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Editor-in-chief
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


Publisher
Biomedia srl
Via L. Temolo 4, 20126 Milano

Responsible Editor
Giuseppe Agosta

Editorial Secretary
Chiara Riva
Biomedia srl
Via L. Temolo 4, 20126 Milano
Tel. 0245498282
email: biochimica.clinica@sibioc.it

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ISSN print: 0393 – 0564
ISSN digital: 0392- 7091



BC: Articoli scritti da G. Da Rin

Importanti informazioni dall’esame dello striscio periferico
Important information from the peripheral smear examination
<p><span style="font-size:9pt">Rarely, platelets can interact with other blood elements, forming platelet aggregates. This paper presents an isolated case of platelet satellitism around neutrophils, lymphocytes and monocytes with platelet phagocytosis by both neutrophils and monocytes. The subject was an 89-year-old woman with breast cancer on anti-estrogenic hormone cancer therapy. Whole blood sample collected in a tube with K</span><span style="font-size:5pt">2</span><span style="font-size:9pt">EDTA anticoagulant was analysed within 4 hours, using Sysmex XN-9000 analyzer. The complete blood count presented the following results: white blood cell 4.0x10</span><span style="font-size:5pt">9</span><span style="font-size:9pt">/L, red blood cell 3.58x10</span><span style="font-size:5pt">12</span><span style="font-size:9pt">/L, haemoglobin 116 g/L, haematocrit 34.9%, mean corpuscular volume 97.5 fL, mean corpuscular haemoglobin 32.5 pg, mean corpuscular haemoglobin concentration 332 g/L, red blood cell distribution width 14.6% and platelet 136x10</span><span style="font-size:5pt">9</span><span style="font-size:9pt">/L. The present case report describes the platelet satellitism around neutrophils, lymphocytes and monocytes and the interesting, and very rare phenomenon of platelet phagocytosis by not only neutrophils but also by monocytes.</span></p>
Biochimica Clinica ; 46(4) e25
Casi Clinici - Case Report
 
I cambiamenti fisiologici dell’ematopoiesi e patologie associate in gravidanza
Physiological changes in hematopoiesis during pregnancy and associated pathologies
M. Lorubbio  |  R. Rolla  |  G. Da Rin  | 
<p>Pregnancy is a state characterized by multiple changes at haematological level as a consequence of the physiological adaptation of the organism. This review describes both the physiological modifications that can be observed during pregnancy and the associated pathological conditions as well. The main physiological changes consist in the increa-se of the plasma volume, in the leukocyte and immunological function, in the onset of mild thrombocytopenia and in changes in the coagulation and fibrinolysis systems. During pregnancy, the white blood cell count is increased by 36% compared to the values found in non-pregnant women. In normal pregnancies, the number of neutrophils in all three trimesters is significantly higher than the lymphocyte count, while pregnant women who develop preeclampsia have a lower neutrophil to lymphocyte ratio (NLR) caused by the increase in lymphocytes. Both the increase in plasma volume (approximately 50%), the delayed production and the shorter lifespan of red blood cells cause physiological decreases in hemoglobin and hematocrit, resulting in what is known as &ldquo;physiological anemia&rdquo;. Given the increased physiologi-cal demand, the most frequent causes of anemia in pregnancy are those from nutritional deficiencies of iron, folate and vitamin B12. Mean platelet counts decreased during pregnancy in all the women, beginning in the first trimester and continuing throughout pregnancy, with the nadir occurring at the time of delivery. Thrombocytopenia in pregnant patients is due to a number of causes. The clinical laboratory plays a fundamental role in monitoring physiological pregnancy and for detecting pathological conditions that can arise from conception to childbirth.</p>
Biochimica Clinica ; 46(3) S019-S030
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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
 
Evaluation of a multiplex immunochromatographic assay for the rapid detection of carbapenemase-producing Enterobacteriaceaefrom culture colonies
<p>Introduction: the increasing worldwide spread of multidrug resistant bacteria, in particular of carbapenemase-producing Enterobacteriaceae(CPE), represents a serious clinical and public health concern. An accurate and fast detection of infected patients or colonized carriers is thus mandatory.<br />Aim of this study was to assess the performance of a multiplex immunochromatographic assay (NG-Test CARBA 5, NG Biotech, Guipry, France) for the rapid detection of carbapenemases directly from pure bacterial colonies.<br />Methods: seventy-five non-replicated Enterobacteralesisolates with decreased susceptibility to carbapenems, including 71 Klebsiella pneumoniae, 3Escherichia coli and1Enterobacter cloacae, were analysed with NG-Test CARBA 5. At the same time the combination disk test (CDT) was performed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) indications, while confirmation of carbapenemase production was achieved by polymerase chain reaction (PCR).<br />Results: PCR assay could find 66 CPE strains, including 64 Klebsiella pneumoniae[53 producing Klebsiella pneumoniae carbapenemase (KPC), 5 New Delhi metallo-&beta;-lactamase (NDM), 2 class D oxacillinases (OXA-48), 1 Verona integron-encoded metallo-&beta;-lactamase (VIM) and 3 co-producing NDM and OXA-48] and 2 Escherichia coli (2 NDM+OXA-48) while 9 isolates were found as non-carbapenemase producing: 7 Klebsiella pneumoniae, 1 Escherichia coli, 1 Enterobacter cloacae. CDT allowed us to consider those 9 strains as extended spectrum &beta;-lactamase (ESBL) or AmpC &beta;-lactamase producers. NG-Test CARBA 5 successfully identified 66/66 CPE showing 100% sensitivity and 100% specificity. Unlike NG-Test CARBA 5, CDT was not able to correctly identify 5 strains co-producing NDM and OXA-48 carbapenemases.<br />Conclusion: NG-Test CARBA 5 is a reliable assay that can be useful in settings requiring a rapid identification of CPE directly from culture colonies. Moreover, this test is an easy-to-use option that could avoid misidentification of carbapenemases co-producers strains.</p>
Biochimica Clinica ; 43(4) 394-398
Contributi Scientifici - Scientific Papers
 
Esame emocromocitometrico: telemedicina e competenze
S. Buoro  |  G. Da Rin  | 
Biochimica Clinica ; 43(3) 348-350
Lettere all'Editore - Letters to the Editor
 
Medicina di laboratorio e Medicina d’urgenza: un connubio indissolubile
Laboratory Medicine and Emergency Medicine: an essential partnership
<p>Laboratory Medicine and Emergency Medicine: an essential partnership. A better understanding of the pathophysiological bases of many pathologies, along with the considerable technological advances occurred over last few years, have allowed to broaden number and complexity of in vitro diagnostic tests. The emergency department is the clinical setting with the highest risk of forensic disputes, and this explains the inclination that many emergency physicians have towards defensive medicine. Disproportionate request of laboratory tests, with poor awareness on the impact of inappropriateness, is one of the leading negative aftermath of this attitude. The predictable consequences are economic, but also encompass the risk of generating direct damage to the patients, especially in the presence of false positive test results. Since diagnostic appropriateness represents an essential element for patient safety and for sustainability of the National Healthcare System, the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and the Academy of Emergency Medicine and Care (AcEMC) have organized a joint meeting entitled &quot;Laboratory Medicine and Emergency Medicine: an essential partnership&quot;, of which this document is a summary. The issues that have been discussed represent major diagnostic dilemmas faced by emergency physicians, and for which the contribution of laboratory medicine may be decisive. These include acute systemic infections, acute abdominal pain, acute chest pain, head injury and acute bleeding. Since timely transmission of test results is an additional critical element for the clinical decision making in emergency settings, the document will also include considerations on sample transportation from the emergency room to the laboratory.</p>
Biochimica Clinica ; 42(4) 335-342
Documenti - Documents
 
Sicurezza del paziente e rischio clinico nel processo ematologico di laboratorio
Patient safety and clinical risk in the clinical laboratory haematological process
<p>&nbsp;Patient safety, defined as the prevention of harm to patients, is the ultimate goal for medical laboratories. Risk management principles should therefore be considered an integral part of laboratory processes, especially of those activities directly impacting on patient care. This work aims to identify the most critical phases of haematological process and the risk reduction actions that improve patient safety. Risk analysis of the laboratory haematological process was carried out through Failure Mode, Effects and Analysis Criticality methodology. A form including the phases of the process, error modes and their possible effects, errors occurrence, detectability and severity scores and risk index (RI), has been prepared and sent to eight Italian laboratories. A multidisciplinary team performed the analysis in each laboratory, then two team leaders of the project comprehensively analysed the collected data. The process was divided in 8 phases (medical prescription, request acceptance, sample collection, transportation, reception and processing, results reporting and validation), 25 activities (17 pre-analytical, 4 intra-analytical, 4 post-analytical) and 43 failure modes. RI, calculated for each activity, ranged from 11 to 33. The most critical topics (RI &gt;25) were: patient identification, peripheral blood smear review, interpretative comments and report validation. Staff training plays a central role in the entire laboratory haematological process and in the phases identified as critical. An effective management related to the attainment and maintenance of skills represents the best action in order to reduce risks of adverse events for patients. The promotion of procedures aimed to harmonize the interpretative comments and peripheral blood smear review is also pivotal</p><p>&nbsp;</p>
Biochimica Clinica ; 42(4) 300-312
Contributi Scientifici - Scientific Paper
 
La diagnosi di malaria: ruolo dell’esame emocromocitometrico nello screening
The diagnosis of malaria: the role of the haematology analyzers as first level screening
R. Rolla  |  G. Da Rin  |  V. Granero  |  F. Dima  |  A. Fanelli  |  S. Francione  |  C. Ortolani  |  S. Pipitone  |  S. Buoro  | 
<p>The diagnosis of malaria: the role of the haematology analyzers as first level screening. Malaria is one of the three most common infectious diseases worldwide, and is caused mainly by four species of Plasmodium: P. falciparum, P. vivax, P. malariae and P. ovale. The disease is endemic in developing countries but it is also gradually involving Western Countries like Italy. Albeit in 1970 the World Health Organization has included Italy among the malaria-free countries, malaria has become the most frequently imported tropical disease.&nbsp; Microscopic examination of the peripheral blood smear is the gold standard for diagnosing malaria. Although this test is quick, cheap and readily applicable, it has also some drawbacks such as low sensitivity and the need of qualified personnel. Therefore, an effective screening test for detecting malaria in cases with low clinical suspicion or characterized by non-specific symptoms is increasingly necessary, especially in Countries where the disease is not endemic. A new generation of hematological analyzers, whose performance may be potentially useful for the screening of subjects with suspected malaria infection has made available. Many fully-automated hematological analyzers, using different techniques (optical-cytochemical, optical fluorescence, multiangle polarized dispersion and volume-conductance-scatter), can now identify the presence of the malarial parasites in peripheral blood, producing specific cell distributions. The blood count can hence be regarded as a new diagnostic opportunity in malaria infection, since it is one of the basic investigations performed in febrile patients, and is also a simple and fast test, that can be performed in virtually all clinical laboratories.</p>
Biochimica Clinica ; 42(3) 191-209
Rassegne - Reviews
 
Documento di consenso SIBioC-Medicina di Laboratorio e Academy of Emergency Medicine and Care (AcEMC) sull’utilizzo in Pronto Soccorso dei biomarcatori per la diagnosi di sepsi batterica
Biomarkers for diagnosing sepsis in the emergency department: a consensus document by SIBioCMedicina di Laboratorio and the Academy of Emergency Medicine and Care
<p>This article is drafted as a consensus document involving eight members of the Italian Society of Clinical Biochemistry and Laboratory Medicine (SIBioC) and eight members of the Academy of Emergency Medicine and Care (AcEMC), to whom a questionnaire was submitted for obtaining opinions on some recommendations about the use of biomarkers for diagnosing sepsis and managing antibiotic therapy in the emergency department. These recommendations were drafted following the National Guidelines Program (PNLG). According to the cumulative consent, three &quot;A&quot; recommendations (strongly recommended indication) emerged, which include biomarker availability (always available on prescription), clinical use (always interpreted in according to clinical data) and timing of the request based on half-life of the analyte. Recommendations of type &quot;B&quot; (indications carefully considered) included a general agreement about the clinical usefulness of sepsis biomarkers, the combination of procalcitonin (PCT) and Creactive protein (CRP), the possibility to be free on prescription to the laboratory, the use of cut-offs favoring a high negative predictive value, the use of more analytically sensitive assays and the possibility of using PCT for monitoring antibiotic therapy, with timing of ordering defined according to the metabolism of the analyte. As regards the specific biomarkers, a similar &ldquo;B&rdquo; consensus has been reached for measuring both PCT and CRP, and for measuring lactic acid. The measurement of other biomarkers is discouraged except for presepsin, for which there is still substantial uncertainty in favor or against.</p>
Biochimica Clinica ; 42(1) 62-73
Documenti SIBioC - SIBioC Documents
 
I commenti interpretativi nel referto ematologico di laboratorio
Interpretative comments in the laboratory hematology report
<p>Interpretative comments in the laboratory reports&nbsp;can improve the quality of diagnostic information. The complete blood count with differential (CBC-diff) is one of the&nbsp;hematology laboratory tests with demonstrated clinical usefulness. CBC-diff may include a peripheral blood smear if&nbsp;numerical or morphological review criteria are fulfilled. As such, hematologists need specific skill for interpreting and&nbsp;conveying the diagnostic information to clinicians by using adequate communication approaches. A survey carried&nbsp;out by the SIBioC Diagnostic Hematology Study Group (GdS-DE) showed a heterogeneous situation about the use&nbsp;of the hematological interpretative comments. In each laboratory, different descriptions were used even for the same&nbsp;cell abnormalities. Moreover, some laboratories omit to report relevant morphological abnormalities, such as&nbsp;activated or atypical lymphocytes as well as immature granulocytes, which are often necessary for the diagnosis.&nbsp;Therefore, the GdS-DE has decided to select appropriate comments and to propose a standardized reporting system.&nbsp;First, 423 comments from 13 laboratories were analyzed. These comments were revised with the purpose of: a)&nbsp;reducing the number, b) standardizing the language, c) providing an information in a format that could be easily&nbsp;understood by patients and clinicians, and d) increasing the quality of clinical information. The GdS-DE decided to&nbsp;provide written information for both physicians and patients or for physician&rsquo;s use only. The former is represented by&nbsp;59 comments using a simple and not frightening language, whereas the latter is a letter for the physician in which&nbsp;more specific information is provided.</p>
Biochimica Clinica ; 40(3) 255-269
Documenti SIBioC - SIBioC Documents
 
Valutazione multicentrica dei conteggi cellulari ottenuti con 8 analizzatori ematologici automatici
Multicenter evaluation of blood cell counts on 8 automated hematology analyzers
<p>The cellular analysis&nbsp;performed on hematology analyzers is based on the interaction of cells with electrical or optical signals. The&nbsp;heterogeneity of adopted methods and technologies by different analyzers can translate in a lack of homogeneity in&nbsp;analytical performance. This study compares 8 hematological analyzers vs. optical microscopy (OM) and, where&nbsp;possible, also compares the analyzers among each other. Correlations were assessed by Pearson&#39;s coefficient of&nbsp;correlation, Passing and Bablock regression and Bland-Altman bias plot analysis. The comparison among analyzers&nbsp;regarding leukocyte differential counts showed a good level of agreement, except for the basophil cell count. For this&nbsp;&ldquo;critical population&rdquo;, the bias ranged from -5,8% (Cell-Dyn Sapphire vs. XN-9000) to 30,6% (Advia 2120i vs. XE-2100). The comparison between automated differential leukocyte counts and OM showed also a good level of&nbsp;agreement, with a bias ranging from -0,9% to 8.9%. The bias for basophil cell count was however very high (79.5%).</p>
Biochimica Clinica ; 40(3) 195-203
Contributi scientifici - Scientific Papers
 
L’iniziativa dei laboratori della Regione Veneto “Passaggio al Litro”
"Switching to the Liter": the initiative of laboratories in Veneto Region
Biochimica Clinica ; 40(2) 166-167
Lettere all'Editore - Letters to the Editor
 
Armonizzazione del referto ematologico con l’impego di unità di misura conformi al Sistema Internazionale
Harmonization of the hematology test report by using units according to the International System (SI)
<p>The&nbsp;need for harmonizing hematology reporting units remains an important challenge for the clinical laboratory community.&nbsp;In 2014, the SIBioC Diagnostic Hematology Study Group (GdS-DE) carried out a survey to assess the state-of-the-art&nbsp;of the Italian hematology laboratories. The survey showed that the majority of laboratories report results using units of&nbsp;measurement that do not conform to SI. In some European countries, initiatives to harmonize hematology reporting&nbsp;units were taken some years ago. In particular, in the UK for the reporting of laboratory hematology results the SI units&nbsp;have been used since April 2013 (this includes hemoglobin and mean corpuscular hemoglobin concentrations in g/L).&nbsp;The aim of this GdS-DE proposal is to advocate a national initiative for promoting the adoption of SI units for&nbsp;hematology reporting. This will optimise the comparability of results among different laboratories and prevent the&nbsp;misinterpretation of data, which may worsen the patient&#39;s outcome.</p>
Biochimica Clinica ; 39(6) 627-630
Opinioni - Opinions
 
Stato dell’arte della diagnostica ematologica nei servizi di Medicina di Laboratorio in Italia
State of the art of diagnostic hematology in clinical laboratories in Italy
<p>One of the challenges for laboratories&nbsp;performing diagnostic hematology is the harmonization of diagnostic process. This is a consequence of the rapid&nbsp;technological advancement that has characterized the recent development of automated blood cell counters, with&nbsp;new automation models and new types of parameters provided. In this context, the SIBioC Study Group of Diagnostic&nbsp;Hematology has conducted a survey among Italian laboratories. The aim was to focus on the different ways of&nbsp;organizing the service. The questionnaire consisted of 36 questions, made available on the SIBioC website for&nbsp;members and non members of the society. Responses were received via e-mail, regular mail or fax from 78&nbsp;laboratories. The survey showed differences among laboratories with regard to the organizational models adopted,&nbsp;degree of automation and completeness of final laboratory reports. However, a relative homogeneity in the validation<br />rules, review rate, turnaround time and amount and type of available resources was observed. An unexpected finding&nbsp;was the low relevance that the majority of laboratories gave to the occurrence of atypical lymphocytes, thus not&nbsp;reporting the presence of these cells in interpretative comments.</p>
Biochimica Clinica ; 39(1) 025-040
Contributi scientifici - Scientific Papers