Hematological and morphometric differences of blood cells from rheas, Rhea americana (Struthioniformes: Rheidae) on two conservation farms / Diferenças hematológicas e morfométricas de células sanguineas de emas, Rhea americana (Struthioniformes: Rheidae) em dois criatórios conservacionistas

Abstract Today, blood tests are an indispensable tool in avian medicine. This study aimed to describe and compare hematological and morphometric data of erythrocytes, leukocytes and thrombocytes of rhea, Rhea americana. To do so, 58 rheas of both sexes on two farms, one in Cachoeiro do Itapemirim, Espírito Santo (ES), and the other in São Carlos, São Paulo (SP), were selected. Blood samples were taken and their RBC counts, PCV and Hb levels were determined and used in hematimetric index calculations. The total and differentiated leukocyte counts and the TPP and fibrinogen serum levels were also obtained. The results from the two farms analyzed were compared by means of the t test. There were differences in the parameters of the erythrocyte series between the two flocks because of a process of hypochromic macrocytic anemia observed among the rheas in ES. The values for the erythrocyte series and indexes were: RBC, 2.81 ± 0.15 x106/μl; PCV, 44.20 ± 2.86%; Hb, 12.12 ± 0.74 g/dL; MCV, 15.75 ± 0.89 fL; MCH, 43.18 ± 1.82 pg; and MCHC, 27.44 ± 0.80 g/dL. The values for the leukocyte series were: WBC, 12,072 ± 4116 /μL; heterophils, 64.10 ± 9.90%; eosinophils, 2.05 ± 2.06%; monocytes, 6.40 ± 2.99%; lymphocytes, 26.93 ± 9.62%; and basophils, 0.52 ± 1.27%. These can all be suggested as references for rheas reared in Brazil. Statistical differences were observed in erythrocyte length measurements, which were higher in the rheas in SP than in those in ES. Regarding width, the heterophils, lymphocytes and monocytes of the birds in ES were statistically greater than those of the birds in SP. It was concluded that rheas may exhibit morphometric alterations to blood cells and differences in blood elements according to the type of management to which they are subjected.

Resumo Atualmente exames de sangue são ferramentas indispensáveis na medicina aviária. Este estudo teve como objetivo descrever e comparar valores hematológicos e morfométricos de eritrócitos, leucócitos e trombócitos de emas, Rhea americana. Para isso, foram selecionadas 58 emas de ambos os sexos de dois criatórios, um em Cachoeiro do Itapemirim, Espírito Santo (ES) e o outro em São Carlos, São Paulo (SP). Amostras de sangue foram coletadas e realizadas a hematimetria, Hto e dosagem de Hb que foram utilizados nos cálculos dos índices hematimétricos. Também foram efetuadas as contagens total e diferencial de leucócitos, além da dosagem de proteínas total e do fibrinogênio séricos. Os resultados referentes às duas propriedades analisadas foram comparados pelo Teste t. Ocorreram diferenças nos parâmetros da série vermelha entre as aves dos dois criatórios devido a um processo de anemia macrocítica hipocrômica observado nas emas do ES. Os valores para a série vermelha e índices hematimétricos como: hematimetria, 2,81±0,15 x106/μl; Hto, 44,20±2,86%; Hb, 12,12±0,74 g/dL; VCM, 15,75±0,89 fL; HCM, 43,18±1,82 pg; CHCM, 27,44±0,80, além dos valores da série branca como: leucometria total, 12.072±4.116/μL, heterofilo, 64,10±9,90%, eosinófilo, 2,05±2,06%, monócito, 6,40±2,99%, linfócito, 26,93±9,62%, basófilo, 0,52±1,27% foram sugeridos como os de referência para as emas criadas no Brasil. Diferenças estatísticas foram observadas no comprimento de eritrócitos, o qual estava maior nas emas de SP do que aquelas do ES. Em relação à largura, os heterófilos, linfócitos e monócitos das aves do ES foram estatisticamente maior do que aquelas das aves de SP. Concluiu-se que emas podem apresentar alterações morfométricas de células sanguíneas e diferenças nos elementos do sangue de acordo com o tipo de manejo a que são submetidos.

Comparative leukocyte morphometric analysis between endemic Anurans from Brazil and the invasive species Lithobates catesbeianus / Análise morfométrica comparada entre Anuros endêmicos do Brasil e a espécie invasora Lithobates catesbeianus

Amphibians are potentially reliable and efficient bioindicators. Existing anuran white blood cell morphology studies are limited, with only a few morphometric studies available. We employed morphometric techniques to characterize leukocytes of selected Neotropical anurans from Brazil and compare our findings with the exotic American Bullfrog (Lithobates catesbeianus), genus Ranidae. We compared blood smears of 28 specimens from six different genera (Hyla, Phyllomedusa, Hypsiboas, Scinax, Physalaemus, and Proceratophrys) with samples from L. catesbeianus. Leukocyte average diameter was calculated by an image analysis software. One-way analyses of variance and Bonferroni tests were used on statistical analyses. Lymphocytes, neutrophils, eosinophils, and basophils were significantly smaller than the reference ranges reported for other amphibian genera, including Lithobathes, whereas monocyte diameters did not differ significantly between genera. This is the first study to evaluate leukocyte morphometrics of Brazilian anuran species. Our findings suggest that geographical separation could possibly influence leukocyte morphometry.(AU)

Anfíbios são indicadores ambientais potencialmente confiáveis e eficientes. Estudos referentes à morfologia de leucócitos de anuros são limitados, com poucos estudos morfométricos disponíveis em literatura. O presente estudo empregou técnicas morfométricas para caracterizar leucócitos de anuros Neotropicais brasileiros selecionados e compará-los com a espécie exótica rã-touro (Lithobates catesbeianus), família Ranidae. Esfregaços sanguíneos de 28 espécimes pertencentes a seis gêneros diferentes (Hyla, Phyllomedusa, Hypsiboas, Scinax, Physalaemus e Proceratophrys) foram comparados com amostras de esfregaços de L. catesbeianus. A média do diâmetro dos leucócitos foi calculada por um software de análise de imagens. One-way e teste de Bonferroni foram utilizados para avaliação estatística. Linfócitos, neutrófilos, eosinófilos e basófilos mostraram-se significativamente menores que os valores de referência reportados em outros gêneros de anfíbios, incluindo Lithobathes; por outro lado, a média do diâmetro dos monócitos não demonstrou variação significativa entre os gêneros. Esse é o primeiro estudo de avaliação morfométrica de leucócitos em espécies de anuros brasileiros. Nossos resultados sugerem que a separação geográfica possivelmente influencia a morfometria leucocitária.(AU)

Usefulness of Flow Cytometric Analysis for Detecting Leptomeningeal Diseases in Non-Hodgkin Lymphoma

BACKGROUND: The clinical usefulness of flow cytometry (FCM) for the diagnosis of leptomeningeal diseases (LMD) in non-Hodgkin lymphomas has been suggested in previous studies but needs to be further validated. With this regards, we evaluated the use of FCM for LMD in a series of Korean patients with non-Hodgkin lymphoma. METHODS: FCM and cytomorphology were conducted using samples obtained from clinically suspected LMD patients, follow-up LMD patients, and those with high risk of developing tumorigenic diseases. We then compared results of FCM and cytomorphology. In total, 55 and 47 CSF samples were analyzed by FCM and cytomorphology, respectively. RESULTS: Of the samples analyzed, 25.5% (14/55) and 12.8% (6/47) were positive by FCM and cytomorphology, respectively. No samples were determined as negative by FCM but positive by cytomorphology. Seven patients were positive only by FCM and negative by cytomorphology, and six among them were clinically confirmed to have LMD either by follow-up cytomorphology or imaging study. CONCLUSIONS: We observed a high detection rate of tumor cells by FCM compared with cytomorphology. FCM study can be useful in early sensitive detection of LMD.

Neurologic Manifestations of Enterovirus 71 Infection in Korea

Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients' mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.

Hematological, morphological and morphometric characteristics of blood cells from rhea, Rhea Americana (Struthioniformes: Rheidae): a standard for Brazilian birds / Características hematológicas, morfológicas e morfométricas de células sanguíneas de emas, Rhea americana (Struthioniformes: Rheidae): um padrão para aves brasileiras

Abstract Blood exams are an indispensable tool in bird medicine. This study aimed at describing values and aspects of rheas' hematology, Rhea americana, as well as analyzing the morphology and morphometry of all blood cells. Fifty eight adult rheas of both sexes from two farms, one in Cachoeiro de Itapemirim, Espírito Santo State and the other in São Carlos, São Paulo State, were selected. Blood samples were taken and RBC count, PCV and Hb levels measured and used in hematimetric indexes calculations. The total and differentiated leukocyte counts, as well as the TPP and fibrinogen were determined. Erythrocytes, leukocytes and thrombocytes were identified and characterized morphologically. The values for the red series and hematimetric indexes were: RBC (2.81±0.15×106/μL), PCV (44.20±2.86%), Hb (12.12±0.74 g/dL), MCV (15.75±0.89 fL), MCH (43.18±1.82 pg), MCHC (27.44±0.80 g/dL); the values of white series were: WBC (12.072±4116/μL), heterophils (64.10±9.90%), eosinophils (2.05±2.06%), monocytes (6.40±2.99%), lymphocytes (26.93±9.62%), basophils (0.52±1.27%). One may conclude that on average, rheas' blood cells are larger than those of other birds, but these cells in smears cannot be differentiated only by their size. Besides rheas' leukocytes have different components and coloring as in other bird species, however, there are no components or staining aspects unique to the species.

Resumo Exames de sangue são uma ferramenta indispensável na medicina de aves. Este estudo teve como objetivo descrever valores e aspectos da hematologia de emas, Rhea americana, bem como analisar a morfologia e morfometria de todas as células sanguíneas. Cinquenta e oito emas adultas de ambos os sexos de dois criatórios, um em Cachoeiro do Itapemirim, ES e o outro em São Carlos, SP foram selecionadas. Amostras de sangue foram coletadas e CTH, Ht e níveis de Hb foram mensurados e usados para o cálculo dos índices hematimétricos. A contagem total e diferencial de leucócitos, assim como, PPT e fibrinogênio foram determinados. Eritrócitos, leucócitos e trombócitos foram identificados e caracterizados morfologicamente. Os valores para série vermelha e índices hematimétricos foram: CTH (2,81±0,15×106/μL), Ht (44,20±2,86%), Hb (12,12±0,74 g/dL), VCM (15,75±0,89 fL), HCM (43,18±1,82 pg), CHCM (27,44±0,80 g/dL); os valores da série branca foram: CTL (12,072±4116/μL), heterófilos (64,10±9,90%), eosinófilos (2,05±2,06%), monócitos (6,40±2,99%), linfócitos (26,93±9,62%), basófilos (0,52±1,27%). Pode-se concluir que, na média, células sanguíneas de emas são maiores que as de outras aves, porém, não é possível diferenciar estas células em esfregaços somente pelo seu tamanho. Além disso, leucócitos de emas possuem diferentes componentes e coloração como acontece em outras espécies de aves, no entanto, não há nenhum componente ou aspectos tintoriais exclusivo para a espécie.

Effects of ethyl pyruvate on leukocyte-endothelial interactions in the mesenteric microcirculation during early sepsis treatment

OBJECTIVES: Experimental studies on sepsis have demonstrated that ethyl pyruvate is endowed with antioxidant and anti-inflammatory properties. This study aimed to investigate the effects of ethyl pyruvate on leukocyte-endothelial interactions in the mesenteric microcirculation in a live Escherichia coli-induced sepsis model in rats. METHODS: Male Wistar rats were administered an intravenous suspension of E. coli bacteria or were subjected to a sham procedure. Three hours after bacterial infusion, the rats were randomized into the following groups: a control group without treatment, a group treated with lactated Ringer’s solution (4 mL/kg, i.v.), and a group treated with lactated Ringer’s solution (4 mL/kg, i.v.) plus ethyl pyruvate (50 mg/kg). At 24 h after bacterial infusion, leukocyte-endothelial interactions were investigated using intravital microscopy, and the expression of P-selectin and intercellular adhesion molecule-1 was evaluated via immunohistochemistry. White blood cell and platelet counts were also determined at baseline and 3 h and 24 h after E. coli inoculation. RESULTS: The non-treated and lactated Ringer’s solution-treated groups exhibited increases in the numbers of rolling leukocytes (∼2.5-fold increase), adherent cells (∼3.0-fold), and migrated cells (∼3.5-fold) compared with the sham group. In contrast, treatment with Ringer’s ethyl pyruvate solution reduced the numbers of rolling, adherent and migrated leukocytes to the levels observed in the sham group. Additionally, the expression of P-selectin and intercellular adhesion molecule-1 was significantly increased on mesenteric microvessels in the non-treated group compared with the sham group (p<0.001). The expression of both adhesion molecules was reduced in the other groups, with ethyl pyruvate being more effective than lactated Ringer’s solution. Infusion of bacteria caused significant leukopenia (3 h), followed ...

Flow Cytometric White Blood Cell Differential Using CytoDiff is Excellent for Counting Blasts

BACKGROUND: The usefulness of the CytoDiff flow cytometric system (Beckman Coulter, USA) has been studied in various conditions, but its performance including rapidity in detecting and counting blasts, the most significant abnormal cells in the peripheral blood, has not been well evaluated. The objective of this study was to evaluate the performance of the CytoDiff differential counting method in challenging samples with blasts. METHODS: In total, 815 blood samples were analyzed. Samples flagged as "blasts" or "variant lymphocytes" and showing 0.8) for neutrophils and lymphocytes but poor (r<0.8) for other cells. When the cutoff value of the CytoDiff blast count was set at 1%, the sensitivity was 94.4% (95% CI; 91.2-96.6) and specificity was 91.9% (95% CI; 89.0-94.1). The positive predictive value was 88.4% (95% CI; 84.4-91.5) (304/344 cases) and negative predictive value was 96.2% (95% CI; 93.9-97.7) (453/471 cases). The CytoDiff blast counts correlated well to the manual counts (r=0.9223). CONCLUSIONS: The CytoDiff method is a specific, sensitive, and rapid method for counting blasts. A cutoff value of 1% of at least 1 type of blast is recommended for positive CytoDiff blast counts.

A Case of Leukemoid Reaction in Pancreatic Ductal Adenocarcinoma / 대한소화기학회지

Leukemoid reaction is defined as leukocytosis exceeding 50,000 cells/mm3. When it occurs in a patient with a malignancy, secondary causes such as infections, drugs, hematologic diseases and hemorrhage need to be ruled out. After excluding such causes, paraneoplastic leukemoid reaction can be considered as a diagnosis of exclusion. Paraneoplastic leukemoid reactions have been described in association with lung, gastrointestinal, genitourinary and head and neck cancers. However, pancreatic cancer with leukemoid reaction has been rarely reported. We diagnosed a case of a 55-year-old Korean woman with extreme leukocytosis associated with advanced pancreatic cancer.

White Blood Cell, Hemoglobin and Platelet Distribution Width as Short-Term Prognostic Markers in Patients with Acute Myocardial Infarction

The aim of this study was to assess the prognostic value of combined use of white blood cell (WBC), hemoglobin (Hb), and platelet distribution width (PDW) in patients with acute myocardial infarction (AMI). This study included 1,332 consecutive patients with AMI. Patients were categorized into complete blood cell (CBC) group 0 (n=346, 26.0%), 1 (n=622, 46.7%), 2 (n=324, 24.3%), and 3 (n=40, 3.0%) according to the sum of the value defined by the cut-off levels of WBC (1, > or =14.5x10(3)/microL; 0, or =12.7 g/dL), and PDW (1, > or =51.2%; 0: or =2 (odds ratio, 3.604; 95% confidence interval, 1.040-14.484, P=0.043) was an independent predictor for in-hospital death. The prognostic impact of the combined use of CBC markers remained significant over 12 months. In conclusions, combination of WBC, Hb, and PDW, a cheap and simple hematologic marker, is useful in early risk stratification of patients with AMI.

Hematologia e bioquímica sérica de equinos de concurso completo de equitação em treinamento / Hematology and serum biochemistry of event horses in training

Avaliaram-se a hematologia e a bioquímica sérica em equinos de concurso completo de equitação (CCE) em treinamento durante testes de esforço incremental em esteira ergométrica de alta velocidade. Foram utilizados 16 equinos em delineamento experimental inteiramente ao acaso com quatro tratamentos e quatro repetições em esquema de parcelas subdivididas, utilizando-se como fontes de variação nos tratamentos a idade e o histórico de treinamento em CCE. As parcelas foram constituídas pelos testes incrementais realizados nas fases inicial e final do treinamento. As subparcelas foram representadas pelos tempos de avaliação e coletas. Os equinos do grupo experimental novos iniciantes apresentaram valor médio do hematócrito de 43,24%, sendo inferior ao hematócrito do grupo adultos iniciantes, 45,63%, novos experientes, 46,39%, e competidores, 47,74%. Houve diferença (P<0,05) entre os testes físicos realizados nas fases inicial e final do treinamento, com redução na concentração plasmática de glicose, de 112 para 98,88mg/dL, nas concentrações séricas de creatinina, de 1,41 para 1,29mg/dL, e de proteínas totais, de 6,52 para 6,38g/dL, na contagem de monócitos, de 0,54 para 0,48 10³/mm³, e com aumento na concentração plasmática de lactato, de 3,31 para 3,79mmol/L, na concentração sérica de ácido úrico, de 1,44 para 1,77mg/dL, no hematócrito, de 44,19 para 46,90%, na concentração de hemoglobina, de 14,33 para 15,10g/dL, e na contagem de leucócitos totais, de 9,26 para 9,61 10³/mm³. O treinamento dos equinos de CCE aumentou o condicionamento físico dos equinos, com maior capacidade de metabolização do lactato após o exercício e aumento nos valores basais do hematócrito e da concentração de hemoglobina.

Was evaluated the hematology and serum biochemistry in event horses (CCE) in training during incremental treadmill tests. Sixteen horses were used in a completely randomized design with four treatments and four repetitions in subdivided parcels, using age and previous history of training in events as sources of treatment variation. The parcels constituted of incremental treadmill tests performed at the beginning and end of training. The subparcels were represented by the time of evaluation and collection of samples. The equines of new beginners group had mean hematocrit value of 43.24%, being lower than the hematocrit of adult beginners group, 45.63%, new experienced group, 46.39%, and competitors group, 47.74%. There were differences (P<0.05) between the tests performed at the beginning and end of training, with reduction in glucose plasma concentration, from 112 to 98,88mg/dL, in seric concentration of creatinine, 1.41 to 1.29mg/dL, and total protein, 6.52 to 6.38 g/dL, in monocyte count, 0.54 to 0.48 10³/mm³, and an increase of lactate plasma concentration, from 3.31 to 3.79mmol/L, in seric concentration of uric acid, 44 to 1.77mg/dL, in hematocrit, 44.19 to 46.90%, in hemoglobin concentration, 14.33 to 15.10 g/dL, and blood cell count, 9.26 to 9.61 10³/mm³. The training of event horses improves physical performance of horses, with increased capacity of lactate metabolism after exercise and increased basal hematocrit and hemoglobin concentration.

Procalcitonin and C-Reactive Protein in the Diagnosis and Prediction of Spontaneous Bacterial Peritonitis Associated With Chronic Severe Hepatitis B

BACKGROUND: Procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) are inflammatory markers used to diagnose severe bacterial infections. We evaluated the diagnostic role of these markers and compared their accuracy for spontaneous bacterial peritonitis (SBP) associated with chronic severe hepatitis B (CSHB). METHODS: PCT and CRP concentrations, WBC count, and other hematological parameters were measured in serum from 84 well-characterized patients with CSHB, of whom 42 had SBP. Receiver operating characteristics (ROC) curve analysis was performed to assess the diagnostic accuracy. RESULTS: PCT and CRP concentrations were significantly higher in the CSHB patients with SBP (n=42) than CSHB patients without SBP (n=42). PCT and CRP concentrations were more accurate than WBC count for the diagnosis of CSHB-associated SBP. The optimal cutoff value of PCT was 0.48 ng/mL. The PCT concentration was significantly correlated with the CRP concentration and WBC count. CONCLUSIONS: Serum PCT and CRP seems to be better markers than WBC for the diagnosis of CSHB patients with SBP.

Intra-Amniotic Infection/Inflammation as a Risk Factor for Subsequent Ruptured Membranes after Clinically Indicated Amniocentesis in Preterm Labor

The aim of this study was to determine whether intra-amniotic infection/inflammation (IAI) was associated with subsequent ruptured membranes in women with preterm labor and intact membranes who had a clinically indicated amniocentesis. This retrospective cohort study included 237 consecutive women with preterm labor (20-34.6 weeks) who underwent amniocentesis. The clinical and laboratory parameters evaluated included demographic variables, gestational age, C-reactive protein (CRP) and amniotic fluid (AF) white blood cell, interleukin-6 (IL-6) and culture results. IAI was defined as a positive AF culture and/or an elevated AF IL-6 level (>2.6 ng/mL). The primary outcome was ruptured membranes in the absence of active labor occurring within 48 hours of amniocentesis. Preterm premature rupture of membranes subsequently developed in 10 (4.2%) women within 48 hr of amniocentesis. Multivariate analysis demonstrated that only IAI was independently associated with the ruptured membranes occurring within 48 hr of amniocentesis. In the predictive model based on variables assessed before amniocentesis, only CRP level was retained. IAI is an independent risk factor for subsequent ruptured membranes after clinically indicated amniocentesis in preterm labor. Prior to amniocentesis, measurement of serum CRP level can provide a risk assessment for the subsequent development of ruptured membranes after the procedure.

Predictive Factors of Response to Medical Therapy in Crohn's Disease Patients with Intestinal Obstruction / 대한소화기학회지

BACKGROUND/AIMS: Crohn's disease is a chronic inflammatory bowel disease. Stricture is a very important indication for surgical intervention as strictures can lead to intestinal obstruction. Strictures can be divided into inflammatory and fibrous strictures. Intestinal obstruction due to inflammatory stricture is expected to be resolved with medical treatment. However, factors that can predict the response to medical treatments are unknown. In the present study, we aimed to identify the factors that can predict the response to medical treatments in Crohn's disease patients with intestinal obstruction. METHODS: Data were collected by retrospectively reviewing the medical records of patients with Crohn's disease who visited the emergency department at Samsung Medical Center in Seoul from January 1, 2000 to December 31, 2010 because of intestinal obstruction. Based on the response to medical treatments, we classified the patients as responders and non-responders and compared the clinical, biochemical, and radiological findings of the two groups. RESULTS: A total of 39 patients were enrolled. Twenty-nine patients responded to medical treatments whereas 10 patients did not. Significant differences were observed between the two groups in terms of vomiting and duration of disease before the development of obstruction. CONCLUSIONS: Patients who responded to the medical treatments exhibited a higher incidence of vomiting and longer duration of disease before the development of obstruction. However, further prospective studies are needed to identify the factors that can predict the response to medical treatments.

Purpose and Criteria for Blood Smear Scan, Blood Smear Examination, and Blood Smear Review

A microscopic examination of an appropriately prepared and well-stained blood smear by a knowledgeable laboratory professional is necessary and clinically useful in a number of circumstances and for a variety of reasons. In this article, an attempt is made to delineate the purpose and criteria for blood smear examination in a variety of circumstances that are encountered in everyday laboratory hematology practice. A blood smear scan serves to at least (a) verify the flagged automated hematology results and (b) determine if a manual differential leukocyte count needs to be performed. Blood smear examination/manual differential leukocyte count with complete blood count (CBC) provides the complete hematologic picture of the case, at least from the morphologic standpoint. Blood smear review with or without interpretation serves to ensure that no clinically significant finding is missed, besides providing diagnosis or diagnostic clue(s), particularly if and when interpreted by a physician.

Determining the Dose of Azathioprine Based on the Lower Limit of Leukocyte Count in Patients with Crohn's Disease / 대한소화기학회지

No abstract available.

How Should Azathioprine Be Dosed in Crohn's Disease? A Novel Strategy of Maximum Dose-titration Based on the Lower Limit of Leukocyte Count and Tolerability / 대한소화기학회지

BACKGROUND/AIMS: Although general guidelines have suggested weight-based dosing of azathioprine (AZA, 2.5 mg/kg/day) for Crohn's disease (CD), a substantial number of patients develop bone marrow suppression. The aim of this study was to evaluate the maximum dose of AZA not based on weight but titrated according to the lower limit of leukocyte count for maintaining remission in patients with CD. METHODS: Among a total of seventy-eight patients with CD, who had been followed-up at Kosin University Gospel Hospital (Busan, Korea) from 2010 to 2011, those treated with the maximum dose of AZA meeting both drug-tolerability and leukocytes count of more than 4,000/mm3 for steroid-free maintaining remission were enrolled. The titrated maximum AZA dose and its relationship with weight were evaluated. RESULTS: A total of 42 patients (male, 32 patients; mean age, 31 years) were enrolled. The maximum dose of AZA was 49.1 mg/day. The dose per weight was 0.87 mg/kg/day and negatively correlated with body weight (gamma=-0.51, p=0.01) and BMI (gamma=-0.33, p=0.034). AZA dose per weight in the below 40 years old group was significantly higher than that in the above 40 years old group (p=0.039). CONCLUSIONS: Dose decision of AZA based only on weight could put the patients to inappropriately low or high dose resulting in need of additional therapy or serious side effect, respectively. Therefore, the maximum dose-titration based on the lower limit of leukocyte count and tolerability is a novel and a valuable strategy in deciding the dose of thiopurines.

Metabolismo oxidativo de leucócitos em animais infectados pelo Vírus da Leucemia Bovina / Oxidative burst of leukocytes from bovine leukemia Virus-Infected Cattle

A infecção pelo vírus da leucemia bovina (VLB) leva ao desenvolvimento de linfocitose persistente (LP) ou linfossarcomas, principalmente em rebanhos bovinos leiteiros. Entretanto, os eventos que induzem tais manifestações ou o efeito da infecção na função das diferentes populações de leucócitos são pouco conhecidos. Avaliou-se o efeito da infecção pelo VLB na produção intracelular de peróxido de hidrogênio (H2O2) em leucócitos circulantes, mensurada pela fluorescência produzida pela diclorodihidrofluoresceína, utilizando-se de citometria de fluxo. As células foram obtidas de cinco vacas soronegativas; cinco vacas infectadas pelo VLB, alinfocitóticas; e cinco vacas infectadas, manifestando LP. Verificou-se que a infecção pelo VLB não altera a porcentagem de leucócitos circulantes produzindo H2O2, com ou sem prévio estímulo por adição in vitro: de 12-miristato 13-acetato de forbol (PMA); de lipopolissacarídeos de Escherichia coli (LPS); ou Staphylococcus aureus. Todavia, a produção de H2O2 em leucócitos de animais apresentando LP, com ou sem estímulo, foi menor que aquela verificada em leucócitos de animais soronegativos e de animais soropositivos alinfocitóticos. Os estímulos aumentaram a porcentagem de leucócitos produzindo H2O2 e a produção intracelular média em animais soronegativos ou naqueles infectados alinfocitóticos. Contudo, em leucócitos de vacas soropositivas manifestando LP, a fagocitose de S. aureus não elevou a porcentagem de leucócitos produzindo H2O2. Também, apenas a adição de PMA elevou a produção intracelular de H2O2 em leucócitos de fêmeas soropositivas manifestando LP. Concluiu-se que bovinos infectados pelo VLB, manifestando LP, apresentam menor produção intracelular de H2O2, demonstrando vulnerabilidade funcional refletida por imunossupressão.

Widespread Bovine Leukemia Virus (BLV) infection leads to persistent lymphocytosis (PL) or lymphosarcoma, mainly in dairy herds. Nevertheless, neither the sequence of events that conducts to these symptoms, nor the effect of infection on function of different leukocyte populations, is well known. We evaluated the effect of BLV infection on immune response of cows through the analysis of hydrogen peroxide (H2O2) intracellular production of circulating leukocytes after in vitro stimuli with phorbol-12-myristate-13-acetate (PMA), Escherichia coli lipopolysaccharides (LPS), or Staphylococcus aureus. Cells were obtained from five BLV-non infected cows, five BLV-infected, non-lymphocytotic cows, and five BLV-infected cows with PL, and analyzed by flow cytometry. Intracellular production of H2O2 was measured by dichlorodihydrofluorescein diacetate dependent fluorescence. Results showed that BLV infection does not alter the percentage of H2O2-producing circulating leukocytes (H2O2-PCL), with or without previous stimuli. However, the average of H2O2 intracellular production, with or without previous stimuli, in leukocytes obtained from cows with PL was smaller than those from cells obtained from BLV-negative cows and from BLV-infected, non-lymphocytotic cows. Moreover, stimuli increased H2O2 intracellular production and the percentage of H2O2-PCL obtained from BLVnegative cows and from BLV-infected, non-lymphocytotic cows. Conversely, neither phagocytosis of S. aureus and stimulus with LPS increases H2O2 intracellular production, nor phagocytosis increases the percentage of H2O2-PCL, when leukocytes were obtained from cows with PL. Thus, results show that BLV-infected cattle, with PL, have an impaired H2O2 intracellular production, demonstrating functional vulnerability reflected by immunosuppression.

Clinico-hematological profile of Chediak-Higashi syndrome: Experience from a tertiary care center in south India.

Introduction: Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disorder characterized by partial ocular and cutaneous albinism, increased susceptibility to pyogenic infections, the presence of large lysosomal-like organelles in most granule-containing cells and a bleeding tendency. The abnormal granules are most readily seen in blood and marrow leukocytes, especially granulocytes; and in melanocytes. Other clinical features include silvery hair, photophobia, horizontal and rotatory nystagmus and hepatosplenomegaly. Materials and Methods: The clinico-hematological profile of a series of 5 cases of CHS encountered at JIPMER Hospital with diagnostic work-up done in the Department of Pathology over the last 6 years is presented. The diagnostic work-up included complete hemogram with peripheral smear, bone marrow examination, skin and liver biopsies. Results: The age of the patients ranged from 5 months to 3 years. All patients had silvery hair and partial albinism and presented with fever and recurrent chest infection. Two patients were stable. Three patients were in accelerated phase; of them, 1 patient with associated hemophagocytic syndrome had a rapidly fulminant course. Peripheral blood smear showed anomalously large granules in the leukocytes. Skin biopsy showed sparse, coarse melanin pigment in the epidermis, and liver biopsy done in 2 patients with accelerated phase showed portal lymphohistiocytic aggregates. Conclusions: The diagnostic hallmark of CHS is the occurrence of giant inclusion bodies (granules) in the peripheral leukocyte and their bone marrow precursors. The case series is being presented because of the rarity of CHS and varied spectrum of clinical and hematological presentation.

Weight-length relationship, condition factor and blood parameters of farmed Cichla temensis Humboldt, 1821 (Cichlidae) in central Amazon

A criação de peixes carnívoros nativos vem recebendo grande atenção devido ao promissor uso na aquicultura. Entre estes peixes destacam-se os tucunarés do gênero Cichla, de grande interesse para a pesca esportiva e a indústria de peixes ornamentais da Amazônia. O presente estudo descreve a relação peso-comprimento, fator de condição relativo (Kn) e parâmetros sanguíneos do tucunaré Cichla temensis Humboldt, 1821 cultivado na Amazônia central. Os peixes submetidos a treinamento alimentar na alevinagem receberam ração extrusada contendo 45% de proteína bruta na engorda e tiveram Kn variando de 0,925-1,199, indicando boas condições de higidez no cultivo. A equação obtida da relação peso-comprimento foi P = 0,0073.Ct3,1435, indicando crescimento do tipo isométrico, que é o mais desejável para peixes em uma piscicultura. O número de eritrócitos, trombócitos e leucócitos totais, hematócrito, concentração de hemoglobina, volume corpuscular médio (VCM), concentração da hemoglobina corpuscular média (CHCM), linfócitos, monócitos e neutrófilos mostrou variação intra-específica. Foi observada correlação positiva significativa (p<0,001) do número de eritrócitos totais com a concentração de hemoglobina e o hematócrito. Estes foram os primeiros resultados sobre parâmetros sanguíneos de C. temensis e poderão ser usados como referência para comparação em estudos futuros para avaliar o estado de saúde deste peixe em diferentes ambientes, pois a medida destes parâmetros pode ser usada como ferramenta rápida para diagnóstico de doenças, estresse ou desnutrição.

Farming of native carnivore fish species has drawn attention due to their promising use in aquaculture. Among these species, tucunaré of the genus Cichla stand out, them being of high economical interest for sport fishing and Amazon’s industry of ornamental fish. The present study describes the weight-length relationship (WLR), relative condition factor (Kn), red blood cell parameters, thrombocytes and leukocytes count of Cichla temensis Humboldt, 1821, farmed in central Amazon. Fish that underwent food training during fingerling culture received extruded ration containing 45% of crude protein during fattening, and had Kn with values from 0.925-1.199, which indicated good health condition during the culture. The equation obtained from the WLR was W = 0.0073Lt3.1435, indicating an isometric growth, which is the desirable for fish of fish farm. Red blood cell counts, total thrombocyte and leukocyte counts, hematocrit, hemoglobin concentration, mean corpuscular volume (MCV), concentration of mean corpuscular hemoglobin (MCHC), lymphocytes, monocytes and neutrophils had intra-specific variation. A significant (p<0.001) positive correlation of the red blood cells number with the hemoglobin concentration and hematocrit was found. These are the first sets of blood parameters for C. temensis and could be used as reference for comparison in further studies to evaluate the health status of this fish in different environments, because assessment of these parameters may be used as quick tool for diagnosing diseases, stress and malnutrition.