Association Between Thyroid Hormone Status and Complete Blood Count Parameters in Anemic Patients

@#Introduction: Anemia and thyroid conditions effect each other in clinical practice. Anemia may induce alteration in thyroid hormone status and various thyroid conditions induce various types of anemia. In present study, we aimed to study the thyroid function tests of the anemic subjects and to compare characteristics and laboratory features of the three groups; hypothyroid, hyperthyroid, and euthyroid subjects. Methods: Anemic subjects divided into three groups according to the thyroid hormone status, either as hyperthyroid, hypothyroid and euthyroid groups. Hemogram indices and laboratory parameters compared between three groups. Results: Mean red cell distribution width (RDW) of hypothyroid anemic subjects was significantly lower than the RDW of euthyroid anemic subjects (p=0.003). White blood cell (WBC) count of hypothyroid anemic subjects was significantly reduced compared to the euthyroid (p<0.001) and hyperthyroid (p=0.047) anemic subjects. Significant inverse correlation between RDW and TSH (r=-0.25, p=0.001), between RDW and hemoglobin (r=-0.44, p<0.001), between RDW and hematocrit (r=-0.35, p<0.001) and between RDW and mean corpuscular volume (r=-0.53, p<0.001) were noted. Conclusions: Since anemia is common in thyroid conditions, besides its role in differential diagnosis of the anemia, RDW could also serve as an adjunct diagnostic tool in estimation of the thyroid hormone status in anemic subjects.

Analysis of the factors related to the blood pressure control in hypertension

Objective: To determine the factors associated with blood pressure control and comparing anthropometric and clinical parameters of subjects with well-controlled hypertension to those with poorly controlled blood pressure

Study Design: Observational cross-sectional study

Place and Duration of Study: Abant Izzet Baysal University Hospital, Bolu, Turkey, from January to June 2016

Methodology: Medical data obtained and recorded from computerised database and case files of our clinic. Subjects with mean blood pressure above target levels were defined as poorly controlled and others were as well-controlled hypertension group according to JNC VIII

Results: Out of 342 subjects, only 116 [33.9%] were aware of normal blood pressure range. The number of patients who had a blood pressure on goal in the group and knew the normal range o blood pressure was significantly higher than the patients in group who did not know the normal range of blood pressure. Body mass index and waist circumference were both significantly higher in poorly controlled compared to well-controlled hypertensive subjects. Treatment compliance was significantly associated with better control of hypertension

Conclusion: Striking results of present study indicate that lower body mass index and lesser waist circumference along with treatment compliance and awareness of normal blood pressure ranges are important factors that affect reaching treatment targets in hypertensive subjects

Haemogram parameters in vitamin D deficiency

Objective: To study haemogram derived inflammatory indices, mean platelet volume [MPV], red cell distribution width [RDW], and neutrophil to lymphocyte ratio [NLR] in vitamin D deficient patients and to compare to those subjects with normal vitamin D levels. Study Design: Descriptive study. Place and Duration of Study: Abant Izzet Baysal University Hospital, Bolu, Turkey, from March to May 2017

Methodology: Patients' data visiting the outpatient clinics of the institution was retrospectively obtained from patients' files and computerised database. Subjects were grouped into normal vitamin D and vitamin D deficiency groups, according to the serum Vitamin D levels. Seasonal threshold value for vitamin D in Bolu region was set as 10 ng/ml. General characteristics and laboratory data of the study population were recorded and compared

Results: Vitamin D deficiency was more common in subjects working inside as compared to those working outside [p=0.02], and in subjects with comorbidities compared to those without comorbidities [p=0.31]. Body mass index [BMI], MPV, NLR were significantly higher in vitamin D deficient group as compared to subjects with normal vitamin D levels. A MPV greater than 6.22 has 89% sensitivity and 55% specifity for vitamin D deficiency, and NLR greater than 1.69 has 76% sensitivity and 55% specifity for vitamin D deficiency

Conclusion: Elevated MPV and NLR may be the indicator of underlying serious vitamin D deficiency. Physicians should be alert and order a vitamin D assay in patients with elevated MPV or NLR, especially in endemic areas for vitamin D deficiency

case of secondary hypertension due to giant hydatid cyst

Hydatid cyst is a parasitic infection which causes enormous morbidity and mortality worldwide. The pathogenic organism responsible for hydatid cyst is Echinococcus granulosus. Despite the fact that the characteristic cysts of the disease usually occur in liver and lungs, they may also occur in aberrant localisations. Subjects either present with symptoms of infection itself or local complications due to compressive mass effect of the cyst. Here, we report a case of secondary hypertension due to extrinsic compression of the right renal artery by a giant hepatic hydatid cyst. A 78-year woman presented with poorly controlled hypertension. She has been treated for hypertension with an angiotensin converting enzyme inhibitor plus calcium channel blocker for the last 2 years. Imaging studies revealed narrowing of the right renal artery and external compression, caused by a giant hydatid cyst. The giant hydatid cyst was treated by cyst aspiration and alcohol injection. Despite cessation of angiotensin converting enzyme inhibitor plus calcium channel blocker, she remained normotensive on follow-up visits. New onset and resistant hypertension cases in elderly should be carefully evaluated for secondary causes of hypertension, including renovascular conditions. Mass effect of the hydatid cyst disease should be considered in the differential diagnosis

Haemogram parameters in vitamin d deficiency

[RDW], and neutrophil to lymphocyte ratio [NLR] in vitamin D deficient patients and to compare to those subjects with normal vitamin D levels

Study Design: Descriptive study

Place and Duration of Study: Abant Izzet Baysal University Hospital, Bolu, Turkey, from March to May 2017

Methodology: Patients' data visiting the outpatient clinics of the institution was retrospectively obtained from patients’ files and computerised database. Subjects were grouped into normal vitamin D and vitamin D deficiency groups, according to the serum Vitamin D levels. Seasonal threshold value for vitamin D in Bolu region was set as 10 ng/ml. General characteristics and laboratory data of the study population were recorded and compared

Results: Vitamin D deficiency was more common in subjects working inside as compared to those working outside [p=0.02], and in subjects with comorbidities compared to those without comorbidities [p=0.31]. Body mass index [BMI], MPV, NLR were significantly higher in vitamin D deficient group as compared to subjects with normal vitamin D levels. A MPV greater than 6.22 has 89% sensitivity and 55% specifity for vitamin D deficiency, and NLR greater than 1.69 has 76% sensitivity and 55% specifity for vitamin D deficiency

Conclusion: Elevated MPV and NLR may be the indicator of underlying serious vitamin D deficiency. Physicians should be alert and order a vitamin D assay in patients with elevated MPV or NLR, especially in endemic areas for vitamin D deficiency

case of secondary hypertension due to giant hydatid cyst

Hydatid cyst is a parasitic infection which causes enormous morbidity and mortality worldwide. The pathogenic organism responsible for hydatid cyst is Echinococcus granulosus. Despite the fact that the characteristic cysts of the disease

usually occur in liver and lungs, they may also occur in aberrant localisations. Subjects either present with symptoms of infection itself or local complications due to compressive mass effect of the cyst. Here, we report a case of secondary hypertension due to extrinsic compression of the right renal artery by a giant hepatic hydatid cyst. A 78-year woman presented with poorly controlled hypertension. She has been treated for hypertension with an angiotensin converting enzyme inhibitor plus calcium channel blocker for the last 2 years. Imaging studies revealed narrowing of the right renal artery and external compression, caused by a giant hydatid cyst. The giant hydatid cyst was treated by cyst aspiration and alcohol injection. Despite cessation of angiotensin converting enzyme inhibitor plus calcium channel blocker, she remained normotensive on follow-up visits. New onset and resistant hypertension cases in elderly should be carefully evaluated for secondary causes of hypertension, including renovascular conditions. Mass effect of the hydatid cyst disease should be considered in the differential diagnosis

Mean platelet volume to lymphocyte ratio as a novel marker for diabetic nephropathy

Objective: to compare mean platelet volume to lymphocyte ratio [MPVLR] of diabetic nephropathy subjects to those diabetics without diabetic nephropathy

Study Design: observational, cross-sectional study

Place and Duration of Study: tertiary referral hospital, in Bolu, Turkey, from July to December 2017

Methodology: patients with type 2 diabetes mellitus admitted to the Internal Medicine Clinic, were included. Patients were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. MPVLR was calculated mathematically by division of MPV by lymphocyte count

Results: there were 162 subjects [79 females, 83 males]. The MPVLR in patients with diabetic nephropathy and nonnephropathic diabetic groups were 4.1 [2.09-11.84] and 3.4 [1.37-25.56], respectively. The difference was reached statistically significant level [p <0.001]. The best cut-off value for MPVLR was 3.66 [AUC=0.733, p <0.001]; MPVLR predicted diabetic nephropathy with 71.1% sensitivity and 67.4% specificity, at this level

Conclusion: the MPVLR is an easily calculated and efficient index that can be considered a powerful and independent predictor of diabetic nephropathy in diabetic patients. We suggest that, it can be useful adjunct to standard tests in the diagnosis of diabetic nephropathy

Could red cell distribution width be a marker of thyroid cancer?

Objective: To study red cell distribution width [RDW] values, a novel inflammatory marker in routine hemogram, of patients with benign or malignant thyroid nodules and to compare with healthy population

Study Design: Descriptive study

Place and Duration of Study: Abant Izzet Baysal University Hospital, Bolu, Turkey, from November 2015 and February 2017

Methodology: The hemogram values of patients undergone thyroid surgery for thyroid nodule between November 2015 and February 2017 were retrospectively analyzed, and compared to those in healthy subjects. Subjects with infectious or inflammatory diseases were excluded. Patients' characteristics and laboratory data were obtained from institutional computerized database. Preoperative hemogram values of thyroid nodule patients were recorded. One-way ANOVA and Kruskal-Wallis tests were performed to compare variables with significance at p<0.05

Results: Median RDW of malignant nodule group was 15.8 [12.9-19.5] and was significantly higher than both of those in benign nodule [15] and control groups [14], [p<0.001]

Conclusion: Elevated RDW in patients with thyroid nodules in preoperative period should alert the physician for possible malignancy and this cost-effective marker also can help support other modalities [ultrasound scan, and fine needle aspiration biopsy] to distinguish malignant from benign nodules

Determination of anti-nuclear antibody pattern distribution and clinical relationship

Autoantibodies are immunglobulins occurred directly against autoantigens that are known as endogen antigens. Autoimmune disease is an occasion that the body begins a fight against its own cells and tissues. The antibodies that are created by the body against its own cell nuclei are called as anti-nuclear antibodies [ANA], and one of the methods used for detection and pattern of ANA is indirect immunofluorescence test [IIF]. In the present study, it was aimed to determine the rate of ANA positivity and patterns of the positive specimens, and to investigate the relationship between ANA positivity and diseases in patients. ANA test results of a total of 3127 patients admitted during March 2010 to December 2012 were evaluated retrospectively. ANA test [HEp 20-10, EUROIMMUN, Germany] was used in dilution of 1:100 in IIF test. A total of 494 [15.8%] resulted as ANA positive. ANA positivity rate was significantly higher in female patients than the male ones [p<0.001]. The most frequent ANA patterns were coarse speckled pattern [154 patients, 31.2%], nucleolar pattern [89 patients, 18.0%], fine speckled pattern [57 patients, 11.5%], and speckled pattern [48 patients, 9.7%]. ANA positivity was most commonly determined in rheumatoid arthritis [RA] [42 patients, 8.5%], systemic lupus erythematosus [SLE] [29 patients, 5.9%], and rheumatoid vasculitis [RV] [28 patients, 5.7%]. The most frequent symptoms or findings were joint pain [127 patients, 26.0%] and anemia [28 patients, 5.7%]. ANA positivity rates were found to be significantly higher in patients with RA [p < 0.001], with SLE [p < 0.001], and with Raynaud phenomenon [p=0.001] in comparison to the controls. Amongst the most frequent diseases evaluated, no significant differences were found between the control groups and the groups of RV [p=0.089], multiple sclerosis [p=0.374], and Sjogren syndrome [p=0.311] in terms of ANA positivity rates. The present study is the first study reporting the positivity rate and distribution of ANA in Bolu located in northwestern Turkey. Information about the pattern types and the distribution of the patterns according to the diseases and symptoms contribute in diagnosis of autoimmune diseases. It is observed that clinical diagnosis has been supported significantly by ANA test according to data of our study