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Extended standard program and new parameters

Dear colleagues,

we would like to support you in the aimed diagnosis of autoimmune encephalitis and other neuro-immunological diseases by regularly updating our analyses spectrum. We have summarized the most important current additions to our analyses program to give you a quick overview:

Our request form „Neural antibodies“ (Formtype 18) was updated accordingly. If you would like to get the newest template version, please request the required amount by email to neuroak@laborkrone.de or by telephone on +49 (0)5222 8076-259. Please also use this number if you have any questions regarding antibody-requests or for ordering the latest price list. To order shipping material please call +49 5222 8076-429.

Dear colleagues,

with 1^st June 2019 we have adapted our analyses of lymphocyte subpopulations.

Instead of testing for various individual queries, we now offer you the choice of either a small or a full immune status. We also continue to offer the analysis of regulatory T-cells as well as chronic T-cell activating markers. This way, you can specifically request the necessary tests to match the patients’ needs.

For all analyses, we will need fresh EDTA whole blood from you, as usual. To determine the absolute cell count, we will automatically prepare a full blood count. For requesting this laboratory analysis we would ask that you notify us on the request form as to whether you would like a full or a small immune status.

Should you have any further questions regarding this, please call Dr. rer. nat. Juliane Fazio on telephone 05222 8076-207.

Kind regards,
Labor Krone

Dear colleagues,

Sensitivity testing of pathogens in our laboratory is carried out in accordance with the rules and regulations of the clinical & laboratory standards institute (CLSI). Here, changes were recently made to the testing of enterobacteria and pseudomonas aeruginosa, which were implemented by us as of 1st April 2019. In more detail, the minimum inhibition concentration (MIC) for the testing of ciprofloxacin and levofloxacin was reduced.

This change may have an impact on your therapeutic considerations on the one hand; on the other hand, more strains could be classified as 3MRGN in future. Further information can be found in the original tables as below:

Table 1 and 2: Current MIC values as of 1st April 2019

Table 3: Previous MIC values

Please do not hesitate to contact us, if you have any further queries.

Dr. med. Patricia Wehmeier
Fachärztin für Mikrobiologie, Virologie und Infektionsepidemiologie
Fachärztin für Innere Medizin, ABS-Expertin (DGI)
Tel. +49 5222 8076-324

Update of the analyses program

Dear colleagues,

We constantly adjust our diagnostics for neural antibodies to the latest findings and diagnostic possibilities. Hence we update our analyses program as of the 11th February 2019. Please note the following important changes we would like to point out:

Changes to the standard program: Serum VGKC-complex antibodies (RIA) are no longer tested as part of the standard program. Meanwhile there is sufficient evidence that increased VGCK-complex antibodies without demonstration of antibodies against LGI1 and CASPR2 have no clinical relevance in primary diagnosis (further information). However, individual requests are still possible. In addition to the cell-based assay, which is included in the standard program, testing for mGluR1-antibodies is carried out (further information). These changes do not result in a price increase.

Additional information on the request form (Formtype 18): The individual request for classical onconeural antibodies (immunoblot) in the category “Autoimmune encephalitides” is omitted. The test alone is insufficient for this indication and already included in the standard program. Within the section “Polyneuropathy/Immune neuropathy” the classical onconeural antibodies are still available as separate requests. The new test available in our diagnostic spectrum is myositis-specific and myositis-associated antibodies by immunoblot. A detailed list of the parameters included can be found under the indication “Myositis”. Within the category “Polyneuropathy/Immune neuropathy” we also have a screening for paranodal antibodies by tissue-based assay on offer.

Please order your desired quantity of the newest request form (Formtype 18) by e-mail to neuroak@laborkrone.de or by telephone: +49 5222 8076-259. Please do not use the previous form any longer. We are also happy to answer any of your queries about neural antibody requests. Shipping material can be ordered via telephone +49 5222 8076-444.

According to current data of the WHO, gonorrhea is the third most common sexually transmitted infection (STI) worldwide.  Unfortunately, there is no reliable epidemiological data from Germany as gonococcus infections do not fall under the mandatory reporting obligation. In addition to this, a global increase in resistance is observed. For the collection of valid data regarding the resistance situation in Germany, in 2013, project GORENET, in which Labor Krone takes part, was established.

In view of the resistance situation in our region, we can follow the recommendations of the S2k-guidelines for empiric therapy: In our submissions, sensitivity for ceftriaxone is at 100 % (OWL alone at 100 %) and azithromycin at 88 % (OWL alone at 93 %). It should be noted, that administration of azithromycin in the empiric treatment rather aims at the co-infection with chlamydia.

An alternative ciprofloxacin therapy should only be used after previous testing, as the current resistance situation is insufficient for empiric treatment. The exact resistance situation is listed in the table below.

Conclusion: The guideline-oriented empiric therapy with ceftriaxone and azithromycin is recommended for this region. Prior to therapy commencement, swab diagnostics for gonococcus-PCR and gonococcus cultures (CAUTION: different swab kits!) should be carried out. Pathogen demonstration by PCR is more sensitive than a culture; however, resistance testing is only possible for culture-bred pathogens. Therapy monitoring can be in consideration of clinical aspects, if necessary, a swab for gonococcus culture 3 – 7 days after the end of therapy can be taken. Testing via PCR only makes sense a minimum of 2 weeks after the end of treatment, as otherwise avital pathogens could be detected. Partners should also be treated!

Resistances for Neisseria gonorrhoeae in OWL, or total number of returns from Labor Krone, period: 01.01.16 – 31.12.2018

Please do not hesitate to contact us if you have any further questions.

Department of microbiology

Dr. med. Patricia Wehmeier, Dipl.-Biol. Andreas Groß, telephone +49 5222 8076-0

We would like to ask you to request quantitative CMV-PCR instead of CMV-pp65 antigen from 01.01.2019. The required sample quantity of 3 ml EDTA-blood.

Evaluation criteria: < 100 IU/ml (detection limit)

Pre analytically this method is less susceptible to faults. It also has a higher sensitivity and reproducibility for the demonstration of CMV reactivation, especially for immunosuppressed patients or leukopenic patients. The high sensitivity of quantitative CMV-PCR is the method of choice for CMV monitoring under immunosuppression or after organ transplants. CMV-dna can be detected in the blood already up to 4 weeks prior to the onset of a CMV associated disease, so that any necessary therapy can be started as early as possible.

On the other hand, if there is no virus demonstration by PCR, a CMV-associated disease can be almost ruled out.

Your contact in our laboratory:

Dr. Sylvia Schön Tel. +49 5222 8076-159
Dr. rer. nat. Robert Kulis-Horn Tel. +49 5222 8076-209

Extension of the assays on offer for the testing of neural antibodies

Dear colleagues,

Labor Krone already offers a broad spectrum of assays for the analysis of neural antibodies. For instance, there are panels available for the testing of relevant antibodies associated with autoimmune encephalitides, polyneuropathies or myasthenic syndromes.

In addition to this, diagnostics for MOG (myelin oligodendrocyte glycoprotein)-antibodies by live-cell assay is carried out at Labor Krone now. MOG-antibodies are important indicators on suspicion of ADEM (acute disseminated encephalomyelitis), NMO/NMOSD (neuromyelitis optica spectrum disorders) or myelitis. Labor Krone has the benefit of using the live-cell assay, a highly sensitive method, developed by Prof Dr Markus Reindl (University of Innsbruck). All assays concerning neural antibodies will be evaluated and individually interpreted by Dr Corinna Bien (Neurologist, assistant physician for laboratory medicine) and Prof Dr Christian Bien (Head physician of the Epilepsy Centre Bethel, Bielefeld, Germany). For any questions regarding results, please contact our specialist advisory service during our telephone consultation hours, weekdays from 11.00 a. m. to 12.00 p. m., +49 5222 8076-300.

For the analysis of MOG-antibodies we recommend to test the serum. CSF may be tested additionally, if desired. Approximately one milliliter is required of each material. The samples can be send by mail without cooling requirements any day of the week. Analyses are usually carried out twice a week. In case of positive findings, an endpoint titration is regularly performed.

You’ll find general information relating to the analysis of neural antibodies at Labor Krone online. For any questions regarding antibody-requests or for ordering the request form Formtype 18, please contact us on the following telephone number +49 5222 8076-259 or send an E-Mail to neuroak@laborkrone.de. To order shipping material please call +49 5222 8076-444.

In 2017 our laboratory noticed an increase in requests for malaria testing. We concluded, that the amount of cases with suspicion of malaria has risen and therefore necessitates relevant laboratory diagnostics. We always strive to carry out malaria diagnostic requests as quick and best as possible to avoid any delay in determining diagnosis. To achieve this, we rely on your support.

On suspicion of malaria could you please take an additional EDTA-monovette (for rapid analysis, “thick drop” and blood smear) on top of the tubes for the “normal” parameters (i.e. blood count). May we ask that this additional monovette is put in the green single-use polybag with the remark “malaria” and the respective request form. By doing this, the malaria request will be spotted immediately on material arrival and evaluation started without any delay. Already prepared green polybags can be requested at our shipping department, contact details as below.

As the diagnosis malaria is potentially life-threatening may we ask that a telephone number is given, so that positive findings can be communicated with you at once.

Please do not hesitate to contact us, should you have any questions.

Microbiology

Dr. med. Patricia Wehmeier Phone: +49 5222 8076-324
Nadine Weise Phone: +49 5222 8076-312
Andreas Groß Phone: +49 5222 8076-317

Shipping department Phone: +49 5222 8076-444

Dear colleagues,

from the 1^st January 2018, the Ärztearbeitsgemeinschaft OWL e.V. and the MVZ Labor Krone are converting the coagulation analytics from the STAGO analyses systems to Siemens analyses systems. The following table provides an overview of the converted parameters with the changed reference ranges:

Validation of the new test methods did not show signs of any significant deviation of test results in comparison to the previously used method.

In the aPTT evaluation in individual cases, with a heparin concentration in the normal therapeutic range, slightly shorter PTT values than before have to be expected.

Please note the changed cutoff (< 440 ng/mL) in D-dimers (FSP) for the exclusion of a thromboembolic event. Furthermore, extremely increased D-dimers (FSP) will only be shown as > 8000 ng/mL in the future.

Should you have any further questions please contact Dr. Thomas Eller on tel. +49 5222 8076-289.