Rinsho byori. The Japanese journal of clinical pathology
-
To evaluate the clinical application of measuring procalcitonin (PCT) level for diagnosis of bacterial sepsis in patients with and without systemic inflammatory response syndrome(SIRS), we studied the relationship between blood culture (BC) and serum PCT level in clinical 207 cases. In addition, we evaluated the time courses of PCT and other inflammatory markers: tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), E-selectin, WBC count and C-reactive protein (CRP) in 5 bacterial septic patients with SIRS. Serum PCT showed sensitivity of 41% and specificity of 61%, while BC showed specificity of 88%. ⋯ In contrast, 10 cases with BC(-) and serum PCT over 10 ng/ml were presumably due to some cytokine elevation caused by virus infection or collagen diseases. In 5 cases studied for inflammatory markers, TNF-alpha level elevated earlier than the others and followed by PCT, IL-6, WBC, CRP, and E-selectin. It was suggested that the measurement of serum procalcitonin in septic patients is clinically useful marker to diagnose gram-negative bacterial septic patients with SIRS.
-
Specimen misidentification in pathology laboratories may have serious consequences. Reports on the frequency of errors in pathology laboratories in Japan are rare. We reviewed near-miss and incident reports over 7 years in our laboratory, extracted those associated with misidentification, analyzed annual changes in numbers and content, and discussed the problems faced and measures taken to prevent misidentification. ⋯ Two-thirds of misidentification events occurred associated with gross specimens, similar to findings in other studies. With the introduction of new technologies that minimize the possibility of human errors (e.g., barcode reading, digital imaging of every specimen, and installation of a glass slide printer), education on medical safety, and the use of multiple safety nets (e.g., diagnosis cancelling and slide checking), errors have decreased, but have not been eliminated completely. Recording errors and reporting them to the hospital and social community, and maintaining a sustainable quality improvement system is very important to reduce errors in pathology.
-
Liver-type fatty acid binding protein (L-FABP) is a 14kDa protein found in the cytoplasm of human renal proximal tubules. Fatty acids are bound with L-FABP and transported to the mitochondria or peroxisomes, where fatty acids are beta-oxidized, and this may play a role in fatty acid homeostasis. Moreover, L-FABP has high affinity and capacity to bind long-chain fatty acid oxidation products, and may be an effective endogenous antioxidant. ⋯ Furthermore, a multicenter trial has shown that urinary L-FABP is more sensitive than urinary protein in predicting the progression of CKD. With respect to diabetic nephropathy and acute kidney disease (AKI), urinary L-FABP is an early diagnostic of kidney disease or a predictive marker for renal prognosis. After many clinical studies, urinary L-FABP was approved as a new tubular biomarker promulgated by the Ministry of Health, Labour and Welfare in Japan.
-
In recent years, much attention has been paid to respiratory complications of transfusion. Transfusion related acute lung injury (TRALI) is defined as an acute lung injury that is temporally associated with blood transfusion. TRALI is one of the leading causes of mortality. ⋯ Recent data on transfusion mortality from the Food and Drug Administration revealed that TACO was the second highest cause of death in the United States. Our data also suggested a steep increase in the reported cases of TACO in Japan. Precautionary measures should also be implemented for this emerging complication.
-
Quality assurance of point of care testing (POCT) is thought to be difficult since it is mainly performed by doctors or nurses away from the laboratory. According to POCT guideline second edition, published by The Japan Society for Clinical Laboratory Automation, all the stages of POCT, i.e. from "before sample collection" to "after result reporting", need to be managed. ⋯ Considering the POC coordinator's role, many activities are associated with quality assurance and are indispensable; however, as all laboratory staff can coordinate POCT, information about what is needed at the point of care and should be collected put into action. Our laboratory's participation in blood glucose measurements on the ward and in outpatients is described as an example.