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Maria Stella Graziani

Deputy Director
Martina Zaninotto

Associate Editors
Ferruccio Ceriotti
Davide Giavarina
Bruna Lo Sasso
Giampaolo Merlini
Martina Montagnana
Andrea Mosca
Paola Pezzati
Rossella Tomaiuolo
Matteo Vidali

International Advisory Board Khosrow Adeli Canada
Sergio Bernardini Italy
Marcello Ciaccio Italy
Eleftherios Diamandis Canada
Philippe Gillery France
Kjell Grankvist Sweden
Hans Jacobs The Netherlands
Eric Kilpatrick UK
Magdalena Krintus Poland
Giuseppe Lippi Italy
Mario Plebani Italy
Sverre Sandberg Norway
Ana-Maria Simundic Croatia
Tommaso Trenti Italy
Cas Weykamp The Netherlands
Maria Willrich USA
Paul Yip Canada

Biomedia srl
Via L. Temolo 4, 20126 Milano

Responsible Editor
Giuseppe Agosta

Editorial Secretary
Andrea di Bello
Biomedia srl
Via L. Temolo 4, 20126 Milano
Tel. 0245498282


ISSN print: 0393 – 0564
ISSN digital: 0392- 7091

BC: Articoli scritti da C. Crespi

Il calcolo del kappa index come valida alternativa alla determinazione delle bande oligoclonali nell’iter diagnostico dei pazienti con sclerosi multipla
The Kappa Index as a valid alternative to oligoclonal bands determination in the diagnostic process of patients with multiple sclerosis
<p>Introduction: the role of the kappa free light chains (KFLC) index in the diagnostic workup of multiple sclerosis (MS) is still a matter of debate.<br />Methods: 667 subjects from three reference laboratories have been enrolled, including 181 MS patients and 486 controls with other immune-mediated or non-inflammatory disorders. Serum and cerebrospinal fluid KFLC index, serum and cerebrospinal fluid albumin and IgG concentrations were measured on BNII nephelometer (Siemens Healthineers. Marburg. Germany), while oligoclonal bands (OCB) were detected by isoelettrofocusing on Hydrasys system (Sebia. Bagno a Ripoli. Italia).<br />Results: KFLC index was higher in MS than in controls [median (interquartile range - IQR) 76.56 (35.05) versus 17.99 (2,34), p &lt;0.001]. A cut-off of 5.0 resulted in 93.9% (min-max 82.6-96.0) sensitivity and 77.4% (70.3-80.3) specificity, with positive and negative predictive values of 60.7% (41.4-69.3) and 97.2% (93.6-98.0), respectively. OCB assessment yielded 94.6% (87.9-96.5) sensitivity and 91.4% (86.6-94.8) specificity, with positive and negative predictive values of 87.5% (78.6-92.0) and 96.4 (93.6-98.0), respectively. The three laboratories showed similar results, making it possible to adopt common thresholds. The relatively low specificity of KFLC may be related to the characteristics of the control population, in particular to the percentage of subjects with inflammatory conditions associated with intratechal immunoreactivity.<br />Conclusions: an algorithm for the diagnostic management of MS could be suggested based on the KFLC index as screening test, followed by the detection of OCB, in case of a positive result. Future studies are needed to evaluate possible relationships between KFLC index, as a quantitative variable, and other clinical features of MS, such as severity of the disease and prognostic scores.</p>
Biochimica Clinica ; 45(1) 044-051
Contributi Scientifici - Scientific Papers
Assenza di bande monoclonali liquorali e positività del rispettivo indice siero-liquor: una discrepanza da indagare attenatamente
Absence of liquoral monoclonal bands and positivity of the respective serum-liquor index: an unespected findings to be carefully investigated
<p>A 13 year-old child whit headache, nausea and repeated episodes of vomiting was hospitalized at the Major Hospital of Charity of Novara. A lumbar puncture and biochemical investigations on cerebrospinal fluid (CSF) including oligoclonal bands (OCB) screen were performed. Kappa and Lambda free light chains (kFLC and &lambda;FLC) and IgG concentrations were measured in serum and CSF by nephelometry. OCB were evaluated by isoelectric focusing (IEF) followed by immunofixation (IMF). A negative IgG index, no OCB IgG (type I pattern), positive kFLC index with increased levels of kFLC (0.14 mg/dL) and &lambda;FLC (0.14 mg/dl in CSF) were found. The FLC data suggested an intrathecal synthesis. A CSF IMF was then performed using anti-IgM peroxidase together with the IgM index using Reiber&rsquo;s hyperbolyc graphic. The presence of a monoclonal IgM band and 76% of intrathecal IgM synthesis was demonstrated. A subsequent molecular biology investigation was performed on CSF and revealed a clear positivity for enterovirus.</p>
Biochimica Clinica ; 44(4) e34-e36
Casi Clinici - Case Report
Individuazione e identificazione di una nuova variante emoglobinica durante la quantificazione dell’emoglobina glicata
Incidental detection of a new hemoglobin beta variant performing HbA1c measurement
<p>Incidental detection of a new hemoglobin beta variant performing HbA1c measurement. Hemoglobin &alpha; and &beta; chain variants can be incidentally detected during the glycated hemoglobin (HbA1c) determination. A 58-year-old female was investigated for HbA1c with Tera 3 Capillarys system (CE, Sebia). Quantification of HbA1c was invalidated by the presence of a double peak in the HbA0 zone. Standard high performance liquid chromatography (HPLC), performed with VARIANT IITM Analyzer (Biorad), did not separate the variant from Hb A0. &beta;-globin gene sequencing showed a heterozygous variation of nucleotide sequence HBB: c.376C&gt;A; beta 125 (H3) Pro&gt;Thr. The new variant, called Hb-Novara, was found also in the daughter of the proband, associated with an alpha-talassemic trait. The hemoglobin stability tests of both subjects were normal. A combination of different technologies (such as HPLC and CE) can be useful in the detection of new hemoglobin variants. Although Hb-Novara seems to be asymptomatic, it could produce relevant hematological phenotypes when associated with &alpha; or &beta; chain defects</p><p>&nbsp;</p>
Biochimica Clinica ; 42(4) e56-e58
Casi clinici - Case Report