Francesco Dima

High-workload endurance training may increase serum ischemia-modified albumin concentrations

Abstract The measurement of cardiac troponins has emerged as the biochemical “gold standard” for the diagnosis and management of patients with acute chest pain. However, earlier markers should support investigation strategies, as several patients with acute coronary syndrome might present with non-diagnostic concentrations. Ischemia-modified albumin (IMA), measured by the albumin cobalt binding (ACB) assay, was recently proposed for early detection of myocardial ischemia. To establish the potential influence of endurance training on the diagnostic approach to patients with suspected myocardial injury, cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK-MB), myoglobin and IMA were evaluated in healthy individuals subjected to different aerobic workloads. The concentrations of both IMA and CK-MB were significantly increased in athletes subjected to high-workload endurance training, whereas the concentration of cTnT and myoglobin was not influenced by physical exercise in the medium term. Taken together, our results demonstrate that demanding aerobic physical activity might influence the generation of IMA, which might be increased in the medium term following high-workload endurance training, while the concentration of other conventional markers of myocardial injury remains non-diagnostic.

Processing of Diagnostic Blood Specimens: Is It Really Necessary to Mix Primary Blood Tubes after Collection with Evacuated Tube System?

BACKGROUND The preanalytical phase is considered the most vulnerable phase in biopreservation, biobanking, and laboratory diagnostics. Accurate mixing after blood collection is claimed to be important and recommended by the manufacturers. OBJECTIVE To evaluate whether it is really necessary to mix the primary blood tubes immediately after blood collection by means of evacuated tube systems. MATERIAL AND METHODS Blood from 300 outpatients was equally and randomly divided into three groups: G1, sodium citrate vacuum tubes; G2, lithium heparin vacuum tubes; and G3, K2EDTA vacuum tubes. All vacuum tubes were processed using three different procedures. Procedure 1: Gold Standard (P1): All specimens mixed gently and carefully by inverting five times as recommended; Procedure 2: Rest time (P2): All specimens remained 5 min in the upright position, followed by gentle careful mixing by inverting five times; Procedure 3: No mix (P3): All specimens were left in upright position without mixing afterwards. The influence of the primary mixing tube procedure was evaluated for clinical chemistry, hematology, and coagulation parameters by paired t-test. The bias from the mixing procedure was also compared with quality specifications derived from biological variation. RESULTS Significant differences (p<0.017) were found for: i) red blood cell count and hematocrit when P1 was compared with P2; ii) alanine aminotransferase and erythrocyte sedimentation rate when P1 was compared with P3; iii) red blood cell count, hematocrit, and hemolysis index when P2 was compared with P3. Surprisingly, clinically significant differences were found only for sodium when P1 was compared with P2, and P1 was compared with P3. No fibrin filaments or microclots were observed in any samples. CONCLUSION Primary blood tubes mixing after collection with evacuated tube system appears to be unnecessary.

Management of preanalytical phase for routine hematological testing: is the pneumatic tube system a source of laboratory variability or an important facility tool?

Sir, The preanalytical phase plays a pivotal role among the major determinants of global laboratory efficiency, as the great majority of errors in the entire testing process remains in this area [1]. There are several crucial steps in preanalytical phase that span from the appropriateness of test request to the correct collection, handling, transport, and storage of the specimen [2]. Appropriate sample transport is an integral part of obtaining a valid and timely laboratory test result [3]. The pneumatic tube system (PTS) has been reported to be a rapid and reliable method of transporting diagnostic blood specimens between hospital departments, thereby eliminating the need for human couriers [4]. However, the PTS has been implicated as a cause for hemolysis of transported blood specimens as well [5, 6]. The aim of this study was to evaluate the impact of a PTS for routine hematological testing and to validate this transport system in our accredited laboratory medicine. A group of 50 apparently healthy volunteers of both sexes from University of Verona, Italy, were enrolled to blood withdrawal after 8 h fasting. Each volunteer provided an informed consent for being enrolled in this study. The entire procedure was also carried out in agreement with the Declaration of Helsinki and under the terms of all relevant local legislation. The collection of all diagnostic blood specimens was performed by a single, expert phlebotomist, following the international standard from Clinical Laboratory Standard Institute (CLSI) [7]. All volunteers were maintained seated during 15 min prior to phlebotomy to eliminate possible interferences of blood distribution due to different posture. After this interval, a vein was located on forearm by a subcutaneous tissue transilluminator device (Venosc opio IV plus, Duan do Brasil, Brazil), without tourniquet, to avoid the venous stasis interference [8], and two amounts of blood were consecutively drawn by venipuncture with 20 G straight needles (Terumo Europe NV, Leuven, Belgium), directly into two identical 3.0-mL vacuum tubes containing 5.9 mg of ethylenediamine tetraacetic acid dipotassium Salt K2EDTA Venosafe (lot 1206037, REF VF-053SDK06; Terumo Europe NV, Leuven, Belgium). To eliminate any possible interferences due to either the contact phase or the tissue factor, about 2 ml blood were preliminarily collected in a tube without additive Vacuette (lot A12070MN, REF 455001; Greiner Bio-One GmbH, Kremsm€ unster, Austria) before the tubes with K2EDTA, and then discarded. All the samples were collected into the same type and lot of vacuum tubes. Immediately after the venipuncture, all vacuum tubes were gently inverted five times as recommended by the manufacturer [7]. After that (~2 min), to either one of the two tubes from each volunteer, two different transport procedures were alternatively applied. Transport procedure I: Diagnostic blood specimens were kept in vertical, closure-up position, and hand carried by our laboratory personnel in an appropriate biohazard container at room temperature (20 1 °C) from the phlebotomy service to the core laboratory [9]. The mean transport time was 7 min. Transport procedure II: The PTS is an Op1000 (Oppent S.p.A, Milan, Italy) which connects the phlebotomy service outside the hospital with the core laboratory on the 1st floor (point-to-point). There are no heat or cold sources along this route. The system generates a maximum speed of 3 m/s. Transport time from phlebotomy service to core laboratory is 85 s. Paired samples were analyzed at the same time for routine hematological testing (<15 min after blood collection) on the same Advia 2120i hematology system (Siemens Healthcare Diagnostics , Deerfield, IL, USA). The parameters tested included red blood cell count (RBC), reticulocytes (RETIC), hematocrit (HCT), hemoglobin (HGB), mean red cell volume (MCV), mean red cell hemoglobin content (MCHC), red blood cell distribution width (RDW), white blood cells (WBC) count, and WBC differential, including lymphocytes (LYMPHO), monocytes (MONO), neutrophils (NEU), eosinophils (EOS), basophils (BASO) and large unstained cells (LUC), platelet count (PLT), mean platelet volume (MPV) and

Comparing the performance of three panels rules of blood smear review criteria on an Italian multicenter evaluation

The aims of this study were to compare the diagnostic accuracy of blood smear review criteria, by means of three different panel rules, those proposed by: the International Consensus Group for Hematology [41‐ICGH rules], the Italian Survey [IS rules] and the Working Group on Hematology‐SIBioC (WGH) consensus rules (WGH rules).

Performance evaluation of the automated nucleated red blood cell count of five commercial hematological analyzers

Recent automated hematology analyzers (HAs) can identify and report nucleated red blood cells (NRBC) count as a separate population out of white blood cells (WBC). The aim of this study was to investigate the analytical performances of NRBC enumeration on five top of the range HAs.

Assessment of reticulated platelets with automated hemocytometers: are we measuring the same thing?

*Corresponding author: Prof. Giuseppe Lippi, Section of Clinical Biochemistry, University Hospital of Verona, Piazzale L.A. Scuro, 10, Verona 37134, Italy, E-mail: giuseppe.lippi@univr.it; ulippi@tin.it. http://orcid.org/0000-0001-9523-9054 Francesco Dima and Valentina Montolli: Section of Clinical Biochemistry, University of Verona, Verona, Italy Johannes J.M.L. Hoffmann: Medical and Scientific Affairs, Abbott Hematology, Hoofddorp, The Netherlands Letter to the Editor