Volume 42, Issue 3

The new generation of clinical chemistry and coagulation analyzers is equipped with technical features allowing a systematic check of sample quality, including an assessment of the so-called HIL (“hemolysis”, “icterus”, “lipemia”) indices. These measures enable an accurate and reproducible assessment of sample hemolysis in serum or plasma, hence the hemolysis index (H-index) is now also increasingly used for monitoring and benchmarking phlebotomy performance. Reliable evidence attests that intravascular hemolysis is not such a rare phenomenon, and its prevalence may be especially higher in geographical areas where congenital hemolytic diseases are endemic, as well as in healthcare settings where patients with acquired hemolytic disorders are more frequently visited or hospitalized. It is hence conceivable that monitoring phlebotomy performance based on the rate of hemolyzed specimens received by the laboratory may not be so straightforward, provided that specimens drawn from patients with intravascular hemolysis can be identified and excluded from the analysis. The aim of this article is to provide an overview of potential drawbacks in using the H-index alone for monitoring phlebotomy performance, and to offer potential solutions to improve its efficiency for this scope. We therefore suggest that the H-index may only be used for purposes of benchmarking phlebotomy performance when the overall number of diagnoses of hemolytic diseases or the haptoglobin values measured by the laboratories are comparable across different healthcare settings or geographic areas.

This recommendation aims to provide up-to-date information and the latest consensus on diabetes diagnosis from a group of experts in Germany. The disease diabetes mellitus is classified and its different types are described briefly. Options for diagnosis are presented including current cut-off values as well as reference intervals to recognize glucose utilization disorders like impaired fasting glucose or impaired glucose tolerance. Special attention is paid to the measurement value imprecision. The minimal difference (MD) is introduced as an excellent measure to distinguish measurement results which are analytically different from each other. Potential caveats considering pre-analytics in glucose measurement and limitations of HbA 1c assessment for diagnosis of diabetes mellitus are presented. Taken together, this recommendation provides a comprehensive overview of the state of the art in diabetes mellitus diagnosis and also critically evaluates potential pitfalls. The aim of recommendations like this one issued by the German Diabetes Association is to provide the diabetologist and his team the information he needs for his daily practice. These recommendations are updated annually. They are written by a group of experts, but they are not evidence-based guidelines. This specific recommendation for diabetes diagnosis briefly describes the diabetes types and the different options for diagnosis. Also the caveats and the practical procedure are presented.

Background: A review of the literature shows that the role of laboratory diagnostics in the multidisciplinary concept of patient blood management (PBM) is underrepresented, so the contribution that laboratory diagnostics can make needs to be elucidated. Methods: The central objective of this study was to decrease the volume of blood drawn for laboratory diagnostics as part of a hospital quality management project focussed on increasing efficiency and reducing the turnaround time (TAT) of laboratory results. Optimization potential within the complete preanalytical process was reviewed to obtain potential improvement measures. These measures fell into two groups: training to reduce preanalytical errors in the entire hospital and using blood collection tubes with lower nominal fill volumes. Results: A validation of the success of these measures was performed after 1 year. The occurrence of several blood collection non-compliances had decreased substantially. By changing the blood collection tube volume, approximately 177 L less patient blood was drawn for diagnostic purposes in the 384-bed hospital per year. For geriatric and intensive care unit (ICU) patients, there was a very significant reduction in diagnostic blood loss (−27.2% ICU, −42.5% geriatric patients). The number of tubes used per patient per day decreased by 13%. Conclusions: In conclusion, this approach represents an important lab-side contribution to PBM concepts.

Background: The genetic variations of influenza viruses pose a real challenge to the vaccine strategies and medical treatment of patients. Methods: In this study, the molecular epidemiology and evolution of influenza A(H3N2) strains were analyzed from April 2014 to March 2017 in Yantai area of eastern China. Results: The phylogenetic analysis of the hemagglutinin (HA) sequences of influenza A(H3N2) showed that all of the influenza A(H3N2) strains during the study period belonged to the genetic clade 3c with the mutations N145S (epitopeA), V186G (epitopeB), P198S (epitopeB) and F219S (epitopeD). Most strains (12/14) of the 2014/2015 season fell into the subgroup 3C.3a characterized by A138S (epitopeA), R142G (epitopeA), F159S (epitopeB) and T128A (epitopeB), while strains isolated from the 2015/2016 and 2016/2017 seasons clustered in 3C.2a shared mutations N144S (epitopeA), F159Y (epitopeB), K160T (epitopeB) and Q311H (epitopeC). The strains isolated from the 2014/2015 and 2015/2016 seasons was were genetically and antigenically distinct from the given vaccine strains. The evaluation of vaccine efficacy (VE) against circulating strains estimated using the pepitope model suggested that little or no protection against circulating strains from 2014/2015 and 2015/2016 seasons was afforded by the given vaccine strains. The sequence analysis of the neuraminidase (NA) showed that all of the analyzed strains had no substitution in the catalytic sites or the framework sites or the supporting the catalytic residues or the oseltamivir resistance substitutions. Conclusions: The results of the study suggested that the vaccine strains provided suboptimal protection against influenza A(H3N2) strains, especially in the 2014/2015 and 2015/2016 seasons and the A(H3N2) strains circulating in the Yantai area were still susceptible to NA inhibitors. Continued systematic antigenic and molecular surveillance of the influenza virus is essential to developing strategies for the prevention and control of influenza.

Background: Asthma is a chronic inflammatory lung disease and oxidative stress is an important component in airway inflammation. This study aims to investigate dynamic thiol/disulfide homeostasis in patients with asthma. Methods: A total of 103 subjects, including 56 patients with asthma and 47 healthy controls, of similar age and gender were included in the study. The native thiol, total thiol and disulfide levels and the disulfide-native thiol, disulfide-total thiol and native thiol-total thiol ratios were analyzed and compared between the asthma and control groups using a novel automatized spectrophotometric assay. Results: The levels of native thiol (p<0.001), total thiol (p<0.001) and disulfide (p<0.001) were significantly lower and the C-reactive protein (CRP) levels (p<0.001) were significantly higher in patients with asthma when compared with those in the control group. A negative correlation was detected between CRP levels and native thiol, total thiol and disulfide levels (p<0.05). A significant positive correlation was detected between forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) levels and native thiol and total thiol levels (p<0.01). Conclusions: The thiol/disulfide homeostasis parameters may be used as novel oxidative stress markers in asthma but further studies are needed to investigate the role of thiol/disulfide homeostasis in asthma.