Volume 32, Issue 2

Demographic changes and the increasing proportion of elderly among the overall population call for consideration of the morphology and function of the ageing kidney. Its hallmarks include progressive loss of kidney function reserve and potential for compensation. Differentiation from true kidney disease and/or injury is of paramount importance. Early diagnosis allows for treatment which should delay progression of renal disease in the elderly. The glomerular filtration rate (GFR) is the recommended laboratory parameter to establish glomerular function of the kidney base and classify different stages of chronic renal diseases. Current discussions focus on estimated GFR formulas based on endogenous substances (creatinine and cystatin C). Unfortunately, these estimated GFR formulas were not specifically developed for the old population and reference ranges for a normal renal function are not defined beyond the age of 70 years. Studies show inconsistencies between data sets of formulas depending on age and diseases. “Gold standard”-like, validated methods for determination of glomerular and tubular renal function in the old population are not available at this time Until the validation of estimated GFR formulas of new biomarkers, one relies on formulas tested and additional renal and non-renal laboratory parameters. These should be applied according to recent physical findings. Age, disease and ongoing therapy should influence the selection of a formula with the least deviation from the gold standard (exogenous clearance). The consistent use of standardised methods and calibrators will advance the estimation of renal function in the elderly. The initial assessment of the ageing kidney remains a challenge with the risk of both over- and underestimating kidney function. Follow-up investigation is essential to monitor changes from individual baseline kidney function. The main goal of the current and future studies will be the individual assessment of kidney function in the elderly considering its functional reserve.

Demographic changes and the increasing proportion of elderly among the overall population call for consideration of the morphology and function of the ageing kidney. Its hallmarks include progressive loss of kidney function reserve and potential for compensation. Differentiation from true kidney disease and/or injury is important, since early diagnosis allows for treatment that may delay progression of renal disease in the elderly. The glomerular filtration rate (GFR) is the recommended laboratory parameter to describe glomerular function of the kidney and hence to distinguish the different stages of chronic renal diseases. Current discussions focus on estimated GFR formulas based on endogenous substances (creatinine and cystatin C). Unfortunately, these estimated GFR formulas were not specifically developed for the aged population and reference ranges for a normal renal function are not defined beyond the age of 70 years. There are inconsistencies between data sets of formulas depending on age and disease. No methods have been validated for determination of glomerular and tubular renal function in the elderly. Until the validation of estimated GFR formulas or new biomarkers, one relies on formulas tested and additional renal and non-renal laboratory parameters. These should be applied according to recent physical findings. Age, disease and ongoing therapy should influence the selection of a formula with the least deviation from the gold standard (exogenous clearance). The consistent use of standardised methods and calibrators will advance the estimation of renal function in the elderly. The initial assessment of the ageing kidney remains a challenge with the risk of both over- and underestimating kidney function. Follow-up investigation is essential to monitor changes from individual baseline kidney function. The main goal of current and future studies will be the individual assessment of kidney function in the elderly considering its functional reserve.

While in large clinical laboratories the implementation of total laboratory automation is continuously proceeding, this concept is mostly not suitable for small- and middle-sized laboratories or for testing laboratories of blood donation services due to costs and required space. For these facilities, however, a rational level of automation can be achieved by the installation of stand-alone work cells for pre-analytical and selected analytical processes. In this review, the features of some automated pre-analytical sample processing systems and automated systems for the serological testing for infectious diseases are described exemplarily and compared with each other. The major advantages of automated systems, compared to a solely manual workflow, are described. Essential factors which have to be considered for making the choice for an appropriate automated system are pointed out. Zusammenfassung Während in großen klinischen Laboratorien die Einführung der totalen Laborautomation weiter fortschreitet, kann dieses Konzept für kleine und mittelgroße Laboratorien oder Testlaboratorien von Blutspendediensten aufgrund der hohen Kosten und des Platzbedarfs in den meisten Fällen als nicht geeignet angesehen werden. Für solche Einrichtungen kann eine rationelle Automation durch die Installation von einzeln stehenden „automatisierten Zellen” für präanalytische und ausgewählte analytische Prozesse erzielt werden. In dieser Übersichtsarbeit werden die Charakteristika einiger automatisierter präanalytischer Probenverarbeitungssysteme und automatisierter Systeme für die serologische Infektionsdiagnostik exemplarisch beschrieben und miteinander verglichen. Die wesentlichen Vorteile von automatisierten Systemen im Vergleich zu einem ausschließlich manuellen Arbeitsablauf werden dargestellt. Essentielle Faktoren, die bei der Wahl eines geeigneten automatisierten Systems berücksichtigt werden müssen, werden hervorgehoben.

The increase of productivity and safety of diagnostic testing as well as the reduction of costs and fulfilling the strict legal recommendations and guidelines are major tasks in blood bank services. To achieve all these aims without allocating enormous capacities of personnel, the introduction of automated technologies and data processing systems may be the only alternative. In the present assessment, we describe the most widely distributed automatic systems for blood bank services. This review describes the currently available automated immunohaematological systems and illustrates the evaluation of the fully automated system – Ortho AutoVue ® Innova – as compared to standard manual methods. Work processes of our blood bank were reviewed to establish where improvements could be achieved before installing the automated testing instrument. The suitability of automation and data processing in order to support the bulk of routine and emergency work was explored. The improvement of the arrangement of the workspace led to a reduction of the specimen receipt operator working process time by 6%, whereas the review of the activity of the operator's time led to a reduction of 53%. Consistent results were achieved for blood group (100%), rhesus typing (100%), antibody screening (100%) and for auto control (87%) using the manual Diamed system and the automatic AutoVue ® system. A consistent result of 82% was achieved for antibody screening with frozen samples with known antibodies. The turnaround time, as calculated from the receipt at the blood bank to the completion of standard cross-match, blood typing and antibody screening, was decreased up to 17% using the automatic system due to the standardisation and automation of testing. The Ortho AutoVue ® Innova system automates routine blood bank testing encompassing blood typing, cross-matching and antibody screening with high reliability, sensitivity and specificity compared to standard manual methods. Zusammenfassung Der allgemeine Trend im Bereich des Blutbankwesens ist die Produktivität und Sicherheit der durchgeführten immunhämatologischen Untersuchungen zu erhöhen. Gleichzeitig wird angestrebt, die anfallenden Kosten in der Blutbank zu reduzieren und die gegenwärtigen strengen Empfehlungen und Richtlinien zu erfüllen. Automatisierte Technologien und Datenverarbeitungsprozesse sind eine wichtige Alternative, um diese Ziele mit begrenztem Personalaufwand zu erreichen. Diese Übersicht stellt die wichtigsten der gegenwärtig verfügbaren automatisierten immunhämatologischen Systeme vor und stellt am Beispiel der Validierung des voll automatisierten Systems Ortho AutoVue ® Innova im Vergleich zu manuellen Standardmethoden die konkrete Umsetzung dar. Abläufe und Arbeitsprozesse in der Blutbank wurden retrospektiv analysiert, um im Vorfeld vor Einführung der Automation notwendige Maßnahmen umzusetzen. Die Möglichkeiten der Blutbankautomation und Datenverarbeitung zur Unterstützung der Routine- und Notfalldiagnostik wurden untersucht. Die Umstrukturierung und Neuorganisation der Laboreinsatzplätze führte zu einer Verringerung der Prozessierungszeit der Proben durch die medizinisch-technischen Assistenten von 6%, während die Optimierung der Arbeitsabläufe zu einer Zeitersparnis von 53% führte. Für die durchgeführten Blutgruppenbestimmungen, Rhesustypisierungen und Antikörpersuchtestungen, wurden unter Verwendung des automatischen AutoVue ® -Systems und des manuellen Diamed ® -Systems übereinstimmende Ergebnisse (100%) erzielt. Der gesamte Zeitaufwand der Untersuchung einer Probe von dessen Ankunft in der Blutbank bis zur Freigabe der Kreuzprobe, Blutgruppenbestimmung und Antikörpersuchtest, konnte durch den Einsatz des AutoVue ® Innova-Systems aufgrund der standardisierten und automatisierten Testung um bis zu 17% reduziert werden. Das Ortho AutoVue ® Innova-System automatisiert die Standard-Routinetestungen der Blutbank mit hoher Zuverlässigkeit, Sensitivität und Spezifität verglichen mit manuellen Standardmethoden.

With increasing self-driven momentum, haematological diagnosis has developed from rather philosophical approaches in ancient Greece to the application of logical principles to investigating human blood within the last two centuries. The 20th century was a time of industrial standardisation and thus a period in which established procedures operated by humans evolved in haematology. In the 21st century, modern computers and network technologies are being integrated into complex instruments, linked to each other mechanically and logically by control systems based on algorithms. Automation in haematology now permits comprehensive and highly precise diagnosis. This will be illustrated by four analysis systems. These diagnostic tools are not only of importance for diagnostic purposes but also for screening of blood donors and blood products.

In the framework of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a panel of clinical chemical parameters was determined to provide objective information on health status and particular health risks, in addition to parent interview data and anthropometric measurements. In total, 43 parameters covered three areas of particular public health interest: micronutrient deficiency, seroepidemiology of infectious diseases and immunization status, and risk indicators or risk factors for chronic non-communicable diseases. A review of available evidence regarding valid reference or cut-off values, as well as standardization of laboratory methods, lead to categorization of these parameters into five classification categories. The present paper discusses initial descriptive results on selected parameters representing the various categories. To determine the public health impact of measurement results, and perhaps to derive normative reference data relevant to healthcare, more detailed analyses will be required. As a first step, these will focus on cross-sectional analyses of the association between biochemical parameters and other health-related anthropometric and sociodemographic variables. Intermediate and long-term objectives will include the construction of multidimensional reference values taking into account several laboratory data and other clinical information at the same time, and the prognostic validation of reference or cut-off values based on follow-up of study participants for clinical outcomes.

In the framework of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a series of clinical chemical parameters was determined in order to provide objective information on health status and particular health risks in addition to parent interview data and anthropometric measurements. In total, 43 parameters covered three areas of particular public health interest: nutrient deficiency, sero-epidemiology of past infectious diseases and immunization status, and risk indicators or risk factors for chronic non-communicable diseases. The parameters were classified into five categories: these reflected the availability of reference ranges or cut-off values that are valid for children and young people, and they also depended on the degree of standardization of each test method. The present paper discusses initial descriptive results for selected parameters representing the various categories. In order to assess the public health significance of the results, and perhaps to derive standard reference ranges relevant to health care, more detailed analyses will be required. As a first step, these will focus on cross-sectional analyses of the association between biochemical parameters and other health-related anthropometric and socio-demographic variables. Intermediate and long-term objectives will include the construction of multidimensional reference ranges taking into account several laboratory parameters and additional clinical information, and the prognostic validation of reference ranges or cut-off values for selected parameters based on follow-up of study participants for clinical outcomes.