American journal of clinical pathology最新文献

Validation of monocyte CD169 expression as a valuable rapid diagnostic marker of SARS-CoV-2 and other acute viral infections. 验证单核细胞 CD169 表达是 SARS-CoV-2 和其他急性病毒感染的重要快速诊断标志物。

IF 2.3 4区医学

American journal of clinical pathology Pub Date : 2024-09-21 DOI: 10.1093/ajcp/aqae127

Chiara Pratesi, Rita De Rosa, Eliana Pivetta, Kathreena Vattamattathil, Giacomo Malipiero, Desré Ethel Fontana, Giancarlo Basaglia, Paolo Doretto

{"title":"Validation of monocyte CD169 expression as a valuable rapid diagnostic marker of SARS-CoV-2 and other acute viral infections.","authors":"Chiara Pratesi, Rita De Rosa, Eliana Pivetta, Kathreena Vattamattathil, Giacomo Malipiero, Desré Ethel Fontana, Giancarlo Basaglia, Paolo Doretto","doi":"10.1093/ajcp/aqae127","DOIUrl":"https://doi.org/10.1093/ajcp/aqae127","url":null,"abstract":"Objectives: Acute infectious diseases are some of the most common reasons for receiving medical care, and analysis of the host immune response is an attractive approach for their diagnosis. The present study aimed to evaluate the potential usefulness of CD169 expression on peripheral monocytes (mCD169) as a marker of viral-associated host immune response.Methods: In a large mono-institutional cohort of 4,025 patients evaluated for SARS-CoV-2 (CoV2) and other viral infections, mCD169 analysis was performed by rapid flow cytometry assay.Results: Increased mCD169 values (median, 17.50; IQR, 8.40-25.72) were found in 1,631 patients with CoV2+ acute infection compared to 2,394 in CoV2- patients (median, 2.35; IQR, 2.0-3.25) (odds ratio [OR], 21.84; 95% CI ,17.53-27.21; P < .001). Among CoV2- patients, 1,484 (62.0%) were assessed for other viral infections, and viral etiology was laboratory confirmed in 428 patients (CoV2- Vir+), with RNA viruses most frequently detected (94.6%). Higher levels of mCD169 were also confirmed in CoV2- Vir+ compared to CoV2- Vir- patients (OR, 10.05; 95% CI, 7.35-13.74; P < .001).Conclusions: mCD169 analysis by rapid flow cytometry assay may be a sensitive broad marker useful for the rapid triage of patients with suspected acute viral infections and could potentially be directly applied to eventual new emergent viral outbreaks.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Culture and other direct detection methods to diagnose human granulocytic anaplasmosis. 用培养和其他直接检测方法诊断人类粒细胞无形体病。

IF 2.3 4区医学

American journal of clinical pathology Pub Date : 2024-09-21 DOI: 10.1093/ajcp/aqae126

Maria E Aguero-Rosenfeld, Lois Zentmaier, Dionysios Liveris, Paul Visintainer, Ira Schwartz, J Stephen Dumler, Gary P Wormser

{"title":"Culture and other direct detection methods to diagnose human granulocytic anaplasmosis.","authors":"Maria E Aguero-Rosenfeld, Lois Zentmaier, Dionysios Liveris, Paul Visintainer, Ira Schwartz, J Stephen Dumler, Gary P Wormser","doi":"10.1093/ajcp/aqae126","DOIUrl":"https://doi.org/10.1093/ajcp/aqae126","url":null,"abstract":"Objectives: We sought to assess the performance of 3 laboratory tests on blood specimens for direct detection of Anaplasma phagocytophilum, the cause of human granulocytic anaplasmosis (HGA), in patients tested at a single medical institution in New York State.Methods: Direct tests included microscopic blood smear examination for intragranulocytic inclusions, polymerase chain reaction (PCR), and culture using the HL-60 cell line. The HGA cases testing positive by only 1 direct test were not included, unless HGA was confirmed by acute or convalescent serology using an indirect immunofluorescent assay.Results: From 1997 to 2009, 71 patients with HGA were diagnosed by at least 1 of the 3 direct test methods. For the subgroup of 55 patients who were tested using all 3 methods, culture was positive for 90.9% (50/55) vs 81.8% (45/55) for PCR vs 63.6% (35/55) for blood smear (P =.002). Most cultures (79.3%) were detected as positive within 1 week of incubation.Conclusions: Although using culture to detect A phagocytophilum is likely not amenable for implementation in most hospital laboratories, in our experience, culture had the highest yield among the direct tests evaluated.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Site-discordant expression of myeloid cell nuclear differentiation antigen in blastic plasmacytoid dendritic cell neoplasm. 髓细胞核分化抗原在大疱性浆细胞树突状细胞瘤中的不同部位表达。

IF 2.3 4区医学

American journal of clinical pathology Pub Date : 2024-09-20 DOI: 10.1093/ajcp/aqae128

Philip L Bulterys, Atif Saleem, Ryanne A Brown, Roberto A Novoa, Kerri E Rieger, Yasodha Natkunam, Sebastian Fernandez-Pol

{"title":"Site-discordant expression of myeloid cell nuclear differentiation antigen in blastic plasmacytoid dendritic cell neoplasm.","authors":"Philip L Bulterys, Atif Saleem, Ryanne A Brown, Roberto A Novoa, Kerri E Rieger, Yasodha Natkunam, Sebastian Fernandez-Pol","doi":"10.1093/ajcp/aqae128","DOIUrl":"https://doi.org/10.1093/ajcp/aqae128","url":null,"abstract":"Objectives: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic neoplasm that can show clinical, morphologic, and immunophenotypic overlap with acute myeloid leukemia. Myeloid cell nuclear differentiation antigen (MNDA) is a nuclear protein expressed by myelomonocytic cells previously reported to be reliably absent in BPDCN and proposed as a useful adjunct for the distinction of BPDCN and acute myeloid leukemia. We encountered a case of BPDCN that showed strong nuclear expression of MNDA in bone marrow and breast samples and weak to absent expression in skin samples, prompting us to reevaluate the expression of MNDA in BPDCN.Methods: We collected all available BPDCN cases from the Stanford University archives collected in the past 10 years and subjected them to MNDA immunohistochemistry. In select cases, molecular profiling by next-generation sequencing was performed.Results: We found 4 cases (of 8 total examined [50%]) with convincing site-discordant MNDA expression. This expression was seen in 3 of 6 (50%) bone marrow samples, 1 of 2 (50%) breast soft tissue samples, and 3 of 14 (up to 21%) skin samples and was not obviously predicted by age, sex, history of myeloid neoplasm, or treatment history. In 2 cases, MNDA was strongly expressed in 2 distinct sites (breast/bone marrow, skin/bone marrow) and negative in subsequent samples.Conclusions: Our findings suggest that MNDA expression in BPDCN is anatomic site dependent and transient, with noncutaneous infiltrates showing more frequent expression than cutaneous infiltrates. These results caution against the use of MNDA to exclude BPDCN when considering the differential diagnosis of a blastic extramedullary infiltrate.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epstein-Barr virus–positive, primary cutaneous marginal zone lymphoma, with transformation: Case report and review of the literature Epstein-Barr 病毒阳性、原发性皮肤边缘区淋巴瘤，伴有转化：病例报告和文献综述

IF 3.5 4区医学

American journal of clinical pathology Pub Date : 2024-09-18 DOI: 10.1093/ajcp/aqae124

Lori Soma, Liliana Crisan, Jack Reid, Winston Lee, Joo Song, Michelle Afkhami, Geoffrey Shouse, Fei Fei, Olga Danilova, Raju Pillai, Jasmin Zain, Christiane Querfeld

{"title":"Epstein-Barr virus–positive, primary cutaneous marginal zone lymphoma, with transformation: Case report and review of the literature","authors":"Lori Soma, Liliana Crisan, Jack Reid, Winston Lee, Joo Song, Michelle Afkhami, Geoffrey Shouse, Fei Fei, Olga Danilova, Raju Pillai, Jasmin Zain, Christiane Querfeld","doi":"10.1093/ajcp/aqae124","DOIUrl":"https://doi.org/10.1093/ajcp/aqae124","url":null,"abstract":"Epstein-Barr Virus (EBV) positive primary cutaneous marginal zone lymphoma (PCMZL) is uncommon and subsequent transformation is rare. Methods: We report a patient with EBV positive PCMZL with subsequent transformation to plasmablastic lymphoma and review the literature for transformed PCMZL to assess clinical and pathologic characteristics. In the case we describe, the patient presented with multifocal PCMZL, developed large B cell transformation with plasmacytic differentiation, followed by plasmablastic transformation (PBL), and ultimately died of disease progression despite multiple lines of therapy. Past history was significant for psoriatic arthritis (multiple prior lines of immunomodulatory therapy). The lymphomas and non-involved bone marrow share the same somatic DNMT3A and TET2 mutations, suggesting clonal relatedness and an association with clonal hematopoiesis (CH). Results: Eighteen cases complied the cohort (seventeen cases from the literature and the case reported herein). Nearly half of the eighteen cases of PCMZL with transformation died of progressive disease (44%). Transformed cases were more commonly seen in patients with &gt;2 sites at initial diagnosis. EBV was assessed in 5 patients, 3 were positive (all died of disease). Two patients with NGS studies demonstrated TET2 and DNMT3A mutations. Conclusions: Transformation of EBV positive PCMZL appears to be a poor prognostic indicator, with our reported case being the first well defined case transformed to PBL, suspected to arise from myeloid-CH.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Utility of CCR7 to differentiate classic Hodgkin lymphoma and other B-cell lymphomas by flow cytometry and immunohistochemistry 通过流式细胞仪和免疫组化技术，CCR7 在区分典型霍奇金淋巴瘤和其他 B 细胞淋巴瘤方面的作用

IF 3.5 4区医学

American journal of clinical pathology Pub Date : 2024-09-17 DOI: 10.1093/ajcp/aqae119

Xueyan Chen, Lori Soma, Claire Murphy, Maria Tretiakova, Kikkeri N Naresh, Jonathan R Fromm

{"title":"Utility of CCR7 to differentiate classic Hodgkin lymphoma and other B-cell lymphomas by flow cytometry and immunohistochemistry","authors":"Xueyan Chen, Lori Soma, Claire Murphy, Maria Tretiakova, Kikkeri N Naresh, Jonathan R Fromm","doi":"10.1093/ajcp/aqae119","DOIUrl":"https://doi.org/10.1093/ajcp/aqae119","url":null,"abstract":"Objectives Classic Hodgkin lymphoma (CHL) is characterized by infrequent neoplastic Hodgkin and Reed-Sternberg (HRS) cells in an inflammatory background. The diagnostic utility of CC-chemokine receptor 7 (CCR7) in CHL was explored using flow cytometry and immunohistochemistry (IHC). Methods Neoplastic specimens and non-neoplastic lymph nodes were immunophenotyped and CCR7 expression was measured semiquantitatively by flow cytometry (clone 3D12) and IHC (clone 150503). Results Our results showed that CCR7 was expressed on HRS cells in the vast majority of CHL cases (45/48 by flow cytometry, 57/59 by IHC) but rarely expressed in neoplastic cells in diffuse large B-cell lymphoma, not otherwise specified (1/25 by flow cytometry, 2/40 by IHC) and nodular lymphocyte predominant Hodgkin lymphoma (0/4 by flow cytometry, 1/13 by IHC). Primary mediastinal large B-cell lymphoma (PMLBCL) revealed weak CCR7 expression by flow cytometry in most cases (8/10) but only occasionally by IHC (2/12). Both cases (2/2) of T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) also showed CCR7 expression detected by flow cytometry compared with IHC (0/7). The HRS cells demonstrated a greater percentage of positive cells and greater antigen intensity than the other B-cell lymphomas by IHC. The expression identified by flow cytometry in PMLBCL and THRLBCL but not by IHC suggests that there may be differences in the detection capabilities of the 2 techniques or the 2 CCR7 clones used. Conclusions The expression of CCR7 in HRS cells suggests its potential utility in differentiating CHL from other B-cell lymphomas. Incorporating CCR7 into flow cytometry and IHC panels may further enhance the diagnostic sensitivity of CHL.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

RhD-positive red blood cell allocation practice to RhD-negative patients before and during the COVID-19 pandemic 在 COVID-19 大流行之前和期间为 RhD 阴性患者分配 RhD 阳性红细胞的做法

IF 3.5 4区医学

American journal of clinical pathology Pub Date : 2024-09-17 DOI: 10.1093/ajcp/aqae113

Yvette C Tanhehco, Mark Fung, Daniela Hermelin, Jennifer Becker, Wen Lu

{"title":"RhD-positive red blood cell allocation practice to RhD-negative patients before and during the COVID-19 pandemic","authors":"Yvette C Tanhehco, Mark Fung, Daniela Hermelin, Jennifer Becker, Wen Lu","doi":"10.1093/ajcp/aqae113","DOIUrl":"https://doi.org/10.1093/ajcp/aqae113","url":null,"abstract":"Objectives The red blood cell (RBC) D antigen is highly immunogenic, and anti-D alloimmunization can cause hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. This study examined how RhD-negative patients who required packed RBCs (pRBCs) were handled during the COVID-19 pandemic and whether policies and practices on RhD-positive pRBC allocation to RhD-negative patients changed. Methods The Association for the Advancement of Blood & Biotherapies (AABB) Clinical Hemotherapy Subsection distributed a 17-question survey to physician AABB members to elucidate the impact of the COVID-19 pandemic on the policies and practices governing the provision of RhD-positive pRBCs to RhD-negative patients. Results There were 215 respondents who started the survey, but only 104 answered all the questions. Most institutional policies (130/155 [83.87%]) and personal practices (100/126 [79.37%]) on pRBC selection did not change during the COVID-19 pandemic. The practice of switching back to RhD-negative pRBCs after administration of RhD-positive pRBCs is variable. More than half of respondents (56/104 [53.85%]) reported offering Rh immunoglobulin to any Rh-negative patients who received RhD-positive pRBCs. Conclusions Despite RhD-negative pRBC supply challenges, most institutional policies and personal practices on when to provide RhD-positive pRBCs to RhD-negative patients did not change during the pandemic.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Additional reporting of diffuse and homogeneous ROS-1 SP384 immunoreactivity enhances prediction of ROS1 fusion-positive non-small cell lung cancer. 额外报告的弥漫性和均匀性 ROS-1 SP384 免疫反应增强了对 ROS1 融合阳性非小细胞肺癌的预测。

IF 2.3 4区医学

American journal of clinical pathology Pub Date : 2024-09-12 DOI: 10.1093/ajcp/aqae118

Bokyung Ahn, Se Jin Jang, Hee Sang Hwang

{"title":"Additional reporting of diffuse and homogeneous ROS-1 SP384 immunoreactivity enhances prediction of ROS1 fusion-positive non-small cell lung cancer.","authors":"Bokyung Ahn, Se Jin Jang, Hee Sang Hwang","doi":"10.1093/ajcp/aqae118","DOIUrl":"https://doi.org/10.1093/ajcp/aqae118","url":null,"abstract":"Objectives: ROS-1 immunohistochemistry (IHC) is a common method for screening ROS1 fusion in the clinical management of non-small cell lung cancer. The interpretation criteria for ROS-1 SP384 IHC, however, remain unestablished.Methods: Sixty-five non-small cell lung cancer cases underwent AmoyDx ROS1 fusion real-time polymerase chain reaction (PCR) study and ROS-1 SP384 IHC tests, which were retrieved for analysis. ROS-1 IHC tests were interpreted based on the established classifiers as well as the presence of diffuse homogeneous immunoreactivity. The diagnostic accuracies of these ROS-1 IHC interpretation methods were evaluated by comparing them with the ROS1 real-time PCR results.Results: Previous ROS-1 IHC classifiers demonstrated high sensitivity for positive ROS1 real-time PCR results (100%), but they showed low specificities (25%-50%) and overall accuracies (58%-72%). In contrast, the diffuse homogeneous ROS-1 immunoreactivity predicted positive ROS1 real-time PCR results with much higher specificity (94%) and overall accuracy (95%), albeit with a slightly lower sensitivity (97%). Some cases that showed discrepancy between diffuse homogeneous ROS-1 immunoreactivity and real-time PCR results involved rare ROS1::LDLR fusion and suboptimal IHC staining.Conclusions: A 3-tier reporting system for ROS-1 SP384 IHC testing combining previous interpretation criteria and diffuse and homogeneous immunoreactivity may better predict ROS1 fusion status without decreasing specificity.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142278971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The significance of CD49f expression in pediatric B-cell acute lymphoblastic leukemia 小儿 B 细胞急性淋巴细胞白血病中 CD49f 表达的意义

IF 3.5 4区医学

American journal of clinical pathology Pub Date : 2024-09-11 DOI: 10.1093/ajcp/aqae105

Anna Hunyadi, Csilla Kriston, Gábor Szalóki, Borbála Péterffy, Bálint Egyed, Ágota Szepesi, Botond Timár, Dániel J Erdélyi, Krisztina Csanádi, Nóra Kutszegi, Ágnes Márk, Gábor Barna

{"title":"The significance of CD49f expression in pediatric B-cell acute lymphoblastic leukemia","authors":"Anna Hunyadi, Csilla Kriston, Gábor Szalóki, Borbála Péterffy, Bálint Egyed, Ágota Szepesi, Botond Timár, Dániel J Erdélyi, Krisztina Csanádi, Nóra Kutszegi, Ágnes Márk, Gábor Barna","doi":"10.1093/ajcp/aqae105","DOIUrl":"https://doi.org/10.1093/ajcp/aqae105","url":null,"abstract":"Objectives CD49f is an adhesion molecule present on malignant lymphoblasts in B-cell acute lymphoblastic leukemia; it is associated with a poor prognosis. CD49f expression has been proposed as a marker for measurable residual disease (MRD) marker, but this marker has yet to be implemented in clinical practice. Methods In this study, we used flow cytometry to detect CD49f expression by leukemic blasts in paired bone marrow and cerebrospinal fluid samples at diagnosis and bone marrow at day 15 of treatment. Results At diagnosis, 93% of bone marrow and 100% of cerebrospinal fluid lymphoblasts expressed CD49f. The intensity of CD49f expression statistically significantly increased during treatment (P &lt; .001). In MRD-negative end-of-treatment samples, only a small population of hematogones expressed CD49f. Interestingly, the intensity of CD49f expression varied among the different groups of recurrent genetic abnormalities. The ETV6::RUNX1 fusion and ETV6::RUNX1 combined with the high hyperdiploid group were associated with increased expression, whereas the Philadelphia-like group showed low CD49f expression. The lower CD49f expression at diagnosis predicted a lower MRD rate at day 15 of treatment. Conclusions We concluded that CD49f can be used as an MRD marker and possible prognostic factor in B-cell acute lymphoblastic leukemia.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142191237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical decision support improves autoimmune/paraneoplastic antibody panel utilization 临床决策支持提高了自身免疫/副肿瘤抗体面板的利用率

IF 3.5 4区医学

American journal of clinical pathology Pub Date : 2024-09-10 DOI: 10.1093/ajcp/aqae101

Robert D Nerenz, Sam I Hooshmand, Eric Jackowiak, David Shirilla, Yushan Yang, Kai Yang, Ahmed Z Obeidat

{"title":"Clinical decision support improves autoimmune/paraneoplastic antibody panel utilization","authors":"Robert D Nerenz, Sam I Hooshmand, Eric Jackowiak, David Shirilla, Yushan Yang, Kai Yang, Ahmed Z Obeidat","doi":"10.1093/ajcp/aqae101","DOIUrl":"https://doi.org/10.1093/ajcp/aqae101","url":null,"abstract":"Objectives Selection of autoimmune/paraneoplastic antibody panels remains challenging because health-care professionals often lack familiarity with panel contents, recommended specimen types, and antibody combinations for a given patient. Inappropriate use adds cost, prompts unnecessary additional workup, and delays the identification of the true cause of patient symptoms. In this study, we assessed whether order-entry clinical decision support can improve autoimmune/paraneoplastic antibody panel utilization. Methods An order-entry clinical decision support tool was embedded in the electronic health record system. Using a nested panel structure, the decision support tool prompted clinicians to identify their patient’s clinical presentation and guided selection of the appropriate tests. In addition, the tool featured a duplicate checking function to alert clinicians when placing multiple orders with substantially similar antibody content within a 3-month period. Panel ordering practices were assessed during the 12 months before implementation and compared with the 6 months immediately following implementation. Results Clinical decision support significantly reduced the monthly test volume of all orderables from 75.8 per month before implementation to 54.5 per month after implementation (incident rate ratio [IRR], 0.72; 95% CI, 0.63-0.81; P &lt; .001). Placement of multiple orders for panels with substantially overlapping antibody content also decreased significantly, from 7.0 per month to 1.2 per month (IRR, 0.17; 95% CI, 0.07-0.33; P &lt; .001). The number of neural-specific antibodies detected remained unchanged, but the reduction in total test volume increased the neural-specific antibody positivity rate from 4.2% to 6.8% (IRR, 1.61; 95% CI, 0.94-2.70; P = .075). Conclusions Order-entry clinical decision support offers an efficient and effective approach to improve the utilization of autoimmune/paraneoplastic antibody panels.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142191172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term isoagglutinin monitoring after ABO-incompatible kidney transplantation. ABO 血型不相容肾移植后的长期异凝集素监测。

IF 3.5 4区医学

American journal of clinical pathology Pub Date : 2024-09-10 DOI: 10.1093/ajcp/aqae122

Han Joo Kim,Yousun Chung,Hyungsuk Kim,Youngmin Ko,Young Hoon Kim,Sang-Hyun Hwang,Heung-Bum Oh,Dae-Hyun Ko

{"title":"Long-term isoagglutinin monitoring after ABO-incompatible kidney transplantation.","authors":"Han Joo Kim,Yousun Chung,Hyungsuk Kim,Youngmin Ko,Young Hoon Kim,Sang-Hyun Hwang,Heung-Bum Oh,Dae-Hyun Ko","doi":"10.1093/ajcp/aqae122","DOIUrl":"https://doi.org/10.1093/ajcp/aqae122","url":null,"abstract":"OBJECTIVESThis study aimed to evaluate whether a 2-week period of daily isoagglutinin titer testing after ABO-incompatible kidney transplantation (ABOi-KT) is sufficient to ensure successful engraftment and to advocate for an extension of the monitoring duration in specific situations.METHODSWe reviewed patients from January 2022 to December 2023 at Asan Medical Center who underwent therapeutic plasma exchange (TPE) due to elevated ABO antibody titers and suspected acute antibody-mediated rejection (AMR) after ABOi-KT. Data collected included pre- and posttransplantation laboratory results, clinical and procedural information, imaging studies, and needle biopsy results of the renal graft.RESULTSWe encountered 3 cases of acute AMR 2 weeks after transplantation. All cases exhibited simultaneous increases in anti-ABO antibody isoagglutinin titers, creatinine, and C-reactive protein levels. Clinical signs, including fever, suggested possible infection, and renal graft biopsy, confirmed AMR in all cases. Two cases underwent graftectomy, while the third recovered renal function after conservative treatment, including TPE.CONCLUSIONSOur findings suggest that a 2-week monitoring period for isoagglutinin titers after ABOi-KT may not be sufficient to detect late AMR. Extending the monitoring duration and considering lifelong fresh-frozen plasma transfusion with graft-compatible blood types, along with periodic isoagglutinin titer testing in cases of suspected AMR, may improve long-term graft outcomes.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142191170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0