Maria Stella Graziani

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Martina Zaninotto

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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
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Marcello Ciaccio Italy
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Philippe Gillery France
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BC: Articoli scritti da R.M. Dorizzi

Siero o plasma? Un quesito non nuovo che attende risposte nuove
Serum or plasma? An old question awaiting for new answers.
<p>There is a continual debate on what type of sample a clinical laboratory should use. While serum is still considered the gold standard and remains the required sample matrix for some assays, laboratories must consider turn-around time, which is an important metric for laboratory performance and, more importantly, plays a critical role in patient care. In addition, a body of evidence emphasize the choice of plasma samples in order to prevent modifications of some measurands due to the coagulation process and related interferences. Advantages and disadvantages of serum and plasma are discussed on the basis of current literature and evidence. In addition, data are provided on the current utilization of the matrix (serum or plasma) in Italy and in other Countries. Finally, a rational for a possible shift from serum to plasma is provided.</p>
Biochimica Clinica ; 43(2) 178-186
Documenti - Documents
La procalcitonina in terapia intensiva: dubbi che rimangono?
Procalcitonin in intensive care: unresolved doubts
<p>Procalcitonin (PCT), a test marketed by some twenty years, is available virtually on all the platforms present in clinical laboratories of any size, even if its precise role is still debated. PCT is requested especially by intensive care units (ICU) and it has been included in algorithms to guide the administration of antibiotics (AB). However, several reports concluded that, despite a theoretical physio-pathological basis, there is no unambiguous evidence that the inclusion of PCT in algorithms is effective to guide AB treatment. In 2012 the Cochrane Collaboration concluded that &ldquo;Further high-quality research is needed to confirm the safety of this approach in intensive care. Moreover, future studies should also establish cost-effectiveness by considering country-specific costs of procalcitonin measurement and potential savings in consumption of antibiotics and other healthcare resources, as well as secondary cost savings due to lower risk of side effects and reduced antimicrobial resistance&rdquo;. In 2015, the National Institute for Clinical Heath Excellence concluded that the test is promising but there is still insufficient evidence to recommend its use to guide the AB treatment of sepsis in ICU. Recently, in a paper published in the Clinical Chemistry journal among the limiting factors preventing widespread use of PCT in sepsis and antibiotic stewardship it was included: the limited availability (and high cost) of PCT, the reluctance showed by clinicians to deescalate antibiotics based on PCT results and the uncertainty about the generalizability of previous studies results. The duration of therapy generally tends to be longer compared to what was recommended by guidelines, and PCT-guided antibiotic discontinuation may be of little benefit in hospitals where duration of therapy is already optimized.</p>
Biochimica Clinica ; 42(2) 146-151
Opinioni - Opinions
Varianti rare dell’emoglobina: la nostra esperienza con gli analizzatori Sysmex di ematologia
Rare hemoglobin variants: our experience with Sysmex hematology analyzers
<p>The consolidation of laboratory activities optimizes resources and improves the expertise of the staff that encounters more frequently rare and exceptional cases. In the recent months, the Romagna Greater Area Laboratory, which provides a diagnostic service for over a million inhabitants in North Italy, detected an unusual instrumental alarm in a few routine blood counts. Further investigations demonstrated the presence in the samples of hemoglobin (Hb) variants, characterized with subsequent molecular analysis as Hb Leiden and Hb G-Ferrara. These Hb variants reduce the fluorescence signal hampering the differential leukocyte count carried out by the Sysmex XE2100 hematology analyzer. In all the investigated cases, irregular contracted red blood cells (RBC) and target RBC were present. HPLC analysis of the two Hb variants shows Hb Leiden and Hb G-Ferrara peaks at 4.28 min and 3.23 min of elution time, respectively. It is clinically important to identify carriers of these variants in specific clinical setting, since heterozygotes for these Hb variants are asymptomatic, but complications could be induced by drug therapies, viral infection or heterozygosity for b-thalassemia or other Hb variants. Our findings demonstrate the importance to investigate samples with low fluorescence when assayed using Sysmex analyzers. Finally, the reported cases confirm the effectiveness of tight integration between huge routine workload and specialized competence for the detection of unusual clinical conditions.</p>
Biochimica Clinica ; 40(4) 334-337
Contributi scientifici - Scientific Papers