Assessing post-analytical phase harmonization in European laboratories: a survey promoted by the EFLM Working Group on Harmonization

OBJECTIVES

Harmonization of the laboratory total testing process (TTP) is critical to improving patient outcome. In 2016, an EFLM survey on the harmonization of TTP underlined the serious shortcomings pertaining to the post-analytical phase. In 2023, the WG-H conducted a new survey aiming to update information in the 2016 harmonization report in order to ascertain whether countries that had declared they were keen to adopt SI units had continued with this program, the aim being to verify the state-of art in harmonization units in areas of laboratory medicine not included in the previous survey.

METHODS

Questionnaires were distributed to the Presidents and National Representatives of EFLM Full Member Societies and EFLM affiliate Members. The survey questions were grouped into three categories: measurement units, reference intervals, and nomenclature/terminology, and results were evaluated using Survey Monkey software and Excel.

RESULTS

A total of 123 questionnaires from 31 countries were analyzed. A trend (+19.3 %) was observed toward a wider use of SI units for general clinical biochemistry parameters. The results for tests not included in the 2016 survey (i.e., endocrinology diagnostics and coagulation panels), demonstrated that for reports on hormones, responses were satisfactory, 70-90 % of the responders adopting the recommended units, whereas for coagulation test panels, a serious lack of harmonization was found, "seconds", which are inaccurate and not recommended, being widely used units (91 %).

CONCLUSIONS

The findings made in the 2023 survey demonstrated a progressive, albeit slow, improvement in harmonization reports. However, further efforts at improvement are mandatory.

Molecular Aspects of Allergen-Specific Immunotherapy in Patients with Seasonal Allergic Rhinitis

A systematic review and narrative synthesis of publications was undertaken to analyze the role of component-resolved diagnosis technology in identifying polysensitization for the provision of allergen-specific immunotherapy to patients with seasonal allergic rhinitis. A search of publications was carried out in electronic databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search helped to identify 568 publications, 12 of which were included in this review. Overall, 3302 patients were enrolled. The major finding was that component-resolved diagnostics change the choice of relevant allergens for allergen-specific immunotherapy in at least 50% of cases. Sensitization to allergen components differs with age, type of disease, and overall disease duration. Patients who had both bronchial asthma and allergic rhinitis were sensitized to a larger number of allergens than patients who had bronchial asthma alone.

ABO system combination with Rh, Kell and MN group in Georgian blood donors

There are numerous scientific data about the study of the prevalence of blood group antigens in the different donor population. Several studies showed that the profile of major blood group antigens is not similar in blood donors from different local areas.

RESEARCH OBJECTIVE

Our scientific goal was to study of the prevalence blood group antigens in the Georgian blood donor population. In the current study, we analyzed the 48 phenotypically combinations based on four major (ABO, Rh, Kell, and MN) blood groups.

RESEARCH METHODS

The blood of 1009 donors has been studied on RBC antigens. The sample were collected from the diagnostic laboratory of Medina Ltd Health Centre of Batumi. Blood typing of the sample has been carried out on the basis of the immunogenetics laboratory of Batumi Shota Rustaveli State University. The universal monoclone antibodies was used for identify minor blood group antigens. We used as forward as reverse grouping methods. For identification erythrocytes, blood group antigens also were used ID cards, such as ABO/D + Reverse Grouping.

RESULT

12 phenotypic combinations have been identified in each O, A, B, AB group of ABO system. Out of 48 theoretically possible phenotypic combinations, we can actually find 1,9 times less phenotypes and the real amount is 25 phenotypes. The remaining 23 phenotypic combinations have not been observed in the studied donors. These are: 1. O, Rh^-K⁺ MM; 2. O, Rh^-K^- MN; 3. O, Rh^-K^- NN; 4. A, Rh^-K⁺ MN; 5. A, Rh^-K⁺ MM; 6. A, Rh^-K⁺ NN; 7. A, Rh^-K^- MM; 8. A, Rh^-K^- NN; 9. B, Rh⁺K⁺ NN; 10. B, Rh^-K⁺ MN; 11. B, Rh^-K⁺ MM; 12. B, Rh^-K⁺ NN; 13. B, Rh^-K^- MN; 14. B, Rh^-K^- MM; 15. B, Rh^-K^- NN; 16. AB, Rh⁺K⁺ MN; 17. AB, Rh⁺K⁺ NN; 18. AB, Rh⁺K^- NN; 19. AB, Rh⁺K^- MM; 20. AB, Rh^-K⁺ MN; 21. AB, Rh^-K⁺ MM; 22. AB, Rh^-K⁺ NN; 23. B, Rh^-K^- NN. The value of χ² in the case is equal to 3221,16. The P-Value is < .00001. The result is significant at P < .05. Out of 1009 studied donors 349 are carriers of phenotypic group A (II), while 19 donors carry AB (IV) group specification. This means that 36.23% of the studied donors have A antigen on the surface of erythrocyte membrane. The majority of them A1 subgroup.

CONCLUSION

As our research showed there is a quit high polymorphism of blood group phenotype combinations in Georgian blood donors in the example of one clinic. This kind of data is very important for the clinics' rational preparation of whole blood or blood components.

[COMPARATIVE ANALYSIS OF ANTIBACTERIAL EFFECT OF PHYTOANTIBIOTICS AND ANTIBIOTICS]

The objective of this study was to determine the antibacterial activity of individual medicines and containing sum of the phyto-extracts against the bacteria causing nosocomial infections in compare to antibiotics. In the investigation were involved four strains of gram-negative bacteria Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter spp. Each object was investigated on antibiotic resistance using Kirby-Bauer diffusion method on 22 types of antibiotics. The objects of the study were: Sanguinarine, Chelerythrine and Berberine hydrochloride (of lab quality); essential oils and aromatic waters of Eucalyptus, Salvia and Lavanda. For determination their antibacterial activity was used Raits serological dilution method with adaptation. The results show that the antibiotic resistant bacteria did not rise in non-diluted and 1:1 diluted test-tubes. In 1:5 diluted test-tubes was observed a little turbidity and growth, as for in other test-tubes - intensive growth. The investigated phyto-medicines show the higher antibacterial activity than the antibiotics.

SOME CLINICALLY IMPORTANT ERYTHROCYTE BLOOD GROUP ANTIGENS IN DONORS

The distribution of erythrocyte blood group antigens was evaluated among 656 donors; samples were provided by the diagnostic laboratory "Medina" Ltd Health Centre of Batumi. Lab analysis of the sample was conducted by the immunogenetics laboratory at Batumi Shota Rustaveli State University. The frequency of the ABO allele system in donors was as follows: r (0.70), q (0.23), p (0.07). The distribution of Rhesus (Rh) factor in the donor population was as follows: Rh(-) was found among 16.3±1.43% of investigated donors; the Rh(+) phenotype was found in 83.7±1.43% of donors. Additionally, the CcDee phenotype frequency was 29.9±1.78%; CCD-ee was 17.2±1.47%; ccddee was 14.9±1.38%; and CcD-Ee was 13.9±1.34%; ccD-Ee phenotype was 11.1±1.22%; ccD-ee was 5.5±0.88%; same phenotype indicators -2.1±0.55 were observed for CcD-EE and ccD-EE; CCD-Ee was 1.4±0.45%, CCD-EE was 0.4±0.26%; and finally, the frequency of Ccddee phenotype amounts was 1.1±0.40%, ccddEe and CCddee phenotypes were both 0.2±0.17%. The analysis of the Kell system allele revealed a low frequency for the p allele at 0.05, whereas the frequency of the q allele was 0.95. This large epidemiologic analysis of donor blood provides valuable information for hematological and transfusion centers to inform the preparation of blood components for transfusion.

DETECTION OF CTX-M GENE ANTIBIOTICS RESISTANCE IN KLEBSIELLA PNEUMONIA ISOLATES OF HOSPITALS IN ADJARA (GEORGIA)

Research describing the epidemiology of antibiotic resistant microbes is vital to the proactive development of new antimicrobial agents. In the last years, CTX-M extended-spectrum β-lactamases (ESBLs) have emerged worldwide and have replaced classical TEM and SHV-type ESBLs in many countries. CTX-M-15 is currently the most frequent, with a pandemic distribution, and its rapid spread is facilitated by incorporation of resistance genes in mobile genetic elements. The ESBL is efficacious in Gram-negative bacteria and thus closely associated with nosocomial environments, often colonizing the intestines, particularly in older and dependent patients. Little is known about the CTX-M ESBLs among Klebsiella pneumonia in Adjara. Our paper describes the detected and characterized ESBLs among Klebsiella pneumonia isolates from patients in two different hospitals in Adjara.

The association of some genetic factors with pulmonary tuberculosis in Georgian and Azeri ethno groups

Pulmonary Tuberculosis (TB) is still one of the major public health problems. Over the last half decade the significant problem is an increased ratio of drug-resistant TB cases. TB is as well the most significant infectious disease in the country of Georgia. Pulmonary tuberculosis is assessed as a complex infectious disease affected by both, environmental and genetic factors. Present study was undertaken to find out the correlation between pulmonary tuberculosis and erythrocyte blood groups antigens determinant alleles (ABO - r, p, q; Rh D+, Rh D- and MN - p, q) in two different, Georgian and Azeri, ethno groups. Immune-serological methods, direct reaction of universal monoclonal antibodies were used. Materials processed by biostatistician methods. The study had shown different correlation of pulmonary tuberculosis to erythrocyte blood groups determinant alleles in Georgian and Azeri ethno groups. In Georgian ethno group pulmonary TB correlates with ABO-r and p, Rh-D,+' and MN-p alleles, whether ABO-q, Rh-D,-' and MN-p in Azeri ethno group.

Prevalence of Mycoplasma hominis and Ureaplasma urealiticum in pregnant and women with reproductive problems

The aim of the research was to explore women with reproductive problems and pregnant women on Mycoplasma and Ureaplasma as well as to investigate spread of these microbes in the women of reproductive age. There were investigated 100 women with reproductive problem and 96 pregnant women. It was found that 64% of women with reproductive problem and 60% of pregnant women had Ureaplasma urealyticum with high titer (more then 1000 cells in ml), but Mycoplasma hominis was detected approximately in equal % of non-pregnant and pregnant women (12% - non-pregnant women; 16% - pregnant women). It is recommended to investigate women before planning pregnancy.

Composition of erythrocytic (ABO, Rh-Hr, Kell, MN) group antigens characteristic of the Ozurgeti district's population

Erythrocytic group antigens represent a genetically stably determined trait. Investigation of antigens of the said system in different regions is of the greatest importance in terms of both the creation of demographic data of the region as well as practical medicine, especially for transplantology and transfusiology. The peripheral or venous blood of 232 local natives (healthy donors) of Ozurgeti district of Guria region has been taken as the test subject. The test subject was taken by random methods in different vilifies (Bakhvi, Mshvidobauri, Ozurgeti, Likhauri, Gurianta, Bokhvauri, Dvadzu, Pampaleti) To identify the ABO, Rh-Hr, Kell, MN system antigens, an express-method using monoclonal antibodies has been applied. In studying the ABO system, it was fixed that the highest distribution frequency was characteristic of the 0(I) group (52.3±3.2%), then follows the group A(II) (38.5±3.2%). The distribution frequency of the B(III) group is (8.2±1.8%) and that of AB(IV)--(0.8±0.5). The population's 85.2±2.32% is the carrier of the Rh+ phenotypic group, while 14.7±2.3% belongs to the Rh-phenotypic group. In studying the concentration of alleles, the low concentration of p(K) allele was detected that equaled 0.2; the concentration of q(K) allele made 0.8, that of p(M)--0.65, and that of q (N) - 035.

Detection of tolerance against human chorionic gonadotropin at malignant and benign tumors of female reproduction system

The main aim of this study was to investigate the possibility of hCG synthesis during malignant gynecological tumors and establish the level of tolerance against hCG in malignant and benign tumors. We have examined peripheral blood of 86 patients with malignant and benign tumors of reproductive system and healthy donors, aged 42-65 for detection of anti-hCG auto-antibodies and possibility of hCG synthesis. Investigation have shown that in case of malignant tumors as auto-antibody concentration is low and hCG level is high, hCG plays a role of autocrine growth factor for tumor cells and maintains the malignancy and tumor growth. The existence of auto-antibody indicates that immune system is not completely tolerant to hCG. During studies on the effectiveness of anti-tumor vaccine, this fact should be taken into consideration.