Abstract Introduction Hepatitis B virus (HBV) remains a major public health burden. This study evaluated hematologic characteristics across different serologically defined HBV patterns among hospital attendees in southwest China. Methods A total of 5828 individuals were included in the study. Individuals were classified into 5 study-defined serologic patterns: hepatitis B surface antigen positive (HBsAg+)/hepatitis B e antigen positive (HBeAg+) (active replication stage), HBsAg+/hepatitis B e antibody positive (HBeAb+) (immune control stage), HBsAg+/HBeAg−/HBeAb− (transition infection stage), isolated anti–hepatitis B core (HBc), and anti-HBc+/anti-HBs+ (resolved infection stage), according to qualitative HBV serology. These descriptive patterns are not validated clinical infection phases. Results The overall HBsAg seropositivity rate was approximately 3%. HBsAg positivity was more frequent in male individuals (odds ratio, 1.26), whereas the odds of HBsAg positivity were lower in participants younger than 24 years of age (odds ratio, 0.33). Neural network models showed moderate ability to discriminate immune states using complete blood cell count–derived indices (area under the curve = 0.721). Nevertheless, the lymphocyte to monocyte ratio and systemic inflammation response index revealed a substantial trend from innate immune activation in active replication/transition infection stage to adaptive immune predominance in immune control/resolved infection stage. The isolated anti-HBc pattern was characterized by a reduced eosinophil to lymphocyte ratio, although this association is descriptive and does not establish occult infection or immune surveillance. Discussion Complete blood cell count–derived inflammatory indices were associated with different serologic HBV patterns. More evidence of immune transition or progressive immune remodeling is required, however.
Abstract Introduction Ascorbic acid (vitamin C) interferes with oxidase-peroxidase–based clinical chemistry assays. We evaluated endogenous ascorbic acid interference across 19 routine analytes and ascorbate oxidase (AOx) pretreatment efficacy. Methods Plasma from 100 patients with ascorbate-containing bowel preparation exposure was split into untreated and AOx-treated aliquots. The untreated aliquot received an equal-volume 0.9% sodium chloride vehicle under identical incubation (37 °C, 15 minutes), controlling for dilution and handling. Both aliquots were analyzed on a Roche cobas c702 Chemistry Analyzer. Lipid profiles were compared before and after colonoscopy in 176 patients. Bias was assessed against European Federation of Clinical Chemistry and Laboratory Medicine–allowable bias; reference change values used local imprecision. Concentration dependence was assessed by correlation, regression, and tertile analysis. Results Lipid changes stayed within reference change values; only triglyceride (TG) reduction with the high-ascorbate solution exceeded the Clinical Laboratory Improvement Amendments 2025 criterion (−27.21% vs ±15%). After AOx, TG levels changed markedly (+28.48%), with alanine aminotransferase (−45.15%) and aspartate aminotransferase (+46.43%) showing larger opposite changes. Concentration did not predict individual TG bias (R² = 0.056); no analyte survived Bonferroni correction. Discussion Ascorbate oxidase altered several analytes, TG most clearly, with an opposite aspartate aminotransferase/alanine aminotransferase pattern. Because concentration did not predict interference, concentration-based screening is an ineffective gatekeeper; exposure-triggered selective AOx pretreatment appears to be more practical, pending assay-specific local validation.
Abstract Introduction Hemolysis and other preanalytical errors compromise laboratory test accuracy, delay reporting, and may require repeat specimen collection. Methods We conducted a PROSPERO-registered systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. PubMed/MEDLINE and KoreaMed were searched from inception to May 17, 2026, with supplementary manual and institutional source searching. Eligible studies evaluated preanalytical interventions related to blood specimen collection or handling and reported hemolysis, specimen rejection, recollection, misidentification, or broader preanalytical error outcomes. Risk ratios for hemolysis were pooled using a random-effects model; secondary outcomes were summarized narratively. Results Seventeen studies were included in the qualitative synthesis, and 7 provided event and denominator data for hemolysis meta-analysis. Preanalytical interventions reduced hemolysis compared with conventional practice (risk ratio, 0.48 [95% CI, 0.28-0.81]; P = .0066), representing an approximately 52% relative risk reduction. Heterogeneity was substantial (I2 = 92.4%). Secondary studies generally reported reductions in sample rejection, nonconforming specimens, or broader preanalytical errors. Certainty of evidence was low for hemolysis and very low for secondary outcomes. Discussion Preanalytical quality interventions may reduce hemolysis and improve specimen quality, but evidence remains limited by heterogeneity, nonrandomized designs, and inconsistent outcome reporting.
Abstract Introduction Atypical presentations of inborn errors of metabolism, such as methylmalonic acidemia, often mimic metabolic emergencies such as diabetic ketoacidosis (DKA) or acute encephalitis syndrome. Here we present the case of an 8-month-old girl who was admitted with severe dehydration, respiratory distress, and rapidly progressing encephalopathy. Methods The patient was initially treated for infantile-onset DKA. However, several features were atypical for DKA, such as persistent metabolic acidosis despite correction of hyperglycemia, hyperammonemia, and rising lactate concentrations. Results Urine organic acid analysis by gas chromatography–mass spectrometry raised suspicion of an underlying inborn error of metabolism, whereas genetic testing identified a homozygous MMAA pathogenic variant consistent with cobalamin A (cblA)–type methylmalonic acidemia. Discussion Despite substantial overlap in clinical presentation, the child received timely intervention and recovered completely.
Abstract Introduction Liquid chromatography–tandem mass spectrometry quantifies 25-hydroxyvitamin D2 (25[OH]D2) and D3 (25[OH]D3) separately, but clinical reporting often emphasizes total 25(OH)D. We characterized component composition and repeat test changes in routine adult hospital testing. Methods We retrospectively analyzed a pseudonymized dataset derived from routine laboratory records for vitamin D tests performed from June 2019 through November 2022. Cross-sectional analyses used first tests from 2808 adults; longitudinal analyses compared first and last tests in 446 retested adults. Vitamin D2–contributory composition was defined exploratorily as a 25(OH)D2 share of at least 10%, with sensitivity analyses using 5%, 20%, and a continuous measure. Results Median total 25(OH)D was 24.6 ng/mL (approximately 61.5 nmol/L), and 71.3% of results were below the local reference cutoff. Vitamin D2–contributory composition occurred in 16.3% and was associated with sex, season, and ordering service. Among retested adults, median changes were 4.3 ng/mL for total 25(OH)D, 4.2 ng/mL for 25(OH)D3, and −0.1 ng/mL for 25(OH)D2. Total change correlated with 25(OH)D3 change (ρ = 0.98; P < .001) but not with 25(OH)D2 change (ρ = 0.04; P = .46). Discussion Fractionated measurements revealed compositional variation within total 25(OH)D categories and predominantly D₃-related changes on repeat testing. The clinical implications of these patterns require further evaluation.
