scholarly journals High anion gap metabolic acidosis caused by D-lactate

2020 ◽  
Vol 30 (1) ◽  
pp. 153-157 ◽  
Author(s):  
Matthias Weemaes ◽  
Martin Hiele ◽  
Pieter Vermeersch
Keyword(s):  
Lactic Acidosis ◽  
Clinical Presentation ◽  
Point Of Care ◽  
Venous Blood ◽  
False Negative ◽  
Blood Analysis ◽  
Anion Gap ◽  
Blood Collection ◽  
Urine Organic Acid ◽  
Time Of Admission

Introduction: D-lactic acidosis is an uncommon cause of high anion gap acidosis. Materials and methods: A 35-year old woman was admitted to the emergency room with somnolence, drowsiness, dizziness, incoherent speech and drunk appearance. Her past medical history included a Roux-en-Y bypass. Point-of-care venous blood analysis revealed a high anion gap acidosis. Based on the clinical presentation, routine laboratory results and negative toxicology screening, D-lactate and 5-oxoprolinuria were considered as the most likely causes of the high anion gap acidosis. Urine organic acid analysis revealed increased lactate, but no 5-oxoproline. Plasma D-lactate was < 1.0 mmol/L and could not confirm D-lactic acidosis. What happened: Further investigation revealed that the blood sample for D-lactate was drawn 12 hours after admission, which might explain the false-negative result. Data regarding the half-life of D-lactate are, however, scarce. During a second admission, one month later, D-lactic acidosis could be confirmed with an anion gap of 40.7 mmol/L and a D-lactate of 21.0 mmol/L measured in a sample collected at the time of admission. Main lesson: The time of blood collection is of utmost importance to establish the diagnosis of D-lactic acidosis due to the fast clearance of D-lactate in the human body

scholarly journals Implementation of HbA1c Point of Care Testing in 3 German Medical Practices: Impact on Workflow and Physician, Staff, and Patient Satisfaction

2018 ◽  
Vol 12 (3) ◽  
pp. 687-694 ◽  
Author(s):  
Karl-Heinz Patzer ◽  
Payam Ardjomand ◽  
Katharina Göhring ◽  
Guido Klempt ◽  
Andreas Patzelt ◽  
...  
Keyword(s):  
Point Of Care ◽  
Venous Blood ◽  
Blood Collection ◽  
Point Of Care Testing ◽  
Practice Physician ◽  
Medical Practices ◽  
Scarce Resources ◽  
Staff Members ◽  
Before And After ◽  
Time Savings

Background: Medical practices face challenges of time and cost pressures with scarce resources. Point-of-care testing (POCT) has the potential to accelerate processes compared to central laboratory testing and can increase satisfaction of physicians, staff members, and patients. The objective of this study was to evaluate the effects of introducing HbA1c POCT in practices specialized in diabetes. Method: Three German practices that manage 400, 550, and 950 diabetes patients per year participated in this evaluation. The workflow and required time before and after POCT implementation (device: Alere Afinion AS100 Analyzer) was evaluated in each practice. Physician (n = 5), staff (n = 9), and patient (n = 298) satisfaction was assessed with questionnaires and interviews. Results: After POCT implementation the number of required visits scheduled was reduced by 80% (88% vs 17.6%, P < .0001), the number of venous blood collections by 75% (91% vs 23%, P < .0001). Of patients, 82% (vs 13% prior to POCT implementation) were able to discuss their HbA1c values with treating physicians immediately during their first visit ( P < .0001). In two of the practices the POCT process resulted in significant time savings of approximately 20 and 22 working days per 1000 patients per year (95% CI 2-46; 95% CI 10-44). All physicians indicated that POCT HbA1c implementation improved the practice workflow and all experienced a relief of burden for the office and the patients. All staff members indicated that they found the POCT measurement easy to perform and experienced a relief of burden. The majority (61.3%) of patients found the capillary blood collection more pleasant and 83% saw an advantage in the immediate availability of HbA1c results. Conclusions: The implementation of HbA1c POCT leads to an improved practice workflow and increases satisfaction of physicians, staff members and patients.

scholarly journals SARS-CoV-2 laboratory diagnostic methods: a systematic review

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Rúben Nunes ◽  
Carolina Melo ◽  
Diana Martins ◽  
Fernando Mendes
Keyword(s):  
Systematic Review ◽  
Point Of Care ◽  
False Negative ◽  
Culture Technique ◽  
Diagnostic Methods ◽  
Blood Collection ◽  
Medical Subject Headings ◽  
Serological Tests ◽  
Detection Rates ◽  
Specimen Handling

Abstract Background The new SARS-CoV-2 is a single-stranded RNA β-coronavirus, and it is comprising by structural proteins (N), (S), (E) and (M). Timely and accurate detection is necessary for spread control of SARS-CoV-2 infection, avoiding inaccurate outcomes. Therefore, in this systematic review, it is purpose to evaluate a set of laboratory diagnostic techniques and methods, analyse their specificity, sensitivity, contributing to improve detection rates and reduce false negative and false positive diagnostic results. Methods In this review, we used literature available on the indexed search database ‘PubMed’, concerning the following keywords: ‘SARS-CoV-2’, ‘Specimen handling’, ‘Cell Culture Technique’, ‘Viral Antigen’, ‘Immunoassay’, ‘NAAT’ according to Medical Subject Headings Mesh and applying the Prisma Diagram methodology. Results DD-PCR and CRISPER had more promising results, but they are unconventional and expensive NAAT methods, the usage of the target RdRp/He gene has exhibited very encouraging results improving sensitivity and specificity. After the onset of symptoms, the sensitivity of the immunoassay varies considering of blood collection day. The antigen detection test showed the highest specificity reached, however is sensitivity is lower compared to NAAT assays. Conclusions In summary, RT-PCR still considered the gold standard and precisely detects the presence of virus RNA, although with some flaws in sensitivity, while the serological tests identify a previous infection by the virus, detecting antibodies, allowing the kinetic and immunological studies, not being able to use as a diagnostic method. The molecular point of care testing equipment’s revelled be the future in the rapid and accurately diagnosis of SARS-CoV-2.

scholarly journals A Real-World Setting Study: Which Glucose Meter Could Be the Best for POCT Use? An Easy and Applicable Protocol During the Hospital Routine

2018 ◽  
Vol 12 (5) ◽  
pp. 1053-1060
Author(s):  
Alessio Mancini ◽  
Giampaolo Esposto ◽  
Silvana Manfrini ◽  
Silvia Rilli ◽  
Gessica Tinti ◽  
...  
Keyword(s):  
Point Of Care ◽  
Venous Blood ◽  
Blood Analysis ◽  
Clinical Settings ◽  
Point Of Care Testing ◽  
Laboratory Reference ◽  
Glucose Meter ◽  
Reliability And Robustness ◽  
Error Grid ◽  
Venous Blood Sampling

The aim of this retrospective study is to evaluate the reliability and robustness of six glucose meters for point-of-care testing in our wards using a brand-new protocol. During a 30-days study period a total of 50 diabetes patients were subjected to venous blood sampling and glucose meter blood analysis. The results of six glucose meters were compared with our laboratory reference assay. GlucoMen Plus (Menarini) with the 82% of acceptable results was the most robust glucose meter. Even if the Passing-Bablok analysis demonstrates the presence of constant systematic errors and the Bland-Altman test highlighted a possible overestimation, the surveillance error grid analysis showed that this glucose meter can be used safely. We proved that portable glucose meters are not always reliable in routinely clinical settings.

scholarly journals HbA 1c determination from HemaSpot™ blood collection devices: comparison of home prepared dried blood spots with standard venous blood analysis

2019 ◽  
Vol 37 (9) ◽  
pp. 1463-1470 ◽  
Author(s):  
J. M. Hall ◽  
C. F. Fowler ◽  
F. Barrett ◽  
R. W. Humphry ◽  
M. Van Drimmelen ◽  
...  
Keyword(s):  
Venous Blood ◽  
Dried Blood Spots ◽  
Blood Analysis ◽  
Blood Collection ◽  
Blood Spots

Venipuncture in the medical physiology laboratory.

1998 ◽  
Vol 274 (6) ◽  
pp. S62 ◽  
Author(s):  
B J Martin ◽  
J B Watkins ◽  
J Ramsey
Keyword(s):  
Medical Education ◽  
Venous Blood ◽  
Blood Analysis ◽  
Blood Collection ◽  
First Year ◽  
Unique Role ◽  
Gastrointestinal Physiology ◽  
Physiology Laboratory ◽  
Laboratory Experiences ◽  
Blood Data

Medical physiology laboratories, traditionally devoted to animal experimentation, face unprecedented difficulties linked to cost, staffing, instrumentation, and the use of animals. At the same time, laboratory experiences with living creatures play a unique role in medical education. In this article we describe the use of venipuncture and subsequent blood analysis, with medical students serving as both subjects and experimenters, in a sequence of first-year physiology laboratories. These experiments are safe, robust, inexpensive, and time efficient, and they teach the principles of cardiovascular, respiratory, renal, nutritional, and gastrointestinal physiology. In addition, they enhance medical education in several other important dimensions. First, they teach safe venous blood collection and handling, a training appropriate for students at this level. Second, by serving each week as subjects as well as experimenters, students experience aspects of both sides of the doctor-patient relationship. Third, the laboratories can be used to teach fundamentals of research design and analysis. Finally, because blood analysis is central to medicine, and because the student's own blood data are discussed, students are enthusiastic and cooperative, and the clinical relevance of the data is clear.

scholarly journals COVID-19 Seroprevalence among Healthcare Workers of a Large COVID-19 Hospital in Rome Reveals Strengths and Limits of Two Different Serological Tests

2021 ◽  
Vol 18 (5) ◽  
pp. 2650
Author(s):  
Giuseppe Vetrugno ◽  
Daniele Ignazio La Milia ◽  
Floriana D’Ambrosio ◽  
Marcello Di Pumpo ◽  
Roberta Pastorino ◽  
...  
Keyword(s):  
Blood Test ◽  
Healthcare Workers ◽  
Point Of Care ◽  
Venous Blood ◽  
Administrative Staff ◽  
Serological Tests ◽  
Predictive Values ◽  
Work From Home ◽  
Significant Difference ◽  
Sensitivity Specificity

Healthcare workers are at the forefront against COVID-19, worldwide. Since Fondazione Policlinico Universitario A. Gemelli (FPG) IRCCS was enlisted as a COVID-19 hospital, the healthcare workers deployed to COVID-19 wards were separated from those with limited/no exposure, whereas the administrative staff were designated to work from home. Between 4 June and 3 July 2020, an investigation was conducted to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (IgG) antibodies among the employees of the FPG using point-of-care (POC) and venous blood tests. Sensitivity, specificity, and predictive values were determined with reverse-transcription polymerase chain reaction on nasal/oropharyngeal swabs as the diagnostic gold standard. The participants enrolled amounted to 4777. Seroprevalence was 3.66% using the POC test and 1.19% using the venous blood test, with a significant difference (p < 0.05). The POC test sensitivity and specificity were, respectively, 63.64% (95% confidence interval (CI): 62.20% to 65.04%) and 96.64% (95% CI: 96.05% to 97.13%), while those of the venous blood test were, respectively, 78.79% (95% CI: 77.58% to 79.94%) and 99.36% (95% CI: 99.07% to 99.55%). Among the low-risk populations, the POC test’s predictive values were 58.33% (positive) and 98.23% (negative), whereas those of the venous blood test were 92.86% (positive) and 98.53% (negative). According to our study, these serological tests cannot be a valid alternative to diagnose COVID-19 infection in progress.

scholarly journals A surrogate virus neutralization test to quantify antibody-mediated inhibition of SARS-CoV-2 in finger stick dried blood spot samples

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amelia E. Sancilio ◽  
Richard T. D’Aquila ◽  
Elizabeth M. McNally ◽  
Matthew P. Velez ◽  
Michael G. Ison ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Venous Blood ◽  
Host Cells ◽  
Dried Blood Spot ◽  
Blood Collection ◽  
Widespread Application ◽  
Live Virus ◽  
Dilution Series ◽  
Wide Range ◽  
Blood Spot

AbstractThe spike protein of SARS-CoV-2 engages the human angiotensin-converting enzyme 2 (ACE2) receptor to enter host cells, and neutralizing antibodies are effective at blocking this interaction to prevent infection. Widespread application of this important marker of protective immunity is limited by logistical and technical challenges associated with live virus methods and venous blood collection. To address this gap, we validated an immunoassay-based method for quantifying neutralization of the spike-ACE2 interaction in a single drop of capillary whole blood, collected on filter paper as a dried blood spot (DBS) sample. Samples are eluted overnight and incubated in the presence of spike antigen and ACE2 in a 96-well solid phase plate. Competitive immunoassay with electrochemiluminescent label is used to quantify neutralizing activity. The following measures of assay performance were evaluated: dilution series of confirmed positive and negative samples, agreement with results from matched DBS-serum samples, analysis of results from DBS samples with known COVID-19 status, and precision (intra-assay percent coefficient of variation; %CV) and reliability (inter-assay; %CV). Dilution series produced the expected pattern of dose–response. Agreement between results from serum and DBS samples was high, with concordance correlation = 0.991. Analysis of three control samples across the measurement range indicated acceptable levels of precision and reliability. Median % surrogate neutralization was 46.9 for PCR confirmed convalescent COVID-19 samples and 0.1 for negative samples. Large-scale testing is important for quantifying neutralizing antibodies that can provide protection against COVID-19 in order to estimate the level of immunity in the general population. DBS provides a minimally-invasive, low cost alternative to venous blood collection, and this scalable immunoassay-based method for quantifying inhibition of the spike-ACE2 interaction can be used as a surrogate for virus-based assays to expand testing across a wide range of settings and populations.

Sign in / Sign up

Export Citation Format

Share Document