Quality in the extra-analytical phases of urinalysis

The chemical, physical and morphologic urine examination has undergone radical changes over the last few years, so that the time has come for introducing further changes and modifications in various steps of this important test. The breakthroughs of new technologies have allowed making the laboratory report much more informative for the stakeholders. Nevertheless, important considerations for improving the quality throughout the testing process were also raised, especially in the preanalytical phase. Currently, it might be advisable to pursue consolidation and standardization of the analytical phase, as well as redefinition of clinical targets through construction of a complete, integrated and much more clinically meaningful report. This article aims to review the state of the art in urinalysis, as well as providing useful information for achieving more standardization and quality of this useful diagnostic test

Quality in the extra-analytical phases of urinalysis

The chemical, physical and morphologic urine examination has undergone radical changes over the last few years, so that the time has come for introducing further changes and modifications in various steps of this important test. The breakthroughs of new technologies have allowed making the laboratory report much more informative for the stakeholders. Nevertheless, important considerations for improving the quality throughout the testing process were also raised, especially in the preanalytical phase. Currently, it might be advisable to pursue consolidation and standardization of the analytical phase, as well as redefinition of clinical targets through construction of a complete, integrated and much more clinically meaningful report. This article aims to review the state of the art in urinalysis, as well as providing useful information for achieving more standardization and quality of this useful diagnostic test

Development of a preanalytical errors recording software

Uvod: Iako je doprinos laboratorijskoj dijagnostici od integralne važnosti u procesu donošenja kliničkih odluka, kvaliteta rada i sigurnost tijekom dijagnostičkih analiza od ključnog su značaja za unaprjeđenje zdravstvene zaštite koja je na visokom stupnju što se kvalitete i sigurnosti tiče. Unatoč izvanrednom napretku u kvaliteti cjelokupnog procesa laboratorijske analize, prijeanalitička varijabilnost predstavlja vodeći izvor pogrešaka i nesigurnosti. Uvođenje sistematične politike bilježenja prijeanalitičkih pogrešaka uvelike bi poboljšala definiranje ključnih aktivnosti tog procesa, planiranje i praćenje učinkovitih radnji s ciljem poboljšanja cjelokupnog procesa. U ovom članku želimo dati opis kompjuterskog programa razvijenog za bilježenje prijeanalitičkih pogrešaka u našem laboratoriju. Materijali i metode: Naš smo program razvili na temelju Microsoftovog programa Access. Glavna polja uključena u program obuhvaćala su brojač za progresivno brojanje uzoraka, datum primitka uzorka, identifikacijski broj uzorka, ime bolesnika, tip pretrage, odjel s kojeg je bolesnik upućen, matriks uzorka, tip nesukladnosti, radnja koja je poduzeta kako bi se riješio problem, drugo polje za moguće radnje koje su dodatno poduzete, identifikacijski broj operatera. Baza podataka nalazi se na središnjem računalu unutar našeg laboratorijskog informatičkog sistema, tako da se do nje može doći s bilo kojeg računala u laboratoriju, što omogućuje kontinuirani i standardizirani unos podataka. Rezultati i rasprava: Uvođenje kompjuterskog programa za sistematično bilježenje prijeanalitičkih pogrešaka donosi velika poboljšanja, kao što su harmonizacija protokola za bilježenje incidenata, jednostavnost digitalnog bilježenja, eliminaciju rukom pisanih izvješća, uključivanje mjera učinkovitosti ključnih segmenata laboratorijskog rada, jednostavna prilagodba korisniku (laboratoriju), korištenje tablica s podacima za opsežne statističke analize, poboljšano pretraživanje i obrada podataka kao i poboljšana izrada statističkih izvješća.Background: Although the contribution of laboratory diagnostics is integral to the clinical decision making, quality and safety in diagnostic testing are essential to furthering the goal of high-quality and safe healthcare. Despite remarkable advances in the quality of the total testing process, the preanalytical variability is the leading source of errors and uncertainty. As such, the implementation of a systematic policy for recording preanalytical errors would grant major benefits for identifying critical activities of this process, planning and monitoring effective actions for improvement. The aim of this article is to describe the software developed for the recording of preanalytical errors in our laboratory. Materials and methods: We have developed error recording software based on Microsoft Access. The main fields included in the software comprehend a numerator for progressive enumeration of the samples, the date of receipt of the specimen, the Sample ID, the patient\u27s name, the type of request, the referring ward, sample matrix, the type of non-conformity, the action undertaken to solve the problem, a second field for possible additional actions undertaken, and the operator ID. The database is stored on a common repository in our laboratory information system, so that it can be accessed by any computer in the laboratory, allowing continuous and standardized input of the data. Results and discussion: The implementation of a software for systematical recording of preanalytical errors grants major benefits, including harmonization of incident reporting practices, simplicity of digital recording, elimination of handwritten reports, inclusion of validated measures of laboratory performance, handily customization, exportation on worksheets for comprehensive statistical analyses, improved data searching and processing, as well as production of improved statistical reports

Development of a preanalytical errors recording software

Uvod: Iako je doprinos laboratorijskoj dijagnostici od integralne važnosti u procesu donošenja kliničkih odluka, kvaliteta rada i sigurnost tijekom dijagnostičkih analiza od ključnog su značaja za unaprjeđenje zdravstvene zaštite koja je na visokom stupnju što se kvalitete i sigurnosti tiče. Unatoč izvanrednom napretku u kvaliteti cjelokupnog procesa laboratorijske analize, prijeanalitička varijabilnost predstavlja vodeći izvor pogrešaka i nesigurnosti. Uvođenje sistematične politike bilježenja prijeanalitičkih pogrešaka uvelike bi poboljšala definiranje ključnih aktivnosti tog procesa, planiranje i praćenje učinkovitih radnji s ciljem poboljšanja cjelokupnog procesa. U ovom članku želimo dati opis kompjuterskog programa razvijenog za bilježenje prijeanalitičkih pogrešaka u našem laboratoriju. Materijali i metode: Naš smo program razvili na temelju Microsoftovog programa Access. Glavna polja uključena u program obuhvaćala su brojač za progresivno brojanje uzoraka, datum primitka uzorka, identifikacijski broj uzorka, ime bolesnika, tip pretrage, odjel s kojeg je bolesnik upućen, matriks uzorka, tip nesukladnosti, radnja koja je poduzeta kako bi se riješio problem, drugo polje za moguće radnje koje su dodatno poduzete, identifikacijski broj operatera. Baza podataka nalazi se na središnjem računalu unutar našeg laboratorijskog informatičkog sistema, tako da se do nje može doći s bilo kojeg računala u laboratoriju, što omogućuje kontinuirani i standardizirani unos podataka. Rezultati i rasprava: Uvođenje kompjuterskog programa za sistematično bilježenje prijeanalitičkih pogrešaka donosi velika poboljšanja, kao što su harmonizacija protokola za bilježenje incidenata, jednostavnost digitalnog bilježenja, eliminaciju rukom pisanih izvješća, uključivanje mjera učinkovitosti ključnih segmenata laboratorijskog rada, jednostavna prilagodba korisniku (laboratoriju), korištenje tablica s podacima za opsežne statističke analize, poboljšano pretraživanje i obrada podataka kao i poboljšana izrada statističkih izvješća.Background: Although the contribution of laboratory diagnostics is integral to the clinical decision making, quality and safety in diagnostic testing are essential to furthering the goal of high-quality and safe healthcare. Despite remarkable advances in the quality of the total testing process, the preanalytical variability is the leading source of errors and uncertainty. As such, the implementation of a systematic policy for recording preanalytical errors would grant major benefits for identifying critical activities of this process, planning and monitoring effective actions for improvement. The aim of this article is to describe the software developed for the recording of preanalytical errors in our laboratory. Materials and methods: We have developed error recording software based on Microsoft Access. The main fields included in the software comprehend a numerator for progressive enumeration of the samples, the date of receipt of the specimen, the Sample ID, the patient\u27s name, the type of request, the referring ward, sample matrix, the type of non-conformity, the action undertaken to solve the problem, a second field for possible additional actions undertaken, and the operator ID. The database is stored on a common repository in our laboratory information system, so that it can be accessed by any computer in the laboratory, allowing continuous and standardized input of the data. Results and discussion: The implementation of a software for systematical recording of preanalytical errors grants major benefits, including harmonization of incident reporting practices, simplicity of digital recording, elimination of handwritten reports, inclusion of validated measures of laboratory performance, handily customization, exportation on worksheets for comprehensive statistical analyses, improved data searching and processing, as well as production of improved statistical reports

Cylindruria

The morphological analysis of urine sediment is an essential part of urinalysis and casts are important elements of urinary sediment. Their shape is typically cylindrical, with extremities often rounded. Casts form within the renal tubules and are made of Tamm-Horsfall glycoprotein (THG). Under some physiological or pathological conditions THG fibrils aggregate giving rise to casts, whose formation is favoured by a number of factors including high urine osmolality and/or low pH. Casts can be found in normal subjects, in non-renal conditions, such as fever, dehydration, and acute heart failure as well as in virtually all renal diseases. Casts can be classified on the basis of their morphology as hyaline, granular, waxy, fatty, cellular (leukocytic, erythrocytic, epithelial), containing crystals or microorganisms, pigmented and mixed. As the correct identification of casts is crucial for an accurate and timely diagnosis of renal disorders, laboratory professionals should be trained to identify and classify casts properly

An unusual case of a spurious, transfusion-acquired haemoglobin S

An unusual case of a spurious, transfusion-acquired haemoglobin S

Casual identification of severe gastric atrophy with macrocytosis complicated by acute coronary syndrome.

Chronic atrophic gastritis (CAG) and gastric cancer are leading causes of morbidity and mortality worldwide. Serum pepsinogens have been used as biomarkers of gastric mucosa status, including gastric inflammation, so that they might be useful for detection of gastric atrophy or gastric neoplasm at an early stage. Serum pepsinogen 1 and pepsinogen 2 concentrations are known to increase in the presence of Helicobacter pylori-related non-atrophic chronic gastritis, and the eradication of this pathogen is associated with a significant decrease in their values. We describe here the case of an asymptomatic 60 years old man, with a casual serological diagnosis of severe gastric atrophy, macrocytosis and severe complications, culminating in an acute coronary syndrome. This case report raises some important considerations, such as the fact that CAG could not be correctly and early diagnosed and that it may be misleadingly regarded as a rare condition, whereas its prevalence is conversely largely underestimated. This may lead to severe complications that may include gastric malabsorption and vitamin B 12 deficiency, along with gastrointestinal, neurologic, psychiatric, cardiovascular, cerebral and peripheral vascular disorders

Identificazione casuale di atrofia gastrica severa con macrocitosi complicata da sindrome coronarica acuta

Chronic atrophic gastritis (CAG) and gastric cancer are leading causes of morbidity and mortality worldwide. Serum pepsinogens have been used as biomarkers of gastric mucosa status, including gastric inflammation, so that they might be useful for detection of gastric atrophy or gastric neoplasm at an early stage. Serum pepsinogen 1 and pepsinogen 2 concentrations are known to increase in the presence of Helicobacter pylori-related non-atrophic chronic gastritis, and the eradication of this pathogen is associated with a significant decrease in their values. We describe here the case of an asymptomatic 60 years old man, with a casual serological diagnosis of severe gastric atrophy, macrocytosis and severe complications, culminating in an acute coronary syndrome. This case report raises some important considerations, such as the fact that CAG could not be correctly and early diagnosed and that it may be misleadingly regarded as a rare condition, whereas its prevalence is conversely largely underestimated. This may lead to severe complications that may include gastric malabsorption and vitamin B12deficiency, along with gastrointestinal, neurologic, psychiatric, cardiovascular, cerebral and peripheral vascular disorders

The Sleeping Remnant. Effect of Roux-En-Y Gastric Bypass on Plasma Levels of Gastric Biomarkers in Morbidly Obese Women: A Prospective Longitudinal Study

Background: Morpho-functional modifications of the gastric remnant after Roux-en-Y gastric bypass (RYGB) have not been completely defined, due to its inaccessibility for bioptic mapping. The aim of the study is to evaluate such modifications using Gastropanel®, a non-invasive blood test cross-checking four gastric biomarkers, able to provide a snapshot of mucosa conditions. Subjects and Methods: Twenty-four women undergoing RYGB were prospectively enrolled. Gastropanel® parameters (pepsinogens, Gastrin-17 and immunoglobulins against Helicobacter pylori), biometrical/clinical data were collected preoperatively and at 6-months follow-up. Results: All parameters showed significant reduction (p < 0.05). Pepsinogen I reduction correlated with BMI percent decrease. Conclusions: The exclusion of food transit is responsible for significant drop in gastric output, hardly representing a risk factor in the remnant carcinogenesis, being unexposed to alimentary carcinogenic agents