Laboratory Test Requests Research Articles

The Limping Child: A Guide for the Trainees.

Limping is a common presenting complaint in children. Despite this, it remains to be a diagnostic challenge for treating physicians due to an expanded list of etiologies. It arises from a spectrum of disorders, ranging from physiological variations of gait at different stages of development to systemic causes, such as inflammatory diseases or musculoskeletal infections. On rare occasions, non-musculoskeletal causes could result in limping. The diagnostic challenge increases in younger age children where a detailed physical examination that helps identify the exact source of pathology may not be possible. In older patients who have a well-developed gait cycle, the physical assessment might be easier. Clinical assessment in a child presenting with a limp includes gait analysis, which is essential to guide the appropriate request of diagnostic laboratory tests and imaging studies. In this paper, we provide a practical guide for a trainee in General Pediatric and Pediatric Rheumatology on an approach to a limping child, aiming to identify the common causes of limping and to describe normal and abnormal gait cycles. We also discuss other diagnostic considerations in the assessment of these children.

Preoperative coagulation tests: A narrative review of current guidelines

IntroductionHemostasis tests are traditionally requested for all patients requiring any surgical act or invasive diagnostic-therapeutic procedure to prevent hemorrhagic complications. The aim of this study is to assess the necessity of requesting standard pre-procedure hemostasis tests. MethodologyA narrative literature review was conducted using the PubMed data-base. Search terms included «Hemostasis» or «Blood coagulation» in combination with «Preoperative care», «Preoperative period», or «Preoperative procedure». Additionally, a targeted search was performed to find recommendations from international societies related to the topic. ResultsA total of 233 articles were found, 17 were pre-selected, and after full-text evaluation, 14 relevant articles were identified. The targeted search yielded an additional 12 articles.The request for tests should be individualized according to the clinical history. Standardized screening questionnaires for hemostasis disorders are useful and complement the aforementioned approach. Factors such as age, ASA classification, bleeding potential-complexity of the procedure, and anesthetic technique may influence their request. DiscussionThe incidence of hemostasis disorders in the general population is very low, and these can mostly be detected through clinical history. Thus, it is the clinical history that should guide the need for laboratory test requests. ConclusionsPreoperative hemostasis tests should not be indiscriminately requested for all patients needing an intervention or invasive diagnostic-therapeutic procedure, but rather when there are doubts about their hemostatic competence or as advised by the nature of the procedure they are undergoing.

Quantification of Ions in Human Urine-A Review for Clinical Laboratories.

Urine is an organic fluid produced by the kidney, and its analysis is one of the most requested laboratory tests by clinicians. The ionic composition of urine has been shown to be a good health indicator: it is useful for the diagnosis of several diseases, as well as monitoring therapeutics. This review considers laboratorial techniques that have been used throughout time for the quantification of ions in urine, and also considers some methodologies that can potentially be used in clinical laboratories for this kind of analysis. Those methods include gravimetry, titration, flame emission spectrophotometry (flame photometry), fluorimetry, potentiometry (ion selective electrodes), ion chromatography, electrophoresis, kinetic colorimetric tests, enzymatic colorimetric tests, flow cytometry, atomic absorption, plasma atomic emission spectrometry, and paper-based devices. Sodium, potassium, chloride, calcium, and magnesium are among the most important physiological ions, and their determination is frequently requested in hospitals. There have been many advances regarding the analysis of these ions in 24 h urine. However, there is still some way to go concerning the importance of intracellular ions in this type of sample as well as the use of occasional urine for monitoring these parameters.

Frequency and pattern of test utilization rate in clinical biochemistry laboratory: two different large hospital examples

Abstract Objectives Clinical Biochemistry Laboratories (CBL) are the most frequently utilized laboratory group in healthcare, and their significance in patient care is indisputable. This study investigated the frequency and pattern of test utilization rate in CBL at two large hospitals’ outpatient and inpatient clinics. Methods A total of 43,732,428 CBL tests, including clinical chemistry, immunoassay, coagulation, specific proteins, CBC, and urinalysis, were conducted for 12,182,382 patients across two large hospitals in different settings between 2018 and 2022. These tests were analyzed alongside patient admissions data, with a focus on the distribution across various clinics. Results 94 and 93 % of those admitted to Hospitals 1 and 2 were outpatients. They had applied to CBL laboratories for 27.1–30.3 % of outpatients and 81.2–88.7 % of inpatients for at least one test. When analyzing the rates at which laboratory tests were requested for outpatients, it was found that emergency departments had the highest test-requesting rates, ranging from 19.99 to 45.36 %. This was followed by internal medicine clinics, with rates ranging from 13.77 to 14.8 %, and inpatient intensive care units, with rates between 24.31 and 30.14 %. Outpatients had 10–11 test requests for each patient and 16–31 for inpatients. The most frequently requested laboratory tests were CBC, glucose, creatinine, urea, AST and ALT in two hospitals. Conclusions Despite significant variations in location, structure, medical staff, and patient demographics, approximately one-third of outpatients and 85 % of inpatients at these hospitals undergo testing in CBL. CBLs are essential for screening, diagnosis, prognosis, and healthcare treatment.

Incidence and management of Lyme disease: a Scottish general practice retrospective study.

The true burden of Lyme disease in primary care in Scotland is unknown. Epidemiological data are currently based on laboratory-confirmed reports as there is no mandatory reporting of clinical cases. To analyse data from general practice in NHS Highland (North) over a 6-year period to assess the incidence and management of Lyme disease in primary care. This was a retrospective descriptive study. Study data from 2017 to 2022 were extracted from all 63 general practices within NHS Highland (North). Consultations for Lyme disease were identified via Lyme-related clinical Read codes, requests for borrelia tests , free text, 'tags' and/or Lyme disease antibiotic scripts. Using Read codes to identify patients with Lyme disease or suspected Lyme disease gave an estimated average annual incidence of 124/100 000 population, which was 2.1 times more than estimates based solely on laboratory-confirmed reports. The incidence figures increased 5.2 times (362/100 000 population) when patients with Lyme disease or suspected Lyme disease (identified via Read codes, laboratory test requests, and free text tags) who were given antibiotic treatment were taken into account. Local 'hot spots' of infection were identified. Analysis of the antibiotic data indicates that antibiotic prescribing in NHS Highland largely follows the National Institute for Health and Care Excellence (NICE) guidelines. This data analysis pathway can, and should, be rolled out across the whole of Scotland to assess the incidence and management of Lyme disease in primary care and allow appropriate allocation of resources.

Inappropriate laboratory test utilization in outpatient tertiary care: Implications for value-based healthcare.

To assess the rate of inappropriate repetition of laboratory testing and estimate the cost of such testing for thyroid stimulating hormone (TSH), total cholesterol, vitamin D, and vitamin B12 tests. A retrospective cohort study was carried out in the Family Medicine and Polyclinic Department at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Clinical and laboratory data were collected between 2018-2021 for the 4 laboratory tests. The inappropriate repetition of tests was defined according to international guidelines and the costs were calculated using the hospital prices. A total of 109,929 laboratory tests carried out on 23,280 patients were included in this study. The percentage of inappropriate tests, as per the study criteria, was estimated to be 6.1% of all repeated tests. Additionally, the estimated total cost wasted amounted to 2,364,410 Saudi Riyals. Age exhibited a weak positive correlation with the total number of inappropriate tests (r=0.196, p=0.001). Furthermore, significant differences were observed in the medians of the total number of inappropriate tests among genders and nationalities (p<0.001). The study identified significantly high rates of inadequate repetitions of frequently requested laboratory tests. Urgent action is therefore crucial to overcoming such an issue.

Double positivity for rheumatoid factor and anti-CCP autoantibodies: improving referral from primary care of patients suspected of having rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic progressive autoimmune inflammatory disease with significant morbidity and mortality. The course of the disease can be modified if diagnosis is early and treatment appropriate. In this study, we aimed to evaluate a new strategy for early identification of RA patients in primary care settings (the 'diagnostic bottleneck') based on serological biomarkers and to manage inappropriate rheumatoid factor (RF) laboratory test requests. A two-arm study was carried out. The first arm corresponded to a retrospective observational descriptive study of patients referred for RF testing from primary care using the current laboratory workflow. The second arm included the following prospective interventions: cancelation of RF requests corresponding to patients with previous negative results for RF over a one-year period; and automatic reflex testing antibodies against cyclic citrullinated proteins (anti-CCP) for patients displaying RF values >30IU/ml. Outcomes from both arms were then compared. As double positivity for RF and anti-CCP notably increases the positive likelihood ratio of RA. The intervention enabled a reduction of 2813 tests in 22 months. Moreover, the frequency of unnecessary referrals was reduced from 22% to 8.2%, while that of missed patients decreased slightly (from 21% to 16%), with the number of patients diagnosed per RF request remaining unchanged. In terms of costs, we saved 19.4 RF tests per anti-CCP test added.We developed a simple and cost-effective strategy for reducing the time to diagnosis of RA that can improve patients' quality of life. This approach was supported by primary and specialised care.

A National Laboratory Perspective: The Impact of the Covid-19 Pandemic on the Management of Patients With Non-Communicable Disease in South Africa: Impact of COVID-19 on patients with noncommunicable diseases.

The aim of this study was to determine the impact of the COVID-19 pandemic on test requests for the diagnosis and routine care of patients with various non-communicable diseases (NCD) across South Africa (SA). A retrospective audit of laboratory test requests received from hospital outpatient departments and primary healthcare facilities across SA was performed. The following analytes were studied: glycated hemoglobin (HbA1c), lipids profiles, thyroid-stimulating hormone (TSH), and thyroxine (fT4), as well as triiodothyronine (fT3), serum protein electrophoresis (SPE), serum free light chains (SFLC), and prostate specific antigen (PSA); these tests were used as a proxy of NCD detection and follow-up. Requests received during the 3 waves of the pandemic were compared to requests received within the same period during 2017 - 2019. During the first wave, requests for all analytes were reduced, with the biggest reduction observed for SPE (- 37%); TSH (- 29%); fT4 (- 28%); and HbA1c (- 25%). Requests received from urban facilities showed a larger decrease compared to those from rural facilities. During the third wave there was an increase in requests for all analytes; the biggest increase observed was for fT3 (21%) and HbA1c (18%). The COVID-19 pandemic had a significant impact on the South African population receiving care in the public healthcare sector.

Homologation of results of manual and automated urine microscopic analysis: a review of the bibliography

Introduction: urinalysis represents one of the most requested laboratory tests for the diagnosis and follow-up of urinary and renal system diseases. Although manual microscopy has been the traditional method, its process is characterized by being laborious and time-consuming. For this reason, automated systems have been introduced with the aim of improving the accuracy of the results. Objective: to establish the relevance of the homologation of manual and automated urine microscopic analysis results through a literature review.Methods: this study is based on descriptive research of bibliographic documents with a retrospective analysis. For the collection of information, various databases such as PudMED, Scielo, Google Scholar, Scopus, Elsevier were consulted. During the bibliographic search, 25 articles related to the subject of the study were found, for which the PRISMA methodology was used.Results: by analyzing the different investigations, it was found that the automated analyzers showed an adequate concordance with manual microscopy for red blood cells, white blood cells and epithelial cells. However, in the case of bacteria and casts, a lower concordance was evidenced. Conclusion: urine microscopic analysis is crucial in medical diagnosis. The transition from manual methods to automated equipment has improved the efficiency and accuracy of the results. The comparison between both methods is fundamental to ensure the reliability of the results, which contributes to provide safe and appropriate treatments for patients

Multiple Myeloma in a 27-Year-Old Female Presenting with Recurrent Low Back Pain

Multiple Myeloma or Kahler's disease is a neoplasm characterized by proliferation of plasma cells in bone marrow where the most common clinical manifestations include bone pain secondary to osteolysis, kidney damage and hypercalcemia. The most common risk factors associated with this pathology are advanced age, family history of multiple myeloma, alcoholism, smoking, among others. Diagnosis includes the presence of monoclonal protein or paraprotein in serum and urine by electrophoresis, presence of free chain protein in 24-hour urine and immunofixation in serum. We present a clinical case of a 27-year-old female patient who presented lumbar pain as the initial manifestation and on requesting laboratory tests showed alterations compatible with myeloma. Laboratory studies were requested confirming the diagnosis of Multiple Myeloma kappa stage ISS-III in current treatment with cyclophosphamide, dexamethasone and thalidomide.

The importance and added value of patient involvement in person-centred medication reviews.

Background: The iSIMPATHY (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) team is conducting person-centred medication reviews using a 7-step review tool focusing on ‘what matters to you’1.&#x0D; iSIMPATHY is an EU-funded partnership between Scotland, Ireland and Northern Ireland. One of the main drivers for change is the WHO 3rd global patient safety challenge, Medication Without Harm which aims to reduce severe avoidable medication-related harm by 50% globally in the next 5 years, with one of the key action areas being polypharmacy2. To date over 1400 person-centred medication reviews have been conducted with patients in Northern Ireland. These reviews aim to reduce inappropriate polypharmacy, promote adherence and health literacy and provide patient education.&#x0D; Personal and Public Involvement (PPI) feedback was sought prior to the project starting and patient engagement has continued throughout.&#x0D; Method: Structured, person-centred medication reviews were conducted in acute medical wards in a secondary care setting in Northern Ireland. Priority was given to those on 10 or more medicines or a high risk medicine, over 50 and resident in a care home or approaching end of life. Data were collected for a cohort of 66 patients who consented to an iSIMPATHY review. Data were analysed to determine the interventions made due to patient involvement in the review as compared with interventions which could be made by completing a kardex (medicine list) review only.&#x0D; Results: An average of 9.3 interventions were made per patient, significance was graded using the Eadon system, with 4.4% graded 3 (significant but does not lead to an improvement in patient care), 88.9% graded 4 (significant and results in an improvement in standard of care) and 6.7% graded 5 (very significant and prevents major organ failure or an adverse reaction of similar importance). Interventions included checking and requesting laboratory tests, omitted medicines started, adjustments made for allergy, frailty, renal or liver impairment and identification of adverse drug reactions. Importantly, 88% (n=58) of patients had an intervention made because the medication review was discussed with them. This resulted in 38% additional interventions and included 22% of grade 5 interventions.&#x0D; The themes of additional interventions were: adherence and inhaler education (19%), identification of unmet/unknown health need and symptom control (15%), community support services (15%), lifestyle (12%), reduction and stopping unnecessary/inappropriate medicines (10%), identification of important additional information (10%), sick day rules (8%), self-care (7%) and referral to other services (5%).&#x0D; Conclusion: Patient involvement in their medication review leads to the identification of new and unmet needs, allows for the provision of counselling on medicines, adherence and lifestyle and prompts discussion and action on the deprescribing of inappropriate and unnecessary medicines. These additional interventions are clinically significant for the patient.&#x0D; Next steps: Medication reviews and data collection continues with the aim of scale and spread. For results and learning opportunities search https://www.isimpathy.eu/.&#x0D; &#x0D; https://www.isimpathy.eu/&#x0D; Medication Safety in Polypharmacy Technical Report, World Health Organisation 2019.&#x0D; &#x0D; https://www.who.int/initiatives/medication-without-harm&#x0D; &#x0D; Eadon, H. Assessing the quality of ward pharmacists’ interventions. Int. J. Pharm. Pract 1992, 1, 145–147&#x0D; &#x0D;

Trends in diagnostic tests ordered for children: a retrospective analysis of 1.7 million laboratory test requests in Oxfordshire, UK from 2005 to 2019

ObjectiveTo better understand testing patterns in children, we measured temporal trends in paediatric testing from 2005 to 2019 in Oxfordshire, UK.DesignDescriptive study of population-based secondary data.SettingOxfordshire University Hospitals National Health...

Improving diagnosis and treatment of hypomagnesemia.

Magnesium is one of the most abundant cations in the body and acts as a cofactor in more than 600 biochemical reactions. Hypomagnesemia is a highly prevalent condition, especially in subjects with comorbid conditions, but has received less attention than other electrolyte disturbances. This review will discuss magnesium physiology, absorption, storage, distribution across the body, and kidney excretion. After reviewing the regulation of magnesium homeostasis, we will focus on the etiology and clinical presentation of hypomagnesemia. The role of laboratory medicine in hypomagnesemia will be the main purpose of this review, and we will discuss the laboratory tests and different samples and methods for its measurement. Although free magnesium is physiologically active, total serum magnesium is the most commonly used measurement in laboratory medicine and is apt for clinical purposes; however, it is not appropriately used, and many patients with hypomagnesemia remain undiagnosed and not treated. Using information technologies, laboratory medicine can largely improve the diagnosis and treatment of hypomagnesemia through the design and establishment of automatic demand management and result management interventions by acting in the first and last steps of the laboratory cycle, test requests, and actions taken after test results, to unmask patients with hypomagnesemia and improve the number of patients undergoing treatment.

Why C-reactive protein is one of the most requested tests in clinical laboratories?

C-reactive protein (CRP) is an acute-phase protein which is synthesized by the liver in response to the secretion of several inflammatory cytokines including interleukin 6 (IL-6), IL-1 and tumor necrosis factor (TNF). CRP was the first acute-phase protein to be described and adopted in clinical laboratories as an exquisitely sensitive systemic marker of inflammation and tissue damage. The measurement of CRP is widely used for the diagnosis and monitoring of inflammatory conditions, including sepsis, trauma, and malignancies. In the last decades, impressive advances in analytical methods (from qualitative to high-sensitivity assays), automation and availability of results in a short time, not only translated in an increasing demand for the right management of systemic inflammatory diseases, but also in evaluating subclinical inflammatory processes underlying atherothrombotic events. CRP measurement is one of the most requested laboratory tests for both the wide range of clinical conditions in which it may assure a valuable information and some analytical advantages due to the evidence that it is a "robust biomarker". Even recently, the measurement of CRP received new interest, particularly as a biomarker of severity of Coronavirus disease 2019 (COVID-19), and it deserves further concern for improving demand appropriateness and result interpretation.

Attitudes and practices in the management of attention deficit hyperactivity disorder among Brazilian pediatric neurologists who responded to a national survey: a cross-sectional study.

Attention deficit hyperactivity disorder (ADHD) has a prevalence of 5.3% among children and adolescents. It is characterized by attention deficit, hyperactivity, and impulsivity. We aimed to conduct a survey involving pediatric neurologists in the management of ADHD and compare the results with the current literature and guidelines. Descriptive analytical study of a virtual environment, was used Test of equality of proportions for comparison between two groups of pediatric neurologists (working as specialists for > 6 versus ≤ 6 years), with a significance level of P = 0.05. This cross-sectional study used a virtual questionnaire covering the steps in the diagnosis and treatment of children with ADHD. The inclusion criteria were professionals who had completed their residency/specialization in pediatric neurology and clinical neurologists working in pediatric neurology. Among the 548 electronic invitations sent, 128 were considered valid. For all participants, the diagnosis was clinically based on the disease classification manuals. Combination treatment promotes improvement of symptoms (96.9%). Among psychostimulants, short-acting methylphenidate was the most commonly prescribed medication (85.2%). Headache was the most common side effect (77.3%). Altogether, 73.4% of the participants requested laboratory tests, 71.1% requested an electrocardiogram, and 42.2% requested an electroencephalogram. Pediatric neurologists working as specialists for ≤ 6 years had more frequent referrals to psycho-pedagogists for diagnosis (P = 0.03). The participants complied with clinical guidelines, emphasizing the relevance of diagnostic manuals and treatment guidelines for an eminently clinical situation and enabling uniformity in quality treatment.

Ultrassonografia diagnóstica: acompanhamento do processo cicatricial após lipoaspiração da gordura cervicomentual

ABSTRACT Mechanical liposuction of cervicomental fat is part of the aesthetic procedures of orofacial harmonization. Ultrasonography stands out for illustrating soft tissues with high-resolution images in the diagnostic and postoperative stages. The present study aimed to report the case of a female patient, 54 years old, in good general health, confirmed by all previously requested laboratory tests, whose main complaint was the presence of excess fat in the jowl region. The stages after the liposuction procedure were followed by high-resolution ultrasound examinations in order to assess the healing of the manipulated tissues, and ultrasound evaluations were performed in the postoperative follow-up periods of 30, 60 and 120 days. Through the present study, it was possible to conclude that ultrasonography is an important ally in the postoperative follow-up of neck liposuction, allowing to follow the evolution of the post-surgical repair process.

The usefulness of implementing minimum retest intervals in reducing inappropriate laboratory test requests in a Dutch hospital.

Inappropriate use of laboratory testing remains a challenging problem worldwide. Minimum retest intervals (MRI) are used to reduce inappropriate laboratory testing. However, their effectiveness and the usefulness in reducing inappropriate laboratory testing is still a matter of debate. The aim of this study was to evaluate the effectiveness ofbroadly implemented MRIs as a means of reducing inappropriate laboratory test requests. We performed a retrospective study in a general care and teaching hospital in the Netherlands, where MRI alerts have been implemented as standard care since June 7th 2017. Clinical chemistry test orders inadult internal medicine patients placed between July 13th2017 and December 31st 2019 were included. The primary outcome was the effectiveness of MRIs, expressed as percentages of tests ordered and barred as a result of MRIs. Of a total of 218,511 test requests, 4,159 (1.90%) got an MRI alert. These MRIs were overruled by physicians in 21.76% of the cases. As a result of implementing MRIs, 3,254 (1.49%) tests were barred. The financial savings for the department of internal medicine directly related to the included barred laboratory tests during this period were 11,880 euros on a total amount of 636,598 euros for all performed tests. Only a small proportion of laboratory tests are barred after implementation of MRIs, with a limited impact on the annual costs. However, MRIs provide a continuous reminder to focus on appropriate testing and the effectiveness of MRIs is potentially higher than described in this study.

Evaluation of Laboratory Performance in Consideration with Pre analytical and Post analytical Quality Indicators.

Implementation of Quality indicators (QIs) plays an imperative role in improving the total testing process, as it provides a quantitative basis for evaluating the laboratory performance. Besides monitoring of analytical quality specifications, several lines of experimental and clinical evidence have alluded a pivotal role of extra-analytical phases in improving the quality of laboratory services and therefore a relevance of pre- and post-analytical steps have been speculated on the overall quality in the total testing process and consequently on clinical decision-making. This was a retrospective study designed to evaluate and review different extra-analytical quality indicators in NABL accredited clinical biochemistry laboratory at BJ Medical College and Civil Hospital, Ahmedabad, Gujarat in an endeavour to ameliorate the performance of the laboratory. All Clinical Chemistry Laboratory test requests with their respective samples from January 2018 to December 2021 were included in the study. A total of 1,439,011samples were processed, and were evaluated for seven QIs [(% of number of suitable samples not received; QI-8), (% of number of samples received in inappropriate container; QI-9), (% of number of samples hemolysed; QI-10), (% of number of samples with inadequate sample volume; QI 12) (% of number of samples received mismatched; QI 15), (% of number of samples reported after turnaround time; QI 21) and (% of number of samples with critical values informed; QI 22)] based on defined criteria of Quality Specification given by International Federation of Clinical Chemistry. Total number of preanalytical errors was 53,669 (3.72%). Among the preanalytical errors, inadequate sample volume (2.37% of total samples; 63.49% of total pre-analytical errors) was the most common anomaly followed by Not received samples (24.18%) hemolysis (8.26%) mismatched (3.91%) and 0.14% samples were received in Inappropriate container; manifesting that the error frequency was unacceptable for QI 21 and QI 8, acceptable for QI 10, minimally acceptable for QI 15 and optimum for QI QI 9. Furthermore, there was year-wise progressive decline in error rate of inadequate sample volume, hemolysed sample received and mismatched samples. Total number of post analytical errors were 19,002 (1.32%). TAT outlier and critical values communicated were the two QIs evaluated for this phase and results of both QI were within acceptable limits. Quality indicators serve as a tool to monitor process performance and consequently derived error rates warrant active intervention to improve the laboratory services and patient health care. Dissemination of certified documents, regular staff training and evaluation needs to be conducted.

Development and validation of diagnostic algorithms for the laboratory diagnosis of porphyrias.

Porphyrias are rare metabolic disorders of the haem synthesis. They can present with acute neurovisceral attacks, cutaneous symptoms, or a combination of both. As they present with a wide variety of clinical symptoms, diagnosis is often delayed and correct interpretation of porphyria-related tests remains a challenge for many physicians. We developed and validated two algorithms for the laboratory diagnosis of porphyrias based on presenting symptoms. Based on a literature search and clinical/laboratory expertise, we developed algorithms for acute and cutaneous porphyrias. We validated these algorithms using all porphyria related laboratory test requests between January 1st 2000 and September 30th 2020 in UZ Leuven. In addition, we also evaluated our algorithm using samples from the European porphyria network (EPNET) external quality assessment scheme (2010-2021). Sensitivity of the algorithm for acute porphyria was 100.0% [74.9%-100.0%] (13 acute intermittent porphyria (AIP) and 1 variegate porphyria [VP]) with a specificity of 98.5% [91.0%-100.0%] (65 patients). Sensitivity of the algorithm for cutaneous porphyria was 100% [95.1%-100.0%] (7 VP, 59 porphyria cutanea tarda (PCT), 23 erythropoietic protoporphyria (EPP), 2 X-linked erythropoietic protoporphyria [XLEPP]) with a specificity of 93.9% [82.9%-98.5%]. There were no diagnostic samples of other types of porphyria. The algorithms correctly identified 18 of the 19 EPNET porphyria cases. One of the two hereditary coproporphyria cases was missed. The algorithms for acute and cutaneous porphyria showed high sensitivity and specificity and can be used to aid the clinician in correctly interpreting the laboratory findings of porphyria-related tests.

LABORATORY EXAMS IN PREGNANT WOMEN

During prenatal care, professionals should request laboratory tests immediately, seeking to identify cases of viral and/or bacterial infections that bring future complications or are transmitted vertically to the fetus. Reflection study, built in 2022, from reading articles, abstracts and books. It was noticed that routine laboratory tests in prenatal care are of paramount importance and must be requested according to the guidelines protocol in the first consultation.