The incidence of candidiasis has steadily increased with the number of patients with opportunistic infection. Candidiasis is often observed in patients with leukemia, malignant lymphoma and aplastic anemia, all of whom show immunodeficiency. Factors contributing to the increased incidence of candida infections include the overuse of broad-spectrum antimicrobial agents, and the prolonged survival of patients with immunodeficiency. Candida is a major causative organism of nosocomial infection, as are P. aeruginosa and methicillin-resistant Staphylococcus aureus. The number isolated was greater in the order of C. albicans > C. glabrata > C. tropicalis > C. parapsilosis > C. krusei. C. albicans, which was detected most frequency, was isolated from 60-70% of all samples every year. Isolated frequencies of C. albicans were 66-77% from sputum, 43-70% from urine, and 62-72% from vaginal swabs. In regard to annual changes in deep-seated candidiasis among autopsied cases, the incidence reached a peak in the 1985 to 1988 period, and thereafter decreased. The number of cases with infection of the stomach was largest, followed by the esophagus, the lung and kidney. These cases with deep-seated candidiasis showed low values or levels of lymphocyte, neutrophil, hemoglobin, hemoglobin total protein and total cholesterol.
Genetic testing of hematological malignancy is-.indispensable to categorize and diagnose leukemia. The quantitation of fusion gene mRNA built up by chromosomal translocation including BCR-ABL1 (major, minor), RUNX1-RUNX1T1, and PML-RARA and detection of the JAK2 (V617F) mutant gene are performed by our- selves in our hospital. Efficient, practical use is necessary because the number of medical technologists is limited and numbers of tests are increasing annually. The detection of leukemic cells is important in hematological tests. In addition, experienced medical technologists can predict the existence of fusion mutant genes. In this report, we introduce our experience regarding the practical use and operation of biomarkers for leukemia. Medical technologists take advantage of peripheral blood tests for screening, such as the complete blood count (CBC), hemogram, fibrin and fibrinogen degradation products (FDP), and the quantitation of fusion gene mRNA, which offers a definitive diagnosis including BCR-ABL1, RUNX1-RUNX1T1, and PML-RARA, and genetic tests are performed efficiently. [Review].
Nearly one-half of all hematopoietic progenitor cell transplantation (HCT) procedures involve recipient- donor ABO incompatibility. ABO-incompatible HCT places the recipient at an increased risk of acute and delayed hemolytic reactions, delayed RBC engraftment, and pure red blood cell aplasia. Additionally, clinical and laboratory evaluations for potential non-ABO, minor RBC antigen-antibody discrepancies may be benefi- cial to facilitate safe transfusions before, during, and after transplantation. It is important for medical tech- nologists to play a role in ABO-incompatible HCT as members of the medical team. Medical technologists should obtain accurate laboratory data and analyze the outcomes in patients receiving ABO-incompatible HCT.
Routine laboratory tests are performed in almost all hospitals in the world. If you can fully interpret such routine laboratory tests, you can evaluate the general condition of patients in detail. In the reversed clinico- pathological conference (RCPC), we analyzed a patient's condition using only data from routine laboratory tests, as one of the most effective training methods to acquire the ability to interpret routine laboratory tests. In this RCPC, we discussed routine laboratory data from a patient who was transported by ambulance due to systemic weakness, and conducted interpretation of the data using the method of Shinshu University Hospital. At Shinshu University Hospital, we consider the time series results of the routine laboratory tests according to 13 steps, because our aim is to understand the patient's condition without oversight rather than to make a diagnosis. [Review].
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for hematologic ma- lignancies. However, there are some potentially fatal complications, including graft-versus-host disease or infections, and transplant-related mortality is still high. One of the life-threatening complications related to allo-HSCT is cardiotoxicity. There are several causes of cardiotoxicity, such as pre-transplant chemothera- py, conditioning chemotherapy, cytokine storms due to sepsis or allogeneic immune reactions, rapid altera- tion of body fluid, and ischemic heart disease caused by transplant-associated thrombotic microangiopathy or calcineurin inhibitors. Echocardiography is a very useful and convenient method when assessing the cardiac function in daily clin- ics. The ejection fraction is a useful surrogate marker of the cardiac systolic function, and the trans-mitral valve inflow pattern is a useful surrogate marker of the cardiac diastolic function. There are several causes of cardiotoxicity during the course of allo-HSCT. In the pre-phase of allo-HSCT, the cumulative dose of anthracycline before transplantation is correlated with the rate of cardiac complications. In the acute phase of allo-HSCT, we should bear in mind cyclophosphamide-induced cardiotoxicity. Since these cardiotoxicities sometimes cannot be detected in the cardiac systolic function but can in the diastolic one, we should evaluate the cardiac diastolic function such as trans-mitral valve inflow pattern with echocar- diograms. In addition, some types of conditioning chemotherapies could have significant impacts on cardiac functions even in the chronic phase of allo-HSCT. In conclusion, it is very important to assess cardiac systolic and diastolic functions using echocardiograms for the improved management of cardiotoxicity in allo-HSCT recipients. [Review].
Despite the marked progress in the procedure of allogeneic hematopoietic stem cell transplantation (allo- HCT) as a curative therapy for hematological malignancy, we still need to resolve issues in clinical laboratory testing for the assessment of transplant patients. For example, minimal residual disease (MRD) negativity before transplantation is known to be associated with good survival, but the widespread use of the multi-color flow cytometry system is needed for the routine assessment of MRD. In addition, we should apply an appropriate testing system for counting harvested bone marrow cells with careful consideration of the meas- urement principle of testing equipment because bone marrow is different from peripheral blood in its compo- sition of cells and components. It is also a problem that the short tandem repeat-polymerase chain reaction (PCR) for the evaluation of donor chimerism is not covered by Japanese national health insurance. Tissue biopsy is useful for the diagnosis of graft-versus-host disease, transplantation-associated microangi- opathy, and sinusoidal obstruction syndrome. It is, however, potentially dangerous for patients who have thrombocytopenia after allo-HCT to undergo a biopsy. Non-invasive tests including surrogate makers for the diagnosis of those complications are highly desirable, but they have been not established. Moreover, limitations in the diagnosis of infection after allo-HCT by laboratory tests include the poor clinical utility of the viral antibody test after allo-HCT and the fact that quantitative virus PCR tests after allo-HCT are not covered by Japanesehational health insurance. The number of long-term transplant survivors has increased in recent years. We therefore need to focus on treatment strategies against long-term complications after allo-HCT and the improvement of the quality of life. Further progress in laboratory medicine in the allo-HCT field may contribute to the prevention of late complications and/or improvement of the quality of life. I.
Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a curative treatment for many kinds of hematological diseases, but high transplant-related mortality (TRM), involving almost one quarter of patients who receive allo-HCT, remains problematic. TRM is mainly caused by infection (bacteria, virus, and fun- gus), acute or chronic graft versus host disease (GVHD), and/or organ dysfunction, such as-that involving the liver, lung, and/or kidney. Post-transplant infectious or noninfectious pulmonary complications are some of the important events after allo-HCT that may often be associated with TRM. The pre- or post-transplant pulmonary function test (PFT) plays an important role for the following reasons: 1) It may predict the devel- opment of noninfectious pulmonary complications such as chronic GVHD of the lung, i.e., bronchiolitis oblit- erans syndrome (BOS). 2) The diagnostic criteria and evaluation of the severity of BOS contain some PFT parameters. Therefore, we are not able to diagnose a patient with BOS nor evaluate the severity without PFT. 3) Pre- and post-transplant PFTs predict TRM and/or the overall transplant outcome. In order to improve the allo-HCT outcome, future studies of PFT in allo-HCT are needed. [Review].
Transplantation therapy for hematopoietic diseases is conducted by a team led by an attending physician. After transplantation, various adverse effects occur, such as graft versus host disease (GVHD) and thrombotic microangiopathy (TMA), recurrence, and engraftment failure. Therefore, attending physicians are busy with the evaluation of laboratory data, monitoring of immunosuppressants, use of blood products, and management of infectious diseases. Under such circumstances, laboratory technicians play various roles. Our blood test technicians conduct tests to predict outcomes desired by attending physicians and report them quickly and accurately. For that purpose, they must develop skills to interpret test results and examine morphological findings. In this report, we introduce our efforts to improve post-transplantation medical care. [Review].
In this study, we investigated the correlations of values of biochemical and hematological tests obtained using microliter-scale fingertip blood samples collected with a newly developed blood collection device with those using conventional venous blood. Eighty volunteer subjects were enrolled in the study. Blood sam- ples were drawn from the fingertip of the ring finger by a single puncture and 60 μL of each sample was promptly and accurately aspirated into a blood collection chip. Then the chip was tightly sealed with chip container and was shaken to mix the contents without dispersing. For biochemical tests except of HbAlc, blood was collected without anticoagulant and centrifuged to obtain 15 μL of serum which was then diluted with 190 pL of physiological saline for the assay. For hematological tests and HbAlc, the sample was as- sayed with blood collected using EDTA-2K. As a result, a good correlation of the test values was obtained between the assay with fingertip blood and that with venous blood. The correlation coefficients were found to be 0.97 in TG, T-CHO, HDL-C, LDL-C, GLU, ALT, γ-GTP, UA, BUN and HbAlc and ≥ 0.95 for WBC, RBC, Hgb, and Hct. These results suggest that our microliter-scale blood testing can be comparable to the assay using venous blood and may be useful as a rapid and simple test for determination of basic clinical tests near the reference intervals. [Original].
Standardization based on clinical guidelines and personalization by molecular-targeted therapy have been introduced into the field of cancer treatment. To select patients appropriate for molecular-targeted drugs, various companion diagnostics have been developed. To catch up with revision of the clinical guidelines and progress of companion diagnostics, the effective utilization of "Guidelines for clinical examinations JSLM2015" is desirable. [Review].
The clinical laboratory is essential to medicine in general. Clinical laboratory staff with a core of medical technologists are asked to take part in disaster medicine, and their education and training are urgently neces- sary to markedly contribute to disaster medicine. Clinical laboratory staff who participate in disaster medicine should have the following: 1) understanding of disaster medicine and the skills to implement it, 2)warm spirits of togetherness with disaster victims and enthusiasm to help them, 3) physical strength and self-control, 4) the ability to communicate and connect with other staff, 5) the ability to devise clinical laboratory systems according to the situation. It is desirable for associations of clinical laboratory and those of disaster medicine to work together to de- velop education programs and certification systems, and for education programs to be developed into medical technologist-training schools. [Review].
Inflammatory biomarkers have been considered as a promising option to help diagnose infections, where uncertainty exists in the clinical or microbiological diagnostic approach. However, there is an inherent weakness in biomarkers, given the fact that infection is one, but not all, of the causes of inflammation. Clas- sical markers such as white blood cells or c-reactive proteins confer a low diagnostic accuracy. Procalcitonin or presepsin, relatively new markers, show better, but still imperfect overall sensitivity/specificity of -75- 80%, indicating that it is difficult to use any biomarkers as a sole diagnostic test of infection. Serial meas- urements of procalcitonin provide information regarding stopping antibiotics earlier, and could be utilized in the context of an antimicrobial stewardship program. Further research is necessary to investigate the pos- sibility of utilizing biomarkers in combination with other genetic diagnostic methods as rapid, point-of-care, tests. [Review].
It may not be common for laboratory tests to be employed immediately after a disaster in front-line healthcare settings. However, this is not because laboratory tests are not needed in post-disaster healthcare settings, but because the implementation of triage, which prioritizes the saving of lives, is the initial aim of a Disaster Medical Assistance Team (DMAT). Disaster response ability has been reported to be exerted according to the level of experience. After the Great East Japan earthquake, by the cooperation of related societies and organizations, diagnostic reagents and instruments were supplied to 3 core university hospitals in the affected areas, contributing to building a system whereby necessary medical items could be obtained in three affected Prefectures of the Tohoku region. We should always remember that front-line medical care activities in affected areas are possible due to the backup provided by logistic support teams. The more the system for DMAT is improved, the more effective the support system will be after the super-acute phase of a disaster. [Review].
In this report, we reviewed the results of RCPC held at the 63rd national congress of the Japanese Society of Laboratory Medicine. The case was a 9th decade female with dementia, who had anemia pointed out on a routine laboratory check. The type of anemia was macrocytic(MCV>130 fL). The serum Vit.B12 and folate levels were markedly decreased. However, her anemia was not improved despite supplementation with Vit.B12 and folate (data on MCV were improved). The WBC increased gradually, but she subsequently died. Laboratory data were assessed by three doctors (DN, NM, and TT: blood cell counts, smear morpholo- gy of peripheral blood cells, and clinical chemistry, respectively). They diagnosed the patient with a hema- tological disorder, probably neoplastic hematological diseases; however, it was very difficult to make a further clinical diagnosis because of the necessary data not presented at this meeting. The final diagnosis was acute myeloid leukemia (AML-M4). The direct cause of death was rupture of her spleen due to the massive infil- tration of neonlastic cells. rReviewl.
The metabolism and nutrition section of JSLM2015 was constructed following the previous version JSLM2012. The examinations of dyslipidemia and glucose metabolism and weight loss and obesity were described in the first chapter Laboratory data approach and the second chapter Symptoms, respectively. Dyslipidemia, diabetes, gout and hyperuricemia, and osteoporosis were described in the third chapter Diseas- es. This paper provides an outline with a focus on dyslipidemia examination and dyslipidemia in the first and third chapters, respectively. [Review].
During disasters, medical services are occasionally provided by temporary medical offices organized within emergency shelters. The types of disease dealt with by these offices change with time after the event, and their conditions also change depending on the time needed for normal activities to resume. As usable devic- es and test methods are limited due to various causes, such as interrupted life lines, it is necessary for medi- cal service providers to flexibly manage the situation, and for supporters to provide them with resourceful support. [Review].
As natural disasters have been occurring more frequently in recent years, the need to prepare for a future disaster is growing. Based on the experience of the Great Hanshin earthquake occurred in 1995, we pre- dicted that laboratory test demand will be increased one week post-disaster. Also, the provision of medical and health care services is indispensable in areas affected by disasters for not only acute-phase patients, but also for those with diabetes, hypertension, and chronic diseases. This study summarized how laboratory medicine supplies were provided to the region affected by the Great East Japan earthquake occurred in 2011. In order to provide laboratory medicine supplies in the affected region, the Japanese Society of Laboratory Medicine set up a committee to respond to the Great East Japan earthquake as a temporary measure. Since electric power and water supplies are cut after a disaster, we decided to provide support using Point-Of-Care Testing (POCT) devices and disposable In-Vitro Diagnostic (IVD) reagents. A total of 40 companies agreed to provide support, and more than 100 IVD reagents were prepared. We posted the above information on our website, and updated it immediately when additional support requests were made. In addition, volunteer clinical technologists were sent to the affected region for 8 weeks, in order to support laboratory tests per- formed in temporary clinics or first aid stations. This experience was immediately applied to medical sup- port activities performed after the 2016 Kumamoto earthquake. This study identified the usefulness of la- boratory tests and clinical technologists in disaster-affected regions. [Review].
In recent years, Japan has been hit by natural disasters such as earthquakes, typhoons, torrential rains, and heavy snow every year without exception. When such disasters occur, human lives are put at risk. These emergency situations are an unrivaled sphere of activity for physicians, nurses, and emergency life-saving technicians, and the need for these workers becomes the focus of society; however, for advanced rescue in the acute phase of disasters and to prevent disease onset in the chronic phase, clinical laboratory tests are expected to play a major role in developing more accurate diagnoses and promoting prompt medical care. In this paper, I examine whether clinical laboratory tests are beneficial for practicing disaster medicine.
A high sensitivity quantitative assay for hepatitis B virus (HBV) surface antigen (HBsAg-HQ assay) was recently developed and is useful for earlier detection of HBV reactivation. We created HBsAg-HQ assay operational proce- dures by the sample transport system and laboratory information system. In this study, we evaluated the perfor- mance and utility of the HBsAg-HQ assay based on our operational procedures using internal quality control (IQC) data and 13,762 samples routinely measured for 8 months. The IQC data of the HBsAg-HQ assay demonstrated good accuracy (CV: 1.6-2.7%). The difference in IQC data between two of the same analyzers or several reagent lots had no clinical significance. Of 13,762 samples, HBsAg titer was negative in 12,592(91.5%) and positive in 1,169(8.5%), and HBsAg negative samples were remarkably lower(<0.001 IU/mL) than the cut-off value(0.005 IU/mL). Among 114 HBsAg weakly positive samples ranging from 0.005 to 1.000 IU/mL, false positive results occurred in 12 samples, which were converted into negative results after re-measurement. We could effectively perform carry-over prevention and dilution of high titer samples using our operational procedures. Furthermore, we performed inhibition test in 52 HBsAg weakly positive samples, and 20 samples, most of which were taken from patients with connective tissue disease or malignancy, were judged as non-specific reactivity. Taken together, our operational HBsAg-HQ assay procedures may contribute to efficient workflow for routine testing. Moreover, the HBsAg-HQ assay may be clinically useful for not only highly sensitive assays, but also for reducing false positives.
MicroRNAs (miRNA) are non-coding small RNAs. Exosomes carry extracellular miRNAs in plasma and other body fluids. Levels of plasma miRNAs show disease-specific changes. Thus, miRNAs are expected to be new biomarkers in many diseases. However, the method of analysis of plasma miRNAs is not well established. In this study, we tested the influences of high speed centrifugation and membrane filtration on results from plasma miRNA analysis using reverse transcriptase-based quantitative polymerase chain reac- tion (RT-qPCR). We studied plasma from 12 normal subjects. The level of plasma miR-451 did not change significantly after high speed centrifugation and filtration, rather showed slight increment, 1.543 ± 0.263 fold (mean±SD, N=3). The levels of plasma miR-126 and miR-223 decreased with high speed centrifugation and filtration, (0.038 ± 0.008 fold and 0.041 ± 0.003 fold, respectively). Our data suggested that removing platelets and cellular debris from plasma with high speed centrifugation and/or filtration is essential for stand- ardization of plasma miRNA analysis. [Original].
