Haematological profile of Malaria patients at a tertiary care hospital of Konkan region, Maharashtra State, India

Background: Malaria is a numero-uno infectious, killer disease in the developing world including India. This disease is caused by Plasmodium parasitic species with mosquitoes acting as vectors of transmission. Hematological tests include RBC, WBC and platelet parameters, peripheral blood examination which change based on parasitaemia need to be evaluated in various malaria affected regions to get prompt malarial diagnosis. Prompt diagnosis leads to prompt treatment avoiding troublesome malarial complications. Objectives: The present observational cross-sectional study was undertaken to estimate the Hematological profile in malaria cases diagnosed in a tertiary care hospital of Konkan region, Maharashtra. Methods: All the patients referred to Hematology section, Department of Pathology with malaria were evaluated with clinical details. The data was collected from 1st January 2017 to 31st December 2020 for three years’ duration. Total malarial cases studied were 50 cases. CBC/ PBS examination was done on EDTA blood sample. The RBC parameters, WBC parameters and platelet counts were studied with respect to malarial parasitaemia. Parasite index was found on smear and malarial diagnostic confirmation was also done using rapid kit test. All the findings were filled in MS-Xcel sheet 2010 and data was analyzed manually. Results: Malaria caused by P.vivax was predominant in present study. Patients in age range of 15-30 years were more affected in present study, that is, younger people were affected. Male predominance was seen. Fever was most common presenting symptoms followed by chills and rigor in present study. Hb, RBC count, PCV – showed that anemia was more common hematological change in present study, as these values were lower than normal level. Red cell indices like MCV, MCH, MCHC, RDW and peripheral blood smear revealed all the values in a normal range showing normocytic normochromic RBCs in the present study. Patients with malaria having normal TLC followed by leucopenia were more common in present study. Thrombocytopenia was most common hematological change seen in present study. Conclusion: Hematological parameters are measurable indices of blood that serve as a marker for malarial diagnosis.

Rouleaux formation of white blood cells and platelets in leukemia / Formação de rouleaux de glóbulos brancos e plaquetas em leucemia

The objective of this study was to measure the effects of glucose and salt level on white blood cells, red blood cells and platelets (PLTs) in the blood of a leukemic patient by using a white light microscope. Different concentrations of glucose and salt in the range of 0 mM to 500 mM were admixed in the blood sample to prepare blood smear. We revealed that shape of erythrocytes, leukocytes and platelets changes and form aggregates. Increasing concentrations of glucose cause to increases aggregation process of white blood cells, red blood cells and platelets. And the increasing concentration of sodium chloride causes to increase rouleaux formation and aggregation of platelets but dehydration due to increased sodium chloride concentration causes to break the aggregation of white blood cells. Comparison of CBC reports of these samples with and without analytes shows that total leukocyte count (TLC) decreases gradually towards normal ranges of leukocytes which is favorable in the treatment of leukemia but at the same time decreasing level of hemoglobin HGB, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and increasing level of red blood cell (RBCs) causes to reduce oxygen supply which is in favor of cancer growth and anemia. This work provides us the base for translation this in vitro study towards the in vivo case of blood microvasculature as a non-invasive methodology.

O objetivo deste estudo foi medir os efeitos da glicose e do nível de sal nos glóbulos brancos, glóbulos vermelhos e plaquetas (PLTs) no sangue de um paciente leucêmico usando um microscópio de luz branca. Foram misturadas diferentes concentrações de glicose e sal na gama de 0 mM a 500 mM na amostra de sangue para preparar esfregaço de sangue. Descrevemos que a forma dos eritrócitos, leucócitos e plaquetas muda e forma agregados. O aumento das concentrações de glicose aumenta o processo de agregação de glóbulos brancos, glóbulos vermelhos e plaquetas. E a crescente concentração de cloreto de sódio causa o aumento da formação de rouleaux e a agregação de plaquetas, mas a desidratação devido ao aumento da concentração de cloreto de sódio causa a quebra da agregação de glóbulos brancos. A comparação dos relatórios de CBC dessas amostras com e sem analitos mostra que a contagem total de leucócitos (TLC) diminui gradualmente para os intervalos normais de leucócitos, o que é favorável no tratamento da leucemia, mas ao mesmo tempo diminui o nível de hemoglobina HGB, hemoglobina corpuscular média (MCH ), a concentração média de hemoglobina corpuscular (MCHC) e o aumento do nível de glóbulos vermelhos (RBCs) reduz o suprimento de oxigênio, o que é a favor do crescimento do câncer e da anemia. Este trabalho fornece a base para a tradução deste estudo in vitro para o caso in vivo de microvasculatura de sangue como uma metodologia não-invasiva.

Comparison of hematocrit and platelet levels obtained from peripheral venous catheter vs venipuncture in patients admitted at Philippine Children’s Medical Center for dengue fever

OBJECTIVES@#To determine the statistical agreement between hematocrit and platelet counts obtained via peripheral venous catheters and venous puncture. It also aims to compare the success rate of obtaining samples via PVC and the hemolysis rate between different gauges of IV catheter.@*DESIGN@#Prospective Cross-sectional Study.@*PARTICIPANTS@#Clinically stable patients admitted for dengue aged 1 to 18 years old and are eligible to be enrolled in the study. Twenty-two patients were enrolled and completed the study.@*INTERVENTION@#Paired samples of venous blood collection using venipuncture and PVC on the contralateral arm was done during daily serial CBC monitoring. Hematocrit and platelet values between the two methods were analyzed using Bland-Altman Analysis.@*MAIN OUTCOME MEASURES@#Statistical agreement of platelet and hematocrit levels obtained using PVC and Venipuncture.@*RESULTS@#We had 22 patients and a total of 67 paired samples. Out of the 67 samples submitted, two samples each from PVC (2.9%) and venipuncture (2.9%) were clotted. There was100% success rate in both methods at the first attempt of collection. None on the samples had hemolysis. On the average, hematocrit measurements from venipuncture are increased by 1.17 (units) compared to PVC, while platelet measurements from PVC are increased by 4.83 (units) compared to venipuncture. There is no significant difference in both platelet count and hematocrit between the two methods, demonstrating agreement between the two methods.@*CONCLUSIONS@#There is statistical agreement between samples drawn from PVC and venipuncture in terms of hematocrit and platelet counts in dengue pediatric patients. Success rate and hemolysis rates between the two methods are the same. PVC is an acceptable alternative to venipuncture.

Hematological profile, total plasma protein and fibrinogen concentrations of clinically healthy adult Campeiro horses / Perfil hematológico, concentração de proteínas totais e fibrinogênio plasmático de equinos adultos e clinicamente sadios da raça Campeiro

ABSTRACT: This research was performed by a multidisciplinary and interagency team and sought to determine the blood profile, total plasma protein and fibrinogen concentrations of clinically healthy adult Campeiro horses. A total of 138 horses (14 stallions, 74 non-pregnant and 50 pregnant mares) over three years of age from breeders located in the states of Santa Catarina and Rio Grande do Sul were divided into groups according to age, sex and pregnancy status. Statistical analysis of the data was performed using the ANOVA test, Student's T test, and descriptive analyses (P<0.05). There was a significant difference (P<0.05) in the values for MCV, MCH, and total number of eosinophiles when comparing different age groups. There was also a notable difference (P<0.05) in the total plasma protein and total number of eosinophile variables when comparing pregnant females to non-pregnant females. These results show that the Campeiro breed presents certain peculiarities regarding variables in the complete blood count, total plasma protein and fibrinogen compared to the values described by other authors for other breeds. Thus, it is suggested that the values established in this study should be used as benchmarks for interpreting erythrocyte and leukocyte counts when evaluating these variables in Campeiro horses.

RESUMO: O presente trabalho foi executado por uma equipe multidisciplinar e interinstitucional, objetivando determinar o perfil hematológico, a concentração de proteínas totais e o fibrinogênio plasmático de equinos adultos e clinicamente sadios da raça Campeiro. Foram utilizados 138 animais (14 machos inteiros, 74 fêmeas vazias e 50 prenhes), com idades acima de três anos, provenientes de criatórios localizados em Santa Catarina e Rio Grande do Sul, divididos em grupos de acordo com a idade, sexo e estado gestacional. A análise estatística dos dados foi realizada por meio do teste ANOVA, teste t de Student e análise descritiva (P<0,05). Houve diferença significativa (P<0,05) para os valores do HCM, VCM e número total de eosinófilos, quando comparadas as diferentes faixas etárias. Também houve diferença (P<0,05) para as variáveis PTP e número total de eosinófilos, quando comparadas fêmeas prenhas e vazias. A partir desses resultados, pode-se concluir que os equinos Campeiros apresentam particularidades com relação às variáveis do hemograma, proteínas totais e fibrinogênio plasmático, quando comparados aos descritos por outros autores em outras raças. Sendo assim, sugere-se que os valores estabelecidos no presente estudo sejam tomados como valores de referência na interpretação do eritrograma e leucograma para a avaliação dessas variáveis em equinos da raça Campeiro.

Hemoglobina reticulocitaria: un nuevo parámetro del hemograma de gran valor en el diagnóstico y manejo de la eritropoyesis deficiente en hierro / Reticulocyte hemoglobin: a new complete blood count (CBC) parameter valuable in the diagnosis and management of iron-deficient erythropoiesis

Resumen: la incorporación de los autoanalizador de hematología al laboratorio clínico no solo mejoró la calidad de los resultados de los parámetros convencionales del hemograma sino que ha permitido,especialmente con aquellos de última generación, introducir nuevos parámetros de gran utilidad clínica. Uno de los nuevos parámetros es la hemoglobina reticulocitaria, la cual se vislumbra como una potente herramienta en el diagnóstico y el manejo de la eritropoyesis deficiente en hierro en sus diferentes manifestaciones, en particular la deficiencia absoluta de hierro, la deficiencia funcional de hierro y el secuestro del hierro. La hemoglobina reticulocitaria en todos los casos en donde hay eritropoyesis deficiente en hierro es el primer parámetro detectable en el hemograma y, a su vez, es el primero que se normaliza cuando la terapia administrada ha sido la adecuada; además, ha demostradoser costo eficiente, sobre todo por ser un parámetro del hemograma más que una prueba adicional. El único problema, hasta el momento, es que solo está disponible en algunos autoanalizadoresde hematología como los de las compañías Siemens y Sysmex, en sus modelos de cuarta generación, también conocidos como hemograma tipo VI o hemograma ampliado o extendido. Con el presente módulo se pretende presentar este nuevo parámetro que la comunidad médica debe incorporar como propio y los laboratorios clínicos deberían estar preparados para incorporarlo a sus portafolios de servicios, como una nueva herramienta complementaria en la prevención, la detección y el manejo de la eritropoyesis deficiente en hierro en sus diversas manifestaciones.

Abstract: the incorporation of hematology autoanalyzers in the clinical laboratory improved the quality of the results of conventional blood count (CBC) parameters. In addition, these machines, especially those of last generation, have allowed introducing new parameters of great clinical utility. One of these new parameters is the reticulocyte hemoglobin that is emerging as a powerful tool in the diagnosis and management of iron-deficient erythropoiesis. Also is useful in several of its forms, particularly in absolute iron deficiency, functional iron deficiency, and iron sequestration. The reticulocyte hemoglobin in all cases where there is iron-deficient erythropoiesis is the first parameter detectable in the CBC, in turn; it is the first that is normalized when the administered therapy has been adequate. It has also proven to be cost effective, especially for being a CBC parameter more than an additional test. The only problem so far is that it is only available in some hematology autoanalyzers as those of Siemens and Sysmex companies, in its fourth generation models, also known as type-VI CBC or expanded or extended CBC. With this module pretends to present a new parameter that the medical community should incorporate as own and the clinical laboratories should be prepared to include it into their service portfolios as a new complementary tool in the prevention, detection, and management of iron-deficient erythropoiesis in its various manifestations.

Prevalence of discordant microscopic changes with automated CBC analysis / Prevalência de alterações microscópicas discordantes com análise automatizada do hemograma

Introduction: The most common cause of diagnostic error is related to errors in laboratory tests as well as errors of results interpretation. In order to reduce them, the laboratory currently has modern equipment which provides accurate and reliable results. The development of automation has revolutionized the laboratory procedures in Brazil and worldwide. Objective: To determine the prevalence of microscopic changes present in blood slides concordant and discordant with results obtained using fully automated procedures. Materials and method: From January to July 2013, 1,000 hematological parameters slides were analyzed. Automated analysis was performed on last generation equipment, which methodology is based on electrical impedance, and is able to quantify all the figurative elements of the blood in a universe of 22 parameters. The microscopy was performed by two experts in microscopy simultaneously. Results: The data showed that only 42.70% were concordant, comparing with 57.30% discordant. The main findings among discordant were: Changes in red blood cells 43.70% (n = 250), white blood cells 38.46% (n = 220), and number of platelet 17.80% (n = 102). Discussion: The data show that some results are not consistent with clinical or physiological state of an individual, and cannot be explained because they have not been investigated, which may compromise the final diagnosis. Conclusion: It was observed that it is of fundamental importance that the microscopy qualitative analysis must be performed in parallel with automated analysis in order to obtain reliable results, causing a positive impact on the prevention, diagnosis, prognosis, and therapeutic follow-up. .

Introdução: A causa mais comum de erro no diagnóstico relaciona-se com erros de exames laboratoriais, bem como erros de sua interpretação. E com o intuito de reduzi-los, atualmente o laboratório dispõe de equipamentos modernos com resultados precisos e confiáveis. O desenvolvimento da automação revolucionou os procedimentos laboratoriais no Brasil e no mundo. Objetivos: Verificar a prevalência de alterações microscópicas presentes em lâminas hematológicas concordantes e discordantes com resultados obtidos por meio de procedimentos totalmente automatizados. Materiais e métodos: No período de janeiro a julho de 2013, foram analisados os parâmetros hematológicos de 1.000 lâminas. A análise automatizada foi realizada em equipamento de última geração, cuja metodologia baseia-se em impedância elétrica e é capaz de quantificar todos os elementos figurados do sangue em um universo de 22 parâmetros. A hematoscopia foi realizada por dois microscopistas ao mesmo tempo. Resultados: Os dados demonstraram que apenas 42,70% foram concordantes, confrontando com 57,30% discordantes. Os principais achados entre os discordantes foram alterações na série vermelha 43,70% (n = 250), série branca 38,46% (n = 220) e plaquetária 17,80% (n = 102). Discussão: Os dados comprovam que alguns resultados não são compatíveis com a clínica, nem condizem com o estado fisiológico de um indivíduo e podem não ser explicitados por não terem sido investigados, o que pode comprometer o diagnóstico final. Conclusão: Observou-se a importância de a análise hematoscópica qualitativa ser realizada em paralelo à análise automatizada para que se obtenha resultados confiáveis, que cause impacto positivo na prevenção, no diagnóstico, no prognóstico e no seguimento terapêutico. .

O mosaico inflamatório nos subtipos de carcinoma basocelular / The Inflammatory Mosaic in the Histological Subtypes of Basal Cell Carcinoma / Mosaico Inflamatorio en los Subtipos de Carcinoma de Células Basales

Introdução: O carcinoma basocelular (CBC) é definido como um tumor localmente invasivo e de progressão lenta. À medida que ele se espalha, inicia-se um processo inflamatório crônico com recrutamento de diversos tipos celulares. Objetivo: Caracterizar o infiltrado inflamatório, nos diferentes subtipos de CBC, através da identificação e quantificaçãode suas células. Método: Foi realizado estudo retrospectivo de 71 blocos de parafina de pacientes diagnosticadoscom CBC não recorrente. As análises imuno-histoquímicas foram realizadas pela técnica de estreptoavidina-biotinaperoxidase (CD3, CD20, CD68, CD8, CD4, Ki-67 e MAST cell), além da técnica do azul de toluidina para mastócitos. Resultados: Os subtipos mais frequentes foram o infiltrativo (26%) e o superficial (23%). Na composição do infiltrado inflamatório, os linfócitos TCD 4+ corresponderam à população mais numerosa (216,2±22,23), seguida por mastócitos(111,0±7,88), linfócitos TCD 8+ (57,38± 5,94), linfócitos B (55,9± 6,83) e macrófagos (21,18±2,58). Houve uma baixa atividade proliferativa celular total (47,61±7,48), no entanto em formas mais agressivas esse dado foi inverso e com infiltrado rico em mastócitos. O subtipo adenoide apresentou o mais denso infiltrado, enquanto o cístico apresentouo mais discreto. Observou-se relação inversa entre o número de mastócitos e de linfócitos T, sem correlação comagressividade. Conclusão: No CBC, o infiltrado inflamatório peritumoral sugere uma resposta imunológica mediada por células TCD 4+ e composição variando de acordo com o tipo de tumor. Sugere-se que as características de cada tumor possam promover diferenças no microambiente tecidual, induzindo alterações na composição do infiltrado que poderiam tanto auxiliar quanto impedir o crescimento tumoral

mRNA quality control pathways in Saccharomyces cerevisiae.

Efficient production of translation-competent mRNAs involves processing and modification events both in the nucleus and cytoplasm which require a number of complex machineries at both co-transcriptional and posttranscriptional levels. Mutations in the genomic sequence sometimes result in the formation of mutant nonfunctional defective messages. In addition, the enormous amounts of complexities involved in the biogenesis of mRNPs in the nucleus very often leads to the formation of aberrant and faulty messages along with their functional counterpart. Subsequent translation of these mutant and defective populations of messenger RNAs could possibly result in the unfaithful transmission of genetic information and thus is considered a threat to the survival of the cell. To prevent this possibility, mRNA quality control systems have evolved both in the nucleus and cytoplasm in eukaryotes to scrutinize various stages of mRNP biogenesis and translation. In this review, we will focus on the physiological role of some of these mRNA quality control systems in the simplest model eukaryote Saccharomyces cerevisiae.

Evaluation of the Mindray BC-6800 Complete Blood Counts Analyzer

BACKGROUND: The BC-6800 (Mindray, China) is a recently developed hematology analyzer that utilizes 'SF Cube Technology' to improve the reliability of complete blood counts (CBC), white blood cell (WBC) differentials, and erythroblast counts. In this study, we evaluated the performance of the BC-6800 for CBC, WBC differentials, reticulocyte counts, and erythroblast counts and analyzed the efficiency of its flag system. METHODS: Specimens from 100 healthy controls and 95 patients were used. We performed precision and correlation studies of CBC, WBC differentials, reticulocyte counts, and erythroblast counts. We also analyzed the efficiency of the flag system in detecting abnormal blood cells. RESULTS: The coefficients of variation (CVs) of precision were 0.9800 for CBC except erythrocyte indices, and >0.9500 for WBC differentials except monocyte and basophil. The WBC differentials and erythroblast counts obtained using the BC-6800 were well correlated with those of manual counts. The efficiencies of the flag system were 77.9% for Blasts, 82.1% for Immature Gran, 86.3% for Atypical Lymph, and 92.6% for NRBC present. CONCLUSIONS: The BC-6800 showed good precision and correlation with pre-existing hematology analyzers. The flag systems were quite efficient for detecting abnormal blood cells. Our study demonstrated that the BC-6800 hematology analyzer exhibits suitable performance and is helpful in routine laboratories.

Testigos de la historia: proceso de la calidad hematológica (hematimetría) en venezuela / Hematology quality process (hemogram) in venezuela

La calidad hematológica en Venezuela, orientada a garantizar la confiabilidad de los resultados de la hematimetría, ha sido difícil de implementar. Los esfuerzos tanto individuales como institucionales, descritos según nuestras vivencias en el área, confirman la necesidad de continuar trabajando para lograr la acreditación de los laboratorios.

Hematologic quality in Venezuela, intended to ensure the reliability of the CBC results, has been difficult to implement. Both individual and institutional efforts, described according to our experiences in the area, confirm the need to continue the work to achieve laboratories accreditation.

Predicción de la concentración de linfocitos T CD4 en sangre periférica con base en la teoría de la probabilidad: Aplicación clínica en poblaciones de leucocitos, linfocitos y CD4 de pacientes con VIH T / CD4 Lymphocytes Prediction Based on the Theory of Probability: Clinical application on leukocytes, lymphocytes and CD4 populations of HIV patients

Introducción. Se han desarrollado modelos para la predicción de la tasa de disminución de células CD4 en pacientes con VIH/sida con base en redes neurales y, también, en la variabilidad de la disminución de los recuentos de CD4 en pacientes seropositivos y seronegativos, con el recurso de métodos epidemiológicos. Objetivo. Predecir la población de linfocitos T CD4, a partir de la información del cuadro hemático sobre leucocitos y linfocitos, mediante la teoría de la probabilidad. Métodos. Se evaluaron los cuadros hemáticos de siete casos particulares, determinando la cantidad total de leucocitos y linfocitos, y la cantidad de linfocitos CD4 por medio de citometría de flujo. A partir de un trabajo previo, se desarrolló una inducción con la que se determinaron los conjuntos A, B, C y D, con base en los cuales se calculó la probabilidad de aparición de combinaciones específicas de valores de leucocitos, linfocitos y CD4, en rangos de 1.000 leucocitos para 128 casos. Resultado. Se predice que los rangos de leucocitos inferiores a 5.000 y 4.000 por mm3 de sangre periférica se asocian a menos de 570 linfocitos CD4 por µl con una probabilidad de 0,92 y 1, respectivamente. A medida que disminuye la cantidad de las poblaciones de leucocitos, el porcentaje de aciertos entre las tres medidas es más efectivo. Conclusión. La teoría de la probabilidad reveló una autoorganización matemática de las poblaciones celulares estudiadas, que permitió desarrollar predicciones clínicas para el número de células CD4 a partir del cuadro hemático, disminuyendo los costos y deduciendo los resultados de la citometría de flujo.

Background: Models for the prediction of the CD4 decrease rate in VIH/AIDS patients have been developed with neural networks, and also for the prediction of the variability in CD4 counts decrease in seropositive and seronegative patients with epidemiological models. Objective: to predict the TCD4 lymphocyte population, beginning with the Complete Blood Count (CBC) information of leucocytes and lymphocytes, through probabilistic theories. Methods: Seven CBC of particular cases were evaluated, by determining the total count of leucocytes and lymphocytes, and the proportion of CD4 Lymphocytes by flow cytometry. Based on a previous work an induction was developed; with that induction the sets A, B, C and D were determined. Based on that sets we established the probability of aparition of specific combinations of leucocytes, Lymphocytes ans CD4 values, in ranges of 1.000 leucocytes, in 128 cases. Results: it is predicted that the leucocytes ranges lower than 5,000 and 4,000 per cubic milimeter of peripheral blood are associated with less than 570 CD4 per microliter with a probability of 0.92 and 1 respectively. As the quantity of populations diminishes, the success percentage between the three measures is more effective. Conclusion: The probability theory revealed a mathematical self-organization of the studied cellular populations, allowing the development of predictions in a clinical level for the CD4 number from the CBC, diminishing costs and deducting the results of the flow cytometry.

Comprehensive kinetic study of delignification, carbohydrate degradation, cellulose chain scissions and hexenuronic acid reactions during kraft pulping prosopis chinensis.

Prosopis Chinensis represents one of the most suited fiber sources for the production of a wide range of high quality papers and high-purity dissolving pulps. The optimization of kraft pulping covering both continuous and batch processes demands kinetic models suitable for advanced control and offline optimization of the cooking operation. Quite recently, an improved kinetic model structure for softwood kraft cooking has been published, which considers varying alkali and temperature profiles during the cooking [1]. Unfortunately, most alkaline cooking models are based solely on softwood [2, 3]. This work contributes to an improved kinetic model for kraft cooking of Prosopis, suitable for advanced control of modern displacement cooking processes such as the continuous batch cooking process (CBC). After impregnation where the initial lignin has been removed, the bulk and residual delignification have been studied in a batch reactor as a function of the [OH-], [HS-], ionic strength, [Na+], and temperature. The underlying kinetic expressions are similar to those used in the Andersson model also including a mechanism for determining kraft pulping of Prosopis chinensis,the distribution of lignin and carbohydrate species 2 and 3 as a function of the cooking conditions. The kinetic equations were successfully validated against experimental data from a pilot plant digester applying conventional batch cooks. Furthermore, the formation of hexenuronic acid bound to the xylan backbone and its degradation / dissolution were described by a consecutive first-order reaction. In agreement to other studies, the temperature and the effective alkali charge revealed a strong influence on the hexenuronic acid content in the pulp while the effect of sulfidity proved to be insignificant. The role of ionic strength on the HexA content remained unclear. An increase in the ionic strength resulted in a higher maximum HexA content shifted to a higher kappa number (about 58), but with progressive delignification to a kappa number typical for unbleached Prosopis Chinensis, kraft pulp (about 15), the HexA content decreased to a level more than 20% lower as compared to pulps cooked at lower ionic strength.

Complete Blood Count Reference Values of Donated Cord Blood from Korean Neonates / 대한진단검사의학회지

BACKGROUND: In the public cord blood (CB) banks, only safe CB units with adequate cell doses are processed and stored. Complete blood count (CBC) of CB is crucial for estimating total nucleated cells (TNC) and screening suitable CB units without hematologic abnormalities. We analyzed CBC parameters of the donated CB from healthy Korean neonates to establish CBC reference values. METHODS: A total of 2,129 Korean CB units, donated and processed during the period from August 2007 to December 2007, were enrolled. We measured hemoglobin (Hb), white blood cell (WBC) count, differential count of WBC, platelets and nucleated red blood cell (nRBC) count by XE-2100 automated hematology analyzer (Sysmex, Japan), and estimated reference value of each parameter by using parametric (Mean+/-2SD) and/or non-parametric methods (2.5-97.5 percentile). And also, we compared the result of each parameter in relation to sex of neonates and delivery method. RESULTS: Because the differences of CBC values among different subgroups were not remarkable, we established the reference intervals as follows without subgroup division: Hb, 9.0-14.4 g/dL; WBC count, 5.6-18.5x103/microL; differential count of WBC (neutrophils, 40.8-72.4%; lymphocytes, 17.2-46.7%; monocytes, 4.9-12.8%; eosinophils, 0.7-7.0%; basophils, 0.0-1.6%); platelet, 130-287x103/microL; nRBCs, 0.0-13.1/100 WBC. CONCLUSIONS: We established cord blood CBC reference values of healthy Korean neonates using a large-scale CB units. The established CBC reference values from our study will be useful as basic data for CBC interpretation and assessment of transplant suitability of donated CB.

Diagnostic Approach to Patients with Anemia

Anemia is defined as an insufficient amount of RBC mass to adequately deliver oxygen to peripheral tissues. For practical purposes, however, the measurements of three parameters that can be obtained from the complete blood count (CBC) are enough to establish the presence of anemia; hemoglobin (Hb) concentration, hematocrit, and RBC number. Among these, the Hb level is the most convenient parameter to establish the diagnosis of anemia. Anemia is not a disease by itself but mostly a consequence of the underlying acquired or genetic abnormality. Although the clues to the cause of anemia may be found from the history and physical examination, three parameters from CBC provide most critical information for the differential diagnosis of anemia; mean corpuscular volume (MCV), red cell distribution width (RDW), and the reticulocyte count. MCV provides information on the size of the red cell. Values greater than 100 fL usually signify a nuclear maturation defect resulting in macrocytic anemias, while values less than 80 fL are diagnostic of hemoglobin synthesis defect causing microcytic anemias. Meticulous evaluation of the serum iron status and body iron storage is essential to the differential diagnosis of microcytic anemias. RDW is a measure of the red cell size variation. It is increased by the appearance of microcytic or macrocytic cells, or both. The reticulocyte count is a useful laboratory measurement of effective red cell production. Hemolytic anemia or acute bleeding can increase the reticulocyte count. There are four clinically useful laboratory measurements indicating the presence of hemolytic process; the reticulocyte count, the serum bilirubin, the serum lactate dehydrogenase (LDH), and the serum haptoglobin concentration. Once the presence of hemolytic anemia is established, laboratory assessment to differentiate between intravascular and extravascular hemolysis is important because clinical conditions producing intravascular hemolysis may be anticipated in certain clinical situations, which may be complicated by acute renal failure or disseminated intravascular coagulation that needs immediate interventions. If the definitive cause of anemia cannot be established by examining the peripheral blood, a bone marrow study may be helpful.

Clinicopathological Analysis of Antibiotic Treatment after Appendectomy: A Randomized Prospective Trial

PURPOSE: The optimal antibiotic regimen for appendicitis still remains poorly defined. The aim of this study was to define the optimal duration and route of antibiotics after an appendectomy, with regard to the clinicopathololgical aspects. METHODS: This study was performed on 73 consecutive patients who underwent an appendectomy. Groups A and B, which were composed of cases of simple appendicitis (phlegmonous and suppurative type) and complicated appendicitis (gangrenous and perforated type), respectively. Group A was randomized after the appendectomy into either A1 (n=17), a 1-day course of a combination of IV first generation cephalosporin and tobramycin; or to A2 (n=26), a 3-day course of the same regimen. Group B was randomized into either B1 (n=16), a 3-day course of a combination of IV cephalosporin, tobramycin, and metronidazole, followed by conversion to a 4-day course of a combination of PO third generation cephalosporin and metronidazole; or B2 (n=7), a 7-day course of a combination of IV cephalosporin and metronidazole, along with a 5-day course of tobramycin. The total leukocyte count (WBC), neutrophil count, and C-reactive protein (CRP) were analyzed preoperatively and on POD #3 and #7. An intraoperative culture of the surface of the appendix was also performed. RESULTS: The most common cultured organism was Escherichia coli (n=30). Ampicillin and first generation cephalosporin were 73% and 49% resistant to Gram-negative organisms, respectively. Third generation cephalosporin and imipenem were 100% sensitive. The subjects in group A were all under normal limits in the postoperative laboratory analyses, and had no complication. Groups B1 and B2 showed no significant differences in their WBC (P=0.301), neutrophil count (P=0.730), and complications (P=0.907), with the exception of CRP (P=0.040). CONCLUSION: After the appendectomy, simple appendicitis was treated with antibiotics for 24 hrs, with no complications. For complicated appendicitis, a 3-day IV course, followed by a conversion to 4-day PO antibiotics, was found to be safe. Surveillance of the WBC and neutrophil counts, CRP values, and body temperature permitted safe utilization of this regimen.

Neutropenia in Psychiatric Out-Patients / 대한정신약물학회지

OBJECT: The study was performed to examine the psychotrophic drugs used in psychiatric out-patients in which neutropenia developed and current state of consultation and to confirm the importance of complete blood count and differential count (CBC/DC). SUBJECTS AND METHODS: The subjects were 60 patients of our university hospital in which neutropenia developed in out-patient department (OPD) of psychiatry during recent three years. The absolute neutrophil counts of patient were below 2,000/mm3. RESULTS: The reasons why exam was performed were mainly to follow-up exam during medications. Mood stabilizers such as carbamazepine, phenytoin, sodium valproate were identified to cause neutropenia in the group using multiple drugs, and clozapine was highly related in the group using single drug. But many kinds of drugs were related with neutropenia. We have not checked well enough the CBC/DC and have not consulted well to hematologist in OPD of neuropsychiatry. CONCLUSIONS: It is important to find neutropenia in the psychiatric out-patients using psychotropic drugs. We had better check CBC/DC routinely and consult to hematologist.

The Hematologic Effect of Antiepileptic Drugs

PURPOSE: There have been controversies on the hematologic effects of antiepileptic drugs according to the mono or combined antiepileptic therapy. We evaluated the hematologic changes of the patients who have been taking antiepileptic drugs for more than 4 months and compared the changes of these values according to the mono or combined therapy. METHODS: From May, 1989 to April, 1995, we had examined the blood samples of 89 patients 1) when they were diagnosed as the convulsive disorder and 2) when they had taken antiepileptic drugs for more than 4 months so that their serum drug concentration was enough to be effective for the seizure control. We classified these patients as 4 groups according to the drugs they had taken; 1st group: population treated with valproic acid, 2nd group: population treated with carbamazepine, 3rd group: population treated with phenobarbital and 4th group: population treated with combined antiepileptic drugs (mostly valproic acid with other antiepileptic drugs). We examined and compared their hematologic values such as counts of white blood cell (WBC), red blood cell (RBC), platelet and hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). RESULTS: 1) Mean age of the patients was 6.9+/-4.1 year and the mean duration of antiepileptic medication was 3.5+/-1.2 years. Age and the duration of medication had no influence on the study. 2) No significant differences were found on the WBC, RBC, Hb, Hct and MCHC before and after the medication in all the groups. 3) Statistically significant changes were found on MCV and MCH values before and after the medication in the 1st and 4th group (p<0.05, each group). CONCLUSIONS: We observed the significant increases on MCV and MCH in the patients who had taken valproic acid singly or combined with other antiepileptic drugs. It is necessary to take periodic CBC follow up to evaluate the changes of MCV and MCH in these patients. Additional investigation is needed to obtain the hamatologic side effects according to the various dosing regimens and durations of drug administration.