Automated Blood Count Research Articles

Analysis and Interpretation of Automated Blood Count in the Treatment of Chronic Paracoccidioidomycosis.

Blood count is crucial for assessing bone marrow's cell production and differentiation during infections, gaging disease severity, and monitoring therapeutic responses. The profile of blood count in chronic forms of paracoccidioidomycosis (PCM) has been insufficiently explored. To better understand the changes in hematological cells in different stages of the PCM chronic form, we evaluated the blood count, including immature blood cells in automated equipment, before and during the treatment follow-up of 62 chronic PCM patients. Predominantly male (96.8%) with an average age of 54.3 (standard deviation SD 6.9) years, participants exhibited pre-treatment conditions such as anemia (45.2%), monocytosis (38.7%), and leukocytosis (17.7%), which became less frequent after clinical cure. Anemia was more prevalent in severe cases. Notably, hemoglobin and reticulocyte hemoglobin content increased, while leukocytes, monocytes, neutrophils, immature granulocytes, and platelets decreased. Chronic PCM induced manageable hematological abnormalities, mainly in the red blood series. Monocytosis, indicating monocytes' role in PCM's immune response, was frequent. Post-treatment, especially after achieving clinical cure, significant improvements were observed in various hematological indices, including immature granulocytes and reticulocyte hemoglobin content, underscoring the impact of infection on these parameters.

Automated Hematological Approach and Protein Electrophoretic Pattern in Tilapia (Oreochromis niloticus): An Innovative and Experimental Model for Aquaculture

This study aimed to assess the usefulness of two innovative automated methods (automated blood count counters and flow cytometry) for hematological investigation in Tilapia to make a contribution to the clinical diagnostics of this farmed species. Moreover, serum total proteins and their electrophoretic fractions (prealbumin, albumin, α-, β-, and γ-fraction), as health condition indicators, were assessed. The analysis of serum total proteins and electrophoretic fraction showed a normal and typical electrophoretic pattern of healthy fish (serum total proteins, 3.70 ± 0.62 g/dL; prealbumin, 0.44 ± 0.20 g/dL; albumin, 1.17 ± 0.66 g/dL; α-fraction, 1.49 ± 0.64 g/dL; β-fraction, 0.32 ± 0.16 g/dL; and γ-fraction, 0.29 ± 0.13 g/dL). The relationships between the values of red blood cells (RBCs), white blood cells (WBCs), and thrombocytes (TCs) obtained with the two automated methods were determined using Pearson correlation analysis. The results showed a significant positive correlation between automatic blood cell counting and flow cytometry analysis for RBCs (r = 0.97, p < 0.0001) and WBCs (r = 0.91, p < 0.0001), whereas no correlation was found for TCs (r = −0.11, p = 0.66). The preliminary results gathered in this study seem to highlight the usefulness of the new analytical techniques herein investigated in tilapia, suggesting their application in the hematological investigation of farmed fish species and their usefulness for monitoring the health and well-being of fish reared in aquaculture.

A study to evaluate platelet parameters in patients with type 2 diabetes mellitus: A case-control study

Abstract Background: Diabetes mellitus is a multifactorial disorder characterized by persistent elevation of plasma glucose and permanent complications of both small and large vessels. The high mortality rates, a decline in quality of life, and high morbidity rates are mostly caused by these problems. When blood vessels are injured, the normal hemostatic process depends heavily on platelets to maintain their integrity. Objectives: This study aimed at comparing various platelet indices between people with type II diabetes and people who appeared to be in good health status. Materials and Methods: This case-controlled study was carried out at the Azadi Teaching Hospital’s Laboratory in Duhok. Four milliliters of blood were collected from diabetics and non-diabetic controls into ethylenediaminetetraacetic acid anticoagulant tubes. Glycated hemoglobin and complete blood count were evaluated by automated chemistry analyzer Cobas 6000 (Roche) and automated blood count analyzer (Coulter, Sweden), respectively; platelet parameters including platelet count, platelet distribution width, mean platelet volume, platelet-large cell ratio, and platelet crit were obtained. Diabetic patients were divided into two groups: Group 1 with good glycemic control (HbA1c < 7%) and Group 2 with poor glycemic control (HbA1c ≥ 7%). Statistical software SPSS 26.0 was used. Results: The mean age of diabetic patients in this study was 50.97 ± 10.91 years. The mean values of platelet parameters except for platelet counts were significantly higher among diabetic patients when compared to non-diabetic subjects as well as among diabetic patients with poor glycemic controls compared to those with good glycemic control. Conclusion: All platelet indices apart from platelet count were significantly elevated among patients with diabetes mellitus than healthy subjects and also in relation to the degree of glycemic control of the disease with a P value of <0.05.

Frequency and Outcome of Pregnant Females Presenting With Thrombocytopenia at a Tertiary Care Hospital.

Platelet-related problems are more frequently discovered in women during pregnancy because screening is carried out as part of the initial clinic examination using automated blood counts. This study was done to find out the frequency and outcomes of pregnant females presenting with thrombocytopenia at a tertiary care hospital. This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore, Pakistan, from April 2023 to September 2023. This study involved 280 pregnant women presenting in the third trimester. Blood examination was acquired, and a platelet count less than 150x109/L was labeled as thrombocytopenia. Outcome variables were frequency of thrombocytopenia, while post-delivery, frequency of placental abruption, preterm delivery, stillbirth, need for blood transfusion, and poor Apgar score were noted and compared among women with and without thrombocytopenia. In a total of 280 pregnant females, the mean age and gestational age at the time of presentation were 29.34±4.38 years and 31.30±2.87 weeks, respectively. The mean BMI of the females was 27.97±4.72 kg/m2. Thrombocytopenia was noted in 34 females (12.1%). Placental abruption, preterm delivery, need for blood transfusion, stillbirth, and poor Apgar score were observed in 1.4%, 4.3%, 8.2%, 1.1%, and 2.1% cases, respectively. Placental abruption (11.8% vs. 0.0%; p<0.001), preterm delivery (29.4% vs. 0.8%; p<0.001), need of blood transfusion (35.3% vs. 4.5%; p<0.001), stillbirth (8.8% vs. 0.0%; p<0.001), and poor Apgar score (17.6% vs. 0.0%; p<0.001) were all significantly higher among pregnant women with thrombocytopenia as compared to those with a normal platelet count. The frequency of thrombocytopenia was 12.1% among pregnant females. The frequency of placental abruption, preterm delivery, need for blood transfusion, stillbirth, and poor Apgar score were all significantly higher among pregnant women with thrombocytopenia as compared to those with a normal plateletcount, irrespective of the patient's age, parity, and BMI.

White blood cells in a healthy adolescent population according to social and health characteristics

BackgroundThe immune system constitutes a sensory system both for heritable and non-heritable factors. Among the latter, social and environmental determinants of health may influence and shape the immune system in early life. To study the relationship between leukocytes and determinants of health in adolescence, we assessed total and differential white blood cells (WBC) according to social and environmental determinants of health in a healthy adolescent population. MethodsAs part of the population-based cohort Epidemiological Health Investigation of Teenagers in Porto (EPITeen), 1213 adolescents were evaluated at the age of 13. Total and differential WBC were evaluated through a venous blood sample using an automated blood counter (Sysmex®XE-5000, Hyogo, Japan). Sociodemographic, behavioral, and clinical data were collected through self-administered questionnaires. ResultsParticipants with better socioeconomic conditions (enrolled at private schools or higher parental education) had significantly lower total WBC levels, and the latter showed a lower percentage of neutrophils and higher percentage of lymphocytes. Those who practiced sports had significantly lower total WBC levels and neutrophil percentage, as well as a significantly higher percentage of eosinophils and lymphocytes. Adolescents with chronic disease, chronic medication, or allergic diseases had a significantly higher percentage of eosinophils and a lower percentage of monocytes. With increasing body mass index and systemic inflammation, we found a significant increase in total WBC levels. ConclusionWBC linked to different immune response patterns are associated with several social and environmental determinants of health in adolescence.

The relationship of platelet to lymphocyte ratio with the presence and extent of coronary atherosclerosis detected by coronary computed tomography angiography

Objectives: Platelet-lymphocyte ratio (PLR) combines the predictive risk of platelet and lymphocyte counts into a single risk index. PLR has been studied as a predictive marker in a variety of cardiovascular diseases. However, our understanding of the link between PLR and coronary artery disease (CAD) remains limited. The present study aimed to evaluate the relationship between PLR and intensity of coronary atherosclerosis in patients with suspected CAD. Methods: In this retrospective study, we included 221 patients undergoing dual-source 64-slice coronary computed tomography angiography (CCTA). Total and different types of leukocyte counts were measured with an automatic blood counter. Based on a modified version of the American Heart Association's categorisation, the coronary artery tree was divided into 16 segments. To assess the extent of coronary atherosclerosis, the number of affected coronary segments was counted. Coronary artery plaques were classified into three categories: (1) calcified plaque, (2) non-calcified plaque, and (3) mixed plaque. Results: After multivariable backward stepwise regression analysis, PLR remained as an independent predictor for both the presence and extent of coronary atherosclerosis (OR=2.38, 95% CI: 1.27-4.47 and OR=1.66, 95% CI: 1.10-2.51, respectively). There was no significant relationship between PLR and plaque morphology. Conclusions: Higher PLR was associated with the intensity of coronary atherosclerosis detected by CCTA. Further research is necessary to determine the optimal approach to using PLR in medical practice.

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio reflect disease activity and flares in patients with systemic lupus erythematosus-A prospective study.

To determine the association between neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with disease activity and flares in an inception cohort of patients with systemic lupus erythematosus (SLE) using a prospective study design. Consecutive adult patients (age≥21) who fulfilled the 1997 American College of Rheumatology (ACR) or the 2012 Systemic Lupus International Collaboration Clinic Classification (SLICC) Criteria for SLE were followed every 3 months, with SLE disease activity assessed by using SLEDAI-2K, and disease flares defined and captured by the SELENA-SLEDAI Flare Index (SFI). NLR and PLR were computed from the automated machine-counted blood count differentials. Linear mixed model and generalized estimating equation model were constructed to analyze the associations between NLR/PLR and SLEDAI-2K and disease flares, with multivariate adjustments. Of 290 patients recruited, the median (IQR) duration of follow-up and baseline SLEDAI-2K were 4.7 (3.2-6.1) years and 2 (0.5-3.5), respectively. On multivariable analyses, NLR was shown to be positively and significantly associated with SLEDAI-2K (estimate of coefficient (β)=0.05, P<0.01) and severe disease flares (odds ratio [OR] 1.05, P<0.05), but not with overall disease flares [OR 1.02, non-significant]. While PLR was shown to be positively associated with SLEDAI-2K [β=0.09, P<0.05], no statistically significant association between PLR and overall or severe disease flares was found [OR 1.00 and OR 1.06 respectively, non-significant]. Derived readily from automated blood count differentials, the NLR potentially serves as a surrogate prospective marker of disease activity and severe disease flares in SLE patients.

The Serum Total and Lipid-Bound Sialic Acid with Hematological-Biochemical Parameter Levels in Dogs with Dirofilariosis

The present study was planned to investigate the potential changes in the levels of serum total sialic acid (TSA), lipid-bound sialic acid (LSA) and hematological-biochemical parameters in the dogs naturally infected by Dirofilaria immitis. The patient group included the 7 dogs clinically and parasitologically (Modified Knott and PCR) diagnosed with Dirofilaria immitis while 7 healthy dogs were assigned as the control group. The biochemical parameters, blood gas parameters and hematological parameters were tested in the blood samples taken properly according to the guidelines from all the study animals using modular auto-analyser, blood gas analyser and automated blood count devices, respectively. Serum TSA and LSA levels were measured spectrophotometrically using Sydow and Katapodis methods, respectively. Compared with the healthy group, the dogs diagnosed with dirofilariosis were found to have significantly increased levels of serum troponin, triglycerides, VLDL, LDL, BUN, urea and creatinine and enzymatic activities of CK-MB, ALT, AST, ALP and LDH, and statistically significantly decreased levels of cholesterol and HDL (p&lt;0.05). The increases in levels of total protein and total bilirubin, and enzymatic activity of CK were found statistically insignificant (p&gt;0.05). A significantly decreased level of RBC and a significantly increased level of WBC was determined in the dogs with dirofilariosis (p&lt;0.05). The decreases in the levels of Hct and Hb were found statistically insignificant (p&gt;0.05). The differential blood count test of the dogs with dirofilariosis indicated statistically significantly increased eosinophil count (p&lt;0.05). The increases in the neutrophil and basophil counts, and the decreases in the lymphocyte and monocyte counts were detected to be statistically insignificant (p&gt;0.05). In the dogs with dirofilariosis, the decreases in the levels of pCO2, HCO3 and BE as the venous blood gas parameters were detected to be statistically significant (p&lt;0.05). The decreases in the levels of pH and pO2 were determined to be insignificant (p&gt;0.05). The levels of serum TSA and LSA of the dogs with dirofilariosis were found statistically significantly higher than the healthy group (p&lt;0.05). As a conclusion, statistically significant differences were identified between the dogs with dirofilariosis and healthy dogs in terms of sialic acid levels and certain biochemical, venous blood gas and hematological parameters. On the other hand, the present study is the first to investigate the serum sialic acid levels in the dogs with dirofilariosis.

Assessment of Reticulocyte and Erythrocyte Parameters From Automated Blood Counts in Vaso-Occlusive Crisis on Sickle Cell Disease.

Sickle cell disease is a complex genetic disease involving cell adhesion between red blood cells, white blood cells, platelets and endothelial cells, inducing painful vaso-occlusive crisis (VOC). We assessed reticulocyte and erythrocyte parameters in a cohort of confirmed SCD patients, and investigated whether a combination of these routine laboratory biomarkers of haemolysis could be used to predict VOC development. Reticulocyte and erythrocyte parameters were evaluated using the Sysmex XN-9000 analyser. A total of 98 patients with SCD were included, 72 in steady state and 26 in VOC. Among the 72 patients in steady state, 22 developed a VOC in the following year (median: 3 months [2–6]). The following parameters were increased in SCD patients with VOC development compared to SCD patients without VOC development in the following year: reticulocyte count (94.6 109/L [67.8–128] vs. 48.4 109/L [24.9–87.5]), immature reticulocyte count (259 109/L [181–334] vs. 152 109/L [129–208]) reticulocyte/immature reticulocyte fraction (IRF) ratio (6.63 109/(L*%) [4.67–9.56] vs. 4.94 109/(L*%) [3.96–6.61]), and medium fluorescence reticulocytes (MFR) (19.9% [17.4–20.7] vs. 17.1% [15.95–19.75]). The association of a reticulocyte count of >189.4 109/L and an MFR of >19.75% showed a sensitivity of 81.8% and a specificity of 88% to predict VOC development in the following year. Based on our findings, a combination of routine laboratory biomarkers, as reticulocyte count, immature reticulocyte count and fluorescent reticulocyte fraction at steady state, could be used to predict VOC development in SCD.

Platelet Activation Markers in Children with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

The study aimed to evaluate mean platelet volume (MPV), platelet distribution width (PDW), and platecrit in children with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), to assess the predictive value of these platelet activation markers for adverse outcomes, and to correlate their levels with various data in these patients. This prospective cohort study included 60 children with PAH-CHD as group I and 60 children with CHD and no PAH as group II. Another 60 healthy children of matched age and sex served as the control group. All included children were evaluated by echocardiography. MPV, PDW, and platecrit were also measured using an automated blood counter. All patients were followed up for death or readmission for 6 months. MPV, PDW, and platecrit were significantly higher in group I compared to group II and the control group and they correlated well with increasing severity of PAH. MPV, PDW, and platecrit positively correlated with right ventricular diameter and mean pulmonary artery pressure, however they correlated negatively with right ventricular systolic and diastolic function. The best cut-off of platelet activation markers levels to predict poor prognosis in group I was > 11.2 FL with 75% sensitivity and 96.6% specificity for MPV, > 12.7 FL with 75% sensitivity and 61.5% specificity for PDW, and > 0.505% with 75% sensitivity and 93.2% specificity for platecrit. MPV, PDW, and platecrit were elevated in children with PAH-CHD and found to be good predictive markers for poor prognosis in these children.

Pseudothrombocytosis Due to Red Blood Cell Fragmentation in Haemoglobin-H Disease

Red cell fragmentation may result in erroneously high platelet counts by automated blood counters. Therefore, any abnormal platelet counts in a full blood count analysis should be re-evaluated either using blood film manual counting or with more accurate automated analysis options.

Neutrophil-to-lymphocyte ratio in patients with white-coat hypertension

Introduction: White coat hypertension (WCH), a distinct phenotype of hypertension, is defined as elevated office blood pressure (BP) measurements during repeat visits with normal out-of-office BP measurements. The association of WCH with cardiovascular risk remains unclear; however, current data support an association between untreated WCH and the risk for cardiovascular events, cardiovascular mortality, and all-cause mortality. Increased inflammatory processes may explain the underlying pathophysiology of the increased risk for cardiovascular events in WCH; therefore, we evaluated the neutrophil-to-lymphocyte ratio (NLR) of patients with WCH compared with matched normotensive controls. &#x0D; Material and Method: Forty-five eligible subjects with WCH and 45 age, sex, and BMI matched healthy and normotensive subjects were included in the study. The subjects were assessed by office arterial BP and 24-hour ambulatory BP measurements. An automated blood count analyzer measured the NLR values. &#x0D; Results: The mean NLR in the patients-with-WCH group was significantly higher than that in the control group (2.67±0.27 vs. 2.46±0.34, p

THE EFFECT OF METFORMIN AND GLIMEPIRIDE ON PLATELET COUNT AND INDICES AMONG DIABETIC PATIENTS WERE ATTENDING JABER ABU ALIZ DIABETIC CENTER IN KHARTOUM STATE

Diabetes mellitus (DM) is a global pandemic, Platelets have crucial role in accelerated atherosclerosis and thrombosis which characterize DM.&#x0D; Aim&#x0D; The aim of the study was to detect the effect of two major oral hypoglycemic drugs (Metformin and Glimepiride) on platelet count and indices{ MPV (Mean platelet volume), PLCR (platelet large cell ratio),PDW (platelet distribution width)}.Beside, to studythe effects of variation induration of the drug, dose of drug, HbA1C level and associated complications.&#x0D; Material and methods&#x0D; A case control study was performed 146subjects 50 were using metformin, 46 were using Glimepiride in addition to 50 apparently healthy non-diabetic matching for age and sex subjects have been tested as control group.&#x0D; EDTA anti-coagulated venous blood samples has been taken from eachsubject , platelet count and indices were measured using automatic blood counter (Sysmex KX-21N) and HbA1C was Measured using Ichroma II . Statistics was performed by SPSS (version 22).&#x0D; Results&#x0D; The results showed that both types of treatment (Metformin, Glimepiride)have reduced the platelets indices but the reduction in Glimepiride was insignificant except in PDW when comparedwith controls. Also both treatments have no effect on platelet count and there was insignificant variation between different doses of metformin and Glimepiride.Glimepiride diabetic patients from 15 to 20 yearshave increased platelet count in contrast to patients whom used glimepiride for less than 15 years.there was increased platelet count and decreased platelet indices in patients with foot ulcers whom using glimepiride than patients without complications. Also increased platelet indices in patients with HbA1C level less than 6% in contrast to those with HbA1C more than 7%.&#x0D; Conclusion &#x0D; It is concluded that both types of drugsreduce platelet indices. Glimepiride have a good prognostic effect on the Pro-thrombotic state and accelerated atherosclerosis which is associated with type 2 study population because the platelet indices were insignificant compared withcontrols.&#x0D; Keywords: Diabetes Mellitus, Metformin, Glimepiride, platelet count and indices

Complete blood cell count measures in retinal artey occlusions.

To investigate the role of complete blood cell count (CBC) measures in retinal artery occlusion (RAO). This was a case-control study, including 73 newly diagnosed RAO patients and 73 sex- and age-matched subjects without RAO. On the same day of RAO diagnosis, a blood sample was collected and CBC was determined using an automatic blood counter. Dimensional CBC indices, such as mean platelet volume (MPV) and red cell distribution width (RDW), and some CBC-combined indices, including neutrophil/lymphocyte ratio (NLR), derived NLR [dNLR=neutrophils/(white blood cells - neutrophils)] and platelet/lymphocyte ratio (PLR), were evaluated. Erythrocyte sedimentation rate (ESR) was also measured. Median neutrophils, red cell distribution width (RDW), NLR and dNLR were 4.5x109 /L (IQR=3.8-5.8), 13.4% (IQR=12.7-14.75), 2.47 (IQR=1.85-3.13) and 1.70 (IQR=1.26-2.18) in RAO patients and 4x109 /L (IQR=3.18-4.93), 12.9% (IQR=12-14), 1.86 (IQR=1.42-2.44) and 1.32 (IQR=1.02-1.64) in controls. RAO patients had significantly higher values of neutrophils (p=0.003), RDW (p=0.0011), NLR (p=0.0001) and dNLR (p=0.0001). There were no significant differences between the values of white blood cells, lymphocytes, platelet count, MPV and PLR. Multivariate logistic regression models revealed a statistically significant correlation between RAO and increased RDW (OR=1.36, 95% CI=1.06-1.73, p=0.015), NLR (OR=2.02, 95% CI=1.34-3.06, p=0.0009) and dNLR (OR=3.4, 95% CI=1.71-6.75, p=0.0005). Results suggest that RDW, NLR and dNLR may be involved in the pathogenesis of RAO and predict its occurrence. However, high-quality epidemiologic studies, preferably of cohort design, are warranted to confirm whether, or not, an RDW, NLR and dNLR may be considered potential biomarkers of RAO.

Red Cell Distribution Width (RDW) and Complete Blood Cell Count-Derived Measures in Non-Arteritic Anterior Ischemic Optic Neuropathy.

Purpose: To assess the role of complete blood cell count (CBC) dimensional indices and CBC-derived measures in non-arteritic anterior ischemic optic neuropathy (NA-AION).Methods: In this retrospective case-control survey, 37 newly diagnosed NA-AION patients and 37 sex- and age-matched cataract controls were enrolled in 2017-2018. On the same day of NA-AION diagnosis, a blood sample was collected and CBC was determined using an automatic blood counter. CBC dimensional indices, such as mean platelet volume (MPV) and red cell distribution width (RDW), and CBC-combined indices, including neutrophil/lymphocyte ratio (NLR), derived NLR [dNLR = neutrophils/(white blood cells - neutrophils)], and platelet/lymphocyte ratio (PLR), were evaluated. Erythrocyte sedimentation rate (ESR) was also measured.Results: Mean platelet count, median MPV, RDW, NLR, and dNLR were 221±48 x 109/L, 8.2 fL (IQR=7.6-8.9), 13% (IQR=12-14.5), 2.50 (IQR=1.77-3.06), and 1.73 (IQR=1.31-2.07) in NA-AION patients and 248±56 x 109/L, 7.60 fL (IQR=7.05-8.25), 12% (IQR=11.6-13), 1.95 (IQR=1.43-2.49) and 1.36 (IQR=1.07-1.69) in controls. NA-AION patients showed significantly lower platelet count (p=0.03) and significantly higher median values of MPV (p=0.01), RDW (p=0.015), NLR (p=0.03), and dNLR (p=0.01). Multivariate logistic regression models disclosed a significant correlation only between higher levels of RDW and NA-AION (p≤0.05). The attributable risk of the association between NA-AION and RDW was 33%.Conclusions: Results suggest that RDW may be somehow involved in the pathogenesis of NA-AION. However, high-quality cohort studies are warranted to confirm whether, or not, an altered RDW may be considered a potential biomarker of this vascular disorder affecting the optic nerve.

Haematological Presentations in Acute and Chronic Tramadol Intoxication

Introduction Tramadol is a synthetic centrally acting analgesic used worldwide for pain relief, but now abused as a euphoria generating substance. The short- and long-term implications of tramadol intoxication on blood cells and its components are still hazy and controversial. Aim Our primary aim was to evaluate the alterative pattern of haematological parameters resulting from acute or chronic tramadol intoxication. Method The study was made of acute and chronic phases of sixty male rats (Rattusnorvegicus) randomly pair-divided into established groups of six male rats each. The acute stage consisted of a control group of 6 rats administered with normal saline solution, and a treatment group of 6 rats administered with lethal dose of tramadol. The control group for the chronic stage consisted of 6 rats that were administered normal saline solution. Whereas, the tramadol-dependent groups comprised of 3 groups of 6 rats each administered orally with 50 mg/kg, 100 mg/kg, and 200 mg/kg of tramadol for 90 days respectively. Statistical analyses consisted of the one-way analysis of variance (ANOVA), Student’s t-test, and Pearson’s Correlation using the JMP statistical discovery™ software version 14.1. Blood samples were collected after anesthetic sacrifice by cardiac puncture for the analysis of full blood count and red cell indices using SYSMEX Automated Blood Count machine (SYSMEX KX-21N ANALYZER) and microscopy for blood film reading. Results Results of the acute phase of the study showed that the packed cell volume (PCV) in the treatment group (51.00±2.96%) was significantly higher (t=3.99, p=0.002) than control (37.83±1.43%). Similarly, the haemoglobin concentration (Hb) in the treatment group (14.70±0.46 g/dL) was significantly higher (t=5.10, p=0.005) than control (11.55±0.41 g/dL). The mean cell haemoglobin concentration (MCHC) was significantly lower (t=2.67, p=0.02) in the control group (28.30±0.52 g/dL) than treatment (30.43±0.61 g/dL). However, that of the chronic phase exhibited a progressive increase in platelet count which was proportional to increasing dosage of treatment (t=8.59, p=0.007). Conclusion This study has demonstrated that tramadol administration could cause haematological alterations which could be beneficial if administrated optimally and deleterious, if abused. Therefore, indiscriminate and prolonged use of tramadol should be monitored to avert haemotoxicity.

Comparative study of platelet indices in coronary artery diseases

Introduction: With urbanization and increase in sedentary lifestyle, prevalence of CAD (Coronary artery disease) is looming large as the new epidemic afflicting Indians. Altered platelet morphology and functions have been linked with the formation and propagation of thrombotic event. Platelet indices (Mean platelet volume - MPV, Platelet distribution width - PDW, Platelet large cell ratio - PLCR) are determinants of platelet functionality. Aims and Objectives: 1. To study platelet indices (MPV, PDW, P-LCR) in CAD; 2. To compare platelet indices in patients with myocardial infarction, stable CAD and control population. Material and Methods: A comparative and prospective study was conducted on 100 patients each of MI & stable CAD on antiplatelet therapy and 100 age and sex matched healthy individuals as controls. Platelet indices were measured using an Automated Blood Counter SYSMEX XN-1000. Troponin T and CK-MB levels were collected from clinical data in MI cases. Results: Platelet indices were significantly higher in MI patients in comparison to stable CAD and control groups. Stable CAD patients also showed significantly higher platelet indices in comparison to control groups. (p value Conclusion: The present study showed a significantly higher MPV, PDW and P-LCR in CAD patients in comparison to control group. Among CAD patients, MI patients had significantly higher platelet indices than stable CAD patients. Hence platelet indices can be used as simple and cost effective predictive parameters to predict CAD. Their use in a risk stratification system to predict MI and in response to intervention are worthy of consideration. Keywords: Coronary artery diseases, Platelet indices, Mean platelet volume, Platelet distribution width, Platelet large cell ratio.

Obesity-Driven Acceleration of Acute Promyelocytic Leukemia Development in Mice with Inserted PML-RARa

While a number of solid tumors are identified as obesity-associated cancers, multiple myeloma and acute promyelocytic leukemia (APL) are the only hematologic malignancies included in this category. APL is a highly treatable form of AML characterized by maturation arrest at the promyelocyte stage, and frequent cures with combined ATRA and Arsenic Trioxide therapy. APL is initiated by a chromosomal translocation that causes the fusion of thePMLandRARAgenes, leading to the production of PML-RARA protein. To determine if obesity accelerates the development of APL, we used a genetically-engineered knock-in model in which human PML-RARA cDNA was inserted into the 5' untranslated region of the murine cathepsin G gene (Ctsg), which targets expression to early myeloid progenitor cells. This knock-in transgene was extensively backcrossed (&amp;gt;20 generations) into the C57BL/6J (B6) genetic background, which has been consistently shown to render mice susceptible to diet-induced obesity.Ctsg-PML-RARA mice developed on the B6 background generate a lethal APL-like leukemia with a latency of 8-12 months, and a penetrance of about 60%, as cooperating mutations occur and cause clinical disease. We placed cohorts of B6.Ctsg-PML-RARA heterozygous (mCG+/PR) and wild-type (WT) mice, genotyped by PCR, on high-fat (HFD) [57% coconut oil fat] and low-fat (LFD) [10% coconut oil fat] diets, collecting peripheral blood via the retro- orbital sinus at 30 day intervals and performing automated blood counts to observe temporal associations in disease development. HFD feeding significantly accelerated the development of APL in mCG+/PR mice, leading to anemia, thrombocytopenia, leukocytosis of the granulocyte series, and splenomegaly. Survival rate reduction demonstrated sexual-dimorphism, with male HFD-fed mCG+/PR mice displaying a median leukemia-free survival time of 211 days compared to 266 days in the female HFD-fed mCG+/PR cohort. In contrast, LFD-fed mCG+/PR male mice showed a median survival time of 318 days, whereas none of LFD-fed mCG+/PR female group nor any of the WT groups on HFD or LFD have reached median survival as of 325 days. Moreover, no signs of leukemia were observed in either HFD- and LFD-fed WT groups, indicating that adiposity alone had no leukemogenic effect. These studies clearly demonstrate that obesity accelerates leukemogenesis in theCtsg-PML-RARA mouse model of acute promyelocytic leukemia. High density flow cytometry will be applied in the bone marrow of the different groups to evaluate the modulation of multiple hematopoietic cell lineages and cell surface markers. Disclosures No relevant conflicts of interest to declare.

Prognostic Role of the Red Blood Cell Distribution Width (RDW) in Hodgkin Lymphoma

Simple SummaryThe red blood cell distribution width (RDW) increases in inflammatory conditions and is described as having a prognostic role in different types of cancer. As Hodgkin lymphoma (HL) has a proinflammatory background, we aim to study the prognostic role of RDW in HL. We report in a large retrospective series of homogenously treated HL, for the first time, that RDW is a simple, cheap, and easily available prognostic factor in HL, that identifies a group with worse EFS, OS, and a higher potential incidence of secondary malignancies. RDW seems to be related to most adverse prognostic factors in HL and this may make RDW a good candidate to be included in current or new prognostic scores for HL.The red blood cell distribution width (RDW) is a parameter available from an automated blood count, which measures the degree of heterogeneity of erythrocyte volume and increases in inflammatory conditions. The prognostic role of RDW has been described in different types of cancers. Hodgkin lymphoma (HL) is a hematological malignancy, known to have a proinflammatory background. We aim to study the prognostic role of RDW in HL. We retrospectively analyzed 264 patients with HL from two hospitals in the Balearic Islands between 1990 and 2018. Higher levels of RDW were independently related to anemia, B-symptoms, and low albumin. In age ≥45 years, the presence of lymphopenia and higher RDW were independently associated with worse event-free survival (EFS) and overall survival (OS). Long-term incidence of secondary malignancies was significantly higher in patients with higher RDW, particularly lung cancer. In conclusion, we report for the first time that RDW is a simple, cheap, and easily available prognostic factor in HL that identifies a group with worse EFS, OS, and a higher potential incidence of secondary malignancies. RDW seems to be related to most adverse prognostic factors in HL, making RDW an excellent candidate to be included in prognostic scores for HL.

Pharmacokinetics-Guided Dosing of Hydroxyurea Can Achieve Near-Pancellular Fetal Hemoglobin Expression in Sickle Cell Anemia: F-Cell Analysis As a Benchmark for Disease-Modifying Therapy

Background: Hydroxyurea is the standard of care for children with sickle cell anemia (SCA). We have developed and prospectively validated a population pharmacokinetics (PK)-based dosing model to initiate hydroxyurea at a personalized dose that achieves maximum tolerated dose (MTD) quickly and produces a more robust HbF response than traditional weight-based dosing. HbF is distributed unequally across RBCs, and most mature RBCs have no detectable HbF. Genetic traits and hydroxyurea increase the number of HbF-containing RBCs. Measurement of HbF alone reflects an average of the HbF content across all RBCs in a lysate, so the varying, cell-specific compartmentalization of HbF across RBCs is not evaluated. In contrast, flow cytometry can be used to detect HbF-containing RBCs (F-cells) and non-F-cells, and the amount of HbF per F-cell (F/F-cell) can also be quantified. Prior studies indicate that an F/F-cell of 10 pg should completely prevent sickling. Methods:We studied participants in the Therapeutic Response Evaluation and Adherence Trial (TREAT, ClinicalTrials.gov NCT02286154), which is a prospective study with the primary objective of developing and evaluating a population PK model to predict the MTD of hydroxyurea for individualized dosing. Individuals with genotype-confirmed HbSS or sickle-β0-thalassemia (both classified here as SCA) were enrolled; none had gene-deletion HPFH. We recently developed a multiparametric flow cytometric assay (F-cell analysis) to measure the amount and distribution of HbF in all RBCs and in immature (CD71+) reticulocytes. The total number of HbF-containing RBCs (F-cells) and HbF-containing immature reticulocytes (F-retics) were enumerated. Mean concentration of HbF per F-cell (F/F-cell) was calculated from F-cell number, Hb F quantitation by capillary zone electrophoresis, and automated blood counts (RBC count and hemoglobin concentration). Results:To date, 36 TREAT patients have had F-cell analysis with a mean age of 5.6 years (median 4.1; range 1.2-21.1). Mean age at start of hydroxyurea was 3.2 years (median 1.0; range 0.5-19.5) with a mean duration of hydroxyurea therapy of 2.4 years (median 2.1; range 0.5-4.1). Mean dose of hydroxyurea at the time of F-cell analysis was 27.0 mg/kg (median 27.6; range 17.8-38.6). HbF induction was robust with a mean HbF level of 30.8% (median 32; range 7.7-52.6). HbF level had a curvilinear association with F-cell fraction (Figure A). Mean total F-cell fraction (percent of all RBCs that are F-cells) was 82.2% (median 89.8; range 33.6-99.0); 24/36 (67%) had &amp;gt;80% F-cells, and 17/36 (47%) had &amp;gt;90% F-cells, indicating the ability to achieve a near pancellular distribution of HbF with PK-guided hydroxyurea therapy in a significant fraction of patients, especially those with high adherence (Figure B). The mean F/F-cell was 11.9 pg (median 11.5; range 5.1-19.4; Figure C), and 26/36 (72%) had an mean F/F-cell ≥10 pg, an amount of HbF in an individual RBC that completely prevents sickling (mean F/F-cell does not reflect the variance of F/F-cell across the RBC population). All patients who had a HbF level ≥30% (22/36, 61%) had mean F/F-cell ≥10 pg (Figure D). Of those with total F-cells ≥80%, 22/24 (91%) had mean F/F-cell ≥10 pg. As expected, higher total F-cells and mean F/F-cell were associated with higher hemoglobin concentration and lower reticulocyte counts. Mean F/F-cell &amp;gt;16 pg was associated with a mean hemoglobin &amp;gt;10 g/dL and mean absolute reticulocyte count &amp;lt;100x106/mm3. Bland-Altman analysis of total F-cells and F-retics showed a mean bias of 33.5 percentage points (total F-cells &amp;gt; F-retics), indicating the difference between F-cell production (F-retics) and peripheral survival advantage of F-cells. For F-cells &amp;gt;80%, however, the difference between F-cell and F-retic fraction decreased rapidly, consistent with little non-F-cell production by the bone marrow. Discussion: PK-guided dosing of hydroxyurea at MTD can achieve near-pancellular HbF expression in a large fraction of patients with sickle cell anemia. Our data suggest that an F-cell fraction of 80% and a mean F/F-cell of 10 pg should be the minimum goals for hydroxyurea therapy to minimize or prevent sickling, hemolysis, and anemia. These same minimum goals should apply to any HbF-inducing therapy, including genetic therapies, and F-cell analysis should be included in the standard laboratory analysis for these treatments. Figure Disclosures Quinn: Celgene: Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Research Support. Ware:Bristol Myers Squibb: Other: Research Drug Donation; Addmedica: Other: Research Drug Donation; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees; Nova Laboratories: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: DSMB.