Journal of the Medical Technologist Association of Thailand
- Thailand: The Association of Medical Technologist of Thailand, c2018.
- 6243-6424 pages: illustrations; 26cm.
- Journal of the Medical Technologist Association of Thailand, Volume 46, Issue 1, April 2018 .
Includes bibliographical references.
[Article Title: Prevalence and Specificity of Red Cell Alloantibodies in Repeated Antibody Screening among Thai Blood Donors/ Sarisa Chidtrakoon, Nichapa Jeumjanya, Wiradee Sasikarn, Kamphon Intharanut and Oytip Nathalang, p. 6242-6252]
Abstract: Antibody screening test in donor plasma is important to prevent severe transfusion reactions due to immune mediated hemolysis in the recipients. An automated analyzer is widely used for mass screening; however, an increased numbers of units with positive antibodyscreening compared with conventional techniques may result in blood supply fluctuations.We repeated antibody screening test to establish evidence-based guidelines for antibody testing among Thai blood donors. Altogether, 136 out of 4,834 donor plasma samples with positive antibody screening test were repeat-tested using the conventional tube test and columnagglutination test. Only positive samples were determined for antibody specificity and analyzed according to sex, age groups and ABO types. Unaltered positive antibody screening results were 81 (1.68%) samples. The frequencies of positive alloantibodies were significantly higher among female than male donors ( p = 0.041) and no significant differences were found in different age groups. Positive donors were significantly higher in B blood group than other blood groups ( p = 0.005). Antibody identification results belonged to a single antibody, 61 samples (75.32%); multiple antibodies, 12 samples (14.80%) and unidentified antibodies, 8 samples (9.88%).Antibodies in the Lewis system were the most common, followed by those of the MNS system. Potent anti-Mi a of 2 donor plasma could be used as standard human antisera. In conclusion, the impacts of repeated antibody screening established evidence-based guidelines for antibody testing among Thai blood donors. This application was useful for not only reducing unnecessarilyremoved blood products but also expanding the in-house antisera. A similar strategy can be implemented in laboratories with related problems. https://scispace.com/papers/prevalence-and-specificity-of-red-cell-alloantibodies-in-mqs6xrry73 [Article Title: Evaluation of the Thalassemia and Hemoglobin E Screening in Community Hospitals/ Yupin Jopang, Rawiwan Puangpruk, Paripat Netnee and Kanticha Nampimai, p. 6255-6265]
Abstract: The purpose of this retrospective descriptive study was to evaluate the use of mean corpuscular volume (MCV) values less than 80 fL and mean corpuscular hemoglobin (MCH) values less than 27 pg combined with the dichlorophenolindophenol test (DCIP test) in a national screening protocol for thalassemia and hemoglobin E (Hb E) screening of pregnant women and their partners in community hospitals. The interpreted results were compared with the results obtained from Hb typing and DNA analysis for α 0 -thalassemia and β-thalassemia as gold standard. Study participants consisted of 7,615 Thai pregnant women and their partners who were positive on the preliminary screening and attending antenatal care services in 63 community hospitals of the 4 provinces; Nakhon Ratchasima, Chaiyaphum, Buriram, and Surin. The 7,615 blood samples were initially screened for α 0 -thalassemia and β-thalassemia by using 9 different hematology analyzers. A total of 6,382 blood samples were tested for the presence of Hb E by using DCIP kit. The screening results were compared with the results of Hb typing and DNA analysis. The study reveals that the Coulter DxH500, Coulter LH780, Dirui BF 6800, Pentra ES60, Pentra XL80, Cell-Dyn Ruby, Sysmex XN-1000i, and Sysmex XS-800i could be used to detect α 0 -thalassemia and β-thalassemia with the reference cutoff values of MCV 80 fL and MCH > 27 pg was detected by Mindray BC6800. However, this did not indicate that the cutoff values of MCV< 80 fL and MCH < 27 pg were not suitable for Mindray BC6800 as only one sample might not represent significant data. Hb E screening with DCIP test revealed 93.8% positive predictive value, 83.2% negative predictive value and 89.5% accuracy. It was also found that the factors affecting the misinterpretation were the lacking of knowledge and interpretation skill of laboratory personnel and insufficiency of quality control systems of the laboratories. Based on these results, using the combined test of blood indices and Hb E screening for pregnant women and their partners following the national screening protocol, all clinical laboratories should be concerned over false negative results and the proper quality control system. Moreover, personnel who are responsible for the screening should get a competent training. https://scispace.com/papers/evaluation-of-the-thalassemia-and-hemoglobin-e-screening-in-2pg7j6e4bb [Article Title: Prevalence of Hypertension, Dyslipidemia and Renal Insufficiency in Type 2 Diabetic Patients/ Kwuntida Uthaisar Kotepui, Rattanaporn Saimee and Manas Kotepui, p. 6267-6279]
Abstract: Thailand is amidst a demographic transition showing an aging trend with increasing non-communicable diseases including diabetes. The aim of this work was to study the prevalence of hypertension, dyslipidemia, and renal insufficiency in type 2 diabetic patients. Data were extracted from medical records of 6 health promoting hospitals and 1 general hospital in Nong Wua Saw District, Udon Thani Province, Thailand. Two hundred and thirty four records of Type 2 diabetic patients were retrieved and reviewed for hypertension, HbA1c level, blood urea nitrogen (BUN), creatinine level, blood lipid profile, microalbuminuria and eGFR during 2015-2016. Forty-one percent of the diabetic patients presented hypertension, thirty four percent LDL-C more than 130 mg/dL and forty eight percent eGFR less than 90 mL/min/1.73m 2 . Age, BUN, creatinine, and eGFR of diabetic patients were associated with hypertension. Moreover, age, BUN, creatinine, and HbA1c of diabetic patients were associated with eGFR stage. Univariate analysis of diabetic patients with hypertension and parameters adjusted by age and gender has confirmed association of hypertension and eGFR stage of the patients. In conclusion, this study indicated that persons with T2DM tend to have hypertension, dyslipidemia, and kidney problem. Moreover, results of this study will serve as primary epidemiological data leading to further studies on factors associated with hypertension, dyslipidemia, and renal insufficiency in type 2 diabetic patients which will help therapeutic regimen of T2DM. https://scispace.com/papers/prevalence-of-hypertension-dyslipidemia-and-renal-3yakfqg1mp [Article Title: Comparative Study of Chronic Kidney Disease Stages by GFR Derived from CKD-EPI Formula Using Enzymatic and Jaffe’s Kinetic Methods in Diabetic Patients Type 2/ Wannapa Kaewnoy, Kesinee Jankaew, Wisut Kangwantrakul, Jindarat Trakulthong, Siriporn Proungvitaya and Limthong Promdee, p. 6280-6296]
Abstract: The purpose of this study was to compare the eGFR with CKD-EPI from serum creatinine determined by Jaffe’s kinetic method (Cr Jaf ) and enzymatic method (Cr). The study enz was performed in 107 type 2 diabetic patients, 49 males and 58 females with mean age of 64 years recruited from diabetic clinic at Thungsong Hospital, Nakhon Si Thammarat Province. Highly correlated of Crand Cr Jaf in all subjects was found (r = 0.936, p < 0.001). However, enz Cr was significantly lower compared to Cr Jaf (1.31 ± 0.90 mg/dL and 1.41 ± 0.87 mg/dL, enz respectively, p < 0.001). Crin subjects with eGFR ≥ 60 mL/min/1.73 m 2 (n = 58) was lower enz than Cr Jaf significantly (0.83 ± 0.20 mg/dL and 0.97 ± 0.22 mg/dL, espectively, p < 0.001), whereas the difference between Cr and Cr Jaf was not found in subjects with eGFR < 60 mL/ enz min/1.73 m 2 (n = 49), (1.90 ± 1.50 mg/dL and 1.94 ± 1.05 mg/dL, respectively, p = 0.117). eGFR-Cr was significantly higher than eGFR-Cr Jaf in all samples (65 ± 30 and 58 ± 25 mL/ enz min/1.73 m 2 , respectively, p < 0.001) and those with eGFR ≥ 60 mL/min/1.73 m 2 (89 ± 16 and 77 ± 15 mL/min/1.73 m 2 , respectively, p < 0.001). The number of subjects with eGFR-Cr and enz eGFR-Cr Jaf ≥ 60 mL/min/1.73 m 2 were 59 and 51, and those with eGFR-Cr and eGFR-Cr Jaf enz < 60 mL/min/1.73 m 2 were 48 and 56, respectively. The same number of subjects with stage 4 and stage 5 CKD of eGFR-Crand eGFR-Cr Jaf were 11 and 5, respectively. Therefore, using enz eGFR to differentiate CKD stages with creatinine determined by enzymatic method may not be superior to those with Jaffe’s kinetic method in type 2 diabetic patients. https://scispace.com/papers/comparative-study-of-chronic-kidney-disease-stages-by-gfr-iwylzll7xt [Article Title: Preparation of Whole Blood Quality Control Materialsfor Blood Glucometer/ Sriprai Pudjeeb, Jiraporn Sithithaworn and Panutas Kritpetcharat, p. 6297-6310]
Abstract: It has been forecasted that diabetic patients in Thailand will increase to 4.3 million people in 2030. In order to prevent, control and surveillance of the risk group for diabetes, the Ministry of Public Health has launched measures to screen for the risk group using questionnaire and measure finger pricked blood glucose by using point of care blood glucometers. The blood glucometers are now widely used in primary health care hospitals but commercial whole blood control with known glucose ranges are required for quality control and these control materials are costly and sometimes unaffordable. The objective of this study was to develop the in-house whole blood controls based on 2 different protocols. The first protocol used 30 mM glyceraldehyde (GA) while the second protocol used a combination of 30 mM GA and 2.4 mM sodium iodoacetate (IA) These control materials were examined for the homogeneity, stability and accuracy. The whole blood controls consisted of low, normal and high glucose levels. Protocol 1 showed high homogeneity, stability up to 23 days at 4 o C and accuracy of 85.59%, 92.60% and 94.65%, respectively. The whole blood controls from protocol 2 had high homogeneity, stability up to 35 days at 4 o C and accuracy of 99.95%, 99.94% and 99.99% for low, normal and high glucose levels, respectively. In conclusion, the whole blood preparation method in protocol 2 described in this study provided reliable materials for quality control of the glucometers. However, further studies are required before the application in primary health care hospitals. https://scispace.com/papers/preparation-of-whole-blood-quality-control-materialsfor-4tdj1jbdmu [Article Title: Functional Sensitivity and Dilution for Serum Thyroglobulin Measurement in Differentiated Thyroid Carcinoma/ Aunchalee Laipiriyakun, Busara Satayaban, Boontham Amornkitticharoen, Jiraporn Sriprapaporn and Surasawadee Ausavarat, p. 6311-6325]
Abstract: There are many factors that affect the performance of serum thyroglobulin (Tg) measurement such as functional sensitivity, defined as the concentration that results in a 20% coefficient of variation, interference from thyroglobulin autoantibodies (TgAb) and high Tg level in which appropriate dilution is required. The protocol for serum thyroglobulin measurement is needed for effective laboratory processing. Here, we evaluated functional sensitivity of Tg, TgAb and thyroid stimulating hormone (TSH) according to the National Academy of Biochemistry (NACB) using electrochemiluminescence immunoassay. The functional sensitivity of Tg, TgAb and TSH were 0.11 ng/mL, 28.3 IU/mL and 0.014 µ IU/mL, respectively. We found 20.9 percent of the 1,426 cases were TgAb-positve when 30 IU/mL were used as a cut-off level. There was a linearity of Tg level versus undiluted signal until the signal reach at 5,079,926 relative light units (RLU) (r 2 = 0.98) for 343 records. In case of high Tg level, we recommend 1:10 dilution for sample with undiluted signal below 5,000,000 RLU and 1:100 dilution for undiluted signal above 5,000,000 RLU. Although the Tg levels of 1:10 and 1:100 dilutions were significantly different (mean difference = 4.2%) in 45 samples but the values were not exceeding the total allowable error (TEa of Tg = 21.9%). This study proposed functional sensitivity and dilution protocol for serum thyroglobulin measurement based on the laboratory performance which can be used as a guide or reference source for laboratory services. https://scispace.com/papers/functional-sensitivity-and-dilution-for-serum-thyroglobulin-3xrkfyqv6j [Article Title: Study of Blood Glucose Testing Data: Principles of Measurement and Technology/ Natthacha Aurkanjananan, Thanthip Thuansri, Suphada Suranaphonchai and Wanvisa Treebuphachatsakul, p. 6326-6337]
Abstract: Blood glucose testing (BGT) by glucose meters is useful for glycemic control in diabetic patients to avoid complications. BGT is the most widely used point of care testing in hospitals and hospitals for health promotion in Thailand. The objective of this article was to update the information on blood glucose testing by glucose meter focusing on principle of measurement, enzyme, co-enzyme, and important characteristic data that were indicated in publications and/or in packaging inserts. Data for 106 glucose meters that were used in Thailand ’ s hospital settings and published in research articles from 2011-2016 were reviewed and summarized. The most commonly used technology principle for BGT by glucose meter was GDH-amperometry (54.7%). Capillary blood was a common sample for all BGT by glucose meter and only 20.4% were applicable with other blood sample types. Three co-enzymes, i.e., NAD, PQQ, and FAD were found in current technology of BGT by glucose meters. Pyrroloquinolinequinone (PQQ) was the mostly frequently used coenzyme for BGT (41.4%). Approximately seventy-five percent of glucose meter displayed results within 5 seconds. Storage temperature for blood glucose test strips ranges from 4 to 30 ° C (45.5%). Blood sample volume used for BGT by glucose meters ranges from 0.3-0.5 ul (63.6%). In conclusion, one hundred and six glucose meters were operated by two measuring systems: photometric and amperometric while the latter was more commonly used. These two systems could be used with either GOx or GDH. Review from data published in journals from 2011-2016 indicated that the technique most frequently employed for glucose meters in Thailand’s hospital settings is GDH-PQQ-amperometry. https://scispace.com/papers/study-of-blood-glucose-testing-data-principles-of-344tat8r9s [Article Title: Effect of Anticoagulants and Pre-analytical Time on Serum and Plasma Growth Factor Analysis/ Mewadee Preecha, Tulyapruek Tawonsawatruk and Apirom Vongsakulyanon, p. 6337-6348]
Abstract: Growth factors in blood are important for wound healing and contributed mainly from platelets. Currently, there is no consensus about measurement method and suitable anticoagulant for growth factor analysis. One hundred blood samples (ten collections) were drawn into various blood collecting tubes including clot activator, plain, citrate, heparin, and ethylenediaminetetraacetic acid (EDTA). Serum or plasma obtained at 15 minutes, 4, 8 and 24 hours were analyzed for the presence of growth factors. Three platelet growth factors, [platelet-derived growth factor (PDGF)-AA, PDGF-BB and epidermal growth factor (EGF)], and erythropoietin were increased in the concentration with time in serum but unchanged in plasma. Other growth factors showed no difference between serum and plasma. Furthermore, serum PDGF-AA, PDGF-BB, and EGF showed moderate correlation with platelet count. In conclusion, types of anticoagulant, time before analysis and platelet count affected the concentration of some growth factors in blood. https://scispace.com/papers/effect-of-anticoagulants-and-pre-analytical-time-on-serum-17nxvm1dry [Article Title: Assessment of Hematology and Clinical Chemistry Laboratory Performance by Six Sigma Metric; Department of Medical Technology, Trang Hospital/ Tassanee Sirithansakul, p. 6348-6374]
Abstract: The assessment of analytical efficiency and quality control (QC) are important for reliability of laboratory results. Maximum benefits given for patients are accurate laboratory results with suitable quality control in clinical laboratory. This study aimed to use sigma metric for performance assessment and QC planning tools in hematological and clinical chemistry laboratory of Trang Hospital. Imprecision and inaccuracy of individual assays were calculated from internal quality control (IQC) and proficiency testing (PT) or external quality assessment (BOAS). Sigma metric was calculated from (%TEa - %bias) / %CV to assess laboratory competency. A 6-month collective retrospective set of data obtained from October 2016 to March 2017 was analyzed in this study. Data analyses were performed on two analyzers; Beckman Coulter (LH780) automatic blood cell counting analyzer and Beckman Coulter (AU680) clinical chemistry analyzers. LH780 was routinely operated to determine platelet count (PLT), red blood cell count (RBC), hemoglobin concentration (HGB) and mean cell volume (MCV) parameters at the world class and excellent performance level. Two AU680 analyzers were operated to evaluate 26 laboratory items of clinical chemistry laboratory. The calculated sigma metrics have shown that more than 80% of the evaluated parameters are ranked at world class and excellent performance levels. The sigma metric results are categorized according to the rule of thumb and single rule 1 35' N=2 (Pf < 0.01, P ed > 90) was selected as quality control for the majority of analyzed parameters. This has been shown to be an appropriate and flexible rule with high error detection capability and low false rejection rate for clinical laboratory. By using sigma matric, we have controlled cost effectiveness of quality control planning and a reduction of workload. However, the sigma analysis of WBC, low-density lipoprotein (LDL), blood urea nitrogen (BUN) and total protein (TP) has shown marginal performance. In this circumstance, the laboratory needs to solve and improve the quality of result by increasing the frequency of calibration and quality control. [Article Title: Complement Receptor Ig Expression in Human Monocyte-Derived Macrophages/ Kanokwan Lunwongsa, Tunyaluk Youngsawang, Savitri Boonsri, Chatuporn Wanitthanakhom, Jittipan Chanpaen, Watunyoo Buakaew, Nateelak Kooltheat, Pachuen Potup, Yordhathai Thongsri and Kanchana Usuwanthim, p. 6375-6388]
Abstract: Complement receptor of the immunoglobulin superfamily (CRIg) is specifically expressed on macrophages which enhance phagocytosis of the innate immune system. Previous study found that dexamethasone can activate the expression of CRIg on macrophages. Macrophage polarization has different functions. However, the association of those expressions on each stage of macrophage has not been reported. Thus, the objective of this study was to observe CRIg expression on MO, Ml and M2 human macrophages. Monocyte-derived macrophages were cultured and the differentiation of macrophages MO, M1 and M2 were observed by inverted microscope, flow cytometry and quantitative reverse transcription PCR (qRT-PCR). Cells were treated with low and high concentrations of dexamethasone for 24 hours. Then, the treated cells were harvested for VSIG4 expression analysis by qRT-PCR. The results showed that dexamethasone stimulated MO macrophages significantly increased the VSIG4 expression compared to the untreated control (p < 0.05). Moreover, M2 macrophages treated with low concentration of dexamethasone had significantly higher VSIG4 expression than the untreated cells (P < 0.05). The results suggested that VSIG4 are differently expressed in macrophages polarization. M2 macrophage has high VSIG4 expressions that mediate anti-inflammation and wound healing. [Article Title: The Utilization of Anti-HCV Signal to Cut-off Ratio (S/CO) in Predicting HCV-Viremia/ Sunida Vandelaer, p. 6389-6397]
Abstract: Hepatitis C virus (HCV) infection is a common cause of acute and chronic hepatitis among Thais population. The routine reactive anti-HCV is not indicated to active HCV infection. HCV antigen is not available in the routine service. An expensive RT-PCR study is required to confirm HCV viremia. The aim of the current study was to determine the relation of signal-to-cut off (S/CO) ratio of anti-HCV antibody in predicting HCV viremia. A cross-sectional study of 641 anti-HCV antibody positive patients by Architect anti-HCV 3.0 attending at King Chulalongkorn Memorial Hospital. All samples were also tested for HCV-RNA by Cobas Tagman HCV testing. Among the 641 patients with HCV infection, 385 (60.06%) were male and 256 (39.94%) were female with the mean age of 51.97 ‡ 12.09 years, ranging 15-87 years. There was significant difference in S/CO ratio of 5.04 between viremic and non-viremic patients. The sensitivity and specificity were 100% and 68.12%, respectively, whereas the positive and negative predictive values were 87% and 100%, respectively. The study showed that anti-HCV S/CO ratio is useful to predict non-viremic patients. A cut-off value of 5.04 by Architect anti-HCV 3.0 can determine the utility of HCV-RNA testing. Patients with S/CO < 5.04 might not be viremic; therefore, HCV-RNA testing is not recommended. [Article Title: Routine Syphilis Screening in Pregnancy of Nakornping Hospital, Chiang Mai Province: Traditional and Reverse Algorithms/ Patcharapom Tariyo', Uraiwan Wichasilp', Supansa Pata? Songvuth Tuongratanaphan and Areerat Nirunsittirat, p. 6398-6410]
Abstract: Syphilis is a sexually transmitted infection caused by Treponema pallidum. The infection during pregnancy can cause adverse outcomes such as fetal death, preterm birth, low birth weight and congenital syphilis. Two algorithms are currently used for syphilis diagnosis: traditional and reverse algorithm. This study aimed to compare the results from three syphilis screening methods consisting of the routine practice of Nakornping Hospital, Chiang Mai Province, traditional and reverse algorithms. The descriptive cross-sectional study was conducted in 600 pregnant women in Nakornping Hospital during June and December 2016. Participants' sera were tested by using rapid plasma reagin (RPR) and commercial immunochro-matography strip tests. The results of 3 algorithms were compared. The inconsistent results were confirmed by the fluorescent treponemal antibody absorption procedure assay (FTA-ABS). Four pregnant women (0.67%) were diagnosed as syphilis infection. The reverse algorithm detected all syphilis infected-patients while routine screening by Nakornping Hospital and the traditional algorithm detected only 2 cases which revealed 50% detection error in traditional algorithm. These results demonstrated that the reverse algorithm should be considered an algorithm of choice for syphilis screening in pregnant women. [Article Title: The Effectiveness of the Multi-language Illustration of Sputum Collection for Tuberculosis Diagnosis for Immigrant Workers/ Supit Phokhao, p. 6411-6420]
Abstract: This experimental study aimed to evaluate the effectiveness of the multi-language illustration of sputum collection for tuberculosis diagnosis for immigrant workers at Nopparat Rajathanee Hospital. The multi-language illustration was developed to describe the characteristics of sputum for tuberculosis diagnosis. The multi-language illustration was used to explain the sputum collection for acid fast bacilli stain (AFB) in 135 immigrant workers (test group) and compared to the control group immigrant workers, in which the multi-language illustration was not used. The correlations between multi-language illustration use and rate of sputum sample and AFB positive were analysed. The result found that rate of sputum sample and AFB positive were 52.6 and 8.2% in test group, while 31.9 and 5.2% for control group. It was found that rate of sputum sample in test group was increased 2.39 times when compared to control group (95%CI = 1.44-3.86) (p < 0.001). Whereas, positive rate of AFB in the test group and the control group were not significantly different. The study showed that the use of multi-language illustration of sputum collection is able to increase the rate of sputum collected by immigrant workers.