Evaluating the Performance of the Sysmex DI-60 Automated Cell Image Analyzer for the Differential Analysis of Leukocytes

Background@#The Sysmex DI-60 system (Sysmex, Japan) is an automated cell image analyzer. This study aimed to evaluate the performance of the DI-60 system for the differential analysis of leukocytes. @*Methods@#A total of 220 samples were analyzed in this study. The agreement between DI-60 pre-classification and manual verification by experts was determined. The correlation between the differential leukocyte counts obtained using the DI-60 system and those manually obtained in the peripheral blood smears were determined. @*Results@#The pre-classification agreement of DI-60 was 91.0%. The correlation coefficients of normal five-part differentials were 0.9163 (segmented neutrophils), 0.9017 (lymphocytes), 0.8533 (monocytes), 0.8345 (eosinophils), and 0.3505 (basophils). The sensitivity, specificity, positive predictive value, negative predictive value, and the efficiency of counting the abnormal cells, including blasts, promyelocytes, myelocytes, metamyelocytes, lymphocyte variants, and erythroblasts, were determined. The efficiency of the DI-60 system in counting the blasts, promyelocytes, myelocytes, metamyelocytes, lymphocyte variants, and erythroblasts was 99.5%, 100.0%, 95.9%, 96.5%, 98.6%, 100.0%, and 95.9%, respectively. @*Conclusions@#The pre-classification agreement of DI-60 was higher than that of previous studies. The correlation between the differential leukocyte counts obtained with the DI-60 system and those of manual counting was acceptable. The performance of DI-60 as a screening tool in clinical laboratories may be good; however, it is yet to replace manual slide review.

Weak D Testing is not Required for D− Patients With C−E− Phenotype

BACKGROUND: Although testing to detect weak D antigens using the antihuman globulin reagent is not required for D− patients in many countries, it is routinely performed in Korea. However, weak D testing can be omitted in D− patients with a C−E− phenotype as this indicates complete deletion of the RHD gene, except in rare cases. We designed a new algorithm for weak D testing, which consisted of RhCE phenotyping followed by weak D testing in C+ or E+ samples, and compared it with the current algorithm with respect to time and cost-effectiveness. METHODS: In this retrospective study, 74,889 test results from January to July 2017 in a tertiary hospital in Korea were analyzed. Agreement between the current and proposed algorithms was evaluated, and total number of tests, time required for testing, and test costs were compared. With both algorithms, RHD genotyping was conducted for samples that were C+ or E+ and negative for weak D testing. RESULTS: The algorithms showed perfect agreement (agreement=100%; κ=1.00). By applying the proposed algorithm, 29.56% (115/389 tests/yr) of tests could be omitted, time required for testing could be reduced by 36% (8,672/24,084 min/yr), and the test cost could be reduced by 16.53% (536.11/3,241.08 USD/yr). CONCLUSIONS: Our algorithm omitting weak D testing in D− patients with C−E− phenotype may be a cost-effective testing strategy in Korea.

Performance Evaluation of the Preanalytic Module of the ACL TOP 750 Hemostasis Lab System

No abstract available.

Eosinophilic Meningitis after Bovine Graft Duraplasty for Arnold-Chiari Malformation Type 1 in a 33-year-old Man

Cases of pediatric eosinophilic meningitis following duraplasty with a bovine graft have been reported. These patients recovered following the surgical removal of the dural graft or steroid therapy. Decompression for Chiari malformation is a common procedure in both pediatric and adult neurosurgery. We describe the case of a 33-yr-old male patient with eosinophilic meningitis following Chiari decompression via bovine graft duraplasty. Cerebrospinal fluid (CSF) study showed 49 red blood cells/μL and 129 leukocytes/μL with 17% eosinophils. There was no evidence of infectious disease. To our knowledge, this is the first report of adult eosinophilic meningitis after bovine graft duraplasty in Korea.

Multiple Brain Abscesses Caused by Nocardia asiatica in a Patient With Systemic Lupus Erythematosus: The First Case Report and Literature Review

No abstract available.

Analysis of Blood Culture Data at a Tertiary University Hospital, 2006-2015 / 대한임상미생물학회지

BACKGROUND: Cumulative blood culture data provide clinicians with important information in the selection of empiric therapy for blood stream infections. METHODS: We retrospectively analyzed blood culture data from a university hospital during the period from 2006 to 2015. Only the initial isolates of a given species for each patient were included. RESULTS: The number of blood cultures per 1,000 inpatient-days increased from 64 in 2006 to 117 in 2015. The ratio of significant pathogens to total isolates was 0.56-0.63. The most common organisms were Escherichia coli in 2006-2010 but changed to coagulase-negative staphylococci (CoNS) in 2011. The proportion of Staphylococci aureus was decreased during the study period, but Klebsiella pneumoniae was increased. Enterococci were increased, especially E. faecium, which was more frequently isolated than E. faecalis in 2015. Pseudomonas aeruginosa was decreased during the study, but Acinetobacter baumannii was increased. The prevalence of methicillin-resistant S. aureus (MRSA) changed from 62.2% to 53.9%, while vancomycin-resistant E. faecium increased to 35.8%. Extended-spectrum beta-lactamase (ESBL)-producing E. coli and K. pneumoniae increased to 25% and 34%, respectively, in 2015. Starting in 2008, three E. coli and 11 K. pneumoniae isolates were carbapenem-resistant Enterobacteriaceae (CRE), and three were carbapenemase-producing Enterobacteriaceae (CPE). The prevalence of imipenem-resistant A. baumannii rapidly increased during the study period. CONCLUSION: About 60% of all blood isolates were significant pathogens. The most common isolates changed from E. coli to CoNS in 2011. ESBL-producing E. coli and K. pneumoniae, vancomycin-resistant E. faecium, and imipenem-resistant A. baumannii were increased during the study, while the proportion of MRSA tended to decrease slightly. Of the total isolates, 14 were CRE, and 3 were CPE.

Bone Marrow Oxalosis in a Patient With Pancytopenia Following Bilateral Nephrectomy

No abstract available.

The Prognostic Value of Serum Levels of Heart-Type Fatty Acid Binding Protein and High Sensitivity C-Reactive Protein in Patients With Increased Levels of Amino-Terminal Pro-B Type Natriuretic Peptide

BACKGROUND: Amino-terminal pro-B type natriuretic peptide (NT-proBNP) is a well-established prognostic factor in heart failure (HF). However, numerous causes may lead to elevations in NT-proBNP, and thus, an increased NT-proBNP level alone is not sufficient to predict outcome. The aim of this study was to evaluate the utility of two acute response markers, high sensitivity C-reactive protein (hsCRP) and heart-type fatty acid binding protein (H-FABP), in patients with an increased NT-proBNP level. METHODS: The 278 patients were classified into three groups by etiology: 1) acute coronary syndrome (ACS) (n=62), 2) non-ACS cardiac disease (n=156), and 3) infectious disease (n=60). Survival was determined on day 1, 7, 14, 21, 28, 60, 90, 120, and 150 after enrollment. RESULTS: H-FABP (P<0.001), NT-proBNP (P=0.006), hsCRP (P<0.001) levels, and survival (P<0.001) were significantly different in the three disease groups. Patients were divided into three classes by using receiver operating characteristic curves for NT-proBNP, H-FABP, and hsCRP. Patients with elevated NT-proBNP (≥3,856 pg/mL) and H-FABP (≥8.8 ng/mL) levels were associated with higher hazard ratio for mortality (5.15 in NT-proBNP and 3.25 in H-FABP). Area under the receiver operating characteristic curve analysis showed H-FABP was a better predictor of 60-day mortality than NT-proBNP. CONCLUSIONS: The combined measurement of H-FABP with NT-proBNP provides a highly reliable means of short-term mortality prediction for patients hospitalized for ACS, non-ACS cardiac disease, or infectious disease.

Massive Transfusion Protocols for Pediatric Patients

The number of massive transfusions for pediatric patients has risen owing to the increasing number of complex surgeries and trauma centers. However, as there are only a few studies on pediatric massive transfusion, adult massive transfusion protocols are used for pediatric patients in many hospitals and institutions. Although massive transfusion protocols would improve the outcomes and reduce the received blood products during transfusion, pediatric patients differ from adults in the tolerability to transfusion, incidence of coagulopathy, and mechanisms of injuries. Therefore clinical physicians have requested for a pediatric massive transfusion protocol. Herein, we reviewed pediatric massive transfusion protocols that have been used in various clinical settings. To date, only a few single-center studies with a small number of pediatric patients have been performed. Even though these studies did not show improvement in outcomes such as mortality and side effects, they reported a short preparation time for fresh frozen plasma products and a low coagulopathy rate in pediatric massive transfusion groups. Therefore, large, prospective, multicenter studies are needed to identify the empiric ratio of blood products for improving outcomes of pediatric patients who need massive transfusion.

Screening PCR Versus Sanger Sequencing: Detection of CALR Mutations in Patients With Thrombocytosis

BACKGROUND: Mutations in calreticulin (CALR) have been reported to be key markers in the molecular diagnosis of myeloid proliferative neoplasms. In most previous reports, CALR mutations were analyzed by using Sanger sequencing. Here, we report a new, rapid, and convenient system for screening CALR mutations without sequencing. METHODS: Eighty-three bone marrow samples were obtained from 81 patients with thrombocytosis. PCR primers were designed to detect wild-type CALR (product: 357 bp) and CALR with type 1 (product: 302 bp) and type 2 mutations (product: 272 bp) in one reaction. The results were confirmed by Sanger sequencing and compared with results from fragment analysis. RESULTS: The minimum detection limit of the screening PCR was 10 ng for type 1, 1 ng for type 2, and 0.1 ng for cases with both mutations. CALR type 1 and type 2 mutants were detected with screening PCR with a maximal analytical sensitivity of 3.2% and <0.8%, respectively. The screening PCR detected 94.1% (16/17) of mutation cases and showed concordant results with sequencing in the cases of type 1 and type 2 mutations. Sanger sequencing identified one novel mutation (c.1123_1132delinsTGC). Compared with sequencing, the screening PCR showed 94.1% sensitivity, 100.0% specificity, 100.0% positive predictive value, and 98.5% negative predictive value. Compared with fragment analysis, the screening PCR presented 88.9% sensitivity and 100.0% specificity. CONCLUSIONS: This screening PCR is a rapid, sensitive, and cost-effective method for the detection of major CALR mutations.

Unexpected Antibody Screening Tests Including Di(a) in Patients with a History of Multiple Packed Red Cell Transfusion / 대한수혈학회지

BACKGROUND: The Di(a) antigen has been detected with a relatively higher incidence among Koreans with a frequency of 6.4 to 14.5%. In South Korea, commonly used unexpected antibody screening panels do not include Di(a) antigen positive cells. We screened patients who previously received multiple packed red cell transfusion using two cells without Di(a) antigen and three cells including Di(a) antigen to evaluate the effectiveness of three screening cells. METHODS: A total of 307 patients who had received packed red cell transfusion more than three times during the last 6 months in our hospital were enrolled. They were employed for unexpected antibody screening test using two sets of screening cells not including Di(a) antigen and three sets including Di(a) antigen by LISS/Coombs gel card. RESULTS: Among 307 patients, 12 were positive using two cells and 15 were positive using three cells. Three patients showed discordant result and one of them was positive for the cell including Di(a) antigen (0.33%). Antibody identification was performed using the panel which does not include Di(a) antigen and it was negative for all of the antigens listed on the panel so that the presence of anti-Di(a) was suspected. CONCLUSION: It can be difficult to use three cells including Di(a) antigen for all patients due to cost, however, use of three cells is recommended in patients with multiple transfusion history.

Evaluation of AutoLab Rapid Plasma Reagin and AutoLab Treponema pallidum Latex Agglutination for Syphilis Infection Testing / 임상검사와정도관리

BACKGROUND: Automated assays have recently been developed for efficient serological testing of syphilis infection. Here, we evaluate the performance of new automated serological assays for syphilis infection. METHODS: The precision, linearity, and detection limit of the automated kits AutoLab rapid plasma reagin (RPR) (IVD-RPR) and AutoLab (Treponema pallidum Latex Agglutination) TPLA (IVD-TPLA) (IVDLab Co., Korea) were evaluated using an immunoturbidimetric method. In addition, the results of these tests were compared with those obtained using the HiSens Auto RPR LTIA (HBi-RPR) and HiSens Auto TP LTIA (HBi-TPLA) tests (HBi Co., Korea) with 122 serum samples. RESULTS: Both the IVD-RPR and IVD-TPLA kits showed acceptable precision for the positive controls (IVDLab Co., Korea). The within-run and total precision of IVD-RPR were better than those of HBi-RPR at cut-off levels (CV, 7.0% to 7.4% for IVD-RPR; CV, 33.3% to 40.0% for HBi-RPR). The IVD-RPR and IVD-TPLA kits demonstrated acceptable linearity and limits of detection. The agreement rate between IVD-RPR and HBi-RPR was 83.60% (102/122). Nineteen samples were IVD-RPR negative but HBi-RPR positive; 12 of these were from patients with a history of syphilis. The agreement rate between IVD-TPLA and HBi-TPLA was 96.72% (118/122). All discrepant results were IVD-TPLA positive and HBi-TPLA negative. CONCLUSIONS: IVD-RPR and IVD-TPLA exhibited acceptable precision, linearity, and limits of detection for the diagnosis of syphilis infection. IVD-RPR was suitable for monitoring syphilis infections with good precision that was near cut-off levels. IVD-TPLA was useful for detecting primary syphilis infection.