RIV did not significantly interfere with the prothrombinase-based assay used for the assessment of APCr, and this was observed to occur independently of FV status. However, only concentrations up to 400 ng/mL were tested and, therefore, what occurs in the presence of higher doses remains to be investigated.

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal nonneoplastic hematopoietic stem cell disease characterized by an acquired mutation of the PIG-A gene with reduction or absence of CD55 and CD59. The absence of these proteins renders PNH erythrocytes susceptible to complement-mediated hemolysis. We report the case of a PNH patient before and during pregnancy until delivery. We observed and treated some postpartum thrombotic complications. Eculizumab should be used with caution in pregnancy. There are several reports supporting its use in these patients. This case should be considered paradigmatic of a series of clinical situations that may occur in the course of a pregnancy in patients with PNH: increased need for transfusion, need to increase the dose of Eculizumab, and insurgence of fetal sufferance. Moreover, after delivery, the patient, despite adequate prophylaxis with low-molecular-weight heparins, presented severe complications: development of pleural and peritoneal effusion, pulmonary embolism, bilateral upper limbs thrombophlebitis, and a possible abdominal angina with a transient paralytic ileus. All these complications were overcome and now the baby is healthy and the mother has returned to the usual therapeutic regimen.

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This paper compares, in a hub and spoke (H&S) setting, the performance of two automated methods in rapid diagnosis of urinary tract infections (UTI). 2335 midstream urine samples obtained from adult patients were considered. In the spoke laboratory, rapid diagnosis of UTI was performed by using bacteria quantification with a Sysmex UF-1000i analyzer. In the hub laboratory, rapid diagnosis of UTI was performed by using Alifax Alfred and HB&L analyzer. Moreover, in the hub laboratory, a quantitative culture was performed in all samples. Using UF-1000i with a cut-off at 175 bacteria/µl, sensitivity was (SE) 0.95, specificity (SP) 0.80, negative predictive value (NPV) 0.98, positive predictive value (PPV) 0.64, and diagnostic accuracy (DA) 0.84. Using Alifax Alfred and HB&L with a cut-off at 30000 bacteria/ml, SE was 0.99, SP 0.99, NPV 0.99, PPV 0.98 and DA 0.98. In an H&S setting, UTI screening with UF-1000i is acceptable for routine applications. In our setting, after implementation of an UF-1000i based UTI screening, the number of bacterial cultures was thought to be reduced to 50%. Therefore, using the Alifax Alfred and HB&L system, with a higher SP, it was assumed that there is need to carry out further urine microbiological tests, allowing to perform reliable samples of about 70%. Another relevant positive aspect may be the availability of the negative results within 9 to 10 h after samples collection.