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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 M. Seghezzi

Ruolo del laboratorio nella diagnostica differenziale di un grave caso di anemia
The role of the clinical laboratory in the differential diagnosis in a patient with severe anemia
M. Seghezzi  |  A. Carobene  |  S. Buoro  | 
<p>A male, 54 years old, presented to the emergency department of Bergamo Papa Giovanni XXIII hospital, with confusion and neurological symptoms.<br />The peripheral blood cells count, performed on the Sysmex XN-20, showed a severe macrocytic anemia: hemoglobin 42 g/L, mean corpuscular volume 107 fL, accompanied by the morphology flag &ldquo;fragments&rdquo;. The morphological evaluation on the blood smear, strongly recommended with a blood cell count showing such values, confirmed the presence of erythroblasts, and revealed several morphological alterations (remarkable anisopoikilocytosis, basophilic stippling, hypersegmented neutrophils). The patient was admitted to the hospital and transfused. Further investigations showed a severe deficiency of vitamin B12, an abnormal lactate dehydrogenase activity, and an undetectable haptoglobin concentration. After the transfusions, the patient recovered quickly, and was able to report about a previous gastric resection; the information was missed at admission because of the patients confusional state. The possibility of metal poisoning or cupper deficiency were not investigated.</p>
Biochimica Clinica ; 45(4) e35
Casi clinici - Case report
 
Variabilità biologica dei parametri dell’esame emocromocitometrico in soggetti sani
Biological variation estimates of complete blood count parameters in healthy subjects
<p>Background: the complete blood count (CBC) is the test more frequently requested in clinical practice. Therefore, estimating the biological variation (BV) of CBC parameters is essential for assessing the analytical performance of hematological analyzers and for enabling accurate data interpretation and appropriate clinical management. This study was aimed to define BV estimates and reference change value (RCV) of CBC parameters.<br />Methods: the study population consisted of 21 healthy volunteers, who had BV of CBC parameters assessed with Sysmex XN. The study protocol, the analytical measurements and the statistical analysis were carried out according to current recommendations of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM).<br />Results: Within-subject BV ranged between 0,3% for mean cell hemoglobin (MCH) and 19,7% for immature granulocytes (IG), whilst between-subjects BVs ranged between 0,9% for mean corpuscolar haemoglobin concentration (MCHC) and 66,6% for microcytic red blood cells (Micro-R). The RCV ranged between 2,3% for MCH and 73,5% for IG.<br />Conclusion: This study has allowed the estimation of BV of many CBC parameters, some of which have not been currently explored, thus leading the way to use RCV calculated according to time of monitoring and/or differentiated by sex.</p>
Biochimica Clinica ; 43(4) 384-393
Contributi Scientifici - Scientific Papers
 
Tre neonati con sindrome di Down ed alterazioni ematologiche
Three neonates with Down syndrome and hematological abnormalities
<p>Three neonates with Down syndrome and hematological abnormalities. We report three cases of neonates with Down syndrome. In the first newborn, the complete blood count (CBC) showed leukocytosis (30x109/L). The presence of rare blasts, with morphological characteristics attributable to megacaryocytic blasts, were appreciated at the review of peripheral blood. In the second case the patient was hospitalized for severe anemia and neutropenia. The visual inspection of the peripheral blood smear showed the presence of rare undifferentiated blasts. The third patient was a premature neonate, with fetal hydrops. The CBC showed 172x109/L leukocytes and anemia. The peripheral blood smear showed erythroblasts and dysplastic platelets, prevalence of blasts, some of them with cytoplasmic blebs. In the all cases the diagnosis was Transient Abnormal Myelopoiesis (TAM), rather frequent in patients with Down syndrome. It is a transient syndrome characterized by the presence of megacaryoblasts in peripheral blood and mutation of the GATA1 gene. The information obtained by the visual inspection of the peripheral smears, could be important for a correct diagnosis, especially when the CBC data are not particularly abnormal</p>
Biochimica Clinica ; 42(4) e47-e49
Casi Clinici - Case Report
 
Utilità della determinazione della frazione delle piastrine immature nella diagnostica delle trombocitopenie autoimmuni
Role of the determination of immature platelet fraction in the diagnosis of autoimmune thrombocytopenia
<p>A 34 years old woman presented progressive severe thrombocytopenia, without major bleeding. The diagnostic tests for systemic lupus erythematosus, HIV infection and HCV infection, were negative. The platelet count was 9x10<sup>9</sup>/L, with elevated immature platelet fraction (IPF). Bone marrow aspirate was normal; the final diagnosis was immune thrombocytopenia (ITP). ITP is an autoimmune disease characterized by low platelet count in the absence of other causes of thrombocytopenia. IPF is a parameter of Sysmex hematological analyzers that measures young platelets in peripheral blood. It is elevated in peripheral platelet destruction and it is low in hypoproliferative thrombocytopenias, making it useful in differential diagnosis. This case report demonstrates the utility of IPF in diagnosis, management and follow up of ITP.</p>
Biochimica Clinica ; 42(3) e40-e42
Casi clinici - Case report
 
Indagine conoscitiva congiunta SIBioC-Medicina di Laboratorio e Associazione Italiana Pneumologi Ospedalieri (AIPO) relativa alla gestione del processo diagnostico del liquido pleurico
Results of a survey produced by the Italian Society of Clinical Biochemestry (SIBioC) and the Italian Association of Hospital Pneumologists (AIPO) concerning pleural fluid analysis
<p>The aim of this paper is to present the preliminary results of a joint project by SIBioC-AIPO working group on &ldquo;Body cavities fluids&rdquo;. The main purpose of the working group is to achieve a harmonized and shared diagnostic pathway related to pleural fluid (PF) analysis. The multistep project begins with a state of the art analysis. A survey, sent to both laboratory medicine personnel and pneumologists, was conducted between October and December 2016. The questionnaire (21 questions) was made available through the web-based SurveyMonkey platform. Overall, 408 replies were collected, 40.4% from laboratory medicine specialists, 3.2% from laboratory technicians, 49.3% from pneumologists and 7.1% from professionals with non-specified qualification. Regarding the pre-analytical phase, the most critical issue resulted to be the clinical query, due to the lack of structured communication between clinicians and laboratory personnel. While over 76% of laboratory professionals stated that the working diagnosis was unavailable, 87% of pneumologists affirmed that the clinical question had been forwarded to the laboratory. An important issue was the widespread use of inappropriate containers for PF collection (60% of inappropriate tubes). Regarding the panel of tests, a satisfactory agreement was reached on the need to perform macroscopic analysis and cytometric evaluation, along with the assessment of pH, glucose, total proteins, lactate dehydrogenase and the respective ratios between PF and serum concentrations. As expected, the availability of verified or validated analytical methods, notably pH analysis, has emerged as a critical point. The layout of the laboratory report also needs improvements and better harmonization. Despite the many critical issues emerged from this survey, a positive feedback was reflected by a notable general interest on PF analysis, leading thus the way to produce a joint consensus document involving clinicians and laboratory personnel, as suggested by more than 30% of responders.</p>
Biochimica Clinica ; 42(2) 119-130
Contributi Scientifici - Scientific papers
 
Conteggio e contenuto di emoglobina reticolocitario in un caso di grave anemia
Reticulocyte count and hemoglobin content in a case of severe anemia
<p>A 4 years old child from Sry Lanka was admitted in our hospital after several blood transfusions for severe anemia in her country. Very low hemoglobin (65 g/L) and ferritin (&lt;1 ng/mL) concentrations were detected, consistent with iron deficiency anemia. The reticulocyte count and the hemoglobin content (Ret-He) were low (49,20x10<sup>9</sup>/L and 13.7 pg respectively). An important number of causes of iron deficiency anemia were excluded. The patient was treated with iron infusion for two weeks, with good recovery of hemoglobin levels iron stores, Ret-He and reticulocyte number. The patient was then treated with oral iron supplementation, but a considerable decrease of Ret-He and reticulocyte count was observed, so the infusive therapy was reintroduced. Diagnosis and treatment were optimized by the synergy between the clinical laboratory and pediatricians, utilizing these hematological parameters. The blood transfusions could thus be stopped and the bone marrow biopsy could be avoided. This case demonstrates the importance of the reticulocyte count and the Ret-He in the management of iron deficiency anemia.</p>
Biochimica Clinica ; 41(2) e09-e12
Casi clinici - Case report
 
Confronto tra l’applicazione “body fluid” di due analizzatori ematologici e il metodo in microscopia ottica per l’analisi cellulare del liquido cefalorachidiano
Comparison between “body fluid” mode of two hematology analyzers and the microscopy method for cellular analysis of the cerebrospinal fluid
M. Seghezzi  |  T. Mecca  |  P. Dominoni  |  E. Lochis  |  C. Saleri  |  B. Manenti  |  A. Crippa  |  S. Buoro  | 
<p>In the cerebrospinal fluid (CSF), the white blood cell count (WBC) and cell differentiation in mononuclear (MN) and polymorphonuclear (PMN) cells are useful tools in the diagnosis of central nervous system disease. We evaluated the analytical performance of the &ldquo;body fluid&rdquo; module of the hematology analyzers Mindray BC-6800 and Sysmex XN-9000 in the cytometric analysis of the CSF. 110 CSF samples were collected and analyzed with BC-6800, XN-9000 and evaluated by optical microscopy (OM). The diagnostic concordance between each analyzer and OM, as well as between the two analyzers were evaluated.The comparison between each analyzer and OM showed correlation coefficients ranging from 0.65 to 0.99 and bias ranging from 0.06x10<sup>6</sup> cell/L to 19.9x10<sup>6</sup> cell/L. The comparison between BC-6800 and XN-9000 showed a good correlation for total cell counts, WBC, MN and PMN (both in absolute and percentage values) with a correlation coefficient ranging from 0.83 to 0.98 and bias ranging from -0.2 to -43.8x10<sup>6</sup> cell/L. The introduction of automated methods for CSF analysis could be very useful in the routine work of a laboratory analysis.</p>
Biochimica Clinica ; 40(4) 322-327
Contributi scientifici - Scientific Papers
 
Valutazione analitica della misura di nuovi parametri emocitometrici su analizzatore Sysmex XN-9000
Assessment of the analytical performance of novel parameters of automated blood count on Sysmex XN-9000
<p>Recent technological advancements in laboratory hematology have promoted the introduction of many innovative parameters, which have the potential to enhance the clinical efficiency of this diagnostic area. This study aimed to&nbsp;assess the analytical performance of some of these new parameters available on Sysmex XN-9000 according to the&nbsp;International Council for Standardization in Haematology (ICSH) guidelines. Our evaluation included the assessment&nbsp;of imprecision (both intra- and inter-assay), carryover, sample stability and comparison with optical microscopy. The&nbsp;new red blood cell and platelet parameters displayed CV comprised between 0.7% and 34.6%. The new leukocyte&nbsp;parameters immature granulocyte (IG), hight fluorescence cell and cell population data (CPD) were characterized by&nbsp;CV ranging from 1% to 24%. Carryover was negligible for all parameters. Samples stability showed different trends&nbsp;for the different parameters, especially for CPD, depending on temperature and time of testing. The comparison of&nbsp;IG and nucleated red blood cell (NRBC) enumeration determined with Sysmex XN-9000 and optical microscopy&nbsp;yielded Pearson&rsquo;s correlation coefficients comprised between 0.82 and 0.99. The absolute bias was 0.83% and -0.06% for IG and NRBC, respectively. The results of this evaluation show that the innovative parameters available on&nbsp;Sysmex XN-9000 display, with some exceptions, acceptable performance, in line with data obtained with other&nbsp;analyzers. The results of sample stability studies are helpful to identify the best storage conditions for these&nbsp;parameters.</p>
Biochimica Clinica ; 40(3) 217-224
Contributi scientifici - Scientific Papers
 
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