LabMed, Volume 2, Issue 3 (September 2025) – 5 articles

Cell population data (CPD) parameters generated by Sysmex XN-series analysers are promising biomarkers for a variety of disease states. Routine use of CPD parameters, however, will require extensive evaluation of potential pre-analytical variables that may affect reliability. At present, no information on the comparability of CPD parameters generated using different blood collection tubes is available. In this preliminary study, we evaluated the impact of four commonly used blood collection tubes—dipotassium (K₂) EDTA, tripotassium (K₃) EDTA, trisodium citrate, and lithium heparin—on the generation of CPD parameters in whole blood from a cohort of 10 healthy donors. We also evaluated the stability of the CPD parameters generated at 4 h post-collection. Statistically significant differences in the CPD were observed across all blood collection tubes: whole blood anticoagulated with K₃EDTA induced minimal biases and was comparable to whole blood anticoagulated with K₂EDTA at collection; however, whole blood anticoagulated with citrate and heparin were associated with more substantial and more widespread biases in several parameters with potential clinical relevance. Notably, the biases observed in whole blood anticoagulated with K₃EDTA increased in both number and magnitude at 4 h post-collection, whilst the CPD parameters generated with whole blood anticoagulated with K₂EDTA remained stable. Although further confirmatory investigations are required, these findings highlight the importance of anticoagulant selection, as well as the need for further pre-analytical research, to support the integration of CPD parameters generated by Sysmex XN-series analysers into routine diagnostic workflows. Full article

In recent years, antiviral therapy has proved crucial in the treatment of infectious diseases, particularly infections by highly variable viruses such as human immunodeficiency virus, hepatitis B, hepatitis C, SARS-CoV-2 or bacteria such as Mycobacterium tuberculosis. Under the effect of selection pressure, this variability induces mutations that lead to resistance to antiviral and antibacterial drugs, and thus to escape from treatment. The use of Advanced Biological Laboratories (ABL) assays technology combined with next-generation sequencing (NGS) and automatized software to detect majority and minority variants involved in treatment resistance has become a mainstay for establishing therapeutic strategies. The present study demonstrated high concordance between majority and minority subtypes and mutations identified in 15 samples across four NGS platforms: ISeq100 (Illumina (San Diego, CA, USA)), MiSeq (Illumina), DNBSEQ-G400 (MGI (Santa Clara, CA, USA)) and Mk1C MinION (Oxford Nanopore (Oxford Science Park, UK)). However, nanopore technology showed a higher number of minority mutations (<20%). The analysis also validated the pooling of microbiological samples as a method for detecting mutations and genotypes in viral and bacterial organisms, using the easy-to-use DeepChek^® bioinformatics software, compatible with all four sequencing platforms. This study underlines the constant evolution of microbiological diagnostic research and the need to adapt rapidly to improve patient care. Full article

Cardiac amyloidosis (CA) results from the deposition of either immunoglobulin light chain (AL) or transthyretin (ATTR) amyloid fibrils in the myocardium, causing restrictive cardiomyopathy and, if left untreated, can lead to early death. Advancements in non-invasive diagnostic modalities have led to an increased recognition of the disease. Monoclonal gammopathy plays a pivotal role in the diagnostic algorithm for CA, particularly in differentiating AL from ATTR. This review highlights the importance of monoclonal protein detection through serum protein electrophoresis, immunofixation electrophoresis, and serum free light chain assays as initial screening tools. However, these tests alone are insufficient for a definitive diagnosis due to the complexities associated with coexisting monoclonal gammopathies and the potential for false negative and positive results. Advanced imaging modalities, such as echocardiography, cardiac magnetic resonance, and nuclear scintigraphy, along with tissue biopsy, are crucial for confirming CA and accurately determining the CA subtype. Full article

Rapid, safe, and field-deployable molecular diagnostics are crucial for the effective management of infectious disease outbreaks, particularly those involving highly infectious pathogens, which can produce clinical symptoms similar to less infectious pathogens, thus raising potential biosafety concerns. In this study, we evaluated DNA/RNA Defend Pro (DRDP) buffer, a novel viral-inactivating transport medium designed to stabilize nucleic acids and allow direct PCR without nucleic acid extraction. To ensure critical qPCR parameters were not compromised by using DRDP, we conducted serial dilution tests using herpes simplex viruses 1 and 2 (HSV-1, HSV-2) and varicella-zoster virus (VZV), comparing DRDP to standard universal transport medium (UTM). Detection sensitivity, determined by cycle quantification (Cq) values, favored DRDP, as UTM samples required a 2–3-fold dilution to mitigate PCR inhibition. DRDP maintained reliable PCR compatibility at reaction volumes containing up to 25% buffer. At higher DRDP concentrations (30–35%), PCR inhibition occurred due to EDTA content but was fully reversible by adding supplemental magnesium. Furthermore, DRDP samples did not require an initial 95 °C thermal lysis step, thus simplifying the procedure without reducing PCR sensitivity or efficiency. Full article

Fluid-sensitive sequences on MRI [Magnetic Resonance Imaging] have widely been used to assess soft tissue oedema. Windowing techniques play a significant role in adjusting the contrast to highlight the pathology. The purpose of this study is to establish the impact of modified MRI window parameters, with a narrower window width than window level, in assessing soft tissue oedema in a plethora of musculoskeletal pathologies. Fifty randomly selected patients with a range of musculoskeletal pathologies resulting in soft tissue oedema on MRI were included in the study. Two separate images of each MRI study were taken on a PD fat suppressed sequence, one with default windowing range and another with window width lower than that of window level. Both images were reviewed by two radiologists and were assessed for diagnostic effectiveness in terms of image resolution and depiction of pathology. Assessment was semi-quantitatively compared and graded on the Likert scale, from 1 to 5, with 1 indicating poor quality and 5 indicating excellent quality. Friedman’s test was then conducted to compare the scores of both images. In most of the cases, the image with the modified window/level setting was significantly better in terms of depicting pathology and having better resolution, though some cases showed no clear preference. Friedman’s test showed that the score for images with modified window settings was significantly higher. Images with modified windowing in conjunction with standard imaging protocols help to assess soft tissue oedema. Full article