Selected Hematological Biomarkers to Predict Acute Mortality in Emergency Department Patients. Recent Polish Hospital Statistics

Objectives:To determine the efficacy of the abbreviated Mortality in Emergency Department Sepsis (MEDS) score, the Modified Early Warning (MEW) score and near-patient-test (NPT) lactate levels in predicting 28-day mortality in...

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.

Introduction: This study aimed to investigate associations of red cell distribution width (RDW), RBC mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with coronary artery calcium score (CACS) in patients without history of coronary artery disease (CAD). Methods: In this cross-sectional study, 832 consecutive patients without history of CAD who presented with acute chest pain and underwent coronary artery calcium scoring by MDCT were included. Differences in CACS among multiple RBC indices categories which were high RDW (&gt;55 fL) VS low-to-normal RDW, low MCV (&lt;80 fL) VS normal-to-high MCV, low MCH (&lt;27 pg) VS normal-to-high MCH, low MCHC (&lt;31 g/dL) VS normal-to-high MCHC were statistically calculated. Results: The cohort comprised of 60% men (500 of 832) with mean age of 59±14 years. Median Framingham’s 10-year risk for cardiovascular disease was 4% (Interquartile range; IQR 1%-16%). Sixty percent of patients had zero CACS followed by 21.5% with CACS 1-100, 9.9% with CACS 101-400 and 8.1% with CACS&gt;400. Mean ± SD of the RBC indices were 43±14 fL for RDW, 88±6 fL for MCV, 30±2 pg for MCH and 34±2 g/dL for MCHC. Compared to patients with normal-to-high MCV, those with low MCV (n=73) had significant lower CACS (0; IQR 0-5 VS 0; IQR 0-49; p 0.047). There was no statistically significant difference in CACS between RDW groups (p 0.45), MCH groups (p 0.19), MCHC groups (p 0.26) as shown in the figure. Multivariate analysis showed no statistically significant association of all the RBC indices with either CACS&gt;0 (high RDW - p 0.83, low MCV - p 0.17, low MCH - p 0.26, low MCHC − p 0.06) or CACS&gt;100 (high RDW - p 0.69, low MCV - p 0.18, low MCH - p 0.93, low MCHC − p 0.77). Conclusion: Our study did not show significant association of RDW, MCV, MCH and MCHC with either presence or severity of coronary calcification in patients without history of CAD

Sample stability is a crucial aspect for the quality of results of a haematology laboratory. This study was conducted to investigate the reliability of haematological testing using Sysmex XN in samples stored for up to 24 h at different temperatures. Haematological tests were performed on whole blood samples collected from 16 ostensibly healthy outpatients immediately after collection and 3 h, 6 h or 24 h afterwards, with triple aliquots kept at room temperature, 4 °C or 37 °C. No meaningful bias was observed after 3 h under different storage conditions, except for red blood cell distribution width (RDW) and platelet count (impedance technique, PLT-I) at 37 °C. After 6 h, meaningful bias was observed for mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) at room temperature, red blood cell (RBC) count, mean corpuscular haemoglobin concentration (MCHC), MCH, MCV and PLT-I at 4 °C, and RBC, RDW, MCHC, MCH and PLT-I at 37 °C. After 24 h, a meaningful bias was observed for MCHC, MCV, platelet count (fluorescent technique, PLT-F) and mean platelet volume (MPV) at room temperature, MCHC, MCV, PLT-I and MPV at 4 °C, and all parameters except RBC count and MPV at 37 °C. Great caution should be observed when analysing results of haematological tests conducted more than 3 h after sample collection.

Time to treatment is a significant predictor of mortality in emergency department (ED) patients with bacterial sepsis. Strategies for the early detection of bacterial infection and sepsis are lacking. Clinical gestalt is a tool for assessing and synthesizing the entire clinical picture, focusing on the first clinical impression at presentation. This study aimed to assess ED physicians' clinical gestalt for the prediction of bacterial infection and mortality in ED patients presenting with signs and symptoms of infection. Prospective, observational study with a 30-day follow-up. Patients aged 18 or older presenting to the ED with signs and symptoms compatible with an infection and abnormal vital signs were included. ED physicians recorded their clinical gestalt using a visual analog scale (VAS) to assess the likelihood of bacterial infection and responded to a dichotomous question regarding the probability of a patient's death. The main outcome was the confirmed diagnosis of an acute bacterial infection. Final diagnoses, based on laboratory and follow-up information, were adjudicated by an expert panel. In total, 444 patients were included. Median age was 68 years [IQR 51, 80] and median National Early Warning Score (NEWS) was 5 [IQR 3, 7]. Median VAS for physicians' clinical gestalt regarding bacterial infection likelihood was 8.2 [IQR 6.7, 9.0] of 10 in patients with bacterial infection, 2.3 [IQR 1.2, 4.3] in patients with viral infection, 4.6 [IQR 4.0, 7.3] in patients with an infection due to another pathogen, and 2.3 [IQR 1.1 6.2] in patients with no acute infection (p-value = <0.001). Clinical gestalt's sensitivity regarding 30-day mortality was 57.1% [95%CI 37.2 to 75.5] with a specificity of 83.4% [95%CI 79.7 to 86.9]. In this study of ED patients presenting with signs and symptoms of infection, clinical gestalt was shown to be useful differentiating between bacterial and infections of other causes. Antibiotic prescription rate increased with the likelihood of bacterial infection according to physician gestalt. Lastly, simple heuristic prognostication of mortality (likely vs. unlikely) carried some, but limited, prognostic value.

The stability of quantitative blood count parameters using the ADVIA 2120i hematology analyzer

Objective: to study the development of the morphophysiological blood profile of young purebred Tashla sheep (first lambing) depending on age, as well as during the administration of a dietary supplement (DS) containing fatty acids and iodine. Materials and Methods: the study involved 16 Tashla lambs, divided into control and experimental groups of 8 animals each. The animals in the experimental group received the DS at a dose of 1 ml/kg of body weight daily. The duration of administration was 30 days (from the day of birth to the 30th day after birth). The lambs received the DS individually. Blood samples were collected for clinical blood analysis (at 2 hours postnatal age, 7, 14, 21, 30, 60, and 90 days postnatal age). The clinical analysis included the following parameters: WBC (leukocytes), RBC (red blood cells), HGB (hemoglobin), HCT (hematocrit), MCV (mean corpuscular volume), MCH (mean corpuscular hemoglobin content), MCHC (mean corpuscular hemoglobin concentration), RDW (red blood cell distribution width), PLT (platelets), MPV (mean platelet volume), PDW (platelet distribution width), and PCT (platelet crit). Results. The most pronounced changes with age were observed in lambs of both groups for WBC, RBC, HGB, MCV, and PLT. Significant differences in WBC, MCV, MCH, MCHC, RDW, PLT, MPV, and PDW parameters were observed after the use of the dietary supplement, primarily at 90 days of age. This indicates that the use of a dietary supplement based on fatty acids and iodine has a significant impact on the development of the blood system, particularly the erythrocyte and leukocyte components, increasing their values. Furthermore, it is possible to quantitatively assess the effect of the supplement on the development of the morphophysiological status of young Tashla sheep only after 90 days of age.

BackgroundPulmonary hypertension (PH) is a common complication of cardiopulmonary disease. In dogs, PH commonly occurs secondary to myxomatous mitral valve disease (MMVD). Red blood cell and platelet indices including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), mean platelet volume (MPV) and platelet distribution width (PDW), have previously been found to be indicators for predicting and prognosing PH in humans. Therefore, this study aimed to investigate whether these indices are associated with MMVD and/or PH in dogs.MethodsTwo hundred and forty-six dogs were retrospectively recruited for the study and classified into 4 groups: normal (n = 49), MMVD (n =102), PH (n =17), MMVD+PH (n =78). A sub-analysis was performed in dogs with MMVD without evidence of PH according to stage B1 (n =20), stage B2 (n =15), stage C (n =67). The data are expressed as median (interquartile range).Results and discussionNo significant differences (p < 0.05) were found in MCV, RDW and MPV among all groups (normal, MMVD, PH and MMVD+PH). However, decreases in MCH and MCHC were found in MMVD [22.40 (20.90-23.50) pg and 35.25 (33.08-36.90) g/dL], MMVD+PH [22.25 (20.85-23.98) pg and 35.65 (33.30-37.33) g/dL] and PH groups [21.20 (20.60-22.20) pg and 33.80 (32.75-35.70) g/dL] compared to the normal dogs [24.29 (23.55-24.90) pg and 38.20 (37.50-39.05) g/dL] (p < 0.001). Decreases in PDW were found in dogs in the MMVD+PH [15.10 (14.98-15.30) %] groups compared to dogs in the normal group [15.30 (15.10-15.50) %] (p = 0.004). Sub-analysis of MMVD dogs without PH showed a decrease in MCH in dogs with stage B2 MMVD [21.00 (20.50-22.90) pg] and stage C MMVD [22.40 (20.90-23.20) pg] compared to normal dogs [24.29 (23.55-24.90) pg] (p < 0.001). MCHC of dogs with stage B1 [36.55 (33.53-37.78) g/dL] (p = 0.004), B2 [32.90 (32.00-35.00) g/dL] (p < 0.001) and C MMVD [35.30 (33.30-36.80) g/dL] (p < 0.001) were lower than those of normal dogs [38.20 (37.50-39.05) g/dL]. PDW in the stage C MMVD group [15.10 (15.00-15.30) %] was reduced compared to the normal group [15.30 (15.10-15.50) %] (p = 0.042) and the stage B1 MMVD group [15.35 (15.23-15.68) %] (p = 0.002). MCH, MCHC and PDW were negatively correlated with the left atrial and left ventricular size.ConclusionDecreases in MCH and MCHC are related to MMVD, precapillary PH and postcapillary PH while PDW are associated with MMVD severity but not with the presence of PH.

The diagnostic usefulness of red cell distribution width (RDW) in association with usual biochemical and haematological parameters in detection of iron deficiency has been studied in a representative sample population of 384 children aged six months to six years in Reunion. Traditional parameters measured included serum ferritin (Fri), total iron binding capacity (TIBC), serum iron (SI), transferrin saturation (TSat), free erythrocyte protoporphyrin (FEP), mean corpuscular haemoglobin concentration (MCHC), mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV) and haemoglobin concentration (Hb). RDW is an index of the variation in red cell size (anisocytosis). This recently derived parameter is measured by some models of electronic cell counter. It is not usually used in epidemiological investigations. Of the children studied, 13.6% had Hb less than 11 g/dl. The Pearson correlation coefficients between circulating iron parameters (SI, TSat, TIBC) or iron storage parameters (Fri) and RDW, MCV, MCH and FEP were greater than with Hb. The best correlations were observed for RDW, MCV and MCH with all other parameters. In this study, the upper limit value of RDW was defined as 18% using a Technicon model H-6000 counter. Other iron deficiency criteria were also defined and found to be in agreement with the international reference values for children aged six months to six years; MCV less than 70 fl, MCH less than 22 pg, MCHC less than 32%, FEP greater than 35 micrograms/dl whole blood, SI less than 6 mumols/l, TIBC greater than 85 mumols/l, TSat less than 10% and Fri less than 12 micrograms/l. The combination of sensitivity and specificity was best for RDW and worst for MCHC.(ABSTRACT TRUNCATED AT 250 WORDS)

BackgroundAdaptation, including changes in blood properties, to whole-body cryostimulation may depend on many factors, including body mass.AimThis study investigates whether hematological parameters change similarly in a group of people with obesity and a group of men with normal body weight after 10 and 20 cryostimulation treatments.MethodsIn our non-randomized trial, the participants were divided into two groups based on their body fat percentage: 14 men with a high (HBF = 29.35%) and 10 with a normal percent of body fat (NBF = 11.40%) and subjected to 20 whole body cryostimulation treatments (-120°C for 2–3 minutes). Blood samples were taken before the first and after the 10th and 20th cryostimulation. The following parameters were determined: red blood cells (RBC), hemoglobin concentration (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelets (PLT), red blood cell distribution width (RDW-SD), mean platelet volume (MPV), white blood cells (WBC), neutrophils (NEUT), lymphocytes (LYMPH), monocytes (MONO), eosinophils (EO) and basophiles (BASO).ResultsStatistically significant differences were found in red blood cells parameters such as RBC, HCT, MCV and MCHC. Time influence was noted for HCT, MCV and MCHC. Two-way ANOVA showed a significant correlation (for time and group) for 2 paramateres: RBC and MCV. For platelet parameters statistically significant differences were found for PLT (group influence) and MPV (time and group interaction). In white blood cells parameters statistically significant differences in levels of LYMPH were noted. Higher levels were observed for HBF group.ConclusionsAll observed changes were within the reference range, but hematological markers changed unevenly in people who are obese and non-obese. Therefore, it appears that an amount of fat tissue could be a factor causing the differences in adaptation to low temperature. It is suggested that 20 whole body cryostimulation sessions restore the state of homeostasis disturbed after 10 sessions.Trial registrationACTRN 12619000524190.

First report of Mediterranean stomatocytosis/macrothrombocytopenia in an Indian family: a diagnostic dilemma

BackgroundGastric cancer (GC) is one of the leading causes of cancer-related death worldwide. This study was designed to investigate the prognostic values of red blood cell (RBC)-associated indicators, including RBC, hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and RBC distribution width (RDW) in resectable GC patients.MethodsIn this retrospective study, a total of 104 pathologically confirmed GC patients were recruited. These cases were divided into two groups according to the median values of pretreatment RBC, HGB, HCT, MCV, MCH, MCHC, or RDW. To evaluate the changes in RBC-associated indicators values after treatment, we introduced the concept of post-/pre-treatment ratios (≤1 suggested RBC, HGB, HCT, MCV, MCH, MCHC, or RDW values were not increased after therapy, while >1 represented those in increased levels).ResultsThe lower pretreatment MCHC levels were correlated with worse overall survival (OS), while pretreatment levels of RBC, HGB, HCT, MCV, MCH, or RDW were not. The whole course of treatment (surgery plus adjuvant chemotherapy) significantly decreased the values of MCHC, and increased the values of MCV and RDW, whereas it had no obvious effects on the values of RBC, HGB, HCT, or MCH. Patients with post-/pre-treatment MCV ratio >1 had an increased survival ratio. Meanwhile, post-/pre-treatment RBC, HGB, HCT, MCH, MCHC, or RDW ratios were not correlated with outcomes. Multivariate Cox regression analysis revealed that the American Joint Committee on Cancer (AJCC) stage (III), and lower pretreatment MCHC levels were independent risk factors affecting OS. The receiver operating characteristic (ROC) curve analysis showed that an MCHC value of 341.98 g/L was the optimal cutoff value for prognosis, with a sensitivity of 58.3% and a specificity of 75.0%.ConclusionsPretreatment MCHC levels could become a potential prognostic factor for resectable GC.

There are no studies that investigated the association between red blood cell (RBC) and platelet (PLT) indices in relation to obesity in a cohort of exclusively late adolescents. Hence, we aimed to explore this potential relationship. A cohort of adolescents (n=156) aged between 16-19 years was included. Iron homeostasis parameters [i.e. RBC, hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW)] and platelet indices [i.e., PLT, mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW)] were determined on the automatic hematology analyzer. Their indexes (i.e. MCV/RBC, MCH/RBC, RDW/MCV, MPV/PLT and PDW/PCT) were calculated. Univariate binary regression analysis showed negative associations between body mass index (BMI) and RDW, PDW, and PDW/PCT, respectively, and positive associations between BMI and MPV and PCT, respectively. However, only RDW kept the independent negative association with BMI in multivariate binary regression analysis [Odds Ratio (95% Confidence Interval)=0.734 (0.548-0.983); p=0.038]. Lower RDW values are the independent predictor of higher BMI in the adolescent population. As a low-cost and simply measured parameter, RDW could be a useful diagnostic biomarker in young populations with overweight/obesity.

The aim of this study was to investigate that annual change of haematological parameters in Angora goat. Thirteen goats (six female and seven male aged 1.5 years at the beginning of the experiment) were used in this study. For this purpose, to determine haematological parameters, blood samples were taken from jugular vein of each goat in every month for one year. Red blood cells (RBC), mean corpuscular volume (MCV), haematocrit (Hct), haemoglobin (Hb), mean corpuscular haemoglobin concentration (MCHC), mean corpuscular haemoglobin (MCH), red cell distribution width (RDW), white blood cell (WBC), lymphocytes (Lym), granulocyte (Gra), monocyte (Mon), thrombocytes (THR), mean platelet volume (MPV), plateletcrit (Pct) and platelet distribution width (PDW) were analysed by haematology analyser. The data obtained were analysed using two-way repeated measures analysis of variance (ANOVA). As a result of statistical analysis, gender x month interactions were statistically different (P < 0.01) for RBC, MCV, Hb, Mon, THR, MPV and Pct, while significant differences (P < 0.01) were found among the months for Hct, MCH, MCHC, RDW, WBC, Lym, Gra and PDW. As a result of this study, it was determined that seasonal changes, different physiological periods and environmental stress that occurred during experimental periods had significant effect on the annual pattern of erythrocyte, leukocyte and thrombocytes of Angora goats.

IntroducionTo assess the prognostic and discriminative accuracy of high-sensitivity cardiac troponin T (hs-cTnT) for prediction of inhospital mortality in emergency department (ED) patients with suspected infection.MethodsProspective observational derivation study in...