Diagnostic accuracy of serum iron and total iron binding capacity [TIBC] in iron deficiency state

Objective: To determine the diagnostic accuracy of serum iron and total iron binding capacity [TIBC] in detection of iron deficiency

Study Design: Descriptive, analytical study

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, from January 2013 to October 2015

Methodology: Data of 1,815 patients with results of serum iron, TIBC and ferritin from January 2013 to October 2015 was retrieved from Laboratory information System [LIMS] of AFIP. Diagnostic Accuracy Studies [STARD] guidelines were followed. Subjects of either gender, aged 1 - 68 years were included. Cases with raised serum ferritin levels [male > 336 ng/ml, female > 307 ng/ml] were excluded. Serum Ferritin was taken as gold standard with specificity of 99% and sensitivity of 80% at concentration of 30 ng/ml. Transferrin saturation was determined by dividing serum iron by TIBC and multiplying by 100

Results: Out of 1,815 subjects, 931 [51.29%] were males and 884 [48.71%] were females. The median age of the patients were 29.1 years [Inter-quartile range, IQR 19.1]. Taking ferritin as gold standard, the sensitivity and specificity of serum iron was 63.5% and 38.6%, respectively; while that of TIBC was 64.5 % and 42.8%, respectively. Ferritin showed poor correlation with iron, TIBC and transferrin saturation

Conclusion: Serum iron and TIBC give no additional information in the diagnosis of iron deficiency anemia and these tests are redundant for the diagnosis of iron deficiency state, if serum ferritin is available

Pre-analytical errors in a peripheral hospital laboratory

To analyse pre-analytical errors which account for the major contribution towards laboratory errors. Cross-sectional descriptive study. Combined Military Hospital Kohat, Pakistan from 1[st] January to 30[th] June 2012. For six months laboratory staff was asked to register rejections and causes for rejection of all samples; including in-patient samples from wards as well as out-patient samples collected in the laboratory. In addition all samples where disparity was noted by the clinicians in the laboratory results were also included for analysis. Suspected samples were reanalyzed, tests were also repeated on fresh samples of the patients and a critical appraisal was made. Among a total of 328418 analyses, clinicians/laboratory staff notified 350 questionable findings, 270 of which were confirmed errors. Out of total 270 errors, 77% were pre-analytical, 8% were analytical, 15% were post analytical errors. Out of total pre-analytical errors 8% were incorrect samples, 21% were misidentifications, 51% were faulty sampling techniques and 20% were incomplete/illegible laboratory request forms. The pre-analytical phase in the total testing process currently appears to be more vulnerable to errors than the other phases. Consequently, the pre-analytical phase should be the main target for further quality improvement. Therefore identifying the critical steps in the pre-analytical phase is a prerequisite for continuous quality improvement, further error reduction and thus for improving patient safety

Brucella melitensis presenting as erythema nodosum-like lesions

Brucellosis is a chronic granulomatous zoonosis with protean manifestations. Cutaneous involvement in Brucellosis is a relatively rare phenomenon. We describe a case of Brucella melitensis infection presenting with erythema nodosum like skin lesions involving palms and soles in a 70 years old lady