Differential diagnostics of Thalassemia Minor by artificial neural networks model.

BACKGROUND: Current methods used to diagnose the thalassemia minor (TM) patients require high-cost assays, while broader screening based on routine blood count has limited specificity and sensitivity. This study developed a new screening technique for TM patients' diagnosis. METHODS: The study enrolled 526 patients database that included 185 verified α and ß TM cases, and control group consisted of iron-deficiency anemia (IDA), myelodysplastic syndrome (MDS), and healthy patients. More than 1,500 artificial neural networks (ANNs) models were created and the networks that gave high accuracy were selected for the study. TM patients were identified from the general database using the best-optimized ANNs. RESULTS: Comparison between three or six routine blood count parameters determined a slightly higher accuracy of the model with the three-parameter scheme, including mean corpuscular volume, red blood cell distribution width, and red blood cell. Based on these parameters, we were able to separate TM patients from the control group and MDS group, with specificity of 0.967 and sensitivity of 1. Including IDA patients into comparison gave lower but, still, very good values of specificity of 0.968 and sensitivity of 0.9. CONCLUSION: ANN-based TM diagnostics should be used for broad automatic screening of general population prior diagnosis with high-cost tests.

Leukocytosis in obese individuals: possible link in patients with unexplained persistent neutrophilia.

BACKGROUND: Recently, it was shown that fat tissue produces and releases inflammatory cytokines, and that obesity may be regarded as a state of low-grade inflammation. In this regard, we aimed to establish an association between obesity and persistent leukocytosis. PATIENTS AND METHODS: We present clinical observations of obese subjects primarily referred for further evaluation of leukocytosis without a cause and validated the link between leukocytosis and elevated body mass index (BMI) in a cross-sectional study. RESULTS: During 1999-2005, 327 patients were referred for further investigation because of persistent leukocytosis. Of these, 15.3% were asymptomatic obese, mostly females, with mild persistent neutrophilia accompanied by elevated acute-phase reactants. After careful evaluation, no recognized cause for leukocytosis was found other than the fact that the patients were obese. During a mean follow-up of 45.6 months, the leukocytosis and the elevated acute-phase reactants persisted and no new causes for leukocytosis were evident. Furthermore, in a cross-sectional analysis of 3716 non-smoker subjects, 62 were found to have leukocytosis. Compared with the population with a normal white blood count range, these subjects with leukocytosis had higher BMI, serum C-reactive protein (CRP) levels, waist circumference, and neutrophil and platelet count (all P < 0.0005). After logistic regression analysis, only BMI was shown to be associated with leukocytosis (P < 0.0005). CONCLUSIONS: Obesity is recognized as a possible cause for reactive leukocytosis. Awareness of this 'obesity-associated leukocytosis' may help the clinician to avoid more extensive and unnecessary diagnostic work-up, particularly in similar obese subjects.

The appearance of aggregated erythrocytes in the peripheral blood of individuals with insulin resistance.

BACKGROUND: Insulin resistance is associated with low-grade inflammatory response. The probability that the acute-phase response is associated with enhanced erythrocyte adhesiveness/aggregation was not explored. METHODS: The degree of erythrocyte adhesiveness/aggregation was evaluated by using a simple slide test. The insulin resistance was evaluated by insulin and glucose concentrations after a night of fasting. The inflammatory response was evaluated by variables of acute-phase response. RESULTS: A significant correlation (r = -0.2, p = 0.02) was noted between insulin resistance expressed as the HOMA index and the degree of erythrocyte adhesiveness/aggregation. This was probably due to the concomitant acute-phase response and the presence of increased amounts of inflammation-sensitive proteins that were found to correlate significantly with the degree of erythrocyte adhesiveness/aggregation. In the multiple linear regression analysis, erythrocyte sedimentation rate and fibrinogen concentration but not HOMA index were found to correlate significantly (p < 0.0001 and p = 0.0007 respectively) with the degree of red blood cell adhesiveness/aggregation. CONCLUSIONS: Insulin resistance is associated with an enhanced degree of erythrocyte adhesiveness/aggregation and this is related to the presence of enhanced inflammation-sensitive plasma proteins that are part of the acute-phase response. These findings might have hemorheological consequences and might contribute to the pathophysiology of the insulin-resistance syndrome.