1.Inappropriate Positioning of Separator Gel in Blood Collection Tube: A Case Report
Wan Norlina Wan Azman ; Noorazliyana Shafii ; Siong Hu Wong ; Aniza Mohd Jelani
Malaysian Journal of Medicine and Health Sciences 2021;17(No.3):308-310
Blood collection tubes containing separator gel are widely used in many clinical laboratories because of easy to
use, convenience and several other advantages. However, they are not void of limitation. We describe an unusual
case with a floating separator gel in the primary blood collection tube. The blood sample was collected into a BD
Vacutainer SST II Advance tube, from a 51 years old man admitted for community acquired pneumonia and had history of hyperproteinaemia. Inappropriate positioning of the separator gel was observed after centrifugation, whereby
the separator gel floated above the serum. Detection of abnormal separator gel floatation pattern in this patient’s
sample before analysis had prevented potential technical problem and production of erroneous result caused by
aspiration of separator gel. The limitation of blood collection tube with separator gel especially in patients with hyperproteinaemia should be made aware among laboratory personnel and physicians.
2.The Level of N-Carboxymethyllysine and C-Reactive Protein in Type 2 Diabetes Mellitus and it’s Association with HbA1c in Diabetic Nephropathy
Mohd Zulhafiz Mat Rahim ; Wan Norlina Wan Azman ; Najib Majdi Yaacob ; Wan Mohd Izani Wan Mohamed ; Noorazliyana Shafii
Malaysian Journal of Medicine and Health Sciences 2023;19(No.4):282-289
Introduction: N-Carboxymethyllysine (CML) is involved in diabetic nephropathy (DN) via production of oxidative
stress, growth factors and cytokines. C-reactive protein (CRP) is an inflammatory marker associated with diabetes
risk. This study is to determine the level of serum CML and CRP in Type 2 diabetes mellitus (T2DM) patients and
healthy subjects and to determine the correlation between CML and CRP with glycated haemoglobin (HbA1c) in
T2DM patients. Methods: This is a case-control study on 73 T2DM patients without nephropathy, 74 T2DM patients
with nephropathy and 73 healthy subjects, aged from 18 to 65 years old. Fasting venous blood was taken and analysed for CML, CRP, HbA1c, and creatinine. The comparisons of serum CML and CRP among the three groups and
the correlation between CML and CRP with HbA1c (in T2DM patients) were determined. Results: The differences in
CML [median (Interquartile Range) (IQR)] between healthy subjects [131.80 (73.56) ng/ml] and T2DM patients without nephropathy [188.80 (55.95) ng/ml]; between healthy subjects and T2DM patients with nephropathy [237.70
(439.04) ng/ml] were statistically significant (P<0.001). The differences in CRP [median (IQR)] between healthy
subjects [1.64 (1.91) ng/ml] and T2DM patients without nephropathy [2.15 (5.64) ng/ml]; between healthy subjects
and T2DM patients with nephropathy [4.75 (6.91) ng/ml] were statistically significant (P<0.001). Logistic regression
showed CML and CRP are independent predictors of diabetic groups. There was no correlation between HbA1c with
CML and CRP in T2DM groups. Conclusion: Since serum CML and CRP are independent predictors of DN, their
levels can be used to identify high-risk diabetic patients prone to developing DN.
3.C-reactive Protein, Albumin, Urea, CRP/Albumin Ratio, and Urea/Albumin Ratio: A Retrospective Evaluation in COVID-19 Patients
Nor Amirah Mohammad Nazri ; Wan Norlina Wan Azman ; Norsyuhadah Musa ; Tuan Salwani Tuan Ismail ; Azian Harun ; Najib Majdi Yaacob ; Sarina Sulong ; Sirajudeen K.N.S ; Mahaya Che Mat ; Hani Ajrina Zulkeflee ; Siti Sarah Mustapa
Malaysian Journal of Medicine and Health Sciences 2023;19(No.6):164-170
Introduction: C-reactive protein (CRP), urea, albumin, CRP/albumin ratio (CAR) and urea/albumin ratio (UAR) could
be valuable biomarkers for determining the severity of illness in patients with COVID-19. This study aimed to determine the association between these markers and disease severity in COVID-19 patients on admission and days five to
seven after admission. Methods: This retrospective study includes 153 adult COVID-19 patients admitted to Hospital
Raja Perempuan Zainab II and Hospital Ampang from January 2021 to December 2021. Patients’ serum CRP, urea,
albumin and creatinine levels were recorded on admission and on days five to seven after admission. The patients
were categorised based on the Annex 2e guidelines published by the Ministry of Health, Malaysia and further classified as mild to moderate disease (stages 1-3) and severe to critical illness (stages 4-5). Results: On admission, urea,
creatinine, CRP, UAR and CAR were significantly higher in the severe to critical group (p<0.001). The optimal cut-off
value for the UAR was 0.16; the area under the curve (AUC) was 0.760, and sensitivity and specificity were 63.6%
and 85.7%, respectively. The AUC of the CAR was 0.752, with 54.2% sensitivity and 91.4% specificity at an optimal
cut-off value of 1.63. In severe to critical COVID-19 patients, albumin levels decreased significantly on days five to
seven after admission, while urea levels remained significantly higher in this group (p<0.001, p<0.05, respectively).
Conclusion: CRP, urea, albumin, CAR and UAR are promising biomarkers for predicting the severity of disease in
COVID-19 patients.
4.The Frequency and Cost of Redundant Biochemistry Test in Tertiary Teaching Hospital
Siti Nadirah Ab Rahim ; Julia Omar ; Aniza Mohammed Jelani ; Najib Majdi Yaacob ; Wan Norlina Wan Azman
Malaysian Journal of Medicine and Health Sciences 2022;18(No.1):114-120
Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation
is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of
redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes
in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients
admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test
results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in
LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests
were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More
than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST,
Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards
and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600
thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future
intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration
among physicians and laboratory professionals can minimise test inappropriateness.