ABSTRACT Objectives The purpose of this study was to compare data obtained from the reticulocyte channel (RET channel) heated to 41 °C with those obtained from impedance channel (I-Channel) at room temperature in the samples with the mean corpuscular hemoglobin concentration (MCHC) < 370 g/L and in samples with the MCHC > 370 g/L, in the presence of cold agglutinins. Methods In this study, 60 blood samples (group 1) with the MCHC < 370 g/L (without cold agglutinins) and 78 blood samples (group 2) with the MCHC > 370 g/L (with cold agglutinins) were used to compare the two analytical channels of the XN-9000 analyzer in different preanalytical conditions. The parameters evaluated in both groups were the following: red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT), mean cell volume (MCV), RBC-most frequent volume (R-MFV), mean hemoglobin concentration (MCH) and mean cellular hemoglobin concentration (MCHC). Results The results of this study showed an excellent correlation with both channels of the XN-9000 analyzer in samples with and without cold agglutinins, except for the MCHC. The bias between the values obtained in the I-channel and those obtained in the RET channel of both groups was insignificant and remained within the limits of acceptability, as reported by Ricos et al. for all considered parameters, except for MCHC. Conclusions The presence of cold agglutinins in blood samples can be detected by a spurious lowering of the RBC count and by a spurious increase in the MCHC. The RET channel represents a great opportunity to correct the RBC count in a rapid manner without preheating. However, neither methodology can completely solve the residual presence of cold agglutinins in all samples, despite the MCHC values being < 370 g/L.

The therapy of HIV infection has been dramatically improved over the years, and allowed the achievement of unexpected results. The availability of many drugs, and the knowledge of HIV related pathogenesis, helped in selecting highly effective antiviral therapies, yet today a major challenge stands, that is the selection of the best regimen(s) in clinical practice. In this frame, evidence-based medicine remains a cornerstone of modern medicine, but its structure needs to be adapted to the new challenges, made by an excess of information (not always fully reliable), by highly sophisticated statistical systems that may overlook the clinical practice despite their ability to define the statistical significance, and the limited number of independent controlled studies. The revision of the criteria of evidence-based medicine, and their adaptation to the new tools available, may allow a better contribution to the definition of the best therapy for each single patient.

La terapia dell'infezione da HIV è molto cambiata negli anni, permettendo oggi il raggiungimento di risultati assolutamente inattesi. La disponibilità di nuovi farmaci, e la conoscenza della patogenesi della malattia da HIV, ha contribuito a selezionare terapie particolarmente efficaci. Oggi tuttavia rimane la sfida prima-ria della personalizzazione della terapia, ossia la scelta della migliore terapia per ciascun paziente. In tale contesto, la medicina basata sulla evidenza rimane fondamentale, tuttavia essa deve essere adattata alle nuove sfide, legate all'eccesso di informazione scientifica (non sempre pienamente attendibile), alle modalità di analisi statistica, spesso finalizzate più alla definizione della significatività statistica che all'identificazione del dato avente rilevanza clinica, e la scarsità di studi controllati indipendenti. La revisione dei criteri della medicina basata sull'evidenza, e il suo adattamento ai nuovi strumenti di analisi oggi disponibili, può aiutare a definire una metodologia di analisi finalizzata alla identificazione della migliore terapia per ciascun paziente.