists of the covalent association of the unique and enigmatic apolipoprotein(a) to apoliprotein B100. Despite the high degree of homology with low density lipoproteins, Lp(a) displays distinctive physico-chemical properties, function and metabolism. The present article reviews the main biological and clinical evidences about the association between raised concentration of Lp(a) and atherothrombotic diseases and provides tentative guidelines to improve the clinical usefulness of Lp(a) measurements.

Phase measurement of acoustic fields based on a moving target

A new technique to measure phase distribution of ultrasound beams is presented. This method is based on the phase measurement of the Doppler signal backscattered by a moving target traveling at constant velocity, which represents a scanning element exploring the held under examination. It is produced by mechanical equipment consisting of a modified string phantom in which the commonly used cotton thread was substituted by a thin nylon thread with some tight knots over it. The thread diameter was chosen small enough to produce knots smaller than the acoustic field wavelength in order to have "pointlike" moving targets. This paper describes how the Doppler signal phase is related to the phase field and the numerical method to extract a phase field distribution from the backscattered signal. Experimental results obtained for two circular transducers, strongly and weakly focused, respectively, are finally shown and commented.

Effect of pyridoxal 5'-phosphate on human neutrophil respiratory burst and adhesion on serum coated microplates

The effect of pyridoxal 5'-phosphate (PP) on human polymorphonuclear leukocytes respiratory burst and on cellular adhesion on serum coated microplates was investigated. No dose-response effect was observed after 10 min pre-treatment at 37 degrees C of human neutrophils with increasing doses of PP, ranging from 0.05 mM/L to 0.5 mM/L. The production of superoxide anion (O2-), after challenging cells with 0.5 pM/L formyl-methyonyl-leucyl-phenylalanine, 50 ng/mL phorbol myristate acetate or 50 pg/mL concanavalin A was comparable to that observed by pre-treating cells with phosphate buffered saline only (control, no PP), therefore indicating that PP did not affect neutrophil respiratory burst in our assay conditions. Evaluation of the effect on cellular adhesion onto fetal bovine serum pre-coated microplates produced the same results. As previous results showed that PP in the range of 0.01 mM/L to 0.6 mM/L proved to be an efficient inhibitor of neutrophil aggregation, the evidence reported here might contribute to establish PP as a good in vitro leukocyte anti-aggregant which does not affect other functional parameters.

Expression of genes involved in nucleotide excision repair and sensitivity to cisplatin and melphalan in human cancer cell lines

DNA repair has been proposed to be an important determinant of cancer cell sensitivity to alkylating agents and cisplatin (DDP). Nucleotide excision repair (NER), which represents one of the most important cellular DNA repair processes able to remove a broad spectrum of DNA lesions, is involved in the recognition and repair of the crosslinks caused by DDP and melphalan (L-PAM). In this study, the mRNA levels of the different genes involved in NER (ERCC1, XPA, XPB, XPC, XPD, XPF) were examined in a panel of eight different human cancer cell lines, together with the overall DNA repair capacity using a host cell reactivation assay of a damaged plasmid. A statistically significant correlation was observed between the relative expression of XPA/XPC (P < 0.05) and ERCC1/XPC (P < 0.05) mRNAs. No correlation was found between the DDP and L-PAM IC50S and the relative mRNA expression of the tested NER genes. When the overall cellular DNA repair capacity was studied, carcinomas seemed to have a higher repair activity than leukaemias; but this repair DNA activity correlated neither with the mRNA expression of the different NER genes nor with DDP and L-PAM IC50S. These data seem to suggest that even if the NER pathway is an important determinant for the cytotoxicity of alkylating agents, as demonstrated by the extremely high sensitivity to alkylating agents in cells lacking this repair system, other factors have to play a role in regulating the cellular sensitivity/resistance to these antitumour drugs.

Usefulness of lipids, lipoprotein(a) and fibrinogen measurements in identifying subjects at risk of occlusive complications following vascular and endovascular surgery

The study was designed to establish the usefulness of measuring lipoprotein(a) [Lp(a)], total cholesterol, triglycerides, low-density lipoprotein [LDL]-cholesterol, high-density lipoprotein [HDL]-cholesterol, total-to-HDL-cholesterol ratio and fibrinogen in identifying subjects at risk of occlusive complications following vascular and endovascular surgery, including primary successful ileofemoral percutaneous transluminal angioplasty, infrainguinal and aortic bypass graft and carotid endarterectomy. A total of 68 volunteers subjected to vascular and endovascular surgery were recruited to the study. Six months after successful interventions, no occlusive complications verified by angiography were observed in 45 patients (66%; No-restenosis group), whereas significant restenosis or reocclusion occurred in 23 patients (34%; Restenosis group). Significant lower concentrations of Lp(a) (p=0.032), total cholesterol (p<0.0001), LDL-cholesterol (p=0.001) and total-to-HDL-cholesterol ratio (p<0.0001) and higher concentrations of HDL-cholesterol (p=0.048) were observed in the No-restenosis group compared to the Restenosis group. The concentrations of triglycerides (p=0.080) and fibrinogen (p=0.510) did not differ significantly between groups. In multivariate discriminant analysis, the best predictors of restenosis or reocclusion were in decreasing order: LDL-cholesterol, Lp(a), total-to-HDL-cholesterol ratio, HDL-cholesterol and total cholesterol. A statistical difference of particular interest was observed in the overall distribution of Lp(a) concentrations between groups (p<0.0001), occlusive complications being unlikely to occur in patients with Lp(a) concentrations below 50 mg L(-1). The potential interference from a concurrent acute phase response, the most common source of elevation of Lp(a) in humans, was less likely in view of the absence of differences in erythrocyte sedimentation rate between the No-restenosis and Restenosis groups (p=0.463). In conclusion, the results of the present investigation point to a definite role of the combined measurements LDL-cholesterol, Lp(a), total-to-HDL-cholesterol ratio, HDL-cholesterol and total cholesterol in the identification of subjects at risk of occlusive events following vascular and endovascular surgical procedures.

Evaluation of the analytical performances of a new fully automated commercial immunonephelometric assay for lipoprotein(a)

Several commercial methods have been proposed for lipoprotein(a) (Lp(a)) measurements over the past decades. However, only a few of them appear completely suitable in terms of analytical performance, costs and practicability. We evaluated the analytical performance of a new commercial fully automated immunonephelometric assay for Lp(a) measurements on the IMMAGE Immunochemistry System. Mean within- and between-run coefficients of variation were 2.7% (range 1.2-4.7%) and 3.8% (range 1.8-7.9%), respectively. The linearity of the assay was confirmed up to 102 mg/dl and the deviation from the expected values did not exceed 4% (mean deviation: 1.9%). Moreover, the relative non-linearity was acceptable, ranging from 1.4% to 1.6% and hence constantly lower than the 2.5% upper limit. Since there is no reference method for Lp(a) measurements, 100 routine random serum samples measured by the IMMAGE Immunochemistry System immunonephelometric assay were further compared with two other commercial immunonephelometric assays (Array LPA immunonephelometric assay and BNA Latex-Enhanced Lp(a) nephelometric assay). Non-parametric regression and relative Spearman's correlation coefficients were satisfactory, (y=1.009x - 1.38; r=0.998 IMMAGE Immunochemistry System vs. Array LPA and y=0.922x - 0.40; r=0.989 IMMAGE Immunochemistry System vs. Behring Nephelometer Analyzer (BNA) Latex Lp(a) assay). On the basis of the results of the present evaluation we conclude that the analytical performance and the main technical features of the IMMAGE Immunochemistry System immunonephelometric assay make it a suitable method for Lp(a) measurement in clinical laboratories.

Cystic fibrosis: when should high-resolution computed tomography of the chest Be obtained?

OBJECTIVE

To provide indications for high-resolution computed tomography (HRCT) of the chest in patients with cystic fibrosis (CF).

DESIGN

We compared the HRCT and conventional chest radiography (CCR) scores and assessed their correlation with clinical scores and pulmonary function tests.

SETTING

Department of Pediatrics, Federico II University, Naples, Italy.

SUBJECTS

A total of 30 patients with CF 6.75 to 24 years of age.

RESULTS

CCR scores correlated highly with HRCT (r = -0.8) and clinical (r = 0.5) scores, whereas total HRCT scores were not related to clinical scores. Of all the specific HRCT findings, only bronchiectasis appeared related significantly to the clinical score (r = 0.6). Most pulmonary function tests were related to CCR and total HRCT scores, but not to HRCT scoring of specific changes. Forced vital capacity and CCR scores appeared the best predictors of the HRCT score (multiple R = 0.58 and 0.79, respectively). In patients with mild lung disease, HRCT detected bronchiectasis and air trapping in 57% and 71% of the cases, respectively. In patients with more abnormal chest radiographs, bronchiectasis and air trapping were demonstrated on HRCT in all cases.

CONCLUSIONS

These findings suggest that HRCT of the chest is most useful in the identification of early lung abnormalities in patients with CF with mild respiratory symptoms, whereas for established disease, CCR is still the first-line imaging technique. The advantage of detecting early changes on CT imaging awaits additional confirmation, at least until early therapeutic interventions affecting significantly the final outcome of the disease are demonstrated. In patients with advanced disease, HRCT may be useful in the evaluation of specific lung changes when more aggressive treatment such as chest surgical interventions is indicated. Given the cost of the procedure and the high radiation dosage compared with CCR, a careful assessment of the cost:benefit ratios of HRCT is strongly recommended in CF.

[Three-dimensional imaging with computerized tomography. Etiologic considerations and methods for studying temporo-mandibular joints]

INTRODUCTION

The temporomandibular joint (TMJ) had always been studied with conventional tomography and, more recently, with Magnetic Resonance Imaging. Computed Tomography (CT) can demonstrate periarticular soft tissues only. Recently, the introduction of three-dimensional (3D) CT reconstructions with dedicated softwares permitted to demonstrate functional changes in the TMJ with a simple and accurate measurement system.

MATERIAL AND METHODS

We examined 347 patients with TMJ disorders using two different 3rd generation CT units and acquiring two series of scans, with the mouth closed and in maximum opening. 3D reconstructions on predefined planes were obtained with a dedicated software and integrated with the electronic measurements of the following morphologic and functional parameters: zygomatic tubercle height, axis of sagittal inclination of the mandibular condyle, TMJ movement range and changes in torsion/dislocation of condylar angle.

RESULTS AND DISCUSSION

CT showed the TMJ easily. This examination lasts about 10 minutes, plus 10-15 more minutes for 3D reconstructions. Some artifacts were found on 3D images--thresholding artifacts, defined as pseudoforamina and pseudocalcifications. Neverthless, 3D imaging can easily demonstrate an articular district which is very complex in both morphology and function, supporting or replacing similar subconscious processes made by radiologists themselves. This technique was well accepted by all our patients and functional results were always in agreement with clinical findings. Moreover, CT is the only technique showing both TMJ sides at the same time. Our measurement system was easy to perform, repeatable and comparable also thanks to its potentials of standardization on different CT units.

CONCLUSIONS

CT with 3D reconstructions appears the gold standard technique for functional TMJ studies. Even though it provides no information on the joint disk--which MRI does--3D CT permits easy and accurate measurements of both TMJ sides which can support clinical findings.

Modification of serum apolipoprotein A-I, apolipoprotein B and lipoprotein(a) levels after bisphosphonates-induced acute phase response

Lipoprotein(a) (Lp(a)) is a low density lipoprotein-like particle displaying strong atherothrombotic properties. Although the concentration of Lp(a) in plasma is under strong genetic regulation, there are emerging evidences that several other factors, such as hormonal disorders, acute phase, liver and renal failure may affect its metabolism. The aim of the present study was to investigate whether bisphosphonates, an effectual drug in the treatment of malignant hypercalcemia and Paget's disease of bone, known to induce a concomitant acute phase, may have a significant influence on Lp(a) concentrations. Nine subjects (four men and five women), with plasma Lp(a) concentrations in the range between 6.4 and 17.7 mg/dl, were subjected to a single intravenous infusion of bisphosphonates (7.5 mg of aminohydroxybutylidene and 5.0 mg of aminohydroxylidene), previously dissolved in 250 ml of saline. Lp(a), apo A-I, apo B, C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured at the baseline and after days one, two, four and seven. CRP, ESR and Lp(a) started to increase after two days from the treatment, reaching statistical significance after day two, four and seven, respectively. Apo B and apo A-I decreased significantly after days one and two, respectively. Although patterns and relative amounts of the increase of CRP were substantially different among the subjects studied, the increase of Lp(a) was more homogeneous; the peak of Lp(a) concentrations was reached only seven days after treatment in the group as a whole, in agreement with previous observations. In univariate regression analysis, significant correlations were found only between apo A-I and ESR, and apo A-I and Lp(a). The present study suggest that Lp(a) behaves as an acute phase protein. Besides, we observed a slight but significant decrease of apo A-I and apo B after administration of bisphosphonates.

Pulmonary manifestations of Gaucher disease: an increased risk for L444P homozygotes?

Pulmonary disease is a complication of Gaucher disease (GD), a lysosomal disorder due to the deficiency of glucocerebrosidase. Lung involvement was investigated through chest radiography, high-resolution computed tomography of the chest, pulmonary function tests (PFT), and oxygen saturation (SaO2) at 21% FI(O2) in 13 Italian GD patients, six homoallelic for the L444P mutation (Group A), seven with various genotypes (Group B). Echocardiography and transcutaneous oxygen tension measurement at room air and after breathing 100% oxygen were performed to exclude pulmonary hypertension and/or intrapulmonary shunts. A score index (SI) including lung involvement evaluated the severity of GD. In three Group A patients with respiratory symptoms and in an asymptomatic male interstitial involvement was demonstrated; one child died of aspiration pneumonia. Group B patients had no signs of lung damage; PFT were normal in all cases but one. SaO2 was normal in both groups. Pulmonary vascular disease was ruled out in three cases with respiratory symptoms. In Groups A and B the median SI were 22 and 13, respectively (p < 0.01). L444P homozygotes appear at major risk for developing pulmonary disease, even at earlier ages. A comprehensive evaluation of lung involvement is recommended primarily in these subjects.

Positive immunostaining with MLuC1 of bone marrow aspirate predicts poor outcome in patients with small-cell lung cancer

BACKGROUND

Immunocytochemistry has been proven able to identify tumor cells in bone marrow aspirate (BMA) of patients with SCLC. However, few data exist about the clinical significance of the procedure.

PATIENTS AND METHODS

108 BMA taken from 60 patients were incubated with the MoAb MLuC1 (cluster 6) and stained by the APAAP (alkaline phosphatase-antialkaline phosphatase) method. The serum levels of LDH, TPA, NSE and CEA were also studied in relation to bone marrow involvement by means of discriminant analysis.

RESULTS

Immunocytochemistry of the aspirate with MLuC1 detected positive cells in 23 patients (38%) (38 of 108 samples) vs. 13% of the conventional biopsies studied without MLuC1 (P < 0.001). With respect to bone marrow positivity, three groups of patients were identified: those with no positive cells in the aspirate and negative biopsy (group A); those with less than 10 positive cells in the aspirate and negative biopsy (group B); and those with more than 10 positive cells or clumps in the aspirate or positive biopsy (group C). Group C patients had poorer median survivals than those in the other two groups (5.5 vs. 11 months, respectively, P = 0.01). Discriminant analysis showed that the four serum markers were poor discriminators of the degree of bone marrow involvement, with only 55% of grouped cases being correctly classified.

CONCLUSIONS

These results show that detection of bone marrow involvement i) can be improved by the use of MLuC1 ii) is not predictable by conventional tumor markers, and iii) is related to poor outcome.

Standardization and clinical management of lipoprotein(a) measurements

The present article proposes personal suggestions to improve determinations and clinical interpretation of results of lipoprotein(a) assays. Methods and procedures for sampling and quantification of the various isoforms of lipoprotein(a) in serum, plasma and urine are reviewed with the aim of improving the reliability and reproducibility of results and reinforcing the clinical utility of lipoprotein(a) measurements.

Evaluation of five new liquid stable applications on the Roche Cobas Integra

In the present study the analytical performances of five new liquid applications on the Roche Cobas Integra were evaluated: urea and high density lipoprotein (HDL) cholesterol in serum and glucose, creatinine and inorganic phosphorus in urine. The analytical evaluation consisted of imprecision, linearity and method comparison performed against either the actual Cobas Integra granulate applications or the corresponding methods on a Hitachi 704, according to the National Committee for Clinical Laboratory Standards protocols. Over 3700 results were obtained within 3 months. Average values of within-run and between-day coefficients of variation (CVs) were 1.15% and 1.48%, respectively, holding to a mean total CV of 2.17%. The linearity was excellent for all the five applications evaluated as the relative non-linearity was always within 1.53%, thus completely fulfilling the 2.5% upper limit. A strict correlation was observed by comparing results of 120 samples with either the corresponding granulate applications on Cobas Integra or the Hitachi reagents. Linear regression analysis of the results yielded correlation coefficients always above 0.987 and the slopes of the Passing & Bablok regression lines did not deviate by more than 7% from unity. No drift was observed over 4 hours of operations. In conclusion, the performance of these new Cobas Integra liquid applications, as demonstrated by the present study, proved them to be highly suitable for routine use in clinical laboratories.

Effects of nandrolone decanoate (Decadurabolin) on serum Lp(a), lipids and lipoproteins in women with postmenopausal osteoporosis

Although lipoprotein(a) (Lp(a)) concentrations are mainly regulated genetically, it has been reported that variations in sex hormone concentrations may have effects on serum Lp(a). We evaluated the effect of nandrolone decanoate, a testosterone-derived synthetic anabolic steroid, on serum Lp(a), lipids and lipoproteins in 19 postmenopausal women who were given parenteral nandrolone decanoate (Decadurabolin) once a week for 3 weeks. At the 4th week, a significant decrease was observed for total cholesterol (p = 0.003), Lp(a) (p = 0.0003), apolipoprotein A-I (apo A-I) (p < 0.0001), and high density lipoprotein-cholesterol (HDL-C) (p < 0.0001). Moreover, a significant decrease in serum albumin concentration (p = 0.002) was concomitantly observed. We conclude that the administration of nandrolone decanoate significantly affects the lipid profile of postmenopausal women, showing controversial effects in terms of cardiovascular risk.

Comparison of aminosidine (paromomycin) and sodium stibogluconate for treatment of canine leishmaniasis

Twelve dogs naturally infected with Leishmania infantum were treated subcutaneously with aminosidine at a dose of 10 mg kg-1 per day for four weeks. Antimonial compounds were used as reference drugs in twelve Leishmania-infected dogs. Eleven of the twelve dogs submitted to aminosidine therapy responded within 30 days. The treatment with the aminoglycoside antibiotic presented a marked decrease of anti-Leishmania antibody titres than the controls. Aminosidine also reduced urinary protein, serum IgG, and circulating immune complex concentrations. Side effects were observed only in a dog with pre-existent renal lesions. This study proved that aminosidine is an effective, tolerable and safe drug for the treatment of canine leishmaniasis and that it could be used as a suitable substitute for antimonial therapy.

Clinical performance of leukocyte differential on the new Roche Cobas Vega haematological analyzer

The Roche Cobas Vega is a five-part differential haematological analyzer evolving from the former Cobas Helios, Argos and Micros. As the leukocyte differential of Cobas Vega displays several interesting features, we analyzed its clinical performance and compared it either to three other commercial haematological analyzers (Technicon-Bayer H*2, Coulter STKS and Abbott CD-3500) or to the manual reference method, as described in the National Committee for Clinical Laboratory Standards (NCCLS) H20-A protocol. Within- and between-batch coefficients of variations (CVs) of the white blood cell differential were satisfactory and close, or even better than the ones reported for the other instruments: 0.81% (neutrophils), 1.87% (lymphocytes), 6.76% (monocytes), 7.73% (eosinophils) and 22.55% (basophils). The identification of abnormalities in the white blood cell differential was obtained either on the basis of the instrument-specific ranges or on the generation of one or more flags by comparison with results of the manual reference method. The Vega demonstrated remarkable performance in terms of specificity (90.0%), sensitivity (91.6%) and both positive (97.7%) and negative (69.1%) predictive values; likewise, the global efficiency was the best (90.3%) among the analyzers we evaluated. The flags generated in the presence of morphological abnormalities of the samples displayed excellent sensitivity (from 88.9% to 100%), specificity (from 93.5% to 98.3%) and satisfactory positive (from 51.1% to 66.7%) and negative (from 98.3% to 100%) predictive values. We conclude that the analytical performance of the new Cobas Vega haematological analyzer can significantly improve the identification of various haematological abnormalities as an important contribution to the accuracy is provided by the new staining for granulocytes.