Assessing total erythrocyte count as a potential attribute for estimating hemoglobin in Cholistani cattle.

The main objective of the study was to confirm whether a specific and constant interrelationship exists between total erythrocyte count (TEC) and hemoglobin (Hb) concentration in Cholistani cattle blood and to navigate the potential of TEC for estimating Hb level in Cholistani cattle (n = 264) grouped as per gender (males, n = 122; females, n = 142) and age (young, n = 140; adults, n = 124). The TEC and Hb (HbD) estimation was carried out through veterinary hematology analyzer. The Hb was also calculated as TEC × 3 and was termed as HbC. Linear regression was implied, and accordingly, scatterplots were drawn between TEC, HbD, HbC, and corrected Hb (CHB). The regression prediction equation hence attained was used to deduce corrected hemoglobin (CHb). A significant (P ≤ 0.05) difference was noticed between HbD and HbC. A non-significant (P ≥ 0.05) difference was noticed, however, between HbD and CHb. Tests of level of agreement indicated a higher Cronbach's alpha and intraclass correlation coefficient (0.682 for average measures) for HbD and CHb as compared to that for HbD and HbC (0.559 for average measures). A convention of Hb concentration as three times of TEC (× 3) is not valid for Cholistani cattle. A different pen-side hematological formula, i.e., Hb (g/dL) = 0.66(TEC) + 6.1, however, provides a better estimate of Hb from the TEC in cattle blood. Using hemocytometry for TEC in the field, all the stakeholders associated with veterinary research, academics, and practice may benefit from this formula in resource-poor countries.

Predictive Value of Blood Markers in Nonfunctional Pituitary Adenomas using Artificial Neural Network.

Background: Nonfunctioning pituitary adenomas (NFPAs) are the most common pituitary tumors and although they do not secrete hormones, they can have systemic effects. These tumors affect the function of other organs in the body by exerting pressure on the pituitary gland. There are differences between biomarkers NFPAs compared to healthy people. This study was conducted to show blood marker changes in adenomas compared to healthy people. Materials and Methods: This article compared the blood markers of NFPAs with healthy individuals retrospectively. The difference between blood markers in the two groups was statistically investigated where the predictive value of blood markers in the differentiation of the two groups was determined. An artificial neural network was also designed using the blood markers with its accuracy and predictive value determined. Results: A total of 96 NFPAs (nonfunctional pituitary adenoma) and 96 healthy individuals were evaluated. There was statistically a significant difference and positive correlation in platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and derived neutrophil to lymphocyte ratio between NFPAs and healthy individuals. There was a significant and negative correlation between red blood cell (RBC), lymphocyte, and monocyte between the two groups. RBC as an independent factor was associated with NFPAs. In this study, the artificial neural network was able to differentiate between NFPTs cases and healthy individuals with an accuracy of 81.2%. Conclusion: There are differences between blood markers in NFPAs relative to healthy people and the artificial neural network can accurately differentiate between them.

Effect of delayed sample draw after blood collection for haemoglobin test in South Korea.

Between April and May 2022, 10 healthy adult non-patients were recruited from Pusan National University Hospital. Venous blood drawn into a syringe was transferred into test tubes with a zero-to-45-minute delay. The transfer was done sequentially in two positions with the syringe and the needle adaptor end (1) heading downwards and (2) heading upwards. Haemoglobin levels gradually increased over time in position 1 transfer while they gradually decreased in position 2. Therefore, blood must be transferred quickly from a syringe to a tube for reliable test results. What this study adds: Our findings confirm that delays between blood collection and transfer can affect haemoglobin levels.

Incidence of traumatic lumbar punctures in adults: the impact of a patient's first procedure.

INTRODUCTION: Lumbar puncture (LP) is a widely used diagnostic method in patients of all ages. Blood-contaminated cerebrospinal fluid samples are frequent and may compromise diagnostic accuracy. OBJECTIVES: We determined age-specific incidences of traumatic LPs (TLPs) in adults and examined factors that accounted for the incidence of TLPs. METHODS: Erythrocyte count data from 15,812 LP procedures (2,404 were performed twice) were collected from hospital records of patients aged from 18 to 104 years. The incidence of TLPs in a patient's second LP procedure was evaluated with logistic regression analysis using the first LP, the time between the procedures and age as predictors. RESULTS: The incidence of TLP in the second procedure was at least double that in the first procedure. If the first procedure was traumatic, the odds ratio of a TLP in the second procedure was 7-40-fold. One day between the successive procedures was associated with an over 10-fold odds ratio increase of TLP, and a week was still 4-8-fold odds ratio increase. Age was also associated with the incidence of TLP. CONCLUSIONS: Two factors (a week or less between a patient's two LP procedures or a traumatic first LP) multiply the odds of the second procedure being traumatic and contribute to whether a patient's following LP procedure is successful.

Additional value of red blood cell parameters in predicting uncommon α-thalassemia; experience from 10 years of α-globin gene sequencing and copy number variation analysis.

INTRODUCTION: The diagnosis of rare forms of α-thalassemia requires laborious genetic analyses. Accurate sample selection for such evaluation is therefore essential. The main objectives of this study were to investigate the predictive power of red blood cell parameters to detect rare forms of α-thalassemia (substudy 1), and to explore the frequency of rare versus common forms of α-thalassemia in our sample population (substudy 2). METHODS: In substudy 1, we reviewed all blood samples selected for extended α-hemoglobinopathy evaluation at our laboratory during 2011-2020 (n = 1217), which included DNA sequencing and/or copy number variation analysis. We assessed α-thalassemia positive samples at different levels of mean corpuscular hemoglobin (MCH) alone and in combination with results for red blood cell count (RBC) or red cell distribution width (RDW). In substudy 2, we examined the distribution of α-thalassemia genotypes for all samples submitted to a first-tier hemoglobinopathy evaluation at our laboratory during 2014-2020 (n = 6495). RESULTS: In substudy 1, both RBC and RDW added predictive value in detecting rare forms of α-thalassemia in samples from adults and children. In adult samples with MCH ≤ 23 pg, the presence of erythrocytosis increased the detection rate from 27% to 74% as compared to non-erythrocytosis, while normal RDW increased the detection rate from 36% to 86% as compared to elevated RDW. In substudy 2, rare forms of α-thalassemia were detected in 12% of α-thalassemia positive samples. CONCLUSION: Initial assessment of MCH, RBC, and RDW provided valuable predictive information about the presence of rare forms of α-thalassemia during hemoglobinopathy evaluation.

Investigation of the relationship between red blood cell distribution width and mortality in patients with hemophagocytic lymphohistiocytosis: a retrospective study

ABSTRACT BACKGROUND: Red blood cell distribution width (RDW) is related to sepsis-related mortality. Hemophagocytic lymphohistiocytosis (HLH) is a syndrome caused by severe infection, tumors, or autoimmunity without a specific diagnosis. OBJECTIVE: To explore the correlation between RDW and mortality in patients with HLH. DESIGN AND SETTING: A retrospective study conducted in a hospital in China. METHODS: A total of 101 inpatients with HLH from January 1, 2017 to December 31, 2021 were divided into non-survivor (n = 52) and survivor (n = 49) groups. A non-parametric test was used to analyze demographic, clinical, and laboratory data between groups. Independent variables with P < 0.05 were analyzed using binary logistic regression to screen out mortality-related variables. Selected variables were subjected to multivariate logistic regression analysis, and those with strong correlations were screened. Receiver operating characteristic (ROC) curves of strongly correlated variables and area under curve (AUC) values were obtained. RESULTS: The APACHE II score, RDW, and platelet (PLT) and fibrinogen (FIB) levels (P < 0.05) different significantly. RDW, PLT, FIB were correlated with mortality. The AUC values of RDW, PLT, and FIB were 0.857, 0.797, and 0.726, respectively. RDW was associated with mortality in patients with HLH (P < 0.01, cut-off value: 16.9). The sensitivity and specificity of predicting mortality were 97.96% and 96.1%, respectively. CONCLUSION: Logistic regression analysis showed a correlation between RDW and patients' mortality. Therefore, RDW can be used to predict mortality in patients with HLH.

Haematological Traits in Symptomatic and Asymptomatic COVID-19 Positive Patients for Predicting Severity and Hospitalization.

Objective: The present investigation aims on the clinical attributes and haematological parameters between symptomatic (COVID-19 ICU) and asymptomatic (COVID-19 homes isolation) patients as predisposing sign for COVID-19 related mortality. Materials and Methods: A retrospective cohort research was conducted of admitted patients to ICU, who were suffering from severe COVID-19 in Aseer Central Hospital, Abha, Kingdom of Saudi Arabia (KSA) from July 2020 until September 2020. The study included individuals with COVID -19 and ICU admission as symptomatic group and others who are COVID-19 positives with quarantine as asymptomatic group. Epidemiological, clinical and haematological laboratory data were retrospectively collected, analysed with control subjects. Results: Of the 38 ICU patients studied, the most common symptoms were fever and respiratory distress (100%), cough (86.8%). Majority were of Saudi origin (78.9%). Eighteen (47.4%) COVID-19 ICU patients showed leukocytosis, 6 (15.8%) had severe thrombocytopenia (with most having thrombocytopenia), 18 (47.4%) were anaemic. A significant correlation was observed between the WBC, RBC, Hb, platelets, neutrophil and lymphocyte count between ICU inmates compared with quarantine (p < 0.001) and RBC, Hb, neutrophil and lymphocyte count with control groups (p < 0.001). Conclusion: From the observations it is evident that, the blood tests have potential clinical value in predicting COVID-19 progression. Further, patient characteristics including age, leukocyte count, RBC, platelets and differential leukocyte counts may be significant predictors for monitoring the progression of the critical illness observed in SARS-COV-2 patients. Also, treatment procedures can be re-defined further to reduce COVID-19 mortalities in more critically ill COVID-19 individuals.

Evaluating three biomarkers as prognostic factors of in-hospital mortality and severity in heart failure: A prospective cohort.

OBJECTIVE: To identify the relationship between red blood cell distribution width (RDW, %), interleukin-6 (IL-6) (pg/ml), high sensitivity-c-reactive protein (hs-CRP) (mg/l), in-hospital mortality and disease severity among patients with heart failure (HF). METHODS: Prospective cohort. We included adults diagnosed with acute non-ischemic HF in 2015. The dependent variables were in-hospital mortality (yes or no) and disease severity. The latter was assessed with the Get With The Guidelines-HF score. We used hierarchical regression models to describe the pattern of association between biomarkers, mortality, and severity. We used the Youden index to identify the best cut-off for mortality prediction. RESULTS: We included 167 patients; the mean age was 72.61 (SD: 11.06). The majority of patients presented with New York Heart Association classification II (40.12%) or III (43.11%). After adjusting for age and gender, all biomarkers were associated with mortality. After adding comorbidities, only IL-6 was associated. The final model with all clinical variables showed no effect from any biomarker. The best cut-off for RDW, hs-CRP and IL-6 for mortality were 14.8, 68.7 and 52.9, respectively. IL-6 presented the highest sensitivity (100%), specificity (75.35%) and area under the curve (0.91). CONCLUSIONS: No biomarker is independent from the most important clinical variables; therefore it should not be used for management modifications.

The predictive accuracy of preoperative erythrocyte count and maximum tumor diameter to maximum kidney diameter ratio in renal cell carcinoma.

Background: The purpose of this study was to investigate the predictive accuracy of erythrocyte count and maximum tumor diameter to maximum kidney diameter ratio (TKR) in patients with renal cell carcinoma (RCC). Methods: We retrospectively analyzed the clinicopathological epidemiological characteristics of patients with RCC in the First Hospital of Shanxi Medical University from 2010 to 2014. Among them, 295 cases with complete follow-up data at the time of visit were selected. We collected data including erythrocyte counts and length of each diameter line of the tumor and kidney. To predict the prognosis of RCC, receiver operating characteristic (ROC) curve analysis was used to calculate the cutoff value of each parameter. Results: Of the 295 included patients, 199 (67.5%) were male, 96 (32.5%) were female, and the mean (± SD) age was 56.45±11.03 years. The area under the curve (AUC) of the erythrocyte count and the TKR for predicting the prognosis of RCC were 0.672 (SD 0.031; P<0.001) and 0.800 (SD 0.030; P<0.001), respectively. When the cutoff value of the erythrocyte count and TKR count were 3.975 and 0.452, the highest Youden index values were 0.309 and 0.685, and the corresponding sensitivity and specificity were 0.826 and 0.685, and 0.483 and 1.000, respectively. Conclusions: An erythrocyte count <3.975×1012/L and a TKR >0.452 were found to be risk factors for poor prognosis in patients with RCC.

Traumatic lumbar punctures in diagnostic and intrathecal treatment punctures of pediatric hemato-oncology patients.

Successful first diagnostic lumbar puncture (LP) is crucial because intrathecal chemotherapy has not yet protected the central nervous system against cancer cells. If blood contaminates the cerebrospinal fluid (CSF) with blasts, they may enter the central neural system and compromise the patient's health. We retrospectively determined the incidence of traumatic lumbar punctures (TLP) in 2,507 LPs of 250 pediatric hemato-oncology patients aged from one to 18 years, including both diagnostic and intrathecal treatment procedures, and 2,617 LPs of 1,525 other age-matched pediatric patients. We used ≥10 erythrocytes/µL in the CSF sample as the criterion of TLP. TLPs were less frequent in hemato-oncology patients than in other patients (31.6% vs. 48.5%, p < 0.0001). The incidence of TLP was significantly lower in the first diagnostic LP than in subsequent intrathecal treatment LPs (20.5% vs. 31.6%, p = 0.0046). According to logistic regression analysis, the odds of TLP was 1.6-fold if the LP procedure was not performed in the hemato-oncology department. The odds of the patient's next LP being traumatic were threefold if the previous first LP was traumatic. A week or less time between the first and next LP tripled the odds of TLP as well. The patient's age category was not significantly associated with the incidence of TLP. Given the risks of TLP, hemato-oncology patients' first diagnostic LP should include administration of chemotherapy, as generally recommended, and be performed under general anesthesia or deep sedation by an experienced physician to optimize not only the success of the first LP procedure but also following procedures.

Ninety-day repeated oral toxicity study of saponified Capsicum annum fruit extract with 50% capsanthin in Sprague-Dawley Rats with a 28-day recovery period.

A ninety-day oral toxicity study of saponified Capsicum annum fruit extract with 50% (w/w) capsanthin (SCFE-50 C) was performed by oral gavage administration to male and female Sprague-Dawley (SD) rats at doses of 0, 500, 1000 and 2000 mg/kg BW/day for a period of ninety consecutive days. To assess the reversal of toxicity, the treatment phase was followed with a twenty-eight-day recovery period. The treatment with SCFE-50 C in both male and female SD rats showed no mortality, and no treatment-related toxicologically significant changes were observed in any groups. No significant differences between treated and control groups were found in feed consumption, body weight gain, individual organ weights, ocular examination, clinical chemistry or blood biochemistry. The necroscopy and histopathology examination did not reveal any clinically significant changes in male and female rats from the 2000 mg/kg BW/day group. According to this study, the no observable adverse effect level (NOAEL) for saponified Capsicum annum fruit extract with 50% (w/w) capsanthin (SCFE-50 C) administered by oral gavage for 90-days is > 2000 mg/kg BW/day in SD rats.

Optical mesoscopy, machine learning, and computational microscopy enable high information content diagnostic imaging of blood films.

Automated image-based assessment of blood films has tremendous potential to support clinical haematology within overstretched healthcare systems. To achieve this, efficient and reliable digital capture of the rich diagnostic information contained within a blood film is a critical first step. However, this is often challenging, and in many cases entirely unfeasible, with the microscopes typically used in haematology due to the fundamental trade-off between magnification and spatial resolution. To address this, we investigated three state-of-the-art approaches to microscopic imaging of blood films which leverage recent advances in optical and computational imaging and analysis to increase the information capture capacity of the optical microscope: optical mesoscopy, which uses a giant microscope objective (Mesolens) to enable high-resolution imaging at low magnification; Fourier ptychographic microscopy, a computational imaging method which relies on oblique illumination with a series of LEDs to capture high-resolution information; and deep neural networks which can be trained to increase the quality of low magnification, low resolution images. We compare and contrast the performance of these techniques for blood film imaging for the exemplar case of Giemsa-stained peripheral blood smears. Using computational image analysis and shape-based object classification, we demonstrate their use for automated analysis of red blood cell morphology and visualization and detection of small blood-borne parasites such as the malarial parasite Plasmodium falciparum. Our results demonstrate that these new methods greatly increase the information capturing capacity of the light microscope, with transformative potential for haematology and more generally across digital pathology. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.

Cannabidiol on 5-FU-induced oral mucositis in mice.

PURPOSE: The aim of this study was to evaluate the clinical, histological, hematological, and oxidative stress effects of cannabidiol (CBD) in mice with induced oral mucositis. METHODS: We used 90 mice of the CF-1 strain in which oral mucositis was induced using a protocol with 5-fluorouracil (5-FU) chemotherapy. The animals were divided randomly into 10 study groups. Three groups were treated with different doses of CBD (3, 10, and 30 mg/kg), while 2 were control groups (positive control: 5-FU + mechanical trauma + placebo; and negative control: mechanical trauma + placebo), and 2 experimental times were studied (4 and 7 days). All treatments were by intraperitoneal administration. RESULTS: In the clinical evaluation, the groups treated with CBD showed less severity of oral lesions compared with the positive control at both experimental times. The intensity of the inflammatory response was also lower in the groups treated with this drug, but there was no statistically significant difference when compared with the positive control. With regard to erythrocyte, leukocyte, and platelet counts and anti-oxidant enzyme activity, the groups treated with CBD showed better results, but only some of these variables showed statistically significant differences. CONCLUSIONS: CBD seems to exert an anti-inflammatory and anti-oxidant activity favoring a faster resolution of oral mucositis in this animal model.

Erythrocyte count is associated with prognosis in Chinese patients with primary biliary cholangitis.

Erythroid parameters have been indicated to be important prognostic factors for liver diseases. The present study aimed to evaluate the prognostic value of the erythrocyte count in Chinese patients with primary biliary cholangitis (PBC) and develop a prognostic model. The clinical data of 301 patients with PBC were retrospectively reviewed. Univariate and multivariate Cox regression analysis was performed to identify potential prognostic risk factors. Bivariate correlation analysis was used to determine the correlation coefficient of the erythrocyte count and biochemical indices. The prognostic values of different factors were compared by receiver operating characteristic (ROC) curve analysis. A novel prognostic model was constructed using multivariate logistic regression. Multivariate regression analysis suggested that the erythrocyte count was an independent risk factor/prognostic index (P=0.042). The erythrocyte count in peripheral blood decreased as the histological stage progressed (P<0.001). The erythrocyte count was correlated with albumin, liver stiffness and Fibrosis-4. Compared with that of platelets, the area under the ROC curve of the erythrocyte count was significantly greater. A similar area under the ROC curve was determined for the erythrocyte count, albumin and total bilirubin (P>0.05). A novel prognostic model was established as follows: P=1/{1 + e-[6.140-3.193 × Ln(erythrocyte count) -0.184 × albumin + 0.827 × Ln(total bilirubin)]}. The novel model had a comparable prognostic value to that of the GLOBE score and UK-PBC risk score, and had a better performance than the Mayo risk score at baseline (0.838 vs. 0.787). In conclusion, the erythrocyte count is an independent risk factor/prognostic index in Chinese patients with PBC. It was correlated with liver function and fibrosis in Chinese patients. The novel model incorporating the erythrocyte count and biochemical indices at baseline may serve as a prognostic tool in Chinese patients with PBC (Trial registration number, ChiCTR-ONRC-10002070; date of registration, 2010-05-10).

Management of Anemia in Nondialysis Chronic Kidney Disease: Current Recommendations, Real-World Practice, and Patient Perspectives.

In nondialysis CKD (ND-CKD), anemia is a multifactorial and complex condition in which several dysfunctions dynamically contribute to a reduction in circulating hemoglobin (Hb) levels in red blood cells. Anemia is common in CKD and represents an important and modifiable risk factor for poor clinical outcomes. Importantly, symptoms related to anemia, including reduced physical functioning and fatigue, have been identified as high priorities by patients with CKD. The current management of anemia in ND-CKD (i.e., parameters to initiate treatment, Hb and iron indexes targets, choice of therapies, and effect of treatment on clinical and patient-reported outcomes) remains controversial. In this review article, we explore the epidemiology of anemia in ND-CKD and revise current recommendations and controversies in its management. Exploring data from real-world clinical practices, particularly from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps), we highlight the current challenges to translating current recommendations to clinical practice, providing patients' perspectives of anemia and how it affects their quality of life. Finally, we summarize recent advances in the field of anemia that may change the way this condition will be managed in the future.

Genotoxicity and subchronic toxicological study of a novel ginsenoside derivative 25-OCH3-PPD in beagle dogs.

BACKGROUND: Ginsenosides have been widely used clinically for many years and were regarded as very safe. However, a few researches on the toxicities of these kinds of agents showed that some ginsenosides may have side-effect on the rats or dogs. So it is extremely necessary to further clarify the potential toxicity of ginsenosides. This study was carried out to investigate long-term toxicity and genotoxicity of 25-methoxydammarane-3, 12, 20-triol (25-OCH3-PPD), a new derivative of ginsenoside, in beagle dogs. METHODS: Twenty-four beagle dogs were divided randomly into four treatment groups and repeatedly orally administered with 25-OCH3-PPD capsule at 60, 120, and 240 mg/kg/day for 91 consecutive days. Ames, micronucleus, and chromosomal aberration tests were established to analyze the possible genotoxicity of 25-OCH3-PPD. RESULTS: There was no 25-OCH3-PPD-induced systemic toxicity in beagle dogs at any doses. The level of 25-OCH3-PPD at which no adverse effects were observed was found to be 240 mg/kg/day. The result of Ames test showed that there was no significant increase in the number of revertant colonies of 25-OCH3-PPD administrated groups compared to the vehicle control group. There were also no significant differences between 25-OCH3-PPD administrated groups at all dose levels and negative group in the micronucleus test and chromosomal aberration assay. CONCLUSION: The highest dose level of 25-OCH3-PPD at which no adverse effects were observed was found to be 240 mg/kg per day, and it is not a genotoxic agent either in somatic cells or germs cells. 25-OCH3-PPD is an extremely safe candidate compound for antitumor treatment.

Factors influencing survival time of hemodialysis patients; time to event analysis using parametric models: a cohort study.

BACKGROUND: Survival analysis of patients on maintenance hemodialysis (HD) has been the subject of many studies. No study has evaluated the effect of different factors on the survival time of these patients. In this study, by using parametric survival models, we aimed to find the factors affecting survival and discover the effect of them on the survival time. METHODS: As a retrospective cohort study, we evaluated the data of 1408 HD patients. We considered the data of patients who had at least 3 months of HD and started HD from December 2011 to February 2016. The data were extracted from Shiraz University of Medical Sciences (SUMS) Special Diseases database. Primary event was death. We applied Cox-adjusted PH to find the variables with significant effect on risk of death. The effect of various parameters on the survival time was evaluated by a parametric survival model, the one found to have the best fit by Akaike Information Criterion (AIC). RESULTS: Of 428 HD patients eligible for the analysis, 221 (52%) experienced death. With the mean ± SD age of 60 ± 16 years and BMI of 23 ± 4.6 Kg/m, they comprised of 250 men (58%). The median of the survival time (95% CI) was 624 days (550 to 716). The overall 1, 2, 3, and 4-year survival rates for the patients undergoing HD were 74, 42, 25, and 17%; respectively. By using AIC, AFT log-normal model was recognized as the best functional form of the survival time. Cox-adjusted PH results showed that the amount of ultrafiltration volume (UF) (HR = 1.146, P = 0.049), WBC count (HR = 1.039, P = 0.001), RBC count (HR = 0.817, P = 0.044), MCHC (HR = 0.887, P = 0.001), and serum albumin (HR = 0.616, P < 0.001) had significant effects on mortality. AFT log-normal model indicated that WBC (ETR = 0.982, P = 0.018), RBC (ETR = 1.131, P = 0.023), MCHC (ETR = 1.067, P = 0.001), and serum albumin (ETR = 1.232, 0.002) had significant influence on the survival time. CONCLUSION: Considering Cox and three parametric event-time models, the parametric AFT log-normal had the best efficiency in determining factors influencing HD patients survival. Resulting from this model, WBC and RBC count, MCHC and serum albumin are factors significantly affecting survival time of HD patients.

Influences of red blood cell and platelet counts on the distribution and elimination of crystalloid fluid.

BACKGROUND AND OBJECTIVE: A high number of blood cells increases the viscosity of the blood. The present study explored whether variations in blood cell counts are relevant to the distribution and elimination of infused crystalloid fluid. MATERIALS AND METHODS: On three different occasions, 10 healthy male volunteers received an intravenous infusion of 25mL/kg of Ringer's acetate, Ringer's lactate, and isotonic saline over 30min. Blood hemoglobin and urinary excretion were monitored for 4h and used as input in a two-volume kinetic model, using nonlinear mixed effects software. The covariates used in the kinetic model were red blood cell and platelet counts, the total leukocyte count, the use of isotonic saline, and the arterial pressure. RESULTS: Red blood cell and platelet counts in the upper end of the normal range were associated with a decreased rate of distribution and redistribution of crystalloid fluid. Simulations showed that high counts were correlated with volume expansion of the peripheral (interstitial) fluid space, while the plasma volume was less affected. In contrast, the total leukocyte count had no influence on the distribution, redistribution, or elimination. The use of isotonic saline caused a transient reduction in the systolic arterial pressure (P<0.05) and doubled the half-life of infused fluid in the body when compared to the two Ringer solutions. Isotonic saline did not decrease the serum potassium concentration, despite the fact that saline is potassium-free. CONCLUSIONS: High red blood cell and platelet counts are associated with peripheral accumulation of infused crystalloid fluid.

Evaluation of two automated cell counters for the analysis of hematopoietic progenitor cell apheresis products.

INTRODUCTION: Routine hematology parameters in hematopoietic progenitor cell apheresis products (HPC-A) are usually determined using automated cell counters. These instruments, however, are designed to analyze whole blood samples, that differ considerably from HPC-A in blood cell composition. This study evaluates the performance of two automated cell counters for the analysis of HPC-A. METHODS: Routine hematology parameters [red blood cells (RBC), hematocrit (HCT), mean corpuscular volume (MCV), white blood cells (WBC), WBC differentiation, and platelets (PLT)] were determined on the Unicel DxH 800 instrument (Beckman Coulter) and the XN-350 instrument (Sysmex). Correlations with the reference methods, intrarun precision, and linearity of the analyses were studied. RESULTS: Good correlations were found for almost all parameters. However, RBC count was overestimated by XN-350, using the impedance technique, as was neutrophil percentage using DxH 800. Coefficients of variation for intrarun precision were below 10% on both analyzers for all parameters, except for neutrophil percentage (14.7%) and PLT (10%) on DxH 800. Both instruments showed good linearity for all parameters, except for RBC and HCT on DxH 800. CONCLUSION: With the exception of the measurement of neutrophils on DxH 800 and RBC by the impedance technique on the XN-350, routine hematology parameters in HPC-A can safely be determined using automated cell counters.

Remote peripheral tissue oxygenation does not predict postoperative free flap complications in complex head and neck cancer surgery: A prospective cohort study.

BACKGROUND: Patients undergoing free flap reconstruction after head and neck cancer may develop free flap complications. In the perioperative period, haemoglobin content and oxygen tissue saturation (StO2) measured directly on the free flap reflect peripheral tissue oxygenation. However, in this type of surgery, StO2 cannot always be applied directly or proximate to the free flap. The aim of this study was to assess the possible value of StO2 measured at the thenar eminence and other 24hour perioperative factors on free flap complications. METHODS: Inclusion criteria corresponded to patients with head and neck cancer with free flap surgery in whom direct StO2 could not be monitored on the flap nor in its peripheral area. Patient characteristics and intraoperative data, such as haemoglobin and fluid management, were prospectively collected. StO2 was measured remotely on the thenar eminence. Data were collected for 24hours and free flap complications were recorded for up to 15days after surgery. Patients were thereafter classified into two groups: with or without free flap complications and the data were compared in consequence. RESULTS: Forty consecutive patients were prospectively included. Ten patients had postoperative free flap complications and were compared to the 30 other patients without complications. The haemoglobin level at the reperfusion of the flap: (AUC 0.80 [0.65-0.91], threshold 9.9g/dL, P<0.001) and body mass index [BMI] (AUC 0.80 [0.64-0.72], threshold 24.5kg/m2, P<0.01) were significantly related to complications. CONCLUSION: In head and neck complex oncologic reconstructive surgery, haemoglobin and BMI were the most sensitive tools for predicting postoperative free flap complications, while thenar eminence StO2 was not.