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BC: Articoli scritti da D. Debbia

Una paziente con dolori ossei diffusi: il ruolo del laboratorio nel diagnosticarne la causa
A female patient with diffuse bone pain: the role of the clinical laboratory in the diagnostic process
D. Debbia  |  P. Natali  |  L. Ferrara  |  M. Varani  |  G. Longo  |  T. Trenti  | 
<p>Multiple myeloma (MM) represents 10% of all hematologic malignancies; in 15% of MM the monoclonal component consists of only free light chains. A 53 year-old patient performs at the Corelab laboratory (AOU-AUSL Modena) blood tests for bone pain. Serum electrophoresis shows hypogammaglobulinemia (5,5 g/L). The laboratory professional decides to carry on further studies: a serum immunofixation that highlighted the presence of kappa free light chains not traceable to any heavy chain and the measure of the serum free light chains (sFLC) with the following results: FLC-&kappa; 26 777 mg/L (i.r. 3.3-19.4); FLC-&lambda; 6.15 mg/L (i.r. 5.7-26.3); ratio FLC (rFLC), 435.31 (i.r. 0.26-1.65). The light chain MM is a type of MM difficult to recognize. The laboratory professional&#39;s own initiative defines a procedure of &quot;personalized medicine&quot; oriented to to the patient&#39;s needs. The expertise of the laboratory professional is crucial in assuring the patient the best outcome when carried out on the basis of the available guidelines.</p>
Biochimica Clinica ; 43(4) e35-e36
Casi Clinici - Case Report
 
Sensibilità al glutine: il test di attivazione dei basofili (BAT) può aiutare nella diagnosi differenziale?
Gluten hypersensitivity: basophil activation test (BAT) may help in the differential diagnosis
T. Scacchetti  |  D. Debbia  |  E. Boni  |  T. Trenti  | 
<p>Gluten hypersensitivity: basophil activation test (BAT) may help in the differential diagnosis? The main forms&nbsp;of gluten-related disorders are wheat allergy (WA), celiac disease (CD) and possibly immune-mediated disease&nbsp;(gluten sensitivity). S-IgE play an essential role in WA. For CD tests available are anti-tissue transglutaminase (tTG)&nbsp;IgA, anti-endomysium (EMA) and deamidated gliadin peptides (DGP) antibodies IgG particular. For other immunemediated&nbsp;diseases there is currently no test available. The usefulness of basophil activation test (BAT) in anaphylactic&nbsp;adverse reactions, late-onset allergy has been demonstrated. We report the case of a woman of 46 years old with&nbsp;disorders of wheat tied overt clinical signs, intestinal and extra-intestinal symptoms, whose tests above were all&nbsp;negative. Only the BAT showed a stimulation of basophils exposed (52.9%) to extract wheat. We diagnosed gluten&nbsp;sensitivity (GS) on the basis of an algorithm for the differential diagnosis of gluten-related disorders, including CD,&nbsp;GS and WA. We believe that the BAT confirms a hypersensitivity reaction to wheat not-IgE-mediated, not CD.</p>
Biochimica Clinica ; 40(4) e31-e34
Casi clinici - Case report
 
Confronto tra un metodo nefelometrico ed un metodo turbidimetrico per la determinazione delle catene leggere libere sieriche: punti di forza e criticità
Comparison between a turbidimetric and a nephelometric method for the measurement of serum free light chains: strengths and weaknesses
<p>Background: monoclonal gammopathies include a broad spectrum of pathologies, and free light chains (FLC) measurement is recommended by guidelines for the diagnosis, follow up and prognosis of plasma cell dyscrasia. The aim of the study is to compare the measurement of FLC performed with two different analytical platforms, a nephelometer and a turbidimeter, in order to assess the analytical and diagnostic agreement.<br />Methods: 87 consecutive samples received by the laboratory with a request of FLC measurement were analyzed on nephelometer Immage 800 (Beckman Coulter, USA) and turbidimeter Optilite (The Binding Site, UK), using the same antibodies (Freelite, The Binding Site, UK).<br />Results: by applying the Passing-Bablok regression and the Bland-Altman analysis, a proportional and constant systematic error but non-significant bias for FLC ratio (rFLC) has been observed. By applying the Weighted Cohen&rsquo;s Kappa (WK) test to the rFLC values, an excellent diagnostic agreement between the two instruments has been shown, considering both the normal range (0.26 &ndash; 1.65) (WK=0.87) and the diagnostic range for multiple myeloma (&lt;0.01 or &gt;100) (WK=0.84).<br />Conclusions: Although there are statistical differences between the measurements performed by the two instruments, these do not affect the diagnostic agreement, that is excellent. Nevertheless, the turbidimeter is provided with a software that can automatically detect the antigen excess; by diluting further the samples automatically, it performs fewer dilutions than the nephelometer and provides a wider range of measurement, especially for low concentrations. These characteristics assist the operator both during the analysis and the validation phases of the results, saving time and resources. On the basis of the results of the study, it can be concluded that the turbidimeter shows better performances compared to the nephelometer.</p>
Biochimica Clinica ; 17(1)
Contributi Scientifici - Scientific Papers