CBC Parameters Research Articles

Are Leukocyte and Platelet Abnormalities and Complete Blood Count Ratios Potential Prognostic Markers in Canine Sepsis?

Background: Sepsis is a common disease in which early diagnosis and prognosis assessment are the main aims in order to arrange a prompt and effective treatment.Objectives: (1) To compare leukogram parameters (WBC, segmented and band neutrophils, lymphocytes, monocytes), platelet count (PLT), mean platelet volume (MPV), and some leukocyte/platelet ratio such as NLR, NBNLR, PLR, and MLR between dogs with systemic inflammatory response syndrome (SIRS) and sepsis. (2) To investigate any difference in the trend of these latter parameters between survivors and non-survivors septic dogs.Animals: 57 dogs with confirmed sepsis and 57 dogs with non-septic SIRS.Methods: A review of the medical records was conducted in order to find dogs with sepsis. Sepsis was defined as the presence of an infectious focus with fulfillment of systemic inflammatory response syndrome criteria (SIRS). Septic dogs had to have a CBC at admission and another CBC within 48 h from the previous timepoint. Purebreds with CBC breed-related abnormalities were excluded, together with dogs without confirmed sepsis and dogs with only a single CBC. NLR, NBNLR, PLR, and MLR were calculated. Univariate analysis of all blood parameters studied was assessed between SIRS and septic dogs. Generalized Estimating Equations models for repeated measures were used to test if the blood parameters studied were modified between survivors and non-survivors in the septic group.Results: Septic dogs had lower median segmented neutrophils count and NLR compared to SIRS dogs (p = 0.02 and p = 0.04, respectively). Lastly, septic dogs had a higher prevalence of toxic neutrophil than SIRS dogs (p = 0.01). We found that for a 1-unit increase of PLR and MLR, the risk of death increased by 50.5 and 60%, respectively.Conclusion and Clinical Importance: Evaluation of NLR at hospital admission may be a useful marker of inflammation, although it showed low sensitivity in differentiating SIRS and septic dogs. The monitoring of some CBC parameters, especially PLR and MLR may be useful in the establishment of prognosis in septic dogs.

Comportamiento fisiológico de pollos de engorde usando dietas con Tithonia diversifolia y

Los probióticos permiten establecer y controlar la microflora beneficiosa y gradualmente reducen la microflora patógena. Tithonia diversifolia (TD) es una alternativa para reemplazar la proteína de otras fuentes más caras en las dietas para aves de corral; por lo tanto, los tratamientos usaron reemplazos de TD con 0, 5, 10 y 15% con (WP) y sin adición de probióticos (W/OP): Saccharomyces cerevisiae (SC), Lactobacillus Acidophilus (LA) and Bacillus subtilis (BS) y la mezcla de estos (MP) para estimar la digestibilidad in vivo. Se utilizaron 300 aves Cobb avian, con un peso promedio de 453.4 ± 24 g distribuidos aleatoriamente con un arreglo factorial 4x5x3x5. La digestibilidad de la materia seca (DM), proteína cruda (CP) y fibra (CF) se determinó mediante el método de recolección de heces totales; adicionalmente: se analizaron el hemograma (CBC) y la química sanguínea (BC). La digestibilidad de la DM aumentó con la proporción de TD (15%) en la dieta y alcanzó el 68% W/OP; mientras que esta variable aumentó a 70.67% con SC (P

Correlation Between Helicobacter Pylori Infection and Iron Deficiency Anemia in School-Aged Children

Background: Iron deficiency anemia (IDA) is recognized as a common nutritional problem in infants and young children in developing countries mainly due to poor nutrition in most cases. Objective: To evaluate the association between H. pylori infection and iron deficiency anemia in school-aged children. Patients and Methods: This study was conducted on 60 participants divided into two groups. Group I: formed of 30 patients suffering from iron deficiency anemia with hemoglobin (Hb) less than l1g/dL. Group II: formed of 30 healthy children (control Group) Results: In the current study we found that there was a significant decrease in weight and BMI among cases group p-value <0.001. In the current study, we found that there was a significant decrease in all CBC parameters among cases versus control. In the current study we found that there were significant differences between the two groups regarding nutritional status as in cases there was a higher percentage of low iron sources in the diet, there was a significant decrease in serum iron, ferritin, and TIBC in cases versus control. In the current study, we found that there was a significant increase in the number of positive samples for H pylori antigen in stool among cases versus control 63.3% versus 23.3% p-value 0.002. Conclusion: The results of this study demonstrate a significant association between children with iron deficiency anemia and positive H. pylori infection in school-age children. Moreover, H. pylori infection may be one of the significant causes of iron deficiency anemia.

Correlation Between Helicobacter Pylori Infection and Iron Deficiency Anemia in School-Aged Children

Background: Iron deficiency anemia (IDA) is recognized as a common nutritional problem in infants and young children in developing countries mainly due to poor nutrition in most cases. Objective: To evaluate the association between H. pylori infection and iron deficiency anemia in school-aged children. Patients and Methods: This study was conducted on 60 participants divided into two groups. Group I: formed of 30 patients suffering from iron deficiency anemia with hemoglobin (Hb) less than l1g/dL. Group II: formed of 30 healthy children (control Group) Results: In the current study we found that there was a significant decrease in weight and BMI among cases group p-value <0.001. In the current study, we found that there was a significant decrease in all CBC parameters among cases versus control. In the current study we found that there were significant differences between the two groups regarding nutritional status as in cases there was a higher percentage of low iron sources in the diet, there was a significant decrease in serum iron, ferritin, and TIBC in cases versus control. In the current study, we found that there was a significant increase in the number of positive samples for H pylori antigen in stool among cases versus control 63.3% versus 23.3% p-value 0.002. Conclusion: The results of this study demonstrate a significant association between children with iron deficiency anemia and positive H. pylori infection in school-age children. Moreover, H. pylori infection may be one of the significant causes of iron deficiency anemia.

COVID-19 Disease - Temporal Analyses of Complete Blood Count Parameters Over Course of Illness, and Relationship to Patient Demographics and Management Outcomes in Survivors and Non-Survivors: A Longitudinal Descriptive Cohort Study

Background: More detailed temporal analyses of complete (Full) blood count (CBC) parameters, their evolution and relationship to patient age, gender, co-morbidities and management outcomes in survivors and non-survivors with COVID-19 disease could help identify prognostic clinical biomarkers. Methods: From 29 January 2020 until 28 March 2020, we performed a longitudinal cohort study of COVID-19 inpatients at the Italian National Institute for Infectious Diseases, Rome, Italy. Nine CBC parameters as a continuous variable were studied [neutrophils, lymphocytes, monocytes, platelets, mean platelet volume, red blood cell count, haemoglobin concentration, mean red blood cell volume and red blood cell distribution width (RDW %)]. Model-based punctual estimates and difference between survivors and non-survivors, overall, and by co-morbidities, at specific times after symptoms, with relative 95% CI and P-values were obtained by marginal prediction and ANOVA-style joint tests. All analyses were carried out by STATA 15 statistical package. Main Findings: 379 COVID-19 patients [273 (72% were male; mean age was 61.67 (SD 15.60)] were enrolled and 1,805 measures per parameter were analysed. Neutrophil counts were on average significantly higher in non-survivors than in survivors (P60 years(p=0.001). Age (p=0.042), obesity (p=0.002), chronic renal failure (p=0.002) and cardiovascular diseases (p=0.009) were independently associated with poor patient clinical outcome at 30 day after symptom onset. Interpretation: Increased neutrophil counts, reduced lymphocyte counts, higher median platelet volume, anemia with anisocytosis, in association with obesity, chronic renal failure, COPD, cardiovascular diseases and age >60 years predict poor prognosis in COVID19 patients.Funding Statement: Ricerca Corrente e Finalizzata Italy Ministry of Health, AIRC (IG2018-21880); Regione Lazio (Gruppi di ricerca, E56C18000460002).Declaration of Interests: The authors declare no competing interest.Ethics Approval Statement: This study was approved by the IRB of Italian National Institute for Infectious Diseases “Lazzaro Spallanzani” (INMI), in Rome (Italy).

Longitudinal analysis of complete blood count parameters in advanced-stage lung cancer patients.

BackgroundMetastatic lung cancer is a debilitating disease, but with the advances in immunotherapy, therapeutic options have vastly increased. Numerous complete blood count parameters (CBC) have been described as easily accessible biomarkers that might predict response to immunotherapy. However, to date, no comprehensive study has been performed on the longitudinal changes of these parameters during cancer progression.MethodsThe clinicopathological variables and CBC parameters of 986 advanced stage lung cancer patients were retrospectively analyzed. Blood tests were performed as part of the routine checkup and the results were recorded at the time of the diagnosis of the primary tumor, the diagnosis of brain or bone metastases, and also during the last available follow‐up.ResultsIn the experimental subcohort, 352 and 466 patients were diagnosed with brain and bone metastases, respectively. The control group consisted of 168 patients without clinically detectable or other distant organ metastases. In our longitudinal analyses, we found significantly decreasing absolute lymphocyte count (ALC: P < 0.001), and significantly increasing absolute neutrophil count (ANC: P < 0.001) levels in all patient subgroups, irrespective of histopathological type and metastatic site. Interestingly, patients with brain metastases had significantly descending‐ascending platelet count (PLT) trendlines (P < 0.001), while the bone metastatic subgroup exhibited significantly ascending‐descending trendlines (P = 0.043).ConclusionsSignificantly decreasing ALC, significantly increasing ANC and fluctuating PLT levels may be found in brain and bone metastatic lung cancer patients during disease progression. Our findings might contribute to improve personalized healthcare in this devastating malignancy.Key pointsSignificant findings of the study Significantly decreasing ALC, and significantly increasing ANC levels can be found in advanced‐stage lung cancer patients during disease progressionPatients with brain metastases have descending‐ascending PLT trendlines, while patients with bone metastases exhibit ascending‐descending trendlines during disease progression What this study adds The descending values for ALC, and the ascending mean values for PLT and ANC, might be suggestive of poor response to second‐ or third‐line immunotherapy in advanced‐stage lung cancer patients.The current study might help to improve patient selection and treatment strategies for brain and/or bone metastatic lung cancer patients.

Vitamin B12 Deficiency Among the Healthy Jordanian Adult Population: Diagnostic Levels, Symptomology and Risk Factors.

Compared to the data available for developed countries, there is a marked scarcity of information on the levels and symptomology of vitamin B12 deficiency in developing countries, particularly in the Middle Eastern region. To explore (a) the risk factors associated with a deficiency of vitamin B12, and (b) the baseline (cut-off) serum level of vitamin B12 for a clinically-symptomatic deficiency in the Jordanian adult population. A total of 485 subjects were included in this study. Blood samples were drawn for biochemical analysis and data regarding socio-demographics, general health, anthropometric measures, and past medical, surgical, and medication history were collected. To explore the cut-off point, we compared all parameters included in a standard complete blood count as well as the main symptoms reported to be associated with B12 deficiency between groups of different B12 cut-off values, consisting of those above and below 200, 175, 150 and 125 pg/ml. Low dairy intake habits, age, recurrent headaches, heartburn, and peptic ulcer disease were found to be significantly associated with lower vitamin B12 levels. Surprisingly, daily smoking was associated with significantly higher B12 levels. The results revealed that none of the included potential indicators of B12 deficiency could be considered an indicative feature of deficiency. There were no significant differences neither in the symptoms nor in the CBC parameters between any of the tested study groups. Low dairy intake, older ages, recurrent headaches, heartburn, and peptic ulcer disease all could be considered as risk factors of having low vitamin B12 levels within the Jordanians. Also, they tend to have lower levels of vitamin B12 levels, in comparison to countries in the West, without necessarily having deficiency symptoms. The cut-off value to diagnose functional B12 deficiency could be less than 125 pg/ml for the Jordanians. More local studies are needed to establish an accurate vitamin B12 cut-off value for the population in Jordan.

Association between monocyte to high-density lipoprotein cholesterol ratio and bicuspid aortic valve degeneration

Background/aim From a pathophysiological point of view, inflammation is thought to be more dominant in bicuspid aortic valve (BAV) stenosis than tricuspid aortic valve (TAV) stenosis. Our study aimed to determine the association between monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR), a new inflammatory marker, and the speed of progression of stenosis and pathophysiology of BAV stenosis.Materials and methods A total of 210 severe aortic stenosis patients (70 consecutive BAV patients, 140 matched TAV patients) were retrospectively enrolled in the study. Clinical and echocardiographic data and laboratory results related to our research were collected retrospectively from the patients’ records. MHR was measured as the ratio of the absolute monocyte count to the HDL-C value.ResultsSeventy BAV (mean age: 72.0 ± 9.1 years, 42.9% female) and 140 TAV patients (mean age: 77.9 ± 8.3 years, 51.4% female) with severe aortic stenosis were enrolled in this study. There was no difference between the two groups in terms of another baseline demographic or clinic findings except age (P < 0.001). Monocyte count, hemoglobin level, mean platelet volume was significantly higher, and HDL-C level was significantly lower in the BAV group, while other lipid and CBC parameters were found to be similar. In the multivariate analysis, MHR (P = 0.005, 95% CI: 0.90–0.98) and, as expected, age (P = 0.001, 95% CI: 1.02–1.11) were found to be significant as the independent predictor of BAV, after adjusting for other risk factors. Conclusion Our study showed a significant correlation between increased MHR and BAV. MHR was determined as a significant independent predictor for the speed of progression and diagnosis of severe BAV stenosis in multivariate analysis.

Clinical and Biochemical Characteristics of Severe Hypothyroidism Due to Autoimmune Thyroiditis in Children.

Introduction: In the majority of countries, autoimmune thyroiditis is the main cause of acquired hypothyroidism in children. Typically, the natural course of the disease is initially insidious and the diagnosis is incidental. There are some children who develop severe hypothyroidism without a proper diagnosis. The aim of the study was to analyze the clinical and biochemical profiles of children with severe primary hypothyroidism due to autoimmune thyroiditis.Materials and Methods: We analyzed the records of 354 patients diagnosed between 2009 and 2019 with autoimmune thyroiditis. Only patients with TSH above 100 μIU/mL, associated with decreased free thyroxine and the presence of antithyroid antibodies, were enrolled in the study. The analysis encompassed clinical symptoms, thyroid and biochemical status, bone age, and imaging.Results: Twenty-six children were enrolled in the study. The mean age at diagnosis was 10.26 ± 3.3 years, with a female preponderance of 1.8:1. The most frequent symptom was growth impairment (77%) and weight gain (58%). Goiters were present in 42% of patients. Less common findings were pituitary hypertrophy (four patients) and hypertrichosis (three patients). Median values at the time of diagnosis were TSH 454.3 uIU/ml (295.0–879.4), anti-TPO antibodies 1,090 IU/ml, and anti-Tg antibodies 195 IU/ml. Anti-TSHR ab were evaluated only in six out of the 26 patients. The characteristic biochemical profile was correlated with the grade of hypothyroidism, and the strongest correlations were found with CBC parameters, lipid profile, aminotransferases, and creatine.Conclusion: In children with severe hypothyroidism, the most sensitive symptoms are growth arrest and weight gain despite the fact that, in some children, the auxological parameters at presentation could be within normal values for the population. The specific biochemical profile closely correlates to the severity of thyroid hormone deficiency and involves mostly erythropoiesis, liver function, and kidney function. Pituitary enlargement should be considered in each child with severe hypothyroidism. It is necessary to conduct prospective studies evaluating the actual frequency of anti-TSHR antibodies and pituitary enlargement in children with extremely high TSH, especially those presenting without goiters.

Stability of complete blood count parameters depends on the storage temperature, storage time, transport position and selected stability criterion

Purpose: To evaluate stability of CBC parameters in samples containing K3-EDTA in Hema&Tube brand evacuated tubes stored at 4 °C and room temperature in upright, horizontal and upside-down transport positions for up to 240 min by comparing with different stability criteria. Methods: A total of 450 outpatient samples, 75 for each condition, were stored for 240 min. Blood samples were analyzed at baseline, 60th, 120th and 240th min of storage time using Sysmex® XT-4000i hematology analyzer. CBC results were compared according to the paired samples t-test, one CV% change, CVI, BV DES 2014, RCPA, IQMH, EFLM Biological Variation 2019, ESfEQAand CLIA stability criteria. Results: In all transport conditions, almost all CBC parameters were unstable according to the paired samples t-test. Based on one CV % change RBC, hemoglobin, hematocrit, RDW-CV, neutrophils, platelets, MPV, PDW and plateletcrit were unstable in some transport conditions. However, most parameters were stable at all conditions, except especially for MCH, MPV, PDW and plateletcrit, while just MPV and PDW were unstable at RT in all transport conditions according to the lower and higher CVI, respectively. Conclusions: Paired samples t-test and one CV% change stability criteria are not suitable for decision. Clinical laboratories should establish the impact of storage time, storage temperature and transport positions for each CBC parameter while paying attention to the brand of evacuated tube according to the lower CVI of biological variation data stability criteria since it is more related to the impact of analysis deviation on clinical decisions to prevent misdiagnosis.

Utility of Urine KOH in Detecting Candiduria in Infants

Background: Candida species are common cause of urinary tract infection in infants requiring medical care. Candida fungal elements may be demonstrated in urine using microscopic examination with potassium hydroxide (KOH). However, detection of these elements does not always correlate with candiduria. Objectives: To establish the utility of urine KOH in identifying candiduria and to determine the risk factors, as well as urinalysis and CBC parameters associated with candiduria. Methods: This prospective cross-sectional study included admitted infants 1 year and below with urine culture and with any risk factor/s for candiduria. Additional urine KOH testing was done using clean catch or catheter method. Urine culture was used as the gold standard. Results: Among the 90 study participants with both urine culture and urine KOH, 13 (14%) had candiduria. The use of indwelling catheter, presence of urinary tract anomalies, positive leukocyte esterase in urinalysis, and increased monocyte counts in CBC are all associated with candiduria. Urine KOH has sensitivity of 100%, (CI 75.2-100%), specificity 59.7%, (CI 47.9-70.7%), PPV 29.5%, (CI 17.7-45.2%), and NPV 100%, (CI 92.2-100%) in detecting candiduria. Conclusions: Negative urine KOH has excellent negative predictive value, while positive urine KOH result may warrant further investigation. Urine KOH results should be interpreted with caution depending on patient’s risk factors, clinical status, and other laboratory results prior to initiation of empiric antifungal therapy. Positive urine KOH may not always require treatment.

Akut Apandisit Tanısında Tam Kan Sayımı Parametrelerinin Tanısal Değeri: Sadece Beyaz Küre Değerini Dikkate Almamalıyız

Objective: Appendectomy is the most common urgent surgical procedure but a diagnosis of acute appendicitis still remains challenging. In this retrospective study, we aimed to evaluate the value of the complete blood count CBC test parameters in acute appendicitis.Materials and methods: Data of 131 patients who underwent appendectomy between January 2016 – December 2016 were collected retrospectively. Demographic features, CBC parameters and final histopathological results of the patients were recorded. The patients were divided into two groups according to the final pathological results Group 1: Acute appendicitis group, Group 2: Normal appendices group and were compared in terms of WBC white blood cell , platelet count, hemoglobin level, RDW red cell distribution width , MPV mean platelet volume and NLR neutrophil to lymphocyte ratio values.Results: 13 of 131 patients had normal appendices. WBC, platelet and NLR values were signifcantly higher in Group 1 compared to the Group 2 p

Trends of utilization of Complete Blood Count parameters for patient management among doctors in Azad Kashmir.

Objective:To determine the trends of utilization of CBC parameters in patient management among doctors in different hospitals in Kashmir, Pakistan.Methodd:A self-administered questionnaire-based survey was carried out amongst doctors working in four hospitals of Kashmir i.e. Combined Military Hospital, Muzaffarabad, Combined Military Hospital, Rawalakot, Abbas Institute of Medical Sciences, Muzaffarabad, and District Hospital, Kotli during August to December 2017.Results:Out of 500 physicians, 217 physicians answered the questionnaire, representing a response rate of 43.4%. Only three of the 11 parameters in the CBC report i.e. hemoglobin, white blood cell count and platelets were selected as frequently or always useful by more than 80% of physicians. Rest of the eight parameters of the CBC were found useful by less than 80% of the physicians. Most agreed that the current format of a CBC report gives adequate information.Conclusion:The present study concludes that majority of the physicians utilize only three of the basic parameters on the complete blood count. An educational intervention can be planned for the physicians to increase their knowledge about the utility of other parameters.

VARIATION OF CBC PARAMETERS WITH STORAGE TIME AND TEMPERATURE

This study demonstrates that it is possible to perform clinically valid CBC on K2-EDTA anti-coagulated blood 24 hours after collection on refrigerated sample, though not for differential count parameters. On 24-hour sample, MPV and RET%, MCHC should not be considered for diagnosis. HAEMATOCRIT, MCV and RDW consistently elevated with sample’s age, even at 24 hours, not to be evaluated.&#x0D; After 24 hours WBC, RBC, HGB, PLATELET can be evaluated. Stability of WBC counts up to 24 hours is acceptable for all samples, except EOSINOPHIL (at 4 degree Celsius) counts not stable beyond 24 hours. Altered results obtained in manual differential count, cannot be considered a solution for differential count on aged samples. &#x0D; Most reliable haematological results are obtained from samples analysed same day within 5-8h, soon after collection. When immediate analysis is not possible, sample stability (only CBC parameters except MPV; not differential count) can be prolonged up to 48 hr. on refrigeration. A sample with borderline eosinophil or basophil count stored under refrigeration, still can give report of significant increase in parameters with prolonged storage. Thus refrigeration can’t be considered as a solution to prolong storage time in case of bloodsamples, requiring differential count for clinical diagnosis.&#x0D; Keywords: CBC variation, Temperature, Time, Aged Sample, Refrigeration.

The adipokines and inflammatory status in the era of pediatric obesity

IntroductionObesity is associated with a chronic inflammation due to the deficiency in immune activity related to adipose tissue. A wide-spectrum of pro-inflammatory cytokines secreted by adipocytes play an important role in the assessment of obesity-associated inflammatory status.The aim of this study was to assess the relationship between IL and 1β, IL-6, TNF α, leptin, and inflammatory status in children with overweight/obesity. Material and methodsWe performed a cross-sectional study on 193 children, admitted to a Pediatric Tertiary Hospital in Romania. The children were divided according to BMI into: the study group-91 children with overweight/obesity, and the control group-102 children with normal BMI. Demographic, anthropometric, and laboratory parameters including the serum levels of several adipokines (leptin, IL-1β, IL-6, and TNF α) were assessed in both groups. ResultsOur findings revealed significantly higher values of leukocytes, lymphocytes, platelets, AST, and ALT, as well as for the lipid metabolism parameters including cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, and CRP, in children with overweight/obesity. We found significantly higher levels of adipokines in the serum of children with overweight and obesity assessed for leptin, IL6, and TNF α (p = 0.0145/p < 0.0001/p = 0.004/), except for IL-1β serum levels. ConclusionsChildhood overweight and/or obesity is associated with a systemic inflammatory status demonstrated by increased levels of CBC parameters. Pro-inflammatory adipokines are also an essential factor in obesity-related inflammatory status according to our findings that underlined the importance of increased serum levels of IL-6, TNF α, and leptin in pediatric patients with overweight/obesity. Clinically, CBC parameters along with adipokines might represent useful diagnostic tools for low-grade systemic inflammation in children with overweight or obesity.

Beyond the Routine CBC: Research CBC Parameters Associated with Myelodysplastic Syndromes and Underlying Mutations

Background: Myeloid neoplasms and reactive conditions cannot be readily distinguished by conventional CBC parameters. Given the time, expense and clinical expertise associated with the diagnostic workup of myeloid neoplasms, there is a clear need for a cost-effective screening laboratory test that can rapidly and accurately select for patients with cytopenias or cytoses potentially related to myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPN), respectively. Recent studies showed that incorporating NE-WX, a research CBC parameter related to neutrophil complexity, and IPF, an immature platelet fraction parameter, into a conventional CBC analysis helps identify patients with high likelihood of MDS (PMID 30406952) or JAK2-positive polycythemia vera (PMID 30601597), respectively. Our exploratory analysis was focused on using all research CBC parameters in combination with standard CBC parameters and mutational data to compare control patients to those with active myeloid disease, and MDS in particular. Methods: We measured standard and research CBC parameters (92 parameters overall) using the Sysmex XN series hematology analyzer in a cohort of 592 consecutive patients (pts), out of which 221 had abnormal CBC due to an underlying myeloid neoplasm (MDS 83 pts, MPN 54 pts, MDS/MPN 24 pts, acute myeloid leukemia 21 pts, clonal or non-clonal cytopenia or cytoses 33 and 6 pts, respectively) and 371 age-matched control patients with normal CBC. The former group was tested for the presence of somatic mutations in 95 genes associated with hematologic malignancies and included patients with active disease (n=127) and in remission (n=94). The MDS cohort included 59 patients with active disease and 24 patients in remission. We developed a variety of models (Linear and Logistic Regression, Decision Trees, Random Forests, Neural Networks, Support Vector Machines, Gradient Boosting) to predict the presence of an active myeloid neoplasm or active MDS using both CBC and molecular data, as well as CBC data alone. These models were compared using a leave one patient out cross-validation method and a champion model was chosen. Correlation matrix analysis was used for establishing relationships between MDS-associated mutations and CBC parameters, where a relevant association was considered at the levels of above 0.25 or below -0.25. Results: Table 1 lists the leave one out performance of the champion predictive models for the active myeloid and MDS cohorts based on different variables (all CBC parameters, mutations, age and gender), along with their corresponding sensitivity and specificity. Table 2 shows the most discriminatory research CBC parameters in the MDS cohort reflecting dysplastic changes in neutrophil morphology (NE-SFL, NE-WY, NE-WX, NE-FSC, NE-SSC) and degrees of cytopenia (increased IPF and decreased TNC). The standard parameters included Hgb, MCV, MCH, WBC and absolute neutrophil count. Several mutations showed a strong association with certain CBC parameters in the MDS cohort. ASXL1 was associated with lymphocyte complexity (LY-X; 0.38), TNC (0.28), WBC (0.28) and neutrophil (0.27) count and lower immature reticulocytes fraction (-0.67), RBC (-0.30) and reticulocyte (-0.31) counts, similar to the findings of the recently published mouse model expressing ASXL1 truncating protein (PMID 29113963), while DNMT3A and SF3B1 mutations showed higher platelet correlations (0.32). In addition, the latter was associated with lower neutrophil granularity (-0.32), cell size (-0.32) and nuclear complexity (-0.39). TP53 showed positive association with neutrophil and lymphocyte parameters reflecting population heterogeneity (0.26-0.40). Conclusions: Our exploratory study demonstrated that the Sysmex XN research parameters, which are measured with all routine CBCs, may be used in patients with abnormal CBC to build a predictive model with high specificity to rule out a clonal myeloid neoplasm, including MDS. The model's performance improves with the addition of the molecular status as a variable, while it appears to be independent of age and gender. In the entire MDS cohort, the most relevant research parameters in the predictive model are reflective of dysplastic neutrophil morphology and can be objectively measured. In addition, it appears that there may be unique CBC parameter signatures associated with an underlying mutation. Disclosures Pozdnyakova: Sysmex corporation of America: Research Funding. Niculescu:Sysmex America, Inc: Consultancy. Kroll:Sysmex America, Inc: Consultancy. Kim:Quanterix, Inc: Consultancy; Papgene, Inc: Consultancy; LabCorp, Inc: Consultancy.

Chronic Myeloid Leukemia in Adolescents and Young Adults: A Single Institute Experience

Background and Objectives: CML is a myeloproliferative neoplasm characterized by the dysregulated production and uncontrolled proliferation of mature and maturing granulocytes with fairly normal differentiation. It mainly affects adults, and is rarely seen in children. The average age at diagnosis of CML is around 64 years. There are few studies describing CML in adolescents and young adults. In Qatar we have one of the largest cohorts of adolescents and young adults with CML. This study aims to study this cohort and find out if there are any differences from older patients with CML. Methods: A retrospective analysis of 169 patients with CML treated at NCCCR over a 23-year period, 83 of them are younger than 40 years at diagnosis (adolescents and young adults) vs. 86 age 40 or older at diagnosis (controls). Comparison was done of all characteristics at diagnosis, including: gender, BMI, ethnicity, CBC parameters, spleen size, Sokal score, bone marrow findings, treatment modality, with response assessment using ELN guidelines. Results: Both groups were matched with regards to gender and ethnicity. Adolescents and young adults had higher WBC count and larger spleen on diagnosis compared to controls (174.1 vs. 142.2; and 18.0 vs. 15.6). 4 young patients presented in blast-phase vs. 1 in control group. 5 adolescents and young adults underwent allogeneic stem cell transplant vs. 1 patient in the control group. During a mean follow up of 70.7 months in adolescents and young adults vs. 72.7 months in the control group there were 2 deaths vs. 1 respectively. However, there were no other significant differences between the two groups, with regards to TKI used, or response at 1 year / latest assessment. Conclusions: Based on this data we may conclude that CML present more aggressively in adolescents and young adults as compared with older patients, however there is no difference in outcome. This might reflect different underlying etiology / better tolerance to treatment in the younger group. Table Disclosures No relevant conflicts of interest to declare.

Clinico-Pathological Profiles of Obese Patients with Chronic Myeloid Leukemia (CML) and Their Response to Therapies (TKIs)

Background and Objectives: Cancer patients in Qatar are managed in a standardized manner through a single center guided by the National Cancer Framework. Most cancer medication-dosing is based on weight and height (body surface area), however in CML, tyrosine kinase inhibitors (TKIs) dosing is fixed. Obesity, defined by a BMI of 30 or more, presents a risk to health yet to the best of our knowledge, there have been no large studies on obesity and response to TKI therapy in CML. The aim of this study was to explore the clinical characteristics of obese and non-obese CML patients, and compare their response to standard dose TKI therapy. Methods: A retrospective analysis was performed of 123 patients treated for CML in chronic phase at NCCCR over a 23-year period, 69 obese (BMI &gt; 30) vs. 54 with normal BMI = 18.5 - 24.99 (controls). Comparisons were made of characteristics at diagnosis including: gender, age, ethnicity, CBC parameters, spleen size, Sokal score, bone marrow findings, TKI prescribed, together with response assessment using ELN guidelines. Results: Mean age at diagnosis was lower in obese patients compared with control group (39.0 vs 42.2). Obese patients had lower WBC count and higher Hgb at diagnosis (mean WBC 153.9 vs. 193.0; mean Hgb 11.4 vs. 10.3). A higher proportion of obesity group was females (31/69) compared to control group (14/54). Spleen size and Sokal scores were lower in obesity group (17.1 vs. 18.3 and 0.81 vs. 0.91 respectively). More obese patients received Imatinib (40 vs. 12 in control group) compared with other TKIs (21 vs. 37 in control group). Few patients in obesity group had to switch to an alternative TKI (13 vs. 20 in control group). Compared to control group more obese patients achieved a major molecular response (MMR defined as BCR-ABL/ABL (IS) value below 0.1%) (47 of 60 vs. 22 of 42; p = 0.011). Conclusions: The data suggests differences in clinical characteristics and response to treatment between obese and non obese patients that warrants further investigation. Obese patients with CML were younger at diagnosis, had better response to treatment and were less likely to need switch TKI due to failure of treatment. Table Disclosures No relevant conflicts of interest to declare.

Characterization of the Rate, Predictors, and Thrombotic Complications of Thrombocytosis in Iron Deficiency Anemia

Introduction: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide and is frequently untreated or undertreated (Kesselbaum et al. 2014). The association of thrombocytosis with IDA is well-recognized, with recent work elucidating its underlying physiology (Xavier-Ferrucio et al. 2018). Thrombocytosis in IDA may predispose to thrombotic complications, as described in many case reports. Given that IDA is ubiquitous, even minor increases in thrombotic risk due to thrombocytosis have dramatic public health implications. Data describing the rate, predictors, and risk of thrombotic complications are limited. This study characterizes these features of thrombocytosis in IDA. Methods: We queried a large institutional patient data repository containing comprehensive chart data for over 5.8 million patients to identify patients with IDA with and without thrombocytosis and thrombotic events over a 40-year time period (1979 to 2019). Demographic information, hematological parameters, thrombosis history, and other medical history were collected at time of peak thrombocytosis, time of IDA diagnosis, and clinical baseline (before IDA diagnosis or after resolution). The fidelity of query data was assessed by performing detailed manual chart review of 700 total patients. Clinical diagnoses of IDA were verified by confirming ferritin values &amp;lt;30 ng/ml and consistent CBC parameters. Temporal association of thrombocytosis with IDA was confirmed and patients with other causes of thrombocytosis (including active malignancy, infection, inflammatory bowel disease, recent surgery/trauma, inflammatory arthritis, and myeloproliferative neoplasms) were excluded. Only arterial and venous thrombotic events occurring concurrently with IDA or IDA with thrombocytosis were included. Data were analyzed using t-tests, chi-square tests, Pearson correlations, and multivariate regression. Results: Our queries identified 36,327 IDA cases and 15,022 IDA with thrombocytosis cases. Query fidelity rates were 95% and 75%, respectively, yielding a true thrombocytosis rate of 32.6% in patients with IDA. After excluding cases with other causes of thrombocytosis, we calculated a 7.8% rate of thrombosis in patients with IDA and a 15.8% rate of thrombosis in patients with reactive thrombocytosis secondary to IDA (Table 1, Figure). The odds ratio for thrombosis in IDA with thrombocytosis vs IDA alone was 2.23 (2.09-2.38, p&amp;lt;0.0001). Both venous and arterial thrombotic events were more likely in patients with IDA and thrombocytosis (Table 1). Risk factors for thrombotic events were slightly more common in patients with IDA and thrombosis (OR 1.28, Table 1). Mean duration of IDA episode (from IDA diagnosis to normalization of hemoglobin and platelet count) was 2.03 years. Among patients with IDA and thrombocytosis, ferritin and hemoglobin (Hgb) were both moderately negatively correlated with platelet count (Plt) (Table 2). Platelet mass index (Plt x MPV) at time of IDA diagnosis and peak thrombocytosis was significantly higher than baseline. Platelet mass index and Hgb were strongly negatively correlated at peak thrombocytosis. Multivariate regression including age, sex, WBC count, Hgb, Plt, and MCV demonstrated a significant predictive relation between decreasing Hgb and increasing Plt at peak thrombocytosis. Conclusions: In this large retrospective analysis, we describe the rate and predictors of thrombocytosis in IDA in addition to rates of thrombosis in IDA patients with and without reactive thrombocytosis. Combining queries of a massive clinical database with manual chart review to ensure data validity, we found a 32.6% rate of thrombocytosis in IDA, negative correlations between both Hgb/ferritin and Plt, and a 2-fold increased thrombotic risk in patients with thrombocytosis reactive to IDA relative to IDA alone. We also found increased total body platelet mass in IDA patients with thrombocytosis, which may contribute to this increased thrombotic risk. Thrombosis rates overall were high, possibly due to database inclusion of more morbid inpatients in addition to outpatients. Given the global burden of untreated and undertreated IDA, our findings suggest that adequate IDA treatment may reduce thrombotic complications and associated morbidity and mortality. Acknowledgements: A. Song is the recipient of the American Society of Hematology HONORS Award (provides research support). Disclosures Kuter: Daiichi Sankyo: Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding; Merck Sharp Dohme: Consultancy, Honoraria; Up-to-Date: Consultancy, Honoraria, Patents &amp; Royalties: 3 Up-to-Date chapters; Caremark: Consultancy, Honoraria; Bristol Myers Squibb (BMS): Consultancy, Honoraria, Research Funding; Platelet Disorder Support Association: Consultancy, Honoraria; Alnylam: Consultancy, Honoraria, Research Funding; Zafgen: Consultancy, Honoraria; UCB: Consultancy, Honoraria; Genzyme: Consultancy, Honoraria; Kezar: Research Funding; Principia: Consultancy, Honoraria, Research Funding; Shire: Consultancy, Honoraria; Takeda (Bioverativ): Consultancy, Honoraria, Research Funding; Kyowa-Kirin: Consultancy, Honoraria; Momenta: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Argenx: Consultancy, Honoraria, Research Funding; Agios: Consultancy, Honoraria, Research Funding; Actelion (Syntimmune): Consultancy, Honoraria, Research Funding; Dova: Consultancy, Honoraria; Protalix: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Protalex: Consultancy, Honoraria, Research Funding; Shinogi: Consultancy, Honoraria; Rigel: Consultancy, Honoraria, Research Funding. Al-Samkari:Agios: Consultancy, Research Funding; Dova: Consultancy, Research Funding; Moderna: Consultancy.

The role of recombinant Human erythropoietin in neonatal anemia

AimTo estimate the blood level of Erythropoietin(EPO) in neonates with anemia of prematurity (APO) and in late hypo-regenerative anemia and to clarify role of EPO in correction of anemia and reducing the number of blood transfusions. MethodsThis study was carried out on 60 neonates divided into; group I (30 preterm neonates) with AOP received EPO (250 IU/kg/dose subcutaneously 3 times weekly for 4 weeks), compared to group II (30 neonates) with AOP treated only with blood transfusion. CBC parameters and transfusion requirements were followed during therapy. Serum level of EPO was measured by ELISA technique. ResultsBy the end of the 4th week of therapy, there was significant increase in group I post r-Hu EPO compared to group II regarding reticulocyte counts (P < 0.001) leading to rise of the Hb (P < 0.001), Hct levels (P < 0.001) with subsequent reduction in the overall number of blood transfusions (P < 0.001). ConclusionEPO therapy in conjunction with iron, vitamin E and folic acid, stimulated erythropoiesis and significantly reduced the need for blood transfusion in AOP.