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Therapeutic Leukapheresis for the Management of Hyperleukocytosis: Ten-year Experience in a Tertiary Care Hospital.

Banseok KIM ; Kyongae LEE ; Sinyoung KIM ; Hyun Ok KIM

Laboratory Medicine Online.2016;6(3):159-164. doi:10.3343/lmo.2016.6.3.159

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

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Comparing the Efficacy of Samsung LABGEO PT10 and Bio-Rad Variant II Turbo for HbA1c Measurement in Three Types of Blood Samples.

Jong Eun PARK ; Hyung Doo PARK

Laboratory Medicine Online.2016;6(3):152-158. doi:10.3343/lmo.2016.6.3.152

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

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Performance Evaluation of the CLINITEK Novus Automated Urine Chemistry Analyzer.

Jisook YIM ; Sang Guk LEE ; Sunmi CHO ; Young Cheol WON ; Jeong Ho KIM

Laboratory Medicine Online.2016;6(3):147-151. doi:10.3343/lmo.2016.6.3.147

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

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Performance Evaluation of Automated Clinical Chemistry Analyzer for Indocyanine Green (ICG) R15 Test.

Ju Heon PARK ; Eun Jeong WON ; Hyun Jung CHOI ; Seung Jung KEE ; Soon Pal SUH

Laboratory Medicine Online.2016;6(3):140-146. doi:10.3343/lmo.2016.6.3.140

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

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Association between Glycemic Control and Hematologic Indices in Type 2 Diabetic Patients.

Yejin OH ; Gye Cheol KWON ; Sun Hoe KOO ; Jimyung KIM

Laboratory Medicine Online.2016;6(3):134-139. doi:10.3343/lmo.2016.6.3.134

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

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Clinical Pharmacogenetic Testing and Application: Laboratory Medicine Clinical Practice Guidelines Part 1.

Sollip KIM ; Yeo Min YUN ; In Suk KIM ; Sang Hoon SONG ; Hye In WOO ; Kyung A LEE ; Woochang LEE ; Hyun Jung CHO ; Misuk JI ; Hyo Jin CHAE ; Soo Youn LEE ; Sail CHUN

Laboratory Medicine Online.2016;6(3):119-133. doi:10.3343/lmo.2016.6.3.119

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

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Analytical Characteristics of High-Sensitivity Cardiac Troponin Assays.

Fred S APPLE ; Paul O COLLINSON

Laboratory Medicine Online.2014;4(1):55-62. doi:10.3343/lmo.2014.4.1.55

BACKGROUND: Cardiac troponins I (cTnI) and T (cTnT) have received international endorsement as the standard biomarkers for detection of myocardial injury, for risk stratification in patients suspected of acute coronary syndrome, and for the diagnosis of myocardial infarction. An evidence-based clinical database is growing rapidly for high-sensitivity (hs) troponin assays. Thus, clarifications of the analytical principles for the immunoassays used in clinical practice are important. CONTENT: The purpose of this mini-review is (a) to provide a background for the biochemistry of cTnT and cTnI and (b) to address the following analytical questions for both hs cTnI and cTnT assays: (i) How does an assay become designated hs? (ii) How does one realistically define healthy (normal) reference populations for determining the 99th percentile? (iii) What is the usual biological variation of these analytes? (iv) What assay imprecision characteristics are acceptable? (v) Will standardization of cardiac troponin assays be attainable? SUMMARY: This review raises important points regarding cTnI and cTnT assays and their reference limits and specifically addresses hs assays used to measure low concentrations (nanograms per liter or picograms per milliliter). Recommendations are made to help clarify the nomenclature. The review also identifies further challenges for the evolving science of cardiac troponin measurement. It is hoped that with the introduction of these concepts, both laboratorians and clinicians can develop a more unified view of how these assays are used worldwide in clinical practice.
Acute Coronary Syndrome ; Biochemistry ; Biomarkers ; Diagnosis ; Hope ; Humans ; Immunoassay ; Myocardial Infarction ; Troponin*

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A Case of Catheter-related Kocuria marina Bloodstream Infection in a Patient with Multiple Myeloma.

Mi Na LEE ; Hee Jae HUH ; Borham KIM ; Cheol In KANG ; Kihyun KIM ; Chang Seok KI ; Nam Yong LEE

Laboratory Medicine Online.2014;4(1):51-54. doi:10.3343/lmo.2014.4.1.51

Kocuria species are gram-positive cocci that are commonly found on human skin, mucosa, and oropharynx. They can cause opportunistic infections in patients with underlying disease or intravenous catheterization. Although several cases of bacteremia caused by Kocuria rosea, Kocuria kristinae, and Kocuria rhizophila have been documented, K. marina has not been reported as a bloodstream pathogen. We isolated K. marina from the blood of a patient with multiple myeloma as a cause of catheter-related bacteremia. The VITEK II system (bioMerieux, Inc.) identified the isolate as K. variance. However, 16S rRNA gene sequencing analysis identified the isolate as K. marina. Accurate identification of Kocuria to the species level requires molecular methods that precisely identify these rare pathogens.
Bacteremia ; Catheter-Related Infections ; Catheterization ; Catheters ; Genes, rRNA ; Gram-Positive Cocci ; Humans ; Methods ; Mucous Membrane ; Multiple Myeloma* ; Opportunistic Infections ; Oropharynx ; Skin

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Performance Comparison of ImmunoCAP and HYTEC 288 in the Quantitative Tests of Allergen-specific IgE.

Seung Hee LEE ; Sun Min LEE ; Hyung Hoi KIM ; Chulhun L. CHANG ; Eun Yup LEE

Laboratory Medicine Online.2014;4(1):43-50. doi:10.3343/lmo.2014.4.1.43

BACKGROUND: In vitro measurement of allergen-specific IgE has become an important part of allergy diagnoses. HYTEC 288 system (Hycor Biomedical Inc., USA), which was recently introduced in Korea, is a fully automated immunoassay for quantitative measurements of allergen-specific IgE. In this study, we compared the clinical utility of this in vitro allergy test with that of ImmunoCAP assay (ImmunoDiagnostics, Sweden). METHODS: To evaluate the reproducibility of HYTEC 288 system, 50 serum samples were tested in duplicate each for Dermatophagoides pteronyssinus (d1) and D. farinae (d2) specific IgE. To assess the agreement between ImmunoCAP and HYTEC 288 assays, 56 serum samples were tested for the other 21 allergen-specific IgE. RESULTS: No significant differences within the range of quantitative analysis were observed between HYTEC 288 and ImmunoCAP assays for d1 and d2 (P=0.65 and 0.55, respectively). The agreements of HYTEC allergen-specific IgE assay with ImmunoCAP within +/-1 class grade were 80% and 100% for d1 and d2, respectively. The correlation coefficients between HYTEC 288 and ImmunoCAP results within the range of quantitative analysis were overally 0.90, regardless of allergen, for d1 and d2 specific IgE, 0.91 and 0.98, respectively. Running times for the HYTEC 288 and Phardia 100 were 5.5 and 4.6 min per test, respectively. CONCLUSIONS: Hycor HYTEC 288 showed a favorable agreement with ImmunoCAP and can be used for fully automated quantitative measurements of allergen-specific IgE in the clinical laboratory.
Automation ; Dermatophagoides pteronyssinus ; Diagnosis ; Hypersensitivity ; Immunoassay ; Immunoglobulin E* ; Korea ; Running

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Establishment and Multicenter Evaluation of a National Reference Panel for Syphilis Antibodies in Korea.

Hee Jin HUH ; Seok Lae CHAE ; Deok Ja OH ; Quehn PARK ; Chae Seung LIM ; Tae Hyun UM ; Yun Mi PARK ; Young Joo CHA

Laboratory Medicine Online.2014;4(1):36-42. doi:10.3343/lmo.2014.4.1.36

BACKGROUND: Establishment of a national reference panel for syphilis antibodies is necessary to evaluate the performance of in-vitro diagnostic tests for syphilis and to verify test quality. This study aimed to establish a national reference panel for syphilis antibodies, to assess the suitability of a panel for non-treponemal and treponemal testing, and to assess the reactivity of the various tests currently in use. METHODS: Treponemal pallidum particle agglutination (TPPA)-positive and -negative fresh frozen plasma samples were obtained. After the fresh frozen plasma was converted to serum by defibrination, the samples were pooled. Two candidate reference standards containing no syphilis antibodies and 10 candidate reference standards containing syphilis antibodies were prepared on the basis of reactivity in the TPPA assay. Candidate reference standards were tested by three laboratories using five non-treponemal tests and four treponemal tests. RESULTS: All three laboratories reported positive non-treponemal test results for the mixed-titer performance panel (MP)/6-MP/12. MP/1, MP/2, and MP/3 were negative for non-treponemal tests. MP/4 and MP/5 were reported either as positive or negative according to the laboratories. All laboratories reported positive TPPA results for MP/3-MP/12 and negative results for MP/1 and MP/2. No significant difference was detected among the treponemal testing results in three laboratories. CONCLUSIONS: We established 12 candidate national reference standards containing various concentrations of syphilis antibodies. A collaborative study using nine tests demonstrated that 12 candidate national reference standards presented consistent results, except a few assays with low sensitivity, and thus could be used as a national reference panel for syphilis antibody testing.
Agglutination ; Antibodies* ; Diagnostic Tests, Routine ; Korea* ; Plasma ; Syphilis*

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