Dr. Kristina J Behan

Objective Amorphous urate crystals can obscure significant findings during a routine urinalysis. There is no standardized protocol to minimize their effect.
Materials and Methods We tested 210 urine specimens. Three specimens had high red blood cell (RBC) or white blood cell (WBC) counts. Fifty-six specimens formed amorphous urates. Sediment from these specimens was treated with 50 mM sodium hydroxide (NaOH) at a 1:2 and/or 1:4 dilution. We warmed 22 specimens with crystals at various temperatures.
Results Amorphous urate crystals formed in concentrated urine with an acidic pH. Adding 50 mM NaOH dissolved amorphous urates, revealing the presence of underlying bacteria and yeast, but WBC and RBC counts were grossly decreased. Prewarming unspun specimens to 60 degrees C for 90 seconds dissolved most amorphous urates.
Conclusion The protocol to eliminate amorphous urate crystals is to prewarm the specimen before testing. Adding 50 mM NaOH to sediment dissolves amorphous urates to enhance the visibility of bacteria and yeast but has a deleterious effect on WBC and RBC.

The COVID-19 pandemic has taken a major toll on the economy and funding for public education. For that reason, the pandemic has a worrisome effect on the sustainability of university/college based Medical Laboratory Sciences MLS training programs. Stakeholders of university-based MLS programs include university administrators, students, clinical affiliates and faculty. Each group has specific goals and challenges that affect the sustainability of the program. This report details strategies that can be used to satisfy the goals specific to key stakeholders that lead to sustainability. These strategies apply in pandemic times and in the back-to-normal future.

Healthcare professions face complex care environments with growing attention to the number of preventable hospital deaths. Interprofessional communication and teamwork are key elements in reducing medical errors, and are core competencies of interprofessional collaborative practice. Interprofessional education occurs when students from different disciplines learn together, and/or when faculty from one discipline instruct students in another. Simulated healthcare scenarios provide high-impact learning environments for students with many benefits. Simulation-interprofessional education has been used very little between Clinical Laboratory Sciences and BSN nursing students. The faculty from a growing university sought to improve student-learning outcomes through team-teaching and student role playing in simulation and science laboratories. Two IPE projects were undertaken. Both projects demonstrated increases in the cognitive, psychomotor and affective domains of learning.

Literature is scarce regarding medical laboratorians and their attitudes about interprofessional interactions with other healthcare providers. We investigated learning and attitudes in a joint project that brought Clinical Laboratory Sciences (CLS) students and Nursing students together. The nursing and CLS faculty created a simulated post-partum patient who developed deep vein thrombosis followed by pulmonary embolism. The patient was heterozygous for the Factor V Leiden mutation. The simulations occurred in two venues. The patient scenario occurred at the student Nursing Skills and Simulation Learning Center “SIM lab” at the bedside of the patient experiencing symptoms of deep vein thrombosis and pulmonary embolism, with the nursing students responding to the patient’s distress. CLS students collected blood from the patient during the crisis. The laboratory scenario occurred in the CLS teaching laboratory. CLS students performed real time PCR on the patient for the Factor V Leiden mutation, and instructed the nursing students how to interpret the results.
Learning gains were measured by survey after the 2 events. Retention of learning was measured 6 weeks after the second event took place. All students showed sustained learning about venous thromboembolism, its risk factors, and genetic mutations that predispose towards thrombophilia.
Students’ attitudes about interprofessional education and each other’s professions were surveyed before and after the experience. Students valued the experience and 87% of them responded that they are interested in pursuing more interprofessional education training opportunities.

Red blood cells (RBCs) are freely permeable to glucose and do not require insulin to facilitate its transport. [...]a percent of hemoglobin is glycated in all individuals, those without diabetes (HbA1c reference range <5.7%), and those with type 1 and type 2 diabetes. The HbA1c value has a high correlation with average blood glucose for the previous 2-3 months in individuals with either type 1 or type 2 diabetes.6.7 The look back time period is related to the average time that a hemoglobin molecule is available for glycation. The average life span of RBCs is 120 days.11 Conditions that alter the life span of the RBC, such as hemolytic anemia, iron deficiency anemia, and blood loss will negate this association.12 The student should be educated that the presence of hemoglobin variants, such as HbS, HbE and HbC, interferes with some HbA1c methods.10'13 As yet undetermined variability between individuals can also affect the rate of glycation.14 The ADA continues to recommend bi-annual measurement of HbA1c for individuals with diabetes who are in good glycemic control, and more frequent testing if therapy has changed.10 Blood glucose is influenced by diet, hydration, exercise, illness, and medication. Because the glucose was not steady state, the final HbAlc of 10.8% (with its eAG of 263 mg/dL) was misleading.

Objective: Hemoglobin A1c (HbA1c) is the standard measurement of glycemic control, and the HbA1c value can be used to estimate average glucose using a formula. Several studies suggest that the relationship between average glucose and HbA1c may be different for Blacks. This project enrolled non-Hispanic black and white individuals with type 2 diabetes and evaluated the relationship between HbA1c and blood glucose.
Method: 22 black and 29 white adults with type 2 diabetes were included in the analysis. Approximately 42 measurements (fasting and postprandial glucose) were collected over three months and compared to HbA1c of the third month. The effect of race was evaluated by ANCOVA and χ2 analysis testing the slope and intercepts simultaneously for HbA1c and its relationship to fasting glucose and to postprandial glucose.
Results: The relationship between HbA1c and glucose was not statistically significantly different between Blacks and Whites (ANCOVA: P = 0.968 for fasting glucose, P = 0.428 for postprandial glucose), allowing us to calculate estimated fasting and postprandial glucose disregarding race. For fasting glucose, the linear regression is FGmg/dl = (18.939 X HbA1c%) – 1.864, R2 = 0.586, P < 0.0001. For postprandial glucose, the linear regression is ln(PPGmg/dl) = (1.261 X ln(HbA1c%)) + 2.555, R2 = 0.614, P < 0.0001. Predicted values for postprandial glucose based on HbA1c were similar to estimated average glucose values reported by ADAG.
Conclusion: This study reinforces the A1c-Derived Average Glucose (ADAG) group finding that the relationship between HbA1c and glucose is similar in non-Hispanic black and white adults with type 2 diabetes.

Objective: Glucose levels decrease in whole blood in vitro, but there are several methods that minimize the loss, including special tubes and ice. This study evaluated whether sedimentation by gravity in an upright position was a viable alternative.
Design: Lithium heparinized blood was collected from 20 individuals without a diagnosis of diabetes. The samples were allowed to sediment at ambient temperature and were tested in quadruplicate at 30 minute intervals. A Repeated Measures ANOVA compared the means of each time-point.
Results: Plasma glucose results were not statistically different between 30 minutes and 60 minutes after collection (p = 0.156). At 90 minutes after collection, glucose was significantly different than the initial glucose readings (p <0.001). Each reading thereafter also showed a statistically significant difference from the initial reading.
Conclusions: Samples for glucose measurement are stable in lithium heparin for no longer than 60 minutes when held in an upright position prior to centrifugation.

Hemoglobin A1c (HbA1c) testing can be inaccurate in persons with elevated amounts of Hemoglobin F, or with abnormal hemoglobins found in sickle cell trait, HbC trait and HbE trait. These variants are more prevalent in African and Asian Americans, the same demographic that has an increased risk of diabetes. Variant hemoglobins might cause a false increase or decrease in HbA1c, depending on methodology and manufacturer. Case studies of two African American patients, one with and one without variant hemoglobins, are presented. The major methods used to assay HbA1c, immunoassay, HPLC and boronate affinity are described, and compared for their ability to detect variant hemoglobins. An algorithm is proposed to test new patients using the HPLC method to identify or rule out the presence of the most common variant hemoglobins. Patients with variant hemoglobins can subsequently be assigned to HbA1c methods proven
to be accurate in the presence of those hemoglobins.