Interview with Dr. Branko Jaglikovski about the most common laboratory tests during a COVID-19 pandemic

What are the most common laboratory tests performed in Avicena Laboratory from the beginning of the pandemic until today?

From the beginning of the pandemic until today, as the situation changed in the world and in our country, so did the demands of patients and doctors, in terms of laboratory tests.

Molecular PCR tests have been performed in the Avicena Laboratory since the very beginning of the pandemic, and are still demanded and performed daily. In addition to these tests, doctors and patients need and do tests for concentration of antibodies in the blood of patients who know (or do not know) that they have been in contact with the virus. A wide range of biochemical and immunological tests are performed daily to monitor the condition of patients with COVID-19.

Although the COVID-19 pandemic still lasts, of course there are all the other patients who visit our laboratory for any other condition not related to SARS-CoV-2. Let’s not forget the patients who have various chronic non-communicable diseases and who need to monitor their condition.

Then there are all the routine and specific tests for children and adults, pregnant women, all kinds of microbiological tests, other molecular diagnostics and more.

Can COVID-19 positive patients come to the lab for other laboratory tests?

In the past few months we have provided a new and completely separate space for receiving patients for COVID-19, completely physically separated from the rest of the laboratory space, with an area of 260m², and we have made more investments in powerful ventilation systems, disinfection, protective equipment, latest material processing technology. COVID-19 positive patients who request other laboratory tests are admitted in this section. There is also the possibility for our mobile teams to take material for analysis at home, whether it is for patients who are positive for the virus or regular laboratory tests.

All patients in need of laboratory tests not related to COVID-19 are admitted regularly through the main entrance of the laboratory. Recently, the capacity to receive a larger number of patients has been expanded in this area as well, so that we currently have 9 rooms available for taking material for analysis, only in the laboratory in Taftalidze. This reduces the waiting time, given the fact that in a pandemic, the number of people waiting for an indoor service must be limited.

What other laboratory tests are needed in patients with COVID-19 and what do they tell us?

Biochemical monitoring of patients with COVID-19 using laboratory tests is crucial for assessing the severity and progression of the disease, as well as for monitoring treatment. Certain laboratory tests are associated with adverse progression of COVID-19 and provide important prognostic information. Usually, it is necessary to make the basic set of laboratory tests, which give us an insight into the general condition of the organism, indicate whether it is a bacterial or viral infection, but also provide information on the severity of the disease and possible prognosis in which direction the disease is moving, in order for the doctors to intervene in a timely manner.

Most often, patients have a blood count with sedimentation, markers of inflammation (CRP, D-Dimers, ferritin), analysis of certain enzymes and tests that indicate the function of the liver, kidneys, heart muscle and more. (ASAT, ALAT, LDH, CK-MB, Troponin).

There are also specific analyzes such as Interleukin-6, which provides information on the degree of immune response and is a predictor of the so-called “Cytokine storm”, which is actually an excessive immune response of the body and is the cause of many adverse outcomes. By monitoring this parameter, it is possible to monitor when the patient’s condition is deteriorating and to undertake appropriate treatment in a timely manner.

In patients who have COVID-19 or have recovered, D-dimers test is often mentioned. What is important to know about D-dimers?

Blood clotting (coagulation) is a natural and protective mechanism of the body from bleeding. When there is damage to the wall of blood vessels, there occurs adhesion of the platelets (thrombocytes), fibrin (fibrin filament network) and activation of many mechanisms, the ultimate goal of which is to create a “plug” that will stop bleeding.

D-dimers represent fragments, parts of fibrin degradation, and detection of elevated levels are a sign that the coagulation system is being activated (possibly excessively).

Normal levels of D-dimers in healthy adults are 0.5 mg / L FEU.

Elevated levels of D-dimers in patients with COVID-19 are often a sign that there is a risk of blood clots forming, which can explode with the circulation and cause a blood vessel to clog. Therefore, after an examination by a specialist doctor, appropriate therapy should be given and this condition should be treated.

It is very important to note that different laboratories may use different methods, instruments, technologies, so there may be different reference values and tests for the determination of D-dimers and therefore results from different laboratories should not be compared and care should be taken in which units the value is expressed.

Why COVID-19 antibody tests are important?

The combination of both types of tests (with swabs – PCR and antibodies) gives a complete and realistic picture of what is happening in the human body, so that the immunity tests and molecular tests are complementary and complement each other. If molecular tests detect the presence of the virus itself or even just the RNA sequence of the virus, by measuring the concentration of antibodies, you can see if the organism has been in contact with the virus and what the body’s immune response is in the fight against this virus.

The immunology tests performed in Avicena Laboratory are “CE” certified and are performed on a fully automatic immunoassay analyzer manufactured by Siemens Healthineers.

The tests have extremely high clinical sensitivity and specificity.

It is extremely important to note that only Avicena Laboratory performs tests to measure the concentration of so-called neutralizing IgG antibodies to COVID-19 by the manufacturer Siemens – as the latest generation of tests of this type.

COVID-19 usually stimulates the immune response by producing many antibodies that act as an army to help fight the virus — however, only a small subset of those antibodies are capable of being neutralized, that is, a small number of these antibodies can block the virus thus preventing it from infecting extra cells.

The IgG antibody test of Siemens Healthineers has been proven to measure these neutralizing antibodies and provide information on their exact concentration.

 Finally, I would like to mention that it is very important for patients to be in constant communication with their doctor and to follow all the recommendations and guidelines of doctors, to take care of their health, to make the necessary controls and checks and to keep their health and the health of their loved ones.