Comparative study on erythrogram parameters of Cell-Dyn Ruby and Humacount 5l / Estudio comparativo de los parámetros del eritrograma de Cell-Dyn Ruby y Humacount 5l

SUMMARY: The use of hematological counts for the prevention, diagnosis and follow-up of hematological diseases has increased. Indeed, the correct operation of a clinical laboratory is essential to producing comparable results. However, there is a paucity of validation and reproducibility studies among the different existing methods for clinical analysis. Therefore, our aim was to assess the commutability of the results provided by analyzers with different measuring systems. Sixty venous blood samples were obtained from patients, without discriminating for age or sex. Then, an automated hematological analysis was performed using the Cell-Dyn Ruby and HumaCount 5L instruments. The variables measured were: RBC, Hb, HCT, MCV, MCH and MCHC. The data were compared by a one-way ANOVA and Pearson's correlation coefficient. Statistical significance was fixed at p < 0.05. There were no statistically significant differences for RBC, HCT, MCH or MCHC. In addition, with the exception of MCHC, all the analytes showed a good correlation coefficient between the two instruments. There is a variety of automated systems for the clinical laboratory and it is essential for the clinician to know the different methodologies used in hematological analyzers as well as their sensitivity and specificity. Therefore, our results are useful for demonstrating the importance of practical knowledge of the analyzers mentioned.

RESUMEN: El uso de recuentos de células sanguíneas para la prevención, diagnóstico y monitoreo de enfermedades hematológicas ha ido en aumento. Por ello, el funcionamiento correcto de un laboratorio clínico es indispensable para producir resultados comparables. Sin embargo, existen pocos estudios de validación y reproducibilidad de los diferentes métodos de análisis clínico existentes. Por lo tanto, nuestro objetivo fue evaluar la intercambiabilidad de los resultados entregados por los analizadores que utilizan diferentes sistemas de medición. Se obtuvieron sesenta muestras de sangre venosa de pacientes, sin discriminar por edad o sexo. Los eritrogramas fueron obtenidos utilizando los analizadores automatizados Cell-Dyn Ruby y HumaCount 5L. Las variables medidas fueron: RBC, Hb, HCT, MCV, MCH y MCHC. Los datos fueron comparados por ANOVA a una vía y la correlación de Pearson. La significación estadística se estableció en el nivel estándar p<0,05. No hubo diferencias estadísticamente sig- nificativas para RBC, HCT, MCH y MCHC. Con la excepción de la MCHC, todos los analitos presentaron un buen coeficiente de correlación entre los dos analizadores comparados. Existen varios sistemas de automatización para su uso en laboratorios clínicos. Por lo tanto, es primordial para el clínico estar familiarizado con las diferentes metodologías utilizadas en los analizadores de sangre, así como su sensibilidad y especificidad. Nuestros resultados son útiles para mostrar la importancia del conocimiento práctico de los diferentes sistemas de medidas comparados.

The rare holley antibody associated with a severe hemolytic transfusion reaction: the importance of this antibody identification to find a compatible blood unit / Raro anticorpo associado à reação transfusional hemolítica grave: a importância de sua identificação para encontrar uma unidade sanguínea compatível

ABSTRACT The correct identification of erythrocyte antibodies is fundamental for the searching for compatible blood and haemolytic transfusion reactions prevention. Antibodies against antigens of high prevalence are difficult to identify because of the rarity of their occurrence and unavailability of negative red cells for confirmation. We report a case of 46-years-old woman, diagnosed with hemoglobinopathy, and who had symptomatic fall in hemoglobin levels (5.3g/dL) after blood transfusion suggestive of transfusion reaction. The patient's blood type was O RhD-positive. Irregular antibody screening was positive and demonstrated a panreaction against all erythrocytes tested, but this result was not reactive with dithiothreitol. Using negative red cells for antigens of high prevalence of our inventory we could identify in the serum of the same erythrocytes an anti-Holley antibody associated with anti-E. Molecular analysis confirmed that the patient was negative for E and Holley antigens. The crossmath with compatible units confirmed the results. Holley is a high prevalence antigen of the Dombrock blood system whose negative phenotype is extremely rare in all populations and is associated with hemolytic transfusion reactions. This is an antibody that is difficult to identify because laboratories need to have experience in solving complex cases, and have available a large stock of rare sera and erythrocytes, as well other tools such as enzymes, thiol reagents and molecular tests. The correct identification of a rare antibody is initial and mandatory for searching of compatible donors, and to guarantee a satisfactory transfusional support.

RESUMO A correta identificação dos anticorpos eritrocitários é fundamental na busca de sangue compatível e na prevenção das reações transfusionais hemolíticas. Anticorpos contra antígenos de alta prevalência são de difícil identificação, devido à raridade de sua ocorrência e à indisponibilidade de hemácias negativas para sua confirmação. Apresentamos aqui o caso de uma paciente do sexo feminino, 46 anos, com diagnóstico de hemoglobinopatia, que apresentou queda sintomática dos níveis de hemoglobina (5,3g/dL) após transfusão sanguínea, sugestiva de reação transfusional. O tipo sanguíneo da paciente era O RhD-positivo. A pesquisa de anticorpos irregulares foi positiva, demonstrando panreação contra todos os eritrócitos testados, mas não reativo ao ditiotreitol. Utilizando hemácias selecionadas negativas para antígenos de alta prevalência do nosso inventário, foi possível identificar no soro da mesma um anticorpo anti-Holley associado a um anti-E. A análise molecular confirmou que a paciente era negativa para os antígenos E e Holley, e as provas de compatibilidade com unidades fenotipadas confirmaram os resultados. Holley é um antígeno de alta prevalência do sistema sanguíneo Dombrock, cujo fenótipo negativo é extremamente raro em todas as populações e está associado a reações transfusionais hemolíticas. Trata-se de anticorpo de difícil identificação, pois os laboratórios precisam ter experiência na resolução de casos complexos, grande estoque de soros e eritrócitos raros, além de outras ferramentas, como enzimas, reagentes tiol e testes moleculares. A identificação correta de um anticorpo raro é inicial e obrigatória para a busca de doadores compatíveis, garantindo um suporte transfusional satisfatório.

Active Brazilian crack cocaine users: nutritional, anthropometric, and drug use profiles

Objective: To evaluate the nutritional status of crack users and to analyze its correlation with drug use profiles. Methods: Cross-sectional study with 108 crack users. Anthropometric data were assessed through body mass index (BMI) and bioimpedance (BIA) measurements. A blood test to analyze hematocrit, hemoglobin, glucose, and lipid profiles was also performed. Crack use was determined through a standardized interview. Results: Based on BMI and BIA, most individuals were eutrophic (about 70%). Regarding hematological parameters, we found that hemoglobin and hematocrit levels were below normal for 32.4 and 30.6% of patients, respectively. Considering normal parameters, a large part of the sample (60.2%) had low levels of HDL cholesterol and high levels of triglycerides (38%). There were no significant correlations between drug profile and nutritional variables. Conclusion: This is a pioneering study that examines the nutritional status of crack users. Our results showed that most crack users present normal anthropometric findings and the prevalence of underweight is low. However, blood analysis showed changes and a specific type of malnutrition.

Hematological and biometric traits of tuvira Gymnotus inaequilabiatus (Valenciennes, 1839) (Gymnotiformes: Gymnotidae) from the Brazilian Pantanal

ABSTRACT This study describes the hematological and biometric characteristics of male and female Gymnotus species from the Pantanal, Mato Grosso do Sul state, Brazil. Fifty adult specimens of Gymnotus inaequilabiatus were weighed, measured, and then euthanized. Blood was collected by puncturing the celiac mesenteric vein to determine the hematocrit, hemoglobin content, number of erythrocytes, mean corpuscular volume, mean corpuscular hemoglobin concentration, glucose level, absolute value of leukocytes, and relative value of leukocytes and thrombocytes. Body weight and relative condition factor did not differ (P > 0.05) between the sexes, as well as erythrogram and the blood glucose values. Hematocrit ranged from 18.0% to 54.0%; hemoglobin from 1.1 to 14.7 g dL-1; number of erythrocytes from 0.2 × 106 to 3.8 ×106 µL-1; MCV from 24.2 to 321.7 fL; and MCHC from 4.2 to 44.5 g dL-1. In the differential count were identified thrombocytes, lymphocytes, neutrophils, monocytes, basophils, immature leukocytes, and PAS-positive granular leukocyte (PAS-GL). Females had a higher percentage of immature leukocytes (P < 0.05) than males. Glucose levels, erythrogram, leukogram, and the morphology of defense cells are comparable to other fish species of the Pantanal. Thrombocytes were the most frequent defense cells, followed by lymphocytes and neutrophils.

Ecocardiografia Padrão, com Strain e Strain Rate com Speckle Tracking Bidimensional em Macaco-Capuchinho (Cebus Apella, Linnaeus, 1758) / Standard Echocardiography, Strain and Strain Rate by Two-Dimensional Speckle Tracking in Capuchin Monkey (Cebus Apella, Linnaeus, 1758)

Introdução: O macaco-capuchinho é uma espécie de primata não humano que demonstra grande potencial para estudos pré-clínicos devido às semelhanças anatômicas e fisiológicas com os seres humanos. Objetivo: Estudar os índices de deformação miocárdica em macacos-capuchinhos anestesiados utilizando speckle tracking. Métodos: Foram utilizados dezesseis animais do Parque Zoobotânico, em Teresina, Piauí, Brasil, com restrição química, utilizando uma combinação de cetamina e midazolam. Os estudos ecocardiográficos foram obtidos nos modos B, M e Doppler, medindo-se strain e strain rate através de speckle tracking. Resultados: As variáveis que apresentaram coeficientes de correlação estatisticamente significativos em relação ao peso foram a parede livre do ventrículo esquerdo em diástole (PLVEd), diâmetro interno do ventrículo esquerdo em diástole (DIVEd), diâmetro interno do ventrículo esquerdo em sístole (DIVEs), onda E, A'VD, movimento do anel mitral (MAM) e excursão sistólica do plano do anel tricúspide (TAPSE). A frequência cardíaca (FC) mostrou correlação positiva com a onda E e a onda A e correlação negativa com o tempo de relaxamento isovolumétrico (TRIV). A fração de encurtamento (FS) apresentou correlação positiva com a razão entre as ondas E e A (r = 0,61). TAPSE mostrou correlações positivas com E'VD e A'VD. Os valores obtidos para o strain circunferencial (-18,17 ± 4,68%), radial (47,13 ± 5,24%) e longitudinal (-26,46 ± 5,155%) para os macacos-capuchinhos estavam dentro dos intervalos normais para machos e fêmeas. Conclusão: O presente estudo fornece os primeiros valores de referência para medidas ecocardiográficas em modos B, M e Doppler para macacos-capuchinhos anestesiados com cetamina e midazolam. Os valores de strain e strain rate obtidos utilizando a técnica de speckle tracking mostraram-se semelhantes aos obtidos em seres humanos, sugerindo que esta ferramenta pode ser explorada em estudos pré-clínicos utilizando o modelo do macaco-capuchinho

Introduction: The capuchin monkey is a type of nonhuman primate that has shown great potential for preclinical studies because of its anatomical and physiological similarities to humans. Objective: To study the indices of myocardial deformation in anesthetized capuchin monkeys using speckle tracking. Methods: Sixteen animals from the Zoobotanical Park, Teresina, Piauí, Brazil, were used and chemically restrained using a combination of ketamine and midazolam. Echocardiography recordings were obtained in B, M and Doppler modes, and strain and strain rate were measured using speckle tracking. Results: The variables that showed statistically significant correlation coefficients in relation to weight were LVFWd, LVIDd, LVIDs, E wave, A'RV, MAM and TAPSE. HR showed a positive correlation with the E wave and A wave and a negative correlation with IVRT. FS presented a positive correlation with the E/A wave relationship (r = 0.61). TAPSE showed positive correlations with E'RV and A'RV. The values obtained for circumferential (-18.17 ± 4.68%), radial (47.13 ± 5.24%) and longitudinal (- 26.46 ± 5.15%) strain for the capuchin monkeys were within the normal ranges for males and females. Conclusion: The present study provides the first reference values for echocardiographic measurements in B, M and Doppler modes for capuchin monkeys anesthetized with ketamine and midazolam. The strain and strain rate values obtained using speckle tracking showed similarities with those obtained in humans, suggesting that this tool has the potential to be exploited in preclinical studies using the capuchin monkey model

Hematimetria manual e automática em jaguatiricas (Leopardus pardalis - Linnaeus, 1758) / Manual and automated blood cells count in ocelots (Leopardus pardalis - Linnaeus, 1758)

Aparelhos de automação, cujo uso está estabelecido na hematologia dos animais domésticos, ainda não são empregados rotineiramente em felídeos selvagens. Esse estudo objetivou avaliar a técnica automatizada na contagem de células sanguíneas de jaguatiricas (Leopardus pardalis), comparando-a com a técnica manual. Foram coletadas amostras sanguíneas de oito jaguatiricas, que se submeteram à contagem de eritrócitos, leucócitos, plaquetas e à determinação do volume globular pelo método manual padrão e por meio do aparelho BC - 2800 VET® com a configuração para gatos domésticos. Os resultados foram avaliados por meio do teste t para dados pareados, e as técnicas submetidas à análise de correlação de Pearson. A técnica automatizada demonstrou resultados estatisticamente semelhantes para eritrócitos e leucócitos. Apenas para volume globular houve diferença significativa entre as técnicas manual e automatizada, mas a correlação foi alta. Apesar de não haver diferença significativa entre as técnicas para plaquetas, a correlação foi baixa. Conclui-se que o aparelho BC - 2800 VET® com a configuração para gatos domésticos é uma técnica confiável na realização do eritrograma e do leucograma para jaguatiricas. Para a determinação do parâmetro volume globular, o aparelho pode ser utilizado, desde que se faça a correção. Para a contagem de plaquetas, a técnica manual é recomendada.(AU)

Automated equipment, whose use is established in hematology of domestic animals, is not yet routinely used in blood cells count of wildlife, due to lack of studies that validate its use. The purpose of this study was to evaluate the automated technique for blood cells count of ocelots (Leopardus pardalis), comparing it with the manual technique. Blood samples were collected from eight ocelots, which were submitted to counting of erythrocytes, leukocytes, platelets and packed cell volume by the standard manual method and by the device VET ® 2800 BC with the configuration for domestic cats. The results were evaluated using the t test for paired data and the techniques submitted to Pearson correlation. The automated technique showed statistically similar results to erythrocytes and leukocytes. Significant difference was found only for packed cell volume between the manual and automated techniques, but the correlation was high. Although there was no significant difference between the techniques for platelets, the correlation was low. We concluded that the 2800 BC VET ® device with the configuration for domestic cats is a reliable technique in performing the erythrocyte and leukocyte counts for ocelots. The device may be used to determine packed cell volume, provided the correction is made. The manual technique is recommended for the platelet count.(AU)

Estimation and Comparison of Erythrocyte and Hemoglobin Levels in Subjects with Healthy Periodontium and Chronic Periodontitis

Objective: To compare and evaluate the relationship between anemia and periodontitis by estimation of peripheral blood between healthy patients and chronic periodontitis patients. Material and Methods: Of the total of 230 outpatients approached to participate in the study, 100 eligible patients were selected as per the selection criteria. After written consent, these patients were divided into two groups according to the clinical parameters as healthy and disease (chronic periodontitis) groups. Under aseptic conditions, venous blood samples were obtained by vein-puncture in the ante-cubital fossa without excessive venous stasis and the mean value of erythrocytes (EC), hemoglobin concentration (HGB), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were measured. Paired t-test was employed to find the significance of study parameters on continuous scale within the group analysis and unpaired t-test (two tailed, dependent) was used to find the significance of study parameters on continuous scale in the inter group analysis. Results: Generally, the healthy group reported higher levels of EC, HGB, MCV and MCH than the periodontitis group. The mean hemoglobin level was significantly higher (p-value<0.05) in healthy patients (12.66 ±1.41 gm/dl) whereas a slightly lower level of 11.32±1.85 gm/dl was observed in patients with chronic periodontitis. Similarly, the range of erythrocyte count of healthy patients was significantly higher (3.69-5.29 million/µl) than chronic periodontitis patients (3.33-5.97 million/µl). Whilst MCV was higher in healthy patients but non-significant, higher mean MCH of 27.75 ± 3.25 pg/cell was reported in healthy patients compared to mean of 25.73 ± 3.22 pg/cell in patients with chronic periodontitis. Conclusion: Significant hematological differences in EC, HGB, MCV and MCH between healthy periodontium and chronic periodontitis subjects were seen indicating mild anemia.

Assessment of blood sample stability for complete blood count using the Sysmex XN-9000 and Mindray BC-6800 analyzers

Background: Different hematological analyzers have different analytical performances that are often reflected in the criteria for sample stability of the complete blood count. This study aimed to assess the stability of several hematological parameters using the XN-9000 Sysmex and BC-6800 Mindray analyzers. Methods: The impact of storage at room temperature and 4 ◦C was evaluated after 2, 4, 6, 8, 24, 36 and 48h using ten normal and 40 abnormal blood samples. The variation from the baseline measurement was evaluated by the Steel­Dwass­Critchlow­Fligner test and by Bland­Altman plots, using quality specifications and critical difference as the total allowable variation. Results: Red blood cells and reticulocyte parameters (i.e. hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cell distribution width, immature reticulocyte fractions, low-fluorescence reticulocytes, middle-fluorescence reticulocytes, high fluorescence mononuclear cells) showed less stability compared to leukocyte and platelet parameters (except for monocyte count and mean platelet volume). The bias for hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration and red blood cell distribution width coefficient of variation was higher than the critical difference after 8h using both analyzers. Conclusion: Blood samples measured with both analyzers do not show analytically signifi- cant changes in up to 2h of storage at room temperature and 4 ◦C. However, the maximum time for analysis can be extended for up to 8h when the bias is compared to the critical difference

Febre de origem indeterminada em portador de marcapasso definitivo / Fever of unknown origin in permanent pacemaker carrier

O implante de marcapasso tem sido cada vez mais utilizado, em decorrência de sua segurança e dos baixos índices de complicação. No entanto, a infecção de dispositivos é um quadro grave, que apresenta elevada morbimortalidade e alto custo de tratamento. Algumas vezes essa infecção evolui com endocardite bacteriana, complicação cuja incidência vem aumentando nos últimos anos. É de difícil diagnóstico e tratamento, seja pela inespecificidade dos sintomas clínicos seja pela variação dos achados de imagem no ecocardiograma. Descrevemosum caso de febre de origem indeterminada em portador de marcapasso, que investigação posterior demonstrou ser decorrente de infecção dos cabos-eletrodos e de endocardite secundária. O paciente foi tratado comantibioticoterapia prolongada e retirada do sistema por cirurgia aberta.

Pacemaker implantation has increased due to their safety and low complications rate. However, the infection of the devices is a serious event with high morbidity and mortality rates and high treatment cost. Infections may evolve to bacterial endocarditis, whose incidence has increased in the last years. It is difficult to diagnose and treat due to the unspecificity of clinical symptoms and variation in imaging findings at theechocardiogram. We report a case of fever of unknown origin in a pacemaker carrier, which later proved to havebeen caused by electrode-cable infection and secondary endocarditis. The patient was treated with prolonged antibiotic therapy and retrieval of the device by open surgery.

Prevalence of hemoglobinopathies in school children: the importance of using confirmatory methods / Prevalência das hemoglobinopatias em crianças em idade escolar: a importância do uso de métodos de confirmação

The hemoglobinopathies are included among the most common genetic diseases in the world. In Brazil, hemoglobinopathies are related to the diversity of racial backgrounds and the degree of interbreeding. The study focused on the prevalence of hemoglobinopathies using conventional and confirmatory laboratory tests in children from public schools in Ribeirão Preto-SP. The study involved the participation of 427 children between six and nine years of age. Hematologic evaluation, hemoglobin electrophoresis on cellulose acetate at alkaline pH, quantification of hemoglobin fractions by high performance liquid chromatography (HPLC) and detection of -α^3.7 deletion for α thalassemia by polymerase chain reaction were performed. The results of hemoglobin electrophoresis on cellulose acetate and HPLC of the children studied showed the presence of 30 children (7%) with hemoglobinopathies. Eleven children presented results indicating suspicion of S/β-thalassemia; their parents and/or siblings were evaluated and confirmed the presence of only Hb S. The analysis of deletion -α^3.7to characterize α-thalassemias sampling performed on 207 participants identified 26 children (12.6%) with deletion -α^3.7. Thus, 54 (12.6%) of the children studied present this genetic alteration. For the detection of α-thalassemias it is necessary to use confirmatory methods such as molecular analysis and evaluation of family members in doubtful cases to facilitate genetic counseling in families, in which deletion -α^3.7 is more frequent in Brazil...

As hemoglobinopatias estão incluídas nas doenças genéticas mais comuns no mundo. No Brasil, as hemoglobinopatias são relatadas pela diversidade racial e o grau de miscigenação. O estudo focou a prevalência das hemoglobinopatias usando métodos laboratoriais convencionais como a eletroforese de hemoglobina em acetato de celulose em pH alcalino e confirmatório por reação em cadeia de polimerase (PCR) em crianças de escolas públicas de Ribeirão Preto-SP. O estudo envolveu a participação de 427 crianças entre 6-9 anos de idade. Determinaram-se os valores hematológicos, efetuou-se eletroforese de hemoglobina em acetato de celulose em pH alcalino, quantificação das frações de hemoglobina por HPLC e a detecção da deleção -α^3,7 pela PCR. Os resultados da eletroforese de hemoglobina em acetato de celulose e do HPLC, nas crianças estudadas, mostraram a presença de 30 crianças (7%) com hemoglobinopatias. Onze crianças apresentaram resultado indicando a suspeita de S/β-talassemia; seus pais e/ou irmãos confirmaram a presença de apenas a Hb S. A análise da deleção -α^3,7, uma das alterações que estão presentes na α-talassemia, realizada em 207 participantes, identificou 26 crianças (12,6%) com a deleção -α^3,7. Dessa forma, 54 (12,6%) das crianças estudadas apresentam hemoglobinopatias. Para a deleção da α-talassemias é necessário utilizar métodos confirmatórios como as análises moleculares e avaliação de membros da família, em casos duvidosos, facilitando o aconselhamento genético nas famílias, sendo a deleção -α^3,7 mais frequente no Brasil...

Biometría hemática en el control médico del entrenamiento de deportistas cubanos de alto rendimiento / Hematic biometry in medical training monitoring of cuban high-performance athletes

Introducción: el control médico del entrenamiento deportivo lleva implícita la medición de parámetros hematológicos y de los índices eritrocitarios, incluido el conteo de reticulocitos, además de controles bioquímicos para velar por el estado de salud del deportista y obtener mejores resultados deportivos. Objetivo: analizar el comportamiento de las variables de los estudios hematológicos realizados a los deportistas de las preselecciones que participaron en los juegos Panamericanos Guadalajara 2011. Método: se realizó un estudio descriptivo transversal que tuvo como universo a 804 deportistas de alto nivel que integraban las preselecciones nacionales que se preparaban para constituir los equipos nacionales que participarían en los Juegos Panamericanos en Guadalajara, México, 2011. A todos se les realizó el perfil hematológico como parte del pasaporte biológico establecido para este tipo de competición. Además, a 328 se les realizó electroforesis de hemoglobina. Resultados: se encontraron cifras de hemoglobina y hematocrito significativamente más bajas en el sexo femenino. La concentración de hemoglobina corpuscular media presentó diferencias significativas por grupo de deporte. En los deportistas a quienes se les realizó electroforesis de hemoglobina se encontraron 15 AS. Conclusiones: los hallazgos de esta investigación son de gran utilidad para el diagnóstico y seguimiento de la salud de los deportistas de alto rendimiento sometidos a fuertes cargas físicas de trabajo(AU)

Introduction: medical management of sports training implies the measurement of hematological parameters, red cell indices, reticulocyte count and biochemical controls to care for the athletes´ health condition and to obtain higher sports scores. Objective: to analyze the behavior of the variables in hematological studies of athletes who participated in the presets Pan American Games Guadalajara 2011. Methods: a descriptive cross-sectional study was carried out with a universe of 804 high-performance athletes from national teams, who were training to participate in the Pan American Games in Guadalajara, Mexico, 2011. Hematological profile was performed as part of the biological passport established for this type of competition. Additionally, a hemoglobin electrophoresis was carried out in 328 of them. Results: significantly lower hemoglobin and hematocrit figures were found in females. The Mean Corpuscular Hemoglobin Concentration (MCHC) showed significant differences by group of sports. In athletes who underwent electrophoresis, Hb 15 AS were found. Conclusions: the findings of this research are useful for diagnosis and health monitoring of athletes of high-performance, under heavy physical workloads(AU)

Determinación de parámetros hematoquímicos en pacientes VIH-SIDA tratados con antirretrovirales / Determination of hematochemical parameters in HIV/AIDS patients treated with antiretrovirals

INTRODUCCIÓN: la terapia con antirretrovirales ha tenido un gran impacto en la calidad de vida de las personas que viven con VIH/SIDA. Los pacientes tratados con estos fármacos necesitan una vigilancia estricta debido a sus efectos tóxicos. MÉTODOS: se realizó un estudio de 50 pacientes VIH/SIDA con tratamiento antirretroviral, atendidos en el hospital Dr. Juan Bruno Zayas entre mayo y septiembre del 2011. Se determinó la variación de parámetros hemato-bioquímicos que incluyeron estudios de perfil lipídico, hemático y renal. RESULTADOS: las mayores afectaciones de los lípidos estuvieron en los pacientes del esquema Rescate. Todos los esquemas mostraron alteraciones de las proteínas totales, la microalbuminuria y la mayoría de los pacientes de los esquemas 4, 1 y Rescate presentaron anemia. Los pacientes estudiados presentaron alteraciones discretas de los parámetros analizados, CONCLUSIONES: la toxicidad de los tratamientos aplicados está por debajo de la reportada en otras investigaciones.

INTRODUCTION: Antiretroviral therapy has had a great impact on the quality of life of people living with HIV/AIDS, but these drugs require strict surveillance due to their toxic effects. METHODS: A study was conducted of 50 HIV/AIDS patients under antiretroviral treatment cared for at Dr. Juan Bruno Zayas hospital from May to September 2011. Determination was performed of variations in hematochemical parameters, including lipid profiles and hematological and renal studies. RESULTS: Most alterations in lipids were found in patients from the Rescue scheme. All schemes showed alterations in total proteins and microalbuminuria, whereas most patients in Schemes 4, 1 and Rescue had anemia. The patients studied presented moderate alterations of the parameters analyzed. CONCLUSIONS: Toxicity of the treatments applied is below that reported by other studies.

El hemograma: nueva clasificación y perspectivas / Hemogram: new classification and perspectives

A través del tiempo, el surgimiento y desarrollo de nuevos métodos analíticos se han visto unidos a la introducción de nuevas tecnologías y a su incorporación al trabajo diagnóstico e investigativo del laboratorio clínico. En los últimos años, los indicadores de exactitud y precisión de los procedimientos en el laboratorio de hematología se han elevado extraordinariamente gracias a la llegada de los sistemas automatizados de conteo y caracterización de células sanguíneas.Desde principios de la segunda mitad del pasado siglo, la continúa fabricación de diversos modelos de contadores hematológicos por parte de las compañías proveedoras y firmas comerciales, ha nutrido el mercado internacional de distintas series de estos equipos. La combinación de principios de detección tales como la impedancia eléctrica, la radiofrecuencia, las medidas de dispersión y absorción de la luz halógena o láser en diversos ángulos y la citometría de flujo, como bases del conteo y caracterización de las poblaciones celulares hemáticas, ha hecho posible el surgimiento de autoanalizadores hematológicos de mayor costo y complejidad.Como fruto de los avances de esta tecnología y su aplicación al laboratorio de hematología, el hemograma o biometría hemática, como indicación de primera línea en la evaluación clínica de los desórdenes y respuestas del sistema hematopoyético, es hoy día una de las pruebas más accesibles y solicitadas al laboratorio clínico.1,2Esta técnica ha sido objeto de infinidad de variaciones en aspectos tales como la forma automatizada o manual de su realización, el número de parámetros que la componen, la manera de interpretarlos y la elevación de los indicadores de exactitud y precisión de sus..

Avaliação do desempenho analítico do analisador hematológico Sysmex® XE-2100D / Performance evaluation of the Sysmex XE-2100D automated hematology analyzer

Introduction: The Sysmex® XE-2100D is a multiparameter hematology analyzer designed for hematology testing in samples with ethylenediamine tetraacetic acid (EDTA). Objectives: Considering the importance of this hematology analyzer for clinical and laboratory practice, the objective of this study was to evaluate its analytical performance, comparing the obtained results with quality specifications described in literature. Material and method: In the evaluation of analytical performance, according to recommendations of the document H26-A2 of the Clinical and Laboratory Standards Institute (CLSI), intra-run imprecision, inter-run imprecision, linearity, carryover, autosampler evaluation, clinical sensitivity of the atypical lymphocytes flag (n = 400 samples) were included, as well as the comparison between automated and manual leukocyte differential count (n = 400 samples), based on an adaptation of the document H20-A2 of CLSI. Results: Repeatability, reproducibility, linearity and carryover were satisfactory according to the manufacturer's specifications. The clinical sensitivity of the atypical lymphocytes flag showed efficiency, sensitivity and specificity of 92.5%, 65.2% and 94.1% respectively. The correlation coefficients between the automated and manual differential counts of neutrophils, lymphocytes, monocytes, eosinophils and basophils were 0.991, 0.99, 0.872, 0.974 and 0.557, respectively. Conclusions: The results were in accordance with quality specifications described in literature, indicating reliability in Sysmex® XE-2100D. This fact ensures certainty to both laboratory professionals and medical staff. We conclude that the Sysmex® XE-2100D showed excellent analytical performance, and is useful to provide reliable hematology data...

Introdução: O Sysmex® XE-2100D é um analisador hematológico multiparamétrico destinado à realização de testes hematológicos em sangue anticoagulado com ácido etilenodiamino tetra-acético (EDTA). Objetivos: Considerando a sua importância na prática clínica e laboratorial, o objetivo deste estudo foi avaliar seu desempenho analítico, comparando os resultados obtidos com especificações de qualidade descritas na literatura. Material e método: Na avaliação de desempenho analítico, conforme recomendações do documento H26-A2 do Clinical and Laboratory Standards Institute (CLSI), foram incluídos ensaios de verificação da imprecisão intraensaio ou repetitividade, imprecisão entre ensaios ou reprodutibilidade, linearidade, carryover (arraste), avaliação do mecanismo homogeneizador de amostras, sensibilidade clínica do alerta morfológico (flag) de linfócitos atípicos (n = 400 amostras) e a comparação entre a contagem diferencial de leucócitos automatizada e a manual (n = 400 amostras), baseada em uma adaptação do documento H20-A2 do CLSI. Resultados: Os ensaios de verificação da repetitividade, reprodutibilidade, linearidade, carryover (arraste) foram satisfatórios conforme especificações do fabricante. O ensaio de sensibilidade clínica do alerta morfológico (flag) de linfócitos atípicos mostrou eficiência, sensibilidade e especificidade de 92,5%; 65,2% e 94,1% respectivamente. Os coeficientes de correlação entre as contagens diferenciais automatizadas e manuais de neutrófilos, linfócitos, monócitos, eosinófilos e basófilos foram de 0,991; 0,99; 0,872; 0,974 e 0,557 respectivamente...

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.

Técnica de cuantificación de la agregación eritrocitaria por análisis digital de imágenes / Erythrocyte aggregation quantification technique using digital image analysis / Técnica de quantificagáo do agregado eritrocitário por análise digital de imagens

La caracterización de agregados eritrocitarios es importante para analizar las posibles alteraciones en la microcirculación observadas en ciertas patologías vasculares como la hipertensión y la diabetes. El objetivo de este trabajo fue estandarizar una técnica que pueda ser utilizada por cualquier operador con un equipamiento similar. Para ello se prepararon distintas suspensiones de glóbulos rojos de dadores sanos en plasma autólogo, que fueron observadas con un microscopio óptico invertido. Se registraron para su análisis las imágenes de los agregados con una cámara digital. Se realizaron los recuentos de células individuales, agregados de 2 a 4 células, agregados de 5 ó más células y amas (redes de agregados de gran tamaño). Se midió el perímetro y el área, obteniéndose un parámetro de forma (ASP) de cada agregado de 5 ó más células. Los resultados obtenidos permitieron estandarizar el protocolo de trabajo concluyendo que la dilución óptima de glóbulos rojos en plasma autólogo para esta técnica es 0,5%.

Characterization of erythrocyte aggregates is important in the analysis of the possible alterations observed in the microcirculation of certain vascular pathologies such as hypertension and diabetes. The objective of this work was to standardize a technique that can be used by any operator having similar equipment. For that purpose, different suspensions of red blood cells from healthy donors were prepared in autologous plasma and then observed with an inverted light microscope. The images of the aggregates were recorded with a digital camera in order to be later analyzed. Individual cell count was carried out, as well as 2 to 4 cell- aggregates, 5 or more cell- aggregate and amas (big aggregate networks). Measurement of perimeter and area of each of the aggregates made up of 5 or more cells was performed, getting a shape parameter (ASP). Due to the results obtained, this working protocol has been standardized and it can be concluded that the optimal dilution of red blood cells in autologous plasma is 0.5% for this particular technique.

A caracterizagáo de agregados eritrocitários é importante para analisar as possíveis alteragóes na microcirculagáo observadas em certas patologias vasculares como a hipertensáo e a diabetes. O objetivo deste trabalho foi padronizar uma técnica que possa ser utilizada por qualquer operador com um equipamento similar. Para isso foram preparadas diversas suspensóes de glóbulos vermelhos de doadores saudáveis em plasma autólogo, que foram observadas com um microscópio óptico invertido. Foram registradas para a sua análise as imagens dos agregados com uma camera digital. Realizaramse as recontagens de células individuais, agregados de 2 a 4 células, agregados de 5 ou mais células e amas (redes de agregados de grande tamanho). Foi medido o perímetro e a área, obtendo um parametro de forma (ASP) de cada agregado de 5 ou mais células. Os resultados obtidos permitiram padronizar o protocolo de trabalho concluindo que a diluigáo ótima de glóbulos vermelhos em plasma autólogo para esta técnica é de 0,5%.

Redistribuição postmortem de barbitúricos em tecidos biológicos humanos / Postmortem redistribution of barbiturates in human biological tissues

Os barbitúricos são fármacos com atividade depressora do sistema nervoso central e estão relacionados com elevados números de casos de intoxicações e uso não-médico em vários países. No Brasil, a droga antiepiléptica mais encontrada em casos de intoxicação é o fenobarbital, pois os pacientes relatam que "essa é uma substância com ação forte no cérebro". De fato, os barbitúricos estão altamente relacionados com tentativa de suicídio e homicídio. Nesses casos existe a necessidade da quantificação dessas substâncias para correlacionar com a causa mortis. No entanto, as análises toxicológicas postmortem são de difícil execução e interpretação, pois a concentração de agentes tóxicos encontrados é bastante complexa e afetada não só pela condição de deterioração do corpo, mas também por um processo conhecido como redistribuição postmortem. Em geral, concentrações mais elevadas são encontradas no sangue situado nos sítios centrais (como o sangue coletado da cavidade cardíaca) em comparação aos níveis verificados nos vasos periféricos (como a veia femoral). Em outros casos, o tempo entre a morte e o exame postmortem é suficiente para que algumas substâncias que normalmente estariam presentes no sangue não estejam mais disponíveis neste fluido biológico. Há ainda um agravante, pois não existem valores de referências para a maioria das amostras biológicas não-convencionais, dificultando assim a interpretação dos resultados. Os exames toxicológicos devem ser realizados em amostras biológicas e tem como objetivo a avaliação da intoxicação como circunstância qualificadora do delito, como causa de periculosidade ou imputabilidade. O objetivo deste trabalho foi o desenvolvimento e aplicação de métodos de identificação de barbitúricos (butalbital, secobarbital, pentobarbital e fenobarbital) em amostras postmortem (sangue cardíaco, sangue femoral e fígado). Os analitos foram extraídos das amostras utilizando a micro extração em fase líquida (LPME), identificados...

Barbiturates are a class of drugs that act as central nervous system depressant and are associated with high numbers of poisoning cases and non-medical use in several countries. In Brazil, phenobarbital is the most related antiepileptic drug involved in intoxication cases. Patients report that "this drug is a substance with strong action in the brain." In fact, barbiturates are highly related to attempted suicide and homicide cases, in which quantification of these substances to correlate with the possible cause of death is necessary. However, postmortem toxicological analyses are difficult to perform and interpret, because the concentration of toxic agents found is quite complex and affected not only by deterioration condition of the body but also by a process known as postmortem redistribution. In general, higher concentrations are found in the blood located in central sites (e.g. heart cavity) compared with the levels found in peripheral vessels (such as the femoral vein). In other cases, the time between death and postmortem examination is enough for some substances that would normally be present in the blood are no longer available in this biological fluid. Besides, there are few reference values for most non-conventional biological samples, making it difficult to interpret the results. The objective of this work was the development and application of methods for identification of barbiturates (butalbital, secobarbital, pentobarbital and phenobarbital) in postmortem samples (heart blood, femoral blood and liver). The analytes were extracted by using liquid-phase micro extraction (LPME) and quantified by gas chromatography-mass spectrometry (GC-MS). After the development and validation, analytical methods were applied in real cases of eleven corpses autopsied by Death Verification Service of São Paulo City (USP-SVO), with suspected of barbiturates involvement. Nine cases were positive for phenobarbital. The mean ratio of blood femoral / cardiac blood was...

Levels of apolipoproteins as risk factors for coronary artery disease / Níveis de apolipoproteínas como fatores de risco para doença arterial coronariana

INTRODUCTION: The Saudi population is renowned for their unhealthy diet and physical inactivity. OBJECTIVE:To investigate apolipoproteins B (apo B), A-I (apo A-I) and B/A-I as risk factors that might be associated with increased incidence of the coronary artery disease. METHODS: Two hundred and twenty subjects suspected of having the coronary artery disease underwent coronary angiography and blood draw following a 12-hour fast. Apolipoproteins B and A-I were both measured by turbidimetric methods. RESULTS: One hundred and forty subjects were positive and 80 subjects were negative for the coronary artery disease. Both apolipoproteins were found to be statistically significant as risk factors for the coronary artery disease: apolipoprotein B (105.33±29.22 versus 94.56±24.35 mg/dL, p<0.003), apolipoprotein A-I (123.98±25.6 versus 133.5±24.1 mg/dL, p<0.004) and apolipoproteins B/A-I (0.88±0.28 versus 0.72±0.2, p<0.0001). CONCLUSIONS:Measurements of apolipoproteins B, A-I and calculation of apolipoproteins B/A-I ratio either instead of or in addition to the customary measurements of lipoprotein cholesterol may significantly add to predicting and assessing the coronary risk factors in the Saudi population.

INTRODUÇÃO: A população da Arábia Saudita é conhecida por sua dieta não-saudável e inatividade física. OBJETIVO: Investigar as apolipoproteínas B (apo B), AI (apo AI) e B/AI como fatores de risco que podem estar associados ao aumento da incidência da doença arterial coronariana. MÉTODOS: Duzentos e vinte pacientes com suspeita de doença art RESULTADOS: Cenerial coronariana foram submetidos à angiografia coronária e extração de sangue após jejum de 12 horas. As apolipoproteínas B e AI foram medidas por métodos turbidímetros.to e quarenta pacientes foram positivos e 80 foram negativos para a doença arterial coronariana. Ambas apolipoproteínas foram estatisticamente significativas como fatores de risco para doença arterial coronariana: apolipoproteínas B (105,33±29,22 versus 94,56±24,35 mg/dL, p<0,003), AI (123,98±25,6 versus 133,5±24,1, p<0,004) e B/A-I (0,88±0,28 versus 0,72±0,2, p<0,0001). CONCLUSÕES: As medidas das apolipoproteínas B, AI e o cálculo da relação B/AI tanto por ou em adição às medidas habituais de colesterol das lipoproteínas podem aumentar significativamente a previsão e avaliação dos fatores de risco coronariano na população saudita.