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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 T. Trenti

Variability of cardiac troponin levels in normal subjects and in patients with cardiovascular diseases: analytical considerations and clinical relevance. A consensus document by the Study Group on Cardiac Biomarkers from Italian Society of Biochemical Chemistry (SIBioC) and European Ligand Assay Society (ELAS)
<p><span style="font-family:arialmt,sans-serif; font-size:9.0pt">In accordance with all the most recent international guidelines, the variation of circulating levels of cardiac troponins I and T, measured with high-sensitivity methods (hs-cTnI and hs-cTnT), should be used for the detection of acute myocardial injury. Recent experimental and clinical evidences have demonstrated that the evaluation of hs-cTnI an hs-cTnT variations is particularly relevant: for the differential diagnosis of Acute Coronary Syndromes in patients admitted to the Emergency Department (ED); for the evaluation of cardiovascular risk in patients undergoing major cardiac or non-cardiac surgery, and in asymptomatic subjects of the general population aged &gt;55 years and with comorbidities; for the evaluation of cardiotoxicity caused by administration of some chemotherapy drugs in patients with malignant tumors. The aim of this document is to discuss the fundamental statistical and biological considerations on the intraindividual variability of hs-cTnI and hs-cTnT over time in the same individual. Firstly, it will be discussed in detail as the variations of circulating levels strictly depend not only on the analytical error of the method used but also on the intra-individual variability of the biomarker. Afterwards, the pathophysiological interpretation and the clinical relevance of the determination of the variability of the hs-cTnI and hs-cTnT values in patients with specific clinical conditions are discussed. Finally, the evaluation over time of the variation in circulating levels of hs-cTnI and hs-cTnT is proposed for a more accurate estimation of cardiovascular risk in asymptomatic subjects from the general population.</span></p>
Biochimica Clinica ; 47(1) 097-117
Documenti SIBioC - SIBioC Documents
 
Alte concentrazioni di IL-6 nel liquido di dialisi peritoneale in un paziente affetto da peritonite
High levels of IL-6 on peritoneal dialysate in a patient with peritonitis.
G. Canu  |  G. Alfano  |  S. Tagliavini  |  T. Trenti  |  M. Varani  | 
<p><span style="font-family:arialmt,sans-serif; font-size:9.0pt">Icodextrin has been associated with sterile peritonitis in patients on peritoneal dialysis. This peritonitis causes a cloudy effluent and mild abdominal discomfort, both resolved after the discontinuation of icodextrin. We report here a case of icodextrin-associated peritonitis coupled with high level of interleukin-6 (IL-6) on peritoneal dialysate. After the rechallenge with icodextrin, the Interleukin -6 (IL-6) increase was 9.8 fold higher, while the increase of the leucocyte count was only 4.3 fold higher compared to baseline. The icodextrin discontinuation induced a decrease of IL-6 and leucocyte count to baseline values while the peritoneal dialysate became clear.&nbsp;</span><span style="font-family:arialmt,sans-serif; font-size:9pt">In conclusion, IL-6 could be considered a sensitive biomarker for the diagnosis of icodextrin-associated peritonitis.</span></p>
Biochimica Clinica ; 46(4) e22
Casi Clinici - Case Report
 
Dalla sepsi al COVID-19: il ruolo emergente di MDW
From sepsis to COVID-19: the emerging role of Monocyte Distribution Width (MDW).
G. Riva  |  V. Nasillo  |  M. Luppi  |  E. Tagliafico  |  T. Trenti  | 
<p><span style="color:#211D1E; font-size:9.0pt">Immune activation of the monocyte-macrophage population plays a pivotal role in the systemic hyper-inflammatory response, typically observed during severe dysimmune diseases, such as sepsis and COVID-19. In this commentary, we have reviewed the literature data on the novel cytometric marker of monocyte activation, known as MDW (Monocyte Volume Distribution Width), a monocyte dimensional parameter obtainable by blood count examination, which has recently been approved for clinical use as &ldquo;Early Sepsis Indicator&rdquo; (ESId), in patients accessing the Emergency Department. In particular, in this Opinion paper, we highlight the main clinical applications and relevant perspectives of this new test: from its use for (early) diagnosis of sepsis, in different hospital settings, to its emerging prognostic role in patients with COVID-19, as a biomarker of disease severity. In view of the reported evidence, we discuss the clinico-pathological notion that, basically, severe COVID-19 can be considered a new form of viral sepsis. Further clinical studies are needed to better understand the pre-analytical and analytical variables of this parameter, correlate MDW dynamics with those of other humoral and cytometric markers, and validate the new diagnostic and prognostic applications of MDW on large multicenter case series.</span></p>
Biochimica Clinica ; 46(4) 336
Opinioni - Opinions
 
Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers
Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers
<p>Cardiovascular risk evaluation in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers.</p><p>Joint document of the Italian Societies of Clinical Biochemistry: European Ligand Assay Society, Sezione Italiana (ELAS), Societ&agrave; Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC), Societ&agrave; Italiana di Patologia Clinica e Medicina di Laboratorio (SIPMeL) Patients undergoing major surgery have a substantial risk of cardiovascular events during the perioperative period.</p><p>Despite the introduction of several risk scores based on medical history, classical risk factors and non-invasive cardiac tests, the possibility to predict cardiovascular events in patients undergoing non-cardiac surgery remains limited. The cardiac-specific biomarkers natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the peri-operative period. This Consensus Document aims to discuss the value of preoperative levels and perioperative changes in cardiac-specific biomarkers to predict adverse outcomes in patients undergoing major non-cardiac surgery. Based on several prospective observational studies and 6 meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing noncardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cTnT and cTnI, especially in elderly patients or those with comorbidities. This evidence should be considered in future international guidelines on the evaluation of perioperative risk in patients undergoing major noncardiac surgery.</p>
Biochimica Clinica ; 46(3) 255-267
Documenti SIBioC - SIBioC Documents
 
Applicazione dell’analisi dei Big Data nella valutazione dell’utilità clinica della determinazione degli anticorpi anti SARS-CoV-2 di tipo IgM: l’esperienza di Modena
Big Data analysis to evaluate the clinical utility of IgM anti SARS-CoV-2 determination: the Modena experience
<p>Introduction: since the scarce diagnostic accuracy of specific circulating antibodies for SARS-CoV-2, we aimed to assess the clinical utility of IgM detection in SARS-CoV-2 using the Big Data analysis. Methods: this is a retrospective study; all the blood samples collected between March and September 2020 were processed using a lateral flow immunoassay (LFIA) kit for IgG and IgM antybody testing. Positives results were tested again using a chemiluminescent method. Subjects confirmed with a positive result were contacted for a molecular test.<br />Results: more than 69 000 serological tests (from 42 911 subjects) were performed. 94.5% (40 559/42 911) of subjects had negative results for both IgG and IgM. 1.5% (n = 640) subjects had both IgG and IgM positive results, and viral RNA research confirmed positivity in 16% (85/533). Among subjects with IgG negative and IgM positive results (n=271), a positivity was confirmed in 1% (4/270). Conversely, in subjects with IgG positive and IgM negative results, a positivity was confirmed in 8% (97/1 215). Therefore, the analysis suggests that up to 98% of serological test results of IgM positivity and IgG negativity are false positive.<br />Discussion: the study, based on Big Data analysis application, proved the scarce clinical utility of IgM detection in COVID-19 management, and underlines the responsibility of laboratory professionals in highlighting the limitations of the serological tests also due to uncertainty in their interpretation.</p><p>&nbsp;</p>
Biochimica Clinica ; 46(2) 154-159
Contributi Scientifici - Scientific Papers
 
Determinazione e utilizzo clinico di autoanticorpi e/o di profili autoanticorpali nelle malattie epatiche autoimmuni – aggiornamento 2021
<p>Description and clinical use of autoantibody determination in autoimmune liver diseases &ndash; update 2021, on behalf of the Study Group &ldquo;Autoimmune Diseases&rdquo; of the Italian Society of Clinical Biochemistry. The autoantibody assessment in the field of autoimmune liver disease is crucial both for diagnosis and prognosis. Although these autoantibodies are sometime present even in the normal healthy individuals, their presence is a prerequisite to diagnose autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC); some of these autoantibodies are included in the diagnostic scoring system for these diseases. The laboratory diagnostics of autoimmune liver diseases, traditionally carried out using indirect immunofluorescence testing (IFT) on rodent tissue slices, has achieved substantial improvements due to innovative analytical opportunities, such as ELISA-based diagnostic assay and Multiple Immunodot Liver profile test based on recombinant or purified antigens. The aim of this document is to highlight the crucial role of the new antigen specific tests for a better diagnostic strategy in the field of the three major autoimmune liver diseases AIH, PBC and Primary sclerosing cholangitis (PSC).</p>
Biochimica Clinica ; 46(1) 078-082
Documenti - Documents
 
Il laboratorio di autoimmunità nella diagnosi di miopatia autoimmune necrotizzante indotta da statina
The autoimmunity laboratory in the diagnosis of necrotizing autoimmune myopathy induced by statins
<p>Statins have been recently associated with a necrotizing autoimmune myopathy (NAM) characterized by inflammation, myopathy and muscle necrosis and by the presence of anti 3-hydroxy-3-methylglutaryl-coenzim A reductase antibodies (anti-HMGCR). This case report describes a case of a man who was taking atorvastatin, complaining muscle weakness and creatine kinase (CK) very high levels. The main laboratory and autoimmunity tests (including the major myositis antibodies) were negative, despite a muscle biopsy showed a myopathic process. Because of these results the detection of anti-HMGCR antibody was activated and the positive result confirmed the diagnosis of NAM. The patient stopped the statin therapy and started a steroid therapy with improvement in muscle symptoms and mild decrease of CK. The role of the autoimmunity laboratory in the diagnostic path of this rare autoimmune disease is fundamental. Though statin-associated NAM is a rare entity, it should be considered in patients who continue to have CK elevation and muscle weakness during or after discontinuation of statin therapy.</p>
Biochimica Clinica ; 45(4) e27
Casi clinici - Case report
 
Le criticità della fase post-analitica della determinazione delle crioglobuline: risultati di uno studio pilota condotto in Emilia-Romagna
Critical issues of the post-analytical phase for cryoglobulin determination: results of a pilot study carried out in Emilia-Romagna, Italy
<p>Introduction: cryoglobulins (CRG) are immunoglobulins that precipitate at low temperature and dissolve at 37 &deg;C. The difficulties associated to the analisys of cryoproteins, are related to the pre-analytical phase, including the collection of the sample and the maintenance of the heat chain; to the analytical phase, because of the many manual steps involved and, to the post-analytical phase as well, due to the operator-depending interpretation of immunofissation (IFE). The Department of Laboratory Medicine of Modena promoted a pilot study to verify the incidence of the post-analytical phase in the accuracy of the CRG analisys.<br />Methods: 30 images of CRG-IFE plates were selected and sent to 8 centers of the Emilia Romagna region that agreed to join the project; 13 different laboratory professionals have been involved in the IFE interpretation.<br />Results: out of 30 IFE, only 3 (10%) were interpreted with the excellent concordance of 100% by all the participants; 10 of them (33%) showed a good concordance, 75-99%; 14 (47%) sufficient concordance, 50-74%; 3 (10%) a poor concordance &lt;50%. Out of 8 centers involved, 4 participated with more than one operator. Arbitrarily assuming that the analysis can be considered acceptable when at least 75% of the participants agree on the interpretation of the gels, the results show that only in 43% of cases the acceptability was reached.<br />Discussion: this pilot study highlights the need to harmonize the CRG determination, not only the pre-analytical and analytical procedures, but also the post-analytical phase. To this end, it could be highly recommended that the clinical laboratories participate to external quality assessment control programs, as the one promoted by UK-NEQAS. Moreover, scientific societies and their Study Groups, can play an important role by promoting the harmonization of CGR evaluation.</p>
Biochimica Clinica ; 45(4) 388-394
Contributi Scientifici - Scientific Papers
 
Utilizzo in Pronto Soccorso dei metodi ad alta sensibilità per le troponine cardiache per i pazienti con sospetto di infarto acuto del miocardio senza sopraslivellamente del tratto ST Documento Congiunto del Gruppo di Studio Inter-Societario sui Biomarcatori Cardiaci delle Società Italiane di Biochimica Clinica: European Ligand Assay Society, Sezione Italiana (ELAS), Società Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC), Società Italiana di Patalogia Clinica e Medicina di Laboratorio
Use of the high-sensitivity methods for cardiac troponins measurement in patients admitted to the Emergency Department with a clinical suspicion of a non-ST segment elevation myocardial infarction Joint document of the Italian Societies of Clinical Biochemistry: European Ligand Assay Society, Sezione Italiana (ELAS), Società Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC), Società Italiana di Patologia Clinica e Medicina di Laboratorio (SIPMeL).
<p>The use of serial measurement of cardiac troponin (cTn) is recommended by international guidelines for the diagnosis of myocardial infarction (MI) since 2000. However, the are some relevant differences among the recommendations proposed by the three different international guidelines published in 2020-2021 for the management of patients admitted to the Emergency Department (ED) with a clinical suspicion of a non-ST-segment elevation MI (NSTEMI). In particular, there is no agreement among these authoritative international guidelines about the cut-off or absolute change values to be used for diagnosis of MI. Another important controversial issue is whether there are, at present time, sufficient evidences on the diagnostic accuracy and cost effectiveness related to cut-off values suggested for the most rapid algorithms (0-1 or 0-2 hours) recommended for the rule-in/rule-out of NSTEMI. Finally, another important issue concerns the possible bias existing between the demographic and clinical characteritics of the patients enrolled in some multicenter trials compared to those routinely admitted to ED of the city Hospitals of some European countries, including Italy, for the diagnosis of NSTEMI. Considering the recommendations from these international guidelines, the Study Group of Cardiac Biomarkers, supported by the Italian Scientific Societies SIBioC&nbsp;(Societ&agrave; Italiana di Biochimica Clinica), ELAS (Italian Society of the European Ligand Assay Society) and SIPMeL (Societ&agrave; Italiana di Patologia Clinica e medicina di Laboraratorio), decided to revise the document previously published in 2013 about the management of patients admitted to ED with suspect NSTEMI, and so to prepare suggestions more specifically designed for the clinical institutions operating in the healthcare system in Italy.</p>
Biochimica Clinica ; 45(4) 412-426
Documenti SIBioC - SIBioC Documents
 
Proteinuria nel COVID-19: l’importanza di un esame consolidato in una patologia complessa
P. Natali  |  T. Trenti  | 
Biochimica Clinica ; 45(3) s097-s099
Lettere all'editore - Letters to the editor
 
Cinetica e caratteristiche biologiche della risposta umorale all’infezione da SARS-CoV-2: implicazioni vaccinali
Kinetics and biological characteristics of humoral response developing after SARS-CoV-2 infection: implications for vaccination
<p>With the ongoing coronavirus disease 2019 (COVID-19) pandemic outbreak spreading all around the world, an extensive vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now universally regarded as one of the most effective strategies for counteracting the unremittent spread of this novel coronavirus. Nonetheless, the reasonable need to identify segments of the population in which vaccination shall be prioritized for avoiding a possible shortage of vaccines seems to collide with indications provided by many national and international healthcare organizations, that endorse widespread vaccination irrespective of a positive history of prior symptomatic or asymptomatic SARS-CoV-2 infection. To this end, this document provides an ad interim guidance aimed at prioritizing SARS-CoV-2 vaccination in people who are more likely to be infected, re-infected and/or to develop more aggressive COVID-19 illness, essentially based on routine assessment and monitoring of anti-SARS-CoV-2 immune response.</p>
Biochimica Clinica ; 45(1) 087-090
Documenti SIBioC - SIBioC Documents
 
Introduzione ai Big Data e all’Intelligenza Artificiale in Medicina di Laboratorio
Introduction to Big Data and Artificial Intelligence in Laboratory Medicine
<p>Currently, thanks to the growing computing capacity and the increasing availability of digital data, Data Science is playing an important role in the future development of Laboratory Medicine. However, the concepts of Big Data (BD) and Artificial Intelligence (AI) can still be interpreted in various ways. Clinical laboratories are certainly among the health care organizations producing an important number of data that can be considered BD and it is certainly not a coincidence that they are among the first health organizations to have implemented computer systems within their workflows. Through a process called Data Mining it is possible to extract useful information from BD using automatic or semi-automatic methods that must be preceded by Data Cleaning in order to ensure the cleanliness and correctness of the data themself. Regarding Data Analysis, several Machine Learning or Deep Learning techniques based on different algorithms or on the functioning principle of neural networks can be used; for the development of these techniques, R and Python programming languages are really useful. Although many applications can be useful in Laboratory Medicine, there are still some obstacles to overcome, including poor harmonization of data or fragmentation of sources; moreover, the issue of data accessibility must be managed considering patient&rsquo;s privacy as a priority. Finally, there is an increase apprehension related to the awareness of the inevitable innovation in the Laboratory Medicine field in the near future, because of these new approaches. To face these challenges, it is necessary that these topics become familiar to the professionals of Laboratory Medicine. Aim of this Document is to share information about BD and AI in order to contribute to the introduction and development of these methodologies in the field of Laboratory Medicine.</p>
Biochimica Clinica ; 45(1) 057-067
Documenti - Documents
 
Raccomandazioni ad interim di SIBioC per l’analisi sierologica dell’infezione da SARS-CoV-2
Ad interim SIBioC recommendations for serological assessment of SARS-CoV-2 infection
<p>The recent pandemic outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated with the pathology called COVID-19 (coronavirus disease 2019), has now become one of the most strenuous health care challenges since the emergence of the three pandemics caused by influenza viruses during the past century. Throughout the clinical decision-making of COVID-19, laboratory tests are essential for supporting the screening, diagnosis, prognostication and therapeutic monitoring of this severe infectious disease. Serological testing, that reflects the humoral immune response developing after interaction between the host and the virus (or its components), enables to garner a vast array of clinical information which can be especially used in seroprevalence or seroconversion studies. To this end, the Task Force on COVID-19 of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) has endorsed a series of technical, practical and clinical ad interim recommendations, aimed at facilitating and optimizing the introduction, clinical usage and governance of SARS-CoV-2 serological immunoassays in routine practice.</p>
Biochimica Clinica ; 45(1) 091-099
Documenti SIBioC - SIBioC Documents
 
52° Congresso Nazionale: Virtual Edition
Biochimica Clinica ; 44(3) 321
Notizie SIBioC - SIBioC News
 
Valutazione precoce del danno cardiaco da farmaci chemioterapici: importanza della misura delle troponine cardiache I e T con metodi ad alta-sensibilità analitica
High-sensitivity cardiac troponin I and T methods for the early detection of myocardial injury in patients on chemotherapy
<p>Important advances achieved in pharmacological cancer treatment have led progressively to a reduction in mortality from many forms of cancer, and increasing numbers of previously incurable patients can now hope to become cancer-free. Yet, to achieve these improved outcomes a high price has been paid in terms of untoward side effects associated with treatment, cardiotoxicity in particular. Several recent studies have reported that cardiac troponin assay using high-sensitivity methods (hs-cTn) can enable the early detection of myocardial injury related to chemotherapy or abuse of drugs that are potentially cardiotoxic. Several authors have recently suggested that changes in hs-cTn values enable the early diagnosis of cardiac injury from chemotherapy, thus potentially benefitting cancer patients with increased troponin values by initiating early cardioprotective therapy. However, large randomised clinical trials are needed in order to evaluate the cost/benefit ratio of standardised protocols for the early detection of cardiotoxicity using the hs-cTn assay in patients treated with chemotherapy.</p>
Biochimica Clinica ; 44(3) 279-286
Documenti SIBioC - SIBioC Documents
 
Confronto tra un metodo nefelometrico ed un metodo turbidimetrico per la determinazione delle catene leggere libere sieriche: punti di forza e criticità
Comparison between a turbidimetric and a nephelometric method for the measurement of serum free light chains: strengths and weaknesses
<p>Background: monoclonal gammopathies include a broad spectrum of pathologies, and free light chains (FLC) measurement is recommended by guidelines for the diagnosis, follow up and prognosis of plasma cell dyscrasia. The aim of the study is to compare the measurement of FLC performed with two different analytical platforms, a nephelometer and a turbidimeter, in order to assess the analytical and diagnostic agreement.<br />Methods: 87 consecutive samples received by the laboratory with a request of FLC measurement were analyzed on nephelometer Immage 800 (Beckman Coulter, USA) and turbidimeter Optilite (The Binding Site, UK), using the same antibodies (Freelite, The Binding Site, UK).<br />Results: by applying the Passing-Bablok regression and the Bland-Altman analysis, a proportional and constant systematic error but non-significant bias for FLC ratio (rFLC) has been observed. By applying the Weighted Cohen&rsquo;s Kappa (WK) test to the rFLC values, an excellent diagnostic agreement between the two instruments has been shown, considering both the normal range (0.26 &ndash; 1.65) (WK=0.87) and the diagnostic range for multiple myeloma (&lt;0.01 or &gt;100) (WK=0.84).<br />Conclusions: Although there are statistical differences between the measurements performed by the two instruments, these do not affect the diagnostic agreement, that is excellent. Nevertheless, the turbidimeter is provided with a software that can automatically detect the antigen excess; by diluting further the samples automatically, it performs fewer dilutions than the nephelometer and provides a wider range of measurement, especially for low concentrations. These characteristics assist the operator both during the analysis and the validation phases of the results, saving time and resources. On the basis of the results of the study, it can be concluded that the turbidimeter shows better performances compared to the nephelometer.</p>
Biochimica Clinica ; 44(2) 149-156
Contributi Scientifici - Scientific Papers
 
Una paziente con dolori ossei diffusi: il ruolo del laboratorio nel diagnosticarne la causa
A female patient with diffuse bone pain: the role of the clinical laboratory in the diagnostic process
D. Debbia  |  P. Natali  |  L. Ferrara  |  M. Varani  |  G. Longo  |  T. Trenti  | 
<p>Multiple myeloma (MM) represents 10% of all hematologic malignancies; in 15% of MM the monoclonal component consists of only free light chains. A 53 year-old patient performs at the Corelab laboratory (AOU-AUSL Modena) blood tests for bone pain. Serum electrophoresis shows hypogammaglobulinemia (5,5 g/L). The laboratory professional decides to carry on further studies: a serum immunofixation that highlighted the presence of kappa free light chains not traceable to any heavy chain and the measure of the serum free light chains (sFLC) with the following results: FLC-&kappa; 26 777 mg/L (i.r. 3.3-19.4); FLC-&lambda; 6.15 mg/L (i.r. 5.7-26.3); ratio FLC (rFLC), 435.31 (i.r. 0.26-1.65). The light chain MM is a type of MM difficult to recognize. The laboratory professional&#39;s own initiative defines a procedure of &quot;personalized medicine&quot; oriented to to the patient&#39;s needs. The expertise of the laboratory professional is crucial in assuring the patient the best outcome when carried out on the basis of the available guidelines.</p>
Biochimica Clinica ; 43(4) e35-e36
Casi Clinici - Case Report
 
Medicina di Laboratorio e Medicina d’Urgenza: il connubio continua
Laboratory medicine and emergency medicine: a perpetual relationship.
<p>The essential goals that laboratorymedicine shall pursue to adequately fulfill clinical needs can be summarized in delivering high quality information,availability of clinically usable tests and turnaround time. The governance of urgent laboratory testing encompassesa harmonious integration of clinical needs and laboratory organization. Clinical laboratories shall hence be morefocused on the pre-preanalytical phase, be involved in proactive efforts for standardizing pre-analytical and analyticalprocedures, optimize the post-analytical and post-post-analytical phases, thus providing a complete information andallowing the achievement of favorable outcomes. Throughout this ample and multifaceted process, the strictcooperation between laboratory professionals and emergency physicians is pivotal. As rationale follow-up of thecollective article published concomitantly with the first joint Academy of Emergency Medicine and Care (AcEMC) -Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) meeting, this new collective paperaims to summarize the topics discussed during the second joint event &ldquo;Laboratory Medicine and EmergencyMedicine: a resumed link&rdquo;, specifically including the governance of urgent tests, acid-base disorders, venousthromboembolism, acute heart failure, trauma, acute intoxications, viral diseases and other emerging infections.</p>
Biochimica Clinica ; 43(3) 296-304
Documenti - DOCUMENTS
 
Una malattia neurologica di difficile inquadramento
A neurological disease difficult to classify
<p>We describe a case of a 32 year old woman visiting to the NeurologyUnit with progressive bi-frontal headache and reduced visual acuity followed by disequilibrium and dysarthria.<br />Cerebrospinal fluid (CSF) analysis documented pleyocitosis with slight CSF-blood-barrier damage.<br />Routine laboratory tests that were all negative except for the presence of serum anti-myelin oligodendrocyteglycoprotein (MOG) antibody.<br />Thanks to the laboratory test results, neurologists could classified the patient as a case of encephalomyelitis anti-MOG antibody related and have treated her with methylprednisolone followed by Rituximab with clinical improvementand reduction of brain lesion.<br />Anti-MOG antibody associated to encephalomyelitis is currently considerated as a distinct nosologic entityimmunopathogenetically identifiable among the neuromyelitis spectrum disorders.<br />The case illustrated here underlines the central role of the clinical laboratory for the correct diagnosis of demyelinatingnervous system diseases.</p>
Biochimica Clinica ; 43(3) e28-e30
Casi Clinici - Case Report
 
Paziente pediatrico con oliguria e adenopatia cervicale: il ruolo degli analizzatori a cattura di immagine per l’esame standard delle urine
Urinalysis in a pediatric patient with oliguria and cervical lymphadenopathy: role of automated imageanalysis systems.
<p>Automated urinalysis instruments image-based for cell analysis can identify non-squamousepithelial cells (NSE). Among these elements, expert pathologists can distinguish the so called Decoy Cells (DC),Polyomavirus BK (BKV)-infected elements primarily seen in immunocompromised patients. Epstein-Barr virus (EBV)infection can induce a transient immunosuppression in immunocompetent patients, and this could lead to areactivation of a latent BKV infection in urothelial cells: this is a rare event in pediatric patients. This study reports thecase of a 4 year-old child with lateral lymphadenopathy, fever and oliguria. Automated urinary sediment analysisevidenced the presence of many NSEs identifed as DC, generating a subsequent virological investigation with a finaldiagnosis of concomitant BKV and EBV infection. The combination of an automated technology, an efficientmiddleware and the expertise of the laboratory professionals , allowed the proper identification of these peculiarreactive elements, which could easily be mistaken for malignant atypical cells.</p>
Biochimica Clinica ; 43(2) e20-e23
Casi Clinici - Case Report
 
Siero o plasma? Un quesito non nuovo che attende risposte nuove
Serum or plasma? An old question awaiting for new answers.
<p>There is a continual debate on what type of sample a clinical laboratory should use. While serum is still considered the gold standard and remains the required sample matrix for some assays, laboratories must consider turn-around time, which is an important metric for laboratory performance and, more importantly, plays a critical role in patient care. In addition, a body of evidence emphasize the choice of plasma samples in order to prevent modifications of some measurands due to the coagulation process and related interferences. Advantages and disadvantages of serum and plasma are discussed on the basis of current literature and evidence. In addition, data are provided on the current utilization of the matrix (serum or plasma) in Italy and in other Countries. Finally, a rational for a possible shift from serum to plasma is provided.</p>
Biochimica Clinica ; 43(2) 178-186
Documenti - Documents
 
Disegno e sviluppo di una applicazione per dispositivi mobili per migliorare l’appropriatezza prescrittiva degli esami di laboratorio del medico di medicina generale: focus sull’ipertensione arteriosa
An application for mobile devices to improve the appropriateness of laboratory test request by general practitioners: focus on blood hypertension
<p>The prevalence of consultations of general practitioners (GPs) is huge, and for an unknown number of patients a consistent amount of diagnostic laboratory tests is requested. One of the tasks of GPs is to identify patients in need of specific laboratory tests, to improve the patient outcomes taking at the same time into consideration the risk of over-diagnosis and treatment and the available resources as well. To support GPs in their decisional process, we developed a dedicated software application (APP) for mobile devices; the APP contents were developed in collaboration with GPs, with students of a GP training course and with laboratory medicine specialists. We identified the laboratory tests useful for the management of the most frequent diseases observed in GPs&#39; offices,&nbsp; that are supported by the best available evidence. The first attempt was made considering blood hypertension. Aim of the paper is the description of the process of the APP development,&nbsp; that&nbsp; includes data available from national and international guidelines. This promising tool could help GPs to prescribe suitable laboratory tests in different clinical scenario (diagnosis, evaluation of therapy, monitoring) and to promote the implementation of the evidence-based practice of laboratory medicine, reducing the requests of inappropriate tests and accurately identifying patients who need a second level referral (nephrologist, endocrinologist).</p>
Biochimica Clinica ; 43(1) 052-058
Contributi Scientifici - Scientific Paper
 
Il Grading of Recommendations Assessment Development and Evaluation(GRADE) quale metodologia sistematica e trasparente per valutare l’esame di laboratorio nella formulazione di raccomandazioni e linee guida
The Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology assystematic and transparent framework to evaluate diagnostic test value in supporting guide lines andrecommendations issuing.
<p>A multidimensional pathway based on GRADE Evidence to Decision (EtD) frameworkis presented. The aim of the document is to define a valid process to assess the adoption of a diagnostic test and theconsequences of the decision. The framework includes three sections reflecting the main steps of GRADE EtD:formulating the relevant question, making an assessment of the evidence, and drawing conclusions. As a matter ofexample, the EtD framework is used to present the evidence concerning the molecular diagnosis of sepsis inneonates including seven dimensions: (1) formulating the question; (2) assessment of diagnostic test accuracy; (3)certainty of the evidence; (4) effects of test on the main patient outcome; (5) balance between the desirable andundesirable effects; (6) resource use; (7) equity, acceptability and feasibility. The example is used to better elucidatethe concepts and to show how reviewers may complete each dimension with the relevant information avaiable.Several factors could influence the final decisions: the relevance of the problem, the values of diagnostic accuracy,the effects of the test on main patient outcome; other issues may play a role. The framework consists of acomprehensive decision aid model to ensure that all important criteria are considered to explain a judgment. Thisapproach could help health professionals to use the best available research evidence in a structured and transparentway to inform decisions in the context of laboratory medicine.</p>
Biochimica Clinica ; 43(1) 076-089
Documenti - Documents
 
La riorganizzazione del settore dedicato alla diagnostica proteica: un esempio virtuoso fondato su criteri di Evidence Based Laboratory Medicine e di sostenibilità economica
The organization of the protein unit: a beneficial example founded on evidence based laboratory medicine criteria and on the appropriate use of the available resources
P. Natali  |  T. Trenti  | 
<p>The sustainability of the National Health Service is a current subject of debate&nbsp; due to the pressure that the changes in our societies are having on health systems. Reviewing diagnostic processes is increasingly urgent to contain costs and to maintain the quality of the health services provided.The Evidence Based Laboratory Medicine (EBLM) approach allows to identify and eliminate obsolete methods, replacing them with more adequate ones. The EBLM approach can also provide higher diagnostic accuracy, a rationalisation of diagnostic pathways, a reduction of turnaround-time and a decrease of costs. To reach these objectives, a careful analysis of production processes and assessment of the costs are both necessary. The EBLM approach has been applied to the Protein Unit of Laboratory of Modena. The change in the workflow of the Bence Jones protein determination and the consolidation of the measurement of a number of serum proteins on clinical chemistry analysers allowed a better diagnostic accuracy coupled to important economical savings. The savings made it possible to extend the availability of the free light chains measurements (that before was restricted to patients admitted to the haematology department) to the out-patients of the Province of Modena. The EBLM approach is the most effective way to reach such objectives: really, providing better quality performance does not necessarily correspond to an increase of costs. In addition to developing an adequate level of scientific expertise, the laboratory professional must acquire managerial skills to introduce up-to-date diagnostic methods and to optimize the use of assigned resources, in all areas of laboratory medicine.</p><p>&nbsp;</p>
Biochimica Clinica ; 43(1) 044-051
Contributi Scientifici - Scientific Paper
 
Efficacia e utilità del monitoraggio terapeutico di autoanticorpi e farmaci inibitori del Tumor Necrosis Factor alpha in pazienti in trattamento per patologie autoimmuni
Therapeutic monitoring of autoantibodies Tumor Necrosis Factor α inhibitor drugs: efficacy and benefit for patients with autoimmune diseases
<p>Therapeutic monitoring of autoantibodies Tumor Necrosis Factor &alpha; inhibitor drugs: efficacy and benefit for patients with autoimmune diseases. Tumor necrosis factor alpha (TNF&alpha;) is a proinflammatory cytokine involved in the pathogenesis of chronic inflammatory disease, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Chron&rsquo;s disease and ulcerative colitis. TNF&alpha; inhibitors (anti-TNF&alpha;) are monoclonal antibodies drugs directed against TNF&alpha; (i.e. adalimumab, infliximab, etarnecept, golimumab and certolizumab). Their effect consists in reducing the inflammatory response of autoimmune diseases. Several randomized controlled trials and observational studies evaluated the therapeutic efficacy of these drugs and reported a clear benefit for patients affected by chronic inflammatory disease treated with anti-TNF&alpha;, but also a high risk of reactions and infections in the injection site. These drugs are immunogenic, and consequent anti-drug antibodies (ADA) formation may decrease the functional drug concentration resulting in a loss of response. Therefore, we evaluated the impact of ADA on therapeutic response through meta-analyses, showing that detectable ADA significantly reduced TNF&alpha; inhibitors response. ADA could interfere with drugs and compromise their effects, so the determination of serum ADA levels could improve the patient&rsquo;s management. Even if the decrease of therapeutic response, due to ADA production, is well documented, the clinical benefit of serum ADA determination remains unclear. At the moment, there are many indications about the use of immunogenicity test to guide the therapy, but more information should be acquired before implementing this test in clinical practice.</p>
Biochimica Clinica ; 42(3) 266-273
Documenti SIBioC - SIBioC Documents
 
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
 
Appropriatezza della richiesta di esami ed esiti clinici: il caso delle malattie renali, tiroidee e della celiachia
Appropriateness of test request and clinical outcome: the example of kidney, thyroid and coeliac disease
<p>This document analyzes the topic of appropriateness of test request. It is organized in 4 parts. The first deals with the theme of appropriateness, the consequences of insufficient or excessive test request and the need to balance guideline indications with the clinical need of a single patient. The other 3 parts present the cases of thyroid, chronic kidney and coeliac disease. With regard to the thyroid function, population screening, excluding neonates, is not recommended; on the contrary, it is highly recommended to evaluate the thyroid function in any individual with even only a minimal clinical suspect. The thyrotropin (TSH) is the test of choice with reflex free T4 and free T3, according to specific algorithms. The contemporaneous measurement of free FT3, free FT4 and TSH, except for specific cases, should be discouraged due to the high frequency of unjustified abnormal findings. Anti-thyroperoxidase antibodies are the test of choice for autoimmune thyroid diseases. In chronic kidney disease (CKD), the estimated glomerular filtration rate (eGFR) based on serum creatinine in most cases is the best indicator of renal function, provided that creatinine is measured with the accurate enzymatic method. In borderline situations, a confirmatory eGFR calculation based on cystatin C is recommended. Urinary albumin, expressed as albumin/creatinine ratio, is an essential complement for CKD staging. The diagnosis of coeliac disease requires integration between clinical, histological and serological data. The anti-transglutaminase IgA is the test of choice; only when an IgA deficit is present, the test to be used is IgG antigliadin deamidate peptides. The genetic HLA DQ2/DQ8 test is indicated for screening of subjects at risk: if negative, coeliac disease can be excluded.</p>
Biochimica Clinica ; 41(3) 266-285
Documenti - Documents
 
Il laboratorio clinico nelle indagini tossicologiche
The role of clinical laboratory in toxicological investigations
<p>Clinical toxicology laboratory activities are carried out both for clinical purposes, providing support to the diagnosis and treatment of intoxicated patients, and for medico-legal aspects, providing data with value of judicial proof. The new Italian law (no. 41, March 23, 2016) considers vehicular homicide and road traffic injuries criminal offences to be severely punished, especially if the driver is under the influence of alcohol or psychotropic substances. Since toxicology results have an impact on administrative and legal decisions, analytical reliability and traceability of data, including the implementation of a chain of custody of samples, are crucial. Forensic toxicological analyses use conventional matrices (blood and urine) and alternative matrices (hair, saliva, sweat). To assess the current use of illicit drugs, blood is the matrix of choice because substance concentrations correlate with subject&rsquo;s physical and mental status at the time of collection. On the other hand, urine testing is simple, rapid and non-invasive. A positive result indicates that the substance assumption was from several hours to a few days prior to sampling. The hair matrix is suitable to identify past use or abuse and segmental hair analysis allows the reconstruction of the history of abuse. Analytical methods for alcohol and drugs of abuse include qualitative screening tests and quantitative confirmatory tests. A negative result of the screening test does not require further investigation, while a positive result cannot assume forensic value without confirmatory analysis. The use of mass spectrometry in combination with chromatographic or electrophoretic separation techniques for confirmatory tests has found the consensus of the international scientific community.</p>
Biochimica Clinica ; 41(3) 216-227
Rassegne - Reviews
 
Accuratezza dell’immunonefelometria come metodo di screening per la determinazione della proteinuria di Bence Jones
Accuracy of immunonephelometry as a screening method for Bence Jones proteinuria
<p>The Bence Jones protein (BJP) is an important biomarker for the identification and management of patients with plasma cell dyscrasia. The recommended method for BJP detection is the immunofixation, which is a time consuming and expensive procedure. The aim of the study was to evaluate immunonephelometry (INA) as a screening method for the identification of urine samples negative for BJP and to compare it to a simplified immunofixation method (uIFE-3). First morning urine samples were collected from 1000 consecutive patients and analyzed by INA. Samples with free light chain concentrations &gt;10 mg/L and &gt;5 mg/L were considered positive. All samples were further analyzed by uIFE-3 using 3 antisera (anti-GAM, -&kappa; and -&lambda;). The INA results (at both cut-off levels) were compared with the uIFE-3, showing a poor accuracy due to the high number of false positives and false negatives. Consequently, INA resulted unable to accurately screen BJP.</p>
Biochimica Clinica ; 41(2) 148-153
Contributi scientifici - Scientific papers
 
Le revisioni della letteratura biomedica
The reviews of the biomedical literature
<p>The reviews of the biomedical literature aim to summarize and disseminate the knowledge about a specific topic intended as a disease treatment or a diagnostic biomarker. They include narrative and systematic reviews (SR). Narrative reviews simply describe the features about a specific topic. On the contrary, SR are performed to answer to a specific question by using a standardized methodology to obtain results that may be reproduced by other authors. SR may include studies of diagnostic or therapeutic efficacy and prognostic value according to the scope. SR of treatment efficacy are generally focused on the efficacy of a new treatment in comparison with the one considered as reference, commonly used in the clinical therapeutic protocols. SR focused on diagnostic test accuracy generally retrieve data on diagnostic sensitivity and specificity from original studies in order to estimate pooled likelihood ratios or predictive values. Finally, SR of prognostic studies explore the ability of a specific marker to predict the outcome of interest. A SR implies to plan a systematic literature search strategy by Medline and other biomedical databases, defining inclusion criteria for study selection. Statistical analyses allow to pool data in a meta-analysis to provide an estimates of the effect power. This paper summarize the main features of different type of SR to help readers in the comprension of a SR and meta-analysis. Their utility in clinical practice and biomedical research is also illustrated.</p>
Biochimica Clinica ; 41(2) 175-182
Documenti - Documents
 
Sensibilità al glutine: il test di attivazione dei basofili (BAT) può aiutare nella diagnosi differenziale?
Gluten hypersensitivity: basophil activation test (BAT) may help in the differential diagnosis
T. Scacchetti  |  D. Debbia  |  E. Boni  |  T. Trenti  | 
<p>Gluten hypersensitivity: basophil activation test (BAT) may help in the differential diagnosis? The main forms&nbsp;of gluten-related disorders are wheat allergy (WA), celiac disease (CD) and possibly immune-mediated disease&nbsp;(gluten sensitivity). S-IgE play an essential role in WA. For CD tests available are anti-tissue transglutaminase (tTG)&nbsp;IgA, anti-endomysium (EMA) and deamidated gliadin peptides (DGP) antibodies IgG particular. For other immunemediated&nbsp;diseases there is currently no test available. The usefulness of basophil activation test (BAT) in anaphylactic&nbsp;adverse reactions, late-onset allergy has been demonstrated. We report the case of a woman of 46 years old with&nbsp;disorders of wheat tied overt clinical signs, intestinal and extra-intestinal symptoms, whose tests above were all&nbsp;negative. Only the BAT showed a stimulation of basophils exposed (52.9%) to extract wheat. We diagnosed gluten&nbsp;sensitivity (GS) on the basis of an algorithm for the differential diagnosis of gluten-related disorders, including CD,&nbsp;GS and WA. We believe that the BAT confirms a hypersensitivity reaction to wheat not-IgE-mediated, not CD.</p>
Biochimica Clinica ; 40(4) e31-e34
Casi clinici - Case report
 
Armonizzazione in Medicina di Laboratorio
Harmonization in Laboratory Medicine
F. Ceriotti  |  M. Panteghini  |  A. Tosetto  |  V. Valentini  |  L. Politi  |  R. Rolla  |  T. Guastafierro  |  T. Köken  |  E. Capoluongo  |  C. Mazzaccara  |  V. D'Argenio  |  V. D'Argenio  |  G. Lippi  |  M. Plebani  |  D. Giavarina  |  M. Berardi  |   A survey on sample matrix and preanalytical management in clinical laboratories  |  D. Bozzato  |  G. Messeri  |  M. Zaninotto  |  M. Vidali  |  A. Padoan  |  G. Parigi  |  A. Clerico  |  L. Sciacovelli  |  M. Ciaccio  |  G.L. Salvagno  |  G. Barberio  |  G. Barberio  |  G.L. Salvagno  |  M. Pepe  |  M. Panteghini  |  F. Braga  |  G. Gessoni  |  M. Montagnana  |  N. Doğan  |  M. Barberis  |  M. Barberis  |  A. Marchetti  |  F. Borrillo  |  L. Bonfanti  |  P.M. Ness  |  G. Messeri  |  S. Nannini  |  J. Queraltò  |  M. Zaninotto  |  A. Mosca  |  BM. Henry  |  G. Santini  |  A. Coglianese  |  V. D'Argenio  |  E. Fiorio  |  L. Crinò  |  M. A. V. Willrich  |  A. Modenese  |  M. Berardi  |  G. Nordera  |  M. Girelli  |  R. Tomaiuolo  |  D. Giavarina  |  R. Dittadi  |  L. Pighi  |  V. Guaraldo  |  G. Bambagiotti  |  E. Franceschini  |  R. Danesi  |  M. Locatelli  |  F. Balboni  |  D. Cosseddu  |  M. Savoia  |  S. Bernardini  |  C. Domenichini  |  M. Lamonaca  |  M. Perrone  |  M. Perrone  |   per il Gruppo di Studio Intersocietario SIBioC-SIPMeL Diabete Mellito  |  P. Pradella  |  A. Padoan  |  M.T. Sandri  |  L. Belloni  |  A. D'Avolio  |  T. Trenti  |  A. Fortunato  |  T. Trenti  | 
Biochimica Clinica ; 39(6) 546-547
Editoriale - Editorial
 
Armonizzazione in Medicina di Laboratorio
Harmonization in Laboratory Medicine
F. Ceriotti  |  M. Panteghini  |  A. Tosetto  |  V. Valentini  |  L. Politi  |  R. Rolla  |  T. Guastafierro  |  T. Köken  |  E. Capoluongo  |  C. Mazzaccara  |  V. D'Argenio  |  V. D'Argenio  |  G. Lippi  |  M. Plebani  |  D. Giavarina  |  M. Berardi  |   A survey on sample matrix and preanalytical management in clinical laboratories  |  D. Bozzato  |  G. Messeri  |  M. Zaninotto  |  M. Vidali  |  A. Padoan  |  G. Parigi  |  A. Clerico  |  L. Sciacovelli  |  M. Ciaccio  |  G.L. Salvagno  |  G. Barberio  |  G. Barberio  |  G.L. Salvagno  |  M. Pepe  |  M. Panteghini  |  F. Braga  |  G. Gessoni  |  M. Montagnana  |  N. Doğan  |  M. Barberis  |  M. Barberis  |  A. Marchetti  |  F. Borrillo  |  L. Bonfanti  |  P.M. Ness  |  G. Messeri  |  S. Nannini  |  J. Queraltò  |  M. Zaninotto  |  A. Mosca  |  BM. Henry  |  G. Santini  |  A. Coglianese  |  V. D'Argenio  |  E. Fiorio  |  L. Crinò  |  M. A. V. Willrich  |  A. Modenese  |  M. Berardi  |  G. Nordera  |  M. Girelli  |  R. Tomaiuolo  |  D. Giavarina  |  R. Dittadi  |  L. Pighi  |  V. Guaraldo  |  G. Bambagiotti  |  E. Franceschini  |  R. Danesi  |  M. Locatelli  |  F. Balboni  |  D. Cosseddu  |  M. Savoia  |  S. Bernardini  |  C. Domenichini  |  M. Lamonaca  |  M. Perrone  |  M. Perrone  |   per il Gruppo di Studio Intersocietario SIBioC-SIPMeL Diabete Mellito  |  P. Pradella  |  A. Padoan  |  M.T. Sandri  |  L. Belloni  |  A. D'Avolio  |  T. Trenti  |  A. Fortunato  |  T. Trenti  | 
Biochimica Clinica ; 39(6) 546-547
Editoriale - Editorial
 
Raccomandazioni per l'implementazione e la gestione del "point-of-care testing" (POCT)
Recommendations for the implementation and management of the point-of-care testing (POCT)
Biochimica Clinica ; 35(3) 242
DOCUMENTI SIBioC - DOCUMENTI SIBioC