ISSN  2587-2362  |  E-ISSN  2618-642X
International Journal of Medical Biochemistry - Int J Med Biochem : 3 (3)
Volume: 3  Issue: 3 - 2020
1.The role of immature granulocytes and inflammatory hemogram indices in the inflammation
Said Incir, Hatıce Kant Calti, Kerim Erhan Palaoglu
doi: 10.14744/ijmb.2020.02986  Pages 125 - 130
INTRODUCTION: In this retrospective study, we aimed to assess the role of immature granulocyte percentage (IG%), inflammatory complete blood count (CBC) parameters and indices in investigating the severity of inflammation, to evaluate their correlation, and to determine their predictive ability in classifying inflammation.
METHODS: We obtained hematological and biochemical data of the 161 outpatients for this study. Patients were assigned to three groups according to their C-reactive protein (CRP) levels. Group I had a CRp-value of <3 mg/L (non-inflammatory group) (n=58), Group II had a CRP level between 3 to 9mg/L (low-grade inflammatory group) (n=59), and Group III had a CRP level of >9mg/L (clinically significant inflammatory group)(n=44). The between-group differences were evaluated concerning sex, age, CRP, procalcitonin, IG%, CBC parameters and indices, including Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR) and Systemic Immune-Inflammatory Index (SII).
RESULTS: In Group II, the levels of CRP (p<0.0001), platelet count (p<0.05), PLR (p<0.05), NLR (p<0.05) and SII (p<0.01) were significantly higher than those in the Group I. In Group III, CRP (p<0.0001), IG% (p<0.0001), procalcitonin (p<0.01), platelet count (p<0.05), PLR (p<0.01), NLR (p<0.05) and SII (p<0.01) values showed a significant between-group difference when compared to Group I. A significant difference between Group II and Group III was detected for, CRP (p<0.0001) and IG% (p<0.05). There were significant positive correlations among IG% and CRP (p<0.001), platelet count (p<005), PLR (p<0.05) and SII (<0.05). The sensitivity and specificity values of the IG% using a cut-off value of >0.2 were 75.3% and 52.5%, respectively.
DISCUSSION AND CONCLUSION: The findings obtained in this study suggest that to detect the severity of inflammation, it would be more reliable to evaluate the combination of CBC parameters with biochemical markers instead of looking at a single one.

2.Serum bone profile and cathepsin K expression as a prognostic factor in patients with and without breast cancer metastasis
Yaongamphi Vashum, Thyagarajan Krishnamurthy, Mathangi Somanathan, Fathima Bushra Sheriff M, Shila Samuel
doi: 10.14744/ijmb.2020.19870  Pages 131 - 138
INTRODUCTION: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer-related death among women worldwide. Breast cancer bone metastasis is associated with skeletal events, including acute fractures, compression of the spinal cord, surgery and radiotherapy to the spine, as well as bone pain and hypercalcemia, resulting in decreased mobility and diminished quality of life. Greater understanding of the bone metastasis pathophysiology will highly likely to lead to the discovery of an effective treatment option. This study aims to test whether the serum bone profile and expression level of cathepsin K (CTSK) in breast carcinoma is associated with metastasis.
METHODS: In this study, 116 participants, 58 patients who had been diagnosed with breast cancer (n=22 without metastasis and n=36 with metastasis) and 58 healthy controls were included. Serum biochemical profile and immunostaining of CTSK in the breast carcinoma were investigated.
RESULTS: The mean values of calcium, 25-OH Vitamin D, ALP, albumin, phosphorus, magnesium, TSH, cholesterol, PTH and CRP (mg/L) were 11.5±2.03, 28.12±10.5, 93.3±7.9, 3.9±0.3, 3.7±1.64, 1.8±0.24, 2.5±1.5, 165.1±28.02, 63.4±18.9 and 7.7±4.9. Individual data revealed that 70% of patients without metastasis has PTH above normal while 65% has calcium and 62% patients has ALP above normal levels, which were further increased in metastasis. Low Mg levels were detected in 13/58 of the patients with breast cancer and 3/58 of the control group.13/58 of the patients with breast cancer showed low total calcium, and 32/58 of the breast cancer group showed high calcium levels.
DISCUSSION AND CONCLUSION: The present study results suggest that CTSK expressions are associated with a higher tumour stage and distant metastasis, suggesting serum bone profile and level of CTSK expression are significant parameters in the disease diagnosis and monitoring of breast cancer metastasis.

3.The evaluation of rapid serum tubes for various immunoassay tests
Esra Firat Oguz, Emis Deniz Akbulut, Mujgan Ercan Karadag, Canan Topcuoglu, Turan Turhan
doi: 10.14744/ijmb.2020.29494  Pages 139 - 142
INTRODUCTION: One of the most crucial steps on the preanalytical process that affect laboratory test results is proper and timely blood collection. In this study, we aimed to compare Rapid Serum Tubes (RST) and Serum Separator Tubes (SST) with no additive Z tubes concerning various immunoassay tests.
METHODS: Blood samples were collected from 50 healthy volunteers into three blood collection tubes. Sera from Z tube, SST and RST were analysed simultaneously for thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), folate, vitamin B12, 25-OH vitamin D (25-OHD), parathyroid hormone (PTH), cortisol, ferritin, human chorionic gonadotropin (hCG) on DXI800 autoanalyser (Beckman Coulter, USA). The results were evaluated by comparing each tube pairs (Z tube-SST, Z tube-RST) according to desirable bias.
RESULTS: There was no statistically significant difference between the two tube pairs for most analytes. There was not any significant clinical difference according to a desirable bias for the analytes tested.
DISCUSSION AND CONCLUSION: RST offers acceptable clinical performance for the immunoassay tests performed in this study on DXI platform. The laboratory turn-around-times for immunoassay tests could be shortened approximately 15-20 minutes by the usage of RSTs.

4.Evaluation of incompatibility in measurement of erythrocyte sedimentation rate by two different modes of automated analyzer and demonstration of surpassing with a manipulation
Esra Acar, Fatih Hunc, Hale Maral Kir
doi: 10.14744/ijmb.2020.29974  Pages 143 - 149
INTRODUCTION: Erythrocyte sedimentation rate (ESR) is an elementary and low-cost point of care test commonly used to investigate inflammatory activity, not used for the diagnosis of any particular disease. The present study aims to investigate the diversity in measurements within ESR analyzer modes and demonstrate an alternative manipulation which can reduce the diversity among the modes.
METHODS: Measurements were performed in three groups (cycle mode, random mode, manipulation using application of shaker before running random mode) by VISION ESR analyzer on a randomly selected 120 patients' sample from the central laboratory. Statistical analysis was performed with IBM SPSS 20.0 Software. The data were also evaluated using the Bland-Altman method to compare three groups and related subgroups.
RESULTS: In all groups, we found the statistical differences between cycle mode and random mode (P=0.00). In our study, the findings showed that adding the shaker process in random mode yields more optimum results in ESR values, which was higher than 20 mm/h (P=0.295).
DISCUSSION AND CONCLUSION: According to our analysis, the findings suggest that the compatibility between cycle mode and random mode is weaker; therefore, in clinical laboratory routine, it is preferably recommended to use cycle mode. When operators use random mode, it is more likely recommended, to ensure that the K3-EDTA tubes are exactly mixed with the samples not only manually mixing but also applied shaker process.

5.Exchange of thiol-disulfide pairs in scorpion envenomation
Merve Ergin Tuncay, Betul Ozbek Iptec, Ozlem Bingol, Mustafa Caliskanturk, Salim Neselioglu, Ozcan Erel
doi: 10.14744/ijmb.2020.51523  Pages 150 - 154
INTRODUCTION: The present study aims to analyze thiol-disulfide profile tests in scorpion envenomation.
METHODS: This study included 35 patients with scorpion envenomation and 41 healthy individuals. Thiol-disulfide test panel and myeloperoxidase and catalase activities were determined in both groups.
RESULTS: Patients with scorpion envenomation group had significantly higher native thiol concentrations and significantly lower disulfide amounts than the control group (p=0.001, for both). Also, total thiol levels were higher in patients than healthy individuals (p>0.05). Significantly decreased the disulfide/native thiol ratios and significantly increased disulfide/total thiol ratios and native/total thiol ratios were obtained in patients with scorpion sting than in the healthy subjects (p<0.001, for all ratios). Both catalase and myeloperoxidase activities increased in patients with scorpionism than controls (p<0.05, for both).There were powerful relationships among enhanced myeloperoxidase activities and thiol-disulfide system tests (p<0.05, for all).
DISCUSSION AND CONCLUSION: The equilibrium between thiol-disulfide couples was disrupted in scorpion envenomation. As thiol metabolism is a key component in inflammatory, immune and detoxification mechanisms, excessive thiols may be a response to these processes in scorpionism.

6.The effects of chlorhexidine-based preservative tubes on routine urinalysis stability
Inanc Karakoyun, Fatma Demet Arslan, Anil Baysoy, Murat Aksit, Ayfer Colak, Banu Isbilen Basok
doi: 10.14744/ijmb.2020.52824  Pages 155 - 160
INTRODUCTION: To evaluate the effects of chlorhexidine-based preservative tubes on analytes for routine urinalysis.
METHODS: Urine specimen (n=84) aliquots in polystyrene tubes (PS) with no additives (Fıratmed Co. Ltd., Istanbul, Turkey) and in Becton–Dickinson Vacutainer® Plus Urinalysis Preservative (BD-UAP) tubes (Becton Dickinson Inc., NJ, USA) were analyzed on automatic modular urine analyzer (Dirui Industry, Changchun, China) and the results were compared. Stability was assessed by re-analyzing urine samples in BD-UAP tubes after three and six hours of storage and comparing with initial results. Cohen’s kappa coefficient (κ) was calculated to assess the agreement of results.
RESULTS: Squamous epithelial cell and pH agreement between the tubes was moderate (κ=0.60 and 0.58, respectively). Bilirubin, ketone, protein, nitrite, and glucose showed perfect agreement with the PS tube and remained stable for up to six hours in the BD-UAP tube (κ=1.00, 0.92, 0.83, 0.93, 1.00, respectively). Red blood cells, white blood cells, bacteria, blood, and leukocyte esterase showed moderate to substantial stability at six hours (κ=0.56, 0.77, 0.76, 0.87, 0.57, respectively).
DISCUSSION AND CONCLUSION: Although storage in chlorhexidine-based preservative tubes has limited effects on chemical strip analysis, these tubes may not be considered optimal for microscopic examination.

7.Evaluation of high-sensitivity cardiac troponin measurement procedure performance in serum: the vidas 3 high sensitivity cardiac troponin I
Nergiz Zorbozan, Gokce Filiz Atikeler
doi: 10.14744/ijmb.2020.83997  Pages 161 - 165
INTRODUCTION: International recommendations suggest that when laboratories begin to use a new measurement procedure, the analytical performance of the new procedure should be evaluated. In this study, we evaluated the analytical performance of the Vidas 3 high sensitivity cardiac troponin I assay.
METHODS: The precision, linearity, and measurement procedure comparison study were performed according to international standardized protocols (EP15-A3, EP06-A and EP09c). Serum samples were analyzed 20 times and at a frequency of three runs/day on five consecutive days for the calculation the CV% of repeatability and within-laboratory precision. The highest concentration hs-cTnI calibrator was diluted for the preparation of five pools with a concentration range of 9.6–16450 ng/L. The Beckman Dxl 800 analyzer was chosen as the comparative measurement procedure.
RESULTS: For low- and high-level concentrations, CV% of repeatability was calculated as 3.12 and 4.74; CV% of within-laboratory precision was calculated as 3.04 and 2.07, respectively. The linear regression analysis showed a line with a good correlation coefficient (r>0.99) over the entire range tested. PassingBablok regression was described with the equation y=0.2995+1.006 x. There was no significant deviation from linearity (p=0.800). The 95% confidence interval of the intercept value and slope value was calculated as -1.3734 to 1.0214 and 0.9973 to 1.022, respectively. The mean absolute difference was -12.1ng/L (95% CI=-24.2479 to 0.0979).
DISCUSSION AND CONCLUSION: Vidas 3 hs-cTnI measurement procedure is a precise and linear method for the determination of hs-cTnI. There is no significant difference between Vidas 3 and the Beckman Dxl 800 measurement procedure.

8.Monocyte, neutrophil, eosinophil and lymphocyte volume levels in multiple myeloma patients
Esma Menevse, Abdullah Sivrikaya, Mehmet Dagli, Hamiyet Kose
doi: 10.14744/ijmb.2020.85057  Pages 166 - 170
INTRODUCTION: Multiple myeloma (MM) is a malignant proliferation of monoclonal plasma cells in the blood that may also cause renal failure. The most frequent complications of MM are painful pathological fractures, anemia, hyperkalemia, renal failure and recurrent bacterial infections. Seen from this aspect, it is indicated that inflammation is a significant component of the neoplastic process.
METHODS: The present study aims to evaluate the association of monocyte, neutrophil, eosinophil and leucocyte volume values in patients with MM as a retrospective study. Sixty patients with MM aged 64.5±11.2 and 107 healthy control aged 64.9±10.3 years who were admitted to the Polyclinic of Hematology in the Faculty of Medicine of the Selcuk University were included in this study.
RESULTS: The monocyte, lymphocytes, neutrophil volume levels were significantly higher in patients as 175.62±8.06; 95.05±6.08; 152.51±8.18, respectively, compared with the control group 170.41±8.15; 89.78±4.92; 148.19±8.04, respectively. The eosinophil volume levels were 157.5±22.4 in the patients group and 157±17.3 in the control group (p=0.953) The findings obtained in this study suggest that monocyte, lymphocytes, neutrophil volume values except eosinophil volume may be used a potentially prognostic biomarker in patients with Multiple myeloma.
DISCUSSION AND CONCLUSION: The present study aimed to evaluate a biomarker that is easily analyzed. This study suggests that monocyte, lymphocytes, neutrophil volume values except eosinophil volume may be used as a potentially prognostic biomarker in patients with Multiple myeloma. And also, monocyte, lymphocyte and neutrophil volume levels are significant parameters that can be applied lower in cost.

9.A comparative study on the performances of 77 elektronika urised 2-LabUmat2 and Dirui FUS200 - H800 urine analyzers
Ugur Ercin
doi: 10.14744/ijmb.2020.04706  Pages 171 - 177
INTRODUCTION: This study aims to compare the analytical performance of the 77Elektronika brand LabUmat2-Urised2 model integrated urine analyzer and Dirui brand FUS200-H800 model integrated urine analyzer.
METHODS: Urine samples of 139 patients randomly selected from male and female patients of all age groups who were admitted to Ufuk University Faculty of Medicine, Dr. Ridvan Ege Hospital between 24.02.2020-28.02.2020 were analyzed on both devices.
RESULTS: The results of the samples whose WBC (white blood cell), RBC (red blood cell) and Squamous epithelial were measured using two different methods in microscopic analyzers were perfectly compatible in the same range and with three parameters (Gamma values 0.916; 0.770; 0.961, respectively). For the samples where crystal and cylinder tests were carried out in microscopic analyzers, Cappa values were 0.486 and 0.495, respectively. As the result of Passing-Bablok Regression analysis used for the method comparison of microscopic analyzers, Cusum test results were p<0.01, p=0.01 and p=0.65, respectively for the linearity in the measurement of WBC, RBC and Squamous epithelial. According to the Bland-Altman Compatibility Chart prepared to determine the difference between methods, the difference between the results of the measurements of WBC, RBC and Squamous epithelial in both devices were -29.3±1.96 SD (95% CI, lower limit: -174.6; upper limit: 116); 43.3±1.96 SD (95% CI, lower limit: -119.7; upper limit: 206.2); -4.0±1.96 SD (95% CI, lower limit: -87.8%; upper limit: 79.9), respectively. When the results of the chemical analyzers of each device were compared, the findings showed that there was a high correlation between leukocyte and protein levels. When the compliance of chemical and microscopic units of each device was examined, a high correlation was found for WBC and a medium level correlation for RBC.
DISCUSSION AND CONCLUSION: Although both devices revealed similar results, confirmation with the manual microscope might be required, especially in pathological samples. Therefore, microscopic analyzers are still needed to be developed concerning method and software although automatic urine analyzers provide standardization and reduce the workload of laboratories.

10.Evaluation of sigma value and quality goal index for brain natriuretic peptide test
Yasemin Ustundag, Kagan Huysal, Cuneyt Eris, Seyhan Duger, Sevim Esmedere Eren, Senol Yavuz
doi: 10.14744/ijmb.2020.74046  Pages 178 - 182
INTRODUCTION: In this study, we aimed to evaluate the analytical process by determining the sigma values and quality goal index (QGI) of the brain natriuretic peptide (BNP) test parameter performed in our emergency laboratory.
METHODS: BNP levels were tested using a commercially available immunoassay autoanalyser (Advia Centaur XP; Siemens Healthcare Diagnostic Ltd., Muenchen, Germany). Bias was calculated by comparison with the group mean for each external quality assessment report, and an internal quality control-based approach was applied. The internal quality control results of the BNP test levels between September and December 2018 and external quality program reports were used in the coefficient of variation (CV) and bias calculations. The sigma metrics and QGI were calculated.
RESULTS: The sigma metric calculated from the external quality control was 2.1 and the QGI was 0.34. In the internal quality control study, the sigma level was 1.92, and the QGI was 0.55, as calculated at the 400 pg/ml level. The QGI level suggests that the problem in the BNP study was imprecision.
DISCUSSION AND CONCLUSION: Unsatisfactory sigma levels for BNP tests were achieved using both methods of calculating sigma metrics.

11.Leukocyte stability in hemogram samples waiting at room temperature
Berrin Oztas
doi: 10.14744/ijmb.2020.14622  Pages 183 - 185
INTRODUCTION: Management of preanalytical, analytical and post-analytic processes is essential to obtain reliable results in clinical biochemistry laboratories. One of the most significant of these processes is ensuring sample stability. In this study, we aimed to evaluate hourly changes of leukocyte parameters at room temperature for 24 hours.
METHODS: In this study, 30 randomly selected hemogram samples from Kocaeli University Faculty of Medicine Central Laboratory were included. These samples were analyzed on the Beckman Coulter Unicel DXH 800 analyzer (Beckman Coulter, Miami, FL) immediately after being admitted to the laboratory (0. hour) and after waiting for 2, 4, 8, 24 hours in the room (23-25°C), the results were repeated again. In this study, leukocyte, lymphocyte, basophil, neutrophil, monocyte, eosinophil parameters were evaluated using the GraphPad Prism 6 program. The values were expressed as mean±Standard deviation (SD). P<0.05 was used for statistical significance.
RESULTS: A statistically significant difference was observed in the levels of leukocyte, lymphocyte, basophil, neutrophil and monocyte parameters. No significant difference was observed in eosinophil levels. The findings showed that the earliest increase occurred in neutrophil and lymphocyte values at the 2nd hour (p<0.001). An increase in the 4th-hour measurements was observed in basophil and monocyte levels (p<0.001).
DISCUSSION AND CONCLUSION: Our study showed that leukocyte subparameters, neutrophils and lymphocytes were the earliest affected parameters. Our findings suggest that when the waiting times of hemogram samples exceed two hours, the results will not be reliable concerning leukocyte parameters.

12.Atypic separator gel flotation in blood collection tube in a patient with hyperproteinemia
Nesibe Esra Yasar, Dildar Konukoglu
doi: 10.14744/ijmb.2020.53824  Pages 186 - 188
Serum separator gel tubes are widely used in laboratories for blood collection since their advantages. These contain a gel that forms a barrier between serum and clot after centrifugation. Rarely, some conditions may arise from unusual separation patterns. In this case, the floating separator gel due to hyperproteinemia was reported. A 49-year-old woman admitted to the chest diseases department. The blood sample was collected into a gel separation tube, transported to the Medical Biochemistry Laboratory within 45 minutes and centrifuged at 1500 g for 10 minutes. The separator gel formed the topmost layer, with the serum in the middle and the clot at the bottom. The sample was re-centrifuged, but this atypical phenomenon did not change. The serum was aspirated under the gel layer by a pipette. Biochemical analyses showed markedly elevated total protein concentration (147 g/L). The patient's file revealed that she had no history of chronic disease other than chronic obstructive pulmonary disease. When consulted, the clinician informed us that the patient was directed for further examination because of the high total protein levels. Laboratories should be careful of the limitation of gel separation tubes. In addition, all samples must be visually checked before analysis, as an aspiration of misplaced gel may obstruct the analyzer probes; causing technical problems, time loss, adverse patient outcome, and extra cost.

13.Contribution of laboratory clinical consultation for excessively low Hba1c results to the diagnosis
Yasemin Tuba Sutasir, Cemal Kazezoglu, Selen Zeliha Mart Komurcu, Omur Tabak
doi: 10.14744/ijmb.2020.88700  Pages 189 - 191
When interpreting the results of a glycosylated haemoglobin (HbA1c) level, factors affecting the life span of the red blood cells should be kept in mind as it may affect the measurement of the HbA1c. Severe hemolysis may result in a falsely low HbA1c level. In this case study, in the diagnosis of hemolysis, a case who has switched the laboratory to an alarm condition is presented. In a 21-year-old male patient with hemolytic anemia, the HbA1c level was incompatible with blood glucose. Peripheral blood smear was performed by clinical laboratory consultation revealed Heinz bodies in erythrocytes, which were deficient in glucose 6 phosphate dehydrogenase enzyme. In the clinic, the diagnosis of favism due to glucose 6 phosphate dehydrogenase enzyme deficiency was considered. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells in humans. In the diagnosis of hemolysis case with clinical laboratory consultation, attention was drawn to the low HbA1c results that did not match the blood glucose measurement result. This study emphasizes that an extremely low HbA1c level can serve as a marker of hemolysis.

14.How to implant neutrophil-to-lymphocyte ratio cut-off for COVID-19 to the laboratory information system
Ozgur Aydın
doi: 10.14744/ijmb.2020.70783  Page 192
Abstract | Full Text PDF

15.Challenges and opportunities for medical biochemistry assistants during COVID-19 pandemic
Muammer Yucel, Mert Uge
doi: 10.14744/ijmb.2020.10337  Pages 193 - 194
Abstract | Full Text PDF

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