ABSTRACT
INTRODUCTION: New generation osmotic gradient ektacytometry has become a powerful procedure for measuring red blood cell deformability and therefore for the diagnosis of red blood cell membrane disorders. In this study, we aim to provide further support to the usefulness of osmotic gradient ektacytometry for the differential diagnosis of hereditary spherocytosis by measuring the optimal cutoff values of the parameters provided by this technique. METHODS: A total of 65 cases of hereditary spherocytosis, 7 hereditary elliptocytosis, 3 hereditary xerocytosis, and 171 normal controls were analyzed with osmotic gradient ektacytometry in addition to the routine red blood cell laboratory techniques. The most robust osmoscan parameters for hereditary spherocytosis diagnosis were determined using receiver operating characteristic curve analysis. RESULTS: The best diagnostic criteria for hereditary spherocytosis were the combination of decreased minimal elongation index up to 3% and increased minimal osmolality point up to 5.2% when compared to the mean of controls. Using this established criterion, osmotic gradient ektacytometry reported a sensitivity of 93.85% and a specificity of 98.38% for the diagnosis of hereditary spherocytosis. CONCLUSION: Osmotic gradient ektacytometry is an effective diagnostic test for hereditary spherocytosis and enables its differential diagnosis with other red blood cell membrane diseases based on specific pathology profiles.
Subject(s)
Erythrocyte Deformability , Erythrocyte Membrane/metabolism , Flow Cytometry/instrumentation , Flow Cytometry/methods , Spherocytosis, Hereditary/blood , Spherocytosis, Hereditary/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Chronic Disease , Female , Humans , Infant , Male , Middle Aged , OsmosisABSTRACT
Objetivo: Describir las características clínico-epidemiológicas de los niños diagnosticados de gripe A H1N1 2009 en urgencias de 4 hospitales. Material y métodos: Estudio prospectivo multicéntrico de julio a diciembre 2009. Se incluyó a los pacientes diagnosticados de gripe A H1N1 2009 por PCR en tiempo real en urgencias. La solicitud de la prueba se hizo según los protocolos establecidos en cada momento de la epidemia. Se recogieron datos epidemiológicos, clínicos, de laboratorio y evolutivos. Resultados: Se incluyeron 456 casos con una mediana de edad de 6,5 años (PC25-75 3-10,6).Presentaron factores de riesgo para complicaciones de la gripe 266 pacientes (59,4%); principalmente complicaciones pulmonares (47%), cardiovasculares (17%), neurológicos (14%) e inmunodeficiencias (11%). La clínica más frecuente fue fiebre (96%), tos (88%), rinorrea (72%), mialgias o astenia y dificultad respiratoria y, menos frecuentes, síntomas digestivos y neurológicos. Se solicitó radiografía de tórax a 224 pacientes (49%), presentando un 31% infiltrados lobares y un 15% intersticiales. Ciento cuarenta pacientes fueron hospitalizados (31%), necesitando el apoyo de la unidad de cuidados intensivos (mediana de estancia 4 y 3,5 días, respectivamente).Las complicaciones más frecuentes fueron neumonías y crisis de broncospasmo. Fallecieron3 pacientes (un paciente previamente sano por miocarditis y 2 con encefalopatía por fallo respiratorio). Otro caso de miocarditis se recuperó con secuelas. Conclusiones: El perfil del paciente con gripe A H1N1 2009 diagnosticada en urgencias fue el de un escolar, con factores de riesgo de complicaciones, que presentaba sintomatología respiratoria febril de corta evolución al que pudo darse de alta. Además de las complicaciones respiratorias habituales de la gripe, destacaron los casos de afectación miocárdica (AU)
Objective: To describe clinical and epidemiological features of influenza A H1N1 2009 diagnosed patients in the Emergency Department of 4 hospitals. Material and methods: Prospective multicentre study conducted from july to december 2009. The patients diagnosed by Real-Time PCR of influenza A H1N1 2009 in the emergency department were included. The test was requested according to the protocols established throughout the epidemic. Epidemiological, clinical, laboratory variables and outcomes were evaluated. Results: A total of 456 cases were included, with a median age of 6.5 years (PC25-75 3-10.6). There were risk factors of complications In 266 patients (59.4%) due to the influenza, mainly: respiratory (47%), cardiovascular (17%), neurological (14%) and immunosuppression (11%). The most frequent symptoms were fever (96%), (88%) cough, (72%) rhinorrhoea, muscle aches orasthenia and breathing difficulties and, less common, gastrointestinal and neurological symptoms. Chest X-ray was performed on 224 cases (49%), with lobar (31%) and interstitial (15%) infiltrates. One hundred and forty patients (31%) were hospitalised and 3.2% required Intensive Care Unit (median stay 4 and 3.5 days, respectively). The most frequent complications were pneumonias and bronchospasms. Three patients died (a previously healthy patient with myocarditis and 2 patients with encephalopathy due to respiratory failure). Another case of myocarditis recovered with sequelae. Conclusions: The profile of patient with influenza A 2009 diagnosed in the emergency department was a school child, with risk factors of complications, presenting with respiratory symptoms and fever over a short time, and who can be discharged. It is important to emphasise myocarditis, as well as the usual respiratory complications of influenza virus (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Influenza A Virus, H1N1 Subtype/classification , Influenza A Virus, H1N1 Subtype/immunology , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Emergencies/epidemiology , Emergency Medicine/methods , Risk Factors , Bronchial Spasm/complications , Prospective Studies , Radiography, Thoracic/methods , Bronchial Spasm/epidemiologyABSTRACT
OBJECTIVE: To describe clinical and epidemiological features of influenza A H1N1 2009 diagnosed patients in the Emergency Department of 4 hospitals. MATERIAL AND METHODS: Prospective multicentre study conducted from july to december 2009. The patients diagnosed by Real-Time PCR of influenza A H1N1 2009 in the emergency department were included. The test was requested according to the protocols established throughout the epidemic. Epidemiological, clinical, laboratory variables and outcomes were evaluated. RESULTS: A total of 456 cases were included, with a median age of 6.5years (PC(25-75) 3-10.6). There were risk factors of complications In 266 patients (59.4%) due to the influenza, mainly: respiratory (47%), cardiovascular (17%), neurological (14%) and immunosuppression (11%). The most frequent symptoms were fever (96%), (88%) cough, (72%) rhinorrhoea, muscle aches or asthenia and breathing difficulties and, less common, gastrointestinal and neurological symptoms. Chest X-ray was performed on 224 cases (49%), with lobar (31%) and interstitial (15%) infiltrates. One hundred and forty patients (31%) were hospitalised and 3.2% required Intensive Care Unit (median stay 4 and 3.5days, respectively). The most frequent complications were pneumonias and bronchospasms. Three patients died (a previously healthy patient with myocarditis and 2 patients with encephalopathy due to respiratory failure). Another case of myocarditis recovered with sequelae. CONCLUSIONS: The profile of patient with influenza A 2009 diagnosed in the emergency department was a school child, with risk factors of complications, presenting with respiratory symptoms and fever over a short time, and who can be discharged. It is important to emphasise myocarditis, as well as the usual respiratory complications of influenza virus.
