The Red Blood Cell Counts before HAART Treatment may be Related to the Long-Term Immune Reconstitution in HIV Patients.

Red blood cell (RBC) count in blood is an important clinical test, since erythrocytosis (high RBC count) and erythropenia (low RBC count) are features of severe diseases. For example, erythrocytosis occurs in certain tumors or in hypoxic conditions, while erythropenia accompanies blood loss, iron deficiency, or poisonings by hemolytic toxicants. In current routine clinical laboratory practice, the RBC count is determined automatically using a hemocytometer or via microscopy. The latter allows for both the RBC count and identification of sizes and morphologies of erythrocytes, although the method is quite complex and time-consuming. Electrochemical methods for determining erythrocytes concentration (RBC count) are known, although they are few and have not been utilized in routine clinical laboratories. The main advantages of the electrochemical methods are due to the simplicity of measurement procedure, high sensitivity, and high speed of analysis. However, existing electrochemical techniques were developed for use with animal erythrocytes. For example, a proposed electrochemical method [1] of determining red and white blood cell counts using a graphite electrode was developed for measurements in rabbit blood, and the effect of electrode potential on the behavior of blood cells was examined; however, the mechanism of the observed effects was unclear. Recently, an attempt was made to develop a method to determine the amount of peroxidase activity of sheep red blood cells on the pyrolytic graphite electrode [2]. This is an indirect electrochemical method that used the electroreduction of oxygen formed in a reaction of hydrogen peroxide with a sample of sheep erythrocytes to characterize the RBC sample. The present work explored the possibility of using direct electrooxidation of an RBC suspension on an optically transparent ITO electrode. Theoretically, the likelihood of the electrochemical activity of the blood cells is quite high, since the surface of RBC membranes contains electron-donor and electron-acceptor functional groups. Moreover, circumstantial evidence of erythrocyte electrochemical activity has been shown [3], manifesting as morphological changes of cells depending on electrode potential. The goal of the present work was to develop an electrochemical method for determining the number of erythrocytes and their morphologies in real time. A suspension of erythrocytes containing 8∙109 – 8∙1011 cells/L was prepared by diluting packed RBCs of apparently healthy donors with isotonic physiologic saline (0.15 M NaCl). A three-electrode electrochemical cell was used, and an optically transparent ITO electrode (Sigma-Aldrich, USA) with a surface area of 28.3 mm2formed the bottom of the cell. A carbon black electrode was used as the auxiliary electrode, with a silver/silver chloride electrode as the reference electrode. Polarization measurements were performed using an IPC Pro L potentiostat ("Kronas", Russia) in cyclic scan mode, with a scan rate of 10 mV/s. Erythrocyte morphology depending on the electrode potential was examined in real time using an Eclipse TS100 inverted microscope (Nikon, Japan), with 40X lens magnification. Polarization measurements on the ITO electrode were carried out in isotonic saline containing a suspension of erythrocytes. It was observed (Fig. 1A) that the suspension of erythrocytes under these conditions is electrochemically active at anodic potentials between +400 mV and +1,000 mV (Ag/AgCl). It should be emphasized that this is the first time that direct evidence of RBC anodic oxidation has been obtained. This phenomenon was used to determine the number (concentration) of erythrocytes in blood or other biological media, since erythrocyte electrooxidation produced a limiting current on the polarization curves. The dependence of limiting current on RBC concentration (Fig.1B) is linear across ca. two orders of magnitude of erythrocyte concentrations (8∙109 – 8∙1011 cells/L), with a correlation coefficient for the calibration curve in that range R 2= 0.99. Previously it was reported [3] that simultaneous microscopy studies allow for the morphology of red blood cells in the process of electrode polarization to be evaluated. In the potential range utilized in the present work, the morphological transformation of RBCs with normal discocyte morphology into stomatocytes was observed between electrode potentials of ca. +600 to +1,000 mV. Thus, the proposed electrochemical method with concurrent microscopy shows promise for the analytical determination of blood cell counts and their morphological analysis. This may have a wide range of applications, including determination of the effects of blood interaction with foreign materials or monitoring of stored blood quality. 1. Ci Y.-X., Li H.-N., Feng J. Electroanalysis 1998 10(13): 921-925. 2. Sepunaru L., Sokolov S.L., Holter J., Neil P. N.P., Compton R.G. Angew. Chem. Int. Ed. 2016 55(33): 9768-9771. 3. Khubutiya M.Sh., Evseev A.K., Mirzaeian M., Borovkova N.V., Goroncharovskaya I.V., Goldin M.M. 229th ECS Meeting, 2016, San Diego: Abs. 1632. Figure 1

To the Editor: Gait is a robust marker of frailty1 and is associated with multiple adverse health outcomes.2 Hematological investigations are routinely ordered in clinical practice, and some red blood cell (RBC) indices have been linked to frailty and gait.3 Establishing the contribution of RBC indices to gait in older adults will provide insights into new biomarkers and potential interventions. This cross-sectional investigation was conducted within the Central Control of Mobility in Aging Study (CCMA). The goal of CCMA is to identify brain mechanisms for mobility in aging. Inclusion criteria included aged 70 and older and community dwelling. The Albert Einstein College of Medicine institutional review board approved the study protocol. Blood collection was introduced in CCMA in 2013 as part of a new substudy. Of the 310 CCMA participants evaluated between July 2013 and September 2014, 230 (74%) underwent blood tests; blood was collected and analyzed using standard protocols. RBC indices, white blood cell (WBC) count (k/μL) and interleukin (IL)-6 levels (pg/mL) were examined for this study4, 5 Reasons for missing data included refusal (n = 42) and logistical constraints (n = 38). Based on reported and predicted associations with mobility,3 the following RBC indices were examined: RBC count (cells/μL), hemoglobin (g/dL), hematocrit (%), mean corpuscular volume (fl), mean corpuscular hemoglobin (pg), mean corpuscular hemoglobin concentration (g/dL) and red cell distribution width (RDW, %). Because chronic diseases may affect gait,6 a summary Global Health Status index (GHS; range 0–10) was derived based on presence of diabetes mellitus, chronic heart failure, arthritis, hypertension, depression, stroke, Parkinson's disease, chronic obstructive pulmonary disease, angina pectoris, and myocardial infarction.2 Participants walked at their normal pace on a computerized walkway (180 × 35.5 × 0.25 inches) in a quiet, well-lit hallway. The computer software recorded gait variables as the mean of two trials.2, 7 Eight quantitative variables were summarized into three statistically independent gait factors (domains) using factor analysis, as reported previously.2, 7 These three factors (standard deviation units, higher scores better) accounted for 88% of variance in gait performance. The pace factor loaded highest on gait velocity and stride length; the rhythm factor on cadence, swing time, and double support time; and the variability factor on swing time and stride length variability. Independent predictive validity of these gait domains has been shown for dementia (rhythm, variability), vascular dementia (pace), and falls (rhythm, variability) in older adults.2, 7 Multiple linear regression analyses were used to determine associations between RBC indices and gait factors, controlling for age, sex, and education. All analyses were performed on SPSS version 21 (SPSS, Inc., Chicago, IL). The mean age of the participants was 78.3 ± 6.6, 55.2% were female, and mean education was 14.7 ± 3.2 years. Higher rhythm factor was associated with higher RBC count (P = .01), hematocrit (P = .02), and RDW (P = .04) (Table 1). RBC indices were not associated with the pace and variability domains. Inflammation may confound the association between rhythm and RBC indices.4 After controlling for inflammation using WBC count and IL-6 levels,4 the association between gait rhythm and RBC count (P < .001) and between gait rhythm and hematocrit (P < .001) persisted but not between gait rhythm and RDW (P = .11). The association between rhythm and RBC count (P < .001), hemoglobin (P = .001), and hematocrit (P < .001) remained after adjustment for chronic diseases. The current study found an association between RBC indices (RBC count, hematocrit, RDW) and gait rhythm but not the pace and variability domains in older adults. Higher RBC indices were associated with better gait rhythm scores. These findings suggest a specificity of hematological mechanisms for causing perturbations in discrete aspects of gait and not a global effect of RBC indices on overall gait performance in aging. Abnormal RBC indices are markers of disease conditions such as pernicious anemia, stroke, and vasculitis, which could affect gait through the central and peripheral nervous system, muscles, and vasculature. Low hemoglobin (a constituent of RBC count and hematocrit) is associated with risk of frailty.8 Low RBC count and hematocrit may also act through cerebral hypoperfusion and tissue hypoxia to create gait rhythm deficits. The effect of RDW on rhythm was attenuated after adjustment for inflammatory markers, which is linked to risk of frailty.2 The cross-sectional design is a limitation. Longitudinal studies are needed to establish causality. RBC indices are widely available in clinical settings. If the current findings are cross-validated in future studies, early identification and management of this modifiable risk factor could help ameliorate distal gait-related cognitive and mobility outcomes. The study was supported by National Institute on Aging Grants R01AG03692101A1 (PI: R. Holtzer), 3R01AG036921–02S1 (PI: R. Holtzer), and RO1AGO44007–01A1 (PI: J. Verghese). Conflict of Interest: Dr. Verghese has received research support from National Institutes of Health (NIH) Grants R01AG039330–01, PO1 AG03949, R01AG036921–01A1, RO1 AGO44829–01A1, and RO1AGO44007–01A1) Dr. Verghese has reviewed for the NIH. Dr. Verghese is a member of the editorial board of the Journal of the American Geriatrics Society. Author Contributions: Onuoha, Verghese: study concept, data acquisition, data analysis, data interpretation, drafting manuscript. Sponsor's Role: The funding sources had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

Background: Beta-Thalassaemia is a public health issue. Generally, very few people know about it in detail. Due to ignorance, government bear tremendous financial cost to care for it. Methods: This was a cross sectional observational study conducted in an outdoor patient department (OPD) of Gynecology and obstetrics of a Postgraduate Medical Institute at Peshawar, from August 2012 to Jan 2013. A Total of 56 women in their last trimester of pregnancy were included. Required information's were recorded on predesigned proforrma as per objectives of the study. Results: Most of the participants were of age 20 to 49 years with mean+ SD of 34+3.4years. Majority (87.5%) of the Red Blood Cell (RBC) count was equal or less than 4600000/cmm3. A few (12.5%) of the participants had their RBC count more than 4600000/cmm3. More than two-thirds (76.79%) had RDW (Red Cell Width Distribution SD) below 45%, while less (20.21%) had RDW more than 45%. The seven cases that had high RBC count underwent Hb- Electrophoresis where in two cases (3.2%) were reported to be ? -thalssaemia trait. Conclusion: Majority of the patient were having low RBC count that needed further investigations i.e Serum Ferritin to confirm the iron deficiency. Similarly those who have had high RBC count when subjected to Hb-electrophoresis, showed B.thallassemia trait. We suggest all those cases having RBC count more than 4600000/cmm3 and RDW-SD less than 45% may further be screened for thalssaemia trait, that may help to counselling families for future.

598-P: Lower Hematocrit Is Predictive of Treatment-Required Eye Diseases in Japanese Patients with Diabetes Mellitus

BackgroundImmuno-hematological abnormalities are common among HIV infected individuals as well as patients with highly active antiretroviral therapy (HAART). However, the immuno-hematological outcome of Dolutegravir based antiretroviral therapy (ART) usage is not well investigated.ObjectivesTo assess hematological and immunological parameters among adult HIV patients before and after initiation of Dolutegravir based ART regimen at St. Peter Specialized Hospital, Addis Ababa, Ethiopia.MethodsA cross-sectional study was conducted from May to July 2021 at St. Peter Specialized Hospital among adult HIV patients. A total of 422 HIV patients on Dolutegravir based ART (combination of Dolutegravir/lamivudine/tenofovir disoproxil fumarate (DTG/3TC/TDF)) for a minimum of 3 months were selected using convenient sampling methods. Socio-demographic as well as clinical data of the participants was obtained using pre-tested structured questionnaires and a review of medical records. Hematological parameters such as CBC was obtained using Beckman coulter automated hematology analyzer and immunological parameters such as CD4 count were determined using BD FACS presto. Statistical analysis of the data was done using SPSS version 21. Paired t-test was used to compare dependent variables before and after initiation of the new HAART and binary logistic regression was used to determine predictors of immuno-hematological abnormalities. P-value < 0.05 was considered as statistically significant.ResultsOf 422 adult HIV patients, about 273(64.7%) were females. The mean age of study participants was 42.2 years (±10.4SD). The mean white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (Hb), platelet distribution width (PDW), CD4 count, as well as lymphocyte percentage, neutrophil percentage, and platelet counts (PLT) were increased significantly(P<0.05) after 3 months of the Dolutegravir based therapy. While, red cell distribution width (RDW) and mean cell hemoglobin (MCH) were decreased (P<0.05) after the treatment. Other hematological parameters such as mean cell volume (MCV), hematocrit (HCT), mean cell hemoglobin concentration (MCHC), mean platelet volume (MPV) and platelet distribution width (PDW) showed no significant change. On the other hand, the most common hematological abnormalities identified after the new HAART were anemia (12.1%); followed by Leucopenia (11.3%), neutropenia (6%), and thrombocytopenia (4%). Anemia was associated with female sex (AOR = 7.8, 95% CI: 1.9–32.2, P<0.005) and WHO clinical stage III/IV (AOR = 16, 95% CI: 10.63–66.46, P<0.01).ConclusionThere was a significant change in certain immuno-hematological parameters such as WBC count, RBC count, PLT count, Hb, PDW, CD4 count, lymphocyte and neutrophil percentage after initiation of the Dolutegravir based therapy. Anemia was the most common hematological abnormality. Further studies are required to fully comprehend the outcome of the new treatment regimen on immuno-hematological parameters.

Anemia is associated with increased rates of heart failure (HF)-related mortality and hospitalization. No studies have focused on the association between the red blood cell (RBC) count and the prognosis of patients with HF with mildly reduced left ventricular ejection fraction (HFmrEF). We retrospectively analyzed the effect of the RBC count on outcome events in patients with HFmrEF. We investigated the association of the RBC count with outcome events in 1691 patients with HFmrEF (mean age: 68 years; 35% female) in Xiangtan Central Hospital. Using Cox proportional hazards models, the RBC count was assessed as both a continuous and categorical variable. During follow-up (median: 33 months), cardiovascular death occurred in 168 patients (114 men and 54 women). After adjusting for established risk factors, each 1.0 × 1012 cell/L increase in the RBC count was associated with a 28% lower risk of cardiovascular death in men and a 43% lower risk in women. Patients with low RBC counts had a 0.5-fold higher risk of cardiovascular death than those with normal RBC counts. The hazard ratio for men was 1.42 (95% confidence interval [CI]: 1.07-1.89), and the hazard ratio for women was 1.79 (95% CI: 1.20-2.67). The RBC count was not significantly associated with the composite endpoint of cardiovascular death and HF readmission (cardiovascular events) (p > .05). A decreased RBC count is associated with increased cardiovascular mortality in patients with HFmrEF. Correcting a low RBC count might potentially reduce the risk of cardiovascular death in patients with HFmrEF.

Sir, We read with interest the study by Distelmaier and colleagues1. They analyzed the association between the blood parameters and new-onset atrial fibrillation (AF) after acute myocardial infarction (MI), as diagnosed with coronary angiography. The patient group with the occurrence of AF after AMI had a significantly higher level of haemoglobin and higher red blood cell counts compared with the group without. The odds ratios of haemoglobin and the red blood cell count for the occurrence of AF were significantly high. The occurrence of AF is multifactorial, and the parameters predictive of AF remain to be explored; therefore, identifying such parameters would be helpful to prevent the development of subsequent adverse complications and mortality in the management of MI patients. The findings of this study are thus valuable, although the authors did not fully seem to state a hypothesis and perspectives for the reported epiphenomenon. In another recent study conducted by Oda et al2, a higher level of haemoglobin was reported to be associated with AF. Both studies1,2 appear to have found similar results, which indicate that it is necessary to think about the meaning of red blood cell parameters. In our clinical experience, a good parameter for the occurrence of AF is ageing, which is referred to as an oxidative condition3. We have paid special attention to the relevance of oxidative stress in cardiometabolic pathologies. Notably, oxidative stress conditions are involved in the pathogenesis of AF3,4. Thus, we wonder if some patients had a relatively high red blood cell level (even though it was not at the level of polycytemia), which could have led to oxidative stress. For instance, information obtained from patients with pathologies related to hypoxia, including sleep apnoea syndrome, and measurement of oxidative stress markers should be included in future studies. Additional information about abdominal obesity and the smoking status (which are also associated with oxidative stress) should also be included. Distelmaier group study did not offer such data1. In the Oda group study2, erythropoiesis, a factor associated with increased red blood cell parameters, was discussed in terms of the occurrence of AF. This seems to be an important point, considering that hypoxia can also stimulate erythropoiesis. Measuring the erythropoietin level may be of interest in future work. Linked to erythropoiesis, iron metabolism is another point to debate regarding the association between the red cell biology and heart pathophysiology. Ferritin has already been reported to be associated with an increased cardiovascular risk5. Measurement of the iron metabolism, therefore, needs to be simultaneously considered. Hyperhaemodynamic states (accompanied with hyperviscosity)2 and impaired rheological properties6 caused by increased red blood cell parameters would be additional points, because these can enhance oxidative stress. Also, a relative decrease in the plasma volume (even if it is not at the level of obvious dehydration) leads to increased red blood cell parameters. Although this cannot be thought to contribute directly to the occurrence of AF, it may provide a potential basis for AF if overlapping some conditions (e.g. sympathetic nerve activation and oxidative stress) are also present7. The fact that the haematocrit level did not show a similar impact on the occurrence of AF in a manner proportional to the haemoglobin and red blood cell counts in this study1 is seemingly confusing. This implies that subsequent investigation is necessary, while it may also lead to a hint of hypothesis about the association between red blood cell parameters and AF. For more sophisticated future research based on this study1, a detailed analysis of the heart rates and blood pressure levels at admission and prior to the onset of AF, as well as unification of the timing of data collection (blood and electrocardiogram examinations), clarification of the underlying diseases (i.e. valvular heart diseases)8, and therapeutic situations (including fluid therapy) should be included. Although we outlined an aspect of cardiometabolic pathologies from the viewpoint of oxidative stress, further studies with hypotheses from a wide range of research fields are called for, because these will be useful to identify predictors of the onset of AF during the post-MI management.

Incremental analysis of diagnostic peritoneal lavage fluid in adult abdominal trauma

Background Hemoglobin (A1c) is a key marker for long-term glycemic control and reflects the average blood glucose levels over the preceding 3-4 months. High levels of red blood cell (RBC) parameters—such as RBC count, hemoglobin (Hgb), hematocrit (HCT), red cell distribution width (RDW), mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC)—can affect the rate of glycation*s, RBC*s lifespan, and the proportion of glycated hemoglobin, potentially leading to discrepancies between the A1C value and the actual average glucose concentration. Understanding how these RBC parameters influence A1c is crucial for accurate diabetes diagnosis and management, particularly in individuals with conditions that cause erythrocytosis. This study investigated whether A1C results are associated with RBC parameters in patients with type 2 diabetes. Methods A retrospective data analysis using the Quest Diagnostics database identified all patients with type 2 diabetes who received A1C and RBC parameters testing from the years 2022 to 2024. A1c test results were evaluated in patients diagnosed with type II diabetes along with their corresponding RBC parameters. The nonlinear correlation test (nlcor in R) was employed to assess statistically significant correlation between A1c and each of the RBC parameters. Results Over one million A1C results with corresponding RBC parameters were identified during the study period. The A1c values demonstrated a strong correlation with other markers except for RDW (Figure). Higher levels of Hgb, HCT, and RBC counts were associated with increased A1c levels, whereas higher MCV and MCHC levels were associated with decreased A1c levels. There are no differences between correlation patterns between males and females and the data was combined. The P-values are calculated based on the non-linear correlation test between A1c and each of the RBC parameters and are significant at &amp;lt;0.001. Conclusion Elevated RBC parameters may skew A1c measurements, making it essential to consider these factors when interpreting results, especially in individuals with conditions such as polycythemia, androgen replacement, dehydration, or other disorders affecting RBC parameters. This study provides valuable insights for clinicians seeking to accurately interpret A1c results and could lead to improved diabetes management and better patient care for those affected by conditions influencing erythrocytosis.

Background: An Immune Reconstitution Inflammatory Syndrome (IRIS) event is a presentation or a paradoxical worsening of a pre-existing infection following initiation of anti-retroviral therapy in the presence of a decreasing viral load and features consistent with an inflammatory process. This study was conducted to find out the significance of different clinical parameters like hemoglobin, albumin, viral load, erythrocyte, body mass index in the people living with HIV/AIDS with IRIS in Nepalese population. Methods: The study was descriptive with control group. The study included patients who experienced IRIS after initiation of highly active antiretroviral therapy (HAART) with control group as patients who were HIV positive without HAART treatment. This study was carried out on 44 HIV infected individual who initiated HAART and then suffered from IRIS and compared with 56 control HIV infected person without IRIS visiting National Public Health Laboratory (NPHL) for routine HIV viral load testing and CD4 count between April and August, 2014. Results: The patients were categorized into highly active antiretroviral therapy (HAART) naive (n=56) and on HAART with immune reconstitution inflammatory syndrome (IRIS) (n=44). Among 56 individuals naive HAART, viral load 1000 copies/ml among which 02 were female (34.83 ± 2.030 years) and 10 were male (41.34 ± 1.462 years). The comparison of CD4 count between the naive and patients enrolled for HAART; the risk of having CD4 count <200 cell/mm3 is significantly greater in male than that of female. The BMI ratio of HAART to naive patients (19.88 ± 0.7290) was lower than that of HAART enrolled patients (21.78 ± 0.3546). The hemoglobin value showed significant (P value<0.0001) difference among PLHIV having CD4 level less than 200 (9.9 ± 2.156), between 200-500 (11.63 ± 1.946) and more than 500 CD4 level (12.71 ± 1.850). Significant (P<0.0001) viral load suppression showed among HAART initiated female patients with IRIS when compared with naive female patients without IRIS. BMI, hemoglobin level, total leukocyte count, albumin level, HDL level, ESR value, CRP level and absolute eosinophil level less than 351 cells/mm3 showed significant (P<0.05) difference among HAART naive and on HAART female patients with IRIS. Significant (P<0.0001) viral load suppression showed among HAART initiated male patients with IRIS when compared with naive female patients without IRIS. BMI (18-26), hemoglobin level below 8 g/dl, TLC, serum albumin level below 5 g/dl, HDL level below 61 mg/dl, ESR level, CRP value and absolute eosinophil count showed significant (P<0.05) difference between HAART naive and on HAART male patients with IRIS. Hemoglobin level, HDL, TLC, ESR, CD8, AEC, viral load, BMI and serum albumin level showed significant (P<0.0001) difference among HAART initiated patients with IRIS when compared to different level of CD4 T cell count. Conclusion: Prevalence of anemia was high in HAART naive patients while leucopenia prevalence was higher in patients on HAART and their prevalence increased as the CD4 count decreased. HIV Patients should be investigated for hematological and immunological changes following with appropriate therapeutic interventions. The study findings reemphasize the importance of nutritional and immunological parameters to assess the stage of the disease, initiate antiretroviral therapy and monitor the response in disease progression.

Currently, the optimal therapy of primary liver cancer (PLC) remains to be hepatic resection. For better management of the patients, we evaluated the prognostic predicting value of red blood cell (RBC) count, a routine laboratory parameter, on the long-term survival of patients who underwent surgical treatment.Clinical and laboratory data of 758 patients, who underwent surgical hepatic resection, were retrospectively studied by χ2 tests and logistic regression. All patients were enrolled at Henan Cancer Hospital, Zhengzhou, China, from February 2009 to July 2013, and none of them received any other treatments before surgery. Kaplan–Meier survival analysis and Cox proportional hazard models were used to examine the influence of RBC counts on patients’ survival.The Cox univariate and multivariate analyses showed that preoperative RBC count was an independent risk factor of poor prognosis after surgical treatment. The Kaplan–Meier curves showed that the overall survival (OS) of patients without reduced preoperative RBC counts was significantly better than those patients with reduced preoperative RBC counts (P < 0.001). Concordantly, compared with the patients with either reduced preoperative and/or postoperative RBC counts, patients without reduced RBC counts preferred to be low Child–Pugh grades (P = 0.0065), which implies a better hepatic function. In addition, low RBC count was found to be significantly associated with patients of female (P = 0.003), younger age (P = < 0.001), and with higher AST/ALT ratio (P = 0.005).This study revealed that patients with preoperative RBC counts lower than normal had worse OS rates than those without reduced preoperative RBC counts, perhaps due to the significant correlation of reduced preoperative RBC count to patients’ worse Child–Pugh grade that reflect the loss of liver functions.

Kidney Transplantation in Patients With HIV Infection

Ideal body weight with proper physical activity and good sleep are essential parameters for good quality of life. This study is concerned with assessing the association of general obesity, physical activity and sleeping hours with hemoglobin (Hb) concentration and red blood cell (RBC) parameters in healthy adults in Sudan. In this cross sectional study, 1086 healthy adults between 20 and 60 years were included out of which 275 were males and 811 were females. A complete blood count (CBC) was performed for Hb, RBC count, PCV, MCH and MCHC using Sysmex KX-21 automated hematology analyzer. The median and 95 percentile (2.5th to 97.5th) range values for Hb and RBC count in underweight were 13.0 (Range: 9.6-16.7) g/dl and 4.6 (Range: 3.6-5.8) ×1000/µL respectively, while Hb and RBC count in obese were 13.1 (Range: 10.4-17.0) g/dl and 4.6 (Range: 3.7-5.9) ×1000/µL respectively, with no significant difference. The RBC count (p=0.004) and Hb (p≤0.001) were significantly high in physically active compared to physically inactive participants; whereas the hemoglobin concentration (p=0.047), red blood cells (p=0.007) and hematocrit (p≤0.001) values were significantly low in long-term sleep compared to normal sleeping hours. In conclusion, there were no significant differences in hemoglobin concentration, RBC count, PCV, MCH and MCHC between under weight, normal weight, overweight and obese persons. Increased physical activity was associated with higher Hb levels and RBC counts, while long-term sleep showed lower Hb and RBCs.

We investigated the associations between red blood cell (RBC) count, hemoglobin (Hb) levels, muscle properties, and muscle strength in community-dwelling older adults, and examined whether RBC count and Hb levels were linked to muscle strength through muscle mass and/or quality, and whether these relationships were influenced by physical activity. The study included 85 community-dwelling older adults (39 males; mean age 75.3±6.7 years). The participants visited the laboratory in the morning for venous blood sampling to analyze blood biomarkers. Quadriceps femoris muscle thickness (MT, muscle mass index) and echo intensity (EI, muscle quality index) were measured via B-mode ultrasonography, and maximum isometric knee extension strength was assessed using a dynamometer. The average daily step count was recorded for 2 weeks as an index of physical activity. Correlation and mediation analyses were used to investigate the associations between blood biomarkers and muscle properties, strength, and physical activity. The RBC count and Hb levels were positively correlated with MT and muscle strength, and negatively correlated with EI. After adjusting for age and sex, the correlations between RBC count, Hb levels, and MT and muscle strength remained significant, whereas the associations with EI disappeared. In the mediation analyses, the direct effect of RBC count and Hb levels on muscle strength was not significant, whereas the indirect effect of MT was, regardless of whether physical activity was adjusted. In community-dwelling older adults, lower RBC counts and Hb levels appear to be associated with diminished muscle mass, potentially resulting in muscle weakness.

The objective of this study is to analyze CSF red blood cell (RBC) count from first-attempt lumbar punctures and to analyze parameters associated with first-attempt lumbar punctures and hemorrhagic lumbar puncture. This is a prospective analysis of consecutive patients who underwent lumbar puncture for any reason other than suspected acute subarachnoid hemorrhage. Analyzed parameters were the following: age, indication for lumbar puncture, aPTT ratio, PTT, platelet count, patient's position, needle type (atraumatic/standard), needle diameter, person performing lumbar puncture (medical student/resident/attending physician), number of lumbar levels punctured, necessity of needle repositioning, CSF RBC and white blood cell count, and protein level. Lumbar puncture resulting in RBC count >5 RBC/mm2 was classified as hemorrhagic lumbar puncture (different cut-offs were studied: >5/>10/>100/>500/>1000 RBC). In total, 169 elective lumbar punctures in 165 different patients were included. First-attempt lumbar puncture occurred in 22% >5 RBC, in 19.5% >10 RBC, in 4.5% >100 RBC, in 3% >500 RBC, and 1.5% >1000 RBC count. First-attempt lumbar puncture was associated with non-hemorrhagic lumbar puncture for each of the RBC count cut-offs (OR for non-hemorrhagic lumbar puncture in first-attempt lumbar puncture 2.8, 95% CI 1.4-5.7). The presence of a hemorrhagic disorder (concerning cerebral amyloid angiopathy in all patients) and higher aPTT ratio were associated with hemorrhagic lumbar puncture. Atraumatic needle use was associated with non-hemorrhagic lumbar puncture for RBC count cut-offs ≤5 and ≤10 RBC (OR for non-hemorrhagic lumbar puncture in atraumatic needle use 2.5 [95% CI 1.3-4.8] and 2.2 [95% CI 1.1-4.4], respectively). First-attempt lumbar puncture and hemorrhagic lumbar puncture were not associated with other parameters. Slightly elevated CSF RBC count after first-attempt lumbar puncture occurs relatively frequently, but is even more frequent in non-first-attempt lumbar puncture. Atraumatic needle use is associated with non-hemorrhagic lumbar puncture.