Blood Count Values Research Articles

Mean Platelet Volume in Patients with Chronic Venous Insufficiency

Objective: the mean platelet volume (MPV) is a good indicator of platelet activity; it is reported to increase in diseases associated with inflammatory processes and in vascular diseases. This study investigated the importance of mean platelet volume in patients with chronic venous insufficiency (CVI) and whether the MPV was likely to be a predictor of the CVI. Methods: 117 patients who were diagnosed as CVI by colored Doppler Ultrasound (CDU) method and 49 healthy volunteers (forming the control group) were enrolled to this study, which was planned retrospectively. The patients’ blood count values taken within one month before and after the CDU evaluation were recorded by the hospital information system. The complete blood count, routine biochemical tests and thyroid function tests of the patients diagnosed with CVI were compared to the control group. Results: Significant differences were not detected between the patients and the control group in terms of the levels of creatinine, aspartate aminotransferase, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, erythrocyte, sedimentation speed, leukocyte, haemoglobin and thrombocyte (p>0.05). The thyroid stimulating hormone and the MPV levels were significantly lower in the control group (p<0.05). Conclusion: MPV levels as an easy, cheap and practical data extracted from complete blood count, were found higher in patients diagnosed with CVI compared to the control group. This may be originated from endothelium changes as an answer to venous hypertension and dilatation in CVI. MPV can be used as a follow-up marker in CVI patients. J Clin Exp Invest 2016; 7 (1): 73-77

Novel Stratification of Mortality Risk by Kidney Disease Stage

Background: Chronic kidney disease (CKD) is a common disorder with a variable clinical course and it is associated with increased mortality. The Intermountain Risk Score (IMRS) is an electronic risk calculator that utilizes complete blood count (CBC) and basic metabolic panel (BMP) values to predict mortality in various healthcare populations. We hypothesized that IMRS would predict mortality in patients with CKD even with adjustment for serum phosphate and urinary albumin. Methods: Three thousand eight hundred seventy-two patients with CKD classes IIIA-V had IMRS calculated retrospectively and survival analysis was performed investigating 1- and 5-year mortality. Kaplan-Meier survival curves were generated for predefined IMRS groups of low, medium and high risk for CKD patients overall and by sex and CKD stage. Serum phosphate and urinary albumin/creatinine ratios were modeled in multivariate Cox-proportional hazard models. Receiver operator characteristic curves were used to determine c-statistics for mortality. Results: For all patients with CKD, mortality was significantly greater for those with medium- or high-risk compared to low-risk IMRS categories, among each CKD stage. Overall, IMRS was predictive of mortality at both 1 and 5 years, even when adjusted for CKD stage and predicted mortality more accurately than CKD stage alone. Albuminuria was not independently associated with mortality and serum phosphate weakly predicted mortality. Conclusion: IMRS is a strong predictor of mortality in patients with CKD and is robustly complementary to CKD stage in refining risk prediction. Given the universal availability and low cost of the CBC and BMP, IMRS may be of a substantial value in CKD risk assessment and management.

Treatment of severe refractory epistaxis in hereditary hemorrhagic telangiectasia using a two-flap nasal closure method.

Nasal closure has been shown to effectively manage severe epistaxis refractory to other treatments in patients with hereditary hemorrhagic telangiectasia (HHT). The nasal closure procedure may be underutilized because of its surgical complexity and flap breakdown. This work is a retrospective review of 13 HHT patients treated for severe epistaxis with nasal closure between 2005 and 2013. Operating room (OR) time, need for revision surgery, preprocedure, and postprocedure epistaxis severity score (ESS), complete blood count values, and Glasgow Benefit Inventory (GBI) questionnaire results were collected for each patient. The technique is described. We characterize a typical nasal closure patient and compare outcomes based on our experience with the traditional 3-flap closure and a simplified 2-flap nasal closure procedure. The average candidate for nasal closure in this series had an ESS of 7.88, hemoglobin (Hgb) of 8.3 g/dL, and received multiple transfusions, iron therapy, and cautery/coagulation procedures. Average ESS subsequent to nasal closure using the 2-flap method is 0.92 and mean GBI score is 56.3. Comparison of 5 patients who underwent the traditional 3-flap nasal closure procedure and 8 patients receiving the 2-flap nasal closure showed no significant difference in postoperative ESS or GBI metrics. Mean operating room times of the traditional and simplified methods were 3.12 hours and 1.44 hours (p = 0.0001). Mean time to first revision for 8 nasal closure patients was 21.5 months. In short-term follow-up, the 2-flap procedure showed comparable effectiveness with significantly reduced complexity and operative time compared to the traditional nasal closure method.

Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study.

BackgroundCardiovascular parameters can be impaired by repeated infections with P. falciparum. This study aimed at investigating the influence of gametocyte carriage on; the prevalence of fever and splenomegaly, blood pressure, heart rate and haematological indices in children <15 years, in the Mount Cameroon area.MethodsA cross-sectional study was carried out, from February to July 2013. A child with axillary body temperature ≥37.5 °C was considered febrile and splenomegaly was investigated by palpation. Systolic and diastolic blood pressures as well as heart rate were assessed by non-invasive methods. Malaria parasites were detected and density assessed from Giemsa-stained thin and thick blood films. An auto haematology analyser was used to obtain complete blood count values such as haemoglobin (Hb), haematocrit (Hct), red blood cell (RBC) and white blood cell (WBC) counts, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular haemoglobin (MCH). Univariate analyses were used to examine influence of gametocyte carriage on fever and splenomegaly while, multiple linear regression models were used to evaluate influence of independent variables on the dependent variables.ResultsOf a total of 454 children examined, malaria parasitaemia, fever, splenomegaly and gametocyte carriage were detected in 36.6, 21.6, 14.3 and 7.3 % of them respectively. Children who were asexual parasite and gametocyte positive (ASP + Gam Pos) had significantly highest (P = 0.03, P = 0.002) prevalence of fever and splenomegaly (39.4 %, 33.3 %) respectively than their aparasitaemic (AP) and asexual parasite positive (ASP Pos) equivalents (19.0 %, 10.9 % and 22.8 %, 16.9 % respectively). The presence of asexual malaria parasitaemia significantly influenced the MCV (P = 0.03), MCH (P = 0.03) and heart beats /min (0.03) while gametocytaemia significantly influenced the Hb (P < 0.001), Hct (P < 0.001), RBC (P < 0.001) and systolic blood pressure (P < 0.05).ConclusionGametocyte carriage significantly influenced the prevalence of fever, splenomegaly and some cardiovascular indices. In effect, children concurrently having asexual parasitaemia and gametocytes had significantly lower, Hct, Hb levels, RBC and platelet counts and systolic blood pressure.

Observed full blood count and lymphocyte subset values in a cohort of clinically healthy South African children from a semi-informal settlement in Cape Town.

The paediatric full blood count and lymphocyte subset reference intervals used by the National Health Laboratory Service (NHLS), South Africa (SA), are taken from two international reference interval publications. Differences in reference intervals suggest that international data sets may not be appropriate for use in SA. To study immunohaematological values of a group of clinically healthy children from an informal settlement in Cape Town, SA, to assess whether international paediatric reference intervals used by the NHLS are appropriate. A cross-sectional study of 207 female and 174 male HIV-uninfected children living in an informal settlement in Cape Town was performed. Full blood counts, automated differential counts and lymphocyte subset analysis were done using internationally accepted technologies. Data were categorised by age and reference intervals compiled using medians and 95% confidence intervals (CIs). Gender comparisons were calculated by non-parametric tests. Although median and 95% CI values differed slightly, physiological trends for red cell, platelet, white blood cell differential and lymphocyte subsets were similar to international reference intervals currently in use at the NHLS. Benign ethnic neutropenia was not a significant finding, and gender-specific intervals were not necessary until 12 years of age. Lower overall median values for haemoglobin and haematocrit, and higher median values for mean cell volume and red cell distribution width, were noted. Assessment of haemoglobin, red cell distribution width and calculated Mentzer ratios suggested underlying iron deficiency in 14.2% of participants. Paediatric immunohaematological reference intervals observed in this study are similar to, and support continued use of, international paediatric reference intervals. Underlying iron and related nutritional deficiencies may be contributing to lower haemoglobin levels noted in local children. A larger nationwide study, including all ethnic groups, is recommended.

Increased oxidative stress markers may be a promising indicator of risk for primary ovarian insufficiency: a cross-sectional case control study.

The aim of this study was to evaluate serum levels of inducible nitric oxide synthase (INOS), myeloperoxidase (MPO), total antioxidant status (TAS), and total oxidative status (TOS) in women with primary ovarian insufficiency (POI) and to compare them with healthy fertile women. We also examined the possible risk factors associated with POI. This cross-sectional case control study was conducted in Zekai Tahir Burak Women's Health Education and Research Hospital. The study population consisted of 44 women with POI (study group) and 36 healthy fertile women (control group). In all patients, serum levels of INOS, MPO, TAS, and TOS were determined. INOS and MPO levels were measured by enzyme-linked immunosorbent assay whereas colorimetric method was used for evaluating TAS and TOS levels. Age, body mass index (BMI), obstetric history, smoking status, family history, comorbidities, sonographic findings, complete blood count values, C-reactive protein and baseline hormone levels were also analyzed. Student's t-test or Mann-Whitney U test was used to compare continuous variables between the groups; categorical data were evaluated by using Pearson χ2 or Fisher exact test, when appropriate. Binary logistic regression method was used to identify risk factors for POI. We found significantly elevated levels of INOS (234.1±749.5 versus133.8±143.0; p=0.005), MPO (3,438.7±1,228.6 versus 2,481.9±1,230.1; p=0.001), and TOS (4.3±1.4 versus 3.6±1.4; p=0.02) in the sera of the study group when compared to the BMI-age matched control group. However, difference in serum levels of TAS were not significant between the 2 groups (1.7±0.2 versus 1.6±0.2; p=0.15). Logistic regression method demonstrated that BMI <25 kg/m2, nulliparity, family history of POI, smoking, and elevated serum levels of INOS, MPO, and TOS were independent risk factors for POI. We found an increase in INOS, MPO, and TOS in women with POI. These serum markers may be promising in early diagnosis of POI. Further large-scale studies are required to determine whether oxidative stress markers have a role in diagnosing POI.

Hantavirus infection among children hospitalized for febrile illness suspected to be dengue in Barbados.

Emerging picture of hantavirus infection in the South America is characterized by greater proportion of childhood infection and wider spectrum of disease from mild asymptomatic to lethal cardiopulmonary disease. Barbados is endemic for dengue and leptospirosis, both of which share clinical features with hantavirus infection and in many cases neither of these diagnosis could be confirmed. We investigate whether some of the children hospitalized with suspected dengue could indeed have been hantavirus infections. In this prospective study children hospitalized with suspected dengue were tested for hantavirus infection using ELISA for the IgM antibodies. Thirty-eight children tested positive for hantavirus infection. They presented with fever, headache and mild respiratory and gastrointestinal symptoms and signs. None of them had features suggestive of hantavirus cardiopulmonary syndrome. Blood count values ranged from low to normal to high for their age. There were no deaths. Hantavirus infection is prevalent in this Caribbean country. It predominantly presents with milder disease and is responsible for some of the nonspecific febrile illnesses in children.

Design and Validation of an Augmented Hematopoietic Cell Transplantation-Comorbidity Index Comprising Pretransplant Ferritin, Albumin, and Platelet Count for Prediction of Outcomes after Allogeneic Transplantation

Pretransplant values of serum ferritin, albumin, and peripheral blood counts were previously suggested to provide prognostic information about hematopoietic cell transplantation (HCT) outcomes. Whether these “biomarkers” have prognostic value independent of each other and the HCT-comorbidity index (HCT-CI) is unknown. We analyzed data from 3917 allogeneic HCT recipients at multiple sites in the United States and Italy using multivariate models including each biomarker and the HCT-CI. Data from all sites were then randomly divided into a training set (n = 2352) to develop weights for the relevant biomarkers to be added to the HCT-CI scores and a validation set (n = 1407) to validate an augmented HCT-CI compared with the original index. Multivariate analysis with data from one site showed that ferritin, albumin, and platelets—not neutrophils or hemoglobin—were independently associated with increased nonrelapse mortality (NRM) and decreased overall survival. Findings were validated in data from the other sites. Subsequently, in a training set from all sites, ferritin >2500 mg/dL (hazard ratio [HR], 1.69); albumin 3 to 3.5 g/dL (HR, 1.61) and <3.0 g/dL (HR, 2.27); and platelets 50 to <100,000 (HR, 1.28), 20 to <50,000 (HR, 1.29), and <20,000 (HR, 1.55) were statistically significantly associated with NRM. Weights were assigned to these laboratory values following the same equation used to design the original index. In the validation set, the addition of the biomarkers to the original index to develop an augmented HCT-CI resulted in a statistically significant increase in a higher c-statistic estimate for prediction of NRM (P = .0007). Ferritin, albumin, and platelet counts are important prognostic markers that further refine the discriminative power of the HCT-CI for transplant outcomes.

Meaning of the Oral Hygiene in Children, Due to Atherosclerosis Generation

Research focused on association between periodontal diseases and atherosclerosis has been substantial in recent years. It is now well known that chronic inflammation plays an important role in initiation and evolution of atherosclerosis. The bacterial plaque is a key pathology leading to periodontal inflammation. As reported by other authors, bacteria causing periodontal disease were found within the carotid arteries in adults, thus association between periodontal disease in childhood and peripheral vascular disease seem justifiable. The purpose of this study is to investigate the potential link between certain bacteria found in children with periodontal disease and the process of atherosclerosis in adults. Research was carried out in 97 children of which 58 aged between 6-14 comprised an experimental group, whereas 39 children aged of 6-13 comprised the control group. Based on physical examination, the oral hygiene in children of the experimental group was average or bad, while in children of the control group the oral hygiene was good. Blood samples and subgingival plaques were obtained to proceed with microbiological testing by PCR technique. The results of tests showed Aggregatibacter actinomycetemcomitans in 55% and Prevotella intermedia in 79% of children in the experimental group. Only 2 cases of Prevotella intermedia were detected in the control group, however, no cases of Porphyromnas gingivalis were found in either groups. Full blood count, serum homocysteine, CRP, fibrinogen and HDL cholesterol values were normal in both groups. Total cholesterol value was increased in 24,14% in the experimental group vs. 5,15% in the control group, thus increase of total serum cholesterol concentration in children with bad oral hygiene may by a risk factor of atherosclerosis.

Value of the platelet to lymphocyte ratio in the diagnosis of ovarian neoplasms in adolescents.

Relationships between poor prognosis of ovarian malignancies and changes in complete blood count parameters have been proposed previously. In this work, we aimed to evaluate clinicopathologic features in adolescents with adnexal masses and sought to establish any predictive value of the platelet to lymphocyte ratio (PLR) in diagnosis. This retrospective study was conducted on 196 adolescent females with adnexal masses. Three groups were constituted with respect to clinical or histopathology results: group 1, non-neoplastic patients (n:65); group 2, neoplastic patients (n:68); and group 3 expectantly managed patients (n:63). The main parameters recorded from the hospital database and patient files were age, body mass index (BMI), chief symptoms, diameter of the mass (DOM), tumor marker levels, complete blood count values including absolute neutrophil, lymphocyte, and platelet counts, mean platelet volume, platelet distribution width, and platecrit, surgical features, and postoperative histopathology results. The expectantly managed patients were younger than the other groups (p=0.007). The mean body mass index (BMI) was higher in the neoplastic group (p=0.016). Preoperative DOM, CA125, mean platelet volume and PLR were statistically significantly different between the groups (p<0.05). ROC curve analysis demonstrated that increased PLR (AUC, 0.609; p=0.011) and BMI (AUC, 0.611; p=0.011) may be discriminative factors in predicting ovarian neoplasms in adolescents preoperatively. When the cut-off point for the PLR level was set to 140, the sensitivity and specificity levels were found to be 65.7% and 57.6%, respectively. We suggest that beside a careful preoperative evaluation including clinical characteristics, ultrasonographic features and tumor markers, PLR may predict ovarian neoplasms in adolescents.

Role of blood cells dynamism on hemostatic complications in low-risk patients with essential thrombocythemia

Patients with essential thrombocythemia (ET) aged less than 60 years, who have not suffered a previous vascular event (low-risk patients), may develop thrombotic or hemorrhagic events. So far, it has not been possible to identify useful markers capable of predicting which of these patients are more likely to develop an event and therefore who needs to be treated. In the present study, we analysed the relationship between vascular complications and longitudinal blood counts of 136 low-risk ET patients taken over a sustained period of time (blood cells dynamism). After a median follow-up of 60 months, 45 out of 136 patients (33%) suffered 40 major thrombotic and 5 severe hemorrhagic complications. A total number of 5,781 blood counts were collected longitudinally. Thrombotic and hemorrhagic events were studied together (primary endpoint) but also separately (thrombotic alone = secondary endpoint; hemorrhagic alone = tertiary endpoint). The primary endpoint showed no significant association between platelet and WBC count at diagnosis and risk of any event (platelet, p = 0.797; WBC, p = 0.178), while Hb at baseline did show an association (p = 0.024). In the dynamic analysis with Cox regression model, where the blood count values were studied by time of follow-up, we observed that the risk for Hb was 1.49 (95% CI 1.13-1.97) for every increase of 1 g/dL, and that this risk then marginally decreased during follow-up. WBC was associated with an increased risk at baseline for every increase of 1 × 10(9)/L (hazard ratio (HR) 1.07, 95% CI 1.01-1.13, p = 0.034), the risk was stable during follow-up (HR 0.95, p = 0.187 at 60 months). Also, for each increment at baseline of 100 × 10(9) platelets/L, HR was increased by 1.08 (95% CI 0.97-1.22, p = 0.159) and decreases during follow-up. In conclusion, this study is the first to evaluate in ET low-risk patients, the risk of developing a thrombotic/hemorrhagic event considering blood counts over time. Overall our study shows that the risk changes over time. For example, the risk associated with WCC is not linear as previously reported. An interesting new finding is that PLT and even Hb contribute to the risk of developing vascular events. Future treatments should take into consideration these findings and aim to control all parameters over time. We believe this early study may help develop a dynamic analysis model to predict thrombosis in the single patient. Further studies are now warranted to further validate our findings.

A Case of Solitary Pulmonary Mass with Air-Bubble Sign: What Is Your Diagnosis?

• Available online at www.eurasianjpulmonol.com A 58-year-old male patient was admitted to our clinic with complaints of productive cough and weight loss (6 kg) having begun with flu-like symptoms 15 days ago. His medical history included the use of acetylsalicylic acid after a cerebrovascular event from 9 years ago. The patient, who worked as a car mechanic, had 40 packs-year of smoking history. In the physical examination, his vital findings and oxygen saturation were within normal reference intervals, and no abnormality was observed, except limping in his right foot. Pulmonary function tests revealed mild obstructive dysfunction. The laboratory test value of C-reactive protein was 7.3, and the values of complete blood count and biochemistry were within normal intervals. The PPD test result was 10 mm.

A new utilization area for hyperbaric oxygen? Improving quality of stored blood.

Since blood bags have the ability for diffusion of gases, we investigated whether hyperbaric oxygen (HBO) exposure affects several vital parameters of stored blood. Bloods obtained from the same persons were used as both control and HBO groups and stored in pediatric bags with citrate-phosphate-dextrose solution. HBO administration was performed at 2.5 atm for 90 min, started 1 day after blood collection and repeated every 2 days for a total of 10 times. The study was terminated on the 21st day. Complete blood count, glucose, pH, and osmotic fragility values were measured every week. Glucose and pH levels decreased in stored blood. In the HBO-exposed group, these decreases were less than in the control. In addition, mean corpuscular and platelet volumes tended to increase during storing process, but with HBO, these indexes remained lower, near physiologic levels. Another interesting finding of the study was the relative stable osmotic fragility ratio in the HBO group compared to the control blood. HBO exposure has positive effects on pH, stability of erythrocytes, and energy source (glucose) of the medium. Thus, we concluded that HBO may be a useful application for life and quality of stored blood.

Clozapine-induced euphoria: a case report.

To the Editor: We describe a case of treatment-resistant schizophrenia in which clozapine initiation and titration caused transient euphoria. Case report. Mr A is a 64-year-old man with a 35-year history of treatment-refractory schizophrenia (DSM-IV criteria), who was experiencing chronic delusions and auditory and visual hallucinations. He underwent multiple trials of different antipsychotics in the past, including trifluoperazine, chlorpromazine, olanzapine, and haloperidol, with minimal improvement in the psychotic symptoms. Past medical history included obesity, chronic obstructive pulmonary disease, and benign prostatic hypertrophy. He reported smoking 1 pack of cigarettes per/day and sporadic alcohol and cannabis abuse. He also reported experimenting with opioids in his adolescence. Current medications included haloperidol decanoate 200 mg intramuscular/monthly and finasteride 5 mg and terazosin 10 mg by mouth at bedtime. Medical assessment revealed normal physical examination, electrocardiogram, and laboratory values and no known drug allergies. To target the chronic delusions and auditory and visual hallucinations, clozapine was started on an outpatient basis at 12.5 mg and increased weekly in 12.5–25-mg increments, with regular weekly follow-ups and monitoring of vital signs and complete blood count values. Mr A tolerated initiation and titration fairly well. He developed mild tachycardia, ranging from 105–120 beats/min. His blood pressure remained within normal values; however, on several occasions, transient orthostatic hypotension with a 10-point drop in systolic and diastolic blood pressure was observed. Shortly following initiation of clozapine, Mr A started reporting feeling “high.” He described feeling elated, followed by intense feelings of euphoria and happiness starting 10 to 20 minutes after clozapine administration and lasting up to 2 hours. He also endorsed mild dizziness that initially paralleled euphoric feelings and then stopped. He described these sensations as being very similar to the effect of opioids that he had abused in adolescence. He denied experiencing a similar effect from other neuroleptics that he was given in the past. Mr A continued to experience this effect for 2 months while still undergoing clozapine titration. Once the clozapine level reached the total daily dose of 150 mg, the effect diminished in its strength and intensity and eventually disappeared. This is a first report in the literature describing clozapine-induced euphoria that started shortly after clozapine initiation and lasted for several months into clozapine titration; the effect resembled that of opioids in this case. Clozapine1 and opioids2 share certain pathophysiologic effects that can be responsible for the above-described effect. First, both clozapine and opioids can produce orthostatic hypotension that can be responsible for reduced brain oxygenation, creating the feeling of euphoria that initially occurred in this case. Second, opioid-induced euphoria and feeling “high” are related to the dose-dependent increase of dopamine in certain brain areas, for example, in the nucleus accumbens,2 which is believed to have a central role in addiction physiology. Interestingly, studies in animal models show that clozapine administration can produce an increase of dopamine in the nucleus accumbens,3 which could, in part, explain the euphoric feelings experienced by Mr A. Additionally, it appears that clozapine can affect D1 and D2 receptors and that modulation of D1 and D2 receptors could either reduce or increase, respectively, craving for substance abuse.4,5 Therefore, it is possible that the clozapine-related increase in dopamine concentration, in the case of Mr A, transiently experienced as the subjective feeling of being “high,” could reactivate opioid-induced synaptic plasticity of dopamine reward pathways. This hypothesis requires further investigation.

Clinical analysis of 106 cases of Kawasaki disease in infants

Objective Through investigating the clinical and laboratory characteristics of Kawasaki disease (KD) in infants younger than 12 months in order to improve the accuracy of early diagnosis of KD and decrease the risk of coronary artery lesion (CAL). Methods Clinical manifestations, diagnosis and treatment of total 106 patients younger than 12 months with KD hospitalized in Chengdu Women and Children's Central Hospital from Jan.2006 to Jan.2014 were reviewed. Results (1)Among 106 cases, 72 cases were male and 34 cases were female, the ratio of male to female was 2.1︰1.0.The age varied from 2 months to 12 months, and the average age was (8.4±2.7) months.Twenty-eight cases were younger than 6 months, 78 cases were within 6 months to 12 months.(2)KD scattered the whole year and occurred more frequently in spring and summer.The average duration of fever before final diagnosis was (8.0±3.5) days.The major clinical manifestation were erythema and cracking of lips (77.4%, 82/106 cases), rash (73.6%, 78/106 cases), eye conjunctival hyperemia (70.8%, 75/106 cases), changes in extremities (59.4%, 63/106 cases), strawberry tongue (48.1%, 51/106 cases), cervical lymphadenopathy (40.6%, 43/106 cases), respectively.Among 106 cases, 33 cases (31.1%) were diagnosed as incomplete KD (IKD), 86 cases (78.9%) accompanied with one or more than one systematic or organic lesion, 33 cases (31.1%) were misdiagnosed before the final diagnosis of KD, 32 cases (30.2%) accompanied with CAL.Ninety-five point nine percent(94/98 cases) were sensitive to the first dose of intravenous immunogloblin (IVIG) therapy.(3)Compared with the infants of KD older than 6 months, the infants younger than 6 months had longer fever duration before the final diagnosis, higher prevalence of IKD, higher incidence of gastrointestinal involvement and anemia, higher white blood count, lower haemoglobin and albumin values, higher incidence of CAL and coronary artery aneurysms (CAA) (all P 0.05). Conclusions (1) Infants KD, especially younger than 6 months old had higher rate of IKD, often accompanied with other organic lesion, and were easily to be misdiagnosed and missed diagnosis.Most infants KD were sensitive to the first dose of IVIG therapy.(2) Infants of KD younger than 6 months old were more prone to suffer from CAL and CAA.(3) To avoid misdiagnosis and missed diagnosis of infants KD, cardiac ultrasonography is important for those who have unexplained fever over 5 days and were not sensitive to the treatment, especially the male. Key words: Infant; Kawasaki disease; Clinical manifestation; Coronary artery lesion

A Case Report: Hallermann-Streiff Syndrome

Hallermann-Streiff is a rare syndrome characterized by multiple congenital anomalies, especially in the head and face. It was first described by Hallermann in 1948 and later by Streiff in 1950. Patients have a bird-like face, skin atrophy, dwarfism, various eye abnormalities, and hypotrichosis. In the case admitted to our hospital with complaints of fever, cough, and failure to thrive, we detected microphthalmia, bilateral leukocoria, cataract, eyebrow hypotrichosis, a prominent nose, and depressed nasal root. The patient was diagnosed with Hallermann-Streiff syndrome. This case was presented because of its rare occurrence in the literature. In the respiratory system examination of the patient, rhonchi and rales were found. The abdomen was free of organomegaly. The results of the cardiovascular system and genitourinary system examination were normal. The values of the complete blood count; serum electrolytes; liver and kidney function tests; growth hormone, thyroid, and parathyroid hormone levels; and immunoglobulins (IgA, IgG, IgM, and IgE) were found to be normal (Table 1). In the radiological examination, bronchopneumonia infiltration was detected on the right side in the chest radi - ography. Minimal dilatation was observed in the lateral ventricles and third ventricle in the brain tomography. No pathology was found in the whole-body radiographies. His echocardiography examination result was normal. In a chromosome analysis carried out with the GTG-banding technique on a peripheral blood culture, no number or structural anomaly was observed. The case was diagnosed with Hallermann-Streiff syndrome, considering the clinical findings. The patient was followed up by the ophthalmic clinic due to the eye-related symptoms.

Relationship between late arteriovenous fistula (AVF) stenosis and neutrophil–lymphocyte ratio (NLR) in chronic hemodialysis patients

Objectives: Primary cause of late arteriovenous fistula (AVF) dysfunction is venous stenosis as result of neointimal hyperplasia. The mechanism of AVF stenosis is not exactly understood. But inflammation is a contributing factor for development of AVF stenosis. Neutrophil–lymphocyte ratio (NLR) reflects systemic inflammation, and it was investigated in many diseases. The aim of this study was to investigate the relationship between NLR and AVF stenosis in chronic hemodialysis patients. Materials and methods: Of 593 patients applied to the department of interventional radiology between January 2011 and November 2012, a total of 108 patients meeting the appropriate criteria were included in this study. All patients were assessed with Color Doppler ultrasonography and then digital subtraction angiography was used for the patients with abnormal results. Sixty-four patients were classified as patients with AVF stenosis (group 1) and 44 patients without AVF stenosis (group 2). Routine biochemical and complete blood count values measured six months ago were recorded for all patients. Results: Mean NLR (3.47 ± 0.46 vs. 2.27 ± 0.22; p < 0.001) was higher in group 1 compared to group 2, whereas high-density lipoprotein (HDL; 31.8 ± 12.6 mg/dL vs. 51.5 ± 11.9 mg/dL; p < 0.001) was lower in group 1. NLR level was correlated with degree of AVF stenosis (r = 0.625; p < 0.01). Receiver operating characteristic curve analysis showed that NLR (optimal-cut-off = 2.70) was a useful parameter in prediction of AVF stenosis (AUC = 0.893, sensitivity = 98.4% and specificity = 75%; p < 0.001). NLR level and HDL < 30 mg/dL in logistic regression analysis are independent predictors of AVF stenosis. Conclusions: For hemodialysis patients with increased level of NLR and decreased level of HDL, regular monitoring with regard to the development of AVF stenosis may be beneficial. Our study suggests that the mechanism of AVF stenosis might have similarities to that of atherosclerosis.

Association of maternal iron status with birthweight at third trimester in pregnant women

To investigate the association between maternal iron status at the third trimester and fetal birthweight, maternal serum iron, ferritin, total iron-binding capacity (TIBC), and complete blood count values were measured at 36-weeks gestation. Delivery database on mothers who delivered babies at Chungbuk National University Hospital between January 2008 and March 2013 was extracted. A total of 353 uncomplicated term babies were analyzed using hierarchical regression and ANCOVA. Maternal age (standardized regression coefficient β=0.115, P&lt;0.05), height (β=0.108, P&lt;0.05), BMI (β=0.210, P&lt;0.001), and gestational age (β=0.298, P&lt;0.001) were significantly associated with birthweight. However, birthweight was not associated with maternal iron parameters. After adjusting for maternal age, height, BMI, and gestational age, babies born to mothers with lower mean values of hemoglobin, hematocrit, and serum ferritin were heavier than those born to mothers with higher values. Babies born to lower hemoglobin (11 g/dL) mothers were heavier than those born to higher hemoglobin (12 g/dL) mothers. However, birthweight was not significantly different between mothers with 10 g/dL or 13 g/dL of hemoglobin. Comparing birthweight according to 30 ug/dL of serum iron, 360 ug/dL of TIBC, 15 ng/mL of serum ferritin, and 10% transferrin saturation, babies born to mothers of the lower group were heavier than those born to mothers of the higher group. Therefore, maternal serum iron status at the third trimester seems to not be associated with birthweight.

Chronic myeloid leukemia with an e1a3 BCR-ABL fusion protein: transformation to lymphoid blast crisis

Chronic myelogenous leukemia (CML) results from the neoplastic transformation of a hematopoietic stem cell. CML is cytogenetically characterized by the presence of the Philadelphia chromosome (Ph’). Most patients with CML express e13a2 or e14a2 mRNAs that result from a rearrangement of the major breakpoint cluster regions (M-BCR) generating the 210-kDa (p210BCR-ABL) fusion proteins b2a2 or b3a2 respectively. The e1a3 CML-related atypical translocation has been reported with an indolent clinical course, low leukocyte count, long chronic phase even without treatment and good response to therapy. We report the case of a patient initially diagnosed as CML in chronic phase whose cells expressed the e1a3 variant. The patient readily responded to imatinib 400 mg with the achievement of a rapid complete cytogenetic response and the normalization of the blood count values, but after 5 months transformed into lymphoid blast crisis.

Nickel and blood counts in workers exposed to urban stressors.

Nickel (Ni) and Ni compounds are widely present in the urban air. The purpose of this study is to estimate exposure of individuals to Ni and the correlation between this exposure and the values of blood counts in outdoor workers. This study focused on a sample of 101 outdoor workers (55 male and 46 female; 65 nonsmokers and 36 smokers), all employed in the municipal police in a large Italian city. The personal levels of exposure to Ni were assessed through (a) environmental monitoring of Ni present in the urban air obtained from individual samples and (b) biological monitoring of urinary and blood Ni. The blood count parameters were obtained from the hemochromocytometric tests. Pearson correlation coefficients (r) were calculated to assess the association between the blood and urinary Ni and the complete blood count. Multiple linear regression models were used to examine the associations between the complete blood count and the independent variables (age, gender, years of work for current tasks, cigarette smoking habit (current and never smoker), values of airborne Ni, and blood and urinary Ni). Multiple linear regression analysis performed on the total group of 101 subjects confirms the association among the red blood cells count, the hematocrit, and the urinary Ni (R(2) = 0.520, p = 0.025 and R(2) = 0.530, p = 0.030). These results should lead to further studies on the effects of Ni in working populations exposed to urban pollutants. The possibility that the associations found in our study may be partially explained by other urban pollutants (such as benzene, toluene, and other heavy metals) not taken into consideration in this study cannot be ruled out.