Anion gap physiology and faults of the correction formula

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The anion gap is a calculated fundamental laboratory parameter used to identify and monitor acid-base disturbances. A recently popularized correction formula transforms the resulting integer to compensate for hypoalbuminemia and improve diagnostic yield. Clinical pharmacists should be aware of the underlying biochemistry, interpretation, and limitations of this formula to discern drug- and disease-related etiologies. Summary The anion gap is utilized in most care settings, ranging from outpatient monitoring to inpatient intensive care units. Supported by decades of experience, the original anion gap derives its value from its simplicity. Applying the anion gap in metabolic acidosis can help narrow differential diagnosis and detect concomitant acid-base disorders. To account for hypoalbuminemia and potential missed diagnoses, a correction formula was developed to improve sensitivity. Yet, the law of electroneutrality ensures that hypoalbuminemia is already accounted for in the original anion gap, and the proposed correction formula was derived from samples unrepresentative of human physiology. Evidence from clinical trials shows no benefit from applying the correction formula. Conclusion There is no advantage to correcting the anion gap, and such correction may increase the risk of misinterpretation or error. Clinicians should understand these limitations when diagnosing or trending acid-base disturbances.

Deucravacitinib, an Oral, Selective Tyrosine Kinase 2 (TYK2) Inhibitor, Compared With Placebo and Apremilast in Moderate to Severe Psoriasis: Integrated Laboratory Parameter Results From the Phase 3 POETYK PSO-1 and POETYK PSO-2 Trials

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Troponin interference with special regard to macrocomplex formation

Biomarkers, such as troponin-T and troponin-I, are regarded as the gold standard laboratory parameter for diagnosing many cardiological diseases. These parameters have been approved for clinical use. Many cardiological guidelines recommend the analysis of troponins in the majority of cardiological disease diagnoses and to also gain prognostic information. Nonetheless, many medical circumstances could cause false troponin elevations. In this article, we focus on troponin artifacts, particularly macro-immune complex formation, as important interference factors. Therefore, we performed a literature search from 2006 to 06/2021.

A STUDY OF CLINICAL PROFILE AND LABORATORY PARAMETER IN MULTIPLE MYELOMA AT SMS MEDICAL COLLEGE & HOSPITAL, JAIPUR

Introduction: Myeloma is characterized by the neoplastic proliferation of a single plasma cell of terminally differentiated B lymphoid cells that produces monoclonal immunoglobulin. Myeloma often manifests with many clinical symptoms and organ damage, including anemia, hypercalcemia, renal insufficiency, lytic bone lesion, hyperviscosity, amyloidosis, and infection. Background : Bone marrow examination gold standard in establishing the diagnosis of multiple myeloma along with clinical ,radiological and laboratory parameters the histological criteria for staging will help in determining the prognosis. Objective: To correlate the clinical and laboratory parameter in the diagnosis and staging of multiple myeloma in the SMS Medical College & Hospital Jaipur. Materials and Methods: All haematological sample of multiple myeloma and histopathology specimens received of respective tissues in Department of Pathology SMS Medical College & Attached Hospital, Jaipur. Study from 2019 to 2020. Results : 49 patients were included in this study. The mean age was 59.08 years. Male :female ratio 1.6:1.Most common clinical presentation weakness. The most common morphologic type of MM was mature myeloma followed by plasmablastic and immature type accounting 60%,24%, 16% each. Amongst the variable hemoglobin ,serum creatinine ,serum urea, and presence of bone lesion in single or multiple site were found to be statistically significant. Conclusion: The present study highlight correlation between clinical presentation, radiological findings and laboratory parameters establishing the diagnosis of multiple myeloma. The present study has application of DurieSalmon criteria and its staging system in the limited resources setting for diagnosis. Bone marrow aspiration and biopsy help in establishing diagnosis of multiple myeloma. The existence of two Staging System DSS & ISS with no mutually common parameters raises the possibility that they both are valid in differing situation and are tools for diagnosis of multiple myeloma.

Reticulocyte Hemoglobin Content as a Best Indicator of Iron Deficiency in Female Patients with Diffuse Non-Scarring Hair Loss

Background and objective: Iron deficiency is a well-documented cause of diffuse non-scarring hair loss. We aimed to find the best representative laboratory parameter for iron deficiency. Methods:This was a cross-sectional observational study conducted on 51 female patients with diffuse non-scarring hair loss and iron deficiency state. Iron deficiency was diagnosed as serum ferritin below 30 ng/ml, TSAT below 20% or CHr below 29 pg. Results: Among 51 female patients with diffuse non-scarring hair loss with laboratory proven iron deficiency; low CHrwas reported in 50 (98%) patients, low TSAT was reported in 43 (84.3%) patients, low serum ferritin was reported in 28 (55%). Conclusion:The reticulocyte hemoglobin content (CHr) shows the highest frequency of iron deficiency in patients with diffuse hair loss and iron deficiency state.

Dynamics of the level of calprotectin in patients with rheumatoid arthritis during rituximab biosimilar (Acellbia “Biocad”) therapy

Objective. To study the relationship between the level of calprotectin (CP) and RA activity, the level of acute phase reactants, proinflammatory cytokines, chemokines and growth factors, to assess its dynamics during rituximab (RTM) biosimilar therapy.Material and methods. 20 patients with RA were examined. All patients received 2 intravenous infusions of RTM (Acellbia®) at a dose of 600 mg with an interval of 2 weeks against the background of methotrexate therapy. The level of CP in blood serum was measured by ELISA.Results. Before starting DAS28 (5.6 [4.9–6.8]), SDAI (27.17 [23.08–39.9]) and CDAI (26.6 [22.25–37.0]) corresponded to the high disease activity. A decrease in disease activity was noted after 12 and 24 weeks of therapy: the DAS28 value was 4.28 [3.24–4.75] and 4.14 [3.11–4.66], respectively (p<0.05). Before the start of therapy, patients with RA had a higher CP level compared with healthy donors 9.68 (4.5–21.5) and 2.39 (1.52–4.45) μg/ml, respectively (p<0.05). Against the background of RTM therapy, there was a decrease in the CP level 12 weeks after the first infusion of the drug in the group as a whole by 26.5% from the initial level, among patients with moderate/no effect of therapy – by 32.7% from the initial level.Conclusion. The CP level significantly decreases during therapy and can be used to monitor the effectiveness of therapy. The predictive value of this laboratory parameter requires further study.

Early transfusion of convalescent plasma improves the clinical outcome in severe SARS-CoV2 infection

Plasma harvested from convalescent COVID-19 patients (CCP) has been applied as first-line therapy in the early phase of the SARS-CoV2 pandemic through clinical studies using various protocols. We present data from a cohort of 267 hospitalized, severe COVID-19 patients who received CCP. No transfusion-related complications were reported, indicating the overall safety of CCP therapy. Patients who eventually died from COVID-19 received CCP significantly later (3.95 versus 5.22 days after hospital admission) and had higher interleukin 6 (IL-6) levels (28.9 pg/ml versus 102.5 pg/ml) than those who survived. In addition, CCP-transfusion caused a significant reduction in the overall inflammatory status of the patients regardless of the severity of disease or outcome, as evidenced by decreasing C-reactive protein, IL6 and ferritin levels. We conclude that, CCP-transfusion is a safe and effective supplementary treatment modality for hospitalized COVID-19 patients characterized by better expected outcome if applied as early as possible. We also observed that, IL-6 may be a suitable laboratory parameter for patient selection and monitoring of CCP therapy effectiveness.

Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients

BackgroundUremic symptoms are major contributors to the poor quality of life among patients on dialysis, but whether their prevalence or intensity has changed over time is unknown.MethodsWe examined responses to validated questionnaires in two incident dialysis cohort studies, the Choices for Health Outcomes in Caring for ESRD (CHOICE) study (N=926, 1995–1998) and the Longitudinal United States/Canada Incident Dialysis (LUCID) study (N=428, 2011–2017). We determined the prevalence and severity of uremic symptoms—anorexia, nausea/vomiting, pruritus, sleepiness, difficulty concentrating, fatigue, and pain—in both cohorts.ResultsIn CHOICE and LUCID, respectively, mean age of the participants was 58 and 60 years, 53% and 60% were male, and 28% and 32% were black. In both cohorts, 54% of the participants had diabetes. Median time from dialysis initiation to the symptoms questionnaires was 45 days for CHOICE and 77 days for LUCID. Uremic symptom prevalence in CHOICE did not change from baseline to 1-year follow-up and was similar across CHOICE and LUCID. Baseline symptom prevalence in CHOICE and LUCID was as follows: anorexia (44%, 44%, respectively), nausea/vomiting (36%, 43%), pruritus (72%, 63%), sleepiness (86%, 68%), difficulty concentrating (55%, 57%), fatigue (89%, 77%), and pain (82%, 79%). In both cohorts, >80% of patients had three or more symptoms and >50% had five or more symptoms. The correlation between individual symptoms was low (ρ<0.5 for all comparisons). In CHOICE, no clinical or laboratory parameter was strongly associated with multiple symptoms.ConclusionsThe burden of uremic symptoms among patients on dialysis is substantial and has not changed in the past 15 years. Improving quality of life will require identification of the factors that underlie the pathogenesis of uremic symptoms and better ways of removing the toxins that are responsible.