The Importance of Manual Urine Microscopy

Research presented today at the National Kidney Foundation spring clinical meeting indicates that manual microscopy surpasses automated analyzers when assessing kidney injury. The abstract is titled “Manual Microscopy: Not a Lost Art” and says, in part: “In this study, we examined if a significant difference exists between the reported ranges of granular and muddy brown casts using manual microscopy as compared to an automated urine analyzer in an acute kidney injury cohort.”

According to one of the abstract’s authors, Dr. Sharda, “What our research has been able to show so far is that the automated system under reported the value of granular casts in our patient cohort of acute kidney injury. The automated system still has utility as a screening test, but manual microscopy should be done in all cases of abnormal kidney function, as accurate quantification of casts could have some prognostic benefit to patients.”

The poster is available online. The authors are currently writing a paper on their research; their contact information is here.

On the Lab Medicine Website

In case you’ve missed it, here is the table of contents for the current issue of Lab Medicine. New articles are uploaded regularly, so be sure to check back often.

Theoretical knowledge helps troubleshoot wonky results, but unfortunately that knowledge is easy to forget if it’s not used every day. If you’ve worked the chemistry bench long enough to have forgotten some of theory behind the analytes, check out this series of articles to refresh your memory.

In the latest edition of our podcast series, Dr. Alex Thurman walks listeners through diagnosing a new acute leukemia in the middle of the night.

ASCP Call for Abstracts

Do you want to present your research at a national meeting? The American Society for Clinical Pathology is currently accepting abstract submissions for their Annual Meeting. This year it’s in October in Tampa, Florida. Soak up the sun while presenting your work and networking with your peers.

How Do We Monitor the New Anticoagulants-Podcast

As may or may not be aware, Lab Medicine has a podcast series geared toward laboratory professionals and pathologists. In a recent installment, Dr. Geoffrey Wool discusses the laboratory’s role in monitoring the new anticoagulants. Click this link to listen.

 

 

A Possible Method to Diagnose Invasive Meningococcal Infection

Saying the word “meningitis” is a sure-fire way to scare parents of young children or college students. Invasive infections caused by Neisseria meningitidis are rare but serious. Mortality rates can run around 15%; complications include amputations due to tissue necrosis and hearing loss. In short, N. meningitidis infections are nothing to mess around with.

In order to avoid death and extremity loss, the infection needs to be diagnosed early. Trouble is, the early symptoms can be similar to those of a run-of-the-mill viral infection. Some patients do not exhibit the elevated white blood cell count so common in bacterial infections. Without clear signposts to guide the way, how can clinicians catch this fast-moving infection early in its course? A handful of esoteric hematology parameters might hold the key.

Demissie et al recently published this paper in The Pediatric Infectious Disease Journal about using neutrophil counts to diagnose meningococcal infection in children. It’s behind a paywall, but here’s the gist:

-Your automated hematology analyzer needs to report immature white blood cells.

-Using total white blood cell (WBC) counts or total neutrophil counts alone is insufficient.

-The parameters to check are absolute neutrophil count (ANC), immature neutrophil count (INC), and immature-to-total neutrophil ratio (ITR).

-Patients with invasive meningococcal infection (or, the authors also say, a serious bacterial infection) display abnormalities in at least one of the three parameters.

What do you think about these guidelines? Do you think they’d be effective in diagnosing invasive meningococcal infections?

-Kelly Swails