Abstract 158: Red Blood Cell Indices and Coronary Calcification in Patients Without a History of Coronary Artery Disease

Red Blood Cell Indices and Development of Hospital-Acquired Anemia During Acute Myocardial Infarction

Objective: To explore the predictive values of routine blood test results for iron deficiency (ID) screening in children. Methods: Routine blood test results and serum ferritin (SF) levels from 1 443 healthy children (862 boys, 581 girls) aged 6 months to 18 years, who were seen for well-child visits between June 2017 and May 2019 in Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. ID was defined as SF<20 μg/L, iron deficiency anemia (IDA) as ID with anemia (hemoglobin(Hb)<110 g/L at 6 months-5 years of age, Hb<120 g/L at 6-18 years of age), non-anemia ID as ID without anemia, non-ID anemia as SF≥20 μg/L with anemia, and healthy control subjects as those with SF≥20 μg/L but without anemia. The blood test results including Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), and the percentage of low hemoglobin density (LHD) of healthy control, non-anemia ID, non-ID anemia, and IDA groups were compared by analysis of variance (ANOVA) or non-parametric test, quantitative data were described as x±s or M(interquartile range), and receiver operating characteristic curve (ROC) analysis was applied to assess predictive values of routine blood test results and LHD for detecting IDA and ID. Results: Among 1 443 children with median age of 2.1(3.3) years, 1 061 children were in healthy control group, 292 in non-anemia ID group, 43 in non-ID anemia group and 47 in IDA group. The prevalence of ID was much higher than that of anemia (23.5% (339/1 443) vs. 6.2% (90/1 443) , χ(2)=169.76, P<0.01). Compared with control group, non-anemia ID group showed higher LHD (0.088 (0.093) vs.0.073 (0.068), P<0.01) and RDW (0.131±0.013 vs. 0.126±0.008, P<0.01), lower MCV ((80±4) vs. (83±4) fl, P<0.01) and MCHC values ((326±9) vs. (329±8) g/L, P<0.01). IDA group showed higher LHD (0.322(0.544)) and RDW (0.151±0.018), lower MCV ((73±6) fl) and MCHC values((309±14) g/L) than non-anemia ID group (all P<0.01). The area under curve (AUC) values of MCHC, LHD, RDW and MCV for detecting ID were 0.63 (95%CI: 0.60-0.67), 0.63 (95%CI:0.60-0.67), 0.67 (95%CI: 0.63-0.70) and 0.73 (95%CI: 0.69-0.76) respectively. With cutoff limits (MCV<80.2 fl, RDW>0.131 or MCHC<322 g/L), MCV, RDW and MCHC showed higher sensitivity for screening ID than hemoglobin (0.540, 0.469 and 0.336 vs. 0.139, χ(2)=121.70, 87.47, 35.56, all P<0.01). Conclusion: MCV, RDW and MCHC can be used to screen ID in primary health care settings.

Quantitative data on red cell measures of iron status and their relation to the magnitude of the systemic inflammatory response and survival in patients with colorectal cancer

BackgroundRed cell distribution width (RDW), one of many routinely examined parameters, shows the heterogeneity in erythrocyte size. We investigated the association of RDW levels with clinical parameters and prognosis of lung cancer patients.MethodsClinical and laboratory data from 332 patients with lung cancer in a single institution were retrospectively studied by univariate analysis. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.ResultsThe RDW levels were divided into two groups: high RDW (>=15%), n=73 vs. low RDW, n=259 (<15%). Univariate analysis showed that there were significant associations of high RDW values with cancer stage, performance status, presence of other disease, white blood cell count, hemoglobin, mean corpuscular volume, platelet count, albumin level, C-reactive protein level, and cytokeratin 19 fragment level. Kruskal-Wallis tests revealed an association of RDW values with cancer stage in patients irrespective of comorbidity (patient with/without comorbidity: p<0.0001, patient without comorbidity: p<0.0001). Stages I-IV lung cancer patients with higher RDW values had poorer prognoses than those with lower RDW values (Wilcoxon test: p=0.002). In particular, the survival rates of stage I and II patients (n=141) were lower in the high RDW group (n=19) than in the low RDW group (n=122) (Wilcoxon test: p<0.001). Moreover, multivariate analysis showed higher RDW is a significant prognostic factor (p=0.040).ConclusionRDW is associated with several factors that reflect inflammation and malnutrition in lung cancer patients. Moreover, high levels of RDW are associated with poor survival. RDW might be used as a new and convenient marker to determine a patient’s general condition and to predict the mortality risk of lung cancer patients.

Introduction: Blood transfusion services form an essential component of any healthcare system and it is imperative to provide adequate and safe blood for management of patients. Voluntary blood donors form the backbone of this service. However, regular donation by such voluntary donors may cause significant depletion of iron stores in the body. This has the potential to adversely affect the donor’s health, and also to lower the quality of blood being collected subsequently. The temporary deferral of such donors also causes reluctance to return for future blood donations, leading to decrease in size of the donor pool. The prompt detection of subclinical iron deficiency in voluntary blood donors is the need of the hour. Aim: To compare and analyse the difference in red cell parameters of first-time and repeat blood donors. Materials and Methods: A descriptive study was conducted by the Department of Blood Bank and Pathology at Rajarshi Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh, India, from July 2021 to December 2022. After prospective donors were assessed for suitability of blood donation, written informed consent was obtained, and 5 mL venous blood was collected into an Ethylenediaminetetraacetic Acid (EDTA)- anticoagulated vial via the antecubital fossa. Complete blood count was performed within one hour of collection using an automated haematology analyser. The parameters analysed in the study were Red Blood Cell (RBC) count, haemoglobin, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), and Red cell Distribution Width (RDW). The generated data was compiled and statistical analysis, with Kruskal-Wallis test (at a p-value of 0.05) and post-hoc Dunn test was performed to determine the significant differences, if any. Results: The study included 455 participants, out of which 210 were repeat blood donors. The significant differences for MCV, MCH and RDW between groups defined by number of donations (p-value &lt;0.001) was observed. The difference was most significant between the donors having five or more donations compared to donors having no previous donations. No significant differences were observed for other parameters, with p-values for RBC count, haemoglobin, and MCHC being 0.3, 0.07, and 0.09, respectively. Conclusion: Repeat blood donors having low MCV and MCH along with high RDW, with haemoglobin values within normal range, are most susceptible to having subclinical iron deficiency, which needs to be identified and managed pre-emptively, before development of Iron Deficiency Anaemia (IDA). This is necessary in order to retain regular and repeat voluntary blood donors, and also to ensure adequate quality of collected blood.

Background and objective Anemia, particularly iron deficiency anemia (IDA), presents a significant global health challenge, particularly among children under the age of five years in developing nations. Concurrently, febrile convulsions (FC) affect up to 5% of neurologically healthy children aged 6-60 months, causing considerable distress among parents. There is a suggested correlation between fever and iron deficiency, which may exacerbate neurological risks, potentially lowering seizure thresholds and increasing the risk of FC. However, studies investigating the relationship between IDA and FC have shown conflicting results. In light of this, this study aimed to explore this relationship among children aged 6-60 months in Eastern India, an area where this association has yet to be thoroughly investigated. Materials and methods Thecase-controlstudy included children aged 6-60 months. The cases consisted of children presenting with FC, while controls comprised children in the same age group presenting with febrile illness but without seizures. Informed consent was obtained, a detailed history was taken, and clinical examinations were conducted for both groups. Blood investigations were performed to diagnose IDA according to WHO criteria: hemoglobin <11 gm/dl with the classical triad of low mean corpuscular volume (MCV), low mean corpuscular hemoglobin (MCH), and low mean corpuscular hemoglobin concentration (MCHC) for age. Data analysis was performed using the R-based software Jamovi 2.4.8. with appropriate statistical tests. Results We included 81 cases and 80 controls. The study found a statistically significant association between IDA and FC with an odds ratio (OR) of 2.25 [95% confidence interval (CI): 1.03-4.91; p=0.039]. Additionally, the study revealed that hemoglobin levels, MCH, MCV, and MCHCwere lower among cases compared to controls, while the red cell distribution width (RDW) washigher. Both these findings regarding RBC indices were statistically significant(p<0.05). Conclusions Our findings indicate a statistically significant association between IDA and FC among children under five years of age. Implementing measures to prevent IDA and strengthening existing strategies may help alleviate the burden of FC in this vulnerable population.

Objective: Iron deficiency anaemia (IDA) is often associated with congenital heart defect (CHD) in children, especially in developing world. Often it remains undiagnosed due to the unaffordability to do costly tests like serum ferritin. We have done this study to know whether simple test like complete hemogram is sufficient to diagnose IDA in a child with CHD.Materials and Methods: This hospital based observational study was done for a period of one and half year in paediatric ward of a district medical college of eastern India in children up to the age of 12 years with echocardiography confirmed CHD. Blood sample were tested for serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin and hemoglobin concentration (MCH,MCHC) and red cell distribution width (RDW) to diagnose IDA.Results : We found IDA in 46 children out of total 100 CHD cases based on serum ferritin level. Out of 46 IDA children, 40 children (87%) had low MCV, 39 children(84.8%) had low MCH, 33 children (71.7%) had low MCHC, 41 children (89.1%) had high RDW and 37children(80.4%) having microcytic hypochromic picture. In logistic regression analysis we found RDW as the independent predictor of IDA.

Background: red cell distribution width is a marker associated with increased mortality and morbidity in cardiac patients, however it’s relation with coronary artery calcium score (CACS) is not well studied yet. Aim of the work: this study aimed to assess the relation between red cell distribution width (RDW) and coronary artery calcium score (CACS) in the diabetic patients undergoing coronary CT angiography. Patients and methods: this study was conducted on 60 patients presented for assessment of coronary artery disease (CAD) by coronary CT angiography and they were categorized into 2 groups, group (A) diabetics(30 patients),group(B)non-diabetics (30 patients), All patients included in this study were subjected to: History Taking, complete physical examination, multi-slice CT coronary angiography (MSCT) including calcium score(CACS), laboratory investigations including complete blood count (CBC) including RDW(SD&CV), serum calcium level(total and ionized), erythrocyte sedimentation rate (ESR), lipid profile. Results: higher RDW(SD) was associated with the presence of greater coronary complexity of CAD and higher calcium score. In our study total serum calcium and RDW (SD) were found to be independent predictors of high Ca score more than 100, while ionized calcium and systolic blood pressure(SBP) were independent predictors of high Calcium score more than 400. Cut off value of RDW to predict high calcium score (more than 100) was RDW(CV) more than 13.45 & RDW(SD) more than44.45, while Cut off value of RDW to predict high calcium score (more than 400) was RDW(SD) more than 45.1. Conclusions: a greater baseline RDW(SD) value was independently associated with the presence of a greater coronary complexity of CAD and higher calcium score.

Anisocytosis Predicts Worse Survival in Secondary Polycythemia

This study aims to explore the diagnostic and differential values of thalassemia genotypes using combined complete blood count (CBC) and reticulocyte parameter analysis in neonates, considering physiological age-related hematological changes. A retrospective study was conducted from October 2023 to March 2024 involving 315 neonates in the Huangshi area who underwent thalassemia gene detection, CBC, and reticulocyte analysis. Participants were categorized into a control group (n = 83), α-thalassemia group (n = 177), and β-thalassemia group (n = 55). Further subgrouping was based on genotype severity and age (≤28 days and >28 days). A comparative analysis of hematological parameters was performed, and logistic regression models were developed to predict and differentiate thalassemia types. In both age strata, the α-thalassemia group exhibited significantly higher red blood cell (RBC) counts but lower mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) compared to control and β-thalassemia groups (P < 0.05). The β-thalassemia group showed significantly higher red cell distribution width (RDW) than the other groups (P < 0.05). Reticulocyte parameters also showed distinct patterns: the α-thalassemia group had lower reticulocyte counts (RET#), while the β-thalassemia group had a higher immature reticulocyte fraction (IRF). A logistic regression model combining RBC, MCHC, RET#, and IRF to differentiate α- from β-thalassemia achieved an area under the curve (AUC) of 0.879, with a sensitivity of 72.7% and specificity of 89.2%. The combined models generally outperformed single-parameter analyses. Hematological parameters like MCV, MCH, and RDW are effective initial screening indicators for neonatal thalassemia. Integrating reticulocyte analysis with routine CBC enhances screening accuracy and aids in the differential diagnosis of α- and β-thalassemia. This combined, age-stratified approach is valuable for improving early detection and management strategies.

RED CELL DISTRIBUTION WIDTH CORRELATES WITH NT-PROBNP IN PULMONARY HYPERTENSION

ObjectiveEndometriosis is the presence of endometrial tissue outside of the uterine cavity. Certain markers have been used to evaluate the severity of endometriosis. This study aimed to explore the correlation between red blood cell (RBC) indices and the severity of endometriosis.MethodsThis was a cross-sectional study including 200 patients with endometriosis (stage I–II and stage III–IV groups) and 100 patients with other benign ovarian tumors who underwent laparotomy at the Department of Obstetrics and Gynaecology, Margono Regional Public Hospital, between 2021 and 2024. Blood tests were evaluated before surgery and the severity of endometriosis was determined during surgery using the revised American Society for Reproductive Medicine classification.ResultsAmong the obtained RBC indices, mean hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) values were significantly lower in subjects with stage III–IV endometriosis than in those with stage I–II endometriosis and the control group (P=0.000, P=0.000, P=0.006, and P=0.010, respectively). The mean red cell distribution width (RDW) was significantly higher in the stage III–IV group than in the stage I–II and control groups (P=0.000). In addition, univariate analysis indicated that lower preoperative RBC indices (Hb ≤11.9 g/dL, Hct ≤37.1%, MCV ≤82.6 fL, MCH ≤26.6 pg) and higher RDW ≥14.9% were independent risk factors for stage III/IV endometriosis.ConclusionLower RBC indices, including pre-operative Hb, Hct, MCV, and MCH, were significantly associated with the severity of endometriosis, which is potentially caused by dysregulation of iron metabolism and inflammation.

BackgroundHematological abnormalities are common features in falciparum malaria but vary among different populations across countries. Therefore, we compared hematological indices and abnormalities between Plasmodium falciparum-infected patients and malaria-negative subjects in Kosti city of the White Nile State, Sudan.MethodsA comparative, cross-sectional study was conducted at the Clinical Laboratory Unit of Kosti Teaching Hospital from June to December 2018. A total of 392 participants (192 P. falciparum-infected patients and 200 malaria-negative subjects) were recruited in the study. Hematological indices of hemoglobin (Hb), red blood cells (RBCs), white blood cells (WBCs) and platelets were measured, and their median values were statistically compared.ResultsThe majority of P. falciparum-infected patients (67.6%) showed a low-level parasitemia. The median values of Hb concentration, RBC count, mean corpuscular volume (MCV), mean corpuscular Hb (MCH) and mean corpuscular Hb concentration (MCHC) were significantly lower in P. falciparum-infected patients, while the median red cell distribution width (RDW) was significantly higher in the patients compared to malaria-negative subjects. Anemia, low MCV, low MCH, low MCHC and high RDW were significantly associated with falciparum malaria, but parasitemia level was not significantly associated with anemia severity. The median total WBC count was non-significantly higher in P. falciparum-infected patients, with neutropenia being significantly associated with falciparum malaria. The median platelet count was significantly lower in P. falciparum-infected patients, with thrombocytopenia being significantly associated with falciparum malaria.ConclusionsFalciparum malaria among patients in Kosti city of the White Nile State, Sudan is predominantly of low-level parasitemia. It is significantly associated with anemia, low MCV, low MCH, low MCHC, high RDW, thrombocytopenia and neutropenia. However, parasitemia level is not a significant predictor of anemia severity. On the other hand, leucopenia is not useful to predict falciparum malaria. Further large-scale studies in community and healthcare settings and inclusion of patients with complicated or severe malaria and those with high parasite densities are recommended.

Objective: It was aimed to examine the relationship of complete blood count values with recurrent miscarriage.Method: We carried out a case-control study of patients who had recurrent miscarriage between 2010-2018. Data were collected from 50 patients who were meeting the case group inclusion criteria, and age-matched healthy control group with at least one live birth who consisted of 60 women. Red blood cell (RBC), hemoglobin (HB), hematocrit (HTC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), red cell distribution width (RDW) and plateletcrit count (PCT) were examined by complete blood count. SPSS 20.0.0 software was used for statistical analysis. P values &amp;lt;0.05 were regarded as statistically significant.Results: The mean age of the case group was 29.8±5.8 years, and the mean age of the control group was 28.7±5.2 years (p&amp;gt;0,05). MPV and RDW values and PCT calculations were significantly higher than healthy control group (p&amp;lt;0.05). MCHC levels of case group were lower than control group (p&amp;lt;0.05). There were no significant differences between the case and control groups in terms of RBC, HB, HCT, MCV, MCH, PLT, and PDW (p&amp;gt;0.05). Conclusion: Complete blood count parameters such as high MPV, RDW, PCT, and low MCHC could be considered as an important predictor of recurrent miscarriage. Our findings should be supported by further prospective studies involving a larger number of patients in order to clarify the relationship between these blood cell function markers and recurrent miscarriage.

Objective To investigate the association of red cell distribution width (RDW) with all-cause and cardiovascular disease (CVD)-related mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A retrospective analysis was performed on 207 patients who initiated CAPD for more than 3 months between July 2005 and March 2016 in the First Hospital Affiliated to Zhengzhou University. Baseline data on demographic, clinical and biochemical variables as well as comorbidities were obtained; medications and clinic outcomes were recorded. According to receiver operator characteristic curve (ROC) analysis, patients were divided into high RDW (RDW>15.1%) and low RDW (RDW≤15.1%) groups. The data of two groups were compared and Spearman's correlation analysis was used to explore the association of RDW with clinical and biochemical parameters. Survival curves were calculated using Kaplan-Meier method. Cox regression model was employed to analyze risk factors of all-cause and CVD-related mortality. Results In this study, 207 CAPD patients were enrolled. The overall median survival time was 80 months. And the median survival time of high RDW group (68 patients) and low RDW group (139 patients) were 59 months and 96 months, respectively. There were statistical differences in diastole pressure, hemoglobin, hematocrit, serum albumin, intact parathyroid hormone (iPTH), eGFR, cholesterol, lipoprotein a, 4-hour dialysate-to-plasma ratio for creatinine (4hD/Pcr), total Ccr (P<0.05, respectively); the two groups also varied in the proportion of chronic obstructive pulmonary disease, cardiovascular disease and hyperlipidemia, as well as in the use of iron supplements, angiotensin-converting enzyme (ACE) inhibitors or angiotensin Ⅱ receptor blockers (ARB), and beta-receptor blockers (P<0.05, respectively). Cardiovascular event was a leading cause of mortality. Kaplan-Meier survival curves showed that the high RDW group had higher all-cause and CVD-related mortality compared with the low RDW group (P<0.01). The 1-year, 3-year, and 5-year patient survivals of the high RDW and low RDW group were 87.97% vs 97.01%, 58.02% vs 81.53%, and 41.62% vs 67.96%, respectively, demonstrating significant differences (P=0.001). Multivariate Cox regression analysis showed that high RDW was independent risk factor for all-cause mortality (HR=1.212, 95%CI: 1.007-1.458, P=0.042) and CVD-related mortality (HR=1.697, 95%CI:1.030-2.795, P=0.038). Conclusion RDW is associated with mortality risks in CAPD patients and can be stratified as a valuable indicator for the risk of death. Key words: Peritoneal dialysis; Erythrocyte indices; Mortality; Cardiovascular disease