Immature granulocytes index as early marker of sepsis.

INTRODUCTION: Sepsis induces the recruitment of immature neutrophils into the circulation. An immature granulocyte percentage (IG%) count greater than 3% has been shown to be an indicator for the risk of sepsis. The aim of this study was to evaluate the IG% as predictor of sepsis compared to blood culture results and sepsis diagnostic confirmation. METHODS: The study included individuals (n = 301) of both sexes aged ≥18 years who underwent Hospital São Lucas examinations between January and November 2017. For all the patients, IG%, as well as blood culture results, were evaluated. All examinations were obtained from Clinical Laboratory database. Data were analyzed through the SPSS program version 18.0. RESULTS: There was statistical association between blood culture and IG% results (P = 0.009) and between sepsis confirmation and IG% on Pearson chi-square test (P < 0.001). An IG% cutoff point of 2.0% was able to exclude sepsis based on clinical diagnosis with a specificity of 90.9% and a sensitivity of 38.5%. The cutoff value in ROC analyses of IG% based on blood culture results was 0.3% and 0.4% based on clinical diagnosis. CONCLUSION: Our study demonstrated that IG% <2.0% are helpful on the exclusion of sepsis diagnosis with a very high specificity (90.9%). The IG% is a useful additional marker for sepsis diagnosis allowing the early initiation of therapy and better possibilities of recovery.

New red blood cell and reticulocyte parameters and reference values for healthy individuals and in chronic kidney disease / Novos parâmetros e valores de referência eritrocitários e reticulocitários normais e na doença renal crônica

Introduction: The importance of local references values has been well described in the literature; this is because the characteristics of the population may influence the laboratory tests. Objective: To establish the reference range for traditional and extended red blood cell parameters and reticulocyte indices in order to investigate its application in patients with chronic kidney disease (CKD). Materials and methods: 249 blood donors (125 males and 124 females) were selected to establish the reference values. The hemodialysis sample consisted of 62 patients with terminal CKD (48 male and 14 female). All analyzes were performed using the Sysmex XE-5000 automated hematology analyzer. Results: Differences between reference values was observed in relation to gender: red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), percentage of hyperchromic red blood cells (%HYPER), percentage of microcytosis (%MICRO), percentage of macrocytosis (%MACRO), absolute reticulocyte count (RET), reticulocyte hemoglobin content (RET-He), immature reticulocyte fraction (IFR), low fluorescence reticulocytes (LFR), medium fluorescence reticulocytes (MFR), and high fluorescence reticulocytes (HFR). Individuals with CKD presented RBC, HGB, HCT, MCHC, red cell distribution width expressed as coefficient of variation (RDW-CV), percentage of hypochromic red blood cells (%HYPO), percentage of reticulocytes (RET%), RET (female group), IFR, LFR, MFR, and HFR results compatible with the anemic state, which can be observed in 91.8% of patients. All studied parameters were in the area under the curve (AUC) > 0.4. In male group, %HYPO (AUC: 0.806) and IFR (AUC: 0.762) presented higher AUC values, while female group presented %HYPO (AUC: 0.806), %HYPER (AUC: 0.815), and IFR (AUC: 0.660). Conclusion: The medical advancement, the development of new techniques and hematological parameters have revealed important information ...

Introdução: A importância dos valores de referências locais tem sido bastante descrita na literatura, isso porque características da população podem influenciar os testes laboratoriais. Objetivos: Estabelecer o intervalo de referência para parâmetros eritrocitários tradicionais e estendidos e índices reticulocitários a fim de investigar sua aplicação em pacientes com doença renal crônica (DRC). Materiais e métodos: Dos doadores de sangue, 249 pacientes foram selecionados para estabelecimento dos valores de referência (125 homens e 124 mulheres); dos pacientes em hemodiálise, a amostra foi composta por 62 indivíduos com DRC terminal (48 homens e 14 mulheres). Todas as análises foram realizadas no avaliador hematológico Sysmex XE-5000. Resultados: Foi observada uma distinção entre os valores de referência em relação ao gênero: células vermelhas do sangue (RBC), hemoglobina (HGB), hematócrito (HCT), concentração de hemoglobina corpuscular média (CHCM), porcentagem de eritrócitos hiper-hemoglobinizados (%HIPER), porcentagem de microcitose (%MICRO), porcentagem de macrocitose (%MACRO), contagem absoluta de reticulócitos (RET), contagem relativa de reticulócitos (RET-He), fração de reticulócitos imaturos (IFR), reticulócitos de baixa fluorescência (LFR), reticulócitos de média fluorescência (MFR) e reticulócitos de alta fluorescência (HFR). Os indivíduos com DRC apresentaram resultados de RBC, HGB, HCT, CHCM, coeficiente de variação do tamanho dos eritrócitos (RDW-CV), %HIPO, RET%, RET (grupo das mulheres), IFR, LFR, MFR e HFR compatíveis com o estado anêmico, que pode ser observado em 91,8%. Todos os parâmetros estudados apresentaram área sob a curva (AUC) > 0,4. Para o grupo dos homens, a %HIPO (AUC: 0,806) e a IFR (AUC: 0,762) apresentaram melhores valores de AUC; já para o grupo das mulheres foram a %HIPO (AUC: 0,806), a %HIPER (AUC: 0,815) e a IFR (AUC: 0,660). Conclusão: Avanço da medicina e surgimento de novas técnicas e parâmetros ...

Lamellar body count and stable microbubble test on tracheal aspirates from infants for the diagnosis of respiratory distress syndrome.

OBJECTIVES: To evaluate the performance of lamellar body count in tracheal aspirates from intubated preterm babies to predict respiratory distress syndrome. DESIGN: Case-control study. SETTING: Three neonatal intensive care units. PATIENTS: Seventy-two patients not older than 3 days were included in the study, 38 preterm infants with respiratory distress syndrome, 16 preterms without respiratory distress syndrome, and 18 term infants. All required mechanical ventilation. INTERVENTIONS: Lamellar body count was performed in an automated cell counter. Tracheal samples were diluted in dithiothreitol without centrifugation and kept frozen at -20°C until use. Samples were placed in a dithiothreitol-containing test tube at a ratio of one part tracheal aspirate to six parts dithiothreitol solution, vortexed for 10 secs, and aspirated by the cell counter. Lamellar body count was performed using the platelet channel. All results were multiplied by seven. The stable microbubble test was done for comparison. MEASUREMENTS: Lamellar body count and stable microbubble test. MAIN RESULTS: Lamellar body count was significantly lower in the respiratory distress syndrome group compared with the non respiratory distress syndrome preterm group and also with the term group. The median and interquartile range obtained for lamellar body count were 38,500/µL (14,000-112,000) for the respiratory distress syndrome group, 822,500/µL (442,000-962,500) for the non respiratory distress syndrome preterm group, and 633,000/µL (322,000-1,608,000) for the term group (p < .001). The sensitivity and specificity of lamellar body count and stable microbubble test for the diagnosis of respiratory distress syndrome were calculated, taking into consideration the respiratory distress syndrome and the non respiratory distress syndrome preterm groups. Considering a cutoff point of 200,000 lamellar bodies/µL, lamellar body count sensitivity was 92.1% (95% confidence interval 78.6-98.3) and lamellar body count specificity was 93.8% (95% confidence interval 69.8-99.8). The area under the curve was 0.94 (95% confidence interval 0.84-1.00). CONCLUSIONS: Lamellar body count and stable microbubble test can be rapidly and easily performed on tracheal aspirates and they seem to have very good performance for diagnosing respiratory distress syndrome in intubated patients.

Fructose-1,6-bisphosphate inhibits in vitro and ex vivo platelet aggregation induced by ADP and ameliorates coagulation alterations in experimental sepsis in rats.

Sepsis is a systemic response to an infection that leads to a generalized inflammatory reaction. There is an intimate relationship between procoagulant and proinflammatory activities, and coagulation abnormalities are common in septic patients. Pharmaceutical studies have focused to the development of substances that act on coagulation abnormalities and on the link between coagulation and inflammation. Fructose-1,6-bisphosphate (FBP) is a high-energy glycolitic metabolite that in the past two decades has been shown therapeutic effects in great number of pathological situations, including sepsis. The aims of this study were to assess the effects of FBP on platelet aggregation in vitro and ex vivo in healthy and septic rats and evaluate the use of FBP as a treatment for thrombocytopenia and coagulation abnormalities in abdominal sepsis in rat. FBP inhibited platelet aggregation (P < 0.001) in vitro in healthy rats from the smallest dose tested, 2.5 mM, in a dose-dependent manner. The mean effective dose calculated was 10.6 mM. The highest dose tested, 40 mM, completely inhibited platelet aggregation (P < 0.001) induced by ADP. Platelet aggregation in plasma from septic rats was inhibited only with higher doses of FBP, starting from 20 mM (P < 0.001). The calculated mean effective dose was 19.3 mM. Ex vivo platelet aggregation in septic rats was significantly lower (P < 0.05) than healthy rats and the treatment with FBP, at the dose of 2 g/kg, diminished the platelet aggregation at the extension of 27% (P < 0.001), suggesting that FBP is a potent platelet aggregation inhibitor in vivo. Moreover, treatment with FBP 2 g/kg prevented thrombocytopenia (P < 0.001), prolongation of prothrombin and partial thromboplastin time (P < 0.001), but not fibrinogen, in septic rats. The most important findings in this study are that FBP is a potent platelet aggregation inhibitor, in vitro and ex vivo. It presents protective effects on coagulation abnormalities, which can represent a treatment against DIC. The mechanisms for these effects remain under investigation.

Angiotensin converting enzyme ( ACE ) DD genotype: relationship with venous thrombosis

O troemboembolismo venoso (TEV) é uma doenca multifatorial associada com fatores de risco adquiridos e hereditários. Vários polimorfismos, tais como fator V de Leiden, mutacão G20210A da protrombina e as deficiências de proteína C, proteína S e anti-trombina são considerados fatores de risco para TEV. A enzima conversora da angiotensina (ECA) afeta a hemostasia diminuindo a fibrinólise. O polimorfismo no gene da ECA, caracterizado pela insercão/delecão de um fragmento de 287 pb no intron16, está relacionado a variacões nos níveis séricos da enzima. O genótipo DD foi associado com aumento de risco para TEV. Este estudo examinou a freqüência dos alelos I e D e a sua associacão com trombose venosa em um grupo de indivíduos do Sul do Brasil. Foram analisados 71 pacientes com trombose venosa profunda e/ou tromboembolismo pulmonar e 71 indivíduos sem história de trombose. A genotipagem foi realizada através da reacão em cadeia da polimerase. As freqüências do alelo D e do genótipo DD foram, respectivamente, 51,4% e 22,5% para os pacientes, e 64,7% e 45,0% para os controles. A razão de chance (odds ratio = OR) para a hipótese dominante (genótipos DD+ID versus genótipo II) foi 0,75 (IC 95%; 0,29-1,93) e a OR para a hipótese recessiva (genótipo DD versus genótipos ID+II) foi 0,35 (IC 95%; 0,16-0,78). Concluindo, nossos resultados sugerem que o genótipo DD não representa um fator de risco para TEV e pode exercer um efeito protetor para trombose venosa.