Case Report
Agranulocytosis Induced by Overdosage of Mercaptopurine: A Case Report
Issue:
Volume 9, Issue 3, June 2024
Pages:
23-28
Received:
28 June 2024
Accepted:
29 July 2024
Published:
30 August 2024
DOI:
10.11648/j.ajlm.20240903.11
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Abstract: Drug-induced agranulocytosis (DIAG) is a rare but potentially fatal hematological complication. Thiopurines, such as mercaptopurine (6-MP), are widely used in the treatment of chronic inflammatory bowel diseases (IBD), but can cause myelotoxicity due to the accumulation of active metabolites. We report the case of a 48-year-old woman with ulcerative colitis who developed severe agranulocytosis following an accidental overdose of 6-MP. The patient presented with febrile pancytopenia with a neutrophil count of 0.04 G/L. Bone marrow examination revealed normal cellularity with an inversion of the maturation pyramid of the granulocyte lineage. A treatment combining growth factors (filgrastim) and antibiotics (tazobactam) was initiated, leading to progressive improvement over 5 weeks. The toxicity of 6-MP is mainly due to the accumulation of 6-thioguanine nucleotides (6-TGN). The polymorphism of the gene encoding the enzyme thiopurine S-methyltransferase (TPMT) can influence the risk of myelotoxicity. Two strategies are proposed to minimize this risk: evaluation of TPMT activity with dosage adjustment, or regular monitoring of blood counts with gradual dose increase. This case highlights the importance of rigorous biological monitoring when initiating 6-MP treatment, regardless of the TPMT test. Increased vigilance is necessary when using immunosuppressive drugs in the treatment of IBD to optimize efficacy and minimize toxicity.
Abstract: Drug-induced agranulocytosis (DIAG) is a rare but potentially fatal hematological complication. Thiopurines, such as mercaptopurine (6-MP), are widely used in the treatment of chronic inflammatory bowel diseases (IBD), but can cause myelotoxicity due to the accumulation of active metabolites. We report the case of a 48-year-old woman with ulcerativ...
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Review Article
Validation Procedures in Medical Laboratory Testing: A Systematic Review of Best Practices
Issue:
Volume 9, Issue 3, June 2024
Pages:
29-40
Received:
10 August 2024
Accepted:
2 September 2024
Published:
23 September 2024
Abstract: Background: Validation procedures are essential in medical laboratory testing to ensure the accuracy and reliability of test results. As laboratory technologies evolve, staying informed about the need for continuous updates and standardization of validation practices is crucial. This knowledge keeps us at the forefront of high-quality diagnostic services and the latest advancements in the field. Objectives: This systematic review aims to identify and synthesize best practices for validation procedures in medical laboratory testing from 2010 to 2024, highlight common challenges, and provide recommendations for enhancing validation protocols. Methods: A thorough literature search was conducted using PubMed, Scopus, and Web of Science databases for 31 studies published between 2010 and 2024. Studies on validation procedures for various medical laboratory tests, including clinical chemistry, molecular diagnostics, immunoassays, and point-of-care testing, were included. Data were extracted and analyzed to identify trends, standard practices, and gaps in existing validation protocols. Results: The review included 31 studies, revealing several key findings: Standardization of validation protocols significantly improves the accuracy and reliability of laboratory tests. This review focuses on the exciting potential of machine learning and advanced analytical techniques, which have the power to enhance validation processes significantly. Emerging diagnostic technologies like next-generation sequencing and liquid biopsy require rigorous validation to ensure clinical applicability, instilling a sense of caution and responsibility in the audience. Our responsibility is to ensure that adequate quality control measures are in place. These measures are critical for maintaining the integrity of point-of-care and rapid diagnostic tests. Compliance with regulatory requirements is crucial for patient safety and effective validation practices. Conclusion: While robust validation procedures are vital for ensuring the accuracy and reliability of medical laboratory tests, this review underscores the need for continuous updates and standardization of protocols to keep pace with technological advancements.
Abstract: Background: Validation procedures are essential in medical laboratory testing to ensure the accuracy and reliability of test results. As laboratory technologies evolve, staying informed about the need for continuous updates and standardization of validation practices is crucial. This knowledge keeps us at the forefront of high-quality diagnostic se...
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,
Assia El Ouarradi
