European views on patients directly obtaining their laboratory test results.

BACKGROUND: Medicine is a highly professionalized endeavour, by tradition centred on the authority of physicians. Better education and the advent of the information age cater for increased demands on society in general and on health care in particular to enable people to make informed decisions regarding themselves. Participation in medical decisions requires informed knowledge which is hard to obtain without substantial and time consuming professional help. METHODS: We performed a survey amongst the member organizations of European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) in order to investigate the recognition and preparedness of providing help to patients in interpreting their laboratory results. RESULTS: Out of 40 EFLM Member Societies, 27 sent their responses to the survey. In most cases the first line delivery of laboratory results to physicians is by computer link (63%). Patients receive their laboratory results on demand from their physician in 60% of cases. However, 34% of laboratory specialists showed a negative attitude for delivering laboratory results to patients. Yet, in 48% of countries 1-5 patients per day ask a laboratory specialist about the significance of laboratory results outside the reference range. When patients are informed about the purpose of laboratory testing, they seek information primarily from their physician, followed by the internet and the Specialist in Laboratory Medicine. CONCLUSIONS: Changing practices increasingly enabling patient access to their records are on the increase facilitated by recent innovations in information technologies. Successful transfer of some of the responsibilities of physicians, demands a mutual triangular dialogue between the patient, their physician and laboratory medicine.

[Determination of full blood count normal reference values for adults in France]. / Étude des valeurs normales de l'hémogramme chez l'adulte: un besoin pour une meilleure interprétation et pour l'accréditation du laboratoire.

The full blood count (FBC) is the most prescribed laboratory test in France. Due to the lack of data, there is a great variability in reference values of the FBC, between medical laboratories. The aim of this work was to provide normal reference values for FBC in adults. These normal values were defined in a population of 33 258 healthy adults, 19 612 men and 13 646 women. These values were determined after excluding subjects having conditions in order to modify, either directly or indirectly, FBC parameters. For each parameter, we provide results for values of standard parameters, by sex and age, from 16 to 69 years. In addition, we present FBC values from a population of 339 subjects aged over 69 years with no comorbidities. These normal values are proposed to be used in everyday practice. They make it possible to distinguish, without ambiguity, a normal situation from a pathological situation. Moreover, they can be applied to the entire metropolitan France.

Full blood count normal reference values for adults in France.

AIMS: To determine full blood count (FBC) normal reference values for adults. METHODS: FBC normal values for healthy adults were defined, after establishing preanalytical conditions, in a population of 33 258 subjects, 19 612 men and 13 646 women. The values were established after excluding from this population all people having conditions liable to modify, directly or indirectly, FBC parameters. RESULTS: Results for values of standard parameters are provided in detail for each parameter, by sex and by age group from 16 to 69 years of age. In addition, we present FBC values from a population of 339 subjects aged over 69 years with no comorbidities. CONCLUSIONS: These normal values are proposed for use in everyday practice. They make it possible to distinguish, without ambiguity, a normal situation from a pathological situation. Moreover, they might be used over all mainland France.

[Hereditary hemochromatosis, the clinician point of view]. / L'hémochromatose génétique, le point de vue du clinicien.

Hereditary hemochromatosis (HH) is an autosomal recessive disease whose most common form is due to homozygosity for the C282Y mutation of the HFE gene. Its prevalence is estimated between 1/200 and 1/600 in France. This represents potentially several thousands of affected people. The disease is characterized by progressive iron overload, which can lead to irreversible parenchymal tissue damage. When clinical signs become evocative the disease is already at an advanced stage and years of life are probably lost. It is therefore important to detect the disease early. The clinician, either general practitioner or specialist, plays a pivotal role in the diagnostic process: he/she receives complaints of patients, prescribes complementary investigations, conducts the treatment and must organize of the family screening. Based on the French recommendations and on literature data, this paper presents the main lines of management of the patient as responses to the eight following questions: 1) Under what circumstances should the clinician suspect HH? 2) How to conduct investigations in the presence of high ferritin levels? 3) What manifestations must be feared with the worsening of iron overload? 4) What medical evaluation should be performed when the diagnosis of HH has been made? 5) How to conduct iron depletive treatment in practice? 6) How to monitor the treated patient? 7) What is the place of iron-chelating drugs in the treatment of HH? 8) How to take charge of the family members?

Human bone marrow adipocytes support complete myeloid and lymphoid differentiation from human CD34 cells.

In humans, the role of bone marrow (BM) adipocytes in supporting haematopoiesis has been questioned. A co-culture system of CD34(+) cells seeded onto either BM undifferentiated mesenchymal stem cells or differentiated adipocytes showed that BM adipocytes did not support the maintenance of immature progenitors but enabled their complete differentiation along the myeloid and lymphoid pathways. These properties appear to be opposite to those of osteoblasts, although both cell types share a common mesenchymal progenitor. These results suggest that stromal cells play a variety of roles in the haematopoietic microenvironment, which could be significant in situations such as osteoporosis or ageing.

Comparison of red blood cell volume distribution curves and phase-contrast microscopy in localization of the origin of hematuria.

OBJECTIVES: To determine the ability, reliability, and accuracy of urinary red blood cell volume distribution curves obtained with the use of an autoanalyzer to identify the origin of isolated microscopic hematuria and compare the results with those obtained with phase-contrast microscopy (PCM). METHODS: A prospective evaluation was performed in 45 patients with glomerular or nonglomerular microhematuria detected by urinalysis, PCM, radiologic evaluation, endoscopy, and, sometimes, renal biopsy. Urine samples were analyzed in an electronic particle-size analyzer, and the tests were repeated to assess reliability. The kappa correlation coefficient was used to assess reliability and to compare the results with the final diagnosis and with those obtained with PCM. RESULTS: Of the 28 patients who had a single definite cause of hematuria, 16 had glomerular bleeding and 12 nonglomerular bleeding. The origin of hematuria was correctly identified by the autoanalyzer in 60.7% of cases. A statistically significant correlation was found with the final diagnosis (kappa = 0.433, P = 0.048). The reliability was excellent (kappa = 0.917, P <0.0001). Of 16 patients with glomerulonephritis, 10 (62.5%) were correctly identified by PCM and 14 (87.5%) by the autoanalyzer. In 12 patients with nonglomerular bleeding, PCM was accurate in 7 (58%) and the autoanalyzer in 3 (25%). The results were statistically correlated with the findings of PCM (kappa = 0.327, P <0.00001). CONCLUSIONS: The use of an autoanalyzer is easy, reproducible, and noninvasive. It provides reliable information to orient the diagnosis toward glomerular or nonglomerular bleeding. It is as accurate as PCM for screening for the source of hematuria.

[Can urinary corpuscular volume using automated hematology contribute the diagnostic etiology of hematuric microscopy?]. / L'étude volumétrique des hématies urinaires par un automate d'hématologie peut-elle aider au diagnostic étiologique d'une hématurie microscopique?

OBJECTIVES: To assess the value of measuring urinary corpuscular volume (UCV) with a haematology automat for determination of the glomerular or non-glomerular origin of isolated microscopic haematuria (MHi). MATERIAL AND METHODS: Forty-five fresh urine samples taken from 45 consecutive patients, with a median age of 59 years, consultant for MHi on urinary dip-sticks were studied with a haematology automat. After each analysis, MHi was classified into one of the following three groups: High MHi (glomerular, UCV < 50 fl), low MHi (non-glomerular, UCV > 50 fl), MHi of unknown origin (mixed UCV). A complete aetiological assessment of MHi was performed in each case. RESULTS: The aetiological diagnosis of MHi was established in 28 cases (62%), with a glomerular origin in 16 cases and a non-glomerular origin in 12 cases. UCV was of the glomerular (19 cases), non-glomerular (3 cases) or mixed type (6 cases). When UCV indicated a glomerular or non-glomerular origin for MHi (22/28 = 78.6%), the result was exact in 77% of cases (17/22). The sensitivity to diagnose glomerular haematuria was 100%, the specificity was 37.5%, the PPV was 73.7% and the NPV waas 100%. CONCLUSION: The study of UCV can suggest the origin of MHi, but cannot confirm this origin due to its poor specificity.