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Introduction: Indicators that assess relationships among leukocytes may inform more and/or earlier than those measured in isolation. Method(s): Blood leukocyte differential counts collected from 101 Mayo Clinic COVID-19 patients were related to later outcomes following two approaches: (i) as unstructured data (e.g., lymphocyte percentages) and (ii) as data structures that assess intercellular interactions. Analyzing the same primary data, it was asked whether information contents differed among methods and/or when two sets of structured indicators are used. Result(s): While unstructured data did not distinguish survivors from non-survivors (Fig. 1, rectangle A), one data structure (here identified with letters expressed in italics) exhibited one perpendicular inflection that differentiated two patient groups (B). Two survivor-related observations were also distinguished from the remaining data points (B). A second data structure also revealed a single line of observations and a perpendicular data inflection (C), while more (four) patient groups were identified (D). Four validations were conducted: (i) increasing mortality levels among contiguous data subsets (0, 7.1, 16.2, or 44.4%) suggested construct validity (D);(ii) internal validity was indicated because 22 of the 45 survivors detected by the first data structure were also captured by the second one;(iii) the analysis of patients that differed in address, co-morbidities and other aspects supported external validity;and (iv) quasi non-overlapping data intervals predicted statistical validity (E, F). The structured approach also uncovered new and/ or dissimilar information: different leukocyte-related ratios explained the clusters identified in these analyses (E, F). Conclusion(s): Structured data may yield more information than methods that do not assess multicellular interactions. Possible applications include daily, longitudinal, and personalized analysis of hospital data.
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The lung is the most common organ affected by sarcoidosis. Multiple tools are available to assist clinicians in assessing lung disease activity and in excluding alternative causes of respiratory symptoms. Improving outcomes in pulmonary sarcoidosis should focus on preventing disease progression and disability, and preserving quality of life, in addition to timely identification and management of complications like fibrotic pulmonary sarcoidosis. While steroids continue to be first-line therapy, other therapies with fewer long-term side-effects are available and should be considered in certain circumstances. Knowledge of common clinical features of pulmonary sarcoidosis and specific pulmonary sarcoidosis phenotypes is important for identifying patients who are more likely to benefit from treatment.Copyright © ERS 2022.
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T-lineage acute lymphoblastic leukemia (T-ALL) is curable for most children and adolescent and young adult patients with contemporary frontline chemotherapy regimens. During the past decade, improved survival rates have resulted from the optimization of frontline chemotherapy regimens, the use of minimal residual disease (MRD) assessment for evaluating a patient's risk for relapse, and the intensification of treatment based on the persistence of MRD. Optimization of initial therapy is critical because relapsed T-ALL after initial intensive chemotherapy is incurable for most adult patients. Current T-ALL salvage chemotherapy regimens are minimally effective, and unlike in B-cell ALL, there are no approved antibody therapies or chimeric antigen receptor T-cell therapies for relapsed disease. Immunotherapy and small-molecule inhibitors are beginning to be tested in relapsed T-ALL and have the potential to advance the treatment. Until effective salvage strategies are discovered, however, intensive frontline therapy is required for cure. In this article I review the current frontline chemotherapy regimens for adult patients with T-ALL, summarize the novel targeted and immune therapeutics currently in early-phase clinical trials, and outline how these therapies are helping to define an optimal approach for T-ALL.Copyright © 2022 by The American Society of Hematology.
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Background and aims:The ongoing Covid pandemic has burdened the medical system, more so due to the limited availability of ventilators. Our study aims at identifying the role of hematological markers in the risk stratification and the need for ventilator support among ICU admitted COVID-19 patients. Method(s): A single centre prospective study was conducted on 100 Covid positive patients admitted in the ICU to determine association between the haematological markers such as Hb, Platelet count, Total and Differential leukocyte count, CRP, AST, ALT, LDH, Ferritin and D-Dimer with the need for oxygen therapy with or without invasive ventilatory support. Comparative analysis was performed between the 2 groups. Result(s): Neutrophilia, a mean of 76.7% among those ventilated and 71.6% among those non ventilated (p value 0.002;highly significant) and Lymphocytopenia (p value 0.004) with a mean of 14% and 18.6% respectively was noted. Hemoglobin levels were lower in ventilated (mean 11.6g/dl) as against those non ventilated (mean 12.58%) p value 0.046 which was significant. D-dimer was increased in COVID-19 patients;mean 5380 ng/ml in ventilated patients and mean 949ng/ml in those non ventilated (P < 0.001 highly significant). Elevated D-dimer and presence of diabetes correlated with increased chances of mechanical ventilation, while higher hemoglobin levels and associated COPD have a negative association with the need of mechanical ventilation. Conclusion(s): Hypercoagulability along with neutrophilia and lymphocytopenia can be used as positive associations for the need for invasive mechanical ventilation. Copyright © 2022, College of Anaesthesiologists of Sri Lanka. All rights reserved.
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Background: Corona virus causes severe pneumonia of idiopathic nature. The clinical manifestation ranges from mild to severe respiratory problems. Due presences of target receptors and the release of chemical mediators, it also affect other organs including the liver and kidney. Objective: The purpose of this study was to determine the effect of COVID-19 infection on hematological parameters, liver function and renal function. Methods: This multicenter case-control observational study was conducted at Lady reading hospital, Hayatabad medical complex and Khyber teaching hospital Peshawar. A total of 340 samples were processed including 170 COVID-19 patients and 170 control groups. Complete blood count, liver function tests and renal function tests were performed to determine the effect of COVID infection on these parameters. The data were statistically analyzed using SPSS version 22.0. Results: In complete blood count, the mean WBC count was 16632.34±7339.94 which was statistically significant with p value less than 0.05. In differential leukocyte count, the mean neutrophil values were 87.79±7.36 which was statistically significant (p=0.00). The mean value of ALT and ALP were 49.47±100.08, 114.43±64.71 respectively which were higher than the control group. Mean value of urea and creatinine were 70.58±41.89, 1.31±1.12 respectively and was statistically significant (p=0.00). Conclusion: it is concluded that COVID-19 infection affects hematological and biochemical parameters including ALT, ALP, urea and creatinine. Hence these manifestations can be used collectively as a diagnostic and prognostic biomarker.
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Background: Sepsis is an infectious disease (the etiology can be viral or bacterial) with hight mortality, threatening human health. Clinicians need to diagnose the patient's infection in time and look for pathogens in order to develop an effective treatment plan;therefore, a quickly and early screen to diagnose sepsis has become an urgent problem in clinical laboratories. Different inflammatory factors are used to diagnose the sepsis;CRP, IL-6, PCT, ADM, lactate, D-dimer etc., but they also have limitations such as insufficient sensitivity and specificity and requiring additional examination cost. The aim of this study is to use leucocyte counts (neutrophils and monocytes that are activated from pathogenic virus or bacteria) and others morphological change with Mindray BC-6800-plus platform to diagnose sepsis early, quickly, conveniently and at low cost. Methods: A total 957 EDTA-k2 anticoagulant venous whole blood samples were collected: 70 control patients (blood donors) with a normal complete count blood and negative VES, and 887 samples hospitalized at the emergency department with symptoms attributable to sepsis with PCT request. All data was divided in 4 groups: control group, group where sepsis cannot be confirmed, group with confirmed sepsis diagnosis and a group with sepsis from SARS-CoV-2 infection. Morphometric and numeric parameters are reported with Mindray BC-6800 plus: blood count like positional parameters X, Y, Z of neutrophils, lymphocites and monocytes, PLT, NLR (neutrophil lymphocyte ratio) and IMG (index of immature granulocytes). For statistical analysis was used Shapiro Wilk test for distribution analysis and the non parametric Kruskal Wallis test to evaluate significative differences among the groups (p< 0.05) and also examined ROC curve analysis. Results: There is a statistically significant difference between control group and sepsis group for haematological parameters: positional parameters (Neu X, Y, Z;Mon X, Y, Z and Lym X, Y, Z), IMG, NLR, PLT. The roc curves highlight acceptable sensitivity and specificity values for some haematological parameters and suggest a possible cut-off. Conclusions: The BC-6800 plus can help the diagnosis of sepsis upon the admission to the emergency department using some morphological positional parameters.
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Objective: To see the effects of Raj Nirwan Bati (RNB) on the hematobiochemical parameters, coagulation tests, and histopathological changes in the lungs, liver, kidneys and spleen and also to evaluate the immunomodulatory activity of RNBin Wistar rats. Methods: A total of 24 adult albino Wistar rats (of bodyweight 200-250 g) of either sex were divided into 3 groups. In the normal control group (n=8), no drug was administered and in the rest of the groups (A and B), RNB@ 26 mg/kg body weight./day and 260 mg/kg body weight/day respectively were administered orally for a period of 14 d. The blood samples were collected from the jugular vein at zero d (before drug administration) and after the 14th d of drug administration in both groups (A and B). The organ samples (lungs, liver, kidneys, and spleen) were collected after euthanizing the rats using Ketamine anesthesia overdose intraperitoneally (IP) after the 14th d of drug administration. White Blood Cells (WBC), Red Blood Cells (RBC), Hemoglobin (Hb), Hematocrit (HCT), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin(MCH), Mean Corpuscular Hemoglobin Concentration(MCHC), number of platelets, Differential Leucocyte Count(DLC) i.e. the percentage of neutrophils, lymphocytes, eosinophils, monocytes and basophils, neutrophil adhesion percentage, Prothrombin test (PT), Activated Partial Thromboplastin Time (APTT), fibrinogen, D-dimer, Lactate Dehydrogenase (LDH), urea, creatinine, Aspartate Amino Transferase (AST), Alanine amino Transferase (ALT), Alkaline Phosphatase (ALP), C-Reactive Protein (CRP) were evaluated and histological examination of organs were done. Results: After statistical analysis, it was found that the decrease in TLC, RBC, Hb, HCT, and LDH in Wistar rats after RNB intervention in Group A as compared to that of before RNB intervention, was found to be statistically significant (P=0.001, P=0.002, P=0.001, P=0.039, and P=0.008). On the other hand, an increase was observed in MCV, Urea, Creatinine and ALT values in the Wistar rats after RNB intervention in Group ‘A’ as compared to that of before RNB intervention and this increase in values was statistically significant (P=0.007, P=0.001, P<0.001 and P=0.038). After RNB intervention in Group B, the increase in MCH, fibrinogen concentration, and monocytes percentage, was found to be statistically significant (P=0.004, P=0.033, and P=0.001) as well as the decrease in PT and APTT was statistically significant (P=0.007and P=0.002). After comparing the Mean Hematobiochemical and coagulation test parameters in the rats of Group A and Group B, after RNB intervention, it was observed that the concentration of Urea, Creatinine, APTT, and D-dimer were less in Group B as compared to that of Group A and this difference was statistically significant(P<0.001, P<0.001, P<0.001 and P=0.022). Histologically the findings in the lungs of group B were more distortion of lung architecture, most of the alveoli become collapse and make emphysematous changes, more diffuse inflammatory infiltrate within interalveolar septa and around bronchioles as compared to Group A. In the liver of group B rats, the histological findings were mild to moderate distortion of lobular architecture, healthy hepatocytes with more activation of kupffer cells as well as larger and more aggregates of inflammatory cells as compared to group A. Histological findings of kidneys in group A and group B rats were similar to that of control group rats. Conclusion: The results suggest that the RNB is having an immunomodulatory effect. It might be helpful in the restoration of coagulation factors and can help treat the COVID patients. No harmful effects on the lungs, liver, kidney, and spleen were seen. These findings may act as baseline data for planning further clinical trials in human study subjects to evaluate the effects on various comorbidities.
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Introduction: In-person hematology appointments (IHA) are not available in most hospitals and outpatient centers in the state of Santa Catarina, Brazil. Primary care physician (PCP) based hematology telemedicine consultation (HTC) has the potential of being a valuable and cost-effective tool for patients and PCPs. While it has not been previously assessed in our country, it may avoid unnecessary IHA, which frequently require traveling to major cities, reduce waiting times for an IHA, and advise PCPs on better assessing patients that may need a hematology referral. Methods: Sistema Integrado Catarinense de Telemedicina is a statewide online tool to which all public health system PCPs have access. It enables PCPs to set up asynchronous HTCs that are randomly distributed to reference hematology treatment centers. HEMOSC Joinville is one such center and is responsible for approximately one fifth of all HTCs. We prospectively assessed all HTC requests in non-malignant hematology between August 2019 and July 2021 for main clinical features that prompted a hematology referral. All cases with confirmed or likely diagnosis of hematological malignancy under the 2017 World Health Organization (WHO) classification were excluded. WHO anemia definition and severity classification was observed. Severe neutropenia and thrombocytopenia required counts below 500 and 50,000 per microliter. For every HTC, a single diagnostic hypothesis in hematology (DHH) was established based on patient data provided by the PCP. Results: Seven hundred and ninety consecutive patients aged 15 or older were included. Median age at HTC was 55 years (interquartile range, IQR: 39-70), with 282 patients (36%) aged 60 or more. Sixty percent of patients (n=472) were women, with 26 pregnant women (3%) at a median gestational age of 15 weeks (IQR: 12-21). Major DHHs were iron deficiency anemia (n=123, 16%), anemia of undetermined cause (n=107, 14%) and unexplained thrombocytopenia (n=102, 13%). Cytopenias accounted for 499 (63%) of all DHHs. Abnormal complete blood count (CBC) or coagulation tests were the sole reason for HTC, in the absence of any attributable clinical finding, in 597 cases (76%). DHHs were adequately formulated by PCP in 140 cases (18%). CBC information was provided in 594 cases (75%), with mild anemia (n=188, 32%) being the most frequent finding. Median hemoglobin when anemia was the DHH was 10 g/dL (IQR: 8.7 - 11.1). Absence of red blood cell (RBC) indices, differential leukocyte counts and platelet counts were seen in 261 (44%), 441 (74%) and 251 (42%) cases. CBC was collected in excess of 60 days prior to HTC in 118 patients (20%) and no CBC information was provided for 196 patients (25%), 31% of which (n=60) had a cytopenia as DHH. Blood transfusions were reported within 60 days of HTC in 49 patients (6%), and an emergency department evaluation was suggested by the hematology specialist for 72 patients (9%). One hundred and ninety (24%) patients were referred to an IHA after HTC, of which 21 (3%), 115 (15%) and 54 (7%) received low, intermediate and high priority for an appointment. Conclusions: Over the reported two-year period, HTC has prevented 3 in every 4 IHA in our patient population. This is especially relevant considering the need for social distancing and the socioeconomic impacts of the COVID-19 pandemic. Follow-up analyses of these patients to identify IHA at a later date and the confirmation of hematological diagnosis are in order. This study also uncovers inappropriate CBC interpretation and reporting, and failure to associate clinical symptoms and patient history to laboratory findings, which in turn demands providing PCPs with continued medical education in hematology. [Formula presented] Disclosures: Boettcher: Novartis: Speakers Bureau.