Hemogram in cattle

Resolution of refractory generalized granuloma annulare after treatment with alitretinoin

The aim of this review is to assist non-hematologist effective means of interpreting complete blood cell (CBC) counts results especially when encountered with abnormal result for intellectually rewarding practice and to recognize when a subspecialty consultation is reasonable and when it may be circumvented. A complete blood cell count is routine hematology tests in medicine useful for the differential diagnosis of anemia and other medical conditions. A good percentage of CBC results are reported as abnormal, therefore it is in every clinician’s interest to have some understanding of the specific test basics as well as a structured action plan when confronted with abnormal results. It is a series of tests used to evaluate the composition and concentration of the cellular components of blood, which consists: red blood cell (RBC) counts, red cell indices, hematocrit, hemoglobin concentration, white blood cell (WBC) count, classification of white blood cells (WBC differential) and platelet count. CBC provides valuable information about the blood and to some extent the bone marrow, which is the blood-forming tissue. CBC can be use for the following purposes: as a preoperative test to ensure both adequate oxygen carrying capacity and hemostasis, to identify acute and chronic illness, bleeding tendencies, and white blood cell disorders such as leukemia, to monitor a medical condition and changes in the body system caused by medical treatments, to determine the effects of chemotherapy and radiation therapy on blood cell production. CBC can be performed manually using visual examination or automation by fluorescence flow cytometry and impedance. In conclusion, CBC and peripheral blood examination are one of the most commonly ordered tests that provides important information about the kinds and numbers of cells in the blood, abnormalities in any of these types of blood cells may indicate the presence of important medical disorders.

Dermatologic Manifestations of Systemic Diseases in Childhood

Small affordable automated hematology analyzers that produce rapid and accurate complete blood cell counts are a valuable tool to researchers developing blood-handling medical devices, such as ventricular assist devices, for in vitro safety assessments. In such studies, it is common to use the blood of large animals such as cattle and sheep. However, the commercially available instruments have not been evaluated for their ability to measure the blood counts of these animals. In this study, we compare, for the first time, four veterinary analyzers for blood counts on bovine and ovine blood samples. We look at ease of use, repeatability and agreement with a view to inform researchers of the benefits of these instruments in routine measurement of ovine and bovine bloods during in vitro testing. Complete blood cell counts and a three-part differential (granulocytes, monocytes, and lymphocytes) were measured by each of the instruments, and the results compared to those obtained from two additional analyzers used in a reference laboratory. Repeatability and agreement were evaluated using the Bland-Altman method; bias and 95% limits of agreement between the instruments, and between the instruments and two reference instruments, were used to evaluate instrument performance. In summary, there are advantages and disadvantages with all instruments. Of the four instruments tested, the repeatability and agreement was fairly similar for all instruments except one instrument which cannot be recommended for bovine or ovine blood counts.

Reactive granulomatous dermatitis: A useful and encompassing term

Background: Cystoisospora spp. is considered a potential pathogen to cause diarrhoea in cats, and the disease occurs clinically, especially in young, weak and immunocompromised cats. The present study aimed to evaluate the clinical utility and diagnostic roles of neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte (MLR) ratios in diarrheal cats infected with Cystoisospora spp. Materials, Methods & Results: Twenty-five cats with diarrhea due to infection caused by Cystoisospora spp. and 15 healthy cats were included in this study. The anamnesis, clinical and laboratory findings of all cats were recorded. A clinical severity score was generated for diarrheal cats, which included activity, appetite, presence of vomit, and faecal consistency. Also, cats infected with Cystoisospora spp. were classified as systemic inflammatory response syndrome (SIRS) positive (+) and SIRS (-) group according to the presence of at least 3 of the SIRS criteria. The Cystoisospora spp. oocysts were diagnosed by direct smear and simple faecal flotation. Cats found positive for other parasitic and protozoal agents by faeces examination were excluded from the study. Complete blood counts (CBC) were performed with an automated blood cell counter for all cats. Blood smears were prepared (with May-Grunwald Giemsa) from samples, and the CBC results were confirmed microscopically (objective100x). White blood cell (WBC), neutrophil, lymphocyte and monocyte counts were recorded directly from the CBC. The neutrophil-to-lymphocyte ratio was calculated as the ratio of the absolute neutrophil count to the absolute lymphocyte count. The monocyte-to-lymphocyte was calculated as the absolute monocyte count ratio to the absolute lymphocyte count. White blood cell (P = 0.015), neutrophil (P = 0.001), monocyte (P = 0.033), NLR (P = 0.000) and MLR (P = 0.042) of diarrheal cats infected with Cystoisospora spp. were significantly higher than in the healthy group. There was no significant difference between groups in the lymphocyte counts (P > 0.05). SIRS (+) group had statistically significantly higher WBC (P = 0.014), neutrophil counts (P = 0.000), NLR (P = 0.000) and MLR (P = 0.037) than the healthy group. Also, neutrophil counts and NLR of the SIRS (+) group were statistically significantly higher than the SIRS (-) group (P = 0.032; P = 0.001, respectively). However, there was no significant difference SIRS (+), SIRS (-), and healthy groups regarding lymphocyte and monocyte counts (P > 0.05). The clinical severity of the disease positively correlated with NLR and MLR. Also, the best cut-off value of NLR to predict SIRS was > 1.67, with 92.86 % sensitivity and 84.62 % specificity. MLR was not a useful predictor for SIRS. Discussion: NLR and MLR are parameters derived from complete blood count. In recent years, they have been used in human and veterinary medicine as a biomarker in the diagnosis, prognosis and treatment follow-up of various diseases and provide valuable information about inflammation. In cats, there are limited studies on NLR, and to our knowledge, there are no studies on MLR. The current study suggests that NLR and MLR may be used to determine the severity of the inflammatory condition in diarrheal cats infected with Cystoisospora spp., and NLR is a useful marker for predicting SIRS status in these cats. In addition, this study also will contribute to larger-scale studies in the future. Keywords: cats, complete blood count, Cystoisospora, diarrhoea, NLR, MLR, SIRS.

Papa Giovanni XXIII Bergamo Hospital at the time of the COVID-19 outbreak: Letter from the warfront….

Delayed hematological analysis occurs frequently in bovine practice. Interpretation of complete blood count (CBC) results may be affected by artifactual storage-associated changes. The objective of this study was to characterize changes in bovine CBC results that occur over 72 h of storage at room temperature (RT) and 4 °C. Blood samples from 10 clinically healthy Holstein cows were analyzed with the ADVIA 120 hematology analyzer at 0, 24, 48, and 72 h of storage at RT or 4 °C. A two-way repeated-measure ANOVA was used to analyze time and temperature main effects. Time-associated changes in red blood cell (RBC) results were a significant increase in mean corpuscular volume (MCV) (both temperatures) and hematocrit (RT) and a decrease in mean corpuscular hemoglobin concentration (RT). White blood cell counts were relatively stable; however, automated absolute concentrations of monocytes and large unstained cells decreased, whereas concentrations of lymphocytes and eosinophils (RT) increased, over time. There was a statistically significant increase in mean platelet volume (MPV) by 48 h of storage at both temperatures. Changes with storage were more pronounced at RT. Mean CBC results, with the exception of MPV, did not exceed reference intervals. With storage, bovine RBCs become macrocytic and hypochromic, variable changes occur in the automated differential cell count, and the MPV increases. However, most changes, with the exception of MCV, are of little diagnostic relevance. For the most accurate CBC results, bovine blood should be stored at 4 °C and analyzed within 24 h of collection.

The common complications in heart failure patients with implanted ventricular assist devices (VADs) include hemolysis, thrombosis, and bleeding. These are linked to shear stress-induced trauma to erythrocytes, platelets, and von Willebrand factor (vWF). Novel device designs are being developed to reduce the blood trauma, which will need to undergo in vitro and in vivo preclinical testing in large animal models such as cattle, sheep, and pig. To fully understand the impact of device design and enable translation of preclinical results, it is important to identify any potential species-specific differences in the VAD-associated common complications. Therefore, the purpose of this study was to evaluate the effects of shear stress on cells and proteins in bovine, ovine, and porcine blood compared to human. Blood from different species was subjected to various shear rates (0-8000/s) using a rheometer. It was then analyzed for complete blood counts, hemolysis by the Harboe assay, platelet activation by flow cytometry, vWF structure by immunoblotting, and function by collagen binding activity ELISA (vWF:CBA). Overall, increasing shear rate caused increased total blood trauma in all tested species. This analysis revealed species-specific differences in shear-induced hemolysis, platelet activation, and vWF structure and function. Compared to human blood, porcine blood was the most resilient and showed less hemolysis, similar blood counts, but less platelet activation and less vWF damage in response to shear. Compared to human blood, sheared bovine blood showed less hemolysis, similar blood cell counts, greater platelet activation, and similar degradation of vWF structure, but less impact on its activity in response to shear. The shear-induced effect on ovine blood depended on whether the blood was collected via gravity at the abattoir or by venepuncture from live sheep. Overall, ovine abattoir blood was the least resilient in response to shear and bovine blood was the most similar to human blood. These results lay the foundations for developing blood trauma evaluation standards to enable the extrapolation of in vitro and in vivo animal data to predict safety and biocompatibility of blood-handling medical devices in humans. We advise using ovine venepuncture blood instead of ovine abattoir blood due to the greater overall damage in the latter. We propose using bovine blood for total blood damage in vitro device evaluation but multiple species could be used to create a full understanding of the complication risk profile of new devices. Further, this study highlights that choice of antibody clone for evaluating platelet activation in bovine blood can influence the interpretation of results from different studies.

Routine Monitoring of Liver, Renal, and Hematologic Tests After Single- or Double-Dose Methotrexate Treatment for Ectopic Pregnancies After In Vitro Fertilization.

We have developed a rotational speed (RS) modulation system for a continuous-flow left ventricular assist device (EVAHEART) that can change RS in synchronization with a patient's electrocardiogram. Although EVAHEART is considered not to cause significant acquired von Willebrand syndrome, there remains a concern that the repeated acceleration and deceleration of the impeller may degrade von Willebrand factor (vWF) multimers. Accordingly, we evaluated the influence of our RS modulation system on vWF dynamics. A simple mock circulation was used. The circulation was filled with whole bovine blood (650 mL), and the temperature was maintained at 37 ± 1°C. EVAHEART was operated using the electrocardiogram-synchronized RS modulation system with an RS variance of 500 rpm and a pulse frequency of 60 bpm (EVA-RSM; n = 4). The pumps were operated at a mean flow rate of 5.0 ± 0.2 L/min against a mean pressure head of 100 ± 3 mm Hg. The continuous-flow mode of EVAHEART (EVA-C; n = 4) and ROTAFLOW (ROTA; n = 4) was used as controls. Whole blood samples were collected at baseline and every 60 min for 6 h. Complete blood counts (CBCs), normalized indexes of hemolysis (NIH), vWF antigen (vWF:Ag), vWF ristocetin cofactor (vWF:Rco), the ratio of vWF:Rco to vWF:Ag (Rco/Ag), and high molecular weight multimers (HMWM) of vWF were evaluated. There were no significant changes in CBCs throughout the 6-h test period in any group. NIH levels of EVA-RSM, EVA-C, and ROTA were 0.0035 ± 0.0018, 0.0031 ± 0.0007, and 0.0022 ± 0.0011 g/100 L, respectively. Levels of vWF:Ag, vWF:Rco, and Rco/Ag did not change significantly during the test. Immunoblotting analysis of vWF multimers showed slight degradation of HMWM in all groups, but there were no significant differences between groups in the ratios of HMWM to low molecular weight multimers, calculated by densitometry. This study suggests that our RS modulation system used with EVAHEART does not have marked adverse influences on vWF dynamics. The low NIH and the absence of significant decreases in CBCs indicate that EVAHEART is hemocompatible, regardless of whether it is operated with the RS modulation system.

Background: Several laboratory markers derived from a complete blood count (CBC) have been proposed as potential indicators for assessing the risk of cerebral venous thrombosis (CVT). However, limited and conflicting evidence exists regarding this association. This study aimed to evaluate the role of CBC parameters in CVT development and their link to disease characteristics. Methods: This case-control study included patients diagnosed with CVT between March 2018 and March 2021. All participants with CVT were registered in the organized registry system at the Neurology Research Center of Shiraz University of Medical Sciences, Shiraz, Iran (CVT registry code: 9001013381). The control group consisted of age- and sex-matched individuals without systemic diseases. CBC results from the control group and the first recorded hospital CBC of the patient group were collected. Results: The study included 295 patients with CVT [49 with idiopathic CVT (iCVT) and 246 with secondary CVT (sCVT)] and 341 healthy individuals. Among the CVT group, 72.54% were women. Patients with CVT had higher red cell distribution width (RDW) and lower red blood cell (RBC) count, hemoglobin (Hb) levels, and hematocrit compared to the non-CVT group. In iCVT cases, male gender, RBC count, Hb levels, and hematocrit were notably higher compared to sCVT cases. Logistic regression analysis showed that female gender, smoking, and higher hematocrit values were associated with increased probability of iCVT. Conclusion: The study suggests that certain CBC parameters may serve as potential markers for assessing CVT risk and differentiating between iCVT and sCVT cases. Validation and further research are needed to explore the underlying mechanisms.

The Complete Blood Count (CBC) remains one of the most frequently ordered laboratory tests in clinical practice, providing essential diagnostic information about hematologic disorders, infections, and systemic diseases. This paper presents a comprehensive review of CBC interpretation and analysis, focusing on the technical aspects, clinical significance, and quality assurance measures essential for medical laboratory professionals. The study examines the various components of CBC including red blood cell parameters, white blood cell differential, and platelet indices, along with their clinical correlations. Quality control measures, pre-analytical variables, and post-analytical considerations are discussed to ensure accurate and reliable results. Case studies demonstrate practical applications of CBC interpretation in diagnosing anemia, leukocytosis, and thrombocytopenia. The paper emphasizes the importance of correlating automated results with morphological findings and clinical presentation. Current technological advances in hematology analyzers and their impact on CBC analysis are also addressed. This review serves as a comprehensive resource for medical laboratory technicians and specialists in understanding the complexities of CBC interpretation and its clinical applications.

Apparent Life-Threatening Events

Diagnosis of hereditary spherocytosis in the neonate is difficult. Differences in neonatal erythropoiesis, properties of neonatal erythrocytes, and both clinical and laboratory presentation contribute to complexity in diagnosis. Numerous algorithms to aid in diagnosis of neonatal hereditary spherocytosis (HS) have been developed. One of these, the HS index, the mean corpuscular hemoglobin concentration (MCHC)/mean corpuscular volume (MCV) ratio, revealed an index >0.36 was 97% sensitive and >99% specific in diagnosis of dominantly inherited HS in the neonate.1In this issue of Pediatrics, Weiss et al examine the utility of the HS index in a diverse population of neonates using data extracted from 15 Kaiser Permanente Hospitals in northern California.2 The rationale for this study was to compare results to the original HS index study, which was performed in a primarily white population, and secondarily to determine if the index discriminates with serum bilirubin levels.Study eligibility was determined by having had a complete blood cell count (CBC) drawn in the first 7 days of life. This CBC was used to calculate the HS index, as opposed to the original study that included all CBCs on HS infants drawn in the first 90 days of life.1 HS infants were identified by International Classification of Diseases, Ninth Revision and 10th Revision codes. Charts of infants who had osmotic fragility, ektacytometry, or eosin-5'-maleimide (EMA) testing performed were also reviewed. Ektacytometry, only available in specialized laboratories, enables diagnosis of various red cell disorders including HS by measuring erythrocyte deformability as a continuous function of osmolality using a laser-diffraction viscometer. EMA is a flow cytometry–based test that measures binding of fluorescently labeled dye to band 3 and other erythrocyte membrane proteins, providing information on membrane protein deficiency as occurs in HS. Total serum bilirubin levels were obtained in the first 30 days of life.HS prevalence was higher in white and “other” race and/or ethnicities and, not surprisingly, in patients with increased total serum bilirubin levels. HS risk was higher in infants needing phototherapy, requiring readmission for phototherapy, total serum bilirubin levels crossing exchange transfusion threshold, and requiring an exchange transfusion or a red blood cell transfusion in the first month of life. Dichotomized at 0.36, the HS index was 56% sensitive and 93% specific.Why is HS so difficult to diagnose in the neonate? In older children and adults, diagnosing HS is straightforward with positive family history, splenomegaly, icterus, anemia, reticulocytosis, elevated MCHC, and spherocytosis. However, in neonates, a high index of suspicion is required as presentation is different. Up to a third of HS patients exhibit nondominant inheritance and these often present in the neonatal period.3 Neonates with recessively inherited HS due to α-spectrin defects typically present with marked hemolytic anemia.4 Patients with HS with de novo mutations, 21% of cases in a recent survey,5 often present in the neonatal history without associated family history. This is primarily due to spontaneous mutations in ankyrin and β spectrin, both encoded by large genes with high CpG content, a finding often associated with high de novo mutation rates.6 CpG dinucleotides are sites in DNA where a cytosine nucleotide is followed by a guanine nucleotide that may undergo methylation followed by spontaneous deamination, resulting in a cytosine-to-thymine mutation.Jaundice is the most common finding in neonates with HS, often requiring phototherapy and sometimes exchange transfusion. Compared with older children and adults, splenomegaly is uncommon.7 Anemia is present in slightly less than half of neonates with HS, often not occurring until the first few weeks of life, but then at a degree of severity necessitating transfusion.8 When present, there is reticulocytopenia relative to the degree of anemia attributed to the relatively low erythropoietic response observed in neonates.8 In some cases, spherocytes are not present on peripheral blood smear. Elevated MCHC is often found in neonates with HS, whereas reported neonatal MCV values have been inconsistent.Other commonly used HS diagnostic tools (osmotic fragility, ektacytometry, and EMA) all have pitfalls when used in the neonate. Osmotic fragility suffers from lack of specificity, clearly seen in the neonate where an abnormal test cannot discriminate the spherocytes of HS from the spherocytes seen in ABO incompatibility. Also, because of the increased osmotic fragility of neonatal erythrocytes, it is recommended neonatal osmotic fragility curves be used rather than adult curves.9 Similarly, using neonatal samples as normal controls has been considered for ektacytometry and EMA testing because both exhibit different patterns than adult erythrocytes commonly used as controls.10 Diagnostic gene panels continue to gain in popularity, and many clinicians use them as their “go-to” diagnostic test, especially when there are impediments to obtaining osmotic fragility, ektacytometry, or EMA binding testing.11 Although gene panels have limitations such as difficulty in interpretation of variants of uncertain significance and inability to detect heterozygous deletions, they have the ability to diagnose other inherited erythrocyte disorders, such as pyruvate kinase deficiency, when clinical and laboratory findings do not indicate the diagnosis.This study brings to mind the Mentzer index (MCV/red blood cell) used in discrimination of iron deficiency anemia and thalassemia trait.12 An index of <13 suggests thalassemia trait whereas >13 suggests iron deficiency.13 When carefully scrutinized in varying populations, its utility has come into question.14 However, it is still often used as an adjunctive tool, with user understanding it does not replace evaluation of iron status and measurement of hemoglobin A(2) to differentiate iron deficient patients from those with thalassemia trait.How should we use the HS index? The utility in the HS index is primarily as an adjunctive bedside tool to help the clinician formulate a differential diagnosis and move forward with additional diagnostic evaluation as indicated. It is not a definitive diagnostic tool. The study by Weiss et al provides valuable information indicating the index may perform less well in nonwhite patients.The authors end with the cautionary note “RBC indices may vary slightly on the basis of the make and model of hematology analyzer used, and further investigation regarding the typical ranges of HS Index and RDW values among HS neonates using other cell counters may be warranted.” This important comment leads us to a look into the future. As cell analyzers become more and more sophisticated and provide more detailed information on populations of erythrocytes, the dream of making the diagnosis of HS from analyzing parameters of a CBC comes closer to reality.