SEQC Spanish Society of Laboratory Medicine

Spanish Society of Laboratory Medicine

• The microbiology laboratory is crucial to identifying the etiology and focal point of the infection causing sepsis, with the isolation of the pathogen allowing the establishment of the most appropriate treatment in each situation.

• The emergency laboratory plays a key role in guiding the diagnosis of sepsis, and thus the ability to take the necessary samples so that the microbiology laboratory can isolate the pathogen.

• The study of hemostasis in the Clinical Laboratory is one of the basic pillars of hematology. It includes the study of primary hemostasis, more focused on emergency situations for the patient, and secondary hemostasis, which covers a wide group of pathologies.

With the aim of updating knowledge and being able to put into daily practice the latest developments on sepsis and primary and secondary hemostasis in the Clinical Laboratory, the Spanish Society of Laboratory Medicine (SEQC^ML) organized the courses "The laboratory in the diagnosis and prognosis of sepsis: view from the microbiology and biochemistry laboratory” and “Hemostasis and the Clinical Laboratory”; within the framework of the XX Conference of the Scientific Committee, which was held in person on March 30 and 31 in Madrid.

The "Third International Consensus Document for the Definition of Sepsis and Septic Shock" defines sepsis as life-threatening organ dysfunction caused by an exaggerated host response to infection. Sepsis is one of the leading causes of mortality in hospitals around the world: 11 million people die each year from sepsis. In our country, 17,000 people lose their lives each year from this condition.

Sepsis is a time-dependent clinical factor. Its early detection and treatment can reduce mortality by up to 50%, which is why it is and should be treated as an emergency. Fortunately, in recent years there has been considerable development in the arsenal of tools for the diagnosis and prognosis of patients with infection and sepsis. This was noted by Dr. Alba Cebollero Agustí, coordinator of the course "The laboratory in the diagnosis and prognosis of sepsis: view from the microbiology and biochemistry laboratory" and president of the Microbiology Commission of the SEQC^ML, who stressed that the course was designed to be of interest to all Clinical Laboratoryprofessionals. "The objective of the course is to renew concepts and knowledge and to be able to put into daily practice the latest news on this serious condition, useful for all those professionals who actively participate in the care process," she explained.

In the words of Dr. Cebollero Agustí, the microbiology laboratory is crucial to identifying the etiology and focal point of the infection with the isolation of the pathogen, which allowsfor the establishment of the most appropriate treatment in each situation. Likewise, the emergency laboratory must be equipped with the necessary biomarkers for the clinical assessment ofa patient with a suspected infection. More specifically, Dr. Cebollero Agustí highlighted the crucial role of the emergency laboratory "to guide the diagnosis of sepsis, and thus the ability to take the necessary samples, so that the microbiology laboratory can carry out the isolation of the pathogen."

It is important that the emergency and microbiology laboratories are coordinated with each other, but also with the emergency services and ICU of the hospital. As Dr. Cebollero Agustí asserted, "for the diagnosis of the condition to be as early as possible, it is essential that the centers have a Sepsis Code, and work on a homogenization between communities, as well as on an electronic data recording system to collect information on all the patients for whom the Sepsis Code has been activated”. This information can be used to analyze responses and plan improvements,as she commented.

Hemostasis and the Clinical Laboratory

Beyond sepsis, the XX Conference of the Scientific Committee of the SEQC^ML delved into the field of hemostasis in the Clinical Laboratory, one of the basic pillars of hematology, through the course "Hemostasis and the Clinical Laboratory". Through three theoretical and practical sessions, aspects directly related to specific laboratory areas were discussed: primary hemostasis: platelets and thromboelastogram, and secondary hemostasis; indications for molecular and genetic studies; and monitoring of oral anticoagulants.

Hemostasis is a physiological process that maintains the homeostasis of blood flow in the vessels (balance between coagulation and fibrinolysis). According to Dr. Maite Serrando Querol, course coordinator and president of the Hematological Biology Commission of the SEQC^ML, hemostasis is basically made up of two complex processes: “primary hemostasis, the first stage that controls the formation of a hemostaticplug through platelet aggregation (limitation of bleeding in the event of the appearance of a vascular breach); and secondary hemostasis, which consolidates the formation of the primary plug by triggering the activation cascade of coagulation factors, obtaining fibrin”.

Coagulation is essential to effectively control and interrupt the appearance of bleeding, especially from the large vessels. The main pathologies related to hemostasis derive from poor control or loss of equilibrium between clot formation and destruction, such as von Willebrand disease associated with a disorder in platelet aggregation, or diseases with a risk of bleeding, especially those caused by factor VIII and IX deficiency (Hemophilia A and B), among others.

According to Dr. Serrando Querol, both primary and secondary hemostasis are studied in the Clinical Laboratory. “In hemostasis laboratories, whether emergency or routine, we have different profiles that allow us to functionally analyze the intrinsic and extrinsic coagulationpathways. We also have determinations that provide us with information on the patient's ability to manufacture a primary clot (thromboelastogram)”, she explained.

The course "Hemostasis and the Clinical Laboratory" was intended to publicize and describe the determinations that allow for the study of primary and secondary hemostasis in the laboratory. In addition, to know the indication for confirmation studies of the different pathological alterations of the basic profiles of primary or secondary hemostasis, as well as disseminating the high specificity diagnostic confirmation techniques in the genetic and molecular diagnosis of this pathological group. “Other key topicswereto elaborate and explain about the use of algorithms in the hemostasis laboratory, in addition to investigating situations of high vital risk or emergency in hemostasis”, summarized Dr. Serrando Querol.