KBUD 2015 - Özet Kitabı

KLİNİK BİYOKİMYA UZMANLARI DERNEĞİ

ULUSLARARASI KATILIMLI KONGRE & LAB EXPO 2015 01 - 05 Eylül 2015 / AKGÜN OTEL / ELAZIĞ Editörler Neval AKSOY E. Cüneyt CANBULAT Kaya EMERK İlter GÜNER Adnan HAȘİMİ Necip İLHAN Ferruh İȘMAN Dildar KONUKOĞLU Asım ÖREM Fikret Ersan TALU

XXX LCVE PSH US t XXX LCVE PSH

KLİNİK BİYOKİMYA UZMANLARI DERNEĞİ ULUSLARARASI KATILIMLI KONGRE & LAB EXPO 2015 ORGANİZASYON Ondokuz Organizasyon Rek. Dan. ve Paz. Ltd. Ști.

Burhaniye Mah. Doğu Karadeniz Cad. Villa 5 No: 28E Ihlamur Köșk Sitesi Beylerbeyi / ÜSKÜDAR / İSTANBUL Tel: 0 216 318 03 19 t Faks: 0 216 318 02 19 www.ondokuz.org BASIMA HAZIRLIK Ayna Reklam Yay. Org. San. Tic. Ltd. Ști.

1447 Sokak No: 6 D: 4 Alsancak / İZMİR Tel: 0 232 464 39 32 - 464 25 29 www.aynareklam.com BASILDIĞI YER Altındağ Grafik Matbaacılık 2839 Sokak No: 28 1. Sanayi Sitesi / İZMİR Tel: 0 232 457 58 33 t Faks: 0 232 457 89 99 Sertifika No: 20845 BASKI TARİHİ Ağustos 2015

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KONGRE DÜZENLEME KURULU Onursal Bașkan Kaya EMERK Kongre Bașkanı Necip İLHAN Kongre Genel Sekreteri Fikret Ersan TALU Üyeler Neval AKSOY E. Cüneyt CANBULAT İlter GÜNER Adnan HAȘİMİ

Ferruh Kemal İȘMAN Dildar KONUKOĞLU Asım ÖREM

Bilimsel Kurul Halide AKBAȘ Okhan AKIN Neval AKSOY Mutay ASLAN Abdülhakim ARKAN Ebubekir BAKAN Cumhur BİLGİ Nihal BOĞDAYCIOĞLU Cüneyt CANBULAT Salih CENGIZ Müjgan CENGIZ Sedat ÇAĞLAYAN Tülay ÇEVLİK Sadettin DÜRÜYEN Charles S. EBY Kaya EMERK Evren ERDOĞAN Özcan EREL

Nezaket EREN Mehtap ESEN Uzay GÖRMÜȘ İlter GÜNER Münire HACIBEKİROĞLU Goncagül HAKLAR Adnan HAȘİMİ Necip İLHAN Nevin İLHAN Ferruh Kemal İȘMAN Dildar KONUKOĞLU Pınar KOYUNCU İncilay LAY Alev Lazoğlu ÖZKAYA Kandice Kottke MARCHANT Ferzane MERCAN Koza MURAT Arzu ORAN

Asım ÖREM Yeșim ÖZARDA Fatma ÖZBAKIR Ferhan SAĞIN Muhittin SERDAR Mustafa SERTESER Çiğdem SÖNMEZ Özlem SÖNMEZ Önder ȘİRİKÇİ Fikret TALU Turan TURHAN Özlem TÜYSÜZ Fikriye URAS Ahmet VAR Cevat YAZICI Eser Yıldırım Sözmen Ümmügülsüm YILDIZ Cevdet ZÜNGÜN

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Kandice KOTTKE-MARCHANT Kandice KOTTKE-MARCHANT

Charles S. EBY Charles S. EBY Kaya EMERK

Mustafa SERTESER

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Turan TURHAN

Mehtap ESEN Ferzane MERCAN

Ebubekir BAKAN

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Koza MURAT

Arzu ORAN

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Protokol

Continuous Improvement Tools for Lean Lab Design Algorithm to Diagnose Bleeding Disorders Kandice KOTTKE-MARCHANT

EXPO New Recombinant Factor Concentrates for Hemophiliacs: Impact on Patients and Clinical Laboratories Charles S. EBY Uydu sempozyumu:

Kaya EMERK

EXPO

VIII KLİNİK BİYOKİMYA UZMANLARI DERNEĞİ ULUSLARARASI KATILIMLI KONGRE & LAB EXPO 2015

Mustafa SERTESER

EXPO

Adli Biyokimyasal Toksikoloji ve Kalite

EXPO

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Mehtap ESEN

EXPO

Muhittin SERDAR

Ebubekir BAKAN

EXPO

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EXPO

EXPO

Beklenmeyen HbA1c

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Prof. Dr. Muhittin A. SERDAR

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XIV KLİNİK BİYOKİMYA UZMANLARI DERNEĞİ ULUSLARARASI KATILIMLI KONGRE & LAB EXPO 2015

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SUNUMLAR

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Design Appropriate laboratory design is important for efficient workflow and quality laboratory testing. improvement in mind. Lab techs were actively involved in the designing the laboratory to streamline workflow and optimize efficiency. A case study will be presented to demonstrate how use of continuous improvement workstation design, inventory management system, energy efficiency and green laboratory practices.

Objectives 1. Describe continuous improvement tools Relate how continuous improvement tools can be used in the design of laboratory space Discuss how energy efficiency and sustainable practices in laboratories can help the environment

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Testing Disorders of the coagulation system span the clinical spectrum from bleeding diathesis to asymptomatic to thrombophilia. However, despite this variety of clinical scenarios, patients may present with very similar initial laboratory findings. This lecture will discuss some practical topics in hemostasis that will benefit pathologists, laboratory directors and physicians in diagnosis of hemostasis disorders. The lecture will

hemostasis diagnosis and selection of appropriate testing for individual patients.

Objectives: 1.

Outline an algorithmic approach to diagnosing the cause for an elevated PT and APTT Describe the benefits of a consultative service in hemostasis testing for helping physicians order the correct tests and understand patient results.

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preference, but diagnosis may be delayed or never made in places with inadequate access to good medical care and laboratory services. The clinical signs and symptoms of hemophilia A and B are identical, as

FIX activity: life threatening hemorrhages, require factor infusions for minor and major traumas. hemorrhages, require factor infusions for minor and major trauma and surgery. for major trauma and surgeries.

Long term complications of the severe and moderate forms of hemophilia A and B include disabling arthritis and joint damage due to recurrent hemorrhages and inflammation, typically affecting the knees, the past, but current factor concentrates are either recombinant proteins or, if purified from human plasma, zero. a one stage modified APTT clotting test, and a two stage chromogenic test. Most clinical laboratories use a

APTT performed for each dilution

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Commercial APTT reagents use different activators to initiate clotting: silica, kaolin, ellagic acid,

Two-stage factor assay

for concentrates derived from human plasma or from recombinant cell culture technology. Laboratory monitoring of plasma peak and trough factor activities during infusions is essential to ensure adequate

and FIX. They are classified as biological medicines and must be assigned an activity or potency for prepared from human plasma, the one stage clotting assay and two stage chromogenic assay methods did not produce similar activity results when determining potency for some recombinant products, which can for product labeling and which method was used in the clinical laboratory.

required less often and less recombinant protein will be used which will improve compliance, reduce costs, and improve quality of life. Other pharmaceutical companies are using different molecular techniques to

test method and reagents that laboratories should not use to measure the activity of specific recombinant factors, and by regulators to use consistent methods and standards when assigning a label potency to a and clinical laboratories would have to use the same recombinant factor used by each patient to calibrate

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Table 1.Differences between one stage APTT clotting and two stage chromogenic assays when measuring

Recombinant factor Recombinant FVIII-attached to immunoglobin Fc Biogen-ELOCATE* Recombinant FIX-attached immunoglobin Fc Biogen-ALPROIX* Recombinant FVIII-attached to polyethylene glycol (PEG) BAY94- 9027^ Recombinant FIX-attached polyethylene glycol (PEG) N9-GP Novo-Nordisk^

One stage APTT

Two stage chromogenic

Acceptable performance compared to chromogenic method

Compared to one stage APTT, less positive bias at factor activities < 20%

Lower activity with kaolin activator compared to ellagic acid and silica

Minimal data available. Appears accurate. Few chromogenic FIX products, and low demand

PEG interferes with silica activated APTT reagents-underestimates FIX in-vitro activity

Accurate measurement of activity

Ellagic acid activator APTT agrees with chromogenic activity

Minimal data available. Appears accurate. Few chromogenic FIX products, and low demand

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The liver is the predominant site for synthesis and clearance of proteins involved in formation and platelet production. Chronic liver diseases causes major changes in the hemostasis system. For many years, these changes were believed to shift the balance toward bleeding based on abnormal routine hemostasis tests and frequent bleeding complications. However, the view is changing due to laboratory studies showing parallel decreases in clotting and natural anticoagulant pathways to produce a rebalanced, but Much of the evidence supporting a balanced hemostasis state in patients with stable end stage introduction of this hemostasis test into clinical laboratories will require more research to prove its clinical usefulness as well as instrument and reagent improvements.

for bleeding prior to invasive procedures or surgeries. However, clinical decisions based on the results of these two tests are based mostly on longstanding practice behaviors instead of strong clinical evidence.

What we learn from a PT or APTT is how long it takes to produce enough thrombin to start forming a fibrin

a patient with stable, advanced liver disease or cirrhosis with a prolonged PT or APTT is also at increased risk of bleeding due to decreased production of multiple clotting factors by the liver hepatocytes. But the thrombin.

Thrombin generation testing is currently a research tool. The basic principle involves activation of the coagulation system to produce thrombin which activates a fluorescent substrate to produce a signal. thrombin; peak rate of thrombin generation; and the area under the curve called endogenous thrombin

clinical conditions is: The more thrombin formed, the greater the risk of thrombosis and the less thrombin formed, the greater the risk of bleeding. When thrombin generation studies are performed in a way that activates Protein C, stable cirrhotic patients have a relative prothrombotic, instead of a hypothrombotic, pattern, supporting the model of a rebalanced, and not shifted toward bleeding, coagulation system (figure without convincing clinical evidence that this reduces bleeding complications.

Primary hemostasis involves von Willebrand dependent adhesion of platelets at a site of blood vessel injury and subsequent platelet activation, and aggregation. Patients with chronic liver disease are sequestration of platelets in the spleen due to portal hypertension, decreased bone marrow production due to reduced production by the liver of TPO, a hormone which stimulates megakaryocytes, and decreased life span of platelets which could be due to consumption or possibly immune mediated clearance in some

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patients. There are some data to support an increased risk of bleeding after liver biopsies if the platelet whole blood, have not been validated as predictors of bleeding complications in patients with liver disease.

Increased von Willebrand factor levels in many patients with stable liver disease may compensate for qualitative and quantitative platelet defects.

If the hemostasis changes in patients with stable, end stage liver disease and cirrhosis produce a fragile,

liver failure. Many complications can trigger abrupt liver decompensation in vulnerable patients, but the three major causes are: infections, kidney failure, and vasomotor dysfunction causing inadequate organ processes leading to consumption of platelets, coagulation factors, and their regulatory proteins, as well as activation of fibrin clot breakdown which is called fibrinolysis. The laboratory consequences are severe which is a biomarker of fibrin breakdown by the enzyme plasmin. The clinical consequences include signs of hepatic failure including encephalopathy, worsening jaundice, and bleeding.

Management of acute on chronic liver failure is similar to management of other causes of overt, acute disseminated intravascular coagulopathy: treat and reverse the underlying cause if possible and restore hemostasis reserves and balance without massive volume infusions which can increase vascular pressure infusions in these critically ill patients is empiric and not based on clinical trials. Treatment options include: cryoprecipitate or fibrinogen concentrates to restore fibrinogen levels for thrombin to convert to fibrin; drugs factor stored in endothelial cells.

Advanced liver cirrhosis can only be reversed by a liver transplant which involves major surgery on a stable patient with a fragile rebalanced hemostasis system or an acute on chronic liver failure patient with a disrupted hemostasis system. Many transplant surgeons and anesthesiologists use a point of care, whole blood hemostasis test method called thromboelastography to monitor changes in blood clotting cup or the pin rotates. Different activators are used to start clotting, and the instrument displays changes based on thromboelastography parameters are more empiric than evidence based, following an algorithm seems to reduce blood transfusions compared to not following one. Innovations in transplant surgery and anesthesiology techniques have also reduced bleeding dramatically. It is now common to perform a liver system.

We now recognize that a prolonged PT or APTT in a stable cirrhosis patient does not predict the same cautious about transfusing plasma before performing invasive procedures. What is missing is a laboratory test which is easy to perform and has been validated to more accurately assess the hemostasis balance in patients with liver disease. Until then, laboratorians and clinicians will continue to struggle with the hemostasis management of patients with advanced liver disease.

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Figure 1. cellular and protein components of prohemostasis and antihemostasis pathways have adequate capacities

hemostasis functions producing an imbalanced state and increased risk of hemorrhage and possibly thrombosis.

Thrombin generation curve from normal plasma. The lag time indicates delay after adding activator to under the curve and represents the thrombin. Under conditions of deceased thrombin production, the lag time can be prolonged, peak rate of thrombin

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fibrin formation, α

α

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* * * * * * * * *

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1.

* * * * * * * * *

ise de: * * * *

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* * * * * * * * * *

1.

IoI=CVi/CV

kabul edilir.

RDD=21/2 x Z x (CVA2+CVI2) 1/2

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Referanslar 1.

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protokoller ile ilgili dahi bir standart yoktur.

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ifade edilmektedir.

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Analitik Hatalar

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TEST Hemogram

Tam kan Tam kan Plazma

aPTT

Plazma

Refleks test

Refleks test kriteri Lipid paneli

Refleks test Direkt LDL

Tam idrar analizi

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desteklenmesi gerekmektedir.

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ile denetlenmektedir.

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Akut Hepatik Porfirialar

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Referanslar

δ

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bir histir.

nosisepsiyondan kaynaklanmaz.

Lif grubu Miyelinsiz

C C

1. a. Nosiseptif

b.

Periferik c. Psikojenik

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a. Akut b. Kronik a. b. Postherpetik nevralji c. d. a. b. c. d.

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δ

β

β α

α

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α

α

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POSTER SUNUMLARI

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1

,

1

1 2 3 4

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Aktiviteleri 1

1

1

1 2

o

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1 1

2 3 4

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1

1

1

Toker1 1

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Interference on HbA1C 1

, Mahmut Bozkurt1, Mustafa Timurkaan

1

1 2

HbA1C test having a significant role in the treatment of diabetic patients can be measured by means of various methods in clinical biochemistry laboratories. HbA1C measurement today.

1C bin variants in patients affects the measurement of HbA1C test, which is one of the tests most preferred which is one of HbA1Cmeasurement methods used in monitoring and diagnosis, with hemoglobin variant. and routine test measurements.

1C chromatog 1C 1C ram, abnormal band was detected in the patient. We took sample from the patient again and sent it for hemoglobin electrophoresis. In the end, HbD was detected.

Although HbA1C measurement by HPLC is accepted as gold standard, hemoglobin variant can cause 1C

te evaluating inappropriate results of glycated hemoglobin, therefore if there is HbA1C, which is inconsistent with clinical presentation, chromatograms should be studied and it should be reported according to it.

HbA1C

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Nurcan Kilic Baygutalp1

, Fatih Baygutalp , Nurinnisa Ozturk

, Harun Polat ,

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In the present study, we investigated the relationships among handedness score, Beck depression points healthy controls

tructions.

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with Psychopathology 1

, Nuran Karabulut

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Thyroid disorders are highly prevalent in patients with schizophrenia. Changes in the levels of thyroid hormones cause the occurrence of psychiatric disorders and affect the response to treatment. The aim of this study was to investigate the changes in thyroid hormone levels in patients with chronic schizoph renia and to reveal the association between psychiatric symptoms with hormones.

These findings suggest that the subclinical hypothyroidism observed in the chronic schi zophrenic patients may be associated with treatment of neuroleptics. In chronic schizophrenic patients should be considered the possible alterations of thyroid hormones while treating.

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1

1

1

1 2 3

β

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SÖZLÜ BİLDİRİMLER

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1

1

1 2

Hypercholesterolemia is a lipoprotein metabolic disorder which causes atherosclerosis, car colored fruits and vegetables. The aim of the present study is to investigate the possible effects of lycopene

pitated then blood samples and brain tissues were taken for biochemical analyzes.

and lycopene regulate lipoprotein metabolism. Accordingly these data lycopene may act as a hipocholes

for comprehensive evaluation.

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1

1

1 2

3

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Alev Kural1 1 2

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1

1

, Dilara Kaman1, Mehmet Akbulut

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,

1

1

, Tevfik Noyan

1 1 2 3 4 5

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ad libitum olarak beslenirken, kontrol grubu ratlara sadece standart rat yemi verildi. Rutin biyokimyasal

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1

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5 6

olarak analiz edildi.

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1 1 2 3 4

β-

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1 1 2 3 4

Patlama Analizi

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SS-11

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İNDEKS

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