Romolo Dorizzi - Academia.edu (original) (raw)
Papers by Romolo Dorizzi
La Rivista Italiana della Medicina di Laboratorio, 2021
La Rivista Italiana della Medicina di Laboratorio, 2021
Clinical Chemistry and Laboratory Medicine (CCLM), 2020
La Rivista Italiana della Medicina di Laboratorio, 2020
Internal and Emergency Medicine, 2018
The reliability of initial high-sensitivity cardiac troponin T (hs-cTnT) under limit-of-detection... more The reliability of initial high-sensitivity cardiac troponin T (hs-cTnT) under limit-of-detection in ruling-out short-and longterm acute coronary events in subjects for suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not definitely settled. In a retrospective chart review analysis, 1001 subjects with hs-cTnT ≤ 14 ng/L out of 4053 subjects with hs-cTnT measured at Emergency Department (ED) presentation were recruited. The main outcome measure is fatal or non-fatal myocardial infarction (MI) within 30 days; secondary outcomes are MI or major acute coronary events (MACE) as a combination of MI or re-hospitalization for unstable angina within 1 year. In subjects with hs-cTnT < 5 ng/L [32.6% of cases, mean age 63 years (interquartile range 23)], no cases (0%, NPV 100%) had MI within 30 days, 2 cases (0.6%, NPV 99.4%) MI at 1-year, and 11 cases (3.4%, NPV 96.6%) MACE at 1-year. Patients with hs-cTnT < 5 ng/L would have benefited from a shortened decision (9.30 h and 53% overnight ED stay saved). Hs-cTnT < 5 ng/L is confirmed as safe for patients and comfortable for physicians in ruling out MI or MACE both at short and long term, suggesting that a sizable number of patients can be rapidly discharged without unnecessary diagnostic tests and ED observation.
Scandinavian journal of clinical and laboratory investigation, Jan 15, 2015
SIR: The Hub Laboratory of The Greater Romagna Area is a ‘ Shared Resource Laboratory ’ , opened ... more SIR: The Hub Laboratory of The Greater Romagna Area is a ‘ Shared Resource Laboratory ’ , opened in 2009, that provides Laboratory Medicine service for more than one million inhabitants living in an area of about 5000 square km in North Italy. In the Laboratory more than 3000 Complete Blood Cell Counts (CBCs) are daily processed with a good chance of fi nding really rare cases. Recently we investigated a 37-year-old Italian woman who attended one of the 94 blood drawing centers served by our laboratory with a request of CBC in August 2014. All the hematological parameters including Red Blood Cells (RBC), White Blood Cells (WBC) and Platelets (PLT) were within reference limits but the hematology analyzer (Sysmex XE-2100) measured a very low fl uorescence signal in DIFF scattergram (Figure 1), failed to measure the differential WBC and gave the warning fl ag ‘ abnormal scattergram ’ . The surfactant applied in DIFF channel induces complete lysis and shrinkage of the RBC membrane and increases the permeability of WBC, thus permitting a polymethine fl uorescent dye to combine with nucleic acids of permeabilized cells. The intensity of fl uorescence detected by analyzer refl ects the nucleic acid content of the WBC [1]. A technical artifact appears implausible because the DIFF defect was confi rmed using the other fi ve XE-2100 analyzers equipping our laboratory, no other samples measured in that day showed the same DIFF channel defect and Quality Control yielded satisfactory results. Since the same fl uorescence DIFF defect was persistently present in three samples collected and analyzed in June 2012, April 2013 and August 2014, we suspected a stable cause of the phenomenon. We hypothesize that the RBC lysis could interfere with the WBC staining. A blood smear was observed and a normal WBC differential count with several irregularly contracted RBC were detected (Figure 2). Oxidative damage, particularly in patients with G6PDH defi ciency and some hemoglobinopathies including unstable hemoglobins, are characteristic causes of irregularly contracted RBC morphology [2]. Scandinavian Journal of Clinical & Laboratory Investigation, 2015; 75: 436–437
La Rivista Italiana della Medicina di Laboratorio, 2021
La Rivista Italiana della Medicina di Laboratorio
British Journal of Haematology, 2020
1. Moore BJB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368:473–4. 2. ... more 1. Moore BJB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368:473–4. 2. Copaescu A, Smibert O, Gibson A, Phillips EJ, Trubiano JA. The role of IL-6 and other mediators in the cytokine storm associated with SARSCoV-2 infection. J Allergy Clin Immunol. 2020;146:518–34.e1. 3. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033–4. 4. Opoka-Winiarska V, Grywalska E, Rolinski J. Could hemophagocytic lymphohistiocytosis be the core issue of severe COVID-19 cases? BMC Med. 2020;18:214. 5. Debliquis A, Harzallah I, Mootien JY, Poidevin A, Labro G, Mejri A, et al. Haemophagocytosis in bone marrow aspirates in patients with COVID-19. Br J Haematol. 2020;190:e70–e73. 6. Dewaele K, Claeys R. Hemophagocytic lymphohistiocytosis in SARS-CoV2 infection. Blood. 2020;135:2323. 7. Dimopoulos G, de Mast Q, Markou N, Theodorakopoulou M, Komnos A, Mouktaroudi M, et al. Favorable Anakinra Responses in Severe Covid-19 Patients with Secondary Hemophagocytic Lymphohistiocytosis. Cell Host Microbe. 2020;28:117–23.e1. 8. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. 9. Fardet L, Galicier L, Lambotte O, Marzac C, Aumont C, Chahwan D, et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol. 2014;66:2613–20. 10. Wood H, Jones JR, Hui K, Mare T, Pirani T, Galloway J, et al. Secondary HLH is uncommon in severe COVID-19. Br J Haematol. 2020;190:e268–e288.
Summary From the theory to the practice; a very interesting proposal from the Education Committee... more Summary From the theory to the practice; a very interesting proposal from the Education Committee of the Association of Clinical Biochemistry for the Evidence Based Laboratory Medicine diffusion Evidence based laboratory medicine (EBLM) needs to be integrated into working practices throughout the profession; all the beginners should learn EBLM as part of their core curriculum and all the practicing laboratorians should understand the EBLM tools. Since EBLM does not easily lend itself to lecture style or large group teaching as it is as much about the practical skills as about the theory, the traditional training courses are not the appropriate teaching format. The ACB Education Committee recently made several proposal for the EBLM diffusion: 1) incorporation of EBLM into Pre-Registration Training; 2) organization of ACB accredited University courses and training day at the national meeting (courses content should be reviewed, didactic and interactive teaching sessions introduced whe...
Annals of Hematology, 2021
Major manufacturers of hematology analyzers are investing in the digitalization of blood smears a... more Major manufacturers of hematology analyzers are investing in the digitalization of blood smears and in software capable to autonomously classify morphological alterations [1, 2]. The increase in the number of laboratories using digital morphology analyzers as a companion to the traditional microscope encouraged us to evaluate external quality assessment (EQA) slides also with this technology [3]. UKNEQAS is an EQA provider widely spread all over the world that accepts results traditionally from conventional microscopy and recently from digital morphology analyzers. The areas of blood film observed with a microscope are personalized so the evaluation is highly subjective and operator dependent. On the other hand, CellavisionTM, that is the most widely used digital hematology imaging software [2], autonomously chooses the most significant areas to be evaluated and the operator is forced, in order to have a complete evaluation of the smear, to observe all the white blood cell cells (WBC), red blood cell cells (RBC), and platelets images. In December 2020, UKNEQAS distributed an interesting EQA film (code 2008BF1), derived from a patient suffering from acute leukemia and sickle cell disease. The sample was evaluated by 535 participants all over the world, for most microscope users. While 97.2% of the participants correctly identified “blast cells,” only 9.2% recognized “sickle cells” in the film. Clearly, it is very important to recognize sickle cell diseases since it will influence the management of acute leukemia. The presence of blasts in the code 2008BF1 EQA film diverted the attention of most microscope users “masking” the abnormal RBC morphology hiding an additional diagnosis. Figure 1 refers to the digital acquisition of this slide using CellavisionTM software. Section A of the figure shows that the software correctly recognized the blasts, section B, dedicated to the morphology of RBCs, allowed to easily recognize some sickle cells and boat-shaped cells (red rings). Our laboratory started to use the digital morphology analyzers to evaluate the UKNEQAS EQA samples about a year ago and we were able to detect the sickle cells before receiving the UKNEQAS report. The reported case confirms the value of the digital morphology analyzers in helping to see not only the beam but also the mote.
Summary The Healthcare Imperative: lowering costs and improving outcomes: once again Institute of... more Summary The Healthcare Imperative: lowering costs and improving outcomes: once again Institute of Medicine leads the way
British Journal of Haematology, 2020
A 76-year-old woman with advanced non-small-cell lung cancer was treated with nivolumab plus carb... more A 76-year-old woman with advanced non-small-cell lung cancer was treated with nivolumab plus carboplatin and gemcitabine chemotherapy. After the first course of chemoimmunotherapy, we observed mild leukopenia [white blood cell count (WBC), 2 01 9 10/l], some reactive lymphocytes and rouleaux. Twenty days after the second course the haemoglobin concentration was 101 g/l, platelet count 231 9 10/l and WBC 50 59 9 10/l. An automated differential count showed neutrophils 9 61 9 10/l, lymphocytes 40 47 9 10/l and monocytes 0 51 9 10/l. A peripheral blood film showed increased rouleaux formation, reactive lymphocytes, plasmacytoid lymphocytes and plasma cells (top and bottom left). Some lymphoplasmacytoid cells had cytoplasmic vacuoles (bottom right, high power). Immunophenotyping demonstrated a high prevalence of CD19 B cells (93% of lymphocytes); 75% of these B-lineage cells were plasma cells (CD19 CD20 CD38 CD138 CD81 CD27 CD200 HLA-DR with polyclonal cytoplasmic immunoglobulins) while 25% had a normal B-lymphocyte immunophenotype. Total serum protein concentration was 90 g/l with polyclonal hypergammaglobulinaemia. Lactate dehydrogenase was 1102 iu/l. Nivolumab immunotherapy was suspended and dexamethasone was prescribed. The WBC count fell to normal within 10 days. Two months later the morphology of peripheral blood cells was normal and chemotherapy was restarted. Programmed Cell Death-1 (PD-1) (CD279) is a negative co-stimulatory receptor expressed primarily on the surface of activated T cells. Nivolumab is a highly selective humanised monoclonal IgG4 kappa isotype antibody against PD1, which can inhibit the engagement of PD-1 with its ligands (PDL-1 and PDL-2) and hamper inhibitory signals to T cells, with resultant tumour recognition by cytotoxic T cells. Immunotherapy overactivates the immune system and many adverse events affecting many organs have been described. A plasma cell leukaemoid reaction as observed in this patient is rare, however. Blood film examination is important in its recognition.
La Rivista Italiana della Medicina di Laboratorio, 2019
La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine, 2017
La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine, 2018
RiassuntoPremesse.Il conteggio assoluto dei linfociti CD4+, un indicatore importante dello stato ... more RiassuntoPremesse.Il conteggio assoluto dei linfociti CD4+, un indicatore importante dello stato immunitario, è utile nel monitoraggio dei pazienti con infezione da HIV ed è stato utilizzato per molti anni come criterio decisionale per l’inizio della terapia. La condivisione di raccomandazioni Evidence Based da parte delle UU.OO. Malattie Infettive dell’AUSL Romagna ha diminuito la frequenza del monitoraggio citofluorimetrico e la spesa per reagenti e aumentato l’appropriatezza. Scopo dello studio è stato valutare se una riduzione del conteggio dei CD4+ in una coorte di pazienti HIV+ in trattamento con terapia antiretrovirale abbia aumentato la frequenza di eventi clinici maggiori, come lo sviluppo di patologie AIDS defining.Metodi.Poiché il monitoraggio dei linfociti CD4+ nella maggior parte dei pazienti HIV+ seguiti in Romagna è effettuato in un unico Laboratorio, è possibile verificare se l’esecuzione di un numero minore di esami (indicatore di esito economico) sia associata a eventi AIDS defining nei pazienti con carica virale soppressa da oltre 2 anni (indicatore di esito clinico maggiore). In seguito all’adozione da parte degli infettivologi delle linee guida evidence based relative alle modalità di richiesta, sono stati raccolti (studio retrospettivo) i seguenti dati: numero di test CD4+ eseguiti, costo reagenti, aderenza alle raccomandazioni stesse.Risultati.Dal 2014 al 2017 il numero dei conteggi CD4+ eseguiti per monitoraggio è diminuito del 61% (8476 analisi nel 2014, 5718 analisi nel 2015, 4217 analisi nel 2016 e 3250 nel 2017) senza alcuna segnalazione di eventi AIDS defining associata alla riduzione della frequenza della conta dei linfociti CD4 da parte dei clinici e con un risparmio del costo dei reagenti pari a 139.607 euro (−150%).Conclusioni.Un monitoraggio citofluorimetrico dei linfociti CD4+ meno frequente nei pazienti HIV+ con carica virale soppressa stabilmente riduce la spesa del Laboratorio senza aumentare il rischio di sviluppare patologie AIDS defining.SummaryBackground.Absolute CD4+ lymphocyte count, an important indicator of immune status, is clinically useful to monitor patients with HIV infection and was used as one of the decision criteria for starting antiretroviral therapy. Sharing of Evidence Based Recommendations by the Infectious Diseases Units of Romagna Greater Area (AUSL) led to less frequent cytometric monitoring and to a cost reduction. The aim of this study has been to assess if a decreased monitoring of absolute CD4+ lymphocyte count increased the number of major clinical events such as the development of AIDS defining pathologies in a cohort of HIV+ patients treated with antiretroviral therapy.Methods.Absolute CD4+ lymphocyte count monitoring has been carried out in almost all the HIV+ patients treated in Romagna in a single Laboratory. Therefore, we retrospectively assessed the development of AIDS defining events in patients with suppressed viral load for more than 2 years (clinical outcome indicator) when less laboratory tests are requested (outcome indicator of economic impact). Information regarding CD4+ counts, reagent costs and adherence to recommendations were collected retrospectively after infectious disease physicians adopted the recommendations for CD4+ count requesting.Results.The CD4+ counts frequency decreased from 2014 to 2017 by 61% (8476 tests in 2014, 5718 in 2015, 4239 analysis in 2016 and 3250 in 2017) with a reagent cost reduction of 139.607 euro (–150%). In the same period clinicians did not report any AIDS defining event.Conclusions.A CD4+ lymphocytes monitoring appropriate and less frequent in HIV+ patients with steadily suppressed viral load decreased laboratory cost without increasing the risk to develop AIDS defining diseases.
Journal of pharmaceutical and biomedical analysis, Jan 3, 2018
Although recent Cannabis use is widely reported to be associated with drug-related traffic accide... more Although recent Cannabis use is widely reported to be associated with drug-related traffic accidents, the evidence that Cannabis users show an increased risk of being involved in road crashes is still not unequivocally proved. The purpose of the present work is to provide an objective assessment of this hypothesis, by comparing the frequency of occurrence of positive urine analyses in drivers involved in traffic accidents (n = 1406) with that observed in a control population undergoing mandatory urine drug testing (n = 1953). Urine analyses for drugs of abuse were performed by screening immunometric techniques followed by confirmation with UHPLC-QQQ MS, adopting a cut-off concentration for THC-COOH of 15 ng/mL. A case was classified as "positive" when a driver admitted to hospital for road traffic injuries showed urine concentrations of THC-COOH higher than the cut-off. All samples showing positive results for any other controlled drug in urine or blood alcohol concentrati...
La Rivista Italiana della Medicina di Laboratorio, 2021
La Rivista Italiana della Medicina di Laboratorio, 2021
Clinical Chemistry and Laboratory Medicine (CCLM), 2020
La Rivista Italiana della Medicina di Laboratorio, 2020
Internal and Emergency Medicine, 2018
The reliability of initial high-sensitivity cardiac troponin T (hs-cTnT) under limit-of-detection... more The reliability of initial high-sensitivity cardiac troponin T (hs-cTnT) under limit-of-detection in ruling-out short-and longterm acute coronary events in subjects for suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not definitely settled. In a retrospective chart review analysis, 1001 subjects with hs-cTnT ≤ 14 ng/L out of 4053 subjects with hs-cTnT measured at Emergency Department (ED) presentation were recruited. The main outcome measure is fatal or non-fatal myocardial infarction (MI) within 30 days; secondary outcomes are MI or major acute coronary events (MACE) as a combination of MI or re-hospitalization for unstable angina within 1 year. In subjects with hs-cTnT < 5 ng/L [32.6% of cases, mean age 63 years (interquartile range 23)], no cases (0%, NPV 100%) had MI within 30 days, 2 cases (0.6%, NPV 99.4%) MI at 1-year, and 11 cases (3.4%, NPV 96.6%) MACE at 1-year. Patients with hs-cTnT < 5 ng/L would have benefited from a shortened decision (9.30 h and 53% overnight ED stay saved). Hs-cTnT < 5 ng/L is confirmed as safe for patients and comfortable for physicians in ruling out MI or MACE both at short and long term, suggesting that a sizable number of patients can be rapidly discharged without unnecessary diagnostic tests and ED observation.
Scandinavian journal of clinical and laboratory investigation, Jan 15, 2015
SIR: The Hub Laboratory of The Greater Romagna Area is a ‘ Shared Resource Laboratory ’ , opened ... more SIR: The Hub Laboratory of The Greater Romagna Area is a ‘ Shared Resource Laboratory ’ , opened in 2009, that provides Laboratory Medicine service for more than one million inhabitants living in an area of about 5000 square km in North Italy. In the Laboratory more than 3000 Complete Blood Cell Counts (CBCs) are daily processed with a good chance of fi nding really rare cases. Recently we investigated a 37-year-old Italian woman who attended one of the 94 blood drawing centers served by our laboratory with a request of CBC in August 2014. All the hematological parameters including Red Blood Cells (RBC), White Blood Cells (WBC) and Platelets (PLT) were within reference limits but the hematology analyzer (Sysmex XE-2100) measured a very low fl uorescence signal in DIFF scattergram (Figure 1), failed to measure the differential WBC and gave the warning fl ag ‘ abnormal scattergram ’ . The surfactant applied in DIFF channel induces complete lysis and shrinkage of the RBC membrane and increases the permeability of WBC, thus permitting a polymethine fl uorescent dye to combine with nucleic acids of permeabilized cells. The intensity of fl uorescence detected by analyzer refl ects the nucleic acid content of the WBC [1]. A technical artifact appears implausible because the DIFF defect was confi rmed using the other fi ve XE-2100 analyzers equipping our laboratory, no other samples measured in that day showed the same DIFF channel defect and Quality Control yielded satisfactory results. Since the same fl uorescence DIFF defect was persistently present in three samples collected and analyzed in June 2012, April 2013 and August 2014, we suspected a stable cause of the phenomenon. We hypothesize that the RBC lysis could interfere with the WBC staining. A blood smear was observed and a normal WBC differential count with several irregularly contracted RBC were detected (Figure 2). Oxidative damage, particularly in patients with G6PDH defi ciency and some hemoglobinopathies including unstable hemoglobins, are characteristic causes of irregularly contracted RBC morphology [2]. Scandinavian Journal of Clinical & Laboratory Investigation, 2015; 75: 436–437
La Rivista Italiana della Medicina di Laboratorio, 2021
La Rivista Italiana della Medicina di Laboratorio
British Journal of Haematology, 2020
1. Moore BJB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368:473–4. 2. ... more 1. Moore BJB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368:473–4. 2. Copaescu A, Smibert O, Gibson A, Phillips EJ, Trubiano JA. The role of IL-6 and other mediators in the cytokine storm associated with SARSCoV-2 infection. J Allergy Clin Immunol. 2020;146:518–34.e1. 3. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033–4. 4. Opoka-Winiarska V, Grywalska E, Rolinski J. Could hemophagocytic lymphohistiocytosis be the core issue of severe COVID-19 cases? BMC Med. 2020;18:214. 5. Debliquis A, Harzallah I, Mootien JY, Poidevin A, Labro G, Mejri A, et al. Haemophagocytosis in bone marrow aspirates in patients with COVID-19. Br J Haematol. 2020;190:e70–e73. 6. Dewaele K, Claeys R. Hemophagocytic lymphohistiocytosis in SARS-CoV2 infection. Blood. 2020;135:2323. 7. Dimopoulos G, de Mast Q, Markou N, Theodorakopoulou M, Komnos A, Mouktaroudi M, et al. Favorable Anakinra Responses in Severe Covid-19 Patients with Secondary Hemophagocytic Lymphohistiocytosis. Cell Host Microbe. 2020;28:117–23.e1. 8. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. 9. Fardet L, Galicier L, Lambotte O, Marzac C, Aumont C, Chahwan D, et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol. 2014;66:2613–20. 10. Wood H, Jones JR, Hui K, Mare T, Pirani T, Galloway J, et al. Secondary HLH is uncommon in severe COVID-19. Br J Haematol. 2020;190:e268–e288.
Summary From the theory to the practice; a very interesting proposal from the Education Committee... more Summary From the theory to the practice; a very interesting proposal from the Education Committee of the Association of Clinical Biochemistry for the Evidence Based Laboratory Medicine diffusion Evidence based laboratory medicine (EBLM) needs to be integrated into working practices throughout the profession; all the beginners should learn EBLM as part of their core curriculum and all the practicing laboratorians should understand the EBLM tools. Since EBLM does not easily lend itself to lecture style or large group teaching as it is as much about the practical skills as about the theory, the traditional training courses are not the appropriate teaching format. The ACB Education Committee recently made several proposal for the EBLM diffusion: 1) incorporation of EBLM into Pre-Registration Training; 2) organization of ACB accredited University courses and training day at the national meeting (courses content should be reviewed, didactic and interactive teaching sessions introduced whe...
Annals of Hematology, 2021
Major manufacturers of hematology analyzers are investing in the digitalization of blood smears a... more Major manufacturers of hematology analyzers are investing in the digitalization of blood smears and in software capable to autonomously classify morphological alterations [1, 2]. The increase in the number of laboratories using digital morphology analyzers as a companion to the traditional microscope encouraged us to evaluate external quality assessment (EQA) slides also with this technology [3]. UKNEQAS is an EQA provider widely spread all over the world that accepts results traditionally from conventional microscopy and recently from digital morphology analyzers. The areas of blood film observed with a microscope are personalized so the evaluation is highly subjective and operator dependent. On the other hand, CellavisionTM, that is the most widely used digital hematology imaging software [2], autonomously chooses the most significant areas to be evaluated and the operator is forced, in order to have a complete evaluation of the smear, to observe all the white blood cell cells (WBC), red blood cell cells (RBC), and platelets images. In December 2020, UKNEQAS distributed an interesting EQA film (code 2008BF1), derived from a patient suffering from acute leukemia and sickle cell disease. The sample was evaluated by 535 participants all over the world, for most microscope users. While 97.2% of the participants correctly identified “blast cells,” only 9.2% recognized “sickle cells” in the film. Clearly, it is very important to recognize sickle cell diseases since it will influence the management of acute leukemia. The presence of blasts in the code 2008BF1 EQA film diverted the attention of most microscope users “masking” the abnormal RBC morphology hiding an additional diagnosis. Figure 1 refers to the digital acquisition of this slide using CellavisionTM software. Section A of the figure shows that the software correctly recognized the blasts, section B, dedicated to the morphology of RBCs, allowed to easily recognize some sickle cells and boat-shaped cells (red rings). Our laboratory started to use the digital morphology analyzers to evaluate the UKNEQAS EQA samples about a year ago and we were able to detect the sickle cells before receiving the UKNEQAS report. The reported case confirms the value of the digital morphology analyzers in helping to see not only the beam but also the mote.
Summary The Healthcare Imperative: lowering costs and improving outcomes: once again Institute of... more Summary The Healthcare Imperative: lowering costs and improving outcomes: once again Institute of Medicine leads the way
British Journal of Haematology, 2020
A 76-year-old woman with advanced non-small-cell lung cancer was treated with nivolumab plus carb... more A 76-year-old woman with advanced non-small-cell lung cancer was treated with nivolumab plus carboplatin and gemcitabine chemotherapy. After the first course of chemoimmunotherapy, we observed mild leukopenia [white blood cell count (WBC), 2 01 9 10/l], some reactive lymphocytes and rouleaux. Twenty days after the second course the haemoglobin concentration was 101 g/l, platelet count 231 9 10/l and WBC 50 59 9 10/l. An automated differential count showed neutrophils 9 61 9 10/l, lymphocytes 40 47 9 10/l and monocytes 0 51 9 10/l. A peripheral blood film showed increased rouleaux formation, reactive lymphocytes, plasmacytoid lymphocytes and plasma cells (top and bottom left). Some lymphoplasmacytoid cells had cytoplasmic vacuoles (bottom right, high power). Immunophenotyping demonstrated a high prevalence of CD19 B cells (93% of lymphocytes); 75% of these B-lineage cells were plasma cells (CD19 CD20 CD38 CD138 CD81 CD27 CD200 HLA-DR with polyclonal cytoplasmic immunoglobulins) while 25% had a normal B-lymphocyte immunophenotype. Total serum protein concentration was 90 g/l with polyclonal hypergammaglobulinaemia. Lactate dehydrogenase was 1102 iu/l. Nivolumab immunotherapy was suspended and dexamethasone was prescribed. The WBC count fell to normal within 10 days. Two months later the morphology of peripheral blood cells was normal and chemotherapy was restarted. Programmed Cell Death-1 (PD-1) (CD279) is a negative co-stimulatory receptor expressed primarily on the surface of activated T cells. Nivolumab is a highly selective humanised monoclonal IgG4 kappa isotype antibody against PD1, which can inhibit the engagement of PD-1 with its ligands (PDL-1 and PDL-2) and hamper inhibitory signals to T cells, with resultant tumour recognition by cytotoxic T cells. Immunotherapy overactivates the immune system and many adverse events affecting many organs have been described. A plasma cell leukaemoid reaction as observed in this patient is rare, however. Blood film examination is important in its recognition.
La Rivista Italiana della Medicina di Laboratorio, 2019
La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine, 2017
La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine, 2018
RiassuntoPremesse.Il conteggio assoluto dei linfociti CD4+, un indicatore importante dello stato ... more RiassuntoPremesse.Il conteggio assoluto dei linfociti CD4+, un indicatore importante dello stato immunitario, è utile nel monitoraggio dei pazienti con infezione da HIV ed è stato utilizzato per molti anni come criterio decisionale per l’inizio della terapia. La condivisione di raccomandazioni Evidence Based da parte delle UU.OO. Malattie Infettive dell’AUSL Romagna ha diminuito la frequenza del monitoraggio citofluorimetrico e la spesa per reagenti e aumentato l’appropriatezza. Scopo dello studio è stato valutare se una riduzione del conteggio dei CD4+ in una coorte di pazienti HIV+ in trattamento con terapia antiretrovirale abbia aumentato la frequenza di eventi clinici maggiori, come lo sviluppo di patologie AIDS defining.Metodi.Poiché il monitoraggio dei linfociti CD4+ nella maggior parte dei pazienti HIV+ seguiti in Romagna è effettuato in un unico Laboratorio, è possibile verificare se l’esecuzione di un numero minore di esami (indicatore di esito economico) sia associata a eventi AIDS defining nei pazienti con carica virale soppressa da oltre 2 anni (indicatore di esito clinico maggiore). In seguito all’adozione da parte degli infettivologi delle linee guida evidence based relative alle modalità di richiesta, sono stati raccolti (studio retrospettivo) i seguenti dati: numero di test CD4+ eseguiti, costo reagenti, aderenza alle raccomandazioni stesse.Risultati.Dal 2014 al 2017 il numero dei conteggi CD4+ eseguiti per monitoraggio è diminuito del 61% (8476 analisi nel 2014, 5718 analisi nel 2015, 4217 analisi nel 2016 e 3250 nel 2017) senza alcuna segnalazione di eventi AIDS defining associata alla riduzione della frequenza della conta dei linfociti CD4 da parte dei clinici e con un risparmio del costo dei reagenti pari a 139.607 euro (−150%).Conclusioni.Un monitoraggio citofluorimetrico dei linfociti CD4+ meno frequente nei pazienti HIV+ con carica virale soppressa stabilmente riduce la spesa del Laboratorio senza aumentare il rischio di sviluppare patologie AIDS defining.SummaryBackground.Absolute CD4+ lymphocyte count, an important indicator of immune status, is clinically useful to monitor patients with HIV infection and was used as one of the decision criteria for starting antiretroviral therapy. Sharing of Evidence Based Recommendations by the Infectious Diseases Units of Romagna Greater Area (AUSL) led to less frequent cytometric monitoring and to a cost reduction. The aim of this study has been to assess if a decreased monitoring of absolute CD4+ lymphocyte count increased the number of major clinical events such as the development of AIDS defining pathologies in a cohort of HIV+ patients treated with antiretroviral therapy.Methods.Absolute CD4+ lymphocyte count monitoring has been carried out in almost all the HIV+ patients treated in Romagna in a single Laboratory. Therefore, we retrospectively assessed the development of AIDS defining events in patients with suppressed viral load for more than 2 years (clinical outcome indicator) when less laboratory tests are requested (outcome indicator of economic impact). Information regarding CD4+ counts, reagent costs and adherence to recommendations were collected retrospectively after infectious disease physicians adopted the recommendations for CD4+ count requesting.Results.The CD4+ counts frequency decreased from 2014 to 2017 by 61% (8476 tests in 2014, 5718 in 2015, 4239 analysis in 2016 and 3250 in 2017) with a reagent cost reduction of 139.607 euro (–150%). In the same period clinicians did not report any AIDS defining event.Conclusions.A CD4+ lymphocytes monitoring appropriate and less frequent in HIV+ patients with steadily suppressed viral load decreased laboratory cost without increasing the risk to develop AIDS defining diseases.
Journal of pharmaceutical and biomedical analysis, Jan 3, 2018
Although recent Cannabis use is widely reported to be associated with drug-related traffic accide... more Although recent Cannabis use is widely reported to be associated with drug-related traffic accidents, the evidence that Cannabis users show an increased risk of being involved in road crashes is still not unequivocally proved. The purpose of the present work is to provide an objective assessment of this hypothesis, by comparing the frequency of occurrence of positive urine analyses in drivers involved in traffic accidents (n = 1406) with that observed in a control population undergoing mandatory urine drug testing (n = 1953). Urine analyses for drugs of abuse were performed by screening immunometric techniques followed by confirmation with UHPLC-QQQ MS, adopting a cut-off concentration for THC-COOH of 15 ng/mL. A case was classified as "positive" when a driver admitted to hospital for road traffic injuries showed urine concentrations of THC-COOH higher than the cut-off. All samples showing positive results for any other controlled drug in urine or blood alcohol concentrati...