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Zorić L, Štritof PG, Čičak H, Zekan P, Pavasović MG, Blagaić V, Čoklo M, Šimundić AM, Dukić L. Verification of bile acid determination method and establishing reference intervals for biochemical and haematological parameters in third-trimester pregnant women. Clin Chem Lab Med 2024; 0:cclm-2023-1109. [PMID: 38557367 DOI: 10.1515/cclm-2023-1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The aims of this study were to verify the bile acids (BA) method and to establish reference intervals (RIs) for bile acids (BA) and biochemical and haematological parameters in Croatian pregnant women. METHODS BA spectrophotometric method verification was performed on Siemens Atellica Solution CH 930 automated analyser using Sentinel reagent. Stability, precision, trueness, linearity, and RIs, as well as lipemia interference were tested according to CLSI guidelines. BA, biochemical, and haematological parameters were measured in serum (BA, biochemical) and whole blood (haematological) samples of fasting healthy third-trimester pregnant women from Croatia (n=121). The establishment of the RIs was done a priori according to the CLSI EP28-A3C:2010 guideline. Selected reference individuals' data were analysed using parametric, non-parametric, and robust methods. RESULTS Stability study showed that BA are stable in serum samples for 2 days at 20 °C, 14 days at 4-8 °C, and 22 days at -20 °C. The precision study and adult RIs verification met the criteria. Linearity was verified for the concentration range of 3.5-172.1 μmol/L whereas the lipemia interference test showed a positive bias (%) in BA concentration. The determined reference limits generally exhibited better precision for haematological parameters, being lower than the upper recommended value 0.2, unlike biochemical parameters. Haematological parameters showed notable differences between pregnant and non-pregnant women, while many biochemical parameters' RIs remained similar. Only ALT and GGT showed lower non-comparable RI upper limits in the population pregnant women. CONCLUSIONS Spectrophotometric BA method showed satisfactory performance and all examined parameters were within the set criteria. Moreover, RIs for key biochemical and haematological parameters, including BAs, have been established for the first time in the population of Croatian pregnant women.
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Affiliation(s)
- Lara Zorić
- Department of Medical Laboratory Diagnostics, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Petra Glad Štritof
- Department of Obstetrics and Gynecology, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Helena Čičak
- Department of Medical Laboratory Diagnostics, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Paulo Zekan
- Department of Obstetrics and Gynecology, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Maria Gotić Pavasović
- Department of Obstetrics and Gynecology, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Vladimir Blagaić
- Department of Obstetrics and Gynecology, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
| | - Miran Čoklo
- Centre for Applied Bioanthropology, 162067 Institute for Anthropological Research , Zagreb, Croatia
| | - Ana-Maria Šimundić
- Department of Medical Laboratory Diagnostics, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, 119195 University of Zagreb , Zagreb, Croatia
| | - Lora Dukić
- Department of Medical Laboratory Diagnostics, 119195 University Hospital "Sveti Duh" , Zagreb, Croatia
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Bukvić F, Ivković A, Čičak H, Dukić L, Šimundić AM, Marijančević D, Pašalić D. The Association of Serum Calprotectin with Fitness Indicators and Biochemical Markers in High-Level Athletes: A Continuous Dynamic Monitoring during One Competitive Season. Sports (Basel) 2023; 11:243. [PMID: 38133110 PMCID: PMC10748013 DOI: 10.3390/sports11120243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
The objective was to determine the associations between several biochemical indicators and the dynamics of concentration change across four physical fitness phases over the period of a competitive season. Furthermore, associations between serum calprotectin and biomarkers of inflammation or muscle injury and physical indicators were examined. SUBJECTS AND METHODS Twenty professional male water polo players (median age: 28 (22-42)) were included in this study. Serum creatine kinase activity was determined by the automated photometric UV method. The concentrations of calprotectin, C-reactive protein, and myoglobin were measured using an automated immunoturbidimetric method, while an automated immunochemistry method was employed for interleukin-6, troponin I, and cortisol determination. Tests of repeated strength, maximal strength, and static strength were used to evaluate physical activity. RESULTS Serum calprotectin concentrations expressed in median and IQR were significantly different: T1: 2.92 g/mL (2.47; 3.86); T2: 2.35 g/mL (1.26; 2.87); T3: 2.27 g/mL (1.60; 3.27); and T4: 1.47 g/mL (1.04; 2.85) (p = 0.004). Cortisol concentration and CK activity showed significant changes among phases (p = 0.049 and p = 0.014, respectively). Each physical activity examined showed a significant seasonal decrease (all p values were 0.001). Calprotectin serum concentration and indicators of muscular injury, inflammation, and physical activity were found to be correlated during particular stages of the seasonal examination. CONCLUSIONS Calprotectin values determined throughout one competitive season decreased as training intensity among water polo players increased. Serum calprotectin concentrations and indicators were related to biochemical markers of inflammation and muscle damage.
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Affiliation(s)
- Frane Bukvić
- Department of Orthopedics and Trauma Surgery, University Hospital ‘Sveti Duh’, 10000 Zagreb, Croatia; (F.B.); (A.I.)
| | - Alan Ivković
- Department of Orthopedics and Trauma Surgery, University Hospital ‘Sveti Duh’, 10000 Zagreb, Croatia; (F.B.); (A.I.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Helena Čičak
- Department of Medical Laboratory Diagnostics, University Hospital ‘Sveti Duh’, 10000 Zagreb, Croatia; (H.Č.); (L.D.); (A.-M.Š.)
| | - Lora Dukić
- Department of Medical Laboratory Diagnostics, University Hospital ‘Sveti Duh’, 10000 Zagreb, Croatia; (H.Č.); (L.D.); (A.-M.Š.)
| | - Ana-Maria Šimundić
- Department of Medical Laboratory Diagnostics, University Hospital ‘Sveti Duh’, 10000 Zagreb, Croatia; (H.Č.); (L.D.); (A.-M.Š.)
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Domagoj Marijančević
- Department of Clinical Chemistry, University Hospital Centre ‘Sestre Milosrdnice’, 10000 Zagreb, Croatia;
| | - Daria Pašalić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Čičak H, Dukić L, Šimundić AM. Verification of reference interval for urinary alpha1-microglobulin in females. Clin Chim Acta 2020; 504:64-65. [DOI: 10.1016/j.cca.2020.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 11/24/2022]
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Šonjić P, Nikler A, Vuljanić D, Dukić L, Šimundić AM. Clinician's opinion about critical risk results proposed by the Croatian Chamber of Medical Biochemists: a survey in one Croatian tertiary hospital. Biochem Med (Zagreb) 2019; 29:030711. [PMID: 31624464 PMCID: PMC6784420 DOI: 10.11613/bm.2019.030711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/04/2019] [Indexed: 11/12/2022] Open
Abstract
Introduction It has been recommended that each laboratory modify their critical result reporting practices to reflect the clinical needs of their patient populations. The aim of this survey was to assess how well critical laboratory values defined by the Croatian Chamber of Medical Biochemists (CCMB) correspond to the needs of the physicians at University hospital “Sveti Duh” (Zagreb, Croatia). Materials and methods We conducted a survey among physicians from five departments in our hospital. Physicians were asked general questions about critical risk results (if and how they want to be informed). A list of critical risk results defined by the CCMB was offered and physicians were asked to revise the existing critical risk results and suggest adding new parameters. Obtained data were presented as numbers. Where the number of observations was low, ratios were used. Results Survey response rate was 43% (52/121). Majority (48/52) wants to be informed of critical risk results, either personally (31/48) or through a colleague (32/48). They prefer to be informed about critical risk results of prothrombin time, platelet count, haemoglobin, glucose, creatinine, sodium and potassium. Revisions in the CCMB critical risk result list are proposed by 13 out of 48 physicians. Neonatologists approved the CCMB’s list. Conclusions Although most critical risk results defined by the CCMB correspond well to the needs of the physicians in our hospital, some revisions are necessary to meet the particular needs of individual departments. Communication of critical risk results to those who have requested laboratory testing is highly appreciated practice.
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Affiliation(s)
- Pavica Šonjić
- Department of medical biochemistry in oncology, University Hospital for Tumors, "Sestre milosrdnice" University Hospital Center, Zagreb, Croatia
| | - Ana Nikler
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Dora Vuljanić
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Lora Dukić
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ana-Maria Šimundić
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
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Dojder A, Vuljanić D, Špoljarić V, Saračević A, Dukić L, Leniček-Krleža J, Vlašić-Tanasković J, Maradin I, Grzunov A, Šimundić AM. Reporting categories in urine test strip analysis: Croatian survey and call for action. Biochem Med (Zagreb) 2019; 29:020709. [PMID: 31223263 PMCID: PMC6559610 DOI: 10.11613/bm.2019.020709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction In line with the national recommendations, Croatian medical laboratories report urine test strip qualitative analysis results using a categorized scale with defined number of categories. Since concentration ranges for measured analytes have not been provided by national professional authority, it is up to the laboratories to define their own categories. The aim of study was to assess the comparability of concentrations assigned to different categories used in reporting the results of dipstick urinalysis in Croatian laboratories. Material and methods A questionnaire was e-mailed to all Croatian medical laboratories (N = 195). They were asked to provide the number of categories and respective concentrations for each parameter. Data were described as numbers and percentages. Values above the upper reference range limit, which were assigned as normal and/or trace category, were considered as false negative. Results Response rate was 71% (139/195). Seventy percent (98/139) of laboratories report their results with either higher (77/98; 79%) or lower (2/98; 2%) number of categories, relative to the national recommendation, whereas 19/98 (19%) report their results as concentrations. Great heterogeneity of reporting categories was observed. Multiple categories were assigned to same concentrations and there was a large overlap of concentrations for most categories. Considerable proportion of laboratories reported false negative results for ketones (42%), leukocytes (30%) and glucose (21%). Conclusions The concentrations assigned to categories used to report the results of dipstick urinalysis are not comparable among Croatian medical laboratories. There is an urgent need for harmonization and standardization of reporting the results of urine dipstick analysis in Croatia.
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Affiliation(s)
- Ana Dojder
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
- Corresponding author:
| | - Dora Vuljanić
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Valentina Špoljarić
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Andrea Saračević
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Lora Dukić
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Jasna Leniček-Krleža
- Department of Laboratory Diagnostics, Children’s Hospital Zagreb, Zagreb, Croatia
- Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Jelena Vlašić-Tanasković
- Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
- Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Ivana Maradin
- Medical-biochemistry Laboratory “Mirjana Plavetić and Ivana Maradin”, Karlovac, Croatia
- Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Ana Grzunov
- Department of Laboratory Diagnostics, Children’s Hospital Zagreb, Zagreb, Croatia
- Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Ana-Maria Šimundić
- Department of Medical Laboratory Diagnostics, University Hospital “Sveti Duh”, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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Dukić L, Vuljanić D, Ostojić V, Šimundić A. Comparison of skin prick test results with serum specific and total immunoglobulin e concentrations measured on Immulite® 2000 XPI analyzer. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Čičak H, Dukić L, Šimundić A. Verification of reference interval for alpha1-microglobulin in urine. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vuljanić D, Dojder A, Špoljarić V, Saračević A, Dukić L, Leniček-Krleža J, Vlašić-Tanasković J, Maradin I, Grzunov A, Vogrinc Ž, Šimundić AM. Analytical verification of 12 most commonly used urine dipsticks in Croatia: comparability, repeatability and accuracy. Biochem Med (Zagreb) 2019; 29:010708. [PMID: 30799977 PMCID: PMC6366948 DOI: 10.11613/bm.2019.010708] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/28/2018] [Indexed: 11/01/2022] Open
Abstract
Introduction Variability among manufacturers of urine dipsticks, respective to their accuracy and measurement range, may lead to diagnostic errors and thus create a serious risk for the patient. Our aims were to determine the level of agreement between 12 most commonly used urine dipsticks in Croatia, examine their accuracy for glucose and total protein and to test their repeatability. Materials and methods A total of 75 urine samples were used to examine comparability and accuracy of 12 dipstick brands (Combur 10 TestM, ChoiceLine 10, Combur 10 TestUX, ComboStik 10M, ComboStik 11M, CombiScreen 11SYS, CombiScreen 10SL, Combina 13, Combina 11S, Combina 10M, UriGnost 11, Multistix 10SG). Agreement between each dipstick and the reference (Combur 10 TestM) was expressed as kappa coefficient (acceptable κ ≥ 0.80). Accuracy for glucose and total protein was tested by comparison with quantitative measurements on analysers: AU400 (Beckman Coulter, USA), Cobas 6000 c501 (Roche Diagnostics, Germany) and Architect plus c4000 (Abbott, USA). Repeatability was assessed on 20 replicates (acceptable > 90%). Results Best agreement was achieved for glucose, total protein and nitrite (11/11, k > 0.80) and the lowest for bilirubin (5/5, k < 0.60). Sensitivities for total protein were 41-75% (AU400) and 56-92% (Cobas and Architect); while specificities were 41-75% (AU400, Cobas, Architect). Dipsticks' sensitivity and specificity for glucose were 68-98%. Most of the dipsticks showed unacceptable repeatability (6/12, < 90%) for one parameter, most prominently for pH (3/12, < 90%). Conclusions Most commonly used dipsticks in Croatia showed low level of agreement between each other. Moreover, their repeatability varies among manufacturers and their accuracy for glucose and proteins is poor.
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Affiliation(s)
- Dora Vuljanić
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ana Dojder
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Valentina Špoljarić
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Andrea Saračević
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Lora Dukić
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Jasna Leniček-Krleža
- Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and
Laboratory Medicine, Zagreb, Croatia
| | - Jelena Vlašić-Tanasković
- Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and
Laboratory Medicine, Zagreb, Croatia
| | - Ivana Maradin
- Medical - biochemistry Laboratory: "Mirjana Plavetić and Ivana Maradin", Karlovac, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and
Laboratory Medicine, Zagreb, Croatia
| | - Ana Grzunov
- Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and
Laboratory Medicine, Zagreb, Croatia
| | - Željka Vogrinc
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana-Maria Šimundić
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
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Dukić L, Kopčinović LM, Dorotić A, Baršić I. Blood gas testing and related measurements: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2016; 26:318-336. [PMID: 27812301 PMCID: PMC5082214 DOI: 10.11613/bm.2016.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 07/06/2016] [Indexed: 11/01/2022] Open
Abstract
Blood gas analysis (BGA) is exposed to risks of errors caused by improper sampling, transport and storage conditions. The Clinical and Laboratory Standards Institute (CLSI) generated documents with recommendations for avoidance of potential errors caused by sample mishandling. Two main documents related to BGA issued by the CLSI are GP43-A4 (former H11-A4) Procedures for the collection of arterial blood specimens; approved standard - fourth edition, and C46-A2 Blood gas and pH analysis and related measurements; approved guideline - second edition. Practices related to processing of blood gas samples are not standardized in the Republic of Croatia. Each institution has its own protocol for ordering, collection and analysis of blood gases. Although many laboratories use state of the art analyzers, still many preanalytical procedures remain unchanged. The objective of the Croatian Society of Medical Biochemistry and Laboratory Medicine (CSMBLM) is to standardize the procedures for BGA based on CLSI recommendations. The Working Group for Blood Gas Testing as part of the Committee for the Scientific Professional Development of the CSMBLM prepared a set of recommended protocols for sampling, transport, storage and processing of blood gas samples based on relevant CLSI documents, relevant literature search and on the results of Croatian survey study on practices and policies in acid-base testing. Recommendations are intended for laboratory professionals and all healthcare workers involved in blood gas processing.
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Affiliation(s)
- Lora Dukić
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Committee for the Scientific Professional Development, Working Group for Blood Gas Testing; University Department of Chemistry, Medical School University Hospital Sestre milosrdnice, Zagreb, Croatia
| | - Lara Milevoj Kopčinović
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Committee for the Scientific Professional Development, Working Group for Blood Gas Testing; University Department of Chemistry, Medical School University Hospital Sestre milosrdnice, Zagreb, Croatia
| | - Adrijana Dorotić
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Committee for the Scientific Professional Development, Working Group for Blood Gas Testing; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Department of Medical Biochemistry and Haematology, Zagreb, Croatia
| | - Ivana Baršić
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Committee for the Scientific Professional Development, Working Group for Blood Gas Testing; Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Croatia
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Margetić S, Ćelap I, Dukić L, Vukasović I, Virović-Jukić L. Interference of M-protein on prothrombin time test - case report. Biochem Med (Zagreb) 2016; 26:248-54. [PMID: 27346971 PMCID: PMC4910265 DOI: 10.11613/bm.2016.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/21/2016] [Indexed: 12/22/2022] Open
Abstract
The aim of this report was to present a case of interference on prothrombin time (PT) test that directed further laboratory diagnostics and resulted with final detection of monoclonal gammopathy in an 88-year old man. Routine coagulation testing during medical examination at Emergency Department revealed unmeasurable PT (< 7% activity) and activated partial thromboplastin time (aPTT) within reference range. After repeated sampling for coagulation testing, PT was unmeasurable again, as well as fibrinogen level (< 0.8 g/L), thrombin time (TT) was significantly prolonged (107 seconds) and aPTT was within reference range. In both plasma samples refrigerated at 4 ˚C overnight, white gelatinous precipitate was visible between the cell and plasma layers and the presence of monoclonal protein (M-protein) was suggested in our patient. Further laboratory diagnostics revealed total serum proteins at concentration of 123 g/L and the presence of M-protein IgG lambda (λ) at concentration of 47.1 g/L. These results suggested monoclonal gammopathy as an underlying pathophysiological condition in our patient. Activities of coagulation factors II, V, VII and X were within reference ranges or increased. These results and correction of unmeasurable PT result to 67% in mixing test with commercial normal plasma suggest in vitro rather than in vivo interference of M-protein on PT result. In contrast, significantly prolonged TT results in all analysed samples suggest impact of M-protein on this global coagulation test due to possible effect on fibrin polymerization.
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Affiliation(s)
- Sandra Margetić
- Clinical Institute of Chemistry, Medical School University Hospital Sestre milosrdnice, Zagreb, Croatia
| | - Ivana Ćelap
- Clinical Institute of Chemistry, Medical School University Hospital Sestre milosrdnice, Zagreb, Croatia
| | - Lora Dukić
- Clinical Institute of Chemistry, Medical School University Hospital Sestre milosrdnice, Zagreb, Croatia
| | - Ines Vukasović
- Clinical Institute of Chemistry, Medical School University Hospital Sestre milosrdnice, Zagreb, Croatia
| | - Lucija Virović-Jukić
- University Department of Internal Medicine, Medical School University Hospital Sestre milosrdnice, Zagreb, Croatia
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Dukić L, Šimundić AM. Institutional practices and policies in acid-base testing: a self reported Croatian survey study on behalf of the Croatian society of medical biochemistry and laboratory medicine Working Group for acid-base balance. Biochem Med (Zagreb) 2014; 24:281-92. [PMID: 24969922 PMCID: PMC4083580 DOI: 10.11613/bm.2014.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/20/2014] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The aim of this survey study was to assess the current practices and policies in use related to the various steps in the blood gas testing process, across hospital laboratories in Croatia. MATERIALS AND METHODS First questionnaire was sent by email to all medical biochemistry laboratories (N = 104) within general, specialized and clinical hospitals and university hospital centres to identify laboratories which perform blood gas analysis. Second questionnaire with detailed questions about sample collection, analysis and quality control procedures, was sent only to 47 laboratories identified by the first survey. Questionnaire was designed as combination of questions and statements with Likert scale. Third questionnaire was sent to all participating laboratories (N=47) for additional clarification for either indeterminate or unclear answers. RESULTS Blood gas analysis is performed in 47/104 hospital laboratories in Croatia. In 25/41 (0.61) of the laboratories capillary blood gas sampling is the preferred sample type for adult patient population, whereas arterial blood sample is preferentially used in only 5/44 laboratories (0.11). Blood sampling and sample processing for capillary samples is done almost always by laboratory technicians (36/41 and 37/44, respectively), whereas arterial blood sampling is almost always done by the physician (24/29) and only rarely by a nurse (5/28). Sample acceptance criteria and sample analysis are in accordance with international recommendations for majority of laboratories. 43/44 laboratories participate in the national EQA program. POCT analyzers are installed outside of the laboratory in 20/47 (0.43) institutions. Laboratory staff is responsible for education and training of ward personnel, quality control and instrument maintenance in only 12/22, 11/20 and 9/20 institutions, respectively. CONCLUSION Practices related to collection and analysis for blood gases in Croatia are not standardised and vary substantially between laboratories. POCT analyzers are not under the direct supervision by laboratory personnel in a large proportion of surveyed institutions. Collective efforts should be made to harmonize and improve policies and procedures related to blood gas testing in Croatian laboratories.
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Affiliation(s)
- Lora Dukić
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb,
Croatia
| | - Ana-Maria Šimundić
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb,
Croatia
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12
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Dukić L, Simundić AM, Malogorski D. Comparison of digoxin concentration in plastic serum tubes with clot activator and heparinized plasma tubes. Biochem Med (Zagreb) 2014; 24:146-50. [PMID: 24627723 PMCID: PMC3936983 DOI: 10.11613/bm.2014.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 01/15/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction: Sample type recommended by the manufacturer for the digoxin Abbott assay is either serum collected in glass tubes or plasma (sodium heparin, lithium heparin, citrate, EDTA or oxalate as anticoagulant) collected in plastic tubes. In our hospital samples are collected in plastic tubes. Our hypothesis was that the serum sample collected in plastic serum tube can be used interchangeably with plasma sample for measurement of digoxin concentration. Our aim was verification of plastic serum tubes for determination of digoxin concentration. Materials and methods: Concentration of digoxin was determined simultaneously in 26 venous blood plasma (plastic Vacuette, LH Lithium heparin) and serum (plastic Vacuette, Z Serum Clot activator; both Greiner Bio-One GmbH, Kremsmünster, Austria) samples, on Abbott AxSYM analyzer using the original Abbott Digoxin III assay (Abbott, Wiesbaden, Germany). Tube comparability was assessed using the Passing Bablok regression and Bland-Altman plot. Results: Serum and plasma digoxin concentrations are comparable. Passing Bablok intercept (0.08 [95% CI = −0.10 to 0.20]) and slope (0.99 [95% CI = 0.92 to 1.11]) showed there is no constant or proportional error. Conclusion: Blood samples drawn in plastic serum tubes and plastic plasma tubes can be interchangeably used for determination of digoxin concentration.
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Affiliation(s)
- Lora Dukić
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia
| | - Ana-Maria Simundić
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia
| | - Davorin Malogorski
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia
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