Marileia Scartezini

Suitability of a transport box for blood sample shipment over a long period

BACKGROUND Safety transport boxes are increasingly used to ship laboratory specimens but there is little information on their capacity to maintain suitable transportation temperatures. MATERIALS AND METHODS Inner temperature was assessed using a commercially available transport box during an 8-h transportation period in the heat. RESULTS Temperature stability was unsatisfactory during approximately 64% of the transportation time (i.e., from 125 to 450 min). CONCLUSIONS Transport boxes might be unsuitable for shipping specimens over long periods.

Transillumination: a new tool to eliminate the impact of venous stasis during the procedure for the collection of diagnostic blood specimens for routine haematological testing

Introduction:  The collection of diagnostic blood specimens for routine haematological testing (RHT) is traditionally performed with tourniquet. However, the transillumination devices based on cold near‐infrared LEDs have been formerly proposed as a valuable tool for identifying reliable venous accesses, especially in patients with difficult or small veins, such as children. This study was aimed to evaluate whether a transillumination device can advantageously replace the use of the tourniquet during the procedure for collection of blood specimens for RHT and thereby eliminating the discomfort and risk of spurious results caused by excessive or prolonged venous stasis.

Elimination of the venous stasis error for routine coagulation testing by transillumination.

The preanalytical phase is responsible for more than two-thirds of all errors attributed to the clinical laboratory [1–4] and there are only a few routine procedures for the detection of nonconformities in this field of activity [5,6]. In this phase the procedures involving phlebotomy, critical to the obtainment of diagnostic blood specimens, are poorly studied as regards the major sources of errors and the procedures related to quality control process [7,8]. The collection of diagnostic blood specimens for routine coagulation tests are traditionally performed by phlebotomists using a tourniquet [9]. The Clinical and Laboratory Standards Institute (CLSI) recommends the use of the tourniquet for localizing suitable veins for ≤60 s. When performing specimen collection for diagnostic purposes such an interval of time both allows easy localization of vein paths and concomitantly circumvents possible problems due to excess venous stasis [10–12]. Although the venous stasis can influence the concentration and/or the activity of several blood analytes, the tourniquet time is rarely regarded as a potential source of laboratory variability [13–17]. Reportedly, the mean tourniquet application times by phlebotomists were 98 s in public laboratories and 70 s in private laboratories respectively, thus raising some issues about proper specimen collection [18]. The use of transillumination devices, based on cold near infrared light-emitting diodes (LEDs) whose lightsare absorbed by intra-erythrocyte hemoglobin flowing along the veins, has been initially proposed in order to ease the vein puncture in children [19]. The efficacy of palm transillumination for establishing venous access in small infants has already been assessed [20]. Moreover, the transillumination has been proposed for mapping veins to be cannulated prior to ambulatory phlebotomy because it allows accurate visualization of the vein course [21]. Reliability in coagulation testing is pivotal to the appropriate diagnosis and treatment of patients with hemostasis disturbances [17,22]. In this context some preanalytical details/procedures appear critical such as a) adequate fasting time before blood collection [23], b) use of appropriate tubes [24–26] and additives [27], c) appropriateness of blood collection, storage and centrifugation[28–30], and d) strict conformity to the recommendations regarding tourniquet time. Clinical laboratory results are estimated to be able to influence 60% to 70% of medical decisions and thus affect diagnostic outcome and/or patient treatments [31], such as oral anticoagulant therapy employed in patients at risk of thrombosis [32,33] or blood transfusion components prescription [34] recommended in bleeding patients with disseminated intravascular coagulation (DIC) and prolonged

Estudo prospectivo, duplo cego e cruzado da Camellia sinensis (chá verde) nas dislipidemias

FUNDAMENTO: Estudios epidemiologicos establecieron una asociacion entre dislipidemias y aterosclerosis. La terapia nutricional es un punto central de la estrategia preventiva en individuos que presentan factores de riesgo para enfermedad aterosclerotica. OBJETIVO: Investigar los efectos del te verde (Camellia sinensis) en pacientes portadores de dislipidemias. METODOS: El estudio implico a 33 pacientes, con edad entre 21 y 71 anos, que consumian una dieta con bajo tenor graso (el 25% al 35% de las calorias totales y 200mg de colesterol por dia). Se randomizaron para dos tratamientos secuenciales: capsulas conteniendo 250mg de extracto seco del te verde o placebo, administradas por un periodo total de 16 semanas, habiendo cada paciente utilizado te verde (Camellia sinensis) por ocho semanas y placebo en igual periodo. RESULTADOS: Los valores lipidicos basales (mg/dl) fueron los siguientes: HDL-colesterol 60,7 ± 7,3; colesterol total 255 ± 30,9; LDL-colesterol 158,8 ± 29,0; trigliceridos 169,0 ± 61,3 y Apo-B 120,2 ± 18,9. Las variaciones lipidicas promedios, provocadas por el uso del te verde (Camellia sinensis), evidenciaron una reduccion de un 3,9 % (p = 0,006) en las concentraciones del colesterol total y una reduccion de un 4,5 % (p = 0,026) del LDL-colesterol. La ingestion de te verde no influencio significativamente los niveles de HDL-colesterol, de los trigliceridos y de la Apo-B. Resultados no significativos se observaron en la evaluacion de los lipidos sanguineos (colesterol total y LDL-colesterol) con el empleo del placebo. CONCLUSION: Se evidencio el efecto benefico del te verde (Camellia sinensis), que redujo significativamente, en ocho semanas, los niveles de colesterol total y LDL-colesterol en ese grupo de pacientes.BACKGROUND Epidemiological studies have established an association between dyslipidemias and atherosclerosis. Nutritional therapy is a key point in the prevention strategy for individuals who present with risk factors for atherosclerotic disease. OBJECTIVES To investigate the effects of green tea (Camellia sinensis) in patients with dyslipidemias. METHODS The study included 33 patients aged between 21 and 71 years who had a low-fat diet (25-35% of total calories and 200 mg of cholesterol per day). They were randomized for two sequential treatments: 250-mg capsules of green tea dry extract or placebo for a total period of 16 weeks; each patient received green tea (Camellia sinensis) for eight weeks and placebo for another eight weeks. RESULTS Baseline lipid values (mg/dL) were: HDL-cholesterol 60.7 +/- 7.3; total cholesterol 255 +/- 30.9; LDL-cholesterol 158.8 +/- 29.0; triglycerides 169.0 +/- 61.3 and Apo-B 120.2 +/- 18.9. Mean lipid variations induced by the use of green tea (Camellia sinensis) showed a 3.9% reduction (p = 0.006) in total cholesterol concentrations and a 4.5% reduction (p = 0.026) in LDL-cholesterol. The intake of green tea did not significantly influence HDL-cholesterol, triglyceride, and Apo-B levels. Non-significant results were found in the assessment of blood lipids (total cholesterol and LDL-cholesterol) with the use of placebo. CONCLUSION A beneficial effect of green tea (Camellia sinensis) was demonstrated, with a significant reduction of total cholesterol and LDL-cholesterol levels in eight weeks, in the patients studied.

Prospective double-blind crossover study of Camellia sinensis (green tea) in dyslipidemias

FUNDAMENTO: Estudios epidemiologicos establecieron una asociacion entre dislipidemias y aterosclerosis. La terapia nutricional es un punto central de la estrategia preventiva en individuos que presentan factores de riesgo para enfermedad aterosclerotica. OBJETIVO: Investigar los efectos del te verde (Camellia sinensis) en pacientes portadores de dislipidemias. METODOS: El estudio implico a 33 pacientes, con edad entre 21 y 71 anos, que consumian una dieta con bajo tenor graso (el 25% al 35% de las calorias totales y 200mg de colesterol por dia). Se randomizaron para dos tratamientos secuenciales: capsulas conteniendo 250mg de extracto seco del te verde o placebo, administradas por un periodo total de 16 semanas, habiendo cada paciente utilizado te verde (Camellia sinensis) por ocho semanas y placebo en igual periodo. RESULTADOS: Los valores lipidicos basales (mg/dl) fueron los siguientes: HDL-colesterol 60,7 ± 7,3; colesterol total 255 ± 30,9; LDL-colesterol 158,8 ± 29,0; trigliceridos 169,0 ± 61,3 y Apo-B 120,2 ± 18,9. Las variaciones lipidicas promedios, provocadas por el uso del te verde (Camellia sinensis), evidenciaron una reduccion de un 3,9 % (p = 0,006) en las concentraciones del colesterol total y una reduccion de un 4,5 % (p = 0,026) del LDL-colesterol. La ingestion de te verde no influencio significativamente los niveles de HDL-colesterol, de los trigliceridos y de la Apo-B. Resultados no significativos se observaron en la evaluacion de los lipidos sanguineos (colesterol total y LDL-colesterol) con el empleo del placebo. CONCLUSION: Se evidencio el efecto benefico del te verde (Camellia sinensis), que redujo significativamente, en ocho semanas, los niveles de colesterol total y LDL-colesterol en ese grupo de pacientes.BACKGROUND Epidemiological studies have established an association between dyslipidemias and atherosclerosis. Nutritional therapy is a key point in the prevention strategy for individuals who present with risk factors for atherosclerotic disease. OBJECTIVES To investigate the effects of green tea (Camellia sinensis) in patients with dyslipidemias. METHODS The study included 33 patients aged between 21 and 71 years who had a low-fat diet (25-35% of total calories and 200 mg of cholesterol per day). They were randomized for two sequential treatments: 250-mg capsules of green tea dry extract or placebo for a total period of 16 weeks; each patient received green tea (Camellia sinensis) for eight weeks and placebo for another eight weeks. RESULTS Baseline lipid values (mg/dL) were: HDL-cholesterol 60.7 +/- 7.3; total cholesterol 255 +/- 30.9; LDL-cholesterol 158.8 +/- 29.0; triglycerides 169.0 +/- 61.3 and Apo-B 120.2 +/- 18.9. Mean lipid variations induced by the use of green tea (Camellia sinensis) showed a 3.9% reduction (p = 0.006) in total cholesterol concentrations and a 4.5% reduction (p = 0.026) in LDL-cholesterol. The intake of green tea did not significantly influence HDL-cholesterol, triglyceride, and Apo-B levels. Non-significant results were found in the assessment of blood lipids (total cholesterol and LDL-cholesterol) with the use of placebo. CONCLUSION A beneficial effect of green tea (Camellia sinensis) was demonstrated, with a significant reduction of total cholesterol and LDL-cholesterol levels in eight weeks, in the patients studied.

The X-X-/E+E+ genotype of the XbaI/EcoRI polymorphisms of the apolipoprotein B gene as a marker of coronary artery disease in a Brazilian sample

Studies that consider polymorphisms within the apolipoprotein B (apo B) gene as risk factors for coronary artery disease (CAD) have reported conflicting results. The aim of the present study was to search for associations between two DNA RFLPs (XbaI and EcoRI) of the apo B gene and CAD diagnosed by angiography. In the present study we compared 116 Brazilian patients (92 men) with CAD (CAD+) to 78 control patients (26 men) without ischemia or arterial damage (CAD-). The allele frequencies at the XbaI (X) and EcoRI (E) sites did not differ between groups. The genotype distributions of CAD+ and CAD- patients were different (chi (1) = 6.27, P = 0.012) when assigned to two classes (X-X-/E+E+ and the remaining XbaI/EcoRI genotypes). Multivariate logistic regression analysis showed that individuals with the X-X-/E+E+ genotype presented a 6.1 higher chance of developing CAD than individuals with the other XbaI/EcoRI genotypes, independently of the other risk factors considered (sex, tobacco consumption, total cholesterol, hypertension, and triglycerides). We conclude that the X-X-/E+E genotype may be in linkage disequilibrium with an unknown variation in the apo B gene or with a variation in another gene that affects the risk of CAD.

Hormone replacement therapy in postmenopausal women and its effects on plasma lipid levels

Abstract Postmenopausal women run the same risks of coronary heart disease as men. The lipid alterations observed at this time reflect increased blood levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a), and reduced high-density lipoprotein cholesterol (HDL-C) levels. These changes lead to a higher risk of coronary artery disease, and hormonal therapy has a favorable effect on lipid metabolism. In this paper we review the literature on hormone replacement therapy (HRT) in postmenopausal women with the emphasis on the role of lipids in the pathogenesis of coronary heart disease, and on the action of estrogens and their correlation with progestogens, as well as routes of HRT administration. We conclude that the HRT changes the lipid profile in a potentially anti-atherogenic direction, usually reducing LDL-C and increasing HDL-C and triglycerides. Otherwise, for postmenopausal women with established coronary disease HRT is not recommended.

Clinical correlation between a point-of-care testing system and laboratory automation for lipid profile.

BACKGROUND We evaluated the clinical correlation between the CardioChek PA analyzer and a clinical laboratory reference method to use for screening program purposes. METHODS Fasting blood samples were collected on 516 patients (age 20-85 y). One venous sample was collected using a serum tube for the evaluation on a COBAS reference analyzer. A second venous sample was collected in a lithium heparin tube and was evaluated on the CardioChek PA analyzer (CCPA venous). A fingerstick sample (CCPA fingerstick) was evaluated only on the CardioChek PA analyzer. Linear regression analyses were performed for each measured analyte, total cholesterol, HDL-cholesterol and triglycerides. RESULTS The correlation between the CCPA fingerstick and CCPA venous was extremely high for HDL-C and triglycerides, and good for total cholesterol. Our results demonstrated a good clinical agreement for total cholesterol, HDL-C and triglycerides between 97.7% and 94.6% in the comparison of the CCPA to the reference analyzer. CONCLUSIONS We identified the pre-analytic phase as an important step to guarantee the quality of results and indicate that the CardioChek PA is a reliable lipid point-of-care testing system that can be used for the application of clinical screening anywhere.

The polymorphisms -1131T>C and the S19W of the APOA5 gene are not associated with coronary artery disease in a Brazilian population.

Caroline Luise Prochaska*, Geraldo Picheth, Mauren Isfer Anghebem-Oliveira, Costantino Ortiz Costantini, Emanuel Maltempi de Souza, Fábio Oliveira Pedrosa and Marileia Scartezini 1 Department of Medical Pathology, Universidade Federal do Paraná, Curitiba, Paraná, Brazil 2 Costantini Cardiologic Hospital, Curitiba, Paraná, Brazil 3 Department of Biochemistry and Molecular Biology, Universidade Federal do Paraná, Brazil

Controle da qualidade na coleta do espécime diagnóstico sanguíneo: iluminando uma fase escura de erros pré-analíticos

BACKGROUND: The preanalytical phase is responsible for more than two thirds of all errors attributed to the clinical laboratory and it has only a few routine procedures for the detection of nonconformity. In this phase, the procedures involving phlebotomy, critical to the obtainment of diagnostic blood specimen, are poorly studied with regard to major sources of errors and procedures related to quality control process. OBJECTIVES: The aim of this work is to propose a tool for finding failures in the preanalytical phase and to establish quality indicators, with emphasis on procedures for the collection of diagnostic blood specimens, in order to monitor potential sources of error in this phase. MATERIALS AND METHODS: We evaluated phlebotomy procedures employed in ten clinical laboratories in Sao Paulo city, Brazil. All of them with established quality program. The errors that had a frequency higher than 80% were selected to be part of a checklist aiming to evaluate the performance of phlebotomists. Standards and recommendations established by national and international institutions, such as ANVISA, SBPC/ML and CLSI, served as reference to elaborate the checklist. RESULTS: The proposed checklist covers five points of phlebotomy procedures: tourniquet application time, number of phlebotomists that ask patients to clench forearm muscle prior to collection, friction of the forearm muscle in antisepsis process, correct or incorrect sequence of blood collecting tubes and evaluation of accurate or inaccurate homogenization of collected blood specimens. CONCLUSIONS: Phlebotomy evaluation is an essential part of the quality planning in clinical laboratories. The proposed checklist allows error detection in the preanalytical phase, establishment of quality indicators and implementation of corrective and preventive actions with cost effectiveness and improvement in process efficiency.Introducao: A fase pre-analitica e a responsavel por mais de dois tercos de todos os erros atribuidos ao laboratorio e contempla poucos procedimentos rotineiros para a deteccao de nao conformidades. Nesta fase, os procedimentos envolvendo a flebotomia, criticos para a obtencao do especime diagnostico, sao pouco estudados no que diz respeito as principais fontes de erro, bem como aos procedimentos relacionados com o processo de controle da qualidade. Objetivos: Propor uma ferramenta para averiguacao de falhas na fase pre-analitica e estabelecer indicadores da qualidade, com enfase nos procedimentos de coleta do especime diagnostico sanguineo, visando monitorar potenciais fontes de erro nesta etapa. Materiais e metodos: Foram observados os procedimentos de flebotomia empregados em 10 laboratorios clinicos da cidade de Sao Paulo, todos com programa de qualidade estabelecido. Os erros que apresentaram frequencia superior a 80% foram selecionados para elaboracao de uma lista de verificacao, com a finalidade de avaliar o desempenho de flebotomistas. Normas e recomendacoes estabelecidas por instituicoes nacionais e internacionais, como Agencia Nacional de Vigilância Sanitaria (ANVISA), Sociedade Brasileira de Patologia Clinica/Medicina Laboratorial (SBPC/ML) e Clinical and Laboratory Standards Institute (CLSI), serviram de referencia para a elaboracao da lista de verificacao. Resultados: A lista de verificacao proposta aborda cinco pontos do processo de flebotomia: tempo de aplicacao do torniquete, numero de flebotomistas que solicitam ao paciente execucao da constricao do musculo do antebraco previamente a coleta, friccao do musculo do antebraco no processo de antissepsia, sequencia correta ou nao de utilizacao dos tubos de coleta e avaliacao da homogeneizacao adequada ou nao do especime diagnostico coletado. Conclusao: A avaliacao do processo de flebotomia e parte essencial no planejamento da qualidade no laboratorio. A lista de verificacao proposta permite detectar erros na fase pre-analitica, estabelecer indicadores da qualidade e auxilia no estabelecimento de planos de acoes corretivas e preventivas com reducao nos custos e ganho na eficiencia do processo. resumo unitermos Gestao da qualidade Controle da qualidade Indicadores da qualidade em assistencia a saude