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BC: Articoli scritti da R. Guerranti

Sicurezza del paziente e rischio clinico nel processo ematologico di laboratorio
Patient safety and clinical risk in the clinical laboratory haematological process
<p>&nbsp;Patient safety, defined as the prevention of harm to patients, is the ultimate goal for medical laboratories. Risk management principles should therefore be considered an integral part of laboratory processes, especially of those activities directly impacting on patient care. This work aims to identify the most critical phases of haematological process and the risk reduction actions that improve patient safety. Risk analysis of the laboratory haematological process was carried out through Failure Mode, Effects and Analysis Criticality methodology. A form including the phases of the process, error modes and their possible effects, errors occurrence, detectability and severity scores and risk index (RI), has been prepared and sent to eight Italian laboratories. A multidisciplinary team performed the analysis in each laboratory, then two team leaders of the project comprehensively analysed the collected data. The process was divided in 8 phases (medical prescription, request acceptance, sample collection, transportation, reception and processing, results reporting and validation), 25 activities (17 pre-analytical, 4 intra-analytical, 4 post-analytical) and 43 failure modes. RI, calculated for each activity, ranged from 11 to 33. The most critical topics (RI &gt;25) were: patient identification, peripheral blood smear review, interpretative comments and report validation. Staff training plays a central role in the entire laboratory haematological process and in the phases identified as critical. An effective management related to the attainment and maintenance of skills represents the best action in order to reduce risks of adverse events for patients. The promotion of procedures aimed to harmonize the interpretative comments and peripheral blood smear review is also pivotal</p><p>&nbsp;</p>
Biochimica Clinica ; 42(4) 300-312
Contributi Scientifici - Scientific Paper
 
Ruolo del laboratorio nella valutazione di un donatore di organi con sospetta emofilia A
Role of the laboratory in the evaluation of an organ donor with reported haemophilia A
<p>The case concerns a 82-year-old patient, organ donor, affected by diabetes mellitus, hypertension and reported type A haemophilia, showing a traumatic severe cerebral haemorrhage. The Medical Committee started the donor evaluation process: the liver was compatible for a recipient in life-threatening conditions. Although the first level coagulation tests were within the normal range, the Regional Center for Organ and Tissue Allocation of the Tuscany Region - Italy requested further investigations in order to clarify the reported diagnosis of haemophilia and to exclude the presence of a specific FVIII inhibitor. FVII activity was evaluated to assess the protein synthesis of the liver, and FVIII for suspected haemophilia; both of them were normal. Considering the importance of the diagnosis, the parallelisms of both FVII and FVIII were performed; the tests were negative for the presence of inhibitors. Second-level tests therefore rejected the diagnosis of haemophilia and excluded the presence of a specific inhibitor of FVIII. The absence of coagulative alterations allowed the liver explant, which was successfully transplanted on a 59-year-old male recipient.</p>
Biochimica Clinica ; 42(3) e37-e39
Casi clinici - Case report
 
La gestione del rischio clinico in medicina di laboratorio: risultati del questionario congiunto SIBioC-Medicina di Laboratorio e Società Italiana di Ergonomia (SIE) inviato ai laboratori della Regione Toscana
Misidentification in laboratory medicine: results of the Tuscany survey of the Clinical Risk Management Study Group SIBioC and the Italian Society of Ergonomy (SIE)
<p>In the year 2016 the Study Group on Clinical Risk Management of the SIBioC-Laboratory Medicine Society issued a joint survey with the Italian Society of Ergonomics (SIE); the survey was sent to all the clinical laboratories of the Tuscany Region in Italy. This survey had the aim to understand the level of awareness of the clinical laboratory about the clinical risk management, particularly in the patient misidentification field. The results show a very variable consciousness of the problem among different laboratories, with a very multi-faced approach to this important topic. More than the 93% of the participants state that the errors on misidentification are always registered and in the 80% the consequent actions are tracked.</p>
Biochimica Clinica ; 42(2) 141-145
Contributi Scientifici - Scientific papers
 
Echinocitosi associata a diminuita espressione della banda 3 eritrocitaria in un bambino con epilessia idiopatica
Echinocytosis and decreased expression of erythrocyte band 3 in a child with idiopathic epilepsy: a case report
<p>Echinocytosis (EC) is a morphologic change of the erythrocytes usually linked to electrolyte exchange abnormalities, energy depletion and cell dehydration. Herein, we report a case of a child presenting with complex partial epilepsy, consistent peripheral EC, mild unexplained microcitemia and a significantly decreased expression of band 3. No pathogenic mutations were found on the band 3 encoding gene, i.e., solute carrier family 4 (anion exchanger), member 1 (SLC4A1). The observed changes in band 3 expression likely originated at the transcriptional and/or post-transcriptional level. To date, band 3 is considered as a key protein in several neurodevelopmental diseases. The described modifications probably explain the observed clinical phenotype. The likelihood that an alteration in band 3 function could contribute to an erythrocyte morphological abnormality and neurological symptoms represents a fascinating and intriguing hypothesis.</p>
Biochimica Clinica ; 40(4) e27-e30
Casi clinici - Case report
 
La stima dell'incertezza delle misure nel laboratorio clinico
Measurement uncertainty calculation in clinical laboratories
<p>The result of a measurement is only an estimate of&nbsp;the value of the measurand and it is complete only when accompanied by a statement of the measurement uncertainty.&nbsp;The ISO 15189 standard requires that &ldquo;the laboratory shall determine measurement uncertainty for each measurement&nbsp;procedure&rdquo;. The approach to calculate the measurement uncertainty proposed by the &ldquo;Guide to the expression of&nbsp;uncertainty in measurement&rdquo; (GUM) requires the quantification of every source of variability to sum them up for the&nbsp;final calculation (&ldquo;bottom-up&rdquo; approach). To overcome inherent difficulties in the systematic application of this approach&nbsp;in a clinical laboratory, a &quot;top-down&quot; approach is proposed, through the calculation of measurement uncertainty from&nbsp;already existing data of IQC. The proposed approach is checked by applying it to the IQC data for serum glucose and&nbsp;creatinine measurements collected from 19 clinical laboratories. Different approaches to cope with the issue of the&nbsp;estimate of systematic error (bias) are proposed, based either on value-assigned trueness control/reference materials,&nbsp;on the mean value of the employed material defined by the laboratory at the start of the IQC program or on the peer&nbsp;group mean of an interlaboratory program material. The availability of a standardized way to estimate the measurement&nbsp;uncertainty provides a tool to evaluate the analytical quality of results and it allows comparison of the quality of results&nbsp;made available by different laboratories.</p>
Biochimica Clinica ; 39(2) 108-115
Contributi scientifici - Scientific Papers