Hematological parameters: is there a difference between those released by the hematological analyzer and to the customer?

ABSTRACT Objective This study aimed to compare the hematological parameters released by hematological analyzers with those released in customer reports. Methods We conducted a descriptive study in the laboratories of a medium-sized municipality in the state of Minas Gerais registered in the National Register of Health Establishments. Interviews were conducted using a questionnaire to obtain information regarding the parameters released by the analyzers and those available in the customer's report. Results Sixteen laboratories were evaluated, and none of them released all the parameters obtained from the hematological analyzers to customers. The red blood cell distribution width was released in 88% of the laboratories, atypical lymphocytes in 70%, mean platelet volume in 50%, platelet distribution width and platelet count in 20%. No laboratory released information on reticulocytes, fraction of immature reticulocytes and immature granulocytes, nucleated erythrocyte count, immature platelet fraction and reticulocyte hemoglobin, and large platelet rate. Conclusion All evaluated clinical analysis laboratories had at least one parameter that was not released in the customer's report despite being released by the hematological analyzers. The lack of knowledge on the part of professionals about the clinical importance of each parameter of the complete blood count results in a loss in patient assessment, and it is important to include these parameters in the complete blood count report.

Hemoglobin analysis after overload training in athletes / Análise de hemoglobina após treinamento de sobrecarga em atletas / Análisis de la hemoglobina tras el entrenamiento de sobrecarga en atletas

ABSTRACT Introduction: The cardiovascular system provides athletes with the proper conditions for blood circulation, ensuring the stability and normal metabolism of the body's internal environment during exercise. Objective: Investigate the effect of overload training on the hemoglobin of male taekwondo athletes. Methods: Twenty-one male taekwondo athletes (level 2 or higher) were selected and trained for four weeks, five days per week, with an initial load intensity of 60% of the maximum heart rate and a weekly intensity increase of 10%. Before training and on every weekend during training, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), reticulocyte count (Ret) were checked, RBC volume distribution width (RDW), hemoglobin content distribution width (HDW), mean reticulocyte volume (MCVr), mean reticulocyte hemoglobin concentration (CHCMr), serum iron (Fe) and ferritin (Fer). Results: After four weeks of increasing load training, athletes showed a progressive and significant decrease in Hb (P<0.01), manifested as exercise-induced hypohemoglobin, and MCV, MCH, MCHC, CHCMr, HDW, and serum ferritin were significantly or extremely decreased(P<0.) 05, P<0.01); RDW increased significantly (P<0.05); Changes in Ret and serum iron showed no statistical significance (P>0.05). Correlation analysis found that hemoglobin concentration had the highest correlation with MCHC and CHCMr. Conclusion: Four-week incremental load training can induce exercise-induced hypohemoglobin in male taekwondo athletes, its changes being most correlated with MCHC and CHCMr, but without significant correlation with serum Fe, RDW, HDW, and MCV. Level of Evidence: Therapeutic Studies -Investigation of Outcomes.

RESUMO Introdução: O sistema cardiovascular fornece aos atletas as condições propícias para a circulação sanguínea, garantindo a estabilidade e o metabolismo normal do ambiente interno corporal durante o exercício. Objetivo: Investigar o efeito do treinamento em sobrecarga sobre a hemoglobina dos atletas masculinos de Taekwondo. Métodos: Vinte e um atletas masculinos de taekwondo (nível 2 ou superior) foram selecionados e treinados durante 4 semanas, 5 dias por semana, com uma intensidade de carga inicial de 60% da frequência cardíaca máxima e um aumento de intensidade semanal de 10%. Antes do treinamento e em todos os fins de semana durante o treinamento, foi verificada a hemoglobina (Hb), volume corpuscular médio (MCV), hemoglobina corpuscular média (MCH), concentração corpuscular média de hemoglobina (MCHC), contagem de reticulócitos (Ret), largura de distribuição do volume de hemácias (RDW), largura de distribuição do conteúdo de hemoglobina (HDW), volume médio de reticulócitos (MCVr), concentração média de hemoglobina reticulócitos (CHCMr), ferro sérico (Fe) e ferritina (Fer). Resultados: Após 4 semanas em treinamento de carga crescente, os atletas mostraram uma diminuição progressiva e significativa em Hb(P<0,01), manifestada como hipohemoglobina induzida por exercício, e MCV, MCH, MCHC, CHCMr, HDW, e ferritina sérica foram significativamente ou extremamente diminuídos(P<0). 05, P<0,01); RDW aumentou significativamente (P<0,05); Alterações de Ret e ferro sérico não apresentaram significância estatística (P>0,05). A análise de correlação constatou que a concentração de hemoglobina teve a maior correlação com MCHC e CHCMr. Conclusão: O treinamento de carga incremental de quatro semanas pode induzir hipohemoglobina induzida por exercício em atletas taekwondo masculinos, sendo suas alterações mais correlacionadas com MCHC e CHCMr, mas sem correlação significativa com Fe sérico, RDW, HDW e MCV. Nível de evidência: Estudos Terapêuticos -Investigação dos Resultados.

RESUMEN Introducción: El sistema cardiovascular proporciona a los deportistas las condiciones propicias para la circulación sanguínea, garantizando la estabilidad y el metabolismo normal del medio corporal interno durante el ejercicio. Objetivo: Investigar el efecto del entrenamiento de sobrecarga en la hemoglobina de los atletas masculinos de taekwondo. Métodos: Se seleccionaron 21 atletas masculinos de taekwondo (de nivel 2 o superior) y se entrenaron durante 4 semanas, 5 días a la semana, con una intensidad de carga inicial del 60% de la frecuencia cardíaca máxima y un aumento semanal de la intensidad del 10%. Antes del entrenamiento y cada fin de semana durante el mismo, se comprobó la hemoglobina (Hb), el volumen corpuscular medio (MCV), la hemoglobina corpuscular media (HCM), la concentración de hemoglobina corpuscular media (MCH) y el recuento de reticulocitos (Ret), Anchura de distribución del volumen de glóbulos rojos (RDW), anchura de distribución del contenido de hemoglobina (HDW), volumen reticulocitario medio (MCVr), concentración media de hemoglobina reticulocitaria (CHCMr), hierro sérico (Fe) y ferritina (Fer). Resultados: Después de 4 semanas de entrenamiento con carga creciente, los atletas mostraron una disminución progresiva y significativa de la Hb (P<0,01), que se manifestó como hipohemoglobina inducida por el ejercicio, y el MCV, el MCH, el MCHC, el CHCMr, el HDW y la ferritina sérica disminuyeron de forma significativa o extrema (P<0,01). 05, P<0,01); el ADE aumentó significativamente (P<0,05); los cambios en el Ret y el hierro sérico no mostraron significación estadística (P>0,05). El análisis de correlación encontró que la concentración de hemoglobina tenía la mayor correlación con MCHC y CHCMr. Conclusión: El entrenamiento de carga incremental de cuatro semanas puede inducir hipohemoglobina inducida por el ejercicio en atletas masculinos de taekwondo, siendo sus cambios los más correlacionados con MCHC y CHCMr, pero sin correlación significativa con el Fe sérico, RDW, HDW y MCV. Nivel de evidencia: Estudios terapéuticos - Investigación de resultados.

Analysis of hematological parameters in male plateletpheresis donors / 中国输血杂志

【Objective】 To investigate the variation of hematological parameters in male plateletpheresis donors. 【Methods】 A total of 194 male plateletpheresis donors from Fujian Blood Center were divided into two groups according to the frequency of blood donation: Group 1 (n=107), with the number of plateletpheresis donation less than or equal to 12 per year; Group 2 (n=87), with the number of plateletpheresis donation more than 12 per year. Serum ferritin (SF) and related iron metabolism indexes, red blood cell count (RBC), hemoglobin (Hb), hematocrit(Hct), platelet count (Plt) and other blood routine indexes, as well as percentage of reticulocyte counts (RET%), immature reticulocyte fraction(IRF) and other reticulocyte indexes were measured before blood donation and analyzed by statistical methods. 【Results】 Compared with Group 2, the RBC, Hb, Hct, SF in Group 1 were significantly higher, while Plt, RET%and IRF were significantly lower(P<0.05), and the probability of ferritin decrease in Group 1 was lower, with significant difference(P<0.05). 【Conclusion】 As the number of donation increased, male plateletpheresis donors were prone to iron deficiency, and the bone marrow hematopoiesis were obviously enhanced. We should be more concerned about male plateletpheresis donors who donated more than 12 times per year, further more, SF monitoring should be conducted and the blood donation interval should be appropriately extended.

Establishment of a new strategy to correct the interference of chyle blood on the detection of hemoglobin and mean red blood cell hemoglobin concentration / 中华检验医学杂志

Objective:To establish a new strategy for rapid correction of the interference of chyle blood on hemoglobin (HGB) and related indexes by reticulocyte (RET) channel research parameters (HGB-O, MCHC-O) from automatic hematological analyzer.Methods:With the diagnostic experimental design, a total of 90 impatient samples were sequential picked from Fuwai Hospital, which had routine blood testing from June 1 to July 31, 2021. The selected samples were free of hemolysis, jaundice, chylo. The age of the patients was (49.2±5.7) years, with 47 males and 43 females. Three different contents(25, 50, 75 μl) of fat emulsion injection were used to replace plasma in equal amounts to prepare chyle blood samples with mild, medium and heavy degrees of average red blood cell hemoglobin concentration (MCHC). The research parameters (HGB-O, MCHC-O) obtained by the RET channel detection of the automatic blood analyzer were used as the corrected HGB and its related index values (RET method), and the original values (the detection values before adding fat emulsion) and the formula correction values were paired with t-test or Wilcoxon signed rank test, single factor analysis of variance or Kruskal-Wallis rank-sum test, Bland-Altman and correlation analysis to evaluate the correction effect of RET method.Results:There was no significant difference ( H=0.035, P=0.983; H=0.097, P=0.953; H=0.112, P=0.945) between the RET correction values of HGB (g/L) [104.0(83.8, 132.8), 109.0(87.78, 128.25), 104.0(87.8, 131.8)] and the original values [104.0(83.0, 133.0), 107.5(86.75, 129.25), 103.5(85.8, 131.3)] and the formula correction values [104.0(84.0, 133.8), 106.0(86.75, 131.25), 102.5(86.8, 131.3)] in the samples of chythemia with varying degrees of MCHC (g/L) elevation; meanwhile, the RET correction values [366.5(325.8, 341.5), 333.5(323.8, 340.0), 333.5(327.0, 341.25)] and the original values [336.0(324.8, 342.0), 333.0(323.5, 342.3), 332.0(326.75, 340.5)] and the formula correction values [333.5(323.5, 343.3), 331.0(321.0, 338.3), 329.5(325.25, 337.25)] were also not statistically significant ( H=0.049, P=0.976; H=3.149, P=0.207; H=0.883, P=0.643). The detection values of HGB and related indexes corrected by RET method were in good agreement with the original values [96.7% (29/30) of the points were within the 95% consistency limit], and the two were positively correlated (the correlation coefficients were all higher than 0.919, P<0.01). Conclusion:The RET method based on the research parameters of RET channel of automatic hematological analyzer can serve as a new strategy to correct the interference of chyle blood on the detection of HGB and related indexes.

Practical Approach to the Interpretation of Complete Blood Count Reports and Histograms

Improvement in technology and inclusion of new parameters in automated hematology analyzers allows for better and faster detection of anemias. These parameters along with histograms provide details and clues that help to diagnose the etiology of anemia and help bridge the time lag in detection and treatment. Timely and expert interpretation of complete blood counts should not be limited to the pathologist but should also interest the clinician to allow for efficient patient care.

Enfermedades frecuentes durante el período neonatal. Resultados del hemograma, frotis de sangre periférica, conteo de reticulocitos y conteo de plaquetas

RESUMEN El hemograma, el frotis de sangre periférica, el conteo de reticulocitos y el conteo de plaquetas en el período neonatal son exámenes fundamentales en el diagnóstico y seguimiento de algunas enfermedades más frecuentes en esta fase de la vida como la anemia y las infecciones, las cuales, en ocasiones, pueden causar gran morbilidad y mortalidad en el neonato. Se efectúa una revisión bibliográfica de los resultados del hemograma, lámina periférica, conteo de reticulocitos y conteo de plaquetas en el neonato a término y pretérmino describiendo las variaciones de estos parámetros en el síndrome anémico y la sepsis del recién nacido.

ABSTRACT The complete blood count, the peripheral blood smear, the reticulocyte count and the platelet count in the pathological neonatal period are fundamental tests in the diagnosis and follow-up of some of the most frequent diseases in this phase of life, such as anemia and infections, which can sometimes cause great morbidity and mortality in the newborn. A bibliographic review of the results of the hemogram, peripheral lamina, reticulocyte count and platelet count in term and preterm neonates is carried out, describing the variations of these parameters in the anemia syndrome and sepsis of the newborn.

Hemograma, frotis de sangre periférica, conteo de plaquetas y conteo de reticulocitos en el recién nacido normal y sus variaciones fisiológicas

RESUMEN Se define recién nacido normal a aquel niño con peso superior a 2500 gramos e inferior a 4000 gramos, a término, y que no presenta afección ni presente ni probable en el momento del nacimiento. Los valores del hemograma, la morfología del frotis de sangre periférica, el conteo de reticulocitos y de plaquetas en el recién nacido normal varían según su tiempo de vida y son efecto de diferentes causas fisiológicas; aunque también existen numerosas alteraciones patológicas en estos exámenes de laboratorio en caso de determinadas enfermedades que pueden aparecer en esta etapa de la vida. En los recién nacidos pre término estas cambios son más evidentes. Se realizó una revisión bibliográfica sobre el hemograma, lámina periférica, conteo de plaquetas y conteo de reticulocitos en el recién nacido normal donde se exponen los resultados de estos estudios según su tiempo de nacimiento. Se realizan conclusiones.

ABSTRACT A normal newborn is defined as a child weighing more than 2500 grams and less than 4000 grams, at term, and who does not present affection or possible affection at the time of birth. The values of the hemogram, the morphology of the peripheral blood smear, the reticulocyte and platelet count in the normal newborn vary according to their life span and are the effect of different physiological causes; although there are also numerous pathological alterations in these laboratory tests in the case of certain diseases that may appear at this stage of life. In preterm newborns these changes are more evident. A bibliographic review was carried out on the hemogram, peripheral lamina, platelet count and reticulocyte count in the normal newborn where the results of these studies are presented according to their time of birth. Conclusions are made.

Hemoglobina reticulocitaria y su utilidad clínica en el diagnóstico temprano de eritropoyesis por deficiencia de hierro absoluto en mujeres adolescentes / Reticulocyte hemoglobin and its clinical utility in the early diagnosis of erythropoiesis due to absolute iron deficiency in adolescent women / Hemoglobina de reticulócitos e sua utilidade clínica no diagnóstico precoce da eritropoiese por deficiência absoluta de ferro em mulheres adolescentes

La hemoglobina reticulocitaria es un nuevo parámetro dentro de los autoanalizadores hematológicos de cuarta generación, siendo indispensable en el diagnóstico y manejo de eritropoyesis deficiente en hierro, especialmente la deficiencia funcional de hierro, el secuestro de hierro y la deficiencia absoluta de hierro. Además, este parámetro demuestra ser más preciso que las pruebas bioquímicas como el hierro sérico, la ferritina y la saturación de transferrina, en la detección precoz de eritropoyesis deficiente en hierro. El objetivo de la investigación fue describir la utilidad clínica de la hemoglobina reticulocitaria (CHr) en el diagnóstico temprano de eritropoyesis por deficiencia de hierro absoluto en mujeres adolescentes. El tipo de investigación fue descriptivo, analítico, el diseño de campo transversal. La muestra voluntaria, no aleatoria estuvo constituida por 62 mujeres adolescentes con edades comprendidas entre los 14 y 19 años. Como resultado se encontró que el 97% de la muestra tiene disminución de la CHr, indicando eritropoyesis deficiente en hierro, mientras que un 3% de las adolescentes presentan valores normales para la CHr, se realizó la relación diagnostica entre pruebas de laboratorio tales como CHr y el Hierro sérico. También se reportó que el 93% de la muestra presenta déficit de hierro sin anemia, y un 7% tiene anemia ferropénica, el rango de edad con mayor predominio de anemia ferropénica fue entre los 14 y 16 años. Se concluye que la CHr es de utilidad clínica y una nueva herramienta de diagnóstico temprano de eritropoyesis por deficiencia de hierro.

Reticulocyte hemoglobin is a new parameter within the fourth generation hematological autoanalyzers, being indispensable in the diagnosis and management of iron deficient erythropoiesis, especially functional iron deficiency, iron sequestration and absolute iron deficiency. Moreover, this parameter proves to be more accurate than biochemical tests such as serum iron, ferritin and transferrin saturation in the early detection of iron deficient erythropoiesis. The aim of the research was to describe the clinical utility of reticulocyte hemoglobin (CHr) in the early diagnosis of absolute iron deficiency erythropoiesis in adolescent females. The type of research was descriptive, analytical, cross-sectional field design. The voluntary, non-random sample consisted of 62 adolescent females aged between 14 and 19 years. As a result, it was found that 97% of the sample had decreased CHr, indicating iron deficient erythropoiesis, while 3% of the adolescents had normal values for CHr. The diagnostic relationship between laboratory tests such as CHr and serum iron was performed. It was also reported that 93% of the sample presented iron deficiency without anemia, and 7% had iron deficiency anemia; the age range with the highest prevalence of iron deficiency anemia was between 14 and 16 years of age. It is concluded that HRH is clinically useful and a new tool for early diagnosis of erythropoiesis due to iron deficiency.

A hemoglobina reticulócita é um novo parâmetro dentro da quarta geração de auto-analisadores hematológicos, sendo indispensável no diagnóstico e manejo da eritropoiese com deficiência de ferro, especialmente deficiência funcional de ferro, seqüestro de ferro e deficiência absoluta de ferro. Além disso, este parâmetro prova ser mais preciso do que testes bioquímicos como ferro sérico, ferritina e saturação da transferrina na detecção precoce de eritropoiese com deficiência de ferro. O objetivo da pesquisa foi descrever a utilidade clínica da hemoglobina reticulocitária (RCHr) no diagnóstico precoce da eritropoiese absoluta de deficiência de ferro em mulheres adolescentes. O tipo de pesquisa foi descritivo, analítico, de corte transversal do campo. A amostra voluntária e não aleatória consistiu de 62 fêmeas adolescentes com idades entre 14 e 19 anos. Como resultado, descobriu-se que 97% da amostra tinha uma diminuição na HRH, indicando uma eritropoiese com deficiência de ferro, enquanto 3% das adolescentes tinham valores normais para HRH. Também foi relatado que 93% da amostra tinha deficiência de ferro sem anemia, e 7% tinha anemia por deficiência de ferro; a faixa etária com maior prevalência de anemia por deficiência de ferro era entre 14 e 16 anos. Conclui-se que o RHH é clinicamente útil e uma nova ferramenta para o diagnóstico precoce da eritropoiese devido à deficiência de ferro.

Characteristics of bone marrow compensatory erythropoiesis in hereditary spherocytosis / 中华血液学杂志

Objective: To reveal the compensatory features of bone marrow (BM) erythropoiesis in hereditary spherocytosis (HS) and to explore the effect of diferent hemoglobin levels on this compensation. Methods: Clinical and laboratory data of patients with HS were collected, and the peripheral blood absolute reticulocytes counts value was taken as the surrogate parameter to evaluate the ability of erythropoiesis compensation. BM erythropoiesis compensation in HS with diferent degrees of anemia were evaluated. Results: ①Three hundred and two patients were enrolled, including 115 with compensated hemolytic disease, 74 with mild anemia, 90 with moderate anemia, and 23 with severe anemia. ②Hemoglobin (HGB) was negatively correlated with serum erythropoietin in the decompensated hemolytic anemia group (EPO; rs=-0.585, P<0.001) . ③The median absolute reticulocyte count (ARC) of HS patients was 0.34 (0.27, 0.44) ×10(12)/L, up to 4.25 times that of normal people. The maximum ARC was 0.81×10(12)/L, about 10 times that of normal people. The median ARC of patients with compensated hemolytic disease was 0.29 (0.22, 0.38) ×10(12)/L, up to 3.63 times that of normal people. The median ARC of patients with hemolytic anemia was 0.38 (0.30, 0.46) ×10(12)/L, which was significantly higher than the patients with compensated hemolytic disease, up to 4.75 times that of normal people (z=4.999, P=0.003) . ④ ARC was negatively correlated with HGB in the compensated hemolytic disease group (rs=-0.177, P=0.002) and positively correlated with HGB in the decompensated hemolytic anemia group (rs=0.191, P=0.009) . There was no significant difference in the ARC among patients with mild, moderate, and severe anemia (χ(2)=4.588, P=0.101) . ⑤The median immature reticulocyte production index of the mild, moderate, and severe anemia groups was 13.1% (9.1%, 18.4%) , 17.0% (13.4%, 20.8%) , and 17.8% (14.6%, 21.8%) , respectively; the mild anemia group had lower index values than the moderate and severe anemia groups (P(adj) values were both<0.05) , but there was no significant difference between the latter groups (P(adj)=1.000) . The median immature reticulocyte count of patients in the mild, moderate, and severe groups was 5.09 (2.60, 7.74) ×10(10)/L, 6.24 (4.34, 8.83) ×10(10)/L, and 7.00 (3.07, 8.22) ×10(10)/L, respectively; there was no significant difference among the groups (χ(2)=3.081, P=0.214) . Conclusion: HGB can be maintained at a normal level through bone marrow erythropoiesis, while red blood cells are reduced in HS. However, once anemia develops, the bone marrow exerts its maximum erythropoiesis capacity and does not increase, regardless of anemia aggravation or serum EPO increase.

Utilidad clínica del equivalente de hemoglobina reticulocitaria en niños en hemodiálisis / Clinical usefulness of the reticulocyte hemoglobin equivalent in children on hemodialysis

Introducción. La anemia por deficiencia de hierro en hemodiálisis es frecuente. Para su detección se utiliza la ferritina sérica y la saturación de transferrina (ST). El equivalente de hemoglobina reticulocitaria (RET-He) es un análisis que no se modifica en estados inflamatorios y refleja directamente el hierro disponible en médula ósea.Objetivo. Explorar la capacidad diagnóstica de deficiencia absoluta de hierro del RET-He y evaluar su correlación con marcadores tradicionales de ferropenia.Población y métodos. Estudio retrospectivo que comparó RET-He con ferritina y ST en niños en hemodiálisis atendidos en el Hospital Garrahan entre julio de 2016 y julio de 2019. Resultados. En 164 observaciones realizadas en 40 niños, se encontró correlación positiva débil entre hemoglobina y RET-He (r 0,35, p < 0,001), positiva significativa entre ST y RET-He (r 0,52, p < 0,001), negativa baja entre hemoglobina y ferritina (r -0,19, p 0,02) y ausencia de correlación entre hemoglobina y ST (r 0,05, p 0,5). El 50 % presentaba anemia; la ferropénica fue por marcadores tradicionales en el 13 % y por RET-He en el 44 %. El RET-He mostró sensibilidad del 90,9 % (IC 95: 57,1-99,5 %), especificidad del 74,5 % (IC 95: 66,7-81 %), valor predictivo negativo del 99,1 % (IC 95: 94,5-99,9 %) y positivo del 20,4 % (IC 95: 10,7-34,7 %) para detectar anemia ferropénica con valor de corte de 29 picogramos.Conclusiones. Pese a su capacidad limitada, el RET-He como biomarcador de deficiencia de hierro aumenta la detección de anemia ferropénica en niños en hemodiálisis

Introduction. Iron-deficiency anemia is common in hemodialysis patients. Serum ferritin and transferrin saturation (TS) are used for its detection. The reticulocyte hemoglobin equivalent (RET-He) is a marker that is not altered by inflammatory conditions and directly reflects iron availability in the bone marrow.Objective. To explore the diagnostic capability of RET-He to detect absolute iron deficiency and assess its correlation with traditional markers of iron deficiency.Population and methods. Retrospective study comparing RET-He with ferritin and TS in children on hemodialysis seen at Hospital Garrahan between July 2016 and July 2019.Results. In 164 observations carried out in 40 children, a weak positive correlation was found between hemoglobin and RET-He (r = 0.35, p < 0.001), a significant positive correlation between TS and RET-He (r = 0.52, p < 0.001), a low negative correlation between hemoglobin and ferritin (r = -0.19, p = 0.02), and a lack of correlation between hemoglobin and TS (r = 0.05, p = 0.5). Anemia was observed in 50 %; iron-deficiency anemia was detected by traditional markers in 13 % and by RET-He in 44 %. RET-He showed a sensitivity of 90.9 % (95 % CI: 57.1-99.5 %), a specificity of 74.5 % (95 % CI: 66.7-81 %), a negative predictive value of 99.1 % (95 % CI: 94.5-99.9 %), and a positive predictive value of 20.4 % (95 % CI: 10.7-34.7 %) to detect iron-deficiency anemia with a cut-off value of 29 pg.Conclusions. Despite its limited capability, the use of RET-He as a biomarker of iron deficiency increases the detection of iron-deficiency anemia in children on hemodialysis.

Utility of reticulocyte hemoglobin in diagnosing latent iron deficiency and iron deficiency anemia

Background: Iron deficiency is the most common cause of anemia and studies have shown poor cognition, psychomotor and social/emotional development in children who are deficient in iron, even with normal hemoglobin levels, the so-called Latent phase of Iron deficiency. It is therefore crucial to identify LID, as well as IDA at the earliest stage, in order to initiate treatment.' Many tests like serum ferritin and soluble transferring receptor(sTfR) have been described collectively as a panel to detect iron deficiency; however no single test is specific enough to be used independently. Also during treatment it takes weeks to observe changes in Hb, hematocrit or RBC indices, hence the need for a more sensitive and reliable test. Objective was to evaluate effectiveness of CHr in diagnosing LID and IDA.Methods: Samples were collected from 180 children, clinically suspected to be anemic. Complete hemogram and Iron profile were measured. Three groups were defined, LID (Tfsat <20%, Hb >11g/dL; n=52), IDA (Tfsat <20%, Hb <11g/dL; (n=84) and controls (Tfsat >20%, Hb >11g/dL; n=44). The mean values of RBC indices, Iron profile and CHr was compared across the groups. A cut off value of <26 pg CHr was taken to represent Iron deficiency state.Results: Comparison between anemic group and control found that all RBC indices were found to be significantly lower including Reticulocyte hemoglobin. All of the variables in anemic group were lower compared to latent iron deficient group except MCHC and reticulocyte count. CHr was found to be statistically lower in LID and IDA group in comparison to control group.Conclusions: CHr can be used as a valuable indicator in diagnosis as well as follow-up of LID and IDA, which is easily available and inexpensive.

Assessment of Reticulocyte-haemoglobin Equivalent (Ret-He) as a Diagnostic Indicator for Iron Deficiency Anaemia

@#Introduction: Iron deficiency anaemia (IDA) is the most common cause of anaemia. The diagnosis of IDA, however, remains a challenge and is a problem worldwide. Serum iron study is commonly used for IDA diagnosis but there are some limitations. This study was conducted to evaluate reticulocyte-haemoglobin equivalent (Ret-He) as a screening tool for IDA diagnosis in adults. Method: This is a comparative case control study conducted in Hospital Tengku Ampuan Afzan, Kuantan consisting of adult patients with iron deficiency anaemia and a healthy control group. Haematological parameters (Hb, RBC count, MCV, MCH, RDW) inclusive of Ret-He and serum iron parameters (serum iron, transferrin saturation and serum ferritin) were measured. Correlation between Ret-He with other haematological and serum iron parameters were analysed. Results: There were 103 IDA adult patients with majority of them being female (85.4%) with median age of 36 years old. Malay ethnicity (79.6%) contributed to the larger proportion of adult IDA patients. The Ret-He value for patient and control groups were 16.50 ± 4.90 pg and 34.80 ± 1.97 pg, respectively. Ret-He was 89.32% sensitive and 100% specific with 100% positive predictive value (PPV) and 73.11% negative predictive value (NPV) when compared to transferrin saturation. There was significant correlation between Hb, MCH, MCV, RDW and serum iron, transferrin saturation and serum ferritin parameters with Ret-He. Conclusion: Ret-He together with a complete blood count, may serve as an alternative to the serum iron parameters for screening of IDA in adults.

Comparison of automated flowcytometric reticulocyte analysis with manual reticulocyte count

Background: Reticulocytes are young or immature red blood cells released from bone marrow and that contain remanants of ribonucleic acid (RNA) and ribosomes. Reticulocyte count (RC) is the index of erythropoietic activity within bone marrow. The reticulocyte counting methods at clinical laboratories are currently divided into manual and automated.Methods: A total of 500 samples of study cases were processed by manual method using New Methylene Blue (NMB) and automated method based on flowcytometry by PENTRA XLR HORIBA hematology analyzer. All quality control parameters were evaluated and values obtained by both methods were compared using various statistical methods.Results: Automated hematology analyzer provides excellent precision and linearity with no significant carryover. On comparing manual and automated RC method good method correlation was found (correlation coefficient r-0.865), however individual case wise percent deviation between manual and automated RC and CRC varied significantly. In addition within run precision calculated for automated RC differed significantly from manual count. The mean of difference between duplicate readings (150 samples) of manual and automated RC (<5%) were 0.3 and 0.01 respectively while 6.3 and 0.15 respectively for >5% RC. Thus, automated method was found to be more precise than the manual RC.Conclusions: The manual count method for RC associated with significant imprecision compared to flowcytometric method mostly based on interobserver variation and the smaller number of cell being counted. In contrast, the automated method is rapid, easy to operate, count higher number of cells with precise measurement.

A study on incidence of vitamin B12 deficiency in patients with pancytopenia

Background: Pancytopenia is a serious and life threatening illness presented with multiple etiologies. The current study was done with the objective to evaluate the clinic-pathological factors responsible for incidence of pancytopenia in patients with vitamin B12 deficiency and their response to the therapy with vitamin B12.Methods: It was an observational study carried out at Department of Medicine, Mahatma Gandhi Memorial Government Hospital, Trichy, Tamilnadu during the period between December 2016 to December 2017. A total 50 patients with pancytopenia were clinically evaluated along with hematological parameters and bone marrow aspiration.Results: A total of 50 patients were included in the study. The mean age of the patients was 32.84 years with a male to female ratio of 1.5:1. All patients had history of fatigability. Commonest physical presentation was pallor (100%). Megaloblastic anaemia was the predominant blood picture in 58% patients. The common bone marrow finding was hyper cellular marrow with megaloblastic picture. Management with cyanocobalamin preparations and folate supplementations, significantly improved the reticulocyte count percentage in patients with pancytopenia (p=0.01)Conclusion: The study concluded that the most common cause of pancytopenia was megaloblastic anaemia. Detailed haematological investigations along with bone marrow aspiration in patients with cytopenia provided a clear understanding of disease process to identify the etiologies of pancytopenia.

Role of IV administered Iron sucrose with recombinant erythropoietin in the treatment of moderate and severe iron deficiency anemia in the third trimester of pregnancy

Background: Iron deficiency Anemia in pregnancy is one of the most common and intractable nutritional problems in the world today. The objective of this study was to investigate the therapeutic efficacy and safety of rHuEPO combined with IV iron sucrose, in the treatment of pregnant women in third trimester with moderate and severe iron deficiency anemia and whether addition of erythropoietin will increase the rate of rise of Hb without compromising on the safety of the therapy.Methods: 60 pregnant women in the third trimester, diagnosed as cases of moderate and severe iron deficiency anemia were enrolled in this study with 30 subjects in each of the 2 groups. Recombinant Erythropoietin 2000 IU s/c and Inj Iron sucrose 100 mg slow intravenously in 100 ml 0.9% NS over 1 hr on alternate days was administered to the case group and the control group was administered only iron sucrose slow IV in the same dose on alternate days till target Hb (11gm%) was reached. Efficacy measures were reticulocyte count, increase in Hb/week, time to target Hb level and need for continued therapy after 4 weeks.Results: In the case group, the increases in Hb were greater after 1 week of treatment and this was found to be significant (P < .01), the median duration of therapy was shorter in the case group (22 versus 34 days), with more patients reaching the target hemoglobin level by 4 weeks as opposed to 7 weeks in the control group. Average rise in Hb/week was much more in the case group. The groups did not differ with respect to maternal and fetal safety parameters.Conclusions: Iron sucrose plus rhEPO is an effective treatment for iron deficiency anemia in pregnancy probably because of a synergistic action, with rhEPO stimulating erythropoiesis and iron sucrose delivering iron for hemoglobin synthesis.

Subclinical Malaria and Reticulocyte Count in Apparently Healthy Female Undergraduate Students in Rivers State University, Port Harcourt, Nigeria

Aims: The study was aimed at determining subclinical malaria and estimating reticulocyte count in apparently healthy female undergraduate students of Rivers State University, Port Harcourt.Study Design:This is a non-randomized, comparative case-control study.Place and Duration of Study:The study was conducted using female students residing at the hostels of Rivers State University, Port Harcourt. Analysis was carried out at the Haematology Laboratory, Department of Medical Laboratory Science, Rivers State University, Port Harcourt, Nigeria, between July and August, 2018. Methodology:For the subjects used in this study, a total of 32 students (32%) that were diagnosed of having Plasmodium falciparum malariainfection were used as test subjects, while a total of 68 students (68%) that were diagnosed to be Plasmodium falciparumnegative, and withoutOriginal Research Article malaria, were used as control.Thick and thin blood films examination using Giemsa staining technique was used to detect and calculate the malaria parasite density while a thinbloodfilm examination using new methylene blue staining technique was used to evaluate the reticulocyte count in the blood.Results:The reticulocyte count of test subjects (subjects with Plasmodium falciparummalaria) was 0.15 ± 0.04%and that of control subjects (subjects without any malaria parasite) was 0.31 ± 0.08%. The test subjects had significantly lower reticulocyte count (p ˂ 0.0001) than the control subjects. The age range “15-19” years had the highest malaria parasite density of 0.52 ± 0.18%, while “25-29” years had the least parasite density of 0.33 ± 0.24. There was no statistical variation in malaria parasite density according to age ranges (p = 0.13; p ˃ 0.05). However, the age range of “15-19” years had the lowest reticulocyte count as most of the female students within this age group were diagnosed to have been infected with malaria parasite.Conclusion:This study revealed that reticulocyte counts of malaria (Plasmodium falciparum) infected individuals decreased when compared to those without malaria parasite and this decreasewas statistically significant. There was no statistical significant variation in malaria parasite density irrespective of age ranges. Prophylaxis for malaria in such settings would be an efficient means of preventing infectious reservoirs and higher rates of subclinical malaria infection.

Correlação entre as contagens de reticulócitos manual e automática em amostras de felinos anêmicos / Correlation between manual and automatized values of reticulocyte count in anemic feline samples

O objetivo do presente estudo foi correlacionar os valores de reticulócitos pontilhados e agregados obtidos por metodologia manual com a metodologia automática de contagem de reticulócitos totais em amostras de sangue de gatos anêmicos, analisados em um contador hematológico com citometria de fluxo. Para isso, 40 amostras de sangue de pacientes felinos anêmicos, independentemente de idade e sexo, foram utilizadas para a determinação das contagens absolutas de reticulócitos totais pela metodologia automatizada por citometria de fluxo fluorescente e pela técnica manual com corante supravital, em duplicata. Na contagem manual, houve a discriminação entre reticulócitos pontilhados e agregados. Para a correlação entre os métodos, foi realizada a análise de regressão de Passing-Bablok. A média do hematócrito dos gatos foi de 15,25%, tendo a maioria dos gatos (32,5%) apresentado anemia moderada (hematócrito = 17,81%). Como resultados, a análise de regressão demonstrou que a correlação entre a contagem absoluta total automática foi superior à contagem manual de reticulócitos agregados (rho= 0,71; P<0,001) do que a contagem absoluta de reticulócitos pontilhados (rho= 0,68; P<0,001). Os resultados apresentados sugerem que a contagem de reticulócitos total absoluta realizada pelo analisador hematológico ProCyte Dx em gatos anêmicos se refere à contagem absoluta de reticulócitos. Dessa maneira, recomenda-se que os valores possam ser utilizados para a avaliação imediata da condição hematológica de gatos anêmicos.(AU)

The aim of this study was to correlate the punctate and aggregated reticulocytes values obtained by manual methodology and the automatic reticulocyte count in 40 blood samples from anemic cats. Total reticulocyte absolute counts were determined by automated fluorescence flow cytometry and manual methods in 40 blood samples obtained from anemic cats. The manual count was obtained by supravital stain in duplicate to each sample and the reticulocyte morphology were discriminated between punctate and aggregates reticulocytes. Passing-Bablok regression analysis was utilized to compare the methods. Most samples were from anemic cat (15,25%) and the hematocrit mean was 17,81%. Regression analysis showed that the correlation between the absolute total automatic counts is higher with aggregated reticulocytes (rho= 0,71; P< 0,001) than with absolute punctate reticulocytes counts (rho= 0, 68, P< 0.001). Results suggest that the ProCyte Dx reticulocytes count in anemic cats is correlated with aggregate reticulocyte count. Thus, the greater amount of RNA and organelles in aggregate reticulocytes generates a cellular complexity and, therefore, greater impregnation of the dye in an automatic count. Thus, the values obtained by the hematologic instrument can be used for the immediate evaluation of the hematological condition in anemic cats.(AU)

The watershed transform in pathological image analysis: application in rectiulocyte count from supravital stained smears

Background: Morphometric studies based on image analysis are a useful adjunct for quantitative analysis of microscopic images. However, effective separation of overlapping objects if often the bottleneck in image analysis techniques. We employ the watershed transform for counting reticulocytes from images of supravitally stained smears.Methods: The algorithm was developed with the Python programming platform, using the Numpy, Scipy and OpenCV libraries. The initial development and testing of the software were carried out with images from the American Society of Hematology Image Library. Then a pilot study with 30 samples was then taken up. The samples were incubated with supravital stain immediately after collection, and smears prepared. The smears were microphotographed at 100X objective, with no more than 150 RBCs per field. Reticulocyte count was carried out manually as well as by image analysis.Results: 600 out of 663 reticulocytes (90.49%) were correctly identified, with a specificity of 98%. The major difficulty faced was the slight bluish tinge seen in polychromatic RBCs, which were inconsistently detected by the software.Conclusions: The watershed transform can be used successfully to separate overlapping objects usually encountered in pathological smears. The algorithm has the potential to develop into a generalized cell classifier for cytopathology and hematology.

Effect of Ethanol from Extract of Tapak Liman Leaves (Elephantopus scaber Linn.) on Hematopoiesis of Anemia Mice

This study assessed the impact of the electrochemically activated aqueous solutions (ECA AS) on the growth and formationof the biofilm of lactic acid bacteria (LAB). The effectiveness of biocides produced by the unipolar electrochemicalactivation of aqueous solutions of sodium chloride was studied. It was found that sequential treatment of the biofilm withcatholyte and anolyte (fractions ECA AS) lead to the most pronounced decrease in the growth rate and density of bacteria.The results obtained demonstrate antibacterial efficacy and the possibility of using ECA AS for the prevention anddisinfection of aquatic systems, for example, at the enterprises of the agro-industry and the food industry

Contagem de Reticulócitos na Prática Clínica: um Exame Pouco Utilizado / Reticulocytes Counting in Clinical Practice: a Little Examination Used

Objetivo: Estimar o percentual de contagem de reticulócitos em relação aos hemogramas realizados nos laboratórios de análises clínicas de Divinópolis/MG. Métodos: Trata-se de um estudo descritivo realizado nos laboratórios de análises clínicas do município de Divinópolis/MG inscritos no Cadastro Nacional de Estabelecimento de Saúde (CNES). Foi realizada uma entrevista através de questionário a fim de obter as informações dos números de hemogramas e contagens de reticulócitos realizados durante os últimos 12 meses, do atendimento (ambulatorial ou hospitalar), da instituição (pública ou privada), do porte (pequeno, médio ou grande) e de quais os métodos eram utilizados para realização dos exames. Resultados: Dos 15 laboratórios inscritos no CNES, 11 foram entrevistados (73%). Foram realizados 276.666 hemogramas e 4.248 contagens de reticulócitos nos últimos 12 meses em todos os laboratórios, o que significa o percentual de 1,5% de contagem de reticulócitos em relação aos hemogramas realizados. A maioria dos laboratórios é privado (81%), de médio porte (54%) e realizam atendimento ambulatorial (54%). Para realizar o hemograma, a maioria (81%) utiliza a técnica citometria de fluxo e para a contagem de reticulócitos todos realizam a técnica manual com o reagente azul de cresil brilhante. Conclusão: O percentual de contagem de reticulócitos em relação aos hemogramas realizados em laboratórios do município de Divinópolis/MG é baixo, mesmo sendo o primeiro exame complementar para o diagnóstico diferencial da anemia. Essa baixa solicitação pode estar relacionada com a desvalorização do exame no meio clínico ou pela falta de acurácia e pobre reprodutibilidade dos resultados encontrados. (AU)

Objective: To estimate the percentage of reticulocyte counts in relation to blood count performed in the clinical analysis laboratories in Divinópolis / MG. Methods: This is a descriptive study carried out in the clinical analysis laboratories of Divinópolis/MG registered in the National Register of Health Establishment (CNES). A questionnaire interview was conducted in order to obtain information on the number of blood counts and reticulocyte counts performed during the last twelve months. The questionnaire also aimed to identify whether the institution was public or private, whether it was outpatient or hospital care and which methods were used to perform the tests. Results: Of the 15 laboratories registered in the CNES, 11 were interviewed (73%). 276,666 blood counts and 4,248 reticulocyte counts were performed in the last 12 months in all laboratories, which means the percentage of reticulocyte count of 1.5% in relation to the blood counts performed. Most of the laboratories are private (81%), medium-sized (54%) and carry out outpatient care (54%). To perform the blood count, most (81%) use the flow cytometry technique and for reticulocyte counting all perform the manual technique with the bright blue cresyl reagent. Conclusions: The percentage of reticulocyte counts in relation to blood counts performed in laboratories in the city of Divinópolis/MG is low, even though it is the first complementary exam for the differential diagnosis of anemia. This low request may be related to the devaluation of the reticulocyte in the clinical environment or the lack of accuracy and poor reproducibility of the results found. (AU)