Serum Tubes Research Articles

Predictors of Blood Culture Positivity in Pediatric Brucellosis.

To investigate the predictors of blood culture positivity in children with brucellosis. Descriptive study. Department of Pediatric Infectious Diseases in Erzurum Regional Training and Research Hospital, Turkey, from January to December 2015. Eighty-six children under 16 years of age, with brucellosis, were retrospectively evaluated. Compatible clinical findings plus presence of positivity at titers of >1:160 in serum and/or Coombs agglutination tests in a single serum sample and/or a minimum fourfold increase within a 2-3 week interval were diagnostic for brucellosis. Only patients with blood cultures were included. Patients' demographical, clinical, and laboratory risk factors, such as age, gender, presence and duration of symptoms, and laboratory characteristics were analysed. Brucella spp. grew in blood cultures of 24 (27.9%) patients. Children with blood culture positivity had shorter symptom duration than those with negative blood cultures (p=0.03). Absence of personal and household histories of brucellosis (p=0.02 and p=0.04, respectively), lower hemoglobin, iron, and vitamin D (p<0.001, p=0.006, and p=0.006, respectively), and higher leukocyte, CRP, and ferritin (p<0.001, p=0.001, and p<0.001, respectively) levels were associated with isolation of Brucella spp. in blood culture. Children with positive blood cultures had higher serum tube and Coombs agglutination test results (p=0.001 and p<0.001). ROC analysis showed that ferritin at a cut-off level of 122 ng/mL (CI 95% 0.86-0.97, p<0.001) and Brucella Coombs agglutination test at a cut-off level of 1/480 (CI 95% 0.84-0.96, p<0.001) were the most sensitive and specific predictors of bacteremia. Serum hemoglobin, iron, ferritin, vitamin D, and C-reactive protein levels, Brucellar tube and Coombs agglutination tests, and leukocyte count could help to predict definitive diagnosis in pediatric brucellosis when molecular techniques are not feasible, such as in source-limited countries.

Impact of total automation consolidating first-line laboratory tests on diagnostic blood loss.

Background Blood loss for laboratory testing may contribute to hospital-acquired anemia. When implementing the core laboratory (core-lab) section, we consolidated first-line tests decreasing the number of tubes previously dispatched to different sites. Here, hypothesized benefits of the amount of blood volume drawn were explored. Methods We retrieved, using a laboratory information system (LIS), the number of tubes received by laboratories interested in the change from all clinical wards in a year-based period, i.e. 2013 for pre-core-lab and 2015 for core-lab system, respectively. Data were expressed as the overall number of tubes sent to laboratories, the corresponding blood volume, and the number of laboratory tests performed, normalized for the number of inpatients. Results After consolidation, the average number of blood tubes per inpatient significantly decreased (12.6 vs. 10.7, p < 0.001). However, intensive care units (ICUs) did not reduce the number of tubes per patient, according to the needs of daily monitoring of their clinical status. The average blood volume sent to laboratories did not vary significantly because serum tubes for core-lab required higher volumes for testing up to 55 analytes in the same transaction. Finally, the number of requested tests per patient during the new osystem slightly decreased (-2.6%). Conclusions Total laboratory automation does not automatically mean reducing iatrogenic blood loss. The new system affected the procedure of blood drawing in clinical wards by significantly reducing the number of handled tubes, producing a benefit in terms of costs, labor and time consumption. Except in ICUs, this also slightly promoted some blood saving. ICUs which engage in phlebotomizing patients daily, did not take advantage from the test consolidation.

Preconceptional factors associated with haemoglobin concentration in early pregnancy: a community-based cohort study in rural northeastern Tanzania.

Maternal anaemia in early pregnancy is associated with poor pregnancy outcomes. Furthermore, preconceptional health can influence the health during pregnancy. The aim of this study was to investigate which preconceptional factors were associated with haemoglobin (Hb) concentration in early pregnancy. In Tanzania, 226 women were followed at preconception and during early pregnancy. Red blood cell (RBC) morphology, serum micronutrient concentration, demographic characteristics and health status were assessed in preconception and in early pregnancy. The association between preconceptional factors and Hb concentration in early pregnancy was investigated using simple and multiple linear regression analyses stratified by preconceptional anaemia status. Mean Hb was 123 and 119g/l before conception and during early pregnancy (median gestational age 53days) respectively. Preconceptional mid-upper arm circumference (MUAC) (adjusted coefficient (AC) 0.35 95% CI 0.9-0.61) and preconceptional Hb concentration (AC 0.45 95% CI 0.36-0.54) were positively associated with early pregnancy Hb concentration, whereas preconceptional microcytic hypochromic RBC morphology (AC -6.00 95% CI -9.56 to -2.44) was negatively associated with early pregnancy Hb concentration. In addition, treatment of preconceptional malaria was positively associated with early pregnancy Hb concentration (AC 6.45 95% CI 0.74-12.2) among women with preconceptional anaemia. In contrast, among preconceptional non-anaemic women, only preconceptional Hb concentration and medium socio-economic status was positively associated with early pregnancy Hb concentration. Mid-upper arm circumference (MUAC) and Hb measurements in preconception can help to detect women at increased risk of low Hb concentration in early pregnancy.

The Effect of Different Blood Drawing Methods on Hemolysis and Test Results from Intravenous Catheters Used in Emergency Departments.

Hemolysis is frequently reported in samples sent from emergency departments. In our study we aimed to compare the influence of invitro hemolysis on test results and hemolysis ratios of different blood drawing techniques (aspiration method and vacuum filling technique) used to draw blood from intravenous (IV) catheters in Emergency Department. Two techniques (aspiration vs. vacuum filling) used to draw blood into three different tubes (Sarstedt S-Monovette® 4.9 mL Serum Gel tube, BD 5 mL Vacutainer® Rapid Serum Tube (RST), and 5 mL Vacutainer® SST™II tube) and evaluated the effect of the hemolysis index of the sera on the tests analyzed. In the emergency department blood was drawn from 128 consecutive patients into Sarstedt S-Monovette® 4.9 mL Serum Gel tubes using aspiration technique and also into BD 5 mL Vacutainer® Rapid Serum Tubes (RST) and 5 mL Vacutainer® SST™II tubes using vacuum filling technique. All the tests requested from the patients were analyzed on all tubes and the hemolysis index of all the tubes were also evaluated. As a result, the percentage of hemolysis encountered in S-Monovette® vs. SST and S-Monovette® vs. RST was 4.41% vs. 14.71% and 0% vs. 18.97%, respectively (p < 0.001, p < 0.001). In addition to this, the mean values of the test results for each assay in S-Monovette® tubes showed a significant difference when compared to RST and SST (p < 0.01). CKMB and LDH test results found in the tubes filled using the aspiration techniques (S-Monovette®) were statistically significantly lower than the results gathered from the tubes filled using vacuum filling technique (Vacutainer® RST and Vacutainer® SST) (p < 0.001). The test results and HI taken from the aspiration method seemed to be more reliable despite the presence of hemolysis.

Evidence of bluetongue and Epizootic Haemorrhagic disease circulation on the island of Mayotte

A cross-sectional study was conducted to explore the epidemiological situation in Mayotte regarding two orbiviruses: Bluetongue virus (BTV) and Epizootic Haemorrhagic Disease virus (EHDV). In all, 385 individual asymptomatic cattle were blood-sampled (one EDTA and one serum tube per animal) between February and June 2016. Antibody (ELISA) and genome prevalence (PCR) was assessed. Almost all the selected cattle showed antibodies against both BTV and EHDV, at 99.5% (CI95% [98.00, 100]) and 96.9% (CI95% [94.5, 98.3]), respectively. Most of the cattle acquired antibodies in their first years of age. EHDV and BTV genomes were detected in 25.2% (CI95% [21.1, 29.8]) and 18.2% (CI95% [14.6, 22.4]) of samples, respectively. Coinfection with BTV and EHDV was observed in 9.4% of samples (CI95% [6.8, 12.7]). Cattle under three years old were more frequently reported as positive for genome detection by PCR than older cattle. Five serotypes of BTV and one serotype of EHDV were identified from eight samples: BTV-4, BTV-9, BTV-11, BTV-15, BTV-19 and EHDV-6, of which some were reported in neighbouring areas. BTV and EHDV both circulate in Mayotte and in its surrounding territories.

Effects of different anticoagulants on glycated albumin quantification.

IntroductionIn the last 20 years glycated albumin (GA) measurement has been demonstrated to be a reliable glycation marker and recently as the most innovative one in western countries. Glycated albumin has been already adopted by some Asian countries due to its usefulness in diabetes screening. The aim of the present study was to investigate for the first time the effects of different anticoagulants on GA assay.Materials and methodsFrom each of 60 patients a serum tube and K3EDTA, Li-Heparin and NaF-EDTA containing tubes were collected. All tubes were from Sarstedt (Verona, Italy). Glycated albumin was measured in duplicate in each sample tube in a single analytical run with quantILab glycated albumin (Instrumentation Laboratory SpA - A Werfen Company, Milan, Italy) on Architect c8000 analyser (Abbott SRL, Rome, Italy). Comparison of GA% in evaluated tubes was made by paired Wilcoxon test.ResultsMedian and interquartile range GA% concentrations were 15.4% (13.2 - 19.1) in serum, 15.7% (13.6 - 19.9) in K3EDTA, 15.6% (13.3 - 19.7) in Li-heparin and 15.5% (13.1 - 19.3) in NaF-EDTA samples, respectively. Glycated albumin mean relative bias respect to serum was within desirable bias derived from biological variation studies (± 2.9%) when K3EDTA (+ 2.8%), Li-heparin (+ 0.9%) or NaF-EDTA (+ 0.1%), were used as anticoagulants.ConclusionsOur results demonstrate that the GA% assay is not affected by relevant interferences when K3EDTA, Li-heparin or NaF-EDTA are used as anticoagulants, so they can be used interchangeably without a relevant impact on the clinical use of the test.

BRUCELLOSIS

Background: Human brucellosis is a zoonotic infectious disease transmitted from domesticated animals to humans. It remains a major public health problem in Saudi Arabia where 7% of the population still maintains a nomadic life style with domestication of animals. Objectives: This study aims to discover the prevalence of brucellosis and Brucella among patients attending a district government hospital in Majmaah, kingdom of Saudi Arabia. Period: 2 years (from 1st February 2016 to 31st January 2018). Design: Cross sectional descriptive. Settings: King Khalid Hospital, Al Majmaah, Saudi Arabia. Materials (Patients) &amp; Methods: Total 1098 serum samples from the patients with clinical suspicion of brucellosis were screened with rapid slide agglutination test (crescent diagnostics Jeddah) for Brucella antibodies and later confirmed by Serum Tube Agglutination Test. Main Outcome Measures: The result of our study showed that the prevalence of brucellosis among patients attending our study is 9.1%. Results: 100 individuals were found to be seropositive with titers ≥1:160. The result of our study showed that the prevalence of brucellosis among patients attending our study is 9.1%The Majority of the patients presented to the medical OPD and orthopedic unit of the hospital. The prevalence of disease in males was found to be higher as compared to females in the current studied group. The age group 21- 40 years, was found to be far more susceptible to this infection. Majority presented with fever and musculoskeletal complaints. The total seroprevalence rate calculated for the patients attending our hospital is 26.50%. Conclusion: Frequent serological surveillance should be carried out in areas that are endemic. Screening of risk groups, imported animals and household members of active brucellosis must be undertaken. This is a crucial epidemiological move allowing for timely diagnosis and control of disease. Limitations: Our prevalence rate represents a specific segment of the population (i.e., those attending the hospital) and not thegeneral population.

Impact of Blood Collection Tubes and Sample Handling Time on Serum and Plasma Metabolome and Lipidome.

Background: Metabolomics is emerging as a valuable tool in clinical science. However, one major challenge in clinical metabolomics is the limited use of standardized guidelines for sample collection and handling. In this study, we conducted a pilot analysis of serum and plasma to determine the effects of processing time and collection tube on the metabolome. Methods: Blood was collected in 3 tubes: Vacutainer serum separator tube (SST, serum), EDTA (plasma) and P100 (plasma) and stored at 4 degrees for 0, 0.5, 1, 2, 4 and 24 h prior to centrifugation. Compounds were extracted using liquid-liquid extraction to obtain a hydrophilic and a hydrophobic fraction and analyzed using liquid chromatography mass spectrometry. Differences among the blood collection tubes and sample processing time were evaluated (ANOVA, Bonferroni FWER ≤ 0.05 and ANOVA, Benjamini Hochberg FDR ≤ 0.1, respectively). Results: Among the serum and plasma tubes 93.5% of compounds overlapped, 382 compounds were unique to serum and one compound was unique to plasma. There were 46, 50 and 86 compounds affected by processing time in SST, EDTA and P100 tubes, respectively, including many lipids. In contrast, 496 hydrophilic and 242 hydrophobic compounds differed by collection tube. Forty-five different chemical classes including alcohols, sugars, amino acids and prenol lipids were affected by the choice of blood collection tube. Conclusion: Our results suggest that the choice of blood collection tube has a significant effect on detected metabolites and their overall abundances. Perhaps surprisingly, variation in sample processing time has less of an effect compared to collection tube; however, a larger sample size is needed to confirm this.

Coenzyme Q10 protects against hyperlipidemia-induced cardiac damage in apolipoprotein E-deficient mice

BackgroundHyperlipidemia is a well-established risk factor for cardiac damage, which can lead to cardiovascular diseases. Many studies have shown that Coenzyme Q10(CoQ10) protects against cardiac damage in vivo. The aim of this study was to investigate the possible protective effects of CoQ10 against cardiac damage in apolipoprotein E-deficient (ApoE−/−) mice.MethodsEight-week-old male C57BL/6 and ApoE−/− mice were randomly divided into four groups: C57BL/6 mice fed a normal diet (C57BL/6 group); C57BL/6 mice fed a normal diet + CoQ10 (C57BL/6 + CoQ10 group); ApoE−/− mice fed a high-fat diet (ApoE−/− HD group), and ApoE−/− mice fed a high-fat diet + CoQ10 (ApoE−/− HD + CoQ10 group). All groups were fed the different diets for 16 weeks. Blood samples were obtained from the inferior vena cava and collected in serum tubes. The samples were then stored at − 80 °C until used. Coronal sections of heart tissues were fixed in 10% formalin and then embedded in paraffin for histological evaluation. The remainder of the heart tissues was snap-frozen in liquid nitrogen for mRNA or immunohistochemical analysis.ResultsThe metabolic parameters such as total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), and triglycerides (TG) levels were lower in ApoE−/−HD + CoQ10 mice than in ApoE−/− HD mice. There were significant pathophysiological changes (H&E, PAS, Masson and CD68 staining) in ApoE−/− mice in the HD group compared with those in the HD + CoQ10 group. CoQ10 reduced HD-induced cardiac tissue damage via autophagy (p62 and LC3), as evidenced by immunoblotting, immunohistochemistry, and RT-qPCR. CoQ10 also inhibited inflammation (IL-6 and TNF-α) gene expression in ApoE−/− mice.ConclusionsThese results indicate that CoQ10 is a potential therapeutic target for cardiac damage caused by hyperlipidemia.

Glucose variation in centrifuged serum and lithium-heparin gel tubes stored for up to 96 hours at room temperature or 4 °C

This study aimed to verify glucose stability within centrifuged serum and lithium-heparin tubes stored at room temperature (RT) or 4 °C. Sixty paired serum (plus gel separator), lithium-heparin (plus gel separator) and K2-EDTA tubes were centrifuged within 30 min from collection. Thirty serum and lithium-heparin tubes were then stored at RT, whilst the other 30 serum and lithium-heparin tubes were kept at 4 °C. Complete cell blood count was performed in serum and plasma after centrifugation, as well as in K2-EDTA paired whole blood tubes. Glucose was measured immediately after centrifugation and 3, 6, 24, 48, 72 and 96 h afterwards. Immeasurable blood cells values were found in serum, whilst residual leukocytes and platelets were present in lithium-heparin plasma. Regardless of storage conditions, glucose concentration decreased 3 h after centrifugation in lithium-heparin tubes, displaying uninterrupted reduction until 96 h. Mean decrease per hour was higher in plasma tubes stored at RT than at 4 °C. Performance specification was exceeded between 6 and 24 h of storage in most plasma tubes. Glucose concentration significantly decreased in serum tubes between 24 and 48 h, regardless of storage conditions. The mean glucose variation never exceeded performance specification throughout the study period. Mean glucose decrease per hour in plasma was not associated with blood cells counts before and after centrifugation, and was probably attributable to the presence of blood cells entrapped within the gel. Delayed glucose measurement in centrifuged serum tubes may be clinically viable up to 96 h, whilst it may be unadvisable in centrifuged lithium-heparin tubes.

Phlebotomy tube interference with nuclear magnetic resonance (NMR) lipoprotein subclass analysis

BackgroundLipoprotein subclass analysis by nuclear magnetic resonance (NMR) can be used in risk assessment of atherosclerotic cardiovascular disease (ASCVD). There is little information in the literature regarding phlebotomy tube interferences with NMR testing. MethodsPooled human serum was exposed to phlebotomy tubes manufactured by Becton Dickinson (BD), Greiner Bio-One, or Sarstedt. Serum was analyzed on the Axinon lipoFIT by NMR assay and by conventional lipid assays performed on a Roche Cobas 8000 system. The effect of incomplete fill volume was also assessed. ResultsAnalytical interference in NMR lipoprotein subclass results was observed across many different tube types. The 5 mL Greiner Bio-One Z Serum Sep Clot Activator tube correlated the best with non-gel containing serum tubes from BD and Greiner Bio-One. BD Serum Separator Tubes (SSTs) displayed strong interferences across several NMR analytes that were enhanced with decreased tube fill volumes. Interferences were also observed with different sizes of Greiner Bio-One Z Serum Sep Clot Activator tubes. Interference was generally not observed with conventional lipid testing, although minor interference was found for some tubes with lipoprotein(a) [Lp(a)]. ConclusionsNMR lipoprotein subclass analysis should be standardized by both tube type and tube size to prevent risk of analytical interference.

Next-generation rapid serum tube technology using prothrombin activator coagulant: fast, high-quality serum from normal samples.

Background Incomplete blood clotting or latent clotting in serum is a common laboratory problem, especially for patients on anticoagulant therapy or when serum tubes are centrifuged before clotting is completed. We describe a novel approach to producing high-quality serum using snake venom prothrombin activator complex (OsPA) as an additive in blood collection tubes for non-anticoagulated (normal) individuals. Methods Plasma clotting assays were performed using a Hyland-Clotek instrument. Blood clotting was visually observed, and thromboelastography was also performed to determine the important parameters of coagulation. Thrombin generation was assayed using the chromogenic substrate S-2238, and biochemical analytes in the serum were determined on chemistry and immunoassay analysers. Fibrinogen was determined by either ELISA or Clauss fibrinogen assay. Results We initially showed that OsPA had strong coagulation activity in clotting not only recalcified citrated plasma and recalcified citrated whole blood, but also fresh whole blood in a clinical setting. The use of TEG clearly showed improved speed of clotting and generation of a firmer clot. We also showed that the use of OsPA to produce serum did not interfere with the determination of commonly measured biochemical analytes. The underlying clotting mechanism involves a burst of thrombin production at the initial stages of the clotting process upon contact with prothrombin in blood. Conclusions These results demonstrate rapid generation of high-quality serum, contributing to faster turnaround times with standardised quality samples, for accurate analyte determinations in normal individuals.

Impact of biological matrix on inflammatory protein biomarker quantification based on targeted mass spectrometry.

Serum and plasma are widely used matrices in biological and clinical studies. To improve reliability and consistency of markers quantification, the influence of these matrices on proteins was evaluated by targeted mass spectrometry. 65 proteins were quantified in matched blood samples collected in serum, ethylenediaminetetraacetic acid and heparin plasma tubes from 40 healthy and 10 pathological individuals. Only 52% of the proteins were not impacted by any of the biological matrices tested, and the effects on quantification of proteins affected was matrix and protein dependent. Matrix comparisons using mass spectrometry is therefore recommended to assess the relevance of using surrogate matrix, performing biomarker discovery study or evaluating the clinical use of biomarkers in large clinical cohorts.

The effects of the conjunctival Brucella vaccine on some biochemical parameters in sheep.

The genus Brucella causes significant economic losses due to infertility, abortion, stillbirth or weak calves, and neonatal mortality in livestock. Brucellosis is still a zoonosis of public health importance worldwide. In the past, vaccination was administered subcutaneously and nowadays, the conjunctival vaccine is administered. There is no definite information about the changes of the biochemical parameters and antibody response after conjunctival vaccination. In this study, the investigation of the changes in the levels of some biochemical parameters due to the conjunctival vaccination for brucellosis was aimed. Thirty sheep were used as an animal material. The vaccine was done single dose against Brucella melitensis and the blood was drawled from Vena jugularis during 4months. Antibody levels were determined by serum tube agglutination test. Alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), glucose, total protein, and albumin levels were measured using commercial autoanalyzer in sera. The antibody titers (p < 0.001) increased significantly at first month compared to the pre-vaccination, but at the second month began to fall. There was no statistically significant changes in glucose, AST, ALT activity after vaccination (p > 0.005). The significant amount of total protein and ALP decreased after vaccination (p < 0.005). LDH levels and total protein levels were significantly increased (p < 0.005). In conclusion, conjunctival vaccine was considered to be used as a safe to protect the sheep from brucellosis and the results of the study may be used to improve the efficiency of brucellosis eradication programs within livestock management.

Thymoquinone reduces cardiac damage caused by hypercholesterolemia in apolipoprotein E-deficient mice

BackgroundHypercholesterolemia is a well-established risk factor for cardiac damage, which can lead to cardiovascular diseases. Many studies have shown that thymoquinone protected rats from doxorubicin-induced cardiotoxicity and cardiac damage. The aim of this study was to investigate the possible protective effects of thymoquinone against cardiac damage in apolipoprotein E knockout (ApoE−/−) mice.MethodsEight-week-old male ApoE−/− mice were randomly divided into three groups: control group fed a normal diet (ND group), a high cholesterol diet (HD group) or HD mixed with thymoquinone (HD + TQ group). All groups were fed the different diets for 8 weeks. Blood samples were obtained from the inferior vena cava and collected in serum tubes. The samples were then stored at − 80 °C until used. Coronal sections of heart tissues were fixed in 10% formalin and then embedded in paraffin for histological evaluation. The remainder of the heart tissues was snap-frozen in liquid nitrogen for mRNA or immunohistochemical analysis.ResultsThe metabolic characteristics of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-c), and high-sensitivity C-reactive protein (hs-CRP) were lower in ApoE−/−HD + TQ mice than in ApoE−/− HD mice. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) gene and protein expression was lower in the heart tissue of ApoE−/−HD + TQ mice than in those of ApoE−/−HD mice. Furthermore, the levels of macrophages and pro-inflammatory cytokines were lower in the cardiac tissues of ApoE−/−HD + TQ mice than in those of ApoE−/−HD mice.ConclusionsThese results indicate that thymoquinone may provide a potential therapeutic target for cardiac damage caused by hypercholesterolemia.

Validation of an Enclosed Blood Collection System in a Pediatric Laboratory.

Preanalytical, analytical, and postanalytical issues are often magnified in pediatric laboratories, and traditional vacuum-based blood tubes can contribute to some of these issues. Because of this, we investigated adopting an enclosed blood collection system that can perform vacuum or gentle aspiration blood collection, eliminating syringes, transfer device, and transfer steps, as well as potentially minimizing preanalytical error in the pediatric laboratory. We embarked on a validation of this tube system, in comparison with our current collection tubes, across most in-house tests at a large pediatric hospital. Twenty adult volunteers were recruited. Blood was drawn into lithium heparin, serum, EDTA, and citrate tubes of each commercial tube type for comparison. For some tests, remnant blood from pediatric syringe draws was used when available. Samples were then processed and analyzed across all general areas of the clinical laboratory, and correlations of the results from the 2 tube systems were performed. Across 95 tests in the core laboratory and blood bank, almost all demonstrated clinically acceptable comparisons, with most R values >0.90. Only 3 of 95 tests demonstrated clinically significant differences between the tube systems. Our validation of the enclosed blood collection system demonstrated acceptable results when compared with our current collection tubes. Additionally, with some minor modifications, our automated instruments could utilize ultralow-volume tubes from the enclosed blood collection system for direct tube sampling, which is impossible using our current small-volume tubes with our main chemistry analyzer.

Impact of blood cell counts and volumes on glucose concentration in uncentrifuged serum and lithium-heparin blood tubes.

Although it is known that glucose concentration exhibits a time-dependent decay in uncentrifuged serum and lithium-heparin blood tubes, no evidence exists on how this variation may depend on blood cell counts (CBC) and volumes. Venous blood was drawn from 30 non fasting healthy volunteers into three serum and three lithium-heparin tubes. One serum and lithium-heparin tubes were centrifuged within 15 min after collection and glucose was measured with a hexokinase assay. The second and third serum and lithium-heparin tubes were maintained at room temperature for 1 and 2 h after the first tubes were centrifuged. These other tubes were then centrifuged and glucose was measured. CBC was performed in the first lithium-heparin tube, before centrifugation. The mean decrease of glucose was higher in lithium-heparin plasma than in serum (0.33 vs. 0.24 mmol/L/h; p<0.001). Glucose concentration decreased by 7% and 5% per hour in lithium-heparin plasma and serum, respectively. In univariate analysis, the absolute decrease of glucose concentration was associated with sex (higher in men than in women), red blood cell (RBC) count, hematocrit, white blood cell (WBC) count, neutrophils and monocytes in both lithium-heparin plasma and serum. In multivariate analysis, the decrease of glucose concentration remained independently associated with RBC, WBC, neutrophils and monocytes in both sample matrices. No significant association was found with platelet number and erythrocyte or platelet volume. Glucose concentration decrease in uncentrifuged lithium-heparin and serum tubes depends on the baseline number of RBC, WBC, neutrophils and monocytes within the tubes.

A case report of spontaneous abortion caused by Brucella melitensis biovar 3

BackgroundBrucellosis is a worldwide zoonotic disease caused by Brucella spp. Brucella invades the body through the skin mucosa, digestive tract, and respiratory tract. However, only a few studies on human spontaneous abortion attributable to Brucella have been reported. In this work, the patient living in Shanxi Province in China who had suffered a spontaneous abortion was underwent pathogen detection and Brucella melitensis biovar 3 was identified.Case presentationThe patient in this study was 22 years old. On July 16, 2015, she was admitted to Shanxi Grand Hospital, Shanxi Province, China because of one day of vaginal bleeding and three days of abdominal distension accompanied by fever after five months of amenorrhea. A serum tube agglutination test for brucellosis and blood culture were positive. At the time of discharge, she was prescribed oral doxycycline (100 mg/dose, twice a day) and rifampicin (600 mg/dose, once daily) for 6 weeks as recommended by the World Health Organization (WHO). No recurrence was observed during the six months of follow-up after the cessation of antibiotic treatment.ConclusionsThis is the first reported case of miscarriage resulting from Brucella melitensis biovar 3 isolated from a pregnant woman who was infected through unpasteurized milk in China. Brucellosis infection was overlooked in the Maternity Hospital because of physician unawareness. Early recognition and prompt treatment of brucellosis infection are crucial for a successful outcome in pregnancy.

Order of draw practices in venous blood sampling at clinical biochemistry departments in the Danish health care system

BackgroundDeviation in blood collection procedures is a central source of preanalytical variation affecting overall analytical and diagnostic precision. The order of draw of venous sampling is suspected to affect analytical results, in particular for coagulation analysis. Here we compare the procedures in venous blood sampling among clinical biochemistry departments to assess the uniformity of order of blood draw and adherence to international guidelines in the Danish health care system. MethodsWe collected venous order of draw procedures from 49 clinical biochemistry departments at 22 public hospitals in Denmark. Procedures were compared to the international guidelines fromthe Clinical Laboratory Standards Institute (CLSI) and World Health Organization (WHO), and assessed in relation to department ISO 15189:2012 accreditation. ResultsWe observed seven different order of draw procedures related to citrate, serum, heparin, and EDTA tubes, and the use of discard tubes in relation to coagulation assays. 31 departments (63.3%) were found to adhere to CLSI and WHO guidelines. A majority of departments instructs the use of discard tubes before collection for coagulation assays in citrate tubes (44 departments; 89.8%). The citrate tube was the first sample tube to be drawn for most departments (35 departments; 75.5%); and the preferred order of non-citrate tubes was serum-heparin-EDTA (36 departments; 73.5%). Adherence to the CLSI and WHO guidelines was not associated with department ISO 15189:2012 accreditation (p = .57). ConclusionsVenous order of draw procedures is diverse at Danish clinical biochemistry departments and show moderate adherence to international guidelines.

The effect of vitamin C and/or E supplementations on type 2 diabetic adult males under metformin treatment: A single-blinded randomized controlled clinical trial

Background and aimRecently, there has been an increasing interest in the influence of antioxidant vitamins on the efficacy of oral hypoglycemic therapy in type 2 diabetic patients (T2DM). This single-blinded randomized controlled clinical trial aimed to investigate the effect of vitamin C and/or E supplementation on the efficacy of oral hypoglycemic therapy in T2DM Palestinian male patients from the Gaza Strip. MethodsForty T2DM male patients aged 40–60 years on metformin treatment were randomly divided into four groups, each group received an additional one of the following daily oral supplements for 90 days: placebo; vitamin C; vitamin E and vitamin C plus vitamin E. After overnight fasting, venous blood specimens were collected from all individuals into K3-EDTA tubes and serum tubes for measuring the biochemical and hematological parameters of the study at baseline and after 90 days of vitamins supplementation. ResultsThe results revealed that vitamin C and/or E improve fasting blood sugar (FBS), HbA1c, lipid profile, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), reduced glutathione (GSH); and Quantitative Insulin Sensitivity Check Index (QISCI) compared with diabetic patients group that received placebo. ConclusionThis study provided additional evidence on the beneficial effects of supplementing antioxidant vitamins in T2DM which could improve the clinical condition and attenuate or prevent diabetic pathogenesis and complications that, secondly to poor glycemic control, could attribute to the imbalance between the decline in the endogenous antioxidants and increasing production of the reactive oxygen species leading to the oxidant-mediated damage present in the diabetic context.