Effect of Severe Hemolysis in Blood Samples on Laboratory Results / 日本農村医学会雑誌

In this study, we investigated the effects of severe hemolysis (hemoglobin [Hb] > 500 mg/dL) in blood specimens by classifying them into non-hemolysis, hemolysis (Hb ≤ 500 mg/dL), and severe hemolysis. Investigated items were total protein (TP), albumin (ALB), total bilirubin (T-Bil), direct bilirubin (D-Bil), aspartate transaminase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LD), alkaline phosphatase (ALP), gamma-glutamyl transferase (γ-GT), creatine kinase (CK), amylase (AMY), cholinesterase (ChE), blood urea nitrogen (BUN), creatinine (Cre), sodium (Na), potassium (K), chloride (Cl), calcium (Ca), uric acid (UA), triglycerides (TG), total cholesterol (T-Cho), high-density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), and C-reactive protein (CRP), and actual clinical test results were used. Based on the results, we were able to classify the error relationships into three groups according to hemolysis status. Group A shows an error between non-hemolysis and hemolysis, and an even stronger error in severe hemolysis (T-Bil, AST, LD, Na, K, Ca, and UA). Group B showed no error between non-hemolysis and hemolysis, but errors in strong hemolysis (ALB, D-Bil, ALT, γ-GT, CK, AMY, TG, T-Cho, HDL-C, and LDL-C). Group C shows no errors in either hemolysis or strong hemolysis (TP, ALP, ChE, BUN, Cre, Cl, and CRP). Among these, the Group B classification was a new finding. In situations where the measurement of hemolyzed specimens is unavoidable, it is important that clinical laboratory technologists be aware of its impact and provide the results in a way that can be used in clinical practice.

Involvement of Medical Technologists in Outpatient Care for Memory Loss and Dementia by Pre-Appointment Testing / 日本農村医学会雑誌

Medical technologists at our hospital have begun to conduct tests before outpatient appointments for memory loss and dementia. They administer the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15), take patients' medical history, and perform auxiliary diagnostic tests for cognitive function. Technologists at our hospital assessed 365 patients (mean age 80 years; 172 men and 193 women) in this way between May 2018 and May 2019. We determined a cutoff value for the MMSE and tested the validity of the technologists’ assessments of these patients by comparing them against physicians' clinical diagnosis. Our hospital sees many patients with Alzheimer’s disease, and 85% of patients diagnosed with dementia had an MMSE score of 23 or lower. The MMSE is a highly reliable screening test for dementia, and technologists scored it similarly to physicians. Addition of the GDS-15 showed that outpatients with dementia had underlying anxiety symptoms and depression. It is important that technologists continue their involvement in outpatient care as certified dementia specialists while also continuing to consider which tests they should conduct.