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Maria Stella Graziani

Deputy Director
Martina Zaninotto

Associate Editors
Ferruccio Ceriotti
Davide Giavarina
Bruna Lo Sasso
Giampaolo Merlini
Martina Montagnana
Andrea Mosca
Paola Pezzati
Rossella Tomaiuolo
Matteo Vidali

EIC Assistant
Francesco Busardò

International Advisory Board Khosrow Adeli Canada
Sergio Bernardini Italy
Marcello Ciaccio Italy
Eleftherios Diamandis Canada
Philippe Gillery France
Kjell Grankvist Sweden
Hans Jacobs The Netherlands
Eric Kilpatrick UK
Magdalena Krintus Poland
Giuseppe Lippi Italy
Mario Plebani Italy
Sverre Sandberg Norway
Ana-Maria Simundic Croatia
Tommaso Trenti Italy
Cas Weykamp The Netherlands
Maria Willrich USA
Paul Yip Canada

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Via L. Temolo 4, 20126 Milano

Responsible Editor
Giuseppe Agosta

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Chiara Riva
Biomedia srl
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ISSN print: 0393 – 0564
ISSN digital: 0392- 7091

BC: Articoli scritti da D. Avino

Un soggetto con pancitopenia e febbre persistente
A subject with pancytopenia and persistent fever
<p>We report a case of a 75-years-old female with pancytopenia, fever unresponsive to antibiotic therapy and persistent cough, hepatosplenomegaly and lymphadenopathy. Bone marrow shows pathological cells; some of them showed &ldquo;hand-mirror&rdquo; morphology and numerous hemophagocytosis. Atypical T lymphocytes with CD3+CD5-CD7-CD2++CD8+CD56- immunophenotype are detected by flow-cytometric analysis. Based on this evidence, Hemophagocytic lymphohistiocytosis (HLH) in lymphoproliferative disease is suspected and confirmed by biopsy. HLH is a rare and life-threatening hematologic disease caused by excessive activation of immune system resulting in a systemic hyperinflammation with tissue destruction and multiorgan failure. According to HLH-2004 diagnostic criteria, HLH can be diagnosed in a patient with mutations in HLH-related genes or with at least 5 out of 8 diagnostic criteria (fever, hemophagocytosis, splenomegaly, high ferritin, elevated soluble-CD25, cytopenia, low natural killer cell activity, and hypertryglyceridemia or hypofibrinogenemia). HLH diagnosis is very challenging and integration&nbsp;of clinical-anamnestic, instrumental and laboratory information are essential for diagnosis and therapeutic strategy.</p>
Biochimica Clinica ; 45(4) e30
Casi clinici - Case report
Indagine conoscitiva sulla qualità del referto dell’esame emocromocitometrico
A survey on the quality of the hematological reporting among the Italian laboratories
<p>Introduction: the Working Groups &ldquo;Hematology&rdquo; and &ldquo;Extra-Analytical Variability&rdquo; of the Italian Society of Clinical Biochemistry (SIBioC) promoted a survey investigating the quality of the complete blood count reporting among Italian Laboratories.<br />Methods: the survey included 36 questions and was sent to all the SIBioC members. 251 laboratories participated in the survey.<br />Results: there is a full concordance in reporting the traditional parameters (leukocytes, erythrocytes and platelet count, hemoglobin, hematocrit and the calculated indices, plus the leukocytes differential count), while other relatively new parameters, like the mean platelet volume (MPV) and the platelet distribution width (PDW) are reported by 70% of the laboratories. A low percentage of laboratories (20-30%) do not report the presence of abnormal cell populations, if detected (blasts, immature granulocytes, plasma cells, prolymphocytes and erythroblasts). 70% of laboratories do not report the erythrocyte and leukocyte related parameters available on the new analyzers. Specific reference intervals for gender and age are adopted by 68% of the laboratories, but only 50% have instrument-specific intervals. 83% of the laboratories include interpretative comments in the report, but only in less than half of them these are harmonized according to the recent available recommendations. 83% of the laboratories have a shared document to manage critical values, that are communicated to the requesting physician by 90% of the laboratories.<br />Discussion: activities promoted by the SIBioC Hematology working group to harmonize the hematological report have been effective on traditional parameters reporting with a substantial improvement compared to the 2014 survey. Two issues remain however unresolved: the inclusion of interpretative comments and of the recent available parameters in the report.</p>
Biochimica Clinica ; 44(2) 129-142
Contributi Scientifici - Scientific Papers
Un caso di linfoadenopatia, epatosplenomegalia e triptasi elevata
A case of lymphadenopathy, hepatosplenomegaly and elevated serum tryptase level
<p>A case of lymphadenopathy, hepatosplenomegaly and elevated serum tryptase level. Mastocytosis is a rare clonal disease characterized by neoplastic proliferation of mast cells in one or more organs, frequently skin and bone marrow. Diagnosis and classification of mastocytosis is based on the identification of neoplastic mast cells in according to the morphological, immunophenotypical and/or molecular criteria established by the WHO. For the diagnosis, serum levels of the tryptase which correlate with quantity and activity of mast cells is particulary useful. This case reports about a 60-year-old man with hepatosplenomegaly, modest monoclonal component, reactive lymph node hyperplasia and moderate macrocytic anemia (haemoglobin:129 gr/L). Bone marrow aspiration shows areas of infiltration of atypical mast cells type II and rarely type I with aberrant immunophenotype: CD45++CD117++CD2+CD25+. The tryptase concentration is significantly increased. According to WHO 2008 criteria, diagnosis of systemic mastocytosis is made. Early diagnosis of mastocytosis is pivotal because immunotherapy is often required to reduce the risk of allergic reactions or major bone complications.</p>
Biochimica Clinica ; 43(1) e1-e3
Casi Clinici - Clinic Case
Alterazioni morfologiche dei megacariociti nelle sindromi mielodisplastiche associate a delezione del braccio lungo del cromosoma 5 [del(5q)], 7 [del(7q)] e 20 [del(20q)] e monosomia del cromosoma 7
Morphological alterations of megakaryocytes in myelodysplastic syndromes with del(5q), del(20q), -7 and del(7q)
<p>Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematopoietic stem cell disorders&nbsp;characterized by ineffective and inefficient hematopoiesis and a high risk of progression to acute myeloid leukemia.&nbsp;The MDS diagnosis is based on morphological evaluation of dysplasia. The choice of therapy depends on the&nbsp;prognostic stratification that is based on peripheral number of cytopenias, on the percentage of blasts and on&nbsp;karyotype according to the criteria IPSS (International Prognostic Scoring System). Some aspects of megakaryocyte&nbsp;dysplasia correlate with specific chromosomal abnormalities. We evaluated morphological characteristics of&nbsp;megakaryocytes in bone marrow of 28 patients with MDS presenting a complex karyotype, in which at least one of&nbsp;the following anomalies was present: -7, del(7q), del(5q) and del(20q). Megakaryocyte dysplasia was confirmed on&nbsp;at least 30 elements for each sample according to 2008 WHO criteria. In MDS with del(5q), megakaryocytes were&nbsp;slightly smaller with an eccentric and not lobed nucleus. Monosomy 7 was associated with evidence of&nbsp;micromegakaryocytes and a negative prognostic significance. Isolated deletion of the 20q was associated with&nbsp;dysmorphic megakaryocytes and has favorable prognosis, especially when at diagnosis this alteration is isolated and&nbsp;it has been recently associated with refractory thrombocytopenia. In summary, we showed that each of the&nbsp;considered genetic alterations was associated with a specific megakaryocytic morphology.</p>
Biochimica Clinica ; 40(3) 229-233
Contributi scientifici - Scientific Papers