Background: We organized the MEQAS (Mongolian External Quality Assessment Scheme) since 2008, on basis of the Cooperation agreement between Ministry of Health and Sysmex Corporation in the establishment of Hematology external quality control and reference laboratory system.
Therefore, since 2017 year we have set up from 1^st to 4^th External Quality Assessment (EQA) for blood morphology testing. Method: This EQA for blood morphology testing included 177 clinical pathologists, 57 technologists, and 36 technicians (270 participants in total). We assessed their ability to distinguish the blood cells on a real-time basis online. Result, discussion: Out of all participants, the clinical pathologists got marks ranging 70.1%, technologists got 59.0%, technicians got 58.2%. Continual trainings should be organized by different programs for laboratory specialists. A real-time online method was adopted in an EQA for the first time. This allowed the participants to know their results immediately after completing the assessment.
The overall results of the participants were generated in form of graphs immediately after the completion of the EQA. This allowed for visualization of areas where the percentage of correct answers were low, which were explained extensively during the discussion of answers.
As the results directly reflect the knowledge and skills of each participants, this form of EQA is suggested to be an extremely useful mean for determining the future education platform. Conclusions
1. The ability of clinical pathologists to distinguish blood cells and to interpretation are unsatisfactory.
2. The ability of biomedical technologists and technicians to distinguish blood cells are unsatisfactory.

Purpose: Follow-up examinations in kidney donors is an essential yet necessary process in organ transplantation. In this study, we aimed to evaluate kidney function using biomarkers and biomarker based eGFR in kidney donors within 5 years of organ transplantation. Materials and method: 91 donors enrolled in our study. We measured body weight and blood and urine samples for laboratory tests. eGFR was calculated using 6 estimations. Result: The mean serum creatinine in participants was 0.81±0.22 mg/dL, cystatin C was 1.11±0.19 mg/dL, urea was 31.44±8.02 mg/L. Systolic hypertension in subjects was 130.0±16.5 mmHg while diastolic hypertension was 78.4±10.8 mmHg. In all donors, 15.9% (n=14) had hematuria, 23.6% (n=21) had proteinuria, 24.7% (n=19) had albuminuria. Body weight, creatinine, cystatin C and urea measurements had gradually increased over the years. The average eGFR was 72.9±17.9 to 112.8±34.0 ml/min/1.73m² showing 0.15%-35.22% before donation. Follow – up rate was 28.3-59.2% of total donors.Having health insurance and living far from Ulaanbaatar city influenced follow – up rate. Donor registration data should be updated regularly. Conclusion
1. Serum creatinine, cystatin C, urea was increasing in living kidney donors. Hypertension and microalbuminuria was greater than other donor study results.
2. eGFR decreased 0.15-35.22% in donor. CKD EPI combined equation was best for donor.
3. Health insurance and living far from Ulaanbaatar city were the influencing follow – up rate. Registration data is missing in 25.5%-82.4% of total donors suggesting enhancement in data collection.

Background: The WHO recommends the ideal rate for cesarean section to be 15% of the total birth, but researchers are still attracting attention to the fact that in recent years this rate has been steadily increasing, and risk is not decreasing worldwide. Incidence of postcesarean section inflammation and infection are 8-10 times higher than vaginal birth. The determination of lactate levels in early diagnosis of sepsis is clinically significant and the higher the lactate level increases the risk of mortality. Objective: The aim of the study is to improve early detection of inflammation and infection and prevention of serious complications by using risk factors of postcesarean section inflammation and infection, and detecting procalcitonin and lactate in maternal blood. Materials and Methods: This research is conducted between 2015-2017 based at the “Urguu” Maternity Hospital, Obstetric Clinic of National Center for Maternal and Child Health of Mongolia. Factors affecting postcesarean section inflammation and infection are calculated based on multifactorial regression analysis. Procalcitonin was determined by enzyme binding assay while lactate, C-reactive protein, and lactate dehydrogenase were determined by “E-311” the fully automated analyzer. Results: According to the results of the study, the probability of inflammatory and infectious complication is 2.4% when the duration of labor increases by one unit, 34.8% when the risk of amniotic fluid increases, 14.6% when the pregnancy process become more complicated. Whereas, excessive fetal weight statistically increases the risk of infection, but its impact is low. The result of the study shows that the procalcitonin sensitivity was 65%, and the specificity was 96%. Lactate resulted in sensitivity of 56%, but with only 67% specificity. C-reactive protein had a sensitivity of 65% and a specificity of 96%. Lactate dehydrogenase resulted in sensitivity of 95%, and specificity of 82% in the diagnosis of sepsis. Conclusion Postterm pregnancy, premature rupture of membranes, multifetal pregnancy, prolonged labor, placenta previa, pyelonephritis, chronic hepatitis, chronic hypertensive disorder, anemia, emergency cesarean section, preeclampsia are risk factors and it is statistically significant at (P<0.0001). The biomarkers have a direct correlation to all stages of inflammation and infections, which are important for the diagnosis.

BACKGROUND: In the recent years, mesenchymal stem cells have become increasingly utilized in regenerative medicine and tissue engineering applications because of their properties for self-renewal, differentiation and immunoregulation. The use of stem cells of various clinical applications is highly expected and the production of good quality stem cells is very critical for basic studies. In the bone marrow, hematopoietic and mesenchymal stem cells from an unique niche in which the oxygen tension is low. Hypoxia may have a role in maintaining stem cell fate, self renewal and multi-potency. We investigated whether low oxygen culture would be beneficial for hematopoietic stem cell and mesenchymalstemcell. MATERIAL: BMCs from 8-12 week aged, 15 mice were subjected to hypoxic conditioning by culture for 8-10 days in 20%, 3%, 1% oxygen. For culture 1x105cell/ml were seeded in colony forming assay and 2x106cell/ml were seeded in L-glutamin mediain chamber slide. We counted cell colonies under different hypoxic condiontins by Olympus IX71 fluorescence microscope. After cell culture in chamber slide, we stained cells by anti-CD90 and anti-CD105 then counted positive cells by Olympus IX71 fluorescence microscope. RESULTS: Compared to normoxic cells and hypoxic cells well morphologically differentiated and counted by Olympus IX71 microscope. More colonies were observed at 3%, 1% oxygen. Statistical significances were identified with granulocytes and macrophage colony (p<0.05) in hypoxic condition. More anti-CD90 and anti-CD105 markers were observed at 3% oxygen condition. Statistical significances were identified in 3% oxygen condition with cell markers(p<0.001). CONCLUSIONS: Our data suggests low physiological oxygen culture could improve the stemness of macrophage and granulocytes colony and improve the differentiation of mesenchymal cells. Long term culturewith additional cell markers will be necessary to confirm whether low physiological oxygen levels also improve genomic stability

Backround: Hematology departments of health laboratories, over capital city and 21 provinces both of governmental and private sectors in this country, have to take responsibilities for providing hematology analysis. A wide range of technology and methods have been implemented among these laboratories. Harmonization of the hematology investigations of different laboratories with standard service all over the country is the major goal to reach. We organized the MEQAS (Mongolian External Quality Assessment Scheme) since 2008 on basis the Cooperation agreement between Ministry of Health and Sysmex Corporation in the establishment of Hematology external quality control and reference laboratory system in Mongolia. This is the report of our 8-year experience of MEQAS as the national project, covering increasing numbers of laboratory members. In 2008-2017 years we set up total 18 MEQAS in Mongolia. Materials and Methods:
Survey Materials
In each survey, the following three different of survey materials were used;
Sample A : Hematology Control Material 1*
Sample B : Hematology Control Material 2*
Sample C : Fresh Whole Blood Sample**
*Hematology Control Material provided by Sysmex Corporation
**Under cooperation of National Center for Transfusiology, a fresh whole blood sample was drawn from a healthy donor and prepared on the same day of sample delivery, according to the procedures reported by Kondo H et. all.
Standard Analyzers
3 units of fully-automated standard analyzers (KX-21, pocH-100i, XS-1000i), installed at the Shastin Central Hospital, were used to assign the target values for the survey materials. These standard analyzers have been calibrated with SCS-1000® before the survey, and monitored with hematology controls, e-CHECK(XS) ® and EIGHTCHECK-3WP® on daily basis.
Instructions & Sample Distribution
On every survey, the workshop was held to give guidance and distribute the survey samples to each participant.
Categorization of Peer Group
Participating data were divided into two peer groups, based on methodology; Group 1: laboratories used automated hematology analyzer (in further Auto’s), Group 2: manually examined group. Each laboratory was given ID number and was asked to analyze these samples 3 times and report the all data and average for CBC 8 parameters.
Statistical Evaluation Method
For individual reports, the results for each participant were evaluated and expressed according to peer group mean and standard deviation index (SDI), Precision index (PI), Absolute evaluation, Scoring system and Target-value evaluation methods (A B C D evaluation). Results:
The Auto’s inter-lab CV% of WBC for fresh whole blood showed decrease from 6.1 to 4.2 comparing with17^th and 18th MEQAS.
The Auto’s Inter-lab CV% of RBC for fresh whole blood showed decrease from 3.7 to 3.4 comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% of HGB for fresh whole blood were very stable (2.9%, 3.0%), respectively from 17^th to 18^th MEQAS.
The Auto’s inter-lab CV% HCT for the fresh whole blood showed go down from 5.5% to 4.8% comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% PLT for fresh blood showed go down from 10.2% to 8.2% comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% of CBC parameter for fresh blood and control Material (Sample A) showed go down from 1^st to 18^th MEQAS.
The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) were big difference comparing with Japan’s CV%. Conclusion:
1. The Auto’s inter-lab CV% of WBC, RBC and PLT for fresh whole blood has been decrease respectively 4.2%, 3.4%, 8.2% in the 18^th MEQAS and there was difference in the CV% between manufacturers.
2. The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) showed go down from 1^st to 18^th MEQAS but were big difference comparing with Japan’s CV%. Acknowledgements We would like to express our appreciation to the Sysmex Corporation (Japan) for providing financial supports investigate this study.

Introduction:When a central nervous system disorder (meningitis, encephalitis, hemorrhage, leukemia infltration and other neoplasma) is present, cerebrospinal fluid (CSF) shows various changes that reflected the condition. Therefore it is essential to test CSF. Different types of CSF tests include cell count; cell differentiation; chemistry; immunology; microbiology and molecular biology. CSF cell count and cell differentiation in particular, are crucial in differentiating diagnosing various CNS disorder needing immediate care and in evaluating the treatment. The patient’s prognosis largely depends on how accurate diagnosis was done and how early treatment was provided. There for CSF test require high precision and accuracy. In Mongolia until now 2st and 3st level hospital using manual method for CSF cell count and cell differentiation test. In this test has 2 actual problems, which is depends on the analytical techniques, skills and sample stability specific problem. But in Japan in 2011 newly designed Sysmex XN Series hematology analyser with body fluid mode (CSF,pleural effusion, peritoneal and synovial fluid). On The First Central Hospital of Mongolia In 2013 frst timeinstalled Sysmex XN-2000 hematology analyser andpossible use of body fluid automatic testing methods.Materials and methods:We evaluated the basic assay performance of the body fluid mode on the automated hematology analyzer XN-2000, which is used for analysis of CSF fluid. We compared between the manual method and XN-2000 analysis for nucleated (WBC), mononuclear (MN) and polymorphonuclear (PMN) cells was also randomly studied using 10 CSF samples of inpatient section our hospital.Results:In CSF samples the coeffcient correlation(r) for WBC/µl, MN%, PMN% were respectively 0.83, 0.95 ба 0.95.Discussion:The correlation for MN%, PMN% were between automate and manual method was good, that is similar to the other researchers. Whereas the correlation for WBC/µl slightly low, this was probably correlation relatively weak or show discrepancies. In introduction inscriptive in analysis accuracy can to affect analytical techniques skills, sample stability and specifc many problems. Therefore scientifc studied and proven ability specifcity, sensitivity, reproducibility, quality, personnel low cost and spend less time, automatically Sysmex XN series hematology analyzer is desirable to domesticate an appropriate level of medical laboratories.

Abstract: Type 2 diabetes is one of the non communicable diseases which are cause of mobility and mortality of world population. By the study of other researchers in our country early diagnosis of type 2 diabetes is more than 10%, in total of 84.3% of all diagnosed patients, vascular complication has been revealed. In this study we involved 64 people to reveal renal complication which is one of the microvascular of diabetes mellitus and did statistical analyses. We estimated renal complication according to the classification of 5 phases of clinical and laboratory indices. We defined amount of creatinine by fully automatic analyzer CHEMIX-180, amount of urine protein microalbumin and creatinine by CABOY 720 analyzer and proportion was accounted according to terminology. From all participants, 53.1% was male, 46.9% was female, average age was 54.2 years. 29,7% of the all participants had the first and second phase of nephropathy, 14.1% had the third phase, 12.5% had the fourth stage or clinical nephropathy. There wasn’t any participant whom chronic renal failure was revealed. Microalbuminuria analyze is important to reveal renal complication of type 2 diabetes and determine the phase in detail.

Background. Puerperal infection following caesarean section remains a major cause of maternalmorbidity and mortality. It is still one of actual problems in Obstetrics and has incidence rate 2-10%. It isestimated 150 000 maternal deaths due to infection worldwide, despite tendency to decline septicemiaafter C-section due to wide usage of antibiotics in the obstetric practice, postpartum infection hasincreased last decade. Post-Caesarean sepsis incidence rate is above 20%. An assortment of pathologicagents may cause puerperal infection including bacteria, virus and parasites. In 30-40s of last centurymain reason of infection was Streptococcus, then in 40-60s major role was played by Staphylococcus,later in 70-80s Gram-Negative Aerobic Bacteria took its place.Objective. To improve prevention and treatment of post-caesarean sepsis by detection of its causes andantibiotic sensitivity. Materials and methods: We reviewed patients admitted to First Maternity Hospitaland National Center for Maternal and Child Health and who had post-caesarean sepsis between 2011-2013. Statistics analysis had been performed by SPSS-17 software programme, whereas statisticsprocess by X2 test, Fisher test, and t-test. Confi rmation rate was 95%. P<0, 05.Results. The clinical course of 361 post-caesarean patients with septicemia was reviewed prospectively.Primary dysfunctional labour (P<0.033), preterm rupture of the membranes (P<0.0001), ineffectivelabour induction (P<0.001) are risk factors for infectious morbidity. Considerations should be given toprophylactic antibiotic therapy by choosing correct medicine at the correct time. E.coli 29,4%, Intestinalbacteria 9,1%, Staphylococcus epidermis’s 8,9%, Staphylococcus aureus 7,2%, Gram-NegativeBacteria 6,6%, Streptococcus 5,3%, Gram-Positive Bacteria 2,8%, Candida albicans 1,4%, Micoplasma1,1% were responsible for bacteremia, respectively.Conclusion. Bacteriology of all patients diagnosed with post-caesarean sepsis in 74, 7% was positivefor pathologic bacterial cultures. Infection caused by 1 bacteria in 141 cases (39, 1%), by 2 bacteria in 56cases (15, 5%), by 3 bacteria in 2 cases (0, 6%), without any detection of bacteria 162 cases (44, 9%).

Background:Mesenchymal stem cells derived from bone marrow and adipose tissue are being applied to tissue engineering and cell therapy. The use of stem cells of various clinical applications is highly expected and the production of good quality stem cells is very critical for basic studies. In the bone marrowmesenchymal stem cells from an unique niche in which the oxygen tension is low. Hypoxia may have a role in maintaining stem cell fate, self renewal and multi-potency. We investigated whether low oxygen culture would be beneficial for mesenchymal stem cell. Results:BMCs from 8-10 week aged, 6 mice were subjected to hypoxic conditioning by culture for 7 days in 20%, 3%, 1% oxygen. For culture 1x106 cell/ml were seeded in media with L-glutamine in each dish. During the culturing, cell colonies were checked once in three days. After cell culture, we stained cells by CD90 then counted CD90 positive cells by fluorescence microscope. More colonies and mesenchymal cells were observed at 3%, 1% oxygen and also colonies were bigger in hypoxic condition. Statistical significances were identified mesenchymal cells (p<0.05) in hypoxic condition. Conclusions:Our data suggests low physiological oxygen culture could improve the differentiation of mesenchymal cells. Long term culture will be necessary to confirm whether low physiological oxygen levels also improve genomic stability.