BACKGROUND: Hyperleukocytosis is a medical emergency that is characterized by increased blood viscosity and predisposition to various neurological, pulmonary, and gastrointestinal complications. In addition, patients are at risk of the tumor lysis syndrome because of the increased tumor burden. Therapeutic leukapheresis is an important treatment for these emergent states. In this study, we retrospectively analyzed therapeutic leukapheresis procedures that were performed in our institution during the last 10 yr. METHODS: We retrospectively analyzed therapeutic leukapheresis procedures conducted from July 2005 to March 2015 at a tertiary care hospital. We present our observations, especially the procedural characteristics and hematological parameters before and after the aforementioned procedures. RESULTS: Seventy-two patients underwent a total of 146 therapeutic leukapheresis procedures. The average presenting white blood cell (WBC) count was 268×10(3)/µL, and ranged from 54×10(3)/µL to 673×10(3)/µL. After an average of two sessions, a statistically significant drop in the WBC counts was observed. The average WBC removal rates during the initial and entire therapeutic leukapheresis procedures of each patient were 33% and 46%, respectively. The platelet count and hemoglobin concentration were significantly reduced. CONCLUSIONS: Therapeutic leukapheresis significantly reduces peripheral WBC counts and is a safe and effective procedure for the treatment of hyperleukocytosis.
Blood Viscosity ; Emergencies ; Humans ; Leukapheresis* ; Leukemia ; Leukocytes ; Platelet Count ; Retrospective Studies ; Tertiary Healthcare* ; Tumor Burden ; Tumor Lysis Syndrome

BACKGROUND: Hemoglobin A1c (HbA1c) is a good marker for monitoring glycemic control. The Samsung LABGEO PT10 HbA1c test (Samsung Electronics, Korea) was developed as a point-of-care testing approach. This study evaluated the levels of HbA1c in three different types of blood specimens using two different methods. METHODS: We used correlation analyses to compare the results obtained using Samsung LABGEO PT10 and Bio-Rad Variant II Turbo (Bio-Rad Laboratories, USA) to determine the levels of HbA1c in three different types of blood samples: capillary blood, EDTA whole blood, and lithium (Li)-heparin whole blood. RESULTS: The correlation coefficient for the level of HbA1c in capillary blood based on LABGEO PT10 vs. that in EDTA whole blood based on the Variant II Turbo was r=0.9619; that in capillary blood based on LABGEO PT10 vs. that in Li-heparin whole blood based on the Variant II Turbo was r=0.9619; that in capillary blood vs. that in EDTA whole blood based on the LABGEO PT10 was r=0.9697; that in capillary blood vs. that in Li-heparin whole blood based on the LABGEO PT10 was r=0.9724; and that in EDTA whole blood vs. that in Li-heparin whole blood based on the LABGEO PT10 was r=0.9730. CONCLUSIONS: The LABGEO PT10 was suitable for analyzing HbA1c. The results for the measurement of HbA1c levels in capillary blood were comparable to that in the whole blood samples. Additionally, LABGEO PT10 can be used for patients who are unable to take venipuncture.
Capillaries ; Edetic Acid ; Humans ; Lithium ; Phlebotomy ; Point-of-Care Systems ; Point-of-Care Testing

BACKGROUND: We aimed to evaluate the performance of the CLINITEK Novus urine chemistry analyzer (Siemens, UK). METHODS: The precision, correlation, and carryover study were performed using two kinds of commercial quality control materials and 40-55 freshly collected patient specimens. We calculated exact and within-1-block agreement, along with kappa agreement, to compare the semi-quantitative results between urine chemistry analyzers. The urine specific gravity taken by a refractometer was compared with the analyzer results. Moreover, we analyzed additional urine specimens for protein to evaluate the agreement of results between those of the CLINITEK Novus and the AU680 analyzers (Beckman Coulter, Japan). RESULTS: The precision study showed acceptable results; within-1-block agreement was 100% in all tested items. The urine chemistry results from the CLNITEK Novus analyzer demonstrated ≥85.1% within-1-block agreements with those of the Uriscan Super, and the kappa test results were ≥0.81. The comparison of specific gravity with manual refractometer showed a good correlation (r=0.991), and the protein comparison with the AU680 analyzer also showed a good correlation (with exact and within-1-block agreements being 75.9% and 100.0%, respectively). The carryover rates were 0% in all tested items, except specific gravity and heavy blood tests. CONCLUSIONS: The CLINITEK Novus analyzer showed good performance in terms of precision, comparison, and carryover in this study. Therefore, the CLINITEK Novus automated urine analysis is expected to be useful for routine urinalysis in a clinical laboratory.
Chemistry* ; Hematologic Tests ; Humans ; Quality Control ; Specific Gravity ; Urinalysis

BACKGROUND: The conventional indocyanine green retention rate at 15 minutes (ICG R15) test is inefficient and inconvenient because it requires the use of a manual spectrophotometer and several samples per patient. This study aimed to establish the automation of the ICG R15 test using an automated clinical chemistry analyzer, and to evaluate the calculation of R15 with a small number of samples. METHODS: The performance of the AU5832 (Beckman Coulter, USA) for determining ICG concentration was evaluated in accordance with the Clinical Laboratory Standards Institute (CLSI) guidelines. The R15 results for 77 patients determined by spectrophotometry and AU5832 were compared. We evaluated the calculation of R15 with three samples, except for one sample in which the results had been obtained previously, at 5, 10, and 15 minutes after injection of ICG into the patients, and compared the results with those obtained with four samples. RESULTS: The automated ICG test using the AU5832 system showed proper performances according to CLSI. Although the difference in the R15 results between the two methods was within the 95% confidence interval, the R15 was adjusted by the regression equation because it was slightly lower according to the automated method compared with the manual method. The R15 with three samples (0, 5, and 15 minutes) showed the best correlation with conventional R15 with four samples (r2=0.996). Compared with the manual method, the R15 result using the AU5832 showed excellent agreement with four samples (kappa value 0.904) and with three samples (kappa value 0.880). CONCLUSIONS: The ICG R15 test using the AU5832 system is comparable with the conventional method in clinical use.
Automation ; Chemistry, Clinical* ; Humans ; Indocyanine Green* ; Methods ; Spectrophotometry

BACKGROUND: Diabetes mellitus (DM) is characterized by impaired glucose regulation and various complications. It is known that chronic inflammation and platelet activation play a role in development of insulin resistance or diabetic complications. This study investigated whether hematologic parameters are useful for monitoring blood glucose regulation or complications in DM patients. METHODS: Total 90 diabetic patients were divided into two groups according to their hemoglobin A1c (HbA1c) levels: 59 regulated DM patients with HbA1c levels<7% and 31 unregulated DM patients with HbA1c levels≥7%. RESULTS: White blood cell counts (P=0.021), neutrophil counts (P=0.005), monocyte counts (P=0.040), neutrophil % (P=0.042) and the neutrophil lymphocyte ratio (NLR) (P=0.032) were significantly higher in the unregulated DM group compared to that in the regulated DM group. There were no differences in lymphocyte counts, lymphocyte %, monocyte %, mean neutrophil volume, mean monocyte volume, platelet count, and mean platelet volume between groups. Neutrophil counts and NLR were higher in unregulated DM patients with complications than in the regulated DM group. A positive correlation was observed between HbA1c and white blood cell count (r=0.389, P<0.001) and neutrophil count (r=0.361, P<0.001). CONCLUSIONS: In DM patients, neutrophil counts and NLR were related to glycemic control and the presence of complications. Additionally, neutrophil counts showed a positive correlation with HbA1c. Therefore, neutrophil counts and NLR can be used as related markers for diabetic regulation and complications during the follow-up of diabetic patients.
Blood Glucose ; Diabetes Complications ; Diabetes Mellitus ; Follow-Up Studies ; Glucose ; Humans ; Inflammation ; Insulin Resistance ; Leukocyte Count ; Lymphocyte Count ; Lymphocytes ; Mean Platelet Volume ; Monocytes ; Neutrophils ; Platelet Activation ; Platelet Count

Pharmacogenetics is a rapidly evolving field, and the number of pharmacogenetic tests for clinical use is steadily increasing. However, incorrect or inadequate implementation and use of pharmacogenetic testing in clinical practice may result in an increase in medical costs and adverse patient outcomes. This document contains suggested pharmacogenetic testing guidelines for clinical application, interpretation, and reporting of the results through a literature review and evidence-based expert opinions. The clinical laboratory practice guideline includes clinical pharmacogenetic testing covered by public medical insurance in Korea. Technical, ethical, and regulatory issues related to clinical pharmacogenetic testing are also addressed. This document aims to improve the utility of pharmacogenetic testing in routine clinical settings.
Expert Testimony ; Humans ; Insurance ; Korea ; Pharmacogenetics

Here, we report a case in which the rapid diagnosis of tuberculous pericarditis was made using Mycobacterium tuberculosis (MTB)-specific interferon-gamma release assay on peripheral blood and pericardial effusion. Acid-fast bacilli staining, mycobacterial culture, and nucleic acid amplification targeting MTB using pericardial fluid were negative. However, elevated adenosine deaminase (ADA) activity in pericardial fluid and interferon-gamma release assay positivity in both pericardial fluid and peripheral blood indicated the presence of tuberculous pericarditis. After anti-tuberculous and steroid treatment, the patient's clinical symptoms improved, and pericardial effusion has not reoccurred.
Adenosine Deaminase ; Diagnosis* ; Interferon-gamma Release Tests* ; Interferon-gamma* ; Mycobacterium tuberculosis ; Pericardial Effusion ; Pericarditis, Tuberculous*

Infants with Down syndrome have increased incidences of transient abnormal myelopoiesis (TAM) and acute leukemia, which are usually associated with acute megakaryoblastic leukemia (AMKL). A 5-day-old girl with Down syndrome was diagnosed with TAM; 4 months later, acute leukemic transformation was suspected. Bone marrow (BM) examination was performed, and the infant was diagnosed with acute leukemia (80% blasts). Although BM aspirates showed the presence of megakaryocytic blasts with cytoplasmic blebs, flow cytometry analysis revealed that they were negative for cells with CD41a and CD61 immunophenotypes. Further analysis revealed that the megakaryocyte-related marker CD42a was positive in 57% of blasts. Morphologic and immunophenotypic features are required to establish the lineage of megakaryocytic blasts, which are necessary for diagnosing AMKL. As most cases of AMKL were positive for CD41 and/or CD61 markers, their presence was evaluated during routine analysis. In order to identify the immunophenotypic features of AMKL in an infant with Down syndrome, we performed additional flow cytometry for CD42a, one of the megakaryocytic markers, and were able to assist in the early diagnosis of AMKL, as well as to use CD42a as an effective follow-up marker.
Blister ; Bone Marrow ; Cytoplasm ; Down Syndrome* ; Early Diagnosis ; Female ; Flow Cytometry ; Follow-Up Studies ; Humans ; Incidence ; Infant* ; Leukemia ; Leukemia, Megakaryoblastic, Acute* ; Myelopoiesis

BACKGROUND: Infectious vaginitis is a common gynecologic disease that is primarily caused by three pathogens (Trichomonas vaginalis, Gardnerella vaginalis, and Candida species). The aim of this study was to confirm the effects of other infectious vaginitis-related test results on the interpretation of Gram stain and Papanicolaou (Pap) smear test results for disease diagnosis. METHODS: A total of 300 vaginal samples were collected from women presenting symptoms of vaginitis. The presence of the three previously mentioned pathogens was evaluated using both a Gram stain and Pap smear test, and interpreted twice by 4 different observers. The first interpretation was performed without any information, and a second interpretation was performed with knowledge of results of an Affirm VPIII test that was used to diagnose infectious vaginitis. The results from the two interpretations were compared and the sensitivity and specificity of both tests were evaluated. RESULTS: For the Gram stain samples, the detection rates of G. vaginalis were increased in the second interpretation by 6.2%, while the detection rates of Candida spp. were decreased by 0.3%. For the Pap smear test samples, the detection rates of G. vaginalis were increased in the second interpretation by 7.0%, and the detection rates of Candida spp. were increased by 2.0%. The sensitivity of both tests was increased in the second interpretation by 5.5% to 66.7%. There was no difference in the specificity between the two interpretations. CONCLUSIONS: We demonstrated that there is significant inter-observer variation when using Gram stain and Pap smear test results to diagnose infectious vaginitis. The detection rates and sensitivity of both tests changed when the results from an additional test were incorporated into the interpretation. Additional studies are needed to develop objective criteria and a standardized interpretation system for the evaluation of results from these diagnostic tests.
Candida ; Diagnosis* ; Diagnostic Tests, Routine ; Female ; Gardnerella vaginalis ; Genital Diseases, Female ; Humans ; Knowledge of Results (Psychology) ; Observer Variation ; Papanicolaou Test* ; Sensitivity and Specificity ; Vaginitis*

BACKGROUND: Hyaluronic acid (HA) is present in the connective tissues wherein it functions as a lubricant. HA is known to be increased in both synovial fluid and serum when inflammation occurs in the joint. We measured serum HA concentrations by automated assays and determined its reference interval and its usefulness as a diagnostic marker in patients with rheumatoid arthritis (RA). METHODS: Serum specimens collected from 121 healthy individuals and 253 patients with various arthritis were used for measuring HA with two automated assays, namely, LPIAACE (Mitsubishi, Japan) and LT Auto Wako (Wako, Japan). The association between serum HA concentration and the diagnosis of RA was estimated by receiver operator characteristic (ROC) analysis and multivariate logistic regression. RESULTS: The 95th percentile upper reference limit of serum HA was 57.28 ng/mL (90% confidence interval [CI], 46.30-68.20 ng/mL) for LPIAACE and 72.64 ng/mL (90%% CI, 57.30-85.70 ng/mL) for LT Auto Wako. Area under the ROC curve values of serum HA for discriminating the RA group from the non-RA group were 0.68 for LPIAACE and 0.70 for LT Auto Wako. The odds ratio for serum HA in predicting RA was 1.02 (95% CI, 1.02-1.04) for LPIAACE and 1.03 (95% CI, 1.02-1.05) for LT Auto Wako. CONCLUSIONS: This study provides a reference interval for serum HA concentrations in Koreans. This result suggests that the serum HA concentrations could be helpful as a complementary marker for discriminating RA from other types of arthritis, as well as distinguishing patients with RA from healthy controls.
Arthritis ; Arthritis, Rheumatoid* ; Connective Tissue ; Diagnosis* ; Humans ; Hyaluronic Acid* ; Inflammation ; Joints ; Logistic Models ; Odds Ratio ; ROC Curve ; Synovial Fluid