Diabetes Hematology Coagulation In Pregnancy An Issue Of Clinics In Laboratory Medicine

This issue focuses on three disease sections: Diabetes, Hematology and Coagulation, and covers diagnostic and management issues during pregnancy of selected topics in each section. The chapters cover new concepts, evolving management and important impacts on the mother and unborn child.

Acute respiratory infections are responsible for an estimated 4 million deaths annually worldwide, and are the leading cause of death in children younger than 5 years. Over 1 million people in the United States are hospitalized each year with pneumonia. Mycobacterium tuberculosis infects one third of world’s population. There are more than 1 million tuberculosis-related deaths worldwide each year. Emerging resistance to multiple available antimicrobial agents has hampered the ability to treat tuberculosis and hospital-acquired respiratory infections. The laboratory diagnosis of respiratory infections is an important part of patient management and treatment. In addition to culture isolation of pathogens, advances have been made in a number of non-culture methods. This issue of Clinics in Laboratory Medicinee reviews state-of-the-art laboratory diagnosis of respiratory infections, as well as the testing of susceptibility to antibiotics and antiviral agents. Among some of the respiratory infections covered are: Cystic fibrosis infections; Pertussis; Pharyngitis; Fungal infections. Among the diagnostic tests are: Interferon gamma release assays; Molecuar diagnosis of TB; Urine antigen tests and discussion of Antibiotic resistance in nosocomial respiratory infections.

Molecular pathology has significantly matured over the past decade to establish itself as a discipline in its own right. Patient diagnosis, prognosis, management and care have been influenced by molecular pathology testing algorithms on a global scale. Whether it pertains to carrier status of deleterious genes, diagnosis by molecular techniques, assessment of appropriate remission post treatment, parentage or forensics testing – molecular pathology continues to increase its presence and influence in the diagnostic laboratory armamentarium. Furthermore, intellectualization and proprietization of molecular pathology with respect to the discovery of new genes and or new techniques continues to pose new challenges of test ownership, legalities, liabilities, widespread acceptance and utility. This issue of Laboratory Clinics seeks to provide selective state of the art understanding of molecular pathology with respect to its relationship to key pathology disciplines as well as the current challenges and promise for the future.

In October of 2011, CLSI published a new guideline EP23A on “Laboratory Quality Control Based on Risk Management. In March, 2012, CMS announced its intention to incorporate key concepts from EP23A into its Interpretative Guidelines and QC policy for “Individualized Quality Control Plans. Thus begins a new era of Quality Control in the Age of Risk Management. This issue is intended to help laboratories with the transition between traditional QC practices and the new risk management approach. Laboratories face a steep learning curve to apply risk analysis for identifying and prioritizing failure-modes, developing and implementing control mechanisms to detect those failure-modes, and assessing the acceptability of the residual risks that exist after implementation of a QC Plan. One of the main benefits of the new risk analysis based QC Plans should be an integration of all the control mechanisms that are needed to monitor the total testing process, including pre-analytic, analytic, and post-analytic controls. One of the main risks of the new approach is an expectation that Statistical QC is no longer important, even though SQC still remains the most useful and flexible approach for monitoring the quality of the analytic process. The key to the future is the successful integration of all these control mechanisms to provide a cost-effective quality system that monitors all phases of the total testing process. This issue should help laboratories understand the evolution of QC practices to include risk management, but also to recognize the need to maintain traditional techniques such as Statistical QC, especially during the transition to well-designed and carefully-validated QC Plans. Risk analysis may be risky business unless laboratories proceed carefully and cautiously.

Topics in this clinically focused publication devoted to Cardiac Markers include: Overview of cardiac markers in heart disease; Methodologies for measurement of cardiac markers; Natriuretic peptides in HF and ACS; Tropoinins and high sensitivity troponins; Point-of-care testing for cardiac markers; ST-2 and galectin 3 in patients with heart failure; Cardiac markers following heart surgery and percutaneous coronary intervention; Cholesterol, lipoproteins, high sensitivity CRP and other risk factors for atherosclerosis; Myocarditis and cardiac transplant and rejection; New molecular genetic tests in the diagnosis of heart disease; Biomarkers for cholesterol balance.

This issue of Hematology/Oncology Clinics, guest edited by Dr. Elliott Vichinsky, is devoted to Sickle Cell Disease, and focuses on pathophysiology of hemoglobinopathies, therapeutic targets, and new approaches to correcting ineffective erythropoiesis and iron dysregulation. Articles in this issue include Polymerization and red cell membrane changes; Overview on reperfusion injury in the pathophysiology of SCD; Regulation of ineffective erythropoiesis in iron metabolism; Altering oxygen affinity; Cellular adhesion and the endothelium; Arginine therapy; Role of the hemostatic system on SCD pathophysiology and potential therapeutics; Adenosine signaling and novel therapies; New approaches to correcting ineffective erythropoiesis and iron dysregulation; New approaches to correcting ineffective erythropoiesis and iron dysregulation; Fetal hemoglobin induction; Gene therapy for hemoglobinopathies; and Oxidative injury and the role of antioxidant therapy.

The field of Clinical Microbiology is evolving at a rapid pace, perhaps more so than any other arm of laboratory medicine. This can be attributed to new technology, including high throughput gene sequencing, multiplex molecular assays, rapid evolution of antimicrobial resistance, and discovery of new pathogens. In addition, modern medical procedures, such as solid organ and stem cell transplantation, have resulted in an explosion of infections with agents that historically have been considered to be of low virulence. This issue of Clinics in Laboratory Medicine will highlight some of the advances in diagnostic microbiology, including MALDI-TOF MS, pathogen discovery, and personalized antimicrobial chemotherapy. In addition, one of the papers will focus on implementation of new technologies and how to maximize patient impact of these new methods.

Obstetric hematology is a fast-growing area of medicine covering the diagnosis and management of hematological problems of pregnancy. Comprehensive in approach, The Obstetric Hematology Manual addresses the many hematological conditions that can cause serious problems in pregnancy, delivery and the post-partum period for both mother and baby. Written by a team of international authorities, this text provides up-to-date, evidence-based guidelines on best care, as well as sound advice based on the experience and opinion of experts. Where appropriate, basic principles are discussed to clarify the rationale for management, and systems and procedures for disease prevention are highlighted. Many conditions and cases are discussed, including venous thromboembolism, pre-eclampsia, anemia, thrombocytopenia and inherited disorders. This book will appeal to both trainees and practitioners in obstetrics, obstetric medicine, obstetric anesthesia and hematology. It is also an accessible text for midwives, nurses, and laboratory staff.