Abstracts 8th Congress CSMBLM Rijeka Korekcija N.nikolac 5.11.2015. BO2

Posterski sažetci Poster abstracts
A – Laboratorijska dijagnostika i praćenje A – Laboratory diagnostics and monitoring

zloćudnih bolesti of malignant diseases
A01 A01
Procjena koncentracije tumorskog biljega Assessment of tumor marker ProGRP

ProGRP u pacijenata s karcinomom pluća concentration in patients with small lung
malih stanica cancer
Jozo Ćorić1, Radivoj Jadrić2, Elma Kučukalić1, Berina Hasanefendić1, Jozo Ćorić1, Radivoj Jadrić2, Elma Kučukalić1, Berina Hasanefendić1,
Mirsad Panjeta1 Mirsad Panjeta1
1Department of Clinical Chemistry, Clinical Center of Sarajevo 1Department of Clinical Chemistry, Clinical Center of Sarajevo
University, Sarajevo, Bosnia and Herzegovina University, Sarajevo, Bosnia and Herzegovina
2Department of Biochemistry, School of Medicine, Sarajevo, 2Department of Biochemistry, School of Medicine, Sarajevo,
Bosnia and Herzegovina Bosnia and Herzegovina
Uvod: Gastrin oslobadajući peptid (GRP) je speci- Introduction: Gastin-releasing peptide (GRP) is a
fičan biljeg karcinoma pluća malih stanica (SCLC). specific and secreted product of small cell lung car-
Određivanje ProGRP služi kao pomoć pri diferen- cinoma (SCLC) cells. The assay ProGRP is used to aid
cijalnoj dijagnozi karcinoma pluća u kombinaci- in the differential diagnosis in lung cancer in conjunc-
ji s drugim tumorskim biljezima poput serumske tion with other tumor markers like determination se-
koncentracije neuron-specifične enolaze (NSE). rum concentrations neuron-specific enolase (NSE).
Materijali i metode: ProGRP i NSE određivani su Materials and Methods: ProGRP and NSE were
metodom elektrokemiluminiscencije (ECLIA) na measured by electrochemiluminescence immunoa-
analizatoru Roche-Cobas e601 u serumu 25 zdra- ssay (ECLIA) on Roche-Cobas e601 analyzer in sera
vih osoba i 32 bolesnika s histološki dokazanim obtained from 25 healthy subjects and 32 patients
SCLC. Prosječna dob pacijenta sa SCLC je 62 godina with histological proven SCLC. Median age of SCLC
(raspon: 42-69), a uključuje 19 žena i 13 muškaraca. patients was 62 year old (range: 42-69) and included
Analitička procjena ProGRP-a uključivala je nepre- 19 females and 13 males. Analytical assessment of
ciznost u seriji i između serija. Za unutarnju kontro- ProGRP determination comprised within-run and
lu kvalitete korišteni su PreciControl ProGRP 1 i 2. between-run imprecision. For quality control we use
Rezultati: Median za ProGRP bio je značajno veći u PreciControl ProGRP 1 and 2.
bolesnika sa SCLC u odnosu na kontrolnu skupinu Results: Median values for ProGRP were signifi-
(30,3 vs. 141,2 pg/mL, P<0,001). Razine serumskog cantly higher in patients with SCLC to the control
ProGRP bile su povišene u 78% (25/32) bolesnika. group (30.3 vs. 141.2 pg/mL, P<0,001). Serum ProGRP
Slični rezultati dobiveni su određivanjem NSE. Ne- levels were elevated in 78% (25/32) patients. We fo-
preciznost u seriji s komercijalnim kontrolama za Pre- und similar results with NSE. Within-run imprecision
ciControl ProGRP 1 je 4,6%, a za PreciControl ProGRP on the commercially controls for PreciControl ProGRP
2 je 3,6%; nepreciznost iz dana u dan za PreciControl 1 is 4.6% and 3.6% for PreciControl ProGRP 2; betwe-
ProGRP 1 je 7,5%, a za PreciControl ProGRP 2 je 8,2%. en-day imprecision for PreciControl ProGRP 1 is 7.5%
Zaključak: Serumska koncentracija ProGRP je spe- and 8.2% for PreciControl ProGRP 2 respectively.
cifično povišena kod pacijenata sa SCLC. Prikazani Conclusion: Serum ProGRP level were specifically
rezultati analitičke procjene metode za određivanje elevated in SCLC patients. The presented results of
ProGRP-a na Roche-Cobas e601 analizatoru ukazuju the analytical evaluation methods for the determi-
na prihvatljivu točnost i preciznost. nation of ProGRP on the Roche-Cobas e601 analyzer
showed an acceptable accuracy and precision.
e-adresa: coricjozo@hotmail.com
e-mail: coricjozo@hotmail.com
Biochemia Medica 2015;25(Suppl 1):S1–S158

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Posterski sažetci: A – Laboratorijska dijagnostika i praćenje zloćudnih bolesti
Poster abstracts: A – Laboratory diagnostics and monitoring of malignant diseases
A02 A02
Povezanost vrijednosti prokalcitonina i Correlation between procalcitonin

C-reaktivnog proteina prvi postoperativni and C-reactive protein values on first
dan s razdobljem oporavka pacijenta nakon postoperative day and patient’s recovery
operacija zloćudnih bolesti crijeva period after malignant bowel disease surgery
Sanja Dobrijević1, Ljiljana Mayer1, Danko Velimir Vrdoljak2, Sanja Dobrijević1, Ljiljana Mayer1, Danko Velimir Vrdoljak2, Mihaela
Mihaela Gaće1, Zvjezdana Špacir Prskalo1, Petra Pozaić1, Iva Kirac2 Gaće1, Zvjezdana Špacir Prskalo1, Petra Pozaić1, Iva Kirac2
1Kliničkajedinica za medicinsku biokemiju u onkologiji, Klinika 1Medical Biochemistry Laboratory, Institute for Tumors,
za tumore, Klinički bolnički centar Sestre milosrdnice, Zagreb, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia
Hrvatska 2Department of Surgical Oncology, Institute for Tumors,
2Kirurška onkologija, Klinika za tumore, Klinički bolnički centar University Hospital Centre Sestre milosrdnice, Zagreb, Croatia
Sestre milosrdnice, Zagreb, Hrvatska
Uvod: Prokalcitonin (PCT) i C-reaktivni protein (CRP) Introduction: Procalcitonin (PCT) and C-reactive
biljezi su upale s različitom dinamikom sinteze i raz- protein (CRP) are inflammatory markers with diffe-
gradnje u organizmu. Zbog učestalih zahtjeva za rent synthesis and degradation dynamics. Our aim
istodobno određivanje PCT-a i CRP-a u serumu cilj je was to determine number of cases where CRP does
bio utvrditi u koliko slučajeva CRP ne prati dinamiku not follow PCT dynamics, and investigate if PCT
PCT te da li vrijednost PCT-a prvi dan nakon opera- values on first postoperative day after malignant
cije zloćudne bolesti crijeva korelira s duljinom opo- bowel disease surgery correlates with patient’s reco-
ravka pacijenta. very period.
Ispitanici i metode: U periodu od 1.8.2013. do Subjects and Methods: In 1-year period 181 pati-
31.7.2014. zbog zloćudne bolesti crijeva operiran je ents were operated due to malignant bowel disea-
181 pacijent. Retrospektivnom analizom prikupljeni se. Data about length of postoperative hospital stay,
su podaci o duljini postoperativnog boravka u bol- PCT and CRP concentration in serum from 1st to 6th
nici, PCT-u i CRP-u u serumu od 1. do 6. postopera- postoperative days were collected retrospectively.
tivnog dana. Isključeni su pacijenti kojima nisu odre- Patients whose inflammatory parameters were not
đeni upalni parametri 1. postoperativni dan. Skupi- measured on first postoperative day were excluded.
na je činila 67 ispitanika, 61% muškaraca, 64 godine Group included 67 patients (61% men) with medi-
(30-80). PCT je određen na Elecsys 2010 (Roche Dia- an age 64 (30-80). PCT was determined on Elecsys
gnostics GmbH, Njemačka), a CRP na Architect c4000 2010 (Roche Diagnostics GmbH, Germany), and
(Abbott Laboratories, SAD). Za statističku obradu po- CRP on Architect c4000 (Abbott Laboratories, USA).
datak korišten je MedCalc Version 10.2.1.0. (Mariaker- MedCalc Version 10.2.1.0. (Mariakerke, Belgium) was
ke, Belgija). P<0,05 smatran je statistički značajnim. used for statistical analysis. P<0.05 was considered
Rezultati: Duljina postoperativnog boravka u bolnici statistically significant.
bila je 10 (8-13) dana. Ustanovljena je statistički zna- Results: Significant correlation between recovery
čajna povezanost između duljine postoperativnog period and PCT values (r=0.31; P=0.011) and CRP va-
boravka u bolnici i vrijednosti PCT-a (r=0,31; P=0,011) lues on first postoperative day (r=0.29; P=0.019) was
te CRP-a (r=0,29; P=0,019). Kod 51% ispitanika 2. po- observed. On the second postoperative day, decre-
stoperativni dan prisutan je pad koncentracije PCT-a ase in PCT concentration and increase of CRP value
i porast CRP-a. Ne postoji statistički značajna razlika were noted in 51% subjects. There was no statisti-
(P=0,096) u vrijednostima PCT-a u skupini ispitanika cally significant difference (P=0.096) in PCT values in
koji su postoperativno u bolnici proveli ≤10 dana od the group of patients who spent ≤10 days in hosip-
onih koji su proveli više od 10 dana. Vrijednost PCT- tal after surgery of those who spent >10 days. PCT
a viša od 1,16 ng/ml određena 1. postoperativni dan values higher than 1.16 ng/mL determined on first
uz osjetljivost 45,2% (95%Cl 27,3 - 64,0) i specifičnost postoperative day indicate that postoperative hos-
pital stay will be longer than 10 days with sensitivity

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77,8 % (95%Cl 60,8 - 89,9) indicira da će postoperativ- of 45.2% (95%CI 27.3-64.0) and specificity of 77.8%
ni boravak u bolnici biti dulji od 10 dana. (95%CI 60.8-89.9).
Zaključak: Dužina boravka pacijenata u bolnici na- Conclusion: Correlation between recovery period of
kon operacija zloćudnih bolesti crijeva slabo koreli- patients in the hospital after malignant bowel disea-
ra s vrijednostima upalnih parametara 1. postopera- se surgery and inflammatory parameters on first po-
tivni dan. Kod više od polovice pacijenata pad PCT-a stoperative day was statistically significant. In more
može se uočiti dan prije pada CRP-a. than half of patients decrease of PCT values can be
seen one day before decrease of CRP values.
e-adresa: saana.smail@gmail.com
e-mail: saana.smail@gmail.com
A03 A03
Dijagnostički potencijal humanog The diagnostic potential of human

epididimis proteina 4 (HE4) i ROMA indeksa epididymis protein 4 (HE4) and ROMA index
u žena s rakom jajnika in women with ovarian cancer
Zvjezdana Špacir Prskalo1, Ljiljana Mayer1, Mihaela Gaće1, Sanja Zvjezdana Špacir Prskalo1, Ljiljana Mayer1, Mihaela Gaće1, Sanja
Dobrijević1, Mario Puljiz2, Ilija Alvir2, Ivica Mamić2, Damir Danolić 2 Dobrijević1, Mario Puljiz2, Ilija Alvir2, Ivica Mamić2, Damir Danolić2
1Klinička jedinica za medicinsku biokemiju u onkologiji, Klinika 1Medical Biochemical Laboratory, Institute for Tumors,
za tumore, Klinički bolnički centar Sestre milosrdnice, Zagreb, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia
Hrvatska 2Department of Surgical Oncology, Department of Gynecology
2Zavod za kiruršku onkologiju, Odjel za ginekološko-onkološku Oncology Surgery, Institute for Tumors, University Hospital
kirurgiju, Klinika za tumore, Klinički bolnički centar Sestre Centre Sestre milosrdnice, Zagreb, Croatia
milosrdnice, Zagreb, Hrvatska
Uvod: Rak jajnika, koji se u Hrvatskoj nalazi na pe- Introduction: Ovarian cancer which in Croatia is fif-
tom mjestu novodijagnosticiranih tumora u žena, th in newly diagnosed cancer in women; 440 newly
bilježi kontinuirani porast incidencije, i na samom je diagnosed die 301 women. In recent years, the argu-
vrhu uzroka smrti ginekoloških maligniteta; od 440 ments are that the HE4, either by itself or in combi-
novodijagnosticiranih godišnje umre 301 žena, naj- nation with CA 125 as part of the ROMA calculations
češće radi prekasnog otkrivanja. Standardno kori- far more reliable marker (no increases in endome-
šten CA125 manjkave je osjetljivosti i specifičnosti. U triosis, cysts and non-gynecological malignancies).
zadnjih nekoliko godina nižu se argumenti da je HE4 First time in Croatia examined the utility of HE4 and
(humani epididimis protein 4), bilo kao samostalan ROMA calculating the classification of ovarian tu-
biljeg, bilo u kombinaciji s CA 125 kao dio ROMA izra- mors of other gynecological malignancies.
čuna daleko pouzdaniji biljeg (ne raste u endometri- Subjects and Methods: The study included 63 pa-
ozi, cistama, miomima i ne-ginekološkim maligniteti- tients of Institute for tumors with preoperative fin-
ma). Ovim je istraživanjem, po prvi puta u Hrvatskoj, dings demonstrated tumor mass in the pelvis of un-
ispitana korisnost HE4 i ROMA izračuna klasifikaciji known etiology. In 20/63 women subsequent histo-
tumora jajnika od ostalih ginekoloških maligniteta. pathologic diagnosis was confirmed ovarian cancer.
Ispitanici i metode: U istraživanje je uključeno sve- HE4 and CA125 measurement were the Elecsys 2010
ukupno 63 pacijentica Klinike za tumore, KBCSM s (Roche). The subjects were classified according to
predoperativnim nalazom dokazane tumorske mase menopausal status, to the ROMA calculation formu-
u zdjelici nepoznate etiologije. U 20/63 žena je na- la is used.
knadnom patohistološkom dijagnostikom potvrđen

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rak jajnika. HE4 i CA125 mjerni su na Elecsys 2010 Results: Measured concentrations of HE4 in a group
(Roche). Ispitanice su klasificirane prema menopau- of women with ovarian cancer 131.7 (76.6-639.9) mg/
zalnom statusu, kako bi se za ROMA izračun koristila mL was significantly higher than other gynecologi-
primjerena formula. cal malignancies 52.6 (48.1-62.2) mg/mL; P<0.001.
Rezultati: Izmjerena koncentracije HE4 u skupini ROC analysis revealed 64.7% sensitivity and 90.5%
žena s rakom jajnika 131,7 (76,6-639,9) mg/ml je bila specificity with cutt-of 95.62 mg/mL; AUC of 80.3%
statistički značajno viša od ostalih ginekoloških ma- for the HE4 and 70.6% sensitivity and 88.9% speci-
ligniteta 52,6 (48,1-62,2) mg/mL; P<0,001. ROC anali- ficity with the cutt-of 34.1 mg/mL; AUC of 82.2% for
zom je ustanovljena 64,7% osjetljivost i 90,5% speci- the calculation of the ROMA in distinguishing ovari-
fičnost uz cutt-of 95,62 mg/mL; AUC 80,3% za HE4 i an cancer from other cancers.
70,6% osjetljivost i 88,9% specifičnost uz cutt-of 34,1 Conclusion: The results confirm literature data of
mg/mL; AUC 82,2% za ROMA izračun u razlikovanju the usability of HE4 and ROMA calculation. Confir-
tumora jajnika od ostalih maligniteta. med the relevance and usefulness of preoperative
Zaključak: Dobiveni rezultati usklađeni su s litera- findings clinician operator to be doing just about
turnim dokazima o uporabljivosti HE4 i ROMA izra- ovarian cancer. Incomparably smaller number of fal-
čuna. Potvrđena je relevantnost i korisnost predope- se positive results in comparison with CA125 makes
rativnog nalaza kliničaru-operateru da se radi upra- HE4 almost ideal organ specific tumor marker. Cal-
vo o raku jajnika. Neusporedivo manji broj lažno po- culation HE4 with CA125 within ROMA calculation
zitivnih rezultata u usporedbi s CA125 čini HE4 goto- increases the sensitivity with only a slight reduction
vo idealnim organ specifičnim tumorskim biljegom. in specificity. Gynecologists and oncologists in HE4
Kalkulacija HE4 s CA125 u okviru ROMA izračuna recognize the potential for monitoring therapy and
povećava osjetljivost uz tek neznatnu redukciju spe- progress of the disease.
cifičnosti. Vjerojatno će uskoro ginekolozi, onkolozi,
radioterapeuti u HE4 prepoznati potencijal za praće- e-mail: zspacir@net.hr
nje učinka terapije i progresa bolesti.
e-adresa: zspacir@net.hr
A04 A04
Dijagnostička vrijednost tumorskog biljega Diagnostic value of HE4 tumor marker in

HE4 u ginekološkoj onkologiji gynecological oncology
Dragana Šegulja, Danica Matišić, Ivana Lapić, Dunja Rogić Dragana Šegulja, Danica Matišić, Ivana Lapić, Dunja Rogić
Klinički zavod za laboratorijsku dijagnostiku, Klinički bolnički Department of Laboratory Diagnostics, University Hospital
centar Zagreb, Zagreb, Hrvatska Centre Zagreb, Zagreb, Croatia
Uvod: Karcinom jajnika je druga najčešća maligna Introduction: Ovarian cancer is the second most
bolest i peti uzrok smrti od karcinoma u žena. Pe- common malignancy and the fifth cause of can-
togodišnje preživljenje kod epitelnog karcinoma cer death in women. Five-year survival in epithelial
jajnika otkrivenog u FIGO stadiju I je 90%. Danas se ovarian cancer detected in FIGO stage I is 90%. To-
<30% Ca jajnika dijagnosticira u FIGO stadiju I ili II. day, <30% ovarian Ca are diagnosed in FIGO stage
CA125, do nedavno jedini tumorski biljeg u laborato- I or II. CA125, recently the only tumor marker in di-
rijskoj dijagnostici Ca jajnika, nedovoljne je dijagno- agnostics of ovarian Ca, has insufficient diagnostic
stičke specifičnosti i osjetljivosti. S ciljem poboljšanja specificity and sensitivity. Several different proteins
dijagnostike Ca jajnika ispitivano je nekoliko različi- are investigated to improve diagnostics of ovarian
tih proteina. Obećavajuće rezultate dao je sekretor- Ca. Promising results have been obtained for secre-
ni glikoprotein HE4 (engl. human epididymal protein tory glycoprotein HE4. The aim of this study was to

S58
4). Cilj ovog rada je ispitati dijagnostičku vrijednost examine the diagnostic value of HE4 in patients re-
biljega HE4 kod bolesnica upućenih na određivanje ferred to UHC Zagreb for determination of CA125.
CA125 u KBC Zagreb. Subjects and Methods: HE4 and CA125 markers
Ispitanici i metode: Određena je vrijednost biljega were determined in 80 patients with median age
HE4 i CA125 u 80 bolesnica s medijanom dobi 60 go- 60 (21-85) by electrochemiluminescent method on
dina (21-85), elektrokemiluminiscentnom metodom Cobas 6000cee (ECLIA,Roche Diagnostics). Results
na analizatoru Cobas 6000cee (ECLIA, Roche Diagno- were analyzed using statistical program MedCalc.
stics). Rezultati su obrađeni u statističkom programu Results: Patients were divided into two groups:
MedCalc. those with benign diseases (N=28): endometriosis,
Rezultati: Bolesnice su podijeljene u dvije skupine. ovarian cysts, benign ovarian neoplasm, leiomyo-
Jednu su skupinu činile bolesnice s benignim obo- ma, and patients with malignant gynecological dis-
ljenjima (N=28): endometrioza, cista jajnika, dobro- eases (N=52): malignant ovarian, uterus, cervix and
ćudna novotvorina jajnika, lejomiom, a drugu bole- breast neoplasm. The median value of CA125 was
snice s malignim ginekološkim oboljenjem (N=52): 64.5 KIU/L (7.09-8277), while the median value of
zloćudna novotvorina jajnika, uterusa, cerviksa i bra- HE4 was 117.4 pmol/L (11.2-1999). Although the area
davice. Medijan vrijednosti CA125 bio je 64,5 kIU/L under the ROC curve for HE4 (AUC 0.790) was larger
(7,09-8277), dok je medijan vrijednosti HE4 bio 117,4 than the area under the ROC curve for CA125 (AUC
pmol/L (11,2-1999). Iako je površina ispod ROC krivu- 0.739), the difference in AUCs was not statistically
lje za HE4 (AUC 0,790) veća od površine ispod ROC significant (P=0.410). The CA125 sensitivity of 92%
krivulje za CA125 (AUC 0,739), razlika u AUC nije sta- and specificity of 43% was obtained by cut-off 35
tistički značajna (P=0,410). Kod granične vrijednosti KIU/L while for HE4 sensitivity was 53% and specific-
CA125 (35 kIU/L) dobivena je osjetljivost od 92% uz ity 82% by cut-off 140 pmol/L.
specifičnost 43%, dok je za HE4 uz graničnu vrijed- Conclusion: Results of this study are consistent with
nost od 140 pmol/L dobivena osjetljivost 53% i spe- current literature data. Since CA125 has been shown
cifičnost od 82%. on studied population as a marker of greater sensitiv-
Zaključak: Rezultati ovog ispitivanja u skladu su s ity and HE4 of greater specificity in the diagnosis of
aktualnim literaturnim podacima. Budući da se je na gynecological malignancies, particularly ovarian can-
ispitivanoj populaciji CA125 pokazao biljegom veće cer, optimal diagnostic value would be achieved by si-
osjetljivosti, a HE4 veće specifičnosti u dijagnostici gi- multaneously determining the both studied markers.
nekoloških malignih bolesti, osobito karcinoma jajni-
ka, optimalna dijagnostička vrijednost postigla bi se e-mail: ivana.lapic@hotmail.com
istovremenim određivanjem oba ispitivana biljega.
e-adresa: ivana.lapic@hotmail.com
A05 A05
Serumski slobodni laki lanci kao novi Serum free light chains as new
prognostički biomarker u kroničnoj prognostic biomarker in chronic
limfocitnoj leukemiji lymphocytic leukemia
Blaženka Dobrošević, Mirjana Fijačko, Jasna Pavela, Barbara Vuković, Blaženka Dobrošević, Mirjana Fijačko, Jasna Pavela, Barbara Vuković,
Vatroslav Šerić Vatroslav Šerić
Odjel za kliničku laboratorijsku dijagnostiku, Klinički bolnički Department Of Clinical Laboratory Diagnostics, Clinical Hospital
centar Osijek, Osijek, Hrvatska Centre Osijek, Osijek, Croatia
Uvod: Kronična limfocitna leukemija B-stanica (B- Introduction: Chronic lymphocytic leukemia B-
KLL) je najčešća leukemija odrasle dobi. Oboljeva sta- cell ( B-CLL) is the most common form of leukemia

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rija populacija, medijan dobi kod dijagnoze je iznad among elderly. Male-to-female ratio is 2:1 with a
60 godina, uz odnos muškaraca i žena 2:1. Bolest ima median age of 60 years. It has unpredictable cli-
nepredvidiv tijek, medijan preživljenja varira od 2-20 nical course, median survival varies from 2-20 ye-
godina. Stoga, kontinuirano se radi na pronalaženju ars. Because of this, continuous effort has been put
prognostičkih biomarkera preživljenja. Serumski β2- into finding prognostic biomarkers useful for pre-
mikroglobulin, stanični biljezi CD38 i ZAP-70 pozna- dicting survival. Serum β2-microglobulin, cell mar-
ti su neovisni prognostički biomarkeri za B-KLL. Na kers CD38 and ZAP-70 are established indepen-
osnovu novih istraživanja povišene koncentracije se- dent prognostic biomarkers in B-CLL. Recent data
rumskih slobodnih lakih lanaca povezane su sa loši- has shown that elevated levels of serum free light
jom prognozom u pacijenata s B-KLL –om. Cilj našeg chains (sFLC) were shown to be adverse progno-
istraživanja je usporediti koncentracije serumskih stic factor in B-CLL. The goal of our research is to
slobodnih lakih lanaca i koncentracije serumskog compare the concentrations of sFLC with a concen-
β2-mikroglobulina, kao klasičnog prognostičkog bi- trations of a well known prognostic biomarker, se-
omarkera, kod pacijenata s B-KLL-om. rum β2-microglobulin, among patients with B-CLL.
Ispitanici i metode: Istražili smo retrospektiv- Subjects and Methods: We studied retrospecti-
no 39 pacijenata (28 muškaraca i 11 žena, godina vely 39 patients (28 male and 11 female, median age
69,03±11,1) s novo dijagnosticiranim B-KLL-om. Svi 69.03±11.1) with newly diagnosed B-CLL. All pati-
su imali tipičan imunofenotip, koekspresiju staničnih ents had typical immunophenotype, coexpress CD5,
biljega CD5, CD19, CD20 i CD23 uz restrikciju lakih la- CD19, CD20 and CD23, restricted kappa or lambda
naca kapa ili lambda, određen protočnom citome- chain, determined by flow cytometry. All patients
trijom. Svi pacijenti su imali izmjerene koncentracije had retrospectively determined concentrations of
serumskih slobodnih lakih lanaca kapa i lambda, te sFLC kappa and lambda and concentration of β2-
koncentraciju serumskog β2-mikroglobulina nefelo- microglobulin by nephelometry (Siemens Healthca-
metrijski (Siemens Healthcare Diagnostics, Marburg, re Diagnostics, Marburg, Germany). By calculation
Njemačka). Računski smo odredili ukupnu koncen- we have determined the total concentration of sFLC
traciju slobodnih lakih lanaca (kapa+lambda). Da bi (kappa+lambda). We used the statistic Spearman’s
utvrdili korelaciju između ukupnih serumskih slo- rho test to determine the correlation between total
bodnih lakih lanaca i β2-mikroglobulina koristili smo sFLC and β2-microglobulin.
statistički Spearman’s rho test. Results: Based on recent literature articles, the va-
Rezultati: Na osnovu objavljenih literaturnih radova lue of total sFLC above 60 mg/L (cut off ) is a inde-
vrijednost ukupnih slobodnih lakih lanaca iznad 60 pendent prognostic biomarker. Value of serum β2-
mg/L (cut off ) je neovisan prognostički biomarker. microglobulin ranged from 1.79-13.70 g/L (mean
Vrijednosti serumskog β2-mikroglobulina iznosile su 5.04). Value of total sFLC ranged from 13.4-520.2
1,79-13,70 g/L (srednja vrijednost 5,04). Vrijednosti mg/L (mean 111.8). Total concentration of sFLC was
ukupnih slobodnih lakih lanaca iznosile su 13,4-520,2 higher than 60 mg/L in 46% of patients. The total
mg/L (srednja vrijednost 111,8). Povišenu ukupnu concentration of sFLC correlated significantly with
koncentraciju slobodnih lakih lanaca iznad 60 mg/L the serum β2-microglobulin (P=0.01; r=0.54).
ima 46% ispitanika. Ukupna koncentracija slobodnih Conclusion: Our results match the ones from pre-
lakih lanaca statistički značajno korelira s koncentra- viously published literature articles. The concentra-
cijom β2-mikroglobulina (P=0,01; r=0,54). tion of total sFLC is a good, routinely available bio-
Zaključak: Rezultati su podudarni s ranije objavlje- marker of survival.
nim literaturnim podatcima. Ukupna koncentracija
slobodnih lakih lanaca je dobar, rutinski dostupan e-mail: dobrosevic.blazenka@kbo.hr
biomarker preživljenja.
e-adresa: dobrosevic.blazenka@kbo.hr

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Posterski sažetci: B – Statistička obrada laboratorijskih podataka
Poster abstracts: B – Statistical analysis of laboratory data
B – Statistička obrada laboratorijskih B – Statistical analysis of laboratory

podataka data
B01 B01
Rezultati laboratorijske primjene Results of the recommended laboratory

preporučenih kriterija za određivanje criteria appliance for determining diabetes
šećerne bolesti u trudnoći in pregnancy
Bojana Kranjčec1, Jadranka Šanjug2 Bojana Kranjčec1, Jadranka Šanjug2

1Medicinsko biokemijski laboratorij, Opća bolnica Zabok i 1Medical Biochemistry Laboratory, General Hospital Zabok and
bolnica hrvatskih veterana, Zabok, Hrvatska Hospital of Croatian Veterans, Zabok, Croatia
2Odjel za ginekologiju i opstetriciju, Opća bolnica Zabok i 2Department of Gynecology and Obstetrics, General Hospital
bolnica hrvatskih veterana, Zabok, Hrvatska Zabok and Hospital of Croatian Veterans, Zabok, Croatia
Uvod: Usporedba rezultata primjene oGTT testa kod Introduction: The comparison of oGTT test in pre-
trudnica prema kriterijima WHO iz 2006. god. mje- gnant women according to WHO criteria from 2006,
renjem koncentracije glukoze natašte i nakon 120 with the Standard laboratory procedure for the dia-
minuta te Standardnog laboratorijskog postupka za gnosis of diabetes in pregnancy which is in compli-
dijagnozu šećerne bolesti u trudnoći usklađen s pre- ance with the recommendations of the IADPSG and
porukama IADPSG i preporučen od strane Povjeren- which is recommended by the Commission for Pro-
stva za stručna pitanja HKMB, mjerenjem koncentra- fessional Issues CCMB.
cije glukoze natašte, nakon 60 minuta i nakon 120 Subjects and Methods: For the first group of wo-
minuta. men the oGTT test was performed, measuring ve-
Ispitanici i metode: Prvoj skupini trudnica (N=259) nous plasma glucose concentration before loading
rađen je oGTT test mjerenjem koncentracije gluko- them with 75 g of glucose, and after 120 minutes.
ze u venskoj plazmi natašte, prije opterećenja s 75 g For the second group of pregnant women the oGTT
glukoze i nakon 120 minuta. Drugoj skupini trudnica test was performed which measured glucose con-
(N=285) rađen je oGTT test mjerenjem koncentraci- centration before loading with 75 g of glucose, af-
je glukoze natašte prije opterećenja s 75 g glukoze, ter 60 and 120 minutes. The concentration of gluco-
nakon 60 minuta i nakon 120 minuta. Koncentracija se was determined by BC enzymatic UV test (BC
glukoze određivana je preporučenom enzimskom AU680), with supervising preanalytical, analytical
UV metodom s heksokinazom proizvođača Beckman and postanalytical conditions.
Coulter na biokemijskom analizatoru BC AU 680, uz Results: Using WHO criteria for diagnosis of diabe-
kontrolu prijeanalitičih, analitičkih i poslijeanalitičkih tes in pregnancy with the limit value for concentra-
uvjeta. tions of fasting glucose of 7 mmol/L, and then after
Rezultati: Primjenom kriterija WHO za dijagnozu 120 minutes of 7.8 mmol/L, from the first group of
šećerne bolesti u trudnoći uz graničnu vrijednost 259 pregnant women, 21 (8.1%) who had one of these
za koncentraciju glukoze natašte od 7 mmol/L i na- glucose concentrations equal or increased were sin-
kon 120 minuta od 7,8 mmol/L, u prvoj skupini od gled out. By applying the Standard laboratory proce-
259 trudnica izdvojena je 21 trudnica (8,1%) koja je dure for the diagnosis of diabetes in pregnancy with
imala jednu od tih vrijednosti koncentracije glukoze the limit values for fasting glucose of ≥5.1 mmol/L,
jednaku ili povišenu. Primjenom Standardnog labo- after 60 minutes of ≥10.0 mmol/L, and after 120 mi-
ratorijskog postupka za dijagnozu šećerne bolesti nutes of ≥8.5 mmol/L, in the second group of 285
u trudnoći uz granične vrijednosti za koncentraciju pregnant women, 73 (25.6%) which had value of the
glukoze natašte od ≥5,1 mmol/L, nakon 60 minu- concentration of glucose equal or increased were
ta od ≥10,0 mmol/L te nakon 120 minuta od ≥8,5 singled out. The difference in proportions test de-
mmol/L, u drugoj skupini od 285 trudnica izdvojeno monstrated a statistically significant difference for the
je 73 trudnica (25,6%) koja su imale jednu od tih vri- diagnosis of diabetes between these two groups.

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jednosti koncentracije glukoze jednaku ili povišenu. Conclusion: The following Standard laboratory pro-
Testom razlike proporcija dokazana je statistički zna- cedure for the diagnosis of diabetes in pregnancy as
čajna razlika za dijagnostiku šećerne bolesti između recommended by IADPSG and CCMB, in relation to
skupina (P<0,001). the earlier used WHO recommendations, a greater
Zaključak: Kriteriji Standardnog laboratorijskog po- incidence of diabetes in pregnancy, which is in line
stupka za dijagnozu šećerne bolesti u trudnoći pre- with the findings in the literature was detected.
ma preporukama IADPSG i HKMB, u odnosu na do-
tadašnje korištene preporuke WHO, detektiraju veću e-mail: bojanakranjcec@gmail.com
učestalost šećerne bolesti u trudnoći što je i u skladu
s navodima iz literature.
e-adresa: bojanakranjcec@gmail.com
B02 (Usmeno izlaganje) B02 (Oral presentation)
Razlika verifikacijskih protokola za The difference of verification protocols for

ispitivanje preciznosti primjenjena na precision assessment applied to routine
rutinskim koagulacijskim pretragama coagulation tests
Sanda Jelisavac Ćosić1, Désirée Coen Herak2, Vanja Radišić Biljak3 Sanda Jelisavac Ćosić1, Désirée Coen Herak2, Vanja Radišić Biljak3
1Klinika za onkologiju, Klinički bolnički centar Zagreb, Zagreb, 1Department of Oncology and Radiotherapy, University
Hrvatska Hospital Centre Zagreb, Zagreb, Croatia
2Klinički zavod za laboratorijsku dijagnostiku, Klinički bolnički 2Department of Laboratory Diagnostics, University Hospital

3Klinički zavod za medicinsku biokemiju i laboratorijsku 3Institute of Clinical Chemistry and Laboratory Medicine,
medicinu, Klinička bolnica Merkur, Zagreb, Hrvatska Merkur University Hospital, Zagreb, Croatia
Uvod: Cilj rada bio je usporediti rezultate analize Introduction: The aim of the study was to compare
preciznosti primjenjenom na rutinske koagulacijske two verification protocols for precision study appli-
pretrage prema dva verifikacijska protokola: mjere- ed to routine coagulation tests: duplicate measure-
njem u duplikatu tijekom deset dana (protokol 1) i ment during ten consecutive days (Protocol 1) and
mjerenjem u triplikatu tijekom pet dana (EP-15). EP- triplicate measurement during five consecutive days
15 uveden je kao visoko učinkovit protokol koji sma- (EP-15). EP-15 was introduced as a highly efficient,
njuje vrijeme i troškove verifikacije novih uređaja. Hi- time- and money-saving protocol. We hypothesized
poteza rada je da ne postoji razlika rezultata dobive- that there is no difference in results obtained with
nih primjenom dva protokola. two protocols.
Materijali i metode: Istodobno je provedena valida- Materials and Methods: Simultaneous validation
cija uređaja ACL TOP 500 i ACL TOP 300 (Instrumen- of coagulation analyzers Instrumentation Labora-
tation Laboratory, Bedford, SAD) i pripadajućih He- tory ACL TOP 500 and ACL TOP 300 (Bedford, USA)
mosIl reagensa za: PV (PT RecombiPlasTin 2G), APTV was performed using original HemosIL reagents for
(SynthASil), fibrinogen (Fibrinogen-C), AT (Liquid PT (PT RecombiPlasTin 2G), APTT (SynthASil), fibri-
Antitrombin) i D-dimere (D-Dimer HS 500), upora- nogen (Fibrinogen-C), AT (Liquid Antithrombin) and
bom komercijalnih kontrolnih plazmi Normal Con- D-dimer (D-Dimer HS 500) and commercial control
trol Assayed i Low Abnormal Control Assayed za PV, plasma samples, Normal and Low Abnormal Control
APTV, fibrinogen i AT te Low Control i High Control Assayed for PT, APTT, fibrinogen and AT, as well as,
za D-dimere. Za svaki protokol izračunati su koe- Low and High Control for D-dimer analysis. Coeffici-
ficjenti varijacije (CV), a kriterij za procjenu rezultata ents of variation (CVs) were calculated for each pro-

S62
bio je ukupni dozvoljeni CV naveden od proizvođa- tocol. CV’s proposed by the manufacturer were con-
ča. sidered acceptable.
Rezultati: Primjenom oba protokola nije zabilježe- Results: No difference in CVs for APTT and D-Dimer,
na razlika dobivenih CV-ova za pretrage APTV i D- performed with two protocols, was observed, and
dimere, te su u potpunosti zadovoljeni kriteriji pro- the manufacturer criteria were fully achieved. For
izvođača prema oba protokola. Za ostale ispitivane the remaining analysis increased CVs with the EP-15
pretrage primjećen je porast CV-ova primjenom pro- protocol were noticed on both analyzers, compared
tokola EP-15 u odnosu na protokol 1, za 23% za fibri- to Protocol 1. CVs ranged from 23% for fibrinogen to
nogen do čak 241% za AT na ACL TOP 500, te za 26% 241% for AT on ACL TOP 500 and 26% for fibrinogen
za fibrinogen do 85% za AT na ACL TOP 300. Shodno to 85% for AT on ACL TOP 300. Manufacturer’s crite-
tome kriterij proizvođača za fibrinogen zadovoljen ria were achieved for fibrinogen on ACL TOP 300 for
je samo na ACL TOP 300 za obje koncentracijske ra- both concentration levels but not for pathological
zine, što nije bio slučaj za patološku koncentracijsku concentration on ACL TOP 500 according to EP-15
razinu na ACL TOP 500 primjenom protokola EP-15. protocol. For PT on ACL TOP 500 both protocols for
Za PV je primjenom oba protokola zadovoljen krite- both concentrations obtained manufacturer’s crite-
rij proizvođača za obje koncentracijske razine na ACL ria while CVs (2.9% and 3.6%) obtained with the veri-
TOP 500, dok su primjenom protokola EP-15 dobive- fication protocol EP-15 on ACL TOP 300, were slightly
ni CV-ovi za obje koncentracijske razine na ACL TOP above the manufacturer’s criteria (2.2% and 3.1%).
300 (2,85% i 3,60%) bili viši od kriterija proizvođača Conclusion: Results showed the difference betwe-
(2,2% i 3,1%). en the applied verification protocols for some
Zaključak: Dobiveni rezultati ukazuju na razliku pri- analysis that has to be considered during the precisi-
mijenjenih verifikacijskih protokola, o čemu je po- on assessment.
trebno voditi računa.
e-mail: jelisavaccosic.sanda@gmail.com
e-adresa: jelisavaccosic.sanda@gmail.com
B03 B03
Praćenje rezultata QConnect run kontrola QConnect run control result monitoring with
putem QConnect softvera u NAT probiru QConnect software in blood donors NAT
darivatelja krvi screening
Ivana Babić, Margareta Maslović, Jasna Bingulac-Popović, Vesna Đogić, Ivana Babić, Margareta Maslović, Jasna Bingulac-Popović, Vesna Đogić,
Nina Juraković-Lončar, Melita Balija, Irena Jukić Nina Juraković-Lončar, Melita Balija, Irena Jukić
Hrvatski zavod za transfuzijsku medicinu, Zagreb, Hrvatska Croatian Institute of Transfusion Medicine, Zagreb, Croatia
Uvod: Probir darivatelja krvi (DDK) u RH na krvlju Introduction: Nucleic acid testing (NAT) screening
prenosive viruse metodom detekcije nukleinskih procedure for blood born viruses in Croatian blood
kiselina (nucleic acid testing, NAT) koristi vanjske donors includes routine usage of external run con-
run kontrole za praćenje testiranja iz dana u dan. trols to monitor daily testing variation. QConnect
QConnect softver koristi EDC mrežu (EDCNet) za software through EDCNet enables real-time graph-
analizu i izradu grafikona u stvarnom vremenu ko- ing and analysis of controls data using robust peer
risteći podatke o kontrolama za skupinu istovrsnih group data. Evaluation of NAT run controls results
korisnika. Evaluacijom rezultata NAT run kontrola u with EDCNet enables noticing deviating result/
EDC mreži uočavaju se odstupajući rezultati/trendo- trend in performance of testing depending on lot
vi ovisno o lotu reagensa i run kontrola (HBV-DNA, reagents, run control (HBV-DNA, HCV-RNA or HIV-1
HCV-RNA ili HIV-1 RNA) ili korištenom uređaju. RNA positive) and instrument used .
S63
Materijali i metode: NAT probir DDK u RH provo- Materials and Methods: Blood donors NAT screen-
di se na pojedinačnim donacijama korištenjem Pro- ing in Croatia is performed on individual donation
cleix Ultrio Plus testa na uređajima Tigris (Grifols, by using a Procleix Ultrio Plus test on Tigris instru-
Španjolska). Test istovremeno otkriva prisutnost ments (Grifols, Spain). The test simultaneously de-
HBV-DNA, HCV-RNA i HIV-1 RNA temeljem rezulta- tects HBV-DNA, HCV-RNA and HIV-1 RNA based on
ta umnožavanja posredovanog transkripcijom. Po- transcription mediated amplification (TMA). We use
moću QConnect HBVDNA+, HCVRNA+ i HIV-1 RNA+ QConnect HBVDNA+, HCVRNA+ and HIV-1 RNA+
kontrola (Life Technologies LTD, UK) prati se iz dana control (Life Technologies LTD, UK) to monitor daily
u dan rad tri Tigris uređaja. Negativan rezultat NAT performances of three Tigris instruments. NAT nega-
testiranja pozitivne run kontrole za posljedicu ima tive result for positive run control is causing invali-
proglašavanje cijele serije testiranja invalidnom. Od dation of the run. From June, 2014 we started with
lipnja 2014. započeli smo s dnevnim unosom poda- daily data input for run controls lot, test results-s/
taka za lotove run kontrola i reagensa, rezultata testi- co values, reagent lot and used instrument, in EDC-
ranja-s/co vrijednosti i korištenih uređaja u EDC mre- Net (NRL, Australia). The data are being statistically
žu (NRL, Australija). Podaci se statistički obrađuju i processed and displayed as Levey-Jenning chart and
prikazuju pomoću Levey-Jenning grafikona i grafiko- Mean/Scatter report with mean, ±2SD values for our
na raspršenja srednjih vrjednosti s naznačenim sred- peer group (eight laboratories) and our laboratory in
njim vrijednostima, ±2 standardne devijacije (SD) za particular.
našu skupinu istovrsnih korisnika (osam laboratorija) Results: Mean values of our results are very similar
i za naš laboratorij posebno. to those of our peer group. QConnect HIVRNA+ has
Rezultati: Srednje vrijednosti naših rezultata su vrlo highest ±2SD value (12.06±1.64) and HCVRNA+ low-
slične onima naše skupine korisnika. QConnect HI- est (9.33±0.82). Approximately 4-5% of our results
VRNA+ ima najvišu ±2SD vrijednost (12,06±1,64) dok are outliers that do not show any trend.
HCVRNA+ ima najnižu (9,33±0,82). Približno 4-5% na- Conclusion: Through EDCNet we are able to be
ših rezultata smješteno je izvan područja ±2SD te ne part of global control chart of our peer group and
pokazuju nikakav trend u odstupanjima. to evaluate our results in broader context. By en-
Zaključak: Korištenjem EDC mreže možemo sudje- rolment of more users in our peer group we will be
lovati u globalnoj kontrolnoj karti naše skupine isto- able to obtain even more accurate data on our rou-
vrsnih korisnika i vrednovati naše rezultate u širem tine work control.
smislu. Uvrštavanjem većeg broja korisnika u našu
grupu bit ćemo u mogućnosti dobiti još precizniju e-mail: ivana.babic@hztm.hr
analizu kontrole našeg rutinskog rada.
e-adresa: ivana.babic@hztm.hr
B04 B04
Usporedba kvalitete laboratorijskih procesa Comparison of quality of laboratory

za mjerni postupak Troponin I processes for Troponin I determination
Adriana Unić, Lovorka Đerek, Nevenka Stančin Adriana Unić, Lovorka Đerek, Nevenka Stančin
Klinički zavod za laboratorijsku dijagnostiku, Klinička bolnica Clinical Department of Laboratory Diagnostics, University
Dubrava, Zagreb, Hrvatska Hospital Dubrava, Zagreb, Croatia
Uvod: Laboratorijski nalazi imaju značajan utjecaj na Introduction: Laboratory test results have major
donošenje kliničkih odluka što čini kvalitetu cjeloku- impact on clinical decision-making, which makes
pnog laboratorijskog ispitivanja izuzetno važnom. the quality of all laboratory processes extremely im-

S64
Kako bi održali i unaprijedili kvalitetu potrebno je portant. Therefore, it is necessary to objectively eva-
objektivno ocijeniti svaku fazu laboratorijskog pro- luate each phase of overall laboratory process. Six Si-
cesa. Korištenje Six Sigma sustava omogućava us- gma quality system enables the comparison of qua-
poredbu indikatora kvalitete i daje jasnu informaciju lity indicators and information on unacceptable pro-
koji su procesi neprihvatljivi i zahtijevaju daljnje po- cesses which require further improvement. The aim
boljšanje. Cilj rada bio je korištenjem Six Sigma oci- of the study was to assess and compare the quality
jeniti i usporediti kvalitetu pojedinih procesa labora- of individual process for determination of Troponin I
torijskog rada za mjerni postupak troponin I (TnIDx, (TnIDx, Beckman Coulter Inc.) in the Clinical Depar-
Beckman Coulter Inc.) u Kliničkom zavodu za labo- tment of Laboratory Diagnostics, UH Dubrava in the
ratorijsku dijagnostiku KB Dubrava u razdoblju od 6. six months period.
svibnja 2014. do 31. prosinca 2014. Materials and Methods: To assess the quality of
Materijali i metode: Za procjenu kvalitete prijeana- preanalytical phase the number of hemolyzed sam-
litičke faze kao indikator kvalitete promatran je broj ples was observed. To assess the quality of analytical
neprihvatljivih hemolitičnih uzoraka. Za ocjenu kva- phase the internal quality control precision (three
litete analitičke faze korišteni su podaci preciznosti concentration levels) and bias (from the external
unutarnje kontrole kvalitete (tri koncentracijske razi- quality control program) data were analyzed. Desi-
ne) i podaci istinitosti iz programa vanjske kontrole rable specifications based on biological variability
kvalitete. Korišteni kriteriji prihvatljivosti su poželj- were used as an acceptance criteria (TEa<27.91%). To
ne specifikacije temeljene na biološkoj varijabilnosti assess the quality of postanalytical phase Turnaro-
(TEa<27,91%). Za ocjenu kvalitete poslijeanalitičke und time (TAT) was used. The acceptance criteria for
faze kao indikator kvalitete korišten je TAT (engl. tur- issuing Troponin I results is 60 minutes. Sigma values
naround time). Kriterij za izdavanje nalaza troponina were calculated using calculators available on http://
I je 60 minuta. Za izračun Sigma vrijednosti korište- www.westgard.com/six-sigma-calculators.htm.
ni su kalkulatori dostupni na http://www.westgard. Results: The percentage of unacceptable hemo-
com/six-sigma-calculators.htm. lytic samples for Troponin I determination was 3.7%,
Rezultati: U promatranom razdoblju broj neprihvat- Sigma value 3.3. In that period, Sigma values for
ljivih hemolitičnih uzoraka za određivanje troponina analytical performance on the three concentration
I iznosio je 3,7%. Na Six Sigma skali ocjena je 3,3. U levels of troponin I 0.3 g/L, 1.9 g/L and 5.8 g/L were
istom razdoblju Sigma vrijednosti izvedbe metode 1.8, 3.0 and 5.3 respectively. 12.71% results of Tropo-
za tri koncentracijske razine troponina I od 0,30 ug/L; nin I were issued outside the established criteria for
1,9 ug/L i 5,8 ug/L iznose redom 1,8; 3,0 i 5,3 za krite- TAT, Sigma value 2.7.
rije prihvatljivosti temeljene na biološkoj varijabilno- Conclusion: Although all laboratory processes requ-
sti. 12,71% rezultata za troponin I je izdano izvan po- ire improvement and carefully designed strategy of
stavljenih kriterija za TAT. Sigma vrijednost iznosi 2,7. quality control, postanalytical phase had the lowest
Zaključak: Kao najkritičniji proces pokazala se po- sigma value and thus requires additional improve-
slijeanalitička faza iako sva tri procesa zahtijevaju ment of its quality. Generally, laboratories are mainly
unaprjeđenje kvalitete i pažljivo dizajniranu strate- focused on improving the quality of preanalytical
giju kontrole. Iako su generalno laboratoriji sve više and postanalytical processes but the quality of the
usmjereni na poboljšanje kvalitete prijeanalitičkih i analytical process, despite the significant progress,
poslijeanalitičkih procesa i kvaliteta analitičkih pro- still leaves room for improvement.
cesa unatoč značajnom napretku još uvijek ostavlja
prostor za poboljšanje. e-mail: adrianaunic@gmail.com
e-adresa: adrianaunic@gmail.com

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B05 B05
Procjena granične vrijednosti IgA anti-tTG An estimation of IgA anti-tTG cut-off specific
specifične za djecu dijabetičare u svrhu for celiac disease screening of diabetic
njihovog probira na celijakiju children
Merica Aralica, Jasminka Matica Merica Aralica, Jasminka Matica

Klinički zavod za laboratorijsku dijagnostiku, Klinički bolnički Clinical Department of Laboratory Diagnostics, Clinical Hospital
centar Rijeka, Rijeka, Hrvatska Centre Rijeka, Rijeka, Croatia
Uvod: Djeca dijabetičari sklona su celijakiji zbog za- Introduction: Diabetic children are prone to celiac
jedničkih autoimunih mehanizama šećerne bolesti disease (CD) due to autoimmune feature of both dis-
tip 1 (ŠB tip 1) i celijakije. Prema aktualnim kliničkim eases. According to current clinical guidelines IgA
smjernicama IgA protutijelo na tkivnu transgluta- anti tissue transglutaminase antibody (IgA anti-tTG)
minazu (IgA anti-tTG) preporuča se kao test probira is recommended screening test for CD in every sus-
za celijakiju u svakom sumnjivom ili visoko rizičnom pected or high risk case. In routine laboratory prac-
slučaju. U laboratorijskoj praksi koristi se jedinstvena tice single IgA anti-tTG cut-off (producer provided) is
granična vrijednost deklarirana od proizvođača za reported for all screened individuals regardless their
sve osobe bez obzira na njihov klinički status. U sku- clinical status. In cohort of diabetic children we test-
pini djece dijabetičara testirali smo takvu graničnu ed such IgA anti-tTG cut-off to estimate its utility for
vrijednost IgA anti-tTG radi procjene njezine priklad-
this specific group of pediatric patients.
nosti za ovu specifičnu kohortu.
Subjects and Methods: From 2002-2014, total of
Ispitanici i metode: Od 2002. do 2014. godine kod
149 djece dijabetičara određen je IgA anti-tTG enzi- 149 diabetic children (ages <18 years) were screened
mimunoanalizom (Euroimmun, Njemačka) uz gra- by IgA anti-tTG using Enzyme Linked Immunoassay
ničnu vrijednost 20 RU/ml. Djeci je ranije dijagno- (Euroimmun, Germany); cut-off 20 RU/ml (all gen-
sticirana ŠB tip I. Nitko nije imao selektivni manjak ders and ages). Children had previously diagnosed
IgA. Sva djeca s pozitivnim nalazom podvrgnuta su diabetes mellitus type I and no one had total serum
biopsiji crijeva ako nisu imala serokonverziju u peri- IgA deficiency. All children with positive results un-
odu od 9 mjeseci od početnog testiranja uz uobičaj- derwent the bowel biopsy if they missed to turn out
nu prehranu. Statistička analiza je načinjena pomoću negative in period of nine months after initial posi-
statističkog programa MedCalc (Mariakerke, Belgija). tive screening result and regular gluten containing
Rezultati: IgA anti-tTG bio je pozitivan u 14 djece di- diet. Statistical analysis was done in MedCalc (Mar-
jabetičara s naknadno dobivenim pozitivnim nalazom iakerke, Belgium).
biopsije. Jedno dijete imalo negativan rezultat IgA anti Results: IgA anti-TTG was positive in 14 diabetic
tTG i pozitivan nalaz biopsije. Među 134 djece dijabe- children following positive biopsy results. One child
tičara koji nemaju celijakiju lažno pozitivni rezultat IgA had negative IgA anti-tTG but positive biopsy fin-
anti-tTG imalo je njih 15. Krivulja ROC pokazala je gra- ding. Among all CD free diabetic children (N=134)
ničnu vrijednost 34,5 RU/ml u testiranoj skupini; po- false positive results of IgA anti-tTG had 15 of them.
vršina ispod krivulje 0,934; 95%CI 0,882-0,968; P<0,05. ROC curve analysis showed a cut-off of 34.5 RU/ml
Kod granične vrijednosti 34,5 RU/ml IgA anti-tTG ima in screened cohort; an area under the ROC curve of
osjetljivost i specifičnost od 93,3% (95%CI 68,1-99,8) od-
0.934 with 95%CI 0.882-0.968 and P<0.05. At cut-off of
nosno 91,0% (95%CI 84,9-95,3) u probranoj skupini.
34.5 RU/ml IgA anti-tTG sensitivity and specificity are
Zaključak: Krivulja ROC predlaže veću graničnu
93.3% (95%CI 68.1-99.8) and 91.0% (95%CI 84.9-95.3).
vrijednost za IgA anti-tTG od granične vrijednosti
proizvođača u probranoj skupini djece dijabetičara Conclusion: In screened cohort, ROC analysis pro-
uz visoku osjetljivost i specifičnost. Upotreba granič- posed higher IgA anti-tTG cut-off with high sensitivity
ne vrijednosti IgA anti-tTG specifične za djecu dija- and specificity. Providing specific IgA anti-tTG cut-off
betičare mogla bi povećati njegovu dijagnostičku for diabetic children may improve its diagnostic accu-
točnost i smanjiti broj nepotrebnih ponovnih testira- racy and clinical utility in sense of avoiding retesting
nja djece sa slabo pozitivnim nalazom. patients with initial low positive screening results.
e-adresa: merica.aralica@gmail.com e-mail: merica.aralica@gmail.com
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B06 B06
Makroprolaktin – probir, da ili ne? Macroprolactin – to screen or not to screen?
Adriana Bokulić , Ivana Zec, Valentina Vidranski, Željka Bukovec Megla, Adriana Bokulić , Ivana Zec, Valentina Vidranski, Željka Bukovec Megla,
Iva Petek Tarnik, Iva Petek Iva Petek Tarnik, Iva Petek
Klinika za onkologiju i nuklearnu medicinu, Klinički bonički Department of Oncology and Nuclear Medicine, University
centar Sestre milosrdnice, Zagreb, Hrvatska Hospital Centre Sestre milosrdnice, Zagreb, Croatia
Uvod: U zdravih osoba, najčešći oblik prolakti- Introduction: Monomeric prolactin is the most
na u cirkulaciji je monomerni prolaktin, ali su pri- common form of circulating prolactin in healthy in-
sutni i oblici s većom molekularnom masom, kao dividuals, but forms with higher molecular mass are
big prolaktin i big-big prolaktin ili makroprolaktin. also present, such as big prolactin and big-big pro-
Makroprolaktin uzrokuje značajnu interferenciju lactin or macroprolactin. Macroprolactin is an im-
u imunokemijskim metodama te učestalo dovodi portant source of immunoassay interference and
do krive dijagnoze i liječenja pacijenata s hiperpro- often leads to misdiagnosis and mismanagement
laktinemijom. U rutini, najčešće se koristi taloženje of hyperprolactinemic patients. Precipitation with
polietilenglikolom za uklanjanje interferencije ma- polyethylene glycol (PEG) is widely used to detect
kroprolaktina. Cilj je odrediti učestalost u populaci- the presence of macroprolactin. Our aim was to as-
ji naših odraslih pacijenata te odgovoriti na pitanje sess macroprolactin incidence in hyperprolactin-
je li korisno uvesti taloženje u svakodnevnu praksu. emic adults and to decide on its screening policy.
Ispitanici i metode: Od kolovoza 2014. do veljače Subjects and Methods: From August 2014 to Fe-
2015., svi uzorci odraslih pacijenata s koncentraci- bruary 2015, all adult patients’ samples with prolac-
jama prolaktina iznad gornje granice referentnog tin levels above corresponding upper reference limit
intervala (muškarci 381 mIU/L, žene 496 mIU/L), su (male 381 mIU/L, female 496 mIU/L) were tested for
podvrgnuti taloženju (N=380, medijan godina 37, macroprolactin (N=380, median age 37, min 19, max
min 19, max 84). Prolaktin prije i nakon taloženja je 84). Pre-PEG and post-PEG prolactin measurements
mjeren elektrokemiluminiscentnom metodom na were performed with electrochemiluminescence
analizatoru Cobas e601 (Roche, Mannheim, Ger- method on Cobas e601 analyzer (Roche, Mannheim,
many). Taloženje je provedeno prema preporu- Germany). Manufacturer’s recommended procedure
kama proizvođača. Uzorci s koncentracijama pro- for PEG participation was used.
laktina nakon taloženja koji su unutar referentnog Post-PEG results within their corresponding refer-
intervala, smatrani su lažnim hiperprolaktinemija- ence range were considered as falsely hyperprolac-
ma (muškarci 63-245 mIU/L, žene 75-381 mIU/L). Za tinemic (male 63-245 mIU/L, female 75-381 mIU/L).
provjeru razlike u pojavnosti makroprolaktina iz- Chi-square test was used to test for possible sex-de-
među spolova, korišten je hi-kvadrat test (a=0,05). pendent difference in incidence (a=0.05)
Rezultati: Kod 343 (90%) uzoraka, koncentracija pro- Results: In 343 (90%) samples, post-PEG results were
laktina nakon taloženja je bila povišena (57 muška- above post-PEG reference range (57 male and 286
raca, 286 žena). Kod 37 (10%) uzoraka, koncentracija female). In 37 (10%) samples, post-PEG results fell
prolaktina nakon taloženja je bila unutar referentnog within post-PEG reference range (5 male, 32 female)
intervala (5 muškaraca, 32 žene) te je kod tih pacije- and they could be classified as falsely hyperprolac-
nata prisutna lažna hiperprolaktinemija. Nije nađena tinemic. There is no sex-dependent difference in in-
razlika u pojavnosti između spolova (P=0,802). cidence (P=0.802).
Zaključak: Rezultati pokazuju da je kod 10% paci- Conclusion: Results show that 10% of hyperprolac-
jenta prisutna lažna hiperprolaktinemija što može tinemic patients are falsely classified which could
dovesti do nepotrebnih daljnjih pretraga, netočne lead to unnecessary investigation, incorrect diagno-
dijagnoze i neodgovarajuće terapije. Kao rezultat is- sis and inappropriate treatment. As a result of this
pitivanja, naš laboratorij provodi rutinski probir svih study, our laboratory routinely screens all hyperpro-
uzoraka s povišenom koncentracijom prolaktina, ko- lactinemic samples for the presence of macroprolac-
risteći gornju granicu referentnog intervala kao gra- tin, using gender appropriate upper limit as a cut-
S67
ničnu vrijednost. Iz probira se isključuju zahtjevi po- off. Screening excludes requests repeated within 6
novljeni unutar 6 mjeseci, osim ako je već bila prisut- months, unless they were, as a result of previous te-
na lažna hiperprolaktinemija. sting, classified as falsely hyperprolactinemic.
e-adresa: adriana.bokulic@gmail.com e-mail: adriana.bokulic@gmail.com
B07 (Usmeno izlaganje) B07 (Oral presentation)
Izračun slobodnog testosterona: usporedba Free testosterone calculation: two equations

dvije formule comparison
Tihana Pavošević, Iva Lukić, Sanja Mandić, Vesna Horvat, Tihana Pavošević, Iva Lukić, Sanja Mandić, Vesna Horvat,
Odjel za kliničku laboratorijsku dijagnostiku, Klinički bolnički Department of Clinical Laboratory Diagnostics, Clinical Hospital
Uvod: Testosteron je steroidni hormon koji je ~97% Introduction: Testosterone is a steroid hormone.
u cirkulaciji specifično vezan za hormon koji veže About 97% of testosterone in circulation is spe-
spolne hormone (SHBG) i nespecifično za albumine, cifically bound to sex hormone-binding globulin
a samo mali dio je nevezan (slobodan). Slobodni te- (SHBG) and non-specifically to albumin, only small
stosteron (fT) biološki je aktivan oblik testosterona, amount is unbound (free). Free testosterone (fT) re-
a može se mjeriti direktnom metodom ili indirek- presents the biologically active portion of the mo-
tno računskim metodama. Cilj ovog rada je uspore- lecule and can be measured using direct method or
diti dvije različite formule za izračun fT: (1) pomoću indirect calculation methods. The aim of this study
testosterona i SHBG-a i (2) pomoću testosterona, was to compare two different equations for calcula-
SHBG-a i albumina. ting fT: (1) using testosterone and SHBG; (2) using te-
Materijali i metode: Analizirani su uzorci 172 ispi- stosterone, SHBG and albumin.
tanika (58 muškaraca i 114 žena) kojima je zatraže- Materials and Methods: We analyzed 172 se-
na analiza fT u Odjelu za kliničku laboratorijsku di- rum samples (58 men and 114 women) which were
jagnostiku KBC-a Osijek. U uzorcima seruma su iz- requested for fT analysis in our department. Total
mjereni ukupni testosteron i SHBG imunokemijskom testosterone and SHBG were measured using CMIA
(CMIA) metodom na analizatoru Architect i1000SR, (Architect i1000SR, Abbott) and albumin using pho-
te albumini fotometrijskom metodom na analizato- tometric method (Olympus AU680, Beckman Co-
ru Olympus AU680. Pomoću navedenih parametara ulter). Using the obtained values we calculated the
izračunat je postotak fT dvijema različitim metoda- percentage of fT applying two different methods:
ma: (1) iz testosterona i SHBG-a i (2) iz testosterona, (1) from testosterone and SHBG; (2) from testostero-
SHBG-a i albumina. Ispitanici su podjeljeni u skupine, SHBG and albumin. All subjects were classified in
ne prema spolu, te je napravljena usporedba dobi- groups according to sex and results comparison was
venih rezultata Passing-Bablock regresijskom anali- performed using Passing-Bablok regression analysis
zom u MedCalc programu, verzija 12.4.0.0. (MedCalc (MedCalc Software, Mariakerke, Belgium).
Software, Mariakerke, Belgija). Results: Using the first equation in the group of
Rezultati: U skupini muškaraca prvom formulom men 43% of participants had fT values above the
bilo je 43% pacjenata čije su vrijednost fT bile iznad reference range, while in the group of women that
referentnog intervala, dok je u skupini žena takvih percentage was only 14%. Using the second equati-
bilo 14%. Drugim izračunom u skupini muškaraca on, in the group of men, fT values were considerably
taj broj bio je znatno manji i iznosio je 10%, a u sku- lower (10%) and in the group of women these valu-

S68
Posterski sažetci: C – Harmonizacija u laboratorijskoj medicini
Poster abstracts: C – Harmonization in laboratory medicine
pini žena ostao je isti. Passing-Bablock regresijskom es remained unchanged. Passing-Bablok regression
analizom dobiveno je da u skupini žena nema razlike analysis showed no statistically significant difference
između ova dva načina izračuna (y=0,0000(0,0000- in the group of women using these two calculation
0,0000)+1,0000(1,0000-10000)x), dok je u skupini methods (y=0.0000(0.0000-0.0000)+1.0000(1.0000-
muškaraca utvrđeno da razlika postoji, te da je ona 10000)x), while in the group of men the difference
konstantna i neproporcionalna (y=-1,5000(-2,4500-(- was constant and disproportionate (y=-1.5000(-
1,0600))+2,0000(1,8000-2,5000)x). 2.4500-(-1.0600))+2.0000(1.8000-2.5000)x).
Zaključak: Premda se u rutinskoj praksi uglavnom Conclusion: Although calculation of fT using te-
koristi izračun fT pomoću testosterona i SHBG-a, is- stosterone and SHBG is mainly used in the routine
pitanicima s vrijednostima fT izvan referentnog in- practice, subjects who have fT values outside of the
tervala trebalo bi izračunat fT formulom koja koristi i reference range should be calculated using the equ-
albumine, naročito kada su u pitanju muškarci. ation for fT that includes albumin, especially in the
case of men.
e-adresa: tihanapavos@gmail.com
e-mail: tihanapavos@gmail.com
C - Harmonizacija u laboratorijskoj medicini C - Harmonization in laboratory medicine
C01 C01
Uvid u određivanje antinuklearnih antitijela Insight in antinuclear antibodies (ANA)

(ANA) u Hrvatskoj - rezultati ankete radne determination in Croatia – survey results of
grupe Hrvatskog društva za medicinsku Croatian Society of Medical Biochemistry
biokemiju i laboratorijsku medicinu and Laboratory Medicine (CSMBLM) working
(HDMBLM) za laboratorijsku dijagnostiku group for guidelines in laboratory diagnosis
autoimunih bolesti of autoimmune diseases
Lovorka Đerek1, Andrea Tešija Kuna2, Ana Kozmar3, Vedrana Drvar4 Lovorka Đerek1, Andrea Tešija Kuna2, Ana Kozmar3, Vedrana Drvar4
1Klinički zavod za laboratorijsku dijagnostiku, Klinička bolnica 1Clinical Department for Laboratory Diagnostics, University
2Klinički zavod za kemiju, Klinički bolnički centar Sestre 2University Department of Chemistry, University Hospital
milosrdnice, Zagreb, Hrvatska Centre Sestre milosrdnice, Zagreb, Croatia


4Klinički zavod za laboratorijsku dijagnostiku, Klinički bolnički 4Clinical Department for Laboratory Diagnostics, Clinical
centar Rijeka, Rijeka, Hrvatska Hospital Centre Rijeka, Rijeka, Croatia
Uvod: Porast učestalosti autoimunih bolesti prati sve Introduction: The increase in the prevalence of
veća zastupljenost humoralne imunodijagnostike u autoimmune diseases is followed by an increase in
rutinskom radu laboratorija. Cilj anketnog istraživa- humoral immunodiagnostics in routine laboratory
nja bio je stjecanje uvida u broj i vrstu laboratorija work. The objective was to gain insight into a num-
koji se bave humoralnom dijagnostikom te metodo- ber and type of Croatian laboratories that are per-
logiju i dijagnostičke algoritme koji se koriste prili- forming humoral diagnostics, methodology and di-
kom izvođenja pretrage ANA.

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Posterski sažetci: C – Harmonizacija u laboratorijskoj medicini
Poster abstracts: C – Harmonization in laboratory medicine
Materijali i metode: Anketa je izrađena i objavljena agnostic algorithms that are used in ANA determi-
koristeći SurveyMonkey aplikaciju i 26.9.2014 posla- nation.
na na e-mail adrese voditelja 88 laboratorija u se- Materials and Methods: A survey was created and
kundarnoj i tercijarnoj zdravstvenoj zaštiti, te u pri- published using SurveyMonkey application. It was
vatnim ustanovama. Anketa je sadržavala 17 pitanja i sent on 26/9/2014 to 88 laboratories in secondary,
zaključena je 22.4.2015. tertiary health care and private institutions, and clo-
Rezultati: Na anketu je odgovorilo 80/88 laboratori- sed on 22/04/2015.
ja. Analize iz područja humoralne imunodijagnostike Results: Of 80 laboratories that answered the que-
radi 33/80 laboratorija: 16 opće/županijske bolnice, stionnaire 33 perform humoral immunodiagnostics:
13 kliničke bolnice/klinički bolnički centri, 13 privat- 16 in general/county hospitals, 13 in clinical hospi-
ne ustanove, 5 specijalne bolnice. ANA se određuje tals/clinical hospital centers, 13 in private instituti-
u 16/33 laboratorija. ANA probir radi se metodom ons, 5 in specialized hospitals. ANA is determined
indirektne imunofluorescencije na Hep-2 stanicama in 16/33 laboratories. ANA screening is performed
(IIF) u 7/16, fluoroenzim-imuno metodom (FEIA) u using indirect immunofluorescence (IIF)/Hep-2 in
5/16, enzimimuno metodom (ELISA) u 3/16 laborato- 7/16, fluoro enzyme immunoassay (FEIA) in 5/16, line
rija i line-imuno metodom (LIA) u 1/16 laboratorija. immunoassay (LIA) in 1/16 and enzyme immunoa-
Određivanje specifičnosti ANA: a) anti-dsDNA anti- ssay (ELISA) in 3/16 laboratories. Anti-dsDNA anti-
tijela određuju se u 15 laboratorija metodama: FEIA bodies are determined in 15 laboratories using: FEIA
(6/15), ELISA (5/15), Multiplex-imuno metodom (MIA) (6/15), ELISA (5/15), multiplex immunoassay (MIA)
(3/15) i IIF (1/15), b) antitijela na ekstraktibilne nukle- (3/15) and IIF (1/15) methods. Antibodies to extracta-
arne antigene (ENA) u 13 laboratorija metodama: ELI- ble nuclear antigens (ENA) are determined in 13 la-
SA (4/13), MIA 3/13, FEIA 4/13, LIA 1/13 i FEIA+LIA 1/13, boratories using: ELISA 4/13, FEIA 4/13, MIA 3/13, LIA
c) antitijela na centromerne proteine (CENP), histone 1/13 and FEIA+LIA 1/13. Antibodies to centromere
i nukleosome određuju se sporadično. Od sedam la- (CENP), histones and nucleosomes are determined
boratorija koji koriste IIF-ANA probir, 5 određuje titar sporadically. For ANA/IIF 5/7 laboratories determine
i opisuje tip fluorescencije. Ukoliko je ANA probir po- titer and type of fluorescence. If the ANA screening
zitivan, neovisno o metodi, 6/14 laboratorija ne odre- test is positive: 6/14 laboratories do not determine
đuje specifičnost antitijela, 4/14 radi ovisno o titru specificity, 2/14 laboratories determine every orde-
ANA, 2/14 radi ovisno o tipu fluorescencije, dok 2/14 red antibody, 4/14 determines antibody specificity
laboratorija rade sve zatraženo. Među laboratoriji- depending on ANA titer and 2/14 depending on the
ma koji ANA probir rade drugom metodom (ne IIF), type of fluorescence. When another screening met-
samo 5/10 laboratorija navodi obuhvaćene antigene. hod is used (beside IIF), 5/10 laboratories report co-
Zaključak: Rezultati ukazuju na nužnost izrade pre- vered antigens.
poruka i algoritma u svrhu ujednačavanja pristupa Conclusion: Results indicate the need of creating
laboratorijskoj dijagnostici sistemskih autoimunih recommendations and algorithms in order to har-
bolesti na razini Hrvatske. monize the approach to laboratory diagnostics of
systemic autoimmune diseases in Croatia.
e-adresa: vedranadrvar@gmail.com
e-mail: vedranadrvar@gmail.com

S70
Posterski sažetci: D – Biljezi bolesti bubrega i mokraćnog sustava
Poster abstracts: D – Markers of kidney and urinary tract diseases
D – Biljezi bolesti bubrega i mokraćnog D – Markers of kidney and urinary tract

sustava diseases
D01 D01
Učestalost mikrohematurije kod muškaraca Frequency of microhematuria in men older

iznad 35 godina than 35
Zorana Todorić1, Suzi Žlabravec2, Dunja Turner2, Mirjana Sikirica2 Zorana Todorić1, Suzi Žlabravec2, Dunja Turner2, Mirjana Sikirica2
1Poliklinika LabPlus, Split, Hrvatska 1Polyclinic LabPlus, Split, Croatia
2Poliklinika LabPlus, Zagreb, Hrvatska 2Polyclinic LabPlus, Zagreb, Croatia
Uvod: Cilj rada bio je procijeniti učestalost mikrohe- Introduction: The aim of the project was to esti-
maturije kod muškaraca iznad 35 godina u Poliklinici mate the frequency of microhematuria in men older
LabPlus. than 35 in the polyclinic LabPlus.
Ispitanici i metode: U 100 uzoraka svježe mokraće Subjects and Methods: One hundred samples of
(muškarci iznad 35 godina) određivali smo broj eri- fresh urine (men older than 35) were used to deter-
trocita (Erc) na automatiziranom sustavu LabUMat/ mine number of erythrocytes (Erc) by automated
UriSed (77 Elektronika Kft, Budapest, Hungary) koji system LabUMat/UriSed (77 Elektronika Kft, Buda-
radi na načelu refraktometrije (test traka) i manualne pest, Hungary). System works by a refractometry
mikroskopije (sediment), te usporedno i svjetlosnom principle (dipstick) and manual microscopy (sedi-
mikroskopijom vlažnog preparata, supravitalno obo- ment) comparatively to light microscopy of a wet
jenog sedimenta mokraće priređenog prema prepo- sample which is supravitally coloured urine sedi-
rukama europske grupe za analizu mokraće. ment, prepared in accordance with recommenda-
Rezultati: 23/100 ispitanika imalo je pozitivan na- tions of the European group for urine analysis.
laz eritrocita/hemoglobin (Erc/Hb) na test traci. Kod Results: 23/100 patients had positive results in eryth-
3/23 nalaz na test traci bio je 10 Erc/Hb/µL i negati- rocytes/hemoglobin (Erc/Hb) on a dipstick. 3/23 re-
van po vidnom polju (VP); 4/23 su imali na test tra- sults on a dipstick had 10 Erc/Hb/µL and negative in
ci 10-50 Erc/Hb/µL i 2-5 Erc/ VP uz prisutnost kristala the high power field (HPF); 4/23 had a dipstick re-
kalcijeva oksalata; 3/23 imali su 50–300 Erc/Hb/µL i sults 10-50 Erc/Hb/µL and 2-5 Erc/HPF with presence
1-4 Erc/VP uz visoku aktivnost kreatin kinaze i pro- of calcium oxalate; 3/23 had 50-300 Erc/Hb/µL and
teinuriju (<0,3 g/L). 4/23 su imali na test traci 10-50 1-4 Erc/HPF with creatine kinase activity and protein-
Erc/Hb/µL i 1–3 Erc/VP uz PSA 2-4 µg/L. Kod 4/30 na- uria (<0.3 g/L). 4/23 patients had a dipstick result 10-
đeno je 10 Erc/Hb/µL i 1-5 Erc/VP i leukociturija. Kod 50 Erc/Hb/µL and 1–3 Erc/HPF with PSA 2-4 µg/L. 4/30
9/23 nađeno je 10–50 Erc/Hb/µL i 1-3 Erc/VP, bez patients had 10 Erc/Hb/µL and 1-5 Erc/HPF with leu-
drugih patoloških nalaza. kocyturia. 9/23 patients had 10–50 Erc/Hb/µL and 1-3
Zaključak: Mikrohematurija je gotovo uvijek slučaj- Erc/HPF without any other pathological results.
ni i često zanemarivan nalaz. Može biti posljedica ra- Conclusion: Microhematuria is almost always acci-
znih benignih, ali i malignih bolesti. Prvi pokazatelj dental and often neglected result. It can be a con-
neoplazmi uroepitela je izolirana mikrohematurija. sequence of various benign but also malignant dis-
Kako je >3 Erc/VP velikog povećanja prema smjer- eases. The first indicator of neoplasma urothelium
nicama Američkog urološkog društva (AUA) indika- is isolated microhematuria. According to American
cija za daljnju obradu, potrebno je svaki pozitivan Urological Association (AUA) more than 3 Erc/HPF is
nalaz potrvrditi kroz tri slučajna uzorka. Ukoliko je first indicator for further analysis and it is necessary
mikrohematurija i dalje prisutna, treba odrediti pori- to confirm positive results in three random samples.
jeklo eritrocita. Ako su eritrociti dismorfni, potrebna If microhematuria is still present, it is necessary to
je nefrološka, a ako se radi o nativnim eritrocitima, find the origins of the erythrocytes. Dysmorphic
potrebna je urološka obrada bolesnika. Iz dobivenih erythrocytes need further nephrological and native

S71
Posterski sažetci: E – Molekularna dijagnostika
Poster abstracts: E – Molecular diagnostics
rezultata možemo zaključiti da oko 10% bolesnika s erythrocytes need urological analysis. Results show
mikrohematurijom zahtijeva daljnju obradu ili liječe- that 10% of patients with microhematuria demand
nje. further analysis and treatment.
e-adresa: zoranatodoric@gmail.com e-mail: zoranatodoric@gmail.com
E – Molekularna dijagnostika E – Molecular diagnostics
E01 (Usmeno izlaganje) E01 (Oral presentation)
Utjecaj polimorfizama CYP3A4/5 i CYP2D6 The influence of CYP3A4/5 and CYP2D6

na serumske koncentracije risperidona polymorphisms on serum concentrations
i 9-hidroksirisperidona kod pacijenata of risperidone and 9-hydroxyrisperidone
na terapiji pripravkom risperidona s in patients using long-acting injectable
produljenim oslobađanjem risperidone
Lana Ganoci1, Mila Lovrić1, Maja Živković2, Marina Šagud3, Nada Božina1 Lana Ganoci1, Mila Lovrić1, Maja Živković2, Marina Šagud3, Nada Božina1
1Kliničkizavod za laboratorijsku dijagnostiku, Klinički bolnički 1Department of Laboratory Diagnostics, University Hospital
2Klinika za psihijatriju Vrapče, Zagreb, Hrvatska, 2Psychiatric Hospital Vrapče, Zagreb, Croatia
3Klinika za psihijatriju, Klinički bolnički centar Zagreb, Zagreb, 3Department of Psychiatry, University Hospital Centre Zagreb,
Hrvatska Zagreb, Croatia
Uvod: Risperidon (RIS) se metabolizira u aktivni oblik Introduction: Risperidone (RIS) is metabolized to its
9-hidroksirisperidon (9-OHRIS) uglavnom putem active metabolite 9-hydroxyrisperidone (9-OHRIS),
enzima CYP2D6 i u manjoj mjeri putem CYP3A4/5. mainly by the enzyme CYP2D6 and, to a lesser
Antipsihotični učinak risperidona pripisuje se zajed- extent by CYP3A4/5. Its antipsychotic effect is assu-
ničkom djelovanju RIS i 9-OHRIS. Cilj ove studije je med to be related to the active moiety of RIS and
istražiti ulogu genetičkih varijacija CYP2D6 *dupl,*3, 9-OHRIS. The aim of this study is to investigate the
*4, *5, *6, *41, CYP3A4*22 and CYP3A5*3 na serumske role of genetic variations of CYP2D6 *dupl, *3, *4, *5,
koncentracije i metabolički omjer RIS i 9-OHRIS. *6, *41, CYP3A4*22 and CYP3A5*3 on serum concen-
Ispitanici i metode: 70 pacijenata sa shizofrenijom trations and metabolic ratio of RIS and 9-OHRIS.
ne terapiji pripravkom risperidona s produljenim Subjects and Methods: 70 patients with schizophre-
oslobađanjem (RIS-LAI) (raspon doza 25-75 mg) su nia treated with long-acting risperidone (RIS-LAI)
genotipizirani, te su određene ravnotežne serumske (dose range 25-75 mg) were genotyped, and their
koncentracije RIS i 9-OH RIS na 5 i 14 dan. CYP2D6 serum steady-state concentrations of RIS and 9-OH
*dupl i alel *5 analizirani su PCR metodom, dok su RIS were measured on 5th and 14th day. Analysis for
metodom TaqMan® PCR u stvarnom vremenu ana- CYP2D6 *dupl and allele *5 was performed by PCR,
lizirani CYP2D6 aleli *3, *4, *6, *41, te CYP3A4*22 i while real-time PCR analysis by TaqMan® assays was
CYP3A5*3. Koncentracije RIS i 9-OH RIS određene su performed for genotyping of CYP2D6 alleles *3, *4,
kromatografskom metodom na HPLC-DAD. *6, *41, CYP3A4*22 and CYP3A5*3. Concentrations of
Rezultati: Distribucija genotipa CYP2D6: 34 brza RIS and 9-OH RIS were measured by HPLC-DAD.
metabolizatora (EM), 23 intermedijarna metaboliza- Results: The genotype distribution for CYP2D6 was:
tora (IM), 5 sporih metabolizatora (PM), 3 vrlo brza 34 extensive metabolizers (EM), 23 intermediate me-
metabolizatora (UM) i 5 duplikacija varijantnih ale- tabolizers (IM), 5 poor metabolizers (PM), 3 ultrara-
la. Medijan zbroja koncentracija RIS i 9-OHRIS na 5 pid metabolizers (UM) and 5 duplications of variant

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Posterski sažetci: E – Molekularna dijagnostika
Poster abstracts: E – Molecular diagnostics
dan je bio 76,4 nmol/L (95%CI=56,8-102,2), te na 14 alleles. The median active moiety concentrations
dan 42,3 nmol/L (95%CI=34,1-52,4). Koncentracije RIS were on 5th day 76.4 nmol/L (95%CI=56.8-102.2),
+ 9-OHRIS na 14 dan su se statistički značajno razli- on 14th day 42.3 nmol/L (95%CI=34.1-52.4). The ac-
kovale ovisno genotipu CYP2D6 (Kruskall-Wallis test, tive moiety concentrations on 14th day were signifi-
P=0,042). Genotipizacija CYP2D6*41 i metabolički cantly different according to CYP2D6 genotype (Kru-
omjer RIS/RIS-OH otkrili su još 3 PM i 3 IM. Nije bilo skall-Wallis test, P=0.042). Genotyping of CYP2D6*41
značajnog utjecaja varijanata CYP3A4*22 i CYP3A5*3. and metabolic ratio RIS/RIS-OH revealed 3 more pa-
Zaključak: Genotip CYP2D6 je pokazao značajan tients to be PM and 3 IM. No significant influence of
utjecaj na ravnotežne koncentracije RIS i 9-OHRIS. CYP3A4*22 and CYP3A5*3 variants was found.
Genotipizacija CYP2D6*41 važna je za dodatno otkri- Conclusion: The CYP2D6 genotypes had a strong in-
vanje CYP2D6 PM i IM. Vrijednosti koncentracija RIS i fluence on the steady-state serum levels of RIS and
9-OHRIS kod UM na 5 i 14 dan su bile niže od prepo- 9-OHRIS. Genotyping of CYP2D6*41 is important for
ručenog terapijskog raspona. CYP3A4*22 i CYP3A5*3 detection of additional CYP2D6 PM and IM. The ac-
nisu pokazali utjecaj na ravnotežne koncentracije li- tive moiety concentrations for UM on 5th and 14th
jeka. day were bellow recommended therapeutic range.
CYP3A4*22 and CYP3A5*3 did not show influence on
e-adresa: lana.pejnovic@gmail.com the steady-state serum drug concentrations.
e-mail: lana.pejnovic@gmail.com
E02 E02
Genotipizacija interleukin 28 b polimorfizma Genotyping of interleukin 28 b

rs12979860 i praćenje odgovora na polymorphysm rs12979860 and prediction
antivirusnu terapiju kod bolesnika s of viral response to therapy in chronic
kroničnim hepatitisom C hepatitis C patients
Jasna Bingulac-Popović1, Nadia Komparić2, Ivana Furčić3, Vesna Đogić1, Jasna Bingulac-Popović1, Nadia Komparić2, Ivana Furčić3, Vesna Đogić1,
Ivana Babić1, Jadranka Žgrablić-Cetina2, Ivana Babić2, Irena Hrstić2, Ivana Babić1, Jadranka Žgrablić-Cetina2, Ivana Babić2, Irena Hrstić2,
Nina Juraković-Lončar1, Melita Balija1, Irena Jukić1 Nina Juraković-Lončar1, Melita Balija1, Irena Jukić1
1Hrvatski zavod za transfuzijsku medicinu, Zagreb, Hrvatska 1Croatian Institute of Transfusion Medicine, Zagreb, Croatia
2Opća bolnica Pula, Pula, Hrvatska 2General Hospital Pula, Pula, Croatia
3Institut za antropologiju, Zagreb, Hrvatska 3Institute for Anthropological Research, Zagreb, Croatia
Uvod: Genski polimorfizmi u genu interleukin 28B Introduction: Genetic polymorphisms in the in-
(IL28B) utječu na spontano izlječenje ili uspješnost li- terleukin 28B (IL28B) gene has been found to pre-
ječenja hepatitis C (HCV) infekcije. Bolesnici sa CC ge- dict spontaneous clearance or successful treatment
notipom rs12979860 IL28B SNP imaju veću vjerojat- of HCV infection. Patients with CC genotype of
nost eliminacije HCV-a od bolesnika s TT ili CT geno- rs12979860 IL28B SNPs are more likely to elimina-
tipom. CC genotip također predviđa dvostruko veću te HCV than those with TT or CT genotype. Patients
vjerojatnost da se postigne održivi virološki odgovor with CC genotype were twice as likely to achieve an
(SVR) tijekom terapije u usporedbi s drugim genoti- SVR compared with patients with other genotypes.
povima. Cilj istraživanja bio je odrediti virološki od- Aim of the study was to determine the virological
govor na terapiju kod bolesnika s kroničnom HCV response to therapy in patients with chronic HCV
infekcijom s obzirom na genotip IL28B polimorfizma. infection due to the IL28B genotype polymorphism.
Ispitanici i metode: Bolesnici liječeni u OB Pula Subjects and Methods: The patients group from
podijeljeni su u dvije skupine: 1- na dvojnoj tera- General Hospital Pula are divided into two groups:

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Posterski sažetci: F – Automatizacija laboratorijskih postupaka i procesa
Poster abstracts: F – Automatization of procedures and processes in laboratory medicine
piji s pegiliranim interferonom alfa-2a + ribavi- 1- on dual therapy with pegylated interferon alfa-
rinom (N=9) i 2- na trojnoj terapiji s inhibitorima 2a + ribavirin (N=9) and 2- on triple therapy with
NS3/4A-proteaze (N=13). Nakon izolacije genom- NS3/4A protease inhibitors (N=13). After isolation of
ske DNA, određen je IL28B genotip bolesnika po- the genomic DNA, IL28B genotype was determined
moću validirane „in house” RT-PCR metode na ure- using “in house” validated RT-PCR on an ABI 7500
đaju ABI 7500 real-time PCR system. Virusni HCV- real time PCR system. Viral load and genotype were
RNA titar i genotip su određeni prije liječenja kao determined prior to treatment using commercial kits
status viremije korištenjem komercijalnih kitova on the COBAS AmpliPrep/COBAS TaqMan analyzer.
na COBAS AmpliPrep/COBAS TaqMan analizatoru. Results: In the group of the patients on dual the-
Rezultati: Od 9 bolesnika na dvojnoj terapiji bilo je rapy with good respond to therapy, 5/9 were CC,
5 CC genotipa, 3 CT i 1 TT i svi su povoljno reagirali 3 CT and 1 TT genotype. Of the 13 patients on tri-
na terapiju. Od 13 bolesnika na trojnoj terapiji bilo je ple therapy, 3 of them were CC, 8 CT and 2 TT ge-
3 CC, 8 CT i 2 TT genotipa. 5/13 bolesnika isključeno notypes as well. 5/13 patients with viral genoty-
je s terapije zbog lošeg odgovora od toga 1 je CC, 4 pe 1; subtypes 1a and 1b were excluded from
CT genotipa IL28B i svi HCV genotipa 1 te subtipa 1a i therapy due to poor response (1 CC, 4 CT). Ove-
1b koji lošije reagiraju na terapiju. Ukupno gledajući, rall, 5/13 patients were non-responders, of which
5/13 bolesnika bilo je non-respondera, od toga 1/5 1/5 IL28B was CC genotype (20%) and the rema-
CC genotipa IL28B (20%) a ostalih 4/5 (80%) bolesni- ining 4/5 (80%) patients were non-CC genotype.
ka bilo je ne-CC genotipa. Conclusion: Preliminary results show slightly better
Zaključak: Preliminarni rezultati pokazuju nešto bo- response to therapy in chronic HCV patients carriers
lji odgovor na terapiju kod bolesnika s kroničnom of CC IL28B genotype polymorphism. The study con-
HCV infekcijom nositelja CC genotipa IL28B polimor- tinues with including more patients to the triple the-
fizma. S obzirom da se u trojnu terapiju uključuje sve rapy in Croatia, which will enable significant statisti-
više bolesnika u RH, studija se nastavlja što će omo- cal comparison.
gućiti značajniju statističku usporedbu.
e-mail: jasna.bingulac-popovic@hztm.hr
e-adresa: jasna.bingulac-popovic@hztm.hr
F - Automatizacija laboratorijskih postupaka F - Automatization of procedures and

i procesa processes in laboratory medicine
F01 F01
Detekcija parazita malarije pomoću Malaria detection on DXH800 Beckman

hematološkog analizatora Beckman Coulter® Coulter® hematology analyzer in
DXH800 non-endemic area
Sanja Kozić Dokmanović1, Valentina Vidranski2, Vedrana Jukić1, Zdravka Sanja Kozić Dokmanović1, Valentina Vidranski2, Vedrana Jukić1, Zdravka
Čulig1, Martina Kramar1, Adrijana Dorotić1, Renata Laškaj1, Anita Klasić3 Čulig1, Martina Kramar1, Adrijana Dorotić1, Renata Laškaj1, Anita Klasić3
1Odjel za biokemiju i hematologiju, Klinika za infektivne bolesti 1Department for biochemistry and hematology, University hospital
“Dr Fran Mihaljevic”, Zagreb, Hrvatska for infectious diseases “Dr Fran Mihaljevic”, Zagreb, Croatia
2Klinika za onkologiju i nuklearnu medicinu, Klinički bolnički 2Department of Oncology and Nuclear Medicine, University
centar Sestre Milosrdnice, Zagreb, Hrvatska Hospital Centre Sestre milosrdnice, Zagreb, Croatia
3Specijalna bolnica za medicinsku rehabilitaciju Krapinske 3Special Hospital for Medical Rehabilitation Krapinske Toplice,
Toplice, Krapinske Toplice, Hrvatska Krapinske Toplice, Croatia
Uvod: Prevalencija infekcije uzrokovane parazitom Introduction: The prevalence of malaria infection in
malarije u Hrvatskoj je niska, a najčešće je vezana uz Croatia is low and usually associated with traveling

S74
putovanja u endemska područja. Zlatni standard za to endemic areas. A microscopic examination of blo-
dokazivanje parazita malarije u krvi je mikroskopski od smear is the gold standard for malaria parasite
pregled krvnog razmaza, no metoda zahtijeva vrlo detection, but time consuming and requiring a well
dobro educirane laboratorijske djelatnike. Hemato- trained laboratory personnel. Hematology analyzers
loški analizatori čiji se princip rada bazira na VCS teh- that use VCS (V-Volume, C-Conductivity, S-Scatter)
nologiji (V-volumen, C-vodljivost, S-rasap), mjere vo- technology, as DxH800 Beckman Coulter®, may de-
lumene limfocita i monocita, a oni se značajno pove- tect lymphocytes and monocytes volume changes
ćavaju u prisutnosti parazita malarije. Briggs C je sa caused by malaria infection. In 2006, Briggs C. et al
suradnicima 2006. godine predstavila tzv. “Malaria introduced the «malaria factor», a number calculated
factor”, umnožak SD volumena limfocita i monoci- from lymphocyte and monocyte volume SD. During
ta/100, a tijekom infekcije malarijom je u pravilu veći malaria infection, it should be greater than 3.7. Addi-
od 3,7. Ostali hematološki parametri, kao što su: broj tional parameters as platelet count <150×10/L, eo-
trombocita <150×109/L, <0,15% eozinofila, dodatni sinophil percentage <0.15%, presence of additional
vršak u histogramu leukocita, SD volumena mono- peak at threshold of WBC histogram, SD volume of
cita >23,2 i srednja vrijednost volumena monocita monocytes >23.2 and a mean volume of monocytes
veća od 180 fL povećavaju specifičnost procjene. >180 improve specificity.
Materijali i metode: Na hematološkom analizatoru Materials and Methods: We retrospectively collec-
Beckman Coulter® DXH800 ted results of CBC analysis for 12 patients with pro-
retrospektivno su analizirani rezultati kompletne ved malaria infection.
krvne slike (KKS) s dodatnim parametrima za 12 pa- Results: Malaria factor >3.7 was found in 10/12
cijenata kojima je dokazana malarija. patients (median 5.9, IQR: 5.1-7.0), platelet count
Rezultati: Faktor malarije >3,7 dokazan je u 10/12 <150×109/L was found in 8/12 patients (median 99,
pacijenata (medijan 5,9; interkvartilni raspon (IQR): IQR: 62-171×109/L), eosinophil percentage <0.15%
5,1-7,0), Broj trombocita <150×109/L izmjeren je u was found in 4/12 patients (median 0.2, IQR: 0.1-1.2),
8/12 pacijenata (medijan 99; IQR: 62-171×109/L), po- presence of additional peak at threshold of WBC hi-
stotak eozinofila <0,15% izmjeren je u 4/12 pacije- stogram was found in 9/12 patients, SD volume of
nata (medijan 0,2; IQR: 0,1-1,2), prisutnost dodatnog monocytes >23.2 was found in 9/12 patients (medi-
vrška na histogramu leukocita nađen je u 9/12 paci- an 26.5, IQR: 23.3-28.9), mean volume of monocytes
jenata, SD volumena monocita >23,2 izmjerena je u >180 was found in 9/12 patients (median 191, IQR:
9/12 pacijenata (medijan 26,5; IQR: 23,3-28,9), srednja 187.5-196.5).
vrijednost volumena monocita >180 fL izmjerena je Conclusion: We showed that DxH800 Beckman Co-
u 9/12 pacijenata (medijan 191; IQR: 187,5-196,5). ulter® can detect the most changes in CBC caused
Zaključak: Hematološki analizator Beckman Co- by malaria. Data are generated during routine CBC
ulter® DXH800 detektirao je promjene povezane analysis with no additional cost and possibility to
s infekcijom malarije kod većine naših pacijenata. create a flag to warn the operator for possible mala-
Predstavljeni algoritam za detekciju malarije može ria infection. However, each positive result has to be
se provesti tijekom redovne KKS analize te upozo- confirmed by microscopic examination.
riti djelatnika na moguću infekciju malarijom. Svaki
pozitivan rezultat potrebno je potvrditi mikroskop- e-mail: sanja.kozic1@gmail.com
skom analizom.
e-adresa: sanja.kozic1@gmail.com

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F02 (Usmeno izlaganje) F02 (Oral presentation)
Kapilarna elektroforeza u rutinskom Capillary electrophoresis for routine

određivanju HbA1c kod oboljelih od šećerne determination of HbA1c in patients with
bolesti: kratka analitička verifikacija i diabetes: Short analytical verification and
preliminarni klinički rezultati preliminary clinical results
Sandra Božičević, Vanja Radišić Biljak, Maja Krhač, Sandra Božičević, Vanja Radišić Biljak, Maja Krhač,
Marijana Vučić Lovrenčić Marijana Vučić Lovrenčić
Klinički zavod za medicinsku biokemiju i laboratorijsku Department of Medical Biochemistry and Laboratory Medicine,
medicinu, Klinička bolnica Merkur, Zagreb, Hrvatska Merkur University Hospital, Zagreb, Croatia
Uvod: HbA1c je ključna laboratorijska pretraga u kli- Introduction: HbA1c is a crucial laboratory test for
ničkom praćenju šećerne bolesti i procjeni rizika clinical management of diabetes and the risk assess-
za razvoj mikro- i makrovaskularnih komplikacija. ment for the development of micro- and macrovas-
Nedavno je preporučena i dijagnostička primjena cular complications. Expanding indications and limi-
HbA1c, osobito kod pretraživanja šećerne bolesti i tations of analytical methods represent a continu-
predijabetesa u asimptomatskoj populaciji. Prošire- ous challenge in meeting the rigorous requirements
nje indikacija i ograničenja analitičkih metoda, pri- of analytical quality for reliable clinical use. Capillary
sutni i nakon uspostave globalne harmonizacije, electrophoresis, one of the two reference methods
predstavljaju trajan izazov u udovoljavanju rigoro- for HbA1c, recently available for routine laboratory
znih uvjeta analitičke kvalitete za pouzdanu klinič- work, certainly enables a qualitative shift in analysis
ku primjenu. Kapilarna elektroforeza, jedna od dviju of HbA1c. The aim of this preliminary study is to de-
referentnih metoda za HbA1c, odnedavno dostupna termine the analytical features and possible clinical
i za rutinsku laboratorijsku primjenu, svakako omo- benefits of HbA1c results measured by capillary elec-
gućava kvalitativni pomak u analitici HbA1c. Cilj ovog trophoresis compared to immunoassays.
preliminarnog istraživanja je utvrditi analitičke zna- Materials and Methods: Analytical features of
čajke i moguće kliničke prednosti rezultata HbA1c the system for measuring concentration of HbA1c
određenih kapilarnom elektroforezom u odnosu na by capillary electrophoresis (MiniCap Flex Pierc-
imunokemijsku metodu kod kliničkog praćenja še- ing, Sebia, France) are verified in accordance with
ćerne bolesti. CLSI EP15-A2 protocol. Comparison of the results
Materijali i metode: Analitička svojstva sustava za of HbA1c measured by capillary electrophoresis and
kapilarnu elektroforezu HbA1c (Minicap Flex Piercing, accredited Immunoassay on the automatic analyz-
Sebia, Francuska) verificirana su sukladno CLSI EP15- er (Tina-quant HbA1c Gen 2, Cobas Integra 400+,
A2 protokolu. Usporedba rezultata HbA1c određenih Roche Diagnostics, USA) was performed on samples
kapilarnom elektroforezom i akreditiranom imuno- of diabetic patients (N=78) within the clinically rele-
kemijskom metodom na automatskom analizatoru vant concentration range of HbA1c.
(Tina-Quant HbA1c Gen 2, Cobas Integra 400+, Roche Results: The total imprecision of HbA1c mea-
Diagnostics, SAD) izvršena je na uzorcima oboljelih sured by capillary electrophoresis was 1.02/1.62%
od šećerne bolesti (N=78) unutar klinički relevan- (HbA1c=5.0%/30.6 mmol/mol) and 1.24/1.55%
tnog raspona vrijednosti HbA1c. (HbA1c=8.0%/64.3 mmol/mol). Bland-Altman analy-
Rezultati: Ukupna analitička nepreciznost HbA1c sis showed the average deviation of the measured
mjerenog kapilarnom elektroforezom (koeficijent values of HbA1c by capillary electrophoresis in re-
varijacije), iznosila je 1,02/1,62% (HbA1c = 5,0%/30,6 lation to immunoassays -0.24%/- 2.8 mmol/mol
mmol/mol), odnosno 1,24/1,55% (HbA1c = 8,0%/64,3 (95%CI: (-0.16)-(-0.32)%/(-3.8)-(-1.7) mmol/mol), with
mmol/mol). Bland-Altman analiza pokazala je pro- continued significant (P<0.001) increase in bias.
sječno odstupanje vrijednosti HbA1c izmjerenih ka- Passing-Bablok analysis confirmed the systematic
pilarnom elektroforezom u odnosu na imunokemij- and proportional difference between the methods:
sku metodu -0,24%/-2,8 mmol/mol (95%CI: -0,16 do HbA1c(%)capillary electrophoresis=0.8375+0.8750×HbA

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-0,32%/-3,8 do -1,7 mmol/mol), uz kontinuirano zna- 1c(%)immunochemistry; intercept A=0.85; slope B=0.87;
čajan (P<0,001) porast odstupanja s porastom vrijed- HbA1c(mmol/mol)capillary electrophoresis=5.44+0.88×Hb
nosti HbA1c. Passing-Bablok analizom potvrđena je A1c(mmol/mol)immunochemistry; intercept A=5.44; slope
sistematska i proporcionalna razlika između metoda: B=0.88.
HbA1c (%)kapilarna elekroforeza= 0,8375+0,8750×HbA1c(%) Conclusion: Capillary electrophoresis meets the
imunokemija; odsječak A=0,85; nagib pravca B=0,87; rigorous criteria of the analytical quality for reliable
HbA1c (mmol/mol)kapilarna elekroforeza=5,44+0,88×HbA1 clinical use of HbA1c. The concentration dependence
c(mmol/mol)imunokemija; odsječak A=5,44; nagib prav- of the observed difference in the values of HbA1c is
ca B=0,88. probably a consequence of enhanced specificity
Zaključak: Kapilarna elektroforeza u cijelosti udo- of capillary electrophoresis compared to immuno-
voljava rigoroznim kriterijima analitičke kvalitete za chemistry methods. Potential clinical implications of
pouzdanu kliničku primjenu HbA1c. Koncentracijska the observed differences need to be brought in fu-
ovisnost razlike u vrijednostima HbA1c vjerojatno je ture research.
posljedica unaprijeđene specifičnosti kapilarne elek-
troforeze u odnosu na imunokemiju. Eventualne kli- e-mail: vanja.radisic@gmail.com
ničke implikacije uočene razlike valja rasvijetliti u bu-
dućim istraživanjima.
e-adresa: vanja.radisic@gmail.com
F03 (Usmeno izlaganje) F03 (Oral presentation)
Model provjere funkcionalnosti Evaluation of rules in autovalidation

autovalidacijskog algoritma algorithm
Vladimira Rimac1, Krešimir Kuleš2, Željka Vogrinc1, Dunja Rogić1 Vladimira Rimac1, Krešimir Kuleš2, Željka Vogrinc1, Dunja Rogić1
1Kliničkizavod za laboratorijsku dijagnostiku, Klinički bolnički 1Department of Laboratory Diagnostics, University Hospital
2IN2 d.o.o, Zagreb, Hrvatska 2IN2 d.o.o, Zagreb, Croatia
Uvod: Autovalidacija, sustav automatskog izdavanja Introduction: Autovalidation is a part of the labora-
rezultata, dio je laboratorijskog informacijskog su- tory information system whereby laboratory results
stava koji omogućuje validaciju rezultata kroz točno are released without manual human intervention
definirana pravila, odnosno algoritme. Kao pravilo through defined rules and algorithms. Autovali-
mogu se postaviti granice linearnosti analizatora, dation rules may include: analytical measurement
granice ponavljanja rezultata određenog testa (engl. range, interference indices (hemolysis, icterus, lipe-
re-run), vrijednosti serumskih indeksa, kritične vri- mia), critical values or delta checks. Rules must be
jednosti te provjera rezultata testa s prethodnim re- set for laboratory testing and patient population for
zultatima (engl. delta check). Kod definiranja pravila which autovalidation will be applied. The aims of the
potrebno je obratiti pozornost na područje labora- study were to examine the credibility of the rules in
torijskog rada i populaciju pacijenata u ustanovi gdje the algorithm for autovalidation and determine the
će se autovalidacija primjenjivati. Ciljevi ovog rada percentage of samples that were autovalidated in
bili su ispitati vjerodostojnost postavljenih pravila u comparison to the total number of samples includ-
algoritmu prema kojem se provodi autovalidacija, te ed in validation, as well as rules that stop autovalida-
utvrditi postotak autovalidiranih uzoraka u odnosu na tion.
ukupan broj uzoraka uključenih u validaciju, kao i koja Materials and Methods: The validation results in-
pravila u najvećoj mjeri zaustavljaju autovalidaciju. cluded 9805 samples of biochemical tests analyzed

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Materijali i metode: U validaciju su bili uključeni in the Department of Laboratory Diagnostics, Uni-
rezultati općih biokemijskih pretraga 9805 uzoraka versity Hospital Centre Zagreb from May to July
koji su analizirani u Kliničkom zavodu za laboratorij- 2014. Validation was performed in such a way that,
sku dijagnostiku Kliničkog bolničkog centra Zagreb, before starting the system of autovalidation, the re-
u razdoblju od svibnja do srpnja 2014.godine. Vali- sults were reviewed by a medical biochemist who
dacija je provedena na način da je prije pokretanja recorded samples that should meet the rules set in
sustava autovalidacije rezultate pregledao medicin- the algorithm. Statistical analysis was made using
ski biokemičar te bilježio uzorke koji ne bi trebali za- the software MedCalc (version 9.3.2.0).
dovoljiti pravila postavljena u algoritmu. Statistička Results: 78.3% (7677) of the samples included in val-
obrada podataka napravljena je pomoću softwera idation were autovalidated. The highest percentage
MedCalc (verzija 9.3.2.0). of samples (54.9%) was not autovalidated due to set
Rezultati: 78,3% (7677) uzoraka uključenih u valida- rules for analytical measurement ranges, while the
ciju bilo je autovalidirano. Najveći postotak uzoraka lowest percentage of non-validated samples was re-
(54,9%) nije bio autovalidiran zbog postavljenih pra- corded in the rules for interference indices for icter-
vila za granice ponavljanja određenog testa, dok je us (0.6%). The correspondence of autovalidation and
najmanji postotak nevalidiranih uzoraka zabilježen the person who carried it out was 99.5%, i.e. the mis-
kod pravila indeksa ikterije (0,6%). Podudarnost po- match is observed only in 0.5% of samples (38). An
stupka autovalidacije i osobe koja je provodila vali- analysis of Χ2-test data showed no statistically signif-
daciju bila je 99,5%, odnosno neslaganje je zapaže- icant difference (P=0.523) in the number of samples
no samo na 0,5% uzoraka (38). Analizom podataka that were autovalidated (7677) in relation to those
Χ2-testom utvrđeno je da nema statistički značajne validated by medical biochemist (7639).
razlike (P=0,523) u broju uzoraka koji su bili autovali- Conclusion: The analysis of results showed that set
dirani (7677) u odnosu na one koje je validirao medi- rules in the algorithm are credible, and that system
cinski biokemičar (7639). autovalidation can be implemented in routine labo-
Zaključak: Analizom rezultata dobiveno je da su ratory use.
postavljena pravila u algoritmu za opće biokemijske
pretrage vjerodostojna, te da se sustav autovalidaci- e-mail: kutnjakvl@gmail.com
je može implementirati u svakodnevni laboratorijski
rad u KZLD-u.
e-adresa: kutnjakvl@gmail.com
F04 F04
OptiScanner 5000: povremeno praćenje OptiScanner 5000: an intermittent glucose

glukoze u bolesnika sa sepsom monitoring in septic patients
Alessandra Barassi1, Michele Umbrello2, Valentina Salice3, Paolo Alessandra Barassi1, Michele Umbrello2, Valentina Salice3, Paolo
Spanu2, Paolo Formenti2, Luca Massaccesi4, Giancarlo Goi4, Clara Spanu2, Paolo Formenti2, Luca Massaccesi4, Giancarlo Goi4, Clara
Anna Linda Damele5, Angela Leone5, Rossana Stefanelli5, Gaetano Anna Linda Damele5, Angela Leone5, Rossana Stefanelli5, Gaetano
Iapichino2,3, Gian Vico Melzi d’Eril1 Iapichino2,3, Gian Vico Melzi d’Eril1
1Dipartimento di Scienze della Salute, Università degli Studi di 1Dipartimento di Scienze della Salute, Università degli Studi di
Milano, Milano, Italy Milano, Milano, Italy
2Unità Operativa di Anestesia e Rianimazione, Azienda 2Unità Operativa di Anestesia e Rianimazione, Azienda
Ospedaliera San Paolo - Polo Universitario, Milano, Italy Ospedaliera San Paolo - Polo Universitario, Milano, Italy
3Dipartimento di Fisiopatologia Medico-Chirurgica e dei 3Dipartimento di Fisiopatologia Medico-Chirurgica e dei
Trapianti, Università degli Studi di Milano, Milano, Italy Trapianti, Università degli Studi di Milano, Milano, Italy

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4Dipartimento di Scienze Biomediche, Chirurgiche ed 4Dipartimento di Scienze Biomediche, Chirurgiche ed

Odontoiatriche, Università degli Studi di Milano, Milano, Italy Odontoiatriche, Università degli Studi di Milano, Milano, Italy
5Laboratorio di Analisi, Ospedale San Paolo, Milano, Italy 5Laboratorio di Analisi, Ospedale San Paolo, Milano, Italy
Uvod: Još uvijek se raspravlja o optimalnoj razini i Introduction: The optimal level and modality of
načinu kontrole glukoze u kritičnih bolesnika. Pro- glucose control in critically ill patients is still debat-
tokolizirani pristup i upotreba gotovo stalnih teh- ed. A protocolized approach and the use of nearly-
nologija se preporučuju za praćenje hiperglikemije, continuous technologies are recommended to man-
hipoglikemije i glikemijskih promjena. Nedavno smo age hyperglycemia, hypoglycemia and glycemic
predložili protokol temeljen na patofiziologiji gluko- variability. We recently proposed a pato-physiology-
ze koji uzima u obzir koncentraciju glukoze u bole- based glucose control protocol which takes into ac-
snika, unos ugljikohidrata i inzulinsku rezistenciju. count patient glucose/carbohydrate intake and insu-
Cilj ovog istraživanja bio je procijeniti uspješnost na- lin resistance. Aim of the present investigation was
šeg protokola na automatiziranom uređaju za inter- to assess the performance of our protocol with an
valno praćenje koncentracije glukoze u plazmi (Op- automated intermittent plasma glucose monitoring
tiScanner™ 5000). device (OptiScanner™ 5000).
Materijali i metode: OptiScanner™ je upotrebljen u Materials and Methods: OptiScanner™ was used in
6 bolesnika sa sepsom, omogućuje mjerenje glukoze 6 septic patients, providing glucose measurement
svakih 15 minuta, a priključen je bočno na već ugra- every 15 minutes from a side-port of an indwelling
đeni centralni venski kateter. Ciljna koncentracija central venous catheter. Target level of glucose was
glukoze bila je 4,4-8,3 mmol/L. Zabilježena je infuzija 4.4-8.3 mmol/L. Insulin infusion and kcal with nutri-
inzulinom i unos prehrane u kcal. tional support were also recorded.
Rezultati: U studiji je praćeno 6 bolesnika sa sep- Results: Six septic patients were studied for 319 h
som kroz 319 sati (1277 mjerenja); 58 (45-65) sati za (1277 measurements); 58 (45-65) hours for each pa-
svakog bolesnika (mjerenja/bolesnik: 231 (172-265)). tient (measurements/patient: 231 (172-265)). Blood
Ciljna koncentracija glukoze u krvi bila je postignu- glucose was at target for 93 (90-98)% of study time.
ta u 93 (90-98)% ispitivanog vremena. Srednja vri- Mean plasma glucose was 7.0±0.6 mmol/L. Only 3
jednost glukoze u plazmi bila je 7,0±0,6 mmol/L. Za- hypoglycemic episodes (4.3, 4.3, 3.8 mmol/L) were
bilježene su samo 3 epizode hipoglikemije (4,3; 4,3; recorded. Glucose variability was limited: plasma
3,8 mmol/L). Varijabilnost glukoze bila je ograniče- glucose coefficient of variation was 11.7±4.0% and
na: koeficijent varijacije za glukozu u plazmi bio je plasma glucose standard deviation was 0.8±0.3
11,7±4,0%, a standardna devijacija za glukozu u plaz- mmol/L.
mi 0,8±0,3 mmol/L. Conclusion: The local glucose control protocol
Zaključak: Lokalnim protokolom kontrole gluko- achieved satisfactory glucose control in septic pa-
ze postignuta je zadovoljavajuća kontrola glukoze tients along with a high degree of safeness. Au-
u bolesnika sa sepsom uz visoki stupanj sigurno- tomated intermittent plasma glucose monitoring
sti. Automatizirano povremeno praćenje glukoze u seemed useful to assess the performance of the pro-
plazmi činilo se korisnim za procjenu učinkovitosti tocol.
protokola.
e-mail: alessandra.barassi@unimi.it
e-adresa: alessandra.barassi@unimi.it

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Posterski sažetci: G – Akreditacija, organizacija, kvaliteta i upravljanje u laboratoriju
Poster abstracts: G – Accreditation, organization, quality and laboratory management
G – Akreditacija, organizacija, kvaliteta i G – Accreditation, organization, quality and

upravljanje u laboratoriju laboratory management
G01 G01
Prikaz indikatora kvalitete u kliničkoj Quality indicators in clinical laboratory

laboratorijskoj hematologiji hematology
Dragica Ferenec Ružić, Biserka Getaldić, Sandra Margetić, Ivana Vuga, Dragica Ferenec Ružić, Biserka Getaldić, Sandra Margetić, Ivana Vuga,
Nada Vrkić Nada Vrkić
Odjel za laboratorijsku hematologiju i koagulaciju, Klinički Department of Laboratory Hematology and Coagulation,
zavod za kemiju, Klinički bolnički centar Sestre milosrdnice, University Department of Chemistry, University Hospital Centre
Zagreb, Hrvatska Sestre milosrdnice, Zagreb, Croatia
Uvod: Definiranje i kontinuirano praćenje indikato- Introduction: Defining and continuous monitoring
ra kvalitete obaveza je laboratorija akreditiranih po of quality indicators is obligatory for laboratories
normi HRN EN 15189. Ovi mjerljivi pokazatelji trebaju accredited according to the HRN EN 15189. Measure-
obuhvatiti faze rada u laboratoriju u kojima se prema ment of indicators should include different phases
specifičnosti dijagnostičkog područja za samopro- of laboratory work in which, according to the spe-
cjenu kvalitete odaberu nesukladnosti koje se pre- cificity of diagnostic area, selected nonconformities
brojavaju i ocjenjuju u vremenskim intervalima te- are appropriate for quality self-assessment, when
meljem kojih se može provoditi proces poboljšanja counted and evaluated enable process improve-
rada. Cilj je bio učiniti samoprocjenu kvalitete rada ment. The aim was self-assessment of the quality in
u hematološkom laboratoriju koji ima integriranu the hematology laboratory, with integrated organi-
organizaciju rada hitnih i redovnih uzoraka kroz pra- zation of emergency and routine samples, by moni-
ćenje tri ključne nesukladnosti u periodu od godine toring three key nonconformities within one year: 1.
dana: 1. broj zgrušanih uzoraka, 2. broj ponavljanja number of clotted samples, 2. number of repeated
mjerenja radi analitičke greške analizatora, 3. broj measurements due to analytical errors, 3. number of
hitnih uzoraka KKS koje su imali prekoračenje TAT-a. emergency CBC samples, which exceeded TAT.
Materijal i metode: Na Odjelu za laboratorijsku he- Materials and Methods: Nonconformities of pre-
matologiju i koagulaciju bilježe se nesukladnosti analytical, analytical and post-analytical phase were
prema predanalitičkoj, analitičkoj i poslijeanalitičkoj recorded by the Department of Laboratory Hema-
fazi radnog procesa. Pretrage KKS učinjene su na he- tology and Coagulation. CBC was measured on he-
matološkim analizatorima DxH (Beckman Coulter) matology analyzers DxH (Beckman Coulter) and
i Cell-Dyn Sapphire (Abbott). Podatke o izabranim Cell-Dyn Sapphire (Abbott). Data on the selected
indikatorima radnog procesa dobili smo pretraži- indicators of the working process were obtained by
vanjem baze nesukladnosti u programu Microsoft exploring a nonconformities database in Microsoft
Accessu. Access.
Rezultati: U vremenskom periodu od godinu dana Results: In one year period (1.1.2014.-31.12.2014.)
(1.1.2014.- 31.12.2014.) izdano je 124602 nalaza KKS. 124602 CBC reports were issued. Records show that
Prema evidentiranim nesukladnostima zatraženo 918 repeated sampling were requested (0.7%), of
je 918 ponavljanja uzorkovanja (0,7%), od kojih je which the majority was clotted samples 770 (0.6%).
glavnina 770 (0,6%) bila zgrušani uzorci. Mjerenje je Measurement was repeated for 1091 samples (0.9%)
ponovljeno u 1091 uzorku (0,9%) s najučestalijom out of which 509 (46%) for checking differential
kategorijom provjere DKS–509/1091 (46%). Od uku- leucocyte count. 94974 (76.2%) of the total num-
pnog broja izdanih nalaza KKS, hitnih zahtjeva bilo je ber of issued CBC reports were emergency require-
94974 (76,2%), od kojih je na mjesečnoj razini preko- ments, of which 685 samples (0.7%) monthly excee-
račilo TAT 685 uzoraka (0,7%), dok je srednja vrijed- ded TAT, while the annual average TAT value for CBC
nost TAT-a na godišnjoj razini za KKS bila 17,8 minuta. was 17.8 minutes.

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Zaključak: Naši rezultati prema indikatorima kva- Conclusion: According to the quality indicators, our
litete pokazuju vrlo dobar udjel uzoraka koji su bili results show a good proportion of acceptable sam-
analitički prihvatljivi s obzirom da je od ukupno ana- ples considering that 15654 of analyzed samples
liziranih bilo 15654 kapilarnih uzoraka. Inicijalna ana- were capillary samples. Initial analyses of the hema-
liza na hematološkim analizatorima ima prihvatljive tology analyzers have eligible criteria for efficiency
kriterije efikasnosti, kao i prosječno vrijeme za izra- and average time for issuing CBC emergency report.
du hitnih nalaza KKS. Poboljšanje će se temeljiti na The improvement will be established on the analysis
analizi dinamike ovih indikatora na mjesečnoj razini of the monthly dynamics of these indicators and will
te će se time ubrzati rješavanje evidentiranih pogre- speed up the management of recorded errors.
šaka.
e-mail: dfruzic@gmail.com
e-adresa: dfruzic@gmail.com
G02 (Usmeno izlaganje) G02 (Oral presentation)
Identifikacija laboratorijskih procesa s Identification of laboratory processes with

utjecajem na vremensko opterećenje major influence on laboratory turnaround
laboratorijskog rada time
Vesna Šupak Smolčić1,2, Dragana Antončić1, Ivana Vladilo1, Eliza Vesna Šupak Smolčić1,2, Dragana Antončić1, Ivana Vladilo1, Eliza
Bašić1, Diana Jamaković1, Dubravka Lenac1, Jasna Marčelja1, Snježana Bašić1, Diana Jamaković1, Dubravka Lenac1, Jasna Marčelja1, Snježana
Salopek1, Elizabeta Fišić1, Lidija Bilić-Zulle1,2 Salopek1, Elizabeta Fišić1, Lidija Bilić-Zulle1,2
1Kliničkizavod za laboratorijsku dijagnostiku, Klinički bolnički 1ClinicalDepartment of Laboratory Diagnostics, Clinical
2Katedra za medicinsku informatiku, Medicinski fakultet 2Department of Medical Informatics, Rijeka University School of
Sveučilišta u Rijeci, Rijeka, Hrvatska Medicine, Rijeka, Croatia
Uvod: Vrijeme potrebno za izdavanje nalaza je je- Introduction: Time reduction for issuing labora-
dan od temeljnih indikatora kvalitete laboratorij- tory results accompanied with quality improvement
skog rada. Skraćivanje vremena izdavanja nalaza uz presents a major challenge in laboratory work. We
unaprjeđenje kvalitete predstavlja izazov u složenim aimed to identify processes with major influence on
laboratorijskim procesima. Cilj rada je identificirati turnaround time (TAT).
procese s najvećim utjecajem na vrijeme od zapri- Materials and Methods: From January till March
manja uzorka do završetka analize. 2015, we manually recorded duration of several pro-
Materijali i metode: U razdoblju od siječnja do ožuj- cesses in laboratory routine work for 1432 samples
ka 2015. u KZLD-u KBC-a Rijeka ručno su bilježeni po- arrived in the Department of laboratory diagnos-
datci o vremenima za pojedine faze laboratorijskog tics, CHC Rijeka. Sample reception was divided in 5
procesa za 1432 uzorka. Uzorci su podijeljeni u 5 raz- intervals: R1 (7:00-8:00h), R2 (8:00-9:00h), R3 (9:00-
doblja prema vremenu prijema: R1 (7:00-8:00h), R2 10:00h), R4 (10:00-11:00h), R5 (11:00-12:00h). Dura-
(8:00-9:00h), R3 (9:00-10:00h), R4 (10:00-11:00h), R5 tion (minutes) of the following processes was re-
(11:00-12:00h). Za sve uzorke zabilježeno je vrijeme corded: from sample reception to centrifugation
(minute) od prijema do početka centrifugiranja (D1), (D1), from centrifugation to manual barcoding (D2),
od centrifugiranja do ručnog barkodiranja (D2), od from barcoding to placing the sample into analyser
barkodiranja do postavljanja na analizator (D3), vrije- (D3), time on analyser (D4), from the end of analysis
me na analizatoru (D4), vrijeme od završetka analize to archiving (D5) and overall process duration (TAT)
do pohrane uzorka (D5) te ukupno trajanje procesa (D6). Difference of process duration regarding differ-

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(D6). Razlike u trajanju procesa s obzirom na razdo- ent time of receipt were tested using Kruskal-Wallis
blja ispitane su Kruskal-Wallis testom (razina značaj- test (level of significance P<0.05).
nosti P<0,05). Results: The majority of samples were received
Rezultati: Najveći broj uzoraka zaprima se u razdo- in R3 (25%). Average duration (minutes) of each
blju R3 (25%). Prosječno trajanje procesa (minute) process (median, interquartile range) was as fol-
prikazano medijanom i interkvartilnim rasponom: lows: D1=25(20-30); D2=15(15-20); D3=30(15-50);
D1=25(20-30); D2=15(15-20); D3=30(15-50); D4=20(15- D4=20(15-24); D5=12(10-20); D6=115(100-135). Sam-
24); D5=12(10-20); D6=115(100-135). Razdoblja prije- ple reception (D1) lasts equally for intervals R1 to R5
ma od R1 do R5 imaju podjednako trajanje procesa (P=0,122). Process D2 is the fastest, 15(10-15), for sam-
D1 (P=0,122). Proces D2 je najkraći, 15(10-15), za uzor- ples received in R4 (P=0,004). Duration of D3 and D4
ke primljene u razdoblju R4 (P=0,004). Trajanje pro- is significantly longer for samples received during R1
cesa D3 i D4 je značajno dulje za R1 (D3=40(20-59); (D3=40(20-59); D4=20(14-25)) and R2 (D3=30(15-50);
D4=20(14-25)) i R2 (D3=30(15-50); D4=20(15-24)) u D4=20(15-24)) when compared with other intervals
odnosu na ostala razdoblja (oba testiranja P<0,001). (both P<0.001). Process D5 is longer for R1, R2 and
Proces D5 je dulji u R1, R2 i R3 od R4 i R5 (P<0,001). R3 in comparison to R4 and R5 (P<0.001). TAT (D6) is
D6 je najdulji u R1, 125(105-142), zatim u R2, 115(95- the longest for samples received in R1, 125(105-142),
130), dok je u ostalim podjednak (P<0,001). following R2, 115(95-130), while in other intervals re-
Zaključak: Brojem uzoraka najopterećeniji je pri- mains the same (P<0.001).
jem u razdoblju od 9:00-10:00 sati. Ipak, najsporije Conclusion: From 9:00-10:00 am laboratory sample
se obrađuju uzorci pristigli od 7:00-9:00 sati. Kritič- reception is burdened the most. Samples received
ne točke u obradi su ručno barkodiranje te vrijeme from 7:00-9:00 am are processed the slowest. Criti-
do postavljanja na analizator. Za smanjivanje TAT-a u cal points are manual barcoding and time for plac-
tom razdoblju potrebna je optimizacija procesa s ob- ing the sample in the analyser. Personnel manage-
zirom na broj osoblja ili automatizacija. ment optimization or automatization is needed for
TAT reduction.
e-adresa: vesnasupak@gmail.com
e-mail: vesnasupak@gmail.com
G03 G03
Naknadni zahtjevi za laboratorijskim Number of requests required but not

testovima – predanalitički indikator registered (missed tests) – preanalitycal
kvalitete quality indicator
Vesna Šupak Smolčić1,2, Dragana Antončić1, Lidija Bilić-Zulle1,2 Vesna Šupak Smolčić1,2, Dragana Antončić1, Lidija Bilić-Zulle1,2
Uvod: Indikatori kvalitete objektivni su pokazatelji Introduction: Quality indicators are objective way
kvalitete procesa. Jedan od predanalitičkih indika- for accessing the quality of laboratory work. One of
tora kvalitete jest udio laboratorijskih testova koji su the preanalytical quality indicators is the percentage
potrebni, ali nisu primarno zatraženi, tj. postotak na- of tests that are required but not primarily request-
knadno naručenih zahtjeva za dodatnim testovima u ed i.e. requests for additional analysis of the samples
uzorcima koji su već obrađeni ili uzeti u obradu. Cilj already received and analyzed in the laboratory. We

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je bio uspostaviti ovaj indikator kvalitete te utvrditi aimed to establish this quality indicator and to iden-
koji odjeli najčešće naknadno traže dodatne testove. tify departments which frequently make additional
Materijali i metode: Podatci o naknadnim zahtje- requests.
vima prikupljeni su u Kliničkom zavodu za laborato- Materials and Methods: Added test requests were
rijsku dijagnostiku (lokalitet Rijeka) KBC-a Rijeka tije- recorded during 2014 in the Department of labo-
kom 2014. godine. Analiza je učinjena s obzirom na ratory diagnostics (location Rijeka), Clinical Hospi-
Kliničke zavode i Klinike iz kojih su dospjeli naknadni tal Centre Rijeka. Data was analyzed according to
zahtjevi. Indikator kvalitete definiran je kao postotak Clinical departments and Clinics which requested
naknadno traženih zahtjeva za već obrađene uzorke additional analysis. Quality indicator was defined
od ukupnog broja zahtjeva za laboratorijskim pretra- as percentage of requests for additional analysis of
gama za pojedini Klinički zavod ili Kliniku u 2014. go- the samples already analyzed out of total number of
dini. Sigma vrijednost izračunata korištenjem mrež- requests for each Clinical department and Clinic in
nog kalkulatora (https://www.westgard.com/six-si- 2014. Sigma value was calculated using web calcu-
gma-calculators.htm), a vrijednost sigma >3 određe- lator (https://www.westgard.com/six-sigma-calcula-
na je kao granica prihvatljivosti. tors.htm). Sigma >3 was considered as acceptable.
Rezultati: U 2014. godini bilo je ukupno 107.016 za- Results: In 2014 we received a total of 107016 re-
htjeva za laboratorijskim pretragama iz Kliničkih za- quests for laboratory analysis from all Clinical de-
voda i Klinika KBC-a Rijeka, lokaliteta Rijeka. Ukupan partments and Clinics in CHC Rijeka, location Rijeka.
broj naknadno naručenih zahtjeva bio je 1.356 (1,3%) The total number of requests for additional analysis
što odgovara sigma vrijednosti od 3,8. Najčešće na- was 1356 (1.3%) corresponding to a sigma value of
knadni zahtjevi dolaze iz: Centra za hitnu medicinu 3.8. Departments that make requests for additional
(1.113/16.187; 6,9%; sigma 3,0); Klinika za infektivne testing most frequently are: Emergency department
bolesti (31/3.451; 0,9%; 3,9), Zavod za gastroenterolo- (1113/16187, 6.9%, sigma 3.0); Clinic for Infectious
giju (62/11.618; 0,5%; sigma 4,1), Klinika za psihijatriju Diseases (31/3451, 0.9%, 3.9), Department of Gas-
(5/958; 0,5%; sigma 4,1), Klinika za kirurgiju (14/4.882; troenterology (62/11618, 0.5%, sigma 4.1), Clinic for
0,3%; sigma 4,3), Zavod za hematologiju (41/12.859; Psychiatry (5/958, 0.5%, sigma 4.1), Clinic for Surgery
0,3%; sigma 4,3), Klinika za ginekologiju (35/11.752; (14/4882, 0.3%, sigma 4.3), Department of Hematol-
0,3%; sigma 4,3). Klinike i zavode koji imaju vrijed- ogy (41/12859, 0.3%, sigma 4.3), Clinic for Gynecol-
nost sigma >4,5 nismo iskazali. ogy (35/11752, 0.3%, sigma 4.3). Clinical departments
Zaključak: Usprkos naoko niskom postotku naknad- and Clinics with sigma >4.5 are not shown.
no zatraženih zahtjeva za laboratorijskim pretraga- Conclusion: Despite the seemingly low percentage
ma, vrijednosti sigma 3,0 do 4,5 za sedam klinika i of additional requests for laboratory analysis, sigma
zavoda ostavlja značajan prostor za poboljšanje. values from 3.0 to 4.5 for the seven Clinical depart-
ments and Clinics leaves significant room for im-
e-adresa: vesnasupak@gmail.com provement.
e-mail: vesnasupak@gmail.com

S83
G04 G04
Verifikacija imunokemijske metode za Verification of immunoassay for

određivanje anti-Mullerovog hormona determination of anti-Mullerian hormone
Danijela Županić, Renat Mujagić, Lorena Honović Danijela Županić, Renat Mujagić, Lorena Honović
Odjel za laboratorijsku dijagnostiku, Opća bolnica Pula, Pula, Department of Laboratory Diagnostics, General Hospital Pula,
Hrvatska Pula, Croatia
Uvod: Anti-Mullerov hormon (AMH) nastaje u jajni-

Introduction: Anti-Mullerian hormone (AMH) is
cima i testisima. Zadatak mu je kod žena stvaranje
produced by the ovaries and testes. Its role is to
rezerve jajnih stanica i regulacija prijelaza folikula u
make a reserve of oocytes and regulate the transi-
zrelu fazu. Kod muškaraca AMH je odgovoran za nor-
malan razvoj reproduktivnog organa. Cilj ovog rada tion of follicles into a mature phase in women and
je ispitati prihvatljivost reagensa AMH (Roche Dia- the normal development of the reproductive organs
gnostics GmbH, Manheim, Njemačka) za primjenu in men. The aim of this paper is to investigate the
na imunokemijskom analizatoru Cobas e411 kako bi acceptability of AMH reagent (Roche Diagnostics
osigurali pouzdane rezultate laboratorijske pretrage. GmbH, Mannheim, Germany) for the application in
Verifikaciju imunokemijske metode učinili smo pri- immunochemical analyzer Cobas e411 to ensure re-
mjenom CLSI/NCCLS postupka EP 15-A2. liable results of the laboratory test. Verification of
Materijali i metode: Procijenili smo sljedeće para- immunoassay was performed using the CLSI/NCCLS
metre: preciznost (ponovljivost, međupreciznost i procedure EP 15-A2.
ukupna laboratorijska preciznost) koju smo proveli Materials and Methods: We evaluated the
u dvije koncentracijske razine u triplikatu tijekom pet following parameters: Precision in which we deter-
dana. Koristili smo kontrolne uzorke tvrtke Roche (PC- mined repeatability, interprecision and overall labo-
AMH 1 i PC-AMH 2) te je izrazili kao standardno odstu- ratory precision and systematic error (deviation from
panje (s) i koeficijent varijacije (KV). Procijenili smo i the expected values). We used Roche control sam-
sustavnu pogrešku (odstupanje od očekivanih vrijed- ples (PC-AMH 1 and PC-AMH 2).
nosti). Proveli smo ju u dvije koncentracijske razine u Results: In the evaluation of precision the following
duplikatu tijekom pet dana također korištenjem kon- results were obtained: For control sample level 1
trolnih uzoraka tvrtke Roche (PC-AMH 1 i PC-AMH 2). (declared mean value is 7.07 pmol/L), mean va-
Rezultati: Kod procjene preciznosti dobili smo slje-
lue of 7.3 pmol/L, value for repeatability (Sr=0.07,
deće rezultate: Za razinu 1 kontrolnog uzorka (dekla-
CV%=1.0%), interprecision (Sb=0.08, CV%=1.1%)
rirana srednja vrijednost iznosi 7,07 pmol/L) dobive-
and overall laboratory precision (Sl=0.1, CV%=1.4%).
na je srednja vrijednost 7,3 pmol/L te vrijednosti za
ponovljivost (Sr=0,07, KV%=1,0%), međupreciznost For control sample level 2 (declared mean value is
(Sb=0,08; KV%=1,1%) i ukupnu laboratorijsku pre- 38.6 pmol/L), mean value of 39.5 pmol/L, value for
ciznost (Sl=0,1; KV%=1,4%). Za razinu 2 kontrolnog repeatability (Sr=0.7, CV%=1.8%), interprecision
uzorka (deklarirana srednja vrijednost iznosi 38,6 (Sb=0.53, CV%=1.3%) and overall laboratory preci-
pmol/L) dobivena je srednja vrijednost 39,5 pmol/L sion (Sl=0.78, CV%=2.0%). The resulting systematic
te vrijednosti za ponovljivost (Sr=0,7; KV%=1,8%), error for control sample level 1 is 0.184 (2.6%), while
međupreciznost (Sb=0,53; KV%=1,3%) i ukupnu la- for level 2 it is 0.559 (1.4%).
boratorijsku preciznost (Sl=0,78; KV%=2,0%). Dobi- Conclusion: Based on the results of this study,
vena sustavna pogreška za razinu 1 kontrolnog uzor- we can conclude that tested Roche reagent AMH
ka iznosi 0,184 (2,6%), a za razinu 2 0,559 (1,4%). is accetable and we recommend its use in immu-
Zaključak: Dobiveni niski koeficijenti varijacije ispi- nochemical analyzer Cobas e411.
tivanjem preciznosti (ponovljivost, međupreciznost i
ukupna laboratorijska preciznost) te minimalno od- e-mail: danijela.zupanic@pu.t-com.hr
stupanje od očekivanih vrijednosti kontrolnih referen-
tnih materijala dokazuju da je reagens AMH tvrtke Ro-
che prihvatljiv i preporučljiv za primjenu na imunoke-
mijskom analizatoru Cobas e411 tvrtke Roche.
e-adresa: danijela.zupanic@pu.t-com.hr
S84
G05 G05
Molekularna dijagnostika virusa – rezultati Molecular viral diagnostics - external control

vanjske kontrole od 2010. - 2014. results 2010 - 2014
Jasna Bingulac-Popović, Vesna Đogić, Ivana Babić, Tomislav Vuk, Jasna Bingulac-Popović, Vesna Đogić, Ivana Babić, Tomislav Vuk,
Dorotea Šarlija, Nina Juraković- Lončar, Melita Balija, Irena Jukić Dorotea Šarlija, Nina Juraković- Lončar, Melita Balija, Irena Jukić
Hrvatski zavod za transfuzijsku medicinu, Zagreb, Hrvatska Croatian Institute of Transfusion Medicine, Zagreb, Croatia
Uvod: Vanjska procjena kvalitete rada primjenjuje se Introduction: External Quality Assessment were
u Odjelu za molekularnu dijagnostiku (OMD) HZTM applied in the Molecular Diagnostics department
redovito od 1997. za molekularnu dijagnostiku virusa (MDD) of CITM regularly since 1997 for molecular di-
hepatitisa B i C, te HIV-1. Cilj rada je prikaz i analiza agnostics of viral hepatitis B and C, and HIV-1. The
rezultata vanjske kontrole u razdoblju od 2010-2014. aim is to present the results of external control from
Materijali i metode: OMD sudjeluje u Quality Con- 2010-2014.
trol for Molecular Diagnostics (QCMD, Škotska) kon- Materials and Methods: MDD participates in the
troli titra virusa HCV, HBV, HIV-1 te genotipizaciji HBV Quality Control for Molecular Diagnostics (QCMD,
i HCV. Godišnje se testira po 4 panela uzoraka za kon- Scotland) for viral loads of HCV, HBV, HIV-1 and HBV,
trolu titra i po 1 panel za genotipizaciju. Virusni titar HCV genotypes. Annually were tested 4 panel sam-
određuje se RT-PCR komercijalnim kitovima na uređaju ples for viral load and 1 for genotyping. The viral
COBAS AmpliPrepTaqMan docking stanica (Roche Di- load is determined by RT-PCR commercial kits on the
agnostics, SAD), a genotipizacija pomoću PCR-SSOP COBAS AmpliPrepTaqMan docking station (Roche
na uređaju AutoLIPa (Siemens, Njemačka). U radu su Diagnostics, USA) and genotyping using PCR-SSOP
korištena individualna i skupna QCMD izvješća. on the AutoLIPa (Siemens, Germany). In the study
Rezultati: Kriteriji prihvaćanja su ±0,5 log10 (95%CI) were used QCMD individual and group reports.
odnosno do 2SD odstupanja za kvantitativne mole- Results: Acceptance criteria are ±0.5 log10 (95% CI)
kularne testove, dok je za kvalitativne testove kriterij or to 2SD for quantitative results, while for qualitati-
90-100% istinitost rezultata. QCMD izračunava panel ve criteria is 90-100% results accuracy. QCMD calcu-
score kao indikator (ne)zadovoljavajućeg testiranja u lates panel scores as an indicator of (un)satisfactory
odnosu na ciljnu vrijednost. Score 0 označava visoko results compared to the target value. Score 0 signs
zadovoljavajući a 3 je visoko nezadovoljavajući rezul- highly satisfactory and 3 highly unsatisfactory result.
tat. Za određivanje HCV genotipa u 5 godina panel For HCV genotype determination in five years the
score iznosi 0 uz 100% točno testiranje, za HBV-DNA panel score was 0 with 100% accurate testing, for
i HIV-1 RNA panel score se kreće od 0-1. U testiranju HBV and HIV-1 load panel scores ranged from 0-1.
HCV-RNA 2011. jedan pozitivan uzorak bio je negati- For HCV load tests one positive sample was negati-
van (score 2); 2012. za 1 uzorak se log titra razlikovao ve (score 2) 2011; for 1 sample log titre differed by
za 1,2 (dozvoljeno je 0,5 log; score 1); 2013. je u testi- 1.2 (0.5 log is allowed; score 1) 2012; one panel had
ranju 1 od panela imao score 2 (2SD), a 2014. za istu a score 2 (2SD) 2013, and for the same method panel
metodu panel score bio je 0. Kod određivanja HBV score was 0 2014. For HBV genotype twice deviati-
genotipa, u jednom slučaju uzorak je kontaminiran u ons has occurred; the sample is contaminated in a
seriji od 8 uzoraka a u drugom HBV genotip H je kri- series of 8 samples; and HBV genotype H is wrong
vo interpretiran kao miješani D+F (score 1). interpreted as mixed D+F (panel score 1).
Zaključak: Svi djelatnici OMD zajednički su analizira- Conclusion: All MDD employees analyze the results
li rezultate vanjskih kontrola, diskutirali o odstupanju of EQA, discuss the possible critical points of the
i mogućim kritičnim točkama procesa, odlučili o mje- process, and improve decontaminating measures
rama poboljšanja i dekontaminacije što je rezultiralo which resulted in excellent results of external quality
izvrsnim rezultatima vanjske kontrole molekularne assessment of molecular viral diagnostics.
dijagnostike virusa.
e-mail: jasna.bingulac-popovic@hztm.hr
e-adresa: jasna.bingulac-popovic@hztm.hr

S85
G06 G06
Usporedba imunokemijskih metoda za Comparison of two immunoassays for TSH,

određivanje TSH, FT4 i FT3 FT4 and FT3
Jelena Omazić1, Sanja Mandić1,2, Vesna Horvat1,2, Vatroslav Šerić1,2 Jelena Omazić1, Sanja Mandić1,2, Vesna Horvat1,2, Vatroslav Šerić1,2
1Odjel za kliničku laboratorijsku dijagnostiku, Klinički bolnički 1Department of Clinical Laboratory Diagnostics, Clinical
centar Osijek, Osijek, Hrvatska Hospital Centre Osijek, Osijek, Croatia
2Medicinski fakultet Osijek, Sveučilište J.J. Strossmayera u 2University J.J. Strossmayer Medical School Osijek, Osijek,
Osijeku, Osijek, Hrvatska Croatia
Uvod: Određivanje tireotropina (TSH), tiroksina (FT4) Introduction: The thyroid-stimulating-hormone

i trijodtironina (FT3) jedan je od češćih zahtjeva u (TSH), thyroxin (FT4) and triiodothyronine (FT3) are
svakodnevnoj kliničkoj praksi. U analizi se koriste ra- ones of the most required tests. The aim of this
zličite imunokemijske metode. Cilj je istraživanja bio study was to examine comparability of results from
ispitati usporedivost rezultata dobivenih na analiza- Unicel Dxl600 (Beckman Coulter, Tokyo, Japan) and
torima Unicel Dxl600 (Beckman Coulter, Tokyo, Ja- Architect i1000 (Abbott, Wiesbaden, Germany) ana-
pan) i Architect i1000 (Abbott, Wiesbaden, Njemač- lyzers.
ka). Materials and Methods: The verification of meth-
Materijali i metode: Učinjena je verifikacija meto- ods was done on control samples BioRad Lypocheck
da (prema CLSI smjernicama; EP15-A2) za određiva- Immunoassay Plus Control (Biorad Laboratories,
nje sva tri parametra na komercijalnim kontrolnim Marnes-la-Coquette, France) (level1 and level2) for
uzorcima (visoka i niska kontrola) BioRad Lypocheck all three hormones on Unicel and Architect analyz-
Immunoassay Plus Control (Biorad Laboratories, ers. Control samples were tested every day in du-
Marnes-la-Coquette, Francuska) na analizatorima plicate during 10 days for imprecision in series and
Unicel i Architect. Ispitane su nepreciznost u seriji i day-to-day imprecision. Results are shown as coeffi-
nepreciznost iz dana u dan tijekom 10 dana, za sva cient of variation (CV) and compared with Westgard
tri parametra u duplikatu. Podaci su prikazani koe- rules and with CV provided by the manufacturer.
ficijentom varijacije (CV) i uspoređeni sa kriterijima Methods comparison was conducted using 50 pa-
prihvatljivosti prema Westgardu i proizvođaču. tient samples. Statistical analysis was performed us-
Osim toga, učinjena je usporedba metoda analizom ing MedCalc 12.4.0.0 software (MedCalc, Mariaker-
50 uzoraka pacijenata. Statistička analiza je učinjena ke, Belgium). Correlation of results is show trough
pomoću programa MedCalc 12.4.0.0. (MedCalc, Ma- Spearman correlation coefficient. Passing-Bablok re-
riakerke, Belgium). Korelacija između dobivenih vrijed- gression was also used, including the Cusum test for
nosti za svaki parametar prikazana je Spearmanovim linearity. The level of significance was set at P<0.05.
korelacijskim koeficijentom. Učinjena je i Passing-Ba- Results: The measured values of control samples
blok regresijska analiza, uključujući i Cusum test za were within the range recommended by the man-
linearnost. Statistički značajna vrijednost je P<0,05. ufacturer. Results of the imprecision in series and
Rezultati: Izmjerene vrijednosti komercijalnih kon- day-to-day imprecision were in the range of desir-
trola, za sve učinjene analize, bile su unutar vrijed- able specifications provided by manufacturer. The
nosti preporučenih od proizvođača. Rezultati nepre- measured values of TSH on both analyzers, were
ciznosti u seriji i nepreciznosti iz dana u dan bile su within desirable specification according to West-
unutar kriterija proizvođača. Vrijednosti TSH su na gard (I=9.7%), while for FT4 (I=2.9%) and FT3 (I=4%),
oba analizatora, u obje kontrole, bile unutar kriterija the measured values were not within desirable
prihvatljivosti prema Westgardu (I=9,7%), dok za FT4 specification for neither analyzers. Passing-Bablok
(I=2,9%) i FT3 (I=4%) ti kriteriji nisu bili zadovoljeni regression showed that there was proportional
niti za jedan analizator. measurement error between analyzers for TSH
Passing-Bablokovom regresijskom analizom, utvrđe- (y=0.001857+0.9087x) and FT3 (y=0.2439+0.8403x),
no je proporcionalno odstupanje između analizato- and constant and proportional measurement error
ra prilikom određivanja TSH (y=0,001857+0,9087x) i between analyzers for FT4 (y=4.0083+0.8183x).

S86
FT3 (y=0,2439+0,8403x), te konstantno i proporcio- Conclusion: Data gathered through verification of

nalno odstupanje između analizatora prilikom odre- method was within range recommended by the ma-
đivanja FT4 (y=4,0083+0,8183x). bufacturer. Statistical analysis showed that is impos-
Zaključak: Verifikacijom metode dobiveni su rezul- sible to compare results from two different analyz-
tati koji zadovoljavaju specifikacije proizvođača. Sta- ers. That proves that for monitoring of patients, the
tističkom je obradom podataka dokazana neuspo- thyroid hormones need to be determined always on
redivost rezultata dobivenih na dva analizatora što one analyzer.
dokazuje da je za praćenje pacijenata i uspješnost
liječenja, potrebno hormone štitnjače određivati na e-mail: jelena.omazic@gmail.com
istom analizatoru.
e-adresa: jelena.omazic@gmail.com
Utječe li nadzor Hrvatske Does the supervision of the Croatian

akreditacijske agencije (HAA) na Accreditation Agency (CAA) lead to more
djelotvornije prijavljivanje nesukladnosti u effective reporting of nonconformities in the
laboratoriju? laboratory?
Domagoj Marijančević, Adriana Unić Domagoj Marijančević, Adriana Unić

Klinički zavod za laboratorijsku dijagnostiku, Klinička bolnica Clinical Department of Laboratory Diagnostics, University
Uvod: Nesukladnost je svako odstupanje od zahtje- Introduction: Nonconformity is any deviation from
va norme HR EN ISO 15189. Akreditirani laboratoriji the requirements of the ISO 15189. Accredited lab-
obvezuju se osmisliti najprimjereniji način upravlja- oratories commit to develop the most appropriate
nja nesukladnostima. Cilj istraživanja bio je ispitati way to manage nonconformities. The aim of this
utjecaj prvog nadzora tijela za ocjenjivanje suklad- study was to assess the impact of conformity assess-
nosti (HAA) na razvoj svijesti o važnosti prijavljivanja ment bodies first audit on the raise of awareness
nesukladnosti u laboratoriju. about the importance of reporting nonconformities
Materijali i metode: Korištenjem mrežnog pogo- in the medical laboratories.
na Kliničkog zavoda za laboratorijsku dijagnostiku Materials and Methods: Using Clinical Depart-
Kliničke bolnice Dubrava na kojem se nalazi važeća ment for Laboratory Diagnostics network where the
dokumentacija sustava upravljanja kvalitetom re- documentation of the QMS is distributed, the data
trospektivno su dobiveni podaci o broju prijavljenih on nonconformities before and after supervision of
nesukladnosti prije i poslije nadzora HAA. Nesuklad- the CAA was retrospectively obtained. Nonconfor-
nosti su zatim dodatno kategorizirane prema osno- mities are then further categorized according to the
vama za njihovo pokretanje. grounds for their registration.
Rezultati: U Kliničkom zavodu za laboratorijsku di- Results: During multiyear establishment of the QMS
jagnostiku Kliničke bolnice Dubrava u višegodišnjem in the laboratory we reported only four nonconfor-
periodu uspostave sustava kvalitete (prije nadzora mities. During the year following the first CAA audit
HAA) prijavljene su svega četiri nesukladnosti. Tije- we reported eleven nonconformities in total. Before
kom godine dana nakon prvog nadzora HAA prijav- supervision of the CAA, nonconformities were most-
ljeno je ukupno jedanaest nesukladnosti. Prije nad- ly reported on the basis of the internal audits find-
zora HAA, nesukladnosti su najčešće pokretane na ings (3/4) rarely by normal application procedure of

S87
osnovu nalaza unutarnje neovisne ocjene (3 od 4) a nonconformities (1/4). After supervision of the CAA,
rijetko uobičajenim postupkom prijave nesukladno- we experienced noticeable increase in the number
sti (1 od 4). Poslije nadzora HAA, uočljivo je poveća- of initiated nonconformities on the basis of the in-
nje broja pokrenutih nesukladnosti na osnovu na- ternal audits findings (6/11) and in particular we no-
laza unutarnje neovisne ocjene (6 od 11) a naročito ticed the increase in standard reporting of noncon-
povećanje primjećujemo u slučajevima standardne formities (5/11).
prijave nesukladnosti (5 od 11). Conclusion: Considering that the first CAA audit the
Zaključak: Budući da je nakon prvog nadzora HAA number of reported nonconformities was notice-
zamjetno povećan broj prijavljenih nesukladnosti u ably increased in all categories, we are convinced
svim kategorijama, uvjereni smo kako vanjska kon- that external supervision particularly stimulates the
trola osobito poticajno utječe na razvoj svijesti o development of awareness about the importance
važnosti prijavljivanja nesukladnosti u laboratoriju. of reporting nonconformities. In addition, through
Osim toga, vanjski ocjenitelji i eksperti kroz praktič- practical assessment in the laboratory, external as-
nu ocjenu u laboratoriju dodatno osposobljavaju sessors further train the staff about the need to re-
osoblje o nužnosti prijavljivanja svih nesukladnosti port all nonconformities promoting an atmosphere
promovirajući atmosferu u kojoj neće biti namjernih in which there will be no deliberate or accidental
ili slučajnih sakrivanja nesukladnosti. U konačnici, concealment of nonconformities. Ultimately, the ef-
učinkovito upravljanje nesukladnostima dovodi do fective management of nonconformities leads to
prijeko potrebnih popravnih i preventivnih radnji the necessary corrective and preventive actions that
koje čine osnovu procesa neprekidnog poboljšanja form the basis for a continuous improvement pro-
i unaprjeđenja svih segmenata sustava kvalitete la- cess and enhancement of all segments of the quality
boratorija. system in the medical laboratories.
e-adresa: dmarijan@kbd.hr e-mail: dmarijan@kbd.hr
G08 G08
Procjena prihvatljivosti biokemijskih metoda Performance estimation of biochemical

verificiranih na analizatoru Beckman Coulter methods validated on analyzer Beckman
AU5800 pomoću normaliziranog MEDx grafa Coulter AU5800 using normalized MEDx
Anđela Žic1, Vesna Šupak Smolčić1,2, Zvonka Bačić1, Lidija Bilić-Zulle1,2 Anđela Žic1, Vesna Šupak Smolčić1,2, Zvonka Bačić1, Lidija Bilić-Zulle1,2
Uvod: Zamjena postojećeg analitičkog sustava no- Introduction: Prior to the implementation of a new
vim sustavom u laboratoriju zahtjeva provođenje analytical system in routine laboratory work it is re-
analitičke verifikacije prije njegove implementacije quired to perform analytical validation. Method vali-
u rutinski rad. Postupak verifikacije uključuje ispitiva- dation includes measuring inaccuracy (bias) and im-
nje netočnosti (bias) i nepreciznosti (KV) kao mjera precision (CV), measures of systematic and random
sistemske i slučajne pogreške, a koji su potrebni za error, essential data for calculation of the total error
izračun ukupne pogreške metode (TE). TE predstav- (TE). TE represents the measure of quality i.e. over-
lja značajku kvalitete metode tj. maksimalnu pogreš- all error that may occur during measurement. Aim of
ku koja se može dogoditi tijekom mjernog postupka. the study was to show all validated methods on nor-

S88
Cilj rada bio je prikazati normalizirani MEDx graf za malized MEDx graph, simple tool for fast assessment
sve verificirane metode u svrhu lakše i brže procje- of methods performance.
ne prihvatljivosti njihove izvedbe i upotrebe u rutin- Materials and Methods: The process of validation
skom radu. of 32 analytical methods on the analyzer Beckman
Materijali i metode: Postupak verifikacije 32 ana- Coulter AU5800 (Beckman Coulter, USA) has been
litičkih metoda na analizatoru Beckman Coulter conducted during July 2014 in the Department of
AU5800 (Beckman Coulter, SAD) proveden je tijekom Laboratory Diagnostics, CHC Rijeka. Each method
srpnja 2014. godine u Kliničkom zavodu za laborato- is evaluated according to the recommended qual-
rijsku dijagnostiku, KBC Rijeka. Svaka ispitana meto- ity criteria from the database Minchinela et al. (www.
da je procijenjena prema preporučenim kriterijima westgard.com /biodatabase1.htm). TE is calculated
kvalitete iz baze podataka Minchinela i sur. (www. according to the equation TE=Bias+σCV where σ in-
westgard.com/biodatabase1.htm). Ukupna pogreš- dicates desired confidence level (σ=2-6). Expressing
ka (TE) izračunata je prema jednadžbi TE=Bias+σKV CV and bias as the percentage of the TE enables to
gdje σ označava željenu razinu pouzdanosti (σ=2-6). display all operating points in the same normalized
Izražavanjem nepreciznosti i netočnosti u relativnim MEDx graph where each method is presented by its
vrijednostima, kao postotak od ukupne pogreške coordinates CV and bias and defined according to
moguć je prikaz svih radnih točaka na istom norma- the σ value for method performance classification.
liziranom MEDx grafu. Na MEDx grafu svaka je meto- Results: According to the given criteria, perfor-
da prikazana koordinatama KV i bias te procijenjena mance of the validated analytical methods is classi-
prema klasifikaciji izvedbe metode definirane sa σ fied into the following categories: excellent (6σ): CK,
vrijednošću. triglycerides, GGT, ferritin, CRP; good (5σ): amylase,
Rezultati: Izvedba verificiranih analitičkih metoda direct bilirubin, IgM; border (4σ): total bilirubin, IgA,
prema danim kriterijima klasificirana je u sljedeće ALT, cholesterol; poor (3σ): glucose, AST, LDH, urea,
skupine: izvanredna (6σ): CK, trigliceridi, GGT, feritin, iron; unacceptable (2σ): IgG, uric acid, ALP; points
CRP; dobra (5σ): amilaza, direktni bilirubin, IgM; gra- outside the graph: creatinine, total protein, albumin,
nična (4σ): ukupni bilirubin, IgA, ALT, kolesterol; loša Mg, P, Ca, Na, K, Cl, HDL, C3, C4.
(3σ): glukoza, AST, LDH, ureja, željezo; neprihvatljiva Conclusion: The results of analytical validation for
(2σ): IgG, mokraćna kiselina, ALP; točke izvan grafa: many parameters of the new system are not satisfac-
kreatinin, ukupni proteini, albumini, Mg, P, Ca, Na, K, tory according to six sigma. Normalized MEDx graph
Cl, HDL, C3, C4. enables us to easily observe the methods which re-
Zaključak: Rezultati analitičke verifikacije novog quire more frequent control and more strict quality
sustava za mnoge parametre nisu zadovoljavajući criteria.
prema principima 6 sigma sustava. Normaliziranim
MEDx grafom jednostavno se uočavaju metode koje e-mail: angela.zic@gmail.com
je potrebno učestalije kontrolirati i na koje je potreb-
no primijeniti strože kriterije prihvatljivosti.
e-adresa: angela.zic@gmail.com

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G09 G09
Primjena fleksibilnog područja akreditacije Application of a flexible scope of accreditation
Ines Alpeza Viman, Anita Herceg, Dunja Rogić Ines Alpeza Viman, Anita Herceg, Dunja Rogić
Uvod: Klinički zavod za laboratorijsku dijagnostiku Introduction: Department of Laboratory Diagnos-

KBC-a Zagreb zatražio je prvu akreditacijsku ocjenu s tics, UHC Zagreb requested the first accreditation
ciljem dobivanja objektivnog dokaza o uspostavi su- assessment to obtain objective evidence for estab-
stava upravljanja kvalitetom, odnosno o osposoblje- lishing quality management system, and for its ca-
nosti za provedbu određenih laboratorijskih postu- pability to implement specific laboratory proce-
paka. Potvrda o akreditaciji s preciznim popisom tih dures. Accreditation certificate with precise list of
postupaka i pripadajućim informativnim oznakama these procedures and accompanying informational
jest upravo takav dokaz. labels represents such evidence.
Materijali i metode: Za prvu akreditacijsku ocjenu Materials and Methods: 71 laboratory procedure
provedenu u veljači 2014. god. prijavljen je 71 labo- were included in the first accreditation assessment
ratorijski postupak. Kako laboratorijski proces nije conducted in February 2014. As a laboratory process
statičan, naprotiv, vrlo je dinamičan, već u trenut- is dynamic, some laboratory procedures have un-
ku dobivanja Potvrde o akreditaciji neki laborato- dergone changes at the time of obtaining certificate
rijski postupci su doživjeli određenu vrstu izmjene. of accreditation. Changes were not substantial, but
Izmjene nisu bile suštinske, ali su rezultirale novom resulted in a new version of documents, not specifi-
verzijom odgovarajućeg dokumenta - različitom od ed in certificate. After a year >70% of laboratory pro-
one navedene u Potvrdi o akreditaciji. Nakon godinu cedures were revised in documentation and prac-
dana (kod redovnog nadzora) >70% laboratorijskih tice. Therefore, assessors proposed establishment of
postupaka je u praksi i dokumentaciji bilo izmije- flexible scope of accreditation.
njeno. Prijedlog za uspostavu fleksibilnog područ- Results: Management of flexible scope of accredi-
ja akreditacije (od strane ocjenitelja) uslijedio je kao tation is documented with clearly defined elements
posljedica i rezultat opisanog. of application: Conditions under which such scope
Rezultati: Dokumentirano je upravljanje fleksibilnim is applicable - changes apply only to elements not
područjem akreditacije s jasno definiranim elemen- involving method modification; Limits within which
tima primjene: Uvjeti pod kojim se može primijeni- it is applicable – it only applies to already accredited
ti – izmjene se odnose samo na one elemente koji laboratory procedures; Responsibilities in the appli-
ne podrazumijevaju izmjenu metode; Granice u ko- cation - identification and assessment of the need
jima se primjenjuje – odnosi se samo na već akre- for changes, verification and documentation of
ditirane laboratorijske postupke; Odgovornosti u changes and approval of the application, estimate of
samoj primjeni – prepoznavanje i procjena potrebe the need for additional training, implementation of
za izmjenama, verifikacija i dokumentiranje izmjena training, storage of records etc.; Requirements to be
i odobrenje primjene, procjena potrebe za dodat- met - publicly available, constantly maintained list of
nim osposobljavanjem, provedba osposobljavanja, laboratory methods covered by the flexible scope
pohrana zapisa itd.; Zahtjevi koji se moraju ispuniti of accreditation; continuous self-assessment of such
– javno dostupan, stalno održavan, popis laboratorij- scope.
skih postupaka obuhvaćenih fleksibilnim područjem Conclusion: Application of flexible scope of accredi-
akreditacije; kontinuirana samoprocjena fleksibilnog tation is the legalization of introducing changes to
područja akreditacije. already accredited laboratory procedures under
Zaključak: Primjena fleksibilnog područja akredi- clearly defined conditions. It allows proper docu-
tacije je legalizacija uvođenja izmjena u već akredi- mentation tracking of continuously present but not
tirane laboratorijske postupke po jasno definiranim substantial changes. Its application can be consid-

S90
uvjetima. Omogućava odgovarajuće dokumentacij- ered a sign of confidence in assessed body, as it im-
sko praćenje stalno prisutnih, ali ne suštinskih, pro- plies not only independence in introducing changes
mjena. Svojevrstan je znak povjerenja prema tijelu without additional verification of accreditation body
za ocjenu sukladnosti, jer istovremeno podrazumije- but also appropriate - higher - level of responsibility
va samostalnost uvođenja izmjena bez dodatne pro- in their implementation.
vjere od strane akreditacijskog tijela, ali i odgovara-
jući, viši stupanj odgovornosti u provedbi istih. e-mail: ialpeza@kbc-zagreb.hr
e-adresa: ialpeza@kbc-zagreb.hr
G10 G10
Analitička validacija ciklosporina i Analytical validation of cyclosporine and

takrolimusa na analizatoru Roche Cobas 6000 tacrolimus on Roche Cobas 6000 analyzer
Katarina Čepić, Dijana Dževrnja Viro, Antonija Rodin Kurtović, Nada Katarina Čepić, Dijana Dževrnja Viro, Antonija Rodin Kurtović, Nada
Bošnjak Bošnjak
Zavod za medicinsko laboratorijsku dijagnostiku, Klinički Department of Laboratory Diagnostics, Clinical Hospital Centre
bolnički centar Split, Split, Hrvatska Split, Split, Croatia
Uvod: Imunosupresivi kontroliraju odbacivanje tran- Introduction: Immunossupresive drugs are used to
splantata i primarno su zaslužni za uspješnost tran- reduce the immune response in organ transplantati-
splantacije. Međutim, oni suprimiraju sve imunološ- on and autoimmune disease. Such therapies require
ke odgovore i uzrok su brojnim posttransplantacij- lifelong use and nonspecifically suppress the entire
skim komplikacijama, uključujući pogubne infekci- immune system, exposing patients to considerably
je. Terapijsko praćenje predstavlja efikasan način za higer risk of adverse effects. Therapeutic drug mo-
smanjenje neželjenih nuspojava imunosupresivnih nitoring (TDM) ensures that concentrations are not
lijekova i spriječavanje odbacivanja organa. Cilj je bio too high or too low, thereby reducing the risks of
odrediti analitičke značajke Roche Cobas 6000 ana- toxicity or rejection, respectively. The aim of this stu-
lizatora u terapijskom praćenju ciklosporina i takro- dy was to evaluate analytical performance of Roche
limusa. Cobas 6000 analyzer for TDM of cyclosporine and
Materijali i metode: U svrhu analitičke validacije tacrolimus.
ciklosporina i takrolimusa metodom ECLIA (electro- Materials and Methods: For the purpose of analyti-
chemiluminescence immunoassay) na Roche Cobas cal validation of cyclosporine and tacrolimus by
analizatoru određeni su: preciznost u seriji, preci- ECLIA (electrochemiluminescence immunoassay)
znost iz dana u dan te granice prihvatljivosti za od- method on Roche Cobas e6000 analyzer following
stupanje izmjerene vrijednosti od očekivane (engl. parameters were determined: within-run and
bias) na komercijalnim kontrolnim uzorcima u dvije between run imprecision, inaccuracy (bias) using
razine kao i usporedba sa drugom imunokemijskom two levels of commercial control materials and met-
metodom CMIA (chemiluminiscent microparticle hod comparison with analytical system Abbott Ar-
immunoassay) na Abbott Architect i1000 analizatoru chitect i1000, CMIA (chemiluminiscent microparticle
sa humanim uzorcima (N=40). immunoassay) method on human samples (N=40).
Rezultati: Koeficijent varijacije za preciznost u seriji Results: Coefficients of variation (CV) for within-run
iznosi 1,06% i 1,9% za ciklosporin, a 2,94% i 2,52% za imprecision were 1.06% and 1.90% for cyclosporine
takrolimus, dok za preciznost iz dana u dan za ciklos- and 2.94% and 2.52% for tacrolimus. CV for betwe-
porin iznosi 3,8% i 4,8%, a za takrolimus 3,45% i 2,1%. en run imprecision were 3.85 and 4.8% for cyclos-
Bias za ciklosporin iznosi -4,74% i 6,8%, a za takroli- porine and 3.45% and 2.10% for tacrolimus. Inaccu-

S91
mus -7,1% i 1,49%. Rezultat usporedbe koncentracija racy (bias) results for cyclosporine were -4.74% and
ciklosporina na dva analizatora regresijskom anali- 6.80%, and for tacrolimus -7.10% and 1.49%. Passing-
zom po Passing-Bablocku pokazao je da postoji kon- Bablock regression analysis of cyclosporine compa-
stantno odstupanje između metoda (a=21,38; 95%CI rison on two analyzers showed that there was con-
14,44-29,74; b=1,036; 95%CI 0,95-1,15). Bland-Altman stant deviation between methods (a=21.38, 95%CI
plot pokazao je da postoji prosječno odstupanje iz- 14.44-29.74; b=1.036, 95%CI 0.95-1.15). Bland-Altman
među dvije imunokemijske metode. Dok je Passing- plot showed the average deviation between two
Bablock regresijska analiza za takrolimus pokazala methods. Passing-Bablock regression analysis of ta-
statistički značajno (a=0,73; 95%CI 0,28-1,07; b=1,00; crolimus comparison on two analyzers showed stati-
95%CI 0,95-1,07), ali klinički neznatno odstupanje iz- stically significant but clinically insignificant (a=0.73,
među metoda. 95%CI 0.28-1.07; b=1.00, 95%CI 0.9-1.07) deviation
Zaključak: Analitička validacija ispunila je prethod- between methods.
no utvrđene kriterije te se određivanje takrolimusa i Conclusion: Analytical validation of cyclosporine
ciklosporina može uključiti u svakodnevni rad. Rezul- and tacrolimus fulfilled all previously established cri-
tati statističke obrade za ciklosporin i za takrolimus teria and could be implemented in a routine labora-
pokazuju neusporedivost dvije imunokemijske me- tory work. Data obtained by Passing-Bablock regre-
tode što ukazuje na potrebu praćenja ovih lijekova ssion analysis showed that results are not comple-
uvijek istom imunokemijskom metodom i na istom tely comparable, especially for cyclosporine which
analizatoru. confirms the importance of recommendations on
monitoring the values of cyclosporine and tacroli-
e-adresa: katarina.cepic@kbsplit.hr mus on the same analyzer with the same method.
e-mail: katarina.cepic@kbsplit.hr
G11 G11
Usporedba metoda za određivanje Comparison of methods for creatinine

kreatinina na analizatorima Olympus AU400 determination on Olympus AU400 and
i Dimension Xpand Dimension Xpand analyzers
Valentina Šenjug1, Danijela Polak-Erceg1, Anita Klasić1, Lada Surjan2 Valentina Šenjug1, Danijela Polak-Erceg1, Anita Klasić1, Lada Surjan2
1Medicinsko-biokemijski laboratorij, Specijalna bolnica za 1Department for Boichemistry and Hematology, Hospital for
medicinsku rehabilitaciju Krapinske Toplice, Krapinske Toplice, Medical Rehabilitation Krapinske Toplice, Krapinske Toplice,
Hrvatska Croatia
2Biokemijsko-hematološki laboratorij, Opća bolnica Šibensko- 2Department for Boichemistry and Hematology, General
kninske županije, Šibenik, Hrvatska Hospital Šibenik, Šibenik, Croatia
Uvod: Standardizacija metode za određivanje kre- Introduction: Standardization of creatinine deter-

atinina od velike je važnosti za izračun procijenjene mination methods is of high value for estimation
brzine glomerularne filtracije(eGFR) budući je eGFR of glomerular filtration rate (eGFR) since eGFR is the
najvažnija klinička primjena kreatinina. Cilj ovog main clinical use of creatinine. The aim was to com-
rada bio je usporediti kompenziranu Jaffe metodu pare compensated Jaffe method with uncompen-
sa prethodno korištenom nekompenziranom Jaffe sated Jaffe method, compensated Jaffe method
metodom, kompenziranu Jaffe metodu sa enzimat- with enzymatic method and two compensated Jaffe
skom metodom te dvije kompenzirane metode na methods on different analyzers used in laboratory.

S92
različitim analizatorima koji se koriste u našem labo- Subjects and Methods: Study included 47 patients,
ratoriju. serum creatinine values 26-1061 μmol/L. The sam-
Ispitanici i metode: U ispitivanje je bilo uključeno ples were measured with four different methods on
47 pacijenata raspona koncentracija serumskog kre- two different analyzers: enzymatic method (A), com-
atinina od 26 μmol/L do 1061 μmol/L. Uzorci su mje- pensated Jaffe (B) and uncompensated Jaffe meth-
reni paralelno sa četiri metode na dva različita ana- od (C) on Olympus AU400 analyzer and compensat-
lizatora: enzimatska metoda (A), kompenzirana Jaffe ed Jaffe method on Siemens Dimension Xpand ana-
(B) i nekompenzirana Jaffe metoda (C) na Olympus lyzer (D). The results were analyzed using Passing-
AU400 i kompenzirana Jaffe metoda na Siemens Di- Bablok regression analysis.
mension Xpand analizatoru (D). Rezultati su obrađe- Results: The obtained results were: y(B)
ni Passing-Bablok regresijskom analizom. =-0.23+1.03x(A), 95%CI for intercept (-1.70-1.16),
Rezultati: Usporedbom metoda dobiveno je: y(B) for slope (1.02-1.05); y(D)=5.88+0.98x(B), 95%CI for
=-0,23+1,03x(A), 95%CI za odsječak(-1,70-1,16), a intercept (4.00-7.67), for slope (0.96-1.00); y(B)=-
za nagib(1,02-1,05); y(D)=5,88+0,98x(B), 95%CI za 18.71+1.07x(C), 95%CI for intercept (-19.84-(-16.43)),
odsječak y(4,00-7,67), a za nagib (0,96-1,00); y(B)=- for slope (1.04-1.08). The results indicate good meth-
18,71+1,07x(C), 95%CI za odječak na osi y(-19,84-(- od agreement for method B and method A with no
16,43)), a za nagib pravca (1,04-1,08). Rezultati po- significant difference in linearity (P=0.11) and con-
kazuju dobru usporedivost kompenzirane Jaffe me- stant difference between method B and method
tode i enzimatske metode na Olympus AU400, pri D, without significant difference between linearity
čemu nema značajne razlike u linearnosti (P=0,11), te (P=0.11). There is a constant difference between
konstantno odstupanje između kompenzirane me- method B and method C, just as expected because
tode na analizatorima Olympus AU400 i Dimension, of the setting of the methods.
bez značajne razlike u linearnosti metoda (P=0,11). Conclusion: There is a good comparability between
Između nekompenzirane i kompenzirane metode compensated and enzymatic method on Olympus
na Olympus AU400 postoji konstantno odstupanje, AU400. However, we use compensated Jaffe meth-
a takvi rezultati bili su očekivani zbog postavke me- od in routine work in our laboratory because the
toda. price is lower, while enzymatic method is used only
Zaključak: Kompenzirana Jaffe metoda i enzimat- in creatinine determination in pediatric population.
ska metoda na Olympus AU400 dobro su usporedi- The comparison of uncompensated and compen-
ve, ali se zbog cijene u rutinskom radu u našem la- sated method showed constant difference due to
boratoriju koristi kompenzirana Jaffe metoda, a en- mathematical correction of the compensated meth-
zimatska samo za određivanje kreatinina kod djece. od (18 μmol/L), which makes these methods statis-
Usporedba nekompenzirane i kompenzirane me- tically incomparable. Constant difference between
tode pokazala je očekivano konstantno odstupanje the two compensated methods on Olympus AU400
zbog matematičke korekcije kompenzirane metode and Dimension Xpand is within the allowable devia-
(18 μmol/L), zbog čega te dvije metode nisu stati- tion defined by the CSMBLM in the external quality
stički usporedive. Konstantno odstupanje između assessment criteria.
kompenziranih metoda na Olympus AU400 i Dimen-
sion Xpand je unutar dopuštenog odstupanja koje e-mail: valentina.senjug@sbkt.hr
je odredilo HDMBLM u kriterijima vanjske procjene
kvalitete.
e-adresa: valentina.senjug@sbkt.hr

S93
Terapijsko praćenje imunosupresiva: Immunosupressants therapeutic drug

imunokemijska metoda u odnosu na monitoring: immunoassay vs. liquid chro-
tekućinsku kromatografiju s dvojnom matography-tandem mass spectrometry
spektrometrijom masa (LC-MS/MS) (LC-MS/MS)
Andrea Radeljak1, Tajana Filipec-Kanižaj2, Matea Zorić1, Sonja Perkov1, Andrea Radeljak1, Tajana Filipec-Kanižaj2, Matea Zorić1, Sonja Perkov1,
Zlata Flegar-Meštrić1 Zlata Flegar-Meštrić1
1Kliničkizavod za medicinsku biokemiju i laboratorijsku 1Department of Medical Biochemistry and Laboratory
medicinu, Klinička bolnica Merkur, Zagreb, Hrvatska medicine, Merkur University Hospital, Zagreb
2Klinika za unutarnje bolesti, Klinička bolnica Merkur, Zagreb, 2Department of Internal Medicine, Merkur University Hospital,
Uvod: Terapijsko praćenje imunosupresiva ključni je Introduction: Immunosuppressants therapeutic

uvjet za prevenciju nuspojava lijekova i odbacivanje drug monitoring (TDM) is a crucial requirement for
presatka zbog neadekvatne doze nakon transplan- the prevention of adverse drug reaction and graft
tacije organa. Cilj ovog istraživanja bio je usporediti rejection due to incorrect dosage after organ tran-
koncentracije imunosupresiva takrolimusa i ciklos- splantation. The aim of this study was to compare
porina A određene imunokemijskom metodom i concentrations of immunosuppressants tacrolimus
tekućinskom kromatografijom s dvojnom spektro- and cyclosporin A determined by immunoassay and
metrijom masa (LC-MS/MS) tijekom longitudinalnog liquid chromatography-tandem mass spectrometry
praćenja transplantiranih pacijenata. (LC-MS/MS) throughout longitudinal monitoring of
Ispitanici i metode: Koncentracije takrolimusa transplanted patient.
(N=216) i ciklosporina A (N=163) određene su kemi- Subjects and Methods: Tacrolimus (N=216) and
luminiscentnom imunokemijskom metodom na mi- cyclosporin A (N=163) concentrations were mea-
kročesticama (CMIA; Abbott Architect i1000SR), akre- sured by chemiluminescent microparticle immunoa-
ditiranom prema HRN EN ISO 15189, i on-line SPE ssay (CMIA, Abbott Architect i1000SR), accredited
LC-MS/MS (Shimadzu UPLC NEXERA X2 - LCMS-8040) according to HRN EN ISO 15189, and online SPE LC-
u uzorcima pune krvi prikupljenim 12 sati nakon za- MS/MS (Shimadzu UPLC NEXERA X2 - LCMS-8040) in
dnje doze lijeka. Dobiveni rezultati bili su unutar cilj- whole blood samples collected 12 hours postdose.
nih vrijednosti za unutarnju i vanjsku kontrolu kva- The obtained results were within the target values of
litete (Referenzinstitut für Bioanalytik, Deuchland, internal and external quality assurance programme
Survey for immunosuppressives). Usporedivost me- (Referenzinstitut für Bioanalytik, Deuchland, Survey
toda testirana je Passing-Bablok linearnom regresi- for immunosuppressives). The correlation between
jom. Nadalje, u 15 pacijenata je koncentracija imu- methods was assessed using Passing-Bablok linear
nosupresiva praćena istovremeno s obje metode ti- regression. Further, 15 patient were monitored si-
jekom razdoblja od 3 mjeseca analizom od 6 do 22 multaneously by both methods during period of 3
uzoraka, ovisno o pacijentu. months by TDM of immunosuppressants in 6 to 22
Rezultati: Usporedba metoda pokazala je uspo- samples,depending on patient.
redivost između koncentracije imunosupresiva Results: A method comparison showed correlati-
određene imunokemijskom metodom u odnosu on between concentrations measured with immu-
na LC-MS/MS prema jednadžbi: y=-0,3575(-0,7700- noassay versus LC-MS/MS according to the equ-
0,08947)+1,2250(1,1579-1,3000)x za takrolimus i y ation y=-0.3575(-0.7700-0.08947)+1.2250(1.1579-
=-6,4789(-12,2273-2,0000)+1,5634(1,4773-1,6515)x 1.3000)x for tacrolimus and y=-6.4789(-12.2273–
za ciklosporin A. Medijan biasa bio je 17,1% (13,5%- 2.0000)+1.5634(1.4773-1.6515)x for cyclosporin A,
20,3%) za takrolimusa i 50,4% (45,9% -54,9%) za ci- respectively. Median of bias was 17.1%(13.5%-20.3%)
klosporin A. Longitudinalno praćenje 15 pacijenata for tacrolimus and 50.4%(45.9%-54.9%) for cyclos-
pokazalo je da imunokemija precjenjuje koncentra- porin A. Longitudinal monitoring of 15 patients

S94
cije takrolimusa od -10,9% do 71,1%, a ciklosporina A showed that the degree of overestimation by immu-
od -17,9% do 133,8%. noassay varied from -10.9% to 71.1% (tacrolimus) and
Zaključak: Rezultati našeg istraživanja u skladu su -17.9% to 133.8% (cyclosporin A).
s literaturnim podacima- imunokemija precjenjuje Conclusion: Results of our study are in agreement
koncentracija imunosupresiva zbog nespecifičnih with literature data - immunoassay overestimates
križnih reakcija s metabolitima, što dovodi do ordi- drugs concentration due to nonspecific cross-reacti-
niranja nižih doza lijekova, čime se povećava rizik on with metabolites, consequently leding to under-
od odbacivanja organa. Stupanj precjenjivanja je in- dosage of the drug and increasing the risk of organ
dividualan. Stoga je nužno longitudinalno praćenje rejection. The degree of overestimation is individu-
imunosupresiva, poželjno pomoću LC-MS/MS, koji je al. Therefore, longitudinal monitoring of immuno-
zlatni standard u terapijskom praćenju lijekova, zbog suppressants is necessary, prefereably using LC-MS/
izrazite specifičnosti, osjetljivosti i niske cijene anali- MS as a gold standard in TDM owing to it substantial
ze. specificity,sensitivity and low cost of analysis.
e-adresa: radeljak.andrea@gmail.com e-mail: radeljak.andrea@gmail.com
Usporedba dviju ELISA metoda za Comparison of two ELISA methods for

određivanje koncentracije kalprotektina u measuring the concentration of fecal
stolici u pedijatrijskoj populaciji calprotectin in the pediatric population
Irena Linarić, Jasna Obuljen Irena Linarić, Jasna Obuljen

Odjel za medicinsku biokemiju i hematologiju, Zavod za Department of Medical Biochemistry and Hematology,
laboratorijsku dijagnostiku, Klinika za dječje bolesti Zagreb, Department of Laboratory Diagnostics, Children’s hospital
Zagreb, Hrvatska Zagreb, Zagreb, Croatia
Uvod: Kalprotektin je neinvazivni biljeg crijevne Introduction: Calprotectin is non-invasive marker

upale, klinički značajan u dijagnostici i praćenju kro- of intestinal inflammation, clinically significant in
nične upalne crijevne bolesti (KUCB). Cilj istraživanja the diagnosis and monitoring of chronic inflamma-
bio je ispitati podudarnost i dijagnostičku točnost tory bowel disease (IBD). The aim of this study was
dviju ELISA metoda za određivanje koncentracije to examine the correlation and diagnostic accuracy
kalprotektina u stolici u dječjoj populaciji. of two ELISA methods for measuring the concentra-
Materijali i metode: U istraživanje je bilo uključeno tion of fecal calprotectin in the pediatric population.
68 djece (dob 4-17 godina), s kliničkom sumnjom na Materials and Methods: The study included 68
KUCB. Koncentracija kalprotektina u stolici određena children (age 4-17 years) with clinical suspicion of
je dvjema ELISA metodama: Calprest ELISA (Eurospi- IBD. The concentration of fecal calprotectin was de-
tal, Italija) i Calprotectin ELISA (BÜhlmann Laborato- termined by two ELISA methods: Calprest (Eurospi-
ries AG, Njemačka). Dijagnostički kriterij za KUCB bio tal, Italy) and Calprotectin (Bühlmann Laboratories
je pozitivan nalaz crijevne biopsije. AG, Germany). Diagnostic criteria for IBD was posi-
Rezultati: Ispitivanje podudarnosti dvije ELISA me- tive finding of colonoscopy.
tode za kalprotektin Passing-Bablok regresijskom Results: Passing-Bablok regression was used for
analizom pokazalo je da među metodama ne posto- method comparison of two calprotectin ELISA meth-
ji konstantna razlika (A=0), ali je prisutna značajna ods. Regression analysis demonstrated no constant
proporcionalna razlika (B≠1): regresijska jednadžba difference (A=0), but significant proportional differ-
pravca y=-2,2860+0,5882x uz 95%-tni interval pouz- ence (B≠1); regression equation y=-2.2860+0.5882x

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danosti (95%CI) za odsječak (A) od -17,1360 do 2,3520 with 95% confidence interval (95%CI) for the section
koji uključuje vrijednost 0 (A=0) i 95%CI za nagib (B) (A) -17.1360-2.3520 that includes the value 0 (A=0)
od 0,5388 do 0,6425, koji ne uključuje vrijednost 1 and the 95%CI for the slope (B) from 0.5388-0.6425,
(B≠1). Dijagnostička točnost ELISA metoda ispitana which does not include the value 1 (B≠1). The receiv-
ROC (engl. receiver operating characteristic) analizom er operating characteristic (ROC) analysis showed
pokazala je izvrsnu dijagnostičku točnost obje me- excellent diagnostic accuracy of both methods, with
tode, uz površine ispod krivulja (AUC, engl. area un- the area under the curve (AUC) 0.973(95%CI 0.901-
der the curve) 0,973 (95%CI=0,901-0,997) za Calprest 0.997) for Calprest method and 0.982 (95%CI 0.915-
metodu i 0,982 (95%CI=0,915-0,999) za Calprotectin 0.999) for Calprotectin method. Comparison of AUC
metodu. Usporedba površina ispod krivulja pokazala showed that the diagnostic accuracy of the two
je da se dijagnostička točnost dvije metoda statistič- methods are not significantly different (P=0.218).
ki značajno ne razlikuje (P=0,218), pa obje metode ROC analysis showed optimal cut-off values for Cal-
imaju jednaku dijagnostičku točnost. ROC analizom prest and Calprotectin methods of 188 mg/kg (sen-
izračunata optimalna granična vrijednost za Calprest sitivity 90.7%, specificity 96%) and 383 mg/kg (sensi-
metodu je 188 mg/kg (uz osjetljivost 90,7% i specifič- tivity 90.7%, specificity 100%), respectively.
nost 96%), a za Calprotectin metodu 383 mg/kg (uz Conclusion: Comparative testing of Calprest and
osjetljivost 90,7% i specifičnost 100%). Calprotectin ELISA methods for the determination
Zaključak: Ispitivanje usporedivosti Calprest i of fecal calprotectin showed no constant significant
Calprotectin ELISA metoda za određivanje kalpro- difference, but significant proportional differences.
tektina u stolici pokazalo je da među metodama ne These methods are not comparable and cannot be
postoji značajna konstantna razlika, ali postoji zna- simultaneously used in the diagnosis and monitor-
čajna proporcionalna razlika, te se ove metode ne ing of patients. ROC analysis showed excellent and
mogu smatrati podudarnima i ne mogu se istodob- equal diagnostic accuracy of both methods.
no koristiti u dijagnostici i praćenju bolesnika. ROC
analizom pokazana je izvrsna i jednaka dijagnostička e-mail: irenalinaric16@gmail.com
točnost obje metode.
e-adresa: irenalinaric16@gmail.com
G14 G14
Usporedba monoklonalne i poliklonalne Comparison of monoclonal and polyclonal

ELISA metode za određivanje koncentracije ELISA method for determination of the
fekalne elastaze u stolici u pedijatrijskoj fecal elastase in stool in the pediatric
populaciji population
Jasna Obuljen, Irena Linarić, Ana Milčić Jasna Obuljen, Irena Linarić, Ana Milčić
Odjel za medicinsku biokemiju i hematologiju, Zavod za Department of Medical Biochemistry and Hematology,
laboratorijsku dijagnostiku, Klinika za dječje bolesti Zagreb, Department of Laboratory Diagnostics, Children’s hospital
Uvod: Određivanje koncentracije fekalne elastaze Introduction: Determination of fecal elastase (FE) in
(FE) u uzorku stolice klinički je značajno u dijagnosti- stool is clinically significant in diagnosis of pancrea-
ci insuficijencije egzokrinog pankreasa različite eti- tic insufficiency of various etiologies, including cy-
ologije, uključujući cističnu fibrozu, Shwachmanov stic fibrosis, Shwachman syndrome, chronic pancre-
sindrom, kronični pankreatitis, kolelitijazu, ali i pot- atitis, cholelithiasis, and malnutrition caused by
hranjenost uzrokovanu disfunkcijom pankreasa. Cilj dysfunction of pancreas. The aim of this study was

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istraživanja bio je usporedba dviju ELISA metoda za to compare two ELISA methods for quantification of
određivanje koncentracije FE u stolici u djece. FE in pediatric population.
Materijali i metode: U istraživanje je bilo uključeno Materials and Methods: The study included 55
55 djece (dob: 2 mjeseca-17 godina) s kliničkom sum- children (aged 2 months to17 years) with clinical sus-
njom na insuficijenciju egzokrinog pankreasa. Kon- picion of pancreatic insufficiency. The concentrati-
centracija FE u stolici određena je ScheBo pancrea- on of FE was determined with ScheBo stool pancre-
tic elastase 1 (ScheBo Biotech AG, Njemačka) ELISA atic elastase (ScheBo Biotech AG, Germany) ELISA
metodom s monoklonskim protutijelom i Bioserv (monoclonal antibody) and Bioserv pancreatic ela-
pancreatic elastase (Bioserv Diagnostics GmbH, Nje- stase (Bioserv Diagnostics GmbH, Germany) ELISA
mačka) ELISA metodom koja rabi poliklonsko protu- (polyclonal antibody). The measuring range for both
tijelo. Mjerni raspon za obje metode je 15-500 µg/g, methods is 15-500 μg/g and the concentration of FE
a koncentracija FE<200 µg/g je granična vrijednost <200 μg/g is the cut-off value indicating the insuffi-
koja upućuje na insuficijenciju egzokrinog pankrea- ciency of the exocrine pancreas.
sa. Results: Histogram distribution data obtained by
Rezultati: Iz histograma raspodjele podataka dobi- analyzing the results from both methods showed
venih analizom rezultata s obje metode utvrđeno that regression analysis could not be applied to
je da nije moguće primijeniti regresijsku analizu za compare these methods. Analysis of compatibility
usporedbu metoda. Usporedba rezultata mjerenja of results was made by comparison of results to the
učinjena je analizom podudarnosti rezultata u odno- cut-off value (200 μg/g). Results indicated satisfac-
su na graničnu vrijednost (200 µg/g). Ova je analiza tory correlation (39/55, 0.71) of the results of both
pokazala zadovoljavajuću podudarnost (39/55; 0,71) ELISA methods within the reference range (>200
rezultata obje ELISA metode u području normalnih μg/g). In the area of reduced FE values (<200 μg/g)
vrijednosti FE (>200 µg/g). Usporedba rezultata u po- results were matched in 3/16: ScheBo method de-
dručju sniženih vrijednosti FE (<200 µg/g) pokazala tected 3 children with reduced values, whereas Bi-
je nezadovoljavajuću podudarnost ispitanih meto- oserv method detected 16 children, therefore met-
da, pri čemu su ScheBo metodom vrijednosti FE<200 hods were inconsistent in 13/16 children.
µg/g izmjerene u 3 djece, a Bioserv metodom u 16 Conclusion: Compatibility trial of monoclonal Sche-
djece, što znači da su metode u području sniženih bo and polyclonal Bioserv method showed unsa-
vrijednosti FE bile podudarne u 3/16, a nepodudarne tisfactory comparability of results in the area of re-
u čak 13/16 djece. duced values that are clinically significant in the di-
Zaključak: Ispitivanje podudarnosti monoklonalne agnosis of pancreatic insufficiency. Further testing
ScheBo metode i poliklonalne Bioserv metode po- is necessary to determine the possible reasons for
kazalo je nezadovoljavajuću usporedivost rezultata discrepancies of these methods. According to the li-
u području sniženih vrijednosti (<200 µg/g) FE koje terature data, polyclonal method shows higher sen-
su klinički značajne u dijagnostici insuficijencije eg- sitivity than monoclonal method, which could parti-
zokrinog pankreasa. Daljnjim ispitivanjima potrebno ally explain the discrepancy found in the area of low

je utvrditi moguće razloge nepodudarnosti ispitanih values in this study.
metoda. Prema nekim literaturnim podatcima poli-
klonalna metoda pokazuje veću osjetljivost od mo- e-mail: jasna.obuljen@xnet.hr
noklonalne metode, čime bi se mogla djelomično
objasniti i u ovom ispitivanju utvrđena nepodudar-
nost u području niskih vrijednosti.
e-adresa: jasna.obuljen@xnet.hr

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G15 G15
Verifikacija potpuno automatizirane metode Verification of fully automated method

za određivanje Anti-Mullerian hormona u for measuring Anti Mullerian hormone in
serumu na automatskom analizatoru Roche serum on Roche Cobas e601 analyzer
Cobas e601
Daniela Šupe-Domić, Lada Stanišić, Antonija Rodin-Kurtović, Nada Daniela Šupe-Domić, Lada Stanišić, Antonija Rodin-Kurtović, Nada
Bilopavlović, Branka Knežević Bilopavlović, Branka Knežević
Zavod za medicinsko laboratorijsku dijagnostiku , Klinički Department of Laboratory Diagnostics, Clinical Hospital Centre
Uvod: Anti-Mullerian hormon (AMH) se najčešće ko- Introduction: Measurement of Anti Mullerian hor-
risti za procjenu ovarijske rezerve i odgovora na kon- mone (AMH) is mainly used for assessment of ovar-
troliranu stimulaciju jajnika što zahtjeva pravovre- ian reserve and prediction of response to controlled
meno izdavanje nalaza. U našem laboratoriju AMH stimulation which demands timely results reporting.
se određivao jednom mjesečno modificiranom AMH In our laboratory AMH was measured monthly with
Gen II (Beckman Coulter, Republika Češka) ELISA me- modified AMH Gen II (Beckman Coulter, Czech Re-
todom na analizatoru Elisys Duo (Human, Njemačka). public) ELISA method on ElisysDuo (Human, Germa-
Cilj je bio verifikacija potpuno automatizirane elek- ny) analyzer. The aim of this study was verification
trokemiluminiscentne metode (ECLIA) za određiva- of first fully automated electrochemiluminescence
nje AMH u serumu na analizatoru Roche Cobas e601 immunoassay (ECLIA) for AMH determination on
(Roche, Njemačka) i usporedba s rutinskom AMH Roche Cobas e601 (Roche, Germany) analyzer and
Gen II ELISA metodom. comparison with routine AMH Gen II ELISA method.
Materijali i metode: Verifikacija metode je obuhva- Materials and Methods: Verification included fol-
tila slijedeće parametre: preciznost u seriji (ponov- lowing parameters: within-run precision (repeat-
ljivost), preciznost iz dana u dan (međupreciznost) ability), between-run precision and comparison with
i usporedbu s rutinskom ELISA metodom koju je i routine ELISA method, the same one used by manu-
proizvođač koristio u postupku validacije metode. facturer in method validation process. For precision
Za ispitivanje preciznosti kroz 5 dana u triplikatu su determination patient serum samples with AMH
analizirani uzorci seruma pacijenata s koncentraci- concentrations (Sample 1=6.38 pmol/L, Sample
jama AMH (Uzorak 1=6,38 pmol/L i Uzorak 2=21,67 2=21.67 pmol/L) close to concentrations of human
pmol/L) blizu koncentracija humanih uzoraka na serums at which manufacturer claims precision (5.31
kojima je proizvođač deklarirao preciznosti (5,31 pmol/L and 18.20 pmol/L), were analyzed in three
pmol/L i 18,20 pmol/L). Usporedba metoda preve- replicates over five days. Method comparison study
dena je na 40 uzoraka seruma (raspon koncentra- was done using 40 serum samples (concentration
cija 0,92-38,6 pmol/L), a dobiveni rezultati su stati- range 0,92 – 38,6 pmol/L) and Passing-Bablok and
stički obrađeni korištenjem Passing-Bablok i Bland- Bland-Altman analysis of data was performed using
Altman analize u programu MedCalc (Mariakerke, MedCalc(Mariakerke, Belgium) program.
Belgija). Results: Coefficients of variation were 0.65% and
Rezultati: Dobiveni koeficijenti varijacije za ponov- 0.65% for repeatability (manufacturer’s claim: 1.1%
ljivost (CVp) bili su 0,65% i 0,65% (deklarirani CVp: and 1.2%); 0.81% and 1.8% for between-run preci-
1,1% i 1,2%), a za međupreciznost (CVm) 0,81% i sion (manufacturer’s claim: 4.0% and 3.3%). Passing-
1,8% (deklarirani CVm 4,0% i 3,3%). Regresijskom Bablok regression analysis yielded following equa-
analizom prema Passing-Babloku dobiveno je: tion: y(Roche)=0.39(95%CI (-1.31)-0.83)+0.77(95%CI
y(Roche)=0,39(95%CI (-1,31)-0,83)+0,77(95%CI 0,67- 0.67-0.94)x. Bland-Altman plot showed mean differ-
0,94)x. Na Bland-Altman prikazu razlika srednjih vri- ence of 2.5 pmol/L ((95%CI (-4.3)-9.4) with the larg-
jednosti u prosjeku je iznosila 2,5 pmol/L ((95%CI est and also clinically significant differences at 10-20
(-4,3)-9,4) uz najveće, ujedno i klinički značajne razli- pmol/L concentration range where the cut-off limit

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ke u koncentracijskom području od 10-20 pmol/L tj. that separates patients with decreased and optimal
na granici između smanjene i optimalne plodnosti. fertility lies.
Zaključak: Verifikacijom preciznosti dobiveni su re- Conclusion: Precision verification of AMH ECLIA ob-
zultati koji zadovoljavaju specifikacije proizvođača. tained results that fully satisfy manufacturer speci-
Razlike između metoda dobivene usporednom ana- fications. Differences obtained in comparison study
lizom potvrdile su prije objavljene podatke o slaboj confirmed previously published data about poor
usporedivosti metoda. Zbog potpune automatizaci- method agreement. Because of full automation, dai-
je, mogućnosti svakodnevnog izdavanja nalaze i iz- ly results reporting and great precision AMH ECLIA
vrsne preciznosti AMH ECLIA metoda je uvedena u method was introduced in our routine practice.
rutinski rad.
e-mail: antonija.kurtovic@gmail.com
e-adresa: antonija.kurtovic@gmail.com
G16 G16
Usporedba unutarlaboratorijske preciznost, Comparison of within-laboratory precision,

istinitosti i ukupne pogreške mjernih trueness and a total error of measurement
postupaka CMIA i ECLIA metode za procedures for CMIA and ECLIA methods in
određivanje ciklosporina cyclosporine measurement
Marina Njire Bratičević, Antonija Perović, Diana Ljubimir Marina Njire Bratičević, Antonija Perović, Diana Ljubimir
Odjel za biokemijsku i hematološku laboratorijsku dijagnostiku, Department of Biochemical and Hematological Laboratory
Opća bolnica Dubrovnik, Dubrovnik, Hrvatska Diagnostics, General Hospital Dubrovnik, Dubrovnik, Croatia
Uvod: Verifikacija mjernih postupaka u laboratoriji- Introduction: In the laboratory, verification of mea-
ma kojom provjeravamo navode proizvođača otva- surement procedures opens the possibility to com-
ra mogućnost usporedbe različitih metoda. Cilj ovog pare different methods. The aim of this study was
rada bio je usporediti unutarlaboratorijsku preci- to compare within-laboratory precision (CVSl), tru-
znost (KVSl), istinitost (BIAS) i ukupnu pogrešku (TE) eness (BIAS) and total error (TE) for CMIA (Chemilu-
mjernih postupaka za određivanje ciklosporina CMIA minescent microparticle immunoassay) and ECLIA
(engl. chemiluminescent microparticle immunoassay) (Electrochemiluminescence immunoassay) method
i ECLIA (engl. electro-chemiluminescence immunoa- used for cyclosporine measurement.
ssay) metodom. Materials and Methods: According to CLSI guide-
Materijali i metode: Slijedeći protokol CLSI smjer- line protocol EP15-A2, verification of measurement
nica EP15-A2, proveli smo verifikaciju mjernih postu- procedures for cyclosporine measurement was con-
paka za određivanje ciklosporina CMIA metodom na ducted for CMIA method on Architect i2000SR (Ab-
uređaju Architect i2000SR (Abbott Laboratories, Illi- bott Laboratories, Illinois, USA) and for ECLIA met-
nois, SAD) i ECLIA metodom na uređaju Elecsysu 2010 hod on Elecsys 2010 (Roche Diagnostics GmbH,
(Roche Diagnostics GmbH, Mannheim, Germany). Za Mannheim, Germany). For both measurement pro-
oba mjerna postupka kalibracija je izvršena prvog cedures calibration was performed on the first day.
dana verifikacije. Koncentracija ciklosporina mjerena Cyclosporine concentration was measured in qua-
je u dvije koncentracijske razine kontrolnog materija lity control materials in two concentration levels (L1
(L1 i L3) u triplikatu tijekom 5 dana. Korišteni kontrolni and L3) in triplicate for 5 days. Used control mate-
materijal za CMIA-Abbott metodu bio je Multichem rial for CMIA-Abbott method was MultiChem WBT
WBT (Technopath, Ireland) ciljnih vrijednosti 92,3 ng/ (Technopath, Ireland) target values 92.3 ng/mL and
mL i 905 ng/mL te za ECLIA-Roche metodu PreciCon- 905 ng/mL and for ECLIA-Roche method PreciCon-

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trol ISD (Roche Diagnostics GmbH, Germany) ciljnih trol ISD (Roche Diagnostics GmbH, Germany) target
vrijednosti 91,5 ng/mL i 1170 ng/mL. Potrebna pre- values 91.5 ng/mL and 1170 ng/mL. Pretreatment of
dobrada svih uzoraka rađena je korištenjem iste au- all used samples was performed using the same au-
tomatske pipete. Dobivena vrijednosti za preciznosti tomatic pipette. Resulting values for precision were
uspoređena je prema kriterijima proizvođača. compared against the manufacturer’s criteria.
Rezultati: Preciznosti mjernih postupaka za određi- Results: Precision of measurement procedu-
vanje ciklosporina CMIA-Abbott i ECLIA-Roche meto- res CMIA-Abbott and ECLIA-Roche method meet
dom zadovoljile su postavljene kriterije proizvođača. manufacturer’s set criteria. Obtained values for
Dobivene vrijednosti za CMIA-Abbott vs ECLIA-Roc- CMIA-Abbott vs. ECLIA-Roche method for within-
he metodu za unutarlaboratorijsku preciznost (KVSl), laboratory precision (CVSl), trueness (BIAS) and to-
istinitost (BIAS) i ukupnu pogrešku (TE) iznosile su: tal error (TE) were as following: CVSl (L1) 13.87% vs.
KVSl(L1) 13,87% vs 2,91% i KVSl(L3) 9,49% vs 2,23%, 2.91% and CVSl (L3) 9.49% vs. 2.23%, BIAS (L1) -8.86%
BIAS( L1) -8,86% vs 1,57% i BIAS (L3) -14,91% vs 1,37%, vs. 1.57% and BIAS (L3) -14.91% vs 1.37%, TE (L1)
TE(L1) 36,04% vs 7,27% i TE(L3) 33,51% vs 5,74%. 36.04% vs. 7.27% and TE (L3) 33.51% vs. 5.74%.
Zaključak: Uz prednost jednostavnije i brže predo- Conclusion: With the advantage of easier and fa-
brade uzoraka, mjerni postupak ECLIA-Roche meto- ster sample pretreatment, measurement procedure
de pokazao je bolju preciznost, bolju istinitost pre- for ECLIA-Roche method showed better accuracy,
ma ciljnim vrijednostima kontrolnog materijala te better trueness according to target values assigned
manju ukupnu pogrešku mjerenja. to control materials and lower total error.
e-adresa: marinanjire@yahoo.com e-mail: marinanjire@yahoo.com
Analitička verifikacija Combur10Test® M traka Analytical verification of Combur10Test® M

i urinskog analizatora Cobas u411 strips and urine analyzer Cobas u411
Alen Vrtarić, Nora Nikolac, Marijana Miler, Ana-Maria Šimundić Alen Vrtarić, Nora Nikolac, Marijana Miler, Ana-Maria Šimundić
Klinički zavod za kemiju, Klinički bolnički centar Sestre University Department of Chemistry, University Hospital Centre
milosrdnice, Zagreb, Hrvatska Sestre Milosrdnice, Zagreb, Croatia
Uvod: Cilj rada bio je: a) verificirati urinske test-trake Introduction: Our aim was to: a) verify urinary test
za kemijski pregled mokraće Combur10Test® M (Ro- strips for urine chemistry analysis Combur10Test® M
che Diagnostics GmbH, Mannheim) na analizatoru (Roche Diagnostics GmbH, Mannheim) on analyz-
Cobas u411; b) procijeniti usporedivost analizatora er Cobas u411; b) asses the comparability of Cobas
Cobas u411 i Miditron Junior II (oba Roche Diagno- u411 and Miditron Junior II (both Roche Diagnostics,
stics, GmbH, Mannheim) GmbH, Mannheim).
Materijali i metode: Analitička verifikacija provede- Materials and Methods: Analytical verification
na je prema CLSI smjernici EP12-A. Preciznost u seri- was performed according to CLSI guideline EP12-
ji je ispitana na 10 uzastopno ponovljenih mjerenja A. Repetability was tested on 10 consecutively re-
na uzorku negativne kontrole (BIORAD, Liquicheck peated measurements on negative control (BIORAD,
Urinalysis Control Level 1) i dva uzorka bolesnika s Liquicheck Urinalysis Control Level 1) and in two
patološkim vrijednostima. Preciznost iz dana u dan patient samples with pathological values. Precision
je ispitana na kontrolnim uzorcima (Level 1 i 2) u from day-to-day was assesed on control samples
duplikatu tijekom 10 dana. Usporedivost je ispitana (Level 1 and 2) in duplicate for 10 days. Comparabil-
usporedbom 87 uzoraka bolesnika na analizatoru ity was evaluated comparing 87 patient›s samples

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Cobas u411 i Miditron Junior II. Točnost za glukozu, on analyzers Cobas U411 and Miditron Junior II. Ac-
bilirubin i proteine ispitana je usporedbom rezulta- curacy for glucose, bilirubin and proteins was tested
ta test-trake s koncentracijama izmjerenim referen- by comparing the results of test strips with values
tnom metodom na analizatoru Architect c8000 (Ab- measured by reference method on analyzer Archi-
bott, IL, SAD). Preciznost je procijenjena stupnjem tect c8000 (Abbott, IL, USA). Precision was estimated
slaganja ponovljenih mjerenja, točnost stupnjem by the degree of agreement of repeated measure-
slaganja s rezultatom referentne metode, uspore- ments, accuracy by the degree of agreement with
divost izračunom kappa koeficijenta s 95%-tnim in- result of reference method. Comparability was ex-
tervalom pouzdanosti. Kriteriji prihvatljivosti bili su: pressed with kappa coefficient with 95% confidence
preciznost: 90% podudarnosti, pH: prihvatljivo od- interval. Acceptance criteria were: precision: 90%
stupanje ±1 pH jedinica, specifična težina: prihvatlji- agreement of repeated measurements, pH: accept-
vo odstupanje ±0,005 i usporedivost: kappa koefici- able bias ±1 pH unit, specific gravity: acceptable bias
jent ≥0,6. Za statističku obradu podataka korišten je ± 0.005 and comparability: kappa coefficient ≥0.6.
MedCalc (v12.7.2.0, Ostend, Belgium). MedCalc (v12.7.2.0, Ostend, Belgium) was used for
Rezultati: Svi dobiveni rezultati za preciznost zado- statistical analysis.
voljili su definirane kriterije, osim jednog uzorka bo- Results: Precision was acceptable for all parame-
lesnika koji nije zadovoljio kriterije za ponovljivost ters, except for leukocytes in one patient›s sample
za leukocite (slaganje 8/10 mjerenja). Usporedivost (agreement for only 8/10 measurements). Compa-
između analizatora za sve pretrage bila je zadovolja- rability between analyzers was satisfactory, except
vajuća, osim za bilirubin (kappa=0,370 (0,112-0,628)). for bilirubin (kappa=0.370 (0.112 to 0.628)). Accuracy
Točnost za bilirubin je bila zadovoljavajuća (slaganje for bilirubin was satisfactory (agreement 10/10). The
10/10). Uočena odstupanja za proteine (8/10) i gluko- observed differences in proteins (8/10) and glucose
zu (6/10) nisu bila klinički značajna. (6/10) were not clinically significant.
Zaključak: Rezultati dobiveni analitičkom verifikaci- Conclusion: Analytical performance of Combur10T-
jom za kvalitativni pregled mokraće na analizatoru est® M on Cobas u411 analyzer are within acceptance
Cobas u411 sukladni su s definiranim kriterijima te se limits. Observed bias for glucose and proteins are
prihvaćaju za svakodnevni rutinski rad. Odstupanja not clinically significant and are caused by differ-
u provjeri točnosti za glukozu i proteine nisu klinički ences in methodology. Analyzers are comparable,
značajna i posljedica su metodoloških razlika. Anali- except for bilirubin measurement.
zatori su usporedivi, osim za određivanje bilirubina.
e-mail: alenvrtaric@gmail.com
e-adresa: alenvrtaric@gmail.com
G18 G18
Verifikacija metode za određivanje Verification of the method for determining

humanog korionskog gonadotropina na human chorionic gonadotropin on Cobas
analizatoru Cobas e411 e411 analyzer
Petra Filipi, Monika Doželenčić, Ivana Zec, Marijana Miler, Nora Nikolac, Petra Filipi, Monika Doželenčić, Ivana Zec, Marijana Miler, Nora Nikolac,
Ana-Maria Šimundić Ana-Maria Šimundić
milosrdnice, Zagreb, Hrvatska Sestre milosrdnice, Zagreb, Croatia
Uvod: Cilj rada bio je provjeriti ponovljivost, utjecaj Introduction: The aim of this study was to check
interferencije hemolize i prenošenje analita (engl. the reproducibility, hemolysis interference and car-

S101
carryover) u metodi za određivanje humanog kori- ryover for human chorionic gonadotropin (hCG) test
onskog gonadotropina (hCG) na analizatoru Cobas on Cobas e411 analyzer (Roche, Mannheim, Germa-
e411 (Roche, Mannheim, Germany). ny).
Materijali i metode: Ponovljivost je ispitivana na Materials and Methods: The reproducibility was
kontrolnim uzorcima (Preci Control Universal 1 i 2) u examined using control samples (Preci Control Uni-
dvije koncentracijske razine tijekom pet dana u tri- versal 1 and 2) for five days in triplicate. Manufactur-
plikatu. Korišteni su kriteriji prihvatljivosti proizvo- ers acceptability criteria were used: CV (PCU1)=2.1%;
đača: CV(PCU1)=2,1%; CV(PCU2)=4,0%. Utjecaj he- CV (PCU2)=4.0%. The impact of hemolysis was test-
molize ispitan je na tri koncentracijske razine hCG-a ed at three hCG concentration levels according to
prema CLSI protokolu EP7-A2. Hemolizat plazme CLSI protocol EP7-A2. Plasma hemolysate was pre-
pripremljen je metodom osmotskog šoka. Hemoli- pared by osmotic shock. Hemolytic samples were
tični uzorci su pripremljeni dodavanjem hemoliza- prepared by adding hemolysate in increasing con-
ta u rastućem koncentracijskom nizu do konačnih centrations to reach free hemoglobin concentra-
koncentracija slobodnog hemoglobina od 0 (bez tions of 0 (no hemolysate), 2.5; 5.0; 7.5 and 10.0 g/L.
hemolizata), 2,5; 5,0; 7,5 i 10,0 g/L hemoglobina. Za To assess the impact of hemolysis, RCPA (Royal Col-
procjenu utjecaja interferencije hemolize, korišteni lege of Pathologist of Australasia) acceptability crite-
su kriteriji prihvatljivosti RCPA (engl. Royal College of ria were used: ±1 IU/L for hCG <10.0 IU/L; ±10% for
Pathologists of Australasia): ±1 IU/L za hCG <10,0 IU/L; hCG >10.0 IU/L. Effect of carryover was examined by
±10% za hCG >10,0 IU/L. Prenošenje analita ispitano analyzing the low concentration sample in triplicate,
je analizom uzorka niske koncentracije hCG-a u tripli- immediately after the sample with high concentra-
katu, neposredno nakon uzorka visoke koncentracije tion in duplicate, according to the IUPAC (Interna-
u duplikatu, prema IUPAC (engl. International Union tional Union of Pure and Applied Chemistry) protocol.
of Pure and Applied Chemistry) protokolu. Svi uzorci All samples were analyzed on Cobas e411 with origi-
analizirani su na analizatoru Cobas e411 originalnim nal reagent. Statistical analysis was performed using
reagensom. Statistička obrada podataka napravljena Microsoft Excel.
je pomoću programa Microsoft Excel. Results: For lower concentration level, reproducibil-
Rezultati: Za nižu koncentracijsku razinu ponovlji- ity was out of the acceptable criteria (2.8% for PCU1
vost je bila izvan dozvoljenih kriterija (2,8% za PCU1 and 1.5% for PCU2). In examination of hemolysis in-
i 1,5% za PCU2). U ispitivanju utjecaja hemolize, naj- terference, the maximum biases in the concentra-
veća odstupanja na koncentracijskim razinama 181 tion levels of 181 and 3076 mU/mL were 6.1% and
mU/mL i 3076 mU/mL iznosila su 6,1% i -7,5%. U uzor- -7.5%. In samples with low hCG concentration (7.9
cima s niskom koncentracijom hCG-a (7,9 mU/mL) mU/mL), bias was greater than 1 IU/L in the sample
odstupanje je bilo veće od 1 IU/L za koncentracije Hb with Hb>5 g/L. We did not observe false positive re-
>5 g/L. U ispitivanju prenošenja analita nije dokazan sults in the carryover experiment.
porast koncentracije hCG-a u uzorku s niskom kon- Conclusion: The method for hCG determination has
centracijom. satisfactory reproducibility. Impact of hemolysis was
Zaključak: Metoda za određivanje hCG-a ima zado- clinically significant only in the samples with low an-
voljavajuću ponovljivost. Utjecaj hemolize je klinički alyte concentrations in hemoglobin levels above 5
značajan isključivo u uzorcima s nižim koncentraci- g/L. There is no influence of carryover from samples
jama analita pri koncentraciji hemoglobina iznad 5 with the high concentration.
g/L. Kod određivanja hCG-a nema prenošenja anali-
ta s uzorka visoke koncentracije. e-mail: petrafilipi6@gmail.com
e-adresa: petrafilipi6@gmail.com

S102
Verifikacija metode prealbumina na Prealbumin method verification on Beckman

analizatoru Beckman Coulter AU680 Coulter AU680 analyzer
Snježana Hrabrić Vlah1, Davor Valenčić1, Lidija Bilić-Zulle1,2 Snježana Hrabrić Vlah1, Davor Valenčić1, Lidija Bilić-Zulle1,2
Uvod: U kliničkoj praksi prealbumin se smatra do- Introduction: In clinical practice prealbumin is con-
brim pokazateljem pothranjenosti organizma pro- sidered a good indicator of malnutrition as well as a
teinima, ali i kao negativni reaktant akutne faze. Cilj negative acute phase reactant. The aim of this study
je bio procijeniti pouzdanost imunoturbidimetrijske was to evaluate reliability of prealbumin method on
metode mjerenja koncentracije prealbumina na ana- Beckman Coulter AU680 analyzer (Beckman Coulter,
lizatoru Beckman Coulter AU680 (Beckman Coulter, Brea, California, USA) before use in routine practice
Brea, California, USA) prije rutinske primjene u labo- in the laboratory and examine the comparability of
ratoriju te ispitati usporedivost rezultata s referen- results with the Cobas c501 as a reference analyzer
tnim analitičkim sustavom Cobas c501 (Roche Dia- (Roche Diagnostics, Mannheim, Germany).
gnostics, Mannheim, Germany). Materials and Methods: We conducted a short
Materijali i metode: Provedena je skraćena verifika- verification of prealbumin analytical method on
cija analitičke metode prealbumina na ispitivanom Beckman Coulter AU680 analyzer. Prealbumin con-
analizatoru Beckman Coulter AU680. Vrijednosti pre- centrations were determined for 5 days in triplica-
albumina određeni su tijekom 5 dana u triplikatu u te at two concentration levels (total of 30 measure-
dva koncetracijska nivoa (ukupno 30 mjerenja). Ko- ments). It was used a commercial control samples
rišten je komercijalni kontrolni materijal ITA Control ITA Control Sera L2 and L3. Verification includes: wit-
Sera L2 i L3. Verifikacija obuhvaća: preciznost u seriji hin-run imprecision (Cwd), between-run imprecisions
(KVp), međupreciznost iz dana u dan (KVm) i procje- (CVbd) and bias (10 days, ITA Control Sera L2 and L3).
nu mjerne istinitosti (bias) utvrđivanjem odstupanja Comparability of the methods were tested by mea-
izmjerene od očekivane vrijednosti (10 dana, ITAL2 i suring the patient samples (N=20) in a wide concen-
ITAL3). Usporedivost metode je ispitana paralelnim tration range. Beckman Coulter AU680 was investi-
mjerenjem uzoraka bolesnika (N=20) na referen- gated analyzer, Cobas c501 was a reference analyzer.
tnom analizatoru Cobas C501 i ispitivanom analiza- Results: Results of the within-run imprecision for
toru Beckman Coulter AU680 u širem koncentracij- Beckman Coulter AU680 analyzer were: Cwd=1.05%
skom rasponu. (ITAL2) and Cwd=2.12% (ITAL3). Results of betwe-
Rezultati: Rezultati preciznosti u seriji za analizator en-run imprecision were: CVbd=3.7% (ITAL2) and
Beckman Coulter AU680 su: KVp za ITAL2=1,05%, te CVbd=5.44% (ITAL3). Bias was ITAL2=-0.7% and
za ITAL3=2,12%. KVm za preciznost iz dana u dan ITAL3=-4.1% for AU680 analyzer. The results of pre-
bila je za ITAL2=3,7%, dok za ITAL3=5,44%. Rezul- albumin concentrations were compared by Pa-
tati mjerne istinitosti (bias) za analizator AU680 bili ssing-Bablok regression analysis. Results of the
su ITAL2=-0,7% i ITAL3=-4,1%. Rezultati usporednih regression analysis showed good compatibility
mjerenja koncentracije prealbumina na dva anali- (y=0.0230435+1.043478x, 95%CI 1.00-1.167 for the
zatora obrađeni su regresijskom analizom po Pa- slope, 95%CI (-0.009)-0.030 for the intercept of
ssing-Babloku. Rezultati pokazuju dobru podudar- the regression line, P=0.14). Correlation coefficient
nost (y=0,0230435 + 1,043478x, 95% CI 1,00–1,167 za (r=0.95) was satisfactory between AU680 and refe-
nagib, 95% CI -0,009–0,030 za odsječak regresijskog rence analyzer.
pravca, P=0,14). Koeficijent korelacije je bio vrlo za- Conclusion: Desirable analytical specification for
dovoljavajući između ove dvije metode r=0,95. within-run imprecision is 10.9%, between-day im-

S103
Zaključak: Prema kriterijima temeljenim na biološ- precision is 19.1% and bias is 5.5%, who derived from
koj varijabilnosti poželjna specifikacija za preciznost biological variation (www.westgard.com/biological-
u seriji je 10,9%, za preciznost iz dana u dan je 19,1%, variation-database). Prealbumin analytical method
mjerna istinitost je 5,5% (www.westgard.com/biolo- verification on AU680 analyzer shows acceptable
gical-variation-database). Verifikacija analitičke me- imprecisions, bias, good compatibility and can be
tode za mjerenje prealbumina na analizatoru AU680 used in routine practice.
pokazuje prihvatljivu preciznost, istinitost, dobru po-
dudarnost te se može koristiti u rutinskom radu. e-mail: snjezana.hrabric.vlah@gmail.com
e-adresa: snjezana.hrabric.vlah@gmail.com
G20 G20
Verifikacija metode mjerenja koncentracije Verification of serum bicarbonate assay on

bikarbonata u serumu na analizatoru Beckman Coulter AU680 analyzer
Beckman Coulter AU680
Snježana Hrabrić Vlah1, Lidija Bilić-Zulle1,2 Snježana Hrabrić Vlah1, Lidija Bilić-Zulle1,2
Uvod: Koncentracija bikarbonata mjera je poreme- Introduction: Bicarbonate measurements are used
ćaja povezanih s promjenama acido-bazne ravnote- in clinical practice as an indicator disorders associated
že u organizmu. Cilj je bio procijeniti analitičku po- with changes in body acid-base balance. The aim of
uzdanost enzimatske metode mjerenja bikarbonata this study was to evaluate reliability of bicarbonate
u serumu na analizatoru Beckman Coulter AU680 analytical method on BC AU680 analyzer (Beckman
(Beckman Coulter, California, USA) prije upotrebe Coulter, Brea, California, USA) before using in routine
u rutinskom radu te ispitati usporedivost rezultata practice. We wanted to compare serum bicarbonate
mjerenja bikarbonata u serumu na Beckman Coulter concentration measured on BC AU680 analyzer and
AU680 s rezultatima u punoj venskoj krvi izmjerenih results of whole blood bicarbonate concentration
potenciometrijskom metodom na referentnom ABS measured by potentiometric method on Rapid ABS
analizatoru Rapid 348 (Bayer Corporation, USA). 348 (Bayer Corporation, USA) as reference analyzer.
Materijali i metode: Verifikacija analitičke meto- Materials and Methods: We performed short veri-
de za bikarbonate učinjena je prema CLSI smjernici fication of bicarbonate analytical method according
EP15-A2. Korišteni su komercijalni kontrolni uzorci to CLSI guideline EP15-A2. We used commercial con-
BIO-RAD Liquid Assayed u dva koncentracijska ni- trol samples BioRad Liquid Assayed in two concen-
voa u kojima je izmjeren bikarbonat tijekom 5 dana tration levels. Bicarbonate concentrations were me-
u triplikatu. Verifikacija obuhvaća: preciznost u seriji asured for 5 days in triplicate. Verification includes:
(KVp), međupreciznost iz dana u dan (KVm) i procje- within-run imprecision (Cwd), between-run impre-
nu mjerne istinitosti (bias) određivanjem odstupanja cisions (CVbd) and bias (10 days, BioRad L1 and L2).
izmjerene od očekivane vrijednosti (10 dana, BIO- Comparability was examined by measuring bicarbo-
RAD L1 i BIO-RAD L2). Paralelnim mjerenjem uzora- nate concentration in the serum samples and in the
ka seruma i pune venske krvi (N=20) između referen- whole venous blood (N=20).
tnog Rapid 348 i ispitivanog AU680 analizatora ispi- Results: Results of the within-run imprecision for
tana je usporedivost. Beckman Coulter AU680 analyzer were: Cwd=3.44%

S104
Rezultati: Preciznost u seriji za ispitivani analiza- (BioRad L1), Cwd=2.65% (BioRad L2). Results of
tor prikazana je kao KVp=3,44% BIO-RAD L1, te between-run imprecision were: CVbd=3.2% (Bio-
KVp=2,65% BIO-RAD L2 kontrolni materijal. Pre- Rad L1), CVbd=3.18% (BioRad L2). Bias was 0.48%
ciznost iz dana u dan prikazana je kao KVm=3,2% (BioRad L1), -4.81% (BioRad L2) for BC AU680. The
(BIO-RAD L1), i KVm=3,18% (BIO-RAD L2). Rezultati results of bicarbonate concentrations were compa-
mjerne istinitosti (bias): 0,48% (BIO-RAD L1) i -4,81% red by Passing-Bablok regression analysis. Results of
(BIO-RAD L2). Usporedivost bikarbonata među ana- the regression analysis were y=-2.176042+1.104167x,
lizatorima ispitana je regresijskom analizom po Pa- 95%CI 0.8364-1.4651 for the slope, 95%CI (-10.5023)-
ssing-Babloku i pokazuje zadovoljavajuću podudar- 4.0600 for the intercept, P=0.98). Correlation coeffi-
nost (y=-2,176042+1,104167x, 95%CI 0,8364 -1,4651 cient was r=0.84.
za nagib, 95%CI (-10,5023)-4,0600 za odsječak, Conclusion: Desirable analytical specification for
P=0,980). Koeficijent korelacije rezultata između ove within-run imprecision is 4%, between-day impreci-
dvije metode je bio r=0,84. sion is 4.8% and bias is 1.56%, derived from biolo-
Zaključak: Poželjna specifikacija temeljena na bi- gical variation (www.westgard.com/biological-va-
ološkoj varijaciji za preciznost u seriji je 4%, iz dana riation-database). Bicarbonate analytical method
u dan je 4,8%, mjerna istinitost je 1,56% (www.west- verification on the BC AU680 showed acceptable im-
gard.com/biological-variation-database). Verifikacija precision. Bias was departed from desirable values;
analitičke metode za mjerenje koncentracije bikar- the results were slightly lower than the target value
bonata na ispitivanom analizatoru pokazuje prihvat- in control samples BioRad L2. Results of bicarbonate
ljivu preciznost, dok procjena istinitosti u kontrol- concentration showed good compatibility between
nom uzorku L2 odstupa od poželjne, rezultati su ne- these two methods.
što niži od ciljane vrijednosti. Rezultati na Beckman
Coulter AU680 analizatoru usporedivi su s rezultati- e-mail: snjezana.hrabric.vlah@gmail.com
ma Rapid 348 ABS analizatora.
e-adresa: snjezana.hrabric.vlah@gmail.com
G21 G21
Usporedba transkutane i fotometrijske Comparison of transcutaneous and

metode za određivanje ukupnog bilirubina photometric methods for the determination
u zdrave novorođenčadi s klinički of total bilirubin in healthy newborns with
manifestnom žuticom clinically manifest jaundice
Sonja Perkov1, Marko Vukasović2, Jelena Starčić1, Andrea Radeljak1 Sonja Perkov1, Marko Vukasović2, Jelena Starčić1, Andrea Radeljak1
medicinu, Klinička bolnica Merkur, Zagreb, Hrvatska Medicine, Merkur University Hospital, Zagreb, Croatia
2Klinika za ženske bolesti i porode, Klinička bolnica Merkur, 2Department of Gynecology and Obstetrics, Merkur University
Zagreb, Hrvatska Hospital, Zagreb, Croatia
Uvod: Određivanje ukupnog bilirubina u serumu Introduction: Determination of total serum biliru-
novorođenčadi najčešče je izvođena pretraga i zlat- bin (TSB) is one of the most frequently requested
ni standard za procjenu neonatalne hiperbilirubine- laboratory test in newborns and the gold standard
mije. Cilj rada bio je procjena usporedivosti rezultata for assessment of neonatal hyperbilirubinemia.The
ukupnog bilirubina određenog transkutanom i foto- aim of this study was to evaluate the comparability
metrijskom metodom u svrhu kliničke primjene ne- of the transcutaneous bilirubin (TcB) and TSB results

S105
invazivne metode u nadzoru neonatalne hiperbiliru- for clinical application of noninvasive methods to
binemije. supervise neonatal hyperbilirubinemia.
Ispitanici i metode: Istraživanje je obuhvatilo 66 Subjects and Methods: The study included 66 pa-
parova rezultata kod 33 novorođenčadi porođajne irs of results of the 33 newborns gestation age ≥35
dobi ≥35 tjedana, mlađe od 7 dana bez fototerapije weeks during the first week after birth, without pho-
i eksangvinotransfuzije, kojima je traženo određiva- totherapy or exchange transfusion. The concentrati-
nje koncentracije bilirubina u serumu. Koncentracija on of TSB was determined by photometric method
ukupnog bilirubina određena je fotometrijskom me- with 3,5-dichlorophenyldiazonium tetraflouoro bo-
todom s 3,5-diklorfenil-diazonium-tetrafluorobora- rate, accredited according to HRN EN ISO 15189. The
tom, akreditiranom prema normi HRN-EN ISO 15189 i level of TcB was determined as the difference in the
transkutano mjerenjem razlike optičke gustoće svje- optical density of light in the blue and green range
tla u plavom i zelenom području valnih dužina na tri of wavelengths at three measuring points forehead-
mjerne točke prsa-čelo-prsa pomoću Draeger JM- sternum-forehead by Draeger JM-103 (Drager Medi-
103 (Draeger Medical Inc, Telford, PA) bilirubinome- cal Inc., Telford, PA) bilirubinometer. Method com-
tra. Usporedivost metoda testirana je Passing-Bablok parability was assessed using the Passing-Bablok re-
regresijskim modelom i Bland-Altmanovom anali- gression and Bland-Altman analysis.
zom. Results: Passing-Bablok analysis of the values obta-
Rezultati: Passing-Bablok analizom dobivene vrijed- ined (with corresponding 95% confidence intervals)
nosti (s pripadajućim 95% intervalima pouzdanosti) y-axis intercept 16.9091 (-33.8378-53.6455), slope
odsječka na osi y 16,9091 (-33,8378 do 53,6455), te 0.9091 (0.7455-1.351), indicating that there is no sta-
nagiba pravca 0,9091(0,7455 do 1,351), upućuju da tistically significant constant or proportional error
ne postoji statistički značajna konstantna ni propor- between two methods.The Bland-Altman analysis
cionalna pogreška između fotometrijske i transku- demonstrated that transcutaneous bilirubin mea-
tane metode. Bland-Altmanova analiza pokazala je surements tended to underestimate the value of
da transkutani bilirubin podcjenjuje vrijednost uku- TSB: mean difference from the corresponding 95%
pnog serumskog bilirubina: prosječna razlika s pri- confidence intervals between photometric and tran-
padajućim 95% intervalima pouzdanosti između fo- scutaneous methods was 1.4(-2.0-9.3)±11.4%. Altho-
tometrijske i transkutane metode iznosila je 1,4 (-2,0 ugh 90% of results within ±1.96 SD, range difference
do 9,3) ±11,4%. Premda je 90% rezultata unutar ±1,96 of -20.9 (-25.7-(-16.1)) to 23.7% (18.9-28.5)% outside
SD, raspon razlika od -20,9 (-25,7 do -16,1)% do 23,7 the desirable biological criteria for accuracy (8.95%).
(18,9 do 28,5)% izvan je poželjnih bioloških kriterija Conclusion: Our results indicate that there is stati-
za točnost, koji iznose 8,95%. stically significant correlation of transcutaneous and
Zaključak: Naši rezultati ukazuju da postoji statistič- photometric methods in measuring total bilirubin in
ki značajna podudarnost transkutane i fotometrijske term neonates, suggesting a potential clinical appli-
metode u mjerenju ukupnog bilirubina u terminske cation of this noninvasive methods in conjunction
novorođenčadi, što upućuje na mogućnost kliničke with other clinical indicators to assist in the control
primjene ove neinvazivne metode zajedno s drugim of neonatal hyperbilirubinemia. On the other hand,
kliničkim pokazateljima kao pomoć u nadzoru hiper- a wide range of difference indicates a possible cli-
bilirubinemije u terminske novorođenčadi koji nisu nically significant deviations, which is important to
primali transfuziju ili fototerapiju. S druge strane ši- know when interpreting the results.
rok raspon razlika ukazuje na moguća klinički značaj-
na odstupanja, koja je važno poznavati pri tumače- e-mail: radeljak.andrea@gmail.com
nju dobivenih rezultata.
e-adresa: radeljak.andrea@gmail.com

S106
G22 G22
Validacija metode tekućinske kromatografije Validation of high performance liquid

visoke djelotvornosti za mjerenje chromatography method for measuring of
antifungalnog lijeka vorikonazola u serumu antifungal drug voriconazole in serum
Mila Lovrić, Nada Božina, Dunja Rogić Mila Lovrić, Nada Božina, Dunja Rogić
Uvod: Vorikonazol je triazolni antifungalni lijek sa ši- Introduction: Voriconazole (VRCZ) is a triazole anti-
rokim spektrom djelovanja za invazivne gljivične in- fungal agent with a broad spectrum for invasive fun-
fekcije. Metabolizira se u N-okside uglavnom preko gal infection. VRCZ is mainly metabolized to the N-ox-
izoenzima citokroma P450: CYP 3A4 i CYP 2C19. Zbog ide predominantly by cytochrome P450: CYP 3A4 and
genetičkih polimorfizama CYP 2C19, nelinearne, sa- CYP 2C19. Because of genetic polymorphisms of the
turacijske farmakokinetike i brojnih interakcija izme- cytochrome CYP2C19, voriconazole’s nonlinear and
đu lijekova standardne doze vorikonazola ne dovode saturable pharmacokinetics and numerous drug‐drug
do očekivane koncentracije i stoga se preporuča tera- interactions standard doses of the drug do not pro-
duce predictable trough concentrations and therefore
pijsko praćenje. Cilj ovog rada bio je razviti i validirati
therapeutic drug monitoring is highly recommended.
metodu tekućinske kromatografije visoke djelotvor-
The aim of this study was to develop and validate a
nosti za terapijsko praćenje vorikonazola u serumu. high performance liquid chromatography method for
Materijali i metode: Uzorak seruma (250 µL) i klo- voriconazole therapeutic drug monitoring.
ramfenikol kao interni standard (25 µL) su prethodno Materials and Methods: Serum sample (250 μL) and
obrađeni tekućinskom ekstrakcijom s etil acetat /hek- chloramfenikol as internal standard (25 μL) pretreat-
sanom pri lužnatom pH. Organski sloj se upari, a osta- ment was based on liquid extraction with ethyl acetate/
tak se otopi u 200 µL mobilne faze. Analiti se razdvaja- hexane at alkaline pH. Organic layer was then evapo-
ju izokratno, primjenom reverzne-faze na koloni C18, rated and residue desoved in 200 μL mobile phase. The
250 x 4,6 mm ID 5µm (Macherey-Nagel). Za razdvaja- separation was obtained on C18, 250 x 4.6 mm I.D. 5mm
nje je korištena mobilna faza fosfatni pufer / acetoni- column (Macherey-Nagel) by isocratic reversed-phase
tril / metanol (pH 4,6) i protok od 1,5 ml/min. Analiti su chromatography. Compounds were eluated with phos-
kvantificirani detektorom s nizom dioda na 254 nm .. phate buffer/acetonitrile/methanol mixture (pH 4.6) as
Rezultati: Sve kalibracijske krivulje pokazale su do- the mobile phase, at flow rate of 1.5 ml/min. Analytes
bru linearnost (r>0,998) u rasponu od 0,1-10 mg/L. were monitored at diode array detector at 254 nm.
Preciznost u seriji u dva nivoa koncentracija bila je Results: All calibration curves showed good linearity
2,45% i 5,44%. Preciznost između serija bila je 7,56% i (r>0.998) through the range of 0.1-10 mg/L. The within-
6,11%. Točnost, izražena kao postotak pogreške, bila run precision in two concentration levels was 2.45 and
5.44%. Between-run precisions were 7.56% and 6.11%.
je u rasponu od 97,3-106,8%. Granica kvantifikacije je
Accuracy, expressed as percent error, was ranged from
0,038 mg/L, a granica detekcije 0,013 mg/L. Metoda
97.3-106.8 %. The limit of quantitation was 0.038 mg/L
je primijenjena za mjerenje vorikonazola u uzorcima and limit of detection 0.013 mg/L. The method has been
seruma bolesnika. applied to monitor voriconazole in serum of patients.
Zaključak: Na temelju analitičkih parametara: linear- Conclusion: Based on analytical parameters linear-
nosti, preciznosti, točnosti, granice detekcije i kvanti- ity, precision, accurancy, limit of detection and quan-
fikacije predstavljena metoda je pogodna za terapij- titation presented method is suitable for therapeutic
sko praćenje lijeka i farmakokinetičke studije. Meto- drug monitoring and pharmacokinetic studies. The
da pokazuje dobru specifičnost prema drugim pro- method shows good specificity with other prescribed
pisanim lijekovima. Vorikonazol ima visok stupanj drugs. Voriconazole has a high degree of interpatient
varijabilnosti i sugerira se terapijsko praćenje lijeka variability and some data are suggestive that thera-
za poboljšanje učinkovitosti i smanjenje toksičnosti. peutic drug monitoring may improve voriconazole
efficacy and toxicity.
e-adresa: mila.lovric@kbc-zagreb.hr e-mail: mila.lovric@kbc-zagreb.hr
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Posterski sažetci: H – Laboratorijska hematologija i koagulacija
Poster abstracts: H – Laboratory hematology and coagulation
H – Laboratorijska hematologija i H – Laboratory hematology and

koagulacija coagulation
H01 H01
Ispitivanje primarne hemostaze kod Testing of primary haemostasis at

bolesnika s policitemijom rubra verom i patients with polycythaemia rubra vera
sekundarnom eritrocitozom uporabom PFA and secondary erythrocytosis by PFA 100
100 analizatora analyzer
Branka Pauković Sekulić1, Leida Tandara1, Anuška Trlaja2 Branka Pauković Sekulić1, Leida Tandara1, Anuška Trlaja2
1Zavod za medicinsko laboratorijsku dijagnostiku, Klinički 1Department of Laboratory Diagnostics, Clinical Hospital Centre
2Centar za transfuzijsku medicinu, Klinički bolnički centar Split, 2Clinical Centre of Transfusion Medicine, Clinical Hospital Centre
Split, Hrvatska Split, Split, Croatia
Uvod: Ukupan volumen mase eritrocita povećan Introduction: RBC mass is elevated in polycythe-
je kod mijeloproliferativne bolesti policitemije ru- mia rubra vera (PRV) and in secondary erythrocyto-
bra vere (PRV) i sekundarne eritrocitoze koja nastaje sis (SE), associated with hypoxia or increased eryth-
zbog fiziološki ili patološki povećanog lučenja eritro- ropoietin production. Both diseases have been ac-
poetina. Klinički tijek obje bolesti praćen je trombo- companied by thrombosis due to increased viscosity
zom zbog povećane viskoznosti krvi.U liječenju pri- of blood. Low-dose aspirin are applied in the treat-
mjenjuju se niske doze aspirina. Krvarenje kod PRV ment of blood hyperviscosity. Bleeding risk at PRV is
je rjeđe i češće pogađa bolesnike s visokim brojem rare and mostly affects patients with high platelets
trombocita. Očituje se kao kožno i gastrointestinalno count. It manifests itself like skin and gastrointesti-
krvarenje. Kod sekundarne eritrocitoze krvarenja se nal bleeding. At SE bleedings do not appear. Aim of
u pravilu ne javljaju. Cilj ispitivanja je bio procijeniti examination was to estimate the platelet function
funkciju trombocita određivanjem vremena nastan- by determining closure time (CT) by PFA 100 ana-
ka trombocitnog ugruška (CT) PFA-100 analizatorom lyzer (Siemens Healthcare Diagnostics) and compare
(Siemens Healthcare Diagnostics) i usporediti ih pre- them with referent intervals.
ma utvrđenim referentnim intervalima. Subjects and Methods: 36 patients were exam-
Ispitanici i metode: Obrađeno je 36 bolesnika: 18 s ined: 18 with PRV (7 W and 11 M; 55-87 years) and
dijagnozom PRV (7 Ž i 11 M starosti 55-87 godina) i 18 18 with SE (1 W and 17 M; 32-79 years). For all pa-
s dijagnozom sekundarna eritrocitoza (1 Ž i 17 M sta- tients PCR for the mutation V617F in the JAK-2 gene
rosti 32-87 godina). Svim bolesnicima određene su and CBC counts on the Advia 2120 (Siemens) have
pretraga PCR na mutaciju V617F u genu za JAK-2 i pa- been performed. CT was determined in the pres-
rametri krvne slike na hematološkom brojaču Advia ence of the collagen and adrenaline (CEPI–CT) as
2120 (Siemens Healthcare Diagnostics). CT je određe- well as collagen and ADP (CADP–CT) in samples of
no u prisutnosti kolagena i adrenalina (CEPI-CT) te ko- citrated whole blood (0.105 M Na-citrate) and were
lagena i ADP (CADP-CT) u uzorcima pune citratne krvi compared with referential intervals: (CEPI-CT:85-165
(0,105 M Na-citrat) i uspoređeni s utvrđenim referen- s); (CADP-CT:71-118 s). Statistical analysis was made
tnim intervalima: (CEPI-CT: 85-165 s); (CADP-CT: 71-118 by MedCalc 14.8.1 software. Mann-Whitney U-test
s). Rezultati su obrađeni pomoću statističkog progra- (P<0.05) was used for comparison of the results.
ma MedCalc 14.8.1. Za usporedbu rezultata upotrije- Results: Values of the CT were significantly higher
bljen je Mann-Whitney U-test. Statistički značajnom in the patients with PRV (CEPI-CT: median 285,5
razlikom smatrala se vrijednost P<0,05. s; 95%CI:168.6-300 s; P=0.020; CADP-CT: me-
Rezultati: Vrijednosti za CT su bile značajno više u dian 128 s; 95%CI:122.6-167 s; P=0.0025) than
bolesnika s PRV (CEPI-CT: medijan 285,5 s; granice in the patients with the SE (CEPI-CT: median 148

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pouzdanosti od 95%:168,6-300 s; CADP-CT: medijan s; 95%CI:120.8-224.7 s; CADP-CT: median 100.5 s;

128 s; granice pouzdanosti od 95% 122,6-167 s;) nego 95%CI:87-111.8 s).
u bolesnika sa sekundarnom eritrocitozom (CEPI-CT: Conclusion: The comparison of the results con-
medijan148 s; granice pouzdanosti od 95%: 120,8- firmed the clinical utility of this test in the assess-
224,7 s; CADP-CT : medijan 100,5 s; granice pouzda- ment of platelets function in the patients with PRV
nosti 87-111,8 s). at the appearance of bleeding because of the dis-
Zaključak: pretraga se može koristiti za praćenje ease or therapy. Results at SE accord with results
funkcije trombocita u bolesnika s PRV kod pojave kr- from the literature.
varenja zbog same bolesti ili terapije. Rezultati kod
sekundarne eritrocitoze su u skladu s rezultatima iz e-mail: branka.paukovic.sekulic@gmail.com
literature.
e-adresa: branka.paukovic.sekulic@gmail.com
H02 (Usmeno izlaganje) H02 (Oral presentation)
Jesu li trombocitne konstante korisne u Are platelet indices valuable in assessment

procjeni trombopoetske aktivnosti koštane of bone marrow thrombopoietic activity in
srži kod neonatusa sa naglim smanjenjem neonates with sudden decrease in platelet
broja trombocita? count?
Ana Mlinarić, Gordana Fressl Juroš, Ivana Rako, Dunja Rogić Ana Mlinarić, Gordana Fressl Juroš, Ivana Rako, Dunja Rogić
Uvod: Nezrela trombocitna frakcija (IPF), srednji vo- Introduction: Immature platelet fraction (IPF), mean
lumen trombocita (MPV), omjer velikih tromboci- platelet volume (MPV), platelet large cell ratio (P-
ta (P-LCR) i distribucija veličine trombocita (PDW) LCR) and platelet distribution width (PDW) are plate-
su trombocitne konstante (TK) koje se rutinski mje- let indices (PIs) measured as research parameters in
re kao istraživački parametri pri analizi kompletne complete blood cell analysis. We investigated if PIs
krvne slike. Istraživali smo korisnost TK za procjenu could be useful in assessing bone marrow throm-
trombopoetske aktivnosti koštane srži kod neona- bopoietic activity in neonates following sudden de-
tusa nakon naglog smanjenja broja trombocita i te- crease in platelet count (PC) and tested the hypoth-
stirali povećavaju li se vrijednosti TK u adekvatnom esis that PIs increase with adequate bone marrow
trombopoetskom odgovoru koštane srži. thrombopoietic response.
Ispitanici i metode: 32 neonatusa na odjelu ne- Subjects and Methods: 32 neonates admitted to
onatološke intenzivne njege, praćena su tijekom neonatal intensive care unit were monitored dur-
dva mjeseca. Krv je uzorkovana u K3-EDTA epruve- ing 2 months. Blood was sampled in K3-EDTA tubes
te i analizirana na Sysmex XE-5000 analizatoru. Pre- and analysed on Sysmex XE-5000 analyser. Based on
ma kriteriju biološke varijabilnosti broja trombocita, platelet biological variability criteria, PC decrease
smanjenje broja trombocita veće od 20% smatralo greater than 20% was considered significant. In neo-
se značajnim. Kod neonatusa sa uočenim značajnim nates with observed PC decrease, we tested PIs be-
padom broja trombocita testirali smo razliku u TK fore and after this event for differences, using paired
prije i poslije tog događaja parnim t-testom. Kod ne- samples t-test. Otherwise, in neonates without PC
onatusa bez smanjenja broja trombocita, na razlike decrease, we tested PIs of two consecutive samples
smo testirali TK dva konsekutivna uzorka. Vrijednost for differences. The P<0.01 was considered statisti-
P<0,01 je smatrana statistički značajnom. cally significant.

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Rezultati: Uočili smo značajno smanjenje broja Results: We observed significant PC decrease in 16
trombocita kod 16 neonatusa kod kojih je pronađen neonates and found statistically significant increase
statistički značajan porast u IPF (3,1 i 5,2; P=0,004), in IPF (3.1 vs 5.2; P=0.004), MPV (10.6 vs 11.2; P=0.001)
MPV (10,6 i 11,2; P=0,001) i P-LCR vrijednostima (29,7 and P-LCR (29.7 vs 34.4; P<0.001) values before and
i 34,4; P<0,001), prije i nakon smanjenja broja trom- after PC decrease, respectively. In 16 neonates with-
bocita. Kod 16 neonatusa bez značajnog pada broja out significant PC decrease, we found no statistically
trombocita nije bilo statistički značajne promjene u significant difference in IPF (P=0.189), MPV (P=0.021)
IPF (P=0,189), MPV (P=0,021) i P-LCR (P=0,020) vrijed- and P-LCR (P=0.020) values. There was no significant
nostima. Nije bilo značajne razlike u PDW vrijednosti- difference in PDW values in both neonate groups.
ma kod obje skupine neonatusa. Conclusion: Increased MPV, P-LCR and IPF indicate
Zaključak: Povećane vrijednosti MPV, P-LCR i IPF platelets were larger and more immature in neo-
upućuju na prisutnost većih i mlađih oblika trombo- nates following significant PC decrease. Neonates
cita kod neonatusa nakon značajnog smanjenja bro- without PC decrease exhibited no significant dif-
ja trombocita. Kod neonatusa bez smanjenja broja ference in PIs, indicating no additional activation of
trombocita nije bilo razlika u vrijednostima TK, što bone marrow was present. These findings suggest
ukazuje kako dodatna aktivacija koštane srži nije bila IPF, MPV and P-LCR are useful in assessing bone mar-
prisutna. Vrijednosti IPF, MPV i P-LCR mogle bi se ko- row thrombopoietic response following sudden de-
ristiti kao pokazatelji u procjeni trombopoetskog od- crease in PC.
govora koštane srži u slučajevima naglog smanjenja
broja trombocita. e-mail: ana.mlinaric@yahoo.com
e-adresa: ana.mlinaric@yahoo.com
H03 H03
Analitička procjena koagulacijskih Analytical estimation of Sclavo Diagnostics

reagensa Sclavo na poluautomatskom i coagulation reagents on semi-automatic and
automatiziranim koagulometrima automated coagulometers
Vladimira Rimac1, Désirée Coen Herak1, Sanela Šimić Vojak2, Vanja Vladimira Rimac1, Désirée Coen Herak1, Sanela Šimić Vojak2, Vanja
Radišić Biljak3, Dunja Rogić1 Radišić Biljak3, Dunja Rogić1
2Odjel za laboratorijsku dijagnostiku, Opća bolnica Požega, 2Department of Laboratory Diagnostics, General hospital
Požega, Hrvatska Požega, Požega, Croatia

3Klinički zavod za medicinsku biokemiju i laboratorijsku 3Department of Medical Biochemistry and Laboratory
Uvod: Prije primjene novih reagensa u svakodnev- Introduction: According to good laboratory prac-
nom radu potrebno je, prema dobroj laboratorij- tice, before applying new reagents in routine work,
skoj praksi, napraviti njihovu analitičku procjenu. Cilj an analytical assessment is necessary. The aim of this
rada bio je verifikacija koagulacijskih reagensa Scla- study was the verification of Sclavo Diagnostics In-
vo Diagnostics International S.r.I.(Sovicille, Italija) za ternational SrI (Sovicille, Italy) coagulation reagents
određivanje protrombinskog vremena (PV), aktivira- for determination of prothrombin time (PT), acti-
nog parcijalnog tromboplastinskog vremena (APTV), vated partial thromboplastin time (aPTT), functional
funkcionalne koncentracije fibrinogena (Fbg) i aktiv- concentration of fibrinogen (FBG) and the activity of
nosti faktora V (FV). factor V (FV).

S110
Materijali i metode: Verifikacija Sclavo reagensa Materials and Methods: The verification of Sclavo
PT Kit (PV), aPTT-S Kit (APTV), Fibrinogen Kit (Fbg) i reagent PT Kit (PT), aPTT S kit (APTT), Fibrinogen Kit
Factor V Kit (FV) provedena je na automatiziranim (FBG) and Factor V Kit (FV) was performed on auto-
koagulometrima BCS XP/BCT (Siemens Healthcare mated coagulometers BCS XP/BCT (Siemens Health-
Diagnostics, Njemačka) i poluautomatskom koagu- care Diagnostics, Germany) and semi-automatic co-
lometru KC-4A (Amelung, Njemačka). Nepreciznost agulometer KC-4A (Amelung, Germany). Within-run
u seriji (N=10) ispitana je poolom plazmi s vrijedno- imprecision (N=10) was examined with plasma pools
stima u normalnom (razina N) i patološkom područ- in the normal (N levels) and pathological ranges
ju (razina P), a nepreciznost iz dana u dan uporabom (level P) and between-run imprecision (10 days in
kontrolnih plazmi Sclavo Normal i Abnormal Control duplicate) with control plasma Sclavo Normal and
Plasma Kit 10 dana u duplikatu. Za procjenu uspore- Abnormal Control Plasma kit. For method compari-
divosti s drugom metodom analizirano je 30 uzoraka son 30 samples of patient plasma were analyzed af-
plazmi bolesnika nakon analize na referentnim anali- ter analysis on reference analyzers BCS XP/BCT using
zatorima BCS XP/ BCT uporabom reagensa Siemens Siemens Healthcare Diagnostics reagents. Inaccura-
Healthcare Diagnostics. Rezultati nepreciznosti izra- cy results were expressed as mean, standard devia-
ženi su kao srednja vrijednost, standarda devijacija i tion and coefficient of variation (CV). Passing-Bablok
koeficijent varijacije (CV), dok je usporedba rezultata regression analysis was used to compare results with
dobivenih s referentnim reagensima učinjena regre- reference reagents.
sijskom analizom po Passingu i Babloku. Results: Within-run imprecision CVs were <5% for all
Rezultati: Za nepreciznosti u seriji dobiveni su CV- tests. For between-run imprecision the smallest CVs
ovi <5% za sve ispitane pretrage. Za nepreciznosti (<2%) were obtained on both coagulometers for the
iz dana u dan najmanji CV-ovi (<2%) dobiveni su na PV (s) in both concentration levels. The highest CVs
oba sustava za PV (s) za obje koncentracijske razine, (<12%) were obtained for the FV (level N). The corre-
dok su najviši CV-ovi (<12%) dobiveni za FV za razinu lation coefficients obtained with reference reagents
N. Usporedbom rezultata dobivenih s referentnim ranged from 0.789 (FV) to 0.967 (FBG) on the KC-4A,
reagensima koeficijenti korelacije iznosili su od 0,789 and from 0.870 (FV, BCT) to 0.978 (PT-INR, BCS XP).
(FV) do 0,967 (Fbg) na KC-4A, te od 0,870 (FV, BCT) By comparing the results obtained on coagulome-
do 0,978 (PV-INR, BCS XP). Usporedbom dobivenih ters KC-4A and BCS XP/BCT using Sclavo Diagnostics
rezultata na koagulometrima KC-4A i BCS XP/BCT reagents, correlation coefficients ranged from 0.904
uporabom reagensa Sclavo Diagnostics koeficijenti for the FV to 0.983 for the APTT.
korelacije su iznosili od 0,904 za FV do 0,983 za APTV. Conclusion: The tested Sclavo Diagnostics reagents
Zaključak: Ispitani koagulacijski reagensi Sclavo Di- showed satisfactory analytical properties and are
agnostics pokazali su zadovoljavajuće analitičke oso- suitable for use in routine work on semi-automatic
bine te su pogodni za primjenu u svakodnevnom and automatic coagulometers.
radu na poluautomatskom i automatiziranim koagu-
lometrima. e-mail: kutnjakvl@gmail.com
e-adresa: kutnjakvl@gmail.com

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H04 H04
Crvena krvna slika donešene novorođenčadi Red blood count of the term newborns
Ksenija Paradinović, Blaženka Dobrošević, Tara Rolić, Marija Milić, Ksenija Paradinović, Blaženka Dobrošević, Tara Rolić, Marija Milić,
Uvod: Pedijatrijska populacija, najosjetljivija dobna Introduction: Pediatric population, the most sen-
skupina za uzorkovanje, nije u potpunosti pokrivena sitive age group for the sample, is not fully cove-
referentnim intervalima. Za ovu populaciju nemamo red by the reference intervals. We do not have our
vlastite referentne intervale te je preporučena pri- own reference intervals for this population, so it is
mjena referentnih intervala prema literaturnim izvo- recommended to use reference intervals in the lite-
rima, pri čemu je temeljni kriterij sukladnost analitič- rature, where the main criterion is compliance of re-
kih metoda s revidiranim preporučenim metodama vised analytical methods with recommended met-
Hrvatske komore medicinskih biokemičara. hods of the Croatian Chamber of Medical Biochemi-
Cilj je odrediti koncentracijske parametre crvene krv- sts.
ne slike donešene novorođenčadi, te ih usporediti s The goal is to determine the concentration of red
preporučenim referentnim intervalima. blood cells parameters of term newborns, and com-
Materijali i metode: Uzorci kapilarne pune krvi do- pare them with the recommended reference inter-
nešene novorođenčadi (347 uzoraka) u dobi od jed- vals.
nog do pet dana. Određeni koncentracijski i računski Materials and Methods: Samples of capillary whole
parametri crvene krvne slike na hematološkom bro- blood of term newborns (347 samples) at the age of
jaču Sysmex XE2100. Izračun prosječnih dobivenih one to five days. The concentration and the calcula-
vrijednosti i usporedba s harmonizacijskim referen- ted parameters of red blood cells in the blood co-
tnim intervalom. unter Sysmex XE2100. The calculation of the average
Rezultati: Novorođena djeca u prvom tjednu života values obtained
and comparison with the Harmoni-
imaju prosječnu vrijednost eritrocita = 5,82×1012/L, zation reference interval.
hemoglobina = 210 g/L, hematokrita = 0,592 L/L, Results: Newborns in the first week of life have an
MCV = 101,9 fL, MCH = 37,6 pg, MCHC = 359 g/L. average value of red cells = 5.82×1012/L, Hb = 210
Zaključak: Vrijednosti crvene krvne slike novoro- g/L, hematocrit = 0.592 L/L, MCV = 101.9 fL, MCH =
đenčadi Osijeka i okolice dijelom pokazuju više vri- 37.6 pg, MCHC = 359 g/L.
jednosti predloženog referentnog raspona za dob Conclusion: The values of red blood cells of
od 1-14 dana starosti. Predloženi raspon je dob zna- newborns in Osijek and the surrounding area par-
čajnih fizioloških promjena u koncentracijama crve- tly show increased value of the proposed reference
ne krvne slike. Svrsishodno bi bilo izraditi vlastite re- range in age from 1-14 days. The proposed range is
ferentne intervale, te raspon dobi podijeliti. a period of significant physiological changes in the
concentration of red blood cells. It would be useful
e-adresa: ksenija.paradinovic@gmail.com to create own reference intervals and to divide ran-
ge.
e-mail: ksenija.paradinovic@gmail.com

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H05 H05
Validacija koagulacijskih sustava STA Validation of Coagulation Systems STA

Compact Max i STA-R Evolution Compact Max and STA-R Evolution
Ivana Baršić1, Snježana Semenski2, Vesna Šupak Smolčić3, Dragana Ivana Baršić1, Snježana Semenski2, Vesna Šupak Smolčić3, Dragana
Antončić3, Darka Stošić4, Désirée Coen Herak1, Dunja Rogić1 Antončić3, Darka Stošić4, Désirée Coen Herak1, Dunja Rogić1
2Medicinsko biokemijski laboratorij, Opća bolnica Zabok i 2Medical Biochemistry Laboratory, General Hospital Zabok and
3Klinički zavod za laboratorijsku dijagnostiku, Klinički bolnički 3Clinical Department of Laboratory Diagnostics, Clinical

4Biomedica dijagnostika d.o.o., Zagreb, Hrvatska 4Biomedica dijagnostika d.o.o., Zagreb, Croatia
Uvod: Cilj rada bio je provesti validaciju koagulome- Introduction: The aim of this study was to perform
tara STA Compact Max i STA-R Evolution i pripadaju- the validation of coagulation systems STA Compact
ćih reagensa (Diagnostica Stago, Francuska) s nagla- Max and STA-R Evolution (Diagnostica Stago, France)
skom na procjenu metoda za određivanje rutinskih with emphasis on method performance for routine
i specijalnih koagulacijskih pretraga, te usporedba s and special coagulation analyses and to compare
postojećim koagulacijskim sustavima. them with routine coagulation systems.
Materijali i metode: Validacija je provedena isto- Materials and Methods: Validation was performed
dobno na oba koagulometra prema Stago proto- at the same time on both analyzers according to St-
kolu System Method Validation PQ for STA® System ago protocol System Method Validation PQ for STA®
za koagulacijske pretrage: PV, APTV, D-dimere, an- System for PT, APTT, D-dimer, antithrombin, PC, FVII,
titrombin, PC, FVII, FVIII i slobodni PS:Ag. Ispitana FVIII and free PS:Ag. The study included the deter-
je nepreciznost u seriji i nepreciznost iz dana u dan mination of within-run and between-run impreci-
(uporabom komercijalnih kontrolnih plazmi i poo- sion using commercial control samples and patients
lova plazmi bolesnika u normalnom i patološkom plasma pools with normal and pathological values,
području), netočnost, prijenos uzoraka (APTV), uspo- inaccuracy, carry-over (APTT), method comparisons
redba s referentnm metodama na uređajima BCS XP/ with routine analyzers BCS XP/BCT and miniVidas
BCT i miniVidas analizom uzoraka plazmi bolesnika using patient plasma samples (N=33-127), linearity
(N=33-127), linearnost (D-dimeri, slobodni PS:Ag) te (D-dimer, free PS:Ag) and verification of reference
provjera referentnih intervala (≥20 uzoraka zdravih interval (≥20 samples from healthy individuals). Re-
dobrovoljaca). Rezultati validacije statistički su obra- sults were statistically analyzed with MedCalc soft-
đeni uporabom programa MedCalc (verzija 9.3.2.0) i ware (version 9.3.2.0) and estimated according to
analizirani prema kriterijima prihvatljivosti definira- specification criteria from Stago quality documents
nim u dokumentima Stago quality documents SAV SAV 4012 and 4013.
4012 i 4013. Results: For all analytes, CVs met the required speci-
Rezultati: Za nepreciznost u seriji koeficijenti varija- fications for within-run imprecision except for FVIII
cije (KV) za sve pretrage bili su unutar definiranih kri- on STA-R Evolution analyzer (10.1% for normal and
terija osim za FVIII na STA-R Evolution (10,1% u nor- 8.6% for pathological values). Although higher than
malnom i 8,6% u patološkom području). Za D-dime- expected CVs for D-dimer were obtained (STA-R
re dobiveni su nešto viši KV (STA-R Evolution:15,1%, Evolution: 15.1%, STA Compact Max: 7.9%), SDs (0.02-
STA Compact Max: 7,9%), ali su standardne devijacije 0.07 mg/L FEU) were within required specifications.
(0,02-0,07 mg/L FEU) bile unutar definiranih krite- Between-run CVs for all analytes fulfilled specific
rija. Za nepreciznost iz dana u dan za sve pretrage requirements. Passing-Bablok regression analysis
dobiveni KV bili su unutar definiranih kriterija. Uspo- yielded correlation coefficients ranging from 0.811
redbom rezultata s referentnim metodama regre- (APTT) to 0.988 (PC) on STA-R Evolution and from

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Posterski sažetci: I – Predanalitička i poslijeanalitička faza laboratorijskog rada
Poster abstracts: I – Preanalytical and postanalytical phase of laboratory work
sijskom analizom po Passing-Babloku, dobiveni su 0.827 (APTV) to 0.988 (PC) on STA Compact Max. The
koeficijenti korelacije u rasponu od 0,811 (APTV) do linearity stated by manufacturer for D-dimer and
0,988 (PC) na STA-R Evolution, te od 0,827 (APTV) do free PS:Ag was confirmed. Assessment of reference
0,988 (PC) na STA Compact Max. Potvrđena je line- intervals met the defined criteria confirming that
arnost mjernog područja navedena od proizvođača they are applicable for routine work.
za D-dimere i slobodni PS:Ag. Provjera referentnih Conclusion: The obtained results from validation
intervala ukazuje kako se mogu prihvatiti referentni study show optimal analytical performance of both
intervali predloženi od proizvođača. coagulation systems and therefore can be imple-
Zaključak: Dobiveni rezultati ukazuju kako su oba mented in routine practice.
validirana sustava proizvođača Diagnostica Stago
pogodni za uporabu u rutinskom radu. e-mail: ibarsic@kbc-zagreb.hr
e-adresa: ibarsic@kbc-zagreb.hr
I – Predanalitička i poslijeanalitička faza I – Preanalytical and postanalytical phase of

laboratorijskog rada laboratory work
I01 I01
Slučaj neobičnog plutanja gela u Abnormal flotation of separator gel in blood

epruvetama uzoraka krvi triju pacijenata na test tubes in three hemodialysis patients
hemodijalizi s intradijaliznom hipotenzijom with intradialytic hypotension
Meltem Demir1, Sebahat Ozdem2 Meltem Demir1, Sebahat Ozdem2

1Biochemistry Laboratory, Medicalpark Hospital, Antalya, Turkey 1Biochemistry Laboratory, Medicalpark Hospital, Antalya, Turkey
2Department of Medical Biochemistry, Akdeniz University 2Department of Medical Biochemistry, Akdeniz University
Medical Faculty, Antalya, Turkey. Medical Faculty, Antalya, Turkey.
Uvod: Epruvete s gelom često se koriste za uzorko- Introduction: Blood sampling tubes containing
vanje venske krvi u mnogim kliničkim laboratorijima separator gel are widely used in many clinical bio-
budući predstavljaju jednostavan i učinkovit način chemistry laboratories since they provide an easy
za odjeljivanje krvnih stanica od seruma. Prikazuje- and effective way of separating blood cells and se-
mo tri slučaja neobičnog plutanja gela u epruveta- rum. We present 3 cases with abnormal flotation of
ma nakon centrifugiranja. separator gel in test tubes after centrifugation.
Materijali i metode: Uzorci krvi 60-godišnjeg muš- Material and Methods: The blood sample obtained
karca s terminalnim bubrežnim zatajenjem priku- in Hemodialysis Unit of Medicalpark Hospital from a
pljeni su u epruvete s gelom BD SST II Advance Tube 60 years old male patient with end stage renal dis-
(Becton Dickinson, NJ, USA) u Jedinici za hemodija- ease (ESRD) following completion of hemodialysis
lizu bolnice Medicalpark po završetku hemodijalize (HD) was drained into BD SST II Advance Tube (Bec-
pacijenta. Nakon potpunog zgrušavanja, uzorak je ton Dickinson, NJ, USA) containing separator gel.
centrifugiran 10 minuta na 3000 okretaja/min. Following completion of coagulation, sample was
Rezultati: Nakon postavljanja uzorka na analizator, centrifuged at 3000 rpm for 10 min.
predanalitička pogreška dovela je do prekida analize Results: Following placement of test tube in auto-
uzoraka i odgode u izvještavanju nalaza. Analizom analyzer, a preanalytical error caused discontinua-
događaja utvrđeno je savijanje igle za uzorkovanje tion of the measurements and delay in delivery of
na analizatoru zbog zaglavljivanja igle u gelu koji se lab results. A careful analysis revealed bending and

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neuobičajeno nalazio na vrhu epruvete s uzorkom. obstruction of the probe of autoanalyzer due to
Tjedan dana i dva mjeseca nakon ovog događaja, stuck in separator gel that was abnormally floated
isti je slučaj uočen u uzorcima krvi uzetih nakon he- on to the top of tube. One week and 2 months after
modijalize kod druga dva pacijenta s terminalnom the first case, abnormal floating of separator gel was
bubrežnom bolesti. Intradijalizna hipotenzija i vi- observed in post-HD blood samples of two other pa-
soka koncentracija proteina (>162,8 g/L) u uzorcina tients with ESRD. Intradialytic hypotension and high
nakon hemodijalize nađena je u slučaju sva tri paci- protein load (>162.8 g/L) of post-HD blood samples
jenta. Dodatkom goveđeg albumina u uzorke seru- were the common findings in all 3 cases. Raising the
ma zdravih dobrovoljaca postigli smo koncentraciju protein content of blood samples from healthy vol-
proteina veću od 161,6 g/L što je dovelo do plutanja unteers above 161.6 g/L by adding bovine albumin
gela na vrhu epruvete slično onome uočenom kod caused abnormal flotation of separator gel similar to
pacijenata. those we observed in our cases.
Zaključak: Visoka koncentracija proteina vjerojatno Conclusion: Our findings suggested that increased
uzrokovana intradijaliznom hipotenzijom zbog dehi- protein load probably caused by intradialytic hypo-
dracije uzorkovala je neobično plutanje gela na vrhu tension due to dehydration induced the observed
epruvete s uzorcima krvi. Opisani slučajevi upuću- abnormal flotation of separator gel in our cases.
ju na važnost vizualnog pregleda epruveta uzoraka Present findings emphasize the importance of visual
krvi s visokom koncentracijom proteina uz istovre- control of test tubes for abnormal flotation of sepa-
meno smanjenje volumena krvi kako bi se izbjegli rator gel in blood samples with high protein content
nepoželjni učinci na rezultate analize i nepotrebni especially in the presence of accompanying volume
troškovi za laboratorij. loss to avoid unfavorable effects on test results and
laboratory costs.
e-adresa: meldemir52@gmail.com
e-mail: meldemir52@gmail.com
I02 (Usmeno izlaganje) I02 (Oral presentation)
Ionizirani kalcij u serumu - utjecaj vremena Ionized calcium in serum – the influence
od uzorkovanja do centrifugiranja uzorka of time periods from sampling to
i vremena od centrifugiranja do izrade centrifugation, and from centrifugation until
analize analysis
Antonija Perović, Marina Njire Bratičević, Diana Ljubimir Antonija Perović, Marina Njire Bratičević, Diana Ljubimir
Odjel za biokemijsku i hematološku laboratorijsku dijagnostiku, Department of Biochemical and Hematological Laboratory
Opća bolnica Dubrovnik, Dubrovnik, Hrvatska Diagnostics, General Hospital Dubrovnik, Dubrovnik, Croatia
Uvod: Nakon verifikacije seruma kao jednakovrijed- Introduction: After verification of serum as sample
nog uzorka arterijskoj krvi za određivanje ionizira- equivalent to arterial blood for ionized calcium (iCa)
nog kalcija (iCa), ovim radom željeli smo ispitati utje- measurement, aim of our study was to evaluate the
caj vremena od uzorkovanja do centrifugiranja uzorka influence of time periods from sampling to centrifu-
te vremena od centrifugiranja do izrade analize na vri- gation, and from centrifugation until analysis on the
jednosti iCa u serumu, kako bismo procijenili hitnost iCa in serum, in order to assess the urgency of analy-
izrade analize zbog eventualne nestabilnosti uzorka. sis due to possible sample instability.
Ispitanici i metode: Uzorci venske krvi prikupljeni Subjects and Methods: The influence of time peri-
su u Odjelu za biokemijsku i hematološku laborato- ods from sampling to centrifugation was examined
rijsku dijagnostiku Opće bolnice Dubrovnik u spre- on 10 subjects; 3 tubes of blood were collected and
mnike bez antikoagulansa i s gelom. Utjecaj vreme- centrifuged 15 (Tube 1), 30 (Tube 2) and 60 minutes

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na od uzorkovanja do centrifugiranja ispitan je na (Tube 3) after sampling, and analyzed within 10 min-
10 ispitanika kojima su uzeta po 3 spremnika krvi te utes. The influence of time periods from centrifuga-
centrifugirana 15 (1. spremnik), 30 (2. spremnik) i 60 tion until analysis was examined on 15 subjects; 3
minuta (3. spremnik) nakon uzorkovanja i analizira- tubes of blood were collected, centrifuged after 30
na u periodu od 10 minuta nakon centrifugiranja. minutes of the sampling and analyzed at the follow-
Utjecaj vremena izrade analize nakon centrifugira- ing timing: 0-10 (Tube A), 30-40 (Tube B) and 90-100
nja ispitan je na 15 ispitanika kojima su uzeta po 3 minutes (Tube C). Venous blood samples were col-
spremnika krvi te centrifugirana 30 minuta nakon lected in ‘’gel separator’’ serum tubes, all tubes were
uzorkovanja i analizirana u sljedećim vremenima na- completely filled, centrifuged according to the man-
kon centrifugiranja: 0-10 minuta (A spremnik), 30-40 ufacturer’s instructions, without temperature adjust-
minuta (B spremnik) i 90-100 minuta (C spremnik). ment and left at room temperature until analysis.
Svi spremnici su bili napunjeni do nominalnog vo- iCa was measured by potentiometric method on the
lumena, centrifugirani prema preporuci proizvođa- RapidLab 348 analyzer (Siemens, Suffolk, UK). The
ča, bez regulacije temperature i ostavljeni na sobnoj obtained values were compared according to Ril-
temperaturi do analize. Mjerenja su izvršena poten- iBÄK’s criteria (acceptable deviation < 7.5%).
ciometrijskom metodom na uređajima RapidLab 348 Results: iCa deviations in Tube 2 and Tube 3 in re-
(Siemens, Suffolk, UK). Dobivene vrijednosti su uspo- lation to the values in Tube 1 were less than estab-
ređene s dozvoljenim postotkom odstupanja prema lished criteria; medium bias (range); 1.25% (-3.1-3.13)
kriterijima RiliBÄK-a (odstupanje <7,5%). for Tube 2; 1.12% (-1.55-3.91) for Tube 3. iCa devia-
Rezultati: Vrijeme od uzorkovanja do centrifugira- tions in Tube B and Tube C in relation to the values
nja: odstupanja iCa prema vrijednostima u 1. spre- in Tube A were less than established criteria; medi-
mniku su bila manja od postavljenih kriterija; srednji um bias (range); 2.38% (-4.58-2.34) for Tube B; 2.79%
bias (raspon); 1,25% (-3,1-3,13) za 2. spremnik; 1,12% (-4.72-4.80) for Tube C.
(-1,55-3,91) za 3. spremnik. Vrijeme izrade analize na- Conclusion: Different time periods from sampling
kon centrifugiranja: odstupanja iCa prema vrijedno- to centrifugation (up to 60 minutes) and from cen-
stima u A spremniku bila su manja od postavljenih trifugation until analysis (up to 90 minutes) did not
kriterija; srednji bias (raspon); 2,38% (-4,58-2,34) za B influence the stability of the iCa in the serum.
spremnik; 2,79% (-4,72-4,80) za C spremnik.
Zaključak: Vrijeme od uzorkovanja do centrifugira- e-mail: perovic.antonija@gmail.com
nja uzorka (do 60 minuta) i vrijeme od centrifugira-
nja do izrade analize (do 90 minuta) nije utjecalo na
stabilnost iCa u serumu.
e-adresa: perovic.antonija@gmail.com
I03 I03
Utjecaj hemolize na elektroforezu serumskih Effect of hemolysis on serum protein

proteina electrophoresis
Božica Sokolić, Adrijana Dorotić, Renata Laškaj, Gabrijela Smoljkić, Božica Sokolić, Adrijana Dorotić, Renata Laškaj, Gabrijela Smoljkić,
Marija Mijakić Marija Mijakić
Odjel za medicinsku biokemiju, hematologiju i koagulaciju, Department of Medical Biochemistry, Hematology and
Klinika za infektivne bolesti „Dr. Fran Mihaljević“, Zagreb, Coagulation, University Hospital for Infectious Diseases “Dr.
Hrvatska Fran Mihaljević“, Zagreb, Croatia
Uvod: Prema preporukama proizvođača, hemolizira- Introduction: According to manufacturers’ recom-

ni uzorci nisu pogodni za izvođenje elektroforeze se- mendations, hemolyzed samples are not suitable for

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rumskih proteina (ESP) jer hemoliza dovodi do lažno serum protein electrophoresis (SPE) because they
povišene alfa2- i beta-globulinske frakcije. Cilj ovog increase alpha2- and beta-globulin fraction. The aim
istraživanja bio je procijeniti utjecaj hemolize na vri- of this study was to estimate the influence of hemo-
jednosti ESP. lysis on the values of SPE.
Materijali i metode: U razdoblju od 2 mjeseca, pri- Materials and Methods: During the period of 2
kupljena su ukupno 34 hemolizirana i nehemolizi- months, the total of 34 hemolyzed and non-hemo-
rana uzorka seruma. LIH reagens (Beckman Coulter, lyzed serum samples were collected. LIH reagent
SAD) korišten je za utvrđivanje stupnja hemolize. (Beckman Coulter, USA) was used to estimate the
Uzorci s koncentracijom slobodnog hemoglobina degree of hemolysis. According to the concentra-
>0,50 g/L opisani su kao hemolizirani. Ukupni prote- tion of free haemoglobin derived from LIH test, all
ini u serumu određeni su fotomerijskom metodom samples with the concentration of free haemoglo-
na Beckman Coulter AU 680 analizatoru (Beckman bin >0.50 g/L were described as hemolyzed.
Coulter, SAD), a ESP provedena je upotrebom Total serum proteins were measured using a photo-
Hydragel 30 Protein(e) na Hydrasis 2SCAN (Sebia, SAD). metric test on a Beckman Coulter AU 680 analyzer
Usporedba vrijednosti proteina (g/L), alfa-2 (%) i be- (Beckman Coulter, USA). SPE was performed us-
ta-globulinske frakcije (%) napravljena je pomoću ing Hydragel 30 Protein(e) on a Hydrasis 2SCAN (Se-
MedCalc 12.5.0. statističkog programa (Ostend, Bel- bia, USA) in both, hemolyzed and non-hemolyzed
gija). Vrijednost P<0,005 postavljena je kao granica samples. Comparison of the values of proteins (g/L),
statističke značajnosti. alpha-2 (%) and beta-globulin fraction (%) was per-
Rezultati: Kolmogorov-Smirnovljev test normalno- formed using MedCalc 12.5.0. statistical software
sti distribucije pokazao je da vrijednosti proteina i (Ostend, Belgium). P<0.005 was set as the treshold of
alfa-2-globulinske frakcije slijede normalnu raspo- significance.
djelu, a da vrijednosti beta-globulinske frakcije ne Results: Kolmogorov-Smirnov test showed that
slijede normalnu distribuciju te su stoga testirani the values of proteins and alpha-2-globulin fraction
korištenjem neparametrijskog Wilcoxonovog testa. follow normal distribution and that beta-globulin
Parametarskim t-testom dokazana je statistički zna- fraction does not distribute normally and is conse-
čajna razlika između nehemoliziranih i hemoliziranih quently tested using non-parametric tests. Paired
uzoraka u vrijednostima alfa-2-globulinske frakci- t-test showed that there is a statistically significant
je (P<0,001). Ostali testirani parametri nisu pokazali difference between non-hemolyzed and hemolyzed
statistički značajnu razliku između nehemoliziranih samples for the values of alpha-2-globulin fraction
i hemoliziranih uzoraka. Bland-Altmanovom meto- (P<0.001). Other parameters did not show statisti-
dom određena je srednja razlika u vrijednostima al- cally significant difference. Bland-Altman method
fa-2-globulinske frakcije između nehemoliziranih i showed that there is a mean difference between
hemoliziranih uzoraka od -14,2% (±1,96 SD -49,8% do the values of alpha-2-globulin fraction between
21,3%), što se može smatrati klinički značajnom razli- non-hemolyzed and hemolyzed samples of -14.2%
kom prema kriterijima prihvatljivosti temeljenim na (±1.96 SD -49.8% to 21.3%) which can be considered
biološkoj varijabilnosti. as clinically significant difference when compared to
Zaključak: Prema našim rezultatima, hemolizirani desirable bias specification based on biological va-
uzorci seruma nisu prikladni uzorci za ESP jer hemo- riation.
liza može dovesti do statistički i klinički viših vrijed- Conclusion: According to our results, hemolyzed
nosti alfa-2-globulinske frakcije u odnosu na nehe- serum samples are not suitable samples for SPE be-
molizirane uzorke. cause hemolysis can lead to statistically and clinical-
ly higher values of the alpha-2-globulin fraction.
e-adresa: bsokolic@bfm.hr
e-mail: bsokolic@bfm.hr

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I04 I04
Pridržavanje predanalitičkih zahtjeva: ključ Adherence to Pre-examination Procedures:

kvalitete kliničkih laboratorijskih rezultata Key to Quality Clinical Laboratory Results
Bolarinde J. Lawal, Boto Jaiteh, Gibril Bah, Saffiatou Darboe, Davis Bolarinde J. Lawal, Boto Jaiteh, Gibril Bah, Saffiatou Darboe, Davis
Nwakanma Nwakanma
Medical Research Council (MRC) Unit, Gambia Medical Research Council (MRC) Unit, Gambia
Uvod: Predanalitička faza ispitivanja kliničkog uzor- Introduction: The pre-examination phase of clini-
ka poznata je kao najvažnija i najosjetljivija faza cal sample testing has been described as the most
rada medicinskog laboratorija. Cilj ovog istraživa- important and sensitive phase of medical laboratory
nja bio je ispitati kako ispunjavanje predanalitičkih work. The objective of this study was to examine
zahtjeva utječe na kvalitetu laboratorijskih rezul- how adherence to pre-analytical procedures affects
tata. the quality of laboratory results.
Materijali i metode: Ovo retrospektivno istraživa- Materials and Methods: This retrospective stu-
nje provedeno je u Medical Research Council (MRC) dy was conducted in the Biochemistry laboratory
Unit, Gambia – laboratorij akreditiran prema kriteri- of Medical Research Council Unit, The Gambia – a
jima Dobre laboratorijske prakse. Kako bi procijenili Good Clinical Laboratory Practice (GCLP) accredited
učinkovitost i pridržavanje predanalitičkih zahtjeva, laboratory. We studied all the pre-examination poli-
pregledali smo sve predanalitičke zahtjeve, postup- cies, procedures and records maintained by the la-
ke i zapise koje je propisao laboratorij u razdoblju boratory over the period of 2012 to 2014 to assess
od 2012-2014. Kao mjeru kvalitete rezultata ispiti- the effectiveness and adherence to pre-examinati-
vanja pacijenata koristili smo rezultate testa vanj- on processes. Using external proficiency testing (PT)
ske procjene kvalitete (VPK). Također smo pregle- as a measure of the quality of patients’ test results,
dali izvedbu testa vanjske procjene kvalitete tvrt- we also reviewed three years external proficiency
ke OneWorld Accurancy, Kanada, koja je provedena testing performance of the laboratory provided by
kroz tri godine. VPK se radila u tri ciklusa godišnje. OneWorld Accuracy, Canada. The PT ran three cycles
Rezultati: Naši rezultati su pokazali da laboratorij per year.
slijedi vrlo dobro dokumentirane predanalitičke po- Results: Our findings showed that the laboratory
stupke koji su navedeni u laboratorijskom priručni- followed robust and documented pre-examination
ku i standardnim operativnim postupcima. U svim processes as outlined in the Laboratory Handbook
ciklusima, laboratorij je postigao 100%-ni rezultat and standard Operating Procedures. In all the cycles,
(20/20) za 20 od 23 biokemijska parametra registrira- the laboratory scored 100% (20/20) in 20 out of the
na za VPK. Jedino je amilaza tijekom ciklusa 2 u 2014. 23 biochemistry parameters registered for external
godini postigla 60% (12/20), što je ispod granice pri- PT. Only Amylase during Cycle 2 of 2014 scored 60%
hvatljivosti za PK koju je postavio laboratorij (≥80%). (12/20), which is below the laboratory’s acceptable
Zabilježeno je, da dana kada su pokrenuti uzorci ci- PT cut-off score of ≥80%. The recorded root cause
klusa 2.2014., interna kontrola za amilazu nije bila za- analysis indicated that Amylase did not pass internal
dovoljavajuća na dnevnom ciklusu. quality control on the day cycle 2 of 2014 PT samples
Zaključak: Ukupno vrlo uspješna izvedba VPK-a po- were run.
tvrđuje da strogo pridržavanje predanalitičkih po- Conclusion: The overall high PT performance con-
stupaka pozitivno utječe na kvalitetu kliničkih labo- firms that strict adherence to pre-analytical proce-
ratorijskih rezultata. Jedini zabilježeni neuspješan dures impacts positively on clinical laboratory re-
rezultat na testu vanjske procjene kvalitete testa sults quality. The only case of non-adherence to pre-
tijekom tri godine, bila je amilaze u ciklusu 2.2014 analytical procedures in the 3 years under review
zbog nepridržavanja unaprijed zadanih predanali- resulted in failure of the amylase test during cycle 2
tičkih postupaka.To naglašava važnost pridržavanja of 2014 Proficiency Testing. This underscores the im-
unaprijed zadanih predanalitičkih zahtjeva i njihov portance of adherence to pre-analytical procedures

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snažan utjecaj na ukupnu pouzdanost kliničkih re- and its strong impact on overall reliability of clinical
zultata. test results.
e-adresa: blawal@mrc.gm e-mail: blawal@mrc.gm
Vacuette® Glucomedics epruvete i Vacuette® Glucomedics tubes and prevalence

prevalencija gestacijskog dijabetesa of gestational diabetes
Marija Kocijančić, Jelena Čargonja, Alma Delić Knežević Marija Kocijančić, Jelena Čargonja, Alma Delić Knežević
Medicinsko-biokemijski laboratorij, Dom zdravlja Primorsko- Medical Biochemistry Laboratory of Primorsko-Goranska
goranske županije, Rijeka, Hrvatska County Health Care Rijeka, Rijeka, Croatia
Uvod: Točno određivanje koncentracije glukoze Introduction: An accurate plasma glucose measure-
ključno je za točnu dijagnozu dijabetesa, pogotovo ment is essential for correct diagnosis of diabetes,
gestacijskog dijabetesa (GD). Pretpostavili smo da especially for gestational diabetes mellitus (GDM).
će koncentracija glukoze u Glucomedics epruveta- We hypothesized that glucose concentration in Glu-
ma biti lagano povišena, zbog trenutnog djelovanja comedics tubes should be slightly elevated in re-
aditiva koje sadrže, u odnosu na dosadašnje referen- gard to the reference tubes due to the immediate
te epruvete. Cilj studije je bio ispitati jesu li rezultati additive activity. The aims of this study were to as-
dobiveni iz Glucomedics epruveta usporedivi sa re- certain whether the results from Glucomedics tubes
zultatima iz natrij fluorid epruveta te koliko to može compatible with sodium fluoride tubes results and
utjecati na dijagnozu GD obzirom na promjenu u potential impact on the diagnosis of gestational dia-
broju pozitivnih rezultata. betes on basis change of positive results.
Ispitanici i metode: Uzorci venske krvi skupljeni su Subjects and Methods: Venous blood samples
od 97 trudnica koje su došle u laboratorij u jutarnjim were collected from 97 pregnant women who were
satima na screening test za GD. Dijagnostički test za admitted to the laboratory in the morning for GDM
screening GD uključuje oralni test opterećenja glu- screening. Diagnostic test for GDM screening includ-
kozom (75 g glukoze) koji traje dva sata. Tijekom te- ed three points 2h oral glucose tolerance test (OGTT)
sta tri smo puta vadili krv (0h, 1h, 2h) direktno u dvije with 75 g glucose load. Blood was taken three times
različite epruvete: epruveta I (referentna): BD Vacuta- (0h, 1h, 2h) directly into two different plasma vac-
iner® NaF/K2oksalat (lot 4007104, Becton, Dickinson uum tubes: Tube I (reference): BD Vacutainer® NaF/
and Company, Plymouth, UK) i epruveta II: Vacuette® K2oxalate (lot 4007104, Becton, Dickinson and Com-
Glucomedics Na2EDTA/NaF/Na citrat-citratna kise- pany, Plymouth, UK) and Tube II: Vacuette® Gluco-
lina (lot A140411U, Greiner Bio-one, Kremsmunster, medics Na2EDTA/NaF/Nacitrate-citric acid buffer (lot
Austrija). Određivanje koncentracije glukoze učinje- A140411U, Greiner Bio-one, Kremsmunster, Austria).
no je na Beckman AU 2700 analizatoru koristeći hek- Glucose determination was performed on Beckman
sokinaznu metodu. Wilcoxon i McNemarov test su AU 2700 using hexokinase method. The Wilcoxon
korišteni za usporedbu razlike između novih i refe- and McNemar’s tests were applied to evaluate the
rentnih epruveta. Rezultati su analizirani koristeći Pa- difference of the new blood collection tube. Results
ssing-Bablok analizu i Bland-Altman grafove. Razina were analyzed using Passing-Bablok and Bland-Alt-
značajnosti iznosila je P<0,05. man plots for association and differences. The level
Rezultati: Koncentracija glukoze bila je viša u Gluko- of significance was set as P<0.05.
medics epruvetama u odnosu na referentne epruve- Results: Plasma glucose concentrations were statis-
te i ta razlika je statistički i klinički značajna (P<0,001). tically significant higher in Glucomedics tubes com-

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Bland-Altman graf pokazao je visoki stupanj iskrivlje- pared to reference NaF/KOx tubes for all three mea-
nja (8,9 do 9,7%), a Passing-Bablok regresijska analiza surements (P<0.001). Bland-Altman difference plots
je pokazala dobru povezanost između mjerenih vri- showed high mean bias (8.9 to 9.7%), but Passing-
jednosti. Značajna razlika uočena je u povećanju po- Bablok regression analysis showed good association
zitivnih rezultata za dijagnozu GD u mjerenjima glu- among the measured values. Significant difference
koze u Glucomedics epruvetama (49,3%, P<0,001). in change of positive results was shown for Gluco-
Zaključak: Glucomedics epruvete imaju prednosti medics tubes (49.3%, P<0.001).
za najtočniju procjenu koncentraciju glukoze, ali do- Conclusion: Glucomedics tubes have advantages
datna poboljšanja su potrebna u smislu faktora ra- for the most accurate estimation of glucose mea-
zjeđenja. surements, but additional improvements are need-
ed due to dilution factor.
e-adresa: marija.percan@gmail.com
e-mail: marija.percan@gmail.com
I06 I06
Usporedba koncentracije glukoze u serumu i Comparison of glucose concentration in

venskoj plazmi venous plasma and in serum
Bojana Kranjčec, Snježana Semenski, Pavao Tomašković Bojana Kranjčec, Snježana Semenski, Pavao Tomašković
Medicinsko biokemijski laboratorij, Opća bolnica Zabok i Medical Biochemistry Laboratory, General Hospital Zabok and
Uvod: Preporučeni uzorak za određivanje koncen- Introduction: The venous plasma is the recommen-
tracije glukoze je venska plazma. Uzorcima koji se ded sample for determining glucose. It can take up
uzimaju u liječničkim ordinacijama i transportiraju u to several hours between taking a sample in the
laboratorij od vremena uzorkovanja do analize pro- physician’s office and transporting it to the labora-
đe i do nekoliko sati. Uspoređeni su rezultati koncen- tory. Comparison was made between glucose con-
tracije glukoze u serumu i koncentracije glukoze u centration in serum and venous plasma.
venskoj plazmi uzorkovane u epruvete koje sadrže Materials and Methods: Blood samples were
inhibitore glikolize (Na EDTA, NaF, limunsku kiselinu collected in serum tubes without anticoagulant –
i Na citrat). Vacuette Z Serum Sep Clot Activator, Greiner Bio-
Materijali i metode: Uzorci krvi uzeti su u serumsku One and in a test tube containing several inhibitors
epruvetu bez antikoagulansa – Vacuette Z Serum of glycolysis (EDTA, NaF, citric acid and Na citrate) -
Sep Clot Activator, Greiner Bio-One i u epruvetu koja Vacuette Glucomedics, Greiner Bio-One. They were
sadrži nekoliko inhibitora glikolize – Vacuette Gluco- analyzed after it has been more than one hour from
medics, Greiner Bio-One. Analizirani su nakon što je the time of sampling. Concentration of glucose was
prošlo više od jednog sata od vremena uzorkovanja. determined by enzymatic UV test on BC AU680.
Koncentracija glukoze određivana je preporučenom Results: A total of 279 serum samples and 279 sam-
enzimskom UV metodom s heksokinazom proizvo- ples of venous plasma concentration in range of 3.7
đača Beckman Coulter na biokemijskom analizatoru to 15.8 mmol/L glucose were analyzed. Average time
AU 680. from sampling till analysis was 4.3h (1 to 6h). Pear-
Rezultati: Analizirano je 279 uzoraka seruma i 279 son correlation coefficient r=0.9935 with P<0.05, in-
uzoraka venske plazme u koncentracijskom područ- dicate a strong correlation between the concentra-
ju od 3,7 do 15,8 mmol/L glukoze. Prosječno je pro- tion of glucose. Passing Bablok analysis indicates the
teklo 4,3 h (od 1 do 6 h) od uzorkovanja do analize. existence of a constant (+4.722) and proportional

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Pearsonov koeficijent korelacije r=0,9935 uz P<0,05, differences (-7.6%) between the measured values,
ukazuje na izvrsnu povezanost koncentracije gluko- but with different sign was obtained. Bland-Altman
ze. Passing Bablok analizom dobiven je pravac regre- analysis showed that more than 95% of the results
sije koji ukazuje na postojanje konstantne (+4,722) i were within ±1.96SD. Differences between glucose
proporcionalne (-7,6%) razlike među izmjerenim vri- concentrations in the area of higher concentration
jednostima, ali uz različit predznak. Bland-Altman are greater (it is lower in venous plasma compared
analizom utvrđeno je da je više od 95% rezultata to serum).
unutar ±1,96SD te nema statističke značajne razlike Conclusion: No statistical significant differences
između mjerenja, ali su razlike između koncentracije where found in glucose concentration if blood sam-
glukoze veće u području viših koncentracija (niža u pling is done via serum tubes or in the tube with
venskoj plazmi u odnosu na serum). glycolytic inhibitor. In the higher concentration ran-
Zaključak: Nema statstički značajne razlike u kon- ge glucose is lower in the test tube containing a
centraciji glukoze ako se krv uzorkuje u serumske glycolytic inhibitor than in serum specimens which
ili u epruvete s inhibitorima glikolize. Koncentracije is not in accordance with the manufacturer’s decla-
glukoze u višem koncentracijskom području niže su rations regarding to stability of samples. It is possi-
u epruvetama s inhibitorima glikolize nego u serum- ble to obtain blood sample for the glucose deter-
skim epruvetama što nije u skladu s deklaracijama mination in serum tubes only if the analysis is made
proizvođača o stabilnosti uzoraka. Moguće je uzor- within six hours of sampling.
kovanje krvi za određivanje glukoze samo u serum-
ske epruvete ukoliko se analiza obavi unutar 6 sati e-mail: bojanakranjcec@gmail.com
od uzorkovanja.
e-adresa: bojanakranjcec@gmail.com
Analiza podataka o surogatnim biljezima Data analysis of surrogate markers for

kontaminacije uzoraka s K-EDTA detection of K-EDTA contamination
Lora Dukić, Nora Nikolac, Ana-Maria Šimundić Lora Dukić, Nora Nikolac, Ana-Maria Šimundić
milosrdnice, Zagreb, Hrvatska Sestre milosrdnice, Zagreb, Croatia
Uvod: Jedan od preporučenih koraka u postupku Introduction: There is ongoing debate among lab-
uzorkovanja venske krvi – redoslijed epruveta – je oratory professionals on one of the recommended
predmet rasprave između laboratorijskih stručnjaka. steps in phlebotomy procedure – order of draw.
U literaturi postoje kontradiktorni podaci o kontami- Many contradictory data on K-ethylenediaminetet-
naciji uzoraka sa K-etilendiamino tetraoctenom ki- ra acetic acid (K-EDTA) contamination of samples as
selinom (K-EDTA), koja nastaje kao posljedica nepri- consequence of non-compliance to order of draw
državanja preporuka vezanih uz redoslijed epruveta are published. Analytes commonly used as surro-
kod uzorkovanja venske krvi. Kao surogatni biljezi gate markers of K-EDTA contamination are potas-
kontaminacije uzorka s K-EDTA najčešće se spominju sium (K), calcium (Ca) and magnesium (Mg). Aim of
kalij (K), kalcij (Ca) i magnezij (Mg). Cilj našeg istraži- our study was to assess frequency of K-EDTA con-
vanja bio je da utvrditi učestalost kontaminacije se- tamination on samples analyzed in our laboratory
rumskih uzoraka s K-EDTA u našem laboratoriju tije- during one-year period by data analysis of surrogate
kom jedne godine analizom podataka o surogatnim markers.
biljezima.

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Materijali i metode: Iz našeg laboratorijskog infor- Materials and Methods: We extracted data from
macijskog sustava (LIS) smo obradili podatke za peri- our Laboratory Information System (LIS) for one–
od od travnja 2014. do travnja 2015. Analizirani su re- year period (from April of 2014 to April of 2015). Cre-
zultati kreatinina, kalija, kalcija i magnezija za uzorke atinine, potassium, calcium and magnesium results
bolničkih i ambulantinih pacijenata. Za uzorkovanje were analyzed for patient samples collected at hos-
su se koristile epruvete proizvođača Greiner Bio One. pital wards and outpatient samples. Greiner Bio One
Uzorci su se obrađivali na biokemijskom analizato- collection devices were used for collection of sam-
ru Architect c8000. Koncentracija kreatinina >150 ples. Samples were analyzed on Abbott Architect
μmol/L je definirana kao cut-off za poremećaj funk- c8000 biochemistry analyzer. Creatinine concen-
cije bubrega, dok je hiperkalijemijom smatrana kon- tration >150 μmol/L was defined as cut-off for kid-
centracija K ≥5,5 mmol/L. Za hipokalcemiju je defi- ney function disorder, while concentration of K ≥5.5
nirana cut-off koncentracija bila Ca <2,14 mmol/L, a mmol/L was considered as hyperkalemia. Cut-off for
za hipomagnezemiju Mg <0,65 mmol/L. Podaci su hypocalcaemia was Ca <2.14 mmol/L and for hypo-
analizirani pomoću programa Microsoft office excel. magnesaemia it was Mg <0.65 mmol/L. Data were
Rezultati: Analizirani su podaci za 50435 uzora- analyzed using Microsoft office excel 2003 program.
ka. Od ukupnog broja (N=50435), nađeno je 812 Results: Data from 50435 samples were analyzed.
(1,6%) uzoraka s hiperkalijemijom. Kod onih uzoraka Out of total number (N=50435), there were found
(N=391; 0,8%) koji su imali istodobno kreatinin <150 812 (1.6%) samples with hyperkalemia. For those
μmol/L, posumnjalo se na lažnu hiperkalijemiju. U samples (N=391, 0.8%) having creatinine concen-
toj grupi uzoraka, nađeno je N=31 (0,06%) uzoraka tration <150 μmol/L, pseudohyperkalemia was
sa hipokalcemijom, dok hipomagnezemija nije na- suspected. In that sample group, we found N=31
đena. (0.06%) samples having hypocalcaemia, while hypo-
Zaključak: Temeljem ove retrospektivne analize po- magnesaemia was not found.
dataka o surogatnim biljezima zaključujemo da kon- Conclusion: Based on this retrospective data analy-
taminacija uzoraka s K-EDTA nije prisutna kao preda- sis on surrogate markers we conclude that K-EDTA
nalitička pogreška u našoj ustanovi. contamination of samples is not preanalytical error
in our laboratory.
e-adresa: lora.dukic@gmail.com
e-mail: lora.dukic@gmail.com
I08 I08
Utjecaj uzorkovanja manje količine uzorka The influence of inadequate sample volume
od propisane na rezultate krvne slike on complete blood count results
Dragana Antončić1, Doris Ožanić1, Vesna Šupak Smolčić1,2, Dragana Antončić1, Doris Ožanić1, Vesna Šupak Smolčić1,2,
Lidija Bilić -Zulle1,2 Lidija Bilić -Zulle1,2
Uvod: Pogrešan omjer krvi i tekućeg antikoagulan- Introduction: The inadequate ratio of blood and liq-
sa zbog uzorkovanja manje količine krvi od propisa- uid anticoagulant due to insufficient blood volume
ne, može biti uzrokom pogrešnih rezultata. Cilj ovog can lead to erroneous results. The aim of this study
rada je ispitati utjecaj premale količine uzorka na re- was to investigate the influence of insufficient sam-
zultate krvne slike. ple volume on complete blood count (CBC) results.

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Materijali i metode: Istraživanje je provedeno u Kli- Materials and Methods: The study was conducted
ničkom zavodu za laboratorijsku dijagnostiku KBC-a in the Department of laboratory diagnostics, CHC
Rijeka od prosinca 2014. do ožujka 2015. Svi su uzorci Rijeka from December 2014 to March 2015. All the
uzeti u epruvete BD Vacutainer® (Becton Dickinson samples were taken in the BD Vacutainer® (Becton
and Company, Franklin Lakes, NJ, USA) s tekućim Dickinson and Company, Franklin Lakes, NJ, USA)
K3EDTA antikoagulansom i propisanom volumenom with liquid K3EDTA anticoagulant (volume=3mL).
uzorka 3 mL. Parametri krvne slike određeni su na CBC was measured on hematology analyzer ADVIA
analizatoru Advia 2120i (Siemens, Dublin, Ireland). 2120i (Siemens, Dublin, Ireland). Each insufficient
Za svaki nepropisno uzorkovani uzorak (<3 mL) za- sample (<3 mL) was re-sampled to correct volume
traženo je ponovno uzorkovanje do oznake (N=57). (N=57). Paired t-test was used for comparison of
Usporedba rezultata nesukladnog uzorka te isprav- erythrocytes, hemoglobin, hematocrit, MCV, plate-
no uzetog uzorka učinjena je u parnim t-testom za lets and Wilcoxon paired test for leukocytes. Signif-
eritrocite, hemoglobin, hematokrit, MCV i tromboci- icance level was set to P<0.05. Clinically significant
te, odnosno Wilcoxonovim parnim testom za leuko- difference was evaluated according to reference
cite uz razinu značajnosti P<0,05. Klinička značajnost change value (RCV).
ocijenjena je prema vrijednostima klinički značajne Results: There is a statistically significant difference
promjene (RCV). for all the parameters except for MCV and leuko-
Rezultati: Statistički značajna razlika dokazana je za cytes. Mean values of the first and second sample
sve parametre osim MCV-a i leukocita. Srednje vri- (X±SD) and associated P values are: erythrocytes
jednosti prvog i drugog uzorka (X±SD) te pripada- (3.81±0.71×1012/L vs. 3.88±0.71×1012/L; P<0.001), he-
juće P vrijednosti su: eritrociti (3,81±0,71×1012/L vs. moglobin (110±21g/L vs. 112±20g/L; P<0.001); hema-
3,88±0,71×1012/L; P<0,001), hemoglobin (110±21g/L tocrit (0.331±0,065L/L vs. 0.340±0,066L/L; P=0.002),
vs. 112±20g/L; P<0,001); hematokrit (0,331±0,065L/L MCV (87,8±6,5fL vs. 87.6±6,5fL 6,5fL; P=0.287), plate-
vs. 0,340±0,066L/L; P=0,002), MCV (87,8±6,5fL vs. lets (213±162×109/L vs. 219±162×109/L; P=0.019) and
87,6±6,5fL; P=0,287), trombociti (213±162×109/L vs. leukocytes (median (range)): (7.0 (4.6-10.0)×109/L vs.
219±162×109/L; P=0,019) i leukociti (median(raspon)): 7.6 (4.5-11.0)×109/L, P=0.360). There was no clinically
(7,0 (4,6-10,0)×109/L vs 7,6 (4,5-11,0) ×109/L; P=0,360). significant difference for any parameter. RCV values
Klinički značajna razlika nije dokazana za niti jedan are calculated according to analytical coefficients of
parametar. RCV vrijednosti izračunate su temeljem variation (CVa) of internal quality control (Decem-
analitičkih koeficijenata varijacije (KVa) unutarnje ber 2014 - March 2015). The measured bias (%)/RCV/
kontrole kvalitete (prosinac 2014 – ožujak 2015). Iz- CVa (%) are: erythrocytes 2.0/9.2/0.9; hemoglobin
mjerena odstupanja (%)/RCV/KVa (%) su: eritroci- 1.9/8.4/1.0; hematocrit 3.0/8.3/1.3; MCV -0.2/4.3/0.7;
ti 2,0/9,2/0,9; hemoglobin 1,9/8,4/1,0; hematokrit platelets 2.3/25.8/1.9; leukocytes 2.0/32.0/1.8.
3,0/8,3/1,3; MCV -0,2/4,3/0,7; trombociti 2,3/25,8/1,9; Conclusion: There is no clinically significant differ-
leukociti 2,0/32,0/1,8. ence between samples despite statistically signifi-
Zaključak: Unatoč dokazanoj statistički značajnoj cant differences for most parameters. However, re-
razlici, za većinu parametara krvne slike nije doka- sults of the study should be interpreted with caution
zana i klinički značajna razlika. Međutim, rezultate because clinical decision limits can not always be in-
istraživanja potrebno je interpretirati s oprezom jer terpreted according to the biological variability es-
se granice kliničke odluke ne mogu uvijek interpre- pecially in therapeutic procedures.
tirati prema biološkoj varijabilnosti što je posebno
važno prilikom liječenja. e-mail: dragana.antoncic@gmail.com
e-adresa: dragana.antoncic@gmail.com

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Stabilnost laktata u uzorku plazme – alikvot Stability of lactate in a plasma sample -

ili NaF? aliquot or NaF?
Ivana Rako, Ana Mlinarić, Gordana Fressl Juroš, Dunja Rogić Ivana Rako, Ana Mlinarić, Gordana Fressl Juroš, Dunja Rogić
Uvod: U uzorku pune krvi nakon flebotomije nastav- Introduction: Glycolysis continues after phlebo-
lja se proces glikolize koji rezultira sniženjem kon- tomy and results in decreased glucose and increased
centracije glukoze i porastom koncentracije laktata u lactate plasma levels. In order to prevent changes in
plazmi. Kako bi se spriječile promjene u koncentra- lactate concentration, NaF is the most commonly
ciji laktata najčešće se kao stabilizator koristi NaF. U used stabilizer. In UHC Zagreb, blood for lactate de-
KBC Zagreb, krv za određivanje laktata prikuplja se termination is collected in Li-heparin tube, centrifu-
u epruvetu s Li-heparinom koja se centrifugira unu- ged within 15 minutes of sampling, aliquoted and
tar 15 minuta od uzorkovanja, alikvotira i sprema na stored at +4°C until delivery to laboratory. The goal
+4°C do dostave u laboratorij. Cilj je bio dokazati po- was to find out if there are statistically and/or clini-
stoji li statistički i/ili klinički važna razlika u koncen- cally significant differences in the concentration of
traciji laktata izmjerenoj u alikvotu heparinizirane lactate measured in an aliquot of heparinized pla-
plazme (AHP), hepariniziranoj plazmi koja nije odvo- sma (AHP), heparinized plasma which is not separa-
jena od stanica (HP) i u plazmi iz krvi prikupljene u ted from cells (HP), and plasma from blood collected
epruvetu s NaF/K3EDTA (NaFP) koja se preporučuje in NaF/K3EDTA tube (NaFP) recommended for lacta-
za određivanje laktata. te determination.
Materijali i metode: U 52 bolesnika sa sumnjom Materials and Methods: In 52 patients with suspec-
na hipoksiju, krv je prikupljena u epruvete s Li-he- ted hypoxia, blood was collected in Li-heparin and
parinom i NaF/K3EDTA. Vrijednosti laktata izmjere- NaF/K3EDTA tubes. Lactate was measured on Roche
ne su na uređaju Roche Cobas c501 u sva tri uzorka. Cobas C501 analyser in all samples. A statistically si-
Statistički značajna razlika ispitana je korištenjem gnificant difference was tested using the Wilcoxon’s
Wilcoxonovog testa (P<0,05). Klinički važna razlika is- rank sum test (P<0.05). Clinically significant diffe-
pitana je korištenjem Passing-Bablokove regresijske rence was tested using Passing-Bablok regression
analize. analysis.
Rezultati: Izmjerene vrijednosti laktata obuhva- Results: Lactate values were between 0.34 and 5.66
ćaju područje od 0,34-5,66 mmol/L (medijan AHP mmol/L (median AHP 1.17; 95%CI 1.0887-1.2575; HP
1,17; 95%CI 1,0887-1,2575; HP 1,38; 95%CI 1,2800- 1.38; 95%CI 1.2800-1.5875; NaFP 1.01; 95%CI 0.8725-
1,5875; NaFP 1,01; 95%CI 0,8725-1,1300). Wilcoxo- 1.1300). Wilcoxon’s rank sum test results have shown
nov test pokazuje da postoji statistički značajna ra- that there is a statistically significant difference in
zlika u koncentraciji laktata izmjerenoj u AHP i u the concentration of lactate measured in AHP and
HP u odnosu na NaFP (P<0,0001). Passing-Babloko- HP compared to NaFP (P<0.0001). Passing-Bablok
va regresijska analiza za vrijednosti laktata u AHP regression analysis for values in AHP compared
u odnosu na NaFP pokazuje da postoji konstantna to NaFP has shown that there is a constant diffe-
razlika u koncentraciji laktata (95%CI 0,018-0,163; rence in lactate concentration (95%CI 0.018- 0.163;
y=0,1005+1,0342x) koja nije klinički važna. Također, y=0.1005+1.0342x), which is not clinically significant.
za vrijednosti laktata izmjerene u HP u odnosu na Also, there was a proportional difference between
NaFP postoji proporcionalna razlika (95%CI 1,157- values in
the HP compared to NaFP (95%CI 1.157-
1,420; y=0,0744+1,2800x), što je neprihvatljivo s ob- 1.420; y=0.0744+1.280x), which is unacceptable in
zirom na uski referentni interval i veliku intraindivi- view of the narrow reference interval and large in-
dualnu varijabilnost od 27%. traindividual variation of 27%.

S124
Zaključak: Možemo zaključiti da se AHP može kori- Conclusion: We can conclude that AHP can be
stiti kao uzorak za određivanje laktata u plazmi, uz used as a sample to determine lactate levels, if pre-
zadovoljene prijeanalitičke zahtijeve, jer pokazuje analytical requirements are met, because it shows
prihvatljivo odstupanje rezultata u odnosu na pre- an acceptable deviation of results in relation to the
poručeno uzorkovanje krvi. recommended blood sampling.
e-adresa: irako@kbc-zagreb.hr e-mail: irako@kbc-zagreb.hr
I10 I10
Procjena rizika od neautomatiziranog Risk assessment for manual handling of

postupanja s hemolitičnim uzorcima na hemolyzed samples on patient safety
sigurnost pacijenta
Marijana Miler1, Nora Nikolac1, Ana Helena Lukšić1, Ana Bakliža2, Marijana Miler1, Nora Nikolac1, Ana Helena Lukšić1, Ana Bakliža2,
Lora Dukić1, Ana-Maria Šimundić1 Lora Dukić1, Ana-Maria Šimundić1
1Kliničkizavod za kemiju, Klinički bolnički centar Sestre 1University Department of Chemistry, University Hospital
milosrdnice, Zagreb, Hrvatska Centre Sestre milosrdnice, Zagreb, Croatia
2Odjel za laboratorijsku dijagnostiku, Psihijatrijska bolnica “Sveti 2Department of Laboratory Diagnostics, Psychiatric Hospital
Ivan”, Zagreb, Hrvatska “Sveti Ivan”, Zagreb, Croatia
Uvod: Neautomatizirano postupanje s hemolitičnim Introduction: Manual handling of hemolyzed sam-

uzorcima nije standardizirano i dovodi do laborato- ples is not standardized and is error prone. This co-
rijskih pogrešaka koje mogu imati značajan utjecaj uld lead to significant impact on clinical decision
na kliničku odluku te ugroziti sigurnost bolesnika. and patient safety. We aimed to assess the risk for
Cilj istraživanja bio je procijeniti rizik za bolesnika patient safety caused by laboratory errors due to
uzrokovan laboratorijskim pogreškama nastalim manual handling of hemolyzed samples.
uslijed neautomatiziranog postupanja s hemolitič- Materials and Methods: All laboratory samples
nim uzorcima. (N=3185) were visually assessed for hemolysis by
Materijali i metode: Retrospektivnom analizom one person in the period of one week. In this retros-
jedna je osoba na uzorcima zaprimljenim tijekom pective analysis 25 emergency tests were included.
tjedan dana (N=3185) vizualno procijenila stupanj Hemolysis was assessed by comparison with a co-
hemolize usporedbom s obojanom skalom za 25 hit- lor chart and all samples with concentration of free
nih pretraga. Za hemolitične uzorke (koncentracija hemoglobin >0.5 g/L were considered hemolyzed.
slobodnog hemoglobina >0,5 g/L) iz laboratorijskog Data were retrospectively obtained from laboratory
informacijskog sustava prikupljeni su zadani testovi i information system. Correct way of handling the re-
izdani rezultati. Za svaki od testova utvrđen je ispra- sults (results reported or sample rejected) was de-
van način postupanja s rezultatima (izdan ili odbi- termined for each test. Risk assessment was done
jen). Procjena rizika od nepovoljnih događaja nači- according to ISO 14971 standard with 5 risk catego-
njena je prema standardu ISO 14971 s 5 kategorija ri- ries (S1=minimum impact, S2=additional sampling,
zika (S1=minimalni učinak, S2=ponovljeno uzorkova- S3=delayed diagnosis, S4=inappropriate therapy,
nje, S3=odgođena dijagnoza, S4=pogrešna terapija, S5=possible fatal outcome) and frequencies of occu-
S5=potencijalno smrtni ishod) i učestalosti (O1<10%, rrence (O1<10%, O2=10-20%, O3=21-50%, O4=51-
O2=10-20%, O3=21-50%, O4=51-75%, O5=76-100%). 75%, O5=76-100%). Critical categories were defined
Kritične kategorije koje zahtijevaju trenutnu poprav- as those with the highest combination of risk and
nu radnju su imale najveću kombinaciju učestalosti i occurrence rate. For these tests some immediate
rizika.

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Posterski sažetci: J – Ostalo
Poster abstracts: J – Other
Rezultati: U navedenom razdoblju u hitni laborato- corrective measures are necessary to improve the
rij zaprimljeno je 495 hemolitičnih uzoraka s ukupno patient safety.
2518 pretraga (15,5%). Od ukupno zatraženih pretra- Results: In the period of one week emergency labo-
ga u hemolitičnim uzorcima 31% (N=780) rezultata je ratory has received 2518 test requests in 495 hemo-
pogrešno izdano, što je 4,8% od ukupno zatraženih lyzed samples (15.5%). Even 780 results (31%) were
pretraga u tom razdoblju. Većina neispravno izda- incorrectly reported accounting for 4.8% of the to-
nih rezultata (67%) je bila izdana unatoč značajnom tal test volume. The majority (67%) of erroneously
utjecaju hemolize na rezultat dok je 33% je bilo ne- reported results was made available to physicians
potrebno odbijenih uzoraka. Pretrage u kategoriji s in spite of being hemolysed. Even 33% of samples
najvećom kombinacijom učestalosti i rizika bile su were unnecessarily rejected. Tests in critical cate-
troponin T (S5, O5), kalij (S5, O4) i ukupni bilirubin gory with the highest combination of risk and occu-
(S4, O4). rrence rate were troponin T (S5, O5), potassium (S5,
Zaključak: Neautomatizirano postupanje s hemoli- O4) and total bilirubin (S4, O4).
tičnim uzorcima dovodi do rizika od pogrešnog izda- Conclusion: Manual handling with hemolyzed sam-
vanja rezultata za troponin T, kalij i ukupni bilirubin ples may lead to risk of errors in reporting results for
što može bitno utjecati na kliničku odluku i ishod li- troponin T, potassium and total bilirubin which may
ječenja. impact clinical decision and patient outcome.
e-adresa: marijana.miler@gmail.com e-mail: marijana.miler@gmail.com
J – Ostalo J – Other
J01 J01
Dijagnostički značaj i prisustvo IgA i IgG Diagnostic value and presence of IgA and
klase protutijela usmjerenih na Helicobacter IgG Helicobacter pylori antibodies in blood
pylori u serumu simptomatskih bolesnika serum from symptomatic patients
Jordan Petrov Jordan Petrov

PZU PAVLINA, Skopje, Macedonia PZU PAVLINA, Skopje, Macedonia
Uvod: Infekcija Helicobacter pylori jedna je od najče- Introduction: Infection with Helicobacter pylori is
šćih infekcija. Postoji dosta metoda za njenu dijagno- one of the most common infections in the world.
zu. Pored endoskopije, brzog ureaza testa, izdisaj- There are lots of methods for diagnosing H. pylori in-
nog testa, određivanja antigena u stolici, moguće je fection. Beside endoscopy, Rapid urease test, Breath
Helicobacter pylori odrediti i u krvi. Cilj ove studije bio test, Fecal antigen test is measuring H. pylori anti-
je odrediti prisustvo IgG i igA klase protutijela usmje- bodies in blood serum. The aim of this study was to
renih na Helicobacter pylori kod osoba sa znakovima investigate presence of Helicobacter pylori antibod-
bolesti te kod bolesnika s dijagnosticiranom infekci- ies IgG and IgA in patients with symptoms and al-
jom. ready diagnosed patients with Helicobacter pylori in-
Ispitanici i metode: U našoj studiji bila su uključena fection.
ukupno 64 ispitanika, 35 je imalo dijagnosticiranu in- Subjects and Methods: In our study were included
fekciju Helicobacter pylori. ELISA kit H. pylori IgA i IgG 64 patients, 35 of them with already diagnosed He-
firme Monobind USA koristili smo za određivanje licobacter pylori infection. We use ELISA kits H. pylori
koncentracije protutijela u serumu ispitanika. IgA and H. pylori IgG from Monobind USA for mea-
suring serum levels.

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Rezultati: Svi bolesnici s predhodno dijagnosticira- Results: All patients prior diagnosed have higher val-
nom infekcijom imaju više vrijednosti IgG klase pro- ues for H. pylori IgG. 40 patients or 64.5% have high-
tutijela usmjerenih na H. pylori. 40 bolesnika (64,5%) er values for IgG antibodies and 10 patients or 16%
ima povišene vrijednosti IgG klase, a 10 bolesnika have higher values for IgA antibodies respectively.
(16%) ima povišene vrijednosti IgA klase protutijela. From the patients IgA positive 4 have IgG and IgA an-
Od svih bolesnika s povišenim vrijednostima IgA kla- tibodies positive and other 6 were IgG negative.
se protutijela, 4 bolesnika imaju i povišene vrijedno- No one of the prior diagnosed patients was posi-
sti IgG dok preostalih 6 imaju negativan rezultat IgG tive H. pylori IgA antibodies. The results of H. pylori
klase protutijela. Niti jedan od predhodno dijagno- IgA antibodies very well correlated with prior other
sticiranih pacijenata nije bio pozitivan na IgA klasu studies.
protutijela usmjerenih na H. pylori. Rezultati IgA klase Conclusion: Individuals with H. pylori infection
protutijela usmjerenih na H. pylori vrlo dobro su ko- have predominant IgG immune response but is also
relirali sa drugim studijama. known that there is small group seronegative pa-
Zaključak: Bolesnici sa infekcijom H. pylori predomi- tients who are IgG negative and IgA positive. We rec-
nantno imaju IgG klasu protutijela u imunološkom ommend testing IgA with IgG antibody test for more
odgovoru, ali poznato je da postoji mala grupa se- accurate diagnosis. IgA positive result may have very
ronegativnih bolesnika koji su IgG negativni i IgA big clinical significance especially when IgG serol-
pozitivni. Preporučamo testirati IgA zajedno s IgG u ogy is negative.
svrhu točnije dijagnoze. Pozitivan rezultat IgA klase
protutijela može biti klinički značajan pogotovo uz e-mail: genolabdooel@yahoo.com
negativan rezultat IgG protutijela kod bolesnika s in-
fekcijom H. pylori.
e-adresa: genolabdooel@yahoo.com
J02 J02
Abdorminalna pretilost je mogući neovisni Abdominal obesity may be the independent

pokazatelj povišenog serumskog cistatina C predictor of elevated serum cystatin C levels
kod debelih/pretilih žena u postmenopauzi in overweight/obese postmenopausal women
Aleksandra Klisic1, Nebojsa Kavaric1, Milovan Jovanovic1, Najdana Aleksandra Klisic1, Nebojsa Kavaric1, Milovan Jovanovic1, Najdana
Gligorovic-Barhanovic2, Dragica Bozovic2, Marija Matic3 Gligorovic-Barhanovic2, Dragica Bozovic2, Marija Matic3
1Primary Health Care Center, Podgorica, Montenegro 1Primary Health Care Center, Podgorica, Montenegro
2Center of Clinical-Laboratory Diagnostics, Clinical Center of 2Center of Clinical-Laboratory Diagnostics, Clinical Center of
Montenegro, Podgorica, Montenegro Montenegro, Podgorica, Montenegro
3Institute of Medical and Clinical Biochemistry, Faculty of 3Institute of Medical and Clinical Biochemistry, Faculty of
Medicine, University of Belgrade, Serbia Medicine, University of Belgrade, Serbia
Uvod: Ranije studije pokazale su povezanost cistati- Introduction: Previous studies have reported the
na C s postmenopauzom, ali nije jasno da li je ta po- association of cystatin C with postmenopause but it
vezanost posljedica povišene tjelesne težine ili same is not clear whether this association is due to incre-
menopauze. S obzirom na to, naš cilj je bio procijeniti ased weight gain or menopause per se. Therefo-
povezanost cistatina C i spolnih hormona (ukupnog re, we aimed to evaluate the association between
estradiola, ukupnog testosterona, folikul stimuliraju- cystatin C and sex hormones (total estradiol, total
ćeg hormona (FSH), luteinizirajućeg hormona (LH)), testosterone, follicle-stimulating hormone (FSH),
globulina koji veže spolne hormone (SHBG) i antro- luteinizing hormone (LH)), sex hormone-binding

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pometrijskih parametara kod debelih/pretilih žena u globulin (SHBG) and anthropometric parameters in
postmenopauzi s normalnom funkcijom bubrega. overweight/obese postmenopausal women with
Ispitanici i metode: Ukupno 100 debelih/preti- normal kidney function.
lih žena u postmenopauzi (prosječne dobi 56,7±4,8 Subjects and Methods: A total of 100 overweight/
godina) i 50 kontrolnih ispitanica iste dobi i normal- obese postmenopausal women (mean age 56.7±4.8
ne tjelesne težine bilo je uključeno u ovo presječno years), and 50 age-matched normal weight controls
istraživanje. Određene su koncentracije serumskog were included in this cross-sectional study. Serum
cistatina C, kreatinina, ukupnog estradiola i testoste- cystatin C levels, creatinine, total estradiol and testo-
rona, FSH, LH i SHBG. Izmjereni su antropometrijski sterone, FSH, LH, and SHBG were determined. Ant-
parametri (tjelesna težina, visina i opseg struka). In- hropometric parameters (body weight, body height
deks tjelesne težine (BMI) i procjena brzine glome- and waist circumference (WC)) were measured. Body
rularne filtracije (eGFR) dobiveni su računski. Pear- mass index (BMI) and estimated glomerular filtrati-
sonov koeficijent korelacije korišten je za utvrđiva- on rate (eGFR) were calculated. A correlation analysis
nje povezanosti između cistatina C i ostalih varijabli. by Pearson’s (r) correlation coefficient was used to
Višestruka regresijska analiza napravljena je u svrhu determine the relationships between serum cysta-
identifikacije neovisnih čimbenika koji utječu na ci- tin C level and other variables. Multiple regression
statin C i za procjenu konačnih prediktora tih varija- analysis was performed to identify independent fac-
bli. P vrijednost <0,05 smatrana je statistički značaj- tors affecting serum cystatin C and to estimate the
nom. final predictors of its variability. A P value of <0.05
Rezultati: Debele/pretile žene u postmenopauzi was considered as statistically significant.
imale su više koncentracije cistatina C od kontrol- Results: Overweight/obese postmenopausal wo-
ne skupine (P<0,001). Serumski cistatin C korelirao men displayed higher cystatin C levels than normal
je s dobi (r=0,308; P<0,001), BMI (r=0,391; P<0,001), weight group (P<0.001). Serum cystatin C correlated
opsegom struka (r=0,440; P<0,001), FSH (r=-0,209; with age (r=0.308, P<0.001), BMI (r=0.391, P<0.001),
P=0,038), SHBG (r=-0,254; P=0,011), kreatininom WC (r=0.440, P<0.001), FSH (r=-0.209, P=0.038), SHBG
(r=0,361; P<0,001) i eGFR (r=-0,406; P<0,001), ali nije (r=-0.254, P=0.011), creatinine (r=0.361, P<0.001),
korelirao s vrijednostima ukupnog estradiola i testo- and eGFR (r=-0.406, P<0.001), but did not correla-
sterona. Višestruka regresijska analiza pokazala je da te with either total estradiol, or with total testoste-
su jedino opseg struka (Beta=0,349; P<0,001) i eGFR rone levels. After stepwise multiple linear regressi-
(Beta=-0,377; P<0,001) neovisno povezani s cistati- on analysis, only waist circumference (Beta=0.349,
nom C (R2=0,318; P<0,001). P<0.001) and eGFR (Beta=-0.377, P<0.001) were in-
Zaključak: Abdominalna pretilost, ali ne i spolni dependently associated with cystatin C (R2=0.318,
hormoni mogla bi neovisno ukazati na povišene vri- P<0.001).
jednosti serumskog cistatina C kod debelih/pretilih Conclusion: Abdominal obesity, but not sex ste-
žene u postmenopauzi. roids, could independently predict higher serum
cystatin C levels in overweight/obese postmeno-
e-adresa: aleksandranklisic@gmail.com pausal women.
e-mail: aleksandranklisic@gmail.com

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J03 J03
Aktivnost eritrocitne glikohidrolaze Levels of human erythrocyte’s

povezana je s oksidativnim stresom kod glycohydrolases are associated to oxidative
pacijenata s infekcijom umjetnog zgloba stress in patients with prosthetic-joint-asso-
ciated infection
Gian Vico Melzi d’Eril1, Luca Massaccesi2, Giancarlo Goi2, Daniela Gian Vico Melzi d’Eril1, Luca Massaccesi2, Giancarlo Goi2, Daniela
Erba3, Carlo Luca Romanò4, Angela Leone5, Clara Anna Linda Damele5, Erba3, Carlo Luca Romanò4, Angela Leone5, Clara Anna Linda Damele5,
Rossana Stefanelli5, Alessandra Barassi1, Lorenzo Drago6,7 Rossana Stefanelli5, Alessandra Barassi1, Lorenzo Drago6,7
1Department of Health’s Sciences, University of Milan, Milan, Italy 1Department of Health’s Sciences, University of Milan, Milan, Italy
2Department of Biomedical, Surgical and Dental Sciences, 2Department of Biomedical, Surgical and Dental Sciences,
University of Milan, Milan, Italy University of Milan, Milan, Italy
3DeFENS-Department of Food, Environmental and Nutrition 3DeFENS-Department of Food, Environmental and Nutrition
Sciences, University of Milan, Milan, Italy Sciences, University of Milan, Milan, Italy
4C.R.I.O. Unit, IRCCS Galeazzi, Milan, Italy 4C.R.I.O. Unit, IRCCS Galeazzi, Milan, Italy
5Laboratory of Clinical Chemistry, San Paolo Hospital, Milan, Italy 5Laboratory of Clinical Chemistry, San Paolo Hospital, Milan, Italy
6Laboratory of Clinical Chemistry and Microbiology, IRCCS 6Laboratory of Clinical Chemistry and Microbiology, IRCCS
Galeazzi, Milan, Italy Galeazzi, Milan, Italy

7Department of Biomedical Sciences for Health, University of 7Department of Biomedical Sciences for Health, University of
Milan, Milan Italy Milan, Milan Italy
Uvod: Totalna artroplastika kuka i koljena unaprje- Introduction: Primary arthroplasties of total hip
đuju kvalitetu života. U slučaju neuspješnog zahva- and total knee improve the quality of life. Howev-
ta potrebna je ponovljena, resekcijska artroplastika. er, they may fail, necessitating revision or resection
Najozbiljnija komplikacija jest infekcija koja se javlja arthroplasty. Infection is the most serious compli-
kod 0,8-1,9% pacijenata nakon artroplastike koljena cation, occurring in 0.8-1.9% of knee arthroplasties
i 0,3-1,7% pacijenata nakon artroplastike kuka. Sre- and 0.3-1.7% of hip arthroplasties. A central role in
dišnju ulogu u patofiziologiji upale usko povezane the pathophysiologic “vicious cycle” of inflamma-
s infekcijom ima oksidativni stres (OS) zbog preko- tion, deeply related to infection, is played by oxida-
mjerne sinteze reaktivnih kisikovih spojeva (RKS). tive stress (OS) due to an over production of ROS.
Pokazano je kako stupanj O-glikozilacije proteina Recently has been showed that the degree of pro-
N-acetilglukozaminom (O-GlcNAc) može utjecati na teins O-GlcNAcylation may influence the stress re-
put odgovora na stres. Stanične razine O-GlcNAc, sponse pathway; cellular levels of O-GlcNAc, regu-
regulirane O-GlcNAc transferazama (OGT) i O-β-N- lated by O-GlcNAc transferase (OGT) and O-β-N-
acetilglukozaminidazama (OGA), smatraju se senzo- Acetyl-Glucosaminidase (OGA), are considered as
rima OS. Nadalje, OS inducira modifikaciju fizikalno- OS sensor. Moreover, OS induces modifications of
kemijskih osobina eritrocitne membrane te sadržaja the physicochemical properties of erythrocyte (RBC)
enzima u membrani. Zbog njihove uloge u signali- plasma membranes and of the enzyme content of
ziranju ranih promjena na membrani koje nastaju the same membranes. Due to their role in signaling
zbog procesa povezanih s OS, nekoliko membran- early membrane alterations in OS related patholo-
skih i citoplazmatskih eritrocitnih glikohidrolaza gies, several plasma membrane and cytosolic gly-
predložene su kao novi biljezi staničnog OS. cohydrolases of human RBC have been proposed as
Materijali i metode: Za procjenu povezanosti eri- new markers of cellular OS.
trocitnih glikohidrolaza i OS mjerili smo reaktivne Materials and Methods: To evaluate the possible
spojeve tiobarbiturne kiseline (TBARS), hidroperok- association between RBC glycohydrolases and OS,
side plazme (RKS) i ukupni antioksidativni kapacitet thiobarbituric acid reactive substances (TBARS), plas-
(lag-time metodom), citosolni OGA, membransku ma hydroperoxides (ROS) and antioxidant total de-
heksozaminidazu, β-D-glukuronidazu (GCR) i α-D- fenses (by lag-time method), cytosolic OGA, mem-
glukozidazu (αGLU) fluorimetrijskom metodom kod brane Hexosaminidase (Hex), β-D-Glucuronidase

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11 pacijenata s infekcijom umjetnog zgloba i kod 30 (GCR), and α-D-Glucosidase (αGLU) (by fluorimet-
zdravih kontrola. ric assay) have been studied in 11 patients with
Rezultati: Kod pacijenata s infekcijom umjetnog Prosthetic-Joint-associated Infection (PJI) and in 30
zgloba aktivnosti membranske heksozaminidaze matched controls.
(P<0,05), GCR and αGLU (P<0,001) kao i TBARS i RKS Results: In PJI subjects plasma membrane Hex
(P<0,001) su bile značajno više u odnosu na zdrave (P<0.05), GCR and αGLU activities (P<0.001) were sig-
kontrole, dok su ukupni antioksidativni kapacitet nificantly higher as well as TBARS and ROS (P<0.001),
(P<0,01) i aktivnost OGA (P<0,05) bili značajno niži u while lag-time values (P<0.01) and OGA (P<0.05) ac-
odnosu na zdrave kontrole. tivities were significantly lower.
Zaključak: Naši rezultati potvrdili su značajni OS kod Conclusion: Our data confirm the strong OS in PJI,
pacijenata s infekcijom umjetnog zgloba i ulogu ispi- the role of considered enzymes as sensitive OS bio-
tivanih enzima kao osjetljivih pokazatelja OS. Mogu- markers and suggest their possible use to monitor
ća je njihova primjena u praćenju stanja pacijenata s conditions of PJI patients under therapies in order to
infekcijom umjetnog zgoba u terapiji u smislu preve- manage and/or prevent the debridement and reten-
niranja naknadnih zahvata obrade prostetskog zglo- tion of the prosthesis.
ba.
e-mail: gianlodovico.melzi@unimi.it
e-adresa: gianlodovico.melzi@unimi.it
J04 (Usmeno izlaganje) J04 (Oral presentation)
Ukupni bilirubin u serumu debelih/pretilih Serum total bilirubin in overweight/obese

žena u postmenopauzi s metaboličkim postmenopausal women with metabolic
sindromom syndrome
Aleksandra Klisic, Nebojsa Kavaric, Milovan Jovanovic Aleksandra Klisic, Nebojsa Kavaric, Milovan Jovanovic
Primary Health Care Center, Podgorica, Montenegro Primary Health Care Center, Podgorica, Montenegro
Uvod: Metabolički sindrom (MS) je povezan s pove- Introduction: Metabolic syndrome (MS) is associa-
ćanim oksidativnim stresom. Nedavna istraživanja ted with increased oxidative stress. Recent findings
pokazuju da ukupni bilirubin (TB) ima važnu ulogu indicate that total bilirubin (TB) has important role in
u antioksidativnoj obrani. Sukladno tome, cilj nam je antioxidant defense. Therefore, we aimed to deter-
bio utvrditi razinu TB u serumu debelih/pretilih žena mine serum TB level in overweight/obese postme-
u postmenopauzi s MS-om, kao i istražiti potencijal- nopausal women with MS, as well as to investigate
nu povezanost TB-a s komponentama MS-a. its potential association with MS components.
Ispitanici i metode: Ukupno 100 debelih/pretilih Subjects and Methods: A total of 100 overweight/
žena, prosječne dobi 56,7±4,8 godina (49 bez MS-a, obese postmenopausal women, mean age 56.7±4.8
51 s MS-om) bez šećerne bolesti, disfunkcije štitnjače years (49 without MS and 51 with MS) without dia-
ili kardiovaskularnih bolesti, a koje nisu koristile hor- betes, thyroid dysfunction or cardiovascular disease,
monsku terapiju niti bilo koji drugi lijek, sudjelovalo and who were not using hormonal therapy or any
je u ovom presječnom istraživanju. MS je definiran other medication, participated in this cross-sectio-
prema kriterijima Međunarodnog udruženja za še- nal study. MS was defined using International Dia-
ćernu bolest (engl. International Diabetes Federation). betes Federation criteria. Biochemical parameters
Od biokemijskih parametara, u serumu su određeni including serum TB, fasting glycemia, total choleste-
TB, glukoza natašte, ukupni kolesterol, lipoprotein vi- rol, high-density lipoprotein (HDL) cholesterol, low-
soke gustoće (HDL), lipoprotein niske gustoće (LDL) density lipoprotein (LDL) cholesterol and triglyceri-
i trigliceridi. Izmjereni su antropometrijski parametri des were determined. Anthropometric parameters

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(tjelesna masa, tjelesna visina i opseg struka) i krvni (body weight, body height and waist circumferen-
tlak. Izračunat je indeks tjelesne mase (BMI). Za odre- ce), and blood pressure were measured. Body mass
đivanje odnosa između serumskog TB-a i ostalih va- index (BMI) was calculated. A correlation analysis by
rijabli korištena je Spearmanova korelacija (ρ). P vri- Spearman’s (ρ) correlation coefficient was used to
jednost <0,05 smatrala se statistički značajnom. determine the relationships between serum TB level
Rezultati: Kod žena s MS-om dobivene su niže razi- and other variables. A P value of <0.05 was conside-
ne TB-a u serumu u usporedbi sa skupinom bez MS-a red as statistically significant.
(7,90±2,81 vs. 9,53±4,68 µmol/L, P=0,047). Serumski Results: Women with MS displayed lower se-
TB negativno korelira s ukupnim kolesterolom (ρ=- rum TB level as compared with the group without
0,201; P<0,05), LDL - kolesterolom (ρ=-0,235; P<0,05), MS (7.90±2.81 vs. 9.53±4.68 µmol/L, respectively,
trigliceridima (ρ=-0,283; P<0,01), ali je u pozitivnoj P=0.047). Serum TB inversely correlated with total
korelaciji s HDL-kolesterolom (ρ=0,201; P<0,05) kod cholesterol (ρ=-0.201, P<0.05) LDL-cholesterol (ρ=-
svih žena. Nije uočena značajna korelacija TB-a s glu- 0.235, P<0.05), triglycerides (ρ=-0.283, P<0.01), but
kozom natašte, krvnim tlakom ili antropometrijskim positively correlated with HDL-cholesterol (ρ=0.201,
indeksima . P<0.05) in all women. There were no significant
Zaključak: Smanjena antioksidativna obrana, izmje- correlations between TB and fasting glycemia, blo-
rena preko razine TB-a, zabilježena je u debelih/pre- od pressure or anthropometric indices.
tilih žena u postmenopauzi s MS-om. Štoviše, pove- Conclusion: Decreased antioxidant defense as mea-
zanost razine TB-a s lipidnim profilom u debelih/pre- sured by TB was observed in overweight/obese pos-
tilih žena upućuje na to da bi TB mogu biti koristan tmenopausal women with MS. Moreover, the associa-
biljeg MS-a. tion of TB with lipid profile in overweight/obese wo-
men suggests that TB may be a useful marker in MS.
e-adresa: aleksandranklisic@gmail.com
e-mail: aleksandranklisic@gmail.com
J05 J05
Kardiotonični steroidi selektivno inhibiraju Cardiotonic steroids selectively inhibit

unos L-arginina preko y+L transportera u L-arginine uptake by the y+L transporter in
humanim endotelnim stanicama human endothelial cells
Marietha J. Nel, Geoff P. Candy Marietha J. Nel, Geoff P. Candy

Department of Surgery, Medical School, University of the Department of Surgery, Medical School, University of the
Witwatersrand, Johannesburg, South Africa Witwatersrand, Johannesburg, South Africa
Uvod: Dušikov oksid (NO) ima mnoge fiziološke ulo- Introduction: Nitric oxide (NO) plays many physi-
ge, od kojih je najvažnija, vazodilatacija krvnih žila ological roles, of which importantly, is the vasodi-
u svrhu reguliranja krvnog tlaka. NO se sintetizira iz lation of the vasculature in order to regulate blood
svog prekursora, L-arginina uz pomoć enzima dušik pressure. NO is synthesized from its precursor, L-ar-
oksid sintaze (NOS). Stoga je sinteza NO ograničena ginine, by the nitric oxide synthase (NOS) enzyme.
brzinom unosa L-arginina u endotelne stanice krvnih Therefore, NO synthesis is limited by the rate of L-ar-
žila. Prijenos L-arginina u endotelne stanice odvija se ginine uptake by the vascular endothelial cells. The
pomoću dva transportera na glavnoj staničnoj mem- transport of L-arginine into the endothelial cells is
brani, y+L (visok afinitet/mali kapacitet) i y+ (niski by means of two main cell membrane transporters
afinitet/veliki kapacitet) transporteri. Unos arginina namely: the y+L (high affinity/low capacity) and the
putem y+L transportera posebno je važan u stvara- y+ (low affinity/high capacity) transporters. Indeed,
nju NO-a. Endogeni kardiotonični steroidi utječu na arginine uptake by the y+L transporter in particular,

S131
učinkovitost Na+/K+-ATPaza crpke te su stoga uklju- is involved in NO production. Endogenous cardioto-

čeni u etiologiju hipertenzije još od 1970. g. Kardioto- nic steroids affect the efficiency of the Na+/K+-ATPa-
nični steroid, Ouabain, opisan 1980. g, inhibira Na+/ se pump and have therefore been implicated in the
K+-ATPaza crpku, ali mehanizam kojim inhibicija ove etiology of hypertension since the 1970s. The cardi-
pumpe utječe na krvni tlak još uvijek nije u potpu- otonic steroid, Ouabain which was characterized as
nosti razjašnjen. Cilj studije bio je utvrditi utječe li i u such in the 1980s, inhibits the Na+/K+-ATPase pump,
kojoj mjeri Ouabain na unos L-arginina putem y+L i but the mechanism by which this pump inhibition
y+ transportera na endotelnoj staničnoj membrani. affects blood pressure has not yet been fully eluci-
Materijali i metode: Humanim endotelnim stanica- dated. Aim of this study was to establish whether
ma umbilikalne krvi iscrpljen je arginin preko noći. and to what extent Ouabain influences the uptake
Početna razina unosa [3H]-L-arginina mjerena je tije- of L-arginine by the y+L and the y+ endothelial cell
kom 30 sekundi u prisutnosti/odsutnosti Ouabaina, membrane transporters.
sa i bez N-etilmaleimida, inhibitora y+ transportera. Materials and Methods: Confluent human umbili-
Rezultati: Pri koncentraciji od 10 µM, Ouabain je in- cal cord vein endothelial cells were depleted of argi-
hibirao y+L transport L-arginina za 34%, dok je kon- nine overnight. The initial rate of [3H]-L-arginine up-
centracija od 300 μM Ouabaina inhibirala prijenos take was measured over 30 seconds in the presence/
L-arginina ovim transporterom za 88%. Nasuprot absence of Ouabain, with and without N-ethylmalei-
tome, Ouabain nije utjecao na y+ membranski tran- mide, an inhibitor of the y+ transporter.
sporter. Results: At a concentration of 10 µM Ouabain inhibi-
Zaključak: Ovi podaci pokazuju da Ouabain te mož- ted the y+L transport of L-arginine by 34%, while 300
da i drugi kardiotonični steroidi, kao što je digoksin, µM Ouabain inhibited L-arginine transport by this
zaista utječu na unos L-arginina u endotelne stanice. transporter by 88%. In contrast, the y+ membrane
Odgovor na pitanje je li ovaj izravan učinak na unos transporter was not affected by Ouabain.
L-arginina neovisan o aktivnosti Na+/K+-ATPaza Conclusion: These data indicate that indeed, Ouaba-
pumpe potrebno je utvrditi. in and thus possibly other cardiotonic steroids such
as Digoxin, do affect the uptake of L-arginine into
e-adresa: marietha.nel@wits.ac.za endothelial cells. However, whether this is a direct
effect on L-arginine uptake, independent of the Na+/
K+-ATPase pump activity, remains to be determined.
e-mail: marietha.nel@wits.ac.za
J06 J06
Ciste doštitne žlijezde – naša iskustva Small nonfunctional parathyroidal cyst:

diagnostic and therapeutic challenges
Ljubica Fuštar Preradović1, Milena Tadijanović Krnjaić2, Davorin Đanić3, Ljubica Fuštar Preradović1, Milena Tadijanović Krnjaić2, Davorin Đanić3,
Branka Maljković2, Ana Đanić Hadžibegović3, Marina Josipović2 Branka Maljković2, Ana Đanić Hadžibegović3, Marina Josipović2
1Odjel za patologiju i citologiju, Opća bolnica „Dr Josip 1Department for Pathology and Cytology, General Hospital „Dr
Benčević“, Slavonski Brod, Hrvatska Josip Benčević“, Slavonski Brod, Croatia
2Odjel za laboratorijsku dijagnostiku, Opća bolnica „Dr Josip 2Department for Laboratory Diagnostics, General Hospital „Dr
Benčević“, Slavonski Brod, Hrvatska Josip Benčević“, Slavonski Brod, Croatia

3Odjel za otorinolaringologiju, Opća bolnica „Dr Josip Benčević“, 3Department for Otorhinolaryngology, General Hospital „Dr
Slavonski Brod, Hrvatska Josip Benčević“, Slavonski Brod, Croatia
Uvod: Ciste doštitne žljezde (PC) se rijetko nalaze. Introduction: Parathyroid cysts (PCs) account for
Predstavljaju dijagnostički i terapijski izazov. Prvi ih less than 1% of all parathyroid lesions and are most
S132
je opisao Sandström 1880. godine. Do danas je u lite- commonly located along thyroid lobes, rarely at ec-
raturi opisano oko 300 slučajeva. Mogu se naći uz re- topic sites. PCs are important because they can pose
žnjeve štitnjače ili na ektopičnim mjestima, te mogu a differential diagnostic challenge against other cys-
predstavljati značajan diferencijalno dijagnostički tic formations of the neck. PCs can be functional (el-
problem prema drugim cističnim tvorbama vrata. evated serum parathyroid hormone level) and non-
Obzirom na razinu parathormona u serumu mogu functional.
biti funkcionalne i nefunkcionalne. Cilj ovog rada je Subjects and Methods: Four cases of nonfunction-
pokazati značaj ultrazvučno vođene punkcije tan- al PCs are presented. All four female patients under-
kom iglom cističnih tvorbi vrata, te određivanja ni- went physical examination and ultrasonography of
voa parathormona u punktatu i u serumu. the neck with ultrasound-guided fine-needle aspi-
Ispitanici i metode: Opisali smo 4 slučaja nefunk- ration biopsy (UG-FNA). The material thus obtained
cionalnh PC. U svim slučajevima učinjen je fizički was stained by the standard May-Grunwald-Giem-
pregled i pregled vrata ultrazvukom s ultrazvučno sa method. Parathyroid hormone level was deter-
vođenom ciljanom aspiracijskom citološkom punk- mined in aspirate and serum (ECMIA-Cobas e411),
cijom. Dobiveni materijal je za citomorfološku ana- along with serum levels of total calcium, inorganic
lizu bojan standardnom metodom po MGG-u. Svim phosphates.
pacijentima određen je nivo parathormona u pun- Results: In two asymptomatic patients, remission
ktatu i u serumu, ukupni kalcij i anorganski fosfati u occurred after initial aspiration biopsy; one patient
serumu. Koncentracija PTH punktatu i u serumu je had compression syndrome with vocal cord paresis
određena na analizatoru Cobas e411 Roche koji radi that required surgical treatment; and one patient
na principu elektrokemiluminescencije. Radi se o tzv. had cyst recurrence that was surgical removed.
“sendvič” postupku s monoklonskim PTH antitijeli- Conclusion: Cystic neck masses can pose a major
ma. Reakcija traje 18 min. Referentne vrijednosti su: differential diagnostic problem considering differ-
16-65 pg/ml ili 1,6-6,9 pmol/L. Faktor pretvorbe pg/ ent approach, treatment method, and preoperative
ml × 0,106 = pmol/L. and postoperative follow up. Surgical treatment is
Rezultati: Kod sve 4 bolesnice u punktatu je nađena necessary in case of functional and large nonfunc-
visoka razina parathormona. Kod dvije bolesnice bez tional PCs (due to compression syndrome), whereas
simptoma je nakon inicijalne punkcije došlo do remi- individualized therapeutic approach is used in case
sije. Jedna bolesnica je imala kompresivni sindrom of small nonfunctional PCs. UG-FNA, cytological
s parezom glasnice. Kirurški tretman je bio neopho- analysis and determination of parathyroid hormone
dan. Kod četvrte bolesnice cista je recidivirala, ali je level in aspirate and serum are crucial for making an
bez simptoma. accurate diagnosis.
Zaključak: Cistične tvorbe vrata mogu predstavljati
značajan diferencijalno dijagnostički problem zbog e-mail: mtadijanovic@gmail.com
razlika u pristupu bolesniku, načinu liječenja, preo-
peracijskom i poslijeoperacijskom praćenju. Smatra-
mo da je temelj dijagnoze ehografski pregled s UG-
FNA, citološki pregled dobivenog materijala i odre-
đivanje razine PTH u punktatu uz određivanje razine
PTH u serumu. Visoka razina PTH u punktatu ukazuje
da je punktirana tvorba PC. Pretraga je visoko speci-
fična za PC.
e-adresa: mtadijanovic@gmail.com

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J07 J07
Intratekalna aktivnost hitotriozidaze kao Intrathecal chitotriosidase activity as a

potencijalni biljeg progresije bolesti kod potential biomarker of disease progression
pacijenata oboljelih od multiple skleroze in patients with multiple sclerosis
Ivana Lapić, Ljiljana Zaninović, Željka Vogrinc, Milica Trbojević-Čepe Ivana Lapić, Ljiljana Zaninović, Željka Vogrinc, Milica Trbojević-Čepe
Uvod: Multipla skleroza (MS) je kronična upalna bolest Introduction: Multiple sclerosis (MS), as an im-
autoimune etiologije karakterizirana aktivacijom rezi- mune-mediated inflammatory disease, is character-
dentnih makrofaga u središnjem živčanom sustavu. Ka- ized by the activation of resident macrophages in
talitička aktivnost hitotriozidaze pokazatelj je aktivacije the central nervous system. Chitotriosidase activity
makrofaga. Cilj ovog rada bio je ispitati povezanost in- is considered to be a biochemical marker of macro-
tratekalne aktivnosti hitotriozidaze sa stupnjem ones- phage activation. The aim of our study was to assess
posobljenosti bolesnika oboljelih od multiple skleroze. the correlation of intrathecal chitotriosidase activity
Ispitanici i metode: U istraživanje je uključeno 170 with the extent of disability symptoms in patients
bolesnika oboljelih od MS podijeljenih u dvije skupi- suffering from MS.
ne ovisno o težini neuroloških simptoma. Katalitička Subjects and Methods: The study included 170 MS
aktivnost hitotriozidaze u uzorcima likvora i seruma patients classified into two groups according to the se-
određena je fluorimetrijskim mjerenjem produkta verity of neurological disability. Chitotriosidase activity
enzimatske hidrolize 4-metilumbeliferona pri od- in cerebrospinal fluid and serum samples was deter-
govarajućim valnim duljinama ekscitacije (365 nm) mined by measuring the enzymatic hydrolysis product
i emisije (450 nm). Omjer aktivnosti hitotriozidaze u 4-methylumbelliferone fluorimetrically at specified ex-
likvoru i serumu korišten je kao pokazatelj intratekal- citation (365 nm) and emission (450 nm) wavelengths.
ne u odnosu na perifernu aktivnost. Razlika između Chitotriosidase ratio (CSF Chit/Serum Chit) was used as
skupina ispitana je neparametrijskim Mann-Whitney the indicator of intrathecal rather than peripheral activ-
testom u statističkom programu MedCalc. ity. Statistical analysis was performed using MedCalc
Rezultati: U skupini bolesnika s blagim neurološ- and non-parametric Mann-Whitney test was used to
kim deficitima dobiven je medijan omjera aktivnosti assess differences between groups.
hitotriozidaze 0,10 (95%CI 0,09-0,11) te 1,18 (95%CI Results: The median of chitotriosidase activity ratio
0,95-1,29) u skupini bolesnika s umjerenom i teškom was 0.10 (95%CI 0.09-0.11) in the group of patients
onesposobljenosti za samostalan život. Utvrđeno je with minimal disability or abnormal neurological
postojanje statistički značajne razlike (P<0,001) u in- signs and 1.18 (95%CI 0.95-1.29) in patients experi-
tratekalnoj katalitičkoj aktivnosti hitotriozidaze iz- encing moderate or severe disability, showing sta-
među dviju ispitivanih skupina. Dobiveni rezultati tistically significant difference (P<0.001). Our results
ukazuju na povezanost intratekalne aktivnosti hito- show that a higher chitotriosidase activity ratio is as-
triozidaze sa stupnjem neuroloških deficita. sociated with disability accumulation.
Zaključak: Rezultati ovog rada potvrđuju važnu ulo- Conclusion: Our study underlines the importance of
gu urođenog imunološkog sustava u patogenezi the innate immune response in the pathogenesis of
multiple skleroze. Značajan porast intratekalne ak- multiple sclerosis. A significant increase of intrathecal
tivnosti hitotriozidaze utvrđen je kod pacijenata s chitotriosidase activity was found in severely disabled
teškim fizičkim i kognitivnim ograničenjima što ovaj patients with limited physical and cognitive func-
biljeg čini potencijalno korisnim pokazateljem pro- tions. Therefore, chitotriosidase activity ratio could be
gresije bolesti kod bolesnika s multiplom sklerozom. used as a potential biomarker of disease progression
Potrebno je provesti daljnja istraživanja koja uključu- in patients with multiple sclerosis. Further investiga-
ju detaljnu kliničku anamnezu u svrhu utvrđivanja tions with detailed clinical data should be performed
optimalnih granica odluke. in order to establish optimal discrimination criteria.
e-adresa: ivana.lapic@hotmail.com e-mail: ivana.lapic@hotmail.com

S134
J08 J08
Prikaz slučajeva povišenih troponina-I Case report of high values of troponin-I

određivanih visokoosjetljivim testom hsTnI using high sensitive troponin-I test on
kod pacijenta u akutnim stanjima patients in acute conditions
Nena Peran, Lada Surjan, Dijana Pamuković Jaram, Željana Reškov, Nena Peran, Lada Surjan, Dijana Pamuković Jaram, Željana Reškov,
Davorka Sladić Davorka Sladić
Biokemijsko–hematološki laboratorij, Opća bolnica Šibensko- Laboratory of Biochemistry and Hematology, General Hospital
kninske županije, Šibenik, Hrvatska Šibenik, Šibenik, Croatia
Uvod: Troponin-I (TnI) je osjetljiv biljeg oštećenja Introduction: Troponin-I(TnI) is a sensitive marker
miokarda i ima veliko značenje u dijagnozi AIM. Iako of myocardial injury which plays great role in AIM
povišene vrijednosti hsTnI u krvi odražavaju ošteće- diagnosis. Although elevated hsTnI values indicate
nje miokarda, one ne ukazuju na mehanizam koji myocardial injury, they don’t indicate the mechani-
izaziva oštećenja. Cilj rada bio je prikazati slučajeve sm of injury. Our goal was to show all cases of eleva-
svih povišenih hsTnI koji su u akutnim stanjima pri- ted TnI values in patients admitted through ER, in 20
mljeni na hitni bolnički prijem tijekom 20 dana kori- days period, using new ARCHITECT STAT High Sensi-
štenja novog hsTnI testa. tive Troponin-I assay.
Materijali i metode: U ispitivanje je uključeno 67 Materials and Methods: This study included 67 pa-
pacijenata (33 žene, medijan 83 god. i 34 muškarca tients (33 women, age median 83 years and 34 men,
medijan 78 god.) sa povišenim hsTnI. U 25 ispitanika age median 78 years) with elevated hsTnI. 25 patients
je dijagnosticiran AIM. 42 ispitanika (22 žene, medijan were diagnosed with AIM. 42 patients (22 women,
dobi 86 god; 20 muškaraca, medijan dobi 80,5 godi- age median 86 years; 20 men, age median 80.5 ye-
na) nije imalo znakove akutnog koronarnog sindro- ars) didn’t show signs of acute coronary syndrome.
ma. TnI je određivan ARCHITECT STAT High Sensitive ARCHITECT STAT High Sensitive Troponin-I assay was
Troponin-I testom na Architect i 1000 analizatoru. used for TnI quantification on Architect i1000 analyser.
Rezultati: Kod pacijenata sa AIM, zabilježen je zna- Results: Patients diagnosed with AIM showed a si-
čajan porast ili pad hsTnI u razmaku od 3-12 h.Kod 10 gnificant rise/fall of hsTnI levels, within 3-12 hours.
ispitanika prvo mjerenje je bilo >10×99te percentile. In 10 patients the first mesured value was >10×99th
Kod 3 ispitanika vrijednost hsTnI je samo u jednom percentile. In 3 patients only one hsTnI level was over
mjerenju prešla 99tu percentilu. Kod 39 pacijenata 99th percentile. 39 patients, who didn’t show signs
bez znakova AIM nije bilo značajnog pada ili porasta of AIM, didn’t have a significant rise/fall in hsTnI wit-
hsTnI u razmaku od 3-14 h.Kod 2 slučaja zabilježen je hin 3-14 hours. 2 patients showed a significant rise,
značajniji porast, a kod jednog značajniji pad. Kod 10 and 1 showed a significant fall. In 10 patients the
pacijenata prvo mjerenje je bilo >10×99te percentile. first mesurement was >10×99th percentile.
Zaključak: Visoko osjetljivi hsTnI je vrlo osjetljivi bio- Conclusion: High sensitive hsTnI is very sensitive bi-
marker oštećenja stanica miokarda, koje je često, ali ne omarker of myocardial injury, which is often, but not
i uvijek povezano s AIM. Omogućava mjerenje niskih always, conected with AIM. It can detect very low TnI
razina TnI, te može detektirati njegov porast iznad 99te
levels. It can also detect TnI levels >99th percentile
percentile normalne referentne populacije unutar 3 h
of an healthy population, within 3 h after the on-
nakon početka boli u prsima. Dokaz porasta i/ili pada
set of chest pain. The rise and/or fall of TnI levels is
vrijednosti hsTnI je potreban za razlikovanje AIM od
the evidence for AIM and chronic myocardial injury
kroničnog oštećenja miokarda. Vrijednosti hsTnI koje
differentiation. hsTnI levels can be significantly ele-
mogu biti značajno povišene, pa i u razinama koje su
vated, even similar to AIM values. If these values
prisutne kod pacijenata s AIM, ali se ne mjenjaju akut-
don’t change significantly and there are no clinical
no ili imaju trend promjene bez kliničkih znakova is-
signs of ischemic injury, other diagnoses, conected
hemije, zahtjevaju utvrđivanje drugih dijagnoza koje
with myocardial injury, should be considered.
mogu biti povezane sa oštećenjem miokarda.
e-mail: nena.peran1@gmail.com
e-adresa: nena.peran1@gmail.com

S135
J09 J09
Serološki testovi u selektivnoj IgA Serological tests in selective IgA deficiency:

deficijenciji: pokazatelj uspješnosti gluten-free diet performance indicator in
provođenja dijete bez glutena u celijakiji – celiac disease - a case report
prikaz slučaja
Mirjana Fijačko1, Igor Marjanac2, Jasna Pavela1 , Blaženka Dobrošević1, Mirjana Fijačko1, Igor Marjanac2, Jasna Pavela1, Blaženka Dobrošević1,
Silvija Pušeljić2, Vatroslav Šerić1 Silvija Pušeljić2, Vatroslav Šerić1
1Odjel za kliničku laboratorijsku dijagnostiku, Klinički bolnički 1Department of Clinical Laboratory Diagnostics, Clinical
centar Osijek, Osijek, Hrvatska Hospital Centre Osijek, Osijek, Croatia
2Klinika za pedijatriju, Klinički bolnički centar Osijek, Osijek, 2Pediatric Clinic, Clinical Hospital Centre Osijek, Osijek, Croatia
Hrvatska
Uvod: Procjena uspješnosti liječenja celijakije u dje- Introduction: Performance evaluation of treatment
ce na bezglutenskoj dijeti temelji se na poboljšanju of celiac disease in children on gluten free diet is
kliničke slike i normalizaciji seroloških testova: anti- based on the improvement of the clinical picture
tijela na tkivnu transglutaminazu klase IgA (anti tTG and the normalization of serology: IgA antibodies
IgA) i antitijela na deaminirani gliadinski peptid klase against tissue transglutaminase (anti-tTG IgA) and
IgG (anti dGp IgG). Nedavne studije su pokazale da IgG antibodies against deaminated gliadin peptide
serološki testovi nisu u korelaciji sa oporavkom du- (anti-dGp IgG). Recent studies have shown that se-
odenalne mukoze. U djece sa selektivnom IgA defi- rological tests do not correlate with the recovery of
cijencijom (IgA <0,07 g/L) serološki testovi koji se te- the duodenal mucosa. In children with selective IgA
melje na IgA specifičnim antitijelima su negativni, u deficiency (IgA <0.07 g/L), a serological test based
tom slučaju dijagnostika se proširuje na testove koji on IgA-specific antibodies are negative. For those
se temelje na IgG specifičnim antitijelima. Međutim cases diagnostic procedure includes test based on
serološki testovi temeljeni na IgG specifičnim anti- IgG-specific antibodies. However, serological tests
tijelima (anti-tTG, anti-dGp) mogu biti perzistentno based on IgG-specific antibodies (anti-tTG, anti-
povišeni unatoč histološkom oporavku. Kroz prikaz dGp) can be elevated despite histological recovery.
slučaja cilj je pokazati da li serološki testovi celijakije Intention of this case report is to show whether se-
pokazuju oporavak duodenalne mukoze u bezglu- rologic tests for celiac disease show recovery duo-
tenskoj dijeti koja se u pravilu provodi najmanje 12 denal mucosa in gluten free diet, carried out for at
mjeseci. least 12 months.
Ispitanici i metode: Djevojčici u dobi od 10 godina Subjects and Methods: 10 year old girl was di-
dijagnosticiran je inzulin ovisan dijabetes i celijakija. agnosed insulin-dependent diabetes and celiac
Od tada prima propisanu inzulinsku terapiju, uz ade- disease. Since then receives insulin therapy with
kvatnu dijabetičku i bezglutensku dijetu. Koncentra- adequate diabetic and gluten-free diet. IgA was
cija IgA izmjerena je imunonefelometrijskom meto- measured immunonephelometrically on SIEMENS
dom na SIEMENS ProSpec Nephelometru. Seroški te- ProSpec Nephelometer. Serological tests were per-
stovi rađeni su multiplex tehnologijom na Luminex formed on the Luminex 200 analyzer with multiplex
200 analizatoru komercijalnim kitom BMD. technology on commercial BMD kits.
Rezultati: U skladu sa niskom koncentracijom IgA Results: In accordance with the low concentration of
(IgA<0,066 g/L; referentna vrijednost 0,91-2,55) titar IgA (IgA <0.066 g/L, reference value 0.91-2.55) titer of
anti-tTG IgA i anti-dGp IgA u vrijeme postavljanja anti-tTG IgA and anti-dGp IgA at the time of diagno-
dijagnoze bio je nizak. Međutim titar anti-tTG IgG sis was low. However, titers of anti-tTG IgG (118 AU/
(118 AU/ml) i anti-dGp IgG (52 AU/ml) bio je visok ml) and anti-dGp IgG (52 AU/ml) was high (reference
(referentna vrijednost <15). Nakon dvije godine value <15). After two years gluten-free diet, titer of
provođenja bezglutenske dijete titar anti-tTG IgA i anti-tTG IgA and anti-dGp IgA was low and the titer
anti-dGp IgA je očekivano nizak, a titar anti-tTG IgG of anti-tTG IgG (86 AU/ml) and anti-dGp IgG (40 AU/

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(86 AU/ml) i anti-dGp IgG (40 AU/ml) još uvijek je vi- ml) was high, although lower compared to the pre-
sok, premda nešto niži u odnosu na ranije vrijednosti. vious value.
Zaključak: Serološki markeri celijakije u ovom pri- Conclusion: The serological markers of celiac dis-
kazu ne pokazuju oporavak duodenalne mukoze u ease do not show the recovery of the duodenal mu-
bezglutenskoj dijeti. Definitivan odgovor dala bi po- cosa in the gluten free diet. A definite answer would
novljena biopsija, samo pod predpostavkom da je give biopsy, assuming that the diet is properly im-
dijeta pravilno provedena. plemented.
e-adresa: fijacko.mirjana@kbo.hr e-mail: fijacko.mirjana@kbo.hr
J10 J10
Značaj određivanja srčanog visoko The significance of high sensitivity cardiac

osjetljivog troponina I u koronarnoj i troponin I in coronary and non-coronary
nekoronarnoj bolesti disease
Andrea Radeljak1, Ingrid Prkačin2, Dean Mileta2, Ivona Herceg1, Jelena Andrea Radeljak1, Ingrid Prkačin2, Dean Mileta2, Ivona Herceg1, Jelena
Starčić1, Sonja Perkov1 Starčić1, Sonja Perkov1
2Klinika za unutarnje bolesti, Klinička bolnica Merkur, Zagreb, 2Department of Internal Medicine, Merkur University Hospital,
Uvod: Uvođenjem srčanog visoko osjetljivog tro- Introduction: Introducing high-sensitivity cardiac
ponina I (hsTnI) u kliničku primjenu nađeno je da se troponin I (hsTnI) in clinical use it has been found
povišene koncentracije, iznad gornje granice refe- that elevated levels, above the upper limit of the re-
rentnog intervala (muškarci <34,2 ng/L; žene <15,6 ference interval(RI) (men <34.2 ng/L; women <15.6
ng/L), javljaju u koronarnoj i nekoronarnoj bolesti. ng/L), occur in coronary and non-coronary disease.
Cilj ovog rada bio je odrediti važnost koncentracij- The aim of this study was to determine the impor-
skih razina hsTnI obzirom na dijagnozu i kliničku sli- tance of hsTnI levels regarding the diagnosis and cli-
ku, te odrediti granicu kvantifikacije za hsTnI na pri- nical condition and determine the limit of quantifi-
mijenjivanom imunokemijskom analizatoru Abbott cation for the hsTnI on the analyzer Abbott Architect
Architect i1000SR. i1000SR.
Materijali i metode: Retrospektivnom analizom Materials and Methods: Retrospective analysis
obuhvaćena su ukupno 54 bolesnika: 19 s koronar- included 54 patients: 19 with coronary heart disea-
nom bolesti (10 s anginom pectoris i 9 s akutnim se (10 with angina pectoris, 9 with acute transmural
transmuralnim infarktom miokarda) i 35 s nekoronar- myocardial infarct), and 35 with non-coronary dise-
nom bolesti za koje je provedeno minimalno inicijal- ase for which initial measurement and control mea-
no mjerenje i jedno kontrolno mjerenje razine hsTnI. surement of the hsTnI level was conducted. Concen-
Koncentracija hsTnI određivana je kemiluminiscen- tration of hsTnI was determined by a chemilumines-
tnom imunokemijskom metodom na mikročestica- cent microparticle immunoassay (CMIA). The limit
ma (CMIA). Granica kvantifikacije (LoQ) određivana of quantitation (LoQ) was determined according to
je prema protokolu CLSI EP17-A. CLSI protocol EP17-A.
Rezultati: U skupini s koronarnom bolesti maksimal- Results: In the group with coronary heart disease
na koncentracijska razina hsTnI bila je izmjerena kod the maximum concentration of hsTnI was measured
bolesnika s akutnim infarktom miokarda (186134,0 in patients with acute myocardial infarct (186134.0
ng/L), a u skupini nekoronarne bolesti kod bolesnika ng/L) and in the group of non-coronary disease

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s aterosklerotskom perifernom bolesti (4822,8 ng/L). in patients with peripheral atherosclerotic disea-
Prema dijagnozama dobivene su sljedeće koncen- se (4822.8 ng/L). For the following diagnoses the
tracijske razine koje su prikazane kao medijan i ras- obtained concentration levels, presented as medi-
pon (ng/L) za inicijalno/kontrolno mjerenje: akut- an and range (ng/L) for initial/control test were: acu-
ni transmuralni infarkt miokarda (N=9): 269,9(19,6- te transmural myocardial infarct (N=9): 269.9(19.6-
4055,8)/903,8(35,8-186134,0); angina pectoris (N=10): 4055.8)/903.8(35.8-186134.0); angina pectoris (N=10):
97,8(10,5-1477,5)/82,7(7,2-1363,3); fibrilacija/undu- 97.8(10.5-1477.5)/82.7(7.2-1363.3); atrial fibrillation
lacija atrija (N=12): 20,3(5,2-282,2)/21,6(4,5-271,6); waveform (N=12): 20.3(5.2-282.2)/21.6(4.5-271.6);
aterosklerotska periferna bolest (N=5): 427,9(3,0- peripheral atherosclerotic disease (N=5): 427.9(3.0-
4822,8)/2081,6(3,3-4695,7); šećerna bolest (N=7): 4822.8)/2081.6(3.3-4695.7); diabetes mellitus (N=7):
22,3(1,3-73,3)/20,1(1,9-80,4); kronična bubrežna bo- 22.3(1.3-73.3)/20.1(1.9-80.4); chronic renal disease
lest (N=7): 118,9(49,9-163,9)/83,9(25,9-163,0); esen- (N=7): 118.9(49.9-163.9)/83.9(25.9-163.0); essential
cijalna hipertenzija (N=4): 12,25(3,3-16,7)/14,45(4,9- hypertension (N=4): 12.25(3.3-16.7)/14.45(4.9-33.1).
33,1). Verificirana je granica kvantifikacije 4,71 ng/L LoQ was verified at the concentration of 4.71 ng/L
uz KV% 8,41%. with CV% 8.41%.
Zaključak: Kvantifikacijom vrlo niskih koncentracija Conclusion: Quantification of very low concentrati-
hsTnI povećava se mogućnost češćeg i ranijeg otkri- ons hsTnI increases the possibility of more frequent
vanja akutne koronarne bolesti uz obvezno praće- and earlier detection of acute coronary disease with
nje dinamike promjena u odnosu na inicijalne vri- mandatory monitoring the dynamics of change in
jednosti. Dobiveni preliminarni rezultati pokazuju relation to the initial value. The obtained preliminary
povišene koncentracijske razine u odnosu na gor- results show elevated levels of concentration, regar-
nju granicu referentnog intervala ovisno o spolu i u ding to the upper limit of RI depending on gender,
koronarnoj i u nekoronarnoj bolesti te se nalaz hsTnI in coronary and non-coronary disease.Therefore, hs-
mora uvijek razmotriti u kontekstu cjelokupne klinič- TnI level always must be interpreted considering the
ke slike. overall clinical condition.
e-adresa: radeljak.andrea@gmail.com e-mail: radeljak.andrea@gmail.com
J11 J11
Povezanost serumske aktivnosti Relationship between serum chitotriosidase

hitotriozidaze i LDL fenotipa kod pacijenata activity and LDL phenotype in patients with
sa simptomima metaboličkog sindroma developing metabolic syndrome
Martina Horvat, Željka Vogrinc, Milica Trbojević-Čepe Martina Horvat, Željka Vogrinc, Milica Trbojević-Čepe
Uvod: Centralna pretilost, povišeni indeks tjelesne Introduction: Central obesity, increased body mass
mase i krvni tlak, dislipidemija te oštećena tolerancija index, hypertension, impaired glucose tolerance
glukoze su klinički simptomi metaboličkog sindroma and dyslipidemia are factors of metabolic syndro-
koji se povezuje s povećanim rizikom za razvoj ate- me which are associated with increased risk of athe-
roskleroze. Kod takvih pacijenata, prevalencija malih, rosclerosis. In patients with metabolic syndrome,
gustih, aterogenih LDL čestica (fenotip B) učestalija prevalence of atherogenic, small dense low-density
je nego kod zdravih osoba. LDL fenotip B je dodat- lipoprotein (LDL) particles (LDL phenotype B) is fo-
ni faktor kardiovaskularnog rizika dok je fenotip A und more frequently than in healthy individuals. LDL

S138
karakterističan za zdrave osobe. Osim vaskularnog i phenotype B is additional cardiovascular risk factor
metaboličkog, imunološki sustav također ima važnu while phenotype A is typical for healthy individuals.
ulogu u aterosklerotičnim promjenama. Dokazana je Besides vascular and metabolic components, immu-
povišena aktivnost hitotriozidaze koju luče makrofa- ne system also plays important role in atheroscle-
gi u aterosklerotičnim lezijama. Cilj istraživanja bio je rotic lesions. It has been found that chitotriosidase
ispitati aktivnost hitotriozidaze u serumu kod pacije- secreted by macrophages has increased activity in
nata s različitim LDL fenotipovima. Postavljena hipo- atherosclerotic lesions. The aim of this study was to
teza bila je da će među ispitanicima sa simptomima investigate serum chitotriosidase activity in subjects
metaboličkog sindroma osobe s LDL fenotipom B with different LDL phenotypes. Our hypothesis was
imati više vrijednosti aktivnosti hitotriozidaze u seru- that, among subjects with developing metabolic
mu. syndrome, those with LDL phenotype B would pre-
Ispitanici i metode: LDL fenotip i aktivnost hitotrio- sent higher chitotriosidase activity.
zidaze određeni su u serumu 91 ispitanika (22-81 go- Subjects and Methods: LDL phenotype and chito-
dina) koji su imali prisutna barem dva simptoma me- triosidase activity were determined in sera of 91 su-
taboličkog sindroma. LDL fenotip je određen hori- bjects (22-81 years) with at least two factors of me-
zontalnom elektroforezom u gradijentnom poliakri- tabolic syndrome. LDL phenotype was assessed by
lamidnom gelu bez primjene denaturirajućih uvjeta. horizontal electrophoresis in non-denaturing gradi-
Aktivnost hitotriozidaze u serumu izmjerena je flu- ent polyacrylamide gel. Chitotriosidase activity was
orometrijskim određivanjem produkta enzimske hi- determined by measuring enzymatic hydrolysis pro-
drolize, 4-metilumbeliferona. Razlike u aktivnostima duct 4-methylumbelliferone fluorimetrically. Diffe-
hitotriozidaze kod ispitanika s LDL fenotipom A i B rences in chitotriosidase activities between subjects
ispitane su neparametrijskim Mann-Whitney testom. with LDL phenotype A and B were tested using non-
P<0,05 smatrala se statistički značajnom. parametric Mann-Whitney test. P<0.05 was conside-
Rezultati: Medijan serumske aktivnosti hitotriozi- red statistically significant.
daze kod ispitanika s fenotipom A (N=64) iznosio je Results: Serum chitotriosidase activity median in
118 mU/mL (interkvartilni raspon, IKR=82) te kod is- subjects with phenotype A (N=64) was 118 mU/mL
pitanika s fenotipom B (N=27) 179 mU/mL (IKR=161). (IQR=82) and in subjects with phenotype B (N=27) it
Utvrđeno je da je aktivnost hitotriozidaze u serumu was 179 mU/mL (IQR=161). Serum chitotriosidase ac-
ispitanika s fenotipom B statistički viša nego kod is- tivities were statistically higher in LDL phenotype B
pitanika s fenotipom A (P=0,03). in comparison to phenotype A (P=0.03).
Zaključak: Statistički viša aktivnost hitotriozidaze u Conclusion: Significantly higher serum chitotrio-
serumu primijećena kod ispitanika s LDL fenotipom sidase activity detected in subjects with LDL phe-
B u odnosu na LDL fenotip A upućuje na moguću notype B in comparison to LDL phenotype A indica-
povećanu aktivaciju makrofaga te razvijeniju atero- tes possible increased macrophage activation and
sklerozu. Stoga bi serumska hitotriozidaza mogla biti more developed atherosclerotic changes. Therefore,
koristan biljeg u procjeni rizika od ateroskleroze. assessment of chitotriosidase could be a useful mar-
ker for estimation of atherosclerotic risk.
e-adresa: martina.horvat001@gmail.com
e-mail: martina.horvat001@gmail.com

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J12 J12
MakroCK-tip 1 izoenzim - prikaz slučaja MacroCK-type 1 isoenzyme - a case report
Marina Pavić1, Lara Milevoj Kopčinović1, Dragana Šegulja2, Marina Pavić1, Lara Milevoj Kopčinović1, Dragana Šegulja2,
Danica Matišić2 Danica Matišić2
1Klinički zavod za kemiju, Klinički bolnički centar Sestre 1UniversityDepartment of Chemistry, University Hospital
milosrdnice, Zagreb, Hrvatska Centre Sestre Milosrdnice, Zagreb, Croatia
Uvod: Rijetki uzrok visoke aktivnosti enzima krea- Introduction: A rare cause of elevated creatine ki-
tin kinaze (CK) je prisutnost makroenzima (makro- nase (CK) activity is the presence of macroenzymes
CK). Kako povećana aktivnost enzima ne korelira sa (macroCK). MacroCK complicates laboratory results’
kliničkom slikom, prisutnost makroCK može znatno interpretation because elevated enzyme activity
otežati interpretaciju nalaza bolesnika. Cilj ovog rada does not correlate with clinical presentation. Our aim
je prikazati rezultate laboratorijskih nalaza bolesnice was to report a case of macroCK-type 1 isoenzyme.
s dokazanim makroCK-tip 1 izoenzimom. Subjects and Methods: A female patient (58 years)
Ispitanici i metode: Bolesnica (58 godina) je primlje- was admitted to the internal clinic with chest dis-
na u Internističku ambulantu zbog pritiska u grudi- comfort and dizziness. The patients’ history revea-
ma i vrtoglavice. Prema anamnezi je posljednjih mje- led high blood pressure, high fasting and postpran-
seci imala povišen krvni tlak, povišenu glukozu nata- dial glucose in the last few months and dry cough
šte i postprandijalno, a zadnjih nekoliko dana pojavu present for the last few days. Symptoms of gastroe-
suhog kašlja. Prisutni su simptomi gastroezofagalne sophageal reflux disease were also present. An ECG
refluksne bolesti. Učinjen je EKG i uzorkovana krv and venous blood sampling were performed for
za određivanje aktivnosti enzima CK, aspartat-ami- CK, aspartate-aminotransferase (AST), alanine-ami-
notransferaze (AST), alanin-aminotransferaze (ALT), notransferase (ALT), creatine kinase MB isoenzyme
izoenzima kreatin kinaze (CK-MB), kolesterola, trigli- (CK-MB), cholesterol, triglycerides, troponin I (TnI),
cerida, troponina I (TnI), hemoglobina A1c (HbA1c) te hemoglobin A1c (HbA1c) and thyrotropin (TSH) de-
tireotropina (TSH). CK, AST, ALT su određeni prepo- termination. CK, AST, ALT were determined using
ručenim metodama; CK-MB, trigliceridi i kolesterol recommended methods; CK-MB, triglycerides and
metodom suhe kemije; HbA1c, TnI i TSH imunoke- cholesterol using dry-chemistry methods; HbA1c,
mijskim metodama. Prisutnost makroCK utvrđena je TnI and TSH using immunoassays. MacroCK was de-
precipitacijskom metodom uz polietilen glikol (PEG) i termined by polyethylene glycol (PEG) precipitation
elektroforezom na agarozi. followed by agarose electrophoresis.
Rezultati: Po primitku bolesnica je imala povišene Results: Upon admission, the patients’ laboratory
aktivnosti CK=264 U/L, CK- MB=86 U/L, te omjera results were: elevated CK=264 U/L, CK-MB=86 U/L
CK-MB/CK=32%, blago povišene AST=32 U/L, ALT=57 and CK-MB/CK=32%; mildly elevated AST=32 U/L
U/L, te povišene koncentracije HbA1c=54 mmol/mol, and ALT=57 U/L; elevated HbA1c=54 mmol/mol, tri-
triglicerida=2,0 mmol/L, kolesterola=7,8 mmol/L i glycerides=2.0 mmol/L, cholesterol=7.8 mmol/L and
TSH=4,63 mIU/L. TnI je bio negativan (<10 ng/L), TSH=4.63 mIU/L. TnI was negative (<10 ng/L) and
a nalaz EKG-a uredan. Kontrolnim pregledom na- the ECG normal. Repeated laboratory results after 42
kon 42 dana utvrđen je porast enzima (CK=363, CK- days revealed increased enzyme activities (CK=363,
MB=185, CK-MB/CK=51%). Nakon precipitacije PEG- CK-MB=185, CK-MB/CK=51%). After PEG precipita-
om ostatna aktivnost CK-a od 50,2% ukazala je na tion, residual CK activity of 50.2% was indicative
prisutnost makroCK, a elektroforezom je utvrđena of macroCK presence. MacroCK-type 1 isoenzyme
prisutnost makroCK-tip1 (21,1%). (21.1%) was confirmed by electrophoresis.
Zaključak: Povišeni CK, CK-MB, kao i omjer CK-MB/ Conclusion: Elevated CK, CK-MB, and ratio of CK-
CK veći od 25% uz negativan TnI, uredan EKG i nes- MB/CK greater than 25% with negative TnI, normal
pecifične simptome upućuju na moguću prisutnost ECG findings and non-specific symptoms indica-

S140
makroCK u bolesnice. Rano prepoznavanje moguće te the possible presence of macroCK. Early macro-
prisutnosti makroenzima i njegovo dokazivanje važ- CK identification is important for correct diagnosis,
no je kod postavljanja ispravne dijagnoze, pri čemu it contributes to avoiding unnecessary diagnostic
se izbjegava daljnja nepotrebna dijagnostička obra- work-up and additional treatment costs. Since cu-
da i dodatni troškovi liječenja. Budući da su dosadaš- rrent data on macroCK diagnostic significance are
nji klinički podaci o mogućem dijagnostičkom zna- scarce, it is essential to monitor and document this
čenju makroCK vrlo oskudni, bitno ih je pratiti i do- laboratory finding.
kumentirati.
e-mail: marina.pavic@kbcsm.hr
e-adresa: marina.pavic@kbcsm.hr
J13 J13
Nivo proadrenomedulina u ranoj fazi Proadrenomedullin levels in the early phase

septičkog šoka of septic shock
Alessandra Barassi1, Raffaele Pezzilli2, Luca Massaccesi3, Giancarlo Alessandra Barassi1, Raffaele Pezzilli2, Luca Massaccesi3, Giancarlo
Goi3, Angela Leone4, Clara Anna Linda Damele4, Rossana Stefanelli4, Goi3, Angela Leone4, Clara Anna Linda Damele4, Rossana Stefanelli4,
Gian Vico Melzi d’Eril1 Gian Vico Melzi d’Eril1
2Pancreas Unit, Department of Digestive System, Sant’Orsola- 2Pancreas Unit, Department of Digestive System, Sant’Orsola-
Malpighi Hospital, Bologna, Italy Malpighi Hospital, Bologna, Italy

4Lab of Clinical Chemistry, San Paolo Hospital, Milan, Italy 4Lab of Clinical Chemistry, San Paolo Hospital, Milan, Italy
Uvod: Dokazano je kako je proadrenomedulin do- Introduction: It has been shown that proadreno-
bar biljeg koji ukazuje na ozbiljnost septičkog šoka. medullin is a good marker of the severity of sep-
Međutim, ne postoje podatci o ranim promjenama tic shock. However, there are no data on the early
koncentracije proadenomedulina u serumu bolesni- changes in serum proadrenomedullin concentra-
ka s ovom patologijom. tions in patients with this pathology.
Materijali i metode: U istraživanju je praćen dvade- Materials and Methods: Twenty-one patients with
set i jedan bolesnik sa septičkim šokom, a kontrolna septic shock and 21 healthy subjects studied as con-
skupina se sastojala od dvadeset i jednog zdravog trols. Serum concentrations of proadrenomedullin,
ispitanika. Određene su koncentracije proadrenome- procalcitonin, ferritin, CRP and IL-6 were determined
dulina, prokalcitonina, feritina, CRP-a i IL-6 u serumu in all subjects at the initial observation. Patients with
svim ispitanicima kod početnog promatranja. Bole- septic shock were also studied after 24 and 48 hours.
snici sa septičkim šokom također su praćeni i nakon Results: The concentrations of the acute phase pro-
24 i 48 sati. teins were significantly higher in patients with sep-
Rezultati: Tijekom istraživanja koncentracije pro- tic shock than in the control subjects during the en-
teina akutne faze su bile značajno više u bolesni- tire study period (P<0.001). Only procalcitonin sig-
ka sa septičkim šokom nego u kontrolnoj skupini nificantly decreased on the third day of observation
(P<0,001). Prokalcitonin se jedino značajno sma- with respect to both the first day (P=0.002) and the
njio trećeg dana promatranja u odnosu na prvi dan second day (P=0.006). Proadrenomedullin (P=0.017)
(P=0,002) i drugi dan (P=0,006). Proadrenomedulin and IL-6 (P=0.001) showed an AUC significantly dif-
(P=0,017) i IL-6 (P=0,001) pokazali su kako se povr- ferent from the null hypothesis in differentiating the
šina ispod krivulje (AUC) značajno razlikuje od nulte

S141
hipoteze prilikom razlikovanja bolesnika koji su pre- patients who survived and those who did not. The
živjeli i oni koji nisu preživjeli. Za procjenu smrtno- sensitivity and specificity of proadrenomedullin in
sti osjetljivost i specifičnost za proadrenomedulin su the assessment of death were 71.4% and 72.7%, re-
bili 71,4% i 72,7%, dok za IL-6 osjetljivost je bila 92,9% spectively, while IL-6 had a sensitivity of 92.9% and a
i specifičnost 60,6%. specificity of 60.6%.
Zaključak: Proadrenomedulin je pouzdan progno- Conclusion: Proadrenomedullin is a reliable prog-
stički biljeg u bolesnika sa šokom; daljnja istraživanja nostic marker in patients with shock; further studies
na većem broju bolesnika sa septičkim šokom će de- on a more consistent number of septic patients will
finitivno procijeniti može li proadrenomedulin zami- definitively assess whether proadrenomedullin may
jeniti trenutne prognostičke biljege u kritičnih bole- replace the current prognostic markers in critically ill
snika sa šokom nastalim zbog sepse. patients with shock due to sepsis.
e-adresa: alessandra.barassi@unimi.it e-mail: alessandra.barassi@unimi.it
J14 J14
Produkti Plasmodium falciparum utječu Human erythrocyte membrane–bound

na aktivnost glikohidrolaze vezane na glycohydrolases activity is affected by
membranu humanih eritrocita Plasmodium falciparum products
Gian Vico Melzi d’Eril1, Luca Massaccesi2, Giancarlo Goi2, Nadia Papini3, Gian Vico Melzi d’Eril1, Luca Massaccesi2, Giancarlo Goi2, Nadia Papini3,
Silvia Parapini4, Donatella Taramelli4, Angela Leone5, Clara Anna Linda Silvia Parapini4, Donatella Taramelli4, Angela Leone5, Clara Anna Linda
Damele5, Rossana Stefanelli5, Nicoletta Basilico2, Alessandra Barassi1 Damele5, Rossana Stefanelli5, Nicoletta Basilico2, Alessandra Barassi1
3Department of Medical Biotechnology and Translational 3Department of Medical Biotechnology and Translational
Medicine, University of Milan, Milan, Italy Medicine, University of Milan, Milan, Italy
4Department of Pharmacological and Biomolecular Sciences, 4Department of Pharmacological and Biomolecular Sciences,

Uvod: Plasmodium falciparum (Pf) malarija uzrokuje Introduction: Plasmodium falciparum (Pf) malaria
prosječno 600,000 smrti godišnje zbog komplikaci- causes about 600,000 deaths each year because of
ja koje uključuju cerebralnu malariju i tešku anemiju. complications including cerebral malaria and severe
Anemija se javlja kao posljedica parazitom inducira- anemia. Anemia is due to parasite induced hemo-
ne hemolize, diseritropoeze i smanjene deformabil- lysis, diserythropoiesis and reduced deformability,
nosti eritrocita, ubrzanog starenja i uklanjanja nein- accelerated senescence and removal of uninfected
ficiranih eritrocita. Promjene svojstva membrane eri- red blood cells (RBC). Modifications of RBC mem-
trocita mogu se pripisati povećanom oksidativnom brane’s properties can be ascribed to increased oxi-
stresu koji je uzrokovan parazitarnom infekcijom, a dative stress caused by parasite heme products such
uključuje produkte hema kao što su Fe(III)-protopor- as Fe(III)-protoporphyrin IX (hematin) or hemozoin,
firin IX (hematin) ili hemozoin, koji su prisutni u viso- present at high concentration in the plasma of ma-
koj koncentraciji u plazmi pacijenta oboljelih od malaria patients. Several plasma membrane-bound
larije. Utvrđeno je da nekoliko glikohidrolaza vezanih glycohydrolases of human RBC were recognized to
na membranu humanih eritrocita ima ulogu u ranoj have a role in signaling early membrane alterations
fazi patoloških promjena membrane, što ukazuje na both in pathologies suggesting their use as mark-

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mogućnost njihovog određivanja u plazmi kao mar- ers of cellular oxidative stress. The present work was
kera staničnog oksidativnog stresa. Cilj ovog rada aimed to investigate the ability of malaria parasite
bilo je ispitati sposobnost produkta parazita malarije products to alter RBC membrane by affecting glyco-
da promjene svojstva membrane eritrocita utjeca- hydrolases activity.
jem na aktivnost glikohidrolaze. Materials and Methods: RBC from human donors
Materijali i metode: Eritrociti donora inkubirani su were incubated for 24 hours with presence of su-
24 sata u supernatantu dobivenom iz kulture Pf-a, pernatants, derived from Pf cultures, containing
koji je sadržavao produkte hema otpuštenih tijekom heme products released during parasite growth.
rasta parazita. Zatim su eritrociti tretirani sa različitim Then RBC were treated with different concentrations
koncentracijama hematina (20-10-5 µg/ml) ili hemo- of hematin (20-10-5 µg/ml) or hemozoin (10-5-2.5
zoina (10-5-2,5 µg/mL) pročišćenim iz Pf kultura. Ak- µg/mL) purified from Pf cultures. Hexosaminidase,
tivnost heksozaminidaza, β-D- glukuronidaza, α-D- β-D-Glucuronidase, α-D-Glucosidase and acidic Si-
glukozidaza i kisele sijalidaze određene su fluorome- alidase activities were evaluated by fluorimetric as-
trijskom metodom; fluidnost membrane metodom says; membrane fluidity by fluorescence anisotropy
fluorescentne anizotropije. method.
Rezultati: Snižena aktivnost ispitivanih enzima uo- Results: A decrease in the activity of the tested en-
čena je nakon inkubacije eritrocita sa supernatantom zymes was observed after incubation of RBC with
dobivenog iz kultura različitih Pf sojeva. Značajna in- culture supernatants from different Pf strains. More-
hibicija, koja je ovisila o primijenjenoj dozi, uočena je over, a significant dose dependent inhibition was
nakon tretmana sa hematinom ili hemozoinom. Kod observed after treatment with either hematin or he-
primjene najviše doze, hematin je inducirao sniženje mozoin. At the highest dose used, hematin induced
aktivnosti enzima između 66% i 55%. Također je uo- a decrease in the activity of the enzymes between
čeno i sniženje fluidnosti membrane eritrocita nakon 65% and 55%. Likewise a decrease of RBC mem-
tretmana hematinom ili hemozoinom. brane fluidity was observed following treatment
Zaključak: Sniženje aktivnosti glikohidrolaze i po- with hematin or hemozoin.
rast rigidnosti membrane u skladu su sa ubrzanim Conclusion: The decrease of glycohydrolases ac-
starenjem eritrocita, a smatra se i da su hem produk- tivity and the increase in membrane rigidity are in
ti parazita glavni čimbenici koje dovode do ošteće- agreement with accelerated RBC senescence and
nja membrana. the parasite heme products seem to be the main
contributors to these membranes damages.

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J15 J15
Evaluacija koncentracije mijeloperoksidaze Evaluation of plasma myeloperoxidase

u plazmi pacijenta sa erektilnom disfunkcijom in patients with erectile dysfunction of
arteriogenskog i ne-arteriogenskog podrijetla arteriogenic and non-arteriogenic origin
Alessandra Barassi1, Elena Dozio2, Monica Gioia Marazzi2, Elena Alessandra Barassi1, Elena Dozio2, Monica Gioia Marazzi2, Elena
Vianello2, Giovanni Maria Colpi3, Umberto Solimene2,4, Clara Anna Vianello2, Giovanni Maria Colpi3, Umberto Solimene2,4, Clara Anna
Linda Damele5, Angela Leone5, Rossana Stefanelli5, Massimiliano Linda Damele5, Angela Leone5, Rossana Stefanelli5, Massimiliano
Marco Corsi Romanelli2,6, Gian Vico Melzi d’Eril1 Marco Corsi Romanelli2,6, Gian Vico Melzi d’Eril1
1Dipartimento di Scienze della Salute, Università degli Studi di 1Dipartimento di Scienze della Salute, Università degli Studi di
Milano, Milano, Italy Milano, Milano, Italy
2Dipartimento di Scienze Biomediche per la Salute, Cattedra di 2Dipartimento di Scienze Biomediche per la Salute, Cattedra di
Patologia Clinica, Università degli Studi di Milano, Milano, Italy Patologia Clinica, Università degli Studi di Milano, Milano, Italy
3ISES – Istituto per la Sterilità e la Sessualità, Milano, Italy 3ISES – Istituto per la Sterilità e la Sessualità, Milano, Italy
4Centro di Ricerche in Bioclimatologia Medica, Biotecnologie e 4Centro di Ricerche in Bioclimatologia Medica, Biotecnologie e
Medicine Naturali, Università degli Studi di Milano, Milano, Italy Medicine Naturali, Università degli Studi di Milano, Milano, Italy
5Laboratorio di Analisi, Ospedale San Paolo, Milano, Italy 5Laboratorio di Analisi, Ospedale San Paolo, Milano, Italy
6Servizio di Medicina di Laboratorio1-Patologia Clinica, 6Servizio di Medicina di Laboratorio1-Patologia Clinica,
Dipartimento dei Servizi Sanitari di Diagnosi e Cura–Medicina Dipartimento dei Servizi Sanitari di Diagnosi e Cura–Medicina
di Laboratorio, IRCCS Policlinico San Donato, Milano, Italy di Laboratorio, IRCCS Policlinico San Donato, Milano, Italy
Uvod: Disfunkcija endotela i remećenje signalnog Introduction: Endothelial dysfunction and the dis-
puta dušikov oksid- ciklički gvanozin monofosfat ruption of the nitric oxide-cyclic guanosine mo-
(cGMP) smatraju se ranim mehanizmima koji dovode nophosphate (cGMP) pathway have been consid-
do razvoja erektilne disfunkcije (ED). Enzim mijelo- ered the early mechanisms for the development of
peroksidaza (MPO) spada u skupinu hemoproteina i erectile dysfunction (ED). Myeloperoxidase (MPO),
primarno je oslobađaju aktivirani neutrofila i monoc- a heme-containing enzyme mainly released by ac-
iti. Sudjelujući u oksidaciji različitih supstrata smatra tivated neutrophils and monocytes, may contrib-
se da pridonosi razvoju disfunkcije endotela te na taj ute to endothelial dysfunction by promoting oxida-
način i razvoju ED. Koncentracija MPO i njezina kore- tion of different substrates and thus may play a role
lacija sa različitim plazmatskim biomarkerima endo- in ED. MPO level and its correlation with different
telne disfunkcije određeni su u uzorcima pacijenata plasma biomarkers of endothelial dysfunction were
sa ED arteriogenskog (A-ED) i ne-arteriogenskog po- studied in patient with ED of arteriogenic (A-ED) and
drijetla (NA-ED) sa ciljem utvrđivanja razlike između non-arteriogenic (NA-ED) to assess potential differ-
ispitivanih skupina. ences between the two ED subgroups.
Materijali i metode: Dijagnoza ED postavljena je Materials and Methods: Diagnosis of ED was based
primjenom Internacionalnog Indeksa Erektilne Funk- on the International Index of Erectile Function Score.
cije, a etiologija primjenom color doplera penilnih Its etiology was classified with penile echo-color
arterija prije i nakon intrakavernozne injekcije pros- Doppler at baseline and after intracavernous injec-
taglandina E1. Koncentracija MPO, cGMP, ICAM-1, tion of prostaglandin E1. MPO, soluble(s) cGMP, sI-
VCAM-1 i P-selektina u plazmi određena je enzim- CAM-1, sVCAM-1 and sP-Selectin were measured by
imunokemijskom metodom. enzyme-linked immunosorbent assay.
Rezultati: Prilikom usporedbe, koncentracija MPO Results: MPO concentration in A-ED was signifi-
u skupini pacijenta s A-ED bila je značajno viša u cantly higher compared to control subjects and NA-
odnosu na kontrolnu skupinu i skupinu pacijenata ED patients (P<0.05). Plasmatic cGMP level resulted
s NA-ED (P<0,05). Koncentracija cGMP bila je niža lower both in A-ED and in NA-ED patients, whereas
u A-ED i u NA-ED skupini pacijenta, ali nije uočena no difference has been observed between the two
razlika između dvije grupe pacijenta s ED-om. Kon- ED groups. sICAM-1 concentration resulted higher
centracija ICAM-1 bila je viša u A-ED grupi u odnosu in A-ED compared both to controls and NA-ED. sV-

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na NA-ED i kontrolnu skupinu. Koncentracija VCAM- CAM-1 level was the same in controls, A-ED and
1 bila je jednaka u kontrolnoj, A-ED i NA-ED skupini. NA-ED patients. sP-Selectin concentration resulted
Koncentracija P-selektina bila je viša u A-ED i u NA- higher both in A-ED and in NA-ED patients than in
ED skupini u odnosu na kontrolnu, ali nije uočena controls, whereas no difference has been observed
razlika između dvije ED skupine. Korelacijskom anal- between the two ED groups. Correlation analysis
izom dokazana je pozitivna korelacija između kon- indicated a positive correlation between plasmatic
centracije MPO, ICAM-1 i P-selektina u plazmi. MPO, sICAM-1 and sP-Selectin levels.
Zaključak: MPO čini važnu poveznicu između pro- Conclusion: MPO may represent an important link
cesa oksidacije, upale i kardiovaskularnih bolesti, ali between oxidation, inflammation and cardiovas-
predstavlja i potencijalni biomarker za razlikovanje cular diseases and may also represent a potential
dviju podskupina pacijenata sa ED-om. Kod paci- marker to distinguish between the two subgroups
jenta s ED-om, koncentracija cGMP-a mogla bi of ED patients. Moreover, in ED subjects circulating
odražavati lokalnu disfunkciju u procesu signalnog cGMP may reflect the local signaling dysfunction.
prijenosa. Primjena cGMP-a kao potencijalnog mar- The use cGMP as a potential marker for monitoring
kera u praćenju bolesti zahtjeva daljnje istraživanje. the disease needs further investigation.
e-adresa: alessandra.barassi@unimi.it e-mail: alessandra.barassi@unimi.it
J16 J16
Rane razine retinol-vezujućeg proteina su Early retinol-binding protein levels are

povezane s promjenama rasta u djece čije su associated with growth changes in infants
majke imale gestacijsku šećernu bolest born to diabetic mothers
Gian Vico Melzi d’Eril1, Gaia Francescato2, Massimo Agosti2, Luca Gian Vico Melzi d’Eril1, Gaia Francescato2, Massimo Agosti2, Luca
Massaccesi3, Giancarlo Goi3, Clara Anna Linda Damele4, Angela Leone4, Massaccesi3, Giancarlo Goi3, Clara Anna Linda Damele4, Angela Leone4,
Rossana Stefanelli4, Carlo Agostoni5, Alessandra Barassi1 Rossana Stefanelli4, Carlo Agostoni5, Alessandra Barassi1
2Neonatology and NICU, Maternal and Child Department, 2Neonatology and NICU, Maternal and Child Department,
Filippo Del Ponte Hospital, Varese, Italy Filippo Del Ponte Hospital, Varese, Italy

5Department of Clinical Sciences and Community Health, 5Department of Clinical Sciences and Community Health,
Uvod: Trenutno ne postoje biokemijski predskaza- Introduction: Biochemical predictors of infants’

telji promjene rasta kod djece. Istražili smo da li su growth changes are not available. We tested wheth-
retinol-vezujući protein (RBP), dokozaheksaenska ki- er retinol-binding protein (RBP), docosahexaenoic
selina i inzulin (I), mjereni unutar 72 sata od rođenja acid and insulin (I) measured within 72 h from birth
povezani s promjenama rasta u djece čije su majke are associated with growth changes in infants born
imale gestacijsku šećernu bolest (GDM). to mothers with gestational diabetes mellitus (GDM).
Materijali i metode: 56 djece od kojih je 32 čije su Materials and Methods: Fifty six children, 32 born
majke liječene inzulinom (GDM-I) i 24 čije su majke to diabetic mothers treated with insulin (GDM-I) and
liječene posebnom prehranom (GDM-D), procijenje- 24 born to diabetic mothers treated with diet (GDM-
no je u razdoblju od 0, 1, 3, 6 i 12 mjeseci života. D), were evaluated at 0, 1, 3, 6 and 12 months of life.
Rezultati: Multivarijatnom regresijskom analizom uz Results: At multivariable regression performed us-
primjenu generaliziranih procjenjujućih jednadžbi ing generalized estimating equations, early RBP lev-

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utvrđeno je kako su rane koncentracije RBP i indeks els and maternal body mass index were associated
tjelesne mase majki povezani s prosječnim promje- to average weight changes and early RBP and insulin
nama težine dok su rane koncentracije RBP i koncen- levels to average length changes, respectively. There
tracije inzulina povezane s prosječnim promjenama was no difference between GDM-I and GDM-D in-
dužine. Nije bilo razlika između GDM-I i GDM-D dje- fants.
ce. Conclusion: This exploratory study suggests that
Zaključak: Rezultati ovog istraživanja ukazuju da early RBP levels may be a predictor of growth chang-
rane koncentracije RBP-a mogu biti predskazatelji es.
promjena rasta.
J17 (Usmeno izlaganje) J17 (Oral presentation)
Monoklonska gamapatija otkrivena pri Monoclonal gammophaty as an accidental

pretraživanju na oligoklonski IgG tijekom finding on CSF isoelectric focusing
dijagnostičke obrade multiple skleroze for oligoclonal IgG used as part of the
diagnostic workup for multiple sclerosis
Ines Vukasović1, Andrea Tešija Kuna1, Vanja Bašić Kes2, Ines Vukasović1, Andrea Tešija Kuna1, Vanja Bašić Kes2,
Dubravka Čaržavec3, Nada Vrkić1, Dubravka Čaržavec3, Nada Vrkić1,
1Kliničkizavod za kemiju, Klinički bolnički centar Sestre 1University Department of Chemistry, University Hospital
Milosrdnice, Zagreb, Hrvatska Centre Sestre milosrdnice, Zagreb, Croatia
2Klinika za neurologiju, Klinički bolnički centar Sestre 2University Department of Neurology, University Hospital

3Klinika za unutarnje bolesti, Klinički bolnički centar Sestre 3University Department of Internal diseases, University Hospital
Uvod: Prikazati tri slučaja monoklonske gamapatije Introduction: We aimed to present three cases of
(MG) otkrivene pri pretraživanju na oligoklonski IgG monoclonal gammopathy (MG) unexpectedly fo-
(OIgG) tijekom dijagnostičke obrade multiple sklero- und on CSF isoelectric focusing for oligoclonal IgG
ze (MS). (OIgG) carried out as a part of multiple sclerosis (MS)
Ispitanici i metode: Izoelektričnim fokusiranjem diagnostic workup.
(IEF) parnih uzoraka likvora i seruma na agaroznom Subjects and Methods: In the period from March
gelu uz imunofiksaciju (IF) s anti-IgG antitijelom (Se- 1st 2014 to March 1st 2015, isoelectric focusing (IEF)
bia poluautomatski sustav za elektroforezu), u svrhu on agarose gel followed by immunofixation for IgG
dokazivanja OIgG, obrađeno je 240 ispitanika s neu- of paired liquor and serum samples from 240 pati-
rološkim smetnjama koje se mogu pripisati MS tije- ents presented with symptoms corresponding to
kom razdoblja od 1. ožujka 2014. do 1. ožujka 2015. MS were performed using Sebia semiautomated
Bolesnicima s tipom 5 (monoklonski IgG u likvoru i electrophoresis system. Serum samples of patients
serumu) načinjena je dodatno u serumu kvantifika- for whom type 5 pattern (monoclonal IgG bands in
cija IgG, IgA, IgM (imunoturbidimetrija, Architect- CSF and serum) was found on IEF were further su-
c8000, Abbott) i imunofiksacija (Sebia). Bolesnicima s bjected to immunofixation (Sebia) and IgG, IgA,
pozitivnim OIgG tip 2 i tip 3, određen je dodatno i in- IgM quantification (immunoturbidimetry, Architect-
deks specifičnih antitijela (ASI) na neurotropne viru- c8000, Abbott). In patients with positive OIgG, anti-
se (ospice, rubeola, varičela zoster i herpes simpleks). body specificity index (ASI) for neurothropic viruses
Rezultati: Od 240 obrađenih bolesnika na OIgG (Ž/ (Morbilli, Rubella, Varicella Zoster, Herpes simplex)
M=166/74; dob 40.2±15.3), tip 5 je nađen u 3 bole- were assesed.

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snika (Ž/M=2/1). U 2 bolesnika je uz tip 5 dokazan i Results: Out of 240 patients (F/M=166/74; age
tip 3 OIgG što upućuje i na intratekalnu sintezu IgG 40.2±15.3), type 5 pattern on paired serum/CSF
uz monoklonski IgG. Imunofiksacijom seruma po- IEF was found in three patients (F/M=2/1), in two
tvrđen je monoklonski IgG-kappa tipa u dva, a mo- of them in addition with type 3 pattern (indicating
noklonski IgG-lambda u jednog bolesnika. Bolesnici- intrathecal IgG synthesis). Monoclonal IgG-kappa
ma s istovremenom pojavnošću tipova 5 i 3 nađene was found in two and monoclonal IgG-lambda in
su i demijelinizacijske promjene primjenom slikovne one patient. In patients with 3 and 5 OIgG patterns,
tehnike magnetske rezonancije (MRI) te pozitivan demyelinization on magnetic resonance imaging
ASI na neurotropne viruse što podupire istovreme- (MRI) together with antibody specificity index (ASI)
no postojanje MS uz multipli mijelom (MM) u jednog for neurothropic viruses supported the MS diagnosis
bolesnika, te MS i monoklonske gamapatije neodre- in coexistence with multiple myeloma (MM) in one
đene značajnosti (MGUS) u drugog. Trećem ispitani- and monoclonal gammopathy of undetermined si-
ku potvrđen je MGUS, a isključena MS. gnificance (MGUS) in other patient. In third patient
Zaključak: Vrlo rijetko je demijelinizacijska bolest MGUS was diagnosed and MS excluded.
udružena s MG (najčešće MGUS-om) te su suprot- Conclusion: Coexistence of demyelinization disease
stavljeni stavovi o potrebi izvještavanja nalaza tipa 5. and MG (mainly MGUS) has been reported as extre-
Neki stručnjaci smatraju da se nepotrebno uznemi- mely rare with controverses about reporting of type
rava pacijent i povećavaju troškovi dodatnim ispiti- 5 OIgG pattern with intention to avoid anxiety and
vanjima upitnog kliničkog značaja. Naši rezultati pak, unnecessary examination. Our data stressed out the
naglašavaju važnost provedbe dodatnih ispitivanja importance of performing the additional examina-
za razlikovanje MM i MGUS-a kako bi se odmah za- tions for distinguishing MM and MGUS in order to
počelo s terapijom ili donijela odluka o potrebi pra- apply therapy immediately or just follow up the pa-
ćenja pacijenta. tient.
e-adresa: ines.vukasovic@gmail.com e-mail: ines.vukasovic@gmail.com
J18 J18
Nevjerojatna kritična vrijednost – prikaz Unbelievably critical value – case report

slučaja
Gordana Tkalec, Lidija Ivković, Bojana Kranjčec Gordana Tkalec, Lidija Ivković, Bojana Kranjčec
Medicinsko biokemijski laboratorij, Opća bolnica Zabok i Medical Biochemistry Laboratory, General Hospital Zabok and
Uvod: Prema preporukama HKMB potrebno je pra- Introduction: According to HKMB guidelines it is
vodobno i neizostavno izvještavati liječnika o kritič- necessary to send an immediate report to the doc-
nim vrijednostima laboratorijskih pretraga opasnim tor who is responsible for the patient if there is a crit-
po život bolesnika. Za koncentraciju glukoze u seru- ical value in laboratories analysis that is life threat-
mu kritična vrijednost je manja od 2,5 i viša od 27,8 ening for the patients. For glucose critical levels in
mmol/L. Kod dobivene vrijednosti koncentracije glu- serum are below 2.5 and higher than 27.8 mmol/L.
koze u serumu od 101,4 mmol/L prvo se pomislilo na When we acquired a result of 101.4 mmol/L, our first
predanalitičku grešku kontaminaciju uzorka infuzij- thought was to assign it to preanalytical error by
skom otopinom. contamination of the sample with i.v. fluid.
Ispitanici i metode: Pacijent star 56 god. primljen je Subjects and Methods: Patient (56y) was admit-
u Objedinjeni hitni prijem OB Zabok i bolnice hrvat- ted to emergency room in General Hospital Zabok
skih veterana u teškom stanju. Pri primitku od labo- in severe condition. Laboratory analyses as ordered

S147
ratorijskih nalaza tražena je KKS, analiza pH i plinova were: complete blood count, pH analyses, gas anal-
u krvi, PV, glukoza, ureja, kreatinin, ukupni bilirubin, yses, prothrombin time, glucose, creatinine, BUN,
Na, K, AST, ALT, GGT, AP, CK, CK-MB, Troponin I, D-di- total bilirubin, potassium, sodium, AST, ALT, GGT,
meri, CRP, etilni alkohol i pretraga mokraće. Pacijent AP, CK, CK-MB, Troponin I, D-dimer, C-reactive pro-
je zaprimljen u Odjel intenzivnog liječenja gdje je tein, ethyl alcohol and urine analysis. Patient was
kroz nekoliko dana praćen, uzastopno je određivana transferred to the intensive care unit where he was
glukoza, ureja, kreatinin, pH, plinovi u krvi, Na i K da closely monitored by analysing blood glucose lev-
bi za nekoliko dana pacijent bio premješten u drugu els, BUN, creatinine, pH and gas analysis. After a few
bolnicu radi potrebe za dijalizom. days the patient was transferred to another hospital
Rezultati: Laboratorijski nalazi pacijenta pri primit- because the need for dialysis.
ku upućivali su na hiperosmolarnu komu, hemokon- Results: Laboratory results were pointing to hyper-
centraciju te oslabljenu funkciju bubrega. Početna osmolar coma, hemoconcentration and impairment
koncentracija glukoze od 101,4 mmol/L odmah je of the kidney function. First laboratory results were
javljena liječniku kao vrijednost viša od 40 mmol/L, reported to the doctor in charge as a value of glu-
a nakon dilucije javljena je točna kritična vrijednost. cose greater than 40 mmol/L and after dilution and
Uzastopnim određivanjem kroz nekoliko sati i dana repeated analysis an accurate value was reported.
dobivene su vrijednosti glukoze od 93,0 mmol/L, 74,9 Consecutive analysis in the next hours and days
mmol/L, 59,3 mmol/L, 53,3 mmol/L, 41,4 mmol/L, 30,9 had the results of 93.0 mmol/L, 74.9 mmol/L, 59.3
mmol/L, 18,4 mmol/L, 12,5 mmol/L te 4,7 mmol/L. mmol/L, 53.3 mmol/L, 41.4 mmol/L, 30.9 mmol/L,
Zaključak: Iz dobivenih vrijednosti koncentraci- 18.4 mmol/L, 12.5 mmol/L and 4.7 mmol/L.
je glukoze kroz nekoliko sati i dana vidljivo je da je Conclusion: From the values acquired in that period
početna kritična vrijednot glukoze od 101,4 mmol/L of time it is clear that the first result of 101.4 mmol/L
bila točna iako je početno postavljena sumnja da se was accurate although we had doubts about the
radi o predanalitičkoj pogrešci. O svakoj kritičnoj vri- already mentioned preanalytical error. The doc-
jednosti potrebno je što prije obavijestiti liječnika. tor we were communicating with wrote in the pa-
Liječnik koji je obaviješten o kritičnoj vrijednosti glu- tients charts “lab reported glucose level above 40
koze prihvatio je tu informaciju i u nalazu pri primit- mmol/L”.
ku napisao „iz lab. je javljeno da je GUK preko 40“.
e-mail: laboratorij.voditelj@bolnica-zabok.hr
e-adresa: laboratorij.voditelj@bolnica-zabok.hr
J19 J19
Značajnost mjerenja koncentracije Significance of measuring amino

aminokiselina metodom tandemske acid concentrations on tandem mass
spektrometrije masa u dijagnostici i praćenju spectrometer in diagnosing and follow-up
liječenja argininosukcinične acidurije treatment of argininosuccinic aciduria
Ana Škaričić1, Marija Zekušić1, Ksenija Fumić1, Karmen Bilić1, Ana Škaričić1, Marija Zekušić1, Ksenija Fumić1, Karmen Bilić1,
Dunja Rogić1, Johannes Häberle2, Danijela Petković-Ramadža3, Dunja Rogić1, Johannes Häberle2, Danijela Petković-Ramadža3,
Vladimir Sarnavka3, Ivo Barić3,4 Vladimir Sarnavka3, Ivo Barić3,4
1Kliničkizavod za laboratorijsku dijagnostiku Kliničkoga 1Department of Laboratory Diagnostics, University Hospital
bolničkog centra Zagreb i Medicinskog Centre Zagreb, Zagreb, Croatia
fakulteta Sveučilišta u Zagrebu, Zagreb, Hrvatska 2Division of Metabolism, University Children’s Hospital Zürich,
2Division of Metabolism, University Children’s Hospital Zürich, Zürich, Switzerland
Zürich,Switzerland 3Department of Pediatrics, University Hospital Centre Zagreb,
3Klinika za pedijatriju, Klinički bolnički centar Zagreb, Zagreb, Zagreb, Croatia
Hrvatska 4University of Zagreb School of Medicine, Zagreb, Croatia
4Medicinski fakultet Sveučilišta u Zagrebu, Hrvatska

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Uvod: Argininosukcinična acidurija (ASA) je autoso- Introduction: Argininosuccinic aciduria (ASA) is an

mno recesivna aminoacidopatija prouzročena manj- autosomal recessive aminoacidopathy caused by
kom enzima iz ciklusa ureje argininosukcinat-liaze deficiency of the urea cycle enzyme argininosucci-
(ASL) koji cijepa argininosukciničnu kiselinu na argi- nate lyase (ASL) that cleaves the argininosuccinic
nin i fumarat. Bolest se očituje u dojenačkoj dobi s acid to arginine and fumarate. The disease presents
izrazitom hiperamonijemijom i kliničkim manifesta- in infancy with extreme hyperammonemia and cli-
cijama koje uključuju letargiju, somnolentnost, gubi- nical symptoms including lethargy, somnolence,
tak apetita, povraćanje, tahipneju, respiracijsku alka- appetite loss, vomiting, tachypnea, respiratory alka-
lozu i progresivnu encefalopatiju. Kako je hiperamo- losis and progressive encephalopathy. Since hype-
nijemija stanje koje zahtijeva hitan terapijski pristup, rammonemia is a condition that requires urgent the-
za pravovremenu dijagnozu nužno je prepoznati rapeutic approach, it is necessary for timely diagno-
manjkavi enzim iz ciklusa ureje mjerenjem koncen- sis to identify the deficient enzyme of the urea cycle
tracija aminokiselina u plazmi i urinu. by measuring the concentration of amino acids in
Ispitanici i metode: Muško novorođenče s hipera- plasma and urine.
monijemijom nepoznate etiologije. Aminokiseline su Subjects and Methods: A male infant with hype-
kvantificirane metodom tandemske spektrometrije rammonemia of unknown etiology. Amino acids
masa udružene s tekućinskom kromatografijom vi- were quantified by tandem mass spectrometry cou-
soke djelotvornosti (API 3200, tvrtka AB Sciex; UPLC pled with high performance liquid chromatography
Nexera, tvrtka Shimadzu) uz primjenu reagensa (API 3200, AB Sciex; UPLC Nexera, Shimadzu) using
aTRAQ™ tvrtke AB Sciex. Navedenom metodom mo- aTRAQ™ reagent (AB Sciex). Method allows simul-
guće je istovremeno kvantificirati 45 aminokiselina u taneous quantification of 45 amino acids in plasma
plazmi uz interne standarde poznatih koncentracija using internal standards for each amino acid. All co-
za svaku aminokiselinu. Analizirane su i sve kodiraju- ding regions of the ASL gene were analyzed in co-
će regije gena za ASL u suradnom inozemnom cen- llaborative international center University Children’s
tru University Children’s Hospital u Zürichu, Švicar- Hospital in Zürich, Switzerland.
ska. Results: Besides extreme hyperammonemia (1047
Rezultati: Uz prisutnu izrazitu hiperamonijemiju µmol/L, N 24-48 µmol/L), plasma amino acid analysis
(1047 µmol/L, N 24-48 µmol/L), u nalazu aminokise- showed high levels of citrulline (415 µmol/L, N
lina u plazmi nađene su izrazito povišene koncentra- 9-35 µmol/L) and argininosuccinate (1308 µmol/L),
cije citrulina (415 µmol/L, N 9-35 µmol/L) i arginino- which is not present in healthy individuals. Argini-
sukcinične kiseline (1308 µmol/L) koja se ne nalazi u ne concentration was borderline low (18 µmol/L,
zdravih ljudi. Koncentracija arginina bila je granično N 6-130 µmol/L). Based on these findings, the di-
niska (18 µmol/L, N 6-130 µmol/L). Na osnovu ovog agnosis of argininosuccinic aciduria was establis-
nalaza postavljena je dijagnoza argininosukcinične hed. In accordance with the diagnosis, molecular
acidurije. U skladu s postavljenom dijagnozom na- genetic investigation identified non-sense muta-
đeno je da je pacijent homozigot za još neopisanu tion c.1128C>A p.(Tyr376*) in the ASL gene in a ho-
besmislenu (engl. non-sense) mutaciju c.1128C>A mozygous state that has not been described so far.
p.(Tyr376*) u genu za ASL. Conclusion: Measurement of the concentration of
Zaključak: Mjerenje koncentracije aminokiselina amino acids using tandem mass spectrometry is
metodom tandemske spektrometrije masa nužno necessary in all conditions with hyperammonemia
je kod svih stanja s hiperamonijemijom nepoznatog of unknown etiology, particularly in the differential
uzroka, a osobito u diferencijalnoj dijagnostici pore- diagnosis of urea cycle disorders. It is also of great
mećaja ciklusa ureje. Također je u dijagnosticiranih importance to continuously measure ammonia and
bolesnika nužno uz amonijak mjeriti i aminokiseline amino acid levels in plasma and urine as part of tre-
u plazmi i urinu kao jedan od parametara pri praće- atment monitoring in patients with confirmed dia-
nju uspješnosti liječenja. gnoses.
e-adresa: askaricic@yahoo.com e-mail: askaricic@yahoo.com

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J20 J20
Optimizacija metode za određivanje Optimization of the method for

katalitičke aktivnosti ekto-ATPaze u determination of the catalytic activity of
ljudskom serumu ecto-ATPase in human serum
Anita Somborac Bačura1, Karmela Barišić1, Monika Janković1, Anita Somborac Bačura1, Karmela Barišić1, Monika Janković1,
Diana Salem1, Ognjen Čulić2, Tihana Žanić Grubišić1 Diana Salem1, Ognjen Čulić2, Tihana Žanić Grubišić1
1Zavod za medicinsku biokemiju i hematologiju, Farmaceutsko- 1Department of Medical Biochemistry and Hematology, Faculty
biokemijski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska of Pharmacy and Biochemistry, University of Zagreb, Zagreb,
2Farmaceutsko-biokemijski fakultet Sveučilišta u Zagrebu, Croatia
Zagreb, Hrvatska 2Faculty of Pharmacy and Biochemistry, University of Zagreb,
Zagreb, Croatia
Uvod: Ekto-ATPaze su transmembranski enzimi koji Introduction: Ecto-ATPases are transmembrane

sudjeluju u hidrolizi izvanstaničnog ATP-a i ADP- enzymes involved in hydrolysis of extracellular
a. Izvanstanični ATP te drugi nukleotidi i nukleozidi ATP and ADP. Extracellular ATP and other nucleo-
su važne signalne molekule koje reguliraju različite tides and nucleosides are important signaling mol-
učinke u gotovo svim tkivima: kontraktilnost glatkih ecules that regulate a variety of effects in almost
mišića, vaskularni tonus, imunosni odgovor, nocicep- all tissues: smooth muscles contractility, vascular
ciju, neurotransmisiju, embrionalni razvitak, hemo- tone, immune response, nociception, neurotrans-
stazu. Osim membranski vezanih oblika enzima, u mission, embryonic development, hemostasis. In
tjelesnim tekućinama poput seruma mogu se prona- addition to the membrane bound form of the en-
ći i topljivi, enzimski aktivni oblici ekto-ATPaze. Po- zyme, soluble active forms of ecto-ATPase may be
remećena regulacija ekto-ATPaze sudjeluje u pato- found in body fluids such as serum. Dysregulation
genezi raznih oboljenja kao što su degenerativni ne- of ecto-ATPase participates in pathogenesis of vari-
urološki odgovor, akutna upala, rast tumora i meta- ous diseases (degenerative neurological response,
staziranje. Stoga je selektivna inhibicija te regulacija acute inflammation, tumor growth and metasta-
ekto-ATPaze jedno novo znanstveno područje koje sis). Therefore, selective inhibition and regulation of
se trenutno istražuje s velikim zanimanjem. Cilj ovog ecto-ATPase is a new scientific field currently being
rada bio je optimirati uvjete određivanja katalitičke explored with great interest. The aim of this study
aktivnosti ekto-ATPaze u ljudskom serumu. was to optimize conditions for determination of the
Materijali i metode: Određivanje katalitičke aktiv- catalytic activity of ecto-ATPase in human serum.
nosti ekto-ATPaze u ljudskom serumu provedeno je Materials and Methods: The catalytic activity of ec-
uz upotrebu ATP-a kao supstrata. U indikatorskoj re- to-ATPase in human serum was measured using the
akciji mjerena je količina oslobođenog anorganskog ATP as a substrate. The amount of released inorganic
fosfata spektrofotometrijskom metodom, s amoni- phosphate was measured using the spectrophoto-
jevim heptamolibdatom i askorbinskom kiselinom metric method, with ammonium heptamolybdate
kao reducensom, na 620 nm. Za optimiranje uvjeta and ascorbic acid as a reducing agent, at 620 nm.
korišten je ‘’pool’’ serum te je određena katalitička ‘’Pool’’ serum was used for optimization of reaction
aktivnost ekto-ATPaze u 20 uzoraka zdravih osoba. conditions, and catalytic activity of ecto-ATPase was
Statistička analiza provedena je upotrebom Sigma- determined in 20 healthy individuals. Statistical anal-
Stat programa. ysis was performed using the SigmaStat program.
Rezultati: Optimiranjem uvjeta postignuta je zado- Results: The satisfactory enzyme activity at 37°C
voljavajuća aktivnost enzima na 37°C uz 50 mmol/L was obtained with 50 mmol/L HEPES-Tris buf-
HEPES-Tris pufer, pH 7,2 koji je sadržavao 5 mmol/L fer, pH 7.2, containing 5 mmol/L CaCl2 and 3
CaCl2 i 3 mmol/L ATP, dok je zaustavljanje reakcije mmol/L ATP, whereas the reaction was stopped
izvršeno uz 3 mol/L trikloroctenu kiselinu. Nepreci- with 3 mol/L trichloroacetic acid. Within-run im-
znost unutar serije određena je korištenjem ‘’pool’’ precision was determined using the ‘’pool’’ se-

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seruma (N=10; 89,2±19,2 nmol/mL/hr; KV=21,5%). Iz- rum (N=10; 89.2±19.2 nmol/ml/hr; CV=21.5%). The
mjerena katalitička aktivnost ekto-ATPaze u 20 uzo- catalytic activity of ecto-ATPase measured in 20
raka zdravih osoba iznosila je 63,7 (29,6-100,1) nmol/ healthy subjects was 63.7 (29.6-100.1) nmol/ml/hr.
mL/hr. Conclusion: In this work conditions for determina-
Zaključak: U ovom radu optimirani su uvjeti određi- tion of the catalytic activity of ecto-ATPase in hu-
vanja katalitičke aktivnosti ekto-ATPaze u ljudskom man serum were optimized, which is the basis for
serumu, što je osnova za daljnje istraživanje ekto-AT- further research of ecto-ATPase in pathogenesis of
Paze u patogenezi raznih bolesti. various diseases.
e-adresa: kbarisic@pharma.hr e-mail: kbarisic@pharma.hr
J21 J21
Određivanje makroprolaktina taloženjem s The detection of macroprolactin by

polietilen glikolom polyethylen glycol precipitation method
Iva Lukić, Tihana Pavošević, Vesna Horvat, Sanja Mandić, Iva Lukić, Tihana Pavošević, Vesna Horvat, Sanja Mandić,
Uvod: Prolaktin je u serumu prisutan u nekoliko mo- Introduction: Prolactin exists in human blood in
lekularnih oblika te povremeno može tvoriti makro- several molecular forms and can form a macromo-
molekularne komplekse. Makroprolaktin je moleku- lecular complex. Macroprolactin is a product of mo-
la koja nastaje povezivanjem monomera prolaktina nomeric prolactin and imunoglobulin G association.
i imunoglubulina G. Makroprolaktin, u određenoj While macroprolactin retains immunoreactivity to a
mjeri, zadržava imunoreaktivnost kod svih imunoke- certain extent in all prolactin immunoassays, it has
mijskih testova, ali ne posjeduje gotovo nikakvu bio- almost no biological activity in vivo and therefore its
lošku aktivnost in vivo te se njegova prisutnost sma- presence is considered clinically irrelevant. The aim
tra klinički beznačajnom. Cilj ovog istraživanja bilo je of this study was to perform screening procedures,
izvođenje postupka probira na makroprolaktin, talo- using polyethylen glycol (PEG) precipitation meth-
ženjem s polietilen glikolom (PEG), kako bi se osigu- od, to ensure routine detection of macroprolactin.
ralo njegovo rutinsko otkrivanje. Materials and Methods: In a five month period
Materijali i metode: Tijekom 5 mjeseci prikupili smo we collected 29 serum samples with elevated pro-
29 uzoraka seruma s povišenim koncentracijama lactin concentration (≥700 mIU/L). To evaluate the
prolaktina (≥700 mIU/L). Za procjenu koncentracije
prolactin concentrations and rate of recovery in the
i udjela prolaktina u supernatantu, taloženje PEG-
supernatant, the PEG precipitation test according to
om provedeno je u svim uzorcima seruma u skladu s
the method proposed by Olukoga and Kane (1999)
postupkom kojega su opisali Olukoga i Kane (1999.).
was performed on all serum samples. Initial pro-
Početne koncentracije prolaktina i koncentracije na-
lactin and post-PEG prolactin concentrations were
kon taloženja PEG-om mjerene su CMIA metodom
(Architect i1000SR, Abbott). U skladu s literaturom, measured using CMIA (Architect i1000SR, Abbott).
uzorci u ovoj studiji smatrani su pozitivnima na pri- In accordance with most literature data, samples in
sutnost makroprolaktina ako je udio prolaktina na- this study were considered positive for macroprolac-
kon taloženja PEG-om <40%. Uzorci s udjelom pro- tinemia if recovery rate of prolactin was <40%. Re-
laktina >65% smatrani su pretežnom monomernim coveries of >65% were classified as predominantly
oblikom prolaktina, a uzorci s vrijednostima 40-65% monomeric and values between 40% and 65% were
klasificirani su kao nejasni. classified as ambiguous.

S151
Rezultati: Koristeći granicu od 40% za taloženje Results: Using the 40% limit for PEG precipitation,
PEG-om, hiperprolaktinemija se može pripisati ma- hyperprolactinemia was found to be attributed to
kroprolaktinu kod 11 (38%) od 29 pacijenata. Značaj- macroprolactin in 11 (38%) of 29 hyperprolactinemic
no povišene koncentracije prolaktina (≥700 mIU/L) patients. Significantly increased concentrations of
bile su prisutne u 15 (52%) slučajeva. Nadalje, kod prolactin (defined as ≥700 mIU/L) were found in 15
3 uzorka je udio prolaktina nakon taloženja bio 40- (52%) cases. Furthermore, 3 samples showed PEG
65% te su rezultati smatrani nejasnima te bi se uzorci recoveries between 40-65% and should be classi-
trebali podvrgnuti gel-filtracijskoj kromatografiji za fied as indeterminate and be subject to gel-filtration
potvrdu konačne dijagnoze. Serumske vrijednosti chromatography for a definitive diagnosis. Serum
prolaktina kretale su se u rasponu 700-1900 mIU/L. prolactin levels ranged from 700-1900 mIU/L.
Zaključak: Budući da je makroprolaktin jedan od Conclusion: Being one of the major causes of appar-
glavnih uzroka prividne hiperprolaktinemije, probir ent hyperprolactinemia, screening for macroprolac-
na makroprolaktin trebao bi biti uključen u rutinsko tin should be included in the routine management
ispitivanje svih pacijenata s hiperprolaktinemijom of all hyperprolactinemic patients to prevent mis-
kako bi se izbjegle pogrešne dijagnoze, prekomjer- diagnosis, amplification of laboratory testing and
na laboratorijska ispitivanja i neadekvatna liječenja. inappropriate treatment. PEG precipitation enables
Taloženje PEG-om omogućuje jednostavno prepo- easy identification of macroprolactin in routine clini-
znavanje makroprolaktina u svakodnevnoj kliničkoj cal practice.
praksi.
e-mail: lukiciva84@gmail.com
e-adresa: lukiciva84@gmail.com
J22 J22
Prikaz dva novootkrivena slučaja cistične Report of two recently discovered cases of
fibroze; vrijednost istovremenog korištenja cystic fibrosis; the value of the simultaneous
dijagnostičkih testova: kloridi u znoju/ use of diagnostic tests: chloride in sweat and
fekalna elastaza fecal elastase
Irena Linarić1, Jasna Obuljen1, Oleg Jadrešin2 Irena Linarić1, Jasna Obuljen1, Oleg Jadrešin2
1Odjel za medicinsku biokemiju i hematologiju, Zavod za 1Department of Medical Biochemistry and Hematology,
laboratorijsku dijagnostiku, Klinika za dječje bolesti Zagreb, Department of Laboratory Diagnostics, Children’s Hospital
2Odjel za gastroenterologiju i poremećaje prehrane, Klinika za 2Department of Gastroenterology and Nutrition, Department of
pedijatriju, Klinika za dječje bolesti Zagreb, Zagreb, Hrvatska Pediatrics, Children’s Hospital Zagreb, Zagreb, Croatia
Uvod: Cistična fibroza je najčešća nasljedna letalna Introduction: Cystic fibrosis is the most common
bolest u bijeloj populaciji, koja zahvaća sekretorne lethal inherited disease in the Caucasians which af-
stanice epitelnih organa, odnosno egzokrine žlijez- fects the secretory epithelial cells of organs, or exo-
de. Kliničku sliku obilježava kronična opstruktivna crine glands. Clinical presentation characterizes
bolest pluća, a u većine bolesnika (85%) kronična in- chronic obstructive pulmonary disease, and in the
suficijencija pankreasa. Cilj je pokazati važnost odre- majority of patients (85%) chronic pancreatic insuffi-
đivanja klorida u znoju i koncentracije pankreatične ciency. The aim is to show the importance of the de-
elastaze u stolici, nezaobilaznih testova kod otkriva- termination of chloride (Cl) in sweat and concentra-
nja cistične fibroze. tion of fecal elastase (FE), unavoidable tests for the
Ispitanici i metode: Slučaj 1, dijete u dobi od 5 mje- detection of cystic fibrosis.
seci, primljeno zbog nenapredovanja na tjelesnoj

S152
masi, na umjetnoj prehrani, imalo 5-7 kašastih stoli- Subjects and Methods: Case 1, a child five months
ca dnevno, bez znakova masti u stolici, od prijašnjih old, received due to failure to weight, on an artifi-
bolesti registriran respiratorni katar. Slučaj 2, dijete u cial diet, had a 5-7 mushy bowel movements a day,
dobi od dva sata prima se iz KB „Sveti Duh“, indicira with no signs of fat in the stool, by previous diseas-
se kirurški zahvat uslijed distenzije abdomena i sum- es registered respiratory catarrh. Case 2, child aged
nje na perforaciju crijeva; postoperativno, urednog two hours, the surgery was indicated due to ab-
općeg stanja uz slabije napredovanje na tjelesnoj dominal distension and bowel perforation in doubt;
masi – u povijesti bolesti vodi se kao mekonijski ile- postoperatively in good clinical condition with less
us sa peritonitisom, od mikrobioloških analiza uzet progression of weight - a history of meconium ileus
aspirat nazofarinksa. U oba slučaja u sklopu dijagno- with peritonitis, nasopharyngeal aspirate collected.
stičke obrade više puta su, u kratkom vremenskom In both cases, in a short period of time, the concen-
razmaku, učinjene koncentracija klorida (Cl) u zno- tration of Cl in sweat by pilocarpine iontophoresis
ju metodom pilokarpinske iontoforeze, te koncen- method and the concentration of FE, ELISA (Schebo,
tracija fekalne elastaze (FE) ELISA metodom sa mo- Germany), have been done repeatedly.
noklonskim antitijelima (ScheBo, Njemačka). Results: Case 1: anemia, hypoalbuminemia, without
Rezultati: Slučaj 1: anemija, hipoalbuminemija, bez hyponatremia; Cl in sweat 1,2=111.7, 101.8 mmol/L;
hiponatremije; Cl u znoju 1,2=111,7; 101,8 mmol/L; FE1,2,3=<15 µg/g; genotyping: ΔF508 mutation.
FE1,2,3=<15 µg/g; nalaz genotipizacije: mutacija Case 2: mild anemia, hypoalbuminemia, without hy-
∆F508. Slučaj 2: blaga anemija, hipoalbuminemija, ponatremia, Pseudomonas aeruginosa isolated from
bez hiponatremije, iz aspirata nazofarinksa izoliran nasopharyngeal aspirate; Cl in sweat 1,2=103.6, 93.7
Pseudomonas aeruginosa; Cl u znoju 1,2=103,6; 93,7 mmol/L; FE1,2=<15 µg/g, genotyping in progress.
mmol/L; FE1,2=<15 µg/g, nalaz genotipizacije u tije- Conclusion: In both cases cystic fibrosis was sus-
ku. pected; clinical and laboratory findings justified ur-
Zaključak: U oba slučaja postavljena je sumnja na gent requests for analyses: the determination of
cističnu fibrozu; klinička slika uz laboratorijske nalaze chloride in sweat and concentration of fecal elas-
opravdala je hitne zahtjeve za analizama koje mogu tase. These analyses are fast, reproducible and rela-
potvrditi postavljenu sumnju: određivanje klorida tively inexpensive and are an important step in the
u znoju i koncentracije fekalne elastaze. Navedene early diagnosis of cystic fibrosis, without necessar-
analize su brze, reproducibilne i relativno jeftine te ily genotyping. Such an approach helps to quickly
su nezaobilazan korak u ranom dijagnosticiranju ci- care for sick children, because early diagnosis allows
stične fibroze, bez nužnog nalaza genotipizacije. Ta- proper multidisciplinary interventions that positive-
kav pristup pomaže brzom zbrinjavanju bolesnog ly affect the general course of the disease.
djeteta, jer rana dijagnoza omogućava odgovarajuće
multidisciplinarne intervencije koje pozitivno utječu e-mail: irenalinaric16@gmail.com
na opći tijek bolesti.
e-adresa: irenalinaric16@gmail.com

S153
J23 J23
Biro predavača: novi obrazovni resurs u Speakers Bureau: a new educational resource
ponudi Evropske federacije za kliničku offered by European Federation of Clinical
hemiju i laboratorijsku medicinu (EFLM) Chemistry and Laboratory Medicine (EFLM)
Andjelo Beletić1, Elizabeta Topić2, Sverre Sandberg3, Mauro Panteghini4 Andjelo Beletić1, Elizabeta Topić2, Sverre Sandberg3, Mauro Panteghini4
1Centar za medicinsku biohemiju, Klinički centar Srbije, 1Center for Medical Biochemistry, Clinical Centre of Serbia,
Beograd, Srbija; EFLM Working Group Congresses and Belgrade, Serbia; EFLM Working Group Congresses and
Postgraduate Education-Young Scientist Member Postgraduate Education-Young Scientist Member
2Farmaceutsko-biokemijski fakultet, Sveučilište u Zagrebu, 2Faculty of Pharmacy and Biochemistry, University of Zagreb,
Zagreb, Hrvatska; EFLM Committee Education and Training- Zagreb, Croatia; EFLM Committee Education and Training-Chair
Chair 3Norwegian Quality Improvement of Primary Care Laboratories,
3Norwegian Quality Improvement of Primary Care Laboratories, Noklus Department of Global Public Health and Primary
Noklus Department of Global Public Health and Primary Care,University of Bergen, Bergen, Norway; EFLM President
Care,University of Bergen, Bergen, Norway; EFLM President Elect Elect
4Department of Biomedical and Clinical Sciences “Luigi Sacco”, 4Department of Biomedical and Clinical Sciences “Luigi Sacco”,
University of Milano, Milano, Italy; EFLM President University of Milano, Milano, Italy; EFLM President
Uvod: Imajući u vidu vodeću profesionalnu i naučnu Introduction: Considering the professional and sci-
ulogu Evropske federacije za kliničku hemiju i labo- entific leadership of European Federation of Clinical
ratorijsku medicinu (EFLM), postojala je pretpostavka Chemistry and Laboratory Medicine (EFLM), it was
da bi se u okviru EFLM Komiteta (C) i Radnih grupa assumed that a pool of scientists serving as speakers
(WG) mogla odabrati grupa naučnika čiji bi zadatak for educational events organized by national EFLM
bio da kao predavači učestvuju na edukativnim sku- member societies might be selected from EFLM
povima koje organizuju nacionalna društva, članice Committees (C) and Working Groups (WG).
EFLM. Subjects and Methods: With goal to establish the
Ispitanici i metode: U cilju uspostavljanja Biroa pre- EFLM Speakers Bureau and identify eligible lecturers
davača EFLM, te odabira kompetentnih naučnika i and topics, in 2013 the Chairs and members of EFLM
adekvatnih tema, predsednici i članovi C i WG su u C and WG have been invited to give their availability
2013. godini bili pozvani da se izjasne da li su u mo- and propose topics, accompanied with information
gućnosti da učestvuju u radu i predlože teme, za- regarding language(s) used for presentation. Propo-
jedno sa informacijom o jeziku koji će biti korišćen u sals were evaluated and selected by chairs of EFLM
prezentaciji. Predsednici EFLM Committee for Educa- Committee for Education and Training and Com-
tion and Training and Committee for Science su pro- mittee for Science and finally endorsed by EFLM
cenjivali i birali predloge, koje je naposletku odobrio Executive Board (EB).
Izvršni odbor (EB) EFLM. Results: In total 207 topics, grouped into 29 areas,
Rezultati: Ukupno je izabrano 207 tema, grupisanih were selected. Areas with the highest number of
u 29 oblasti. Najveći broj tema (broj se nalazi u zagra- topics (in parentheses) were Preanalytics (15) and
di) je pripadao preanalitici (15) i srčanim markerima Cardiac Markers (15), followed by Accreditation (14),
(15), dok su se neposredno iza njih nalazile akredita- Patient Focussed Laboratory Medicine (14) and La-
cija (14), laboratorijska medicina fokusirana na paci- boratory Management (12). Topics were proposed
jenta i labratorijski menadžment. Teme je predložilo by 40 EFLM officers from 19 EFLM member societies.
40 službenika EFLM, iz 19 nacionalnih društava čla- All lectures were offered to be presented in English,
nova EFLM. Prezentacije na engleskom su na raspo- while some of them in other languages too (i.e.,
laganju za sva predavanja, pri čemu za neke postoji French, Dutch, Croatian, Danish). EFLM EB endorsed
mogućnost da se održe i na drugom jezicima (npr. the establishment of Speakers Bureau in June 2014.
francuski, holandski, hrvatski, danski). EFLM EB je Conclusion: Number of available speakers and are-
odobrio osnivanje Biroa predavača u junu 2014. as covered by the proposed topics indicate that re-

S154
Zaključak: Broj dostupnih predavača i oblasti obu- sources offered through the EFLM Speakers Bureau
hvaćene predloženim temama ukazuju da resursi (http://www.efcclm.org/index.php/EFLM_Spea-
ponuđeni u sklopu EFLM Biroa predavača (http:// kers_Bureau.html) may represent a suitable contri-
www.efcclm.org/index.php/EFLM_Speakers_Bure- bution to support educational events organized by
au.html) mogu predstavljati celishodan doprinos u EFLM member.
podršci edukativnim skupovima organizovanim od
strane EFLM članica. e-mail: andjelo.beletic78@gmail.com
e-adresa: andjelo.beletic78@gmail.com

S155

Abstracts 8th Congress CSMBLM Rijeka Korekcija N.nikolac 5.11.2015. BO2

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Posterski sažetci Poster abstracts

A – Laboratorijska dijagnostika i praćenje A – Laboratory diagnostics and monitoring

Procjena koncentracije tumorskog biljega Assessment of tumor marker ProGRP

Bosnia and Herzegovina Bosnia and Herzegovina

Biochemia Medica 2015;25(Suppl 1):S1–S158

Povezanost vrijednosti prokalcitonina i Correlation between procalcitonin

Biochemia Medica 2015;25(Suppl 1):S1–S158

Dijagnostički potencijal humanog The diagnostic potential of human

Biochemia Medica 2015;25(Suppl 1):S1–S158

Dijagnostička vrijednost tumorskog biljega Diagnostic value of HE4 tumor marker in

Biochemia Medica 2015;25(Suppl 1):S1–S158

Biochemia Medica 2015;25(Suppl 1):S1–S158

Biochemia Medica 2015;25(Suppl 1):S1–S158

B – Statistička obrada laboratorijskih B – Statistical analysis of laboratory

Rezultati laboratorijske primjene Results of the recommended laboratory

Bojana Kranjčec1, Jadranka Šanjug2 Bojana Kranjčec1, Jadranka Šanjug2

Biochemia Medica 2015;25(Suppl 1):S1–S158

B02 (Usmeno izlaganje) B02 (Oral presentation)

Razlika verifikacijskih protokola za The difference of verification protocols for

centar Zagreb, Zagreb, Hrvatska Centre Zagreb, Zagreb, Croatia

Biochemia Medica 2015;25(Suppl 1):S1–S158

Usporedba kvalitete laboratorijskih procesa Comparison of quality of laboratory

Biochemia Medica 2015;25(Suppl 1):S1–S158

Biochemia Medica 2015;25(Suppl 1):S1–S158

Merica Aralica, Jasminka Matica Merica Aralica, Jasminka Matica

Makroprolaktin – probir, da ili ne? Macroprolactin – to screen or not to screen?

e-adresa: adriana.bokulic@gmail.com e-mail: adriana.bokulic@gmail.com

B07 (Usmeno izlaganje) B07 (Oral presentation)

Izračun slobodnog testosterona: usporedba Free testosterone calculation: two equations

Biochemia Medica 2015;25(Suppl 1):S1–S158

C - Harmonizacija u laboratorijskoj medicini C - Harmonization in laboratory medicine

Uvid u određivanje antinuklearnih antitijela Insight in antinuclear antibodies (ANA)

milosrdnice, Zagreb, Hrvatska Centre Sestre milosrdnice, Zagreb, Croatia

centar Zagreb, Zagreb, Hrvatska Centre Zagreb, Zagreb, Croatia

centar Rijeka, Rijeka, Hrvatska Hospital Centre Rijeka, Rijeka, Croatia

Biochemia Medica 2015;25(Suppl 1):S1–S158

Biochemia Medica 2015;25(Suppl 1):S1–S158

D – Biljezi bolesti bubrega i mokraćnog D – Markers of kidney and urinary tract

Učestalost mikrohematurije kod muškaraca Frequency of microhematuria in men older

Biochemia Medica 2015;25(Suppl 1):S1–S158

e-adresa: zoranatodoric@gmail.com e-mail: zoranatodoric@gmail.com

E – Molekularna dijagnostika E – Molecular diagnostics

E01 (Usmeno izlaganje) E01 (Oral presentation)

Utjecaj polimorfizama CYP3A4/5 i CYP2D6 The influence of CYP3A4/5 and CYP2D6

Hrvatska Zagreb, Croatia

Biochemia Medica 2015;25(Suppl 1):S1–S158

Genotipizacija interleukin 28 b polimorfizma Genotyping of interleukin 28 b

Biochemia Medica 2015;25(Suppl 1):S1–S158

F - Automatizacija laboratorijskih postupaka F - Automatization of procedures and

Detekcija parazita malarije pomoću Malaria detection on DXH800 Beckman

Toplice, Krapinske Toplice, Hrvatska Krapinske Toplice, Croatia

Biochemia Medica 2015;25(Suppl 1):S1–S158

Biochemia Medica 2015;25(Suppl 1):S1–S158

F02 (Usmeno izlaganje) F02 (Oral presentation)

Kapilarna elektroforeza u rutinskom Capillary electrophoresis for routine

Biochemia Medica 2015;25(Suppl 1):S1–S158

F03 (Usmeno izlaganje) F03 (Oral presentation)

Model provjere funkcionalnosti Evaluation of rules in autovalidation

Biochemia Medica 2015;25(Suppl 1):S1–S158

OptiScanner 5000: povremeno praćenje OptiScanner 5000: an intermittent glucose

Biochemia Medica 2015;25(Suppl 1):S1–S158

4Dipartimento di Scienze Biomediche, Chirurgiche ed 4Dipartimento di Scienze Biomediche, Chirurgiche ed

Biochemia Medica 2015;25(Suppl 1):S1–S158

G – Akreditacija, organizacija, kvaliteta i G – Accreditation, organization, quality and