Laboratory medicine最新文献

{"title":"An atypical finding on serum immunofixation: a case report.","authors":"Ameerah Davids, David F Keren, Annalise E Zemlin, Fatima B Fazel, David L Murray, Ernest Musekwa, Marizna Korf","doi":"10.1093/labmed/lmaf060","DOIUrl":"https://doi.org/10.1093/labmed/lmaf060","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple myeloma (MM) is characterized by the abnormal proliferation of plasma cells, resulting in the overproduction of distinctive monoclonal proteins (M-protein). Suspected MM necessitates screening for M-protein through a combination of serum protein electrophoresis, serum immunofixation (SIFE), and serum free light chain (SFLC) determination. An M-protein appears as a relatively restricted band on agarose gel, where migration in ɑ-2 is rare.</p><p><strong>Methods: </strong>A 55-year-old man with pulmonary tuberculosis presented with severe lower back pain. On examination, he appeared chronically ill, with conjunctival pallor. X-rays revealed vertebral compression fractures. The full blood count confirmed anemia; however, serum calcium and creatinine levels did not meet myeloma-defining event criteria.</p><p><strong>Results: </strong>The serum protein electrophoresis revealed hypogammaglobulinemia, with the SIFE demonstrating unusual unrestricted κ staining in the ɑ-2 region. A markedly elevated κ SFLC and κ:λ ratio were found. Bone marrow examination demonstrated approximately 90% plasmacytosis. Urine immunofixation revealed a small, restricted κ band disproportionate to the κ SFLC. Notably, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified only polyclonal κ SFLC.</p><p><strong>Discussion: </strong>Given the absence of a discernible M-protein on SIFE, a small κ restriction on urine immunofixation, and a polyclonal increase in κ SFLCs, the patient's condition is being managed as an oligosecretory MM.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can cMyc challenge cTn?","authors":"Qing Li, Chu-Jun Yang, Rui Feng, Xiao-Hui Liu, Zhen-Lu Zhang","doi":"10.1093/labmed/lmaf059","DOIUrl":"https://doi.org/10.1093/labmed/lmaf059","url":null,"abstract":"<p><strong>Introduction: </strong>The early diagnosis of acute coronary syndrome remains challenging, with high-sensitivity cardiac troponin (hs-cTn) exhibiting limitations in the first 3 hours after symptom onset. Cardiac myosin-binding protein C (cMyc) shows promise as an earlier, more specific biomarker.</p><p><strong>Methods: </strong>Comparative analyses of cMyc vs hs-cTn in multicenter studies (eg, the Kaier trial, n = 1954) and the integration of this testing into 0/1-hour algorithms were assessed. Applications in myocardial infarction subtyping, cardiac surgery, heart failure, and prehospital settings were also examined.</p><p><strong>Results: </strong>Cardiac myosin-binding protein appears in circulation within 30 minutes of ischemia and peaks earlier (6 times faster than hs-cTnT). In non-ST-segment elevation myocardial infarction, cMyc combined with hs-cTn increased rule-out rates from 10.9% to 41.9% (P < .001). Its cardiac-specific N-terminal fragment (C0C1f) minimizes false positives, and point-of-care testing feasibility (70-minute turnaround) was demonstrated. Cardiac myosin-binding protein also showed prognostic value in heart failure and cardiac surgery.</p><p><strong>Discussion: </strong>Cardiac myosin-binding protein demonstrates superior early diagnostic capability for acute coronary syndrome compared with hs-cTn, with potential to transform current diagnostic paradigms.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A falsely low lactate: discrepancies in lactate measurement between blood gas and core laboratory instruments due to β-hydroxybutyrate interference-a case report.","authors":"Nadia M Alqurini, Bhawana Adhikari, Hoda A Hagrass","doi":"10.1093/labmed/lmaf061","DOIUrl":"https://doi.org/10.1093/labmed/lmaf061","url":null,"abstract":"<p><strong>Introduction: </strong>Laboratory tests play a crucial role in diagnosing and managing illness. Accurate interpretation, which includes evaluating false-negative and false-positive results, is essential for guiding appropriate clinical interventions and ensuring patient safety.</p><p><strong>Methods: </strong>We present a case involving clinically significant discrepancies in lactate measurements in a patient with acute myeloid leukemia and diabetic ketoacidosis.</p><p><strong>Results: </strong>These discrepancies were caused by interference from elevated levels of ketone bodies-specifically, β-hydroxybutyrate-which may have delayed recognition of the severity of the patient's condition.</p><p><strong>Discussion: </strong>Dilution and spike experiments suggested potential interferences in core laboratory instruments using the Trinder reaction, leading to inaccurate lactate readings.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lupus anticoagulant-hypoprothrombinemia syndrome in a child: a case report.","authors":"Wenling Shang, Xia Zhang, Rui Shi, Lei Ye, Yuefang Wang, Luyun Peng","doi":"10.1093/labmed/lmaf057","DOIUrl":"https://doi.org/10.1093/labmed/lmaf057","url":null,"abstract":"<p><strong>Introduction: </strong>Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is a disease characterized by positive lupus anticoagulant and decreased prothrombin (plasma coagulation factor II). The primary LAHPS symptom is varying degrees of bleeding. LAHPS is rare, and at present there are no clear recommendations for its management. Some patients with this disease have atypical clinical manifestations that are easily confused with other diseases, resulting in misdiagnosis.</p><p><strong>Methods: </strong>We report a case of LAHPS in a male child who initially presented with recurrent epistaxis and past history of ecchymosis. Prothrombin and activated partial thromboplastin times were prolonged, plasma coagulation factor II activity was decreased, and lupus anticoagulant was positive. Subsequently, secondary eyeball bleeding, lumbar pain, fever, and other symptoms occurred.</p><p><strong>Results: </strong>Ultimately, a diagnosis of SLE was made based on his autoantibody results and other tests. Following the administration of methylprednisolone, blood coagulation gradually improved, and no further bleeding was observed.</p><p><strong>Discussion: </strong>In this report, plasma-mixing studies demonstrated inhibitory and co-factor effects, providing a basis for the disease's subsequent diagnosis and treatment in this patient. This case highlights the laboratory test results analyzed and the reference values for clinical diagnosis and treatment.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of anti-IH and transient adult anti-i in infectious mononucleosis potentially masking other red blood cell alloantibodies.","authors":"Johanna Bustillos, Niki Lee","doi":"10.1093/labmed/lmaf052","DOIUrl":"https://doi.org/10.1093/labmed/lmaf052","url":null,"abstract":"<p><strong>Introduction: </strong>A 29-year-old man with multiple co-morbidities, including alcoholic cirrhosis, was admitted for severe alcohol-related hepatitis, epistaxis, and fever of unknown cause. With no history of transfusions, the patient's hemoglobin level had dropped from 100 g/L to 81 g/L, with a platelet count of 46 × 109/L. Pretransfusion testing was ordered for potential transfusion.</p><p><strong>Methods: </strong>Automated group and antibody screen performed on the Quidel Ortho Clinical Diagnostics Vision platform and all complex investigation performed by the conventional manual tube method.</p><p><strong>Results: </strong>Pretransfusion tests showed that the patient was A RhD positive on forward grouping, while the reverse grouping showed an unexpected agglutination in A1 and A2 cells. Stronger agglutination reactions were noted at room temperature. The routine 3-cell antibody screen was negative but showed panreactivity on the saline room-temperature 11-cell panel and nonreactive at 37°C and on the indirect antiglobulin test (IAT). A stronger reaction was observed when the patient's plasma was tested against cord (i) cells than with adult (I) cells. It was concluded that a compound cold antibody anti-IH was present. A compatible O RhD positive red blood cell (RBC) unit was transfused to the patient which was noted to be M positive in addition to 2 A RhD positive platelet units. In the subsequent episode, viral serology returned a positive high avidity index with Epstein-Barr virus and cytomegalovirus mononucleosis assays implying a reinfection or reactivation of both infectious mononucleosis and cytomegalovirus mononucleosis. Therefore, transient anti-i was not ruled out. A new group and screen sample was obtained that demonstrated the same discrepancy in the reverse grouping, but the antibody screen revealed an anti-M alloantibody. An additional 3 crossmatch compatible group O RhD positive, M negative RBC units was transfused, but no clinically significant increment in hemoglobin was observed. A further 3 crossmatch compatible group A RhD positive, M negative RBC units were transfused, finally producing an increment increase in hemoglobin level.</p><p><strong>Discussion: </strong>This report highlights that benign cold antibodies can often be a nuisance in the investigation of RBC alloantibodies. Prewarming techniques must be used to eliminate these interferences and discrepancies, while titration of these cold agglutinins at different temperatures can help differentiate them.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Theoretical and retrograde calculation of blood alcohol: wide estimates using the Academy Standards Board for calculations over an extended period of time.","authors":"Alan H B Wu, Neal Benowitz","doi":"10.1093/labmed/lmaf055","DOIUrl":"https://doi.org/10.1093/labmed/lmaf055","url":null,"abstract":"<p><strong>Introduction: </strong>Toxicologists defend alcohol testing from their laboratories for medicolegal cases.</p><p><strong>Methods: </strong>A 22-year-old woman drank 144.1 g of alcohol over 8.25 hours at work. Precise details of her drinking (time, volume, and alcohol content) were provided. At her shift's end, her supervisor allowed her to drive home, during which time she caused the death of another driver. Her blood alcohol concentration (BAC) was 2.20 g/L, tested a few hours later. She did not drink alcohol after her work discharge. The decedent's family sued her employer for failure to recognize intoxication. An expert was engaged to perform both theoretical and retrograde BAC estimates based on consumption and the reported BAC, respectively.</p><p><strong>Results: </strong>Blood alcohol concentration calculations require use of the volume of distribution and the alcohol metabolism rate. The Academy Standards Board recommends reporting a range of BAC calculations. The theoretical and retrograde calculations in this case largely matched each other, suggesting that the driver did not drink after work. Due to the long interval between alcohol intake and her work dismissal, the theoretical calculation produced a wide BAC range (1.4-4.6 g/L). The retrograde calculation range was tighter (2.6-3.1 g/L).</p><p><strong>Discussion: </strong>A prolonged duration between drinking and testing produces a range of BAC results that can cause ambiguities in legal proceedings.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the diagnostic efficacy of anti-M2-3E, anti-gp210, and anti-sp100 antibodies in primary biliary cirrhosis.","authors":"Rujia Chen, Xinyu Huang, Yun Wang, Ting Wang, Renren Ouyang, Hongyan Hou","doi":"10.1093/labmed/lmaf049","DOIUrl":"https://doi.org/10.1093/labmed/lmaf049","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of primary biliary cholangitis (PBC) relies on the detection of specific antibodies, yet there is variability in the diagnostic accuracy and efficiency among the different diagnostic methods. We aimed to assess the individual diagnostic performance of these markers using different detection methods.</p><p><strong>Methods: </strong>A total of 112 participant-54 with PBC and 58 acting as disease controls-were enrolled. The levels of anti-M2-3E, anti-gp210, and anti-sp100 antibodies were measured using immunoblot tests from Euroimmun, flow cytometry-based multiplex bead immunoarray (MBIA [Tellgen]), and multiplex magnetic barcode encoding (MMBCE [Livzon]) assay. The 6 antigens used in the MBIA assay included recombinant E2 subunits of the pyruvate dehydrogenase complex, branched-chain 2-oxo acid dehydrogenase complex, and 2-oxoglutarate dehydrogenase complex, which together represent the M2-3E epitope group. In addition, recombinant gp210, sp100, and centromere protein B were included for the detection of antinuclear antibodies. Each antigen was covalently bound to a uniquely fluorescence-coded microsphere to allow multiplexed antibody detection in a single sample.</p><p><strong>Results: </strong>Anti-M2-3E and anti-gp210 antibodies showed much higher positivity rates in the PBC group than among control individuals. Quantitative levels of the antibodies were markedly elevated in patients with PBC. The area under the curve for the combined markers was consistently high (0.825-0.837) across platforms, indicating robust diagnostic accuracy. The logistic regression analysis revealed a substantial advantage in combining multiple markers, with anti-sp100 showing the highest odds ratio for PBC diagnosis.</p><p><strong>Discussion: </strong>The study demonstrated consistent diagnostic performance across the immunoblot, MBIA, and MMBCE detection methods for PBC markers. These findings underscore the potential of a multimarker approach to enhance PBC assessments in clinical settings.</p><p><strong>Trial registration: </strong>This study received retrospective approval from the Ethical Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (institutional review board No. TJ-IRB202308129, dated August 12, 2023).</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to professional social media use among medical laboratory scientists.","authors":"Curtiss Johnson, Pranvera Sulejmani, Richard F Puls, Casey P Schukow, Lotte Mulder, Kamran M Mirza, Aadil Ahmed","doi":"10.1093/labmed/lmaf041","DOIUrl":"https://doi.org/10.1093/labmed/lmaf041","url":null,"abstract":"<p><strong>Introduction: </strong>Medical laboratory science professionals face obstacles related to social media use. We aimed to identify social media trends among the medical laboratory science workforce and barriers to professional use.</p><p><strong>Methods: </strong>A 23-item qualitative survey was administered to American Society for Clinical Pathology members, with data collected and managed using Research Electronic Data Capture (REDCap) tools. Statistical analysis was completed using Microsoft Excel and REDCap native functions. Entries that were not complete were excluded; pathologists and students were also excluded due to low response rates.</p><p><strong>Results: </strong>Of the 238 participants who met inclusion criteria, 217 (91.2%) had at least 1 social media account. The most frequently cited uses were entertainment (60.8%) and socializing (50.2%), and the most common barriers to professional social media use were privacy concerns (48.9%) and limited time to dedicate to social media activities (48.5%). Among the 21 participants who did not participate in social media, 17 cited privacy concerns, 11 never considering joining, and 9 cited time concerns as barriers to creating social media accounts.</p><p><strong>Discussion: </strong>Most medical laboratory scientists use social media for personal reasons, with major barriers to professional use being privacy concerns and limited time. Targeted initiatives may be useful for increasing professional social media use.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longstanding, undiagnosed, highly replicative hepatitis B virus reactivation in the presence of high levels of anti-HBs antibodies.","authors":"Mahdi Ouafi, Alexandre Réguème, Stéphane Chevaliez, Emmanuel Faure, Aurélie Guigon, Magali Bouvier-Alias, Valérie Canva, Didier Hober, Laurence Bocket, Enagnon Kazali Alidjinou","doi":"10.1093/labmed/lmaf003","DOIUrl":"10.1093/labmed/lmaf003","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney transplant recipients are among the populations at risk for Hepatitis B Virus (HBV) reactivation, and close monitoring is needed for its early detection.</p><p><strong>Methods: </strong>We describe a case of HBV reactivation in a patient who underwent kidney transplantation more than 30 years ago, with a known serological profile of past HBV infection.</p><p><strong>Results: </strong>Reactivation occurred as a highly replicative infection that went undiagnosed for 7 years due to negative results for HB surface antigen (HBsAg) and high levels of anti-HBs antibodies. Viral genome sequencing showed a high number of mutations in the major hydrophilic region of HBsAg that could explain such a profile.</p><p><strong>Discussion: </strong>This case highlights the usefulness of frequent and systematic HBV viral load testing in patients at risk of reactivation, with anti-hepatitis B core antibodies, regardless of HBsAg detection, aminotransferases, and anti-HBs antibody levels.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":"577-581"},"PeriodicalIF":1.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it anti-D or anti-LW? A brief synopsis of the biology of the LW blood group and the importance and differential laboratory methods to discriminate these specificities.","authors":"Wael Ibrahim, Daoping Zhang, Dennis Williams, Aaron D Shmookler","doi":"10.1093/labmed/lmaf006","DOIUrl":"10.1093/labmed/lmaf006","url":null,"abstract":"<p><strong>Introduction: </strong>The anti-LW antibody is not considered clinically significant. Yet, it can cause some challenges in differentiating it from the anti-D antibody in pretransfusion testing.</p><p><strong>Methods: </strong>This case report discusses a 35-year-old patient with nonmalignant gastrointestinal complications who was identified as having anti-LW during pretransfusion testing. We provide a brief history of the LW system and discuss the laboratory methods used to distinguish anti-LW from anti-D.</p><p><strong>Results: </strong>The patient's prior workup revealed an O RhD-positive blood type and an antibody compatible with anti-D. Auto-control and direct antiglobulin testing with anti-immunoglobulin G were only weakly positive, but the elution was negative. Red blood cell genotyping did not show any RhD variant. Current workup showed the patient's plasma reacting with both RhD-positive and RhD-negative group O cord blood and not reacting with RhD-positive dithiothreitol-treated cells, confirming anti-LW specificity.</p><p><strong>Discussion: </strong>Clarifying an apparent confusion between a true anti-D and a mimicking anti-LW in pretransfusion blood bank testing remains the basis of providing clinically relevant component therapy. Understanding the basics of the LW Blood Group System serology is fundamental to appropriate problem solving.</p>","PeriodicalId":94124,"journal":{"name":"Laboratory medicine","volume":" ","pages":"582-585"},"PeriodicalIF":1.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}