Fecal immunochemical test for hemoglobin versus fecal calprotectin to monitor endoscopic activity in inflammatory bowel disease

Aim: endoscopy identifies inflammatory activity, however, it is an unpleasant test and is not always accessible. The aim of the study was to compare the usefulness of quantitative fecal immunochemical test (FIT) versus fecal calprotectin (FC) to determine endoscopic activity in patients with inflammatory bowel disease (IBD). Methods: cross-sectional prospective observational study. The stool samples were collected within three days before starting the preparation for the colonoscopy. We used the Mayo index for ulcerative colitis (UC) and the simplified endoscopic index for Crohn’s disease (CD). Mucosal healing (MH) was defined as the score 0 points in each of the endoscopic indices. Results: eighty-four patients were included, 40 (47.6 %) with UC. In patients with IBD, FIT and FC showed a significant correlation with the presence of inflammatory activity/MH on endoscopy, with no statistically significant differences between the two receiver-operating characteristic (ROC) curves. Both tests improved their diagnostic performance when assessing patients with UC; the Spearman correlations between FIT and FC and endoscopic inflammatory activity were r = 0.6 (p = 0.0001) and r = 0.7 (p = 0.0001), respectively. In Crohn’s disease, the diagnostic utility of both tests was lower. Conclusions: FIT is an alternative to monitor endoscopic activity among ulcerative colitis patients. In Crohn’s disease, more studies are needed to determine the role of fecal biomarkers. (AU)

Association of erythrocyte deformability with red blood cell distribution width in metabolic diseases and thalassemia trait.

Increased red blood distribution width (RDW) in anemia is related to disturbances in the cellular surface/volume ratio, usually accompanied by morphological alterations, while it has been shown in inflammatory diseases that the activity of pro-inflammatory cytokines disturbing erythropoiesis increases RDW. Recently it has been reported that higher RDW is related with decreased erythrocyte deformability, and that it could be related with the association of RDW and increased risk of cardiovascular diseases. In order to analyze the influence of morphological alterations and proinflammatory status on the relationship between RDW and erythrocyte deformability, we analyzed erythrocyte deformability along with RDW and other hematological and biochemical parameters in 36 α-thalassemia, 20 ß-thalassemia, 20 δß-thalassemia trait carriers, 61 metabolic syndrome patients and 76 morbidly obese patients. RDW correlated inversely with erythrocyte deformability in minor ß-thalassemia (r =-0.530, p <  0.05), and directly in both metabolic syndrome and morbidly obese patients (ρ= 0.270, p <  0.05 and ρ= 0.258, p <  0.05, respectively). Minor ß-thalassemia is often accompanied by more marked cell-shaped perturbations than other thalassemia traits. This could be the reason for this negative association only in this setting. Higher anisocytosis seems to be associated with greater morphologic alterations (shape/volume), which reduce erythrocyte deformability. The proinflammatory profile in metabolic patients can be related to the positive association of RDW with erythrocyte deformability found in these patients. However, further research is needed to explain the mechanisms underlying this association.

Haemorheological parameters in young patients with acute myocardial infarction.

The role played by hemorheological alterations on acute myocardial infarction (AMI) in young patients remains a question of debate. We have carried out a case-control study of 84 AMI patients aged <45 years and 135 sex and age matched controls, in which blood viscosity (BV), plasma viscosity (PV), erythrocyte aggregation (EA) performed with the Myrenne (EA0, EA1) and the Sefam aggregometer (Ta, AI10, gammaD), erythrocyte deformability (ED) along with fibrinogen (Fbg), C-reactive protein (CRP) and plasmatic lipids i.e. total cholesterol (T-Chol) and triglycerides (TG) were determined. AMI patients showed higher, Fbg, TG, EA0, EA1, IA10, gammaD and lower Ta than controls (p=0.029, p<0.001, p=0.013, p=0.003, p=0.010, p=0.025) respectively. No differences in the other rheological parameters were observed. No differences in any rheological parameter were observed regarding the AMI type, number and score of stenosed vessels and the time elapsed since the thrombotic event. After multivariate adjustment, Fbg>380 ml/dl and TG>185 ml/dl were independently associated with a higher risk of erythrocyte hyperaggregability (OR: 5.5 CI 95% 1.04-29.27 and OR: 7.3 CI 95% 2.66-20.03) respectively. EA>8.85 was associated with a increased AMI risk (OR: 5.3 CI 95% 1.98-14.5). These results reinforces the view that in young AMI patients increased Fbg and TG may promote the development of ischaemic events not only through its known mechanism but also by altering rheological blood behaviour, mainly increasing EA.

Haemorheological changes in patients with systemic lupus erythematosus do not seem to be related to thrombotic events.

Atherothrombotic events are significant factors of mortality and morbidity in patients with systemic lupus erythematosus (SLE). The extent that rheological factors may be involved in these events in these patients has not been established. We measured the following rheological parameters in 86 patients with SLE, of whom 16 had suffered venous and/or arterial thrombotic events, and in 86 healthy controls: fibrinogen (Fbg), plasma viscosity (PV), blood viscosity at 230 s(-1) both at native haematocrit (BVn 230 s(-1) and corrected to 45% (BVc 230 s(-1), erythrocyte aggregation at stasis (AE0) and at 3 s(-1) (AE1), aggregation time (Ta), aggregation index at 10 s (AI10), disaggregation threshold (gammaD), and erythrocyte deformability (ED). In addition glucose, total cholesterol (T-Chol), triglycerides (TG), haematocrit (Hct) and Body Mass Index (BMI) were determined. SLE Disease Activity Index (SLEDAI) was also assessed. The patients showed a significant increase in BMI (P=0.030), TG (P<0.001), PV (P=0.007), AE0 (P=0.005), AE1 (P=0.006), AI10 (P=0.024), gammaD (P=0.001), Fbg (P=0.050); and a significant decrease in Ta (P<0.001), Hct (P<0.001) and BVn 230 s(-1) (P=0.003). When patients with SLEDAI10 were compared, the latter had lower Hct (P=0.041) and lower BVn 230 s(-1) (P=0.017) than those with less SLEDAI. No significant differences were found in any of the parameters analysed on comparing patients who had suffered a thrombotic event with those who had not. Our results suggest that, although patients with SLE have moderate rheological changes, these do not seem to be responsible for the increase in the thrombotic tendency in these patients.

Erythrocyte deformability in anaemic patients with reticulocytosis determined by means of ektacytometry techniques.

It is not clearly established whether reticulocyte deformability is lower than that of the mature erythrocytes, as most of studies published on this matter have evaluated this rheological parameter by means of micropipette techniques, which are unsuitable for routine measurements. Information is scarce as regards the evaluation of reticulocyte deformability by means of ektacytometry techniques, routinely used in clinical laboratories. We aimed to evaluate erythrocyte deformability (ED), with ektacytometry, in samples of 44 anaemic patients with peripheral reticulocytosis (reticulocytes: (260+/-150)x10(3)/microl) and in 60 healthy non-anaemic volunteers with a normal reticulocyte count (reticulocytes: (60+/-20)x10(3)/microl). We also determined other factors that may influence ED, such as erythrocyte indices (MCV, MCH, MCHC), glucose, total cholesterol and triglycerides. ED was evaluated determining the elongation indices (EI) at 12, 30 and 60 Pa, by means of the Rheodyn SSD. At the three shear stresses tested, patients showed statistically lower EI than controls, higher reticulocyte count, lower cholesterol levels and higher MCHC (P<0.001, respectively). A statistically significant negative correlation (P<0.01) was found between the reticulocyte count and the EI at 12, 30 and 60 Pa (r=-0.643, r=-0.678 and r=-0.692, respectively), and between the EI and the MCHC (correlation coefficients: -0.743, -0.741 and -0.738; P<0.01). As the differences in ED could be attributed partly to alterations in erythrocyte indices and plasma lipid levels, a linear regression analysis was performed, showing that EI is independently associated with the reticulocyte count. Our results suggest that reticulocytes are responsible for the decreased ED observed in anaemic patients with peripheral reticulocytosis, when this hemorheological parameter is evaluated by means of ektacytometry techniques.