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Rule based processing of the CD4000, CD3200 and CD Sapphire analyser output using the Cerner Discern Expert Module

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 6 2009
P. BURGESS
Summary The latest version of our Laboratory Information System haematology laboratory expert system that handles the output of Abbott Cell-Dyn Sapphires, CD4000s and a CD3200 full blood count analyser in three high-volume haematology laboratories is described. The three hospital laboratories use Cerner Millennium Version 2007.02 software and the expert system uses Cerner Millennium Discern Expert rules and some small Cerner Command Language in-house programs. The entire expert system is totally integrated with the area-wide database and has been built and maintained by haematology staff members, as has the haematology database. Using patient demographic data, analyser numeric results, analyser error and morphology flags and previous results for the patient, this expert system decides whether to validate the main full blood count indices and white cell differential, or if the analyser results warrant further operator intervention/investigation before verifying, whether a blood film is required for microscopic review and if abnormal results require phoning to the staff treating the patient. The principles of this expert system can be generalized to different haematology analysers and haematology laboratories that have different workflows and different software. [source]

Quality control of bone marrow cytology; organization and over 7 years experience in the south-west Netherlands

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 6 2008
A. A. M. ERMENS
Summary To asses the quality of bone marrow cytology of hospital laboratories in the south-west Netherlands a proficiency testing program was implemented. Two sets of bone marrow and blood smears from two patients were sent to 20 hospital laboratories using a tight time schedule biannually. Required results consisted of differential counts of 500 bone marrow cells and 100 peripheral blood cells, together with the description of morphological abnormalities and final conclusions. Twice a year the collected review data were discussed in a plenary session which was also used for continuous education. Over the past 7 years 30 bone marrow samples were evaluated. The coefficient of variations of specific cells counts was large. The amount of correct conclusions ranged from 12% to 100% (median: 61%). Participant attendance of the meetings was 90,100%. The total cost of this scheme of proficiency testing approximately amounted ,7000 per year. The presented formulae for both proficiency testing and haematopathological/cytological education is feasible and fulfilled the need of the participants. [source]

Separation of haemoglobin HbE and HbA2 by the fully automated, high-pressure liquid chromatography Tosoh HLC-723 G7 analyzer

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 5 2008
G. LIPPI
Summary High-pressure liquid chromatography instruments specifically devised for separating haemoglobin (Hb) fractions have been increasingly employed by the hospital laboratories over the recent years since they allow easy and fast screening for several Hb variants. Although such instruments may be proposed as sensitive, specific and reliable alternatives to the classic electrophoretic techniques, a major drawback of this screening strategy is the almost identical retention time of several Hb variants. In particular, at least 18 Hb variants have been reported in the same retention window as HbA2, including HbE, the second most common ,-chain variant in humans after sickle cell trait. Recently, we evaluated the performance characteristics of an improved buffer formulation originally conceived for Hb variants separation procedures on the fully automated high-pressure liquid chromatography instrument Tosoh G7. At variance with other fully automated high-pressure liquid chromatography analyzers, the elution pattern on the G7 in subjects heterozygous for HbE is characterized by the presence of four suggestive peaks (HbF, HbA, HbA2 and HbE), confirming the effective separation of HbE from HbA2. Because of its potential value in the diagnosis of the thalassaemia syndromes, the effective separation of HbA2 from HbE can provide clinical laboratories with a valuable information for the diagnostic reasoning. [source]

Comparison of the reticulocyte mode of the Abx Pentra 120 Retic, Coulter® General-SÔ, Sysmex® SE 9500, Abbott CD 4000 and Bayer Advia® 120 haematology analysers in a simultaneous evaluation

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 6 2001
J. Van Den Bossche
The Abx Pentra 120 Retic, Coulter® General-SÔ, Sysmex® SE 9500, Abbott Cell Dyn® 4000 and Bayer Advia® 120 were evaluated simultaneously in a general hospital laboratory. Linearity, precision, sample stability, carry-over and comparability of the reticulocyte mode were determined following International Council for Standardization in Haematology guidelines for the evaluation of blood cell analysers. All analysers showed good results for dilution, stability and carry-over testing. The between-batch coefficient of variation of the General-SÔ was high compared to the other analysers evaluated. Multiple correlation studies showed good agreement for all analysers in the normal and high reticulocyte range, with correlation coefficients above 0.7. Multiple correlation studies for reticulocytopenic samples (< 15.109/l) were less satisfactory, with a wider range of correlation coefficients (r -values 0.0,0.9). Overall, the General-SÔ, SE 9500 and Advia® 120 gave lower reticulocyte counts than the Pentra 120 Retic and CD 4000. Reagent costs were also evaluated. Reagent consumption was close to the manufacturers' specifications for the SE 9500 (Search reagent), CD 4000 (CD Retic) and Advia® 120 (Retics) but was higher than stated for the Pentra 120 Retic (Retix), General-SÔ (Retic kit) and SE 9500 (Sheath reagent). Our results show that these new generation haematology analysers will meet the needs of hospital laboratories for reliable and cost-effective reticulocyte counting. [source]

Usefulness of mec -associated direct repeat unit (dru) typing in the epidemiological analysis of highly clonal methicillin-resistant Staphylococcus aureus in Scotland

CLINICAL MICROBIOLOGY AND INFECTION, Issue 10 2008
R. V. Goering
Abstract The incidence of the epidemic methicillin-resistant Staphylococcus aureus (EMRSA) strains EMRSA-15 and EMRSA-16 in Scotland has increased dramatically, now accounting for c. 70% and c. 20% of isolates, respectively. Epidemiological tracking of these EMRSA strains is difficult, as c. 50% of EMRSA-15 and c. 35% of EMRSA-16 isolates are indistinguishable using pulsed-field gel electrophoresis (PFGE) and other typing methods. The usefulness of mec -associated direct repeat unit (dru) sequence analysis as a more sensitive approach to tracking the persistence and spread of these ,clonal' EMRSA strains in Scotland was evaluated. Analysis of 47 EMRSA-15 and 57 EMRSA-16 isolates (including two separately cultured isolates of the Harmony collection type strain) obtained from 22 hospital laboratories over an 8-year period (1997,2005) revealed 13 and 12 different dru types, respectively. Whereas some types appeared to be endemic in multiple hospitals, subtypes that may represent specific strain movement among hospitals in a given geographical region were identified in other instances. These results suggest that mec -associated dru typing may have potential for identifying and tracking specific subtypes of otherwise indistinguishable epidemic MRSA isolates such as those in Scotland. [source]

In vitro susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis: a European multicenter study during 2000,2001

CLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2003
M. E. Jones
Objective, To assess the current (2001) activity of respiratory fluoroquinolones and comparator agents against respiratory pathogens isolated in European countries. Methods, During 2000,2001, we prospectively collected 1995 isolates of Haemophilus influenzae, 1870 isolates of Streptococcus pneumoniae and 649 isolates of Moraxella catarrhalis from hospital laboratories in France, Germany, Greece, Italy, Spain and the UK. National Committee for Clinical Laboratory Standards (NCCLS)-approved broth microdilution antimicrobial susceptibility testing methods and interpretive criteria were used throughout. Results, Of the S. pneumoniae isolates, 99.6% were susceptible to moxifloxacin, gatifloxacin and levofloxacin; the corresponding figure for H. influenzae was 100%. All M. catarrhalis isolates had moxifloxacin MICs ,,0.12 mg/L. For all three pathogens, fluoroquinolone susceptibility remained unchanged from the previous 1997,98 study. The incidence of penicillin non-susceptibility in the S. pneumoniae isolates tested remained similar to or higher than that recorded in previous studies: France, 165/291 (56.7%); Germany, 46/506 (9.1%); Greece, 20/55 (36.4%); Italy, 45/364 (12.4%); Spain, 146/268 (54.5%); and the UK, 26/386 (6.7%). Significant levels of resistance to oral compounds (cefuroxime, cefaclor, cefdinir, clarithromycin, azithromycin, tetracycline, and trimethoprim,sulfamethoxazole) were detected among S. pneumoniae isolates. ,-Lactamase production among H. influenzae isolates ranged from 6.2% to 33.1% per country, and ampicillin, clarithromycin or trimethoprim,sulfamethoxazole resistance were the most common phenotypes detected. ,-Lactamase production among M. catarrhalis isolates ranged from 94.1% to 100% per country. Conclusions, With the exception of a few localized reports, resistance to moxifloxacin and other new fluoroquinolones in common respiratory pathogens is a rare occurrence, despite significant resistance to other compound classes. Surveillance will play a key role in tracking changes in fluoroquinolone susceptibility in European countries. [source]

Haemoglobinometry in general practice

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 6 2003
S. M. Lewis
Summary Haemoglobinometry as a primary point-of-care test is well established. This study was undertaken to assess whether haemoglobinometry by itself provides an adequate haematological screening procedure in general practice. In a series of 500 sequential blood counts received by the central hospital laboratory from local doctors, 405 (81%) had a normal haemoglobin. Full blood counts on these samples showed 15% with one or more blood count parameters outside 2SD of normal reference values, including increased MCV, low MCV with low MCH and MCHC, leucocytosis with neutrophilia, a few cases with neutropenia, lymphopenia, monocytosis or eosinophilia. When the limits were set at 3SD, these abnormalities were found in only 7.6% of the cases. Calculation of test utility gave a positive predictive value of 0.83, a negative predictive value of 0.85, with a likelihood ratio of 14.3 and an overall diagnostic reliability of 84%. It was concluded that haemoglobin alone is a valuable primary screening test and a full blood count is required only when anaemia is present or when the patient's history and clinical signs indicate the need for such further investigation. Using this protocol it is unlikely that any serious error will be made in diagnosing a clinically significant condition; the main limitation is failure to diagnose pre-anaemic iron deficiency. [source]

Comparison of the reticulocyte mode of the Abx Pentra 120 Retic, Coulter® General-SÔ, Sysmex® SE 9500, Abbott CD 4000 and Bayer Advia® 120 haematology analysers in a simultaneous evaluation

Negative interference of bilirubin and hemoglobin in the MEIA troponin I assay but not in the MEIA CK‐MB assay

JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 2 2001
Amitava Dasgupta
Abstract Troponin I is a sensitive and specific marker for the diagnosis of myocardial infarction. Several commercially available immunoassays measure the concentration of troponin I in serum. The microparticle enzyme immunoassay (MEIA) for troponin I (Abbott Laboratories, Abbott Park, IL) is widely used in clinical laboratories, including our hospital laboratory. We studied the effect of bilirubin and hemolysis on the MEIA for troponin I and compared our assay with a newly available chemiluminescent assay (CLIA) for troponin I (Bayer Diagnostics, Tarrytown, NY). We also measured CK‐MB concentration using the MEIA CK‐MB assay. One serum pool was prepared by combining several specimens of one patient with elevated troponin I and with a diagnosis of myocardial infarction. Other serum pools were prepared by combining sera with similar troponin I values. All serum pools showed normal bilirubin concentrations and had no hemolysis. Then we supplemented aliquots of serum pools with various concentrations of bilirubin (5.0, 10.0, 15.0, and 20.0 mg/dL). After supplementation, troponin I concentrations were measured again using the MEIA and CLIA. We observed a statistically significant decrease in troponin I concentration in the presence of bilirubin with the MEIA. For example, in serum pool 1, the troponin I concentration was 16.3 (bilirubin: 0.8 mg/dL). In the presence of 5.0, 10.0, 15.0 and 20.0 mg/dL of added bilirubin, the cardiac troponin I concentrations were 13.9, 13.4, 13.3 and 13.0 ng/ml respectively. We observed similar negative interference of bilirubin in troponin I measurement by the MEIA in other pools. The troponin I value decreased slightly (not statistically significant) in one pool and did not change in two other pools in the presence of bilirubin when we measured troponin I concentration using the CLIA. Interestingly, bilirubin did not interfere with the MEIA CK‐MB assay. Moderate hemolysis did not have any effect on the troponin I assay using either the MEIA or CLIA. However, gross hemolysis (hemoglobin > 40 mg/dL) interfered with both assays for troponin I. J. Clin. Lab. Anal. 15:76–80, 2001. © 2001 Wiley‐Liss, Inc. [source]

Preproghrelin Leu72Met polymorphism in patients with type 2 diabetes mellitus

JOURNAL OF INTERNAL MEDICINE, Issue 4 2003
O. Ukkola
Abstract Ukkola O, Kesäniemi YA (University of Oulu, Oulu, Finland). Preproghrelin Leu72Met polymorphism in patients with type 2 diabetes mellitus. J Intern Med 2003; 254: 391,394. Objectives. The association between the Leu72Met polymorphism of the preproghrelin gene and diabetic complications was examined in patients with type 2 diabetes mellitus. Subjects and methods. A total of 258 patients with type 2 diabetes mellitus and 522 control subjects were screened. Genotypes were determined by polymerase chain reaction technique. The diagnosis of coronary heart disease was based on clinical and ECG criteria. Laboratory analyses were carried out in the hospital laboratory. Results. No differences in the genotype distributions and allele frequencies of the preproghrelin Leu72Met polymorphism were found between type 2 diabetes mellitus patients and controls. The polymorphism was not associated with macro- or micro-angiopathy or hypertension. However, Leu72Met polymorphism was associated with serum creatinine (P = 0.006) and lipoprotein(a) [Lp(a)] levels (P = 0.006) with Leu72Leu subjects showing the highest values. This association was observed only amongst diabetic group. Conclusions. The Leu72Met polymorphism of the preproghrelin gene was not related to cardiovascular disease in type 2 diabetes mellitus patients. Leu72Met polymorphism was, however, associated with serum creatinine and Lp(a) levels in diabetic patients. The mechanism might be associated with a possible change in ghrelin product and its somatotropic effect. [source]

Do multipurpose contact lens disinfecting solutions work effectively against non-FDA/ISO recommended strains of bacteria and fungi?

OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2010
Maureen Boost
Abstract Purpose:, Recent outbreaks of microbial keratitis have increased concerns about the efficacy of multipurpose solutions (MPS) against ,real-world' organisms. This study determined, in accordance with FDA/ISO standard methods, the effects of five MPS against clinical isolates and type strains of bacteria, and isolates of fungi from subjects' ocular structures; and of three MPS against environmental fungal isolates. Method:, MPS were challenged with bacteria (type strains (ATCC) and clinical isolates of bacterial pathogens obtained from a district hospital laboratory) and with fungal isolates from both the periocular and conjunctival structures and from environmental air. Results:, All MPS demonstrated at least a 3-log reduction of challenged cell viability of all bacterial species tested, with the exception of MPS D against a canine infection Staphylococcus aureus isolate. Whilst all MPS tested were able to effect a 1.0-log reduction of viability of Fusarium solani (ATCC 36031), only two MPS had 90% viability reduction against all fungi of human origin and only one of these against all environmental fungal isolates. Effectiveness of these two solutions against fungal isolates compared to the remaining three MPS was found to be statistically significant (p = 0.003). Conclusions:, All MPS demonstrated a 99.9% viability reduction against a wide range of bacteria including major ocular pathogens not currently included in the FDA panel. The inability of three MPS to achieve a 90% reduction against fungal isolates is of concern as there has been a recent upsurge in reports of fungal keratitis. We would recommend extension of the current FDA testing panel for MPS to include more fungal isolates. [source]

Can sensitization to aeroallergens disappear over time in children with allergic disease?

ACTA PAEDIATRICA, Issue 9 2010
KD Jacobs
Abstract Background:, Remittance of aeroallergen sensitization has been shown in population-based studies, but there is a common perception that sensitization to aeroallergens rarely if ever disappears in children with allergic disease. Methods:, We retrospectively reviewed all specific IgE tests carried out in children aged 0,18 years at our hospital laboratory over a 14-year period. Of 3115 children sensitized to one or more aeroallergens, 244 (7.8%) were retested after a mean (SD) period of 45 (28) months at their physician's discretion. Results:, Disappearance of sensitization to individual aeroallergens did occur, with remittance rates ranging from 3.1% for house dust mite to 17.5% for cat. However, complete remittance of aeroallergen sensitization was found in only one subject. In up to 35% of cases, remittance of sensitization was offset by the appearance of one or more new aeroallergen sensitizations. Remittance was only observed in children sensitized to multiple allergens (with a median of 3 aeroallergen sensitizations), and their median degree of sensitization was low (median 2.1 kU/L). Conclusion: Aeroallergen sensitization can disappear in children with allergic disease, but only in polysensitized individuals. Complete remittance of sensitization to aeroallergens is rare in symptomatic children. [source]