CBC Parameters Research Articles

Comparison of Microcapillary Blood Sampling Devices for Use in Anti-Doping.

Blood collection is an important facet of anti-doping testing, forming the basis of the hematological module of the athlete biological passport (ABP). Presently, whole blood is collected via venepucture under standardized conditions, in accordance with the World Anti-doping Agency's International Standard for Testing and Investigations (ISTI). Advances in capillary whole blood collection technology now afford the ability to collect microvolumetric capillary whole blood from the upper arm (or other suitable vascular location such as the abdomen) that is "needle-free" and virtually painless. Previous work has demonstrated the suitability and feasibility of capillary whole blood compared with venous using the Tasso+ device. Recently, other microcapillary devices have received FDA approval increasing the options available to the anti-doping community. The present study extends previous work, by collecting microliter capillary whole blood samples via two different FDA approved devices (RedDrop and the Tasso+ device) to compare with venous blood collected simultaneously. Ten participants provided three matched blood samples (2× capillary and 1× venous) in accordance with WADA ABP guidelines for blood sample collection, for a total of 30 samples. Capillary samples from both devices showed excellent laboratory agreement with venous blood for all CBC parameters, with the exception of platelets. Excellent laboratory agreement was also observed between the two microcapillary collection devices. Irrespective of the device, microcapillary blood collection provides a valid alternative to venous blood collection for ABP purposes.

A Case for Co-oximetry: Methemoglobinemia secondary to a Rare Hemoglobin Variant

Abstract Introduction/Objective The presence of dyshemoglobins and some inherited hemoglobin (Hb) variants can cause over or underestimation of oxygen saturation (O2sat) when using a pulse oximeter (ox). These noninvasive medical devices rely on two wavelengths, a pulsing arterial bed, and light absorption properties of Hb to measure the difference between deoxy- and oxy-Hb. In contrast, a co-oximeter (co-ox) requires arterial blood. By using at least four wavelengths, co-ox measures the functional and fractional O2sat to detect all forms of Hb, including those that do not bind oxygen (O2), such as methemoglobin (metHb). Methemoglobinemia may be congenital or acquired, resulting from exposure to certain toxins, metabolic disorders, enzymatic deficiencies such as cytochrome b5 reductase deficiency, or hemoglobinopathies. Methods/Case Report A healthy, adolescent male undergoing a sports physical at his pediatrician’s office was hypoxic by pulse ox and sent to the emergency department (ED) for evaluation. On exam, he had cold, blue tinged fingertips and lips but was otherwise asymptomatic. His O2sat was 88-90% on room air with minimal improvement with 6L of supplemental O2. Co-ox revealed a metHb level > 20%. The father also mentioned that the mother had frequent ED visits for hypoxia. Capillary Hb electrophoresis showed peaks in the HbA, HbF, and HbA2 zones of 78.3%, 17.9%, and 3.6%, respectively. All CBC parameters were within the reference intervals. The large peak in the HbF zone would suggest hereditary persistence of fetal hemoglobin (HPFH); however, the clinical picture was not consistent. Further reference laboratory investigation determined that the patient was heterozygous for Hb Tübingen (HbTüb), a beta globin chain variant resulting from a point mutation at position 106. By mass spectrometry, the variant quantified as 38% of the total hemoglobin, indicating underestimation by electrophoretic techniques. Results (if a Case Study enter NA) NA Conclusion This case presents an essentially asymptomatic patient with hypoxia and elevated methemoglobin levels. Electrophoretic hemoglobinopathy and CBC workup were clinically inconsistent with HPFH and the presence of an aberrant hemoglobin migrating in the HbF must be considered in the differential diagnosis. The manifestation of HbTüb as methemoglobinemia in this context adds complexity to the diagnostic puzzle. Further laboratory exploration into the underlying mechanisms driving this unique presentation is crucial for a comprehensive understanding and tailored management approach.

A-165 Value Of Monocyte Distribution Width In Bacteremia Assessment In Emergency Department Patients

Abstract Background Monocyte distribution width (MDW) is an immune response biomarker and part of a CBC differential. MDW is derived from the distribution of monocyte volumes and elevated MDW values correlate with severe infections and sepsis in Emergency Department (ED) adult patients. Neutrophil to lymphocyte ratio (NLR) is predictive of infections and inflammatory stress. Evaluating these biomarkers could be valuable in bacteremia risk assessment. Bacteremia is the presence of viable bacteria in the bloodstream and is present in up to 20% of septic patients. Blood cultures establish pathogen identity but require culture time, potentially delaying appropriate treatment. Our goal was to characterize MDW and NLR clinical performance in ED patients with suspected bacteremia. Methods This was an observational cohort study of ED patients 18 years and older with CBC differential and blood cultures obtained. MDW values ≥20 is the published cut-off for increased infection risk. Clinical literature suggests that NLR ≥3 is abnormal. We assessed the diagnostic performance of MDW and NLR for positive blood cultures using SPSS Version 25. Results From 07/2021-09/2023, 9,400 blood cultures were ordered and 5174 patients had differential CBCs. The overall blood culture positivity rate was 14.4%. MDW and NLR performance for positive blood cultures is shown in Table 1. Conclusions Our analysis provides evidence that MDW and NLR may be useful for early recognition of bacteremia in ED patients. CBC differential results are reported sooner than culture results. MDW is directly reported, NLR can be readily calculated from the differential. Therefore both could contribute to earlier risk stratification and our findings suggest potentially distinct information from MDW and NLR. Combining MDW with other CBC parameters may provide additional diagnostic advantage. Further analysis will incorporate added clinical data for enhanced decision support in interpreting MDW values in the context of pending blood culture results.

To investigate the relation between LDH and CRP levels and mortality of COVID-19 (SARS-CoV-2) patients admitted in SURGERY ICU at Shariati Hospital from 19 February 2020 till 19 February 2021

Background: The aim of this study is to investigate the relationship between LDH and CRP levels and the mortality of COVID-19 (SARS-CoV-2) patients admitted to the SURGERY ICU at Shariati Hospital from 19 February 2020 to 19 February 2021. Methods: Our study is a cross-sectional descriptive study. A total of 81 patients were enrolled in this study. We examined lab reports, including CBC parameters (WBC, neutrophil count, neutrophil percentage), other inflammatory markers ESR and CRP, and also studied the medical records of cases to collect details about age, gender, length of stay in SURGERY ICU, BMI, fever, survival status, comorbidity, intubation, and NIV. These patients were referred to Shariati Hospital, Tehran, from 19 February 2020 to 19 February 2021, regarding the relationship between LDH and CRP levels and the mortality of COVID-19 (SARS-CoV-2) patients admitted to the SURGERY ICU. The data obtained was analyzed using SPSS software, and a significance value of < 0.05 was considered. Results: In this study, the data of 81 patients were considered. The data were obtained from the medical records of Shariati Hospital, Tehran. We used 11 variables to compare data from different patients that were recorded in the registry and system of medical records in Shariati Hospital, Tehran. The study population included 81 patients, of which 41 were female and 40 were male, ranging in age from 25 to 89. In total, 80.2% had mild disease versus 18.5% who had severe disease. Sixty-five patients survived, and 16 were admitted to the SURGERY ICU with endotracheal intubation and later died. The length of stay in the SURGERY ICU ranged from 1 to 25 days. Out of 81 patients, 52 (62.4%) had comorbidity, and 29 (35.8%) did not have comorbidity. Twelve patients (14.8%) received NIV, and 69 patients (85.2%) did not receive NIV. Most of the patients did not have a fever. The minimum and maximum levels of CRP were 4 and 416, respectively, and for LDH were 9 and 2401, respectively. The prognostic factors for the severity of COVID-19 infection identified in this study (CRP and LDH) help predict the course of the disease at an early stage. Elevated concentrations of CRP and LDH at admission were found to be associated with a higher risk for COVID-19 severity as they were significant (p-value =0.049 and 0.048, respectively). Conclusions: This study’s laboratory investigation showed that the SURGERY ICU patients had significantly higher values of inflammatory markers CRP and LDH than the non-SURGERY ICU patients. LDH and CRP were superior and effective biomarkers in predicting the severity of COVID-19.

Single and Combinations of Rosuvastatin, Celecoxib, and Colchicine Effects on Biochemical and CBC Parameters of Wistar Albino Rats

Drug resistance became a well-known problem in different areas of pharmacology, including anti-cancer therapy and antibiotics. The overcoming of drug resistance either by different drugs or doses, increases the risk of tissue toxicity. The combination of single FDA-approved drugs became one of the solutions shorting the time for new drug approval, and lowering the cost of manufacturing and transporting of drug to pharmacy shelves. Every day a new combination is investigated to narrow the gap in different pharmacological requirements. Lipid-lowering and anti-inflammatory drugs are widely used and are widely available globally. The study aimed to investigate four probabilities of combinations of three single drugs Rosuvastatine (Ro), Celecoxib (Ce), and Colchicine (Co) on biochemical and Complete Blood Count parameters (CBC) to evaluate the reliability and probable effects of these drugs on normal body function. Nine groups (n=6) of Wistar Albino Rats were inoculated with single and combinations of drugs for eight days using the maximum normal human doses of each drug, blood samples were collected in the middle, and at the end of the experiment. Results showed that combinations induced abnormal biochemical, and CBC parameters in ALT, AST, Creatinine, and RBC parameters in all but one (Rosuvastatine-Celecoxibe-Colchicine) of the combination. The study concluded that the combination could be used except that showed a higher level of abnormal physiological parameters, and percussions should taken by more pharmacological and physiological investigation in a bigger scale of studies including longer durations and different animal models before the combinations utilized by human.

ROLE OF HAEMATOLOGY BIOMARKERS IN URINARY BLADDER AND RENAL CELL CANCER PATIENTS TREATED WITH IMMUNE-ONCOLOGICAL DRUGS

Background: Urinary bladder (UB) and Renal Cell Cancer (RCC) are common in men than women with poor outcome. The novel immunotherapy drugs like Immune Check Point Inhibitors (ICIs) are effective but expensive. However, a cost-effective and reliable biomarker to predict response and clinical outcomes is lacking. Objective: To study the association of pre-treatment haematological parameters with clinical outcome in urinary bladder and renal cell cancer patients treated with ICIs. Method: In a retrospective study, we included 52 patients with urinary bladder and RCC treated with ICIs from Jan 2008 to Dec 2019. Clinical evaluation and laboratory investigations were performed as a part of standard protocol. CBC parameters such as WBC, TLC, DLC, Hb, Platelet, Neutrophil:Lymplocyte Ratio(NLR), Platelet:Lymphocyte Ratio (PLR), Lymphocyte:Monocyte Ratio(LMR) were studied at the time of TMC enrolment(first) and before the start (pre-treatment) of the ICIs therapy(io). Results: Amongst the CBC parameters, WBC count, when categorized based on cut off from ROC at the time of TMC enrolment(first) and the pre-treatment of the ICIs therapy(io) were found to be significantly associated with progression of disease with p- value 0.012 with Hazard Ratio (HR) - 2.52 (95% C.I. - 1.2-5.31) & p- value 0.060 with Hazard Ratio (HR) – 1.99 (95% C.I. – 0.96-4.12) respectively. The ROC - based cut off for WBC at the time of TMC enrolment(first) and the pre-treatment of the ICIs therapy(io) were found to be 7.16 X10e3/µL (AUC of 72%) with 71% sensitivity and 72% specificity and 6.48 X10e3/µL (AUC of 74%) with 67% sensitivity and 72% specificity respectively to predict progressed cases with respect to non-progressed cases. Along with WBC, the pre-treatment Absolute Neutrophil Count (ANC) (>3.67)& Absolute Monocyte count (AMC)(>0.42) pre-treatment of the ICIs therapy(io)) showed a significance with Hazard Ratio (HR) – 3.09(95% C.I.– 1.26-7.6) with p-value 0.010, Hazard Ratio (HR) – 3.48(95% C.I. - 1.6-7.57)and p-value <0.001 respectively. The ROC- based cut off for ANC at the pre-treatment of the ICIs therapy(io) were found to be 3.67 X10e3/µL (AUC of 68.4%) with 82.4% sensitivity and 50% specificity. Similarly The ROC- based cut off for AEC at the time of TMC enrolment(first) and AMC at the pre- treatment of the ICIs therapy(io) were found to be 0.22 X10e3/µL (AUC of 69.6%) with 55.9% sensitivity and 82.3% specificity and 0.42 X10e3/µL (AUC of 74.7%) with 72.7% sensitivity and 72.2% specificity respectively to predict progressed cases compared to non-progressed cases. Of 52 patients, 34 (65.4%) had progression. The median (m) PFS was 8.67 months (95% CI 2.26 - 15.09).The one year PFS rate was 46.5 (95% CI 31.2 -60.5). The mPFS in WBC <=7.16 was 26.48 months (95% CI 0 - 53.08) higher than the mPFS of 5.75 (95% CI 0.21 - 11.29) in WBC >7.16 with P value 0.012 at the time of TMC enrolment. Similarly, the mPFS in WBC pre- treatment of the ICIs therapy(io))<=6.48 was13.11 months (95% CI 0 – 28.95) higher than the mPFS of 6.18 (95% CI 2.67-9.68) in WBC >6.48 with P value 0.060.Along with WBC, the mPFS in ANC at the pre- treatment of the ICIs therapy(io)<=3.67 was 27.4(95% CI 0-55.21) higher than the mPFS of 6.18(95% CI 1.47-10.88)in ANC >3.67 with p value 0.010. The mPFS in AMC at the pre-treatment of the ICIs therapy(io)< =0.415 was 27.4 (95% CI 9.41-45.39) higher than the mPFS of 3.91 (95% CI 0.06-7.76) in AMC >0.415with p- value <0.001.We observed mPFS in immunotherapy cycles >=6 to be 15.9 (95% CI 6.98-24.82) was higher than the mPFS of 2.23 (95% CI 0.99-3.481) in immunotherapy cycles<6 with p value 0.025. The patients were followed for a period of 40.35 months (95% CI 26.98 - 53.71). Of 52 patients, 32(61.5%) patients deceased with median OS of 18.46 months (95% CI 10.12 - 26.80) and the one year OS rate was 57.6 (95% CI 41.6 - 70.6). Conclusion: Simple, routinely available and cost effective WBC (TLC), Absolute Neutrophil Count (ANC) ,Absolute Monocyte Count (AMC) and Absolute Eosinophil Count (AEC) from CBC test has a great potential to be used as a biomarker to predict response and clinical outcomes in patients with urinary bladder cancer and RCC patients treated with ICIs.

Importance of the Immature Platelet Fraction in the Etiological Diagnosis of Thrombocytopenia

Thrombocytopenia is defined as a platelet count of less than 150 G/L in the blood. It can be of central or peripheral origin. Newly-formed immature platelets are called reticulated platelets (RP) and are expressed as the immature platelet fraction or IPF. This automated hematological parameter enables us to distinguish between peripheral and central thrombocytopenia in a simple, quick, easily reproducible and non-invasive way. In the present study, our aim was to evaluate the clinical utility of the IPF and its ability to differentiate between central and peripheral thrombocytopenia. In this prospective study, we collected 50 cases of thrombocytopenia in our series. The IPF and all other CBC parameters were measured using the Sysmex XN-1500 analyser. Based on the clinical context and myelogram findings, the subjects in our study were separated into a central thrombocytopenia group and a peripheral thrombocytopenia group. We then assessed variations in IPF between the two groups. The mean IPF in the peripheral thrombocytopenia group was significantly higher than that in the central thrombocytopenia group (15.71 ± 12.02% vs. 5.51 ± 3.04%; p<0.001) and this difference persisted regardless of platelet count. We also established a sensitivity and specificity ROC curve, which showed that the IPF had excellent diagnostic value for differentiating between central and peripheral thrombocytopenia, with an area under the curve of 0.914. We also defined a discriminative cut-off value of 8.5% with a sensitivity of 77.8% and a specificity of 86.4% for defining the origin of thrombocytopenia. Thus, an IPF value above 8.5% points to peripheral thrombocytopenia with increased platelet regeneration. In conclusion, the results of our study have enabled us to formulate recommendations for improving the diagnostic strategy for thrombocytopenia using the immature platelet fraction or IPF.

Evaluation of the Vitamin B12 Deficiency in Megaloblastic Anemia in Tertiary Care Hospital, Lahore.

Background: Megaloblastic anemia is a hematologic disorder characterized by the presence of large, immature red blood cells due to a deficiency in vitamin B12 or folate. It remains a significant public health issue globally, affecting various populations across different age groups and dietary habits. Objective: The objective of this study was to evaluate the prevalence and implications of vitamin B12 deficiency in the development of megaloblastic anemia in a tertiary care hospital in Lahore. Methods: A cross-sectional analysis was conducted on 85 patients over a period of four months. Ethical approval was secured in line with the Declaration of Helsinki. Participants included both genders with hemoglobin levels <10 g/dl or mean corpuscular volume >95 fL, excluding pregnant women and individuals with primary diseases such as hepatic, renal, or cancerous conditions. Verbal consent was obtained before blood sample collection. CBC parameters were analyzed using a Mindray hematology analyzer, and vitamin B12 levels were measured via ELISA. Statistical evaluation was performed using SPSS version 25.0. Results: The mean hemoglobin levels for males and females were 10.06 ± 3.10 g/dl and 9.61 ± 3.25 g/dl, respectively. The mean MCV for males was 99.94 ± 6.63 fL, and for females, it was 100.25 ± 7.90 fL. Vitamin B12 levels averaged at 489.92 ± 468.10 pg/ml for males and 440.19 ± 419.47 pg/ml for females. Of the patients, 47.05% had normal B12 levels, 25.88% were deficient, and 27.05% had high levels of B12. Conclusion: Vitamin B12 deficiency was prevalent among patients with megaloblastic anemia and was independent of gender or age. The findings suggest a strong need for enhanced nutritional awareness and screening practices to identify and treat this deficiency early in at-risk populations.

Performance evaluation of the new Sysmex XR-Series haematology analyser

BackgroundThe new XR-Series haematology analyser from Sysmex provides increased throughput and automation, along with a new reagent in WDF channel for optimised WBC differential. MethodsAn analytical performance study for the XR analyser was conducted to evaluate the WDF channel parameters in comparison to the instrument specifications. Additionally, 7460 samples were measured on XR and XN analysers to compare selected parameters and flags, and 930 randomly selected samples were further evaluated with microscopy. ResultsAll investigated aspects of the analytical performance study for the XR fell within the manufacturer specifications. The correlation coefficients between the two systems for the parameters tested were greater than 0.983 for the main CBC and DIFF parameters, greater than 0.909 for the Extended Inflammation Parameters, and greater than 0.932 for the parameters used in the workflow rulesets of the Extended IPU. Similarly high sensitivities for the detection of abnormal cells were observed for the ‘Blasts/Abn Lympho?’ flag (XN: 100%, XR: 99.0%) and WPC abnormal flags (‘Blasts?’ or ‘Abn Lympho?‘) (XN: 97.0%, XR: 96.0%). XN with WPC channel had a 26% reduction of false positive smears compared to XR with 22% reduction, a statistically non-significant difference. ConclusionThe XR analyser had very good analytical performance, and highly comparable results to the predecessor XN analyser in all investigated parameters, flags and workflow aspects.

The relationship between vertebral compression rates and systemic inflammatory scores in osteoporotic vertebral fractures.

There are many scientific reports on systemic inflammation scores (SIS) associated with decreased bone mineral density in osteoporotic vertebral disease. However, there are no studies on the association of inflammation scores with the risk of collapse in osteoporotic vertebral collapse fractures. The aim of this study was to examine the correlation between the product of platelet and neutrophil counts (PPN), platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), and systemic immune inflammation index (SII) derived from complete blood count analysis in cases of osteoporotic vertebral fractures and fracture severity based on vertebral collapse rates. This study is a retrospective analysis of a cohort of 50 patients aged 50 years or older who presented with osteoporotic vertebral fractures and underwent kyphoplasty at our clinic from 2018 to 2023. The study included both men and women. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to diagnose and differentiate osteoporotic vertebral compression fractures from burst fractures and pathologic fractures. All compression rate measurements were performed with CT. The compression rate of the most affected vertebra (MAV-CR) was calculated. Groups were divided into two categories based on their compression rates: <50% and ≥50%. Initial PPN, PLR, NLR, and SII parameters were used as systemic inflammation scores. No statistically significant differences were found between MAV-CR groups in PPN, PLR, NLR, and SII parameters (p>0.05). No statistically significant correlation was observed between inflammation scores and MAV-CR groups (p>0.05). In this comparison, no significant difference was observed between the selected CBC parameters and the groups divided according to the compression rate (WBC: p=0.725, PC: p=0.069, NC: p=0.732, LC: p=0.513). ROC analysis was performed to analyze the diagnostic tests (AUC=0.372 for PPN, AUC=0.509 for PLR, AUC=0.525 for NLR, and AUC=0.435 for SII). None of the systemic inflammation scores had any predictive value for osteoporotic vertebral collapse fractures. Although it has been established in the scientific literature that systemic inflammation scores are associated with osteoporotic vertebral fractures, our analysis indicates no statistically significant correlation between the parameters of PPN, PLR, NLR, and SII and the severity of compression fractures in individuals with osteoporotic vertebral fractures. In this study, using systemic inflammation scores as a predictive test for the severity of osteoporotic vertebral fractures does not seem appropriate.

Efficacy of different routes of vitamin B12 supplementation for the treatment of patients with vitamin B12 deficiency: A systematic review and network meta-analysis.

This systematic review and network meta-analysis aimed to evaluate the three different administration routes of vitamin B12: oral, intramuscular (IM), and sublingual (SL) routes. We searched four electronic databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL Register of Controlled Trials). We included only comparative studies. We performed a frequentist network meta-analysis to measure network estimates for the relative outcomes. Moreover, we conducted a pairwise meta-analysis using a random effect model to obtain direct estimates for outcomes. All outcomes were continuous, and the relative treatment effects were pooled as mean difference (MD) with 95% confidence intervals. Thirteen studies were included in the meta-analysis, with a total of 4275 patients. Regarding increasing vitamin B12 levels, the IM route ranked first, followed by the SL route (MD = 94.09 and 43.31pg/mL, respectively) compared to the oral route. However, these differences did not reach statistical significance owing to the limited number of studies. Regarding the hemoglobin level, the pooled effect sizes showed no difference between all routes of administration that could reach statistical significance. However, the top two ranked administration routes were the oral route (78.3) and the IM route (49.6). All IM, oral, and SL routes of administration of vitamin B12 can effectively increase the level of vitamin B12 without significant differences between them, as thought previously. However, the IM route was the top-ranked statistically but without clinical significance. We found no significant difference among studied administrated routes in all other CBC parameters and homocysteine levels.

The use of polyethylene glycol as a maintenance treatment of functional constipation in children living in Egypt

BackgroundConstipation is an underestimated but common health problem worldwide, decreasing the quality of life. Functional constipation (FC) is a common pediatric problem, with reported prevalence ranging from 0.7 to 29.6%. In Egypt, there are no established guidelines for the treatment of constipation in children.ObjectivesThe aim of this study was to investigate the efficacy of polyethylene glycol (PEG) as a maintenance treatment for functional constipation (FC) in comparison with the classic treatment using (lactulose and senna) in children living in Egypt.Patients and methodThis is a randomized single-blinded clinical trial study on pediatric patients who presented with functional constipation at the outpatient clinic of Cairo University Specialized Pediatric Hospital. The study was conducted on 80 children with functional constipation, who were divided into 2 groups: group 1 (40 children), who received polyethylene glycol as maintenance treatment; group 2 (40 children), who received classic treatment in the form of osmotic laxative (lactulose) with or without stimulant (senna-sennosides or senna-glycoside) according to the stool consistency.ResultsOur data showed significant improvement in the fecal masses and the number of defecation, fecal pseudo incontinence, painful or hard bowel movement, history of retentive posturing or excessive violation, and large fecal masses in the rectum between group 1 and group 2 after treatment. In group 1, there was a significant improvement in anthropometric measures, CBC parameters, abdominal circumference, and anal fissures and piles after treatment; also, there was a significant decrease in the number of patients that need to continue treatment in group 1 in comparison with group 2 and number of patients that had impaction during treatment. However, there was a statistically significant increase in the number of patients who complained of palatability in group 1.ConclusionPEG has long-term efficacy in the management of pediatric functional constipation. Significant improvement of results in comparison with the classic treatment (lactulose or senna-lax).

Clinical Significance of Serum CD155 Levels in Acute Lymphoblastic Leukemia Patients

Background: Acute lymphoblastic leukemia (ALL) is a hematologic malignancy characterized by poor outcomes in adults. Traditional diagnostic and prognostic markers take into account clinical data but also rely heavily on expensive and invasive tests such as bone marrow studies with cytogenetics. CD155 is an adhesion molecule that also modulates immune response in malignancy. Previous studies have shown that serum CD155 (sCD155) levels are higher in patients with malignancies, and have demonstrated a correlation between higher levels of sCD155 and poor outcomes. This study investigated the diagnostic and prognostic value of sCD155 in adult patients with acute lymphoblastic leukemia. Methodology: 32 adult patients with acute lymphoblastic leukemia and 15 control patients were enrolled in this study. Clinical and outcome data were collected from patients and a blood sample from patients and controls was collected with ELISA testing for sCD155 levels. Results: sCD155 was found to be significantly higher in patients than controls (p&amp;lt;0.05) and was significantly associated with bone marrow aspirate blast count. It was not associated with other clinical parameters including gender, age, initial CBC parameter counts, presence of lymphadenopathy, presence of CNS infiltration, presence of Philadelphia chromosome, type of ALL, or risk stratification of ALL besides being associated with hepatosplenomegaly. ROC curve showed high sensitivity and specificity of sCD155 and Kaplan Meir curve showed a trend towards worse outcomes in patients with high sCD155 but it was not statistically significant. Conclusion: sCD155 remains a promising marker for diagnosis of ALL but further studies are needed to confirm its prognostic value.

Application of micro capillary blood sampling in an anti-doping setting.

Blood collection is an important facet of anti-doping testing, forming the basis of the Athlete Biological Passport (ABP). Traditional blood collection via venipuncture can be uncomfortable for athletes, especially those who are tested frequently or close to competition. Athletes may also have negative perceptions of venipuncture due to past experiences or the risks of adverse health events such as bruising, hematomas, syncope, and general discomfort that has the potential to affect performance. Advances in capillary whole blood collection technology now affords the ability to collect micro-volumetric capillary whole blood from the upper arm (or other suitable vascular location such as the abdomen) that is "needle-free" and virtually painless using devices such as the Tasso+. The present study extends previous work, by collecting microliter capillary whole blood samples via the Tasso+ EDTA device in an official anti-doping setting prior to competition, as well as requiring temperature-monitored cold chain shipping by air to the laboratory before analysis. Fifty-eight matched capillary and venous blood samples were collected under official doping control conditions by certified Doping Control Officers. No impact of sample shipment by air under cool conditions was observed on sample integrity. Provided that no visible clots were identified prior to analysis, capillary and venous blood samples showed excellent laboratory agreement for all CBC parameters, with the exception of platelets. Micro capillary blood collection provides a valid alternative to venous blood collection for ABP purposes, with the advantage of providing a more athlete-friendly experience, particularly close to competition.

Hemoglobin E Prevalence among People Residing in Malaria Areas

Background: Malaria can infect erythrocytes and hence cause different pathogenesis episodes leading to death mostly in pregnant women and children under the age of 5 years. The selective pressure of these parasites leads to the production of new human genetic diseases. The most prevalent genetic alterations in the human genome are thalassemia and hemoglobinopathies (Hb E, Hb S), which are recognized throughout the world, including Saudi Arabia. Methods: From May 2018 to August 2019, 13972 Saudi citizens from King Fahd Central Hospital and premarital facilities in the Saudi Arabian province of Jazan participated in this study. This study aims to compare the prevalence of Hb E and other hemoglobinopathies in positive versus negative cases of malaria. So, CBC, malaria test, Hb-electrophoresis, and molecular study were investigated. Result: For thalassemias and Hb disorders, 36% with abnormal Hb (47% of them) carried Hb S in their blood, 37% with á-thalassemia, 11% for â-thalassemia and 4% of Hb E. Significant variations in CBC parameters were observed in Hb E patients. There was significant decrease in MCV, MCH and MCHC and slightly increase in WBCs, RBCs, RDW and PLT as compared to controls.

Evaluation of systemic immune and inflammatory biomarkers in hidradenitis suppurativa.

We aimed to investigate the interrelation of HS with CBC parameters and new inflammatory indicator parameters, systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). 102 patients diagnosed with HS and 99 healthy controls were included. The medical records and laboratory findings of the participants were reviewed retrospectively. Patients and control group neutrophil, lymphocyte, monocyte, and platelet counts, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), mean platelet volume (MPV), platelet distribution width (PDW) and red cell distribution width coefficient of variation (RDW), SII and SIRI were compared. The patient and control groups differed significantly concerning CRP, neutrophil count, lymphocyte count, monocytes count, platelet count, PLR, and MHR (p<0.05), whereas the mean of MPV and NLR did not show a significant difference in control individuals. SII and SIRI were significantly higher in patients with HS than in controls (p=0.005, p<0.001). Correlation analyses of SII and SIRI with each other and CRP were performed. It was determined that SIRI had a moderate correlation with CRP (r=0. 346, p<0.001). The correlation between SII and CRP was low (r=0.256, p<0.001). In addition, we analyzed the correlation between SII and SIRI and we determined a high level of correlation (r=0.675, p<0.001). Our study has objectively demonstrated that SII and SIRI are more reliable biomarkers than other inflammation parameters in HS patients. Thus, SII and SIRI would be used to evaluate treatment response and follow-up in HS as new indicators.

Clinical significance of serum CD155 levels in acute lymphoblastic leukemia patients

Abstract Background Acute lymphoblastic leukemia (ALL) is a hematologic malignancy characterized by poor outcomes in adults. Traditional diagnostic and prognostic markers take into account clinical data but also rely heavily on expensive and invasive tests such as bone marrow studies with cytogenetics. CD155 is an adhesion molecule that also modulates immune response in malignancy. Previous studies have shown that serum CD155 (sCD155) levels are higher in patients with malignancies, and have demonstrated a correlation between higher levels of sCD155 and poor outcomes. This study investigated the diagnostic and prognostic value of sCD155 in adult patients with acute lymphoblastic leukemia. Methodology 32 adult patients with acute lymphoblastic leukemia and 15 control patients were enrolled in this study. Clinical and outcome data were collected from patients and a blood sample from patients and controls was collected with ELISA testing for sCD155 levels. Results sCD155 was found to be significantly higher in patients than controls (P&lt;0.05) and was significantly associated with bone marrow aspirate blast count. It was not associated with other clinical parameters including Sex, age, initial CBC parameter counts, presence of lymphadenopathy, presence of CNS infiltration, presence of Philadelphia chromosome, type of ALL, or risk stratification of ALL besides being associated with hepatosplenomegaly. ROC curve showed high sensitivity and specificity of sCD155 and Kaplan Meir curve showed a trend towards worse outcomes in patients with high sCD155 but it was not statistically significant. Conclusion sCD155 remains a promising marker for diagnosis of ALL but further studies are needed to confirm prognostic value.

The role of blood inflammatory markers in the preoperative diagnosis of acute appendicitis.

Acute appendicitis (AA) requires a prompt diagnosis. According to postoperative pathological results, a significant number of appendectomies are performed on a normal appendix (NA). The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting and improving the clinical diagnosis of AA, extracting more information from CBC parameters. The study is a retrospective one. The histopathological results of operated appendix from 102 patients, who underwent appendectomy for clinically suspected AA, were extracted from the Galilee Medical Center systems. Two patient groups (NA and true AA) were compared for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and mean platelet volume (MPV). The obtained data were statistically analyzed, using the independent sample t test and Mann-Whitney test. Category data have been compared among groups with the chi-squared test. The primary endpoint of our research was to assess the predictive power of blood biomarkers. Patients with suspected AA, based on clinical picture and contrast enhanced computed tomography (CECT), and with MLR-value ≥0.3357 were 5.25 times more likely than normal to have AA. Patients with NLR-value ≥3.2223 were 7 times more likely than normal to have AA. The differences in PLR and MPV values were not statistically significant. The NLR and MLR biomarkers can assist in diagnosis of AA. This can be particularly helpful in cases where CECT is contraindicated, as in pregnant women or children.

Factor V Leiden (FVL), Prothrombin G20210A and MTHFR C677T Mutations among Patients of Budd-Chiari Syndrome

Abstract Background Many studies ask whether screening Factor V Leiden (FVL), Prothrombin G20210A and Methyl Tetra Hydro Folate Reductase (MTHFR) C677T Mutations should be routinely performed in patients with Budd–Chiari syndrome (BCS). However, the prevalence of these mutations in such patients is substantially variable. This is the first study in clinical pathology department in Ain Shams University to evaluate the importance of this mutational screening in patients with Budd-Chiari syndrome to detect occult genetic susceptibility to thrombophilia. Aim of the Work This study aims to detect Factor V Leiden (FVL), Prothrombin G20210A and MTHFR C677T Mutations among Patients with Budd-Chiari Syndrome. Patients and Methods This study was a cross sectional study conducted on 35 newly of Budd Chiari syndrome patients who were attending tropical department at Ain Shams University Hospitals during the period from April 2020 to January 2021. Informed consent was obtained from all patients in the study. Results results of our study revealed that JAK2 mutation it was detected in 17.1% of patients (6 patients), While PGM was detected in 2.9% of our patients. Furthermore Factor V Leiden Mutation was detected in 65.7%of patients and MTHFR mutation was detected in 48.6% of patients. The present study found no significant statistical difference between patients with Factor V Leiden Mutation &amp; patients with normal Factor V Leiden regarding CBC parameters, levels of ANA, ACL IgM, ACL IgG, PC Deficiency, PS Deficiency and AT III Deficiency. In addition, our study revealed that there was no effect of MTHFR Mutation &amp; JAK2 Mutation on levels of ANA, ACL IgM, ACL IgG, PC Deficiency, PS Deficiency and AT III Deficiency. Also there was no effect for MTHFR Mutation &amp; JAK2 Mutation on outcome of patients, survival and response to treatment. Conclusion BCS is associated usually with genetic thrombophilia. Most commonly Factor V Leiden Mutation in 65.7%, followed by MTHFR mutation in 48.6% of our patients. Although, only Factor V Leiden Mutation has an effect on patients Outcome, Survival and Response to treatment through its effect on CBC parameters, levels of ANA, ACL IgM, ACL IgG, PC Deficiency, PS Deficiency and AT III Deficiency. Otherwise, JAK2 Mutation have significant effect on hemopoiesis.

MEASUREMENT OF STRESS LEVEL IN BUFFALOES BY THE EFFECT OF REPEATED RECTAL PALPATION IN TEACHING ENVIRONMENT

Livestock contributed 60.1 percent to the agriculture value added and 11.5 % in overall GDP during 2020-21 (Economic Survey 2020-21). Livestock plays a major and vital role in socio economic development of rural region of country. According to economic survey of Pakistan, 42.4 million buffalo population is present in Pakistan. Small holding buffalo farming system is present in rural areas of Pakistan. Rectal palpation is the most useful method for conducting pregnancy diagnosis, artificial inseminations and detection of various reproductive anomalies in large domestic animals like cows and buffaloes. This procedure, however, can prove to be stressful and painful for these animals which raise an animal health and welfare issue. Blood picture in terms of changed levels of cortisol, glucose, cholesterol and blood cells may occur in animals subjected to this procedure. Similarly, behavioral symptoms of elevated heart rate and respiratory rates may also occur. The aim of the current project, therefore, was to study the effects of repeated rectal palpation-related stress response in blood constituents in buffaloes so that the appropriate counter measures could be adapted to save the animals from impending pain and stress. The study was conducted on ten buffaloes divided into two groups each i.e. experimental and control. Buffaloes were subjected to rectal palpation procedure. Blood samples were collected before and after rectal palpation for serum cortisol and complete blood cells count. Blood samples were also collected from buffaloes of control group without rectal palpation. Physical parameters were also noted. No statistically significant difference found in cortisol levels, CBC or physical parameters i.e. TPR that demonstrates that rectal palpation procedure inflicts no harm to buffaloes and can be used for the training of students.