Absolute Count Research Articles

Immune effect and prognosis of transcatheter arterial chemoembolization and tyrosine kinase inhibitors therapy in patients with hepatocellular carcinoma.

The combination of transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitors (TKIs) has shown broad prospects in prolonging the survival of patients with hepatocellular carcinoma (HCC). TACE and TKIs can affect the immune microenvironment in patients with HCC. To determine the overall effects and differences between TACE and different TKIs combinations on the immune microenvironment. Data and immune cell profile test results from 213 HCC patients treated with TACE combined with apatinib, lenvatinib, sorafenib, or donafenib before and after 3 wk of treatment were collected. Monocytes were co-cultured with LM3 liver cancer cells, and their ability to inhibit cancer cell growth was analyzed using the MTT method and a nude mouse subcutaneous tumorigenesis experiment. Simulated combined therapy was done using an in situ liver cancer C57BL/6 male mouse model, and the immune response of tumor tissues was analyzed using immunohistochemistry. Compared to before combination therapy, the proportion of programmed cell death protein 1 (PD-1)+ mononuclear cells and the number of CD4+ T cells decreased in the TACE + apatinib group, while the number of absolute count of CD4+ and CD8+ T cells increased in the TACE + lenvatinib group. Furthermore, the number of regulatory cells decreased in the TACE + donafenib group, whereas the number of CD8+ T and natural killer cells increased. Additionally, monocytes in the TACE combined with donafenib or lenvatinib groups had a stronger ability to inhibit cancer cell growth than those in the other groups. Combining TACE with donafenib or lenvatinib increased CD8+ T cell infiltration into the tumor tissue. In addition, the proportion of PD-1+ in CD8+ cells, absolute CD8+ T lymphocyte count, and regulatory T cells proportion were independent prognostic factors affecting the survival time of patients with HCC. TACE, in combination with different TKIs, produces different immune responses. Specifically, TACE combined with donafenib or lenvatinib may induce strong anti-tumor immune responses.

Predictive role of platelets to lymphocytes ratio and neutrophil to lymphocytes ratio in COPD exacerbation

BackgroundThe hallmark of COPD is the progressive destruction of the lung parenchyma, which is frequently brought on by the body's inflammatory reaction to external stimuli (such as smoking cigarettes or pollution). According to reports, the peripheral blood's essential immune-related cell populations' absolute counts and ratios can accurately represent chronic inflammatory diseases. Complex interactions between immune-related cells, such as lymphocytes and neutrophils, are involved in inflammation, which can cause irreversible damage and loss of respiratory tissue. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), two hematological indicators of inflammation, have been studied in a variety of disease states, including solid tumors, systemic lupus erythematosus, coronary artery disease, retinal artery occlusion, chronic kidney disease, and stable COPD.AimCorrelation between NLR and PLR and outcome of COPD exacerbation.Materials and methodsThis cross-sectional study included 80 patients with COPD exacerbation who visited the outpatient clinic or were admitted to the Chest Department. CRP and calculation of NLR and PLR within 24 h from admission and 1 month after discharge were obtained to identify the prognostic value of NLR and PLR for the exacerbation, hospitalization, mechanical ventilation, and mortality in patients with COPD.ResultsDuring COPD exacerbation PLR, NLR showed a statistically significant correlation with the need for hospitalization with a p value < 0.001. As regards correlation with mortality NLR was statistically significant with a p value of 0.006 while PLR showed a non-significant p value of 0.077. PLR and NLR were correlated with CRP as an inflammatory marker and both were statistically significant with p value 0.004 and < 0.001 respectively. During exacerbation, PLR and NLR were correlated with the need for mechanical ventilation and the results were statistically significant with p value < 0.001. PLR and NLR showed a significant increase during exacerbation compared to stable COPD patients 1 month after discharge with p value of < 0.001.ConclusionPLR and NLR are simple tests that could be used to predict the severity of COPD exacerbation and the need for hospitalization, MV, and mortality prediction.

Immune dysfunction prior to and during vaccination in multiple myeloma: a case study based on COVID-19

Infection is the leading cause of death in multiple myeloma (MM). However, the cellular composition associated with immune dysfunction is not defined. We analyzed immune profiles in the peripheral blood of patients with MM (n = 28) and B-cell chronic lymphoproliferative disorders (n = 53) vs. health care practitioners (n = 96), using multidimensional and computational flow cytometry. MM patients displayed altered distribution of most cell types (41/56, 73%), particularly within the B-cell (17/17) and T-cell (20/30) compartments. Using COVID-19 as a case study, we compared the immune response to vaccination based on 64,304 data points generated from the analysis of 1099 longitudinal samples. MM patients showed limited B-cell expansion linked to lower anti-RBD and anti-S antibody titers after the first two doses and booster. The percentages of B cells and CD4+ T cells in the blood, as well as the absolute counts of B cells and dendritic cells, predicted vaccine immunogenicity at different time points. In contrast with the humoral response, the percentage and antigen-dependent differentiation of SARS-CoV-2-specific CD8+ T cells was not altered in MM patients. Taken together, this study defined the cellular composition associated with immune dysfunction in MM and provided biomarkers such as the B-cell percentage and absolute count to individualize vaccination calendars.

A Clinical Study of Drakshadi Syrup in Lowering Absolute Eosinophil Count (AEC) and Immunoglobulin E(Ige) Level in Tamak Swash (Bronchial Asthma) in Children

Childhood asthma is a prevalent chronic disease worldwide, affecting millions of children. Its impact is not only on the children themselves but also on their families, schools, and healthcare systems. Inspite of all recent advances in modern medical science the prevalence is increasing day by day. Aim: The present study is to assess the response of polyherbal compound ‘Drakshadi Syrup’ in lowering AEC and IgE level in childhood bronchial asthma. Materials and Methods: 106 nos. of patient were registered irrespective of sex between the age group 3-16 years out of which 100 patients completed the trial. Routine blood investigations including basic pathological markers i.e., AEC and IgE were recorded before and after 90 days of treatment. Statistical Tool Used: Paired-t test was done in GraphPad prism 10 software for data analysis. Results and Conclusion: After statistical analysis the t value of AEC was 13.31 with p&lt;.0001 i.e., highly significant and in IgE the t value was 9.73 with p&lt;.0001 i.e., highly significant. It can be concluded that the polyherbal compound is very effective in lowering AEC and IgE levels in childhood bronchial asthma.

Development of a machine learning-based model for the prediction and progression of diabetic kidney disease: A single centred retrospective study

BackgroundDiabetic kidney disease (DKD) is a diabetic microvascular complication often characterized by an unpredictable progression. Hence, early detection and recognition of patients vulnerable to progression is crucial. ObjectiveTo develop a prediction model to identify the stages of DKD and the factors contributing to progression to each stage using machine learning. MethodologyA retrospective study was conducted in a South Indian tertiary care hospital and collected the details of patients diagnosed with DKD from January 2017 to January 2022. Bayesian optimization-based machine learning techniques such as classification and regression were employed. The model was developed with the help of an optimization framework that effectively balances classification, prediction accuracy, and explainability. ResultsOf the 311 patients diagnosed with DKD, 227 were selected for the study. A system for predicting DKD has been created for a patient dataset utilizing a variety of machine-learning approaches. The eXtreme gradient (XG) Boost method excelled, achieving 88.75% accuracy, 88.57% precision, 91.4% sensitivity,100% specificity, and 89.49% F1-score. An interpretable data-driven method highlights significant features for early DKD diagnosis. The best explainable prediction model uses the XG Boost classifier, revealing serum uric acid, urea, phosphorous, red blood cells, calcium, and absolute eosinophil count as the major predictors influencing the progression of DKD. In the case of regression models, the gradient boost regressor performed the best, with an R2 score of 0.97. ConclusionMachine learning algorithms can effectively predict the stages of DKD and thus help physicians in providing patients with personalized care at the right time.

Causal role of immune cells in uveitis: Mendelian randomization study.

Uveitis, characterized by inflammation of the iris, ciliary body, and choroid, presents a significant global clinical challenge, contributing substantially to visual impairment. Risk factors include autoimmune diseases and immune cell dysfunctions, yet many remain unidentified. Immune cells, notably T cells, B cells, and monocytes, play pivotal roles in uveitis pathogenesis. While biologic agents show promise, comprehensive studies on immune cell types in ocular diseases are lacking. Genome-wide association studies (GWAS) and Mendelian randomization (MR) present promising avenues to elucidate genetic susceptibilities and causal relationships between immune cell traits and uveitis risk. Two-sample MR analysis was used to evaluate the causal relationship between 731 immune cells and uveitis, and genome-wide significance analysis was performed for genetic variation in 731 immune cells traits (P < 5 × 10-8). Immune characteristics include median fluorescence intensity (MFI), relative cell counts (RC), absolute cell counts (AC), and morphological parameters (MP), which were determined by published GWAS, and public data from the IEU Open GWAS database. The main analysis method of MR is inverse variance weighting (IVW). Heterogeneity and horizontal pleiotropy were also assessed. 5 immunophenotypes, including CD62L-DC %DC, IgD+ CD38dim %B cell, CD3 on CM CD4+T cell, CD3 on CD45RA-CD4 +T cell, and CD3 on CD39+ CD4+ Treg may increase the risk of uveitis. 5 immunophenotypes, including CD11b on CD33dim HLA DR-Myeloid cell, HLA DR on CD33dim HLA DR+ CD11b-myeloid cell, CD14-CD16 + %monocyte, HLA DR on CD14-CD16 + monocyte and PDL-1 on CD14-CD16 + monocyte was negatively associated with the risk of uveitis. Among them, HLA DR on CD14-CD16 + monocyte (OR=0.921, 95%CI =0.875-0.970, P=0.001) and HLA DR on CD33dim HLA DR+ CD11b- (OR=0.879, 95%CI = 0.833-0.927, P=0.00) were negatively associated with the risk of uveitis in bi-direction. These results indicate that 10 immune cells traits are significantly associated with the risk of developing uveitis and 2 of them were strongly associated with uveitis bi-directionally, after excluding the effects of confounding factors such as some immune diseases, which provided new ideas and therapeutic targets for the study of immune mechanism of uveitis.

High serum platelet-to-lymphocyte ratio as a risk factor for severe erythema nodosum leprosum

Introduction: Reactions in leprosy occur during the disease's progression and can result in disability. Hematological examination by calculating the platelet-to-lymphocyte ratio (PLR) can potentially predict leprosy reactions, especially erythema nodosum leprosum (ENL). This study aimed to asses the association between high PLR as a risk factor for severe ENL in multibacillary (MB) leprosy patients at Prof. dr. I G. N. G. Ngoerah General Hospital, Denpasar, Bali. Methods: This case-control study uses data from medical records of leprosy patients treated at Prof. dr. I G. N. G. Ngoerah General Hospital from February 2020 to December 2023. The case group comprises MB leprosy patients diagnosed with severe ENL, while the control group consists of MB leprosy patients without ENL. Platelet-to-lymphocyte is calculated by comparing absolute platelet counts with absolute lymphocyte counts from routine blood tests. Data were analyzed using SPSS version 26 by Chi-square test, sensitivity, specificity test and multivariate analysis. Result: A total of 48 subjects included in this study. The analysis results in this study showed that PLR was a risk factor for severe ENL (OR: 4.20; 95%CI: 1.228 - 14.365). Meanwhile, the cut-off point value used to categorize PLR was 151.37, with a sensitivity of 74% and specificity of 58%. Multivariate analysis showed that PLR had an adjusted odds ratio (aOR) of 2.38 (95%CI: 0.39 - 14.54; p= 0.347). Conclusion: High PLR might be associated with an increased risk of severe ENL reactions in MB leprosy patients.

Plateletcrit and absolute immature platelet count are not impacted by platelet transfusions: a single-centre prospective study

BACKGROUND This is the first study in which the impact of platelet transfusions on seven platelet indices was evaluated in platelet transfusion-dependent patients admitted in the ICU. STUDY DESIGN AND METHODS Among a cohort of 21 ICU patients prospectively studied over eleven months, a total of 19 ICU patients were enrolled. Seven platelet indices were measured before and then, within 18–24 h, after platelet transfusions using the Sysmex XN-10 analyser and statistically investigated as follows: i) apheresis vs. pooled platelet transfusions; ii) pre– vs. post–platelet transfusions; and iii) platelet count (PC) increment vs. PC decrement group. RESULTS A 79.2% of platelet transfusion episodes in ICU patients showed an increase in PC increment within 18–24 h, of which 73.7% had a peak percentage immature platelet fraction (%-IPF) above 10.0% during their stay. No difference was observed in the measurements of platelet indices between the apheresis and pooled platelet transfusion doses (all p > 0.05). Of the seven platelet indices investigated, plateletcrit (PCT) and absolute immature platelet count (A-IPF) were not influenced by platelet transfusions and thus proven to be stable (0.06 vs. 0.07%, p = 0.0901 and 4.6 vs. 4.9 × 109/L, p = 0.4559, respectively), despite their close proximity to platelet transfusion. But the overall effectiveness of these indices in detecting changes over time was not hindered. CONCLUSION A-IPF and PCT are stable after platelet transfusions, regardless of whether patient’s respond to or do not respond to platelet transfusion doses. PCT and A-IPF may thus prove useful in monitoring patient transfusion support and guiding management in thrombocytopenic patients.

COVID 19 Radiological Severity and Its Correlation with Complete Blood Picture Indices

Abstract Background The International Committee on Taxonomy of Viruses (ICTV) named this novel coronavirus as SARS-CoV-2. This infection is still spreading but now less than before, and this virus poses a serious threat to public health, though joint prevention and quarantine mechanisms in almost all provinces of mainland China have been confirmed to be enacted. Due to a lack of specific antiviral treatments and pressure of clinical treatment, thousands of severe cases have died every day worldwide. Our university isolation hospitals as a part from the Egyptian isolation hospitals were in the first line in facing this epidemic. Objectives This work was to investigate the radiological severity in COVID 19 patients and its correlation with complete blood picture indices among a sample of Egyptians. Patients and method This was an observational, analytical &amp; prospective study, recruited 30 cases of COVID 19 patients admitted to Ain Shams University isolation Hospitals. All patients were confirmed to be COVID 19 positive by PCR. Through history taking and clinical examination was done. On admission CBC and CT chest were documented analyzed and correlated. Result 30 COVID 19 patients were recruited with 60% of them were mals, 66% have no comorbidities. Their ages were 54.833± 13.097 ranging from 25 to 85 years old, their most distressing symptom was dyspnoea (53%). Their radiological probability of CT chest were CORADS 5, CORADS 4 and CORADS 3 representing (63.33%, 23%.33, 13.33%) respectively. Almost more than 4/5 (83.33%) of them were admitted in the ward. All patients admitted in the ICU died (16.67%). A highly significant decrease in absolute lymphocytic count with the increase in the degree of probability of CT chest (CORADS degree) with (P value less than 0.001). Also a significant decrease in absolute monocytic count with the increase in the degree of probability of CT chest (P value 0.015). No other CBC indices were found to be have any significant correlation with CT chest severity or probability scoring. A cutoff value of 1.16 thousand /ml or less for lymphocytes and 0.4 thousand /ml or less for monocytes can predict CT chest to be CORADS 5. Conclusion A strong association with lymohocytic and monocytic count of the complete blood picture of COVID 19 patients with the radiological probability of CT chest.

Immunophenotypic Evaluation of Circulating Monocyte Subsets in Beta Thalassemia Major Patients

Abstract Background β-thalassemia is a major public health problem in Egypt with particularly high incidence due to strong cultural preference for consanguineous marriages, and the high carrier rate. Iron overload, which is caused by increased gut iron absorption secondary to ineffective erythropoiesis, and regular blood transfusion is linked to accumulation within different organs with subsequent organ dysfunction. Monocytes are important lineages of innate immunity which activate the adaptive immune response and play a pivotal role in the host response to pathogens. Human blood monocyte subsets classification is based on the expression of CD14 and CD16 cell surface receptors. Aim of the Work To evaluate the circulating monocyte subsets in β-thalassemia major (β-TM) patients and its potential role in prediction of iron overload and chronic inflammation in β- thalassemia major patients. Patients and Methods A Case-Control study conducted on 40 previously diagnosed beta thalassemia major patients attending the outpatient clinic of Ain Shams University Pediatric Hospital, and 20 age and sex matched healthy control subjects. CBC, iron profile, CRP and immunophenotyping for monocyte subsets classification were done. Results Non classical monocytes were found statistically significantly higher in thalassemic patients especially in those with serum ferritin level &amp;lt; 1000 ng/ml (P value &amp;lt; 0.01). In addition, classical monocytes were found to be statistically significantly lower among the patients’ group (P value &amp;lt; 0.01). A negative correlation was found between intermediate monocytes and Transferrin saturation percent (TS%) suggesting its protective role in iron overload thalassemia patients. By using ROC curve, non- classical monocytes predicted ferritin &amp;lt; 1000 ng/ml at a cutoff point of 17.8 % and 0.05 x 10∧9/L for relative and absolute counts respectively. Conclusion All monocyte subsets proposed to have role in predicting iron overload and chronic inflammation β-TM patients. We recommend further studies on β-TM patients with the engagement of activity assays of monocyte subsets to clarify the co-regulatory role in iron hemostasis and chronic inflammation.

P-015 Impaired spermatogenesis in colitis: the role of interferon-γ mediated ferroptosis in sertoli cells by colitic CD4+ T cells

Abstract Study question Does colitis have an impact on spermatogenesis and what could be the potential mechanism? Summary answer Colitis causes sertoli cell ferroptosis and disrupts spermatogenesis in mice due to the migration of colitic CD4+ T cells that produce interferon-γ. What is known already In recent years, there has been a significant increase in rheumatic and inflammatory diseases. Epidemiological data reveals that dysregulated immune conditions can directly or indirectly impact male fertility and sexual function in patients of reproductive age. Inflammatory bowel disease (IBD), which encompasses Crohn’s disease and ulcerative colitis, is a chronic, recurring gastrointestinal inflammatory disorder characterized by bloody stools and weight loss. A study from a Swedish national cohort showed that IBD patients had diminished sperm fertility and increased sperm DNA fragmentation compared to healthy individuals. However, the precise mechanisms underlying male fertility problems in IBD remain unclear. Study design, size, duration In this study, C57BL/6 mice were kept under specific pathogen-free conditions. A murine colitis model that simulates human colitis histological features and symptoms was created using Dextran Sulfate Sodium (DSS). To establish the model, 2-2.5% DSS was added to the mice’s drinking water from days 0 to 7, followed by a three-day recovery period. Participants/materials, setting, methods Testis, epididymis and colon sections were stained with hematoxylin and eosin for histological analysis. The localization and phenotype of infiltrated lymphocytes in epididymis and testis were studied by immunostaining and flow cytometry. Sperm functions including motility, viability, and DNA integrity were assessed by standard assays. Iron, malondialdehyde, and reactive oxygen species (ROS) levels were analysed by commercial kit. Main results and the role of chance Colitis was found to impair male fertility in DSS-induced colitic mice, causing testis and epididymis tissue damage along with inflammatory cell infiltration. Colitis altered the immune cell phenotypes in the testis and epididymis. The proportion and absolute cell count of CD4+ T cells and CD19+ B cells increased after colon inflammation. Testicular sertoli cells in colitic mice exhibited ferroptosis, characterized by increased levels of iron deposition, malondialdehyde, and ROS. We assessed sperm parameters from the cauda epididymis of mice. Compared to the control group, there were significant reduction in sperm concentration, motility, viability and DNA integrity in the group with murine colitis induction. Consistently, we observed lower numbers of active pups from the fathers of the colitis group compared to control mice. CD4+ T cells with interferon-γ producing capabilities accumulated in the testes of colitis mice. Leukocyte flow cytometric analysis and parabiotic mouse model further demonstrated that colitis promoted pathogenic CD4+ T cells migration to the testis through circulation. The treatment of anti-CD4 antibody, anti-interferon-γ antibody or ferroptosis inhibitor can attenuate the colitis-associated testis pathologies. Limitations, reasons for caution Our study was conducted exclusively in mice. The pathogenic effect and the corresponding mechanism of colitis on male fertility in humans still needs to be confirmed. Wider implications of the findings Our team identified the mechanism linking dysregulated gut immune cell activity to testicular dysfunction. By identifying specific molecules on colitic immune cells, which allow their infiltration into the testis, may pave the way for a new therapeutic approach potentially improving the prognosis of colitis and related fertility impairments. Trial registration number not applicable

Evaluation of Eosinophil-Derived Neurotoxin Level and Asthma Severity in Isolated Asthma in Comparison to Asthma with Allergic Comorbidity

Abstract Background Asthma and associated type 2 inflammation are observed in 50–70% of patients with asthma and eosinophilic inflammation is a common feature in many asthma patients, and is associated with a higher risk of a more severe disease. Esinophilic Derived Neurotoxin (EDN) it’s useful as a clinical biomarker for the diagnosis and monitoring of asthma. High levels of EDN have been observed in patients with asthma, with higher levels measured during asthma exacerbations than in those with stable asthma. Objective To compare the association of the level of Esinophilic Derived Neurotoxin and burden of asthma in patients with asthma with Allergic comorbidities such as rhinitis and / or eczema compared to patients with asthma alone. Methods A cross sectional study included 100 adult patients, 50 patients diagnosed as asthma according to GINA guidelines and 50 patients diagnosed as asthma with allergic comorbidity such as Allergic rhinitis and/or eczema were selected from those who presented to the Allergy and clinical immunology clinics at Ain Shams University Hospitals during the period between January to July 2022. Results 50% of the studied population had bronchial asthma alone while the remaining had asthma with allergic comorbidities with most of them had asthma with allergic rhinitis and Most of the patients with allergic rhinitis had mod/severe persistent AR. 77% of total patients had positive SPT and 23% had negative SPT. Most of the patients had positive result for dust mites (Dermatophagoides farina 35% and Dermatophagoides pteronyssinus 30%) followed by pollens (mugwort 27%, rye grass 26% and tobacco 13%) and Animal dander (horse hair 15%, sheep wool 14%, cat hair 13% and dog hair 12%). The Median (IQR) of absolute eosinophil count and total IgE were higher in patients with asthma with Allergic comorbidities [0.68 (0.58 – 0.83) cells/mm3 and 155 (120 – 350) IU/ml respectively] while patients with asthma alone were 0.25 (0.12 – 0.45) cells/mm3 and 68.5 (29 – 123) IU/ml respectively. Our study showed the Median (IQR) of Serum EDN level was higher in patients with asthma with Allergic comorbidities [34 (28 – 40) ng/ml] compared to the patients with asthma alone [15(11 – 18) ng/m]. The quality of life and asthma control test was poor in asthmatic patients with allergic comorbidities compared to patients with asthma alone. Conclusion Serum EDN, Absolute Eosinophilis and total IgE can be used as a marker of T2 inflammation of air ways as their levels were higher in asthma with Allergic comorbidities. Asthma with comorbidities has more symptom burden with poorer quality of life and lower asthma control test than asthma alone; with more concern to be taken for those patients with asthma comorbidities as they have more severe asthma and poorer quality of life

A study on neutrophilic versus eosinophilic predominance in chronic rhinosinusitis patients

Background: Rhinosinusitis is defined as a multifactorial disorder with persistence of symptoms caused by inflammation of the sinonasal mucosa for 12 or more weeks with confirmation by diagnostic nasal endoscopy and computed tomography. The main aim of this study is to analyze the neutrophilic or eosinophilic predominance among CRS patients with histopathological examination for appropriate management, and to understand the association between the endotypes of CRS and blood parameters. Materials and methods: A prospective cohort study was conducted on 137 patients over a period of two years at a tertiary centre. Diagnostic nasal endoscopy (DNE), computed tomography of the nose and paranasal sinus (CT PNS), complete haemogram (CBC), absolute eosinophil count (AEC), erythrocyte sedimentation rate (ESR), immunoglobulin E(IgE) was done. Patients were planned for functional endoscopic sinus surgery (FESS) and specimen was sent for histopathological examination. Results: The comparison between DNE and AEC groups showed statistical significance and so did the comparison between CT and IgE. When we compared the groups of CRS with and without polyps with DNE and CT, there was no statistical significance. Also 64.2% of patients had an eosinophilic predominance. Conclusion: It has also been reported that CRS are highly eosinophilic, also have substantial levels of neutrophils. Importantly, tissue neutrophilia has been associated with a poor response to corticosteroid therapy in patients with CRS with nasal polyps. Keywords: nasal polyp; eosinophils; neutrophils; sinusitis; allergy; asthma; inflammation

Regenerative anemia identification in cats: Red blood cell indices or morphology, what to use?

Anemia, a clinical condition characterized by reduced erythrocytes, is often observed in cats. Regeneration indicates that the bone marrow can respond appropriately to anemia. The absolute reticulocyte count is the reference for differentiating regenerative and non-regenerative anemia, while red blood cell (RBC) indices and morphology provide supplementary information. This study aimed to identify anemia types and establish the most reliable RBC indices and morphology methods in agreement with the reference method. One hundred forty-five cases of cat anemia were prospectively classified using two methods: RBC indices and RBC morphology, and subsequently compared with the absolute reticulocyte count. Based on RBC indices assessment, 27 cases (19%) exhibited regenerative anemia. Based on RBC morphology, 29 (20%) cases were identified as having regenerative anemia. Using the reticulocyte absolute count as a reference method, 34 (23.4%) cases of regenerative anemia were identified. The findings indicated that RBC indices and RBC morphology did not align in evaluating medullary regeneration and that there is a good degree of agreement between RBC morphology assessment and the reticulocyte absolute count in identifying regenerative anemias. Blood smear analysis of RBC morphology was more dependable for classifying regenerative anemia than RBC indices. Further studies should be conducted with a larger number of animals and that allow the identification of the cause of anemia and the monitoring of the animal.

Haemato-biochemical Alteration in Bacteria Associated Respiratory Tract Infection in Dog

The research was undertaken during October, 2022 to June, 2023 to study the changes in haemato-biochemical values of the dogs suffered from respiratory tract infection due to bacteria. Blood samples were collected from healthy control group (Group A) and each dog of different treatment groups (Group B, Group C and Group D) on the 0th day (pre-treatment) and the 10th day (post-treatment) in K3-EDTA vacutainer tubes as well as clot activator-coated vacutainer tubes for haemato-biochemical estimation. In the result of haemato-biochemical study the highly significant difference (**p&lt;0.01) was found in total leucocyte count, absolute neutrophil count and C-reactive protein. Statistically no significant difference (p&gt;0.05) was observed in total erythrocyte count, haemoglobin, absolute eosinophil count, absolute lymphocyte count and albumin. In case of total protein a highly significant difference (**p&lt;0.01) was observed between Group A and Group B on day 0 and on day 10. A highly significant difference was also observed between (**p&lt;0.01) Group B and Group C; Group B and Group D on day 0 and day 10. On the other hand no significant difference (p&gt;0.05) was observed within treatment groups. In case of globulin, statistically no significant difference (p&gt;0.05) was obtained between the Group A and all the treatment groups on day 0 and day 10. No significant difference (p&gt;0.05) was observed within treatment groups. However, a significant difference (**p&lt;0.01) was found between Group B and Group C; Group B and Group D on 0th day and on the 10th day.

Evaluation of a flow cytometry-based method for determination of T-lymphocyte subtypes for quality assessment of cell therapy products

Chimeric antigen receptor-T (CAR-T) cell therapy is currently the best-known type of immune effector cells therapy. For CAR T-cell therapy, the determination of CD3+ T cells is necessary for the quality control of fresh leukapheresis product as starting material. The aim was to validate analytical method for quantification of percentage and absolute count of T lymphocyte subtypes (CD3+, CD4+ and CD8+ cells) in fresh apheresis products using single-platform method on flow cytometer BD FACS Canto II. Validation study included determination of precision, trueness (bias), assessment of linearity, carryover, comparison of results obtained with two different protocols on flow cytometer for CD3+ cells determination and stability study. For between-run precision coefficients of variation (CVs) were <20%, as well as bias for all T-lymphocyte subtypes. For within-run precision, CVs were <10%, except for low CD8+ cell (percentage 10.51% and viable absolute count 12.37%). Comparison of results obtained with two different protocols for CD3+ cells determination shows no statistically significant difference. Statistically significant differences between results of the analysis of CD4+ cells in fresh samples and results obtained after storage at 4 °C (p = .004) and at room temperature (p = .018) were found. In conclusion, method for enumeration of T-lymphocyte subtypes can be used in routine work on BD FACS Canto II instrument for quality assessment of fresh cell products collected by leukapheresis procedure.

Immature platelet fraction levels predict the development of prolonged thrombocytopenia after haematopoietic stem cell transplantation

Prolonged thrombocytopenia (PT) is a serious complication after haematopoietic stem cell transplantation (HSCT). PT has been suggested to be associated with an increased platelet transfusion requirement and poor outcomes after transplantation. Due to the complex mechanism of PT development, it is difficult to diagnose in the early post-transplant period. Our study aimed to identify an early predictive marker for PT after HSCT. Previous studies showed that the clinical utility of immature platelet fraction (IPF) predicts platelet recovery after chemotherapy and successful engraftment. However, the relationship between IPF and PT after HSCT remains unclear. Fifty-two patients with malignant haematological diseases who underwent HSCT were included in the study. We observed the kinetics of recovery of haematological parameters after transplantation and performed receiver operating characteristics (ROC) curve analysis using data from the 52 HSCT patients. The days to rise and peak of IPF, absolute IPF count (A-IPF) and highly fluorescent IPF (H-IPF) were almost synchronised in all patients, at day 10 and day 15, respectively. The begin to rise levels of IPF, H-IPF and A-IPF were all significantly lower in the PT group than in the good engraftment (GE) group (p=0.0016, p=0.0094, p=0.0086, respectively). The peak levels of IPF were significantly lower in the PT group than the GE group (p=0.0036). However, the peaks of H-IPF and A-IPF were not statistically significant between the two groups (p=0.3383, p=0.0887, respectively). The area under the ROC curve (AUC) of IPF rise was 0.739 (95% CI 0.583-0.896; p<0.05) and the cut-off value was 3.5%, while the AUC of IPF peak was 0.800 (95% CI 0.637-0.962; p<0.01) and the cut-off value was 8.0%. In conclusion, early low levels of IPF predict the development of PT after HSCT. These findings may help improve the management and treatment strategies for PT after HSCT.

Utility of Hemogram-based Parameter in Predicting Hospital Stay in Liver Cirrhosis: A 2-year Prospective Observational Study

Abstract Introduction: Hospitalized cirrhosis patients are a major financial burden on health-care systems. In this study, we attempted to evaluate the regular laboratory parameter like absolute eosinophil count (AEC), in liver cirrhosis in relation to length of hospital stay and severity grading systems such as the Child–Turcotte–Pugh (CTP) score and the model for end-stage liver disease (MELD). Materials and Methods: A prospective observational study was done in patients at a rural tertiary care hospital in central India, from October 2019 to September 2020. Calculation of AEC was done by automated complete blood counts in hemogram. Demographics of the patient, laboratory investigations, and outcomes of hospital stay were taken into consideration in the study. To identify predictors of hospital stay, a multivariate Cox regression analysis was used. Results: Among hemogram, with a cutoff value of ≤138, the AEC was found to be a significant predictor of lengthy hospital stays (≥7 days), with a 63.70% likelihood of properly predicting such stays. If AEC ≤138, then there was a 69.80% probability of prolonged hospital stays. Distribution of CTP score was comparable between hospital stay duration, i.e. &lt;7 days and ≥7 days. Proportion of patients with MELD score with ≤9, was significantly higher if duration of hospital stay was &lt;7 as compared to hospital stay duration ≥7 in MELD score 10-19. Conclusions: In hospitalized cirrhotic patients, among the hemogram, the AEC may be used as a low-cost warning indicator for clinical outcomes such as hospital stay.

Prevalence, clinical and haematological profile and outcome of BCR-ABL1-like acute lymphoblastic leukaemia in Indian children: A prospective observational study

BackgroundBCR-ABL1-like acute lymphoblastic leukaemia (ALL) represents a perplexing subclass of ALL mainly due to genomic heterogeneity and non-availability of standardized diagnostic tests. The data on prevalence, clinical–haematological profile and outcome are limited, more so from low-middle income countries. MethodsThis prospective observational study enrolled children<14 years with B-ALL. Recurrent genetic/chromosomal aberrations were excluded. BCR-ABL1-like aberrations were analysed using Polymerized Chain Reaction (PCR) or Next-Generation Sequencing (NGS). Two groups with/without BCR-ABL1-like ALL (Mut+/Mut-) were compared. ResultsOut of 214 eligible children; 75 with “B-other ALL” were analysed for BCR-ABL1-like aberrations. Their prevalence was 34/214 (15.8%) in B-ALL and 34/75 (45.3%) in “B-other” ALL (PCR:33.3% and NGS:53.3%). Majority of the aberrations were JAK2E16 and ILR7e5/ILR7e6 with PCR and RAS pathway and PAX5 fusion with NGS. Baseline demographic, clinical and laboratory parameters including aberrant flowcytometry were comparable in Mut+ and Mut-groups. Children with day-8 absolute blast count (ABC) were higher in Mut+ group. High end-induction minimal residual disease (MRD) was comparable in two groups. Number of NCI-standard risk (SR) at diagnosis with high D-8 ABC or high MRD was higher in Mut+ group. Similar results were found when aberrations were analysed by NGS alone. In all 56 children are alive, 19 had an event (relapse/death). The outcomes were comparable in two groups with median follow-up of 1075 days (IQR: 660–1527); when analysis was based on combined as well as NGS-based methodology alone. ConclusionsWe report 15.8% prevalence of BCR-ABL1-like ALL in children by PCR or NGS. High D-8 ABC was associated with BCR-ABL1-like ALL with no impact on outcomes.

Use of proxy indicators for automated surveillance of severe acute respiratory infection, the Netherlands, 2017 to 2023: a proof-of-concept study.

BackgroundEffective pandemic preparedness requires robust severe acute respiratory infection (SARI) surveillance. However, identifying SARI patients based on symptoms is time-consuming. Using the number of reverse transcription (RT)-PCR tests or contact and droplet precaution labels as a proxy for SARI could accurately reflect the epidemiology of patients presenting with SARI.AimWe aimed to compare the number of RT-PCR tests, contact and droplet precaution labels and SARI-related International Classification of Disease (ICD)-10 codes and evaluate their use as surveillance indicators.MethodsPatients from all age groups hospitalised at Leiden University Medical Center between 1 January 2017 up to and including 30 April 2023 were eligible for inclusion. We used a clinical data collection tool to extract data from electronic medical records. For each surveillance indicator, we plotted the absolute count for each week, the incidence proportion per week and the correlation between the three surveillance indicators.ResultsWe included 117,404 hospital admissions. The three surveillance indicators generally followed a similar pattern before and during the COVID-19 pandemic. The correlation was highest between contact and droplet precaution labels and ICD-10 diagnostic codes (Pearson correlation coefficient: 0.84). There was a strong increase in the number of RT-PCR tests after the start of the COVID-19 pandemic.DiscussionAll three surveillance indicators have advantages and disadvantages. ICD-10 diagnostic codes are suitable but are subject to reporting delays. Contact and droplet precaution labels are a feasible option for automated SARI surveillance, since these reflect trends in SARI incidence and may be available real-time.