Alterações no VCM e suas correlações com os valores de RDW-SD e RDW-CV em caninos e felinos / Variation in MCV and its correlation with RDW-SD and RDW-CV values in dogs and cats

A anemia é uma síndrome caracterizada pela diminuição do número de hemácias, hematócrito e/ou concentração de hemoglobina. Conforme o Volume Corpuscular Médio (VCM), as anemias podem ser classificadas em microcíticas, normocíticas ou macrocíticas. O RDW (Amplitude de Distribuição dos Eritrócitos) também é utilizado para ajudar na classificação das anemias, refletindo a anisocitose da população eritrocitária. Neste estudo retrospectivo objetivou-se determinar a correlação entre o RDW-SD (Desvio Padrão), RDW-CV (Coeficiente de Variação), macrocitose e microcitose em caninos e felinos atendidos na rotina clínica do Hospital Veterinário da Universidade Luterana do Brasil. Para a realização deste estudo, selecionou-se 662 laudos de hemogramas realizados (434 caninos e 228 felinos), com faixa etária de seis meses até 10 anos, foram divididos em dois grupos: Grupo 1 ­ Anemia microcítica (255 caninos e 61 felinos); Grupo 2 ­ Anemia macrocítica (179 caninos e 167 felinos). Posteriormente, correlacionou-se os grupos com os valores de RDW-SD e RDW-CV. As análises de correlação foram realizadas utilizando o teste Spearman, para a análise de significância foi utilizado o T Student, no programa IBM SPSS®Statistics. Na análise estatística do grupo canino, não houve correlação da microcitose com o RDW-SD, enquanto o RDW-CV apresentou uma correlação inversamente proporcional, razoável. No grupo macrocítico canino, a análise de correlação com o RDW-SD foi moderada e diretamente proporcional, e com o RDW-CV foi moderada e diretamente proporcional. No grupo felino, não houve correlação entre microcitose e RDW-SD, e com o RDW-CV houve uma correlação razoável e inversamente proporcional. Entre macrocitose em felinos e o RDW-SD houve uma correlação moderada e diretamente proporcional, já o RDW-CV apresentou uma correlação razoável e diretamente proporcional. Conclui-se que os caninos e felinos do grupo microcítico apresentam uma correlação com o RDW-CV. Contudo, os caninos com macrocitose apresentaram correlação tanto para o RDW-CV quanto para o RDW-SD, e os felinos apresentaram uma maior correlação com o RDW-SD.

Anemia is a syndrome characterized by a low red blood cell count, hematocrit and/or hemoglobin concentration. According to the Mean Corpuscular Volume (MCV), anemias can be classified as microcytic, normocytic or macrocytic. The RDW (Red Cell Distribution Width) is also used to help classify anemias, reflecting the anisocytosis of the erythrocyte population. This retrospective study aimed to determine the correlation between RDW-SD (Standard Deviation), RDW-CV (Coefficient of Variation), macrocytosis and microcytosis in canines and felines treated in the clinical routine of the Veterinary Hospital of Universidade Luterana do Brasil. To carry out this study, 662 blood count reports were selected (434 canines and 228 felines), aged between six months and 10 years, divided into two groups: Group 1 ­ Microcytic anemia (255 canines and 61 felines); Group 2 ­ Macrocytic anemia (179 canines and 167 felines). Subsequently, the groups were correlated with the values of RDW-SD and RDW-CV. Correlation analyzes were performed using the Spearman test, for the analysis of significance the T Student was used, in the IBM SPSS® Statistics program. In the statistical analysis of the canine group, there was no correlation between microcytosis and the RDW-SD, while the RDW-CV showed a reasonable, inversely proportional correlation. In the canine macrocytic group, correlation analysis with RDW-SD was moderate and directly proportional, and with RDW-CV it was moderate and directly proportional. In the feline group, there was no correlation between microcytosis and RDW-SD, and with RDW-CV there was a reasonable and inversely proportional correlation. There was a moderate and directly proportional correlation between macrocytosis in felines and RDW-SD, whereas RDW-CV presented a reasonable and directly proportional correlation. It is concluded that the canines and felines of the microcytic group present a correlation with the RDW-CV. However, canines with macrocytosis showed a correlation for both RDW-CV and RDW-SD, and felines showed a greater correlation with RDW-SD.

Microcytosis in children and adolescents with the sickle cell trait in Basra, Iraq

BACKGROUND: Microcytic anemia, the most common form of anemia in children and adolescents, is a heterogeneous group of diseases that is acquired or inherited. We assessed the frequency and causes of microcytosis in children and adolescents with the sickle cell trait (SCT). METHODS: This descriptive study included 95 subjects (49 males and 46 females) with SCT who attended Basra Center for Hereditary Blood Diseases for evaluation. Investigations included complete blood count, high performance liquid chromatography, capillary electrophoresis, and measurement of serum ferritin and transferrin levels. RESULTS: SCT subjects had a low hemoglobin (Hb) concentration (9.79±1.75 g/dL), low mean corpuscular volume (MCV, 67.43±9.22), low mean corpuscular Hb (21.15±3.64), and a normal red cell distribution width (RDW, 14.00±2.30). Among 95 SCT subjects, 81 (85.26%) had microcytosis, 12 (12.63%) had normal MCV, and 2 (2.11%) exhibited macrocytosis. Sixty-three (77.78%) SCT subjects with microcytosis were iron deficient, and 18 (22.22%) had normal iron levels. The mean serum ferritin and HbA2 levels were significantly lower, while the RDW, sickle Hb, and serum transferrin levels were significantly higher in patients with microcytosis and iron deficiency compared to non-iron deficient subjects (P0.05). CONCLUSION: Despite the frequent occurrence of iron deficiency in SCT subjects, co-inheritance of alpha-thalassemia seemed to be the cause of low MCV in non-iron deficient individuals with microcytosis. Genetic analysis is required to understand the genetic basis of this phenomenon.

Identificación de &-talasemia en anemias microcíticas hipocrómicas refractarias al tratamiento con hierro en Nicaragua / Identification of &-thalassemia in hypochromic microcytic anemias refractory to iron treatment in Nicaragua

Resumen Justificación y objetivo: gran parte de los casos descritos de anemias microcíticas-hipocrómicas corresponden a anemias ferropénicas y síndromes talasémicos. El diagnóstico diferencial se complementa con pruebas de laboratorio como el hierro sérico, ferritina, entre otras; sin embargo, estas son de baja disponibilidad en países en vías de desarrollo. En Nicaragua, el diagnóstico de estas patologías se basa en el historial clínico y análisis hematológicos de rutina. El objetivo de este trabajo fue la implementación de la técnica de cuantificación de hemoglobina A2 en el diagnóstico clínico de β-talasemia. Métodos: se realizó un estudio transversal con 30 pacientes que mostraban microcitosis e hipocromía después de 3 meses de tratamiento con sales de hierro. Se realizó electroforesis de hemoglobina y se utilizó el kit de la casa comercial Beta-Thal HbA2 Quik Column para cuantificar la hemoglobina A2 en cada paciente. El análisis estadístico utilizado fue la prueba de t de student. Se consideraron significativas las diferencias a p<0,05. Esta investigación respetó los principios éticos que conciernen. Se contó con la aprobación del Comité de Ética Institucional, UNAN-Managua. Los participantes dieron su consentimiento informado. Resultados: al aplicar el método para cuantificación de hemoglobina A2, se obtuvo que el 67 % de las muestras presentaron una concentración de hemoglobina A2 mayor al valor de referencia establecido (3,3 %), siendo pacientes diagnosticados para β-talasemia menor. El 33 % restante presentó valores normales de hemoglobina A2 con microcitosis e hipocromía. Se encontraron diferencias estadísticamente significativas entre las medias de glóbulos rojos, volumen corpuscular medio, hemoglobina corpuscular media y hemoglobina A2, entre ambos grupos. Conclusión: el diagnóstico diferencial de anemias microcíticas hipocrómicas refractarias al tratamiento con hierro, se realiza inicialmente por el historial clínico del paciente, pero es necesario contar con pruebas diagnósticas como la cuantificación de hemoglobina A2 que permitan identificar las diversas patologías que cursan con microcitosis e hipocromía.

Abstract Justification and objective: much of the described cases of microcytic-hypochromic anemias are ferropenic anemias and Thalassemia syndromes. The differential diagnosis is complemented by laboratory tests as serum iron, ferritin, among others; However, these are of low availability in developing countries. In Nicaragua, the diagnosis of these diseases is based on clinical history and routine blood analysis. The objective of this work was to implement a technique for quantification of hemoglobin A2 in the clinical diagnosis of β-Thalassemia. Methods: We conducted a cross-sectional study with 30 patients showing hypochromia and microcytosis after 3 months of treatment with iron salts. Hemoglobin electrophoresis was performed, a kit from Beta-Thal HbA2 Quik Column was used to quantify the hemoglobin A2 in each patient. The statistical analysis used was the student's t test. The differences were considered significant at p < 0.05. This research respected ethical principles that concern. It had the approval of the committee of ethics institutional, UNAN-Managua and the participants gave their informed consent. Results: when applying the method for quantification of hemoglobin A2, 67% of samples presented a concentration of hemoglobin A2 greater than the reference value set at 3.3%, these patients were diagnosed with β-Thalassemia minor. The remaining 33% presented normal values of hemoglobin A2 with hypochromia and microcytosis. Statistically significant differences between the averages of red blood cells, mean corpuscular volume, mean corpuscular hemoglobin and hemoglobin A2 between the two groups was observed. Conclusion: The differential diagnosis of microcytic hypochromic anemias refractory to treatment with iron, is initially performed by the clinical history of the patient, but it is necessary to have diagnostic tests such as the quantification of hemoglobin A2, which allow the identification of patients with β-Thalassemia minor within this group. In our study 67% of the studied samples were identified as β-Thalassemia minor.

Anemia microcítica-hipocrómica: anemia ferropénica versus b talasemia menor / Microcytic and hypochromic anemia: iron deficiency anemia versus b thalassemia trait / Anemia microcitica-hipocrômica: anemia ferropênica versus b talassemia menor

Las anemias microcíticas hipocrómicas (m-H) presentan VCM<80 fL y HCM<27 pg. Son producto de la baja biodisponibilidad del hierro (Fe), o del defecto de la síntesis de globinas o del HEMO. La más frecuente es la anemia por deficiencia de hierro (ADH), seguida por las talasemias y las anemias de procesos crónicos. Menos frecuentes son aquellas por defectos en el HEMO o por causas genéticas del metabolismo del Fe. El objetivo del trabajo es revisar, por medio de parámetros de distinta complejidad, diferencias entre ADH y b talasemia heterocigota (b-Tal-het), las m-H de mayor prevalencia en nuestro medio. Los recuentos de eritrocitos y reticulocitos, hemoglobina, ferremia, ferritina, saturación de la transferrina, HbA2, porcentaje de alteraciones morfológicas son menores en la ADH. El VCM, el HCM, la ADE, los índices de microcitosis, transferrina, y los receptores solubles de transferrina son menores en b-Tal-het. El estrés oxidativo está aumentado en ambas patologías. En el análisis de estos parámetros se discute el grado de deficiencia de Fe y/o la mutación de b-Tal-het. Se aplica un algoritmo para m-H a partir del Fe sérico. Una vez descartadas las m-H más comunes, se debe investigar a-Tal-het, la cual se considera la causa de la mayoría de m-H inexplicadas.

Microcytic hypochromic anemia (m-H) presents MCV<80 fL and MCH<27 pg. m-H can result from iron availability, defects in globin or HEMO synthesis. The most frequent m-H is iron deficiency anemia (IDA), followed by thalassemias and anemia chronic disease. Rare m-H are a consequence of HEME defects or iron metabolism genetic defects. The aim of this study is to review the differential diagnosis between IDA and b thalassemia trait (b thal trait), the most frequent in our environment. Results of laboratory tests are analysed. Erythrocytes, hemoglobin, reticulocytes, iron, ferritin, transferrin saturation, HbA2 and percentage of morphologic changes are lower in IDA compared with b Thal trait. MCV, MCH, RDW, microcytic index, transferrin and soluble transferrin receptor are higher in IDA compared with b Thal trait. Oxidative stress is increased in the two forms of microcytoses. Degree iron deficiency in IDA and b Thal trait mutation must be considered in the analysis of the parameters. A flowchart is proposed to evaluate m-H stemming from serum iron value. After excluding the most frequent causes of microcytic anemia, a thalassemia trait must be considered.

As anemias microcíticas hipocrômicas (m-H) apresentam VCM<80 fL e HCM<27 pg. São produto da baixa biodisponibilidade do ferro (Fe), ou do defeito da síntese de globinas ou do HEMO. A mais frequente é a anemia por deficiência de ferro (ADH), seguida pelas talassemias e as anemias de processos crônicos. Menos frequentes são aquelas por defeitos no HEMO ou por causas genéticas do metabolismo do Fe. O objetivo do trabalho é revisar, através de parâmetros de diversa complexidade, diferenças entre ADH e b talassemia heterocigota (b-Tal-het), as m-H de maior prevalência no nosso meio. As contagens de eritrócitos e reticulócitos, hemoglobina, ferremia, ferritina, saturação da transferrina, HbA2, percentagem de alterações morfológicas são menores em ADH. O VCM, o HCM, a ADE, os índices de microcitose, transferrina, receptores solúveis de transferrina são menores em b-Tal-het. O estresse oxidativo está aumentado em ambas as patologias. Na análise destes parâmetros é discutido o grau de deficiência de Fe e/ou a mutação de b-Tal-het. Aplica-se um algoritmo para m-H a partir do Fe sérico. Depois de serem descartadas as m-H mais comuns, deve investigar-se a-Tal-het, a qual é considerada a causa da maior parte de m-H inexplicadas.

Prevalence of common α -thalassemia determinants in south Brazil: importance for the diagnosis of microcytic anemia

Alpha thalassemia has not been systematically investigated in Brazil. In this study, 493 unrelated individuals from the southernmost Brazilian state of Rio Grande do Sul were screened for deletional forms of α-thalassemia. One hundred and one individuals had microcytic anemia (MCV < 80 fL) and a normal hemoglobin pattern (Hb A2 < 3.5 percent and Hb F < 1 percent). The subjects were screened for -α3.7,-α4.2,-α20.5, -SEA and -MED deletions but only the -α3.7 allele was detected. The -α3.7 allele frequency in Brazilians of European and African ancestry was 0.02 and 0.12, respectively, whereas in individuals with microcytosis the frequency was 0.20. The prevalence of α-thalassemia was significantly higher in individuals with microcytosis than in healthy individuals (p = 0.001), regardless of their ethnic origin. There were also significant differences in the hematological parameters of individuals with -α3.7/αα, -α3.7/α3.7 and β-thalassemia trait compared to healthy subjects. These data suggest that α-thalassemia is an important cause of microcytosis and mild anemia in Brazilians.

Perfil hematológico de la beta-talasemia menor en Tucumán / Hematological profile of beta-thalassemia minor in Tucuman

La b-talasemia menor es uno de los desórdenes genéticos más comunes y constituye la principal causa de anemia hereditaria. Si se exceptúan las provincias de Buenos Aires y Santa Fe, es escasa la información bibliográfica acerca de la distribución de la talasemia en la Argentina. Dado que no existen registros sobre el perfil hematológico de la b-talasemia en la región noroeste de la Argentina, el propósito del presente trabajo fue realizar un estudio exploratorio descriptivo de las características hematológicas y electroforéticas de una población de la provincia de Tucumán portadora de b-talasemia. Se estudiaron 52 pacientes derivados para investigación de síndrome talasémico. Se realizó hemograma, reticulocitos, ferremia, electroforesis de hemoglobina, dosaje de hemoglobinas F y A2. En el 46% de los pacientes se confirmó el diagnóstico de rasgo b-talasémico, detectándose leve anemia con microcitosis y Hb A2 aumentada. El estudio del perfil hematológico no demostró diferencias significativas con respecto a edad y sexo y fue similar a lo ya publicado por otros autores. Según el origen étnico, la población estudiada estuvo constituida por un 58% de individuos de origen italiano, 34% de españoles y 8% de árabes, con predominio de la población italiana, similar a trabajos previos en la Argentina.

The b-thalassemia minor is one of the most common genetic blood disorder and it represents the main cause of hereditary anemia. There is scant information in the scientific literature about b-thalassemia minor distribution in Argentina, except for the provinces of Buenos Aires and Santa Fe. There is no published study of this disorder in the northwest of Argentina. The objective of this descriptive and explorative study is to determine the hematological and electrophoretic characteristics of a b-thalassemia minor population in the province of Tucumán. A total of 52 patients with suspected thalassemia syndrome were studied; haemogram, reticulocytes, serum iron, hemoglobin electrophoresis, hemoglobin F and hemoglobin A2 were performed. Forty-six percent of the patients presented a b-thalassemia minor diagnosis, with the following findings: mild anemia with microcytosis and elevated Hb A2. The hematological profile showed no significative differences with respect to age and sex, and it was similar to previous studies, published by different authors. The ethnic origins were as follow: Italians 58%, Spaniards 34% and Arabians 8%, with preponderance of the Italian population, similar to previous studies in Argentina.

Hematologic Characteristics and Hemoglobin Fraction Analysis by High Performance Liquid Chromatogaphy in Patients with Hypochromic Microcytosis: Trials for Detection of beta-thalassemia / 대한진단검사의학회지

BACKGROUND: In Korea, more than 20 cases of beta-thalassemia have been reported up to date. To detect -thalassemia. Hemoglobin (Hb) fractions were measured in patients with hypochromic microcytosis, and we analyzed the hematological characteristics of these patients. METHODS: Among 359, 369 CBCs performed at Asan Medical Center, 229 patients (0.064%) showed hypochromic microcytosis with less than 75 fL of mean corpuscular volume (MCV), less than 24 pg of mean corpuscular hemoglobin (MCH), and less than 18% of red cell distribution width (RDW). We analysed Hb fractions using high performance liquid chromatography (VARIANT(TM) Hemoglobin Testing System). Iron, total iron binding capacity (TIBC), ferritin, and reticulocyte counts were measured and medical history was searched on cases with Hb A2 and F fractions more than 3.5% and 2.0%, respectively. RESULTS: Among the 229 patients with hypochromic microcysis, 44 (19.2%) showed an increased level of Hb A2 and/or F fractions. With the exclusion of 28 patients (23 children <2 years old and 5 pregnant women), 16 (7.0%) showed a significantly increased level of Hb A2 and/or F. However, all 16 patients were diagnosed as having iron deficiency anemia based on their iron status and clinical findings. Three patients who had an increased level of Hb F at more than 5% needed a further study and follow-up to rule out the diagnosis of the hereditary persistence of the fetal hemoglobin. CONCLUSIONS: No thalassemia cases were found in the study. Incidence of beta-thalassemia should be very low, less than 1/359, 369 (0.00027%), in South Korea; a larger population should be screened to detect beta-thalassemia.