Evaluation and optimization of pre-pregnancy and pregnancy thalassaemia screening programmes in Hainan Province / 中国热带医学

@#Abstract: Objective　To evaluate the free thalassaemia screening programme for preconception and pregnancy in Hainan Province, and to provide a theoretical basis for optimizing the screening process for thalassaemia. Methods From November 2020 to July 2021, a survey was conducted on 10 396 adults with Hainan household registration who participated in the Epidemiological Survey of Thalassemia in Hainan Residents in 19 cities and counties of Hainan Province. All of them underwent routine blood tests, haemoglobin electrophoresis tests and genetic tests for thalassaemia. The optimal diagnostic cut-off values for mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and haemoglobin adult type 2 (HbA2) were determined using screening test indexes such as receiver operating characteristic curve and sensitivity. The diagnostic effectiveness of different primary screening programs for thalassemia gene carriers was evaluated. Results Using the existing MCV single-indicator thalassemia primary screening protocol in Hainan Province, where individuals with MCV<82 fL undergo thalassemia gene testing, resulted in a high missed diagnosis rate (34.06%) and low sensitivity (65.94%). The optimal cut-off values for MCV screening for alpha-and beta-thalassaemia were 84.45 fL and 79.05 fL, respectively; the optimal cut-off values for MCH screening for alpha-and beta-thalassaemia were 27.95 pg and 25.15 pg, respectively. The optimal cut-off value for HbA2 screening for alpha-thalassaemia was less than 2.55% and greater than 3.35% for beta-thalassaemia. The "combined HbA2 or MCH or MCV screening protocol" with the cut-off values recommended in this study had a better performance in primary screening for thalassemia, with the highest sensitivity (92.96%) and negative predictive value (92.67%) and the lowest underdiagnosis rate (7.04%), statistically significant differences compared with the existing protocol (P<0.05). Conclusions The current process of screening for thalassemia in Hainan Province may lead to missed diagnoses. The combined use of MCV, MCH and HbA2 for thalassemia screening, adopting locally suitable cutoff values for primary screening indicators, can improve the incidence of missed reporting of thalassemia and enhance diagnostic effectiveness.

Effectiveness of Using Mean Corpuscular Volume and Mean Corpuscular Hemoglobin for Beta-thalassemia Carrier Screening in the Guangdong Population of China / 生物医学与环境科学（英文）

Beta (β)-thalassemia is one of the most common hemoglobinopathies worldwide, creating major public health problems and social burdens in many regions. Screening for β-thalassemia carriers is crucial for controlling this condition. To investigate the effectiveness of mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) for screening β-thalassemia, retrospective data were analyzed for 6,779 β-thalassemia carriers subjected to genetic testing following thalassemia screening in Guangdong province between January 2018 and December 2019. Prevalent mutations observed included CD41/42 (-TTCT) (38.43%), IVS-II-654 (C > T) (25.71%), -28 (A > G) (15.78%), CD17 (AAG > TAG) (10.03%), and β

Estimation of Hb, MCV, MCH variations in different types of febrile seizures

Introduction: Febrile seizures are seizures that occur between the age of 6 and 60 months with a temperature of 38°C (100.4°F) or higher, that are not the result of central nervous system infection or any metabolic imbalance, and that occur in the absence of a history of prior afebrile seizures. Aim of the study: To Estimate the HB, MCV, MCH variations in different types of Febrile Seizures. Materials and methods: This case-control study was conducted at the Department of Pediatrics, Tirunelveli Medical College Hospital, Tirunelveli, from 2017-2018.All cases of febrile seizures which include both simple febrile and complex febrile seizures between the age group of 6 and 60 months. The control group includes the children in the same age group with fever but without seizures Results: Among 75 children presenting with febrile seizures, 52 children were presenting with simple febrile seizures (69.3%) and 23 children were presenting with complex febrile seizures. Average mean Hb level in those children presenting with febrile seizures was 10.37 gm. Average mean Hb level in children those who do not have febrile seizures was 11.48 gm. The p-value between the mean Hb level of 2 groups was less than 0.001 which is statistically significant. In children with febrile seizures, the mean MCV was 70.83. In children, those who do not have febrile seizures the mean MCV was 77.89 which was higher than those of children having febrile seizures. The difference between the two groups was statically significant. Average mean of MCH in children with febrile seizures (23.69) was lower than the children those who are presenting without febrile seizures (27.58). Thus the p-value was less than 0.001 which was statistically significant. Conclusion: The hemoglobin levels were significantly lower in the case group compared to the control group. The present study concluded anemia as a risk factor for febrile seizures and emphasizes the importance of prevention and timely intervention and management of Iron deficiency anemia in children to decrease mortality and morbidity associated with febrile seizures.

Rouleaux formation of white blood cells and platelets in leukemia / Formação de rouleaux de glóbulos brancos e plaquetas em leucemia

The objective of this study was to measure the effects of glucose and salt level on white blood cells, red blood cells and platelets (PLTs) in the blood of a leukemic patient by using a white light microscope. Different concentrations of glucose and salt in the range of 0 mM to 500 mM were admixed in the blood sample to prepare blood smear. We revealed that shape of erythrocytes, leukocytes and platelets changes and form aggregates. Increasing concentrations of glucose cause to increases aggregation process of white blood cells, red blood cells and platelets. And the increasing concentration of sodium chloride causes to increase rouleaux formation and aggregation of platelets but dehydration due to increased sodium chloride concentration causes to break the aggregation of white blood cells. Comparison of CBC reports of these samples with and without analytes shows that total leukocyte count (TLC) decreases gradually towards normal ranges of leukocytes which is favorable in the treatment of leukemia but at the same time decreasing level of hemoglobin HGB, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and increasing level of red blood cell (RBCs) causes to reduce oxygen supply which is in favor of cancer growth and anemia. This work provides us the base for translation this in vitro study towards the in vivo case of blood microvasculature as a non-invasive methodology.

O objetivo deste estudo foi medir os efeitos da glicose e do nível de sal nos glóbulos brancos, glóbulos vermelhos e plaquetas (PLTs) no sangue de um paciente leucêmico usando um microscópio de luz branca. Foram misturadas diferentes concentrações de glicose e sal na gama de 0 mM a 500 mM na amostra de sangue para preparar esfregaço de sangue. Descrevemos que a forma dos eritrócitos, leucócitos e plaquetas muda e forma agregados. O aumento das concentrações de glicose aumenta o processo de agregação de glóbulos brancos, glóbulos vermelhos e plaquetas. E a crescente concentração de cloreto de sódio causa o aumento da formação de rouleaux e a agregação de plaquetas, mas a desidratação devido ao aumento da concentração de cloreto de sódio causa a quebra da agregação de glóbulos brancos. A comparação dos relatórios de CBC dessas amostras com e sem analitos mostra que a contagem total de leucócitos (TLC) diminui gradualmente para os intervalos normais de leucócitos, o que é favorável no tratamento da leucemia, mas ao mesmo tempo diminui o nível de hemoglobina HGB, hemoglobina corpuscular média (MCH ), a concentração média de hemoglobina corpuscular (MCHC) e o aumento do nível de glóbulos vermelhos (RBCs) reduz o suprimento de oxigênio, o que é a favor do crescimento do câncer e da anemia. Este trabalho fornece a base para a tradução deste estudo in vitro para o caso in vivo de microvasculatura de sangue como uma metodologia não-invasiva.

The Effect of Drowning in a Bathtub on Erythrocytes in Victims / 日本温泉気候物理医学会雑誌

  Objective: The aim of the present study was to investigate the effect of bathtub drowning on erythrocytes in victims.   Methods: Thirty-nine consecutive victims with CPA were included in the present study and consisted of 16 males and 23 females, 8-95 years of age, median 78 years old. Data on the arrival examination were analyzed, which consisted of serum sodium (Na) and chloride (Cl), hematocrit (Ht)/hemoglobin (Hb) ratio, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). In addition, the changes of MCV level in accordance with treatment in two bathtub drowning victims, one who was resuscitated and the other who had been under treatment in our hospital, were compared with those in two water intoxication patients.  Results: Of the 39 victims, 18 showed serum Na levels to be lower than normal range (NR) but no victim showed one higher than NR. In serum Cl level, 22 victims showed levels below NR but no one showed a level above NR. As to the value for the Ht/Hb ratio, the ratios were within NR in only three victims and were above NR in the rest. In MCH, three victims showed levels below NR and one victim showed a level above NR. In MCV, 16 victims showed levels above NR but no one showed a level below NR. The comparison of MCV between drowning victims and water intoxication patients pointed out a difference in the effect on treatment: in cases of drowning, MCV increased only on the day of the event and returned to baseline the next day, whereas in cases of water intoxication, MCV remained unchanged for a few days after treatment and then increased.   Conclusion: It is well known that freshwater drowning induces both hyponatremia and hypochloremia, which are caused by water transferred from alveoli to blood vessels. The increased MCV in bathtub drowning victims is induced by the expansion of erythrocytes through lower osmotic pressure, which exceeds the decreased change in hematocrit due to hemodilution, although the mechanism of the change in MCV in water intoxication cases is not identified.

The Effect of Drowning in a Bathtub on Erythrocytes in Victims / 日本温泉気候物理医学会雑誌

<p>  <b>Objective</b>: The aim of the present study was to investigate the effect of bathtub drowning on erythrocytes in victims. </p><p>  <b>Methods</b>: Thirty-nine consecutive victims with CPA were included in the present study and consisted of 16 males and 23 females, 8-95 years of age, median 78 years old. Data on the arrival examination were analyzed, which consisted of serum sodium (Na) and chloride (Cl), hematocrit (Ht)/hemoglobin (Hb) ratio, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). In addition, the changes of MCV level in accordance with treatment in two bathtub drowning victims, one who was resuscitated and the other who had been under treatment in our hospital, were compared with those in two water intoxication patients.</p><p>  <b>Results</b>: Of the 39 victims, 18 showed serum Na levels to be lower than normal range (NR) but no victim showed one higher than NR. In serum Cl level, 22 victims showed levels below NR but no one showed a level above NR. As to the value for the Ht/Hb ratio, the ratios were within NR in only three victims and were above NR in the rest. In MCH, three victims showed levels below NR and one victim showed a level above NR. In MCV, 16 victims showed levels above NR but no one showed a level below NR. The comparison of MCV between drowning victims and water intoxication patients pointed out a difference in the effect on treatment: in cases of drowning, MCV increased only on the day of the event and returned to baseline the next day, whereas in cases of water intoxication, MCV remained unchanged for a few days after treatment and then increased. </p><p>  <b>Conclusion</b>: It is well known that freshwater drowning induces both hyponatremia and hypochloremia, which are caused by water transferred from alveoli to blood vessels. The increased MCV in bathtub drowning victims is induced by the expansion of erythrocytes through lower osmotic pressure, which exceeds the decreased change in hematocrit due to hemodilution, although the mechanism of the change in MCV in water intoxication cases is not identified.</p>

Investigation on reference intervals of MCV,MCH and MCHC levels determined by Mindray BC-6800 hematology analyzer / 重庆医学

Objective To investigate the reference intervals of mean corpuscular volume (MCV) ,mean corpuscular hemoglo‐bin(MCH) and mean corpuscular hemoglobin concentration (MCHC) examined by the MindrayBC‐6800 hematological analyzer to establish the reference intervals suitable for our laboratory .Methods According to the method recommended by the NCCLS C28‐A3 ,600 healthy adult individuals were selected as the reference individuals .MCV ,MCH and MCHC levels were determined by the MindrayBC‐6800 hematological analyzer for constructing the reference intervals ;other 150 healthy persons undergoing the physical examination were selected and their MCH ,MCV and MCHC detection results were collected for verifying the established reference intervals .Results The detection results of MCV ,MCH and MCHC in healthy adults showed a normal distribution ,MCV had sta‐tistical difference among different age periods (P<0 .05);the reference intervals :82 .278 -94 .242 fL for young adults ,83 .032-94 .608 fL for the middle‐aged persons and 83 .137-96 .343 fL for the elderly .MCH had statistical differences between different se‐xes and among different age periods ;the reference intervals :27 .785-32 .415 pg for male young adults ,28 .324-32 .456 pg for male middle‐aged persons and 28 .274-32 .966 pg for male elderly ;27 .367-31 .973 pg for female young adults ,27 .445-32 .215 pg for female middle‐aged persons and 27 .532 -32 .468 pg for female elderly .MCHC had statistical difference between different sexes (P<0 .05) ;the reference intervals :328 .611-352 .810 g/L for male and 323 .771-348 .750 g/L for female .In 150 individuals un‐dergoing the physical examination ,the proportion of individuals locating at the outside of reference interval was less than 10 .0% , therefore the newly established intervals were suitable for this laboratory .Conclusion The sex difference or/and age differences of MCV ,MCH and MCHC exist among adult populations .So the reference intervals are respectively established according to the prac‐tical situation ,which are suitable for this laboratory by verification .

A study of relationship between blood parameters with myocardial infractions.

Background: The aim of this study was to find out the changes in blood parameters in a group of myocardial infarction patients in Jamnagar, Gujarat. Methods: In this cross sectional study conducted at the medicine clinic in GGH general hospital, Jamnagar between May 2012 and April 2013, a total of 100 subjects were included. Parameters like hemoglobin, RBC count, WBC count, platelet count, hematocrit, ESR, Mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, packed cell volume, differential WBC count used. Results: The results of present study revealed that WBC count, ESR, the differential leukocyte count (e.g. neutrophil cells) in patients increased significantly (P <0.01) comparison to controls. While, the differential leukocyte count of lymphocyte & platelet count revealed to decrease significantly (P <0.01) in patients. Conclusion: Abnormal blood parameters are more common among diabetes patients. Elevated WBC count, ESR, neutrophils are present in patients as compared to control. While decreased in lymphocytes & platelets are seen in patients as compared to control.

More reliable erythrocyte parameter MCH than MCV for screening thalassaemia trait / 国际检验医学杂志

Objective To compare the reliability of erythrocyte parameter mean corpuscular volume(MCV)and mean corpuscu-lar hemoglobin(MCH)for screening thalassaemia trait.Methods A fresh venous blood sample with the cut-off value of MCV was sent to 21 hospitals of Zhuhai city for conduct the full blood cell analysis within 1 d.Then the inter-and intra-coefficient of varia-tion (CV)as well as bias values of MCV and MCH were calculated and compared.In addition,10 EDTA-anticoagulant venous blood samples were divided into two parts,the effects of stored temperature and time on MCV and MCH were observed.Results The coefficient of variation(CV)of MCV (4.1%)was significantly greater than that of MCH (2.8%)among 21 laboratories,the qualification rate of MCH detection results was 100%,which was significantly higher than 66.7% of MCV (P 0.05).When these samples were stored under the refrigerated condition for 72 h,MCV had no statistically sig-nificant difference compared with the instant detection results of MCV (P >0.05),when stored at the room temperature for 48 h, MCV was significantly increased (P <0.05),MCV had statistical difference in storage for 48 h between the room temperature and the refrigeration.Conclusion Among laboratories and under different temperature conditions,the reproducibility of MCH is better than that of MCV and is more stable than MCV.MCH as the clinical first-line screening for thalassaemia is more reliable than MCV.

The value of MCV,MCH in the screening of thalassemia / 国际检验医学杂志

Objective To evaluate the value of the tests of mean corpuscular volume (MCV ) ,mean corpuscular hemoglobin (MCH) in the screening of thalassemia .Methods 603 cases were performed MCV and MCH tests and gene detection of thalasse-mia .The results of gene detection were used as reference standard .The sensitivity ,specificity ,accuracy ,positive predictive value and negative predictive value of single or combined results of MCV ,MCH tests were calculated .Results The sensitivity and specificity of single MCV test were 91 .2% and 76 .1% ,single MCH test were 91 .2% and 70 .7% .The sensitivity and specificity of parallel combined tests of MCV and MCH were 94 .8% and 61 .4% ,serial combined tests of MCV and MCH were 88 .4% and 75 .6% .Con-clusion The sensitivity of single MCV or MCH test in the screening of thalassemia is high .Parallel combined tests of MCV and MCH can improve the sensitivity ,and will be widely used in the in the screening of thalassemia .

Critical evaluation of peripheral smear in cases of anemia with high mean corpuscular hemoglobin concentration in children: A series of four cases.

Mean corpuscular hemoglobin concentration (MCHC), a parameter that is reported as a part of a standard complete blood count by automated analyzer, is a measure of the concentration of hemoglobin in a given volume of packed red blood cell. Values of MCHC significantly above reference range are not physiologically possible due to limitations on solubility of hemoglobin. The high MCHC can give us a clue to certain type of hemolytic anemia and necessitate critical evaluation of peripheral smear to reach a definitive diagnosis. Here we are presenting a series of four cases with raised MCHC, emphasizing the importance of systematic and meticulous examination of the peripheral smear to render a definitive diagnosis.