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BC: Articoli scritti da P. Natali

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 ; 44(2) 149-156
Contributi Scientifici - Scientific Papers
 
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
 
La riorganizzazione del settore dedicato alla diagnostica proteica: un esempio virtuoso fondato su criteri di Evidence Based Laboratory Medicine e di sostenibilità economica
The organization of the protein unit: a beneficial example founded on evidence based laboratory medicine criteria and on the appropriate use of the available resources
P. Natali  |  T. Trenti  | 
<p>The sustainability of the National Health Service is a current subject of debate&nbsp; due to the pressure that the changes in our societies are having on health systems. Reviewing diagnostic processes is increasingly urgent to contain costs and to maintain the quality of the health services provided.The Evidence Based Laboratory Medicine (EBLM) approach allows to identify and eliminate obsolete methods, replacing them with more adequate ones. The EBLM approach can also provide higher diagnostic accuracy, a rationalisation of diagnostic pathways, a reduction of turnaround-time and a decrease of costs. To reach these objectives, a careful analysis of production processes and assessment of the costs are both necessary. The EBLM approach has been applied to the Protein Unit of Laboratory of Modena. The change in the workflow of the Bence Jones protein determination and the consolidation of the measurement of a number of serum proteins on clinical chemistry analysers allowed a better diagnostic accuracy coupled to important economical savings. The savings made it possible to extend the availability of the free light chains measurements (that before was restricted to patients admitted to the haematology department) to the out-patients of the Province of Modena. The EBLM approach is the most effective way to reach such objectives: really, providing better quality performance does not necessarily correspond to an increase of costs. In addition to developing an adequate level of scientific expertise, the laboratory professional must acquire managerial skills to introduce up-to-date diagnostic methods and to optimize the use of assigned resources, in all areas of laboratory medicine.</p><p>&nbsp;</p>
Biochimica Clinica ; 43(1) 044-051
Contributi Scientifici - Scientific Paper
 
Accuratezza dell’immunonefelometria come metodo di screening per la determinazione della proteinuria di Bence Jones
Accuracy of immunonephelometry as a screening method for Bence Jones proteinuria
<p>The Bence Jones protein (BJP) is an important biomarker for the identification and management of patients with plasma cell dyscrasia. The recommended method for BJP detection is the immunofixation, which is a time consuming and expensive procedure. The aim of the study was to evaluate immunonephelometry (INA) as a screening method for the identification of urine samples negative for BJP and to compare it to a simplified immunofixation method (uIFE-3). First morning urine samples were collected from 1000 consecutive patients and analyzed by INA. Samples with free light chain concentrations &gt;10 mg/L and &gt;5 mg/L were considered positive. All samples were further analyzed by uIFE-3 using 3 antisera (anti-GAM, -&kappa; and -&lambda;). The INA results (at both cut-off levels) were compared with the uIFE-3, showing a poor accuracy due to the high number of false positives and false negatives. Consequently, INA resulted unable to accurately screen BJP.</p>
Biochimica Clinica ; 41(2) 148-153
Contributi scientifici - Scientific papers