Rare case of benign transient hyperphosphatasemia in a complicated multiorgan adult transplant patient: Case report and literature review.

Background: Transient hyperphosphatasemia, characterized by isolated highly elevated alkaline phosphatase (ALP) activity in the absence of liver or bone disease, is typically seen in children but rarely in adults. Here we report highly elevated ALP activity in a complicated multiple-organ transplant patient due to benign transient hyperphosphatasemia.

Case Report: A 54-year-old male had a complicated past medical history including a bilateral lung transplant for cystic fibrosis in 2006, colonic resection due to colon cancer in December 2011 and subsequent chemotherapy which ended in June 2022.

Concordance between i-STAT Contemporary Troponin I and Beckman High Sensitivity Troponin I Only when Both Tests Were Performed within Two Hours: A Preliminary Study.

Objective: Often in the Emergency Department (ED) of our hospital, troponin I is measured by the i-STAT (contemporary troponin I) followed by analysis of high sensitivity troponin I (hs-TnI) using the Beckman analyzer in the clinical laboratory. In this study, contemporary troponin I concentrations obtained by the i-STAT were compared with the Beckman hs-TnI concentrations in patients with myocardial infarction.

Methods: Troponin I concentrations were determined by both methods in 56 specimens collected from 56 patients admitted to the ED (time between both measurements; <1 h to up to 16 h).

Severe complications in a 25-year-old male after brown recluse spider bite treated by therapeutic plasma exchange: A case report and review of other case studies.

Although in the majority of patients (90%), the bite wound of brown recluse spider resolves spontaneously, some patients may experience a severe reaction requiring hospitalization. A 25-year-old male developed severe hemolytic anemia, jaundice, and other complications following a brown recluse spider bite on his posterior right thigh. He was treated with methylprednisolone, antibiotics, and red blood cells (RBCs) transfusion without response.

Urine Protein Immunofixation Electrophoresis: Free Light Chain Urine Immunofixation Electrophoresis Is More Sensitive than Conventional Assays for Detecting Monoclonal Light Chains and Could Serve as a Marker of Minimal Residual Disease.

Background: Immunoglobulin monoclonal light chains (MLCs) in serum and urine are markers for monoclonal gammopathy and could serve as markers of minimal residual disease (MRD) in multiple myeloma (MM). Excretion of MLCs in urine is known to result in renal damage and shorter survival in patients with LC-predominant MM.

Methods: Retrospective review of urine immunofixation in 1738 specimens at 3 medical centers was conducted to assess the utility of urinalysis for diagnosis and monitoring of monoclonal gammopathy.

Assessing Provider Utilization of COVID-19 Inflammatory Marker Trends in Hospitalized Patients and Implications in Optimizing Value-Based Care During a Pandemic.

Introduction: Numerous inflammatory markers may serve a role in prognostication of patients hospitalized with COVID-19 infection. Early in the pandemic, our health system created an admission order set which included daily d-dimer, c-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin. Given more available outcomes data, limiting standing order of labs that do not affect daily management could result in significant cost savings to the health system without adverse patient outcomes.

Acquired factor V inhibitor in the setting of coronavirus disease 2019 infection.

Factor V inhibitors are a rare cause of life-threatening bleeding. We present a case of an acquired factor V inhibitor likely caused by coronavirus disease 2019 infection. Bleeding was manifested by severe anemia requiring frequent red-cell transfusion, left psoas muscle hematoma, and left retroperitoneal cavity hematoma.

Risk of RBC alloimmunization in multiple myeloma patients treated by Daratumumab.

Background: Daratumumab (DARA) is a human monoclonal antibody for the treatment of multiple myeloma (MM). DARA binds to CD38 on RBCs and interferes with detection of RBC alloantibodies. The objective of this study was to evaluate the risk of RBC alloimmunization in MM patients treated with DARA.

Flow Cytometric, Morphologic, and Laboratory Comparative Study in Patients With Leukocytosis and Cytopenia.

Objectives: We wanted to evaluate the effectiveness of flow cytometry immunophenotyping (FCI) as a screening test for patients with leukocytosis and cytopenia.

Methods: We identified 320 patients during August 2016 to December 2016 and evaluated FCI and morphology of peripheral blood smears (PBSs).

Results: The most common indications for FCI included history of hematologic malignancy (HHM, n = 126), leukocytosis (n = 80), and cytopenia (n = 53).

Fatal pulmonary embolism and pulmonary hemorrhage in lupus anticoagulant hypoprothrombinemia syndrome: a case report and review of literature.

: Lupus anticoagulant hypoprothrombinemia syndrome (LAHS) is a rare disorder characterized by development of lupus anticoagulant and antiprothrombin antibodies. The most common clinical manifestation is bleeding. Clinical management can be challenging due to the subtle balance between the bleeding and thrombotic tendencies.

Factor V and VIII deficiency treated with therapeutic plasma exchange prior to redo mitral valve replacement.

A 33-year-old male was admitted to the hospital for a repeat mitral valve replacement. The original surgery, performed in India in 2008 due to rheumatic heart disease, required massive amounts of plasma replacement during and after the surgery. The patient was admitted to our hospital with extremely low Factor V and Factor VIII activities due to a rare combined Factor V and Factor VIII deficiency.

Establishing an evidence base for critical laboratory value thresholds.

Objectives: Critical values denote laboratory test results indicating a life-threatening situation. The outcomes of this premise have not been rigorously evaluated.

Methods: Five years of inpatient admissions were examined for critical or "near-critical" results (total admissions = 165,066; total test results = 872,503).

Monoclonal B-cell lymphocytosis in healthy blood donors: an unexpectedly common finding.

Circulating monoclonal B cells may be detected in healthy adults, a condition called monoclonal B-cell lymphocytosis (MBL). MBL has also been identified in donated blood, but no systematic study of blood donors has been reported. Using sensitive and specific laboratory methods, we detected MBL in 149 (7.

Monoclonal B-cell lymphocytosis in blood donors.

Monoclonal B-cell populations have been detected in the peripheral blood of apparently healthy individuals by flow cytometry. In 2005, the term monoclonal B-cell lymphocytosis (MBL) was proposed to describe these findings. MBL may be immunophenotypically similar to chronic lymphocytic leukaemia (CLL) and, like CLL, the prevalence is higher in males and older individuals.

Immature platelet fraction as a predictor of platelet recovery following hematopoietic progenitor cell transplantation.

The immature platelet fraction (IPF) as determined by the Sysmex XE-2100 is a rapid automated measure of the least mature component of the platelet population and is thought to correlate with thrombopoietic activity of the marrow. We investigated the ability of IPF to predict platelet recovery following hematopoietic progenitor cell (HPC) transplantation. IPF was compared to standard parameters of hematopoietic recovery, including the immature reticulocyte fraction (IRF), an early predictor of recovery.

Fetal anemia as a response to prophylactic platelet transfusion in the management of alloimmune thrombocytopenia.

The antenatal management of alloimmune thrombocytopenia (ATP) frequently requires fetal blood sampling and prophylactic platelet transfusion. A recent case of ATP complicated by associated red blood cell alloimmunization demonstrated severe hemolysis apparently as a result of ABO incompatibility from transfused platelets.

Overproduction of a P450 that metabolizes diazinon is linked to a loss-of-function in the chromosome 2 ali-esterase (MdalphaE7) gene in resistant house flies.

Up-regulation of detoxifying enzymes in insecticide-resistant strains of the house fly is a common mechanism for metabolic resistance. However, the molecular basis of this increased insecticide metabolism is not well understood. In the multiresistant Rutgers strain, several cytochromes P450 and glutathione S-transferases are constitutively overexpressed at the transcriptional level.

How to successfully influence laboratory test utilization.

In 1994, we discovered that our hospital was higher than the 75th percentile in the average number of laboratory tests performed per inpatient discharge compared with other teaching hospitals with a case mix index of greater than 1.35. Because of the diversity and volume of tests offered, no single project would have significantly affected the number of tests ordered per patient.

Effects of exposure to cypermethrin on saxitoxin binding in susceptible and pyrethroid-resistant houseflies.

Saxitoxin (STX) binding was measured in susceptible (SBO) and pyrethroid-resistant (KDR) female houseflies having only target site insensitivity as a resistance mechanism. In KDR flies, there was a quantitative decrease in STX binding capacity (Bmax) relative to SBO flies coupled with an increase in binding affinity (Kd). Treatment of SBO flies with sublethal doses of cypermethrin resulted in a large decrease in the number of STX binding sites and an increase in STX binding affinity.

Constitutive overexpression of the cytochrome P450 gene CYP6A1 in a house fly strain with metabolic resistance to insecticides.

Messenger RNA levels of the cytochrome P450 gene CYP6A1 were measured in the insecticide resistant Diazinon-R 'Rutgers' strain and in the susceptible strain sbo of the house fly with a cloned cDNA probe. The constitutive expression of the CYP6A1 gene was at least 10 times higher in the Rutgers strain than in the sbo strain. In both strains, CYP6A1 was inducible by phenobarbital treatment of the flies.

An adult case of acute biphenotypic leukemia with characteristic mixed morphology.

A case of acute biphenotypic leukemia with mixed blast morphology and combined myeloid and T-lymphoid features is reported. The leukemic cells consisted of small lymphoid hand-mirror blasts and large blasts with cytoplasmic granules and rare Auer rods. The cells expressed myeloid and immature T-lymphoid features by cytochemistry and immunophenotyping, however T cell receptor genes were in germline configuration.