Intérêt du dosage des récepteurs solubles de la transferrine dans le dépistage de la carence martiale en fin de grossesse

Aim of the study is to compare serum transferrin receptor (sTfR) with ferritin in the diagnosis of iron deficiency at the end of pregnancy. Proteins were determinated by immunonephelometry in 60 patients on serum taken during labor. None of them presented serious inflammatory syndrome or malnutrition on the basis of PINI index. sTfR are >1.50 mg/l, the reference value for young women, by 72% of patients and ferritin < 20 μg/l among 50%. The two parameters are negatively correlated (r: 0.62). In patients with ferriprive anemia (hemoglobin < 10 g/dl), sTfR are highly enhanced (2.1–4.05). In non-anemic patients (hemoglobin > 12 g/dl) with ferritin level within reference value of non-menopaused women (7.17–52.6) sTfR are frequently >1.5 mg/l (0.7–3.09). Indeed, sTfR increase with physiological erythropoïesis activation observed at the end of pregnancy. It is essential to determine references values adapted at the end of pregnancy for an optimal interpretation of sTfR.     

Intérêt du dosage de la désoxypyridinoline urinaire dans le dépistage des métastases osseuses du mélanome

Urinary deoxypyridinoline as a marquer of bone metastases in patients with melanoma. We measured urinary deoxypyridinoline (DPD) in 168 melanoma bearing patients, by an chemiluminescence immunoassay. The results were expressed as ratio to creatinine (DPD/Cr in nmol/mmol). The patients were distributed in five groups: patients without any detectable metastases, patients with cutaneous metastases, with lymph nodes metastases, with visceral or bone metastases. The control group included 40 healthy volunteers. We calculated reference values and means of level DPD/Cr in each group. The mean DPD/Creatinine was significantly higher for women with bone metastases than for the control group (respectely 16.7 nmol/nmol and 4.96 nmol/mmol (p = 0.003)) with a sensitivity of 62 % and a specificity of 98 %. We determinated a cutoff level at 15 nmol/mmol. However, no significantly inter group difference was observed for men. Measurement of urinary DPD is not superior to bone scintigraphy in the early detection of bone metastases, but may provide an useful alternative tool to bone scintigraphy for diagnosis of bone metastases.     

Le récepteur de la transferrine : intérêt dans l'exploration du statut martial

Transferrin receptor: contribution in assessment of iron status. Transferrin receptor is a transmembrane glycoprotein expressed by any cell type except erythrocytes. A soluble form of the transferrin receptor is detectable in human sera. Its concentration is proportional to tissue transferrin receptor cells. The primary function of transferrin receptor is to bind diferric transferrin and to internalize it by the process of receptor-mediated endocytosis. The first available tests were immunoenzymatic techniques; nowadays, nephelemetric or turbidimetric methods are developed and are automated on biochemistry or immunochemistry automates. However, due to lack of standardization, results obtained from different tests cannot be compared with respect to both reference and pathological ranges. Soluble transferrin receptor is a promising tool to detect coexisting iron deficiency in patients with anaemia of chronic diseases.     

Intérêt de la recherche de β2-transferrine dans des prélèvements susceptibles de contenir du LCR

When there is a clinical suspicion of CSF leakage, we can detect the presence of β2-transferrin in fluids from different origins. We used two techniques in the laboratory coupling electrophoresis with immuno-blotting. These two methods are realized on microsamples collected by syringe or on microcollagen sponges. The difference between the two methods concern the nature of the gel electrophoresis: agarose for the first one (zone electrophoresis) which allow separation of β1 and β2 transferrin by the electric charge, and agarose with ampholytes (isoelectrofocusing) allowing separation by isoelectric point of all transferrin isoforms. Whatever the method two controls are used: serum of the patient (negative control) and CSF (positive control).     

Intérêt de l’étude du gène bêtaglobine dans le dépistage des hémoglobinopathies

As part of hemoglobinopathy’s study in the hospital of Saint-Denis, we search β globin gene mutations to complete standard techniques with the assay “βglobin Strip A^ssay” of Vienna Lab Labordiagnostika, sold by Ingen. This assay allows the detection of 20 frequent β thalassemia mutations, hemoglobin S and C. This assay is executed for β thalassemia and in a number of sickle cell diseases (SS and S-β thalassemia). Mutation was found in 38% of β thalassemia. In sickle cell diseases: SS and S-β+ thalassemia in newborns were confirmed. Nevertheless, considering the origin of our sickle cell disease’s patients, it is essential to complete this assay with African mutations.     

Intérêt d’une collaboration entre la coordination des vigilances et la gestion des risques liés aux soins dans un établissement de santé

Health care vigilance committees appeared with time in France. Some vigilance entities are present at a regional level, but all are found at the National Drugs and Health Care Products Safety Agency. Along with health care centers’ certification, vigilance committees’ coordination has evolved: whereas its presence was optional in the first version of certification, it has now imposed itself within health care centers with the more recent versions of certification, detailing the actions it must undertake. In parallel, a lot of attention is put on health care-related risk management with a health care center. Vigilances’ coordination can thus take advantage of this in sharing an incident declaration system common with that of health care-related risks management. This collaboration will enable the generation of a priori risks’ maps, help analyze adverse events and use the notion of criticality within a global safe care policy in each health care facility.