Laboratorio Of Biochimica Clinica

Bolzano, Italy

Laboratorio Of Biochimica Clinica

Bolzano, Italy
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Lippi G.,U.O. di Diagnostica Ematochimica | Caputo M.,Laboratorio Of Patologia Clinica | Banfi G.,University of Milan | Daves M.,Laboratorio Of Biochimica Clinica | And 8 more authors.
Rivista Italiana della Medicina di Laboratorio | Year: 2011

The presence of haemolysis in a biological blood sample is mainly a result of haemolytic anaemia or haemolysis in vitro. Another cause may be inappropriate handling at the time of collection and processing of the sample, and this may affect the reliability of the test results. Haemolysis is assessed by quantification of free haemoglobin, whose limit is 20 mg/l in plasma and 50 mg/l in serum. Haemolysis can be observed visually when the concentration of free haemoglobin exceeds 300 mg/l. Since haemolysis is the most frequent reason for a biological sample to be considered unsuitable for processing in the clinical laboratory, with a prevalence approaching 3% of all samples received, these consensus recommendations have been drafted specifically to assist laboratory professionals in the detection and management of haemolysed specimens. The recommended approach can be summarized as follows: (1) systematic detection and quantification of haemolysis by visual inspection and subsequent quantification of the haemolysis index in all samples with visually detectable haemolysis; (2) immediate notification to the referring department of the presence of haemolysis in the sample, as locally determined; (3) suspension of all tests affected by the presence and/or the degree of haemolysis detected; and (4) timely request for a second sample to allow the tests previously suspended to be performed. © SIBioC-SIMeL.


Lippi G.,U.O. Diagnostica Ematochimica | Mattiuzzi C.,Servizio Governance Clinica | Banfi G.,University of Milan | Buttarello M.,Laboratorio Analisi | And 11 more authors.
Biochimica Clinica | Year: 2013

The collection of venous blood is central in clinical laboratory activity. Although there is widespread perception that this practice is simple and free of complications and side effects, it is undeniable that the vast majority of laboratory errors arises from ignorance, incompetence or negligence during venipuncture. It has hence become advisable to prepare a document in simplified form of checklist, consisting of a concise but comprehensive list of activities to be completed or verified in order to prevent errors during venous blood collection. In the intention of authors, this synthetic checklist is a modular tool, adaptable to different local contexts, it can be easily and gradually implemented, it is supported by scientific evidence and consensus of experts and created with the support of different healthcare professionals and it is adherent to the best practices and requires minimal resources for implementation. It is reasonable to assume that this checklist may be able to withstand system and individual changes, strengthening the standards for safety of both operators and patients, limiting potential failure patterns. We hope that the checklist may be implemented in all healthcare facilities where routine venous blood collection is performed, after adaptation to suit characteristics of local organization.


Lippi G.,UO Diagnostica Ematochimica | Mattiuzzi C.,Servizio Governance Clinica | Banfi G.,University of Milan | Buttarello M.,Laboratorio Analisi | And 11 more authors.
Rivista Italiana della Medicina di Laboratorio | Year: 2013

Summary: The collection of venous blood is essential to obtain biological samples for performance of laboratory testing. Although there is widespread perception that this practice is simple and free of complications and side effects, it is undeniable that the vast majority of laboratory errors arises from ignorance, incompetence or negligence during venipuncture. It has hence become advisable to edit a document in simplified form of checklist, consisting of a concise but comprehensive list of activities to complete or verify, in order to prevent the onset of errors during venous blood collection. In the intention of authors and of the Italian societies of laboratory medicine, this synthetic checklist is a modular tool, adaptable to different local contexts, it can be easily and gradually implemented, is supported by scientific evidence and consensus of experts, has been created with the support of different healthcare professionals, is adherent to the best practices and requires minimal resources for implementation. It is reasonable to assume that this checklist may be able to withstand system and individual changes, strengthening the standards for safety of both operators and patients, limiting potential failure patterns. We also hope that the checklist may be implemented in all healthcare facilities where routine venous blood collection is performed, after adaptation to suit characteristics of local organization. © 2013 Springer-Verlag Italia. Parole chiave: Emolisi ChecklistCampioni non idoneiVariabilità preanalitica Prelievo venoso Raccomandazioni.


Lippi G.,U.O. Diagnostica Ematochimica | Caputo M.,Laboratorio Of Patologia Clinica | Banfi G.,University of Milan | Daves M.,Laboratorio Of Biochimica Clinica | And 8 more authors.
Biochimica Clinica | Year: 2011

The presence of hemolysis in a biological blood sample is mainly caused by hemolytic anemia or hemolysis in vitro. The latter is caused by inappropriate collection and processing of biological samples, which may affect the reliability of test results. Hemolysis is assessed by free hemoglobin quantification, whose limit is 0.02 g/L in plasma and 0.05 g/L in serum, and visually observed when the concentration of free hemoglobin exceeds 0.30 g/L. Since hemolysis is the most frequent cause of unsuitable biological samples in clinical laboratories, with a prevalence approaching 3% of all received samples, these recommendations have been drafted specifically to assist laboratory professionals in detection and management of hemolysed specimens. In summary, the recommended approach is based on: (i) systematic detection and quantification of hemolysis, by visual inspection and subsequent quantification of the hemolysis index on all samples with visually detectable hemolysis; (ii) immediate notification to the referring department of the presence of hemolysis in the sample, as locally determined; (iii) suppression of all results affected by the presence and/or degree of hemolysis; and (iv) timely request of a second sample, on which the previously deleted tests can be performed.


Daves M.,Laboratorio Of Biochimica Clinica | Salvagno G.L.,University of Verona | Cemin R.,Ospedale Regionale di Bolzano | Gelati M.,University of Verona | And 3 more authors.
Clinical Laboratory | Year: 2012

Background: Reliable information on the potential bias arising from processing in vitro hemolysis specimens referred for conventional cardiac biomarker testing is scarce and controversial as yet. The present investigation was designed to assess the influence of low levels of in vitro hemolysis on cardiac biomarker testing. Methods: Three aliquots, prepared by serial dilutions of homologous hemolysed samples collected from 14 different subjects and containing final concentrations of plasma hemoglobin of 0, 0.3, and 0.6 g/L were tested for the following parameters: cardiac troponin I (cTnI) and T (cTnT), myoglobin (Myo), creatine kinase isoenzyme-MB (CK-MB), brain natriuretic peptide (BNP) and NT-prohormone-brain natriuretic peptide (NT-pro BNP). Results: No statistically significant differences were observed in any of the parameters tested nor did the bias achieve clinical significance. Conclusions: The results of this study show that moderate hemolysis, as low as 0.6 g/L, has no influence on the reliability of cardiac biomarker testing.


Daves M.,Laboratorio Of Biochimica Clinica | Bonaguri C.,U.O. di Diagnostica Ematochimica | Scala S.,Laboratorio Of Biochimica Clinica | Cosio G.,Laboratorio Of Biochimica Clinica | And 3 more authors.
Rivista Italiana della Medicina di Laboratorio | Year: 2012

Background: The detection of antinuclear antibodies (ANA) by indirect immunofluorescence assay (IFA) on HEp-2 cells is a fundamental step in the diagnosis of autoimmune diseases. We report the case of five patients that, on IFA for detection ANA (Nova Lite™ HEp-2, Inova Diagnostics), presented an unusual cytoplasmatic pattern. Methods: Serum samples belonging to 5 patients (3 women and 2 men, age 45-69 years). All the samples were analysed with ELISA for detection of antiextractable nuclear antigens (ENA) (anti-Sm, RNP, SSA/Ro, SSB/La, Scl-701 and anti-Jo-1) (ENA Screen, Inova Diagnostics). ANA detection was performed also with IFA using HEp-2 cells from different manufacturers (MBL and Alphadia). Furthermore we performed the detection of anti-mitochondrial antibodies, antismooth muscle antibodies, anti-gastric parietal cell antibodies, anti-liver/kidney microsomal and anti-liver cytosol antibodies on IFA on rat tissue (Inova Diagnostics), and the detection of anti-Sm, RNP, SSA/Ro, SSB/La, Scl-70, Jo-1, PM/Scl, Ku, Cenp-A/B, PCNA, LKM-1, Lc-1, SLA, F-actin and AMA-M2 with Dot Blot (Alphadia). Results: Four patients showed a nuclear speckled pattern at 1:80 dilution, while the fifth patient was negative (<1:80), but all of them showed a cytoplasmic pattern with a round-shaped body of relatively large dimension in about one third of the cells. Detection of all other autoantibodies assayed was negative. Conclusions: We contacted the clinicians of these five patients to obtaine clinical information. Two patients had no definite clinical diagnosis; one was affected by chronic gastritis and one was affected by duodenal ulcer; both the latter patients were in therapy with protonic pump inhibitors. The fifth patient suffered of hypothyroidism and was treated with substitutive therapy. © 2012 Springer-Verlag Italia.


Daves M.,Laboratorio Of Biochimica Clinica | Cemin R.,Ospedale Regionale di Bolzano | Jani E.,Laboratorio Of Biochimica Clinica | Sacco G.,Pronto Soccorso e Astanteria | Lippi G.,Ospedale Universitario Of Parma
Rivista Italiana della Medicina di Laboratorio | Year: 2014

Laboratory testing significantly contributes to the clinical decision making, and the number of tests that a modern clinical laboratory can now perform is considerable. The impact of Laboratory Medicine in Cardiology has substantially evolved and increased over the past years. The cardiac troponin I and T (cTnI and cTnT) are universally regarded as the reference biomarkers for detection of myocardial injury and, understandably, for the diagnosis of myocardial infarction. Novel immunoassays for measurement of cTns have been recently introduced, which are characterized by a considerable improvement of analytical sensitivity and lower imprecision at low concentrations of the proteins. This assays, defined as last generation or high-sensitivity, allow to detect cTn concentrations that were virtually undetectable with the previous methods. On the one hand this has remarkably improved the diagnostic sensitivity for diagnosing myocardial infarction but, on the other, this has reduced the diagnostic specificity. A potential solution of this problem entails diagnostic algorithm based on the serial evaluation of these biomarkers, although the crucial issue still remains the appropriateness of the request. In conclusion, as often occurred in Laboratory Medicine, the leading problem with the use of highly-sensitivity cTn assays is the inappropriateness of ordering and interpretation of test results, and not the biomarker in itself. © Springer-Verlag 2014.


PubMed | Laboratorio Of Biochimica Clinica
Type: Journal Article | Journal: Clinical laboratory | Year: 2012

Reliable information on the potential bias arising from processing in vitro hemolysis specimens referred for conventional cardiac biomarker testing is scarce and controversial as yet. The present investigation was designed to assess the influence of low levels of in vitro hemolysis on cardiac biomarker testing.Three aliquots, prepared by serial dilutions of homologous hemolysed samples collected from 14 different subjects and containing final concentrations of plasma hemoglobin of 0, 0.3, and 0.6 g/L were tested for the following parameters: cardiac troponin I (cTnI) and T (cTnT), myoglobin (Myo), creatine kinase isoenzyme-MB (CK-MB), brain natriuretic peptide (BNP) and NT-prohormone-brain natriuretic peptide (NT-pro BNP).No statistically significant differences were observed in any of the parameters tested nor did the bias achieve clinical significance.The results of this study show that moderate hemolysis, as low as 0.6 g/L, has no influence on the reliability of cardiac biomarker testing.

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