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Maria Stella Graziani

Deputy Director
Martina Zaninotto

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

EIC Assistant
Francesco Busardò

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

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Responsible Editor
Giuseppe Agosta

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

Biochimica Clinica: VOL.45 N.3

Scarica intero fascicolo
L’importante contributo dei Gruppi di Studio SIBioC nell’ambito del percorso di promozione del ruolo della Medicina di Laboratorio
Biochimica Clinica 2021; 45(3) 226-227
DOI: 10.19186/BC_2021.054
Pubblicato online il: 19.07.2021
Editoriale - Editorial
Valutazione della risposta anticorpale post-vaccino COVID-19: fiat lux
M. Plebani  |  G. Banfi  |  G. Lippi  | 
Biochimica Clinica 2021; 45(3) 228-229
DOI: 10.19186/BC_2021.058
Pubblicato online il: 16.07.2021
Editoriale - Editorial
Analisi dei livelli trascrizionali di ciclina D1 nello studio delle discrasie plasmacellulari: revisione sistematica della letteratura
Analysis of cyclin D1 mRNA expression levels in plasma cell dyscrasias: a systematic review of published literature

Overexpression of cyclin D1 (CCND1) occurs often in tumoral plasma cells, mainly – but not exclusively – as a result of the presence of the t(11;14) translocation. Of note, CCND1 mRNA overexpression or the presence of the t(11;14) translocation was shown to impact on the response to anti-plasma cell drugs and influence prognosis, both in patients with multiple myeloma and with immunoglobulin light chain (AL) amyloidosis. In this study, we performed a systematic revision of published literature on molecular assays to measure CCND1 transcript levels in plasma cell dyscrasias, in order to describe currently available assays, their technical characteristics and main applications. Relevant scientific articles were search on PubMed as of October 2020 using combinations of appropriate key words. Of 165 unique studies retrieved, 11 articles fulfilled the inclusion criteria and were further analyzed. Overall, 8 different molecular assays were described and characterized. Most of the studies focused on multiple myeloma, with some studies including also MGUS, plasma cell leukemia and/or AL amyloidosis. Assay design, technical validation and field of application of each assay were systematically reviewed. As more knowledge is gained about the impact of CCND1 expression levels on the biology of tumoral plasma cells and their response to anti-plasma cell drugs, including novel agents specifically targeting t(11;14)-positive clones, molecular assays to quantify CCND1 expression levels in tumoral plasma cells may become a useful complementation to molecular cytogenetics, towards a precision medicine approach to diagnose and treat plasma cell disorders which is based on laboratory medicine.

TAG: ciclina D1   translocazione   discrasia plasma cellulare  
Biochimica Clinica 2021; 45(3) 230-241
DOI: 10.19186/BC_2021.009
Pubblicato online il: 16.03.2021
Rassegne - Reviews
Evaluation of the antiproliferative effect of Bifidobacterium longum BB-536 in solid tumor cell lines, co-cultured with murine splenocytes

Introduction: in the last decade, cancer immunotherapy has delivered impressive results in clinical settings. However, its efficacy has not been consistent probably because of several environmental and genetic factors influencing the outcome. Many studies have indicated that intestinal microbiota could affect the outcome of immune checkpoint inhibitors-based immunotherapy, both in animal models and patients. In particular, the Bifidobacterium genus seems to have a role as a positive regulator of in vivo antitumor immunity by promoting proinflammatory signals in innate immune cells. According to the considerable evidence that demonstrated its crucial role in the carcinogenesis and, overall, in the response to immunotherapy, we decided to use a commercial probiotic and grow its principal strain, the Bifidobacterium longum BB-536, in order to test its capability to affect antitumoral immune responses.
Methods: prior to in vivo studies, we carried out a feasibility evaluation study to test in vitro, antitumoral effects of the isolated probiotic strain. Tumor cell viability was used as parameter to determine Bifidobacterium longum BB-536 anti-proliferative ability before or after heat inactivation.
Results: interestingly, we found that B. longum inhibits cell growth, both in mouse melanoma B16-OVA and colorectal CT26 cells, showing a more pronounced effect on the latter ones.
Conclusion: this preliminary evaluation of live and heat-inactivated probiotic in tumor cell lines indicates a potential cell growth inhibitory effect of these bacterial strains and encourage further studies in mouse models.

TAG: microbiome   immunotherapy   cancer  
Biochimica Clinica 2021; 45(3) 242-247
DOI: 10.19186/BC_2021.021
Pubblicato online il: 22.04.2021
Contributi Scientifici - Scientific Papers
Adesione alle raccomandazioni dei gruppi di studio SIBioC-SIPMeL (Società Italiana di Patologia Clinica e Medicina di Laboratorio) e SID (Società Italiana di Diabetologia) sulla fase preanalitica per la determinazione della glicemia: ancora margini di miglioramento. Risultati di una indagine conoscitiva nazionale
Adherence to the recommendations of the SIBioC-SIPMeL (Società Italiana di Patologia Clinica e Medicina di Laboratorio) and SID (Società Italiana di Diabetologia) study groups on the preanalytical phase for blood glucose measurement: still room for improvement. A National Survey on the state of art.
A. Terreni  |  M. Carta  |  D. Giavarina  |  V. Miconi  |  A. Mosca  |  G. Bonetti  | 

Introduction: glucose measurement is pivotal in the management of subjects with diabetes mellitus. Laboratories should provide the most useful information to the clinician in order to ensure the best patient outcome.
Methods: in October 2019 a survey has been conducted by SIBioC and SIPMeL Study Groups on “Diabetes Mellitus” and by the Italian Diabetes Society to verify if their recommendations on preanalytical phase have had an impact on Italian laboratory procedures. Fifteen questions were submitted to all SIBioC and SIPMeL members and 190 complete responses were collected, corresponding to around 5% of all Italian laboratories.
Results: 74% of the laboratories (n=46) are aware of the recommendations of the “Diabetes Mellitus” Study Groups, but only 24% apply them. 61% of the first group centrifuges the collection tubes immediately, providing a rapid plasma separation; 9% place the tubes immediately in an ice-water slurry and separate the plasma within 30 minutes. Only 14 of the responders use citrate buffer/sodium EDTA/sodium fluoride (NaF) tube in lyophilic formulation.
The survey allowed to determine also which kind of tube is commonly used: for outpatients, 52 (30%) laboratories use serum or heparinized tubes with separator gel, 46 (24%) of the remaining of laboratories use NaF plasma and heparinized plasma tubes. For hospitalized patients, 99 (52%) laboratories utilizes tubes with separator gel or coagulation activator, while 19 (10%) and 15 (8%) respectively use NaF plasma and heparinized plasma. To perform the Oral Glucose Tolerance Test (OGTT), 84 (43%) laboratories uses tubes without glycolysis inhibitors or separator gel, and only 12 laboratories uses tubes with acidified ternary mixture.
Conclusion: considering these non-completely satisfactory findings, the educational activity of SIBioC working groups on “Diabetes Mellitus” and “Variability of Extra-analytical phase” should be continued, since they appear to be essential for the improvement of the laboratory procedures.

TAG: diabete   fase pre-analitica   raccomandazioni  
Biochimica Clinica 2021; 45(3) 248-257
DOI: 10.19186/BC_2021.022
Pubblicato online il: 27.04.2021
Contributi Scientifici - Scientific Papers
Questionario conoscitivo sull'Esame Chimico Morfologico delle Urine in Italia a cura del Gruppo Interdisciplinare Laboratorio e Clinica dell’Apparato Urinario
Results of the survey on chemical and morphological examination of urine in Italy issued by the Italian Interdisciplinary Urinalysis Group
R. Ravasio  |  MA. Burgio  |  F. Balboni  |  F. Manoni  | 

Introduction: the Italian Interdisciplinary Urinalysis Group (GIAU) is a study group aimed to harmonize the standard chemical and morphological urine examination in Italy. The aim of this paper is to present the results of a survey recently released. The survey has been prepared to evaluate the state of the art of the routine standard urine examination in Italy after the issuing by GIAU of the recommendations related to the pre-analytical, analytical and post-analytical phases of the Urine Chemical Morphological Examination (ECMU).
Methods: the questionnaire (47 questions) was made available through the web-based Survey Monkey platform to the members of the two Italian Laboratory Medicine scientific societies (SIBioC and SIPMel).
Results: 553 replies were collected. Regarding the pre-analytical phase, the most critical issue is the use of a monitored (time and temperature) sample transportation to the clinical laboratory only by a small percentage of the laboratories (30%). More than 80% of the laboratories recommends the collection of the mid-stream urine. Regarding the analytical phase, the majority of the participants utilizes dedicated automated analyzers for urine sediment. Only 15.5% of the participants includes the albumin to creatinine ratio in the standard urine examination.
Discussion: the results of the survey give a picture of the state of art of the standard urine examination in Italy. From the comparison with the GIAU previous surveys, it can be concluded that the urinalysis practice in Italy is nowadays more compliant to the indications of the available recommendations and that a general improvement of this laboratory test is observed. Some unsatisfactory answers have been collected for a number of issues, so the role of the GIAU is and will remain fundamental to guide all the laboratory professionals who operate in this laboratory medicine field, towards further advancements.

TAG: esame chimico morfologico delle urine   linee guida   raccomandazioni  
Biochimica Clinica 2021; 45(3) 256-266
DOI: 10.19186/BC_2021.024
Pubblicato online il: 30.04.2021
Contributi Scientifici - Scientific Papers
Sistema Nazionale di Allerta Precoce, una piattaforma web per il contrasto alla diffusione delle Nuove Sostanze Psicoattive
The National Early Warning System, a web-based platform to prevent the spread of New Psychoactive Substances

Introduction: the abuse of New Psychoactive Substances (NPS) has been a major issue since the 1990s, due to the significant impact this phenomenon has on the society and public health. The Italian legislation, in line with the European legislation, is aimed to limit the NPS use in the Country through different intervention strategies.
Methods: the Department for Anti-Drug Policies (DPA) of the Presidency of the Council of Ministers, has activated in Italy the National Early Warning System (SNAP) on NSP reporting, aimed at the early detection of potentially health-threatening phenomena related to the appearance of NPSs in the market. A second aim of the SNAP is the promotion of the technical-analytical expertise of laboratories for the detection of these substances.
Since June 2016, the DPA, where the National Focal Point (NFP) for the verification of the phenomenon of drug dependence is established, has entrusted the coordination of SNAP with the National Centre for Addiction and Doping (NCAD) of the “Istituto Superiore di Sanità”. The Centre works with several partners, including the Pavia Poison Control Centre for clinical toxicology, the Unit of Forensic Toxicology of Sapienza University of Rome for bio-toxicological aspects, and the Central Directorate for Anti-Drug Services for national coordination of seizures operated by law enforcement agencies. To implement this network of collaboration, the NCAD has developed and activated a strategic 'web application' that simplifies the collection of information across the Country, optimizing incoming/outgoing reports between all the involved authorities.
Results: the analysis of the information collected on NPS during 2020 through the SNAP platform, highlighted the circulation of 47 NSPs in Europe, including two synthetic cannabinoids with potential public health risks and the emergence of NPS belonging to the class of benzodiazepines and the benzimidazole family.
Conclusions: The SNAP is an important tool for identifying and notifying the spread of NSPs in our Country very rapidly.

TAG: nuove sostanze psicoattive   sistema nazionale di allerta precoce   centro nazionale dipendenze e doping  
Biochimica Clinica 2021; 45(3) 267-280
DOI: 10.19186/BC_2021.028
Pubblicato online il: 17.05.2021
Contributi Scientifici - Scientific Papers
Identificazione di positività al SARS-CoV-2 attraverso metodi di Machine Learning sui dati dell’esame emocromocitometrico: validazione esterna di modelli allo stato dell'arte
Identification of SARS-CoV-2 positivity using machine learning methods on blood count data: external validation of state-of-the-art models.

Introduction: The aim of the paper is to present the results from the process of external validation of a number of machine learning (ML) models that had been previously developed to detect SARS-CoV-2 virus positivity on both symptomatic and asymptomatic patients on the basis of the complete blood count (CBC) test.
Methods: Briefly, models were trained using a dataset of 816 COVID-19 positive and 920 negative cases collected at the emergency departments of IRCCS Hospital San Raffaele and IRCCS Istituto Ortopedico Galeazzi. 21 parameters, including the results of the CBC analysis, age [60.9 (0.9) years], gender (57% males) and the presence of COVID-19 related symptoms were used. The validation regarded the evaluation of the error rate (through different metrics, including accuracy, sensitivity, specificity and the area under the curve (AUC)) of the models considered. This external validation was conducted on two well balanced datasets coming from two different hospitals in Northern Italy: Desio hospital and Bergamo Papa Giovanni XXIII hospital. 163 positive and 174 true negative patients from Desio, and 104 positive and 145 true negative from Bergamo were included in the validation.
Results: The performance of the predictive models is satisfactory as we can report an average AUC of 95% for both external datasets.
Conclusion: ML models have been applied to hematological parameters for a more rapid and cost-effective detection of the COVID-19 disease. We make the point that validated models may be useful in the management and early detection of potential COVID-19 patients.

TAG: SARS-CoV-2   machine learning   emocromo  
Biochimica Clinica 2021; 45(3) 281-289
DOI: 10.19186/BC_2021.033
Pubblicato online il: 09.06.2021
Contributi Scientifici - Scientific Papers
Comunicare nell’infosfera: sfide e opportunità per la Medicina di Laboratorio
Communicating in the infosphere: challenges and opportunities for Laboratory Medicine

Communication is becoming more important than ever for health care and health care professionals, as the recent COVID-19 pandemic has dramatically highlighted. The fast evolution of the mass and social media and the continuous development of new health-related platforms and applications are imposing new challenges that involve also laboratory medicine and that need to be carefully considered. In fact, these novel, fast and effective strategies of communication are inherently prone to the risk of publishing misleading, incorrect or fake information which can spread uncontrollably and diffuse all over the world in a very short time. However, social media are undoubtedly a great opportunity to communicate, in a responsible and credible way, health-related data and scientific updates and discoveries. As for the therapeutic alliance, it is now required to establish an “information alliance” between different healthcare professionals which, based on a trustworthy relationship, will allow the correct diffusion of health-related information and will contribute to citizens’ education.

TAG: infodemia   disinformazione   misinformazione  
Biochimica Clinica 2021; 45(3) 290-298
DOI: 10.19186/BC_2021.017
Pubblicato online il: 08.04.2021
Opinioni - Opinions
Ricerca sul materiale biologico: ritorno al futuro
Research on biological material: back to the future

Research using biological specimens and health data can accelerate the understanding of many diseases and the effectiveness of preventive, diagnostic and therapeutic interventions. However, researchers have to make a great effort to guarantee respect for transparency and protection of sensitive data of patients, or more generally, of donors whose biological material is collected and stored for future research purposes. Recently, the Committee of Ministers of the Council of Europe proposed new recommendations for the use of biological materials of human origin for future research purposes. The Recommendation CM/Rec(2016)6 focuses on the safeguarding of fundamental rights of the persons, whose biological materials are stored for biomedical research, with particular regard to frail people, unable to provide consent, to guarantee their dignity, integrity and privacy. Furthermore, attention is paid to the transfer of material and data, to the transparency of access policies and to the security in the governance of the collections, in a dimension of globalization and internationalization of research that is a powerful tool to improve human health and healthcare systems.

TAG: biobanche   consenso informato   trattamento dei dati  
Biochimica Clinica 2021; 45(3) 299-304
DOI: 10.19186/BC_2021.053
Pubblicato online il: 06.07.2021
Opinioni - Opinions
Raccomandazione CM/Rec(2016)6 della Commissione dei Ministri agli Stati Membri sull'utilizzo di campioni biologici di origine umana per scopi di ricerca (Adottata dalla Commissione dei Ministri l'11 maggio 2016 al 1256° incontro dei Delegati dei Ministri)
Biochimica Clinica 2021; 45(3) 305-311
DOI: 10.19186/BC_2021.051
Pubblicato online il: 06.07.2021
Documenti - Documents
Principi per l’implementazione e la gestione del point-of-care-testing (POCT): indicazioni essenziali
Implementation and management of the point-of-care testing (POCT): essential indications

In recent years, the field of medicine has considerably changed; an important, widespread trend is the reorganization of medical laboratories. These facilities made an effort to improve their efficiency through a process of consolidation and decentralization. In this context, Point-of-Care Testing (POCT) devices offer numerous advantages, but also pose a clinical risk, particularly in Italy, which is limited by its varied, often inadequate, regional regulations. Some examples are reported, representing scenarios of frequent or bothersome POCT use. This document outlines the SIBioC Working Group recommendations for the safe use of POCT instruments. It defines how these have been updated to the state of technologies and medical requirements. Particular attention has been paid to clinical governance, connectivity, the role of the laboratory director and staff, quality control, education, risk management and the role of the in vitro diagnostic companies. Most of the Italian medical practice is based on hospital experience, but the recent pandemic outbreak of SARS-CoV-2 forces us to re-think about the use of POCT in settings that are outside of the hospital such as local clinics, nursing homes and primary care facilities. These facilities will be the next important field of application for those indispensable tools. Networks of instruments, professionals and competence should be carefully tailored to meet local needs and specific clinical settings.

TAG: raccomandazioni   near-patient-testing   medicina territoriale  
Biochimica Clinica 2021; 45(3) 312-326
DOI: 10.19186/BC_2021.032
Pubblicato online il: 07.05.2021
Documenti SIBioC - SIBioC Documents
Procalcitonin may help in diagnosing bacterial infections in COVID-19 patients during high-dose steroid therapy
A. Batirel  |  N. Eser  |  E. Korlu  |  M. E. Tezcan  | 
TAG: Coronavirus disease-19   procalcitonin   bacterial infection  
Biochimica Clinica 2021; 45(3) 327-329
DOI: 10.19186/BC_2021.020
Pubblicato online il: 16.04.2021
Lettere all'editore - Letters to the editor
Neuromielite ottica in età pediatrica: il laboratorio può essere utile?
Case report: laboratory follow up of myelin oligodendrocyte glycoprotein antibodies titre associated to neuromyelitis optica spectrum disorder
G. Musso  |  M. Nosadini  |  N. Gallo  |  S. Sartori  |  M. Seguso  |  M. Plebani  | 

In September 2018 a previously healthy 6-years-old female was admitted for unspecific visual impairment. Physical examination revealed bilateral papilledema with haemorrhage signs, torpid photomotor reflex and slow eye-blink reflex. No other physical abnormalities or alterations in routine laboratory workup were found.
Brain imaging showed alterations in cortical white matter; both optic nerves and cervical spinal cordanti aquaporin-4 antibodies (AQP4-Ab) and myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) testing was then ordered suspecting a neuromyelitis optica spectrum disorder (NMOSD).
MOG-Ab positivity was found at >1:160 and at 1:40 titre in serum and in cerebrospinal fluid respectively. After steroid treatment, the titre in serum was still positive at 1:160, with mild clinical recovery. Clinical and laboratory follow up was maintained for 1 year, highlighting a fluctuating antibody titre related to both the clinical course and the immunosuppressive treatment.
The need of MOG-Ab laboratory follow-up is still debated, nevertheless it might be useful in predicting clinical relapse, as the presentation of this case report illustrates.

TAG: autoimmunità   anticorpi acquaporina 4   anticorpi anti-MOG  
Biochimica Clinica 2021; 45(3) e020-e022
DOI: 10.19186/BC_2021.025
Pubblicato online il: 05.05.2021
Casi clinici - Case report
Informazioni inaspettate dall’esame emocromocitometrico: variante emoglobinica Hb Leiden rilevata tramite un analizzatore ematologico
Unexpected information from a blood count test: a hemoglobin variant, Hb Leiden, detected with a hematology analyzer

Hemoglobin variants are abnormal forms of hemoglobin that may cause hematological disorders. The variants can be (or not) associated with normal hematology parameters. We were able to identify a hemoglobin variant in a 56-year-old Italian Caucasian male using a hematology analyzer.
A routine complete blood count was performed on the Sysmex XN-9000 analyzer for a patient presenting at the Emergency Department with dizziness. Unusual morphological alarms were reported by the analyzer. The microscopy observation of the peripheral blood smear showed a significant number of contracted ed cells and target red cells. Differential count cytograms showed changes in the distribution of the cell clusters and a reduction in the fluorescence signal. In the hypothesis that these alterations were caused by a hemoglobin variant, a HPLC test was performed and a variant in the D/E zone was detected. Molecular analysis confirmed the presence of a variant identified as Hb Leiden. We were thus able to demonstrate the importance to correlate instrumental alarms with validation rules to detect variants in cases where clinical evidence was lacking. The introduction of a new validation rule that automatically activates reticulocyte count and peripheral blood smear in case of specific instrumental alarms is highly advisable.

TAG: varianti emoglobiniche   emocromo   cromatografia liquida ad alta pressione  
Biochimica Clinica 2021; 45(3) e023-e026
DOI: 10.19186/BC_2021.030
Pubblicato online il: 01.06.2021
Casi clinici - Case report