Background and Objective. Some in vitro diagnostic devices (e.g, blood collection vacuum tubes and syringes for blood analyses) are not validated before the quality laboratory managers decide to start using or to change the brand. Frequently, the laboratory or hospital managers select the vacuum tubes for blood collection based on cost considerations or on relevance of a brand. The aim of this study was to validate two dry K3EDTA vacuum tubes of different brands for routine hematological testing. Methods. Blood specimens from 100 volunteers in two different K3EDTA vacuum tubes were collected by a single, expert phlebotomist. The routine hematological testing was done on Advia 2120i hematology system. The significance of the differences between samples was assessed by paired Student's t-test after checking for normality. The level of statistical significance was set at P < 0.05. Results and Conclusions. Different brand's tubes evaluated can represent a clinically relevant source of variations only on mean platelet volume (MPV) and platelet distribution width (PDW). Basically, our validation will permit the laboratory or hospital managers to select the brand's vacuum tubes validated according to him/her technical or economical reasons for routine hematological tests.

Background

Preanalytical variability, including biological variability and patient preparation, is an important source of variability in laboratory testing. In this study, we assessed whether a regular light meal might bias the results of routine clinical chemistry testing.

Methods

We studied 17 healthy volunteers who consumed light meals containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood for routine clinical chemistry tests before the meal and 1, 2, and 4 hr thereafter.

Results

One hour after the meal, triglycerides (TG), albumin (ALB), uric acid (UA), phosphatase (ALP), Ca, Fe, and Na levels significantly increased, whereas blood urea nitrogen (BUN) and P levels decreased. TG, ALB, Ca, Na, P, and total protein (TP) levels varied significantly. Two hours after the meal, TG, ALB, Ca, Fe, and Na levels remained significantly high, whereas BUN, P, UA, and total bilirubin (BT) levels decreased. Clinically significant variations were recorded for TG, ALB, ALT, Ca, Fe, Na, P, BT, and direct bilirubin (BD) levels. Four hours after the meal, TG, ALB, Ca, Fe, Na, lactate dehydrogenase (LDH), P, Mg, and K levels significantly increased, whereas UA and BT levels decreased. Clinically significant variations were observed for TG, ALB, ALT, Ca, Na, Mg, K, C-reactive protein (CRP), AST, UA, and BT levels.

Conclusions

A significant variation in the clinical chemistry parameters after a regular meal shows that fasting time needs to be carefully considered when performing tests to prevent spurious results and reduce laboratory errors, especially in an emergency setting.

Background.

The various contributors to sport-related anaemia include increased plasma volume, exercise-induced oxidative stress, increased body temperature, acidosis, gastrointestinal bleeding, acute and chronic inflammation as well as compression and damage of red blood cells (RBC) in the capillaries within the contracting muscles. The effective contribution of foot-strike haemolysis is unclear.

Materials and methods.

We studied 18 Caucasian male athletes (mean age, 42 years; range, 34–52 years) before and immediately after a 60-km ultramarathon. Laboratory investigations included the haematological profile along with haptoglobin, potassium, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH) and albumin concentrations and a haemolysis index (HI).

Results.

No significant variations were found in post-exercise values of haemoglobin, RBC count and haematocrit. Mean corpuscular volume and haptoglobin were significantly decreased, whereas RBC distribution width was increased. The concentration of haptoglobin was reduced by approximately 50%, whereas enzyme concentrations were all remarkably increased. The HI remained below 0.5 g/L. After adjusting for plasma volume change, the increases were 1.7% for potassium (P=0.17), 30% for AST (P<0.01), 49% for LDH (P<0.01) and 2.39-fold for CK (P<0.01). A statistically significant association was found between haemoconcentration-adjusted variations of CK and those of AST (r=0.803; P<0.01) and LDH (r=0.551; P=0.02).

Discussion.

This is the first study demonstrating that long-distance running does not induce clinically significant changes in haemoglobin, haematocrit, RBC count or potassium concentration. The significant post-exercise decrease of haptoglobin reflects a certain degree of haemolysis, but the concentration of cell-free haemoglobin remaining below 0.5 g/L and the non-significant variation in RBC count both indicate that the foot-strike haemolysis is very modest or even clinically negligible.

This study evaluated the impact of professional training on serum oxidant and antioxidant status in adolescent endurance athletes and compared it with that of untrained individuals. Firstly, serum thiobarbituric-acid-reactive substances (TBARSs), xanthine oxidase (XO), catalase (CAT), reduced glutathione (GSH), superoxide dismutase (SOD), and total antioxidant capacity (T-AOC) were measured in 67 male runners, cyclists, and untrained adolescents. Seven-day dietary intakes were also assessed. Secondly, for age- and Tanner-stage-matched comparison, 36 out of the 67 subjects (12 for each group) were then selected and investigated. In cyclists, XO, GSH, and CAT were higher as compared with runners and controls. The CAT in runners, but not GSH and XO, was also higher than in controls. TBARS, T-AOC, and SOD did not differ among the study populations. Regarding the inter-individual relationships among serum redox statuses and dietary nutrient intakes, significant correlations were noted in CAT versus carbohydrates, protein, magnesium, and manganese; GSH versus carbohydrates, protein, fat, selenium, zinc, iron, and magnesium; XO versus cholesterol; CAT versus GSH. These findings suggest that the resting blood redox balance in the professional adolescent athletes was well maintained partly by the increase of individual antioxidant in adaptation to chronic exercise.

Doping in sport should be addressed by prevention rather than prosecution

Introduction

Patient-related variables, such as physical exercise, stress and fasting status are important sources of variability in laboratory testing. However, no clear indications about fasting requirements exist for routine haematological tests, nor has the influence of meals been assessed.

Methods

We studied 17 healthy volunteers who consumed a light meal containing a standardized amount of carbohydrates, protein and lipids. Blood was taken for routine haematological tests before the meal and 1, 2 and 4 hours thereafter.

Results

One hour after the meal, neutrophil count and mean corpuscular haemoglobin (MHC) increased significantly, whereas lymphocyte and monocyte counts, red blood cell distribution width, haematocrit, and mean corpuscular volume decreased significantly. A clinically significant variation was only observed for lymphocytes. Two hours after the meal, a significant increase was observed for neutrophils and MCH, whereas lymphocytes, eosinophils, haemoglobin and haematocrit decreased significantly. Clinically significant variations were recorded for lymphocytes, red blood cells (RBC), haemoglobin, haematocrit and MCH. Four hours after the meal MCH was significantly increased, while lymphocytes, eosinophils, RBC, haemoglobin and haematocrit were significantly decreased. Clinically significant variations were recorded for neutrophils, eosinophils, RBC, hematocrit and MCH.

Conclusion

The significant variation of several haematological parameters after a light meal demonstrates that the fasting time needs to be carefully considered in order to interpret the results of haematological tests correctly.

Background

Anaemia in the very elderly is usually dissected to a variety of root causes. The frequency of nutritional anaemias is particularly uncertain, since there is controversy on the real prevalence of folate, vitamin B12 and iron deficiencies, as well as on their potential pathophysiological relationship with anaemia.

Materials and methods

We retrospectively analysed results of haemoglobin, ferritin, folate and vitamin B12 measurements performed on a cohort of unselected subjects over 85 years old who were referred by general practitioners for routine diagnostic check-up to our laboratory over the past 2 years. Furthermore, glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease (MDRD) formula.

Results

The overall prevalence of nutritional deficiencies was low in males (<25%) and very low in females (<15%). Significant differences between anaemic and non-anaemic subjects were observed only for GFR in both males (44±3 versus 67±3 mL/min/1.73m2; p=0.035) and females (42±3 versus 61±3 mL/min/1.73m2; p=0.019). Likewise, a significantly difference in the frequency of anaemic and non-anaemic subjects with values below the conventional thresholds of the parameters tested was observed only for GFR in both males (59 versus 14%; p<0.001) and females (61 versus 41%; p<0.001), and for ferritin in females (15 versus 5%; p<0.001). In multiple linear regression analysis haemoglobin values were significantly associated only with GFR (both in men and women).

Discussion and conclusion

The results of this study suggest that impaired renal function might be the major determinant of anaemia in the very elderly. Accordingly, the cost-effectiveness of screening for nutritional deficiencies in older individuals is doubtful, since it would be associated with substantial expenditure and limited diagnostic efficiency.

Increasing evidence exists that iron overload, a common finding in chronic hepatitis C virus (HCV) infection, plays an important role in the pathophysiology of this disease. The mechanisms by which iron excess induces liver damage along with the benefit of iron depletion via phlebotomy on biochemical and histological outcomes in patients with chronic HCV infection have been discussed in this review. Finally, we focus on the effect of iron reduction on the rate of response to interferon antiviral therapy.

Although essential for cell physiology, an increase or depletion of body iron has harmful effects on health. Apart from iron deficiency anemia and iron overload-related organ tissue damage, there are increasing evidences that body iron status is implicated in atherosclerotic cardiovascular diseases. The hypothesis formulated in 1981 that iron depletion may protect against cardiovascular events is intriguing and has generated a significant debate in the last two decades. Indeed, to study this phenomenon, several investigators have tried to design appropriate experimental and clinical studies and to identify useful biochemical and genetic markers of iron status. The results of the literature on the effect of iron deficiency and overload on vascular health are critically reviewed in this study from a pathogenic and clinical point of view.

Although a number of studies have demonstrated the influence of ABO blood group on plasma levels of von Willebrand factor (VWF), the nature of this association and its clinical importance is still largely unknown.

In this review, the most recent advances in our understanding of the mechanisms by which ABO blood group determines plasma VWF levels and their clinical impact will be discussed.

Von Willebrand disease, the most common hereditary bleeding disorder, arises from quantitative or qualitative defect of von Willebrand factor (VWF). The aim of the treatment is to correct the dual defect of hemostasis caused by the abnormal/reduced VWF and the concomitant deficiency of factor VIII (FVIII). The synthetic vasopressin analogue desmopressin is the mainstay of therapy in about 80% of patients, while nearly 20% are unresponsive and must be treated with FVIII/VWF concentrates. This latter therapeutic option will be focused in the review, with particular consideration to the management of surgery and invasive procedures in these patients.