Clinical Diagnostic Laboratories Research Articles

Assessment of systemic hemodynamic changes in medical workers of PCR laboratories when using personal protective equipment

In the conditions of the COVID-19 pandemic, clinical diagnostic laboratories conducting a test for the presence of coronavirus using polymerase chain reaction (PCR), in most cases, work with significant overload. Performing professional duties in these conditions imposes special requirements on medical personnel. First of all, this concerns the parameters of systemic hemodynamics as an objective criterion of health risk.
 The study aims to analyze the state of systemic hemodynamics in medical workers of PCR laboratories when working in the conditions of the COVID–19 pandemic when using personal protective equipment against a biological factor.
 The researchers have conducted the study in the winter period of the year in PCR laboratories for the diagnosis of a new coronavirus infection. The observation group included 33 people aged 32.5±1.44 years and 1–33 months of experience in the PCR laboratory. We have evaluated the key parameters of systemic hemodynamics, heart rate variability and the degree of oxygen saturation in the blood of laboratory staff. The authors have carried out measurements at the beginning and end of the work shift.
 There was a significant increase in heart rate (by 3.7%), minute heart volume (by 5.2%), myocardial oxygen consumption (by 5.6%) at the end of the work shift compared with its beginning. The values of these parameters of systemic hemodynamics remained within the normal range. At the same time, the increase in the values of these indicators indicates a significant strain on self-regulatory mechanisms and the development of fatigue.
 When using personal protective equipment against a biological factor, the tension of the systemic mechanisms of hemodynamic self-regulation in medical workers of PCR laboratories increases. The degree of severity of the tension of these mechanisms significantly depends on the features of the functional state of the cardiovascular system and vegetative status. At the same time, it is necessary to provide a physiological and hygienic justification for the duration of the periods of work of medical workers of PCR laboratories when using various types of personal protective equipment against a biological factor, which justifies the relevance of further research.
 Limitations. The results of this study were obtained on a relatively small sample. Therefore, in order to increase its representativeness, it is necessary to increase the number of participants, which will allow leveling the existing restrictions.
 Ethics. The study was conducted in compliance with the ethical standards set out in the Helsinki Declaration of 1975 with additions of 2008. The study participants signed a form of "Informed Voluntary consent to conduct a study", developed in accordance with the requirements of the local ethics committee of the Federal State Budgetary Educational Institution of the Volga State Medical University of the Ministry of Health of the Russian Federation.

МИАЗЫ, ПСЕВДОМИАЗЫ И ТРАНЗИТОРНОЕ НОСИТЕЛЬСТВО В ПРАКТИКЕ ЛАБОРАТОРНОЙ ДИАГНОСТИКИ

The problem of differential diagnosis of myiasis and transient carriage is discussed from the point of view of doctors of clinical diagnostic laboratories. Several cases of unusual, controversial and exotic imported myiasis are described. Key words: Laboratory diagnostics, myiasis, pseudomyiasis, transient carriage, fly larvae, Cordilobia spp., Dermatobia spp., Drosophila spp.

Simple, fast and inexpensive quantification of glycolate in the urine of patients with primary hyperoxaluria type 1

In primary hyperoxaluria type 1 excessive endogenous production of oxalate and glycolate leads to increased urinary excretion of these metabolites. Although genetic testing is the most definitive and preferred diagnostic method, quantification of these metabolites is important for the diagnosis and evaluation of potential therapeutic interventions. Current metabolite quantification methods use laborious, technically highly complex and expensive liquid, gas or ion chromatography tandem mass spectrometry, which are available only in selected laboratories worldwide. Incubation of ortho-aminobenzaldehyde (oABA) with glyoxylate generated from glycolate using recombinant mouse glycolate oxidase (GO) and glycine leads to the formation of a stable dihydroquinazoline double aromatic ring chromophore with specific peak absorption at 440 nm. The urinary limit of detection and estimated limit of quantification derived from eight standard curves were 14.3 and 28.7 µmol glycolate per mmol creatinine, respectively. High concentrations of oxalate, lactate and L-glycerate do not interfere in this assay format. The correlation coefficient between the absorption and an ion chromatography tandem mass spectrometry method is 93% with a p value < 0.00001. The Bland–Altmann plot indicates acceptable agreement between the two methods. The glycolate quantification method using conversion of glycolate via recombinant mouse GO and fusion of oABA and glycine with glyoxylate is fast, simple, robust and inexpensive. Furthermore this method might be readily implemented into routine clinical diagnostic laboratories for glycolate measurements in primary hyperoxaluria type 1.

Characterization of SARS-CoV-2 Distribution and Microbial Succession in a Clinical Microbiology Testing Facility during the SARS-CoV-2 Pandemic.

The exchange of microbes between humans and the built environment is a dynamic process that has significant impact on health. Most studies exploring the microbiome of the built environment have been predicated on improving our understanding of pathogen emergence, persistence, and transmission. Previous studies have demonstrated that SARS-CoV-2 presence significantly correlates with the proportional abundance of specific bacteria on surfaces in the built environment. However, in these studies, SARS-CoV-2 originated from infected patients. Here, we perform a similar assessment for a clinical microbiology lab while staff were handling SARS-CoV-2 infected samples. The goal of this study was to understand the distribution and dynamics of microbial population on various surfaces within different sections of a clinical microbiology lab during a short period of 2020 Coronavirus disease (COVID-19) pandemic. We sampled floors, benches, and sinks in 3 sections (bacteriology, molecular microbiology, and COVID) of an active clinical microbiology lab over a 3-month period. Although floor samples harbored SARS-CoV-2, it was rarely identified on other surfaces, and bacterial diversity was significantly greater on floors than sinks and benches. The floors were primarily colonized by bacteria common to natural environments (e.g., soils), and benchtops harbored a greater proportion of human-associated microbes, including Staphylococcus and Streptococcus. Finally, we show that the microbial composition of these surfaces did not change over time and remained stable. Despite finding viruses on the floors, no lab-acquired infections were reported during the study period, which suggests that lab safety protocols and sanitation practices were sufficient to prevent pathogen exposures. IMPORTANCE For decades, diagnostic clinical laboratories have been an integral part of the health care systems that perform diagnostic tests on patient's specimens in bulk on a regular basis. Understanding their microbiota should assist in designing and implementing disinfection, and cleaning regime in more effective way. To our knowledge, there is a lack of information on the composition and dynamics of microbiota in the clinical laboratory environments, and, through this study, we have tried to fill that gap. This study has wider implications as understanding the makeup of microbes on various surfaces within clinical laboratories could help identify any pathogenic bacterial taxa that could have colonized these surfaces, and might act as a potential source of laboratory-acquired infections. Mapping the microbial community within these built environments may also be critical in assessing the reliability of laboratory safety and sanitation practices to lower any potential risk of exposures to health care workers.

Combination of Endobronchial Ultrasound and Modern Cytological Diagnosis in Patients With Intrathoracic Lesions

Objective: To evaluate the effectiveness of endobronchial (EBUS) and endoscopic ultrasound (EUS) in cytomorphological verification of a malignant process using the transbronchial needle aspiration (TBNA) of the lymph nodes and mediastinal organs.Materials and methods: In 2017–2019 we analyzed the cytological samples (standard and cell block) of 172 patients (115 males and 57 females) with an average age of 61 years (25–82 years) in the clinical diagnostic laboratory of Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). Of them 111 were used for immunocytochemical analysis. The majority of the studies (77) were performed in patients with lung cancer in order to identify the stage of the disease. We used combined bronchoscopy under general anesthesia in the operating room with high-frequency ventilation and a rapid on-site evaluation (ROSE).Results: We found the lymph node and mediastinal invasion in 140 (81%) patients who underwent EBUS-EUS TBNA. The non-diagnostic results were obtained in 32 (19%) patients. The combination of EUS and EBUS with TBNA showed the highest effectiveness in the mentioned clinical cases. The sensitivity, specificity, and accuracy of the cytologic analysis during EBUS and EUS with TBNA and no ROSE were 89%, 100%, and 90%, respectively. ROSE reduced the rate of non-diagnostic results and increased the sensitivity (96%), specificity (100%), and accuracy (97%) of the cytologic evaluation.Conclusions: According to the obtained results, we recommend using EBUS-EUS TBNA modalities for morphological verification of the mediastinal lymph nodes as a routine invasive diagnosis component of the preoperative evaluation in patients with lung cancer.

Evaluation of the diagnostic efficacy of a reagent kit for &lt;i&gt;in vitro&lt;/i&gt; diagnosis of West Nile fever using reverse transcription polymerase chain reaction with fluorescent probe-based detection

West Nile fever is a vector-borne zoonotic arbovirus infection with natural foci. Its clinical course is similar to that of acute febrile syndrome, and severe cases may result in neuroinvasive disease. Several genetic lineages (1, 2, and 4) of the West Nile virus (WNV) with different pathogenicity for humans are circulating in the Russian Federation. Therefore, it is an urgent task to develop a diagnostic reagent kit for differentiating between WNV genetic lineages and to implement the kit in clinical laboratory practice.The aim of the study was to conduct technical and clinical tests and evaluate the quality, efficacy, and safety of the Ampligen-WNV-genotype-1/2/4 diagnostic reagent kit for detecting WNV RNA and differentiating between WNV genetic lineages 1, 2, and 4 by reverse transcription polymerase chain reaction (RT-PCR) with fluorescent probe-based detection.Materials and methods. The authors determined the diagnostic sensitivity and specificity of the Ampligen-WNV-genotype-1/2/4 reagent kit (Volgograd Research Institute for Plague Control, Russia) by real-time RT-PCR with 216 clinical samples and 204 biological samples. Sanger sequencing was used as a reference method. Statistical analysis of clinical test results was carried out in accordance with the Russian national standard for clinical laboratory tests (GOST R 53022.3-2008).Results. When tested with the Ampligen-WNV-genotype-1/2/4 reagent kit, real-time RT-PCR demonstrated the analytical sensitivity of 1×104 GEq/mL for the detection of WNV cDNA of genetic lineages 1, 2, and 4. The assessment of its analytical specificity showed no positive results for cDNA samples of heterologous viruses at a concentration of 1×106 GEq/mL. The diagnostic sensitivity with the reagent kit was at least 98.5%, and the diagnostic specificity was at least 99%, with 90% confidence levels for both parameters.Conclusions. The Ampligen-WNV-genotype-1/2/4 reagent kit can be recommended for use in clinical laboratory diagnostics to detect WNV RNA and differentiate between WNV genetic lineages 1, 2, and 4.

Optimization of laboratory support costs in a multidisciplinary hospital: possible solutions. Emphasis on the medical information system

Relevance . Due to the constant improvement of the technical base for laboratory research, the number of laboratory tests, both necessary for the patient and secondary, is increasing everywhere, which cannot but affect the financial costs of laboratory support for a medical organization. The growth of costs requires the search for various ways to optimize costs. Given the widespread introduction of medical and laboratory information systems, it is necessary to develop algorithms for optimizing laboratory appointments and with their help. Goal . To show possible ways to optimize the costs of laboratory research, including using the integration of a medical information system and a laboratory information system. Results . The article describes the main possibilities for optimizing the costs of laboratory research in a multidisciplinary hospital, the feature of which is the territorial removal of clinical units and laboratories. The main optimization mechanisms are considered — an adequate ratio of centralization of laboratory research and decentralization (conducting analyzes at the patient’s treatment site — point of care testing), the creation of “specializations” for clinical diagnostic laboratories, depending on the profile of clinical units and the number of prescribed analyzes by profile. The principle of introduction into the medical information system of control over the appointments of laboratory tests is shown. The economic evaluation of the results of the integration of the medical information system and the laboratory information system was carried out. Conclusion . The joint use of all existing methods of optimizing laboratory service costs will reduce the financial costs of laboratory support while maintaining the quality of medical care.

Diagnostic Challenges and Solutions in Systemic Amyloidosis

Amyloidosis refers to a clinically heterogeneous group of disorders characterized by the extracellular deposition of amyloid proteins in various tissues of the body. To date, 42 different amyloid proteins that originate from normal precursor proteins and are associated with distinct clinical forms of amyloidosis have been described. Identification of the amyloid type is essential in clinical practice, since prognosis and treatment regimens both vary according to the particular amyloid disease. However, typing of amyloid protein is often challenging, especially in the two most common forms of amyloidosis, i.e., the immunoglobulin light chain amyloidosis and transthyretin amyloidosis. Diagnostic methodology is based on tissue examinations as well as on noninvasive techniques including serological and imaging studies. Tissue examinations vary depending on the tissue preparation mode, i.e., whether it is fresh-frozen or fixed, and they can be carried out by ample methodologies including immunohistochemistry, immunofluorescence, immunoelectron microscopy, Western blotting, and proteomic analysis. In this review, we summarize current methodological approaches used for the diagnosis of amyloidosis and discusses their utility, advantages, and limitations. Special attention is paid to the simplicity of the procedures and their availability in clinical diagnostic laboratories. Finally, we describe new methods recently developed by our team to overcome limitations existing in the standard assays used in common practice.

BIOLOGICAL MARKERS IN MODERN VETERINARY PRACTICE

The success of therapeutic measures depends on the availability of the modern methods of diagnostics to practitioners, understanding by them the advantages and existing limitations of each method. Biological markers (BMs) are widely used in scientific and practical medicine as a method for diagnosing the presence or absence of disease, the response to treatment, the reaction of organism to an intervention or therapeutic manipulation, for the disease progress prognosis. BMs provide a unique opportunity for early minimally invasive diagnostics in oncology, nephrology, endocrinology and other specialities. In spite of certain progress much less biological markers are used in veterinary medicine compared to human medicine. Some BMs are not relevant for veterinary medicine others are not studied enough. It may take a very long time from the moment of discovering a molecule potentially significant as a BM to its implementation into practice, or this may never happen at all. This work is aimed at reviewing the available data on the BMs most widely used in veterinary medicine. In the review the data referring to the principles of finding new BMs, the stages of validation, as well as the factors hindering wide implementation of BMs into clinical laboratory diagnostics was systemised. The information about the BMs currently used in the various fields of clinical practice and the BMs panels, was presented. 46 foreign and domestic veterinary and biomedical publications for the last 10 years were analysed.

SOME ASPECTS OF THE APPLICATION OF THE FREQUENCY- RESONANCE METHOD IN THE DIAGNOSIS AND NEUTRALIZATION OF PATHOGENS

Introduction: The method of bioresonance therapy is now quite widespread and occupies a certain and occupies a certain niche in the medical services market. The goal of the work: to study the possibility of using the frequency resonance method research for the detection of Bifidobacterium and Helicobacter pylori and the impact of frequency resonance on the biological environment.&#x0D; Materials and methods: The hardware complex was used in the work developed on the basis of the National Technical University of Ukraine «Igor Sikorsky Kyiv Polytechnic Institute» together with employees of the Institute of Applied Problems of Ecology, Geophysics and Geochemistry». On the basis of the clinical diagnostic laboratory of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department of Ukraine conducted verification of Bifidobacterium and Helicobacter pylori in the in biological media, as well as the study of patients’ blood for sterility according to standard methods. In order to neutralize the pathogens identified during the laboratory the following frequency range was used to neutralize the pathogenic microorganisms detected during the laboratory Х81Х39.2ХХ2 Hz. (X – closed numbers, which will be removed after the protection of intellectual property rights of the authors).&#x0D; Results: Investigation of the possibility of verification of Bifidobacterium and Helicobacter pylori on photographs by frequency resonance method was carried out for the period from October 2021 to January 2022. Comparative analysis of the diagnostic value of the frequency resonance method in comparison with traditional standard methods used in the clinical and diagnostic laboratory of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department of Ukraine showed a sufficiently high verification probability of more than 96 %.&#x0D; Conclusions: The research conducted requires more thorough additional study with the involvement of medical, biological, physical, and radiophysical scientists.

Faecal microscopy – sorting the parasites from the crap

Despite increasing use of molecular diagnostics in clinical parasitology laboratories, a mainstay of faecal parasitology remains microscopy by a capable microbiologist. With decreasing rates of parasitic infection in high income nations such as Australia, the opportunity to regularly see parasitic elements in faeces is decreasing. At times, unusual or suspicious elements may be observed in faecal smears. An important skill for all conducting faecal microscopy is to be able to determine when these elements represent a parasite egg, larva, cyst, oocyst or trophozoite, or an unimportant faecal artifact.

A Rapid Method for Determination of Serum Methotrexate Using Ultra-High-Performance Liquid Chromatography-Tandem Mass Spectrometry and Its Application in Therapeutic Drug Monitoring.

Objectives Methotrexate (MTX) has anticancer therapeutic potential with multiple doses-related adverse effects and toxicities. Immunoassays for therapeutic monitoring of serum MTX have their own limitations. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is considered as the reference method; however, commercially availability of them is limited. We aimed to adapt/develop an in-house LC-MS/MS method for therapeutic monitoring of serum MTX. Materials and Methods Serum protein precipitation was performed using acetonitrile-water containing 250 μM solution of aminoacetophenone as internal standard (IS). Chromatographic separation was achieved on a C18 column with mobile phase of 0.1% solution of formic acid (solvent A) and acetonitrile (solvent B) at a flow rate of 0.4 mL/min. MS was performed under positive ion mode with mass transition for MTX and IS as m/z 455.1→308.1 and 136.2→94.1, respectively. The method was validated by following Bioanalytical Method Validation Guidance for Industry, 2018 and applied on leukemia patients' samples on MTX therapy. Results The correlation coefficient of eight serially diluted calibration standards of 0.09 to 12.5 μM was >0.99 and had linearity with > 95% precision and accuracy at analytical quality control levels. The lower limit of MTX quantification achieved was 0.09 μM with good intensity and sharp peak as compared with blank sample. The total run time of the assay was 5 minutes. The serum MTX levels obtained by this method in leukemia patients exhibited clinical correlation and an excellent agreement with commercial immunoassay used in parallel. Conclusion We were able to develop a rapid, sensitive, and cost-effective LC-MS/MS method suitable for therapeutic drug monitoring of MTX in routine clinical diagnostic laboratories.

Mass Spectrometric Blood Metabogram: Acquisition, Characterization, and Prospects for Application.

In metabolomics, many metabolites are measured simultaneously in a single run. Such analytical performance opens up prospects for clinical laboratory diagnostics. In this work, a mass spectrometric metabogram was developed as a simplified and clinically applicable way of measuring the blood plasma metabolome. To develop the metabogram, blood plasma samples from healthy male volunteers (n = 48) of approximately the same age, direct infusion mass spectrometry (DIMS) of the low molecular fraction of samples, and principal component analysis (PCA) of the mass spectra were used. The seven components of the metabogram defined by PCA, which cover ~70% of blood plasma metabolome variability, were characterized using a metabolite set enrichment analysis (MSEA) and clinical test results of participating volunteers. It has been established that the components of the metabogram are functionally related groups of the blood metabolome associated with regulation, lipid-carbohydrate, and lipid-amine blood components, eicosanoids, lipid intake into the organism, and liver function thereby providing a lot of clinically relevant information. Therefore, metabogram provides the possibility to apply the metabolomics performance in the clinic. The features of the metabogram are also discussed in comparison with the thin-layer chromatography and with the analysis of blood metabolome by liquid chromatography combined with mass spectrometry.

Educational video for training specialists in clinical laboratory diagnostics.

The adaptation of educational programs under restrictions during the SARS-CoV-2 coronavirus pandemic and after it is based not only on the widespread use of video lectures, but also on the introduction of a number of new educational technologies. Hybrid learning will become the cornerstone of future educational technologies in clinical laboratory diagnostics and will contribute to the creation of virtual practical classes with examples of analysis of laboratory testing results based on case histories (Case Technologies). The key aspect in the implementation of video cases into the educational process is the development of video materials. The use of educational video cases developed by Vector-Best in the process of training specialists in clinical laboratory diagnostics during the cycles «Retraining» and «General Improvement» at the Department of Clinical Laboratory Diagnostics of the Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of Russia was a convenient format and received positive assessment of cadets. Currently, the «IVD gallery» section has appeared on the FLM website and the placement of an additional educational resource - a library of educational video cases.

ПОСТУПОВІ КРОКИ ВИРІШЕННЯ ПРОБЛЕМИ ДЕФІЦИТУ МЕДИЧНИХ КАДРІВ У ГАЛУЗІ ЛАБОРАТОРНОЇ ДІАГНОСТИКИ УКРАЇНИ

Topicality. According to the directory of the Center for Medical Statistics of the Ministry of Health of Ukraine on medical staff and the network of health care facilities of the Ministry of Health of Ukraine for 2019-2020, the existing 4329.25 full-time positions of laboratory doctor are filled by 1319 individuals, it is 30.47%. This figure is the lowest among all specialties. The aim of the study. Analysis of some factors of formation of shortage of medical personnel in the field of laboratory diagnostics of Ukraine and gradual steps of their solution. Materials and methods of research. Analysis of current legislative and regulatory documents. Analysis of educational programs and reports on the implementation of the curriculum of the Department of Modern Technologies of Medical Diagnostics and Treatment of the Institute of Postgraduate Education of Bogomolets National Medical University. Results. A characteristic feature of all medical laboratories in Ukraine is the vacant positions of laboratory doctors and / or their filling by specialists with basic biological education, which according to our observations make up more than 90% of the staff. We believe that in order to solve the problem and fill the industry with laboratory doctors, effective steps are the development of 224 specialties "Technologies of medical diagnostics and treatment", which is licensed at medical faculties, the approval of the internship program "Laboratory diagnostics, virology, microbiology" for admission of masters of specialties 22. 222 and 228 and the acquisition of two specializations "Clinical Laboratory Diagnostics" and "Microbiology, Virology" from the graduate of the internship, which allows him to find a job in the vast majority of positions in medical laboratories. A positive example of the popularization of the specialty is the introduction of the discipline laboratory diagnostics for 4 years of study with a volume of 3 credits at the Bogomolets National Medical University in the educational program for preparing students of medical specialties. Conclusion. Already today, certain progressive steps are being taken in the state to overcome the acute shortage of medical personnel in the laboratory, and this gives reason to expect that the staff of the country's medical laboratories will subsequently be filled with young, motivated, qualified personnel who will work in close cooperation with colleagues from clinical departments. solving complex diagnostic problems.

ALPHA-AMYLASE AND METHODS FOR DETERMINATION OF ITS ACTIVITY USED AT CLINICAL LABORATORY

The quality improvement of medical care requires the developing of clinical laboratory patient support. To achieve the effective results need a searching, developing and applying in practice new, with improved properties, methods for estimation analytes, including common ones, such as α-amylase activity. This article presents a review of the main materials published over the past few decades. It includes a description of the structure of α-amylase and its main isoenzymes; its role in human physiology and pathology; diagnostic significance of the α-amylase isoenzymes activity determination in clinical laboratory diagnostics. The principles of the most common methods of α-amylase activity determination are presented, and their important characteristics are compared. The method based on the substrate GalG2CNP using has the best analytical characteristics for the developing reagent kits for measuring the total α-amylase and its pancreatic isoenzyme activities, which can be used in clinical diagnostic laboratories.

P591: Assessing the performance of automated HPO term extraction for deep phenotyping of patients receiving WES/WGS in a clinical diagnostic laboratory

P591: Assessing the performance of automated HPO term extraction for deep phenotyping of patients receiving WES/WGS in a clinical diagnostic laboratory

COMPARATIVE CHARACTERISTICS OF LABORATORY TEST RESULTS AND CAPABILITIES OF THE IMMUF6 IMMUNOCHEMICAL ANALYZER

The article presents the results of comparative studies on some tests determined using reagent kits for chemiluminescent analysis on the immunochemical analyzer ImmuF6 «MedCaptain» (PRC). Comparison of the results of blood tests of patients was carried out in parallel on the analyzer under study and on modern foreign automatic analyzers manufactured by companies considered world leaders in the development and production of reagents and analytical devices. The analysis was carried out on six tests: C-reactive protein, interleukin-6, creatine kinase MB isoenzyme, myoglobin, D-dimer,N-terminal pro-brain natriuretic peptide in the field of reference and pathological values of the analyte. Statistical analysis showed a high degree of correlation of the results of the compared tests: C-reactive protein, interleukin 6, myoglobin, D-dimer, creatine kinase MB isoenzyme with the exception of N-terminal pro-brain natriuretic peptide. This device can be recommended for use in clinical diagnostic laboratories, and, taking into account the established test sets, its use in urgent diagnostics units may be the most relevant.

CLINICAL CASE OF THROMBOCYTOPATHY DIAGNOSIS WITH THROMBOCYTOPENIA

The article is devoted to the description of a clinical case of thrombocytopathy with thrombocytopenia in patient K., who was admitted to the N. N. Burdenko State Medical Hospital to find out the cause of spontaneous multiple hematomas. Due to the complexity of the diagnosis of this condition, we used a wide range of different hematological, biochemical, immunological, and genetic studies. We present this case as an illustration of the difficulties of finding and algorithmizing diagnostics for thrombocytopathies, in accordance with modern classification and the need for the participation of a large number of specialists in clinical laboratory diagnostics. The article provides various laboratory diagnostic methods and their interpretation, as well as focuses on those laboratory tests that allow us to understand the presence of functional disorders and answer questions about where these manifestations of this pathology could be suspected at the initial stages. For diagnosis, methods of hematological, biochemical studies, morphology studies, aggregatogram and flow cytometry data were consistently used to assess the functional properties of platelets, attempts were made to use molecular genetic studies. The absence of molecular genetic markers for this form of thrombocytopathy complicates the final diagnosis, however, it allows us to focus on other methods for diagnosing the functional properties of platelets. The functional properties of platelets in this patient were reduced, which is reflected in a decrease in platelet function when activated with collagen and adrenaline, while the presence of disaggregation is noted when using thrombin and ADP as agents. Flow cytometry of the blood sample of this patient revealed reduced levels of antibodies to activated integrin aIIbß3, P-Selectin alpha granules (CD62p), the amount and volume of secretion of dense granules according to mepacrin, the proportion of procoagulant platelets according to annexin V, which undoubtedly allows us to characterize the functional properties of platelets. This work shows the importance of using modern hematological techniques, which makes it possible to suspect this pathology in mid-level laboratory units and promptly direct the thoughts of clinicians to search for and analyze thrombocytopenia, and in joint consultation with a hematologist, suggest discussing thrombocytopenia together with thrombocytopathy.

Scientific publications and defense of dissertations in the specialty «Clinical laboratory diagnostics»: the current state of the issue

Scientific publications and defense of dissertations in the specialty «Clinical laboratory diagnostics»: the current state of the issue