Effect of thyroid dysfunction on hematological parameters-retrospective study

Background: Thyroid gland is an important endocrine gland in the human body. Thyroid hormones are required for the appropriate development, metabolic balance, differentiation and physiological function of almost all tissues. The thyroid gland produces hormones such as triiodothyronine (T3) and tetraiodothyronine or thyroxine (T4). Under physiological settings, thyroid hormone influences hematological parameters. This study was done to evaluate the effect of various types of thyroid function abnormalities on different haematological parameters. Methods: This was a retrospective study which included 323 subjects who were grouped as hypothyroidism, hyperthyroidism, subclinical hypothyroidism and euthyroid groups. Two blood samples were collected from patients in EDTA tubes and plain tubes for estimation of hematological parameters and thyroid hormonal assay respectively. The results were analysed using SPSS software. Results: The mean age of patients is 34.50 years with females comprising about 89.16% of cases and males comprising 10.84% of cases. Analysis of data obtained showed that there was a significant statistical difference in TLC, MCHC, RDW, TSH, FT4 and euthyroid, hypothyroid, hyperthyroid and subclinical hypothyroid (p value <0.05) respectively. However, there was no significant correlation in Hb, PLT, RBC, PCV, MCV, MCH (p value >0.05) thyroid groups. Conclusions: The study found that thyroid diseases impacted female more frequently than males. Thyroid diseases were more common in age group of 18-28 years. Study also revealed a strong link between haematological parameters and thyroid dysfunction in patients.

Evaluation of red cell indices and manual reticulocyte parameters in iron deficiency, vitamin B12 deficiency and beta thalassemia minor patients in a tertiary care hospital

Background: Reticulocytes are the youngest erythrocytes released from the bone marrow. Their increase or decrease can be an indicator of erythropoietic activity or failure. Manual reticulocyte count is an assay traditionally used to evaluate the status of erythropoiesis. Reticulocyte parameters could be cost effective methods to guide the clinician in treating anaemias. Aim of current study was to evaluate the role of routine red blood cell parameters and reticulocyte parameters in differentiating various anaemias. Methods: This retrospective cross-sectional study was conducted by retrieving the laboratory parameters of patients admitted at Yenepoya medical college hospital from January 2021 to July 2021, duration of 6 months. Fifty cases of anaemia were included. These included records of patients with anaemia based on Serum Ferritin levels, Vitamin B12 levels, and beta thalassemia cases confirmed using electrophoresis. Other various parameters like mean corpuscular volume, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration were also taken into consideration for descriptive statistics. Results: Statistically significant correlation was observed for reticulocyte count, reticulocyte production index and other red blood cell parameters like MCV, MCH and MCHC between iron and vitamin B12 deficiency anaemias. No statistically significant correlation was observed in the beta thalassemia group but specifically showed significance in MCV. Conclusions: Reticulocyte count and reticulocyte production index and good markers apart from the routinely used traditional red blood cell parameters in differentiating between iron deficiency and vitamin B12 deficiency anaemias. However, in beta thalassemia minor cases, the mean corpuscular volume is a better marker. Present study showed male gender predominance in anemia which could be due to ethnic and topographical variations

The Impact of Vehicular Emission on Erythrocyte Level and Red Cell Indices of Occupationally Exposed Subjects in a Given City

Background: The association of combustive emission has been inter-related with haematologic parameters and a likelihoodto pro-inflammatory state. This research is aimed at assessing the impact of vehicular emission on erythrocyte level and red cell indices of occupationally exposed subjects.Methods:The level of haemoglobin concentration, haematocrit, red blood cells, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, and red cell distribution width were determined in four hundred subjects with the aid of Mythic 22 haematology autoanalyser.Results:The comparison of the haemoglobin and haematocrit shows that the value of mean ± standard error value of generator exposed and mechanics respectively were significantly higher than the other groups (p< 0.03). On the otherhand, the red blood cell count for generator exposed and mechanics ranked higherthan the other groups (p< 0.03). The mean cell volume (MCV) of generator exposed and mechanics were 86.57±0.08 fl and 84.49±1.04 fl respectively while control and drivers had values of 93.24±1.13 fl and 93.22±1.13 fl respectively (p< 0.03). The mechanics recorded a mean cell haemoglobin (MCH) of 26.92±0.40 pg which was significantly lower (p< 0.04) than the control (30.37±0.47 pg), generator exposed (39.68±6.38 pg) and drivers (30.42±0.47 pg). Conclusion:The differences amongst the groups and none of the groups were within the medically acceptable ranges which is a pointer to the fact that there might be an underlying inflammatory condition which might be due to occupational exposure

Evaluating iron deficiency anaemia in the third trimester of pregnancy with haematological parameters and serum ferritin concentration

Background: Iron deficiency is the commonest cause of anaemia and at least half of anaemia cases will have causes other than iron deficiency. The objective of this study was to determine the prevalence of iron deficiency anaemia among antenatal mothers based on haematological parameters and serum ferritin levels.Methods: This was a hospital based cross sectional study, conducted at Meenakshi Medical College and Research Institute, Kancheepuram from January 2017 to June 2018. Two hundred antenatal mothers who were diagnosed with anaemia in the third trimester of pregnancy were evaluated by haematological parameters and serum ferritin assay.Results: 38% of women had mild anaemia, 50% had moderate anaemia and 12% had severe anaemia. On peripheral smear, 60% had microcytic hypochromic anaemia indicating iron deficiency, and 12% had megaloblastic anaemia. In 41% of cases, the mean corpuscular volume was <82fL indicative of iron deficiency. Among the 120 women diagnosed with iron deficiency anaemia on smear, the mean ferritin level was 16.62±73.42 (less than 30µg/l). There was a statistically significant low levels of serum ferritin levels in those diagnosed with iron deficiency anaemia (P < 0.05). The serum ferritin level was >160µg/lit in 19% of cases.Conclusions: Based on the haematological parameters and serum ferritin estimation, in 60% of cases, anaemia was due to iron deficiency. Before initiating treatment, it is important to differentiate various types of anaemia, so that appropriate treatment can be given.

Evaluation of Red Cell Indices and Discriminant Functions in the Detection of Beta Thalassemia Trait

Background: The heterozygous state of Beta-Thalassemia i.e. Beta-Thalassemia Trait (BTT) is usually not associated with any clinical symptoms and possesses abnormality in only a single BetaGlobin gene. Materials and methods: The present study was undertaken from October 2015 to October 2017 in the Department of Pathology of Mahatma Gandhi Medical College and Hospital. In our study, a total of 100 subjects were included with mild or no anemia (Hemoglobin >8 gm/dl) who were referred to the central lab for hemoglobin screening. Hb A2 values were determined by Capillary Hemoglobin electrophoresis for all 48 (BTT) and 52 (Normal/non BTT) subjects. The complete hemogram was done by automated hematology analyzer. The values of red cell indices TRBC, MCV and MCH and six discriminative indices were evaluated for detection of β-thalassemia trait. The results were compiled in tabular form and bar diagram. Results: In the present study, the patients in the BTT group had statistically significantly decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) and increased TRBC count as compared to those in non BTT group. Among the six discrimination indices used highest sensitivity was found for Shine and Lal index (87.5%) followed by Mentzer index (79.16%). The highest specificity was found for E and F (88.46%) followed by RDWI (84.61%). Youden’s index was highest for Mentzer index (61.85%) followed by RDWI (55.44%). Conclusion: From this study, we thus conclude that although no screening test can diagnose β− Thalassemia Trait with 100% sensitivity or specificity, among the hematological parameters MCV, TRBC and MCH most efficiently discriminates β−Thalassemia Trait from other microcytic, hypochromic anemia. Mentzer index with CBC may be the simple, low cost, rapid and can be reliably Prachi Gupta, BP Nag, Abha Mathur. Evaluation of Red Cell Indices and Discriminant Functions in the Detection of Beta Thalassemia Trait. IAIM, 2019; 6(3): 50-59. Page 51 used as a screening test for thalassemia as a routine. However none of the formulas are 100% sensitive and specific.

The Variation in Anaemic Parameters in the Ethnic Groups of Pakistan

Aims: To observe any diversity of pattern in the anaemic parameters in the major ethnic groups of Pakistan. Study Design: Observational, cross-sectional. Place and Duration of Study: Department of Medicine, Creek general Hospital, Korangi, Karachi, Pakistan from October 2017 to March 2018. Methodology: 1200 adults above 18 years were included. Pregnant females, age less than 18 years, any severe organ insufficiency, stroke, neurodegenerative disease, known blood dyscrasias or terminal illness at baseline evaluation were excluded. Their ethnic background was grouped into Urdu speaking, Punjabi, Balochi Sindhi, Pashtun, Bengali, and Gilgit according to their place of origin, mother tongue or parents’ place of origin. The complete blood picture was performed to identify anaemia, grade the severity, classify the red cell indices and exclude any blood dyscrasias in each of the ethnic group. Results: Out of 1200 adults, 626(52%) were anaemic. In decreasing order, the most anaemic were Bengalis (57.6%), Sindhis (55%), Urdu speaking (54%), Pashtuns (54%), Balochis (52%), Gilgits (49%) and Punjabis (45%). In males, Sindhis (60%), Pashtuns (57%), Bengalis (56%), and Urdu speaking (51%) were most anaemic. In females, Balochis (71%), Bengalis (64%), Urdu speaking (55%) were most anaemic. Anaemia was prevalent in the younger age group of the Urdu speaking, Pashtun and Sindhis community, while in the rest of the ethnic groups anaemia was most common in the middle age group. In males, anaemia was highest in the young age group of Urdu Speaking, Sindhis, and Pashtuns while in females in all the ethnic groups the middle age group was most anaemic and had least anaemia in elderly females except in Bengalis where the least was in young females. Mild anaemia was most common overall and in both genders. Regarding red cell indices, Punjabis and Bengalis were normocytic while in the rest the most were microcytic. In the males, Urdu speakers, Punjabis and Bengalis were significantly more normocytic anaemic, while Sindhis were more microcytic. In females, in all the ethnic groups’ microcytic anaemia was prevalent. Anaemia was three times more in the Sindhi group of smokers compared to the Sindhi nonsmokers while in the rest of the ethnic groups there was no specific correlation. Conclusion: This survey specifies that in Pakistan the key measures of health status are albeit dependent on the financial status, literacy rate, sanitation, access to primary care facilities, effective role of health providers but the genetic composition and cultural norms also play their part.

Biometria corporal e parâmetros hematológicos de Trachemys scripta elegans e Trachemys dorbignyi (Testudines: Emydidae) criadas em cativeiro em Petrolina, Pernambuco / Body biometry and hematological parameters of Trachemys scripta elegans and Trachemys dorbignyi (Testudines: Emydidae) reared in captivity in Petrolina/PE, Brazil

Este estudo objetivou avaliar a biometria corporal e o perfil hematológico de Trachemys scripta elegans (N=28) e de Trachemys dorbignyi (N=22) criadas em cativeiro na região do submédio do Vale do São Francisco, semiárido nordestino brasileiro, visando estabelecer valores sanguíneos básicos de saúde e gerar dados úteis na fisiologia comparativa de Testudines. Após 120 dias de adaptação e jejum de 24 horas, 2,5 mL de sangue foram coletados do seio occipital dorsal e depositados em tubo com heparina sódica para a avaliação, na sequência, dos níveis hematologicos. A contagem total de eritrócitos (CTE) e global de leucócitos (CGL) foi realizada em câmara de Neubauer; a dosagem de hemoglobina (HGB) pelo método da método da cianometahemoglobina e o hematócrito (HCT) através da técnica do microhematócrito. A partir da CTE estabeleceram-se matematicamente os índices hematimétricos. A biometria corporal também foi avaliada: a) massa corporal (MC, g); b) dimensões máximas da carapaça [comprimento (CMC, cm) e largura (LMC, cm)];c) dimensões máximas do plastrão [comprimento (CMP, cm) e largura (LMP, cm)]; d) comprimento total da cauda (CTC, cm); e) comprimento linear da base da cauda ao orifício cloacal (CprC, cm); f) comprimento linear do orifício cloacal a extremidade da cauda(CpoC, cm). T. scripta elegans apresentaram valores maiores (P < 0,05) para a biometria corporal, enquanto que o CTC e CprC foram maiores (P<0,05) em T dorbignyi. Os níveis hematológicos não diferiram (P>0,05) entre as espécies. Os resultados demostram que a maior parte da variação observada entre T. scripta elegans e T. dorbignyi é explicada pelas variáveis biométricas e que algumas correlações hematológicas caracterizam diferenças interespecíficas. Conclui-se que os resultados lançam luz sobre valores de referência para estas espécies mantidas em cativeiro na região do semiárido e servem como um modelo para a fisiologia comparativa intra e interespécies.(AU)

This study aimed to evaluate the body biometry and hematological profile of Trachemys scripta elegans (N=28) and Trachemys dorbignyi (N=22) reared in captivity in the Brazilian submedium northeastern semi-arid region in the Valley of the São Francisco river. It aimed to establish basic health blood values and generate useful data on the comparative physiology of Testudines. After 120-day adaptation and 24-hour fasting, 2.5mL of blood were collected from the dorsal occipital sinus and deposited into a tube with sodium heparin for evaluation, following, of hematological levels. The red blood cell count (RBC) and GLC was conducted in a Neubauer chamber, the hemoglobin level (HGB) was supplied by the cyanmethemoglobin method and the hematocrit (HCT) was obtained by the microhematocrit technique. Based on the RBC, the hematimetric were mathematically established. Body biometry were also evaluated: a) body mass (BM, g); b) maximum dimensions of the carapace [length (MLC, cm) and width (MWC, cm)]; c) maximum dimensions of plastron [length (MLP, cm) and width (MWP, cm)]; d) total length of tail (TLT, cm); e) linear length from the base of the tail to the cloacal orifice (LPrC, cm); f) linear length from the cloacal orifice to the extremity of the tail (LPoC, cm). T. scripta elegans showed higher values (P<0.05) for biometrics, while TLT and LPrC were higher (P<0.05) in T. dorbignyi. The hematological values did not differ (P>0.05) among species. The results show that most of the variation found between T. scripta elegans and T. dorbignyi is explained by the biometric variables and that some hematologic correlations characterize interspecies differences. It was conclude that the results shed light on benchmarks for these species kept in captivity in the northeastern semi-arid region and serve as a model for intra and interspecies comparative physiology.(AU)

Evaluation of red cell and reticulocyte parameters as indicative of iron deficiency in patients with anemia of chronic disease

Objective: The purpose of this study was to evaluate the effectiveness of mature red cell and reticulocyte parameters under three conditions: iron deficiency anemia, anemia of chronic disease, and anemia of chronic disease associated with absolute iron deficiency. Methods: Peripheral blood cells from 117 adult patients with anemia were classified according to iron status, and inflammatory activity, and the results of a hemoglobinopathy investigation as: iron deficiency anemia (n = 42), anemia of chronic disease (n = 28), anemia of chronic disease associated with iron deficiency anemia (n = 22), and heterozygous β thalassemia (n = 25). The percentage of microcytic red cells, hypochromic red cells, and levels of hemoglobin content in both reticulocytes and mature red cells were determined. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating between the different types of anemia. Results: There was no significant difference between the iron deficient group and anemia of chronic disease associated with absolute iron deficiency in respect to any parameter. The percentage of hypochromic red cells was the best parameter to discriminate anemia of chronic disease with and without absolute iron deficiency (area under curve = 0.785; 95% confidence interval: 0.661–0.909, with sensitivity of 72.7%, and specificity of 70.4%; cut-off value 1.8%). The formula microcytic red cells minus hypochromic red cells was very accurate in differentiating iron deficiency anemia and heterozygous β thalassemia (area under curve = 0.977; 95% confidence interval: 0.950–1.005; with sensitivity of 96.2%, and specificity of 92.7%; cut-off value 13.8). Conclusion: The indices related to red cells and reticulocytes have a moderate performance in identifying absolute iron deficiency in patients with anemia of chronic disease...

Red Blood Cell Indices and Iron Status in Infants and Young Children with Iron Deficiency Anemia / 대한소아혈액종양학회지

PURPOSE: Iron deficiency anemia (IDA) is the most common nutrient deficient disorder in infants and young children. Iron deficiency at this age group can cause serious effects on mental and psychomotor development. We analyzed the hematologic profiles of infants and young children with IDA, comparing them with control group. METHODS: The feeding practices and the iron batteries investigated in 198 anemic patients aged 5 to 36 months who had been brought to Inha General & University Hospital. Control group were 129 healthy infants and children who visited DongBu Municipal Hospital and the local health center for immunizations. They also had hemoglobin concentration (Hb), hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin and red cell distribution width (RDW) tested by the electron counters. Patients with hemoglobin level <11 g/dL who had serum ferritin <10 ng/mL or transferrin saturation <15% were classified as having IDA. RESULTS: Out of the 198 subjects (M:F=1.6:1) with IDA, 81.8% (n=162) was breast feeding more than 6 months. The main causes which they were brought to the clinic were infectious or inflammatory illness, and only 13.1% with IDA were visited for evaluation of pallor or anemia. Correlation between Hb and MCV was much more in IDA group than control group (r=0.709, r=0.368; P<0.001). CONCLUSION: By combining Hb with MCV and RDW as well as iron batteries in screening for iron deficiency and IDA, the accuracy of diagnosis can be increased. We support the use of appropriately iron-fortified formulas or weaning foods, or the routine iron supplement starting at 6 months of age in exclusively breast-fed infants to prevent the iron deficiency.

Assessment of Bull's Mean and Exponentially Adjusted Moving Mean (EAMM) Using Selection of Expected Range in the Red Cell Indices / 대한임상병리학회지

BACKGROUND: Because moving means can be easily shiftable according to their crude data, we made a selective expected ranges to calculate the moving means. Bull's mean (exponential factor, P=0.50) and Exponentially Adjusted Moving Mean (EAMM, P=0.66) were assessed. we studied to determine appropriately expected range and exponential factor. METHODS: We made the target values from RBC indices being measured with H-2 hematology autoanalyzer from 800 patients and the expected range from red cell indices data of additional 600 patients. Both moving means using this expected ranges were calculated. The % difference of Bull's mean and EAMM was compared and total mean of (deltaBull's mean/deltaBatch mean) and (deltaEAMM/deltaBatch mean) was compared. RESULTS: The target values were MCV: 90.6 fL, MCH: 29.8 pg. MCHC: 32.8 g/dL. The expected ranges were within +/-6% of their target values. Among the 20 batches obtained from expected range, there were no above +/-3% difference of red cell indices in both moving means. The comparison between % difference of Bull's mean and that of EAMM showed no difference. Total mean of (deltaEAMM/deltaBatch mean) was higher than that of (deltaBull's mean/deltaBatch mean). CONCLUSIONS: The % difference results of Bull's mean and EAMM were basically similiar within the expected range but EAMM method was more sensitive than Bull's mean method under the aspect of specimen effects, so EAMM was more detectable than Bull's mean on the quality control of red cell indices.

Studies on Normal Values for Red Blood Cells in Korean Children

PURPOSE: Values for hemoglobin, erythrocyte indices and red cell distribution width used in the diagnosis of anemia and iron deficiency are known to vary to some degree according to age. We tried to define age-related changes in red blood cells (RBC) profiles. METHODS: With the eletronic counters routinely used in clinical laboratories we evaluated the RBC profiles of 1,717 samples of blood from children who were considered healthy. Mean, median and percentile curves of hemoglobin, hematocrit, red cell indices and red cell distribution width were calculated in children aged 5 months to 15 yr of age. RESULTS: The median values for hemoglobin and hematocrit were increased substantially during childhood. The values of hemoglobin were increased from 11.6 g/dl at 6-11 months, to 12.0 g/dl at 2 yr of age, 12.7 g/dl at 6-8 yr, reaching a maximum level of 13.7 g/dl at 12-15 yr for males and 13.3 g/dl for females, with an average of 13.5 g/dl for both sexes. The values of hematocrit were also increased from 34.4 % at 6-11 months, 35.5 % at 2 yr of age, 37.4 % at 6-8 yr and achieved 39.3 % for males and 38.6 % for females in adolescence. The MCV at 6-11 months was 76.3 fl; at 2 yr 77.1; and 83.4 fl for males and 84.8 fl for females in adolescence. The increase in MCH parallels the MCV fairly closely from 25.9 pg at 6-11 months of age to 29.0 pg at adolescence. The MCHC remains conatant throughout infancy and childhood. Cut-off values (3 percentile) of hemoglobin were 10.7 g/dl at 6-11 months, 11 g/dl at 1-2 yr and 11.5 after 6 yr. Cut-off values (3 percentile) of MCV were 70 fl at 1-2 yr and 75 fl after 6 yr. Correlation between hemoglobin, MCV, MCH and RDW was relatively significant, but it was much less dependent variables in this reference population than in the children with iron deficiency. CONCLUSIONS: Our findings indicate that there is a developmental change in red blood cell size extending beyond the well-recognized changes seen in the first 6 months of life. Age-related changes in hemoglobin, hematocrit, MCV and MCH must be taken into consideration in order to optimize the identification of individuals with anemia and iron deficiency.