Preanalytical phase in pleural fluid analysis

Kopcinovic, Lara Milevoj; Culej, Jelena

doi:10.21037/jlpm-2021-02

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…No anticoagulants or additives are necessary for most biochemistry tests, although heparinized tubes may be used, except for glucose, for which PF sample must be collected in tubes containing a glycolysis inhibitor to avoid in vitro glucose consumption, especially in heavily cellular samples. 9 Before biochemical analyses, centrifugation is required to eliminate cell debris and correctly carry out investigations, including PF inspection (see below). For pH measurement, the PF sample must be collected in air-tight non-ventilated syringes and transported to the laboratory or point-of-care blood-gas station rapidly and, ideally, ice packed.…”

Section: Pre-analytical Phase: a Frequently Neglected Aspectmentioning

confidence: 99%

The laboratory investigation of pleural fluids: An update based on the available evidence

et al. 2023

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Selecting appropriate laboratory tests based on available evidence is central to improve clinical effectiveness and impacting on patient outcome. Although long studied, there is no mutual agreement upon pleural fluid (PF) management in the laboratory context. Given the experienced confusion about the real contribution of laboratory investigations to guide clinical interpretation, in this update, we tried to identify useful tests for the PF analysis, aiming to unravel critical points and to define a common line in requesting modalities and practical management. We performed a careful literature review and a deepened study on available guidelines to finalize an evidence-based test selection, intended for clinicians’ use to streamline PF management. The following tests depicted the basic PF profile routinely needed: (1) abbreviated Light’s criteria (PF/serum total protein ratio and PF/serum lactate dehydrogenase ratio) and (2) cell count with differential analysis of haematological cells. This profile fulfils the primary goal to determine the PF nature and discriminate between exudative and transudative effusions. In specific circumstances, clinicians may consider additional tests as follows: the albumin serum to PF gradient, which reduces exudate misclassification rate by Light’s criteria in patients with cardiac failure assuming diuretics; PF triglycerides, in differentiating chylothorax from pseudochylothorax; PF glucose, for identification of parapneumonic effusions and other causes of effusion, such as rheumatoid arthritis and malignancy; PF pH, in suspected infectious pleuritis and to give indications for pleural drainage; and PF adenosine deaminase, for a rapid detection of tuberculous effusion.

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Section: Pre-analytical Phase: a Frequently Neglected Aspectmentioning

confidence: 99%

The laboratory investigation of pleural fluids: An update based on the available evidence

et al. 2023

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“…In addition, the stability of biomarkers can also affect the generalization from research to clinical practice. Therefore, it is crucial to study the long‐term in vitro stability of pleural biomarkers 23 . Previous studies revealed suboptimal stability of several pleural fluid biomarkers or parameters such as albumin, 24 pH, 25 adenosine deaminase, 26,27 glucose, 24 and amylase 24 .…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it is crucial to study the long‐term in vitro stability of pleural biomarkers. 23 Previous studies revealed suboptimal stability of several pleural fluid biomarkers or parameters such as albumin, 24 pH, 25 adenosine deaminase, 26 , 27 glucose, 24 and amylase. 24 However, to the best of our knowledge, the stability of pleural fluid CEA has so far not been comprehensively explored.…”

Section: Introductionmentioning

confidence: 99%

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

et al. 2023

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Background: The in vitro stability assessment is essential for investigating the diagnostic accuracy of pleural biomarkers. This study aimed to investigate the long-term stability of pleural fluid carcinoembryonic antigen (CEA) at À80 C to À70 C. In addition, we analyzed the effects of frozen storage on the diagnostic accuracy of CEA for malignant pleural effusion (MPE). Methods: Pleural fluid CEA of participants in two prospective cohorts were stored at À80 C to À70 C for 1-3 years. The CEA level in the stored specimen was measured with an immunoassay, and its level in the fresh specimen was extracted from medical records. The Bland-Altman method, Passing-Bablok regression, and Deming regression were used to analyze the agreement of CEA between the fresh and frozen pleural fluid. In addition, we used receiver operating characteristic (ROC) curves to evaluate the diagnostic accuracy of CEA in the fresh and frozen specimens for MPE. Results: A total of 210 participants were enrolled. The median CEA levels in frozen and fresh pleural fluid specimens were similar (frozen, 2.32 ng/mL; fresh, 2.59 ng/mL; p < 0.01). The slopes and intercepts in the Passing-Bablok regression (intercept 0.01, slope 1.04) and Deming regression (intercept 0.65; slope 1.00) were not statistically significant (p > 0.05 for all). No significant difference was observed between the area under the ROC curves of CEA in the fresh and frozen specimens (p > 0.05 for all). Conclusion: Pleural fluid CEA is seemingly stable when stored at -80 C to À70 C for 1-3 years. Frozen storage does not significantly affect the diagnostic accuracy of CEA for MPE.

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Pleural fluid biochemical analysis: the past, present and future

Zheng

2022

Clinical Chemistry and Laboratory Medicine (CCLM)

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Identifying the cause of pleural effusion is challenging for pulmonologists. Imaging, biopsy, microbiology and biochemical analyses are routinely used for diagnosing pleural effusion. Among these diagnostic tools, biochemical analyses are promising because they have the advantages of low cost, minimal invasiveness, observer independence and short turn-around time. Here, we reviewed the past, present and future of pleural fluid biochemical analysis. We reviewed the history of Light’s criteria and its modifications and the current status of biomarkers for heart failure, malignant pleural effusion, tuberculosis pleural effusion and parapneumonic pleural effusion. In addition, we anticipate the future of pleural fluid biochemical analysis, including the utility of machine learning, molecular diagnosis and high-throughput technologies. Clinical Chemistry and Laboratory Medicine (CCLM) should address the topic of pleural fluid biochemical analysis in the future to promote specific knowledge in the laboratory professional community.

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Preanalytical phase in pleural fluid analysis

Cited by 3 publications

References 15 publications

The laboratory investigation of pleural fluids: An update based on the available evidence

The laboratory investigation of pleural fluids: An update based on the available evidence

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

Pleural fluid biochemical analysis: the past, present and future

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