BACKGROUND

Pre-transfusion testing is done to avoid transfusion morbidity from unexpected RBC antibodies. Available commercial kits from Western brands may not consider racial differences in antibody frequencies between East/Southeast Asians and Western populations. The limited number of blood banks in the Philippines precludes research on RBC antibody screening and identification in the country.

OBJECTIVE

This study aimed to compare RBC antibody screening and identification methods in patients at a tertiary hospital in the Philippines, assess the frequency of major blood group antibodies using both techniques, and review clinical histories of discrepant and nonspecific cases.

METHODOLOGY

Retrospective review showed 118 cases with both screening and identification tests using both conventional tube-based technique and column agglutination or gel-based technique. Antibody frequencies and discrepant or nonspecific results were recorded. Concordance rates were calculated, and differences between the two methods were analyzed using 95% confidence interval (95% CI). Clinical histories of discrepant and nonspecific cases were also reviewed.

RESULTS

The most frequent major blood group was Rh (41 cases or 34.7%), followed by MNS (34 cases or 28.8%) and Kidd (15 cases or 12.7%). The most common antibody was Anti-E (24 cases or 20.3%), followed by Anti-Mia (19 cases or 16.1%), and Anti-M and Anti-c (12 cases each, or 10.2% each). The concordance rate for screening was statistically significant at 72%. Concordance rate for identification was 59.3%, with significant difference in identifying Anti-Mia. Clinical histories for discrepant or nonspecific cases showed previous transfusions, pregnancy, lymphoproliferative conditions, and certain medications.

CONCLUSION

Statistically significant differences between the two methods were found, with the gel-based technique identifying more Anti-Mia cases. Negative results from the tube-based method do not fully exclude Anti-Mia. These discrepancies highlight the benefit of using both methods for comprehensive RBC antibody screening and identification, done as a complement to the other.

Blood Banks ; Blood Transfusion ; Blood Grouping And Crossmatching ; Antibodies

The COVID-19 pandemic highlighted critical gaps in the Philippine health laboratory system, including limited testing capacities, insufficient trained personnel, and inadequate resource distribution. To address these issues, the Philippine government established the Office for Health Laboratories (OHL) and sought technical assistance from the Japan International Cooperation Agency (JICA) through the Project for Strengthening the Philippine National Health Laboratory Network for Infectious Diseases (PHeLNIDs). This project aims to enhance the National Health Laboratory Network's (NHLN) capacity for infectious disease surveillance and response. Phase 1 of the PHeLNIDs project included focus group discussions (FGDs) conducted across 17 regions to assess challenges and develop recommendations for a tier-based laboratory network. Key findings revealed logistical, workforce, transportation, and data management challenges that hinder the effectiveness of specimen referral workflows. Recommendations emphasized decentralizing diagnostic capabilities through subnational reference laboratories, strengthening logistics, and implementing an Integrated Laboratory Information Management System (ILIMS). This article underscores the importance of laboratory decentralization, capacity building, and improved resource management to enhance laboratory-based surveillance and response to emerging infectious diseases. The proposed interventions aim to bolster the Philippine laboratory network, reduce turnaround times, and improve public health outcomes.

Emerging Infectious Disease ; Communicable Diseases, Emerging

Operations research (OR) is a valuable yet underutilized field in clinical laboratory management, offering practical solutions to optimize workflows, resource allocation, and decision-making. Despite its potential, the adoption of OR methodologies remain limited due to a lack of training and familiarity among pathologists and laboratory professionals. This paper addresses this gap by presenting an accessible introduction and practical guide to analyzing operations research problems in clinical laboratories using computer-assisted simulations in R, implemented within the R Studio environment.

The proposed framework emphasizes simplicity and flexibility, leveraging the extensive capabilities of base R to model and analyze critical OR questions. The paper outlines step-by-step methods for defining problems, constructing simulation models, and interpreting results, ensuring that readers can replicate and adapt these techniques to their unique laboratory contexts.

Key features of the framework include its emphasis on reproducibility, customization, and the integration of data-driven insights into decision-making processes. Case studies and examples drawn from real-world laboratory scenarios illustrate the application of R simulations to address challenges such as minimizing turnaround times, balancing staffing levels, and managing inventory efficiently.

This guide aims to empower laboratory professionals and pathologists with the tools and skills to integrate operations research into their practice, fostering a culture of innovation and efficiency in clinical settings. By bridging the gap between OR theory and practical application, this paper contributes to the broader adoption of computational approaches in laboratory management, ultimately enhancing the quality and sustainability of healthcare services.

Human ; Operations Research

Old signage faced iconography, variable layouts, visual presentations, and contents, as well as degradation issues, undermine the effectiveness of hazard communication in the laboratory. A 2016 project was initiated to standardize all hazard signages at the Laboratory Research Division of the Research Institute for Tropical Medicine (RITM), incorporating standard colors and iconography for better compliance and safety. As part of a broader initiative to enhance biorisk practices within the institute, there are plans for improvement and expansion to non-laboratory areas.

Containment Of Biohazards ; Biosecurity ; Laboratories ; Communication ; Laboratory Personnel

This is a case of malignant melanoma with rhabdomyosarcomatous differentiation presenting as a conjunctival mass in a 50-year-old male. Melanoma cells were seen to react with desmin, myogenin and vimentin, indicating rhabdomyosarcomatous differentiation. This condition is very rare, with less than twenty cases reported in the literature, which contributes to the limitations in molecular characterization and standard treatment protocols for this entity. This condition has an aggressive course with a poor prognosis.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Malignant Melanoma ; Melanoma ; Eye ; Rhabdomyosarcoma

Nephroblastoma is an uncommon renal malignancy primarily observed in the pediatric population, with its occurrence in adults being exceedingly infrequent. We describe an extremely rare case of a malignant embryonal tumor presenting in an adult patient with right renal mass. Final histopathologic diagnosis was nephroblastoma with favorable histology. Use of immunohistochemistry studies is generally unnecessary but its rarity in the adult population raises uncertainty in diagnosing this malignancy by histomorphology alone.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Immunohistochemistry ; Wilms Tumor

Sodium nitrite (SN, NaNO2) is a water-soluble, white-yellow crystalline powder with broad applications in food preservation, automotive maintenance, and animal control. It is a strong oxidizing agent that can oxidize hemoglobin iron (Fe) to its oxidized state, leading to methemoglobin formation. An increasing trend of suicide cases by SN ingestion has been reported globally following its popularization in online suicide forums providing detailed instructions of its use solely or as part of a “suicide kit.” We report a case of a 21-year-old male who was found continuously vomiting, with blood per orem and cyanosis of the mouth and digits. Within minutes of the onset of symptoms, the patient lost consciousness and was pronounced dead on arrival at the nearest emergency room. Autopsy findings showed lip erosions, hemorrhage, and perioral and peripheral cyanosis. Internal examination showed characteristic bright red muscle discoloration, dark brown arterial blood, red-brown congested visceral organs, and hyperemic esophageal and gastric mucosa. Methemoglobin studies from sampled arterial blood showed elevated levels (17.5%). Further investigation of the decedent’s belongings, social media posts, and recent online purchases reinforced the intentional sodium nitrite ingestion. While there are plenty of reported SN poisoning in suicide cases internationally, limited reports have been published locally. Death by SN poisoning is preventable with Methylene blue. The role of forensic pathologists through autopsy may be the last chance to detect such cases. The lack of systemic death investigation, experts, and local laboratories to reliably detect the signs of SN poisoning may have affected the low detection rate of cases locally. Further reporting of cases can raise the awareness of medical professionals that is fundamental to the ultimate saving of lives.

Human ; Male ; Young Adult: 19-24 Yrs Old ; Sodium Nitrite ; Suicide ; Poisoning ; Forensic Pathology ; Autopsy

A rectal polyp is found during a routine colonoscopy of a 34-year-old male. He has no known significant family history of inherited disorder. Endoscopic findings reveal a 5-mm JNET 2A polyp in the rectum which is removed via forceps polypectomy. The microscopic examination shows a polypoid colonic mucosa with fairly circumscribed proliferation of low-grade spindle cells in the lamina propria, separating the crypts. The individual spindle cells are uniform in size with abundant eosinophilic cytoplasm. No mitotic figures, nuclear atypia, pleomorphism and necrosis are noted. Likewise, the crypts do not exhibit serrated architecture.

Human ; Male ; Adult: 25-44 Yrs Old ; Schwann Cells ; Hamartoma ; Mucosa ; Mucous Membrane ; Polyps

Cytopathology in the Philippines is currently practiced by board-certified anatomic pathologists who receive only a three-month rotation in the discipline during their four-year combined Anatomic and Clinical Pathology residency training. At present, the country lacks a formal fellowship program in cytopathology, and no national core curriculum has been developed for this subspecialty. Local pathologists with advanced training and extensive experience in cytopathology recognized by the Philippine Society of Pathologists, Inc. (PSP) developed the first national core curriculum for cytopathology fellowship training. This initiative marks the first locally developed guideline for cytopathology fellowship training in the Philippines, representing a significant milestone in the advancement of subspecialty pathology education in the country.

Human ; Cytology

BACKGROUND

Serum-sodium reporting tolerates a total allowable error (TEa) of only ±4 mmol/L, yet many laboratories continue to operate at the marginal three-sigma level because the quantitative benefit of additional sigma capability is poorly characterized.

OBJECTIVES

The study aims to translate sigma metrics into clinically intuitive risk estimates by (1) quantifying the proportion of QC results that exceed the TEa at five sigma levels (2 – 6 σ) and (2) determining whether successive sigma gains produce statistically significant reductions in error.

METHODOLOGY

Five (5) hypothetical assays were parameterized with a common mean of 140 mmol/L and CVs corresponding to 2-, 3-, 4-, 5- and 6-sigma performance. For each assay, 1,000 Monte-Carlo iterations were run, each iteration simulating 36,500 QC results (assuming 100 runs/day for 365 days) drawn from N(μ = 140, σ = μ × CV). The error rate (the proportion of results outside ±4 mmol/L) was recorded per iteration. Distributions were summarized (mean, range, SD); differences were evaluated with one-way ANOVA followed by Tukey’s HSD.

RESULTS

Mean (±SD) error rates declined significantly with increasing sigma: Assay A (2 σ): 0.0456 ± 0.0011; Assay B (3 σ): 0.00270 ± 0.00027;Assay C (4 σ): 6.3 × 10-5 ± 4.1 × 10-5; Assay D (5 σ): 5.8 × 10-7 ± 8.0 × 10-7; and Assay E (6 σ): 2.0 × 10-7 ± 3.1 × 10-7. The maximum single-iteration error rate fell from 0.0505 at 2 σ to 1.1 × 10-4 at 4 σ. The 5 σ and 6 σ processes produced zero TEa violations in ≥96 % of iterations. ANOVA confirmed a global difference (p < 0.001); all pairwise contrasts were significant (p < 0.001) except between 5 σ vs 6 σ (p = 0.62).

NEW ABSTRACT STRUCTURE 1

Each one-sigma gain yields an order-of-magnitude reduction in TEa violations until a plateau is reached at ≥5 σ, where residual analytical risk is negligible. These simulations support the recommendation that laboratories operating serum-sodium assays below 4 σ should prioritize precision improvements or enhanced QC strategies, whereas ≥5 σ assays may safely adopt less intensive QC without compromising patient safety.

Human ; Quality Control ; Total Quality Management ; Tea