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MTSAJUNE2017

LATEST ISSUE
Volume 30 | Number 1 | August 2017
ISSN (online): 1011 5528
Editor: Warren Maule

Cover Image: A Segment of opposition in balance. Nicole Woodbury. Porcelain ceramic carving of bone marrow in the shape of undulating waves. www.nicolewoodbury.com

 
MOST RECENT ARTICLES

Peer reviewed ORIGINAL ARTICLE
Open Access

An audit of the completion of bone marrow specimen request forms at an academic laboratory
MJ Coetzee | G Joubert | M Swart | A Streicher | M Kruger | H Koekemoer
Published online: August 2017

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Background: Bone marrow request forms contain clinical information for the diagnosis of haematological conditions. Because these forms were not being completed adequately we introduced a structured request form in the Free State Province and performed an audit to see how it was completed.
Methods: During four months in 2013 we received 357 requests. We recorded the completion of the time and date, patient details, doctor’s details, full blood count (FBC) results, clinical information, transfusion details, other laboratory tests requested, and details of the procedure completed by technologists.
Results: The patient’s FBC results were absent on 57.7%, the transfusion history on 29.1%, the medication on 23.8%, and information about the clinical examination and HIV status on 9.2% of forms. The technologist had not signed on 27.4%, and details of additional tests were missing on 23.3%.
Conclusion: The lack of completion is similar to those reported for other laboratory request forms. We began to educate students and doctors about the importance of clinical information.

Peer reviewed ORIGINAL ARTICLE
Open Access

Evaluation of a cost-effective ADAMTS13 antigen assay
M Meiring | S Myneni
Published online: August 2017

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Thrombotic thrombocytopenic purpura (TTP) is life-threatening and is characterised by platelet deposition in the microvasculature with thrombus formation in particular organs. This results in thrombocytopenia, microangiopathic haemolytic anaemia, kidney failure and neurological symptoms. It is a rare disorder, but can occur in patients infected with the human immunodeficiency virus (HIV). ADAMTS13 is the 13th member of a disintegrin and metalloprotease with thrombospondin type motifs. Its deficiency causes TTP. Therefore, the measurement of the ADAMTS13 levels in plasma is vital in the diagnosis of TTP and also important in distinguishing it from other thrombotic microangiopathies (TMA’s). Unfortunately, commercial ADAMTS13 antigen assays are expensive for healthcare service providers in developing countries. However, several antibodies and antibody pairs have been produced against ADAMTS13 and are commercially available. In this study, we evaluated an in-house ADAMTS13 antigen assay using two different commercial antibodies and compared the outcomes to that of a commercial ADAMTS13 antigen kit by using the plasma of 40 patients with possible HIV-associated TTP and 40 healthy subjects. The Intra- and inter-assay coefficients of variation were calculated as 8% and 7% respectively. The assay gave linear results between 0.78 to 12.5% ADAMTS13. The limit of detection was 0.2%, and the limit of quantification was 0.8%. The correlation of our assay compared to the commercial test kit was excellent, with a R2 value of 0.9. In addition, the cost of our ADAMTS13 antigen assay was lower than that of the commercial ADAMTS13 antigen test kit. Our cost-effective in-house ADAMTS13 antigen test also produced reliable results. We therefore recommend that this assay be used to diagnose HIV-associated TTP.

Peer reviewed ORIGINAL ARTICLE
Open Access

Impact of airogym exercise on solute removal and oedema on end-stage kidney disease patients: a randomised controlled trial
JK Adam | S Singh | M Nasr | SBN Krishna
Published online: August 2017

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It is well established that end-stage renal disease patients often have other health problems that can be improved by participation in regular exercise programmes. In addition, the reduced physical functioning that is experienced by patients who are on dialysis is potentially addressable through exercise interventions. Very few studies are undertaken to investigate the effect of exercise on solute removal and oedema in patients undergoing hemodialysis in South Africa. In this study, a sample of thirty four patients (17 in the intervention group aged between 25 and 60; 17 in the control group aged between 18 and 60) performed airogym exercises on a cushion for fifteen minutes every hour to achieve a total of sixty minutes of exercise over a four-hour dialysis session, for period of nine months. Results showed there was a significant reduction in the mean serum urea clearance of 30% (p < 0.001) during post hemodialysis over a six month period as compared to pre hemodialysis. A significant reduction was also seen in the creatinine levels post hemodialysis of 17% (p = 0.01) as compared to that of the baseline. The serum urea Kt/V mean values increased from 1.2 at baseline to 1.4 after six months of exercising, suggesting 17% increase in serum urea (p = 0.5). Furthermore, the potassium levels during pre and post hemodialysis dropped by 8% between April and September in both the intervention and control groups. The airogym exercise programme improves the wellbeing and quality of life (QoL) of dialysis patients and can be integrated into a hemodialysis routine with a high long-term adherence.

Peer reviewed ORIGINAL ARTICLE
Open Access

Retrospective data analysis of all requests for flow cytometric immunophenotyping in a tertiary hospital setting
A Prinsloo | J Nel | R Pool
Published online: August 2017

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Flow cytometry is a globally accepted diagnostic tool used for the rapid identification of cells based on their surface and intracellular antigens, especially for the diagnosis of haematological malignancies. The aim of this study was to evaluate the requests received for flow cytometric immunophenotyping and to create a profile of diagnoses. In 2014 data regarding indications and diagnoses were captured from request forms received and final diagnosis reports issued by the Tshwane Academic Division (TAD) of the National Health Laboratory Service (NHLS). A total of 1234 requests were received over the one year period, of which 80.4% were performed and 16.8% were rejected. The most common indications were leukaemia, lymphoma and cytopenia. Nineteen percent of requests received contained no correct indication or clinical history. In total, 103 and 153 diagnoses were established based on peripheral blood and bone marrow aspirate specimens respectively. Samples were mostly rejected due to sample clotting, electronic gate keeping rules and receiving the specimen more than 24 hours after collection.

Peer reviewed ORIGINAL ARTICLE
Open Access

Cancer diagnoses profile of bone marrow specimens from November 2012 to December 2015 in a tertiary academic setting
N Swart | A Prinsloo
Published online: August 2017

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This study aimed to examine the number and type of cancer diagnoses made based on bone marrow aspirates (BMA) using morphology and/or histology, over a three year period. All the data collected (2012-2015) was obtained using the Trak-Care laboratory information system (LIS) of the National Health Laboratory Service (NHLS). Data was categorised into four categories including acute leukaemias (ALs), chronic leukaemias (CLs), Hodgkin’s lymphoma (HL), Non-Hodgkin’s lymphoma (NHL) and a miscellaneous group.
The laboratory test most frequently used to make diagnoses was bone marrow aspiration (BMA) morphology (199), followed by flow cytometry (138), histology (113), fluorescent in situ hybridisation (FISH) (54) and polymerase chain reaction (PCR) (9). In total, the top three conditions diagnosed were acute myeloid leukaemias (AMLs), chronic myeloid leukaemia (CML) and B-cell acute lymphoblastic leukaemia (B-ALL). There was good agreement between the diagnoses made by BMA morphology, BMT histology and flow cytometry.
Results showed that BMA morphology was the most popular diagnostic test used and that this test had excellent agreement with BMT histology and flow cytometry diagnoses. The most frequently diagnosed conditions were the AMLs.

Peer reviewed ORIGINAL ARTICLE
Open Access

A statistical analysis of the South African National board examinations for Intern Medical Technologists for the periods 2008-2012
W Kruger | S Eagleton
Published online: August 2017

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Background: The main role of the Society of Medical Laboratory Technologists of South Africa (SMLTSA) is to promote and regulate the profession of Medical Laboratory Technology in South Africa (S.A.). The National board examinations for Intern Medical Technologists (MTIN) are co-ordinated by the SMLTSA on behalf of the Health Professional Council of South Africa (HPCSA). Passing these examinations is the qualifying criterion for a career in Medical Laboratory Technology. This qualification in Biomedical Technology is unique to S.A. and as such literature regarding the performances of MTIN in the National board examinations is very limited.
Objective: No previous research has been conducted to investigate the performances of MTIN in the National board examinations. For that reason, the examination scores for the periods 2008 to 2012 were analysed for variances in mean scores of MTIN who did their internship at different training laboratories, and who studied at different Higher Educational Institutions (HEI’s) as well as results of MTIN from the province of Gauteng, who specialised in four different disciplines. An analysis of the pass rate for the country was also done.
Method: The One-way analysis of variance (ANOVA) and Pearson Chi-square test were used to detect statistical significant differences in mean performance scores between these groups. Differences were considered significant at a p-value of <0.05.
Results: Several statistical significant differences in performance scores between groups were uncovered.
Conclusion: Statistical findings indicated poor overall performances in these examinations for the periods 2008 to 2012. It is therefore suggested that an in depth investigation be implemented into the suitability of higher education training and the adequacy of Internship programmes offered by training laboratories.


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