Values of peripheral blood NLR, MLR and PLR in differential diagnosis of cytopenic diseases / 白血病·淋巴瘤

Objective:To explore the values of peripheral blood neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) in the differential diagnosis of cytopenic diseases.Methods:A retrospective case series study was conducted. The clinical data of 105 newly diagnosed patients with aplastic anemia (AA), myelodysplastic syndrome (MDS) or primary immune thrombocytopenia (ITP) who were admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2017 to November 2020 were retrospectively analyzed. There were 42 patients with MDS (13 cases of hypoplastic MDS, 23 cases of non-hypoplastic MDS, 6 cases could not be classified), 42 patients with ITP, and 21 patients with AA. The peripheral blood lymphocyte count, neutrophil count, monocyte count, and platelet count of each untreated patient at the time of initial diagnosis were recorded, the NLR, MLR and PLR were calculated, and the differences of NLR, MLR and PLR among different diseases were compared; the differential diagnostic values of each index for AA, MDS and ITP were evaluated by using the receiver operating characteristic (ROC) curve.Results:The NLR [ M (IQR)] in ITP, AA and MDS groups was 3.08 (2.42), 0.57 (0.66) and 0.83 (1.27) ( χ2 = 56.84, P<0.001), the MLR was 0.26 (0.15), 0.13 (0.14) and 0.20 (0.33) ( χ2 = 18.71, P<0.001), and the PLR was 5.12 (9.97), 8.67 (14.21) and 49.32 (78.66) ( χ2 = 47.07, P<0.001). The best cut-off value of NLR for distinguishing ITP from MDS was 1.757, and the area under the curve (AUC) was 0.833 (95% CI: 0.811-0.955), while the sensitivity and specificity were 78.6% and 83.3%, respectively. The best cut-off value of NLR for distinguishing ITP from AA was 1.350, and the AUC was 0.993 (95% CI: 0.981-1.000), while the sensitivity and specificity were both 95.2%. The best cut-off value of PLR for distinguishing AA from MDS was 23.542, and the AUC was 0.841 (95% CI: 0.739-0.944), while the sensitivity and specificity were 85.7% and 73.8%, respectively. The best cut-off value of NLR for distinguishing AA from MDS was 0.764, and the AUC was 0.687 (95% CI: 0.556-0.891), while the sensitivity and specificity were 71.4% and 64.3%, respectively. The best cut-off value of MLR for distinguishing AA from MDS was 0.148, and the AUC was 0.736 (95% CI: 0.614-0.859), while the sensitivity and specificity were both 71.4%. Conclusions:The peripheral blood NLR, MLR and PLR have certain reference values for differential diagnosis of AA, MDS and ITP.

Analysis of risk factors of thrombocytopenia toxicityduring concurrent chemoradiation of gastric cancer / 中华放射肿瘤学杂志

Objective:To investigate the related risk factors of thrombocytopenia grade 2+ G2(+ )] in patients with gastric cancer during chemoradiotherapy.Methods:The pre-treatmentclinical data, hematologic parameters, and the correlation between dose distribution of vertebrae andTPG2(+ ) in non-metastaticgastric adenocarcinoma patients receiving concurrent chemoradiation in Sun Yat-sen University Cancer Center were retrospectively analyzed.Results:A total of 58 patients were included, including 23 cases (40%) in theTPG2(+ ) group and 35(60%) in the TPG2(-) group. There was no statistical difference in baseline clinical data between two groups (all P>0.05). Univariate Logistic regression analysis showed that several baseline parameters including platelet count (PLT), basophil count (BA), lactate dehydrogenase (LDH) and length of CTV (LCTV), the number of vertebrae (VBN), vertebral body volume (VBV), D max, D mean, V 5Gy, V 10Gy, V 20Gy, V 30Gy and V 40Gywere correlated with TPG2(+ )(all P<0.05). However, the multivariate Logistic regressionanalysisshowed that low PLT ( P=0.048), high LDH ( P=0.028), increased LCTV ( P=0.013), high V 20Gy/VBN ( P=0.030) were associated with the risk of TPG2(+ ). Conclusion:In gastric adenocarcinoma patients treated with chemoradiotherapy, correction of PLT reduction before treatment, avoidinglonger CTV and controlled V 20Gy correction for vertebral number may reduce significant thrombocytopenia induced by chemoradiotherapy.

Research progress of platelet apoptosis mechanism in antineoplastic drugs-induced thrombopenia / 解放军医学杂志

Platelets are the blood cells essential for human hemostasis, wound healing and human health. Drug-induced thrombopenia refers to a disease in which the drug causes platelet counts fall below the normal range (<100×109/L), resulting in a series of symptoms, including bleeding, nausea, vomiting, and abdominal pain, etc. The antineoplastic drugs-induced thrombopenia increases not only the potential bleeding risk of patients, but may also reduce the dose of anti-tumor drugs and prolong the treatment interval, or even lead to the ceasing of antitumor therapy in serious cases, which affects the clinical efficacy and survival of patients, leading to the increased medical costs. In recent years, a large number of studies have confirmed that antineoplastic drugs-induced thrombopenia is a disease caused through a non-immune-mediation, including platelet apoptosis. The research status has been reviewed in present paper of platelet apoptosis mechanism in antineoplastic drugs-induced thrombopenia to provide theoretical basis for clinical practice and scientific research.

Risk factors of the thrombopenia in septic patients complicated with acute kidney injury / 中华临床感染病杂志

Objective To investigate the risk factors of thrombopenia(TP)in septic patients complicated with acute kidney injury (AKI).Methods Two hundred and sixty five septic patients complicated with AKI admitted in Intensive Care Unit ICU of Zhejiang Provincial People''s Hospital during January 2012 and December 2016 were enrolled in the study.The clinical data, results of laboratory tests, Acute Physiology and Chronic Health Evaluation (APACHEII) scores, Sequential Organ Failure Assessment (SOFA) scores, therapeutic intervention, and 28-day mortality were documented.Among 265 patients, TP occurred within 7 days in 112 cases (TP group) and did not occur in 153 cases (non-TP group).Multivariable Logistic regression analysis was performed to analyze the risk factors of TP.Results The 28-day mortality rate in TP group was higher in TP group than that in non-TP group (47.3% vs.33.3%, χ2=5.307,P<0.05).Univariate analysis showed that age, C-reactive protein (CRP), procalcitonin (PCT) and APACHEII score, SOFA score, continuous renal replacement therapy (CRRT), heparin anticoagulation, shock, usage of linezolid and bloodstream infections were associated with TP in septic patients with AKI(all P<0.05).Multivariable Logistic regression analysis showed that age≥65 (OR=4.53, 95%CI 1.23-9.24,P<0.05), CRRT(OR=5.24,95%CI 2.14-14.56,P<0.01), heparin anticoagulation(OR=4.56,95%CI 2.13-8.46,P<0.01), usage of linezolid(OR=2.35,95%CI 1.25-5.24,P<0.01), shock(OR=2.15,95%CI 1.03-4.96,P<0.01)and bloodstream infections(OR=4.26,95%CI 1.36-12.48,P<0.01)were independent risk factors for septic patients with TP.Conclusion For septic patients with AKI having these risk factors, the platelet counts should be closely monitored, and intervention measures should be given to reduce the occurrence of TP.

Haematological abnormalities in mitochondrial disorders

<p><b>INTRODUCTION</b>This study aimed to assess the kind of haematological abnormalities that are present in patients with mitochondrial disorders (MIDs) and the frequency of their occurrence.</p><p><b>METHODS</b>The blood cell counts of a cohort of patients with syndromic and non-syndromic MIDs were retrospectively reviewed. MIDs were classified as 'definite', 'probable' or 'possible' according to clinical presentation, instrumental findings, immunohistological findings on muscle biopsy, biochemical abnormalities of the respiratory chain and/or the results of genetic studies. Patients who had medical conditions other than MID that account for the haematological abnormalities were excluded.</p><p><b>RESULTS</b>A total of 46 patients ('definite' = 5; 'probable' = 9; 'possible' = 32) had haematological abnormalities attributable to MIDs. The most frequent haematological abnormality in patients with MIDs was anaemia. 27 patients had anaemia as their sole haematological problem. Anaemia was associated with thrombopenia (n = 4), thrombocytosis (n = 2), leucopenia (n = 2), and eosinophilia (n = 1). Anaemia was hypochromic and normocytic in 27 patients, hypochromic and microcytic in six patients, hyperchromic and macrocytic in two patients, and normochromic and microcytic in one patient. Among the 46 patients with a mitochondrial haematological abnormality, 78.3% had anaemia, 13.0% had thrombopenia, 8.7% had leucopenia and 8.7% had eosinophilia, alone or in combination with other haematological abnormalities.</p><p><b>CONCLUSION</b>MID should be considered if a patient's abnormal blood cell counts (particularly those associated with anaemia, thrombopenia, leucopenia or eosinophilia) cannot be explained by established causes. Abnormal blood cell counts may be the sole manifestation of MID or a collateral feature of a multisystem problem.</p>

Studying antibodies against antigens of neutrophils in the multitransfused patients

Background: Patients who received multiple transfusions of blood and blood products may produce antibodies against antigens of erythrocytes, leukocytes, platelets etc, resulting in many clinical implications. Objectives: To detect frequencies of antineutrophil antibodies in multitransfused patients at National Institute of Hematology and Blood Transfusion (NIHBT). Subjects and methods: The study was conducted on 30 multitransfused patients. Among them there were 12 with thrombocytopenia and 18 with aplastic anemia. Results: 6 cases had anti - neutrophil antibodies, of which 5 had more than 5 times of transfusion, 4 with aplastic anemia and 2 with thrombocytopenia. The sera were further tested with neutrophil panel, revealing 4 samples with anti - NA 1 (13.3%) and 1 sample with anti - NA2 (3.3%). The frequency of anti - neutrophil antibodies in multitransfused patients at IHBT in the study is 20%. Conclusion: Frequency of anti-NA1 was higher than anti-NA2 in multitransfused patients at NIHBT and directly proportional by frequency of NA1 and NA2 antigens in this group. The technical process to identify and classify antineutrophil antibodies in this study can be applied for patients who received multiple transfusions of blood and blood products in Viet Nam

Urea Combine with Glucocorticoid Treatment of Infancy Hemangioma Associated with Thrombopenia Syndrome / 实用儿科临床杂志

Objective To explore the treatment of hemangioma associated with thrombopenia(Kasabach-Merritte syndrome,KMS) in infant.Methods The clinical manifestation and the therapy of 14 cases patients with KMS in hospital from 2003 to 2006 were collected ang analyzed,the 400 g/L urea(manufactured by ourself)combined with methylprednisolone local injection were used and followed 0.5 to 1.0 year.Results Two in 14 cases were emergency exairesis,7 cases were recurred for several times,12 cases were cured,1 case was improved,1 case was loss the connection.Conclusions It is an ideal therapy method to use the urea combined with glucocorticoid to treat infancy KMS,little trauma,definite effective,low side effect,high cure rate.

Therapeutic Effect of Recombinant Human Interleukin-11 on Thrombopenia in Children with Acute Non-Lymphocytic Leukemia after Chemotherapy / 实用儿科临床杂志

Objective To explore the preventive and therapeutic effect of recombinant human interleukin-11(rhIL-11) on thrombocytopenia in children with non-lymphocytic leukemia after chemotherapy.Methods Sixteen children who had non-lymphocytic leukemia were divided into 2 groups by randomization,including a therapeutic group and a control group.RhIL-11[50 ?g/(kg?d)] was injected subcutaneously 24 h after chemiotherapy in the therapeutic group,and applied consecutively 10-14 days,and the control group was treated without RhIL-11.Duration of the thrombocytopenia,infusion of blood platelet,diversity of blood platelets counts and adverse effect were observed of the 2 groups.Differences between groups were examined using statistics analysis.Results There were 16 case-times(59.3%) in the therapeutic group that of could be cured without platelet transfusion,but that of control group only had 3 case-times(14.3%);the diffe-rence between 2 groups was significant(P

Experimental Study on Thrombocytosic Effect of Xuangan Oral Liquid / 中药新药与临床药理

Xuangan Oral Liquid can increase blood platelets to a normal level in mice with thrombocytopenia induced by chemotherapy and radiotherapy. It was shown that Xuangan Oral Liquid can reduce blood coagulation time in mice through capillary and tail-cutting methods, and the difference between control group and treatment group is significant.