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@#Introduction: Haemolytic specimens are a frequent occurrence in clinical laboratories, and they interfere with the analysis of many tests. Case report: We describe here an unusual case of leptospirosis complicated by haemolytic anaemia in a 70-year-old man with established kidney failure. He presented with an abrupt onset of shortness of breath, flushing and erythematous rash after completing haemodialysis. The patient’s biochemistry test samples were however rejected twice as they were grossly haemolysed. The integrated auto-verification alert system implemented in the hospital’s laboratory information system alerted the staff of the possibility of in vivo haemolysis. Discussion: The auto-verification alert system effectively distinguishes between in vitro and in vivo haemolysis and as such can be utilised as a diagnostic aid in patients with suspected intravascular haemolysis. Keywords:
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Aim: The study was aimed at evaluating the levelsof subclinical malaria infection and haemolysis among the residents of Opobo, Rivers State, Nigeria.Study Design:A cross sectional study design was used. The subjects were grouped into males and females and comparisons were made between positive and negative subjects of the same genderand positive subjects of different gender.Place and Duration of Study:The study area wasOpobo Town in Opobo/Nkoro Local Government Areaof Nigeria. The study was carried out within August 2ndto August 26th, 2019 and a total of 89 apparently healthy subjects were recruited, 35 males and 54 females, aged between 16 –70 years. Methodology:Malaria parasite identification was done by thick and thin film using Giemsa’s stain,packed cell volume was by microhaematocrit method, plasma haemoglobin concentrationand wholeblood haemoglobin concentration was determined by cyanmethaemoglobin method Results:The result revealed a total of 24.72% positivity and 75.28% negativity for malaria parasite infection. Among the males, 17.14% positivity and 82.86% negativity for malaria parasite infection were observed while that of the females was20.37% positivity and 79.63% negativity. In comparison of the studied parameters made between females infected with malaria parasites and those that were not infected with malaria parasites, there was no statistical significant difference at p<0.05 in plasma haemoglobin and percentage haemolysis. In comparison of the studied parameters between males infected with malaria parasites and those not infected with malaria parasites, there was no statistical significant difference in plasma haemoglobin and percentage haemolysis. On gender based comparison, there was also no statistical significant difference in level haemolysis.Conclusion:The study has revealed a prevalence rate of 24.72% for subclinical malaria infection and the percentage haemolysis of red blood cells in malaria infected subjects residing in Opobo Town compared to subjects without malaria parasite was not statistically significant. Based on gender difference, males were affected more than females, but the level of red blood cell haemolysis was notstatistically significant after comparison.
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In modern diagnostics, it is extremely important to maintain and ensure quality of laboratory results dispatched. It is part of the total quality management and an essential criterion for accreditation of the laboratory. The analysis of biochemistry samples can be broadly divided into three phases: pre-analytical, analytical and post-analytical phase. We wanted to identify the commonly occurring pre-analytical errors and determine the turnaround time in the emergency biochemistry laboratory at a tertiary care hospital in Delhi.METHODSA cross-sectional study was done on a total of 2,73,111 samples received in the emergency biochemistry laboratory from September 2018 to August 2019 and an analysis of occurrence of pre-analytical errors was done, retrospectively. Additionally, the turnaround time of the laboratory was evaluated over a period of two months from July 2019 to August 2019 and average time was recorded. Data was collected from entry registers and rejected samples registers.RESULTSIn this study it was found that 10.58 % of the total samples received were rejected. Moreover, overall turnaround time was found to be 108 minutes (median value). In the present study, haemolysis was the most common reason for sample rejection. (63.14% of total rejections). Additionally, the second most common error was inadequate samples. 6570 samples were rejected due to this reason (22.73%).CONCLUSIONSHaemolysis was the most common cause of rejection in the emergency biochemistry laboratory. Also, it was seen that the most time-consuming step was analysis in auto-analyser with respect to contribution to turnaround time. As a matter of fact, Pre-analytical errors can adversely affect the treatment of patients. However, most of the errors can be reduced by proper training of the staff and checking competency thoroughly by conduction of practical and theory assessment of laboratory personnel at frequent intervals
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Haemolysis is the most common pre-analytical error encountered in biochemistry laboratories. Several clinical biochemistry laboratories have adopted individual policies regarding rejection of haemolysed samples. The aim of this study was to evaluate the effect of visible haemolysis on biochemistry parameters done in the emergency laboratory.METHODS150 blood samples (50 highly haemolysed, 50 slightly haemolysed and 50 no haemolysis) that were received in the Emergency Biochemistry laboratory of Safdarjung Hospital, New Delhi, were included in the current study. They were analysed for different biochemical parameters and the results compared. Statistical analysis was conducted using Microsoft Excel 2016. Data was presented as, number and median. Mann-U Whitney test was used to test any significant difference between the groups. p< 0.05 was considered to be significant.RESULTSNo significant change was seen in samples with slight haemolysis. However, values of potassium, total and direct bilirubin were significantly elevated (p-value-0.001, 0.002 and 0.015 respectively). Moreover, mean ALP was found to be 290±19.76 U/L in slightly haemolysed samples and 211±16.67 U/L in samples that are highly haemolysed (p=0.049). Therefore, there was a heterogeneous and unpredictable response to haemolysis observed for several parameters that prevents the adoption of reliable corrective measures for results on the basis of the visible haemolysis.CONCLUSIONSThe test values of slightly haemolysed samples can be reported as there is little interference seen. However, in case of highly haemolysed samples, values of ALP, potassium, total, and direct bilirubin should not be reported. Nevertheless, visual assessment is not a reliable method to identify haemolysis, free haemoglobin concentrations should be measured.
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Background: Few women during their pregnancy, labour and postnatal period require critical care related to the pregnancy itself, aggravation of a pre-existing illness and complications of the delivery. Pregnant patients account for a small number of ICU admission - 2-10% two main indications for admission are hypertensive disorders (17.2%-46%) and massive haemorrhage (10%-32.8%). The primary objective of the present study was to review the characteristics of the obstetric patients admitted to our ICU over a 2-year period.Methods: It was a prospective study conducted over 50 patients in high dependency and intensive care unit at Alam hospital over a period of 2 years (October 2014 to October 2016).Results: During the study period a total of 50 obstetric patients were transferred to the intensive care unit (ICU). Antenatal care played significant role in the obstetric outcome. 84% of patients transferred to the ICU during the study period had inadequate or no antenatal care, while 8% were booked in their pregnancy and had adequate antenatal care. ICU interventions included mechanical ventilation used in 20(40%) patients, blood and blood product transfusion in 35(70%) patients’ inotropes in 20 patients (40%) antihypertensive therapy in 20 patients (40%), arterial embolization in 2(4%) patients. Maternal mortality was seen in 10 patients (20%).Conclusions: There is a need for training in emergency obstetrics so that the complication can be managed right at the time of occurrence.
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@#Introduction: Glucose-6-phosphate dehydrogenase (G6PD) deficiency causes red blood cell destruction due to oxidative stress. G6PD is essential for NADPH conversion; which is critical for glutathione reductase to prevent damage to cellular structures. In Malaysia, blood donors are not routinely screened for G6PD deficiency. We hypothesise that G6PD-deficient red blood cells are more likely to haemolyse during storage due to increased oxidative molecules. The objectives of this study were to determine the prevalence of G6PD deficiency among blood donors, describe their characteristics and to evaluate the effects of storage on G6PD-deficient donated blood. Methods: This study was conducted at selected mobile donation centres in Terengganu. Consented blood donors were screened for G6PD status using fluorescent spot tests (FST). G6PD enzyme activities were measured for donors who were G6PD deficient. Effects of storage on haemolysis from G6PD-deficient donors were compared with non G6PD-deficient group. Sixty ml of blood was collected from blood unit to transfer pouch for estimation of haemoglobin (Hb), plasma Hb, percentage of haemolysis and plasma potassium. Serial sampling with a 7-day interval was done from Day 1 to Day 35. Statistical analysis was considered significant if p ≤0.05. Results: A total of 440 blood donors were screened and 12 male donors were found to be G6PD deficient by FST. Enzymatic activities were measured in 11 donors as one donor sample failed to be sent to the centre due to logistic problem. Their enzymatic activities ranged from 1.66-2.93 U/g Hb whereby 6 have severe deficiency and the other 5 were categorised as partial deficiency. Donors were asymptomatic for haemolytic episode. Serial sampling showed there was no significant difference of haemolytic parameters in blood units of G6PD-deficient donors as compared to control (p>0.05). Conclusion: Prevalence of G6PD blood donors in Terengganu mobile centres was 2.7%. G6PD enzyme activities did not correlate with clinical symptoms. Haemolytic parameters were not affected in blood units which were G6PD-deficient.
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Background: Sickle cell disease (SCD) is often associated with liver disease. The constant state of haemolysis, multiple blood transfusion, viral hepatitis, hepatic sinusoidal congestion, haemosiderosis and cholestasis, are all conditions which may eventually evolve into liver disease. Sickle cell disease is a heterogeneous group of disorders that is usually associated with an autosomal recessive structural haemoglobin disorder. Biochemical abnormalities have been associated with SCD and it is usually more pronounced in vaso occlusive crises; an acute bone crisis and common painful complication of SCD, than in steady state. Aim: The aim of the study was to assess some biochemicalparameters in relation to SCD patients in our environment with a view to improving the monitoring and management of these patients. Methodology: The study was a comparative hospital based research carried out at the University of Calabar Teaching Hospital (UCTH), Calabar, South-South Nigeria. Liver function tests were carried out on 60 SCA both in steady state and in crisis and also on 50 apparently healthy adults. The data collected were analyzed using statistical data for social sciences (SPSS) Version 22 for windows. Pearson linear correlation and simple inferential statistical methods were employed for data analysis, a P ≤ 0.05 was considered to be statistically significant. Result: The serum concentrations of AST, ALT, ALP, LDH, Total and conjugated bilirubin were seen to be elevated in VOC compared to in steady state and with the apparently healthy control group. The AST/ALT ratio was also observed to be elevated in VOC as compared with the steady state and the control. Significant product moment correlation was observed in the biochemical parameters both in steady state and in VOC.Conclusion: The findings of this study revealed marked changes in the biochemical parameters of the liver in VOC than in steady state. It will be recommended that routine evaluation and proper interpretation of liver enzymes is paramount in early detection of liver pathology in SCD
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Background: Glucose-6-phosphate dehydrogenase is one of many enzymes that help the body process carbohydrates and turn them into energy. The mechanism by which G6PD deficiency causes neonatal hyper bilirubin may be due to hemolysis, but other mechanisms like secondary impairment of bilirubin conjugation and clearance by the liver may play a role. Therefore, through this study authors attempt to study the need for a newborn screening program for G6PD deficiency because of high prevalence and high risk of incidence due to consanguineous marriages in India.Methods: This study was a prospective cross-sectional study conducted among 350 consecutively born live new-borns in maternity wards and NICU of Krishna Institute of Medical Sciences and Hospital and Research Centre, Karad, Maharashtra during October 2016 to October 2017.Results: The maximum numbers of newborns were in the age group of 0-10 hours (36.80%), followed by in 11-20 hours (21.80%). The mean age among newborns was 2.86'5.83 hours. Out of 350 cases females were 181 (51.71%) and males (48.29%) and female to male ratio was 1.07:1.Conclusions: G6PD deficiency is one of the major causes of neonatal jaundice within 24 hours of life in new-borns. Hence, neonatal screening for G6PD deficiency could be an alternative to the haemolytic crisis prevention strategy in order to optimize affected young child care and prevention of crisis occurrence by avoiding taking contraindicated foods and drugs.
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Aim: This study assessed the level of plasma haemoglobin concentration in CPDA-1 stored blood with a view to determine the extent of haemolysis during the 35 days storage period. Study Design: This is an observational and comparative case-control study. Place and Duration of Study: The study was conducted using healthy male donors residing in Port Harcourt. Analysis was carried out at the Blood Bank of Rivers State University Teaching Hospital, formerly Braithwaite Memorial Specialist Hospital (BMSH), Port Harcourt, Nigeria, from February 1st to March 8th, 2017. Methodology: Blood for transfusion was collected from prospective male blood donor found to be in good health, aged between 18 and 52 years, with haemoglobin level within the range of 13.5 g/dl – 16 g/dl, body weight within 55 kg – 75 kg, and body temperature within 37.0 to 37.50C / 99.50F, into plastic bags containing anticoagulant CPDA-1, and handled under strict sterile condition to prevent bacterial contamination. The blood was stored in a blood bank refrigerator with a constant temperature of +2 to +60C under proper inspection at intervals for colour, turbidity, haemolysis and clot formation. Two milliliters of the sample was collected aseptically at different interval days of collection from the blood bag and analyzed using the HemoCue photometer. Results: Results showed no significant changes in plasma haemoglogin from day 1, 5, and 10, while significant increase in haemolysis occurred from day 15, 20, 25, 30, and 35 (p = 0.000), a significant increase (p<0.05) in plasma haemoglobin was observed from day 15 to day 35 of storage. Conclusion: It is pertinent therefore to note that the use of CPDA-1 does not completely stop the changes that occur in RBC as there are several changes occurring in stored blood collectively called “storage lesions”. Therefore, it is advisable that blood should be transfused within 14 days of storage to avoid transfusion of blood products that has lost most of its benefits to recipients, and where possible whole blood should be processed and components separated before storage to reduce the level of non-viable red blood cells.
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Aims: This study aimed at examining the oxidative stress level of sickle cell anaemia subjects using glutathione and bilirubin levels as markers as well as the red cell parameters. Study Design: Case-control study. Place and Duration of Study: University of Calabar Teaching Hospital, Calabar-Nigeria, between August 2018 and July 2019. Methodology: Subjects comprised 45 SCA patients (27 females, 18 males; age range 10-45 years) attending clinic at University of Calabar Teaching Hospital Calabar, Nigeria and equal number of age and sex-matched control subjects with Hb AA. Blood samples were collected and analyzed by standard methods. The red cell parameters were analysed by automation using FY-Smart-1 auto haematology analyzer. Bilirubin assay was performed using the colorimetric method, while glutathione was performed by enzyme-linked immunosorbent assay technique. Results: The red blood cell count, haemoglobin concentration, and haematocrit values of SCA subjects were significantly lower (p=0.001) compared to values from control subjects, while the red cell indices and red cell distribution width values were increased in SCA subjects (p=0.001). The Total bilirubin, conjugated bilirubin and unconjugated bilirubin were significantly increased (p=0.001) among SCA subjects, while the glutathione concentration values were reduced (p=0.001) when compared to values obtained from control subjects. Conclusion: SCA subjects have marked red cell size variation, lymphocytosis and thrombocytosis. The haemolytic events that occur in sickle cell anaemia results in glutathione depletion.
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Objective@#To establish the information solution for the classification and assessment of specimen quality based on the assembly line. @*Methods@#Before the samples entered into the assembly line, they were took pictures and screened by the image results. For the suspected samples, serum index was detected. Then, the classification criteria of specimen quality were set, and the alarm thresholds of serum indices for each item suitable for our laboratory were established. The results of serum indices were compiled into the corresponding text descriptions and automatically written into the notes of the result reports. The pictures of blood collection tubes were stored in the laboratory information management system (LIMS) and could be accessed at any time for verification. The samples intercepted by the automatic review were further reviewed by manual. @*Results@#The intra-assay coefficients of variation (CV) of serum indices for haemolysis (H), lipaemia (L) and icterus (I) were 0.6%, 0.7% and 1.3%, respectively, indicating that the precision was good. Among 657 770 samples detected by the assembly line, 11.9% of samples were screened out before they entered the assembly line. The detection of serum indices of these samples demonstrated that the samples with haemolysis, lipaemia and icterus accounted for 1.6%, 1.2% and 0.3% of the total samples, respectively. According to the results of the interference experiment, the alarm threshold of hemolytic serum index was set in 11 items, and those of lipaemia and icterus were set in 1 item. @*Conclusion@#By establishing the information solution of specimen quality based on the assembly line, the real-time classification prompting of specimen quality is realized, and the missed detection is avoided, which is helpful to reduce the pre-analysis errors caused by serum quality and simplify the laboratory workflow.
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Resumen El síndrome de HELLP es una complicación multisistémica del embarazo que se distingue por el trastorno hipertensivo más la triada: Hemólisis microangiopática, elevación de enzimas hepáticas y disminución del conteo de plaquetas. Está asociado con la aparición de graves complicaciones perinatales e incremento de la mortalidad materna. Ocurre en 0,5 a 0,9% de todos los embarazos y en 10 a 20% de las pacientes con preeclampsia-eclampsia. Complicaciones obstétricas como ésta pueden pasarse por alto en la práctica clínica, generando situaciones de alto riesgo tanto para la madre como para el embrión, por lo que debe tenerse en cuenta su sintomatología y semiología dadas las dificultades en el diagnóstico diferencial.
Abstract HELLP syndrome is a multisystem complication of pregnancy that is characterized by hypertensive disorder plus the triad: microangiopathic hemolysis, elevation of liver enzymes, and decreased platelet count. It is associated with the appearance of serious perinatal complications and increased maternal mortality. It occurs in 0.5 to 0.9% of all pregnancies and in 10 to 20% of patients with pre-eclampsia/eclampsia. Obstetric complications can be overlooked in clinical practice, generating high risk situations for both the mother and the embryo, therefore, its symptoms and semiology should be taken into account given the difficulties in the differential diagnosis.
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@#Haemolysis interferes with many test results through release of red blood cell (RBC) intracellular contents or via specific analytical interferences. In grossly haemolysed sample, potassium level can be raised considerably dependent on the degree of haemolysis and may exceed the critical limit value. In this case report, the potassium level from a grossly haemolysed sample taken after haemodialysis remains within normal range, and this has led to unnecessary repeated blood samplings hence delay the diagnosis. With the persistently high haemolytic index (HI) of ≥ 400mg/ dL and normal potassium levels in sequences of samples taken post haemodialysis should raise a high suspicion of in vivo haemodialysis related-haemolysis. An effective communication between laboratory and clinician, and a proper, well-designed protocol or guideline on the management of sample haemolysis in clinical laboratory therefore is very essential to ensure all clinically important but rare case of in vivo haemolysis can be identified early and the potential unwanted serious outcomes can be prevented accordingly.
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@#Introduction: Percentage of haemolysis is widely used as a quality parameter to assess red blood cell viability in blood banking. In certain blood banks, serum potassium level is used due to the unavailability of the former test. The relationship between these two tests, however, is still unclear. The objective of this study is to determine the association between haemolysis measured using two different methods for quality control. Methods: A total of forty-four samples of packed red cell in citrate-phosphate-dextrose with optisol were randomly selected from donation drives. Nine millilitres of blood was collected weekly starting from day-2 of storage, followed by day-7, 14, 21, 28, 35 and 42 for assessment of red blood cell haemolysis by measuring serum potassium level and percentage of haemolysis. Results: These two parameters were correlated significantly with a positive moderate linear relationship on day 7, 21 and 28 with r = 0.393, 0.448 and 0.425, respectively and p-values less than 0.01. The linear regression analysis showed there was a significant regression equation which could be used to predict the serum potassium level from the percentage of haemolysis. Conclusion: There were significant increases in the percentage of haemolysis and serum potassium level in the packed red cell units with storage. The serum potassium level would be able to be predicted from the percentage of haemolysis using the regression equations on day 7, 21 and 28. The serum potassium measurement could be used as an alternative test to the percentage of haemolysis before issuing blood.
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HemolysisABSTRACT
La Hemoglobinuria Paroxística Nocturna (HPN) se caracteriza por hemólisis intravascular crónica mediada por complemento. Cuando se produce la hemolisis se libera a circulación Anhidrasa Carbónica- I (AC-I), una enzima que se halla en alta concentración en el eritrocito y por su bajo peso molecular filtra por el glomérulo. El objetivo del presente trabajo fue detectar la excreción de la AC-I en orina de pacientes con HPN por Electroforesis Bidimensional de Utilidad Clínica (2D UC), y compararla con otras causas de hemólisis, de origen renal y postrenal. Se evaluaron 8 pacientes con HPN sin tratamiento con eculizumab un inhibidor del C5 del complemento, y 5 de ellos postratamiento, 12 orinas de pacientes con nefritis lúpica y 10 orinas de pacientes con hemólisis postrenal. La AC-I puede estar presente en la orina, en los tres grupos, sin embargo la relación AC-I/Hemoglobina en la hemólisis intravascular está invertida en comparación con la hemolisis glomerular y post-renal. Los pacientes con HPN tratados con eculizumab no presentan AC-I, y sería de utilidad en el seguimiento de los pacientes tratados con el inhibidor del C5, para evidenciar posibles escapes hemolíticos.
Paroxysmal Nocturnal Hemoglobinuria (PNH) is characterized by chronic complement mediated haemolysis. In these conditions it might be expected that carbonic anhydrase-I (AC-I) would be liberated into the plasma and excreted in the urine, by its high concentration in the erythrocyte and low molecular weight. The objective of the present study was to detect the urinary excretion of AC-I from patients with PNH by wodimensional clinical utility electrophoresis (2D UC) and to compare it with other causes of renal and post-renal haemolysis. We evaluated 8 patients with PNH without eculizumab, a complement C5 inhibitor, 5 of them posttreatment, 12 urine of patients with lupus nephritis and 10 urine of patients with post-renal hemolysis. AC-I may be present in the urine, in all three groups, however, the AC-I/Haemoglobin ratio in intravascular haemolysis is reversed compared to glomerular and post-renal haemolysis. Patients with PNH treated with eculizumab do not have AC-I and would be useful in monitoring patients treated with the C5 inhibitor to evidence possible haemolytic leaks.
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Humans , Hemoglobinuria, Paroxysmal/urine , Carbonic Anhydrase I/metabolism , Carbonic Anhydrase I/urine , Hemolysis , Hemoglobinuria, Paroxysmal/drug therapy , Electrophoresis/methods , Urinalysis/methods , Lupus Erythematosus, Systemic/urine , Hematuria/urine , Antibodies, Monoclonal, Humanized/therapeutic useABSTRACT
Background & objectives: The antimalarial combination drug artemether/lumefantrine has been shown to be effective against malaria parasite through its haemolytic action. This drug is sometimes co-administered with vitamin C in patients with malaria. Vitamin C is associated with antioxidant properties which would be expected to protect against haemolytic effects of this antimalarial drug. This study was designed to investigate in vitro effects of co-incubation of artemether/lumefantrine with vitamin C on the viscosity and elasticity of blood. Methods: Blood was collected from 12 healthy female volunteers with normal haemoglobin genotype (HbAA). A Bioprofiler was used to measure the viscosity and elasticity of untreated blood samples (control) and samples exposed to artemether/lumefantrine (0.06/0.36 mg/ml) alone and with low or high dose vitamin C (equivalent to adult doses of 100 or 500 mg). Results: Artemether/lumefantrine significantly (P<0.05) reduced viscosity of blood from 4.72 ± 0.38 to 3.78 ± 0.17 mPa.s. Addition of vitamin C (500 mg) further reduced blood viscosity to 2.67 ± 0.05 mPa.s. The elasticity of blood was significantly (P<0.05) reduced from 0.33 ± 0.04 mPa.s to 0.24 ± 0.03 mPa.s by the antimalarial drug, and further reduced to 0.13 ± 0.02 mPa.s in the presence of vitamin C (500 mg). Interpretation & conclusions: Co-incubation of blood with vitamin C and antimalarial combination drug potentiates the haemolytic effects of the latter on reducing blood viscosity and elasticity in vitro. This may possibly have implications in relation to haemolysis in patients receiving vitamin C supplementation with artemether/lumefantrine during malaria therapy.
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Gamma-irradiation of blood components is regarded a safe procedure used for prevention of transfusionassociated graft-versus-host disease. However, reports showed that irradiation can cause erythrocyte haemolysis and damage to the RBC membrane. In Universiti Kebangsaan Malaysia Medical Centre (UKMMC), a number of suspected transfusion reactions (TR) featured unusual isolated episodes of red-coloured-urine or haemoglobinuria among paediatric patients without clinical features of acute haemolytic TR. Haemolysis of irradiated red cells was suspected as a cause. This study was conducted to evaluate haemolytic changes of RBC components following irradiation. A prospective, pre- and post- irradiation comparative study was conducted on 36 paired RBC-components in the blood-bank, UKMMC in the year 2013. Samples were tested for plasma-Hb, percent-haemolysis, plasma-potassium (K+) and lactate dehydrogenase (LDH) level. Post-irradiation mean plasma-Hb and percent-haemolysis were significantly higher than pre-irradiation values at 0.09±0.06g/dl VS 0.10±0.06g/dl and 0.19±0.13% VS 0.22±0.13% respectively, while plasma-K+ and LDH values did not show significant difference. However, the mean percent-haemolysis level was still within recommended acceptable levels for clinical use, supporting that irradiated RBC units were safe and of acceptable quality for transfusion. There was no conclusive reason for isolated haemoglobinuria following transfusion of irradiated red-cell products. Further research is suggested to investigate the other possible causes.
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Plasmodium vivax radical cure requires the use of primaquine (PQ), a drug that induces haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals, which further hampers malaria control efforts. The aim of this work was to study the G6PDd prevalence and variants in Latin America (LA) and the Caribbean region. A systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Low prevalence rates of G6PDd were documented in Argentina, Bolivia, Mexico, Peru and Uruguay, but studies from Curaçao, Ecuador, Jamaica, Saint Lucia, Suriname and Trinidad, as well as some surveys carried out in areas of Brazil, Colombia and Cuba, have shown a high prevalence (> 10%) of G6PDd. The G6PD A-202A mutation was the variant most broadly distributed across LA and was identified in 81.1% of the deficient individuals surveyed. G6PDd is a frequent phenomenon in LA, although certain Amerindian populations may not be affected, suggesting that PQ could be safely used in these specific populations. Population-wide use of PQ as part of malaria elimination strategies in LA cannot be supported unless a rapid, accurate and field-deployable G6PDd diagnostic test is made available.
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Female , Humans , Male , Glucosephosphate Dehydrogenase Deficiency/epidemiology , Malaria, Vivax/epidemiology , Antimalarials , Caribbean Region/epidemiology , Geographic Mapping , Glucosephosphate Dehydrogenase Deficiency/genetics , Glucosephosphate Dehydrogenase/genetics , Hemolysis/drug effects , Latin America/epidemiology , Malaria, Vivax/drug therapy , Prevalence , PrimaquineABSTRACT
OBJECTIVE: To supplement and improve the method of haemolysis and agglomeration test of Pharmacopoeia of the People's Republic of China (2010 edition) thus to exclude the interference of colored injections and emulsion injections on haemolysis test.
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Objective To prepare long-circulating temperature-sensitive liposomes with paclitaxel( LTSLP ),develop methods for determination of paclitaxel,related substances and monostearoyl phosphatidylcholine( MSPC ) in LTSLP,and the haemolysis of LTSLP in vitro. Methods HPLC-UV methods for paclitaxel content and related substances and HPLC-CAD method for MSPC in LTSLP were established and validated. Spectrophotometric method was used to determine hemolysis in vitro. Results There was a good linear relationship between peak area and concentration within the range of 60. 39-181. 17μg·mL-1 . Recovery and precision of the method for determination of paclitaxel content met the requirements. Specificity,sensitivity,and system suitability for related substances were consistent with requirements. There was a good linear relationship between peak area and concentration within the range of 1. 5-50. 0μg·mL-1 for the determination of MSPC with good specificity,sensitivity and recovery. Paclitaxel contents in three batches of self-prepared LTSLP were between 90. 0% and 110. 0%,single related substances were below 0. 5% and total impurities were below 2. 0%. There was almost no hemolysis in vitro. Conclusion The methods for determining paclitaxel content,related substances and haemolysis can be used to assess the quality of LTSLP. Self-produced LTSLP consistently meet the quality standards.