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Aim: Although most patients with COVID-19 experience respiratory tract infections, severe reactions to the virus may cause coagulation abnormalities that mimic other systemic coagulopathies associated with severe infections, such as disseminated intravascular coagulation and thrombotic microangiopathy. Fluctuations in platelet markers, which are an indicator of the acute phase response for COVID-19, are of clinical importance. The aim of this study is to evaluate the relationship between disease severity and Platelet Mass Index (MPI) parameters in COVID-19 patients. Material(s) and Method(s): This retrospective observational study was conducted with patients who were diagnosed with COVID-19 in a tertiary hospital. The study was continued with the remaining 280 patients. All laboratory data were scanned retrospectively from patient files and hospital information system. Result(s): A very high positive correlation was found between PMI and PLT. The PMI value in women was significantly higher than in men. It was observed that PMI did not differ significantly in terms of mortality, intubation, CPAP and comorbidity. PMI vs. Pneumonia Ct Severity Score, biochemistry parameters (AST, CRP), hemogram parameters (WBC, HGB, HCT, MCV, LYM, MPV EO) and coagulation factors (aPTT and FIB) at various levels of positive/negative, weak and strong, and significant relationship was found. There was no significant relationship between hormone and D-dimer when compared with PMI. Discussion(s): Although platelet count alone does not provide information about the prognosis of the disease, PMI may guide the clinician as an indicator of lung damage in seriously ill patients.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Background: The usefulness of leukocyte cell population data (CPD) is currently being investigated. In COVID-19 pandemic several reports showed the clinical importance of hematological parameters. Our study aimed to assess CPDs in Sars CoV-2 patients as new disease markers. Method(s): From February to April 2020 (1st wave) 540 and from September to December 2020 (2nd wave) 2821 patients respectively were enrolled. SARS CoV-2 infection diagnosis was carried out by Multiplex rRT-PCR from nasopharyngeal swabs. CPDs were detected by XN 2000 hematology analyzer (Sysmex Corporation). A comparison between two disease waves was performed. Additionally, C-reactive protein (CRP) and lactate dehydrogenase (LDH) were assayed. Result(s): CPDs were classified into: cell complextity, DNA/RNA content and abnormal sized cells. We detected parameters increased from the reference population for all cell types for both 1st and 2nd wave (p<0.05). However, in the 2nd vs 1st wave 5 CPDs vs 9 CPDs were found. In addition we observed higher CPD values of the 1st compared to 2nd wave: (NE-SFL) (p<0.001), (LY-Y) (p<0.0001), (LY-Z) (p<0.0001), (MO-X) (p<0.0001), (MO-Y) (p<0.0001). These findings were confirmed by the higher concentrations of CRP and LDH in the 1st vs 2nd wave: 17.3 mg/L (8.5-59.3) vs 6.3 mg/L (2.3-17.6) (p<0.001) and 241.5 IU/L (201-345) vs 195 IU/L (174-228) (p< 0.001) (median, interquartile range) respectively. Conclusion(s): CPDs showed increased cell activation in 1st wave patients confirmed by clinical and biochemical data, associated with worse clinical conditions. Results highlighted the CPDs as disease characterization markers or useful for a risk model.Copyright © 2023 Sciendo. All rights reserved.
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Objectives: We aimed to compare biomarkers of COVID-19 patients with the Alpha variant (B.1.1.7), the Delta variant (B.1.617), and no mutation detected in our study. Method(s): A total of 600 patients with positive COVID PCR test and Alpha, Delta variant and no mutation detected with Covid PCR mutation test were included in the study. Troponin I, creatinine, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Lactate Dehydrogenase (LDH), fibrinogen, D-dimer, ferritin, number of lymphocytes, lymphocytes (%), platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), trombosite ratio in the blood (PCT), C-reactive protein (CRP) values were analyzed retrospectively. The age, gender, and hospitalization of the patients were evaluated concurrently. Result(s): Age, troponin, creatinine, LDH, PLT, MPV, and D-dimer were laboratory parameters that vary significantly with COVID-19 virus mutation. Age, troponin, LDH, and MPV values were lower in patients with Delta variant according to patients with the Alpha variant. Lymphocytes (N) and lymphocytes (%) values were lower in hospitalized patients relative to outpatients while age, troponin, LDH, CRP, and D-dimer values were higher in hospitalized patients than outpatients irrespective of mutation. Creatinine values were higher only in hospitalized patients with no mutation detected while ferritin and fibrinogen values were higher in hospitalized patients with Delta variant and no mutation detected. Conclusion(s): Age, troponin, creatinine, LDH, PLT, MPV, D-dimer, fibrinogen, ferritin, CRP, lymphocytes (N), and lymphocytes (%) values can guide to evaluate the diagnosis and hospitalization of patients with future different mutations.Copyright © 2023 by Prusa Medical Publishing.
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The aim of our study is analysis of the androgenic status including testosterone (T) and dihydrotestosterone (DHT) in men hospitalized with coronavirus disease 2019 (COVID-19) and them relationship with the course of the disease. This is a monocentric prospective study performed on 125 male patients hospitalized for COVID-19. We conducted hematological examination, blood biochemical profile, hemostasis analysis and hormonal examination (T and DHT levels) lung and chest computed tomography and also assessed outcomes of hospitalization. Low DHT serum level was found only in 18 patients (14.4%). Subjects with low DHT were significantly older compare to subjects with normal DHT. At the same time in patients with normal DHT white blood cells (WBC) count, neutrophils at admission were higher than in patients with low DHT. No correlation was observed between T and DHT serum blood levels. C-reactive protein (CRP) has a weak positive correlation of DHT serum blood concentration (r = 0.22;p = 0.016). The inverse pattern was obtained for T serum blood concentration (r = -0.285;p = 0.001). After divided all males according to T concentrations we conducted next correlation analysis for DHT and CRP in two different groups: with normal T levels and with low T levels. We found that in males with normal T DHT levels are not correlated with CRP (r = 0.095;p = 0.462). However, in males with low T DHT and CRP had weak positive correlation with r = 0.317 (p = 0.012). Higher DHT concentrations are associated with higher CRP levels, however correlation is weak and in patients with normal T is absent, that may indicate anti-inflammatory effect of T and possible proinflammatory effect of DHT.Copyright © 2023 The Author(s).
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Background: Vaccination is considered the most effective preventive strategy to fight COVID-19. The aim of this study was to evaluate two critical concerns about: 1) the kinetic response of IgG and IgM, and: 2) the hematological abnormalities in a longitudinal cohort of health-care workers (HCW) who had received 2 doses of BNT162b2 mRNA-based vaccine. Method(s): Blood and nasopharyngeal swabs were collected from 46 volunteers' participants, previous written consensus, with presumable no symptoms of COVID-19. Anti-SARS-CoV-2 serum immunoglobulin G (IgG) and M (IgM) and hematological parameters were examined. Multivariable mixed-effects models for repeated measure analysis were adopted to evaluate time changes in IgG, IgM and hematological parameters, and to investigate associations with vaccination response. Result(s): Forty-six subjects (N.=46;31.8% men;68.2% women;mean age near 36 years-old) were enrolled among healthcare workers of IRCCS MultiMedica (Milan, Italy). Overall, increase in serological IgG concentration appeared mainly between 21-28 days after the 1st dose, whereas IgM did not reach positivity in all cases. Mean blood cells counts were in normal range but we observed a significant reduction of total white blood cells and absolute lymphocyte counts after the 1st dose, persisting until the day 28. The increase of monocytes and neutrophils the day after the 1st dose subsequently decayed significantly. Eosinophils concentration showed a tendency to increase over time. Peripheral blood smear showed a growing frequency of atypical lymphocytes (lympho-variants), and of plasmacytoid forms, whereas no difference was found in large granular lymphocytes (LGL), although a decay after the boost was evident. The stratification of subjects, relative to the timing of IgG increase, showed the occurrence of 3 different patterns after vaccination, namely early-responders (R+), late-responders (R-) and pauci-responders (PR) with a peculiar kinetics of hematological parameters. Lymphocytes were significantly associated with total IgG: lower in R+ and PR compared to R- (P=0.0193 and P=00054, respectively). Conclusion(s): In healthy subjects, anti SARS-CoV-2 vaccination induced a variety of non-pathologic abnormalities. The response to vaccination was not equal in the groups examined. In PR group a major difference occurred with respect to R- and R+. This work adds novel insight into the puzzle of changes induced by SARS-CoV-2 virus.Copyright © 2022 EDIZIONI MINERVA MEDICA.
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Aim: The aim of this study is to analyze the effectiveness of the leukocyte albumin ratio (LAR) in predicting mortality in critical COVID-19 patients. Material(s) and Method(s): In this retrospectively-designed study, we evaluated a total of 98 critical patients who were hospitalized in the intensive care unit. Patients were divided into two groups according to hospital mortality as survivors (n=43) and non-survivors (n=55). Result(s): The non-survivors group was statistically significantly older (67.3+/-9.7 versus 62.5+/-10.9;p=0.023). HT and DM were detected more in the non-survivors group than in the survivors group (p=0.031, p=0.018, respectively). Mean LAR values were significantly higher in non-survivors than in survivors (5.9+/-3.5 versus 3.3+/-1.4;p<0.001). LAR values was positively correlated with urea (r=0.43, p<0.001), LDH (r=0.35, p<0.001), ferritin (r=0.25, p=0.015), procalcitonin (r=0.34, p<0.001), and pro-BNP (r=0.24, p=0.015) levels. A cut-off value of 3.71 ng/mL for LAR predicted mortality with a sensitivity of 76% and a specificity of 70% (AUC:0.779 95% Cl:0.689-0.870;p<0.001). Multivariable logistic regression analysis revealed that older age (OR:1.114, 95% CI:1.020-1.218;p=0.017) and increased ferritin (OR:1.003, 95% CI:1.001-1.004;p=0.002) and LAR (OR:1.583, 95% CI:1.073-2.337;p=0.021) values were independent predictors of mortality in patients with critical COVID-19. Discussion(s): LAR can be a useful and prognostic marker that can be used to predict mortality in COVID-19 patients admitted to the intensive care unit.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Aim: Recent research have shown that immature granulocytes (IG) can be utilized to predict severe infection, inflammation, and sepsis. As a result, the ability of IG levels to predict the severity of severe COVID-19 and its association with prognosis were studied in our study. Material and Mthods: A total of 317 patients diagnosed with severe COVID-19 in the emergency department were analyzed retrospectively. IGC and IG% levels were compared statistically between patient groups (survivors and non-survivors, those who received and did not get mechanical ventilation (MV) assistance, patients who required and did not require vasopressors, and hospital stays >=10 and <10 days). Result(s): When compared to patients who survived but did not get treatment, non-survivors who got MV and vasopressor support had substantially higher IGC and IG% values (for all p<0.001). Additionally, it was shown that the IG% of patients with hospital stays of >=10 days was substantially greater than that of patients with hospital stays of <10 days (p<0.001). While the IG% cut-off value was >0.45, it reached 75.5% sensitivity, 81.9% specificity, 87.6% NPV and 66.4% PPV for predicting mortality (AUC:0.86, p<0.001). Discussion(s): IG levels are a low-cost, easily accessible, and strong marker that may be used to predict mortality and prognosis in COVID-19 patients.Copyright © 2023, Derman Medical Publishing. All rights reserved.
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Objective: To identify a novel biomarker with high prognostic value SII Systemic Immune-Inflammation Index in the disease progression of COVID-19 patients with its cost effectiveness and less time consuming. Methodology: This cross-sectional study was carried out from November 2021 to February 2022 at the Mardan Medical Complex, Khyber Pakhtunkhwah, Pakistan. The receiver operating characteristic (ROC) curve analysis was used to discover the ideal cut-off values for predictors for disease severity stage, i.e. asymptomatic, mild, moderate, severe, critical, based on their greatest Youden's index. The SII (platelet X neutrophil count/lymphocyte counts) formula was used to compute the systemic immune inflammation index. Result(s): Of the 311 cases studied, 233 were included;155 (66.52%) were male and 78 (33.47%) females. Median age was 38 years (IQR: 18 - 79). Patients had a significant increase in various blood parameters, with an increase in SII index between admission and hospitalization. Normal patients had a SII median 398 (IQR: 312 - 567) upon admission, while abnormal patients had a SII median 659 (IQR: 475 - 1540). Throughout hospitalization, SII index of asymptomatic patients median was 684 (IQR: 470 - 933);cut-off value >= 358, mild patients median 909 (IQR: 183 - 1930);cut-off value >= 501, moderate patients median >= 992 (IQR: 248 - 6099);cut-off value >= 903, severe patients median 1063 (IQR: 104 - 5014);cut-off value >= 1147, critical patients median 1230 (IQR: 100 - 8438);cut-off value >= 1481. Conclusion(s): SII was found to be a significant predictor of COVID-19 patients' severity progression to fatality as an independent prognostic factor. SII is being recommended as a low-cost and less time-consuming blood test for COVID-19 patients.Copyright © 2023, Pakistan Medical Association. All rights reserved.
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Background: In this study, we aimed to investigate the pathological alterations of LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides in COVID-19 patients during the acute phase of infection, and after recovery. Method(s): A retrospective study was performed to examine serum levels of LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides on 55 COVID-19 patients who were hospitalized in our center between February and April 2020. The lipid profile and the hematological parameters were analyzed in the same group of patients before (Group before) and after clinical management (Group after). The laboratory tests results were compared between these two groups, as well as with a group of healthy subjects (Healthy controls), matched for age and sex and selected among the blood donors. Result(s): LDL-cholesterol, HDL-cholesterol, total cholesterol levels were significantly lower in COVID-19 patients (Group before) as compared with normal subjects (P<0.0001). Comparing healthy controls and the group after, statistically significant differences were observed for all parameters except for total cholesterol (P=0.9006). Total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride were found to be significantly higher after recovery than during the acute phase of infection (P<0.0001). C-reactive protein levels were found to be inversely correlated with those of LDL-cholesterol (rs =-0573, P<0.0001), total cholesterol (r=-0.732, P<0.0001), and HDL-cholesterol (r=-0.700, P<0.0001). Conclusion(s): The results of our study seemingly attest that lipids, especially cholesterol, may play an important role in viral replication, internalization and immune activation in patients with COVID-19 infection. Moreover, lipid abnormalities observed during and after this infection could be used for assessing indirectly the response to clinical treatment.Copyright © Journal of Laboratory and Precision Medicine. All rights reserved.
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Objectives: For a definitive diagnosis of COVID-19, respiratory tract samples are evaluated by polymerase chain reaction (PCR). In our study, PCR using a tear sample was used to diagnose COVID-19, and it was questioned whether it was a screening method. Unlike the general practice, Schirmer strips were used instead of a swab for tear sample collection in this study. In addition, the diagnostic values of serum procalcitonin (PCT), C-reactive protein (CRP), and Neutrophil (NEU) count in predicting COVID-19 disease from tears were also questioned. Method(s): A total of 94 patients who were positive for COVID-19 by PCR test were included in this study. Tear samples were obtained from patients with Schirmer strips, commonly used in eye examination, and studied with the PCR technique. CRP, PCT value, and NEU count were also compared between the positive and negative groups of the PCR. The obtained data were analyzed using the R Studio software, and the results were considered statistically significant for p<0.05. Result(s): Of these patients, 61 (64.9%) tear PCR was negative, and 33 (35.1%) tear PCR was positive. The mean age was 61.72 +/- 17.62 years. The patients were divided into two groups: tear PCR positive and negative. There was no significant age difference between these groups. As a result of ROC Analysis;When serum PCT, CRP, and NEU % values were examined in predicting COVID-19 disease from tears, it was seen that CRP (p=0.027) and especially PCT (p=0.003) values of patients with PCR-positive were significantly higher. Conclusion(s): PCR study on tears collected with Schirmer strips is a different and non-invasive method, but it was concluded that the proposed method could not be used as a screening test. In addition, significantly higher serum PCT values were found in patients with COVID-19 positivity in tears (p<0.05). Copyright © 2022 the author(s), published by De Gruyter.
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Objectives: The aim is to investigate the usefulness of lactate dehydrogenase (LDH)/Albumin, LDH/Lymphocyte and LDH/Platelet ratios on the prognosis of coronavirus disease (COVID-19) Alpha (B.1.1.7) variant pneumonia. Method(s): A total of 113 patients who were diagnosed with COVID-19 pneumonia and 60 healthy control group were included in this study. The cases were divided into 2 as classic COVID-19 group, and COVID-19 B.1.1.7 variant group. Complete blood count (CBC) and biochemical parameters of the patients were analyzed retrospectively. Patients with COVID-19 B.1.1.7 variant group were also grouped according to the length of stay in the hospital and the days of hospitalization. Result(s): LDH/Albumin, LDH/Platelet, and LDH/Lymphocyte ratios were found to be higher in COVID-19 B.1.1.7 variant group when compared to the control group (p<0.001). The ferritin, neutrophils/lymphocyte (NLR) ratio, procalcitonin (PCT) and LDH/Albumin had the highest area under the curve (AUC) values in the COVID-19 B.1.1.7 variant group (0.950, 0.802, 0.759, and 0.742, respectively). Albumin, Lymphocytes and hemoglobin values were significantly higher in the COVID-19 B.1.1.7 variant group than in the classic COVID-19 group (p<0.05). Conclusion(s): LDH/Albumin and LDH/Lymphocyte ratios may be useful for clinicians in predicting the risk of progression to pneumonia in COVID-19 B.1.1.7 variant patients. Copyright © 2022 the author(s), published by De Gruyter.
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Background and Aim: Inflammatory markers reproduce amount of disease development or revival. They are used to assess improvement or worsening of the illness. Hence the aim of the study was to determine the correlation of laboratory markers (LDH and CRP) and oxygen requirement with clinical severity in Covid 19 subjects. Material(s) and Method(s): There were 216 subjects admitted to the emergency department of the hospital. The incorporated subjects were divided into two groups: group I subjects had covid19 pneumonia and in group 2 subjects did not have covid 19 pneumonia. Blood count and serum values of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were quantified in all subjects enrolled in the research. An automated hematology analyzer was utilized to perform blood count according to the manufacturer's protocol. Serum samples were analyzed on a fully automated clinical chemistry Instrument. Result(s): LDH was amplified in 82% of subjects, CRP resulted elevated in 98% of subjects, only 21% of subjects presented pathological values of white blood cell (WBC), but 18% had a neutrophils count above the upper normal range value, while 89% of subjects had lymphocytes count below the lower normal range value, as formerly reported. Conclusion(s): LDH and CRP could be helpful for the premature identification of subjects who are at elevated risk for acute respiratory failure. They should be considered a helpful test for the early recognition of subjects who need closer respiratory monitoring and more aggressive supportive therapies to avoid poor prognosis. These subjects could be benefited from a quick hospitalization, a closer observation and correct treatments. Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Background: Prevention of transfusion-associated infections remains a challenge in transfusion medicine. The Mirasol Pathogen Reduction Technology (PRT) System uses riboflavin plus UV light to inactivate residual white blood cells and nucleic acid-containing pathogens to reduce the risk of transmission of bacteria, viruses, parasites, novel pathogens e.g SARS-CoV-2. This demonstrates the cumulative quality data of Mirasol-treated PC produced under routine conditions in our institute in the last year Methods: One hundred sixteen whole blood derived PCs, resulting from the pooling of 5 buffy coats with 250ml PAS-E solution were treated with the Mirasol technology. PCs were mixed with 35 ml Riboflavin solution and illuminated with UV-light in accordance to manufacturer's instructions. For quality control (QC) assessment the following parameters were investigated post-production (PP) and at the end of shelf-life (EOS) at days 5, 6 or 7: pH (ABL80 FLEX Blood Gas Analyzer, at 37degreeC), platelet yield (Cell- Dyn Ruby, Abbott) and CD62P-positive cells with and without TRAP-6 (100muM) using the FACS methodology with FITC-labelled CD62P antibody (Cytomics FC 500 Flow Cytometer, Beckman Coulter). Result(s): Mirasol-treated PCs showed a mean pH of 7.3 at PP and ranged 7.1 to 7.0 at EOS1. Platelet yield PP and EOS were consistent with 3.0 to 3.1 x1011 platelets (PLT)/unit. Platelet activation measured with CD62P+ expression w/o TRAP-6 was 27.7% at PP and ranged from 46.9 to 55.8 at EOS1;CD62P+ expression induced by TRAP-6 was 79.3 at PP and ranged from 72.3 to 68.1 at EOS1. Conclusion(s): The QC data on Mirasol-treated PCs produced during the past year showed encouraging results: all pH values remained far above 6.4, platelet yields remained stable suggesting min cell loss, with EOS yields always above the threshold of 2.5x1011 PLT/unit. Rates of CD62P+cells increased with time, an upregulation of CD62P+ with TRAP-6 was still detectable at EOS up to Day 7. The presented results confirm the data of the initial Mirasol validation at our site, showing the robustness of the technology. (Table Presented).
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Introduction: During the early COVID-19 pandemic period in 2020, the laboratory evaluated Sight OLO haematology analyser as a dedicated instrument for infectious specimens. The Sight OLO analyser is compact, reliable and capable of self-contained waste production to limit biological waste exposure. The instrument can be used in isolation wards, Biosafety Level 3 laboratories or in smaller laboratories. A comparative study is conducted between Sight OLO and Sysmex XN-10 analyser, the blood count analyser used in the main laboratory. Method(s): There were two phases of study. Phase one evaluation was conducted on the haematology bench and Phase two evaluation inside a Biosafety cabinet (BSC). A comparative study is conducted using 40 normal and abnormal K2EDTA samples for each phase. Precision study was conducted using control materials provided by the manufacturer. Sensitivity and specificity studies were also conducted using 100 K2EDTA samples. Result(s): The blood count results of Phase 1 and Phase 2 on Sight OLO demonstrated good concordance with Sysmex XN-10. High agreement between Sight OLO and Sysmex XN- 10 was reflected in the results of regression analysis. The correlation value of FBC parameters ranged from 0.90 to 0.99. The Sight OLO is capable of detecting the presence of blast cells, nucleated RBCs, platelet clumps, atypical lymphocytes, immature granulocytes and platelet abnormal distribution. Conclusion(s): The study demonstrated that the performance of Sight OLO is comparable to Sysmex XN-10 hematology analyser. The instrument has a high potential use in small laboratories for pandemic sample testing or in institutions with limited space and resources.
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Introduction: Coronavirus disease 2019 is caused by severe acute respiratory syndrome. Primarily an infection of the lower respiratory tract, it is now well known to cause multisystem abnormalities. Hematologic manifestations constitute a significant area of concern. Coronavirus disease 2019 causes lymphopenia, neutrophilia, and thrombocytopenia. Method(s): We explored the hemocytometric characteristics of Covid-19 pazients, using the Sysmex XN-1000 (Sysmex Corporation - Japan) hematology analyser and EDTA-anticoagulated peripheral blood sample. The analyzer utilizes fluorescence flow cytometry for the leukocyte differential count, allowing for enhanced subset differentiation based on size (forward scatter;FSC), internal structure/granularity (side scatter;SSC) and DNA/RNA content (fluorescence expression;SFL). Result(s): Despite a decrease in lymphocyte count, an increase in certain subpopulations of lymphocytes was observed in COVID-19. Indeed, reactive lymphocytes antibody-synthesizing and high fluorescence lymphocyte cells were higher as compared with controls. The so-called high fluorescence cells represent lymphoplasmacytoid B cells and plasma cells. These lymphocytes are responsible for the adaptive humoral immune response. In the present study, we observed that in addition to lower absolute count, lynfocytes of patients with COVID-19 were slightly larger in size. The fraction of reactive lynfocytes within the whole population were significantly increase in patiens with COVID-19 and showed a tipical pattern in hemocytometric plot where the reactive lynfocytes appare as isolated population, different from those observed in patients with mononucleosis. A perifheral blood film assesment on light microscope showed a distint population with the caracteristic morphology of plasma cells with abundant basophilic cytoplasm and an eccentric nucleus. Cytoplasmic and nuclear morphological anomalies, from hyposegmented nuclei to apopto-sis, have been observed in circulating granulocytes, associated with an increase in relative counts of immature cells. Conclusion(s): Patients withCOVID-19 showed both quantitative and qualitative differences in leucocyte populations. This study is an analysis of a typical pattern observed in Covid-19 patients using the Sysmex XN -1000 (Sysmex Corporation - Japan) hematology analyzer. The on going study will be the correlation with immunophenotipic and clinical characteristic of these patients to understand the morphological changes observed.
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Introduction: Inflammation mechanisms play a critical role in Coronavirus disease 2019 (COVID-19) severity Systemic immune inflammation (SII) index is reported to have a diagnostic value in COVID-19 diagnosis Sysmex XN-1000 analyzer provides during routine full blood count two parameters for neutrophil activation measurement;NE-SSC, which represents the inner complexity of neutrophils and is strongly related to granularity and NE-SFL, which reveals the neutrophil nucleic acid/protein content and is related to production or release of proteins and reactive oxygen intermediates and one parameter for lymphocytes;the high- fluorescent lymphocyte count (HFLC) as antibody-producing plasma cells. The aim of our retrospective study is the evaluation of SSI index and NE-SSC, NE-SFL & HFLC parameters in COVID-19 patients treated with the relevant medical intervention as outpatients or inpatients. Method(s): Patients admitted to our hospital with COVID-19 diagnosed through real-time reverse transcription polymerase chain reaction, and had a complete blood count (on Sysmex XN-1000 hematology analyzer) within 24 hours of diagnosis were included. We retrospectively recorded the demographic data, the laboratory findings upon admission (NE-SSC, NE-SFL & HFLC) retrieved from the hospital electronic database system and calculated the SII index as followed: platelet count x absolute neutrophil count / absolute lymphocyte count Patients were divided in two groups: patients discharged and treated as outpatients (N = 105) and patients hospitalized in COVID-19 inpatient wards (N = 174) Statistical analysis: Mann-Whitney U test was applied P value of < 0.05 was considered significant. Result(s): The two groups do not differ in genders (P = 0.183) but inpatients are older [70 (58-79) vs 60 (39-71) years, P = 0.000]. Results are summarized in Table 1. SII index values are higher in inpatients in a statistically significant degree (P = 0.000). There is no statistically significant difference in NE-SSC, NE-SFL & HFLC values between the two groups (all P >0.05). Table 1. Results (Table Presented) hospitalization present systemic inflammation in a higher degree as compared to outpatients without any differentiation in neutrophil activation or lymphocyte morphology as indicated by morphology - associated white blood cells studied parameters.
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Introduction: COVID-19 is a viral zoonosis caused by the coronavirus strain SARS-CoV-2. Due to the rapid spread of this emerging infectious disease, the WHO has qualified it as an international pandemic. The objective of our study is to describe the haematological characteristics of patients with COVID-19 hospitalized at the CHU of Oran in Algeria. Method(s): This is a prospective study carried out between July 1st and October 15th, 2020, which included patients hospitalized and/or followed up in COVID-19 units of the CHU Oran in Algeria. The blood count was done on a Hematology Analyzer BC-6800. Result(s): Our study included 68 patients of which 67.2% were male and 32.8% female (sex ratio M/F = 2) with a median age of 65 years Check-ups revealed anemia in 38.2% of patients (mean of Hgb =9, 58 +/- 1, 25 g/dl, normal range: male 13-17g/dl, female 12-16 g/dl). Hyperleukocytosis (62.2%,mean of WBC= 18,44 +/- 6,45 G/l, normal range :4-10 G/l), hyperneutrophilia (72.1%, mean= 15,98 +/- 6,59 G/l, normal range 1,7-7G/l), lymphopenia (66.2% mean=0,75 +/- 0,36 G/l, 1,4 - 4 G/l), Eosinopenia (58.8%, mean=0,0038 +/- 0,0049 G/l, normal range = 0,02- 0,52 G/l), monocytopenia (08.8%, mean=0,12 +/- 0,05 G/l), monocytosis (20.6%, mean=1,16 +/- 0,16 G/l, normal range = 0,12 +/- 0,05), Thrombocytopenia (20,6%,mean=80,57 +/- 32,48) G/l ,thrombocytosis (14.7%, mean=480,30+/- 100 G/l, normal range =120- 400G/l), high MPV (Mean Platelet Volume) in 27.9% of cases, with mean=12,42 +/- 1,37, normal range =7-11f and high PPI (Platelet Distribution Index) in all patients (100% ;normal range 16,46 +/- 0,46%). It is also noted that 85% of patients over 50 years of age have an NLR (Neutrophils-to-lymphocyts ratio) >= 3.13. We found also the mean of MLR (Monocytes-to-lymphocytes ratio= 0,64 +/- 0,50) and the mean of PLR(Platelet-to-lymphocytes ratio= 173,75 +/- 155,21). Conclusion(s): Some parameters such as lymphopenia and eosinopenia have an important diagnostic value, while other parameters such as NLR(Neutrophils-to-lymphocyte ratio), MLR (Monocyte -to-lymphocyte ratio) and PLR (Platelet-tolymphocyte ratio) offer a very valuable prognostic value.
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Introduction: Covid-19 patients may have unusual arrangements of their blood count, compared to most viral infections. Neutrophilia can be associated with lymphopenia within the first few days. Therefore, an increasing neutrophil to lymphocyte ratio on admission has been considered an indicator of the disease severity Among the qualitative anomalies associated with the quantitative ones, reactive lymphocytes and nucleocytoplasmic morphological changes of the neutrophil granulocytes have been reported.Our study aimed to evaluate whether these leukocyte abnormalities modify the morphology of the instrumental cytograms of the Mindray BC6800plus haematological analyser resulting in diagnostic utility. Method(s): We evaluated the instrumental scattergrams provided by the Mindray BC6800plus analyser in 61patients admitted to the Monaldi and SS Trinita Hospitals (Naples and Borgomanero, Italy) with clinical evidence of SARSCoV- 2 infection confirmed with PCR research of viral RNA, comparing them with 61 healthy subjects. We used the 3D-Cube function - which allows a three-dimensional observation - to evaluate the lymphocyte and neutrophil cluster morphology in the DIFF scattergram. Blood cell morphology was assessed by microscopy. A prolonged microscopic review was performed in case of relevant lymphopenia. Result(s): Covid-19 samples showed evocative anomalies of the lymphocyte clusters in 47 out 61 samples (77%) related to the peripheral blood's morphological findings. Cytographic abnormalities concern the presence of an additional high fluorescence lymphocyte cluster - always well separated from the main one - with numerical consistency ranging between a few units to a few dozen (range 7.0 - 126) (Figure 1). Interestingly, the rotation of the 3D-Cube shows a widening of the high fluorescence cells along the FS axis attributable to the heterogeneity of cellular size (Figure 2). The microscopic review showed activated lymphocytes ranging between plasmacytoid and type III Downey morphologies. Positional indices of the neutrophil clusters showed significant differences from normal. Conclusion(s): Further studies need to associate positional indices with cytographic and microscopic anomalies of the neutrophils. The morphology of the lymphocyte clusters resulting from the 3D projections makes possible an accurate activated lymphocytes quantification, especially in severe lymphopenia thus evocative for Covid-19 infection and helpful for diagnostic and prognostic purposes.
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Introduction During long periods of hospitalization, debilitated and immunosuppressed patients are prone to contracting nosocomial fungal infections, such as Candida parapsilosis, which can cause sepsis. Candida parapsilosis, indeed, is able to form firm and persistent biofilms in central venous catheters (CVC) in addition to other medical devices, thus threatening patients undergoing invasive medical procedures [1]. We report a case of Candida parapsilosis sepsis detected in the peripheral blood smear and by the change of the cytograms of the hematology analyzer before to blood culture positivization. Case presentation An 89-year-old woman, positive for the Sars-Cov2 virus, was admitted at the San Donato hospital (Arezzo) for 40 days for Covid symptoms. Laboratory tests show an increase in C reactive protein (10.6 mg/dL), gamma GT (76 U/L), total bilirubin (2.31 mg/dL) and direct (1.46 mg/ dL), creatinine (1.00 mg/dL ) and reduction of glomerular filtrate (50.4 mL/min /1.73 mq). In addition, at the CBC anemia is detected with hemoglobin of 102 (g/L) and thrombocytopenia (32 x 10
ABSTRACT
Background: Histones (i.e., positively charged nuclear proteins) are key components in chromatin functions that under physiological conditions contribute to DNA packaging and regulate gene expression, but they are significantly mobilized in blood and body fluids during cell and tissue injuries in several pathological processes. Histones mediate both inflammatory pathways and coagulative cascade, crucially linked to the severity and mortality of many human pathologies (e.g., thrombosis, sepsis, COVID-19). SARS-CoV-2 and sepsis infections share common laboratory biomarkers, such as Monocyte Distribution Width (MDW), that is mainly linked to the heterogeneity of monocyte volume;these modifications, upon massive inflammatory activation, predict multiorgan dysfunction and increased mortality rate in several pathological conditions. No data are available on the roles of histones as MDW modifiers. Method(s): Comparison of MDW index was undertaken by hematology analyzer UniCell DxH900 Hematology Analyzer (Beckman Coulter) on whole blood samples from patients with COVID-19 and Sepsis. The impact of histones on the MDW characteristics was assessed by the in vitro time-dependent treatment of healthy control whole blood with histones and histones+lipopolysaccharide. Result(s): We demonstrated the breadth of early, persistent, and significant increase of MDW index in whole blood from healthy subject treated in vitro with histones, highlighting changes similar to those found in vivo in classic and viral sepsis patients. The findings of MDW changes are confirmed by digital microscopy of blood smears, highlighting the histone-induced modifications of cell volume, cytoplasmic vacuolization, and nuclear structure alterations of the circulating monocytes. Conclusion(s): Histones contribute to the pronounced and persistent monocyte alterations observed in classical and viral sepsis. Assessment of the biological impact of circulating histone released during COVID-19 and sepsis on monocytes should be considered as key factor modulating both thrombosis and inflammatory processes, as well as the importance of neutralization of their cytotoxic and procoagulant activities by several commercially available drugs (e.g., heparins and heparinoids).