Biochemia MedicaPub Date : 2023-10-05DOI: 10.11613/bm.2024.010501
Cristiano Ialongo
{"title":"Blood alcohol concentration in the clinical laboratory: a narrative review of the preanalytical phase in diagnostic and forensic testing","authors":"Cristiano Ialongo","doi":"10.11613/bm.2024.010501","DOIUrl":"https://doi.org/10.11613/bm.2024.010501","url":null,"abstract":"The analysis of blood alcohol concentration (BAC), a pivotal toxicological test, concerns acute alcohol intoxication (AAI) and driving under the influence (DUI). As such, BAC presents an organizational challenge for clinical laboratories, with unique complexities due to the need for forensic defensibility as part of the diagnostic process. Unfortunately, a significant number of scientific investigations dealing with the subject present discrepancies that make it difficult to identify optimal practices in sample collection, transportation, handling, and preparation. This review provides a systematic analysis of the preanalytical phase of BAC that aims to identify and explain the chemical, physiological, and pharmacological mechanisms underlying controllable operational factors. Nevertheless, it seeks evidence for the necessity to separate preanalytical processes for diagnostic and forensic BAC testing. In this regard, the main finding of this review is that no literature evidence supports the necessity to differentiate preanalytical procedures for AAI and DUI, except for the traceability throughout the chain of custody. In fact, adhering to correct preanalytical procedures provided by official bodies such as European federation of clinical chemistry and laboratory medicine for routine phlebotomy ensures both diagnostic accuracy and forensic defensibility of BAC. This is shown to depend on the capability of modern pre-evacuated sterile collection tubes to control major factors influencing BAC, namely non-enzymatic oxidation and microbial contamination. While certain restrictions become obsolete with such devices, as the use of sodium fluoride (NaF) for specific preservation of forensic BAC, this review reinforces the recommendation to use non-alcoholic disinfectants as a means to achieve “error-proof” procedures in challenging operational environments like the emergency department.","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138541579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biochemia MedicaPub Date : 2023-06-15DOI: 10.11613/BM.2023.020705
Silvia F Benozzi, Gisela Unger, Amparo Campion, Pablo G Milano, Graciela L Pennacchiotti
{"title":"Coffee intake one hour prior to phlebotomy produces no clinically significant changes in routine biochemical test results.","authors":"Silvia F Benozzi, Gisela Unger, Amparo Campion, Pablo G Milano, Graciela L Pennacchiotti","doi":"10.11613/BM.2023.020705","DOIUrl":"https://doi.org/10.11613/BM.2023.020705","url":null,"abstract":"<p><strong>Introduction: </strong>Although current guidelines recommend not drinking coffee prior to phlebotomy, our hypothesis is that drinking coffee does not affect the clinical interpretation of biochemical and haematological test results.</p><p><strong>Materials and methods: </strong>Twenty-seven volunteers were studied in basal state (T0) and 1h after (T1) drinking coffee. Routine haematological (Sysmex-XN1000 analyser) and biochemistry parameters (Vitros 4600 analyser) were studied. Results were compared using the Wilcoxon test (P < 0.05). A clinical change was considered when mean percent difference (MD%) was higher than the reference change value (RCV).</p><p><strong>Results: </strong>Coffee intake produced statistically, but not clinically, significant: i) increases in haemoglobin (P = 0.009), mean cell haemoglobin concentration (P = 0.044), neutrophils (P = 0.001), albumin (P = 0.001), total protein (P = 0.000), cholesterol (P = 0.025), high density lipoprotein cholesterol (P = 0.007), uric acid (P = 0.011), calcium (P = 0.001), potassium (P = 0.010), aspartate aminotransferase (P = 0.001), amylase (P = 0.026), and lactate dehydrogenase (P = 0.001), and ii) decreases in mean cell volume (P = 0.002), red cell distribution width (P = 0.001), eosinophils (P = 0.002), and lymphocytes (P = 0.001), creatinine (P = 0.001), total bilirubin (P = 0.012), phosphorus (P = 0.001), magnesium (P = 0.007), and chloride (P = 0.001).</p><p><strong>Conclusion: </strong>Drinking a cup of coffee 1 hour prior to phlebotomy produces no clinically significant changes in routine biochemical and haematological test results.</p>","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9647589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biochemia MedicaPub Date : 2023-06-15DOI: 10.11613/BM.2023.020601
Jasmina Katanić, Bojan Stanimirov, Vanesa Sekeruš, Maja Đanić, Nebojša Pavlović, Momir Mikov, Karmen Stankov
{"title":"Drug interference with biochemical laboratory tests.","authors":"Jasmina Katanić, Bojan Stanimirov, Vanesa Sekeruš, Maja Đanić, Nebojša Pavlović, Momir Mikov, Karmen Stankov","doi":"10.11613/BM.2023.020601","DOIUrl":"https://doi.org/10.11613/BM.2023.020601","url":null,"abstract":"<p><p>Clinical laboratory practice represents an essential part of clinical decision-making, as it influences 60-70% of medical decisions at all levels of health care. Results of biochemical laboratory tests (BLTs) have a key role in establishment of adequate diagnosis as well as in evaluation of treatment progress and outcome. The prevalence of drug-laboratory test interactions (DLTIs) is up to 43% of patients who had laboratory results influenced by drugs. Unrecognized DLTIs may lead to misinterpreted BLTs results, incorrect or delayed diagnosis, extra costs for unnecessary additional tests or inadequate therapy, as all may cause false clinical decisions. The significance of timely and adequate recognition of DLTIs is to prevent common clinical consequences such as incorrectly interpreted test results, delayed or non-treated condition due to erroneous diagnosis or unnecessary extra tests or therapy. Medical professionals should be educated that it is essential to obtain patient data about medications especially for the drugs used in the last 10 days before biological material collection. Our mini-review aims to provide a comprehensive overview of the current state in this important domain of medical biochemistry with detailed analysis of the effect of drugs on BLTs and to give detailed information to medical specialists.</p>","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10152617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9479380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biochemia MedicaPub Date : 2023-06-15DOI: 10.11613/BM.2023.020702
Ruth Cano-Corres, Gemma Sole-Enrech, Maria Isabel Aparicio-Calvente
{"title":"Definition of icteric interference index for six biochemical analytes.","authors":"Ruth Cano-Corres, Gemma Sole-Enrech, Maria Isabel Aparicio-Calvente","doi":"10.11613/BM.2023.020702","DOIUrl":"https://doi.org/10.11613/BM.2023.020702","url":null,"abstract":"<p><strong>Introduction: </strong>Icterus, if not detected, can affect the validity of results delivered by clinical laboratories, leading to erroneous results. This study aims to define bilirubin interference for some biochemical analytes and compare it with the manufacturer's data.</p><p><strong>Material and methods: </strong>Serum pools prepared with outpatients' samples were spiked with increasing bilirubin concentration (Merck, reference14370, Darmstadt, Germany) up to 513 µmol/L in order to evaluate the bias for the following biochemical analytes: creatinine (CREA), creatine kinase (CK), cholesterol (CHOL), gamma-glutamyltransferase (GGT), high-density lipoprotein cholesterol (HDL), and total protein (TP). For each analyte, six pools of different concentrations were prepared. Measurements were made employing Cobas 8000 analyser c702-502, Roche Diagnostics (Mannheim, Germany). This study employed a study procedure defined by the Spanish Society of Laboratory Medicine.</p><p><strong>Results: </strong>Obtained bilirubin concentrations producing a negative interference were 103 µmol/L for CHOL, 205 µmol/L for TP and 410 µmol/L for CK, but only for CK values less than 100 U/L. Bilirubin concentrations lower than 513 µmol/L do not produce interference for HDL and GGT. Finally, for the studied bilirubin concentrations, there is no interference for CREA higher than 80 µmol/L.</p><p><strong>Conclusion: </strong>Icterus interferences have been defined for each analyte, observing differences compared to data provided by the manufacturer. The evidence indicates that each laboratory should evaluate icteric interferences to ensure the high quality of the delivered results, thus benefiting patient care.</p>","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9653340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Distal renal tubular acidosis in a patient with Hashimoto's thyroiditis: a case report.","authors":"Nontembiso Mhlana, Marizna Korf, Mogamat Razeen Davids, Mogamat-Yazied Chothia","doi":"10.11613/BM.2023.020802","DOIUrl":"https://doi.org/10.11613/BM.2023.020802","url":null,"abstract":"<p><p>Renal tubular acidosis (RTA) is a rare disorder that can be inherited or acquired, and results in an inability of the kidneys to maintain normal acid-base balance. We present a case of recurrent, severe hypokalaemia and rhabdomyolysis in a young woman who had an associated normal anion gap metabolic acidosis and was subsequently diagnosed with distal RTA associated with Hashimoto's thyroiditis. Distal RTA associated with Hashimoto's thyroiditis is rare and probably develops because of autoimmune-mediated mechanisms, causing an inability of the H<sup>+</sup>-ATPase pump in alpha-intercalated cells of the cortical collecting duct to secrete H<sup>+</sup>, with subsequent failure of urinary acidification. In this case, this hypothesis was supported by the exclusion of common genetic mutations associated with distal RTA. We illustrate that utilizing a systematic, physiology-based approach for challenging electrolyte and acid-base disorders enables identification of the root cause and underlying disease mechanisms.</p>","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9647590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Establishment of reference intervals for complete blood count in times of COVID-19 and vaccination.","authors":"Claudia Mendieta-Gutiérrez, Selene Chávez-González, Brenda Ivonne Rodríguez-Romero, Jazmín Anahí Sánchez-Garrido, Arturo Figueroa-Gómez, Jesús Bernabé Licona-Vela, Arturo Cuauhtémoc Juárez-Pérez, Alejandro Cabello-López, Guadalupe Aguilar-Madrid, Carmina Jiménez-Ramírez","doi":"10.11613/BM.2023.020701","DOIUrl":"https://doi.org/10.11613/BM.2023.020701","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 and vaccination may affect some parameters of the complete blood count (CBC). The aim of this study was to determine reference intervals (RI) of CBC in healthy population with different COVID-19 and vaccination backgrounds and compare them with those established previously.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted in donors who attended the Traumatology Hospital \"Dr. Victorio de la Fuente Narváez\" (HTVFN) from June to September 2021. Reference intervals were established using the non-parametric method on Sysmex XN-1000. For differences between groups with different COVID-19 and vaccination backgrounds, non-parametric tests were used.</p><p><strong>Results: </strong>The RI were established in 156 men and 128 women. Haemoglobin (Hb), haematocrit (Hct), red blood cells (RBC), platelets (Plt), mean platelets volume (MPV), monocytes and relative neutrophils were higher in men than women (P < 0.001). The percentiles of Hb, Hct, RBC, MPV and relative monocytes showed higher values; Plt, white blood cells (WBC), lymphocytes, monocytes, neutrophils, eosinophils and absolute basophils, the 2.5th was higher and the 97.5th was lower; for lymphocytes and relative neutrophils, both percentiles had a trend toward lower values, compared to previous RI. Differences between groups with different COVID-19 and vaccination backgrounds, in lymphocytes (P = 0.038), neutrophils (P = 0.017) and eosinophils (P = 0.018) in men; Hct (P = 0.014), RDW (P = 0.023) in women and MPV (P = 0.001) in both, were not considered pathological.</p><p><strong>Conclusions: </strong>The RI for the CBC were established in a Mestizo-Mexican population with different COVID-19 and vaccination backgrounds, so should be updated and validated in different hospitals close to the HTVFN that use the same analyser.</p>","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10152613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9479375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biochemia MedicaPub Date : 2023-06-15DOI: 10.11613/BM.2023.020706
Adriana Bokulić, Ivana Zec, Domagoj Marijančević, Sanja Goreta
{"title":"Androgens in women: Establishing reference intervals for dehydroepiandrostenedione sulphate and androstenedione on the Roche Cobas.","authors":"Adriana Bokulić, Ivana Zec, Domagoj Marijančević, Sanja Goreta","doi":"10.11613/BM.2023.020706","DOIUrl":"https://doi.org/10.11613/BM.2023.020706","url":null,"abstract":"<p><strong>Introduction: </strong>Immunoassays are the most common method in routine practice for measuring androgens in women. Study's aim was to establish new population specific indirect reference intervals (RI) for dehydroepiandrostenedione sulphate (DHEAS) and for new androstenedione test available on automated Roche Cobas electrochemiluminescent immunoassay method.</p><p><strong>Materials and methods: </strong>From extracted laboratory records, testosterone, sex hormone binding globulin and follicle-stimulating hormone were used as reference tests to exclude possibly diseased women. After the data selection steps, the study included 3500 subjects for DHEAS and 520 for androstenedione aged 20-45 years. To evaluate the need for age partitioning, we calculated standard deviation ratio and bias ratio. For each hormone, 90% and 95% RIs were calculated with appropriate statistical method.</p><p><strong>Results: </strong>Total age group (20-45 years) 95% RIs were: 2.77-11.50 µmol/L for DHEAS and 2.48-8.89 nmol/L for androstenedione. Age-stratified 95% RIs for DHEAS were: 3.65-12.76 µmol/L (20-25 years); 2.97-11.50 µmol/L (25-35 years) and 2.30-9.83 µmol/L (35-45 years). Age-stratified 95% RIs for androstenedione were: 3.02-9.43 nmol/L (20-30 years) and 2.23-7.75 nmol/L (30-45 years).</p><p><strong>Conclusion: </strong>New RIs for DHEAS were slightly wider for age group 20-25 and 35-45, while the differences in the age group 25-35 years were more pronounced. Androstenedione RI showed significantly higher concentrations than the manufacturer's. Age-related decrease of androgens should be considered when calculating RIs. We propose population specific, age-stratified RIs for DHEAS and androstenedione on electrochemiluminescent method, which should improve test interpretation in women of reproductive age.</p>","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9653339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biochemia MedicaPub Date : 2023-06-15DOI: 10.11613/BM.2023.020901
Marko Lucijanic, Ivan Krecak, Ena Soric, Anica Sabljic, Davor Galusic, Hrvoje Holik, Vlatka Perisa, Martina Moric Peric, Ivan Zekanovic, Rajko Kusec
{"title":"Higher estimated plasma volume status is associated with increased thrombotic risk and impaired survival in patients with primary myelofibrosis.","authors":"Marko Lucijanic, Ivan Krecak, Ena Soric, Anica Sabljic, Davor Galusic, Hrvoje Holik, Vlatka Perisa, Martina Moric Peric, Ivan Zekanovic, Rajko Kusec","doi":"10.11613/BM.2023.020901","DOIUrl":"https://doi.org/10.11613/BM.2023.020901","url":null,"abstract":"<p><strong>Introduction: </strong>Blood plasma represents a large reservoir of cytokines and other mediators of inflammation. Higher estimated plasma volume status (ePVS) has been shown to correlate with increased thrombotic risk in polycythemia vera patients, but its clinical and prognostic associations in patients with myelofibrosis are unknown which we aim to evaluate in this study.</p><p><strong>Materials and methods: </strong>We retrospectively analysed a multicentric cohort of 238 patients with primary (PMF) and secondary myelofibrosis (SMF). Estimated plasma volume status was calculated using the Strauss-derived Duarte formula. Overall survival (OS) and time to thrombosis (TTT) considering both arterial and venous thromboses were primary endpoints of interest.</p><p><strong>Results: </strong>Median ePVS was 5.8 dL/g and it did not significantly differ between PMF and SMF patients. Patients with more advanced disease features, more pronounced inflammation and higher comorbidity burden had higher ePVS. Higher ePVS (> 5.6 dL/g) was associated with shorter OS in PMF (unadjusted hazard ratio, HR = 2.8, 95% confidence interval, CI (1.79-4.41), P < 0.001) and SMF (unadjusted HR = 2.55, 95% CI (1.1-5.71), P =0.025) and with shorter TTT in PMF (> 7 dL/g, unadjusted HR = 4.1, 95% CI (1.44-11.59), P = 0.009) patients. Associations with OS diminished in multivariate analyses after adjustments for the dynamic-international-prognostic-scoring-system (DIPSS) and myelofibrosis-secondary-to-PV-and ET-prognostic-model (MYSEC-PM), respectively. Association with TTT remained significant independently of JAK2 mutation, white blood cell count and chronic kidney disease.</p><p><strong>Conclusions: </strong>Myelofibrosis patients with more advanced disease features and more pronounced inflammation have higher ePVS, indicative of expanded plasma volume. Higher ePVS is associated with impaired survival in PMF and SMF and higher thrombotic risk in PMF patients.</p>","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10152616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9479377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biochemia MedicaPub Date : 2023-06-15DOI: 10.11613/BM.2023.020902
Bertrand Lefrère, Emmanuel Curis, Randa Bittar, Antoine Levasseur, Pierre Grès, Zoé Guilbert, Belkacem Zenati, Corinne Cherfils, Mehdi Sakka, Dominique Bonnefont-Rousselot
{"title":"Diagnosis of chylous abdominal effusions: what is the triglyceride threshold value?","authors":"Bertrand Lefrère, Emmanuel Curis, Randa Bittar, Antoine Levasseur, Pierre Grès, Zoé Guilbert, Belkacem Zenati, Corinne Cherfils, Mehdi Sakka, Dominique Bonnefont-Rousselot","doi":"10.11613/BM.2023.020902","DOIUrl":"https://doi.org/10.11613/BM.2023.020902","url":null,"abstract":"<p><strong>Introduction: </strong>Chylous abdominal effusions are serious complications that can be triggered by various aetiologies. The biochemical diagnosis of chyle leakage in ascites or in peritoneal fluid capsules relies on the detection of chylomicrons. Assaying the fluid's concentration of triglycerides is still the first-line tool. Given that only one comparative study has sought to quantify the value of the triglyceride assay for diagnosing chylous ascites in humans, our objective was to provide practical triglyceride thresholds.</p><p><strong>Materials and methods: </strong>We conducted a 9-year, retrospective, single-centre study of adult patients and compared a triglyceride assay with lipoprotein gel electrophoresis for the analysis of 90 non-recurring abdominal effusions (ascites and abdominal collections) of which 65 were chylous.</p><p><strong>Results: </strong>A triglyceride threshold of 0.4 mmol/L was associated with a sensitivity > 95%, and a threshold of 2.4 mmol/L was associated with a specificity > 95%. According to Youden index, the best threshold was 0.65 mmol/L with a sensitivity of 88 (77-95)%, a specificity of 72 (51-88)%, and, in our series, a positive predictive value of 89 (79-95)% and a negative predictive value of 69 (48-86)%.</p><p><strong>Conclusions: </strong>In our series, cut-off of 0.4 mmol/L could be used for ruling-out diagnosis of chylous effusions, while cut-off of 2.4 mmol/L could be used for reasonably confirming diagnosis.</p>","PeriodicalId":9021,"journal":{"name":"Biochemia Medica","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10152612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9479379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}